For Healthcare Providers - Ebola Virus Disease and Marburg Virus Disease

Background

Marburg and Ebola viruses are both filoviruses that are distinct from each other but cause clinically similar diseases.
Cases of Ebola virus disease (EVD) and Marburg virus disease (MVD) are rare. But outbreaks occasionally arise in Africa, where the viruses circulate among some populations of animals, such as bats.

Transmission and Risks

Initial cases have animal exposure in areas where the virus is circulating. Transmission then occurs through person-to-person contact. The virus spreads through contact (such as through broken skin or mucous membranes in the eyes, nose, or mouth) with:

Blood or body fluids (blood, saliva, sweat, urine, feces, vomit, breast milk, amniotic fluid, or semen) of a person who is sick with or died from EVD or MVD.
Objects contaminated with body fluids from a person who is sick with or has died from EVD or MVD (such as clothes, bedding, needles, and medical equipment).
Semen from a man who recovered from EVD or MVD (through oral, vaginal, or anal sex).

Risks for EVD or MVD include:

Close contact with people sick with EVD or MVD
- Healthcare workers and household members who do not use proper infection control while caring for patients with suspected or confirmed EVD or MVD are at highest risk of infection and account for almost all cases.
Recent travel to a country experiencing an outbreak of EVD or MVD
- However, both viruses pose little risk to travelers or the general public who have not cared for or been in contact with someone who is sick. A visit to a health care facility could be a risk.

If you have a patient with symptoms and any risk for one of these diseases, please consult your local health jurisdiction.

Signs and Symptoms

Ebola and Marburg symptoms may start 2 to 21 days after a person is infected. The average symptom onset is 7-10 days for EVD, and 5-9 days for MVD.

Symptoms include:

Fever (>100.4°F/38.0°C)
Aches and pains, such as severe headache and muscle and/or joint pain
Weakness and fatigue
Sore throat
Loss of appetite
Gastrointestinal symptoms including abdominal pain, diarrhea, and vomiting
Unexplained hemorrhaging, bleeding, or bruising
Red eyes, skin rash, and hiccups

If you have a patient with symptoms and high risk for one of these diseases, please consult your local health jurisdiction.

Steps for a Patient Under Investigation for EVD or MVD

Recommendations for infection prevention and control precautions for MVD are the same as for EVD in U.S. healthcare settings. Hospital and ambulatory staff members should screen all patients for signs and symptoms and for exposure history in the last 21 days (i.e., incubation period) before onset of symptoms, including travel to endemic areas, contact with sick persons or animals, and other risk factors for viral hemorrhagic fever. If a person has a possible exposure to EVD or MVD and symptoms, follow the identify, isolate, and inform strategy to reduce exposure in your health care facility.

Identify exposure history. Determine whether the person has lived in or traveled to a country with ongoing Ebola or Marburg transmission or has had contact with an individual with confirmed EVD or MVD.
Identify symptoms. Determine whether the person has a fever (≥100.4°F/38.0°C) or compatible symptoms such as headache, weakness, muscle pains, vomiting, diarrhea, abdominal pain, or unexplained bleeding.

If patient confirms exposure risk and any symptoms:
Isolate the patient and determine appropriate PPE.
- The person should immediately be placed in a private room with an in-room bathroom or covered bedside commode.
- Minimize the number of personnel in contact with the patient and maintain a log of all people entering the patient's room.
- Perform only necessary tests and procedures and avoid aerosol-generating procedures.
- If the patient is clinically unstable or is bleeding, vomiting, or has diarrhea, wear PPE according to CDC’s Guidance for Persons Under Investigation for Ebola that are Clinically Unstable. If the patient is clinically stable, wear PPE according to CDC’s Guidance for Clinically Stable PUIs.
Inform your local health jurisdiction and your facility’s infection control program. A person cannot be tested for EVD or MVD without preapproval from your local health jurisdiction. Your local health jurisdiction will follow up with Washington Department of Health to arrange for testing for EVD or MVD.
Further evaluation and management. Complete physical examination and history of patient. Perform routine interventions as indicated by clinical status. Any equipment used on the patient should not be used on any other patient. Follow CDC environmental infection control guidance for cleaning and disinfection of the patient room/area.

Testing

If you have a patient with symptoms of Ebola or Marburg virus disease and risk, please call your local health jurisdiction. Testing is available at Washington Public Health Lab with pre-approval from state and local public health.
Specimens submitted to testing for Ebola or Marburg Virus Disease are considered Category A specimens and must be packaged accordingly. Specimens will not be accepted without approval from state and local public health.
If you are collecting specimens to submit for testing for a patient under investigation for EVD or MVD, be prepared to hold that patient in a private room with an in-room bathroom or covered bedside commode while tests are pending.

How can you prepare now?

Make sure that you have your local health jurisdiction’s contact information.
Print the CDC’s Guidance for Ebola Disease and note your local health jurisdiction’s contact information next to "Notify your health Department".
Ensure that your facility has correct and sufficient PPE to use for a person confirmed as or under investigation for viral hemorrhagic fever who is clinically unstable or is bleeding, vomiting, or has diarrhea.
Review NETEC’s instructions on Marburg Virus: Diagnostic Testing, Packaging, and Shipping.
Read Instructions on Shipping Category A Specimens and verify that your facility has the appropriate materials for submitting Category A specimens.

Resources

For Healthcare Providers - Ebola Virus Disease and Marburg Virus Disease

Resources

General Information

Infection Prevention

Testing/Shipping

Preparedness for Healthcare Facilities