Ebola or Not? Evaluating the Ill Traveler From Ebola-Affected Countries in West Africa

Abstract

Most ill travelers returning from Ebola-affected countries have not had Ebola. However, institutions and public health departments need to be prepared. We present our experience triaging, evaluating and managing 25 ill returned travelers from these countries.

Public Health Management of Persons Under Investigation for Ebola Virus Disease in New York City, 2014-2016

“…In some other jurisdictions, PUIs were assessed at a single facility by using standardized procedures. 17 In New York City, because of the large number of acute care facilities, it was challenging to ensure that all health care facilities were prepared to isolate and stabilize patients suspected of EVD according to the New York State Health Commissioner's mandate. 7 Only 10 of 112 (9%) PUIs were tested for EVD in New York City.…”

Non-COVID-19 Patients with Life-threatening Diseases Who Visited a Fever Clinic: A Single-center, Observational Study in Tokyo, Japan

“…In the era of emerging disease outbreaks, there could be patients with life-threatening diseases that physicians should not overlook. For example, Fairley et al reported that among 25 persons under investigation for Ebola virus disease (EVD), none were diagnosed with EVD, while 4 patients (16%) were diagnosed with life-threatening infections or conditions other than EVD at the EVD treatment center in the United States in 2014-2015 ( 4 ). In the fever clinics, there is a risk of misdiagnosing such life-threatening diseases because there are so many patients that physicians do not have enough time to examine each of them carefully.…”

How Can Emergency Departments Better Prepare for Emerging Infectious Disease Threats? A Returned Traveler With Fever Walks Into Triage…

“…In our health care center, we implemented universal patient screening at all entry points, given the fact that our community hosted a large number of returned travelers from EVDaffected countries, and this system has remained in place to address other outbreaks (8). The adoption of the Identify-Isolate-Inform strategy, used first during the 2014 EVD outbreak, has increased vigilance for other communicable diseases like measles (9).…”

“…Because these infections can present with nonspecific symptoms like fever or myalgias, case definitions currently in use to identify PUI of EVD and MERS must be combined with travel history to yield a reasonably sensitive and specific screening tool. Still, these screening tools may generate many PUIs, especially if concomitant with influenza outbreaks or if emerging infectious disease threats occur in countries that also have high malaria burden (8). Our public health and clinical infrastructure is already facing greater challenges, as was recently seen in New York City and Philadelphia when airplanes returning from the Arabian Peninsula became a national news sensation due to concerns about MERS among passengers with febrile respiratory illnesses (10).…”

“…This was observed in the United States during the 2014-2015 EVD outbreak (11). Delays in care can be deadly for more common infections like malaria or septicemia, and malaria diagnoses were not uncommon among PUIs for EVD (8,11). Conversely, PUIs who screen positive and actually have highly pathogenic infections might get less-than-adequate care due to staff confusion regarding processes or unfamiliarity with recommended personal protective equipment (PPE).…”