As of July 1, 2018, the Ebola outbreak in the Democratic Republic of Congo appeared to be ebbing, but infection preventionists should still be wary of cases related to travel. There have been 53 cases, with 38 confirmed and 15 probable, in Congo. The 29 deaths due to Ebola, which include two healthcare workers, translate to a mortality rate of 55%.
“There is a possibility that a person who has been exposed to Ebola virus and developed symptoms may board a commercial flight or other mode of transport, without informing the transport company of his/her status,” the World Health Organization (WHO) warned.1
The incubation period for Ebola is between 2 to 21 days.
“U.S. healthcare facilities should continue to seek travel histories as a routine part of initial patient triage and assessment,” says Kate Fowlie, a spokeswoman for the Centers for Disease Control and Prevention (CDC). “In the context of the current outbreak, travel to the Ebola-affected health zones in [Congo] or contact with an individual with confirmed Ebola within the previous 21 days should trigger further symptom evaluation.”
Now is a good time for facilities to review their status as frontline, assessment, or treatment centers, and confirm that current health department contact information is readily available, she adds. The CDC recommends a strategy of “Identify, Isolate, and Inform,” which calls for immediately isolating suspected Ebola cases and alerting the facility’s infection preventionist and the health department.
For PPE, CDC recommends following the CDC guidance2 for U.S. healthcare settings that was developed during the 2014-2015 outbreak. Some 11,000 people — including one in the U.S. — died during that outbreak, which also involved the Zaire strain of the Ebola virus.
In addition to the two fatal infections, three other healthcare workers have acquired Ebola during the outbreak. Though they were one of the targeted groups, it was not known at press time whether the healthcare workers who acquired Ebola had received the experimental vaccine that has been implemented on an emergency-use basis.
Since vaccinations began on May 21 through June 30, a total of 3,330 people had been vaccinated in Congo. The vaccine, called rVSV-ZEBOV, was found to be highly protective against the virus in a trial conducted by the WHO in Guinea in 2015. The vaccine has not been licensed by the FDA yet, and there is no recommendation for pre-exposure vaccination of U.S. healthcare workers.
The vaccine consists of an animal vesicular stomatitis virus seeded with the protein of Zaire Ebola, which provokes a human immune response to the Ebola virus.
In a “ring” vaccination approach, contacts with an Ebola case include those living in the same household or those who were visited by the patient in the three weeks prior to diagnosis. Further, “contacts of contacts,” including neighbors or extended family members, may also be vaccinated.
“The ring is not necessarily a contiguous geographic area but captures a social network of individuals and locations that may include dwellings or workplaces further afield, where the index patient spent time while symptomatic, or the households of individuals who had contact with the patient during the illness or after his or her death,” the WHO stated. “Experience suggests that each ring may be composed of an average of 150 persons.”
The current outbreak in Congo began on April 4, 2018. No Ebola cases were being treated in the U.S. as this report was filed, but the CDC has deployed eight experts to the region to assist in the outbreak.
Although the risk to most travelers is low, visitors to Congo should avoid contact with blood or body fluids, funeral or burial rituals that require handling a dead body, raw bush meat, and wild animals. The 2014 outbreak was thought to have begun with a child who was playing in a hollow tree full of bats, which can asymptomatically carry the virus.