CDC investigating potential exposures of American citizens to Ebola in West Africa

On March 13, an American volunteer health care worker in Sierra Leone who tested positive for Ebola virus returned to the U.S. by medevac and was admitted to the NIH Clinical Center for care and treatment.  As a result of this case, CDC is conducting contact tracing of individuals in Sierra Leone, including several other American citizens, who may have had potential exposure to this index patient.  At this time, none of these individuals have tested positive for Ebola. These individuals are volunteers in the Ebola response and are currently being monitored in Sierra Leone.  Out of an abundance of caution, CDC and the State Department are developing contingency plans for returning those Americans with potential exposure to the U.S. by non-commercial air transport. Those individuals will voluntarily self-isolate and be under direct active monitoring for the 21-day incubation period.

One of these American citizens had potential exposure to the individual being treated at NIH and is currently being transported via charter to the Atlanta area to be close to Emory University Hospital. The individual has not shown symptoms of Ebola and has not been diagnosed with Ebola. Upon arrival in Atlanta, the individual will voluntarily self-isolate and be under direct active monitoring for the 21-day incubation period.

Health Care Worker Who Worked While Ill with Pertussis

On September 5, 2014, the public health department of a Maryland hospital was notified of a case of Bordetella pertussis infection confirmed by polymerase chain reaction (PCR) in a staff health care worker (HCW). The HCW experienced onset of diarrhea and malaise (nonrespiratory symptoms atypical of the catarrhal phase of pertussis) on August 26. By September 2, paroxysms of coughing led the HCW to consult a colleague, who ordered the PCR test, prescribed a 5-day course of azithromycin, and advised avoidance of patient care until treatment completion.

Contrary to the hospital's infection control policy, neither the HCW nor the colleague reported the presumptive diagnosis of pertussis to the hospital's public health department. The HCW continued to work in the outpatient department until the positive PCR result was received on September 5, at which time the hospital's public health department was first notified.

The hospital barred the HCW from further work at the hospital while ill, and, in collaboration with local and state public health counterparts, began a contact investigation and stratified patient and HCW contacts by level of exposure.

The HCW had received tetanus, diphtheria, and acellular pertussis vaccine (Tdap) in 2010 and reported an ill family member who had been exposed at school during a widespread outbreak of pertussis affecting the surrounding community in August (1). In all, 47 persons were identified as being exposed to the HCW, including 31 patients ranging in age from 7 days to 12 years (six of whom were too young to receive diphtheria, tetanus, and acellular pertussis vaccine [DTaP]) and 15 HCWs. Of these exposed persons, 22 were considered high-risk contacts (seven patients and 15 HCWs) because they were aged <12 months, or contacts who themselves have close contact with infants under 12 months, pregnant women, or persons with preexisting health conditions at risk for severe illness or complications from pertussis.

All 22 high-risk contacts were assessed for symptoms and received postexposure prophylaxis according to established guidelines (2). Additionally, six HCW high-risk contacts (three staff physicians, two residents, and one nurse) reported symptoms suggestive of pertussis and were excluded from work until completion of a course of antibiotics. No patient contacts reported symptoms. Nasopharyngeal swabs obtained from all symptomatic high-risk contacts were negative for pertussis by PCR. The remaining low-risk contacts, or their identified parents or guardians, were screened for symptoms, informed of the low-risk nature of the exposure, and provided education on the signs and symptoms of pertussis. All 47 persons identified as exposed were contacted by public health investigators.

HCW presenteeism (i.e., working while sick) can jeopardize the well-being of patients and coworkers (3). Because of the need to investigate and limit exposures, clinical activities in a facility can be disrupted when staff members are potentially exposed to transmissible disease. HCWs should not work while ill with a potentially contagious condition.

Positive Tests for Ebola in Volunteer International Aid Worker

Positive Tests for Ebola in Volunteer International Aid Worker

A hospitalized medical aid worker who volunteered in Guinea, one of the three West African nations experiencing an Ebola epidemic, and since returned to the United States has tested positive for Ebola according to the New York City Health Department laboratory, which is part of the Laboratory Response Network overseen by the Centers for Disease Control and Prevention. CDC has confirmed the test results in its Atlanta laboratory.

The patient has been notified of the confirmation test results and remains in isolation.

The healthcare worker had returned through JFK Airport on Oct. 17 and participated in the enhanced screening for all returning travelers from these countries. He went through multiple layers of screening and did not have a fever or other symptoms of illness. The patient reported a low-grade fever to local health officials for the first time yesterday. Yesterday, the patient was transported by a specially trained HAZ TAC unit wearing Personal Protective Equipment (PPE) to Bellevue. The New York City Health Department has interviewed the patient regarding close contacts and activities.

CDC is in close communications with the New York City Health Department and Bellevue Hospital, and is providing technical assistance and resources. Three members of CDC’s Ebola Response Team arrived in New York City last night.  Additional team members will be arriving today to New York City. This team is deployed when an Ebola case is identified in the United States, or when health officials have a very strong suspicion that a patient has Ebola pending lab results.

Ebola is spread through direct contact with bodily fluids of a sick person or exposure to objects such as needles that have been contaminated. The illness has an average 8-10 day incubation period (although it could be from 2 to 21 days). CDC recommends monitoring exposed people for symptoms a complete 21 days.