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

Case definition

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.

This case definition can be applied for cases associated with the ongoing Ebola disease outbreak caused by Bundibugyo virus (BDBV) in the Democratic Republic of the Congo (DRC).

Criteria

Clinical criteria  

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

  • Fever ≥ 38.6°C

AND any of the following:

  • Severe headache;  
  • Vomiting, diarrhoea, abdominal pain;     
  • Unexplained haemorrhagic manifestations in various forms;     
  • 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. 

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 Ebola disease case. 

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 Ebola disease case who was coughing, vomiting, bleeding, or who had diarrhoea;
  • had unprotected sexual contact with a case up to three months after recovery;
  • direct contact with any material soiled by bodily fluids from a probable or confirmed Ebola disease 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;
  • direct contact with bats, rodents, non-human primates, living or dead, in or from Ebola disease affected areas, or bushmeat.

Person under investigation

A person

  • meeting the clinical and the epidemiological criteria;

OR

  • with high-risk exposure and any of the listed symptoms, including fever of any grade.

Case classification for reporting at EU level

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.

Possible case

Not applicable. 

Probable case

A person meeting the clinical and high-risk exposure criteria. 

Confirmed case

A person meeting the laboratory criteria. 

References

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)