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Ebola/VHF
Topic Collection
November 1, 2024

Topic Collection: Ebola/VHF

Though Ebola and other viral hemorrhagic fevers have been recognized for their virulence and biosecurity implications for decades, the 2014-2016 Ebola outbreak in West Africa for the first time spread into metropolitan areas, far exceeding the scope of previous outbreaks, killing thousands, overwhelming health systems, and highlighting international gaps in infectious disease preparedness and response. For the first time, patients with Ebola were treated in American facilities, and we also saw the first secondary cases of Ebola in the U.S. Smaller outbreaks since that time continue to highlight the risk posed by these viruses though advances in vaccination and antiviral therapies hold promise for limiting the impact of future outbreaks. The following resources highlight recent case studies, lessons learned, tools, and promising practices for planning for and responding to Ebola and viral hemorrhagic fever outbreaks.

Each resource in this Topic Collection is placed into one or more of the following categories (click on the category name to be taken directly to that set of resources). Resources marked with an asterisk (*) appear in more than one category.

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Must Reads

ASPR TRACIE. (2024). EMS Infectious Disease Playbook.
This playbook (updated in 2023) synthesizes multiple sources of information in a single planning document addressing the full spectrum of infectious agents to create a concise reference resource for emergency medical services (EMS) agencies developing their service policies. The information can be incorporated into agency standard operating procedures and reviewed by the EMS medical director.
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  • Bridget Kanawati Thank you for your interest in this resource. Unfortunately, funding restrictions preclude our being able to provide printed versions of our resources so all of our products, including this one, are only available electronically. ASPR TRACIE Team
    3/26/2020 2:12:42 PM
  • Frances Thorpe I agree with Tracy, is there a way to order this publication in hard copy format? The information contained in this publication highlights agency infection control policies and is a great resource to have in the department library.
    3/26/2020 12:21:37 PM
  • Tracy Miller Is there any way to order a printed and bound version?
    8/9/2018 5:16:09 PM
Centers for Disease Control and Prevention. (n.d.). Fever in the Returned Traveler. (Accessed 10/31/2024.)
Healthcare professionals can follow the steps in this infographic to evaluate travelers returning from countries with widespread Ebola transmission.
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Centers for Disease Control and Prevention. (2024). Clinical Guidance for Ebola Disease. U.S. Department of Health and Human Services.
This webpage provides comprehensive information for clinicians on Ebola virus disease, including clinical presentation, pathogenesis, treatment, and updated vaccine information with additional references toward the end.
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Centers for Disease Control and Prevention. (2024). Preparing Healthcare Facilities for Ebola Disease. U.S. Department of Health and Human Services.
This webpage is intended to assist public health practitioners plan for possible Ebola virus disease. It includes the top 10 Ebola response planning tips and links to hospital preparedness, personal protective equipment guidance, and cleaning and decontamination protocols.
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Fairley, J., Kozarsky, P., Kraft, C., et al. (2016). Ebola or Not? Evaluating the Ill Traveler from Ebola-Affected Countries in West Africa. Open Forum Infectious Diseases. 3(1).
The authors describe the triage and evaluation of 25 travelers meeting the Centers for Disease Control and Prevention's case definition of a person under investigation at an emergency department, outpatient tropical medicine clinic, or Ebola treatment center. None had Ebola virus disease. The authors emphasize the importance of attention to infection control and considering other life-threatening conditions requiring urgent treatment, influenza vaccination, and other preventive measures for travelers.
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Smith, C., Hughes, S., Karwowski, M., et al. (2015). Addressing Needs of Contacts of Ebola Patients During an Investigation of an Ebola Cluster in the United States - Dallas, Texas, 2014. MMWR Morbidity and Mortality Weekly Report. 64(5):121-123.
In this report, the authors discuss the importance of anticipating the nonclinical needs of those under public health surveillance (e.g., concerns about housing, transportation, education, employment, food, and other household needs). The report also stresses the importance of ensuring these types of support are addressed so that residents will be more likely to comply with quarantine orders, and the utility of community collaboration (with partners such as businesses, schools, community and faith-based organizations, and social services).
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Smith, P., Anderson, A., Christopher, G., et al. (2006). Designing a Biocontainment Unit to Care for Patients with Serious Communicable Diseases: A Consensus Statement. Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science. 4(4).
The authors synthesized consensus recommendations collected from a conference of civilian and military professionals who are involved in the various aspects of biocontainment patient care units. Appendices include in-depth information on medical care issues (e.g., staffing the units, pathology, housekeeping), infection control issues (e.g., personal protective equipment, dealing with infectious waste), facility issues (e.g., air-handling, communication), and psychosocial and ethical issues.
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The BMJ. (n.d.). Ebola Virus Disease.
This webpage provides updated Ebola guidance for healthcare workers, including patient treatment, diagnostics, and lessons learned. A visual clinical care guide provides quick reference information for infection control, personal protective equipment, and convalescence.
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Assessing and Testing

Association of Public Health Laboratories. (2014). Template for Public Health Laboratory Risk Assessment for Ebola Virus Disease (EVD) Testing.
Laboratory staff can download and tailor this template to meet their requirements. It includes comprehensive information on using enhanced precautions and personal protective equipment when handling high-risk Ebola specimens.
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Brainard, J., Pond, K., Hopper, L., et al. (2016). Presence and Persistence of Ebola or Marburg Virus in Patients and Survivors: A Rapid Systematic Review. PLoS Neglected Tropical Diseases. 10(2):e0004475.
In this study, the authors review and summarize 33 studies that examined evidence of presence and persistence of infectious virus in various body fluids compared to onset of Ebola or Marburg illness. Research consistently showed high viral loads in blood during illness, but rarely later than 16 days after illness onset. Filovirus was also found in non-blood body fluids of actively ill patients, but rarely found in survivors, with the exception of semen, which tested positive as late as 203 days after onset of illness.
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* Centers for Disease Control and Prevention. (2024). Guide for Clinicians Evaluating an Ill Person for VHF or Other High-Consequence Disease. U.S. Department of Health and Human Services.
This guide provides information for healthcare providers on evaluating a patient potentially exposed to ebolavirus. It includes information on exposure risk factors and symptoms of Ebola disease, consultation with local, tribal, state, or territorial health departments after a patient is safely isolated, and a testing algorithm for determining when to test an individual with suspected Ebola disease.
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Centers for Disease Control and Prevention. (2024). Laboratory Testing for Patients with a Suspected VHF or High-Consequence Disease. U.S. Department of Health and Human Services.
This webpage provides links to Ebola testing guidance such as specimen collection, transport, and submission as well as packing and shipping information. The page also provides links to additional non-CDC resources for Ebola laboratory practice.
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Centers for Disease Control and Prevention. (2024). Preparing Healthcare Facilities for Ebola Disease. U.S. Department of Health and Human Services.
This webpage is intended to assist public health practitioners plan for possible Ebola virus disease. It includes the top 10 Ebola response planning tips and links to hospital preparedness, personal protective equipment guidance, and cleaning and decontamination protocols.
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* Fairley, J., Kozarsky, P., Kraft, C., et al. (2016). Ebola or Not? Evaluating the Ill Traveler from Ebola-Affected Countries in West Africa. Open Forum Infectious Diseases. 3(1).
The authors describe the triage and evaluation of 25 travelers meeting the Centers for Disease Control and Prevention's case definition of a person under investigation at an emergency department, outpatient tropical medicine clinic, or Ebola treatment center. None had Ebola virus disease. The authors emphasize the importance of attention to infection control and considering other life-threatening conditions requiring urgent treatment, influenza vaccination, and other preventive measures for travelers.
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Hill, C., Burd, E., Kraft, C., et al. (2014). Laboratory Test Support for Ebola Patients Within a High-Containment Facility. Laboratory Medicine. 45(3):e109-e111.
The authors (from Emory University) share the story of two U.S. nationals who contracted the Ebola virus while working in Africa. They list the instruments used to provide core assays and how they were used in the isolation facility.
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James, A., Todd, S., Pollak, N., et al. (2018). Ebolavirus Diagnosis Made Simple, Comparable and Faster than Molecular Detection Methods: Preparing for the Future. Virology Journal. 15(75).
The authors developed a rapid assay for detection of Ebola using recombinase polymerase amplification. They found their assay to be comparable to RT-PCR-based assays, with the same detection limit as PCR and highly specific for Ebola Zaire. They suggest the assay could be useful in low-resource settings lacking capacity for RT-PCR.
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* Nebraska Medicine. (2022). Viral Hemorrhagic Fever or Orthopox Virus ED Screening.
This flowchart is intended to help screen for potential Ebola, Lassa, Marburg, or Orthopox virus cases in the Emergency Department. It includes color coded procedural steps for processing incoming patients, specific questions to ask, screening notes, and infection control guidance.
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Oza, S., Sesay, A., Russell, N., et al. (2017). Symptom- and Laboratory-Based Ebola Risk Scores to Differentiate Likely Ebola Infections. Emerging Infectious Diseases. 23(11):1792-99.
The authors reviewed retrospective data from both positive and negative Ebola patients in Sierra Leone to develop two risk scores on the likelihood of Ebola infection among patients with suspected or confirmed Ebola virus disease. The Ebola symptom-based risk (ESR) score was based on headache, diarrhea, difficulty breathing, nausea/vomiting, loss of appetite, and conjunctivitis. If available, laboratory test results for alanine transaminase, creatine kinase, creatinine, and total bilirubin were added to the ESR score to calculate the Ebola symptom- and laboratory-based (ESLR) score. Among suspected patients who tested positive for Ebola virus disease, the ESR score categorized more than 70% and the ESLR score categorized more than 90% as high risk. The risk scores may be useful in separating patients who meet the case definition by their likeliness of infection and implementing greater protections and directing more resources to those with higher risk scores while awaiting laboratory confirmation of disease.
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Clinical Care

Aluisio, A., Yam, D., Peters, J., et al. (2020). Impact of Intravenous Fluid Therapy on Survival Among Patients with Ebola Virus Disease: An International Multisite Retrospective Cohort Study. Clinical Infectious Diseases. 70(6):1038-1047.
This article summarizes the outcome of a retrospective cohort study that evaluated the survival rate of patients diagnosed with Ebola virus disease who were treated with intravenous (IV) fluid compared to those who were not. Results indicate no difference in survival in patients receiving IV fluids versus those who did not.
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Ansumana, R., Jacobsen, K., Idris, M., et al. (2015). Ebola in Freetown Area, Sierra Leone A Case Study of 581 Patients. The New England Journal of Medicine. 372:587-588.
In this letter to the editor, the authors list treatment protocols used with patients who were admitted to an Ebola treatment center near Freetown, Sierra Leone, on or after September 20, 2014 (the date on which the first patients were admitted to that center). This center saw a 31% case fatality rate, lower than that of other studies.
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* ASPR TRACIE. (2017). Lessons Learned on Crisis Standards of Care in Kenema.
In this video, Dr. Lewis Rubinson shares his personal experiences treating Ebola patients in Sierra Leone.
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ASPR TRACIE. (2017). Step Care for Ebola/Viral Hemorrhagic Fever Patients: Guidance for International Field Hospitals. U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response.
This document is intended to help organizations who want to provide care for Ebola virus disease (EVD)/viral hemorrhagic fever (VHF) patients determine an appropriate level of medical care that they can provide and anticipate the supplies that may be needed. This guidance may be applicable to other diseases where dehydration and electrolyte imbalance are key contributors to mortality.
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* Baker, M. (2015). Ebola Response in West Africa: My Experience. Alabama Department of Public Health.
The speaker for this one-hour, 23 minute video discusses his experience working in West Africa during the 2014-2015 outbreak. He is a pediatric physician, and discusses his experiences, including ethical challenges he experienced in the care of children with Ebola.
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Bauer, M., Timen, A., Vossen, A., and Dissel, J. (2019). Marburg Haemorrhagic Fever in Returning Travelers: An Overview Aimed at Clinicians. Clinical Microbiology and Infection. 21(Supplement):E28-E31.
This article summarizes the epidemiology, pathogenesis, clinical presentation, outbreak control, and diagnosis and treatment of suspected imported cases of Marburg virus haemorrhagic fever.
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Centers for Disease Control and Prevention. (2024). VHF Clinical Care for Safely Performing Acute Hemodialysis in Patients in U.S. Hospitals.
The Centers for Disease Control and Prevention provide this guidance for individuals performing renal replacement therapy in patients with viral hemorrhagic fever.
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* Connor, M., Kraft, C., Mehta, A., et al. (2015). Successful Delivery of RRT in Ebola Virus Disease. Journal of the American Society of Nephrology. 26(1):31-37.
The authors describe the first successful delivery of renal replacement therapy to an Ebola patient and offer safety considerations and clinical practice guidelines based on the experience.
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Diallo, M., Toure, A., Sow, M., et al. (2021). Understanding the Long-Term Evolution and Predictors of Sequelae of Ebola Virus Disease Survivors in Guinea: A 48-Month Prospective, Longitudinal Cohort Study (PostEboGui). Clinical Infectious Diseases.
This study aims to understand long-term Ebola virus disease sequelae prevalence, incidence, and duration over a 48-month period following 803 survivors. Results indicate that while prevalence and incidence of symptoms decreased over time, sequelae were present 48 months post discharge.
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* Eriksson, C., Uyeki, T., Christian, M., et al. (2015). Care of the Child with Ebola Virus Disease. Pediatric Critical Care Medicine. 16(2):97-103.
The authors discuss considerations for the care of children with Ebola virus disease. They emphasize infection control practices to limit disease spread, and supportive care to treat patients.
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* Fairley, J., Kozarsky, P., Kraft, C., et al. (2016). Ebola or Not? Evaluating the Ill Traveler from Ebola-Affected Countries in West Africa. Open Forum Infectious Diseases. 3(1).
The authors describe the triage and evaluation of 25 travelers meeting the Centers for Disease Control and Prevention's case definition of a person under investigation at an emergency department, outpatient tropical medicine clinic, or Ebola treatment center. None had Ebola virus disease. The authors emphasize the importance of attention to infection control and considering other life-threatening conditions requiring urgent treatment, influenza vaccination, and other preventive measures for travelers.
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* Feldmann, H., Sprecher, A., and Geisbert, T. (2020). Ebola. The New England Journal of Medicine. 382:1832-1842.
This article provides a comprehensive overview of Ebola, its virologic, epidemiologic, and ecologic features, and information on disease pathogenesis. For clinicians, it includes guidance for diagnosis, patient care, investigational treatment, vaccines, and outbreak management information.
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Jain, V., Charlett, A., and Brown, C. (2020). Meta-Analysis of Predictive Symptoms for Ebola Virus Disease. PLOS Neglected Tropical Diseases. 14(10).
This literature review aims to identify predictive symptoms associated with Ebola virus disease through a meta-analysis performed for each symptom with the greatest risk for EVD infection. Results show that while current literature is not conclusive for identifying symptoms predictive of EVD, patients with symptoms often found late in EVD were more likely to have a final Ebola diagnosis.
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Kiiza, P., Mullin, S., Teo, K., et al. (2021). Treatment of Ebola-Related Critical Illness. Intensive Care Medicine. 46:285-297.
This article reviews updated care guidelines for treating Ebola-related illness. Information summarizes advancements in point-of-care diagnostics, patient standards of care, drug therapies, and supportive care.
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Kortepeter, M., Dierberg, K., Shenoy, E., et al. (2020). Marburg Virus Disease: A Summary for Clinicians. International Journal of Infectious Diseases. 99(2020):233-242.
This article offers a summary of clinical features, diagnostic testing options, potential medical countermeasures, infection prevention and control recommendations, and additional recommendations related to caring for patients with Marburg virus disease.
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* Lamontagne, F., Fowler, R., Adhikari, N., et al. (2017). Evidence-Based Guidelines for Supportive Care of Patients with Ebola Virus Disease. The Lancet. 391(10121):700-708.
These evidence-based guidelines developed by a 34 member expert panel provide recommendations on the delivery of supportive care for patients in treatment units during a future Ebola outbreak. The panel used the Grading of Recommendations Assessment, Development, and Evaluation methodology to develop 8 clinical recommendations on oral rehydration, parenteral administration of fluids, systematic monitoring and charting of vital signs and volume status, serum biochemistry, staffing ratio, communication with family and friends, analgesic therapy, and antibiotics.
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Lyon, G., Mehta, A., Varkey, J., et al. (2014). Clinical Care of Two Patients with Ebola Virus Disease in the United States. The New England Journal of Medicine. 371:2402-2409.
The authors (from Emory University) present two case reports on two U.S. citizens who contracted the Ebola virus while working in Liberia. Line graphs detail laboratory values in both patients as they received ZMapp, an experimental treatment.
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Maganga, G., Kapetshi, J., Berthet, N., et al. (2014). Ebola Virus Disease in the Democratic Republic of Congo. The New England Journal of Medicine. 371:2083-2091.
This article highlights the authors’ studies of patients from July to October 2014 as they examined whether the outbreak in the Democratic Republic of Congo was related to the outbreak in West Africa.
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Mbala-Kingebani, P., Pratt, C., Mutafali-Ruffin, M., et al. (2021). Ebola Virus Transmission Initiated by Relapse of Systemic Ebola Virus Disease. The New England Journal of Medicine. 384:1240-1247.
The authors provide a case report of acute Ebola virus disease relapse resulting in death in a previously recovered and vaccinated patient.
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Moole, H., Chitta, S., Victor, D., et al. (2015). Association of Clinical Signs and Symptoms of Ebola Viral Disease with Case Fatality: A Systematic Review and Meta-Analysis. Journal of Community Hospital Internal Medicine Perspectives. 5(4).
The authors completed a meta-analysis of articles from 1976 to November 2014 describing the clinical features of Ebola virus disease and identify the following signs and symptoms that may be associated with higher mortality: bleeding, vomiting, diarrhea, abdominal pain, cough, sore throat, and conjunctivitis.
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Smith, P., Boulter, K., Hewlett, A., et al. (2015). Planning and Response to Ebola Virus Disease: An Integrated Approach. (Abstract only.) American Journal of Infection Control. 43(5):441-446.
Like any hazard, the response to Ebola calls for complex tasks to be carried out by people with specific skills. The authors describe a variation of incident command as a framework for providing Ebola virus disease patient care.
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Sueblinvong, V., Johnson, D., Weinstein, G., et al. (2015). Critical Care for Multiple Organ Failure Secondary to Ebola Virus Disease in the United States. Critical Care Medicine. 43(10):2066-2075.
The authors describe three Ebola patients with severe critical illness and secondary multiple organ failure. Two of the three patients died, showing that mortality rates may be high even with aggressive care among those with multiple organ failure.
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Tiffany, A., Vetter, P., Mattia, J., et al. (2016). Ebola Virus Disease Complications as Experienced by Survivors in Sierra Leone. Clinical Infectious Diseases. 62(11):1360-1366.
This research study confirms post-Ebola virus disease complications seen in previous outbreaks and recommends follow-up care begin during hospitalization and immediately following discharge to detect and treat complications before they cause long-term disability.
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Uyeki, T., Mehta, A., Davey, R., et al. (2016). Clinical Management of Ebola Virus Disease in the United States and Europe. New England Journal of Medicine. 374:636-646.
The authors review 27 Ebola virus disease patients treated in the United States or Europe, describing patient characteristics, clinical and laboratory findings, supportive clinical care, investigational therapies, results from virologic and immunologic examination, and outcomes.
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van Griensven, J., Edwards, T., de Lamballerie, X., et al. (2016). Evaluation of Convalescent Plasma for Ebola Virus Disease in Guinea. The New England Journal of Medicine. 374:33-42.
This comparative study evaluated the safety and efficacy of convalescent plasma treatment for Ebola virus disease in Guinea. Results showed that transfusion of convalescent plasma from EVD survivors (unknown antibody titers) in 84 patients resulted in no significant improvement compared to a control group.
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Vetter, P., Kaiser, L., Schibler, M., et al. (2016). Sequelae of Ebola Virus Disease: The Emergency Within the Emergency. The Lancet Infectious Diseases. 16(6):e82-e91.
The authors discuss current knowledge of Ebola virus disease sequelae, challenges to provision of care to survivors, and areas for future research.
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World Health Organization. (2016). Clinical Care for Survivors of Ebola Virus Disease: Interim Guidance.
This document is intended to provide guidance to primary care providers of those who have recovered from Ebola virus disease. Topics include planning for follow-up care, recommended evaluation and clinical management of common sequelae, considerations for children and pregnant women, monitoring for persistent infection, infection prevention and control, and risk communication.
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Decontamination and Waste Management

Fischer, R., Judson, S. Miazgowicz, K., et al. (2015). Ebola Virus Stability on Surfaces and in Fluids in Simulated Outbreak Environments. Emerging Infectious Diseases. 21(7):1243-1246.
The authors simulated environmental conditions and found that the Ebola virus remains active for a longer time on hospital surfaces than it does in African conditions. The virus also lives longer in liquid than it does in dried blood.
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Jelden, K., Gibbs, S., Smith, P., et al. (2015). Nebraska Biocontainment Unit Patient Discharge and Environmental Contamination after Ebola Care. (Abstract only.) American Journal of Infection Control. 43(3):203-205.
The authors describe the decontamination protocols to be taken by the staff at the Nebraska Biocontainment Unit in the event of the following: when a patient treated for Ebola is discharged, when a body of a patient with Ebola is removed, and when environmental decontamination of the isolation unit is required.
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Lowe, J., Hewlett, A., Iwen, P., et al. (2015). Surrogate Testing Suggests that Chlorine Dioxide Gas Exposure Would Not Inactivate Ebola Virus Contained in Environmental Blood Contamination. (Abstract only.) Journal of Occupational and Environmental Hygiene. 12(9):D211-215.
This study finds that decontamination with chlorine dioxide must be preceded by manually wiping down surfaces potentially contaminated by blood to inactivate bacteria present in blood.
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U.S. Department of Labor, Occupational Safety and Health Administration. (2016). Cleaning and Decontamination of Ebola on Surfaces: Guidance for Workers and Employers in Non-Healthcare/Non-Laboratory Settings.
This factsheet provides guidance on Ebola cleaning and decontamination procedures for those who work in non-healthcare and non-laboratory settings. Links to information on disinfectants, waste disposal, and personal protective equipment are provided throughout the document.
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U.S. Department of Labor, Occupational Safety and Health Administration, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, and Environmental Protection Agency. (2016). Safe Handling, Treatment, Transport and Disposal of Ebola-Contaminated Waste.
This fact sheet provides a step-by-step summary of actions workers should take from the point Ebola-contaminated waste is generated through final disposal.
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U.S. Environmental Protection Agency. (2018). List L: Disinfectants for Use Against the Ebola Virus.
The Environmental Protection Agency lists products that meet the Centers for Disease Control and Prevention’s criteria for use against the Ebola virus on hard, non-porous surfaces. Products are listed by name and indicate whether they are approved for use in hospital/healthcare facilities, institutions such as schools and offices, and residences.
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Various Federal Agencies. (2019). Managing Solid Waste Contaminated with a Category A Infectious Substance: Summary.
This is a summary of a guidance document based on extensive federal interagency coordination and stakeholder input and designed to help those who work in healthcare facilities, medical transportation operations, and laboratories better understand infectious waste and how to manage it. Access the full report at https://www.phmsa.dot.gov/sites/phmsa.dot.gov/files/docs/transporting-infectious-substances/6821/cat-waste-planning-guidance-final-2019-08.pdf.
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Various Federal Agencies. (2024). Planning Guidance for Handling Category A Solid Waste.
Based on extensive federal interagency coordination and stakeholder input, the guidance in this document can help those who work in healthcare facilities, medical transportation operations, and laboratories better understand infectious waste and how to manage it.
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Education and Training

ASPR TRACIE. (2020). Highly Pathogenic Infectious Disease Training and Exercise Resources Webinar.
The National Ebola Training and Education Center (NETEC) and ASPR’s Technical Resources, Assistance Center, and Information Exchange (ASPR TRACIE) are partnering on a series of joint webinars featuring NETEC’s suite of free, fully customizable, Homeland Security Exercise and Evaluation Program (HSEEP)-compliant exercise materials, trainings, and other resources. This webinar highlights a new course, exercise templates, and other ASPR TRACIE and NETEC resources.
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ASPR TRACIE and NETEC. (2017). Highly Pathogenic Infectious Disease Exercise Planning for Health Care Coalitions.
The speakers in this webinar discussed exercise templates designed to help manage patients with highly pathogenic infectious diseases; explained how exercises support ASPR's regional, tiered approach; and shared their experiences planning and executing exercises for Ebola and other special pathogens.
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ASPR TRACIE and NETEC. (2017). Highly Pathogenic Infectious Disease Exercise Planning Tools.
Speakers share information on HSEEP-compliant exercise templates that test readiness for highly pathogenic infectious disease patients, and highlight how these exercises support ASPR’s regional, tiered approach and address unique challenges and situations.
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ASPR TRACIE and NETEC. (2018). Healthcare System Readiness for Highly Pathogenic Infectious Diseases.
In this joint NETEC-ASPR TRACIE webinar, speakers provided an overview of the current situation in the DRC; described the regional, tiered system established to manage patients suspected and known to be infected with EVD or other special pathogens; provided updates on current Ebola readiness and trends; reinforced the “Identify, Isolate, and Inform” response framework; and shared best practices and lessons learned from previous experience.
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Centers for Disease Control and Prevention. (n.d.). Fever in the Returned Traveler. (Accessed 10/31/2024.)
Healthcare professionals can follow the steps in this infographic to evaluate travelers returning from countries with widespread Ebola transmission.
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Centers for Disease Control and Prevention. (2015). Preparing Healthcare Workers to Work in Ebola Treatment Units (ETUs) in Africa: Training Toolkit.
This downloadable or hard copy training toolkit replaces the Centers for Disease Control and Prevention’s three-day, in-person training course for healthcare workers planning to work in Ebola Treatment Units in Africa. The course uses lectures, tabletop exercises, and hands-on interactive exercises to teach effective infection prevention and control before they receive additional follow-up training prior to deployment.
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Centers for Disease Control and Prevention. (2021). About Marburg.
This webpage provides an overview of MVD with links to information on transmission, signs and symptoms, risk of exposure, diagnosis, treatment, and prevention guidance, as well as historical outbreak data and additional resources.
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Department of Emergency Health Services. (2018). Emerging Infectious Diseases Videos for Prehospital Providers. University of Maryland Baltimore County.
This instructional series, comprised of nine modules (listed at the top of the page), includes an introduction to infectious diseases, basic infection control concepts, considerations for personal protective equipment (including donning and doffing), personnel decontamination, patient transport, and transfer of patient care for patients with Ebola and other highly infectious diseases.
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European Centre for Disease Prevention and Control. (2014). Safe Use of Personal Protective Equipment in the Treatment of Infectious Diseases of High Consequence: A Tutorial for Trainers in Healthcare Settings. European Union .
This training program provides information on the proper use of personal protective equipment at the point of care and shares information on procurement, preparedness, and capacity building.
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European Centre for Disease Prevention and Control. (2022). Factsheet About Marburg Virus Disease.
This factsheet includes Marburg-specific case definition, pathogen, clinical feature, epidemiology, transmission, and diagnostic information, as well as case management and treatment guidance.
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European Union, European Centre for Disease Prevention and Control. (2014). Safe Use of Personal Protective Equipment in the Treatment of Infectious Diseases of High Consequence: A Tutorial for Trainers in Healthcare Settings.
This training program provides information on the proper use of personal protective equipment at the point of care and shares information on procurement, preparedness, and capacity building.
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Evans, D. and del Rio, C. (n.d.). Ebola Virus Disease: An Evolving Epidemic. (Accessed 10/31/2024.) Emory University.
This online course provides 18 hours of instruction in multiple modules covering key aspects of the 2014 Ebola epidemic.
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Federal Emergency Management Agency. (2015). Ebola Virus Disease Regional Network Coordination Table Top Exercise.
This exercise can help participants plan for coordinated transport of a person diagnosed with Ebola virus disease, between and within states, to the Regional Ebola Treatment Center in Texas.
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Federal Emergency Management Agency. (2015). TALON Ebola Preparedness Tabletop Exercise: Situation Manual.
This situation manual was developed for participants of the Ebola Virus Disease Regional Network Table Top Exercise. It includes scenarios and related questions, and several appendices, including links to helpful resources.
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Love, C., Arneson, S., and Phillips, S. (2015). Ebola Outbreak Response: The Role of Information Resources and the National Library of Medicine. Disaster Medicine and Public Health Preparedness. 9(1):82-85.
The authors explain the functionality of the National Library of Medicine, and how it works with publishers to provide free access to many full-text articles from over 650 biomedical journals and 4,000 online reference books through the Emergency Access Initiative. They also highlight the “Ebola Outbreak 2014: Information Resources” webpage.
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* MESH Coalition. (2016). An Exercise in the Provision of Care for an Adult Patient under Investigation (PUI) for Ebola: A Patient Care Drill. (Free registration required.)
This simulation toolkit provides a situation overview, general information, simulation logistics, post-simulation and evaluation activities, and participant information and guidance along with appendices containing templates and forms for hospitals to test their established protocols for the provision of care to a patient with a suspect highly infectious disease. Multiple injects such as vomiting encourage testing a range of different procedures through the exercise.
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Mountain Plains Regional Disaster Health Response System. (2024). Introduction to Clinical Management of Exposure to Arenaviruses.
This video can help healthcare workers treat patients suspected or confirmed of having arenaviruses (e.g., Lassa virus and "new world" arenaviruses). The speaker shares information on exposure; how to identify, isolate, and inform patients; and how to treat and support patients with confirmed arenaviruses and coinfections.
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National Emerging Special Pathogens Training & Education Center. (n.d.). NETEC Resources for Marburg Virus Disease. (Accessed 10/31/2024.)
This resource page provides an overview of Marburg virus disease, a brief history of outbreaks, and links to additional resources and publications, including clinical guidance, infection prevention information, and laboratory and EMS resources.
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National Emerging Special Pathogens Training & Education Center. (2024). NETEC Resources for Lassa Fever.
This resource page provides an overview and brief history of Lassa Fever, and links to additional resources on topics such as clinical guidance, infection prevention information, waste management, relevant training, and laboratory practices.
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* The Society for Healthcare Epidemiology of America. (2017). Outbreak Response Training Program (ORTP). (Free account required.)
This webpage contains links to four free toolkits that were developed to provide healthcare providers immediate access to key infectious disease outbreak information and resources. The toolkits contain guidance on incident management, emerging pathogens, IPC strategies, COVID-19, communication, negotiation, and implementation. Each toolkit contains checklists, guidance documents, case studies, and fillable tables to meet the planning and response needs prior to or during an infectious disease outbreak.
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* U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2018). Exercise: Tranquil Terminus.
Safely moving patients with highly infectious diseases, like Ebola, to regional treatment centers takes teamwork, preparation, skill and training. Tranquil Terminus, the largest patient movement exercise in U.S. Department of Health and Human Services’ history, tested the nationwide ability to move patients with highly infectious diseases safely and securely to regional treatment centers.
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U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response, and the Centers for Disease Control and Prevention. (2014). Ebola Training Webinar for Healthcare Coalitions and Healthcare Workers.
This webinar presents lessons learned and other best practices for healthcare workers and coalitions as a result of the Ebola epidemic.
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United Kingdom Health Security Agency. (2022). Marburg Virus Disease: Origins, Reservoirs, Transmission and Guidelines.
This webpage contains information on the epidemiology, symptomology, transmission, diagnosis, and treatment of MVD. It also includes U.K. specific guidelines for disease management and prevention and control measures as well as up to date information on recent outbreaks including the 2022 Ghana cases.
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University of Nebraska Medical Center. (n.d.). The Nebraska Ebola Method - For General Public. (Accessed 10/31/2024.)
This course offers eight lessons geared toward educating the general public about the Ebola virus. The podcast summarizes Ebola issues, and the other lessons cover the medical center’s biocontainment unit, and provide information for children/families.
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West Virginia Hospital Association. (2016). Be Smart, Take Part – Emerging Infectious Disease Preparedness and Response for Frontline Healthcare Facilities.
This training program includes a video for people or groups who may come in contact with an individual with a possible infectious disease. It also includes a free, downloadable, Homeland Security Exercise and Evaluation Program-compliant, no-notice drill template for frontline healthcare facilities. Upon registration, West Virginia providers may also access eight brief online courses to reinforce and test the concepts introduced in the training guide video.
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World Health Organization. (2024). Marburg Virus Disease.
This webpage provides a comprehensive overview of MVD that includes case definition recommendations, symptom and treatment information, infection control guidance, and outbreak data, as well as links to additional publications and technical resources.
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Emergency Medical Services

ASPR TRACIE. (2024). EMS Infectious Disease Playbook.
This playbook (updated in 2023) synthesizes multiple sources of information in a single planning document addressing the full spectrum of infectious agents to create a concise reference resource for emergency medical services (EMS) agencies developing their service policies. The information can be incorporated into agency standard operating procedures and reviewed by the EMS medical director.
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  • Bridget Kanawati Thank you for your interest in this resource. Unfortunately, funding restrictions preclude our being able to provide printed versions of our resources so all of our products, including this one, are only available electronically. ASPR TRACIE Team
    3/26/2020 2:12:42 PM
  • Frances Thorpe I agree with Tracy, is there a way to order this publication in hard copy format? The information contained in this publication highlights agency infection control policies and is a great resource to have in the department library.
    3/26/2020 12:21:37 PM
  • Tracy Miller Is there any way to order a printed and bound version?
    8/9/2018 5:16:09 PM
* Bratt, J., Robinson, A., and Alcorta, R. (n.d.). Strategies and Considerations for the Deployment of EMS Personal Protective Equipment in Response to an Ebola Outbreak. (Accessed 10/31/2024.) Maryland Institute for Emergency Medical Service Systems.
This article describes protection of emergency medical services personnel through personal protective equipment (PPE), including requirements, PPE cost (and how to estimate it), PPE deployment strategies, and personnel requirements.
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Centers for Disease Control and Prevention. (2024). Viral Hemorrhagic Fevers: Interim Guidance for Emergency Services. U.S. Department of Health and Human Services.
This webpage provides comprehensive emergency services information for emergency department (ED) and emergency medical services (EMS) staff treating suspected or confirmed Ebola patients. Information includes guidance on ED preparedness training, 911 answering points, air medical transport, and interfacility transport.
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* National Association of State EMS Officials. (2015). NASEMSO After Action Review: Lessons Learned, Best Practices and Recommendations - Ebola Disease Outbreak.
NASEMSO's Domestic Preparedness Committee prepared this document to highlight critical dates during the Ebola outbreak, provide background information on the disease, describe lessons learned from the response, identify best practices, and recommend actions to federal partners.
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* National Emerging Special Pathogens Training and Education Center. (2024). EMS Procedural Guidelines for Special Pathogens.
These model procedural guidelines, created by NETEC's EMS/Patient Transport Work Group, are designed to help EMS agencies develop standard operating procedures for the transport and management of patients suspected or confirmed to have a high-consequence infectious disease. The guidelines address personal protective equipment (PPE) donning and doffing, EMS provider down, PPE breaches, biohazard spills, waste management, ambulance modification, and ambulance cleaning and disinfection. They complement ASPR TRACIE's EMS Infectious Disease Playbook (https://files.asprtracie.hhs.gov/documents/aspr-tracie-transport-playbook-508.pdf).
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* U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2018). Exercise: Tranquil Terminus.
Safely moving patients with highly infectious diseases, like Ebola, to regional treatment centers takes teamwork, preparation, skill and training. Tranquil Terminus, the largest patient movement exercise in U.S. Department of Health and Human Services’ history, tested the nationwide ability to move patients with highly infectious diseases safely and securely to regional treatment centers.
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Wu, H., Fairley, J., Steinberg, J., and Kozarsky, P. (2014). The Potential Ebola-Infected Patient in the Ambulatory Care Setting: Preparing for the Worst Without Compromising Care. Annals of Internal Medicine. 162(1):66-67.
The authors discuss implications of people with undiagnosed Ebola reporting to healthcare facilities. They worked with key stakeholders to develop a list of considerations for patient management, which is displayed in Table 1.
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Ethics

* ASPR TRACIE. (2017). Lessons Learned on Crisis Standards of Care in Kenema.
In this video, Dr. Lewis Rubinson shares his personal experiences treating Ebola patients in Sierra Leone.
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* Baker, M. (2015). Ebola Response in West Africa: My Experience. Alabama Department of Public Health.
The speaker for this one-hour, 23 minute video discusses his experience working in West Africa during the 2014-2015 outbreak. He is a pediatric physician, and discusses his experiences, including ethical challenges he experienced in the care of children with Ebola.
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Beca, J., Ndagije, H., Calain, P., et al. (2014). Ethical Considerations for Use of Unregistered Interventions for Ebola Viral Disease: Report of an Advisory Panel to WHO (World Health Organization). World Health Organization.
This report describes a consultation held in August 2014 to study and consider the ethical implications of using unregistered interventions on Ebola patients that have not yet been evaluated for safety and efficacy in humans.
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Brito, A., Klitzman, R., Redlener, I., et al. (2015). Ethical Issues in Responding to a Global Disease Crisis: Ebola and Beyond. Columbia University, Earth Institute, National Center for Disaster Preparedness.
The speakers discuss ethical issues such as resource allocation and the pharmaceutical development process as they relate to Ebola and other global health threats.
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Cohen, J. and Kupferschmidt, K. (2014). Ebola Vaccine Trials Raise Ethical Issues. Science. 346(6207):289-290.
The authors discuss the ethical concerns associated with having a control group when testing Ebola vaccines.
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Jecker, N., Dudzinski, D., Diekema, D., and Tonelli, M. (2015). Ebola Virus Disease: Ethics and Emergency Medical Response Policy. (Abstract only.) CHEST. 148(3):794-800.
The authors describe an ethics-based policy for healthcare professionals faced with resuscitation of patients with confirmed Ebola virus disease (EVD). Multiple considerations are reviewed for "code" response to EVD patients, which can help teams plan for emergency situations.
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Mello, M., Merritt, M., and Halpern, S. (2015). Supporting Those Who Go to Fight Ebola. PLoS Medicine. 12(1):e1001781.
This article reviews the challenges and opportunities faced by health care providers and academic medical centers who volunteer to provide support to areas heavily impacted by the Ebola outbreak. The authors provide insight on the importance of supporting the moral and ethical duties of health care providers who volunteer to heal and treat those impacted by Ebola, while highlighting risks associated with prolonged provider absences, and ensuring the safety of both practitioners and institutions upon their return.
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Moore, C. (2020). Ebola, Quarantine, and the Need for a New Ethical Framework. Journal of Medical Ethics and History of Medicine. 13:9.
This article reviews the current ethical frameworks in place for Ebola quarantine and their justification for disease prevention, as it relates to the 2014 outbreak in West Africa.
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Narasimhulu, D., Edwards, V., Chazotte, C., et al. (2015). Healthcare Workers' Attitudes Toward Patients With Ebola Virus Disease in The United States. Open Forum Infectious Diseases. 3(2):1-7.
This study tested healthcare workers' willingness to care for Ebola virus disease patients and employees' ethical beliefs about refusing to care for Ebola virus disease patients. Results showed that ethical beliefs influenced willingness to care, but were also balanced by concerns about the risks to personal and family safety.
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Rothstein, M. (2015). The Moral Challenge of Ebola. American Journal of Public Health. 105(1):6-8.
The authors highlight public health ethics and policy principles that should be considered in response to the international Ebola crisis. The principles discussed in this article can also be applied to other public health threats, and infectious disease outbreaks.
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Various Speakers. (2018). The Conduct of Clinical Trials of Treatments during Public Health Emergencies: A Health Policy and Bioethics Consortium. The Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School.
The speakers highlight the ethical considerations and lessons learned from evaluating treatments in emergency situations such as the 2014-2015 Ebola outbreak.
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Venkat, A., Wolf, L., Geiderman, J., et al. (2015). Ethical Issues in the Response to Ebola Virus Disease in US Emergency Departments: A Position Paper of the American College of Emergency Physicians, the Emergency Nurses Association and the Society for Academic Emergency Medicine. Academic Emergency Medicine. 22(5):605-615.
The American College of Emergency Physicians, the Emergency Nurses Association and the Society for Academic Emergency Medicine jointly developed a position paper to share guidance with U.S. emergency physicians, emergency nurses, and other healthcare stakeholders on how to approach the ethical dilemmas posed by the Ebola outbreak.
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World Health Organization. (2015). Ethics of Using Convalescent Whole Blood and Convalescent Plasma During the Ebola Epidemic.
This report highlights the ethical issues associated with using and researching the use of convalescent whole blood and convalescent plasma to treat patients with Ebola in both research and clinical settings.
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Fatality Management

Centers for Disease Control and Prevention. (2020). Recommended Postmortem Preparation of Human Remains Containing Ebola Virus.
This video discusses how to safely handle human remains containing Ebola virus or other viral hemorrhagic fever. Information for healthcare and mortuary workers on effective personal protective equipment use, best practices (e.g., not performing an autopsy or removing medical equipment from human remains), and requirements for body bags, decedent management, and required decontamination equipment and decontamination procedures are provided.
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Centers for Disease Control and Prevention. (2024). Safe Handling of Human Remains of VHF Patients in U.S. Hospitals and Mortuaries.
The Centers for Disease Control and Prevention provides step-by-step guidance for individuals responsible for performing postmortem care on viral hemorrhagic fever patients in U.S. hospitals and mortuaries.
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National Emerging Special Pathogens Training and Education Center. (2024). Decedent Management Considerations for Confirmed or Suspected Viral Hemorrhagic Fever (VHF).
This guide is a planning tool for facilities managing deceased patients with confirmed or suspected viral hemorrhagic fever. It includes information on communication, safety measures, postmortem care, and in-room postportem preparation.
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World Health Organization. (2017). How to Conduct Safe and Dignified Burial of a Patient who has Died from Suspected or Confirmed Ebola or Marburg Virus Disease.
The World Health Organization developed a 12-step burial protocol for Burial Teams, beginning with their arrival to a village and ending with their return to the hospital or team headquarters.
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Hospital/Clinic Policies

Centers for Disease Control and Prevention. (2024). Clinical Guidance for Ebola Disease. U.S. Department of Health and Human Services.
This webpage provides comprehensive information for clinicians on Ebola virus disease, including clinical presentation, pathogenesis, treatment, and updated vaccine information with additional references toward the end.
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* Centers for Disease Control and Prevention. (2024). Infection Prevention and Control Recommendations for Patients in U.S. Hospitals who are Suspected or Confirmed to have Selected Viral Hemorrhagic Fevers (VHF).
This webpage provides guidance for healthcare professionals regarding standard, contact, and droplet precautions when caring for an individual with suspected or confirmed viral hemorrhagic fever.
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Centers for Disease Control and Prevention. (2024). Interim Guidance for U.S. Hospital Preparedness for Patients Under Investigation (PUIs) or with Confirmed Ebola Virus Disease (EVD): A Framework for a Tiered Approach.
This webpage provides guidance for state and local health department staff and those who work in emergency care settings regarding developing preparedness plans for patients who are under investigation for or with confirmed Ebola.
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Christie, A., Neatherlin, J., Nichol, S., et al. (2020). Ebola Response Priorities in the Time of COVID-19. The New England Journal of Medicine. 383:1202-1204.
The authors detail some of the difficulties in attempting the quell recent Ebola outbreaks amid the COVID-19 pandemic. They outline key factors for maintaining successful Ebola outbreak detection and control measures given limited or competing resources.
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Herstein, J., Biddinger, P., Gibbs, S., et al. (2017). High-Level Isolation Unit Infection Control Procedures. (Abstract only.) Health Security. 15(5): 519-526.
The authors share results from a 2016 survey of the 56 original Centers for Disease Control and Prevention–designated high-level isolation units (64% response rate). Variables include written procedures and protocols for tasks such as decontamination, liquid waste disposal, personal protective equipment use, hand hygiene, and PPE use. The authors encourage continued rigorous training to minimize exposure risks.
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Koenig, L. (2014). Identify, Isolate, Inform: A 3-pronged Approach to Management of Public Health Emergencies. Disaster Medicine and Public Health Preparedness. 9(1): 86-87.
The author describes a 3-pronged "Identify, Isolate, Inform" system that can help healthcare providers take the necessary action upon encountering a potential Ebola patient.
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* Lamontagne, F., Fowler, R., Adhikari, N., et al. (2017). Evidence-Based Guidelines for Supportive Care of Patients with Ebola Virus Disease. The Lancet. 391(10121):700-708.
These evidence-based guidelines developed by a 34 member expert panel provide recommendations on the delivery of supportive care for patients in treatment units during a future Ebola outbreak. The panel used the Grading of Recommendations Assessment, Development, and Evaluation methodology to develop 8 clinical recommendations on oral rehydration, parenteral administration of fluids, systematic monitoring and charting of vital signs and volume status, serum biochemistry, staffing ratio, communication with family and friends, analgesic therapy, and antibiotics.
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New York City Department of Health and Mental Hygiene. (2014). NYC DOHMH Guidance Document for Development of Protocols for Management of Patients Presenting to Hospital Emergency Departments and Clinics with Potentially Communicable Diseases of Public Health Concern.
This document provides guidance for emergency departments and outpatient clinics to develop screening and isolation protocols for patients possibly infected with a highly communicable disease of public health concern. The document focuses on initial patient identification, initial infection control measures, notification and patient evaluation, and identification and management of exposed persons.
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Popescu, S. and Leach, R. (2019). Identifying Gaps in Frontline Healthcare Facility High-Consequence Infectious Disease Preparedness. (Abstract only.) Health Security. 17(2).
The authors discuss a gap analysis of a hospital system in Phoenix, including multiple failures of detection and reporting that could be addressed through system and policy corrections as well as more overarching difficulties in maintaining hospital preparedness for high consequence infectious diseases.
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Infection Control

Aborode, A.T., Tsagkaris, C., Jain, S., et al. (2021). Ebola Outbreak amid COVID-19 in the Republic of Guinea: Priorities for Achieving Control. American Journal of Tropical Medicine and Hygiene. 104(6):1966-1969.
This article discusses using Ebola mitigation mechanisms in the Republic of Guinea to combat the 2021 Ebola outbreak in the midst of the COVID-19 pandemic.
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Adepoju, P. (2021). Ebola and COVID-19 in DR Congo and Guinea. The Lancet Infectious Diseases. 21(4):461.
The author describes the differing epidemiology of COVID-19 and Ebola virus disease and the various vaccination strategies for each. The author also explains how experts planned to use capabilities built during past Ebola outbreaks to encourage high COVID-19 vaccination rates.
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* Centers for Disease Control and Prevention. (2024). Infection Prevention and Control Recommendations for Patients in U.S. Hospitals who are Suspected or Confirmed to have Selected Viral Hemorrhagic Fevers (VHF).
This webpage provides guidance for healthcare professionals regarding standard, contact, and droplet precautions when caring for an individual with suspected or confirmed viral hemorrhagic fever.
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Chughtai, A., Barnes, M., and MacIntyre, C. (2016). Persistence of Ebola Virus in Various Body Fluids During Convalescence: Evidence and Implications for Disease Transmission and Control. Epidemiology and Infection. 144(8):1652-1660.
The authors review articles examining persistence of Ebola virus disease in body fluids during the convalescent phase. They note that the virus persists in body fluids following clinical recovery and clearance from the blood and recommend additional study to quantify virus persistence and infectivity after the acute illness phase to better inform infection control guidelines.
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* Keita, A.K., Koundouno, F.R., Faye, M., et al. (2021). Resurgence of Ebola Virus in 2021 in Guinea Suggests a New Paradigm for Outbreaks. Nature. 597:539-543.
The authors used next-generation sequencing to determine that the 2021 outbreak of Ebola virus disease was not due to a novel zoonotic spillover event, but to a persistent or latent infection. The article emphasizes the importance of long-term healthcare and support for survivors of Ebola virus disease.
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Kinganda-Lusamaki, E., Black, A., Mukadi, D.B., et al. (2021). Integration of Genomic Sequencing into the Response to the Ebola Virus Outbreak in Nord Kivu, Democratic Republic of the Congo. Nature Medicine. 27:710-716.
This article reports 744 new genomes of Ebola virus collected from the Democratic Republic of the Congo’s end-to-end genomic surveillance system. The authors discuss how sequence data informed the epidemiologic response and public health decision making.
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Smith, P., Anderson, A., Christopher, G., et al. (2006). Designing a Biocontainment Unit to Care for Patients with Serious Communicable Diseases: A Consensus Statement. Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science. 4(4).
The authors synthesized consensus recommendations collected from a conference of civilian and military professionals who are involved in the various aspects of biocontainment patient care units. Appendices include in-depth information on medical care issues (e.g., staffing the units, pathology, housekeeping), infection control issues (e.g., personal protective equipment, dealing with infectious waste), facility issues (e.g., air-handling, communication), and psychosocial and ethical issues.
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Tang, J., Nicolle, A., Pantelic, J., et al. (2013). Different Types of Door-Opening Motions as Contributing Factors to Containment Failures in Hospital Isolation Rooms. PLoS One. 8(6):e66663.
The authors conducted experiments with different types of doors to assess which allowed the most air into and out of rooms to determine the type of door(s) that hospitals should use for isolation rooms. The effect of human movement on air flow when operating the doors was also examined. The authors contend that sliding doors are the most effective.
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* Kraemer, J., Siedner, M., and Stoto, M. (2015). Analyzing Variability in Ebola-Related Controls Applied to Returned Travelers in the United States. Health Security. 13(5): 295-306.
This study examines the various policies regarding entry screening and quarantine procedures in effect during the 2014 Ebola virus disease epidemic.
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Lessons Learned

ASPR TRACIE. (2016). Lessons Learned in Developing an Effective Regional Ebola CONOPS. United States Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response.
The speakers in this webinar share lessons learned to assist regions in the development of their Ebola concept of operations.
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Bell, B., Damon, I., Jernigan, D., et al. (2016). Overview, Control Strategies, and Lessons Learned in the CDC Response to the 2014-2016 Ebola Epidemic. MMWR Supplement. 65(3):4-11.
The authors provide a history of Ebola virus disease, discuss the response to the recent epidemic, and describe how to apply lessons learned to future outbreaks.
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Brolin Ribacke, K., Saulnier, D., Eriksson, A., and von Schreeb, J. (2016). Effects of the West Africa Ebola Virus Disease on Health-Care Utilization - A Systematic Review. Frontiers in Public Health. 4(222):1-12.
A review of the literature indicates non-Ebola related increases in morbidity and mortality in West Africa due to both a decrease in services available and a decrease in utilization of these services.
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* Connor, M., Kraft, C., Mehta, A., et al. (2015). Successful Delivery of RRT in Ebola Virus Disease. Journal of the American Society of Nephrology. 26(1):31-37.
The authors describe the first successful delivery of renal replacement therapy to an Ebola patient and offer safety considerations and clinical practice guidelines based on the experience.
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Fielding, J., Allen, T., Chu, B., et al. (2016). Report of the Independent Panel on the U.S. Department of Health and Human Services (HHS) Ebola Response. Independent Panel on the U.S. Department of Health and Human Services (HHS) Ebola Response.
This report discusses the findings and recommendations of the independent panel established to examine the U.S. Department of Health and Human Services response to the 2014-2016 Ebola epidemic.
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Foote, M., Daver, R., and Quinn, C. (2017). Using “Mystery Patient” Drills to Assess Hospital Ebola Preparedness in New York City, 2014-2015. (Abstract only.) Health Security. Health Security. 15(5):500-508.
The authors analyzed after-action reports to describe the effectiveness of mystery patient drills to test rapid identification and isolation of potential Ebola cases in emergency departments located in New York City. Several gaps emerged (e.g., ensuring timely screening, staff competency with personal protective equipment, and ensuring staff understand notification procedures and roles). Findings will be used to create a national mystery patient program.
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Herstein, J., Biddinger, P., Kraft, C., et al. (2016). Initial Costs of Ebola Treatment Centers in the United States. Emerging Infectious Diseases. 22(2):350-352.
The authors describe the results of a survey of the 55 designated Ebola treatment centers on their organization and costs incurred to establish.
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Homeland Security Today. (2015). Report Highlights Lessons Learned from Texas Hospital during Ebola Crisis.
This webpage describes the Expert Panel Report to Texas Health Resources Leadership on the 2014 Ebola Events and presents an overview of the findings and recommendations of an independent expert panel charged with reviewing the circumstances surrounding the first patient diagnosed with Ebola Virus Disease in the United States and two nurses who contracted the disease while treating him.
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Houlihan, C., McGowan, C., Dicks, S., et al. (2017). Ebola Exposure, Illness Experience, and Ebola Antibody Prevalence in International Responders to the West African Ebola Epidemic 2014-2016: A Cross-Sectional Study. PLOS Medicine. 14(5):e1002300.
The authors conducted an online survey and antibody testing of oral fluid samples from 268 international volunteers who returned to the United Kingdom and Ireland from West Africa after working during the Ebola outbreak. Samples from two individuals were reactive in initial testing, but follow-up plasma testing was negative, suggesting that asymptomatic infection in returning health workers is rare. Sixteen percent had potential exposures, but none reported receiving post-exposure prophylaxis or being medically evacuated. Of the 21% who reported febrile or diarrheal illness while in West Africa or within one month of return, only 30% were tested for Ebola virus disease. The authors suggest that review and standardization of protocols for the management of possible exposure and illness are needed.
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Jacobsen, K., Aguirre, A., Bailey, C., et al. (2016). Lessons from the Ebola Outbreak: Action Items for Emerging Infectious Disease Preparedness and Response. (Abstract only.) EcoHealth. 13(1):200-212.
The authors identify lessons learned from the Ebola outbreak and list research and policy priorities to prepare for future emerging infectious disease outbreaks. They focus on environmental conditions related to early warning systems, host characteristics related to public health, and agent issues to be addressed through laboratory science.
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Johnson, D., Sullivan, J., Piquette, C., et al. (2015). Lessons Learned: Critical Care Management of Patients with Ebola in the United States. (Abstract only.) Critical Care Medicine. 43(6):1157-1164.
The authors reviewed patient medical records to gather lessons learned from the preparations for and the provision of care of two patients with Ebola virus disease in the biocontainment unit at the University of Nebraska Medical Center.
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* Kamali, A., Jamieson, D., Kpaduwa, J., et al. (2016). Pregnancy, Labor, and Delivery after Ebola Virus Disease and Implications for Infection Control in Obstetric Services, United States. Emerging Infectious Diseases. 22(7):1156-1161.
The authors describe lessons learned through the treatment and delivery of a healthy infant to an Ebola survivor.
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Kardas-Nelson, M. (2019). Ebola in Sierra Leone and DRC: Lessons Learnt. BMJ. 366:I5012.
This article summarizes an interview discussing the experiences of two doctors involved in treating Ebola patients in both Sierra Leone and the DRC from 2013-2016. The author asks about differences in clinical care, communities seeking treatment, experimental treatments, and what is being done at the international level to advance Ebola care and treatment.
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Morgan, D., Braun, B., Milstone, A., et al. (2015). Lessons Learned from Hospital Ebola Preparation. (Abstract only.) Infection Control and Hospital Epidemiology. 36(6):627-631.
A survey was sent to over 250 healthcare institutions who are members of the Society for Healthcare Epidemiology of America to examine costs and challenges associated with hospital Ebola preparation.
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National Academies of Science, Engineering, and Medicine. (2017). Integrating Clinical Research into Epidemic Response: The Ebola Experience.
This report discusses conducting safe and rapid clinical trials of therapeutics and vaccines under development during an outbreak. Using the West African Ebola outbreak to describe lessons learned, the authors identify challenges to conducting research during an epidemic response and identify seven steps to successfully launch clinical trials during an outbreak.
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* National Association of State EMS Officials. (2015). NASEMSO After Action Review: Lessons Learned, Best Practices and Recommendations - Ebola Disease Outbreak.
NASEMSO's Domestic Preparedness Committee prepared this document to highlight critical dates during the Ebola outbreak, provide background information on the disease, describe lessons learned from the response, identify best practices, and recommend actions to federal partners.
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Office of the Assistant Secretary for Preparedness and Response. (2017). Regional Treatment Network for Ebola and Other Special Pathogens.
This report provides information on the regional treatment network established for the management of patients with Ebola and other special pathogens, its oversight and financing, the current state of preparedness, and planning and future considerations.
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The BMJ. (n.d.). Ebola Virus Disease.
This webpage provides updated Ebola guidance for healthcare workers, including patient treatment, diagnostics, and lessons learned. A visual clinical care guide provides quick reference information for infection control, personal protective equipment, and convalescence.
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Toner, E., Shearer, M., Kirk Sell, T., et al. (2017). Health Sector Resilience Checklist for High Consequence Infectious Diseases—Informed by the Domestic US Ebola Response. Centers for Disease Control and Prevention.
The authors discuss the process they used to develop the checklist for isolated cases or limited outbreaks of high consequence infectious disease (e.g., Ebola, Marburg, Lassa, smallpox, SARS, MERS, and H5N1 influenza A). The checklist can help medical and public health authorities work with nongovernmental organizations and private industry, to assess and bolster community health sector resilience.
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* U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2016). U.S. Department of Health and Human Services Ebola Response Improvement Plan Based on Lessons Learned from the 2014-2016 Ebola Epidemic.
This improvement plan addresses the key findings and recommendations of the Report of the Independent Panel on the HHS Ebola Response.
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WHO Ebola Response Team. (2016). After Ebola in West Africa—Unpredictable Risks, Preventable Epidemics. New England Journal of Medicine. 375(6):587-96.
A high level review of the 2013-16 Ebola Viral Disease outbreak reveals that effective management of the next outbreak will require committing resources to both strengthen national health systems and sustain investment in the next generation of vaccines, drugs, and diagnostics.
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Monitoring/Quarantine

Barbisch, D., Koenig, K., and Shih, F. (2015). Is There a Case for Quarantine? Perspectives from SARS to Ebola. (Abstract only.) Disaster Medicine and Public Health Preparedness. 9(5):547-553.
The authors emphasize the need for the public and medical professionals to better understand the meaning of quarantine and explain related terminology. They also provide a case study from Taiwan during the 2002-2003 severe acute respiratory syndrome outbreak. The authors include a quarantine and isolation decision tree that can help policy makers and public health officials in the event of an outbreak.
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* Kraemer, J., Siedner, M., and Stoto, M. (2015). Analyzing Variability in Ebola-Related Controls Applied to Returned Travelers in the United States. Health Security. 13(5): 295-306.
This study examines the various policies regarding entry screening and quarantine procedures in effect during the 2014 Ebola virus disease epidemic.
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Smith, C., Hughes, S., Karwowski, M., et al. (2015). Addressing Needs of Contacts of Ebola Patients During an Investigation of an Ebola Cluster in the United States - Dallas, Texas, 2014. MMWR Morbidity and Mortality Weekly Report. 64(5):121-123.
In this report, the authors discuss the importance of anticipating the nonclinical needs of those under public health surveillance (e.g., concerns about housing, transportation, education, employment, food, and other household needs). The report also stresses the importance of ensuring these types of support are addressed so that residents will be more likely to comply with quarantine orders, and the utility of community collaboration (with partners such as businesses, schools, community and faith-based organizations, and social services).
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Sunshine, G., Pepin, D., Cetron, M., et al. (2015). State and Territorial Ebola Screening, Monitoring, and Movement Policy Statements United States, August 31, 2015. Morbidity and Mortality Weekly Report. 64(40):1145-1146.
This article provides a brief overview of the various policies and procedures regarding Ebola screening and monitoring for asymptomatic individuals.
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Pediatric Issues

American Academy of Pediatrics. (2019). Hemorrhagic Fevers Caused by Filoviruses: Ebola and Marburg. (Note that a paid subscription is required to access this resource.)
This Red Book® chapter is a summary of the epidemiology and clinical manifestations of Ebola and Marburg disease, and includes data from the 2014-2015 Ebola outbreak.
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Davies, H. and Byington, C. (2016). Parental Presence During Treatment of Ebola or Other Highly Consequential Infection. Pediatrics. 138(3):e20161891.
This clinical report from the American Academy of Pediatrics Committee on Infectious Diseases presents options for meeting the needs of patients and their families while posing the least risk to healthcare providers and facilities.
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* Eriksson, C., Uyeki, T., Christian, M., et al. (2015). Care of the Child with Ebola Virus Disease. Pediatric Critical Care Medicine. 16(2):97-103.
The authors discuss considerations for the care of children with Ebola virus disease. They emphasize infection control practices to limit disease spread, and supportive care to treat patients.
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Goodman, A., Meites, A., Anstey, E., et al. (2015). Clinical Inquiries Received by CDC Regarding Suspected Ebola Virus Disease in Children - United States, July 9, 2014-January 4, 2015. Morbidity and Mortality Weekly Report. 64(36):1006-1010.
The following article provides an overview of inquiries to the Centers for Disease Control and Prevention's Emergency Operations Center, which was activated to respond to the Ebola outbreak in West Africa. The Emergency Operations Center and a clinical consultation service were established to assist state and local health departments and health care providers evaluate persons possibly at risk for Ebola. A total of 89 inquiries were received and a discussion of the outcomes is provided.
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Kangbai, J., Heumann, C., Hoelscher, M., et al. (2019). Epidemiological Characteristics, Clinical Manifestations, and Treatment Outcome of 139 Paediatric Ebola Patients Treated at a Sierra Leone Ebola Treatment Center. BMC Infectious Diseases. 19:81.
This article describes a retrospective study to better understand effects of Ebola virus disease on pediatric patients. Medical data for patients under 15 years of age admitted to 34 military hospitals was assessed to determine clinical characteristics and related sociodemographic data.
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Kourtis, A., Appelgren, K., Chevalier, M., et al. (2015). Ebola Virus Disease: Focus on Children. Pediatric Infectious Disease Journal. 34(8):893-897.
The authors provide an overview of the Ebola virus, its epidemiology and transmission, clinical and laboratory manifestations, and treatment and infection control procedures. The authors also discuss what is known about the Ebola virus disease in the pediatric population since research in this area is underdeveloped.
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Olupot-Olupot, P. (2015). Ebola in Children: Epidemiology, Clinical Features, Diagnosis and Outcomes. Pediatric Infectious Disease Journal. 34(3):314-316.
The author looks at the current and past Ebola outbreaks and focuses on infection and how it presents, is diagnosed, and treated in children.
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Shah, T., Greig, J., van der Plas, L., et al. (2016). Inpatient Signs and Symptoms and Factors Associated with Death in Children Aged 5 Years and Younger Admitted to Two Ebola Management Centres in Sierra Leone, 2014: A Retrospective Cohort Study. The Lancet Global Health. 4(7):e495-501.
The authors described outcomes and symptoms relative to symptoms during admission in children five and younger. The study confirmed higher rates of death in children younger than two and those who presented with a high viral load.
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Personal Protective Equipment and Responder Safety

Balci, F. (2016). Isolation Gowns in Health Care Settings: Laboratory Studies, Regulations and Standards, and Potential Barriers of Gown Selection and Use. American Journal of Infection Control. 44(1):104-111.
The author discusses the lack of an isolation gown standard that considers end user desired attributes in addition to barrier resistance.
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Beam, E., Gibbs, S., Hewlett, A., et al. (2015). Clinical Challenges in Isolation Care. (Abstract only.) American Journal of Nursing. 115(4):44-49.
The authors note variation in personal protective equipment practices among nurses in a patient simulation and the potential impact on facility infection control.
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Biondi, M., Garnett, L., Bello, A., et al. (2021). Characterization of Ebola Virus Risk to Bedside Providers in an Intensive Care Environment. Microorganisms. 9(3):498.
To better understand viral transmission, the authors completed an extensive environmental and animal sampling study during intensive care of non-human primates. The found significant unexpected contamination of monitor lines, equipment, and tubes as well as a high risk of exposure during blood draws throughout illness and urine and gastric contents handling in later stage disease.
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* Bratt, J., Robinson, A., and Alcorta, R. (n.d.). Strategies and Considerations for the Deployment of EMS Personal Protective Equipment in Response to an Ebola Outbreak. (Accessed 10/31/2024.) Maryland Institute for Emergency Medical Service Systems.
This article describes protection of emergency medical services personnel through personal protective equipment (PPE), including requirements, PPE cost (and how to estimate it), PPE deployment strategies, and personnel requirements.
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Centers for Disease Control and Prevention. (2024). PPE: Clinically Stable Patients Suspected to have VHF.
This document provides guidance to healthcare workers on donning and doffing personal protective equipment while evaluating a clinically stable person under investigation who does not have bleeding, vomiting, or diarrhea.
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Centers for Disease Control and Prevention. (2024). PPE: Confirmed Patients and Clinically Unstable Patients Suspected to have VHF.
This Centers for Disease Control and Prevention webpage includes guidance for health care staff caring for patients with Ebola or other viral hemorrhagic fever. It also includes steps for donning and doffing personal protective equipment as well as what trained observers should do to ensure these steps are followed.
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Centers for Disease Control and Prevention. (2024). Viral Hemorrhagic Fevers (VHFs): Guidance for Personal Protective Equipment (PPE). U.S. Department of Health and Human Services.
This webpage provides information on clinical PPE guidance for prevention of Ebola virus transmission. It includes a frequently asked questions section related to Ebola PPE, training information, supply considerations, and a PPE calculator.
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Doshi, R., Hoff, N., Bratcher, A., et al. (2020). Risk Factors for Ebola Exposure in Health Care Workers in Boende, Tshuapa Province, Democratic Republic of the Congo. The Journal of Infectious Diseases.
This study aimed to better understand the prevalence and risk factors associated with subclinical and paucisymptomatic Ebola virus disease in healthcare workers. Serologic studies from healthcare workers caring for EVD patients document the marked effects of PPE use but also significant seropositivity in the absence of any clinical disease, consistent with other studies that point to asymptomatic seroconversion in healthcare workers.
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McLaws, M., Chughtai, A., Salmon, S., and MacIntyre, R. (2016). A Highly Precautionary Doffing Sequence for Health Care Workers after Caring for Wet Ebola Patients to Further Reduce Occupational Acquisition of Ebola. American Journal of Infection Control. 44(7):740-744.
The authors reviewed video guidelines to identify exemplary doffing, which they defined as no used personal protective equipment surface coming into contact with mucous membranes, face, or hair.
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United Nations Medical Directors. (2021). Marburg Virus Disease Risk Mitigation Plan for UN Personnel. United Nations Division of Healthcare Management and Occupational Safety and Health.
This document provides occupational health recommendations for U.N personnel traveling to areas impacted by Marburg virus disease cases or outbreaks. This includes precautionary measures to reduce exposure risk when managing suspected or confirmed cases, handling blood or bodily fluids, or cleaning potentially contaminated waste.
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United States Department of Labor, Occupational Safety and Health Administration. (2014). PPE Selection Matrix for Occupational Exposure to Ebola Virus.
The U.S. Department of Labor shares information on the type of personal protective equipment to be worn in various situations (e.g., normal work activities, casual interaction, providing medical and supportive care, cleaning and disinfecting environments, and dealing with waste).
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Plans, Tools, and Templates

Administration for Strategic Preparedness and Response. (2021). National Health Security Strategy. U.S. Department of Health and Human Services.
The goal of the National Health Security Strategy (NHSS) is to strengthen and sustain communities’ abilities to prevent, protect against, mitigate the effects of, respond to, and recover from disasters and emergencies. This webpage includes links to the full text of the strategy, an overview, the NHSS Implementation Plan, the NHSS Evaluation of Progress, and an NHSS Archive.
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Alabama Department of Public Health. (n.d.). Hospital Template for Serious Infectious Disease Procedures. (Accessed 3/17/2021.)
This eight-page template is for the use of hospital administration and planning personnel to identify and communicate key elements of the policy and procedures for screening, identification, and initial management of a suspected serious infectious disease patient. It is intended to be used as a tool to assist in the effective preparation for, implementation, and execution of facility serious infectious disease response plans.
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Centers for Disease Control and Prevention. (2016). Guidance for Developing a Plan for Interfacility Transport of Persons Under Investigation or Confirmed Patients with Ebola Virus Disease in the United States.
This document provides guidance on developing plans for interfacility air or ground transport of persons under investigation and Ebola patients.
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* Centers for Disease Control and Prevention. (2024). Guide for Clinicians Evaluating an Ill Person for VHF or Other High-Consequence Disease. U.S. Department of Health and Human Services.
This guide provides information for healthcare providers on evaluating a patient potentially exposed to ebolavirus. It includes information on exposure risk factors and symptoms of Ebola disease, consultation with local, tribal, state, or territorial health departments after a patient is safely isolated, and a testing algorithm for determining when to test an individual with suspected Ebola disease.
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Chamberlin, M., Okunogbe,A., Moore, M., and Abir, M. (2015). Intra-Action Report A Dynamic Tool for Emergency Managers and Policymakers. RAND Corporation.
The authors coined the term “Intra-Action Report” and tracked and shared the challenges, successes, and lessons being learned and applied during the 2014 response to Ebola.
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* MESH Coalition. (2016). An Exercise in the Provision of Care for an Adult Patient under Investigation (PUI) for Ebola: A Patient Care Drill. (Free registration required.)
This simulation toolkit provides a situation overview, general information, simulation logistics, post-simulation and evaluation activities, and participant information and guidance along with appendices containing templates and forms for hospitals to test their established protocols for the provision of care to a patient with a suspect highly infectious disease. Multiple injects such as vomiting encourage testing a range of different procedures through the exercise.
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Minnesota Department of Health, Association for Professionals in Infection Control and Epidemiology - Minnesota, and Health Care Coalitions of Minnesota. (2019). High Consequence Infectious Disease (HCID) Toolbox for Frontline Health Care Facilities.
This toolbox includes a variety of resources to assist frontline facilities in their readiness activities related to patients with high consequence infectious diseases. Included are planning and training tools, exercise templates, and the components (e.g., screening guide, checklists, posters) to create a readiness binder.
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National Ebola Training and Education Center. (n.d.). NETEC Exercise Templates. (Accessed 9/9/2024.)
This web page includes links to various Homeland Security Exercise and Evaluation Program-compliant templates to assist healthcare coalitions, frontline facilities, assessment hospitals, state-designated Ebola treatment centers, regional Ebola and special pathogen treatment centers, and their respective response partners in the planning and conduct of exercises on the identification, assessment, treatment, management, transport, and transfer of high risk patients. The site includes templates for drills, tabletops, functional, and full-scale exercises. There is also a beginners guide to assist users new to exercise planning.
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National Emerging Special Pathogens Training and Education Center. (2022). Health Care Facility Viral Hemorrhagic Fever Preparedness Checklist.
NETEC developed this checklist to help healthcare facilities assess their ability to identify, isolate, inform, and provide initial treatment to patients known or suspected to be infected with a special pathogen. Healthcare facilities can review their immediate care capabilities and follow links to additional resources that may assist them in filling readiness gaps.
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* National Emerging Special Pathogens Training and Education Center. (2024). EMS Procedural Guidelines for Special Pathogens.
These model procedural guidelines, created by NETEC's EMS/Patient Transport Work Group, are designed to help EMS agencies develop standard operating procedures for the transport and management of patients suspected or confirmed to have a high-consequence infectious disease. The guidelines address personal protective equipment (PPE) donning and doffing, EMS provider down, PPE breaches, biohazard spills, waste management, ambulance modification, and ambulance cleaning and disinfection. They complement ASPR TRACIE's EMS Infectious Disease Playbook (https://files.asprtracie.hhs.gov/documents/aspr-tracie-transport-playbook-508.pdf).
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* Nebraska Medicine. (2022). Viral Hemorrhagic Fever or Orthopox Virus ED Screening.
This flowchart is intended to help screen for potential Ebola, Lassa, Marburg, or Orthopox virus cases in the Emergency Department. It includes color coded procedural steps for processing incoming patients, specific questions to ask, screening notes, and infection control guidance.
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New York City Department of Health and Mental Hygiene. (n.d.). Mystery Patient Drill Toolkit. (Accessed 9/9/2024.)
This toolkit is intended for use by hospital emergency departments, and tests how long it takes for a potential patient with a highly infectious disease to be identified and for staff to begin exposure mitigation procedures; how long it takes for a patient to be transferred to an isolation room; and the capability of the facility to make notifications internally and to the health department. The Toolkit includes scenarios for Ebola Virus Disease, Middle East Respiratory Syndrome, and Measles, but may be modified to suit healthcare facilities of any nature and any type of disease outbreak.
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New York City Health + Hospitals. (2019). Frontline Hospital Planning Guide: Special Pathogens.
This planning guide from New York City Health + Hospitals provides high-level planning information for frontline hospital multidisciplinary teams to support planning and training for the initial care of suspected special pathogen patients while determining whether and when they will be transferred to another facility for further assessment and treatment.
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* The Society for Healthcare Epidemiology of America. (2017). Outbreak Response Training Program (ORTP). (Free account required.)
This webpage contains links to four free toolkits that were developed to provide healthcare providers immediate access to key infectious disease outbreak information and resources. The toolkits contain guidance on incident management, emerging pathogens, IPC strategies, COVID-19, communication, negotiation, and implementation. Each toolkit contains checklists, guidance documents, case studies, and fillable tables to meet the planning and response needs prior to or during an infectious disease outbreak.
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* U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2016). U.S. Department of Health and Human Services Ebola Response Improvement Plan Based on Lessons Learned from the 2014-2016 Ebola Epidemic.
This improvement plan addresses the key findings and recommendations of the Report of the Independent Panel on the HHS Ebola Response.
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Risk Communications

International Federation of Red Cross and Red Crescent Societies. (2018). Psychosocial Support During an Outbreak of Ebola Virus Disease.
Readers can use this document to learn about psychosocial aspects related to Ebola and supportive activities that can be implemented to address these challenges.
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Winters, M., Jalloh, M., Sengeh, P., et al. (2020). Risk Perception During the 2014-2015 Ebola Outbreak in Sierra Leone. BMC Public Health. 20:1539.
This article describes a study aimed at determining how exposure to information, knowledge, and behaviors impacted risk perception during the 2014-2015 Ebola outbreak in Sierra Leone.
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Vaccine/Targeted Treatment

Bausch, D.G. (2021). The Need for a New Strategy for Ebola Vaccination. Nature Medicine. 27:580-581.
Deciding who to vaccinate for Ebola virus in regions at high risk for Ebola outbreaks is difficult because geographic locations of outbreaks are inconsistent, and the understanding of the virus’s reservoirs continues to be limited. This article proposes routine vaccination of at-risk healthcare and frontline workers. It also recommends targeted vaccination during outbreaks.
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Choi, M., Cossaboom, C., Whitesell, A., et al. (2021). Use of Ebola Vaccine: Recommendations of the Advisory Committee on Immunization Practices, United States, 2020. Morbidity and Mortality Weekly Report 70(1):1-12.
This report summarizes recommendations by the Advisory Committee on Immunization Practices to vaccinate adults at high risk of occupational exposure to Zaire ebolavirus. Vaccination is recommended for: persons responding to an outbreak of Ebola virus disease; healthcare personnel working at federally designated Ebola treatment centers; and laboratorians and other biosafety level 4 facility staff.
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Doshi, R., Fleming, M., Mukoka, A., et al. (2020). Vaccination of Contacts of Ebola Virus Disease Survivors to Prevent Further Transmission. The Lancet Global Health. 8(12):E1455-E1456.
The author reviews strategies and actions used to prevent further transmission of Ebola after a relapse case in 2019 resulted in widespread transmission across North Kivu, DRC. New investigational tools, ring vaccination, risk reduction strategies, and established survivor programs are discussed.
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* Feldmann, H., Sprecher, A., and Geisbert, T. (2020). Ebola. The New England Journal of Medicine. 382:1832-1842.
This article provides a comprehensive overview of Ebola, its virologic, epidemiologic, and ecologic features, and information on disease pathogenesis. For clinicians, it includes guidance for diagnosis, patient care, investigational treatment, vaccines, and outbreak management information.
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Gsell, P., Camacho, A., Kucharski, A., et al. (2017). Ring Vaccination with rVSV-ZEBOV Under Expanded Access in Response to an Outbreak of Ebola Virus Disease in Guinea, 2016: An Operational and Vaccine Safety Report. The Lancet. 17(12):1276-84.
The authors describe the first use of an Ebola vaccine in an outbreak setting outside of a clinical trial. More than 1500 individuals, including 303 children age 6 and older, were vaccinated in 4 rings. No confirmed cases were reported among vaccinees or within the rings once vaccination was completed. Mild adverse events were reported in 17% of those age 6-17; 36% of adults also reported adverse events, with 98% being mild. There were no reports of severe vaccine-related adverse events.
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Hansen, F. and Feldmann, H. (2021). Targeting Ebola Virus Replication through Pharmaceutical Intervention. (Abstract only.) Expert Opinion on Investigational Drugs. 30(3):201-226.
This article discusses pharmaceutical interventions which can be used to treat Ebola virus disease. In particular, it examines the FDA-approved monoclonal antibody Inmazeb and the possibility of combining this with other pharmaceuticals which disrupt viral replication.
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Iversen, P., Kane, C., Zeng, X., et al. (2020). Recent Successes in Therapeutics for Ebola Virus Disease: No Time for Complacency. The Lancet Infectious Diseases. 20(9):E231-E237.
This article discusses the recent success of the PALM trial in the DRC in treating acute Ebola virus disease; however, the author underscores the need for continued efforts to treat severe Ebola disease, utilize effective post-exposure prophylaxis, and understand the role of viral persistence as it relates to Ebola.
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* Keita, A.K., Koundouno, F.R., Faye, M., et al. (2021). Resurgence of Ebola Virus in 2021 in Guinea Suggests a New Paradigm for Outbreaks. Nature. 597:539-543.
The authors used next-generation sequencing to determine that the 2021 outbreak of Ebola virus disease was not due to a novel zoonotic spillover event, but to a persistent or latent infection. The article emphasizes the importance of long-term healthcare and support for survivors of Ebola virus disease.
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Lucey, D. (2019). New Treatments for Ebola Virus Disease. (Abstract only.) BMJ. 366:I5371.
This article summarizes Ebola treatment breakthroughs announced in August 2019. The article describes monoclonal antibody clinical trials, new treatment dose protocols, and treatment availability.
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Mulangu, S., Dodd, L., Davey, R., et al. (2019). A Randomized, Controlled Trial of Ebola Virus Disease Therapeutics. The New England Journal of Medicine. 381:2293-2303.
This article outlines the trial of four investigational Ebola therapies during an outbreak in the DRC in 2018. Patients received monoclonal antibody ZMapp (the control group), the antiviral agent remdesivir, the single monoclonal antibody MAb114, or the triple monoclonal antibody REGN-EB3. Of the 681 patients enrolled, results showed both MAb114 and REGN-EB3 reduced Ebola-related mortality.
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Mulangu, S., Mbala-Kingebeni, P., and Mbaya, O.T. (2022). Antibody Use during an Outbreak of Ebola Virus Disease in the Democratic Republic of Congo, 2020. New England Journal of Medicine. 386:1188-1191.
This letter describes scientific breakthroughs leading to antibody treatments for Ebola virus disease, and logistical challenges to distributing the treatments during outbreaks of the Ebola virus.
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Regules, J., Beigel, J., Paolino, K., et al. (2015). A Recombinant Vesicular Stomatitis Virus Ebola Vaccine Preliminary Report. The New England Journal of Medicine. 372:587-588.
The authors share results from two phase 1 trials of an attenuated, replication-competent, recombinant vesicular stomatitis virus (rVSV)-based Ebola prevention vaccine candidate.
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The PREVAIL II Writing Group for the Multi-National PREVAIL II Study Team. (2016). A Randomized, Controlled Trial of ZMapp for Ebola Virus Infection. The New England Journal of Medicine. 375:1448-1456.
A randomized, controlled trial involving 72 patients found that the experimental treatment ZMapp plus the current standard of care was superior to the current standard of care alone by a 91.2% posterior probability. While this is less than the 97.5% pre-study specified probability for superiority and therefore is an inconclusive result, the authors found the results to suggest a positive outcome from the addition of ZMapp to the current standard of care, identified a similar percentage of patients with serious adverse events in both groups, and argued that the study established the feasibility of conducting a randomized, controlled trial during a major public health emergency. Among the factors impacting the results were the inability to enroll the planned 200 patients, which resulted in wide 95% credible intervals, and the deaths of patients before they received all three infusions of ZMapp.
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Tomori, O. and Olatunji Kolawole, M. (2021). Ebola Virus Disease: Current Vaccine Solutions. (Abstract only.) Current Opinion in Immunology. 71:27-33.
This article explores how Ebola vaccines can address traditionally unpredictable outbreaks of Ebola virus which make it difficult to preemptively vaccinate. The authors also highlight the challenges associated with getting vaccines approved for use.
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Women's Health

Black, B., Caluwaerts, S., and Achar, J. (2015). Ebola Virus Disease and Pregnancy. Obstetric Medicine. 8(3):108-113.
The authors provide an overview of the interaction between Ebola and pregnancy, current practices in the field, gaps in knowledge, and potential management strategies.
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Centers for Disease Control and Prevention. (2018). Clinical Guidance for Ebola in People Who Are Pregnant.
This webpage provides guidance for healthcare workers on screening, and treating suspected or confirmed cases of Ebola in pregnant women.
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Foeller, M., Ribeiro do Valle, C., Foeller, T., et al. (2020). Pregnancy and Breastfeeding in the Context of Ebola: A Systematic Review. The Lancet Infectious Diseases. 20(7):E149-E158.
This study evaluated data on pregnant and lactating women diagnosed with acute Ebola virus disease or following recovery. 52 studies were assessed with results showing that nearly all women infected with Ebola virus had adverse pregnancy outcomes. Risk of transmission of Ebola virus from mother-to-child is significant and is likely related to exposure to pregnancy-related fluids and breastmilk.
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* Kamali, A., Jamieson, D., Kpaduwa, J., et al. (2016). Pregnancy, Labor, and Delivery after Ebola Virus Disease and Implications for Infection Control in Obstetric Services, United States. Emerging Infectious Diseases. 22(7):1156-1161.
The authors describe lessons learned through the treatment and delivery of a healthy infant to an Ebola survivor.
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Medina-Rivera, M., Centeno-Tablante, E., Finkelstein, J., et al. (2020). Presence of Ebola Virus in Breast Milk and Risk of Mother-to-Child Transmission: Synthesis of Evidence. Annals of the New York Academy of Sciences.
This systematic review looked at evidence related to the presence of Ebola virus in breastmilk as a potential route for viral transmission during breastfeeding. 148 full text articles were evaluated with eight studies included where breastmilk samples were provided. Results showed that seven of the ten samples detected Ebola virus and four of five infants breastfed Ebola virus positive milk were found to be infected.
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Ottoni, M., Ricciardone, J., Nadimpalli, A., et al. (2020). Ebola-Negative Neonates Born to Ebola-Infected Mothers after Monoclonal Antibody Therapy: A Case Series. The Lancet Child & Adolescent Health. 4(12):P884-888.
The articles reviews a case series that studied two liveborn neonates born to Ebola-positive mothers who received investigational Ebola monoclonal antibody treatment as a part of a clinical trial. The study aims to better understand care of such surviving neonates.
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Sayres, L. and Hughes, B. (2020). Contemporary Understanding of Ebola and Zika Virus in Pregnancy. Clinics in Perinatology. 47(4):835-846.
This article summarizes key information for managing Ebola and Zika virus in pregnant and reproductive aged women, including best practices.
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World Health Organization. (2020). Guidelines for the Management of Pregnant and Breastfeeding Women in the Context of Ebola Virus Disease.
This document provides guidelines and recommendations for the presentation, treatment, and surveillance of women exposed to Ebola virus disease; those who become infected during pregnancy or while breastfeeding; and those who survive Ebola and may become pregnant in the future.
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Agencies and Organizations

Centers for Disease Control and Prevention. Clinical Guidance for Ebola Disease.
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Emory University. Ebola: What's Ahead.
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Institute for Diseases and Disaster Management. Tools and Resources. NYC Health + Hospitals.
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National Emerging Special Pathogens Training and Education Center.
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Occupational Safety and Health Administration. Ebola. U.S. Department of Labor.
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U.S. Food and Drug Administration. Ebola Preparedness and Response Updates from FDA. U.S. Department of Health and Human Services.
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World Health Organization. Ebola Virus Disease.
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This ASPR TRACIE Topic Collection was refreshed in March 2021. It was comprehensively reviewed in April 2015 by John Hick, MD, HHS ASPR and Hennepin County Medical Center.

Additional assistance provided by Alicia Livinski, Biomedical Librarian, HHS National Institutes of Health, and the following subject matter experts (listed in alphabetical order): James A. Geiling, MD, MPH, FCCM, Consultant and Professor of Medicine, Geisel School of Medicine at Dartmouth; Dan Hanfling, MD (Panel Chair, Editor) Contributing Scholar, UPMC Center for Health Security, Member, InterAgency Board, Attending Physician, BestPractices, Inc. (a division of EmCare), and Clinical Professor of Emergency Medicine, George Washington University; Nathaniel Hupert, MD, IPA Consultant, HHS-ASPR-BARDA and HPP, Associate Professor of Healthcare Policy and Research and of Medicine, Weill Medical College, Cornell University HHS ASPR; Aaron Resnick, Planning and Preparedness Manager, Northwest Healthcare Response Network; and Connie Savor Price, MD, Chief, Infectious Diseases, Medical Director, Infection Prevention, Denver Health and Hospital, Professor of Medicine, University of Colorado-Denver.
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