Ebola Virus Agent Information Sheet (keep for redirect)

Boston University
Research Occupational Health Program (ROHP)
617-414-7647

Agent

Ebola virus (Ebola virus disease (EVD), EBO, EBOV) is a member of the Filoviridae family. The filamentous viral particle contains a helical nucleocapsid and is enveloped by a host cell-derived membrane. Each viron contains one molecule of single-stranded, non-segmented, negative-sense viral genomic RNA. Four of the five Ebola virus species have caused disease in humans; Zaire ebolavirus, Sudan ebolavirus, Thai Forest ebolavirus, and Bundibugyo ebolavirus. The fifth, Reston ebolavirus, has caused disease in nonhuman primates but not humans.

Disease/Infection

Ebola hemorrhagic fever (Ebola HF)

Pathogenicity

Ebola hemorrhagic fever (Ebola HF) is a severe, often-fatal disease in humans. The disease is caused by infection with the Ebola virus. 25%-90% case fatality rate.

Biosafety Information

Risk Group/BSL
Risk Group 4
BSL-4

Modes of Transmission

Transmission
Skin Exposure (Needlestick, animal bite, or scratch):Yes
Mucous Membrane Exposure Splash to Eye(s), Nose or Mouth:Yes
Inhalation:Person to person transmission by intimate contact is the main route of infection (direct contact with infected blood, secretions, organs or semen).
Transmission via droplets is suspected.
Ingestion:Unlikely in laboratory setting

Host Range/Reservoir
Humans, monkeys, great apes, duikers, maybe fruit bats

Symptoms
Sudden onset with high fever, malaise, abdominal pain, myalgias, vomiting, diarrhea; conjunctival injection, maculopapular rash, renal and hepatic involvement and hemorrhagic diathesis; involvement of liver, pancreas, kidney, and to a much less degree the CNS and heart; leukopenia, thrombocytopenia and transaminase elevation. Multi organ failure is noted.

Incubation Period
2-21 days (4-9 days in most cases).

Viability

  • Susceptible to 2% sodium hypochlorite, 2% glutaraldehyde, 5% peracetic acid, phenolic disinfectants, paraformaldehyde and 1% formalin
  • Susceptible to ultra-violet irradiation. Triton X-100 will greatly reduce infectivity. Heating to 60°C for 1 hour will render samples noninfectious. Virus is inactivated with 0.3% beta propiolactone for 30 minutes at 37°C. Serum samples can be inactivated by 2 megarad of gamma irradiation.

Survival Outside Host
Virus can survive in blood specimens for several weeks at room temperature and for several weeks in a corpse. However, the virus does not survive for long periods after drying.

Information for Lab Workers

Laboratory PPE

One-piece positive pressure ventilated suit with life support system is utilized. Long sleeve scrub suits will be worn under the positive pressure suit with inner gloves providing added protection against outer glove tear.

Containment

BSL-4 practices and facilities are recommended for activities involving the propagation and manipulation of production quantities or concentrates of Ebola virus. ABSL-4 practices and facilities are recommended for activities involving animals.

PRIMARY HAZARDS: Accidental parenteral inoculation, respiratory exposure to infectious droplets, and/or direct contact with broken skin or mucous membranes. 

SPECIAL HAZARDS: Work with, or exposure to, infected non-human primates, rodents, or their carcasses represents a risk of human infection; use of sharps when handling Ebola virus-infected material.

In Case of Exposure/Disease

Immediately after exposure, lab workers should follow the HIGH AND MAXIMUM CONTAINMENT MEDICAL INCIDENT RESPONSE PLAN (ERP C.1) as provided on site and during training.

  • For all lab exposures which involve BSL-4 pathogens (splashes, needle sticks, punctures, cuts, scratches, …) and for all medical events which require immediate evaluation and treatment (traumatic injury, heart attack, stroke, seizure, … ):
    • Medical Campus: call or have a coworker call the Control Center at 4–6666.
      You will be referred to or transported to the appropriate health care location by the emergency response team.The Control Center operator will activate a communication tree which includes the BU Research Occupational Health Program (ROHP) officer who will help guide the response.
To reach the ROHP directly use the 24/7 hour number (1-617-414-ROHP (7647); or, 4-ROHP (7647) if calling from an on-campus location)
  • You will be connected with the BU Research Occupational Health Program (ROHP) medical officer. ROHP will refer you to the appropriate health care location.
  • Under any of these scenarios, always inform the physician of your work in the laboratory and the agent(s) that you work with.
  • Present the Medical Surveillance Card that every BSL 4 researcher has been provided by ROHP, this wallet size card identifies the agents that the researcher works with; provide the ID card to the treating physician.

Vaccination

None FDA approved. A chimp adenovirus and vesicular stomatitis virus based Ebola vaccines currently undergoing safety trials.

Information for First Responders/Medical Personnel

Public Health Issues

After exposure: Immediately after an exposure to Ebola virus, the lab worker is not considered infectious. He/she can be cared for with standard PPE. On campus exposures will be escorted directly from NEIDL triage room to the Patient Isolation Unit at Boston Medical Center (BMC) where lab workers will be received by a team of physicians and nurses at BMC. In case of a lab worker presenting to BMC ED or other outside medical facility, either the exposed or the caring physicians should immediately contact ROHP for further instructions.

In case of (suspected) illness: Lab worker should contact ROHP directly and when possible, transport will be arranged to bring the patient to BMC’s Patient Isolation Unit. Patient should prevent close contact with household members pending evaluation, if possible. If the worker presents to BMC ED or other outside medical facility, caring physicians should contact ROHP for further instructions and ROHP will consult infectious diseases specialists.

Person-to-person transmission is reported via close personal contact with an infected individual or their body fluids during the late stages of infection. PPE requirements for care of this patient are listed below.

PPE: Droplet Precautions plus Contact Precautions, with face/eye protection, emphasizing safety sharps and barrier precautions when blood exposure likely. Use N95 or higher respiratory protection when aerosol-generating procedure performed. Airborne precautions should be considered if prominent cough, vomiting, diarrhea, hemorrhage.

Other guidance for outside providers: No blood work should be drawn until contact is made with ROHP.

Specimen should be handled with extreme care and enclosed in appropriate shatter proof and spill proof packing for transport to lab. Diagnostic laboratory staff should be notified of suspicion of infection, and tests should be performed under proper containment if Ebola virus is suspected. Please contact ROHP immediately for further details.

Public health officials will be notified.

Diagnosis/Surveillance

Virus detection in blood is difficult in the early stages of disease. PCR is used to diagnose EVD but is only positive around day 3 of illness. Acute and convalescent serologies are to be drawn.

Potential alternate diagnoses with similar presentation should be considered, such as influenza or other respiratory viruses.

First Aid/Post Exposure Prophylaxis

Standard management of potential exposure to Ebola virus is solely based on observation, potential isolation and with symptomatic and supportive treatments.

No approved post exposure prophylaxis or post exposure vaccination available.

Medical countermeasures maybe available post exposure through CDC, ROHP, and Infection Control NEIDL should be contacted immediately to coordinate potential access to investigational measures.

Treatment

Treatment is aggressive supportive care, and is directed at maintaining renal function and electrolyte balance, addressing coagulopathy and combating hemorrhage and shock. Transfusion of convalescent serum may be beneficial. Monoclonal antibodies targeted towards Ebola virus particles and small interfering RNA based treatments have been used with some success in clinical settings under compassionate use. No treatments are FDA approved.

Medical countermeasures may be available for treatment through CDC, and ROHP should be contacted immediately to coordinate potential access to investigational measures.

References

Biosafety in Microbiological and Biomedical Laboratories (BMBL) 5th Edition. US Government Printing Office, Washington, 2007. 

Ebola Hemorrhagic Fever Fact Sheet, CDC. http://www.cdc.gov/vhf/ebola/pdf/ebola-factsheet.pdf

Control of Communicable Diseases Manual. David L. Heymann. Washington DC, USA: American Public Health Association Press, 19th edition 2008

Revised: 12/10/2014

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