Ebola is aptly named for the river adjacent the first recorded outbreak (in 1976), as it has unleashed a steady stream of sickness and death in the recent 2014 Ebola epidemic, the largest ever recorded, even reaching the United States for the first time.
Ebola may “incubate” for two to 21 days before victims show symptoms, and – while it is not highly contagious during incubation – its ability to travel “incognito” enables it to reach distant parts of the globe in infected hosts improperly “screened” before they depart the source locale.
That is why, more and more, people are being screened at airports by being asked if they feel sick or have been recently exposed to anyone sick or who has died of Ebola virus disease (EVD), formerly known as Ebola hemorrhagic fever. Unfortunately, the utility of screening depends largely on the quality and accuracy of the information obtained.
The US Centers for Disease Control (CDC) and the World Health Organization (WHO) report that Ebola is transmitted by body fluids of all types (blood, saliva, urine, tears, mother’s milk, semen, etc.) often introduced into a host’s body by touching these fluids and then touching one’s eyes, nose, mouth, or a cut or sore, by ingesting them or via a mucous membrane.
It may also be transmitted by touching inanimate surfaces (aka, fomites) where the virus can remain viable for several hours, then touching one’s eyes, nose, mouth, a cut, sore, or a mucous membrane. Fomites also include textiles such as bedding or clothing contaminated with infectious fluids.
Ebola is not generally transmitted through the air unless you are near a victim who is sneezing or coughing without properly covering their nose and mouth, and releasing aerosol droplets carrying the virus that can infect you via exposed eyes, nose, mouth, a cut or sore, etc.
People recovered from Ebola can remain infectious for many weeks after symptoms end.
Following are additional tips from Dr. Benjamin Tanner, founder and president of Antimicrobial Test Laboratories, Austin TX:
1. What specific measures should every professional take in light of the possible exposure to EVD, even before symptoms are present? What about PPE?
The level of PPE necessary depends primarily on the stage of disease when contact is made. Before symptoms arise, people infected with Ebola virus are less contagious (though likely still contagious to some degree), so an ordinary face mask, disposable gloves, a disposable gown, frequent handwashing, and avoiding face-touching are advisable. Exposure to a person who is showing symptoms of EVD poses a much greater risk. In those instances I believe the maximum amount of protection available should be utilized, up to positive-pressure biohazard suits. Knowing how to carefully remove contaminated protective equipment after it is worn is a must.
2. How should inanimate surfaces be disinfected?
Data suggest that Ebola virus is relatively easy to disinfect and it does not seem to survive for more than about a day when dry on surfaces However, every last viral particle must be killed because the infectious dose is very low. If a surface is known or suspected of contamination with Ebola virus, I recommend first using an absorbent material (preferably with an incorporated antimicrobial agent) to absorb any liquids that may be present like blood and urine. The used absorbent material will be highly biohazardous, so it must be disposed of and handled properly. Then once "gross soil" has been removed, I recommend spraying the surface liberally with a virucidal disinfectant and then letting it stand for the entire contact time listed on the label, or at least five minutes. The surface should then be wiped with an absorbent cloth and then the cloth should be disposed of as biohazard. If the surface was contaminated by a person late in the stages of Ebola virus disease, very high numbers of viruses may be present, so I recommend repeating the disinfection step. In healthcare settings, rooms where the patient has been should be first decontaminated by a whole-room disinfection device, such as those that utilize UV or hydrogen peroxide, then cleaned and disinfected using ordinary disinfectants.
3. Which EPA-registered disinfectants are effective?
A fresh 1:20 solution of bleach would be my first choice for surface disinfection, though I would expect most EPA-registered virucidal disinfectants to do the job.
4. What types of “community engagement” and educational activities are key to successfully preventing or controlling outbreaks?
I think educational outreach activities should be focused on individual hygiene improvement and on avoiding contact with those who are infected and showing symptoms. I think that attempts to mollify the public and downplay the very real (though hopefully small) risk of an outbreak within the United States is counterproductive.
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