Ugandan Ebola Virus Disease Outbreak Update for Virginia

October 7, 2022

Dear Colleague:

I am writing to provide you with an update on the Ebola virus disease (EVD) outbreak in Uganda caused by Sudan virus (species Sudan ebolavirus). No confirmed, probable, or suspected cases have been reported outside of Uganda, including the U.S. While the overall global risk is low, it is important for clinicians to maintain awareness and obtain a detailed travel history from patients with suspected EVD, especially those that have been in affected areas of Uganda. Signs and symptoms of EVD include headache, myalgias, fatigue, gastrointestinal symptoms, and unexplained bleeding. 

On October 6, 2022, the Centers for Disease Control and Prevention (CDC) issued a Health Alert Network (HAN) health advisory. 

  • Currently, 44 cases, including 10 confirmed and 20 probable deaths have been reported. 
  • The virus spreads by direct contact (through broken skin or mucous membranes) with the blood, urine, feces, saliva, respiratory droplets or other secretions of an infected patient, one who has died of EVD, or with objects contaminated with the virus such as needles. EVD is not spread by airborne transmission.
  • Testing for Sudan virus is currently limited to select laboratory response network (LRN) laboratories and CDC. Virginia’s Division of Consolidated Laboratory Services (DCLS) recently validated a reverse-transcriptase PCR assay to detect the virus. Pre-approval for this testing is required by the Virginia Department of Health (VDH) and CDC. 
  • There is no FDA-licensed vaccine against the Sudan virus. The FDA-approved vaccine ERVEBO (Ebola Zaire Vaccine) is not expected to protect against the Sudan virus.
  • There is no current FDA-approved treatment for Sudan virus infection; treatment consists of aggressive supportive care that may lower its mortality rate. CDC notes a 50% mortality rate in previous Sudan virus outbreaks.

Beginning the week of October 10, 2022, all airline passengers who were in Uganda in the previous 21 days will be routed through five U.S. airports: Washington-Dulles, New York’s John F. Kennedy International, Newark International, Chicago O’Hare, and Atlanta Hartsfield-Jackson. VDH anticipates CDC recommendations for our staff to conduct post-arrival assessment or monitoring of travelers from outbreak-affected areas, but details are not yet available.

Recommendations for Healthcare Providers

 Identify. The majority of febrile patients or travelers presenting in U.S. healthcare facilities do not have EVD, but early consideration of EVD in the differential diagnosis is important.

    • Obtain a thorough travel history from all acutely ill patients returning from affected areas of Uganda. 
    • Ask about epidemiologic risk factors in all travelers returning from areas with an active EVD outbreak. Health workers who do not use proper infection control while caring for Ebola patients, and family and friends in close contact with Ebola patients, are at the highest risk of getting sick. If an ill patient has any risk factors, begin immediate infection prevention and control measures. Begin immediate infection control measures for patients with a concerning travel history.
    • If exposure criteria are met, ask about signs or symptoms of EVD. 
    • If the patient evaluation indicates possible EVD, take action.
  • Isolate the patient in a single room with a private bathroom or covered bedside commode.
    • Patients with EVD are not contagious until symptoms appear.
    • Adhere to infection prevention and control procedures to prevent transmission through direct or indirect contact, including wearing appropriate personal protective equipment (PPE) and using dedicated equipment.
    • Use only essential healthcare workers trained in their designated roles for patient care and keep a log of everyone who enters and leaves the patient’s room.
    • Perform only necessary tests and procedures and avoid aerosol-generating procedures.
  • Inform. Immediately notify your facility’s Infection Prevention and Control Program of a suspected EVD case. Contact the local health department (LHD) for consultation about testing for EVD. If the provider suspects EVD and testing is approved by VDH and CDC, DCLS will test the patient’s blood.  CDC will perform confirmatory testing, if needed.

For More Information

Thank you for your continued partnership.  

Sincerely,

Colin M. Greene, MD, MPH
State Health Commissioner