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The Snohomish Health District Health Officer Dr. Gary Goldbaum sends alerts via email to local health care providers. Alerts cover current local, regional or national health threats and important updates on medical care and protocols. Alerts are written as needed to cover urgent or emergent health issues.

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Ebola virus disease & Influenza

Today’s topics:

  • Ebola virus disease
  • Influenza

Ebola virus disease - update

Action requested: Inquire about travel whenever patients present with fever or other symptoms consistent with Ebola.  Call the Health District (425-339-5278) immediately if Ebola is suspected.  If the Health District concurs, then providers should call 911 to arrange transport to Providence Regional Medical Center Everett (PRMCE) while the Health District alerts PRMCE and the state Department of Health.

Background (from the Centers for Disease Control & Prevention Advisory 10/2/14): The first known case of Ebola with illness onset and laboratory confirmation in the United States occurred in Dallas, Texas, on September 2014, in a traveler from Liberia. The West African countries of Liberia, Sierra Leone, and Guinea are experiencing the largest Ebola epidemic in history. From March 24, 2014, through September 23, 2014, there have been 6,574 total cases (3,626 were laboratory-confirmed) and 3,091 total deaths reported in Africa. Ebola is a rare and deadly disease caused by infection with one of four viruses (Ebolavirus genus) that cause disease in humans. Ebola infection is associated with fever of greater than 38.6°C or 101.5°F, and additional symptoms such as severe headache, muscle pain, vomiting, diarrhea, abdominal pain, or unexplained hemorrhage. Ebola is spread through direct contact (through broken skin or mucous membranes) with blood or body fluids (including but not limited to urine, saliva, feces, vomit, sweat, breast milk, and semen) of a person who is sick with Ebola or contact with objects (such as needles and syringes) that have been contaminated with these fluids. Ebola is not spread through the air or water. The main source for spread is human-to-human transmission. Avoiding contact with infected persons (as well as potentially infected corpses) and their blood and body fluids is of paramount importance. Persons are not contagious before they are symptomatic. The incubation period (the time from exposure until onset of symptoms) is typically 8-10 days, but can range from 2-21 days. Additional information is available at http://www.cdc.gov/vhf/ebola/index.html.

Recommendations (from the Centers for Disease Control & Prevention Advisory 10/2/14):

Early recognition is critical to controlling the spread of Ebola virus. Consequently, healthcare personnel should elicit the patient’s travel history and consider the possibility of Ebola in patients who present with fever, myalgia, severe headache, abdominal pain, vomiting, diarrhea, or unexplained bleeding or bruising. Should the patient report a history of recent travel to one of the affected West African countries (Liberia, Sierra Leone, and Guinea) and exhibit such symptoms, immediate action should be taken. The Ebola algorithm for the evaluation of a returned traveler and the checklist for evaluation of a patient being evaluated for Ebola are available at http://www.cdc.gov/vhf/ebola/pdf/ebola-algorithm.pdf and http://www.cdc.gov/vhf/ebola/pdf/checklist-patients-evaluated-us-evd.pdf .

Patients in whom a diagnosis of Ebola is being considered should be isolated in a single room (with a private bathroom), and healthcare personnel should follow standard, contact, and droplet precautions, including the use of appropriate personal protective equipment (PPE).

If Ebola is suspected, immediately contact the Snohomish Health District (425-339-5210).

The following guidance documents provide additional information about clinical presentation and clinical course of Ebola virus disease, infection control, and patient management:

Persons at highest risk of developing infection are:

  • those who have had direct contact with the blood and body fluids of an individual diagnosed with Ebola – this includes any person who provided care for an Ebola patient, such as a healthcare provider or family member not adhering to recommended infection control precautions (i.e., not wearing recommended PPE
  • those who have had close physical contact with an individual diagnosed with Ebola
  • those who lived with or visited the Ebola-diagnosed patient while he or she was ill

Persons who have been exposed, but who are asymptomatic, should be instructed to monitor their health for the development of fever or symptoms for 21 days after the last exposure. Guidelines for monitoring and movement of persons who have been exposed to Ebola are available at http://www.cdc.gov/vhf/ebola/hcp/monitoring-and-movement-of-persons-with-exposure.html.

Diagnostic tests are available for detection of Ebola at LRN laboratories as well as CDC. Consultation with CDC is required before shipping specimens to CDC. Information about diagnostic testing for Ebola can be found at http://www.cdc.gov/vhf/ebola/hcp/interim-guidance-specimen-collection-submission-patients-suspected-infection-ebola.html.

Influenza

Action requested: Be aware of a correction to the Health alert of 9/22/14—live attenuated influenza vaccine (LAIV) may be administered to healthy children aged 2-8 years who have no contraindications.  Precautions such as asthma or wheezing are not contraindications.

For detailed guidance and additional references, see http://www.doh.wa.gov/Portals/1/Documents/Pubs/348-NonDOH-VACClinicalGuidance-Flu.pdf.

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Health alerts include information about diseases or other health risks or issues that affect Snohomish County.