EBOLA AND MARBURG

Ebola and Marburg are severe zoonotic multisystem febrile diseases caused by RNA viruses. They are notifiable diseases.

Cause

  • Ebola and Marburg viruses. Transmission to humans happens through contact with meat or body fluids of an infected animal. The disease can then be transmitted from human to human through body fluids (including semen for
    months after recovery) and it is highly contagious.

Risk factors

  • Communities around game parks
  • Communities in endemic area
  • Cultural practices like burial rituals
  • Poor infection control policies
  • History of exposure to infected people in the last 2 to 21 days i.e sexual partner, breastfeeding mothers
  • Recent contact with infected animals e.g monkeys, bats, infected game meat

Clinical features

  • Early signs (non specific): sudden fever, weakness, headache, muscle pains, loss of appetite, conjunctivitis
  • Late signs:
    • Diarrhoea (watery or bloody), vomiting
    • Mucosal and gastrointestinal bleeding: chest pain, respiratory distress, circulatory shock
    • CNS dysfunction, confusion, seizures
    • Miscarriage in pregnancy
    • Elevated AST and ALT, kidney injury, electrolyte abnormalities

Note:

Haemorrhage is seen in less than a third of Ebola patients

Differential diagnosis

  • Malaria, rickettsiosis, meningitis
  • Shigellosis, typhoid
  • Anthrax, sepsis, viral hepatitis, dengue, leptospirosis

Investigations

  • Send blood sample to referral laboratory (UVRI Entebbe) for specific testing
  • Notify district epidemic focal person

Management

  • Refer all patients to regional referral hospital for management in an appropriate setting
  • Notify the district health team

Safety of health workers: maximum level of infection control procedures

  • Strict isolation of suspect cases
  • Use of adequate protective gear
  • Minimize invasive intervention
  • Safe handling of linen
  • Appropriate use of chlorine mixtures
  • Proper disposal of health care waste

Patient care

  • Supportive treatment of signs and symptoms
    • Replace and monitor fluids and electrolytes for patients with diarrhoea or vomiting

Triage and contact tracing

  • Triage patient (those who had contact with a patient or not)
  • Contact identification, contact listing and contact follow up

Dead Body handling

  • Avoid washing or touching the dead
  • There should be no gathering at funerals
  • The dead should be buried promptly by a designated burial team

Prevention

  • Health education of the population (e.g. avoid eating wild nimals)
  • Effective outbreak communication and having haemorrhagic viral fever protocols in place
  • Appropriate safety gear for patients/health workers in suspect cases
  • Modification of burial practices
  • Use of condoms