Guideline sources The following summarized guidelines for the management of ebola virus disease are prepared by our editorial team based on guidelines from the World Health Organization (WHO 2022; 2020; 2014), the Center for Disease Control (CDC 2021), and the Ebola Virus Disease Working Group (EBV-WG 2018). 1 2 3 4 5 Guidelines 1. Medical management Monoclonal antobodies: Administer either ansuvimab or atoltivimab/maftivimab/odesivimab for the treatment of patients with RT-PCR confirmed Ebola virus disease and in neonates of unconfirmed Ebola virus disease status, 7 days old, born to mothers with confirmed Ebola virus disease. B Avoid using ZMapp for the treatment of patients with RT-PCR confirmed Ebola virus disease. D Remdesivir: avoid using remdesivir for the treatment of patients with RT-PCR confirmed Ebola virus disease. D Fluid therapy: https://web.pathway.md/diseases/rec5JOeUAIwvNI6UN 1/5 6/29/23, 4:14 AM Ebola virus disease Pathway Administer oral rehydration solution in an adequate amount rather than non-standardized rehydration to reduce mortality in patients with suspected, probable, or confirmed Ebola virus disease. B Administer parenteral rather in patients unable to drink or when volume losses are larger than oral volume intake. B Analgesic therapy: administer analgesic therapy, including parenteral opioids, if necessary to reduce pain in patients with suspected, probable, or confirmed Ebola virus disease experiencing pain. A Antibiotic therapy: administer broad-spectrum antibiotics promptly to reduce mortality in patients with suspected, probable, or confirmed Ebola virus disease and high severity of illness. B 2. Inpatient care Serial clinical assessment: obtain systematic monitoring and charting of vital signs and volume status in all patients with Ebola virus disease. B Serial laboratory assessment: obtain and chart serum biochemistry (such as electrolytes, glucose, and blood gas) in patients with suspected, probable, or confirmed Ebola virus disease, as deemed desirable by the attending clinicians, and manage observed abnormalities according to the clinician's judgment. B 3. Specific circumstances Pregnant patients: provide optimized supportive care in the clinical management of pregnant patients with Ebola virus disease. B Show 7 more Breastfeeding patients: stop breastfeeding if acute Ebola virus disease is suspected or confirmed in a lactating woman or in a breastfeeding child. Separate the child from the breastfeeding woman and provide a breastmilk substitute as needed. B Show 4 more 4. Patient education Communication with relatives: consider facilitating communication with family and friends to reduce psychological distress in patients admitted to the treatment unit with suspected, probable, or confirmed Ebola virus disease. C 5. Preventative measures Personal protective equipment: Ensure that all healthcare workers follow the following precautions while providing clinical care for patients with filovirus disease in order to prevent virus exposure: https://web.pathway.md/diseases/rec5JOeUAIwvNI6UN 2/5 6/29/23, 4:14 AM Ebola virus disease Pathway cover the mucous membranes of their eyes, mouth, and nose completely with personal protective equipment A use either a face shield or goggles B wear a fluid-resistant medical/surgical mask with a structured design not collapsing against the mouth, such as duckbill or cup shape B use a fluid-resistant particulate respirator during procedures generating aerosols of body fluids B wear double gloves, preferably with nitrile material rather than latex B wear protective bodywear in addition to regular on-duty clothing A ; with the choice of bodywear being either a disposable gown and apron, or a disposable coverall and apron, with the gown and the coverall made of fabric tested for resistance to penetration by blood or body fluids or to blood-borne pathogens B ; with the choice of apron being, in order of preference: disposable, waterproof apron, or heavy-duty, reusable waterproof aprons if appropriate cleaning and disinfection between patients are performed, if disposable aprons are not available B wear waterproof boots, such as rubber/gum B wear a head cover covering the head and neck, being separate from the gown or coverall, so that these may be removed separately. B Immunization: Offer pre-exposure vaccination with the rVSV-ZEBOV vaccine in 18 years adults being at highest risk for potential occupational exposure to Ebola virus, such as: responding to an outbreak of Ebola virus disease working as healthcare personnel at designated Ebola treatment centers working as laboratorians or other staff at biosafety level 4 facilities. E 6. Quality improvement Requirements for Ebola treatment unit personnel: ensure a staffing ratio of at least 1 clinician to 4 patients in Ebola treatment units, taking into account the need for patient assessment at least TID and continuous (24 hours/day) monitoring of patients to allow prompt recognition of and reaction to acute changes in condition. B Clinical findings Symptoms Past obstetric history Abdominal pain Miscarriage Arthralgia Vital signs Bleeding tendency Chest pain Hypotension Confusion Signs of shock Cough Tachypnea Diarrhea Ocular exam Dysphagia Fatigue https://web.pathway.md/diseases/rec5JOeUAIwvNI6UN 3/5 6/29/23, 4:14 AM Ebola virus disease Pathway Fever Conjunctival injection Gum bleeding Lab findings Headache Hearing loss Ebola virus RNA Hematemesis Ebola virus antigen Hematochezia Hypocalcemia Hematuria Hypokalemia Hemoptysis Hyponatremia Loss of appetite Melena Myalgia Nausea Nosebleed Odynophagia Throat pain Vaginal bleeding Vomiting Social history Living in or travel to Africa Neurological exam Altered mental status Coma Delirium Neck stiffness Integument exam Ecchymosis Maculopapular rash Petechiae Skin desquamation Serological findings Ebola virus IgG Ebola virus IgM References 1. Richard Kojan, Robert Fowler. Therapeutics for Ebola virus disease. Geneva: World Health Organization; 2022. Open 2. Fran ois Lamontagne, Robert A Fowler, Neill K Adhikari et al. Evidence-based guidelines for supportive care of patients with Ebola virus disease. Lancet. 2018 Feb 17;391 10121 700 708. Open https://web.pathway.md/diseases/rec5JOeUAIwvNI6UN 4/5 6/29/23, 4:14 AM Ebola virus disease Pathway 3. Megan Foeller, Anna Thorson. Guidelines for the management of pregnant and breastfeeding women in the context of Ebola virus disease. Geneva: World Health Organization; 2020. Open 4. Mary J Choi, Caitlin M Cossaboom, Amy N Whitesell et al. Use of Ebola Vaccine: Recommendations of the Advisory Committee on Immunization Practices, United States, 2020. MMWR Recomm Rep. 2021 Jan 8;70 1 1 12. Open 5. No authors listed. Personal protective equipment in the context of filovirus disease outbreak response. Geneva: World Health Organization; 2014. Open https://web.pathway.md/diseases/rec5JOeUAIwvNI6UN 5/5