Information for Health Professionals and Laboratories

Information for Healthcare Providers

Ebola virus disease (EVD) is a severe, often fatal infectious disease affecting humans and non-human primates. The genus Ebolavirus is composed of six species, four of which are known to cause disease in humans (Zaire, Sudan, Tai Forest, Bundibugyo).

Ebola viruses enter the body through mucous membranes, breaks in the skin, or parenterally. The incubation period for EVD is 2 to 21 days (usually 8 to 10 days). Initial signs and symptoms of EVD are nonspecific and can include fever, chills, myalgias, and malaise. Gastrointestinal symptoms, including watery diarrhea, vomiting, and abdominal pain, follow initial symptoms after about 5 days. Other symptoms, such as chest pain, confusion, and unexplained bleeding, may occur.

Reporting and Infection Control

Clinicians should consider EVD in their differential diagnosis for any patient who has signs and symptoms consistent with EVD (such as fever, severe headache, muscle pain, weakness, fatigue, vomiting, diarrhea, stomach pain, and unexplained bleeding) and has traveled to an EVD affected area within the 21 days before the onset of symptoms. 

If there is suspicion of EVD in a patient based on travel history and clinical presentation, healthcare providers should immediately isolate the patient and notify their local health department (LHD) and implement the following EVD-specific infection prevention and control precautions: 

• Immediately isolate the patient in a private room with an in-room bathroom or covered bedside commode.

• Consider methods for performing detailed patient/family interviews in coordination with public health to rapidly clarify a patient's status with minimal contact between healthcare personnel and the patient, such as via telephone communication while healthcare personnel remain outside the isolation room.

• Limit healthcare provider contact with the patient to providing essential patient care; any persons having contact with the patient should practice appropriate precautions and use appropriate personal protective equipment (PPE) (PDF).
  

• Minimize procedures that could create splashes with blood and body fluid or increase environmental contamination with infectious material or create aerosols.
  

Information for Laboratories

Ebola virus testing is available at CDPH, select public health laboratories in California, and by the U.S. Centers for Disease Control and Prevention (CDC). Any Ebola testing performed in California requires approval from CDPH and the CDC. All suspected Ebola virus specimens must be packaged and transported as Category A, UN 2814. To prepare for Ebola virus specimen handling, packaging and shipping, please contact your local public health laboratory for guidance and assistance. If a healthcare provider requests testing, laboratorians should immediately notify the local health department (LHD).  

Laboratory and Biosafety Considerations 

• Presumptive testing for EVD due to Sudan ebolavirus or Zaire ebolavirus can be performed using the BioFire FilmArray NGDS Warrior Panel (it can also detect Tai Forest, Bundibugyo, and Reston viruses). This test is not available at commercial or clinical laboratories. There are currently four laboratories in California approved by the CDC to use the BioFire Warrior Panel: Los Angeles County Public Health Laboratory (PHL), Santa Clara County PHL, CDPH Viral and Rickettsial Disease Laboratory, and Cedars-Sinai Medical Center Laboratory, a Regional Treatment Center for Ebola. Confirmatory testing for presumptive positive samples must be performed at the CDC. 
  

• The decision to test for EVD must be made in conjunction with the patient's clinical care team, the LHD, CDPH, and CDC's Viral Special Pathogens Branch (VSPB). 

• All personnel handling specimens from patients with suspected EVD should adhere to recommended infection control practices to prevent infection and transmission. 

• As a component of the Occupational Safety and Health Administration's (OSHA's) Bloodborne Pathogens Standard, laboratories handling blood and body fluids must have an Exposure Control Plan (PDF) in place to eliminate or minimize employees' risk of exposure to pathogens. 

• Laboratories should conduct extensive risk assessments to identify and mitigate hazards associated with handling specimens from patients with suspected EVD. The proper PPE needs to be identified, available, and staff trained to properly don and doff PPE. Staff need to be specially trained, have passed competency testing, and attended drills to safely receive, handle, and process these specimens. 

• A laboratory should have dedicated space, equipment and supplies for handling and testing specimens from ill patients with suspected EVD for differential diagnosis of other illnesses and should also have plans for minimizing specimen manipulation. Because EVD and other viral hemorrhagic fevers resemble many other infectious diseases in the early stages, in-room disposable point-of-care screening tests for other travel and non-travel related illnesses may be useful for differential diagnosis.

• All waste from suspected EVD patients should be handled as Category A until EVD is ruled out. A waste management plan needs to be in place for lab reagents and Category A waste, including PPE and specimen material. 

• If a facility does not have the appropriate risk mitigation capabilities for testing specimens from suspected EVD patients, then the specimens should be forwarded to another facility that does.