- Ebola Virus Disease (EVD) update
Ebola Virus Disease
Action requested: Be aware of the protocol for managing suspect Ebola Virus Disease (EVD) cases in Snohomish County.
CDC has released new guidance (http://www.cdc.gov/vhf/ebola/hcp/us-hospital-preparedness.html)
describing three levels of preparedness for health care facilities:
- Frontline healthcare facilities—community hospitals and urgent care facilities that are not positioned to fully assess or manage EVD and would generally refer suspect cases to an assessment or treatment;
- Ebola assessment hospitals—hospitals that could assess and manage suspect cases pending laboratory confirmation, with subsequent referral to a treatment center; and
- Ebola treatment centers—hospitals that are prepared to manage EVD cases.
In Snohomish County, Providence Regional Medical Center Everett (PRMCE) has been designated as one of eight EVD treatment centers in Washington State (thank you to PRMCE for offering to serve). Because management of any suspect case requires isolation rooms, well trained staff, and adequate personal protective equipment, concerns have been raised about hospitals other than PRMCE becoming assessment hospitals. Moreover, because even suspect cases locally are currently rare (no exposed travelers are currently known to reside in Snohomish County), we do not expect to see many (if any) suspect cases. Therefore, until the need arises for additional facilities to manage EVD cases, PRMCE will serve as both the assessment and treatment center for Snohomish County.
- When a suspect case is seen in any health care facility, providers should immediately consult the Snohomish Health District at 425-339-5278.
- If the Health District concurs that this is a suspect case, then the provider will call 911 to activate transport to PRMCE and the Health District will alert PRMCE and the Washington State Public Health Laboratory.
Action requested: Continue to vaccinate for influenza and consider use of antivirals to treat disease.
Background & Recommendations (from the Centers for Disease Control & Prevention)
Influenza activity is currently low in the United States as a whole, but is increasing in some parts of the country. Influenza A (H3N2) viruses have been reported most frequently and have been detected in almost all states. Compared with seasons during which influenza A (H1N1) or influenza B viruses have predominated, during seasons when influenza A (H3N2) viruses have predominated, higher hospitalization rates and mortality have been observed, especially among the old, the very young, and those with certain chronic medical conditions.
Of the influenza A (H3N2) viruses collected and analyzed in the United States from October 1 through November 22, 2014, 52% were antigenically different (drifted) from the H3N2 vaccine virus. When predominant circulating influenza viruses have antigenically drifted, decreased vaccine effectiveness has been observed. However, vaccination has been found to provide some protection against drifted viruses. Though reduced, this cross-protection might reduce the likelihood of severe outcomes such as hospitalization and death. In addition, vaccination will offer protection against circulating influenza strains that have not undergone significant antigenic drift from the vaccine viruses (such as influenza A (H1N1) and B viruses). However, the detection of these drifted influenza A (H3N2) viruses highlights the importance of also using neuraminidase inhibitor antiviral medications for treatment and prevention of influenza.
The two prescription antiviral medications recommended for treatment or prevention of influenza are oseltamivir (Tamiflu®) and zanamivir (Relenza®). Evidence from past influenza seasons and the 2009 H1N1 pandemic has shown that treatment with neuraminidase inhibitors has clinical and public health benefit in reducing severe outcomes of influenza and, when indicated, should be initiated as soon as possible after illness onset. Clinical trials and observational data show that early antiviral treatment can:
- shorten the duration of fever and illness symptoms;
- reduce the risk of complications from influenza (e.g., otitis media in young children and pneumonia requiring antibiotics in adults); and
- reduce the risk of death among hospitalized patients.
For more information about prevention and treatment of influenza, see:
Influenza Vaccines Available in United States, 2014–15 Influenza Season: http://www.cdc.gov/flu/protect/vaccine/vaccines.htm
Information for healthcare professionals on the use of influenza antiviral medications: http://www.cdc.gov/flu/professionals/antivirals/
Summary of Influenza Antiviral Treatment Recommendations for clinicians: http://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm#summary
Diagnostic Testing for Influenza: http://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm#diagnostic
Interim Guidance for Influenza Outbreak Management in Long-Term Care Facilities: http://www.cdc.gov/flu/professionals/infectioncontrol/ltc-facility-guidance.htm