Indirect exposure to blood and body fluids (via fomites) has also been implicated in EVD transmission but is not common. It is not known if transmission from direct skin contact is mediated by Ebola virus primarily on the skin where it has been documented by histopathology 15 and RT-PCR of a skin swab 16 or by micro-contamination of the skin with blood or other body fluids. The risk of EVD transmission from direct skin contact with an EVD patient is lower than the risk from exposure to blood or body fluids and may be more likely in severe illness (when the Ebola virus RNA levels are highest). 3 After adjusting for direct contact and exposure to body fluids, adult family members who touched a deceased EVD patient (relative risk = 2.1) and who were exposed during the late hospital phase were at additional risk. 3, 10 In the 1995 Ebola outbreak in Kikwit, among those with direct contact, exposure to body fluids conferred additional risk (relative risk = 3.6) consistent with the importance of direct contact with the blood or other body fluids of infected patients in propagating EVD transmission. 7, 10, 12Several investigations have also demonstrated that persons residing in confined, shared spaces (e.g., homes), but who had no direct physical contact with these cases did not develop EVD. Other studies have reported similar findings, in that all or the large majority of secondary transmissions involved direct physical contact with known EVD patients. 3 All 28 secondary cases involved direct physical contact with a known EVD patient overall, 28 of 95 family members who had direct contact with a primary case became infected, whereas none of 78 family members who did not report direct contact became infected. 14ĭuring an Ebola outbreak in 1995 in Kikwit, Democratic Republic of the Congo, 28 (16%) of the 173 household contacts of 27 primary Ebola cases developed EVD. 3 Ebola virus RNA levels in the blood in patients who died are also on average 2 log 10 higher than RNA copy levels in patients who survived. Persons who have direct contact with infected individuals or their blood and body fluids, such as healthcare personnel without access to appropriate personal protective equipment or other caregivers in hospitals or homes, and persons handling bodies of deceased EVD patients are at high risk for Ebola virus exposure and infection. 3, 7-13 Ebola virus RNA levels in the blood increase logarithmically during the acute phase of illness (Figure 1) 14 and significant numbers of EVD patients have vomiting (67.6%), diarrhea (65.6%) and unexplained bleeding (18% and generally late in the course of disease) 2 presenting opportunities for EVD transmission. Human outbreaks of EVD are hypothesized to begin through direct contact with an infected animal or its body fluids, and human transmission chains are driven by direct contact with the blood or other body fluids of infected patients. Evidence SummaryĮvidence and understanding of Ebola virus transmission is based on epidemiologic and laboratory data, summarized below, including investigations of >20 African outbreaks since 1976. CDC confirms that the healthcare worker is positive for Ebola. The healthcare worker was isolated after the initial report of a fever. The healthcare worker has tested positive for Ebola according to preliminary tests by the Texas Department of State Health Services’ laboratory. On October 10, a healthcare worker at Texas Presbyterian Hospital who provided care for the index patient reported a low-grade fever and was referred for testing. hospitals for possible EVD, and as of Octoone patient, a traveler from Liberia who was visiting Texas, was diagnosed with EVD and died. 5 In addition, people in several states who have had recent travel to West Africa and have developed fever and other symptoms have been evaluated at U.S. healthcare personnel working in West Africa have also become infected with EVD and have returned to the United States for evaluation and treatment. 3 By October 8, 2014, 401 healthcare personnel in West Africa had become infected with Ebola, of whom 232 died. 2 Ebola virus can be transmitted by direct contact with blood, body fluids, or skin of EVD patients or persons who have died of EVD. outbreak of EVD in West Africa, caused by Ebola virus ( Zaire ebolavirus species), is the largest outbreak of EVD in history. Five Ebola virus species within the genus Ebolavirus are known, including four that cause Ebola virus disease (EVD) in humans (a fifth species has only caused disease in nonhuman primates). \).Ebola virus causes severe viral hemorrhagic fever with a high fatality rate.
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