Submitted by Mark Ingerman, MD, Medical Director of Infection Prevention
The Ebola outbreak in West Africa has created concerns regarding the risk of transmission of this viral infection into the U.S. Although the risk is extremely low for an Ebola case to be acquired in the U.S., all precautions should be taken for any patient with risk factors for this virus.
The most important preventive measure is taking an adequate travel history. If the patient has traveled to the U.S. from Guinea, Liberia, Sierra Leone, or Nigeria within 21 days AND is symptomatic, the risk for Ebola viral infection exists. Symptoms include fever, myalgias, headache, nausea, vomiting, and diarrhea at a minimum.
The MLH Emergency Departments (EDs) have been alerted and educated to screen people for risk factors for Ebola. If a patient screens positive for travel history and symptoms, the patient will be placed in a negative pressure room and caregivers will wear maximal personal protective equipment. The appropriate county and state health departments will be called if a case of Ebola is admitted to one of our EDs.
OUTPATIENT OFFICES/URGENT CARE CENTERS
For those clinicians in outpatient offices/urgent care centers, the initial recommendation is to screen all patients for risk factors for Ebola regarding travel history and symptoms as above. If any of your patients are symptomatic and have the appropriate travel history making them at risk for Ebola, the clinician should call 911 and alert EMS to transport this patient to the closest ED. EMS must be alerted of a potential Ebola case to allow them to take the necessary precautions. The clinician should ALSO call the local ED to which the patient will be transported to advise them of the risk of Ebola. While awaiting EMS, place patient in a private room.
There are no recommended laboratory tests to screen patients (either blood or stool) for this viral infection in asymptomatic patients who traveled to those at risk countries. For example, if symptoms such as diarrhea exist in a patient who has traveled to a high risk country for over 21 days without clinical deterioration or worsening symptoms, Ebola virus is highly unlikely.
This has been the largest outbreak of the Ebola viral illness ever recorded. Our most recent Infection Prevention newsletter highlights this and other relevant infection prevention topics. The Q2 newsletter is available at http://intranet/infectionprevention/page41.aspx (MLH network login may be required).
The most recent CDC Health Advisory dated August 4, 2014 is available here. In addition, as the situation evolves, there will be ongoing regular updates from the Centers for Disease Control and Prevention on their website: cdc.gov
If you have further questions, other contacts include your campus ID physicians, Infection Preventionists, or Robert Feinberg, System Director, Emergency Mgmt. & Hazard Mitigation.