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If the patient has both exposure and symptoms, immediately isolate the patient and inform others. Once the condition has progressed a person may notice symptoms like:

Fig.2: Symptoms of EVD[14].

Bleeding: All  people  infected  show  some symptoms  of  circulatory  system  involvement, including  impaired  blood clotting. In 40–50% of cases, bleeding from puncture sites and mucous membranes (e.g. mouth, gastrointestinal tract, nose, ears, vagina and gums), even reddening of eyes and bloody vomit has also been reported[11.12,13].

Fig. 3 Ebola is not Airborne[14].

Fig.4:  Animals susceptible to spread Ebolavirus[14].

- Severe headache
- Muscle pain
- Weakness
- Fatigue
- Diarrhoea
- Vomiting
- Abdominal (stomach) pain
- Unexplained haemorrhage (bleeding or bruising)
- Conjunctivitis
- Genital swelling
- Increased sensitivity to pain on the skin,
- Rashes all over the body,
- And reddening of the roof of the mouth.

Diagnosis of Ebola and Marburg haemorrhagic fevers can be difficult because early symptoms are often similar to other infectious diseases, such as malaria and typhoid fever.If they suspect Ebola or Marburg infection, healthcare providers will isolate infected patients. Laboratory tests can confirm infection within a few days of the onset of symptoms. Also diagnosis is confirmed by isolating the virus, detecting its RNAor proteins, or detecting antibodies against the virus in a person's blood. Isolating  the  virus  by  cell  culture,  detecting  the viral  RNA  by  polymerase  chain  reaction (PCR) and  detecting  proteins  by enzyme-linked immunosorbent assay  (ELISA)  is  effective  early and in those who have died from the disease.

Usually a physician will be able to diagnose the condition with the symptoms alone, but in order to confirm the diagnosis he/she may prescribe tests like-
- Complete Blood Count (CBC),
- Coagulation  studies  (a  test  to  check  for  the amount of time a person’s blood needs to clot),
- Viral antigen  testing  (a  test  to  check  for  the presence of the viral antigen) and
- Liver function test (LFT).

If assessment indicates possible Ebola virus infection, take action.
- Isolate the patient in a private room with a private bathroom or covered, bedside commode and close the door
- Wear appropriate personal protective equipment (PPE).
- Limit the healthcare personnel who enter the room
- Keep a log of everyone who enters and leaves the patient’s room
- Consider alternative diagnoses, and evaluate appropriately
- Only perform necessary tests and procedures
- Avoid aerosol-generating procedures
- Follow CDC guidelines for cleaning, disinfecting, and managing waste.

Think Ebola when you approach a patient.
Start the steps for basic infection control before assessing the patient for risks.
Always use standard precautions
- If there are concerns that the patient could meet the criteria for Ebola, immediately separate the patient from others
- Coming  into  contact  with  the  blood, secretions,  organs  or  other  bodily  fluids  of  an infected person.
- Contact with the bodily fluids of an infected person who has passed away.
- Handling the meat from infected animals.
- Exposure to objects (such as needles) that have been contaminated with infected secretions.
- Healthcare workers may contract the disease through transmission as well through contact with infected bodily fluids.

Treatment and Prevention:
Prevention of infection for tourists, visitors and residents:
For tourists, visitors or residents in affected areas, the risk of infection is considered very low if some elementary precautions are followed:
- Avoiding contact with symptomatic patients and/or their bodily fluids
- Avoiding contact with corpses and/or bodily fluids from deceased patientsalert others, including public health authorities.
- Notify your facility’s infection control program and other appropriate staff
- Contact your state or local public health authorities
- Consult with state or local public health authorities about testing for Ebola
- For a list of state and local health department numbers
- Avoiding any form of close contact with wild animals (including monkeys, forest antelopes, rodents and bats), both alive and dead, and consumption of any type of ‘bushmeat’
- Washing and peeling fruits and vegetables before consumption
- Strictly practising ‘safe sex’
- Strictly following hand-washing routines

Prevention for healthcare workers:
In healthcare settings, the risk level can vary from very low to low. However, the risk is high in the event of mishaps that result in skin penetrations or mucosal exposure to contaminated materials (e.g. needle stick injuries).

Preventive approaches for healthcare workers include:
- Full compliance to vaccinations (notably yellow fever) and malaria prophylaxis as recommended for the target region (including documentation as a vaccination record);
- Sensitisation for viral haemorrhagic fever symptoms before working in endemic countries; and
- Strict implementation of barrier management, use of personal protective equipment, and disinfection procedures, as per specific guidelines[19,20].

Assess your patient for:
Travel to a country with widespread transmission or uncertain control measures (Guinea, Liberia, Sierra Leone, or Mali) within the last 21 days OR Contact with someone with Ebola within the last 21 days AND had a fever at home, or has a current temperature ≥100.4°F (≥38°C).

There are no specific drugs to treat Ebola or Marburg haemorrhagic fevers. If hospitalized, ill people can be given supportive care such as intravenous fluids.During this Ebola time, we cannot care for family and friends that die the way we are used to. While you are waiting for the burial team to arrive, keep a distance of at least 3 feet (1meter) from the body. Do not touch it.Do not touch, wash or clean any dead body.  Burying all who die safely is one of the best ways to make sure we have zero cases of Ebola in Liberia.

Burial teams know this kind of safe burial is very difficult for the family and the community. They will talk to the family members about the different ways they can pay respect without touching the body. All burials will be safe, free, and respect the families.

Fig. 5: Burial teams with special protective clothes[21]

Burial teams wear special protective clothes (the overhaul suits) to keep them safe. Burial teams are watched by others and have chlorine sprayers. They spray the chlorine to clean the body and the area the body was in to kill the Ebola virus and keep the family and the community safe.

Fig. 6: Family Decision for Dead person[21].

The family has the right to decide if the personal things of the dead person will be burned, put in the grave with the person, or sprayed with chlorine to clean them.

Fig. 7: Deliver the Dead body[21]

The burial teams will deliver the body to the cemetery. No bodies will be burned.



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