Ebola & Viral Hemorrhagic Fevers

The most dangerous moment in Ebola care isn't touching the patient — it's taking off the PPE. One contaminated glove pulled the wrong way has killed healthcare workers.

Ebola virus disease (EVD) is caused by filoviruses with a case fatality rate of 25–90% depending on the species and outbreak setting. The natural reservoir is believed to be fruit bats. Transmission occurs through direct contact with blood, body fluids (saliva, vomit, stool, urine, sweat, semen, breast milk), or contaminated surfaces and fomites. Ebola is NOT airborne under normal circumstances, though aerosolized body fluids during vomiting present a theoretical risk. The virus can persist in semen for months after clinical recovery. Incubation: 2–21 days (average 8–10 days). Patients are NOT contagious during incubation — infectiousness begins with symptom onset and increases with disease severity. Clinical progression: sudden onset of fever, severe headache, myalgia, and fatigue → GI phase (profuse vomiting, watery diarrhea, abdominal pain — this is where massive fluid losses occur) → hemorrhagic phase (petechiae, ecchymosis, mucosal bleeding, DIC) → multi-organ failure, shock, and death. Diagnosis: RT-PCR of blood (may be negative in first 3 days of symptoms; repeat if initial test is negative and suspicion remains). Treatment: aggressive supportive care (IV fluid resuscitation to replace massive GI losses, electrolyte correction, blood products for coagulopathy) plus monoclonal antibody therapy for Zaire ebolavirus — FDA-approved options include Inmazeb and Ebanga, which significantly reduce mortality. Infection prevention: use CDC/facility Ebola PPE protocol with trained observer supervision. Configurations may include PAPR or N95-based ensembles, impermeable or fluid-resistant gown or coverall, eye and face protection, double gloves, and leg and foot protection as indicated by protocol. A trained observer MUST supervise donning and doffing. Most healthcare worker infections occur during DOFFING (removal of PPE) due to self-contamination. Donning and doffing procedures are strictly choreographed. Minimize invasive procedures (every needlestick = potential exposure). Safe burial practices are critical for outbreak control — bodies remain highly infectious. Nursing: meticulous PPE compliance per facility protocol, minimize patient contact time while maintaining compassionate care, monitor fluid balance and urine output closely, emotional and psychological support for isolated patients (isolation is profoundly distressing), watch for healthcare worker exposure incidents, and maintain personal wellbeing and stress management during outbreak response.

Key Distinctions

Ebola is transmitted by CONTACT with body fluids, NOT by airborne route — but PPE exceeds standard contact precautions due to the catastrophic consequence of exposure. Students often select airborne precautions (negative pressure room, N95 for all care); the correct answer is enhanced contact/droplet with respirator use per facility protocol, not for airborne transmission. The most dangerous moment is DOFFING (removing PPE), not patient contact — a trained observer is mandatory. Ebola is not contagious during the incubation period; infectiousness begins at symptom onset and increases with disease severity.

Clinical Pearl

Doffing kills healthcare workers, not donning. Every piece of PPE comes off in a specific order with a trained observer watching — there is no shortcut.