Clinical Guidance for Ebola Disease

Most ill travelers returning from an area with an active Ebola disease outbreak or where Ebola disease is endemic are usually ill with a more common infection, such as malaria. Timely identification of other more likely pathogens and access to routine laboratory testing, such as blood counts and chemistries, is essential for providing appropriate patient care.

In the hospital setting, where policies and procedures should be in place to safeguard healthcare workers, consideration of Ebola disease should not delay diagnostic assessments, laboratory testing, and appropriate care for other, more likely medical conditions.

Appropriate screening is essential

Early consideration of Ebola disease in the differential diagnosis of a patient with consistent clinical and epidemiological factors is essential for providing appropriate and prompt patient care and preventing the spread of infection. It is important to systematically assess patients through a screening process and treat infections as they are discovered.

Notify your health department

Healthcare providers with concerns about Ebola infection during their patient's differential diagnosis should contact their jurisdictional health department immediately (via the 24-hour Epi-On-Call contact list ) and follow jurisdictional protocols for patient assessment.

Clinical teams should coordinate with public health officials and CDC to assess the risk of Ebola disease based on the clinical presentation and epidemiologic risk factors. This will help determine if testing is needed and what other causes of illness should be considered (e.g., malaria). This coordination can ensure proper patient care and appropriate precautions are taken to help prevent potential spread within the healthcare setting.

CDC's Viral Special Pathogens Branch (VSPB) is available 24/7 for consultations on Ebola disease by calling the CDC Emergency Operations Center at 770-488-7100 and requesting VSPB's on-call epidemiologist.

Healthcare providers:‎

Review guidance on emergency services, screening, testing, infection control and PPE for viral hemorrhagic fevers, like Ebola disease, here: Site Index | Viral Hemorrhagic Fevers (VHFs) | CDC

Evaluation

Screening resources

Healthcare providers can learn how to evaluate an ill person for a VHF or other high-consequence dis.

Preventing infection

Clinical settings

The following informational materials demonstrate the procedures for putting on and removing PPE for.

Guidance for hospital staff caring for a patient who is suspected or confirmed to have viral hemorrh.

Vaccine information

Pathogenesis

Orthoebolaviruses enter a person's body through mucous membranes, breaks in the skin, or parenterally. They infect many cell types – monocytes, macrophages, dendritic cells, endothelial cells, fibroblasts, hepatocytes, adrenal cortical cells, and epithelial cells. The incubation period may vary depending on the infection route.

Once in the body, orthoebolaviruses migrate from the initial infection site to regional lymph nodes. They then migrate to the liver, spleen, and adrenal gland. Although not infected by an orthoebolavirus, lymphocytes undergo apoptosis, resulting in decreased lymphocyte counts. Hepatocellular necrosis occurs and is associated with dysregulation of clotting factors and subsequent coagulopathy. Adrenocortical necrosis can be found and is associated with hypotension and impaired steroid synthesis.

Ebolaviruses appear to trigger a release of pro-inflammatory cytokines. Subsequent vascular leaks and impairment of clotting ultimately result in multiorgan failure and shock.

Treatment options

Therapeutics

Two treatments are approved by the U.S. Food and Drug Administration (FDA) to treat Ebola disease caused by Ebola virus (species Zaire orthoebolavirus). Inmazeb ® is a combination of three monoclonal antibodies and Ebanga ® is a single monoclonal antibody. Monoclonal antibodies, or mAbs, are artificially produced antibodies that act like natural antibodies to stop the virus from replicating in a person's body. These mAbs bind to a portion of the virus called the glycoprotein and prevent the virus from entering the person's cells.

Both treatments were evaluated, along with two others, in a randomized controlled trial in the Democratic Republic of the Congo. Overall survival was higher for patients who received either Inmazeb ® or Ebanga ® . The efficacy of these treatments has not been established for viruses other than Ebola virus (species Zaire orthoebolavirus).

Supportive care

Clinical management of patients with Ebola disease should focus on supportive care for complications, such as hypovolemia, electrolyte abnormalities, hematologic abnormalities, refractory shock, hypoxia, hemorrhage, septic shock, multiorgan failure, and disseminated intravascular coagulation (DIC).

Recommended care includes volume repletion, maintenance of blood pressure (with vasopressors if needed), and maintenance of oxygenation, pain control, nutritional support, and treatment of secondary bacterial infections and pre-existing comorbidities.

Large volumes of intravenous fluids are often required to correct dehydration due to diarrhea and vomiting. Some patients may develop profound third-spacing of fluids due to vascular leak.

Complications

Ebola survivors can have many chronic complications, including viral persistence of orthoebolavirus in their bodies.

Management for specific populations

Pregnancy

Patients receiving hemodialysis

Recommendations to help hospital-based dialysis providers safely perform hemodialysis in patients wi.

On This Page

• Guiding principles
• Evaluation
• Preventing infection
• Treatment options
• Complications
• Management for specific populations

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Ebola

Learn about Ebola disease, caused by an infection with one of a group of viruses, known as ebolaviruses, that are found primarily in sub-Saharan Africa.

For Everyone

• About
• Signs and Symptoms
• Outbreak History
• How It Spreads