HomeMy WebLinkAbout20141024_Ebola Update Number 2 (PDF)Always working for a safer and healthier community
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October 24, 2014
To: Jefferson County Health Care Providers
From: Tom Locke, MD, MPH, Jefferson County Health Officer
Re: Ebola Update #2
Situation Report: The unprecedented Ebola virus disease (EVD) outbreak in West Africa
continues unabated with case doubling times in the 3-4 week range. Outbreak activity is
confined to three nations: Sierra Leone, Liberia, and Guinea. Spread to Nigeria and Senegal
has been arrested due to diligent containment efforts. If international relief efforts continue to
ramp up, the epidemic can be contained by the end of the year. If these containment efforts
fail, EVD could become endemic in Africa.
Several health care workers who developed EVD while working to combat the epidemic have
been flown back to the U.S. for treatment. To date, all have survived. A single imported
case, a Liberian citizen who developed symptoms while in Dallas has died. Two health care
workers who participated in his care became infected. They have now recovered. A New
York-based physician, recently returned from work with Doctors without Borders has been
diagnosed with EVD. The media frenzy that is stoking and exaggerating public fears about
Ebola continues unabated.
Transmission Risk: The transmission risk of Ebola is well understood. A patient only
becomes infectious once symptoms develop and the viral load begins to rise. Viral titers
increase logarithmically as the illness progresses and virus is shed in virtually all body fluids –
including tears, sweat, and saliva. Gastrointestinal symptoms are prominent with copious
emesis and diarrhea. All of these factors make infection control at the peak of the illness very
difficult and health care providers are at increasing risk of exposure as the infection
progresses. Stringent transmission-based precautions - standard, contact, and droplet – must
be maintained at all times. The CDC has issued new and detailed guidelines for use of
Personal Protective Equipment (PPE) in facilities caring for patients with EVD.
Early Identification of Ebola Patients: All travelers from Ebola affected countries are now
being screened at the time of their departure, at hub airports in Europe, and on arrival in the
U.S. There are no direct commercial flights from West Africa to the U.S. Each traveler will
be contacted daily for 21 days to assure that twice daily temperatures are being taken and to
conduct symptom screening. While it is unlikely that a recently traveler from West Africa
will present for health care at a health care facility on the Olympic Peninsula, all U.S. health
care providers are being asked to obtain a travel history on all patients presenting with a
fever (>=100.4o F) OR other symptoms consistent with EVD (e.g., myalgia, headache,
abdominal pain, vomiting, diarrhea, or unexplained bleeding, bruising, or hemorrhage).
Patients with a travel history to an Ebola-affected country in West Africa (currently Guinea,
Liberia, and Sierra Leone) OR with direct contact (healthcare, laboratory, household, or
Always working for a safer and healthier community
Community Health Environmental Health
Developmental Disabilities Water Quality 360-385-9400 360-385-9444
360-385-9401 (f) (f) 360-379-4487
sexual) with a known or suspected Ebola patient (or with the patient’s blood/body fluids, or
remains) should be promptly isolated pending determination of their Ebola infection status.
Isolation Standards: Initial isolation should be in a closed private room with private
bathroom or commode. If the setting is an outpatient clinic, the exam room door should be
closed and signage put up to prevent unnecessary entry. The Health Department and Jefferson
Healthcare should be immediately contacted to facilitate testing. Isolation should be
maintained until test results are available. All healthcare workers and family members who
enter the room should wear appropriate PPE.
Diagnostic Testing for Ebola: PCR testing with a 6 hours turnaround time is being provided
by the WA State Public Health lab in Shoreline. Testing requires two purple top tubes of
blood. Specimen transport time to the lab is 2-3 hours and must be done in a special container
which the Health Department will supply. It may be necessary to transport the patient to an
alternate facility during this long wait time.
Probable Scenarios: The unanticipated evaluation of an Ebola-infected individual in an
outpatient setting would be an extraordinary occurrence. As the West African outbreak
worsens, however, the number of people being tested and treated for EVD in the U.S. will
increase. Most cases will be in health care workers who have returned from providing care in
the Ebola-affected countries. Some cases will be in recent travelers (<21 days) from Ebola-
affected countries. All of these individuals will be under some form of observation, ranging
from the twice daily temperature and symptom monitoring to full quarantine for those with
high risk exposures (health care workers without adequate PPE or those who have had direct
exposure to cases or their body fluids). People who are being monitored for EVD who
develop fevers and/or Ebola-associated symptoms are the most likely group to need
evaluation locally. These are situations where special protocols are needed – isolation of the
suspect case, PPE for anyone who has contact with them, and expedited testing of a blood
sample.
Priority Tasks: The highest priorities at this time are to assure that systems are in place to
inquire about travel history on all patients who are febrile or have symptoms consistent with
early Ebola infection AND that health care workers are familiar with PPE protocols and have the
opportunity to practice safe donning and doffing of equipment. This is of particular importance
to hospital personnel who may be providing extended care to those in whom Ebola infection is
confirmed. It is likely that definitive care of Ebola patients will be done in tertiary care centers
that have a full range of life support and therapeutic options available. It should be encouraging
that of the 9 individuals who have been treated for Ebola is the U.S., only 1 has died, suggesting
that early diagnosis and treatment can reduce the case fatality rate far below the 60-70% rate
being seen in Africa.
Resources:
Detailed guidelines are available at the CDC website:
http://www.cdc.gov/vhf/ebola/hcp/index.html
Washington State Protocols for Testing, Reporting, and Isolation are available at:
http://www.doh.wa.gov/ForPublicHealthandHealthcareProviders/NotifiableConditions/EbolaReso
urces