Clinician Alert: Outbreak of Ebola virus disease (Sudan ebolavirus) in Central Uganda
On September 20, 2022, the Ministry of Health of Uganda officially declared an outbreak of Ebola virus disease (EVD) due to Sudan virus (species Sudan ebolavirus) in Mubende District, Central Uganda. As of October 27, 2022, no suspected, probable, or confirmed EVD cases related to this outbreak have been reported in the United States or other countries outside of Uganda.
Recommendations for clinicians
It is important for clinicians to be aware the cases of EVD could present in the United States and to consider EVD in patients with compatible symptoms and a relevant travel history. Early consideration of EVD in the differential diagnosis is important for providing appropriate and prompt patient care, diagnostics, and to prevent the spread of infection.
A person infected with EVD is not contagious until symptoms appear (including fever, headache, muscle and joint pain, fatigue, loss of appetite, gastrointestinal symptoms, and unexplained bleeding). The virus is spread through direct contact (through broken skin or mucous membranes) with the body fluids (blood, urine, feces, saliva, droplet, or other secretions) of a person who is sick with or has died from EVD, infected animals, or with objects like needles that are contaminated with the virus. EVD is not spread through airborne transmission.
Healthcare personnel can be exposed to Ebola virus by touching a patient’s body fluids, contaminated medical supplies and equipment, or contaminated environmental surfaces. Splashes to unprotected mucous membranes (for example, the eyes, nose, or mouth) are particularly hazardous. Procedures that can increase environmental contamination with infectious material or create aerosols should be minimized. CDC recommends a combination of measures to prevent transmission of EVD in hospitals including PPE.
Idaho providers with concerns about a patient with suspected EVD should contact Eastern Idaho Public Health at 208-533-3152 or State Comm at 800-632-8000 immediately and will be provided with guidance and support for infection control and further assessment, as appropriate.
· Patients presenting with clinical symptoms such as fever, headache, muscle and joint pain, fatigue, loss of appetite, gastrointestinal symptoms, and unexplained bleeding should have travel history taken. Clinicians should consider possible viral hemorrhagic fever (VHF) or EVD on the differential diagnosis based on travel history.
· If EVD is suspected, patients should immediately be placed in a private room with the door closed, appropriate PPE protocols should be immediately instituted, and only essential personnel necessary to address the patient’s immediate needs should be permitted to enter the room. Aerosol generating procedures should be avoided, and, if must be conducted, should take place in an Airborne Infection Isolation Room, if feasible. Contact Eastern Idaho Public Health at 208-533-3152 or State Comm at 800-632-8000 immediately to plan for further assessment and collection of laboratory specimens.
o All personnel handling specimens from patients with suspected EVD (especially patients with travel history to Uganda three weeks before symptom onset) should adhere to recommended infection control practices to prevent infection and transmission among laboratory personnel.
There is currently no FDA-licensed vaccine to protect against Sudan virus infection. The Ebola vaccine licensed in the United States (ERVEBO,® Ebola Zaire Vaccine, Live, also known as V920, rVSV?G-ZEBOV-GP or rVSV-ZEBOV) is indicated for the prevention of EVD due to Ebola virus (species Zaire ebolavirus), and based on studies in animals, it is not expected to protect against Sudan virus or other viruses in the Ebolavirus genus. Also, there is currently no FDA-approved treatment for Sudan virus.
In the absence of early diagnosis and appropriate supportive care, EVD is a disease with a high mortality rate; occasional outbreaks have occurred mostly on the African continent. With intense supportive care and fluid replacement, mortality rates may be lowered.
Eight laboratories within the Laboratory Response Network (LRN) are able to test using the Biofire FilmArray NGDS Warrior Panel, with more LRN laboratories working toward the ability to test.
For More Information
General Ebola Information
General Resources for Ebola Virus Disease
Clinician Resources
Infection Prevention Resources
Procedures for Safe Handling and Management of Ebola-Associated Waste