Emerging Diseases

Ebola Safety Guidelines for Clinical Laboratory Workers

Laboratory Specimen Collection and Testing

Ebola Virus Disease (EVD) is one of numerous viral hemorrhagic fevers (VHF). It is a severe, often fatal disease in human and nonhuman primates. Ebola virus is spread by direct contact with the blood or body fluids (such as urine, saliva, feces, vomit and semen) of an infected person or by being exposed to objects that have been contaminated with infected blood or body fluids. The incubation period is usually 8–10 days (rarely ranging from 2 to 21 days). Patients can transmit the virus once symptoms appear and through the later stages of disease, as well as postmortem.
 
Recommendations For Specimen Collection By Staff
Any person collecting specimens from a patient with a case of suspected Ebola virus disease should wear appropriate personal protective equipment (PPE), including gloves, water-resistant gowns, full face shield or goggles, and masks to cover all of nose and mouth. Additional PPE may be required in certain situations and guidance can be found at the Centers for Disease Control and Prevention website.
 
Recommendations For Laboratory Testing By Staff
Any person testing specimens from a patient with a suspected case of Ebola virus disease should wear gloves, water-resistant gowns, full face shield or goggles, and masks to cover all of nose and mouth, and as an added precaution use a certified class II Biosafety cabinet or Plexiglass splash guard with PPE to protect skin and mucous membranes. All manufacturer-installed safety features for laboratory instruments should be used.
 
Currently, laboratory testing for Ebola is available at Centers for Disease Control and Prevention (CDC) and the Los Angeles County Public Health Laboratory. If a case of EVD is suspected in your facility and the attending physician requests testing, follow the Ebola Virus Disease Testing: Specimen Referrals to CDC and Los Angeles County PHL Quick Reference Guide.

Zika

Symptoms & Transmission

Zika is virus in the family Flaviviridae and the genus Flavivirus. This genus also includes other viruses such as: yellow fever, West Nile, Japanese encephalitis, and dengue. Zika virus is often asymptomatic, though common symptoms are rash, joint pain, conjunctivitis, and fever all lasting several days to a week. Severe symptoms causing hospitalizations are uncommon and resulting deaths are rare.
 
Zika is transmitted mainly through mosquitos of the Aedes species which also spread both dengue and chikungunya. These mosquitos transmit the virus by biting an infected person followed by biting an uninfected person, thereby spreading the infection. Zika can also be spread from mother to child in utero, through sexual contact, or through blood transfusion. A male who has been infected with Zika can spread the disease through his semen for up to six months.
 
Zika infection during pregnancy can cause birth defects such as microcephaly, defects of the eye, hearing deficits, and impaired growth. Microcephaly is a condition where the baby’s head is much smaller than a typical baby’s head. A baby’s head grows during pregnancy as the baby’s brain grows, so a smaller head can indicate that the baby’s brain has not developed as it should. Microcephaly can be isolated or be linked with other issues such as seizures, developmental delay, intellectual disability, problems with movement and balance, feeding problems (difficulty swallowing), hearing loss, and vision problems. The images are provided by the CDC.
 
For more information view the Zika: An Emerging Disease flyer.

Zika Prevention

Pregnant women should avoid both traveling to areas with active Zika transmission and unprotected sexual contact with males who have traveled to areas with active Zika transmission in the last six months. If
someone must travel, the best way to avoid getting Zika is to avoid getting bit by mosquitos, repellent is highly recommended. Long-sleeved shirts, long pants, long socks, and boots are also recommended to protect against mosquitos. Cribs, strollers, and baby carriers should be covered with mosquito netting. There is no vaccine currently available to prevent Zika. Mosquitos will lay their eggs in/near standing water.
 
Examples of areas where standing water can accumulate from rainfall are buckets, bowls, flower pots, and vases. Animal dishes can also be a problem and it is best if they can be kept inside and/or washed very regularly. Unkempt ponds and pools (for example in uninhabited homes) should be drained and washed with power washers. It is best to follow the “see something, say something” motto and tell the city if this type of thing is noticed. Mosquitos of the Aedes species (the ones that transmit Zika, chikungunya, and dengue) bite aggressively during the day and less at night. They also lay very hardy eggs that can last drying for up to 8 months so emptying standing water may not be enough, the containers should also be scrubbed or power washed and then kept dry by either placing them under a covering or turning them over.

Recommendations For When To Test

If the patient has recently traveled to an area with active Zika transmission in the last 8 weeks (map of active transmission areas provided by the CDC) and displays mosquito bites and/or symptoms within two weeks of travel Zika testing is recommended. If the patient has recently traveled to an area with active Zika transmission in the last 8 weeks and is asymptomatic but also pregnant Zika testing is recommended. If pregnant patient has had unprotected sexual contact with a male who has traveled to an area with active Zika transmission in the last six months Zika testing is recommended.
 
If the biological mother of an infant has been diagnosed with Zika by a medical laboratory, the infant should be tested for Zika as well. If the infant displays symptoms consistent with Congenital Zika Virus Syndrome and the mother was exposed to Zika (from either traveling or sexual contact) the infant should be tested for Zika no matter the maternal results. If the mother was exposed but was not tested the infant (even if healthy) may be tested in parallel with the mother. To date there are no indications that infants can get Zika through breastfeeding.

Recommendations For Specimen Collection & Laboratory Testing

Specimens acceptable for testing are whole blood, serum, amniotic fluid, or urine. Specimens should be transported as Category B Biological substances. When working in the laboratory with possible Zika specimens, treat all bodily fluids as infectious. Use Biosafety Level 2 precautions for appropriate handling of these specimens. Always wear personal protective equipment such as disposable gloves, lab coat, and goggles.

emerging disease
Contact Information

Weekdays
Monday – Friday: 8:00 AM – 5:00 PM
Phone: (909) 458-9430
Fax: (909) 986-3590
 
After Hours
Weekends and Holidays: 5:00 PM – 8:00 AM
County Communication Center
Officer on Duty: (909) 356-3811
or (909) 356-3805
 
Public Health Microbiologists are on duty and will contact you within minutes.

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