Information about Ebola Virus
Table of Contents
- Putting on / taking off PPE - WHO
- Putting on and taking off PPE - CDC (revised)
- Putting on and taking off PPE - Ontario
- Viral Hemorrhagic Fever - Donning & Doffing PPE - University of Nebraska
The following training videos are a joint collaboration between Health Canada, the Royal College of Physicians and Surgeons of Canada, the Public Health Agency of Canada and IPAC Canada
- Royal College Clinical Learning Scenarios for Physicians
(developed in conjunction with IPAC Canada)
Ebola virus disease (formerly known as Ebola haemorrhagic fever) is a severe, often fatal illness caused by Ebola virus. EVD has a case fatality rate of up to 90%. It is one of the world's most virulent diseases.
The virus is transmitted by direct contact with the blood, body fluids and tissues of infected animals or people. Severely ill patients require intensive supportive care. During an outbreak, those at higher risk of infection are health workers, family members and others in close contact with sick people and deceased patients. Ebola virus is not airborne, but may be spread via droplets that are coughed or sneezed from a sick person and enter the eyes, nose, or mouth of another person who is less than two metres away. More information about airborne and droplet transmission...
The first-ever UN mission for a public health emergency, the UN Mission for Ebola Emergency Response (UNMEER), has been established to address the unprecedented EVD outbreak. WHO is a partner in the mission. Its strategic priorities are to stop the spread of the disease, treat infected patients, ensure essential services, preserve stability, and prevent the spread of EVD to unaffected countries.
As of May 8, 2018 the Government of the Democratic Republic of the Congo declared a new outbreak of Ebola virus disease (EVD) in Bikoro in Equateur Province. The outbreak declaration occurred after laboratory results confirmed two cases of EVD.
By May 17th, 2018, a total of 44 Ebola cases have been reported in the area in the past five weeks, including 3 confirmed, 21 probable (including 23 deaths), and 21 suspected. As of 15 May, 527 contacts have been identified and are being followed-up and monitored. Three health care workers were among the 44 cases reported
Congo has agreed to allow the World Health Organization to use an experimental Ebola vaccine to combat an outbreak.
Bikoro health zone is nearly 150 km from Mbandaka, capital of Equateur Province in an area of the country that is very hard to reach. The World Food Programme (WFP) has assisted WHO in putting in place an air-bridge between Kinshasa, Mbandaka and affected areas, with flights six days a week to deliver supplies and personnel.
WHO is calling on development partners to ensure a strong, comprehensive and rapid response to support the DRC Government to prevent and control the spreading of the disease. WHO is working with the Government and key partners to strengthen coordination of the Ebola response at the national level and in the affected Bikoro health zone.
Ring vaccination of contacts began on May 21, 2018. The outbreak was declared over on July 24, 2018, there were a total of 54 confirmed, probable and suspected Ebola cases, of which 33 people had died.
On 1 August 2018, the Ministry of Health of the Democratic Republic of the Congo notified WHO of a new outbreak of Ebola virus disease (EVD) in North Kivu Province, in the eastern part of the country. As of October 15, 2018, a total of 216 confirmed and probable EVD cases, including 139 deaths (case fatality ratio 64%), have been reported. Of the 216 cases, 181 are confirmed and 35 are probable. Alerts were investigated in several provinces of the Democratic Republic of the Congo as well as in The Gambia, South Sudan and Uganda. To date, EVD has been ruled out in all alerts from neighbouring provinces and countries.
In May 11, 2017, the WHO was notified of a cluster of undiagnosed illnessed and deaths with haemorrhagic signs in the Likati health area, Bas-Uélé Province of the Democratic Republic of Congo.
The Global Outbreak Alert and Response Network (GOARN) has been activated to provide additional support if required.
This is the eighth outbreak of Ebola virus disease since its discovery in 1976.
On July 2, 2017, after 42 days (two 21 day incubation cycles of the virus) the WHO declared the end of the outbreak. As a result of this outbreak 4 people died, 4 people survived, a total of 583 contacts were registered and closely monitored by no know contacts developed EVD. .
As of January 17, 2016 the cumulative number of cases attributed to EVD for the 2014-2016 epidemic stands at 28,639 including 11,316 deaths. In October, the first case of Ebola virus transmission outside of Africa, associated with the current outbreak, occurred in Spain. There have been no cases of EVD in Canada.
The EVD outbreak in Liberia was declared over on January 14, 2016.
Guinea was declared free of Ebola transmission on 29 December 2015, and has now entered a 90-day period of enhanced surveillance that is due to end on 27 March 2016.
Human-to-human transmission was declared to have ended in Sierra Leone on 7 November 2015. The country then entered a 90-day period of enhanced surveillance. On 14 January, 68 days into the 90-day surveillance period, a new confirmed cases of EVD was reported in Sierra Leone. Vaccination of contacts and contacts of contacts is underway and the origin of infection is under investigation. Sporadic cases continue to occur in this country.
- WHO situation reports
- Situation maps and epidemiological curves [ref: WHO]
- Timeline of cases with projections [ref: healthmap.org]
¹ includes one case in Senegal, two cases in Mali with subsequent deaths and one case in the U.S.
² includes one case in the U.S. with subsequent death and one case in Nigeria with subsequent death
³ includes one case in the U.K. and one case in Italy
|Summary of epidemiological facts and experience to date: [ref: WHO]
For more information and current updates:
EVD has been nationally notifiable in Canada since 2000. As a nationally notifiable disease, ebolavirus cases are reported to the Public Health Agency of Canada through national surveillance systems. The Agency also works closely with its national and international partners, including the World Health Organization, to track EVD outbreaks.
Health care workers in Canada should be vigilant for persons with symptoms compatible with EVD and who have returned from affected countries within 21 days of symptom onset.
A person with EVD-compatible symptoms is defined as an individual presenting with fever (temperature ≥ 38.0 degrees Celsius) OR at least one of the following symptoms/signs:
Epidemiological Risk Factors:
Person Under investigation (PUI)A person with EVD-compatible symptoms (as defined above) AND EVD has not been ruled out.
Confirmed CaseA person with laboratory confirmation of EVD infection using at least one of the methods below:
For more information on EVD surveillance:
- National Case Definition: Ebola virus disease (EVD) (PHAC 23 January 2015)
- EVD Case Report Form (PHAC 23 January 2015)
- Case definitions of Ebola virus and Marburg virus diseases (WHO August 2014)
EVD is a severe acute viral illness often characterized by the sudden onset of fever, intense weakness, muscle pain, headache and sore throat. This is followed by vomiting, diarrhoea, rash, impaired kidney and liver function. Bleeding from gums, nose, injection sites and gastrointestinal tract occurs in about 50% of patients. Dehydration and significant wasting occur as the disease progresses. Laboratory findings include low white blood cell and platelet counts and elevated liver enzymes.
People are infectious as long as their blood and secretions contain the virus. The incubation period is 2 to 21 days. Other diseases that should be ruled out before a diagnosis of EVD can be made include: malaria, typhoid fever, shigellosis, cholera, leptospirosis, plague, rickettsiosis, relapsing fever, meningitis, hepatitis and other viral haemorrhagic fevers.
There is no effective antiviral treatment for ebolavirus infections. Treatment is supportive, and is directed at maintaining renal function and electrolyte balance, and at combatting haemorrhage and shock.
- Symptoms of Ebola virus disease (PHAC 23 May 2014)
- Ebola clinical care guidelines (Canadian Association of Emergency Physicians, 29 August 2014)
- Ebola virus disease information for clinicians in U.S. healthcare settings (CDC 10 August 2014)
- NEW: Clinical Learning Scenarios (Royal College, February 2015)
For health care providers in Canada: [Ref: PHAC]
- Ebola virus is transmitted by direct contact (e.g., through broken skin or mucous membranes) with the blood or other body fluids (e.g., stool, urine, saliva, semen) of an infected individual and/or indirectly through contact with environmental surfaces and fomites contaminated with body fluids. Airborne transmission has not been documented.
- The incubation period of EVD varies from 2 to 21 days. Cases are not considered to be communicable before the onset of symptoms but communicability increases with each subsequent stage of illness and the case remains communicable as long as blood and body fluids secretions contain the virus. This includes the post-mortem period.
- Use Contact and Droplet Precautions, in addition to Routine Practices, in settings where contact with patients suspected or confirmed to have EVD is anticipated. The need for enhanced PPE (e.g., double gloving, leg and shoe coverings, hair/head covering) is determined by assessing the risk of heavy exposure to blood and body fluids.
- The effectiveness of PPE (gowns, gloves, masks, facial protection, respirators) is highly dependent on appropriate selection and proper use, including correct technique and sequence for putting on and taking off PPE, discarding into designated receptacles, and hand hygiene to minimize risk of transmission [more information].
- In health care settings when aerosol generating medical procedures must be performed on suspected or confirmed EVD patients, strategies to reduce aerosol generation must also be implemented.
- NEW: Infection Prevention and Control Expert Working Group: Advice on Infection Prevention and Control Measures for Ebola Virus Disease in Healthcare Settings (PHAC 19 December 2014)
- Infection Prevention and Control Guidance for Care of Patients in Health-Care Settings, with Focus on Ebola (WHO August 2014)
- Updated personal protective equipment guidelines: Personal protective equipment in the context of filovirus disease outbreak response (WHO 31 Oct 2014):
- Environmental Sanitation Practices to Control the Spread of Communicable Disease in Passenger Conveyances and Terminals (PHAC 23 June 2014)
- Infection Prevention and Control Recommendations for Hospitalized Patients with Known or Suspected Ebola Hemorrhagic Fever in U.S. Hospitals (CDC 5 August 2014)
- VIDEO: PPE Procedures for Suspected Ebola Patients ( The Research Institute for Tropical Medicine)
Samples from patients are an extreme biohazard risk. Testing for Ebola virus should be conducted under maximum biological containment conditions.
The Public Health Agency's National Microbiology Laboratory (NML) is the only facility in Canada that can work with live haemorrhagic fever viruses such as Ebola virus. The NML offers the world's highest level of containment and meets or exceeds all national and international guidelines for safety and security.
Health professionals should not undertake any laboratory testing on a patient suspected of having EVD or any other viral haemorrhagic fever infection.
If a sample requires testing, immediately contact the Agency's 24-hour emergency line: 1-800-545-7661. An expert will assist you in developing an Emergency Response Assistance Plan for the safe shipping of the sample to the Agency's NML.
- NEW: Interim Biosafety Guidelines for Laboratories Handling Specimens from Patients Under Investigation for Ebola Virus Disease (PHAC 19 Oct 2014)
- WHO guidelines on drawing blood: best practices in phlebotomy (WHO 2010)
Updated 20 March 2015
Canadians should avoid all non-essential travel to Guinea due to the ongoing Ebola virus outbreak (Level 3 travel warning).
The risk of a tourist or businessman/woman becoming infected with Ebola virus during a visit to the affected areas and developing disease after returning is extremely low, even if the visit included travel to the local areas from which primary cases have been reported. Transmission requires direct contact with blood, secretions, organs or other body fluids of infected living or dead persons or animals, all unlikely exposures for the average traveller. Tourists are in any event advised to avoid all such contacts. [Ref: WHO]
|Public Health Agency of Canada (PHAC) Links|
- Ebola Virus Disease
- National Case Definition: Ebola Virus Disease (EVD) (23 Jan 2015)
- EVD Case Report Form (23 Jan 2015)
- Environmental Sanitation Practices to Control the Spread of Communicable Disease in Passenger Conveyances and Terminals (1 Aug 2014)
- Public Health Management of Cases and Contacts of Human Illness Associated with Ebola Virus Disease (EVD) (23 Aug 2014)
- Infection Prevention and Control Expert Working Group: Advice on Infection Prevention and Control Measures for Ebola Virus Disease in Healthcare Settings (PHAC 19 December 2014)
- Interim Guidance for Airline Cabin Crews, Cleaning Personnel and Cargo Personnel: How to Protect Yourself and Others from Ebola Virus Disease (12 Sep 2014)
- Testing and Reporting Ebola Virus Disease (17 Sep 2014)
- Prevention of Ebola Virus Infection (29 Sep 2014)
- Surveillance for Ebola Virus Disease (29 Sep 2014)
- Symptoms of Ebola Virus Disease (29 Sep 2014)
- Routine Practices and Additional Precautions for Preventing the Transmission of Infection in Healthcare Settings (2013)
- Hand Hygiene Practices in Healthcare Settings (2013)
- Travel Health Notice (19 Jan 2015)
- Statement from the Minister of Health on Ebola (15 Oct 2014)
- Interim Biosafety Guidelines for Laboratories Handling Specimens from Patients Under Investigation for Ebola Virus Disease (PHAC 19 Oct 2014)
|World Health Organization (WHO) Links|
- General Information on Ebola
- WHO Disease Outbreak News
- WHO Situation Reports
- Ebola Response Roadmap
- Travel Recommendations
- Frequently Asked Questions on Ebola Virus Disease (8 Aug 2014)
- Infection Prevention and Control Guidance for Care of Patients in Health-Care Settings, with Focus on Ebola (August 2014)
- Fact Sheet on Ebolavirus Disease (September 2014)
- How to conduct safe and dignified burial of a patient who has died from suspected or confirmed Ebola virus disease (WHO October 2014)
- Updated personal protective equipment guidelines: Personal protective equipment in the context of filovirus disease outbreak response (31 Oct 2014):
- First meeting of the International Health Regulations Emergency Committee regarding the 2014 Ebola outbreak in West Africa (8 Aug 2014)
- Second meeting of the International Health Regulations Emergency Committee regarding the 2014 Ebola outbreak in West Africa (22 Sep 2014)
- Third meeting of the International Health Regulations Emergency Committee regarding the 2014 Ebola outbreak in west Africa (22 Oct 2014)
- Steps to Putting on Personal Protective Equipment
- Steps to Taking off Personal Protective Equipment
- General Information on Ebola
- Statement on Ebola Virus Disease (30 July 2014)
- Guidance for BC Health Professionals
- Ebola Information
- Infection Prevention and Control (IPC) & Workplace Health and Safety (WHS) Ebola Virus Disease (Ebola) Guidance for Acute Care Settings (22 Oct 2014)
- Emergency Department and Urgent Care Centre Ebola Clinical Assessment tool (for Physicians and Nurse Practitioners) (30 Oct 2014)
- Emergency Department and Urgent Care Centre Ebola Triage Protocol (Screening & Rapid Assessment at presentation to ED/UCC) (22 Oct 2014)
- Care of the Seriously or Critically Ill Patient with Possible or Proven Ebola Virus Disease (Version 11) (27 Oct 2014)
- Suspect/Confirmed Ebola Virus Disease Contact and Droplet Precautions (17 Oct 2014)
- PPE Requirements for Suspect/Confirmed Ebola Virus Disease (17 Oct 2014)
- WET Patient: Donning Personal Protective Equipment (16 Oct 2014)
- WET Patient: Doffing Personal Protective Equipment (16 Oct 2014)
- Dry Patient: Donning Personal Protective Equipment (16 Oct 2014)
- Dry Patient: Doffing Personal Protective Equipment (16 Oct 2014)
- Ebola Waste Management Recommendations (22 Oct 2014)
- Deceased Body: Acute Care Setting Algorithm (DB-AC) (30 Oct 2014)
- Body Handling Protocol (BHP) (30 Oct 2014)
- Ebola Virus Disease (EVD) - Public Health Ontario
- Ebola Virus Disease - Emergency Management
- Ebola Virus Disease Directive #1 - Precautions and Procedures for Acute Care Settings (Revised: 30 Oct 2014)
- Ebola Virus Disease Directive # 2 - Paramedic Services Land and Air Ambulance and First Responder Practices and Procedures (7 Nov 2014)
- NEW: Ebola Virus Disease Directive # 3 - Precautions and Procedures for Primary Care Settings (9 Dec 2014)
- Fact Sheet on Ebola Virus - Ontario (29 Aug 2014)
- EVD Initial Assessment and Management Tool - Primary Health Care Providers (21 Oct 2014)
- Initial Assessment and Management of the Returning Traveller from Countries/areas Affected by Ebola Virus Disease for Emergency Medical Services - Ontario (21 Oct 2014)
- Public Health Management of Travellers from Countries/Areas Affected by Ebola Virus Disease (24 Nov 2014)
|Centers for Disease Control (CDC) Links|
- General Information on Ebola Virus Disease
- Interim Guidance for Environmental Infection Control in Hospitals for Ebola Virus (1 Aug 2014)
- Infection Prevention and Control Recommendations for Hospitalized Patients with Known or Suspected Ebola Hemorrhagic Fever in U.S. Hospitals (5 Aug 2014)
- Interim Guidance for Specimen Collection, Transport, Testing, and Submission for Patients with Suspected Infection with Ebola Virus Disease (6 Aug 2014)
- Sample Packing Instructions Diagram (6 Aug 2014)
- Case Definition for Persons Under Investigation (7 Aug 2014)
- Interim Guidance for Monitoring and Movement of Persons with Ebola Virus Disease Exposure (22 Aug 2014)
- Ebola Medical Waste Management (11 Oct 2014)
- Guidance for Safe Handling of Human Remains of Ebola Patients in U.S. Hospitals and Mortuaries (17 Oct 2014)
- Review of Human-to-Human Transmission of Ebola Virus (17 Oct 2014)
- Guidance on Air Medical Transport for Patients with Ebola Virus Disease (20 Oct 2014)
- 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) (20 Oct 2014)
- What's the Difference Between Infections Spread Through the Air or by Droplets?
- Identify, Isolate, Inform: Emergency Department Evaluation and Management for Patients Who Present with Possible Ebola Virus Disease + Algorithm (27 Oct 2014)
- Algorithm - Evaluating Returned Travelers for Ebola (27 Oct 2014)
- Checklist for Patients Being Evaluated for Ebola Virus Disease in the U.S. (27 Oct 2014)
- Ebola 101 for Health Care Professionals (7 Nov 2014)
- Algorithm for Emergency Departments
- Hospital Checklist for Ebola Preparedness
- Web-Based PPE Training
- APIC: Ebola Infection Prevention and Control Resources
- University of Nebraska Medical Centre: Donning PPE/ Doffing PPE
- Médecins Sans Frontières (Doctors without Borders): Filovirus Haemorrhagic Fever Guideline, 2008
- Published Articles (EID) and Podcasts on Ebolavirus
- Medscape: Donning & Doffing of Personal Protective Equipment (PPE)
- New York City Ebola Training