CDC: Be alert for Ebola signs in African travelers
Two U.S. HCWs develop symptoms of virus
U.S. public health authorities urged health providers to raise their awareness about Ebola virus as two American health care workers became ill with the often fatal disease while caring for infected patients in Liberia. At about the same time, a Liberian man became ill with Ebola and traveled by plane to Lagos, Nigeria, where he died in a hospital.
The Centers for Disease Control and Prevention issued a Health Advisory on July 28, asking U.S. health care providers to be alert for possible signs of Ebola and to isolate patients who have Ebola-like symptoms and have traveled to a country with Ebola cases within the past 21 days. (http://emergency.cdc.gov/han/han00363.asp) The initial symptoms of Ebola are flu-like, with fever and aches accompanied by vomiting and diarrhea. (See box on p.xx.)
At mid-summer, the largest Ebola outbreak in history had reached more than 1,200 cases and 672 deaths in Guinea, Sierra Leone and Liberia. As of late July, it had not appeared outside of West Africa.
Ebola is transmitted through contact with blood and body fluids but is not thought to be airborne. CDC recommends standard, contact and droplet precautions, which means health care workers must wear gloves, gowns, face masks and eye goggles or shields.
Yet because Ebola has a fatality rate as high as 90%, health care workers often wear heavy-duty fluid-resistant suits. An American physician who became ill was working with Samaritan’s Purse, a North Carolina-based international relief agency, which provides boots, a surgical cap, a Tyvek suit, two sets of gloves, neck and chin covering, a face mask, goggles, and a waterproof apron.
Because they can become overheated, health care workers stay in the gear for only about 60 to 90 minutes, then spend about 30 minutes in decontamination, Samaritan’s Purse said in an informational post on its website (www.samaritanspurse.org/article/ebola-virus-claims-more-lives-in-west-africa/).
If the health care workers took such intense precautions, why did they become infected? The route of infection was not clear, but Stephan Monroe, deputy director of CDC’s National Center for Emerging Zoonotic and Infectious Diseases, noted that clinics in Africa have "rudimentary" equipment. Exposure can occur through needlesticks or other exposures as health care workers collect specimens or dispose of bodily fluids, he said in a telephone press conference.
In recent years, the United States and the Netherlands each treated a patient who contracted Marburg hemorrhagic virus, which is similar to Ebola. No one else became infected, Monroe said.
"In both of those cases, the patients presented to the healthcare system before it was identified they had the virus infection, but they were treated with standard barrier nursing and infection control practices in the hospital," he said. "In neither case was there any evidence of health care-associated transmission in those settings."
The bottom line: The hospital environment is much safer in the United States than in Africa. "While it’s clear there is an increased risk for working with patients with Ebola, we’re confident that the standard of care in the U.S. would prevent much of the transmission," he said.
Nonetheless, there is always danger from an undiagnosed case. Health providers, particularly in emergency departments, need to be aware of global outbreaks and their potential to spread, Monroe said. "The point is to raise the level of awareness in emergency rooms and all of the front line places for primary care," he said.
