Health Professionals

Clinical Updates

17 April 2014

Ebola virus disease: West Africa - update

This updates the Clinical Update of 9 April 2014

The outbreak of Ebola virus disease (EVD) in Guinea is ongoing. As of 16 April 2014, a total of 197 cases, including 122 deaths have been reported to World Health Organization (WHO); of these 101 cases have been laboratory confirmed. Cases have been reported from the capital (Conakry) and the districts of Dabola, Djingaraye, Guékédou, Macenta and Kissidougou [1].

A total of 941 contacts have been identified since the beginning of the outbreak; about one third of all contacts are continuing medical observations [1-2]. A total of 24 health care workers have been affected with 13 deaths [1].

As of 16 April, Liberia has reported a cumulative total of 27 clinical cases of EVD, including 13 deaths. The most recent suspected case was identified in Saclapea, Nimba County. Foya, Lofa County, remains the epicentre of the Ebola outbreak [1, 3].

As of 16 April, Mali has reported a cumulative total of six suspected cases from the capital city of Bamako, Kourémalé and Bankoumana in the Koulikoro Region; these cases have subsequently tested negative for Ebola virus [1].

Active surveillance activities in Sierra Leone have not identified any further suspected cases of EVD. Previously reported suspect cases were diagnosed as Lassa fever [2].

The Ministries of Health of Guinea, Liberia, Mali and Sierra Leone, together with WHO and other response partners, are implementing a coordinated response to the outbreak. The outbreak is still evolving and case numbers may continue to increase in the coming days as investigations progress [1].

WHO does not recommend that any travel or trade restrictions be applied to Guinea, Liberia, Mali or Sierra Leone [1].

View a map of areas affected by the outbreak, as of 10 April 2014.

Ebola virus disease

Ebola virus disease is a severe disease caused by a virus of the Filoviridae family. The natural reservoir for Ebola virus is not known, but it has been found in animals including non-human primates and bats [4]. Following an incubation period of four to 16 days (range two to 21 days) illness presents with the sudden onset of fever, headache, joint and muscle aches, and weakness. As the infection progresses, nausea, vomiting and diarrhoea, shortness of breath, confusion, and haemorrhage can occur. This can lead to multi-organ failure, shock, and death. Ebola is transmitted via direct contact with the bodily fluids of an infected person. Ebola has also been reported following contact with the tissues of infected animals such as non-human primates and bats.

Advice for travellers

The risk to most travellers to affected countries in West Africa is considered to be very low even if the visit included travel to the local areas from which primary cases have been reported [5]. There has never been an imported case of Ebola reported in the United Kingdom [6].

It is recommended that the following precautions are taken by travellers to areas with on-going cases:

  • avoid contact with symptomatic patients and
  • their bodily fluids
  • avoid contact with corpses and/or bodily fluids from deceased patients
  • avoid close contacts with alive or dead wild animals (including monkeys, forest antelopes, rodents and bats)
  • avoid consumption of "bushmeat"
  • wash and peel fruits and vegetables before consumption
  • practise safe sex
  • follow strict hand washing routines [5].

Those who are providing medical care or are involved in the evaluation of an outbreak should observe strict barrier precautions. Guidance for healthcare workers who will be working with VHF patients in African healthcare settings has been written by the CDC in conjunction with WHO.

Travellers who have been potentially exposed to Ebola virus should seek medical attention immediately if they experience any symptoms consistent with Ebola within the first 21 days of return to the UK. The Imported Fever Service: Public Health England is available to local infectious disease physicians or microbiologists should specialist advice be needed on 0844 7788990.

United Kingdom guidance on the management and control of viral haemorrhagic fevers (VHF) has been written by the Advisory Committee on Dangerous Pathogens.

References

1. World Health Organization. Regional Office for Africa. Ebola virus disease, West Africa. (Situation as of 16 April 2014). [Accessed 17 April 2014]. Available at: http://www.afro.who.int/en/clusters-a-programmes/dpc/epidemic-a-pandemic-alert-and-response/outbreak-news/4100-ebola-virus-disease-west-africa-16-april-2014.html

2. World Health Organization. Regional Office for Africa. Ebola virus disease, West Africa. (Situation as of 14 April 2014). [Accessed 17 April 2014]. Available at: http://www.afro.who.int/en/clusters-a-programmes/dpc/epidemic-a-pandemic-alert-and-response/outbreak-news.html

3. UNICEF. Liberia. Ebola Outbreak: SitRep #16. 16 April 2014 [Accessed 17 April 2014]. Available at: http://reliefweb.int/sites/reliefweb.int/files/resources/

UNICEF%20Liberia%20SitRep16%20Ebola%20Viral%2

0Disease%2016Apr2014.pdf

4. Beeching NJ, Fletcher TE, Hill DR, Thomson GL. Travellers and viral haemorrhagic fevers: what are the risks? Int J Anti Micro Agents 36:S26-S35, 2010.

5. European Centre for Disease Prevention and Control. Rapid Risk Assessment - Outbreak of Ebola haemorrhagic fever in West Africa. 8 April 2014. [Accessed 17 April 2014]. Available at: http://www.ecdc.europa.eu/en/publications/Publications/Ebola-RRA-West-Africa-8April2014.pdf

6. Public Health England. Ebola. [Accessed 17 April 2014]. Available at: http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsA

Z/Ebola/

Links

Public Health England: Ebola

European Centre for Disease Prevention and Control. Rapid Risk Assessment: Outbreak of Ebola Virus Disease in West Africa

World Health Organization: Ebola haemorrhagic fever

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