Ebola Viral Haemorrhagic Fever (VHF) in West Africa.
Healthcare professionals are particularly vulnerable as they assess and treat individuals. Could you spot Ebola and would you live to tell the tale?
Ebola is frightening and sensational reporting coupled with a high mortality rate fuels anxiety. So let’s remind ourselves of the facts about Ebola so we can keep ourselves safe.
• The outbreak, first detected in March this year in Guinea, was thought to be under control but instead the number of cases rapidly increased in May and spread to neighbouring Sierra Leone and Liberia (see map below)
• The capital cities of the affected countries (Conakry, Freetown and Monrovia) have now all experienced cases
• So far there have been approximately 1200 confirmed or suspected cases with 672 deaths (this outbreak has a 56% mortality rate)
• A person with Ebola was able to fly from Liberia to Lagos in Nigeria (Africa’s largest city with a population of 21
million) where they subsequently died. No further cases have been reported in Nigeria but it has demonstrated how international air travel enables an infected person to spread this infection worldwide
• Healthcare professionals involved in trying to control this outbreak continue to acquire and die from the infection; very sadly this has included Sierra Leones’ top virology expert in
treating viral haemorrhagic fevers
The earliest symptom of VHF is the fever, sometimes in
conjunction with a flu-like illness, and therefore a possible diagnosis of VHF should be considered in any patient who has travelled to West Africa who has a fever within 21 days of leaving that region. The normal incubation period for
VHF is 7-10 days, but it can be up to 21 days.
The late features of the infection are vomiting, diarrhoea and rash with uncontrolled bleeding and multi-organ failure. In the end stages of the infection all of the patient’s body fluids become potentially infectious allowing transmission from person-to-person; blood, stool, urine, vomit, saliva
and even sweat.
The clinical definition for possible VHF is:
Fever > 38oC OR a history of fever within 24 hours
Returned from an endemic country (see map above) within 21 days OR been in contact with body fluids from a patient known or strongly suspected of having viral haemorrhagic fever
If the patient meets the clinical definition discuss them
urgently with the local oncall Public Health Doctor (CCDC), your local oncall Microbiologist or Infectious Diseases Physician and if applicable the Infection Control Team.
If the patient is assessed to be at risk of having VHF then the Microbiologist will arrange for appropriate laboratory diagnostic testing as well as giving advice about infection control.
In the UK the patient will be discussed with the National
Imported Fever Service by the Microbiologist or Infectious Diseases Physician and arrangements made to send an EDTA whole blood or serum sample for molecular testing for VHF. This test is available 24/7 and the result should be available within 2-6 hours. If the patient tests positive for VHF then they should be transferred to the High Level Isolation Unit at the Royal Free Hospital in London.
If the patient tests negative then they can be managed locally for whatever infection is causing their fever.
Infection Control Advice
Is the patient well enough to be managed as an outpatient?
• YES - the patient should be advised to isolate themselves in their own home whilst awaiting the results of diagnostic tests, with at least daily medical review, usually by Public Health England, to ensure that they are not developing other
signs of VHF which might necessitate hospital inpatient treatment. Therefore the local Public Health team should be informed of the patient and that they have not been admitted.
• NO - before the patient can be admitted there are strict infection control procedures that must be put in place. Do not send patients directly to the Accident & Emergency Department without warning them that the patient is coming first, to ensure precautions are put in place beforehand!
Whilst the outbreak of Ebola could spread to the UK it is still
very unlikely that this will happen. Be alert and be prepared, but don’t panic.