Control of Ebola Virus Disease (EVD)

1. Surveillance and Early Case Detection

• Case definition: Clinical suspicion in anyone with fever, fatigue, vomiting, diarrhea, or unexplained bleeding AND an epidemiologic link (contact with a confirmed case, animal reservoir, or burial) within the 21-day incubation window (range 2-21 days, mean ~11 days).
• Laboratory confirmation: RT-PCR of blood is the gold-standard diagnostic. ELISA antigen/antibody detection and virus isolation (BSL-4 required) are also used. Samples must be handled under maximum containment. Specimens should not be tested until at least 3 days after symptom onset (insufficient viral load before this).
• Immediate reporting: In the US, confirmed or suspected EVD must be reported immediately to state/local health departments and the CDC Emergency Operations Center (770-488-7100). Ebola and Marburg hemorrhagic fevers are nationally reportable conditions per the Council of State and Territorial Epidemiologists. WHO notification is mandatory under the International Health Regulations (IHR 2005).

2. Case Isolation and Clinical Management

Isolation Precautions

• At least 2 pairs of gloves
• Fit-tested N95 respirator (or powered air-purifying respirator - PAPR)
• Impermeable or fluid-resistant gown plus protective apron
• Face shield and eye protection
• Shoe covers or rubber boots - no exposed skin whatsoever
• Negative-pressure room is prudent as an extra precaution (although there is no evidence for airborne spread between humans under natural conditions; negative pressure is mandatory when aerosol-generating procedures - e.g., intubation, suctioning - are performed)
• Access limited to a small, designated team trained in EVD infection control
• Buddy system mandatory for supervision of PPE donning and doffing (doffing is the highest-risk moment for self-contamination)

Supportive Care

• Aggressive IV fluid resuscitation and electrolyte correction (hypokalemia, hyponatremia, hypocalcemia, hypomagnesemia are common)
• Nutritional support
• Management of bleeding complications
• Treatment of co-infections
• Critical care support (ventilation, renal replacement) when needed

3. Contact Tracing

• All contacts of a confirmed case are identified and placed under active surveillance for 21 days (the maximum incubation period) from the date of last exposure
• Risk stratification determines the level of monitoring:
  • High risk: Direct contact with body fluids, participation in burial rituals, healthcare workers without PPE - active daily monitoring + possible movement restrictions
  • Some/low risk: Proximity without direct fluid contact - self-monitoring for fever and symptoms, with instructions to immediately notify public health if symptoms develop
• Hospitalization of asymptomatic contacts is not warranted, but contacts who develop fever or any EVD symptom must be isolated immediately until diagnosis is excluded
• Contact tracing failure (due to mistrust, punitive measures, or inadequate resources) was a major driver of the 2013-2016 West Africa epidemic and the 2018-2020 DRC outbreak

4. Safe and Dignified Burials

• Trained Safe and Dignified Burial (SDB) teams to handle all EVD deaths using full PPE
• Disinfection of the body and all surfaces before transport
• Respectful engagement with families and communities to explain the risk and allow cultural elements where safe
• Proper disposal of contaminated materials

5. Infection Prevention and Control (IPC) in Healthcare Settings

• Triage and screening of all patients for fever and EVD risk factors at facility entry
• Dedicated EVD treatment units or Ebola Treatment Centers (ETCs) with clearly defined "clean" and "contaminated" zones
• Sharps safety and waste management (all contaminated materials incinerated or autoclaved)
• Disinfection with agents active against non-enveloped viruses; bleach (0.5% sodium hypochlorite) is effective
• Healthcare worker training with demonstrated PPE competency before patient contact
• Decontamination protocols for ambulances and patient rooms

6. Ring Vaccination (rVSV-ZEBOV / Ervebo)

7. Specific Therapeutics

• Remdesivir has been used experimentally; it was used in the single reported surviving neonate born to an infected mother.
• No specific therapies are approved for Sudan, Ivory Coast, or Bundibugyo ebolavirus infection.

8. Community Engagement and Social Protection

• Transparent, culturally appropriate communication with affected communities
• Involving community and religious leaders in messaging and safe burial protocols
• Avoiding punitive quarantine/containment measures that drive patients away from care
• Addressing social determinants: food security, mental health support, economic protection for those in isolation/quarantine
• The 2025 WHO guidance (informed by the 2025 DRC outbreak) emphasizes multisectoral social protection - coordinated interventions across health, social welfare, education, food security, and mental health systems

9. Environmental and Zoonotic Prevention

• Avoid contact with bats (the presumed reservoir) - particularly avoid entry into caves and mines in endemic areas
• Avoid handling bushmeat (particularly nonhuman primates, bats, porcupines, duikers) in endemic regions
• Disinfectants with claims against non-enveloped viruses (or 0.5-1% bleach solutions) should be used in contaminated environments

10. Travel Measures and Border Control

• Non-essential travel to outbreak areas is not recommended
• Airport exit screening (temperature checks, symptom questionnaires) in affected countries
• Travelers returning from affected areas should self-monitor for 21 days
• The CDC issued interim guidance for travelers from countries affected by the 2026 Ebola outbreak (the 16th DRC outbreak declared September 2025 was declared over after 64 confirmed/probable cases and 43 deaths; ~36,000 people were vaccinated via ring vaccination)
• State laws may mandate quarantine of high-risk returnees

Summary of the 7 Pillars of EVD Outbreak Control

1. Surveillance - rapid case detection and laboratory confirmation
2. Isolation - strict EVD IPC measures in healthcare settings
3. Contact tracing - 21-day active monitoring of all contacts
4. Safe and dignified burials - eliminating transmission at funerals
5. Ring vaccination with rVSV-ZEBOV (Ervebo)
6. Specific therapeutics - monoclonal antibodies (Inmazeb, Ebanga) for Zaire EVD
7. Community engagement and social protection