Editor’s note: This piece is by Dr. Kemper Alston, Medical Director of Infection Prevention at Fletcher Allen Health Care. He is an infectious disease specialist and epidemiologist. He is also a professor in the University of Vermont College of Medicine. It was first published on the Fletcher Allen blog on Oct. 3, 2014.
For the past six months a massive public health crisis has been unfolding in West Africa. The largest outbreak ever of Ebola virus disease is occurring in Liberia, Sierra Leone, and Guinea. Nigeria and Senegal have also had cases, but on a smaller scale. Ebola is a viral infection that typically presents with fever, headache and gastrointestinal symptoms. It has a high fatality rate. At the present time there is no vaccine or specific therapy available. While over 10,000 cases have been reported from these countries, with thousands of deaths, the true numbers are likely much higher due to underreporting.
This epidemic is imposing a tremendous burden on the health care infrastructures of countries with already limited resources. Although a few previously diagnosed cases have been cared for in this country, this week a lot of media attention has focused on Dallas, Texas, where the first imported case was diagnosed in a traveler to the U.S.
There are a few important concepts to keep in mind when considering the threat of Ebola here in Vermont:
• This is not a new disease. Ebola virus disease has occurred in limited outbreaks since 1976, and much has been learned about how to prevent transmission over the past 38 years.
• Ebola is not spread by the airborne route. It is spread by direct contact with the bodily fluids or tissues of a person who is ill. This fact means that widespread transmission in the U.S. is very unlikely to occur. Body fluids include saliva, mucus, vomit, feces, sweat, tears, breast milk, urine, and semen.
Fletcher Allen has been actively planning for the possibility that a person exposed to Ebola, or already ill with Ebola, may present to us for care.
• Preventing transmission does not require high-tech equipment that is not routinely available. Simple barriers, such as gowns, gloves, masks and eye protection are what is required.
• Every hospital in the U.S. should be able to deal with an imported case of Ebola, using strict standard contact and standard droplet isolation.
• The challenge is to have a heightened awareness and to consider the diagnosis in patients who are ill, have traveled from the affected countries within the 21-day incubation period, and have had direct contact with a person stricken with Ebola.
• The epidemic nature of the disease in West Africa reflects a complex interplay of factors that do not exist in the U.S. An epidemic of Ebola in this country is extremely unlikely. Having said that, with the sheer number of infected persons in West Africa, it is nearly certain that more cases will arrive in the U.S.; they need to be promptly recognized, diagnosed, and isolated.
• Ebola is only transmitted by persons who have already become ill. It is not transmitted during the asymptomatic incubation period.
• Fletcher Allen has been actively planning for the possibility that a person exposed to Ebola, or already ill with Ebola, may present to us for care. Effective, prompt communication is key. We will provide compassionate, efficient care while excluding alternative diagnoses and preventing transmission. We will do travel screening as appropriate. We also partner with the Vermont Department of Health.
