AAP: US not protected from Ebola until Africa outbreak is contained

October 13, 2014

SAN DIEGO — Today the AAP’s Committee on Infectious Diseases discussed the current Ebola outbreak, symptoms of the disease, transmission, risk and lessons learned thus far.

“We come to you today humbly, as learners. We are all learning about this disease. Not one of us on the panel has had the opportunity to care for an Ebola patient, so we are all really learning and hope that our interactions and discussions that we’ve been having with the AAP, with the CDC and with our own institutions, as we prepare our home hospitals and our home cities for the possibility of Ebola, may somehow be helpful to you,” Carrie L. Byington, MD,of the University of Utah in Salt Lake City, who led the discussion, said during the seminar.

Symptoms, risk and transmission

There are five species of Ebola virus, according to Byington. The current Ebola outbreak involves Zaire ebolavirus. Death rates for Ebola range from 50% to 90%.

Ebola is transmitted through direct contact with blood or body fluids including urine, feces, saliva, vomit, semen, contaminated objects and infected animals.

Ebola symptoms include fever of at least 101.5⁰F, severe headache, muscle pain, vomiting, diarrhea, abdominal pain and unexplained hemorrhage. Ebola virus has an incubation period of 2 to 21 days and an average of 8 to 10 days.

Patients with fever of at least 101.5⁰F with other symptoms or epidemiologic risk factors within 21 days prior to onset should be considered “under investigation,” according to Byington.

Recommendations and guidance

Panelists and audience members agreed that more guidance is needed on how to manage patients who present to the pediatrician’s office with Ebola-like symptoms.

“The guidance we receive today from the CDC really is guidance for health care facilities that are hospital-based. There is a great deal of attention now with directive to outpatient facilities, urgent care, private practices, community hospitals and health care centers. How can we prepare these facilities, which are likely to encounter patients traveling from an endemic area? We need to know how to handle those patients,” Byington said.

Though there is no formal guidance from the CDC, Byington and panelists recommended patients suspected to have Ebola should be isolated in a private room containing a private bathroom with the door closed. Only mattresses and pillows with waterproof plastic or other waterproof covering should be used. All people entering the patient room should wear gloves, fluid-resistant or impermeable gown, goggles or a face shield and a facemask. Health care providers should practice hand hygiene frequently; before and after patient contact, contact with infectious suspected material, before putting on personal protective equipment and upon removal.

“You should not have contact with patients if you do not have appropriate personal protective gear. Here is really where you need to know the resources of your community. What are your public health resources, your local, state health department and your hospital resources for the appropriate transport of the patient to a facility where appropriate testing and isolation can be completed,” Byington said.

The CDC states having a space of 3 feet or more from a patient provides protection from Ebola. If a patient is suspected to have Ebola, Byington recommends pediatricians keep this distance, obtain travel history and observe the patient’s condition from the doorway.

“Try to have travel history right away, as the patient comes in. Then come to the door; you can gain a great deal of information using your eyes,” she said. “The family is already likely exposed. If you can, have the family deliver necessary care until you can call for backup to have an appropriately protected individual transport the child to the hospital.”

Health care workers should not attempt to disinfect offices, patient rooms or waiting rooms themselves. Byington and panelists recommend alerting the local and/or state health department.

Although Ebola has not significantly impacted the United States in terms of outbreak, cases of Ebola in the United States are probable.

“We can clearly see failings in the health care system and infrastructure in one country affect all countries. We will not be able to be safe in the United States until the outbreak in Africa is contained. There is interconnectedness through our population, primarily through travel. Now that we are seeing Ebola in urban environments, there may be opportunities for individuals to travel outside their country to receive medical care or when they were unknowingly affected [by Ebola],” Byington said. — by Amanda Oldt

For more information:

Byington C. #S3019. Presented at: 2014 AAP National Conference and Exhibition; Oct. 11-14; San Diego.

Disclosure: Byington reports financial ties with Biofire.