Ebola haemorrhagic fever prevention and control plan (second edition) 
 
 
The national health and family planning commission of the People's Republic of China 
 
 
The 2014-08-15 

Ebola hemorrhagic fever is caused by the ebola virus an acute hemorrhagic infectious disease. Mainly through contact with patient or infected animal's blood, body fluids, secretions and excretions and infection, such as clinical manifestations are mainly protuberant fever, hemorrhage, and multiple organ damage. Ebola haemorrhagic fever case fatality rate is high, can reach 50% 90%. The disease was first discovered in Africa, in 1976, mainly in Uganda, Congo, Gabon, Sudan, Liberia, sierra leone, ivory coast, South Africa, guinea, Nigeria and other African countries.
 
An overview, disease
 
(a) etiology
 
The ebola virus is a filamentous virus families, for both single strand RNA virus negative chain segments. Viruses are long filaments, can show rods, filiform, "L" shape, and other forms. Poison grain length is 1000 nm, average diameter of about 100 nm. Viruses have lipid envelope, coated with a brush on the arrangement of bumps, is mainly composed of virus glycoprotein. The ebola virus RNA genome is regardless of segmental negative chain, size of 18.9 KB, 7 structural protein coding and 1 non structural protein.
 
The ebola virus in people, monkey, guinea pigs, such as mammalian cells proliferation, sensitive to Vero and Hela cells.
 
The ebola virus can be divided into Zaire, Sudan, tower, forest type, reston and bundibugyo. Besides reston type of people do not pathogenic, the remaining four subtypes infection after all can lead to disease. Different subtypes of the virus genome nucleotide differences, but the same strain of the virus genome is relatively stable.
 
The ebola virus has moderate resistance to heat, at room temperature and 4 ℃ for 1 month after the infective has no obvious change, need 1 hour, 60 ℃ inactivated virus inactivated 100 ℃ for 5 minutes. The virus to ultraviolet radiation, gamma rays, formaldehyde, hypochlorous acid, phenol and other disinfectants and sensitive fat solvents.
 
(2) the characteristics of epidemiology
 
1. The source of infection and host animals
 
People infected with ebola virus and primates for the disease infection.
 
Now think that the natural reservoir of the ebola virus for bats of fruit bats, especially the hammer head fruit bats, rich's former shoulder fruit bats and small fruit bats, but the way of circulation in nature is unknown.
 
2. The route of transmission
 
Contact transmission is the main way to spread this disease. Can contact with patients and infected animal's blood, body fluids, secretions, infection of waste and pollutants.
 
Cases of infection site mainly for medical institutions and family, in a normal business activities, travel, social interaction and common workplace low risk of infection. The patient infected can maintain high levels of virus in the blood. Medical staff, or other close contacts of the patient's family in patient treatment and nursing care or treatment of patients in the process, if there is no strict protective measures, vulnerable to infection.
 
According to reports in the literature, the semen of patients with ebola haemorrhagic fever can be separated to the virus, so the existence possibility of communication. Animal experiments have shown that the ebola virus can be spread by aerosol. Although has not yet been confirmed cases through sexual transmission and spread through the air, but should be vigilant, do a good job protection.
 
3. The population susceptibility
 
The ebola virus common human susceptibility. Mainly focus on adult disease, which related to exposure or access to more opportunities. There is no data to indicate the difference between different genders.
 
(3) the clinical manifestations
 
The incubation period for 2-21 days of the disease, generally for 8 to 10 days. We have not found the incubation period can be contagious.
 
Patients with acute onset, fever and rapid progress to high fever, fatigue, headache, muscle pain, sore throat, etc; And there may be nausea, vomiting, abdominal pain, diarrhea, skin rash, etc. In course of 3-4 days can enter the stage, with persistent high fever, infection symptoms and digestive tract symptom is aggravating, have different degree of bleeding, including the skin mucous membrane bleeding, hematemesis and hemoptysis, hematochezia, hematuria, etc.; Severe cases can appear disturbance of consciousness, shock and multiple organ involvement, many died of bleeding in 2 weeks after onset, multiple organ dysfunction, etc.
 
(4) the pathological features
 
The main pathological changes is bleeding in the skin, mucous membrane, viscera, multiple organ can see focal necrosis. Liver cells points, focal necrosis is the typical characteristics of this disease, visible small contains and apoptotic bodies.
 
The discovery of 2, case and report
 
Medical institutions at all levels and the entry-exit inspection and quarantine agencies found that conform to the ebola haemorrhagic fever under observation, suspected or confirmed cases, shall timely report the relevant information. Case classification and definition of the reference on the printing of ebola hemorrhagic fever cases related to the path of the diagnosis and treatment of notice (countries who invented electric [2014] 44). Under observation cases, suspected cases and confirmed cases shall be within 2 hours from the infectious disease report information management system for the network straight newspaper, disease name select "ebola haemorrhagic fever" in "other infectious diseases. Entry-exit inspection and quarantine agencies found under observation cases, received by transfer of medical institutions for the network straight newspaper. For disease control and prevention institutions at various levels shall finish the report within 2 hours through the network information 3-level auditing. To report under observation cases, suspected cases after to make further diagnosis, shall be carried out in a timely correction. For confirmed cases shall also report through the public health emergency information system. Information reporting requirements and the way by the Chinese center for disease control and prevention issued.
 
Third, laboratory testing
 
Under observation cases, suspected cases and confirmed cases of blood specimens for laboratory related to the etiology and serological detection, concrete testing plan by the Chinese center for disease control and prevention issued.
 
Laboratory etiology and serological detection related activities in strict accordance with the list of human infection of pathogenic microorganism, carried out in the corresponding level of biological safety laboratory. Virus culture in BSL - 4 laboratory, animal infection experiment on ABSL - 4 the operation of the laboratory, infection without training materials, inactivated materials in BSL - 3 laboratory operations, no infectious materials in BSL - 2 laboratory in BSL - 1 lab operation.
 
Fourth, prevention and control measures
 
There is currently no vaccine to prevent ebola haemorrhagic fever, strict isolation control source, close contact tracing, management, and enhance personal protective measures is the key to the prevention and control of ebola hemorrhagic fever.
 
(a) come from the pestilence area personnel tracking management. Provincial health family planning departments to strengthen monitoring and information communication with the authorities. According to the relevant departments to provide 21 days come from the pestilence area or in the epidemic area travel history of personnel information, refer to the ebola haemorrhagic fever epidemic in China (return) health monitoring and management plan (attachment 1) requirement, coordinate relevant departments to track and follow-up, the deadline for follow-up to leave with 21 days. Information reporting requirements and the way by the Chinese center for disease control and prevention issued.
 
(2) close contacts management. Close contacts is refers to the direct contact with ebola haemorrhagic fever or suspected cases of blood, body fluids, secretions, waste of personnel, such as live together, escort, make a diagnosis and give treatment and disposal of personnel, transshipment patients. To track and close contacts medical observation. Medical observation period for since the last contact with cases or pollution items to 21 days from the date of the end. Medical observation, once the symptoms such as fever, to isolate immediately, and take samples for testing. Detailed in the cases of ebola haemorrhagic fever close contacts judgement and management plan (attachment 2).
 
(3) cases of diagnosis, transshipment and isolation treatment. Once found under observation or suspected cases, medical institutions shall transfer the case to eligible fixed-point hospital isolation treatment, transport work reference "about the ebola haemorrhagic fever transfer work plan notice (countries who invented electric [2014] no. 43). Entry-exit inspection and quarantine departments found under observation cases, cases of transport in accordance with the relevant provisions.
 
Family planning departments for public health organizations designated hospitals and CDC under observation and suspected cases of specimens of diagnosis, treatment and testing work, fixed-point hospital is responsible for the case of isolation treatment management and specimen collection work. Specimens shall do A good personal protection, samples should be in accord with the class A of the international civil aviation organization (icao), the packing and shipping materials according to the human to infect highly pathogenic pathogenic microbial species (drug), or sample transportation management regulations requirements to have engaged in the ebola virus related qualification of laboratory experimental activities.
 
Around to set up by clinical, epidemiological and laboratory testing expert group, is responsible for cases of judgement. According to the clinical course of cases, the laboratory test results, based on the printing of ebola haemorrhagic fever cases related to the path of the diagnosis and treatment of notice (countries who invented electric [2014] 44) timely diagnosis or exclusion.
 
For under observation cases, suspected cases and confirmed cases to take strict disinfection management measures, to do a good job of hospital infection control and prevention. In accordance with the measures of hospital infection management, the medical waste management regulations, the measures for the administration of medical institutions of medical waste, the request of "ebola haemorrhagic fever diagnosis and treatment plan, strengthen personal protection, strictly to the patient's blood, body fluids, secretions, waste and pollution of the medical equipment and other goods and environmental disinfection, and in accordance with the provisions the collection, transport and temporary storage of medical wastes, to the medical waste disposal of centralized treatment units.
 
After the death of the patient, should try to reduce the body moving and transshipment. Bodies should be disinfected with double seal leakage items, burning in a timely manner. Need to do a postmortem, shall, in accordance with the infectious disease patients or suspected patients of infectious diseases autopsy examination regulations is carried out.
 
(4) the epidemiological investigation. Of institution of disease prevention and control at the county level in the area under its jurisdiction suspected cases and confirmed cases of the epidemiological investigation, the investigation contents include: basic information, and see a doctor, clinical manifestation, laboratory examination, history of epidemiology, close contacts information, diagnosis and outcome, such as concrete epidemiological investigation plan by the Chinese center for disease control and prevention issued.
 
Epidemiological investigation personnel should strictly in accordance with the requirements stated in the relevant personal protection. After completion of investigation of institution of disease prevention and control at the county level shall timely to epidemiological case by questionnaire, investigation, report and other data submitted to the superior institution of disease prevention and control.
 
(5) to carry out the public propaganda and education, do a good job in risk communication. Propagandizes the ebola haemorrhagic fever prevention knowledge, improve the public's awareness of self protection and timely response to the social concern.
 
 
 
Attachment: 1. Ebola haemorrhagic fever epidemic area (returning) health monitoring and management solutions in China
 
2. Ebola haemorrhagic fever close contacts judgement and management scheme
 
 
 
Attachment 1
 
 
 
Ebola haemorrhagic fever epidemic area (returning) health monitoring and management solutions in China
 
 
 
A, scope of application
 
This scheme suitable for ebola haemorrhagic fever endemic countries or regions (hereinafter referred to as the epidemic area) of China, within 21 days before coming to China has a history of the epidemic area travel the rest of the staff and returning from the epidemic area of our country citizen health monitoring and management.
 
Second, the epidemic area in China (returning) personnel tracking
 
Family planning departments for public health shall rely on defense around spreading work mechanism, establish a trans-regional, cross-sectoral epidemic areas in China (return) staff briefings, sharing and responsibility mechanism. Strengthening and foreign affairs, commerce, education, entry-exit inspection and quarantine and the departments of public security frontier inspection station cooperation. In access to relevant departments to provide the epidemic area (returning) personnel destination to live in China after the information such as contact information and communication, family planning department of public health to the destination. Local health family planning departments to cooperate with the epidemic area in China (returning) personnel destination (subdistrict offices) of villages and towns government and the public security departments, contact to the affected area (home) in China.
 
Three, the epidemic area in China (home) people management
 
Destination county center for disease control and prevention, after receipt of the information on the epidemic area (returning) personnel epidemiological investigation in China, based on the results of the survey and the ebola haemorrhagic fever close contacts judgement and management plan, such as judged to be close contacts, according to the requirements for medical observation; If out of close contact may, by the destination county center for disease control and prevention organizations related to community health service centers (towns and townships) to guide the epidemic area (home) people in China to do self health care, custody deadline to leave the area with 21 days. During this period, the epidemic area (home) in China, such as fever and other symptoms, timely report the community health service center (towns and townships), the local health administrative departments of family planning according to the report of community health service centers in accordance with the "about printing of ebola hemorrhagic fever cases related to diagnosis and treatment of notice of the path (countries who invented electric [2014] 44) for screening and diagnosis and appropriate treatment.
 
 
 
The attachment 2
 
 
 
Ebola haemorrhagic fever close contacts judgement and management scheme
 
 
 
First, judging principle
 
Close contacts is refers to the direct contact with ebola haemorrhagic fever or suspected cases of blood, body fluids, secretions, waste of personnel, such as live together, escort, make a diagnosis and give treatment and disposal of personnel, transshipment patients.
 
In order to carry out management of close contacts, close contacts can be divided into four kinds of situations:
 
(a) within the medical institution shall include the following close contact situation: not to take effective protective measures (not wearing personal protective equipment as required), direct contact with ebola haemorrhagic fever or suspected cases of blood, body fluids, secretions and excretions (e.g., feces, urine, saliva, semen), or by the pollution of items such as clothing, bed sheets, or used needles. Close contacts can be a doctor, nurse, inspection personnel, health care workers, patients in the same medical institutions, escort the relatives and friends, etc.
 
(2) the family or community close contact includes the following situations:
 
1. To live with cases;
 
During the 2 cases of illness or death (including funerals), contact with case body, or its blood, body fluids, secretions and excretions;
 
3. Contact with the patient objects such as clothes, bed sheets.
 
(3) the port health and quarantine found close contacts:
 
1. Report the situation: (1) by the crew found suspected ebola haemorrhagic fever patients, after the plane landed, boarding survey by the health and quarantine personnel assessment decision. (2) by the health and quarantine personnel through temperature monitoring or passengers found suspicious patients individual health declaration, survey by the health and quarantine personnel assessment decision.
 
2. The judging principle: (1) on the plane in care for the patient's personnel; (2) the patient in your field (family, colleagues, friends, etc.); (3) with the patient on board with one row for each neighbor (including the channel to the other side) and seat before and after each one; (4) after arrival after investigation and assessment, may contact the patient blood, body fluids, secretions and excretions of other passengers and cabin crew.
 
3. On the other inbound transportation found suspicious patients when close contacts with reference to the above principles.
 
(4) other close contact situation: on the territory of China transportation (aircraft, trains, cars, ships, etc.) found suspicious ebola haemorrhagic fever patients, disease prevention and control of the personnel by the reception with reference to the above the port health and quarantine found close contacts of judging principle, investigate the decision after evaluation.
 
Second, the track of close contacts
 
Establish a trans-regional, cross-sectoral close contacts information bulletin, sharing and responsibility mechanism. In close coordination with the relevant departments of the local health family planning department, make close contacts of the track and medical observation.
 
Port health and quarantine personnel to find suspicious close contacts of patients to carry on the inquiry, registration contact information and communication, the destination told note after release, and the information about port local family planning department of public health at the same level, infectious disease by its reference information on related rules, to family planning department of public health.
 
Involving close contacts across regions, it shall notify the relevant provinces trace, to find the close contacts placed under medical observation on the spot. For foreign involved in the implementation or remove medical observation close contacts, family planning department of health of the relevant provinces shall transfer the relevant information in a timely manner to the local provincial foreign affairs office and inspection and quarantine departments to co-ordinate.
 
Third, the management of the close contacts
 
In view of the main route of transmission of the disease is through contact with patients and infected animal variety of body fluids, secretions, waste and pollutant infection, no infectious in latent period, implement medical observation for close contacts, don't need to take isolation medical observation or centralized medical observation.
 
(a) the implementation of medical observation, the cause of the medical observation shall be notified written or oral, time limit, legal basis, matters needing attention and disease related knowledge, at the same time to inform responsible for medical observation healthcare agency contact and contact way, and demands of its, during medical observation, shall not be allowed to leave the residence in the county jurisdiction.
 
(2) medical observation period is 21 days, that is, with cases or items to 21 days from the date of last contact. During the observation by medical institutions designated by the personnel to visit or telephone contact, early and late each asked once a day its body temperature, and other health conditions, fill in close contact with medical observation records, and give necessary help and guidance.
 
(3) medical observation, if close contacts with acute fever, fatigue, sore throat, headaches, joint and muscle pain, vomiting, diarrhea, bleeding symptoms and so on, then immediately to the local institution of disease prevention and control, family planning department of public health report, and in accordance with the provisions, the fixed-point hospital treatment, laboratory examination and screening work samples. At the same time to determine its incidence has close contact with people and medical observation.
 
(4) medical observation lift.
 
1. Close contacts medical observation period, if the contact of suspicious or suspected cases out of ebola haemorrhagic fever diagnosis, all close contacts of the case to remove medical observation.
 
2. Medical observation period, if not appear afore-mentioned symptoms, medical observation.