CDC Health Advisory on Ebola issued for health professionals

NewsBot · Oct 4, 2014

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Evaluating Patients for Possible Ebola Virus Disease: Recommendations for Healthcare Personnel and Health Officials

Summary
The first case of Ebola Virus Disease (Ebola) diagnosed in the United States was reported to CDC by Dallas County Health and Human Services on September 28, 2014, and laboratory-confirmed by CDC and the Texas Laboratory Response Network (LRN) laboratory on September 30. The patient departed Monrovia, Liberia, on September 19, and arrived in Dallas, Texas, on September 20. The patient was asymptomatic during travel and upon his arrival in the United States; he fell ill on September 24 and sought medical care at Texas Health Presbyterian Hospital of Dallas on September 26. He was treated and released. On September 28, he returned to the same hospital, and was admitted for treatment.

The purpose of this HAN Advisory is to remind healthcare personnel and health officials to:

(1) increase their vigilance in inquiring about a history of travel to West Africa in the 21 days before illness onset for any patient presenting with fever or other symptoms consistent with Ebola;

(2) isolate patients who report a travel history to an Ebola-affected country (currently Liberia, Sierra Leone, and Guinea) and who are exhibiting Ebola symptoms in a private room with a private bathroom and implement standard, contact, and droplet precautions (gowns, facemask, eye protection, and gloves); and

(3) immediately notify the local/state health department.

Please disseminate this information to infectious disease specialists, intensive care physicians, primary care physicians, and infection control specialists, as well as to emergency departments, urgent care centers, and microbiology laboratories.

Background
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
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). Infection control personnel and the local health department should be immediately contacted for consultation.

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

Guidelines for clinicians in U.S. healthcare settings are available at http://www.cdc.gov/vhf/ebola/hcp/clinician-information-us-healthcare-settings.html.
Guidelines for infection prevention control for hospitalized patients with known or suspected Ebola in U.S. hospitals are available at http://www.cdc.gov/vhf/ebola/hcp/infection-prevention-and-control-recommendations.html.
Guidelines for safe management of patients with Ebola in U.S. hospitals are at http://www.cdc.gov/vhf/ebola/hcp/patient-management-us-hospitals.html.
The case definitions for persons under investigation (PUI) for Ebola, probable cases, and confirmed cases as well as classification of exposure risk levels are at http://www.cdc.gov/vhf/ebola/hcp/case-definition.html.

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/in...ssion-patients-suspected-infection-ebola.html.

Healthcare personnel in the United States should immediately contact their state or local health department regarding any person being evaluated for Ebola if the medical evaluation suggests that diagnostic testing may be indicated. If there is a high index of suspicion, U.S. health departments should immediately report any probable cases or persons under investigation (PUI) (http://www.cdc.gov/vhf/ebola/hcp/case-definition.html) to CDC’s Emergency Operations Center at 770-488-7100.
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NewsBot · Oct 4, 2014

CDC Ebola algorithm:

Craig Payne · Oct 4, 2014

NewsBot said: ↑

CDC Ebola algorithm:
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I prefer this algorithm:

horseman · Oct 4, 2014

Craig Payne said: ↑

I prefer this algorithm:
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But I have patients with family in the high risk zone, I do need to be aware that they may visit... Same as with TB in Asians. A few clinical guidelines is helpful.

sleep well:D

Mark Russell · Oct 4, 2014

Let's hope it never incubates alongside its cousin H5N1 and discovers an altogether different highway... What's the morbidity of the present outbreak?

Craig Payne · Oct 4, 2014

Mark Russell said: ↑

What's the morbidity of the present outbreak?
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My understanding is that mortality was >60%; BUT that is coming down quickly as more resources are arriving in the affected zones.

Mark Russell · Oct 4, 2014

Craig Payne said: ↑

My understanding is that mortality was >60%; BUT that is coming down quickly as more resources are arriving in the affected zones.
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It does make you wonder where the resources are coming from. We've gone from "no known cure" to a pretty effective antiviral that was supposedly at pre-trial stage. All of the western victims flown out of Africa have made a good recovery - which suggests this virus has been exploited in the lab - one would hope for humanitarian goals. If that is the case, lets hope there's still sufficient philanthropy left in the world to send some vaccines out to the people of Liberia and Sierra Leone, although I'm sure there are some advocates out there that would suggest it might be better for Planet Earth if the bugs made some headway this time. It would make a change from humans leading the wholesale slaughter trade for a while...

Mark Russell · Oct 8, 2014

I know we're being told that ebola is only transmitted through direct contact with body fluids and not as an airborne transmission, but the research seems to suggest otherwise. It might explain why the current outbreak has developed so quickly.......

Let's hope it's just a series of unfortunate errors

http://www.nature.com/srep/2012/121115/srep00811/full/srep00811.html

http://www.bbc.co.uk/news/science-environment-20341423

Craig Payne · Oct 9, 2014

Homeopath Finds a Cure for Ebola: Violin Music

Mark Russell · Sep 22, 2016

Pretty harrowing documentary about the current outbreak.

Craig Payne · Oct 10, 2014

..................................

blinda · Oct 10, 2014

Mark Russell said: ↑

Pretty harrowing documentary about the current outbreak.
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Heart wrenching to watch. Certainly puts my own 'worries' into perspective.

Craig Payne · Oct 12, 2014

I see the conspiracy loons are now coming out in force:
West African Ebola Outbreak is a Hoax

Make no mistake about it the claim of a West African Ebola outbreak which has made it to the Western world is a fake and a hoax. The photographic evidence does not support the existence of a real outbreak and, rather, demonstrates the degree of the fraud.
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Craig Payne · Oct 13, 2014

only in America:

NewsBot · Oct 15, 2014

Facebook's Mark Zuckerberg gives $US25 million to fight Ebola

Admin2 · Oct 15, 2014

Ebola virus epidemic in West Africa

Redirect to:
Western African Ebola virus epidemic

From a page move: This is a redirect from a page that has been moved (renamed). This page was kept as a redirect to avoid breaking links, both internal and external, that may have been made to the old page name.

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Admin2 · Oct 15, 2014

2014 Ebola virus disease epidemic timeline

Redirect to:
West African Ebola virus epidemic timeline

From a page move: This is a redirect from a page that has been moved (renamed). This page was kept as a redirect to avoid breaking links, both internal and external, that may have been made to the old page name.

Read More

Admin2 · Oct 15, 2014

Ebola virus outbreak in the United States

Redirect to:
Ebola virus cases in the United States

From a page move: This is a redirect from a page that has been moved (renamed). This page was kept as a redirect to avoid breaking links, both internal and external, that may have been made to the old page name.

Read More

Craig Payne · Oct 16, 2014

Prevention:

Craig Payne · Oct 16, 2014

More conspiracy nutters:
Ebola Patients & Exposed Persons to be Sent to Death Camps According to HHS Documents

Craig Payne · Oct 17, 2014

The Media Coverage of Ebola is Terrifying -- But the Actual Impact of Ebola is at Least as Scary

Craig Payne · Oct 17, 2014

Current Ebola Related Hoaxes
Just as the H1N1 conspiracy theory machine did in 2009, the Ebola conspiracy theory machine goes into overdrive

Mark Russell · Oct 17, 2014

This is for your benefit, Mr Payne! http://homeopathyplus.com.au/formal...guinea-sierra-leone-liberia-homeopathy-ebola/

Maybe we should send Rhubarb, no doubt his insoles will cure Ebola....

Craig Payne · Oct 18, 2014

The Playboy model and reknown medical expert is at it again:
Jenny McCarthy: ‘Lemon Juice Cures Ebola’ (satire)

Craig Payne · Oct 18, 2014

Mark Russell said: ↑

This is for your benefit, Mr Payne! http://homeopathyplus.com.au/formal...guinea-sierra-leone-liberia-homeopathy-ebola/

Maybe we should send Rhubarb, no doubt his insoles will cure Ebola....
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I am willing to personally pay the airfares for any Homeopath to travel to West Africa so they can administer their cures. I have posted this offer on several Homeopathy facebook pages ... I can't figure out why my posts get deleted and the homeopaths do not take up the offer ...

Mark Russell · Oct 18, 2014

Craig Payne said: ↑

I am willing to personally pay the airfares for any Homeopath to travel to West Africa so they can administer their cures. I have posted this offer on several Homeopathy facebook pages ... I can't figure out why my posts get deleted and the homeopaths do not take up the offer ...
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Can we start a fund to send Brian too?

Craig Payne · Oct 18, 2014

Craig Payne · Oct 18, 2014

,,,,,,,,,,,,,,,,,,,,,,,,,,,,

Craig Payne · Oct 18, 2014

stooooooopid

Craig Payne · Oct 19, 2014

The report claims the Red Cross is injecting people with poison and pretending that they are subsequently dying of Ebola as a means of furthering sinister Western interests.
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Nonsensical Report Claims Ebola Not Real

Craig Payne · Oct 20, 2014

6 Fake Ebola Cures Being Peddled Online

blinda · Oct 23, 2014

Received this email alert for Viruses, from one of my favourite publishers of Open Access Journals MDPI (whose impact factor increased by 30% this year)...

Given the current dramatic evolution of the Ebola virus disease outbreak in West Africa, Viruses Editorial Board member and editor Dr. Jens H. Kuhn (NIH/NIAID/IRF-Frederick) has kindly compiled a list of resources related to the Ebola virus and other filoviruses that were published in the journal Viruses.

http://blog.mdpi.com/2014/09/24/resources-on-ebola-virus/

Craig Payne · Oct 25, 2014

Australian Ebola response 'shambles'

Mark Russell · Oct 25, 2014

CDC issues guidance/explanation in transmission.

http://www.cdc.gov/vhf/ebola/pdf/infections-spread-by-air-or-droplets.pdf

Craig Payne · Oct 28, 2014

NEJM comes out quite strong against quarantine:
http://www.nejm.org/doi/full/10.1056/NEJMe1413139

Craig Payne · Oct 29, 2014

Ebola screening, at a podiatry clinic near you?

Yesterday I discovered first-hand that all of the clinics in our local Midwestern university-based clinic system are having their receptionists ask everybody at check-in:

-- Have you traveled overseas in the past 30 days?
-- Have you been in contact with any person who has Ebola, or the remains of any such person?
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This was the only health-related question that the receptionist was tasked with asking, and it's being asked at ALL clinics of every patient: podiatry, psychiatry, physical therapy, optometrist, all of them.
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Craig Payne · Oct 30, 2014

I have made an offer to send this MP to go to West Africa and take a homeopath with him to fix the ebola problem:
Fight Ebola with homeopathy - MP
Will wait to see if he replies to me!

Craig Payne · Nov 2, 2014

Organic activists reject science, propose ‘natural’ Ebola cure, claim government conspiracy

Craig Payne · Nov 5, 2014

Craig Payne said: ↑

I have made an offer to send this MP to go to West Africa and take a homeopath with him to fix the ebola problem:
Fight Ebola with homeopathy - MP
Will wait to see if he replies to me!
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lol!

MP demoted after suggesting homeopathy use in Ebola fight

NewsBot · Nov 6, 2014

Press Release:
How important is long-distance travel in the spread of epidemics?

BERKELEY — Three scenarios depicting the simulated spread of a simple epidemic from a single point outbreak. Long-range jumps — mimicking air travel, for example — lead to sub-outbreaks. If long-distance jumps are rare, the main outbreak will quickly merge with the satellite outbreaks, leading to a rippling, wave-like growth (left). As the likelihood of long-distance jumps increases, the epidemic spread exhibits a super-linear power-law growth (center) or a stretched exponential or “metastatic” growth. (Simulations by Oskar Hallatschek, UC Berkeley, and Daniel Fisher, Stanford. Video editing by Christian Collins.)

Yet knowing how to predict the spread of these epidemics is still uncertain, because the complicated models used are not fully understood, says a UC Berkeley biophysicist.

Using a very simple model of disease spread, Oskar Hallatschek, assistant professor of physics, proved that one common assumption is actually wrong. Most models have taken for granted that if disease vectors, such as humans, have any chance of “jumping” outside the initial outbreak area – by plane or train, for example – the outbreak quickly metastasizes into an epidemic.

Hallatschek and co-author Daniel Fisher of Stanford University found instead that if the chance of long-distance dispersal is low enough, the disease spreads quite slowly, like a wave rippling out from the initial outbreak. This type of spread was common centuries ago when humans rarely traveled. The Black Death spread through 14th-century Europe as a wave, for example.

But if the chance of jumping is above a threshold level – which is often the situation today with frequent air travel –the diseases can generate enough satellite outbreaks to spread like wildfire. And the greater the chance that people can hop around the globe, the faster the spread.

“With our simple model, we clearly show that one of the key factors that controls the spread of infection is how common long-range jumps are in the dispersal of a disease,” said Hallatschek, who is the William H. McAdams Chair in physics and a member of the UC Berkeley arm of the California Institute for Quantitative Biosciences (QB3). “And what matters most are the rare cases of extremely long jumps, the individuals who take plane trips to distant places and potentially spread the disease.”

This new understanding of a simple computer model of disease spread will help epidemiologists understand the more complex models now used to predict the spread of epidemics, he said, but also help scientists understand the spread of cancer metastases, genetic mutations in animal or human populations, invasive species, wildfires and even rumors.

Hallatschek typically studies in a Petri dish how new mutations spread in colonies of microbes, activity that he models mathematically to understand how evolution fixes new traits in a population. When looking at simple theories of such “epidemic” spread, however, he was surprised to discover that no one knew the answer to a simple question: How does the long-distance dispersal of individuals during an outbreak affect the spread?

When long-distance travel is rare, epidemics spread like a slow, rippling wave, as demonstrated by the simulation (left) and the actual historical spread of the black death during the Middle Ages. (Images courtesy of Oskar Hallatschek and D. Sherman and J. Salisbury)
Simulations show that if the chance of individuals traveling away from the center of an outbreak drops off exponentially with distance – for example, if the chance of distant travel drops by half every 10 miles – the disease spreads as a relatively slow wave.

Simulations also suggested that a slower “power-law” drop off – for example, if the chance of distant travel drops by half every time the distance is doubled – would let the disease get quickly out of control.”

“We were shocked to see that this had not been demonstrated, and saw a chance to prove something really fundamental,” Hallatschek said.

The simple model he used was stripped of real-world complexity, but contained the crucial ingredients needed to predict evolutionary spread and, more importantly, could be captured by a mathematical formula. Hallatschek discovered three types of epidemic situations involving power-law distributions.

In cases where long-range jumps are very rare, epidemics spread in a slow wave, typified by the Black Death. The invasive cane toad also spread in a slow wave after being introduced to Australia in the 1930s. When long-range jumps are common, the disease spreads very rapidly, as in 2002-2003 with SARS (severe acute respiratory syndrome), which was spread around the world by air travelers. An intermediate situation produces satellite outbreaks, but spreads far more slowly than SARS-like cases.

Hallatschek said that previous studies failed to take into account the randomness of jumps, which led people to think that any long-range jump would lead to new outbreaks and rapid spread. But if long-range jumps are extremely rare, distant outbreaks tend to be overtaken by the slow, wavelike spread of the initial outbreak before they can contribute much to the overall epidemic.

He noted that two recent studies of human dispersal – the “Where’s George?” dollar bill tracking study and a 2008 cellphone-user mobility study – suggest that in the real world, humans disperse according to a power-law distribution over distances of up to hundreds of kilometers and exponentially over even longer distances.

In the future, he plans to make his model more and more realistic, first by incorporating networks to mimic the real world where people do not jump randomly, but must travel through airport hubs or train stations. Hallatschek also hopes to test his model by using data on the evolving genome sequences of pathogens as they spread, which provide one measure of where and when satellite outbreaks occur.

The work was supported by the Simons Foundation and QB3, as well as grants from Germany’s Deutsche Forschungsgemeinschaft and the U.S. National Science Foundation.
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Ebola virus epidemic in West Africa

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