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ALLEGAN COUNTY HEALTH DEPARTMENT 3255 – 122ND Ave., Suite 200, Allegan, MI 49010 Office Administration (269) 673-5411 Bioterrorism Preparedness (269) 686-4523 Personal Health (269) 673-5413 Communicable Disease (269) 686-4551 Environmental Health (269) 673-5415 Resource Recovery (269) 673-5415 August 6, 2014 Ebola hemorrhagic fever update The Center for Disease Control stresses that the threat of Ebola spreading outside of West Africa is low and the virus poses little risk to the U.S. No one has caught the disease in the U.S., however, in an effort to be proactive, the Allegan County Health Department is distributing disease information. Background (Source of Information: CDC) Ebola hemorrhagic fever (Ebola HF) is a severe, often fatal disease in humans and nonhuman primates. The natural reservoir remains unknown, though new evidence strongly implements bats as the reservoir host. Transmission Human to human transmission occurs by direct contact with the blood or secretions of an infected person or exposure to objects (such as needles) that have been contaminated with infected secretions. The risk for person-to-person transmission of hemorrhagic fever (including Ebola) viruses is greatest during the latter stages of illness when virus loads are highest; latter stages of illness are characterized by vomiting, diarrhea, shock, and in less than half of infected patients, hemorrhage. Signs and Symptoms • • • • • • • • Fever Headache Joint and muscle aches Weakness Diarrhea Vomiting Stomach pain Lack of Appetite Other Symptoms Rash Red Eyes Hiccups Cough Sore throat Chest pain Bleeding inside and outside of body Difficulty breathing and swallowing Symptoms may appear from 2-21 days after exposure, though 8-10 days is most common. Risk of Exposure In Africa, confirmed cases have been reported in Guinea, Liberia, Sierra Leone, Democratic Republic of the Congo, Gabon, South Sudan, Ivory Coast, Uganda, Republic of Congo, South Africa (imported) Case Definition for Ebola Virus Disease (EVD) Early recognition is critical for infection control. Healthcare providers should be alert for and evaluate any patients suspected of having EVD. Suspected Case Illness in a person who has both consistent symptoms and risk factors as follows: 1) Clinical criteria, which includes fever of greater than 38.6 degrees Celsius or 101.5 degrees Fahrenheit, and additional symptoms such as severe headache, muscle pain, vomiting, diarrhea, abdominal pain, or unexplained hemorrhage; AND 2) Epidemiologic risk factors within the past 3 weeks before the onset of symptoms, such as contact with blood or other body fluids of a patient known to have or suspected to have EVD; residence in—or travel to—an area where EVD transmission is active; or direct handling of bats, rodents, or primates from disease-endemic areas. Malaria diagnostics should also be a part of initial testing because it is a common cause of febrile illness in persons with a travel history to the affected countries. Confirmed Case A suspected case with laboratory-confirmed diagnostic evidence of ebolavirus infection. Diagnosis 1. Within a few days after symptoms begin – Antigen-capture ELISA testing; IgM ELISA; PCR; Virus isolation (not to be attempted in hospital labs). 2. Later in disease course or after recovery – IgM and IgG antibodies 3. Deceased patients – Immunohistochemistry testing; PCR; Virus isolation Treatment Limited to supportive therapy consisting of balancing the patient’s fluids and electrolytes; maintaining their oxygen status and blood pressure; treating them for any complicating infections. If a person has the early symptoms of Ebola HF and there is reason to believe that Ebola HF should be considered, the patient should be isolated and public health officials notified. Supportive therapy can continue with proper protective clothing until samples from the patient are tested to confirm infection. Prevention Hospital Protocol for Possible Infected Patient with Ebola HF Prior to Arrival to ED by Ambulance ( EMS considerations) Emergency Department Protocol after Arrival of Patient to ED with Above Described Symptoms Transfer to Floor Specimen Handling • • CDC recommends a class II biological safety cabinet following biosafety level 3 practices. If labs drawn, routine cleaning and disinfecting procedures can be used for automated analyzers – use ¼ cup household bleach to 1 gallon water. Environmental Infection Control Procedures • • • Environmental surfaces or inanimate objects contaminated with blood, other body fluids, secretions, or excretions should be cleaned and disinfected using standard procedures. Disinfection can be accomplished using a U.S. Environmental Protection Agency-registered hospital disinfectant or a 1:100 dilution of household bleach (1/4 cup bleach to 1 gallon water). For grossly soiled surfaces, (vomitus or stool), use 1:10 dilution of household bleach. Soiled linens should be placed in clearly labeled leak-proof bags at the site of use, transported directly to the laundry area, and laundered following routine healthcare laundry procedures. • • Liquid medical waste such as feces and vomitus can be disposed of in the sanitary sewer following local sewage disposal requirements. Care should be taken to avoid splashing when disposing of these materials. When discarding solid material waste (needles, syringes, and tubing) contaminated with blood or other body fluids from Ebola HF patients, contain the waste with minimal agitation during handling. Incinerate on-site or off-site medical waste treatment resources. Handling of Human Remains • • If patient dies, handling of the body should be minimized. The remains should not be embalmed, washed or prepared in any way. Remains should be wrapped in sealed leak-proof material and cremated or buried promptly in a sealed casket. If an autopsy is necessary, the state health department and CDC should be consulted regarding appropriate precautions. Management of Exposures • • Persons with percutaneous or mucocutaneous exposures to blood, body fluids, secretions, or excretions from a patient with suspected Ebola HF should immediately wash the affected skin surfaces with soap and water. Mucous membranes (e.g., conjunctiva) should be irrigated with copious amounts of water or eyewash solution. Exposed persons should receive medical evaluation and follow-up care, including fever monitoring twice daily for 21 days after exposure. Consult Infectious Disease expert when exposed person develops fever within 21 days of exposure. For more information go to: http://www.cdc.gov/vhf/ebola/index.html If you have any questions please contact me. Jackie Skelton RN, BSN, MPH Communicable Disease Coordinator Allegan County Health Department 269-686-4551 [email protected]