Ebola disease interim case definition for reporting in the EU/EEA

This case definition aims to classify Ebola disease cases for epidemiological purpose and relies on clinical, epidemiological, laboratory and high-risk exposure criteria, allowing the identification of people who are required to be investigated for Ebola disease and the differentiation of probable and confirmed cases for epidemiological reporting in the EU/EEA.

The interim case definition to be applied for cases associated with the ongoing Ebola disease outbreak caused by Bundibugyo virus (BDBV), adapted from [1] is presented below.

Clinical criteria  

In the context of the ongoing Ebola disease outbreak caused by BDBV, any person presenting or having presented before death with:

At least one of the following symptoms:

• systemic symptoms: reported or documented fever, headache, fatigue/asthenia, joint or muscular pain;
• respiratory symptoms: sore throat/pharyngitis, difficulty breathing/dyspnoea;
• digestive symptoms: anorexia/loss of appetite, nausea/vomiting, diarrhoea, abdominal pain;
• other symptoms: skin rash, hiccups, confusion, coma;

unexplained haemorrhagic manifestations in various forms (e.g. bleeding gum, epistaxis, hematemesis, injection bleeding, melaena, haematuria, ecchymosis/haematoma);

OR 

Any person presenting with multi-organ failure; 

OR 

A person who died suddenly and inexplicably. 

Laboratory criteria

 Any of the following:

• Detection of BDBV nucleic acid in a clinical specimen^(*) and confirmation by sequencing or a second assay on different genomic targets;

Isolation of BDBV from a clinical specimen. 

^(*)Persons under investigations that test negative on blood specimens drawn less than 72 hours after symptom onset should remain in isolation and a second test should be performed on a fresh sample taken more than 72 hours following onset of symptoms [2]. 

Epidemiological criteria

In the 21 days before the onset of symptoms:

• having been in an area affected^(**) by the outbreak;

 OR  

• having had contact with a probable or confirmed case. 

(**) Latest epidemiological updates including information on affected areas can be found at the ECDC epidemiological updates and the Communicable Disease Threats Report. Outbreak updates are also available through other official sources such as the World Health Organisation and Africa CDC.

High-risk exposure criteria

A person meeting the epidemiological criteria and any of the following:

• close face-to-face contact (e.g. within one metre) without appropriate personal protective equipment (including eye protection) with a probable or confirmed case who was coughing, vomiting, bleeding, or who had diarrhoea;
• direct contact with any material soiled by bodily fluids from a probable or confirmed case;
• percutaneous injury (e.g. with needle) or mucosal exposure to bodily fluids, tissues or laboratory specimens of a probable or confirmed case;
• participation in funeral rites with direct exposure to human remains in or from an affected area without appropriate personal protective equipment;
• had unprotected sexual contact with a case up to three months after recovery; direct contact with bats, rodents, non-human primates, living or dead, in or from Ebola disease affected areas, or bushmeat.

Only confirmed cases are to be reported at the European level using the EpiPulse Events system and the Early Warning and Response System. The 'probable case' classification is provided for information only.

Any person

• meeting the clinical and epidemiological criteria;

OR

• with high-risk exposure developing any of the symptoms listed as clinical criteria.

Not applicable. 

A person meeting the clinical and high-risk exposure criteria OR a sudden, unexplained death meeting the epidemiological criteria. 

A person meeting the laboratory criteria. 

References

1. EU case definition for viral haemorrhagic fevers. Commission Implementing Decision 2012/506/EU of 8 August 2012, amending Decision 2002/253/EC laying down case definitions for reporting communicable diseases to the Community network under Decision No 2119/98/EC of the European Parliament and of the Council. (p48)
2. ECDC Laboratory guidance and resources. Available at: https://www.ecdc.europa.eu/en/ebola-disease/surveillance-and-updates/eb…).