Elsevier

Mayo Clinic Proceedings

Volume 89, Issue 12, December 2014, Pages 1710-1717
Mayo Clinic Proceedings

Concise review for clinicians
What Clinicians Should Know About the 2014 Ebola Outbreak

https://doi.org/10.1016/j.mayocp.2014.10.010Get rights and content

Abstract

The ongoing Ebola outbreak that began in Guinea in February 2014 has spread to Liberia, Sierra Leone, Nigeria, Senegal, Spain, and the United States and has become the largest Ebola outbreak in recorded history. It is important for frontline medical providers to understand key aspects of Ebola virus disease (EVD) to quickly recognize an imported case, provide appropriate medical care, and prevent transmission. Furthermore, an understanding of the clinical presentation, clinical course, transmission, and prevention of EVD can help reduce anxiety about the disease and allow health care providers to calmly and confidently provide medical care to patients suspected of having EVD.

Section snippets

The 2014 West African Ebola Outbreak

The ongoing outbreak in West Africa is the largest Ebola outbreak in recorded history.2, 4 The first cases occurred in Guinea in December 2013. Cases were identified in neighboring Liberia in March 2014, and in April the outbreak spread into Sierra Leone. In July 2014, EVD was introduced in Nigeria by an ill traveler from Liberia, with subsequent transmission to health care workers. In September 2014, Senegal had an EVD case imported from Guinea. On September 30, 2014, the first case of EVD was

Virology

Ebola is one of several viruses that cause hemorrhagic fever, including Marburg, Lassa, Crimean-Congo, Sin Nombre, yellow fever, and Dengue hemorrhagic fever.6 The hallmark of viral hemorrhagic fever is severe illness, including multiple organ failure and possible death, even in previously healthy persons. Sepsis is often induced through cytokine storm, and hemorrhagic complications occur through thrombocytopenia, hepatic necrosis (with resultant reduction in synthesis of coagulation factors),

Clinical Course

Patients with EVD have abrupt onset of symptoms 8 to 10 days after exposure (range, 2-21 days).2, 10, 11 These symptoms are often nonspecific initially, with fever, chills, myalgia, malaise, and possibly a maculopapular rash.12 After approximately 5 days, patients will often develop abdominal pain, severe watery diarrhea, nausea, and vomiting. Hemorrhagic sequelae may develop, including hematochezia, petechiae, ecchymosis, and mucosal hemorrhage. Fatal cases develop severe clinical signs and

Treatment

Treatment for EVD is largely supportive and includes blood product transfusion, electrolyte replacement, and fluid resuscitation, pressors, and ventilatory support as needed. It is important that patients with suspected EVD are also evaluated for and, if necessary, treated empirically for malaria and typhoid fever. Limited experience with treating EVD in resource-rich settings suggests that the availability of supportive care likely improves patient outcomes substantially. There are no licensed

Transmission

Initial introduction of EVD into human populations likely occurs through contact with an infected animal, such as a bat or monkey. Subsequent human infections, however, occur because of direct contact of mucous membranes or broken skin with blood or body fluids of an infected person.2, 4 Patients are contagious only when they are ill and do not transmit the infection during the incubation period. During severe illness with Ebola, blood, sweat, feces, and vomit are highly infectious. Health care

Infection Control in Health Care Facilities in the United States

The first case of EVD diagnosed in the United States, and the transmission of EVD to members of his health care team, has raised public awareness of the Ebola outbreak. It has also resulted in fears that the outbreak could spread widely in the United States. For sustained transmission of EVD, there needs to be direct contact with blood or body fluids from an infected person while he or she is ill. Owing to standard infection control practices in health care facilities in the United States,

Visitors

Visitors should be limited. If a visitor is considered essential for the well-being of a patient with EVD, the visitor should be educated about modes of transmission of EVD and appropriate PPE use. The visitor should use the same PPE as health care workers. Visitors who have had contact with the patient with EVD before and during hospitalization are a potential source of EVD for other patients, visitors, and staff. Their movement within the facility should be restricted, and they should be

Laboratory Testing

To reduce the risk of health care worker exposure, blood collections for laboratory tests should be minimized and laboratory testing limited to tests that are essential for the patient’s medical care. The clinical laboratory should be contacted before any samples are obtained and sent for testing so that the laboratory staff can take appropriate precautions while handling specimens.

The move to regional centers caring for all patients with EVD would enable these centers to plan for dedicated

Cleaning, Linen, and Waste Management

The Ebola virus is a nonenveloped virus and as such is susceptible to a broad range of hospital-grade disinfectants. However, as an added precaution, the CDC recommends using disinfectants effective against the more resistant nonenveloped viruses (eg, norovirus, rotavirus, adenovirus, and poliovirus) to disinfect environmental surfaces in rooms of patients with EVD. The product label’s instructions for wet contact time should be adhered to strictly to ensure inactivation of the virus.

Stopping the Ebola Outbreak

The current EVD outbreak in West Africa has been the largest, most prolonged outbreak to date. In addition to the direct effects of EVD on populations, there has been disruption of standard medical care for common communicable diseases, such as malaria, that are endemic in the region and huge economic losses and social disruption in a region where the infrastructure is already significantly weakened by years of war and civil unrest. The World Health Organization has declared the Ebola epidemic

Conclusion

The 2014 West African Ebola outbreak has increased the awareness of the disease among health care providers and the general public in the United States. It is important that health care workers understand the modes of transmission and the clinical course to recognize a potential EVD case. Preventing transmission in the community setting requires early recognition and isolation of patients with EVD in a health care facility that has adequate capabilities for infection control and supportive

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Cited by (16)

  • Is there a way out for the 2014 Ebola outbreak in Western Africa?

    2015, Asian Pacific Journal of Tropical Medicine
    Citation Excerpt :

    During severe illness with Ebola, blood, sweat, feces, and vomit are highly infectious [19]. Therefore, it is also thought that healthcare workers who do not follow proper preventative measures are at the highest risk for secondary infection [3]. Moreover, it has also been studied that the route of transmission has an effect on the outcome of the virus [19].

  • Ebola virus disease: Awareness among junior doctors in England

    2015, Journal of Hospital Infection
    Citation Excerpt :

    If these findings are confirmed by other similar studies, educational resources such as e-learning modules, active real-time course, or simulation scenarios may be useful to the relevant groups in order to improve the recognition and the management of EVD. With these additional measures, a better awareness of Ebola might be achieved among the medical staff.8 In conclusion, this study suggests that junior doctors in England do not currently have sufficient knowledge about the clinical features and the epidemiology of EVD.

View all citing articles on Scopus

See also page 1596

Editor’s Note: The content of this article was current as of October 23, 2014, the date of acceptance. The journal recognizes that this is a rapidly evolving field, and we will provide updates in the electronic and print versions of the journal as appropriate. – Thomas J. Beckman, MD, Associate Editor for Concise Reviews.

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