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Ebola Virus Disease by PCR

EVD

Instructions

• Specimens for Ebola Virus Disease may NOT be sent to Beaumont Laboratory without prior approval by Microbiology Administration.
• Beaumont Royal Oak is unable to obtain samples fortesting. Patient should be stabilized, if need be, and transfered to Beaumont Wayne.

Prior approval for testing must be obtained from MDHHS by Beaumont Laboratory personnel. MDHHS and CDC will not approve testing unless the following criteria are fulfilled:

1. The patient must have traveled to or been in contact with a person from the West African countries of Guinea, Liberia, or Sierra Leone within the past 21 days and have symptoms of an illness suggestive of Ebola Virus Disease.
2. An Infectious Diseases physician must determine that the patient is a Person Under Investigation.
3. After specimens have been received in the High Containment Laboratory, the Microbiology Laboratory will be contacted for assistance to complete required MDHHS forms for submission of specimens for testing.
4. Microbiology Administration will work with MDHHS Epidemiology and Infectious Disease to complete the Ebola Virus Consultation forms: http://www.michigan.gov/documents/emergingdiseases/Michigan_EBOLA_Guidance_464829_7.pdf.
5. Results from the following tests will be requested by CDC and MDHHS Epidemiology to appropriately evaluate the patient before approval for testing:
   • Platelet Count
   • AST/ALT
   • INR
   • Creatinine
   • Hgb/HCT
   • Malaria
6. MDHHS is available at 517-335-8165 during normal business hours or at 517-335-9030 after normal business hours. The MDHHS FAX number is 517-335-8263.
7. MDHHS will forward all information to CDC for permission to perform Ebola PCR.
8. No specimens will be sent to MDCH until permission is received from CDC for testing.
9. Approved specimens will be transported to MDHHS by a Beaumont Laboratory courier. Transportation can be arranged by calling Client Services (248-551-1155). After hours, contact the Beaumont Laboratory Courier Coordinator at pager 248-995-4717.
10. Questions about Ebola Virus Disease can be answered by calling the Hotline at 248-898-0880.

Laboratory

All testing is performed by the Michigan Department of Health Human Services(MDHHS), Lansing, MI, following acquisition of approval for testing from that institution.

Performed

Sunday - Saturday.
PCR results available within 24 hours after receipt of the specimen at MDHHS. Positive results are only released by MDHHS upon approval by the Centers for Disease Control and Prevention. 

Reference Range

Negative.

Test Methodology

Polymerase Chain Reaction (CDC methodology).

Interpretation

This assay determines the presence of nucleic acid (RNA) Ebola Virus (Zaire strain) in specimens of blood from patients who have been exposed to persons with the disease.

Clinical Disease

Fever, myalgia, vomiting, diarrhea, and/or abdominal pain are among the most consistently observed signs early in the course of EVD. These symptoms are nonspecific and can be seen in other illnesses (such as malaria, typhoid fever, and Lassa fever) common in the areas where EVD is presently occurring. Clinically evident bleeding is noted in only about one-third of the patients.

Epidemiology

In early 2014, investigation of cases of fever, vomiting, and severe diarrhea led to the identification of Ebola virus disease in Guinea. Previously only a single case of human infection with Tai Forest Ebola virus in Ivory Coast in 1994 had been reported, and Ebola virus disease (EVD) was viewed as endemic in Central, but not West, Africa. The Ebola virus identified in Guinea appears to have had a common ancestor with Zaire Ebola virus strains circulating in Central Africa, with subsequent parallel evolution with them. As of August 21, 2014, EVD in West Africa is now the largest and most complex epidemic of Ebola ever. More than 13,567 cases with a fatality rate of approximately 60% have occurred primarily in Guinea, Sierra Leone, and Liberia. The World Health Organization now registers it as a Public Health Emergency of International Concern (PHEIC).

Incubation Period

The average incubation period is 8-10 days (range 2-21 days).

Transmission

It is critical to take a travel history form patients presenting with these symptoms. This includes dates and location of travel to and within affected areas not just of the patient but of others with whom the patient has been in close contact. For those who have travelled to areas with ongoing Ebola transmission, questions should focus on close contact with or care of ill persons, clinical or laboratory work in medical facilities, preparation of the dead for burial or participation in funeral rites, and handling of bats, rodents, or primates. Use of personal protective equipment (PPE) with any of these activities should be assessed as well.

Reference

1. American Society for Microbiology. 2014. ASM Ebola FAQ. November 2014.
2. Michigan Department of Health and Human Services, 2014. Ebola Virus: Guidance for Michigan Local Health Departments and Healthcare Providers. Revised October 31, 2014.
3. Infectious Diseases Society of America. 2014. IDSA Ebola Guidance. August 21, 2014.

Contacts

Last Updated

10/25/2019