What is the issue?
An outbreak of Ebola virus disease (EVD) in West Africa is ongoing and transmission has been confirmed in Sierra Leone, Liberia and Guinea. A separate outbreak of EVD is also occurring in the Democratic Republic of Congo.
The current list of countries affected by the West African outbreak can be accessed at Centers for Disease Control and Prevention - Ebola.
EVD, previously known as Ebola Haemorrhagic Fever, is a severe and often deadly illness that can occur in humans and primates. It is caused by an Ebolavirus. Ebolaviruses are part of the family Filoviridae, which also includes Marburg virus. Fruit bats of the Pteropodidae family are considered to be a likely natural host.
There is a need for vigilance for illness in people returning to Victoria from affected countries in West Africa, and for strict infection prevention and control precautions for suspected cases during assessment.
Most recent changes to border protection measures include:
- temperature screening of passengers arriving from Ebola affected regions being introduced at all international airports
- in-flight announcements, a detailed travel questionnaire, and an Ebola information card with Hotline number that will direct the caller to the Department of Health will soon be introduced
- all arrivals from EVD affected areas will be monitored by the Department of Health for 21 days from arrival
- Note: predicted total arrivals into Melbourne Airport each week from EVD-affected areas is around five people.
Who is at risk?
Travellers who have visited Ebola affected areas in West Africa or the Democratic Republic of Congo in the previous 21 days. There is a risk of EVD infection if the individual has had:
- contact with blood or bodily fluids of a person or deceased body infected with the Ebola virus
- contact with any object that has been contaminated with blood or bodily fluids of a person with Ebola virus
- unprotected sex with a person who is sick with EVD or up to three months after they have recovered
- contact with or handling of wild animals (alive or dead) or their raw or undercooked meat.
Symptoms and transmission
Symptoms initially include a fever as well as headache and muscle pain. The illness then typically progresses to vomiting, diarrhoea and abdominal pain, and in some cases, internal and external bleeding or bruising.
In this outbreak, Ebola virus is spreading through person-to-person transmission via contact with the blood, secretions, organs or other bodily fluids of infected people, and indirect contact with environments contaminated with such fluid, including in healthcare settings, and through contact at burial ceremonies in West Africa.
The risk of transmission in healthcare settings can be avoided through the appropriate use of infection control precautions and adequate barrier procedures.
All health professionals providing direct personal or clinical care to a person under investigation or a suspected or confirmed case of Ebola, must wear appropriate PPE as per contact, droplet and airborne transmission-based precautions, with maximal skin coverage, which means at a minimum: single use gloves (two pairs to be worn); fluid-resistant or impermeable gown and surgical hood, or a coverall (gowns ideally to mid-calf); eye protection (e.g. goggles or face shield); leg and shoe covers; a P2 respirator.
Aerosol-generating procedures should be avoided unless airborne precautions are in place, including a P2 mask and use of a negative-pressure room.
Prevention and treatment
Every primary care setting and emergency department/urgent care centre should have systems in place to identify and notify the Department of suspected cases of EVD. Further details of responsibilities of your organisation are outlined in the Victorian EVD Plan.
If you suspect Ebola infection isolate the patient, avoid direct contact and call the Department of Health on 1300 651 160 to discuss and agree actions required.
This may include transfer by Ambulance Victoria. Ambulance personnel and receiving facilities must be made aware of the possible diagnosis and will use appropriate PPE.
There is no vaccine available or therapeutic option available for EVD, although experimental vaccines and treatments are under evaluation. Care is supportive.
Laboratory diagnosis is performed on venous blood and throat swab and may include virus isolation, PCR or serology. Do not take clinical specimens except under advice from the Department. Only the Department can authorise testing for EVD in patients in Victoria.
All specimens should be sent to the Victorian Infectious Diseases Reference Laboratory (VIDRL) at the Peter Doherty Institute.
Collection of specimens requires significant precautions. Further information on specimen collection and transport is available from the Commonwealth Department of Health.