Characterization of Ebola Virus Risk to Bedside Providers in an Intensive Care Environment

Abstract

Background: The 2014–2016 Ebola outbreak in West Africa recapitulated that nosocomial spread of Ebola virus could occur and that health care workers were at particular risk including notable cases in Europe and North America. These instances highlighted the need for centers to better prepare for potential Ebola virus cases; including understanding how the virus spreads and which interventions pose the greatest risk. Methods: We created a fully equipped intensive care unit (ICU), within a Biosafety Level 4 (BSL4) laboratory, and infected multiple sedated non-human primates (NHPs) with Ebola virus. While providing bedside care, we sampled blood, urine, and gastric residuals; as well as buccal, ocular, nasal, rectal, and skin swabs, to assess the risks associated with routine care. We also assessed the physical environment at end-point. Results: Although viral RNA was detectable in blood as early as three days post-infection, it was not detectable in the urine, gastric fluid, or swabs until late-stage disease. While droplet spread and fomite contamination were present on a few of the surfaces that were routinely touched while providing care in the ICU for the infected animal, these may have been abrogated through good routine hygiene practices. Conclusions: Overall this study has helped further our understanding of which procedures may pose the highest risk to healthcare providers and provides temporal evidence of this over the clinical course of disease.

Hemorrhagic Fever Viruses: Pathogenesis and Countermeasures

“…The EBOV NHP model is further highlighted in this special issue through cynomolgus macaque transcriptomics and host miRNAs data that are associated with fatal disease outcome [ 18 ]. In depth understanding of pathogenesis through these models can often lead to information that can be used to approach how to treat these diseases using previously approved drugs [ 19 ], how to deploy vaccines that are efficacious [ 20 ], and how routine care in EBOV intensive care units can present risks to health care workers from patients [ 21 ].…”