- Ebola Virus Disease
Action requested: Vaccinate against and treat influenza to prevent complications.
Background & Recommendations
Influenza is increasing rapidly nationally and locally. The Everett Clinic reports a dramatic increase in both influenza testing and positive results. A Snohomish County resident died of influenza on December 7. As noted in earlier alerts, the predominant A(H3N2) strain is relatively virulent and the current vaccine appears not to provide full protection against this strain. Nonetheless, vaccination remains our best strategy to limit spread and reduce complications. In the United States, all recently circulating influenza viruses have been susceptible to the neuraminidase inhibitor antiviral medications, oseltamivir and zanamivir, so treatment with these medications is worth considering to reduce complications. For detailed guidance, see http://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm#modalIdString_CDCTable_0.
Ebola Virus Disease (EVD)
Action requested: Contact public health before referring suspected cases of EVD to an assessment hospital.
Although there have been no confirmed cases of EVD in Washington State, local public health officials are monitoring several dozen people (including two in Snohomish County) who have traveled from the affected West African countries. Experience over the past several months suggests that the likelihood of EVD first being diagnosed in the United States is low and that the potential for person to person spread is even lower. Consequently, fewer treatment centers are required, but all hospitals must be prepared to evaluate for EVD and some hospitals (“assessment facilities”) will be needed to manage suspect cases pending laboratory results. In the Puget Sound region, Harborview Medical Center and Seattle Children’s are the designated treatment centers; Providence Regional Medical Center Everett (PRMCE) is Snohomish County’s designated assessment facility. (Note that assessment facilities must be prepared to manage a case for up to 96 hours, until laboratory results are available, so the demands for training and supplies are largely the same as for treatment facilities.)
Should a suspected case of EVD present in a provider office or Emergency Department, the level of risk and the severity of illness will dictate if the person should be transported to PRMCE for assessment or directly to Seattle for long-term care. I expect that transport to Seattle will be very rare. However, this makes it all the more critical that providers contact public health before arranging transport.
- If EVD is suspected, immediately isolate the patient.
- Call the Health District at 425-339-5278.
- If the Health District determines that the patient should be transported to PRMCE, then the provider should call 911 to arrange transport. If the Health District determines that the patient should be transported to Seattle, then the Health District will notify the appropriate hospital and arrange transport.
Action requested: Consider training to administer naltrexone as part of a comprehensive management program to treat opioid or alcohol dependence.
Background & Recommendations
Naltrexone is an opioid receptor antagonist used primarily in the management of opioid or alcohol dependence. It is available in an extended release injectable suspension, for use as part of a comprehensive management program that includes psychosocial support. In contrast to other medications used for opioid dependence (methadone and buprenorphine), naltrexone may be prescribed by any provider (physician, physician assistant, or nurse practitioner) with prescriptive authority. For more information, see http://www.dpt.samhsa.gov/medications/naltrexone.aspx.
Snohomish County Human Services is sponsoring a free workshop on Friday, January 23, 2015, at the Everett Music Hall (1402 SE Everett Mall Way, Everett, WA 98208). Arturo Taca, MD, (Medical Director of INSynergy Treatment Center) will discuss use of naltrexone. RSVP to Monica Summerset at firstname.lastname@example.org or 425-388-7200.