A CDC health update prompted by a recent outbreak of Ebola virus disease (EVD) in the Democratic Republic of Congo (DRC) serves as a reminder for Texas physicians of the steps that can be taken to protect their patients, staff, and themselves from contracting preventable infectious diseases.
As of May 30, 53 Ebola cases have been reported in the DRC, according to the World Health Organization (WHO). An emergency committee convened on May 18 by WHO determined that the outbreak does not yet meet conditions for declaring a Public Health Emergency of International Concern. Nine neighboring countries, including Congo-Brazzaville and Central African Republic, have been advised by WHO that they are at high risk of spreading the virus. At this time, WHO and the Centers for Disease Control and Prevention (CDC) are not recommending any restrictions in travel related to this outbreak.
While the risk of Ebola being introduced into the United States is currently very low, the CDC health update underscores the importance of:
- Continuing to routinely obtain a travel history from all patients presenting with potential infectious diseases; and
- Using appropriate infection control measures in all health care settings, including implementation of environmental and administrative controls, and using personal protective equipment (PPE) as needed based on the clinical presentation.
Ebola virus is transmitted through direct contact with blood and body fluids containing Ebola virus. Signs and symptoms of EVD include fever, headache, fatigue, vomiting, diarrhea, abdominal pain, and unexplained bleeding or bruising. Many other infectious diseases such as malaria, typhoid fever, and measles are common in travelers from developing countries, and need to be considered in the differential diagnosis of acute infectious illnesses.
Screening for international travel in patients presenting with acute, possibly infectious illnesses should include all countries visited within the preceding three weeks. For such patients reporting recent travel from the DRC, doctors should obtain the exact names of the provinces and cities in the DRC where the traveler has been. Current information about specific areas in the DRC affected by EVD outbreaks can be found on the WHO website. Additional information to evaluate exposure risk for EVD include whether the patient has had any:
- Percutaneous (such as a needle stick) or mucous membrane exposure to blood or body fluids from a patient with suspected or proven EVD.
- Direct skin contact with, or exposure to blood or body fluids of a patient with suspected or proven EVD.
- Involvement in processing blood or body fluids from a patient with suspected or proven EVD without wearing appropriate PPE or observing biosafety precautions.
- Direct contact with the dead body (during funeral rites) of a person with suspected or proven EVD.
If a patient has suspected EVD based on compatible symptoms and travel history, EVD-specific infection control precautions should be taken. Health care facilities should immediately isolate the patient in a single patient room with an in-room bathroom or covered bedside commode using Ebola infection control precautions. Physicians also should promptly consult with their hospital infection prevention and control staff, and notify the local health department to discuss diagnostic evaluation.
The DRC Ministry of Health, in conjunction with international agencies such as WHO and CDC, is engaged in a comprehensive response, which includes administration of Ebola vaccines to health care personnel and contacts of individuals with EVD. Public health agencies are monitoring the developing situation carefully, and will share any updates in recommendations that may impact U.S. physicians and health care providers.
Physicians may subscribe to email updates from WHO about global outbreaks and other health emergencies.
Information in this article was compiled from the World Health Organization; Centers for Disease Control and Prevention; Jane D. Siegel, MD, a pediatric infectious disease physician and chair of TMA’s Committee on Infectious Diseases; and Wendy M. Chung, MD, Chief Epidemiologist of Dallas County Health and Human Services and a member of TMA’s Council on Science and Public Health.