Have Ebola? CDC Will Travel

October 14, 2014

In the wake of a nurse contracting Ebola from a patient at a Texas hospital, the Centers for Disease Control and Prevention (CDC) will send a team of Ebola experts "within hours" to any hospital that diagnoses someone with the deadly virus, the agency's director said today in a press conference.

The agency dispatched personnel to Texas Health Presbyterian Hospital Dallas as soon as it admitted Liberian national Thomas Eric Duncan with Ebola on September 28. However, "in retrospect, we could have sent a more robust hospital infection-control team and been more hands-on with the hospital from day one on exactly how this should be managed," said CDC Director Tom Frieden, MD, MPH, adding that such a team might have prevented the nurse, 26-year-old Nina Pham, from becoming infected.

"Ebola is unfamiliar" said Dr Frieden. "It's scary. And getting it right is really, really important. The stakes are so high."

"We definitely should have put an even larger team on the ground immediately, and we will do that from now anytime there is a confirmed case."

An as yet undetermined breach in infection-control protocol at Texas Health Presbyterian resulted in Pham contracting the virus from Duncan even though she was wearing personal protective equipment. Duncan died on October 8. Pham was admitted to the hospital on October 10 after she reported a low-grade fever. Her condition is stable, said Dr Frieden.

The hospital is actively monitoring 76 other healthcare workers who may have been exposed to Duncan or his blood after his admission, he said. None of them have yet developed Ebola symptoms. A male contact of Pham also is under medical surveillance. He, too, is symptom-free.

Meanwhile, another 48 individuals who were exposed, or may have been, to Duncan before his hospitalization on September 28 have passed the two-thirds mark of the 21-day incubation period for Ebola without symptoms, which usually appear within the first 10 days of exposure. Dr Frieden said that it is unlikely that any these individuals will come down with the hemorrhagic fever produced by the virus.

He noted that the prompt diagnosis and isolation of Pham has limited the number of her possible exposure contacts to one person, compared with 48 for Duncan before he was diagnosed. He visited the emergency department of Texas Health Presbyterian with a high fever on September 25, but was sent home with antibiotics. The hospital missed the diagnosis because his tell-tale travel history — recorded by a nurse in the electronic health record system — somehow did not get communicated to the rest of his care team.

Response Teams Could Decide to Transfer Patients

Since Pham was diagnosed with Ebola on October 11, the CDC has beefed up its team in Dallas, bringing the total to more than 20. They include international experts "who have worked on Ebola outbreaks for decades, people who have stopped Ebola outbreaks in very difficult situations in Africa," said Dr Frieden.

Added to the mix are two nurses from Emory University Hospital in Atlanta, Georgia, where two Americans who contracted the virus during missionary work in Liberia were successfully treated. Emory is one of four US hospitals with biocontainment units designated for bioterrorism and infectious disease outbreaks.

The response team that Dr Frieden promises for other hospitals with confirmed Ebola cases will mirror what the CDC has assembled in Dallas. It will consist of experts in infection control, lab science, experimental therapies, contact tracing, public education, waste management, and other aspects of battling Ebola.

An Ebola response team, Dr Frieden added, would consider whether a newly diagnosed patient should be sent to any of the four US hospitals with special biocontainment units. Earlier this month he said that any US hospital could manage an Ebola case if it complied with CDC guidelines, but, in recent days, Dr Frieden has allowed for the possibility of delegating that care to select institutions. However, he reiterated today that all hospitals should be prepared to at least diagnose Ebola in patients presenting with a fever who have traveled from West Africa in the previous 3 weeks.

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