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SITUATIONAL UPDATE:
As of October 26, 2022, there have been 136 confirmed and probable casesand 53 deaths from the Ebola Virus Disease (EVD) outbreak in Uganda caused by the Sudan virus. In recent weeks, the outbreak has expanded to 7 districts including the capital city, Kampala. There have been no cases or deaths in the United States. The County of Santa Clara Public Health Department continues to work in conjunction with the California Department of Public Health (CDPH) and the Centers for Disease Control and Prevention (CDC) to monitor travelers returning from Uganda to ensure that returned travelers who develop any compatible symptoms are quickly evaluated. Travelers are monitored for a 21-day period from their last possible exposure. Persons Under Investigation (PUI) are defined as individuals who have signs and symptoms consistent with EVD and have an epidemiological risk factor within 21 days before the onset of symptoms. There have been no reported PUIs in Santa Clara to date.
HEALTH CARE PROVIDER ROLES IN THE EVD RESPONSE:
While the likelihood of a confirmed EVD case in Santa Clara County is currently low, all health care providers and emergency medical personnel play a critical role in the early identification, triage, and care of PUI for EVD. The CDC has designated three levels of care to be provided by health care facilities. All health care facilities are considered at minimum Frontline Facilities (including outpatient, urgent care, emergency room, and inpatient settings) and should be able to (1) Rapidly identify and triage a person with relevant exposure history and signs or symptoms (a PUI), (2) Immediately isolate, and take appropriate steps to protect staff caring for the patient, (3) Immediately inform the facility infection control program and other relevant staff, AND the Public Health Department. In addition, facilities should be able to care for a PUI for 12-24 hours while awaiting patient transfer to an Ebola Assessment or Treatment facility.
Designated Assessment Facilities should be prepared to receive and isolate a PUI for EVD and care for the patient for up to 96 hours until an Ebola diagnosis can be confirmed or ruled out and until discharge or transfer is completed. At this point, no assessment facility has yet been identified in Northern California. In the event of a PUI, the County Public Health Department will work with CDPH and CDC to identify an Assessment Facility and facilitate safe transportation for EVD testing.
There is currently one Treatment Facility in California, located in Los Angeles, as well as others throughout the United States. These facilities are responsible for providing comprehensive care to people diagnosed with EVD for the duration of a patient’s illness.
RECOMMENDED HEALTH CARE PROVIDER ACTIONS AT ALL HEALTH CARE FACILITIES:
(1) Screen all patients with infectious disease symptoms for travel history to the outbreak area.
Health care providers evaluating a patient with symptoms of an infection should obtain a complete travel history and inquire specifically about travel to the outbreak area within the 21 days prior to onset of symptoms. Travel history is especially important for patients with fever, rash, acute respiratory symptoms, diarrhea, or vomiting. Facilities are not currently required to screen all patients for travel history, but they should be prepared to do so in the event the risk of local cases increases. Additional CDC guidance on screening can be found here.
(2) Establish/review facility EVD isolation protocols and ensure that all relevant health care personnel have been trained on their implementation.
Health care personnel can be exposed to Ebola virus by touching a patient’s body fluids, contaminated medical supplies and equipment, or contaminated environmental surfaces. Splashes to unprotected mucous membranes (for example, the eyes, nose, or mouth) are particularly hazardous. Procedures that can increase environmental contamination with infectious material or create aerosols should be minimized. At Frontline Facilities, invasive procedures on PUIs should not be performed unless necessary for life-saving support measures. Detailed CDC guidance on appropriate infection control measures can be found here.
(3) Conduct refresher training on appropriate donning & doffing of Personal Protective Equipment (PPE) specific to various EVD scenarios for all relevant health care personnel.
Appropriate use of PPE is imperative to protect health care workers from disease transmission. There are separate PPE recommendations for the following scenarios: (1) A PUI who is clinically stable AND does not have bleeding, vomiting or diarrhea (2) A PUI who is clinically unstable OR is exhibiting obvious bleeding, vomiting, or diarrhea; OR a person with confirmed EVD. Additional CDC guidance on PPE for EVD, including training videos and tutorials can be found here.
(4) Be prepared to report a suspect PUI to the County of Santa Clara Public Health Department IMMEDIATELY by calling (408) 885-4214, ext. 3.
During regular business hours, call (408) 885-4214, ext. 3. After hours and on weekends, page the Health Officer on call by calling County Communications at (408) 998-3438. The health care facility should create (and be prepared to share with Public Health) a log documenting all personnel who entered the PUI’s room or otherwise interacted with the PUI prior to isolation. The County of Santa Clara Public Health Department will work closely with the frontline facility and CDPH to identify immediate next steps including coordination of patient transfer to an assessment or treatment facility.
We appreciate the ongoing hard work and collaboration of health care providers across the county as we ensure we are prepared to assess and triage a patient with suspected EVD.
RESOURCES/REFERENCES
Screening for EVD
https://www.cdc.gov/vhf/ebola/clinicians/evaluating-patients/index.html
PPE
https://www.cdc.gov/vhf/ebola/hcp/ppe-training/index.html
https://www.cdc.gov/vhf/ebola/healthcare-us/ppe/index.html
https://www.cdph.ca.gov/Programs/CID/DCDC/CDPH%20Document%20Library/PPEGuidanceforEVD.pdf
CDC Information regarding frontline, assessment, and treatment centers
https://www.cdc.gov/vhf/ebola/healthcare-us/preparing/hospitals.html
https://www.cdc.gov/vhf/ebola/healthcare-us/preparing/frontline-healthcare-facilities.html
https://www.cdc.gov/vhf/ebola/healthcare-us/preparing/assessment-hospitals.html
https://www.cdc.gov/vhf/ebola/healthcare-us/preparing/treatment-centers.html
NETEC Webinar on Preparing Frontline Healthcare Workers for Ebola
https://www.youtube.com/watch?v=Okh_Sa9cVa4
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