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Ebola Virus Information Page

Background

On March 23, 2014, the Ministry of Health in Guinea notified the World Health Organization (WHO) of a rapidly evolving outbreak of Ebola Virus Disease (EVD).  For the latest updates on Ebola activity, please visit the CDC website at http://cdc/gov/vhf/ebola/index.html and the WHO website at http://www.who.int/csr/disease/ebola/en/.

EVD is an infectious disease caused by the Ebola virus. Symptoms may appear from 2 to 21 days after exposure and include fever, headache, joint and muscle aches, weakness, diarrhea, vomiting, stomach pain, and abnormal bleeding. It is classified as a viral hemorrhagic fever (VHF) because of the fever and abnormal bleeding. Among the VHFs, Ebola is feared because of its high mortality. There are no specific treatments but supportive therapy can be provided to address bleeding and other complications.

Important facts about Ebola include:

Current science shows that people CANNOT get EVD through the air, food, or water. 

  • Ebola virus is transmitted through direct contact with the blood or bodily fluids of an infected symptomatic person or though exposure to objects (such as needles) that have been contaminated.
  • Persons are not contagious until they develop symptoms.
  •  Persons at highest risk for EVD include healthcare workers and family and friends of infected patients.
  • Effective isolation of patients and appropriate infection control measures applied to any suspect EVD patient would contain any potential spread. 

The risk of the spread of EVD in California is extremely low.  While we should be aware of the disease, its symptoms and its potential, it is extremely unlikely that Ebola poses a public health risk to Californians. At the present time, no confirmed cases have been identified in California.

 

Information on Reporting of Suspect Ebola Patients

CDPH, in accordance with guidelines from the Centers for Disease Control and Prevention (CDC), advises that healthcare providers in the U.S. should consider Ebola virus infection in patients who meet the case definition for EVD. The CDC guidance is available at: http://www.cdc.gov/vhf/ebola/hcp/case-definition.html.

Local health departments should use the interim case report form to report suspected EVD cases to CDPH.  The form is titled “Viral Hemorrhagic Fever” and is available at http://cdph.ca.gov/programs/cder/Documents/CDPH%20Viral%20Hemorrhagic%20Fever%20Case%20Report%20Form.pdf.  

Local health departments may also report cases into CALREDIE under “Viral Hemorrhagic Fever (e.g., Crimean-Congo, Ebola, Lassa and Marburg viruses)”.  Jurisdictions not participating in CalREDIE can fax the case report form to (916) 552-8973 or send the report via secure email to cder@cdph.ca.gov.

Per Title 17 CCR 2500, EVD and infections with other Viral Hemorrhagic Fevers (VHF) are reportable.  All persons suspected of having EVD should be reported immediately to the LHJ. 

 

Laboratory Testing

Virus detection is done using a real-time reverse-transcription polymerase chain reaction (rRT-PCR) assay developed by the Department of Defense and approved by the U.S. Food and Drug Administration under emergency use authorization. Testing with the Ebola Zaire RT-PCR assay is available at the CDC and many public health laboratories nationwide, including the Los Angeles County Public Health Laboratory.

Testing for the Ebola virus is coordinated by the U.S. Centers for Disease Control and Prevention (CDC).  No specimens will be tested without consultation with your local health department and CDPH.  CDPH recognizes the urgency of testing for EVD and will work with CDC staff to expedite testing. 

The preferred specimen for Ebola testing is a minimum volume of 4mL whole blood in a plastic collection tube. Whole blood preserved with EDTA (“lavender” or “purple top” plastic vacutainer tube) is preferred, but whole blood preserved with sodium polyanethol sulfonate (SPS), citrate, or with clot activator is acceptable. Specimens should be immediately stored or transported at 2-8°C or frozen on cold-packs to the CDC. Do not submit specimens in glass containers or in heparinized tubes.

Ebola virus is detected only after onset of symptoms, especially fever, and it may take up to 3 days after onset of symptoms for the virus to reach detectable levels.  A negative RT-PCR result on a specimen collected more than 72 hours after symptom onset is sufficient to rule out EVD. All positive RT-PCR results require confirmatory testing by the CDC, which may take 1-3 days. 

The CDC “Interim Guidance for Specimen Collection, Transport, Testing and Submission for Persons Under Investigation for Ebola Virus Disease in the United States” was updated on October 20, 2014, and is available at: http://www.cdc.gov/vhf/ebola/hcp/interim-guidance-specimen-collection-submission-patients-suspected-infection-ebola.html.  A very useful one page poster summarizing the guidance is available at:  http://www.cdc.gov/vhf/ebola/pdf/ebola-lab-guidance.pdf. 

 

Specimen Handling, Packaging and Shipping

Before sending specimens, the case MUST be reported to the local health department and CDPH.

Specific directions for transport, handling, packaging and shipping of specimens to CDC are outlined in the CDC document referred to above. Additional CDPH guidance for packaging and shipping specimens for Ebola testing can be found at the links below.

Specimens for ruling out Ebola virus infection should be shipped as a Category A, risk group 4 agent.  World Courier will ship such packages and is available 24/7. 

The person doing the shipping must be trained and certified to package and ship in accordance with International Air Transport Association (IATA) and Federal Department of Transportation (DOT) regulations. Contact your local public health laboratory for packaging and shipping guidance if you are unfamiliar with IATA regulations and training.

The following two forms must be submitted with the specimen in order for CDC to proceed with testing: 

CDC’s Viral Special Pathogens Branch Specimen Submittal Form available at:  http://www.cdc.gov/ncezid/dhcpp/vspb/pdf/specimen-submission.pdf

CDC DASH form 50-34, available on the CDC website at http://www.cdc.gov/vhf/ebola/hcp/interim-guidance-specimen-collection-submission-patients-suspected-infection-ebola.html

Local public health laboratories can assist submitters in completing these two forms and provide further guidance on how to arrange for shipment to CDC.

Virus detection is done using a real-time reverse-transcription polymerase chain reaction (rRT-PCR) assay developed by the Department of Defense and approved by the U.S. Food and Drug Administration under emergency use authorization. Testing with the Ebola Zaire RT-PCR assay is available at the CDC and many public health laboratories nationwide, including the Los Angeles County Public Health Laboratory.

Testing for the Ebola virus is coordinated by the U.S. Centers for Disease Control and Prevention (CDC).  No specimens will be tested without consultation with your local health department and CDPH.  CDPH recognizes the urgency of testing for EVD and will work with CDC staff to expedite testing. 

The preferred specimen for Ebola testing is a minimum volume of 4mL whole blood in a plastic collection tube. Whole blood preserved with EDTA (“lavender” or “purple top” plastic vacutainer tube) is preferred, but whole blood preserved with sodium polyanethol sulfonate (SPS), citrate, or with clot activator is acceptable. Specimens should be immediately stored or transported at 2-8°C or frozen on cold-packs to the CDC. Do not submit specimens in glass containers or in heparinized tubes.

Ebola virus is detected only after onset of symptoms, especially fever, and it may take up to 3 days after onset of symptoms for the virus to reach detectable levels.  A negative RT-PCR result on a specimen collected more than 72 hours after symptom onset is sufficient to rule out EVD. All positive RT-PCR results require confirmatory testing by the CDC, which may take 1-3 days. 

The CDC “Interim Guidance for Specimen Collection, Transport, Testing and Submission for Persons Under Investigation for Ebola Virus Disease in the United States” was updated on October 20, 2014, and is available at: http://www.cdc.gov/vhf/ebola/hcp/interim-guidance-specimen-collection-submission-patients-suspected-infection-ebola.html. A very useful one page poster summarizing the guidance is available at:  http://www.cdc.gov/vhf/ebola/pdf/ebola-lab-guidance.pdf.    

 

Other Available Guidances and Tools

The CDC poster “Sequence for putting on and removing Personal Protective Equipment”, available at: http://www.cdc.gov/vhf/ebola/pdf/ppe-poster.pdf. This updated poster emphasizes guidance to perform hand hygiene between steps if hands become contaminated and immediately after removing all PPE.

CDC “Interim Guidance for Environmental Infection Control in Hospitals for Ebola Virus,” available at: http://www.cdc.gov/vhf/ebola/hcp/environmental-infection-control-in-hospitals.html.  

Although the role of the environment in transmission of Ebola virus has not been established, in this guidance CDC recommends higher levels of precaution to reduce the potential risk posed by contaminated surfaces in the patient care environment “given the apparent low infectious dose, potential of high virus titers in the blood of ill patients, and disease severity.” Disinfection products with higher potency than what is normally required for an enveloped virus such as Ebola are therefore now recommended. Such products include Environmental Protection Agency-registered hospital disinfectants with a label claim for a non-enveloped virus (e.g., norovirus, rotavirus, adenovirus, poliovirus), and would also include bleach solution. In addition, the new guidance recommends that porous surfaces that cannot be made single use (e.g., carpeting, upholstered furniture and curtains) should be avoided in rooms of suspect EVD patients, and that potentially contaminated textiles (e.g. linens, non-fluid-impermeable pillows or mattresses, and privacy curtains) be discarded as regulated medical waste.

CDC” Interim Guidance for Emergency Medical Services (EMS) Systems and 9-1-1 Public Safety Answering Points (PSAPs) for Management of Patients with Known or Suspected Ebola Virus Disease in the United States”, available at http://www.cdc.gov/vhf/ebola/hcp/interim-guidance-emergency-medical-services-systems-911-public-safety-answering-points-management-patients-known-suspected-united-states.html.

“Guidance for Safe Handling of Human Remains of Ebola Patients in U.S. Hospitals and Mortuaries”, available at http://www.cdc.gov/vhf/ebola/hcp/guidance-safe-handling-human-remains-ebola-patients-us-hospitals-mortuaries.html.  

Specimen Collection, Testing and Shipping Guidelines
Information for Local Health Officers
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Information for Health Care Workers
 
 
Last modified on: 12/17/2014 9:54 AM