- Ebola virus disease
- Enterovirus D68
Ebola virus disease
Action requested: Follow local protocols for transferring patients with suspected Ebola virus disease (EVD) to Providence Regional Medical Center Everett.
Background: As of September 22, the World Health Organization reported 5843 suspected, probable, and confirmed cases of EVD, of which 2803 had died (48% case fatality rate). Projections based on current trends suggest that EVD could ultimately affect upwards of 500,000 persons. The U.S. has mobilized military units to support medical services in western Africa; other countries and many private organizations are also contributing to the effort to manage EVD and stop its spread. Although persons traveling from affected countries to the U.S. are supposed to be screened upon entry, asymptomatic travelers could develop symptoms after arrival. Thus, health care providers must be alert for possible EVD and follow local protocols for transferring patients with suspected EVD to Providence Regional Medical Center Everett (PRMCE).
- Be alert for symptoms consistent with EVD (sudden onset of fever and malaise, accompanied by other nonspecific signs and symptoms, such as myalgia, headache, vomiting, and diarrhea) and ask about travel to an affected African country in the past 21 days or possible exposure to someone else who may have traveled to an affected African country in the past 21 days.
- If EVD is suspected, immediately contact the Snohomish Health District (425-339-5278) to determine if the case should be transferred to PRMCE. The Health District will provide guidance and, if indicated, will alert PRMCE, contact emergency medical services (EMS) for transport to the PRMCE Emergency Department, arrange for appropriate testing, investigate contacts, and initiate disease control measures (e.g., quarantine) as needed. PRMCE will arrange admission to an isolation room and in-patient management.
- Follow standard, contact, and droplet infection control measures if EVD is suspected. For detailed guidance, see http://www.cdc.gov/vhf/ebola/hcp/infection-prevention-and-control-recommendations.html. (CDC has issued interim infection control guidance for emergency medical services (EMS), noting that EMS personnel can safely manage a patient with suspected or confirmed Ebola by following recommended isolation and infection control procedures, including standard, contact, and droplet precautions. For detailed guidance, see http://www.cdc.gov/vhf/ebola/hcp/interim-guidance-emergency-medical-services-systems-911-public-safety-answering-points-management-patients-known-suspected-united-states.html.)
Action requested: Institute standard, contact, and droplet precautions when managing suspected enterovirus D68.
Background: Enterovirus D68 has been identified as the etiology for clusters of severe respiratory illness in the U.S. Details about these clusters can be found in the September 8, 2014, MMWR Early Release: (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm63e0908a1.htm?s_cid=mm63e0908a1_e). The Centers for Disease Control & Prevention has issued updated guidance for clinical management, including recommending standard, contact, and droplet precautions when managing suspected enterovirus D68. For more details, see http://content.govdelivery.com/accounts/USCDC/bulletins/cf26d2 .
Action requested: Know which influenza vaccine preparation to administer to different populations.
Background: Multiple formulations of influenza vaccine are available, including live attenuated and inactivated vaccines, trivalent and quadrivalent vaccines, high-dose vaccines, and vaccines produced using egg-based, cell culture, or recombinant methods. The Advisory Committee on Immunization Practice (ACIP) has issued recommendations adopted by Washington State.
- Administer live attenuated influenza vaccine (LAIV) to healthy children aged 2-8 years who have no contraindications or precautions, but use inactivated influenza vaccine (IIV) if LAIV is not immediately available.
- Quadrivalent vaccine is preferred, but do not delay vaccination if only trivalent vaccine is available.
- Use of high-dose vaccine is reasonable in adults 65 years and older for whom it is not contraindicated, but standard IIV is also acceptable.
- Persons aged 6 months through 8 years may require 2 doses.
For detailed guidance and additional references, see http://www.doh.wa.gov/Portals/1/Documents/Pubs/348-NonDOH-VACClinicalGuidance-Flu.pdf.