Ebola algorithm for the evaluation of the returned traveler

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rim Halaby, M.D. [2]

Algorithm

Is there a FEVER (subjective or ≥101.5°F or 38.6°C) or compatible EVD symptoms (headache, weakness, muscle pain, vomiting, diarrhea, abdominal pain or hemorrhage) in patient who has traveled to an Ebola-affected area in the 21 days before illness onset?

Yes

No

1. Isolate patient in single room with a private bathroom and with the door to hallway closed 2. Implement standard, contact, and droplet precautions (gown, facemask, eye protection, and gloves) 3.Notify the hospital Infection Control Program and other appropriate staff 4. Evaluate for any risk exposures for EVD 5. IMMEDIATELY report to the health department

Report asymptomatic patients with high- or low-risk exposures in the past 21 days to the health department

Determine the risk of exposure

HIGH-RISK EXPOSURE

LOW-RISK EXPOSURE

NO KNOWN EXPOSURE

Percutaneous (e.g., needle stick) or mucous membrane contact with blood or body fluids from an EVD patient OR Direct skin contact with, or exposure to blood or body fluids of, an EVD patient OR Processing blood or body fluids from an EVD patient without appropriate personal protective equipment (PPE) or biosafety precautions OR Direct contact with a dead body (including during funeral rites) in an Ebola affected area without appropriate PPE

Percutaneous (e.g., needle stick) or mucous membrane contact with blood or body fluids from an EVD patient OR Direct skin contact with, or exposure to blood or body fluids of, an EVD patient OR Processing blood or body fluids from an EVD patient without appropriate personal protective equipment (PPE) or biosafety precautions OR Direct contact with a dead body (including during funeral rites) in an Ebola affected area without appropriate PPE

Residence in or travel to affected areas without HIGH- or LOW-risk exposure

Review case with Health Department including: • Severity of illness • Laboratory findings (e.g., platelet counts) • Alternative diagnoses

Is EVD suspected?

Yes

No

TESTING IS INDICATED • The health department will arrange specimen transport and testing at a Public Health Laboratory and CDC. • The health department, in consultation with CDC, will provide guidance to the hospital on all aspects of patient care and management

TESTING IS NOT INDICATED If patient requires in-hospital management: • Decisions regarding infection control precautions should be based on the patient’s clinical situation and in consultation with hospital infection control and the health department • If patient’s symptoms progress or change, re-assess need for testing with the health department If patient does not require in-hospital management • Alert the health department before discharge to arrange appropriate discharge instructions and to determine if the patient should self-monitor for illness • Self-monitoring includes taking their temperature twice a day for 21 days after their last exposure to an Ebola patient