In Washington

Purpose of Reporting and Surveillance

• To identify rare diseases associated with travel.

• To identify potentially exposed laboratory personnel and to provide counseling.

• To raise the index of suspicion of a possible bioterrorism event if no natural exposure source is identified.

Reporting Requirements

• Health care providers: immediately notifiable to Local Health Jurisdiction

• Hospitals: immediately notifiable to Local Health Jurisdiction

• Laboratories: immediately notifiable to Local Health Jurisdiction, specimen submission required

• Local health jurisdictions: suspected or confirmed cases are immediately notifiable to DOH Communicable Disease Epidemiology: 1-877-539-4344

Clinical Criteria for Diagnosis:
 

Clinical criteria for diagnosis
A severe illness with temperature ≥101oF (38.3oC) of <3 weeks duration, no predisposing factors for hemorrhage, no established alternative diagnosis with at least two of the following:

• Petechial or hemorrhagic rash

• Epistaxis

• Hematemesis

• Hemoptysis

• Hematochezia

Bleeding from other sites.

Case Definition

• Probable: A case that meets the clinical case definition, is not laboratory confirmed, and is not epidemiologically linked to a confirmed case, but has appropriate exposure history.

• Confirmed: A case that is laboratory confirmed, or a case that meets the clinical case definition and is not laboratory confirmed, but is epidemiologically linked to a confirmed case.

1. Identification

Diagnosis is made by IgM antibody capture and antigen detection by ELISA or by PCR; by isolation of virus from blood, urine or throat washings; and immunoglobulin G (IgG) seroconversion by ELISA or IFA. Laboratory specimens may be biohazardous and must be handled with extreme care that includes BSL-4 containment, if available. Heating serum at 60°C (140°F) for 1 hour will largely inactivate the virus, and the serum can then be used to measure heat stable substances such as electrolytes, BUN or creatinine.

2. Infectious Agent

3. Worldwide Occurrence

4. Reservoir

5. Modes of Transmission

6. Incubation Period

7. Period of Communicability

Person to person spread may occur during the acute febrile phase when virus is present in the throat. Virus may be excreted in urine of patients for 3-9 weeks from onset of illness.

8. Susceptibility and Resistance

1. Preventive Measures

2. Control of Patient, Contacts and the Immediate Environment

1. Report to local health authority.
2. Isolation: Institute immediate strict barrier isolation in a private hospital room away from traffic patterns. Entry of nonessential staff and visitors should be restricted. Because of the low incidence of nosocomial infections reported from African hospitals, transfer to special isolation units is not considered necessary; however, nosocomial transmission has occurred, and strict procedures for isolation of body fluids and excreta should be maintained. A negative pressure room and respiratory protection is desirable. Male patients should refrain from unprotected sexual activity until the semen has been shown to be free of virus or for 3 months. To reduce exposure to infectious materials, laboratory tests should be kept to the minimum necessary for proper diagnosis and patient care. Technicians should be alerted to the nature of the specimens and supervised to ensure that appropriate specimen inactivation/isolation procedures are followed. Dead bodies should not be embalmed but rather sealed in leak proof material and cremated or buried promptly in a sealed casket.
3. Concurrent disinfection: Patient's excreta, sputum, blood and all objects with which the patient has had contact, including laboratory equipment used to carry out tests on blood, should be disinfected with 0.5% sodium hypochlorite solution or 0.5% phenol with detergent, and, as far as possible, appropriate heating methods, such as autoclaving, incineration or boiling. Laboratory tests should be carried out in special high containment facilities; if there is no such facility, tests should be kept to a minimum and specimens handled by experienced technicians using all available precautions such as gloves and biological safety cabinets. When appropriate, serum may be heat inactivated at 60°C (140°F) for 1 hour. Thorough terminal disinfection with 0.5% sodium hypochlorite solution or a phenolic compound is adequate; formaldehyde fumigation can be considered.
4. Quarantine: Only surveillance is recommended for close contacts (see B2f, below).
5. Immunization of contacts: None.
6. Investigation of contacts and source of infection: Identify all close contacts (people living with, caring for, testing laboratory specimens from or having noncasual contact with the patient) in the 3 weeks after the onset of illness. Establish close surveillance of contacts as follows: body temperature checks at least 2 times daily for at least 3 weeks after last exposure. In case of temperature greater than 38.3ºC (101ºF), hospitalize immediately in strict isolation facilities. Determine patient's place of residence during 3 weeks prior to onset, and search for unreported or undiagnosed cases.
7. Specific treatment: Ribavirin (Virazole), most effective within the first 6 days of illness, should be given IV, 30 mg/kg initially, followed by 15 mg/kg every 6 hours for 4 days and 8 mg/kg every 8 hours for 6 additional days. See also:  Borio L, Inglesby TV, Peters, CJ, et al. Hemorrhagic fever viruses as biological weapons: medical and public health management. JAMA 2002; 287:2391-2405 (in Additional Resources).

3. Epidemic Measures

4. International Measures

Notification of source country and to receiving countries of possible exposures by infected travelers.