Download HAN Update - Clinical Considerations Following End of Widesped

Dedicated to protecting and improving the health and environment of the people of Colorado
HEALTH ALERT NETWORK BROADCAST
MESSAGE ID: 01252016 14:05
FROM: CO-CDPHE
SUBJECT: HAN Update - Clinical Considerations Following the End of Widespread Transmission of Ebola in West Africa
RECIPIENTS: Local Public Health Agencies / IPs / Clinical Labs / EDs / ID Physicians/ Coroners
RECIPIENT INSTRUCTIONS: Local Health Public Health Agencies – please forward to healthcare providers
HEALTH UPDATE
Clinical Considerations Following the End of Widespread Transmission of Ebola in West Africa
January 25, 2016
****Health care providers: Please distribute widely in your office****
KEY POINTS:
•
On December 29, 2015 and January 14, 2016, WHO declared Guinea and Liberia (for the third time)
free of Ebola, respectively. On January 15, 2016 Sierra Leone confirmed an Ebola-related death, the
first reported Ebola case in the country after Sierra Leone was declared Ebola-free by the WHO on
November 7, 2015. Guinea, Liberia and Sierra Leone are classified as countries with former
widespread transmission of Ebola and current, established control measures.
•
Since there are no longer any countries with widespread Ebola transmission, travelers returning
from countries with former Ebola transmission (Guinea, Liberia, and Sierra Leone) are no longer
being actively monitored by public health in Colorado, as per CDC recommendations.
•
Health care providers should obtain a travel history from persons with suspected infectious
diseases. Consideration should be given to obtaining travel history as early as possible, such as at
the point of intake, or during triage, to allow for early identification of persons entering the
health system with suspected infectious diseases who have recently traveled. Outbreaks of
infectious diseases such as malaria, dengue, and enteric infections, as well as emerging
infections like Ebola, Middle East Respiratory Syndrome (MERS) and Zika virus reinforce the value
of consistently obtaining a travel history when evaluating patients with possible infectious
disease.
BACKGROUND INFORMATION:
On December 29, 2015, the World Health Organization (WHO) declared Guinea to be free of Ebola
transmission, 42 days after the last reported case in the country tested negative for Ebola for the second
consecutive time. This followed 3,804 cases in the country since the epidemic began and 2,536 Ebolarelated deaths. Subsequent to the declaration in Guinea, on January 14, 2016 WHO declared Liberia free of
Ebola transmission for the third time. Previously there had been two re-emergences of the disease in Liberia
after the country was declared Ebola free. According to WHO, the most recent cluster in Liberia in
November 2015 was the result of a rare re-emergence of the virus that had persisted in a formerly infected
person. On January 15, 2016, Sierra Leone confirmed an Ebola-related death from earlier in the week,
nearly four months since the last reported Ebola case in the country in September 2015.
4300 Cherry Creek Drive S., Denver, CO 80246-1530 P 303-692-2000 www.colorado.gov/cdphe
John W. Hickenlooper, Governor | Larry Wolk, MD, MSPH, Executive Director and Chief Medical Officer
There are currently an estimated 17,322 Ebola survivors in Guinea, Liberia and Sierra Leone. The potential
for re-emergence, persisting health complications of Ebola survivors, and other global infectious diseases
underscores the importance of continued screening for recent travel history for patients presenting to the
health care system.
Guinea, Liberia, and Sierra Leone are in 90-day periods of enhanced surveillance recommended by WHO.
CDC has removed the Travel Alert for Guinea and recommends US residents traveling to Guinea, Liberia or
Sierra Leone practice usual precautions, avoiding contact with sick people, dead bodies, body fluids,
animals, or raw or undercooked meat. The U.S. government has modified its enhanced Ebola entry screening
and monitoring program for travelers returning from Guinea. Travelers from Guinea are receiving modified
Check and Report Ebola (CARE) kits with instructions to watch their health for 21 days after leaving Guinea
and to contact their state or local health departments if they have a fever or any other symptoms consistent
with Ebola. There remains no entry screening for travelers returning from Sierra Leone or Liberia. Since
there are no longer any countries with widespread Ebola transmission, travelers returning from
countries with former Ebola transmission (Guinea, Liberia, and Sierra Leone) are no longer being
actively monitored by public health in Colorado, as per CDC recommendations.
RECOMMENDATIONS / GUIDANCE:
Outbreaks of infectious diseases such as malaria, dengue, and enteric infections as well as emerging
infections like Ebola, MERS and Zika virus reinforce the value of consistently obtaining a travel history
when evaluating patients with possible infectious disease. Health care facilities and providers should
obtain a travel history from patients with suspected infectious diseases as early as possible, such as at
the point of intake, or during triage. Facilities with an electronic health record could consider
modification of this system to allow for early identification of persons entering the health system with
suspected infectious diseases who have recently traveled. Health care providers should take thorough
histories (covering health, travel, and exposure) and use clinical judgment to evaluate patients based on
those histories and their symptoms.
For any patient returning from Guinea, Liberia, or Sierra Leone and presenting with signs and symptoms
consistent with Ebola (fever, severe headache, muscle pain, vomiting, diarrhea, abdominal pain, or
unexplained hemorrhage), providers should use clinical judgment, taking into account the patient’s
epidemiological history for decisions related to management, diagnostic testing, and treatment, and should
coordinate as needed with the state or local health department to ensure that these patients get
appropriate care without delay. As a reminder, the risk of Ebola is extremely low, but not zero, within
Guinea, Liberia and Sierra Leone.
If a health care provider suspects a possible diagnosis of Ebola based on clinical symptoms and
exposures, the health care provider should:
• Place the patient in a private room with a private bathroom
• Follow routine standard hospital infection control practices/protocols based on symptom
presentation
• Conduct a thorough travel, Ebola virus exposure, and health history; diagnostic testing and treatment
should be based on clinical judgment
• Investigate other potential causes of the patient’s signs and symptoms without delay in patient care
• Call CDPHE at 303-692-2700 (or after hours at 303-370-9395) if the clinical evaluation, including
epidemiologic exposures, is consistent with Ebola.
FOR MORE INFORMATION:
4300 Cherry Creek Drive S., Denver, CO 80246-1530 P 303-692-2000 www.colorado.gov/cdphe
John W. Hickenlooper, Governor | Larry Wolk, MD, MSPH, Executive Director and Chief Medical Officer
For updated clinical guidance on the CDC website, please see: http://www.cdc.gov/vhf/ebola/healthcareus/evaluating-patients/index.html
Contact CDPHE with questions at 303-692-2700 (or after hours at 303-370-9395).
CDC Ebola webpage is updated frequently, and health partners should check this website regularly:
http://www.cdc.gov/vhf/ebola/.
4300 Cherry Creek Drive S., Denver, CO 80246-1530 P 303-692-2000 www.colorado.gov/cdphe
John W. Hickenlooper, Governor | Larry Wolk, MD, MSPH, Executive Director and Chief Medical Officer