Early recognition is critical for infection control. Healthcare providers should be alert for and evaluate any patients suspected of having EVD.
Person Under Investigation (PUI)
A person who has both consistent symptoms and risk factors as follows: 1) Clinical criteria, which includes fever of greater than 38.6 degrees Celsius or 101.5 degrees Fahrenheit, and additional symptoms such as severe headache, muscle pain, vomiting, diarrhea, abdominal pain, or unexplained hemorrhage; AND 2) Epidemiologic risk factors within the past 21 days before the onset of symptoms, such as contact with blood or other body fluids or human remains of a patient known to have or suspected to have EVD; residence in—or travel to—an area where EVD transmission is active*; or direct handling of bats, rodents, or primates from disease-endemic areas.
A PUI who is a contact of an EVD case with either a high or low risk exposure (see below).
A case with laboratory confirmed diagnostic evidence of ebola virus infection.
Contacts of an EVD Case
Contacts of an EVD case have different levels of exposure risk, as follows:
High risk exposures
A high risk exposure includes any of the following:
- Percutaneous, e.g. the needle stick, or mucous membrane exposure to body fluids of EVD patient
- Direct care or exposure to body fluids of an EVD patient without appropriate personal protective equipment (PPE)
- Laboratory worker processing body fluids of confirmed EVD patients without appropriate PPE or standard biosafety precautions
- Participation in funeral rites which include direct exposure to human remains in the geographic area where outbreak is occurring without appropriate PPE
Low risk exposures
A low risk exposure includes any of the following
- Household member or other casual contact1 with an EVD patient
- Providing patient care or casual contact1 without high-risk exposure with EVD patients in health care facilities in EVD outbreak affected countries*
No known exposure
Persons with no known exposure were present in an EVD outbreak affected country* in the past 21 days with no low risk or high risk exposures.
There is limited knowledge of the pathogenesis of human ebolavirus infections and no reported human cases acquired by the aerosol route. There is a threat of ebolavirus as an aerosolized biological weapon, and this study evaluated the pathogenesis of aerosol infection in 18 rhesus macaques. Important and unique findings include early infection of the respiratory lymphoid tissues, early fibrin deposition in the splenic white pulp, and perivasculitis and vasculitis in superficial dermal blood vessels of haired skin with rash. Initial infection occurred in the respiratory lymphoid tissues, fibroblastic reticular cells, dendritic cells, alveolar macrophages, and blood monocytes. Virus spread to regional lymph nodes, where significant viral replication occurred. Virus secondarily infected many additional blood monocytes and spread from the respiratory tissues to multiple organs, including the liver and spleen. Viremia, increased temperature, lymphocytopenia, neutrophilia, thrombocytopenia, and increased alanine aminotransferase, aspartate aminotransferase, γ-glutamyl transpeptidase, total bilirubin, serum urea nitrogen, creatinine, and hypoalbuminemia were measurable mid to late infection. Infection progressed rapidly with whole-body destruction of lymphoid tissues, hepatic necrosis, vasculitis, hemorrhage, and extravascular fibrin accumulation. Hypothermia and thrombocytopenia were noted in late stages with the development of disseminated intravascular coagulation and shock. This study provides unprecedented insight into pathogenesis of human aerosol Zaire ebolavirus infection and suggests development of a medical countermeasure to aerosol infection will be a great challenge due to massive early infection of respiratory lymphoid tissues. Rhesus macaques may be used as a model of aerosol infection that will allow the development of lifesaving medical countermeasures under the Food and Drug Administration’s animal rule.
Wonderful news. Great news. Absolutely great!
An UNDISCLOSED NUMBER of people who had contact with the Ebola virus are coming to Charlotte, North Carolina.
It was dumb to bring the infected to Atlanta, now it’s become really REALLY dumb, bringing people over here to wait 21 days to find out , why not a quarantine boat, or overseas?!
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- MY OPINION RED ALERT ! President Barack Obama has signed an amendment to an Executive Order 13295 : (EBOLA)