Possible Contacts in Dallas Ebola Case Grow to 100

October 02, 2014

Public health authorities are assessing whether roughly 100 individuals in Dallas, Texas, have had direct or indirect contact with a patient who is hospitalized there with the deadly Ebola virus, the head of the Centers for Disease Control and Prevention (CDC) said today at a news conference.

"Our approach is to cast a wide net," said CDC Director Tom Frieden, MD, MPH.

Of this group, only a handful appear to have possibly been exposed to Thomas Eric Duncan, the first patient to be diagnosed with the virus while in the United States, said Dr. Frieden. These individuals will be monitored by healthcare workers who will take their temperatures twice a day and check for other Ebola symptoms besides fever. The disease is contagious only when symptoms appear and there is direct contact with bodily fluids.

As worries heighten about the virus' arrival in the United States, Dr. Frieden reiterated past statements about the ability of the nation's public health infrastructure to handle the challenge.

"We remain confident that we can contain any spread of Ebola within the United States," said Dr. Frieden. "There could be additional cases. If that occurs, systems are in place so that they will not further spread Ebola."

In an interview with Medscape Medical News, a spokesperson for the Dallas County Department of Health and Human Services said none of the 100 or so individuals being assessed have Ebola symptoms.

Duncan had flown from Liberia, one of several West African nations being ravaged by the Ebola virus, to Dallas on September 19, arriving the next day, according to the CDC. He began experiencing Ebola symptoms on September 24. On September 25, he sought care at Texas Health Presbyterian Hospital, which sent him home with a prescription for antibiotics. He returned in worse shape on September 28 and was admitted.

His condition as of early Thursday afternoon was serious, said Dr. Frieden.

Patient Told Hospital in First Visit That He Had Come From Africa

Information continues to emerge as to why Texas Health Presbyterian Hospital did not identify Duncan as possibly having Ebola when he first came there presenting nonspecific symptoms.

Mark Lester, MD, executive vice president of Texas Health Resources, the Texas health department, said in a news conference yesterday that at the first visit, Duncan "volunteered that he had travelled from Africa in response to the nurse operating a checklist and asking that question.

"Regretfully, that information [was] not fully communicated throughout the full team," Dr. Lester said.

At today's news conference, David Lakey, MD, the head of the Texas Department of State Health Services, called Texas Health Presbyterian a "very good hospital" that missed the African travel connection. The lesson for other hospital emergency departments is that it is imperative to take the patient's travel history.

"Ask if they've been outside of the United States," said Dr. Lakey. "If they've been in these areas of Africa that have had Ebola, they have to put Ebola on the differential diagnosis."

No Quarantines Foreseen Beyond Four Family Members

Before he was hospitalized, Duncan was staying with four family members at their apartment. As a precaution, they were ordered Wednesday to stay at home and not receive any visitors until at least October 19 by the Texas Department of State Health Services and its Dallas County counterpart. The order is in effect until the incubation period for Ebola has ended and the family is no longer at risk of having the disease, according to a news release from the Texas health department. In the meantime, they are being supplied with food and other necessary items for daily living.

"The local health department had previously instructed the family to stay home, but a strict public health control order is needed to ensure compliance," the agency stated.

The four family members have not exhibited any Ebola symptoms, which include fever, severe headache, muscle pain, diarrhea, vomiting, and unexplained hemorrhage. These symptoms may crop up from 2 to 21 days after exposure to the virus. The average onset of symptoms is 8 to 10 days later.

Dr. Lakey said at today's news conference that the involuntary quarantine helps ensure that the four family members will be available for daily monitoring. A law enforcement official is posted at their home to enforce the control order. Such a governmental action has not been necessary for other individuals who require monitoring, he said, and he does not intend to place anyone else under involuntary quarantine.

Underlining that point was another speaker, Dallas County Judge Clay Jenkins, the county's top executive. "There should be no further need for orders," said Clay. With regard to Duncan's family members, Clay said, it was "in the public's best interest to know that the public didn't have these people leaving the premises on a regular basis against recommendations."

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