What Clinicians Need to Know about Ebola Hemorrhagic Fever

The current Ebola outbreak is centered in four countries in West Africa: Liberia, Guinea, Sierra Leone, and Nigeria. There have been over 1350 deaths attributed to Ebola in Africa. The death rate is currently averaging 55%-60% with variations in differing parts of the continent. To date, there have not been any confirmed cases of Ebola hemorrhagic virus in the United States. Ebola does not pose a significant risk to the US public.

Symptoms appear anywhere from 2-21 days after exposure. They include fever, severe headache, muscle pain, weakness, diarrhea, vomiting, abdominal pain, and loss of appetite.

The virus can spread in several ways. Most commonly, it is transmitted through direct contact through broken skin or mucous membranes with a sick person’s blood or body fluids (urine, semen, feces, saliva, and/or vomit). A person infected with Ebola is not contagious until symptoms appear. Ebola is not spread through the air by water.

Those at highest risk are healthcare workers who are directly exposed and family members of an Ebola patient. Healthcare workers must wear the proper protective equipment when caring for these patients. This includes gloves, masks and gowns. The CDC recommends standard, contact and droplet precautions for management of hospitalized patients with known or suspected Ebola.

Diagnosis of Ebola may difficult in the early days because the symptoms are initially nonspecific. However, if the patient has recently traveled to West Africa and develops a fever within 3 weeks, laboratory tests for Ebola virus should be considered.

There is no specific treatment for Ebola virus currently. Treatment is mainly directed at supportive care with intravenous fluids, oxygen and treating other infections as they occur. ZMapp is an experimental treatment that is a combination of three different monoclonal antibodies that bind to the protein of the Ebola virus. It has not been approved for use due to lack of clinical data.

Remember that Ebola has not been isolated in the US and the risk to the US public is low. Cases of suspected or confirmed Ebola Hemorrhagic Fever should be reported to the local health department where the patient resides. Further information can be found on the CDC website.

Rohit Balla serves as a partner at ID Care, the largest infectious disease practice in New JErsey. He is also the Infectious Diseases Section Chief At University Medical Center of Princeton at Plainsboro and a Clinical Assistant Professor at UMDNJ-Robert Wood Johnson Medical School.