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MINISTRY OF HEALTH
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SOCIALIST
REPUBLIC OF VIETNAM
Independence - Freedom - Happiness
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No. 2968/QD-BYT
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Hanoi, August 8, 2014
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DECISION
GUIDANCE ON DIAGNOSIS AND TREATMENT OF EBOLA VIRUS DISEASES
THE MINISTER OF HEALTH
Pursuant to the
Government's Decree No. 63/2012/ND-CP dated August 31, 2012 defining the
functions, tasks, powers and organizational structure of the Ministry of
Health;
At the request of
National Hospital of Tropical Diseases in Dispatch No. 409/BVNDTW dated August
08, 2014 providing Guidance on diagnostic and treatment of diseases caused by
Ebola virus,
At the request of
Medical Service Authority – the Ministry of Health,
DECIDES:
Article 1. Guidance on diagnosis and treatment of EBOLA virus diseases
is promulgated together with this Decision
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Article 3. This Decision takes effect from the day on which it is signed.
Article 4. Chief of the Ministry Office , Director of Medical Service
Authority, Chief Inspector of the Ministry of Health, Departments of the
Ministry of Health, Directors of hospitals affiliated to the Ministry of
Health; Directors of Services of Health, heads of health authorities of other
Ministries, heads of relevant units are responsible for the implementation of
this Decision./.
PP THE MINISTER
DEPUTY MINISTER
Nguyen Thi Xuyen
GUIDANCE
DIAGNOSIS AND
TREATMENT OF EBOLA VIRUS DISEASE
I. OVERVIEW
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- Ebola virus is one of
three genera of family Filoviridae (filovirus). The other two are Marburgvirus
and Cuevavirus. There are five species of ebolaviruses including:
+ Zaire ebolavirus (EBOV)
+ Sudan ebolavirus (SUDV)
+ Bundibugyo ebolavirus
(BDBV)
+ Taï Forest ebolavirus
(TAFV).
+ Reston ebolavirus
(RESTV)
BDBV, EBOV, and SUDV have
caused major epidemics in Africa, while RESTV and TAFV have never caused any
epidemic.
- Targets of infection:
+ Hunters and people who
live in the forest and come into contact with infected or infected dead animals
(chimpanzees, apes, monkeys, antelopes, porcupines, fruit bats, etc.)
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+ Undertakers and people
having physical contact with the infected patients’ dead bodies.
+ Health workers who
directly take care of infected patients
II. Symptoms
1. Clinical symptoms
- The incubation period
varies between 2 and 21 days
- Common symptoms
include:
+ Acute fever
+ Headache, muscle pain
and weariness
+ Vomiting/nausea
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+ Stomach pain
+ Conjunctivitis
- Rash: initially a dark
red color as small as pins at hair follicles, then maculopapular rash with
clear boundaries, and ultimately spread usually within the first week of
infection.
- Haemorrhage symptoms
+ Black stool
+ Bleeding from injection
sites
+ Coughing up blood,
gingival bleeding
+ Blood in urine
+ Vaginal bleeding
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- Blood formula: usually
leucopenia, thrombocytopenia
- Increase in AST, ALT
Creatinine and urea in blood may increase while the disease develops
- Coagulation: disseminated
intravascular coagulation
- Urine test: proteinuria
- Test for causes:
looking for antigens, antibodies, PCR, and virus culture Samples used for
testing are blood that are preserved during transport medium and conformable
with regulations on transport of blood-borne viruses.
IV. Ebola diagnosis
1. Suspected cases:
- Having an
epidemiological link within 03 weeks before symptoms are observed:
+In direct contact with
blood or bodily fluids of patients with confirmed or suspected Ebola virus
disease
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+ In direct contact with
bats, rats, or primates from epidemic areas
- - Having clinical
symptoms of the disease
2. Confirmed cases:
Confirmed cases are
suspected cases that are confirmed by positive PCR test.
3. Distinguishing
diagnosis:
- Ebola virus disease
must be distinguished from:
+ Dengue hemorrhagic
fever
+ Streptococcus suis
disease
+ Septicemia due to
meningococcal disease
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+ Leptospira
+ Malaria with
complications
V. Treatment
1. Principles
- No specific treatment
exists; treatment is primarily supportive in nature.
- All suspected cases
must undergo examination at hospitals, isolated, and sampled to test. Confirmed
cases must be hospitalized and completely isolated.
2. Supportive
treatment:
Symptom
Response
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- Reduce temperature
with Paracetamol: 10-15 mg/kg of body weight every 4 – 6 hours, not more than
60 mg/kg of body weight per day
- Avoid using NSAIDs
(Diclofenac, Ibuprofen, etc.) or medicines that contain Salicylate medicines
because they will worsen coagulation.
Pain
- Reduce pain with
Paracetamol (if pain is mild) or morphine (if pain is moderate or severe)
- Avoid using NSAIDs
(Diclofenac, Ibuprofen, etc.) or medicines that contain Salicylate medicines
because they will worsen coagulation.
Diarrhoea, vomiting,
showing signs of dehydration
- Administer Oresol
even when there are no signs of dehydration
- Monitor the signs of
dehydration and carry out rehydration according to the treatment regimen
- Vomiting and nausea
are very common. Antiemetics might help reduce the symptoms and enable the
patient to take Oresol For adults: Chlorpromazine 25-50mg, intramuscular
injection 4 times per day; or Metoclopramide 10mg, intravenous injection or
oral administration 3 times per day until vomiting stops. For children over 2
years: administer Promethazine, monitor signs
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- Use Diazepam to stop
the convulsion. Adults: 20 mg; Children: 0.1 – 0.3 mg/kg, slow intravenous
injection. Then suppress the convulsion with Phenobacbital. Adults: 00 mg/kg;
Children: 10 - 15 mg/kg, slow intravenous injection for 15 minutes.
Signs of acute
bleeding/paleness, emergency signs of hypovolemic shock
- Transfuse blood and
blood products
Shock, multiple organ
dysfunction (if any)
- Ensure the
circulatory volume, fluid balance; maintain blood pressure and urine
production.
- Filter blood, perform
ECMO is necessary
3. Cautions:
- Pregnant women face a
very high risk of miscarriage/preterm delivery, and postpartum bleeding. The
administration of oxytocin and postpartum intervention must comply with
instruction in order to stop the bleeding.
- Breastfeeding women:
Ebola virus can be transmitted through breast-milk. If the mother is suspected
of having Ebola virus disease, the mother and her children must be hospitalized
and isolated until they are treated. The mother should stop breastfeeding.
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A patient shall be
discharged when:
- There is no fever for
at least 3 days without signs of discharge of virus into the environment such
as watery stool, coughing, bleeding, etc.
- Clinical symptoms are
reduced, the patient’s condition is stable, and the patient can do everyday
activities himself/herself.
- With regard to test
results:
+ Negative PCR test (from
the 3rd day after first symptoms)
+ If clinical symptoms
are not reduced after 2 negative PCR tests that are carried out at an interval
of 48 hours, one of which is carried out on the 3rd day or later
from first symptoms, the patient may be taken care of outside the isolation
ward.
VI. Prevention of Ebola
virus prevention
1. Principles
- Takes measures to
prevent and control contamination.
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- Medical facilities must
take standard prevention measures and prevention according to routes of
transmission.
- Provide information and
reports the cases in accordance with Circular No. 48/2010/TT-BYT dated December
31, 2010 of the Ministry of Health.
2. Patients
- Isolate and treat
patients at medical facilities in accordance with instructions of the Ministry
of Health.
- Use personal protective
equipment to minimize transmission.
- Avoid coming into
contract with or moving patients; use personal protective equipment and
specialized vehicles when it is necessary to move patients. Contaminated,
dumped items, and excrements of patients must be treated and sterilized as
prescribed.
- Ebola virus can be able
to persist in semen and breast-milk, thus it is necessary to inform patients of
how to prevent transmission after they are discharged.
- Dead bodies must be handled
in accordance with Circular No. 02/2009/TT-BYT dated May 26, 2009 on guidelines
for hygienic burial and cremation.
3. People in close
contact:
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- Avoid being contact
with patients
- Practice proper
personal hygiene, regularly wash hands with soap; use antiseptics for the nasal
route.
- Make a list of people
in close contact and monitor their health for 21 days from the last contact.
Inform the people in contact of the signs of the disease, prevention and
treatment so that they can avoid infection, monitor their own health, and
recognize symptoms of Ebola virus diseases themselves. Notify the nearest
medical facility if the symptoms are observed for timely diagnosis and
treatment.
4. Transmission
prevention at treatment facilities:
- Adhere to regulations
on classifying, isolating, and treating patients, take measures for controlling
contamination, provide personal protective equipment for health workers,
caretakers, and other patients at the facility in accordance with instructions
of the Ministry of Health.
5. Sterilization,
environmental remediation, and waste treatment at hospitals:
Comply with the
procedures of environmental remediation and waste treatment applied to isolated
areas for highly infectious diseases.
6. Vaccines:
No vaccine against Ebola
virus is currently available.
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