10/9/2014 Ebolavirus - Pathogen Safety Data Sheets

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EBOLAVIRUS
For more information about Ebola, visit Ebola Virus Disease
PATHOGEN SAFETY DATA SHEET - INFECTIOUS SUBSTANCES
SECTION I - INFECTIOUS AGENT
NAME: Ebolavirus
SYNONYM OR CROSS REFERENCE: African haemorrhagic fever, Ebola haemorrhagic fever (EHF,
Ebola HF), filovirus, EBO virus (EBOV), Zaire ebolavirus (ZEBOV), Sudan ebolavirus (SEBOV, SUDV),
Ivory Coast ebolavirus (ICEBOV), Tai Forest ebolavirus (TAFV), Ebola-Reston (REBOV, EBO-R,
Reston Virus, RESTV), Bundibugyo ebolavirus (BEBOV, BDBV), and Ebola virus disease (EVD)
1

2

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4
.
CHARACTERISTICS: Ebola was discovered in 1976 and is a member of the Filoviridae family
(previously part of Rhabdoviridae family, which were later given a family of their own based on their
genetic structure). Five Ebola species have been identified: Zaire ebolavirus (ZEBOV), which was
first identified in 1976 and is the most virulent; Sudan ebolavirus, (SEBOV); Tai Forest ebolavirus
(formerly Ivory Coast ebolavirus); Ebola-Reston (REBOV), originating from the Philippines; and
Bundibugyo ebolavirus (BEBOV), the most recent species discovered (2008)
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3

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Ebola is an elongated filamentous virus, which can vary between 800 - 1000 nm in length, and can
reach up to 14000 nm long (due to concatamerization) with a uniform diameter of 80 nm
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It contains a helical nucleocapsid (with a central axis), 20 - 30 nm in diameter, and is enveloped by
a helical capsid, 40 - 50 nm in diameter, with 5 nm cross-striations
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. The pleomorphic
viral fragment may take on several distinct shapes (e.g., in the shape of a "6", a "U", or a circle),
and are contained within a lipid membrane
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5
. Each virion contains a single-strand of non-
segmented, negative-sense viral genomic RNA
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11
.
SECTION II - HAZARD IDENTIFICATION
PATHOGENICITY/TOXICITY: Ebola virions enter host cells through endocytosis and replication
occurs in the cytoplasm. Upon infection, the virus affects the host blood coagulative and immune
defence system and leads to severe immunosuppression
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12
. Early signs of infection are non-
specific and flu-like, and may include sudden onset of fever, asthenia, diarrhea, headache, myalgia,
arthralgia, vomiting, and abdominal pains
13
. Less common early symptoms include conjunctival
injection, sore throat, rashes, and bleeding. Shock, cerebral oedema, coagulation disorders, and
secondary bacterial infection may co-occur later in infection
8
. Haemorrhagic symptoms may begin
4 - 5 days after onset, including hemorrhagic conjunctivitis, pharyngitis, bleeding gums, oral/lip
ulceration, hematemesis, melena, hematuria, epistaxis, and vaginal bleeding
14
. Hepatocellular
damage, marrow suppression (such as thrombocytopenia and leucopenia), serum transaminase
elevation, and proteinuria may also occur. Persons that are terminally ill typically present with
obtundation, anuria, shock, tachypnea, normothermia to hypothermia, arthralgia, and ocular
diseases
15
. Haemorrhagic diathesis is often accompanied by hepatic damage and renal failure,
central nervous system involvement, and terminal shock with multi-organ failure
1

2
. Contact with
the virus may also result in symptoms such as severe acute viral illness, malaise, and
maculopapular rash. Pregnant women will usually abort their foetuses and experience copious
bleeding
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. Fatality rates range between 50 - 100%, with most dying of hypovolemic shock and
multisystem organ failure
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.
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Pathogenicity between species of Ebola does not differ greatly in that they have all been associated
with hemorrhagic fever outbreaks in humans (excluding Reston) and non-human primates. The
Ebola-Zaire and Sudan strains are especially known for their virulence with up to 90% fatality rate
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, with reduced virulence noted in the Tai Forest ebolavirus and the more recently discovered
Bundibugyo strain, which caused a single outbreak in Uganda
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7
. Bundibugyo was the outbreak
virus in Isiro, Democratic Republic of Congo, in 2012. Ebola-Reston was isolated from cynomolgus
monkeys from the Philippines in 1989 and is less pathogenic in non-human primates. Ebola-Reston
virus appears to be non-pathogenic in humans, with reported health effects limited to serological
evidence of exposure as identified in 4 animal handlers working with infected non-human primates
19
.
EPIDEMIOLOGY: Occurs mainly in areas surrounding rain forests in equatorial Africa
10
with the
exception of Reston, which has been documented to originate in the Philippines
7
. No
predispositions to infection have been identified among infected persons.
The largest recorded ebolavirus outbreak to date began in March 2014, with initial cases reported in
Guinea and then additional cases identified in the surrounding regions (Liberia, Sierra Leone,
Nigeria). A new strain of the ZEBOV species was identified as the causative agent of the outbreak
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HOST RANGE: Humans, various monkey species, chimpanzees, gorillas, baboons, and duikers are
natural animal hosts for ebolavirus
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. Serological
evidence of immunity markers to ebolavirus in serum collected from domesticated dogs suggests
asymptomatic infection is plausible, likely following exposure to infected humans or animal carrion
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. The Ebolavirus genome was discovered in two species of rodents and one species of shrew
living in forest border areas, raising the possibility that these animals may be intermediary hosts
34
. Experimental studies of the virus have been done using mouse, pig, guinea pig, and hamster
models, suggesting wild-type ebolavirus has limited pathogenicity in these models
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.
Bats are considered to be a plausible reservoir for the virus. Serological evidence of infection with
ebolavirus (antibody detection to EBOV, ZEBOV, and/or REBOV) has been reported in fruit bats
collected from woodland and forested areas near Ghana and Gabon, with reduced frequency of
isolation from bats collected in mainland China and Bangladesh
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INFECTIOUS DOSE: Viral hemorrhagic fevers have an infectious dose of 1 - 10 organisms by
aerosol in non-human primates
41
.
MODE OF TRANSMISSION: In an outbreak, it is hypothesized that the first patient becomes
infected as a result of contact with an infected animal
22
. Person-to-person transmission occurs via
close personal contact with an infected individual or their body fluids during the late stages of
infection or after death
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. Nosocomial infections can occur through contact with infected
body fluids for example due to the reuse of unsterilized syringes, needles, or other medical
equipment contaminated with these fluids
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2
. Humans may be infected by handling sick or dead
non-human primates and are also at risk when handling the bodies of deceased humans in
preparation for funerals
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.
In laboratory settings, non-human primates exposed to aerosolized ebolavirus from pigs have
become infected, however, airborne transmission has not been demonstrated between non-human
primates
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. Viral shedding has been observed in nasopharyngeal secretions and
rectal swabs of pigs following experimental inoculation
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INCUBATION PERIOD: Two to 21 days
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COMMUNICABILITY: Communicable as long as blood, body fluids or organs, contain the virus.
Ebolavirus has been isolated from semen 61 to 82 days after the onset of illness, and transmission
through semen has occurred 7 weeks after clinical recovery
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SECTION III - DISSEMINATION
RESERVOIR: The natural reservoir of Ebola is unknown
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2
. Antibodies to the virus have been
found in the serum of domestic guinea pigs and wild rodents, with no relation to human
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transmission
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. Serum antibodies and viral RNA have been identified in some bat species,
suggesting bats may be a natural reservoir
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ZOONOSIS: Zoonosis between humans and animal is suspected
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VECTORS: Unknown.
SECTION IV - STABILITY AND VIABILITY
All information available on stability and viability comes from peer-reviewed literature
sources depicting experimental findings and is intended to support local risk assessments
in a laboratory setting.
DRUG SUSCEPTIBILITY: Unknown. Although clinical trials have been completed, no vaccine has
been approved for treatment of ebolavirus. Similarly, no post-exposure measures have been
reported as effective in treating ebolavirus infection in humans although several studies have been
completed in animals to determine the efficacy of various treatments.
DRUG RESISTANCE: There are no known antiviral treatments available for human infections.
SUSCEPTIBILITY TO DISINFECTANTS: Ebolavirus is susceptible to 3% acetic acid, 1%
glutaraldehyde, alcohol-based products, and dilutions (1:10-1:100 for 10 minutes) of 5.25%
household bleach (sodium hypochlorite), and calcium hypochlorite (bleach powder)
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. The WHO recommendations for cleaning up spills of blood or body fluids suggest
flooding the area with a 1:10 dilutions of 5.25% household bleach for 10 minutes for surfaces that
can tolerate stronger bleach solutions (e.g., cement, metal)
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. For surfaces that may corrode or
discolour, they recommend careful cleaning to remove visible stains followed by contact with a
1:100 dilution of 5.25% household bleach for more than 10 minutes.
PHYSICAL INACTIVATION: Ebola are moderately thermolabile and can be inactivated by heating
for 30 minutes to 60 minutes at 60C, boiling for 5 minutes, or gamma irradiation (1.2 x106 rads to
1.27 x106 rads) combined with 1% glutaraldehyde
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50
. Ebolavirus has also been determined
to be moderately sensitive to UVC radiation
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.
SURVIVAL OUTSIDE HOST: Filoviruses have been reported capable to survive for weeks in blood
and can also survive on contaminated surfaces, particularly at low temperatures (4C)
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. One
study could not recover any Ebolavirus from experimentally contaminated surfaces (plastic, metal or
glass) at room temperature
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. In another study, Ebolavirus dried onto glass, polymeric silicone
rubber, or painted aluminum alloy is able to survive in the dark for several hours under ambient
conditions (between 20 and 250C and 3040% relative humidity) (amount of virus reduced to 37%
after 15.4 hours), but is less stable than some other viral hemorrhagic fevers (Lassa)
53
. When
dried in tissue culture media onto glass and stored at 4 C, Zaire ebolavirus survived for over 50
days
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. This information is based on experimental findings only and not based on observations in
nature. This information is intended to be used to support local risk assessments in a laboratory
setting.
A study on transmission of ebolavirus from fomites in an isolation ward concludes that the risk of
transmission is low when recommended infection control guidelines for viral hemorrhagic fevers are
followed
64
. Infection control protocols included decontamination of floors with 0.5% bleach daily
and decontamination of visibly contaminated surfaces with 0.05% bleach as necessary.
SECTION V - FIRST AID / MEDICAL
SURVEILLANCE: Definitive diagnosis can be reached rapidly in an appropriately equipped
laboratory using a multitude of approaches, including RT-PCR to detect viral RNA, ELISA based
techniques to detect anti-Ebola antibodies or viral antigens, immunoelectron microscopy to detect
ebolavirus particles in tissues and cells, and indirect immunofluorescence to detect antiviral
antibodies
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2

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41
. It is useful to note that the Marburg virus is morphologically
indistinguishable from the ebolavirus, and laboratory surveillance of Ebola is extremely hazardous
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2

14

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. Please see the interim biosafety guidelines for laboratories handling specimens
from patients under investigation for EVD for more information.
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Note: All diagnostic methods are not necessarily available in all countries.
FIRST AID/TREATMENT: There is no effective antiviral treatment
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. Instead, treatment is
supportive, and is directed at maintaining organ function and electrolyte balance and combating
haemorrhage and shock
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.
IMMUNIZATION: None
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PROPHYLAXIS: None. Management of the Ebola virus is solely based on isolation and barrier-
nursing with symptomatic and supportive treatments
8
.
SECTION VI - LABORATORY HAZARDS
LABORATORY-ACQUIRED INFECTIONS: One reported near-fatal case following a minute finger
prick in an English laboratory (1976)
56
. A Swiss zoologist contracted Ebola virus after performing
an autopsy on a chimpanzee in 1994
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57
. An incident occurred in Germany in 2009 when a
laboratory scientist pricked herself with a needle that had just been used on a mouse infected with
Ebola; however, human infection was not confirmed. Additional incidents were recorded in the US in
2004, and a fatal case in Russia in 2004
8
.
SOURCES/SPECIMENS: Blood, serum, urine, respiratory and throat secretions, semen, and organs
or their homogenates from human or animal hosts
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2

53
. Human or animal hosts, including non-
human primates, may represent a further source of infection
54
.
PRIMARY HAZARDS: Accidental parenteral inoculation, respiratory exposure to infectious
aerosols/droplets, and/or direct contact with skin or mucous membranes
54
.
SPECIAL HAZARDS: Work with, or exposure to, infected non-human primates, rodents, or their
carcasses represents a risk of human infection
54
.
SECTION VII - EXPOSURE CONTROLS / PERSONAL PROTECTION
RISK GROUP CLASSIFICATION: Risk Group 4
58
.
CONTAINMENT REQUIREMENTS: Containment Level 4 facilities, equipment, and operational
practices for work involving infectious or potentially infectious materials, animals, and cultures.
Please see the interim biosafety guidelines for laboratories handling specimens from
patients under investigation for EVD for more information.
PROTECTIVE CLOTHING: Personnel entering the laboratory must remove street clothing, including
undergarments, and jewellery, and change into dedicated laboratory clothing and shoes, or don full
coverage protective clothing (i.e., completely covering all street clothing). Additional protection may
be worn over laboratory clothing when infectious materials are directly handled, such as solid-front
gowns with tight fitting wrists, gloves, and respiratory protection. Eye protection must be used
where there is a known or potential risk of exposure to splashes.
OTHER PRECAUTIONS: All activities with infectious material should be conducted in a biological
safety cabinet (BSC) in combination with a positive pressure suit, or within a class III BSC line.
Centrifugation of infected materials must be carried out in closed containers placed in sealed safety
cups, or in rotors that are unloaded in a biological safety cabinet. The integrity of positive pressure
suits must be routinely checked for leaks. The use of needles, syringes, and other sharp objects
should be strictly limited. Open wounds, cuts, scratches, and grazes should be covered with
waterproof dressings. Additional precautions should be considered with work involving animal
activities.
SECTION VIII - HANDLING AND STORAGE
SPILLS: Allow aerosols to settle and, wearing protective clothing, gently cover spill with paper
towels and apply suitable disinfectant, starting at the perimeter and working towards the centre.
Allow sufficient contact time before clean-up.
DISPOSAL: Decontaminate all materials for disposal from the containment laboratory by steam
sterilisation, chemical disinfection, incineration or by gaseous methods. Contaminated materials
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include both liquid and solid wastes.
STORAGE: In sealed, leak-proof containers that are appropriately labelled and locked in a
Containment Level 4 laboratory.
SECTION IX - REGULATORY AND OTHER INFORMATION
REGULATORY INFORMATION: The import, transport, and use of pathogens in Canada is
regulated under many regulatory bodies, including the Public Health Agency of Canada, Health
Canada, Canadian Food Inspection Agency, Environment Canada, and Transport Canada. Users are
responsible for ensuring they are compliant with all relevant acts, regulations, guidelines, and
standards.
UPDATED: August 2014.
PREPARED BY: Centre for Biosecurity, Public Health Agency of Canada.
Although the information, opinions and recommendations contained in this Pathogen Safety Data
Sheet are compiled from sources believed to be reliable, we accept no responsibility for the
accuracy, sufficiency, or reliability or for any loss or injury resulting from the use of the information.
Newly discovered hazards are frequent and this information may not be completely up to date.
Copyright
Public Health Agency of Canada, 2014
Canada
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