Ebola virus disease (EVD) is a rare and deadly viral illness that is reportable to the National Notifiable Disease Surveillance System (NNDSS) in all U.S. states and territories. Healthcare providers should be on alert for and evaluate any patients that are suspected of having EVD.
Early recognition of Ebola is critical for infection control, given it is spread through person-to-person transmission. Individuals can be classified as Persons Under Investigation (PUI) or Confirmed Cases.
Persons Under Investigation (PUI)
Individuals can be classified as a PUI if they have
- Signs and symptoms consistent with Ebola virus disease (EVD).
- An epidemiological risk factor within 21 days (i.e., the incubation period) before the onset of symptoms.
Laboratory-confirmed diagnostic evidence of EVD (i.e., through molecular and/or serologic testing).
Evaluating a Patient
The majority of febrile patients presenting in U.S. healthcare facilities do not have EVD, but early symptoms of the disease are similar to other febrile illnesses. It is important to systematically assess patients for the possibility of EVD through a triage and evaluation process.
1. Get a Travel History
Getting a thorough travel history is important for all acutely ill patients returning from an area with an active Ebola virus outbreak. Begin immediate infection control measures for acutely ill patients with a concerning travel history.
Stay up to date on active travel notices by consulting CDC’s Travelers’ Health website.
Travel History Questions to Ask:
- Have you been to an area with an active Ebola virus outbreak in the past 21 days?
- Have you been in close contact with someone confirmed to have EVD or with someone suspected to have EVD?
- While traveling abroad, did you attend a funeral?
- While traveling abroad, did you care for someone who was sick?
- While traveling abroad, did you have any contact with animals, domestic or wild?
2. Look for Ebola risk factors
Look for epidemiologic risk factors in all travelers returning from areas with an active Ebola virus outbreak. If an acutely ill patient has any of these risk factors, begin immediate infection prevention and control measures.
Risks for Exposures to Ebola virus include:
- Contact with blood or body fluids (including contaminated objects) of acutely ill or dead persons with suspected or confirmed EVD (such as providing care in a home or healthcare setting) without wearing appropriate PPE
- Participation in funeral rituals, including preparation of bodies for burial or touching a corpse at a traditional burial ceremony without wearing appropriate PPE
- Working in a laboratory where human specimens are handled without wearing appropriate PPE
- Handling wild animals or carcasses that may be infected with Ebola virus (primates, fruit bats, duikers)
- Contact with semen from a man who has recovered from EVD (for example, oral, vaginal or anal sex)
- Experiencing a breach in infection prevention and control precautions that result in the potential for percutaneous, mucous membrane, or skin contact with the blood or body fluids of a patient with EVD while carrying out any of the above activities
3. If exposure criteria are met, ask about signs or symptoms compatible with EVD
Signs and symptoms of EVD are nonspecific and similar to many other common causes of febrile illness in returning travelers. Assess a patient’s signs and symptoms along with their travel history and epidemiologic risk factors before initiating immediate infection control measures.
EVD symptoms can appear anywhere from 2 to 21 days after infection.
Illness typically progresses from “dry” symptoms (fever, aches, fatigue) to “wet” symptoms (diarrhea, vomiting, and in some cases, bleeding). A person with Ebola is not contagious until the appearance of symptoms.
Primary signs and symptoms of Ebola often include some or several of the following:
- Fever (≥100.4°F/38.0°C)
- Aches and pains, such as severe headache and muscle and/or joint pain
- Weakness and fatigue
- Sore throat
- Loss of appetite
- Gastrointestinal symptoms including abdominal pain, diarrhea, and vomiting
- Unexplained hemorrhaging, bleeding or bruising
- Red eyes, skin rash, and hiccups
If Patient Evaluation Indicates Possible Ebola Virus Infection, Take Action
If a relevant exposure history is reported AND signs or symptoms are consistent with EVD, take the following steps.
- Isolate the patient in a single room with a private bathroom or a covered bedside commode.
- Adhere to infection prevention and control procedures to prevent transmission through direct or indirect contact, including wearing appropriate PPE and using dedicated equipment.
- Use only essential healthcare workers trained in their designated roles for patient care and keep a log of everyone who enters and leaves the patient’s room.
- Perform only necessary tests and procedures and avoid aerosol-generating procedures.
- Notify your facility’s Infection Prevention and Control Program and other healthcare personnel of a suspected EVD case.
- Contact the local or state health department for consultation about testing for EVD.
Use these assessment tools to help when evaluating fever, and risk of viral hemorrhagic fevers, in returning travelers.
- Borio L, Inglesby T, Peters CJ, et al: Hemorrhagic fever viruses as biological weapons: Medical and public health management. JAMA 287: 2391–2405, 2002.
- Hsu CH, Champaloux S, Keïta S, et al. Sensitivity and Specificity of Suspected Case Definition Used during West Africa Ebola Epidemic [PDF – 408 KB – 16 pages]. Emerg Infect Dis. 2018 Jan; 24(1): 9–14.