TREATMENT
· SUPPORTIVE CARE
rehydration with oral or intravenous fluids - and treatment of specific symptoms improves survival. There is as yet no proven treatment available for EVD. However, a range of potential treatments including blood products, immune therapies and drug therapies are currently being evaluated.
In the ongoing 2018-2019 Ebola outbreak in DRC, the first-ever multi-drug randomized control trial is being conducted to evaluate the effectiveness and safety of drugs used in the treatment of Ebola patients under an ethical framework developed in consultation with experts in the field and the DRC.
· VACCINES
An experimental Ebola vaccine proved highly protective against EVD in a major trial in Guinea in 2015. The vaccine, called rVSV-ZEBOV, was studied in a trial involving 11 841 people. Among the 5837 people who received the vaccine, no Ebola cases were recorded 10 days or more after vaccination. In comparison, there were 23 cases 10 days or more after vaccination among those who did not receive the vaccine. The rVSV-ZEBOV vaccine is being used in the ongoing 2018-2019 Ebola outbreak in DRC.
CHECKLIST FOR PATIENTS BEING EVALUATED FOR EBOLA VIRUS DISEASE
· Assess the patient for a fever (Subjective or ≥ 100.4°F / 38.0°C)
· Determine if the patient has symptoms compatible EVD such as headache, weakness, muscle pain, vomiting, diarrhoea, abdominal pain or
Assess if the patient has a potential exposure from traveling to a country with widespread Ebola transmission* or having contact with an Ebola patient in the 21 days before illness onset
· Suspect Ebola if fever or compatible Ebola symptoms and an exposure are present
· Isolate patient in single room with a private bathroom and with the door to hallway closed
· Implement standard, contact, & droplet precautions
CONDUCT A RISK ASSESSMENT FOR: HIGH-RISK EXPOSURES
Percutaneous (e.g., needle stick) or mucous membrane exposure to blood or body fluids from an EVD patient Direct skin contact with skin, blood or body fluids from an EVD patient
Processing blood or body fluids from an EVD patient without appropriate PPE
Direct contact with a dead body in an Ebola-affected area without appropriate PPE
LOW-RISK EXPOSURES
Household members of an EVD patient or others who had brief direct contact (e.g., shaking hands) with an EVD patient without appropriate PPE
Healthcare personnel in facilities with EVD patients who have been in care areas of EVD patients without recommended PPE
DURING AEROSOL-GENERATING PROCEDURES
Limit number of personnel present
Conduct in an airborne infection isolation room
Don PPE as described in the 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)
PATIENT PLACEMENT AND CARE CONSIDERATIONS
· Maintain log of all persons entering patient’s room
· Use dedicated disposable medical equipment (if possible)
· Limit the use of needles and other sharps
· Limit phlebotomy and laboratory testing to those procedures essential for
diagnostics and medical care
· Carefully dispose of all needles and sharps in puncture-proof sealed containers
· Avoid aerosol-generating procedures if possible
· Wear PPE (detailed in center box) during environmental cleaning and use an EPA-registered hospital disinfectant with a label claim for non-enveloped viruses
Initial patient management
· Consult with health department about diagnostic EVD RT-PCR testing
· Consider, test for, and treat (when appropriate) other possible infectious causes of symptoms (e.g., malaria, bacterial infections)
· Provide aggressive supportive care including aggressive IV fluid resuscitation if warranted
· Assess for electrolyte abnormalities and replete
· Evaluate for evidence of bleeding and assess hematologic and coagulation parameters
· Symptomatic management of fever, nausea, vomiting, diarrhea, and abdominal pain
· Consult health department regarding other treatment options
