EBOLA FACT SHEET AND GUIDANCE ISOS Background Information The largest outbreak of Ebola virus is currently underway in West Africa. The current outbreak is spreading person to person, via bodily fluids (not an airborne virus), causing significant international concern and disrupting both the health and economy of these countries as well as neighboring nations. This outbreak began in Guinea. The first case there occurred in December 2013, though it was not reported to the World Health Organization/identified as Ebola until March 2014. This significant delay means that control measures were not enacted for months, allowing the virus to take hold in the community. Soon after the disease was brought to international attention, cases were also reported in neighboring Liberia. This progression was upsetting but not unpredictable: borders in the affected area are often porous, with people walking from one nation to another on a daily basis. Control measures were enacted in both countries, and seemed effective. By the beginning of April, disease activity slowed. It looked like the outbreak was heading to its end. However, unexpectedly, cases spiked again in late May. New areas were affected. Ebola struck people in areas that had never had an Ebola infection before. The disease also intensified in places where people had previously been infected. There have been cases transported to Europe and North America. The Ebola outbreak in West Africa is not under control, and resources and personnel are stretched in trying to handle the situation. Cultural concerns also play a role: some people in these countries do not believe Ebola is an actual disease. Others are unethically selling a counterfeit “vaccine” to protect people (there is no vaccine for Ebola). Misinformation and mistrust make it difficult to implement national and international health measures – which are critical to bringing the disease under control. This document is the property of Tetra Tech, Inc. (Tetra Tech), and its subsidiaries. Due to the dynamic nature of the topic, material and guidance presented in this document is subject to change. Any reuse of this document without Tetra Tech’s permission is at the sole risk of the user. The user will hold harmless Tetra Tech for any damages that result from unauthorized reuse. Any person utilizing this instruction should seek competent professional advice to verify and assume responsibility for the suitability of this information to their particular situation. EBOLA FACT SHEET AND GUIDANCE Map of confirmed and suspected cases as of October 24, 2014. Check ISOS website regularly for updates. Ebola Facts This document is the property of Tetra Tech, Inc. (Tetra Tech), and its subsidiaries. Due to the dynamic nature of the topic, material and guidance presented in this document is subject to change. Any reuse of this document without Tetra Tech’s permission is at the sole risk of the user. The user will hold harmless Tetra Tech for any damages that result from unauthorized reuse. Any person utilizing this instruction should seek competent professional advice to verify and assume responsibility for the suitability of this information to their particular situation. EBOLA FACT SHEET AND GUIDANCE Ebola belongs to a group of diseases referred to as "viral hemorrhagic fevers" (VHF). Dengue fever, yellow fever, Lassa fever, and Marburg fever are other examples of VHFs. "Hemorrhagic" means these diseases can involve bleeding, which can be one of their more alarming symptoms. Transmission The disease spreads from person to person, or to people from animals or bats. Ebola virus is contained in the blood and body fluids of infected people (vomit, diarrhea, urine, nasal secretions, sweat, ejaculate). These fluids are contagious. If someone has contact with an infected person's body fluids, they can get Ebola. The more symptomatic a person is, the greater the risk of catching the virus from their body fluids. In addition, it is possible to become infected by touching contaminated objects (objects that have germs from an infected person on them). The germs get onto the toucher's hands, and then may accidentally be transferred into the nose, mouth or eyes, or enter the blood stream via cuts on the hands. Clearly, family, caregivers, and medical staff are at high risk. Funeral practices that require touching, washing or kissing the dead body promote spread of the virus. Once a human has been infected, an outbreak can occur if proper precautions are not taken. The current outbreak in West Africa is being spread person to person via bodily fluids. It is still not confirmed how the index case in Guinea was infected, but the subsequent international spread was caused by activities between people. Symptoms Symptoms can start within two days after exposure to the virus. The incubation period is the time between infection (when a person takes in the virus) and when they start to feel ill. For Ebola, the period can range from 2 to 21 days. However, on average, it is about 7-9 days. Usually, the person suddenly feels weak, with a fever, muscle/joint pain, headache and sore throat. Vomiting, diarrhea, rash and abdominal pain follow in most cases. Some people may develop redness of eyes and hiccups. Organ failure and bleeding (both internally and externally) occur in some people. These lead to death. About 50% to 90% of cases are fatal. The Zaire strain is the most lethal strain of Ebola. It is responsible for the current Ebola outbreak. Prevent infection through strict hygiene measures and avoiding contact with body fluids. Diagnosis Blood tests are the only way to firmly diagnose Ebola. Highly specialized equipment is required, and blood samples must be handled securely. Only a few laboratories are able to do this routinely. Often the specimens have to be carefully shipped to international destinations for firm diagnosis. As such, once an Ebola outbreak is underway, patients are not always firmly diagnosed with blood tests. Instead, people This document is the property of Tetra Tech, Inc. (Tetra Tech), and its subsidiaries. Due to the dynamic nature of the topic, material and guidance presented in this document is subject to change. Any reuse of this document without Tetra Tech’s permission is at the sole risk of the user. The user will hold harmless Tetra Tech for any damages that result from unauthorized reuse. Any person utilizing this instruction should seek competent professional advice to verify and assume responsibility for the suitability of this information to their particular situation. EBOLA FACT SHEET AND GUIDANCE who have symptoms and exposures that meet case definitions are considered suspected or probable cases. Treatment There is no treatment or cure for Ebola. Sick people are given supportive therapy, which are treatments that help make them more comfortable but do not cure their illness. These often include IV fluids, supplemental oxygen, and antibiotics if the person has a bacterial infection occurring along with the Ebola virus. (Ebola itself cannot be treated with antibiotics because antibiotics do not work on viruses.) An experimental treatment, ZMapp, has not yet been tested in people, although animal tests are promising. The drug is a combination of antibodies, created in plants. The treatment has been made available to a few healthcare workers who were infected while treating Ebola patients. Some of them have recovered although some did not and subsequently died. On 12 August, the manufacturer, Mapp Biopharmaceutical, announced that supplies had been exhausted. "Any decision to use an experimental drug in a patient would be a decision made by the treating physician under the regulatory guidelines of the FDA. Mapp and its partners are cooperating with appropriate government agencies to increase production as quickly as possible." The experimental antiviral drug BCX-4430, manufactured by BioCryst Pharmaceuticals, has been awarded funding from the US National Institute of Allergy and Infectious Diseases (NIAID) to commence trials against Ebola in non-human primates. The trial is expected to start in September / October 2014. Vaccine There is no Ebola vaccine to protect people from the disease, although research is underway. The US National Institutes of Health will start a safety trial of a vaccine on human volunteers in Maryland, USA. The vaccine has been developed by NIAID and the pharmaceutical company GlaxoSmithKline (GSK), and contains antigenic material from both the Zaire and Sudan strains of Ebola. NIH is also partnered with the Jenner Institute, Oxford University, which has announced it expects to begin human trials of an experimental Ebola vaccine in September 2014. The vaccine is a monovalent type, containing only the Zaire strain, and will be administered in several countries (USA, UK, The Gambia, Mali) to healthy volunteers The current outbreak is spreading person to person, via bodily fluids. The virus is present in fluids like blood, vomit, semen, sweat, etc. The best way to protect yourself is to avoid sick people and their secretions. This document is the property of Tetra Tech, Inc. (Tetra Tech), and its subsidiaries. Due to the dynamic nature of the topic, material and guidance presented in this document is subject to change. Any reuse of this document without Tetra Tech’s permission is at the sole risk of the user. The user will hold harmless Tetra Tech for any damages that result from unauthorized reuse. Any person utilizing this instruction should seek competent professional advice to verify and assume responsibility for the suitability of this information to their particular situation. EBOLA FACT SHEET AND GUIDANCE High risk activities include: Contact with ill people Handling bodies of people who have died from Ebola Touching or eating sick or dead wildlife Eating bush meat Caring for Ebola patients, attending their funerals or burying their bodies To avoid the virus: Stay away from sick people. Do not touch their bodily fluids or objects contaminated with their fluids.