Ebola Exposure (Version )

Transcription

1 Ebola Exposure (Version ) Pediatric Office-Hours Version DEFINITION Exposure to a person with suspected or proven Ebola Travel to or living in an area with recent cases of Ebola. These are countries in West Africa: Guinea, Liberia, and Sierra Leone. Questions about Ebola EXPOSURE to Ebola is defined as: Physical contact (touching) a person with suspected or proven Ebola. Examples include kissing, hugging or holding hands. Another example is sharing eating or drinking utensils. Contact with blood or body fluids of a person with suspected or proven Ebola. Handling of bats or monkeys from areas where Ebola is occurring. TRIAGE ASSESSMENT QUESTIONS FOR EBOLA EXPOSURE Call EMS 911 Now Sounds like a life-threatening emergency to the triager See More Appropriate Protocol Fever occurs more than 21 days after last Ebola EXPOSURE Go to Protocol: Fever (Pediatric) Go to ED Now Fever within 21 days of Ebola EXPOSURE. Abdominal pain, diarrhea, or vomiting within 21 days of Ebola EXPOSURE Headache within 21 days of Ebola EXPOSURE Cough and within 21 days of Ebola EXPOSURE Unexplained bleeding or bruising and within 21 days of Ebola EXPOSURE Any symptoms that are unexplained occur within 21 days of Ebola EXPOSURE Call Local Agency Today Page 1 of 7

2 Ebola EXPOSURE within past 21 days and NO fever or other symptoms such as abdominal pain, diarrhea, headache, vomiting or bleeding/bruising Reason: Report to CDC, Public Health Department, or other designated agency. People exposed to Ebola but without symptoms need to be monitored closely by a health care provider. Home Care Ebola EXPOSURE more than 21 days ago and NO symptoms Reason: No symptoms and beyond incubation period for Ebola (2 to 21 days) Ebola, questions about Home Care Advice Ebola Exposure within 21 Days and Symptoms Go to the Emergency Department (ED): Do not leave until I've called the ED. The ED may have special instructions on how best to get you there. I will call you back. The ED is the best place to get testing and treatment. The ED is most prepared to prevent the spread of this infection to others. Note to Triager: The ED will be most prepared for taking care of such a patient. The ED has correct infection control procedures and personal protective equipment (PPE). Triage Nurse Must Notify Emergency Department (ED): The triager must call ahead to the ED and inform them of patient's symptoms and suspected diagnosis of Ebola. Reason: So that ED can make arrangements to prevent Ebola transmission to others in the hospital. Transport: In some communities, the ED or PHD (Public Health Department) may have a special ambulance for transporting suspected Ebola patients. Follow PHD directives. Isolation Is Needed: Stay in your home until I call you back. Do Not go to school or work. Do Not go to church, child care centers, shopping, or other public places. Avoid close contact with others (hugging, kissing). Do Not shake hands. Protect Others from Body Fluids: Protect others from blood and other body fluids! Body fluids include saliva, stool, urine, vomit, sweat, breastmilk, and semen. Cover any bleeding area with a towel or cloth. Other people should avoid contact with blood or body fluids. They should not touch you or your child. They should not handle your child's bedding or dirty clothes. Fever Medicine: For fever above 102 F (39 C), give acetaminophen before going in. (See Dosage table) Do NOT give aspirin or ibuprofen (Advil, Motrin). Vomiting: Avoid medication until seen. Ebola Exposure within 21 Days and No Symptoms Triage Nurse Must Notify the CDC or the Local Public Health Department: The patient should stay at home and avoid contact with others until he/she has talked with the CDC, public health department (PHD) or other designated agency. Reason: People exposed to Ebola but without symptoms need to followed closely by a health Page 2 of 7

3 care provider. Early detection of symptoms is the only way to prevent spread of the disease. Follow-up care may be provided by CDC, local PHD, other designated agency or your office. Follow CDC and PHD directives Reassurance and Education: Although you were exposed to Ebola, you do not have any symptoms. The Ebola infection starts within 21 days following the last exposure. Since it's been less than 21 days, you still are at risk for coming down with Ebola. You will need to watch for symptoms until 21 days have passed. Stay at Home: Stay at home until you talk with the CDC, public health department, or other designated agency. They will tell you how much isolation is needed during the 21 days. Measure Temperature and Report Any Fever or Symptoms: Measure your temperature 2 times each day until 21 days after exposure. Report any fever or other symptoms to the CDC, local PHD or the HCP following you. Ebola - Symptoms: Symptoms appear 2 to 21 days after the last exposure to Ebola. The average is 8-10 days. Fever is usually the first symptom, especially one higher than F (38.0 C). GI Symptoms: Abdominal pain, vomiting, diarrhea Neuro symptoms: Severe headache, weakness, muscle pain Cough (present in 65% of children with Ebola) Bleeding and bruising are late symptoms. Ebola - How is it Spread? Ebola patients are not contagious until they become sick. They are not contagious during the incubation period. This is the time between exposure and the time a person shows symptoms. The Ebola virus can be spread in several ways. Blood or body fluids of a person sick with Ebola can spread this illness. Body fluids include saliva, urine, vomit, stool, sweat, semen and breastmilk. Touching a dead body can also transmit Ebola. Dirty objects with blood or body fluids on them can spread the disease. Examples are dirty clothing, bedding or needles. Infected animals (e.g., bats and monkeys) can also spread the disease. Mucous membrane transmission: Ebola can start if infected fluid gets into the eyes, nose or mouth. This mainly happens if infected fluid gets on the hands and the person then touches the face. Frequent hand washing is helpful. Skin transmission: The virus in blood or body fluids may pass through an open cut or scrape. Even minor breaks in the skin may transmit the virus. Intact skin is safe if the body fluid is carefully washed off. Ebola is NOT spread in the food supply, tap water or the air. It also is not spread by mosquitoes or other insects. Call Back If: Fever occurs within 21 days of Ebola exposure Abdominal pain, diarrhea, or vomiting occurs within 21 days of Ebola exposure Headache occurs within 21 days of Ebola exposure Cough occurs within 21 days of Ebola exposure Unexplained bruising or bleeding occurs within 21 days of Ebola exposure Other unusual symptoms occur within 21 days of Ebola exposure You have more questions. Page 3 of 7

4 Ebola Exposure Over 21 Days Ago and No Symptoms Reassurance and Education: Symptoms should appear 2 to 21 days after the last exposure to Ebola. The average is 8-10 days. Over 21 days have passed since your last exposure. You did not develop fever or other symptoms of Ebola infection. Therefore, you should be safe from getting Ebola. Call Back If: Fever develops Any unusual symptoms occur You have other questions Questions About Ebola Virus Disease (EVD) Ebola - General Info: Ebola is an infection caused by the Ebola virus. It is a rare disease, but the death rate can be 50%. There have been small outbreaks in Africa since In 2014, a major outbreak of Ebola started in West Africa. On September 30, 2014, the CDC reported the first case of Ebola in the United States. The patient was exposed to Ebola in Liberia. He came down with his first symptoms in Dallas, Texas. Ebola - Symptoms: Symptoms appear 2 to 21 days after the last exposure to Ebola. The average is 8-10 days. Fever is usually the first symptom, especially one higher than F (38.0 C). GI Symptoms: Abdominal pain, vomiting, diarrhea Neuro symptoms: Severe headache, weakness, muscle pain Cough (present in 65% of children with Ebola) Bleeding and bruising are late symptoms. Ebola - How is it Spread? Ebola patients are not contagious until they become sick. They are not contagious during the incubation period. This is the time between exposure and the time a person shows symptoms. The Ebola virus can be spread in several ways. Blood or body fluids of a person sick with Ebola can spread this illness. Body fluids include saliva, urine, vomit, stool, sweat, semen and breastmilk. Touching a dead body can also transmit Ebola. Dirty objects with blood or body fluids on them can spread the disease. Examples are dirty clothing, bedding or needles. Infected animals (e.g., bats and monkeys) can also spread the disease. Mucous membrane transmission: Ebola can start if infected fluid gets into the eyes, nose or mouth. This mainly happens if infected fluid gets on the hands and the person then touches the face. Frequent hand washing is helpful. Skin transmission: The virus in blood or body fluids may pass through an open cut or scrape. Even minor breaks in the skin may transmit the virus. Intact skin is safe if the body fluid is carefully washed off. Ebola is NOT spread in the food supply, tap water or the air. It also is not spread by mosquitoes or other insects. Ebola - Risk Factors: Most Ebola patients have been linked to countries in West Africa. These patients have either lived in or traveled to countries there. These countries include Guinea, Liberia, and Sierra Leone. The risk of getting the illness is highest in these countries. Page 4 of 7

5 Caregivers and close contacts of these patients can also get the disease. But, for most people, your risk of getting Ebola remains very low. Countries where Ebola is occurring can change. The most current list of countries with Ebola outbreaks is on the CDC website. ( Call Back If: You have other questions FIRST AID FIRST AID Advice for Someone Else's Body Fluid on the Skin: Wash skin with soap and water. FIRST AID Advice for Someone Else's Body Fluid in the Eye: Immediate and thorough flushing (irrigation) of the eye with tap water should be done as quickly as possible. (Reason: To rinse out the body fluid). Do this for 2-3 minutes. Wash surrounding skin with soap and water. FIRST AID Advice for Someone Else's Body Fluid in the Mouth: Rinse the mouth with water and spit it out. Do this repeatedly for 2-3 minutes. Wash surrounding skin with soap and water. FIRST AID Advice for Someone Else's Body Fluid in the Nose: Rinse the nostrils with water and then blow your nose. You can do this by splashing water in your nose from a faucet or shower. Do this repeatedly for 2-3 minutes. Wash surrounding skin with soap and water. BACKGROUND INFORMATION Ebola Cause Ebola is an infection caused by the Ebola virus. The infection is spread human-to-human. The first cases may have come from contact with infected bats or monkeys. It is a rare disease, but the death rate can be 50%. There have been small outbreaks in Africa since In 2014, a major outbreak of Ebola started in Guinea in West Africa. On September 30, 2014, the CDC reported the first case of Ebola in the United States. The patient was exposed to Ebola in Liberia. He came down with his first symptoms in Dallas, Texas. Ebola Symptoms Symptoms appear 2 to 21 days after exposure to Ebola. The average is 8-10 days. Symptoms are: Fever. Fever is usually the first symptom. GI Symptoms: Abdominal pain, vomiting, diarrhea. Neuro symptoms: Severe headache, weakness, muscle pain. Cough present in 65% of children with Ebola (Mupere; 2001) Page 5 of 7

6 Bleeding and bruising are late symptoms. Ebola - How is it Transmitted? Infected people do not spread the illness during the incubation period. People with Ebola do not spread the disease until they become sick with symptoms. The Ebola virus can be spread in several ways. Blood or body fluids of a person sick with Ebola can spread this illness. Body fluids include saliva, urine, vomit, stool, sweat, semen and breastmilk. Touching a dead body can also transmit Ebola. Dirty objects with blood or body fluids on them can spread the disease. Examples are dirty clothing, bedding or needles. Infected animals (e.g., bats and monkeys) can also spread the disease. Mucous membrane transmission: Ebola can start if infected fluid gets into the eyes, nose or mouth. This mainly happens if infected fluid gets on the hands and the person then touches the face. Frequent hand washing is helpful. Skin transmission: The virus in blood or body fluids may pass through an open cut or scrape. Even minor breaks in the skin may transmit the virus. Intact skin is safe if the body fluid is carefully washed off. Droplet transmission: If a sick Ebola patient coughs or sneezes, droplet spread could occur. This would require that the spray from a wet cough/sneeze gets into the eyes, nose or mouth of someone during close contact. ( Ebola - How is it NOT Transmitted? Airborne transmission: Airborne transmission refers to spread by airborne virus-containing particles that float in the air for several hours (such as with measles or chickenpox). Ebola is NOT spread this way. Food or water: NOT spread this way. Mosquitoes or other insects: NOT spread this way. Risk Factors - Countries with Ebola Most Ebola patients have been linked to countries in West Africa. These patients have either lived in or traveled to countries there. These countries include Guinea, Liberia, and Sierra Leone. This risk of getting the illness is highest in these countries. Caregivers and close contacts of Ebola patients can also get the disease. But, for most people, your risk of getting Ebola remains very low. Countries where Ebola is occurring can change. The most current list of countries with Ebola outbreaks is on the CDC website. ( Prognosis The World Health Organization (WHO) estimates mortality of the current (2014) outbreak in West Africa to be approximately 55-75%. Internet Resources: Look for Ebola pages on these websites for more information. Australia Department of Health: Centers for Disease Control, United States (CDC): Centers for Disease Control - Traveler Advisories and Traveler's Health: Health Canada: World Health Organization (WHO): Page 6 of 7

7 Expert Reviewer: Ann-Christine Nyquist MD, MSPH; Sections of Infectious Disease and Epidemiology, Children's Hospital Colorado. REFERENCES Adams DA, Jajosky RA, Ajani U, Kriseman J, Sharp P, Onwen DH, Schley AW, Anderson WJ, Grigoryan A, Aranas AE, Wodajo MS, Abellera JP. Summary of notifiable diseases - United States, 201 MMWR Morb Mortal Wkly Rep Sep 19;61(53):1-12 Centers for Disease Control and Prevention. Evaluating Patients for Possible Ebola Virus Disease: Recommendations for Healthcare Personnel and Health Officials. CDC Health Advisory. HAN0037 Available at: Last access 10/4/201 Centers for Disease Control and Prevention (CDC) Ebola Virus Disease (EVD). Available at: Last accessed 10/4/201 Kanapathipillai R. Ebola virus disease--current knowledge. N Engl J Med Sep 25;371(13):e18. Meltzer MI, Atkins CY, Santibanez S, Knust B, Petersen BW, Ervin ED, Nichol ST, Damon IK, Washington ML. Estimating the Future Number of Cases in the Ebola Epidemic --- Liberia and Sierra Leone, MMWR Surveill Summ Sep 26;63:1-1 Mupere E, Kaducu OF, Yoti Z. Ebola haemorrhagic fever among hospitalised children and adolescents in northern Uganda: epidemiologic and clinical observations. Afr Health Sci. 2001Dec;1(2):60- Peacock G, Uyeki TM, Rasmussen SA. Ebola virus disease and children: what pediatric health care professionals need to know. JAMA Pediatr. Published online October 17, 201 doi: /jamapediatrics AUTHOR AND COPYRIGHT Author: Copyright: Barton D. Schmitt, MD, FAAP All rights reserved. Content Set: Telephone Triage Protocols - Pediatric Office-Hours Version Version Year: 2014 Last Revised: 10/28/2014 Last Reviewed: 10/20/2014 Page 7 of 7