Special "News You Can Use" on Ebola Virus Disease October 3, 2014 Infectious Disease, Public Health Ebola 0 Friday, October 3, 2014 From Dr. Wilma Wooten, Public Health Officer, HHSA, County of San Diego: The San Diego County Health and Human Services Agency Public Health Services (PHS) advises all San Diego physicians to review the October 2 health advisory from the Centers for Disease Control and Prevention (CDC) entitled “Evaluating Patients for Possible Ebola Virus Disease: Recommendations for Healthcare Personnel and Health Officials” (copied and pasted at bottom in its entirety). The advisory reminds healthcare personnel to increase vigilance in asking about travel history to Ebola-affected countries in West Africa (Liberia, Sierra Leone, and Guinea) and provides links to resources to address triage, assessment, risk assessment, infection control, and patient management for Ebola virus disease (EVD). PHS requests that physicians conducting evaluations to rule out EVD contact the PHS Epidemiology Program immediately at (619) 692-8499 during business hours, Monday–Friday, and at (858) 565-5255 after hours and on weekends. Additionally: Physicians should obtain a travel history with any patient for whom they are considering a diagnosis of EVD. Ask patients who present with symptoms of EVD about risk factors within the past 21 days before the onset of symptoms, including contact with blood or body fluids of a person known or suspected to have EVD. In Emergency Departments, activate infectious control procedures to isolate patients, use personal protective equipment (PPE) for healthcare personnel, and apply standard, contact, and droplet precautions. In outpatient settings, initiate infection control precautions, arrange to have the patient transported to the Emergency Department, and notify the appropriate infection control leads in advance. Click here for further information about evaluating potential cases with relevant travel history. Although EVD is prominent in the news at this time, a travel history should be obtained in every patient when an infectious etiology is possible. In addition to the recent advisory on EVD, CDC has issued health advisories in the last 12 months on Chikungunya, MERS-Cov, and H5N1 influenza, each of which contains a recommendation on obtaining a travel history. CDC routinely issues travel advisories to alert clinicians and the public of infectious disease threats to prevent illness before travel and to direct diagnostic efforts for illness after travel. Recent advisories of note include measles in the Philippines, polio in several countries, and dengue in Japan. Evaluating Patients for Possible Ebola Virus Disease: Recommendations for Healthcare Personnel and Health Officials This is an official CDC HEALTH ADVISORY Distributed via the CDC Health Alert Network October 2, 2014, 20:00 ET (8:00 PM ET) CDCHAN-00371 Summary The first case of Ebola Virus Disease (Ebola) diagnosed in the United States was reported to CDC by Dallas County Health and Human Services on September 28, 2014, and laboratory-confirmed by CDC and the Texas Laboratory Response Network (LRN) laboratory on September 30. The patient departed Monrovia, Liberia, on September 19 and arrived in Dallas, Texas, on September 20. The patient was asymptomatic during travel and upon his arrival in the United States; he fell ill on September 24 and sought medical care at Texas Health Presbyterian Hospital of Dallas on September 26. He was treated and released. On September 28, he returned to the same hospital and was admitted for treatment. The purpose of this HAN Advisory is to remind healthcare personnel and health officials to: increase their vigilance in inquiring about a history of travel to West Africa in the 21 days before illness onset for any patient presenting with fever or other symptoms consistent with Ebola; isolate patients who report a travel history to an Ebola-affected country (currently Liberia, Sierra Leone, and Guinea) and who are exhibiting Ebola symptoms in a private room with a private bathroom and implement standard, contact, and droplet precautions (gowns, facemask, eye protection, and gloves); and immediately notify the local/state health department. Please disseminate this information to infectious disease specialists, intensive care physicians, primary care physicians, and infection control specialists, as well as to emergency departments, urgent care centers, and microbiology laboratories. Background The first known case of Ebola with illness onset and laboratory confirmation in the United States occurred in Dallas, Texas, on September 2014, in a traveler from Liberia. The West African countries of Liberia, Sierra Leone, and Guinea are experiencing the largest Ebola epidemic in history. From March 24, 2014, through September 23, 2014, there have been 6,574 total cases (3,626 were laboratory-confirmed) and 3,091 total deaths reported in Africa. Ebola is a rare and deadly disease caused by infection with one of four viruses (Ebolavirus genus) that cause disease in humans. Ebola infection is associated with fever of greater than 38.6°C or 101.5°F, and additional symptoms such as severe headache, muscle pain, vomiting, diarrhea, abdominal pain, or unexplained hemorrhage. Ebola is spread through direct contact (through broken skin or mucous membranes) with blood or body fluids (including but not limited to urine, saliva, feces, vomit, sweat, breast milk, and semen) of a person who is sick with Ebola or contact with objects (such as needles and syringes) that have been contaminated with these fluids. Ebola is not spread through the air or water. The main source for spread is human-to-human transmission. Avoiding contact with infected persons (as well as potentially infected corpses) and their blood and body fluids is of paramount importance. Persons are not contagious before they are symptomatic. The incubation period (the time from exposure until onset of symptoms) is typically 8–10 days, but can range from 2–21 days. Click here for additional information. Recommendations Early recognition is critical to controlling the spread of Ebola virus. Consequently, healthcare personnel should elicit the patient’s travel history and consider the possibility of Ebola in patients who present with fever, myalgia, severe headache, abdominal pain, vomiting, diarrhea, or unexplained bleeding or bruising. Should the patient report a history of recent travel to one of the affected West African countries (Liberia, Sierra Leone, and Guinea) and exhibit such symptoms, immediate action should be taken. Click here for the Ebola algorithm for the evaluation of a returned traveler, and click here for the checklist for evaluation of a patient being evaluated for Ebola. Patients in whom a diagnosis of Ebola is being considered should be isolated in a single room (with a private bathroom), and healthcare personnel should follow standard, contact, and droplet precautions, including the use of appropriate personal protective equipment (PPE). Infection control personnel and the local health department should be immediately contacted for consultation. The following guidance documents provide additional information about clinical presentation and clinical course of Ebola virus disease, infection control, and patient management: Click here for guidelines for clinicians in U.S. healthcare settings. Click here for guidelines for infection prevention control for hospitalized patients with known or suspected Ebola in U.S. hospitals. Click here for guidelines for safe management of patients with Ebola in U.S. hospitals. Click here for the case definitions for persons under investigation (PUI) for Ebola, probable cases, and confirmed cases, as well as classification of exposure risk levels. Persons at highest risk of developing infection are: those who have had direct contact with the blood and body fluids of an individual diagnosed with Ebola — this includes any person who provided care for an Ebola patient, such as a healthcare provider or family member not adhering to recommended infection control precautions (i.e., not wearing recommended PPE); those who have had close physical contact with an individual diagnosed with Ebola; those who lived with or visited the Ebola-diagnosed patient while he or she was ill. Persons who have been exposed, but who are asymptomatic, should be instructed to monitor their health for the development of fever or symptoms for 21 days after the last exposure. Click here for guidelines for monitoring and movement of persons who have been exposed to Ebola. Diagnostic tests are available for detection of Ebola at LRN laboratories as well as CDC. Consultation with CDC is required before shipping specimens to CDC. Click here for information about diagnostic testing for Ebola. Healthcare personnel in the United States should immediately contact their state or local health department regarding any person being evaluated for Ebola if the medical evaluation suggests that diagnostic testing may be indicated. If there is a high index of suspicion, U.S. health departments should immediately report any probable cases or persons under investigation (PUI) to CDC’s Emergency Operations Center at (770) 488-7100. Comments are closed.