Naturally-occurring Ebola virus disease (EVD) outbreaks are believed to start with contact with infected wildlife (alive or dead), and then spread from person to person through direct contact with body fluids such as, but not limited to, blood, urine, sweat, semen, breast milk, vomit, and feces. The infection can be spread when open cuts, scrapes, other non-intact skin, or mucous membranes (e.g., lining of mouth, eyes, or nose) come into contact with infectious blood or body fluids.
EVD is not generally spread through casual contact. The risk of infection with Ebola virus is minimal if you have not been in close contact with the body fluids of someone sick with or recently deceased from EVD. You can also get EVD by eating or butchering meat (e.g., bush meat) from an animal infected with Ebola virus.
Individuals exposed while living, working, or traveling in areas experiencing an ongoing outbreak or where EVD is endemic (i.e., found regularly) could develop symptoms up to three weeks after exposure. However, EVD is believed to be contagious only once an individual begins to show symptoms.
While a case may not be diagnosed immediately, it is easy to identify and isolate symptomatic individuals. Only persons having close contact with someone who is sick with EVD or with their body fluids are at significant risk for exposure. This generally includes healthcare workers or family members caring for a sick individual. Aircraft cabin crewmembers and servicing and cargo employees; laboratory workers; mortuary and death care workers; individuals involved in border protection, customs, and quarantine operations; emergency responders; and other workers in other critical sectors may come into contact with sick individuals or their body fluids.
Determining worker exposures
Whenever workers may have exposure to Ebola virus or related hazards, conduct a hazard assessment that considers potential sources of such exposures, jobs and job tasks which may result in worker exposure, and the risks and routes of exposure associated with those jobs or job tasks. Hazard assessments are required whenever the Bloodborne Pathogens (BBP, 29 CFR 1910.1030), Personal Protective Equipment (PPE; 29 CFR 1910.132 and, in construction, 29 CFR 1926.95), and Respiratory Protection (29 CFR 1910.134 and, in construction, 29 CFR 1926.103) standards apply.
The BBP standard requires employers to develop written exposure determinations that detail the job classifications in which all workers have occupational exposure and in which some workers have occupational exposure, along with the tasks performed by such workers that result in exposure.
- Under the BBP standard, “occupational exposure” means reasonably anticipated skin, eye, mucous membrane, or parenteral (i.e., routes other than the gastrointestinal tract, such as through injection) contact with blood or other potentially infectious materials (OPIM) that may result from the performance of an employee's duties. See 29 CFR 1910.1030(b).
- OPIM includes semen, vaginal secretions, cerebrospinal fluid, synovial (joint) fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, saliva in dental procedures, any body fluid that is visibly contaminated with blood, and all body fluids in situations where it is difficult or impossible to differentiate between body fluids. Though the BBP standard does not include them in the definition of OPIM, urine and feces from an individual with suspected or confirmed Ebola may be infectious and should be treated like OPIM.
Employers must also determine if workers’ potential exposures to job hazards are covered by any other standards. For example, employers whose workers use hazardous chemicals for cleaning and disinfection must comply with the Hazard Communication (HazCom) standard (29 CFR 1910.1200).
The BBP, PPE, and HazCom standards each require employers to identify and assess hazards to which their workers may be exposed. In the case of the BBP and HazCom standards, and some PPE standards (e.g., PPE General Requirements, 29 CFR 1910.132), such assessments require written documentation.