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Who this guidance is for

This guidance is for health protection teams during an Ebola disease (EBOD) or Marburg disease (MARD) incident. It describes the categorisation of possible, probable and confirmed cases of EBOD and MARD.

Case definitions for Ebola disease and Marburg disease

Confirmed case

An individual (alive or dead) with a positive laboratory test result (real time polymerase chain reaction (PCR)) from a blood or other body fluid sample.

Probable case

An individual for whom no laboratory results are available (for example waiting for testing or results), but who has:

• clinical illness compatible with EBOD or MARD [note 1]
• fever (temperature greater than 37.5°C) with or without additional symptoms such as severe weakness, severe headache, myalgia, abdominal pain, sore throat, vomiting, diarrhoea or unexplained haemorrhage, with one or more of the following in the 21 days before the onset of symptoms
• contact with an identified potential source of EBOD or MARD (for example, direct contact with a probable or confirmed case without wearing adequate personal protective equipment (PPE) or where there were breaches in PPE)
• exposure to Ebola or Marburg virus-infected body fluids or tissues without wearing adequate PPE or where there were breaches in PPE
• direct handling of bats, antelopes or primates, from Ebola or Marburg-affected areas without wearing adequate PPE or where there were breaches in PPE

Possible case

One definition of a possible case is a deceased individual with epidemiological risks for EBOD or MARD [note 2]

Another definition is an individual for whom no laboratory results are available (for example waiting for testing or results), but who has:

• clinical illness compatible with EBOD or MARD [note 1]
• fever (temperature greater than 37.5°C) with or without additional symptoms such as severe weakness, severe headache, myalgia, abdominal pain, sore throat, vomiting, diarrhoea or unexplained haemorrhage, with one or more of the following in the 21 days before the onset of symptoms
• history of travel to EBOD or MARD affected areas
• direct contact with a confirmed case of EBOD or MARD, or their body fluids (including laboratory staff), but trained and wore appropriate PPE, and had no known breaches in PPE

Note 1: initial symptoms may be not specific, but onset can be sudden with symptoms worsening over a few days, often with severe lethargy, rash, evidence of capillary leak, bleeding or haemorrhage, shock and impaired consciousness.

Note 2: deceased individuals with epidemiological risks for EBOD or MARD should be discussed with the Imported Fever Service for suitable post-mortem testing.

Further definitions

Body fluids

In this guidance, ‘body fluids’ can include blood, vomit, faeces, urine, saliva and semen.

PPE for Ebola disease and Marburg disease cases

For personal protective equipment (PPE) requirements for the management of EBOD or MARD cases, see the Advisory Committee on Dangerous Pathogens (ACDP) guidance on the management of patients with viral haemorrhagic fever.

Time since contact with a potential source of EBOD or MARD

Any individual who has not had contact with a potential source of EBOD or MARD within the last 21 days before the onset of their illness is not deemed to be a possible or probable case of EBOD or MARD.

Further guidance

There is guidance for healthcare professionals on when to suspect Ebola disease (EBOD) and Marburg disease (MARD). This should be the starting point for clinical assessment of a suspected case of EBOD or MARD.