Ebola Virus Information

Ebola Virus Information
Feb 5 cdphadmin

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 athttp://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

The California Department of Public Health Viral & Rickettsial Disease Laboratory (VRDL) now conducts testing for the Ebola virus using the DOD EUA real-time RT PCR assay. Per CDC protocol, all requests for Ebola Virus Disease testing must be triaged by the local and state public health department in collaboration with CDC.   Please contact CDPH duty officer at 916-328-3605 for consultation and to discuss a request for Ebola testing.  Laboratories may contact VRDL for laboratory specific questions at 510-307-8585 during business hours and through the CDPH Duty Officer at 916-328-3605 after hours and on weekends and holidays.

The VRDL capability to test for the Ebola virus, in conjunction with other CDC/LRN-approved testing laboratories in in the state will strengthen the preparedness and response to EVD.

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.

General InformationCDPH Ebola Virus Disease FAQ’s (PDF)

CDC – Case Definition for Ebola Virus Disease (New Window)

CDC – Signs and Symptoms of Ebola (New Window)

CDC – Review of Human-to-Human Transmission of Ebola Virus (New Window)

CDC – Methods of Human Transmission of Ebola (New Window)

CDC – Risk of Exposure to Ebola (New Window)

CDC – Primary Prevention Measures Against Ebola Infection (New Window)

CDC – Diagnosis of Ebola (New Window)

CDC – Treatment of Ebola (New Window)

Specimen Collection, Testing and Shipping Guidelines

CDC – Guidance for U.S. Laboratories for Managing and Testing Routine Clinical Specimens When There is a Concern About Ebola Virus Disease (New Window)

CDPH Ebola Real-Time RT-PCR Assay (PDF)

CDPH Ebola Specimen Packaging and Shipment Guidelines (PDF)

CDC Interim Guidance for Specimen Collection, Transport, Testing, and Submission for Patients with Suspected Infection with Ebola Virus Disease (New Window)

CDC Interim Guidance Regarding Compliance with Select Agent Regulations for Laboratories Handling Patient Specimens that are Known or Suspected to Contain Ebola Virus (New Window)

ASM – Interim Laboratory Guidelines for Handling/Testing Specimens from Cases or Suspected Cases of Hemorrhagic Fever Virus (New Window)

The Laboratory Practice Committee of the American Society for Microbiology (ASM) has drafted this document which includes enhanced precautions to assist laboratory personnel in following guidelines currently recommended by CDC. This document is presented as one possible approach for testing of patients with suspected Hemorrhagic Fever Virus (HFV). Guidelines for testing should be thoroughly discussed with the appropriate medical personnel and a site specific and procedure specific risk assessment should be conducted prior to implementation and may include significant changes of protocols recommended in this document.

Information for Local Health Officers

CDPH Guidance for the Evaluation and Management of US Ebola Contacts (PDF)

The California Department of Public Health recommends that local health departments (LHDs) develop a plan for the evaluation and management of contacts to persons with Ebola Virus Disease. The recommendations in this guidance document are intended for use by LHDs for any individual with potential exposure to an Ebola patient.

CDPH – Planning for and Management of Travelers from Ebola-Affected Countriesand U.S. Ebola Case Contacts for Local Health Departments (PDF)

This document has been updated to reflect consistency in patient evaluation (temperature monitoring).

CDPH Letter: Guidance and Forms for the Evaluation and Management of Contacts to Ebola Virus Disease (PDF)

This document has been updated to reflect consistency in patient evaluation (temperature monitoring) and to change CDPH point of contact to the CDPH Duty Officer.

Sample LHO Ebola Quarantine Order Ebola (Word)

Upon request from many local health jurisdiction, for a standardized framework, the California Department of Public Health (CDPH) developed a model Ebola quarantine order for use by local health officers. The model order was developed with input from CCLHO and CHEAC representatives. CDPH is sharing the current version of the model order solely as a sample for use by local health jurisdictions who may find it useful. The use of this model order format or content is entirely discretionary. Local Health Jurisdictions are encouraged to review this model order with local County Council and adapt as needed for the jurisdiction.

PH14-089: State Health Officer Issues Risk-Based Quarantine Order to Provide Consistent Guidelines for Counties (PDF)

Ebola Preparedness Letter to Local Health Officers from Dr. Chapman (PDF)

Ebola Preparedness Self-Assessment Tool for Local Health Departments (Excel)

Ebola Readiness in Hospitals Assessment Tool for Local Health Departments (Excel)

CDPH All Facilities Letters

AFL 14-21.1: Hospitals – Ebola Virus Disease Information and Preparedness (PDF)

AFL 14-22.1: Clinics – Ebola Virus Disease Information and Preparedness (PDF)

AFL 14-23: Ebola FAQ (PDF)

AFL 14-24: Ebola Virus Disease Medical Waste Management (PDF)

CDPH Teleconferences

CDPH Biweekly Local Health Department Ebola Update Call Minutes – January 21, 2015 (PDF)

CDPH Weekly Local Health Department Ebola Update Call Minutes – January 14, 2015 (PDF)

CDPH Weekly Local Health Department Ebola Update Call Minutes – January 7, 2015 (PDF)

CDPH Weekly Local Health Department Ebola Update Call Minutes – December 3, 2014 (PDF)

CDPH Weekly Local Health Department Ebola Update Call Minutes – November 26, 2014 (PDF)

CDPH Weekly Local Health Department Ebola Update Call Minutes – November 19, 2014 (PDF)

CDPH Weekly Local Health Department Ebola Update Call Minutes – November 12, 2014 (PDF)

CDPH Weekly Local Health Department Ebola Update Call Minutes – November 5, 2014 (PDF)

CDPH Local Health Department Weekly Ebola Virus Update October 15, 2014 (MP3)

CDPH Legislative Conference Call October 15, 2014 (MP3)

CDPH Stakeholder Ebola Teleconference, October 14, 2014 (MP3)

CDPH Stakeholder Ebola Teleconference (Transcript), October 14, 2014 (PDF)

CDPH Teleconference on Ebola Virus Disease, September 25, 2014 (MP3)

CDPH Teleconference on Ebola Virus Disease (Transcript), September 25, 2014 (PDF)

CDPH FormsCDPH Viral Hemorrhagic Fever Case Report Form – DRAFT (PDF)

CDPH Ebola Virus Disease Travel History Form (Word)

Information for Specific Groups

CDC – Information for People Working and Living Abroad (New Window)

CDC Interim Guidance about Ebola Infection for Airline Crews, Cleaning Personnel, and Cargo Personnel (New Window)

Cal/OSHA – Interim Worker Guidance (New Window)

CDC – Advice for Colleges, Universities, and Students about Ebola in West Africa (New Window)

Waste Management Guidelines

CASA Memo – Revised Consensus Recommendations for Dialogue between the Wastewater Sector and Hospitals on the Management of Wastewater Generated by Patients Infected with the Ebola Virus (PDF)

This document details a consensus recommendation on the handling of wastes to be discharged into the sanitary sewer from Ebola virus disease (EVD) patients. This was prepared by the California Association of Sanitation Agencies (CASA) in consultation with the California Department of Public Health (CDPH), and supersedes an earlier version released by CASA. Please use this information as needed to inform any discussions on this topic with wastewater treatment facilities.

CDC – Information on the Survivability of the Ebola Virus in Medical Waste (New Window)

CDC – Information on Cleaning and Decontamination (New Window)

CDPH Ebola Virus Disease Medical Waste Management – Interim Guidelines (PDF)

CDC – Ebola-Associated Waste Management (New Window)

Community Organization

CDC – Ebola Information for Volunteers Working with West African Communities in the United States (New Window, PDF)

CDC – Ebola Information for Leadership of CBOs (New Window, PDF)

Information for Health Care Workers

CDC – Q&A’s about the Transport of Pediatric Patients (< 18 years of age) Under Investigation or with Confirmed Ebola (New Window)

CDPH – PPE Guidance for Management of Ebola Patients in an Inpatient Setting (PDF)

CDPH is issuing a revision of the “Interim Guidance on Personal Protective Equipment (PPE) to be used Healthcare Workers in the Inpatient Hospital Setting During Management of Patients with Suspected or Confirmed Ebola Virus Disease (EVD) in California” to address the recommendation that PPE materials should be fluid-resistant or impermeable, in keeping with the CDC guidelines.

CDPH – Ebola Preparedness and Response for Outpatient and Ambulatory Care Settings (PDF)

CDPH has revised this document, removing the names of specific Ebola-affected countries in West Africa to avoid any inconsistencies. The list of Ebola-affected countries can be obtained at the CDC website at any time.

CDPH Ebola Poster for Waiting Rooms (PDF)

Ebola poster for clinic waiting rooms, emergency rooms, etc.

CDPH Ebola Poster for Waiting Rooms – Spanish (PDF)

CDC – Interim Guidance for Preparing Frontline Healthcare Facilities for Patients with Possible Ebola Virus Disease (New Window)

CDC – Interim Guidance for U.S. Hospital Preparedness for Patients with Possible or Confirmed Ebola Virus Disease: A Framework for a Tiered Approach (New Window)

CDC – Interim Guidance for Preparing Ebola Assessment Hospitals (New Window)

CDC – Interim Guidance for Preparing Ebola Treatment Centers (New Window)

Cal/OSHA – Interim Guidance on Ebola Virus in Inpatient Hospital Settings (PDF) (New Window)

CDC – Guidance for Screening and Caring for Pregnant Women with Ebola Virus Disease for Healthcare Providers in U.S. Hospitals (New Window)

CDC – Video: Respiratory Protection for Ebola (New Window)

ACOG – Practice Advisory: Care of Obstetric Patients During an Ebola Virus Outbreak (New Window)

The American College of Obstetricians and Gynecologists guidelines for caring for pregnancy in the context of Ebola virus disease.

CDC – Infographic: How Ebola is Spread (New Window)

CDC – Questions and Answers about CDC’s Ebola Monitoring & Movement Guidance (New Window)

CDC – Identify, Isolate, Inform: Ambulatory Care Evaluation of Patients with Possible Ebola Virus Disease (Ebola) (New Window)

CDC – Considerations for Discharging Persons Under Investigation (PUI) for Ebola Virus Disease (Ebola) (New Window)

CDC – Identify, Isolate, Inform: Emergency Department Evaluation and Management for Patients Who Present with Possible Ebola Virus Disease (New Window)

CDC – Fact Sheet: Monitoring Symptoms and Controlling Movement to Stop Spread of Ebola (New Window)

CDC – Epidemiologic Risk Factors to Consider when Evaluating a Person for Exposure to Ebola Virus (New Window)

CDC Interim Guidance for Monitoring and Movement of Persons with Ebola Virus Disease Exposure (New Window)

Joint Commission Standards – Safely and Effectively Managing the Infectious Ebola Patient (New Window, PDF)

While surveying healthcare organizations readiness to receive a confirmed or suspected Ebola patient, the highlighted accreditation chapters are focal to identifying strengths and/or gaps to safely and effectively managing the infectious Ebola patient within an organization, while minimizing the risk of transmission to self or others.

CDPH Ebola Scenario and Template for Hospital Drill 2014 (PDF)

The California Department of Public Health (CDPH) has prepared this scenario and template for hospitals to use for an exercise evaluating readiness to manage a patient with suspected Ebola virus disease. This tool was designed to test several levels of hospital preparedness including infection control and laboratory as well as different areas in the hospital such as emergency rooms, hospital floors and intensive care units. This tool is applicable to all hospitals including those planning to stabilize and transfer patients as well as those that will admit patients. The tool also incorporates roles for local public health agencies and CDPH encourages hospitals to involve local public health departments in their planning and exercise. Lessons learned from this process will also be applicable for other diseases for which rapid identification and isolation of patients is important to prevent nosocomial transmission.

CDC – Fact Sheet: Could it be Ebola? Checklist (New Window)

CDC – Recommendations for Safely Performing Acute Hemodialysis in Patients with Ebola Virus Disease in U.S. Hospitals (New Window)

CDC – Guidance on Personal Protective Equipment To Be Used by Healthcare Workers During Management of Patients with Ebola Virus Disease in U.S. Hospitals, Including Procedures for Putting On (Donning) and Removing (Doffing) (New Window)

CDC – Tightened Guidance for U.S. Healthcare Workers on Personal Protective Equipment for Ebola (New Window)

CDC – When Caring for Suspect or Confirmed Patients with Ebola (New Window)

CDC – Fact Sheet: CDC Taking Active Steps Related to Hospital Preparedness for Ebola Treatment (New Window)

CDC Interim Guidance for Environmental Infection Control in Hospitals for Ebola Virus (New Window)

CDC Guidance on Air Medical Transport for Patients with Ebola Virus Disease (New Window)

CDC – Infection Prevention and Control Recommendations for Hospitalized Patients with Known or Suspected Ebola Hemorrhagic Fever in U.S. Hospitals (New Window)

CDC – Ebola Virus Disease Information for Clinicians in U.S. Healthcare Settings (New Window)

CDC – Safe Management of Patients with Ebola Virus Disease in U.S. Hospitals (New Window)

CDC – Tools for Protecting Healthcare Personnel (New Window)

CDC – Health Care Facility Preparedness Checklist for Ebola Virus Disease (New Window)

CDC – Health Care Provider Preparedness Checklist for Ebola Virus Disease (New Window)