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    Ebola Virus Disease Confirmed in a Traveler to Nigeria, Two U.S. Healthcare Workers in Liberia (content)

    Ebola Virus Disease Confirmed in a Traveler to Nigeria, Two U.S. Healthcare Workers in Liberia July 28, 2014    Summary   Nigerian health authorities have confirmed a diagnosis of Ebola Virus Disease (EVD) in a patient who died on Friday in a hospital in Lagos, Nigeria, after traveling from Liberia on July 20, 2014. The report marks the first Ebola case in Nigeria linked to the current outbreak in the West African countries of Guinea, Sierra Leone, and Liberia. Health authorities also reported this weekend that two U.S. citizens working in a hospital in Monrovia, Liberia, have confirmed Ebola virus infection. These recent cases, together with the continued increase in the number of Ebola cases in West Africa, underscore the potential for travel-associated spread of the disease and the risks of EVD to healthcare workers. While the possibility of infected persons entering the U.S. remains low, the Centers for Disease Control and Prevention (CDC) advises that healthcare providers in the U.S. should consider EVD in the differential diagnosis of febrile illness, with compatible symptoms, in any person with recent (within 21 days) travel history in the affected countries and consider isolation of those patients meeting these criteria, pending diagnostic testing.   Background   CDC is working with the World Health Organization (WHO), the ministries of health of Guinea, Liberia, and Sierra Leone, and other international organizations in response to an outbreak of EVD in West Africa, which was first reported in late March 2014. As of July 23, 2014, according to WHO, a total of 1,201 cases and 672 deaths (case fatality 55-60%) had been reported in Guinea, Liberia, and Sierra Leone. This is the largest outbreak of EVD ever documented and the first recorded in West Africa.   EVD is characterized by sudden onset of fever and malaise, accompanied by other nonspecific signs and symptoms, such as myalgia, headache, vomiting, and diarrhea. Patients with severe forms of the disease may develop multi-organ dysfunction, including hepatic damage, renal failure, and central nervous system involvement, leading to shock and death.   In outbreak settings, Ebola virus is typically first spread to humans after contact with infected wildlife and is then spread person-to-person through direct contact with bodily fluids such as, but not limited to, blood, urine, sweat, semen, and breast milk. The incubation period is usually 8–10 days (rarely ranging from 2–21 days). Patients can transmit the virus while febrile and through later stages of disease, as well as postmortem, when persons contact the body during funeral preparations.   On July 25, the Nigerian Ministry of Health confirmed a diagnosis of EVD in a man who died in a hospital in the country’s capital of Lagos (population ~21 million). The man had been in isolation in the hospital since arriving at the Lagos airport from Liberia, where he apparently contracted the infection. Health authorities are investigating whether passengers or crew on the plane or other persons who had contact with the ill traveler are at risk for infection. In addition, health authorities have reported that two U.S. healthcare workers at ELWA hospital in Monrovia, Liberia, have confirmed Ebola virus infection. One of the healthcare workers, a physician who worked with Ebola patients in the hospital, is symptomatic and in isolation. The other healthcare worker, a hygienist, developed fever but is showing no other signs of illness. The physician is an employee of Samaritan’s Purse, a North Carolina-based aid organization that has provided extensive assistance in Liberia since the beginning of the current outbreak. The other healthcare worker works with Soudan Interior Mission (SIM) in Liberia and was helping the joint SIM/Samaritan’s Purse team. The recent cases in a traveler and in healthcare workers demonstrate the risk for spread of EVD in these populations. While no EVD cases have been reported in the United States, a human case, caused by a related virus, Marburg virus, occurred in Denver, Colorado in 2008. Successful implementation of standard precautions was sufficient to limit onward transmission. Other imported cases of viral hemorrhagic fever disease were also successfully managed through effective barrier methods, including a recent Lassa fever case in Minnesota. Recommendations   EVD poses little risk to the U.S. general population at this time. However, U.S. healthcare workers are advised to be alert for signs and symptoms of EVD in patients with compatible illness who have a recent (within 21 days) travel history to countries where the outbreak is occurring, and should consider isolation of those patients meeting these criteria, pending diagnostic testing. For more information:   Additional information on EVD can be found at: http://www.cdc.gov/ebola Interim Guidance on EVD for healthcare workers can be found at: http://www.cdc.gov/vhf/abroad/healthcare-workers.html Travel notices for each country can be found at: Guinea: http://wwwnc.cdc.gov/travel/notices/alert/ebola-guinea Liberia: http://wwwnc.cdc.gov/travel/notices/alert/ebola-liberia Sierra Leone: http://wwwnc.cdc.gov/travel/notices/alert/ebola-sierra-leone The Centers for Disease Control and Prevention (CDC) protects people's health and safety by preventing and controlling diseases and injuries; enhances health decisions by providing credible information on critical health issues; and promotes healthy living through strong partnerships with local, national, and international organizations. ____________________________________________________________________________________ Categories of Health Alert Network messages: Health Alert Requires immediate action or attention; highest level of importance Health Advisory May not require immediate action; provides important information for a specific incident or situation Health Update Unlikely to require immediate action; provides updated information regarding an incident or situation HAN Info Service Does not require immediate action; provides general public health information ##This message was distributed to state and local health officers, state and local epidemiologists, state and local laboratory directors, public information officers, HAN coordinators, and clinician organizations##    

    CDC Continues to Recommend Influenza Antiviral Medications

    CDC continues to recommend the use of the neuraminidase inhibitor antiviral drugs as an important adjunct to influenza vaccination in the treatment of influenza.

    Guidance to US Clinicians Regarding New WHO Polio Vaccination (Content)

    Guidance to US Clinicians Regarding New WHO Polio Vaccination Requirements for Travel by Residents of and Long-term Visitors to Countries with Active Polio Transmission June 2, 2014 Summary On 5 May 2014, the Director-General of the World Health Organization (WHO) accepted the recommendations of an Emergency Committee, declaring the international spread of polio to be a public health emergency of international concern (PHEIC) under the authority of the International Health Regulations (IHR) (2005) and issued vaccination requirements for travelers in order to prevent further spread of the disease. IHR is an international agreement among countries to prevent, protect or control the international spread of disease. All countries have agreed to be bound by recommended activities under IHR. The “temporary recommendations” in response to this PHEIC, the second ever to be issued under IHR, will be reviewed and possibly revised by WHO’s Emergency Committee  in three months. The burden for enforcement of the polio vaccination requirements under this PHEIC declaration lies with polio-affected countries (termed “polio-infected” by WHO). At this time, the United States government is not expected to implement requirements for entry into the United States. U.S. clinicians should be aware of possible new vaccination requirements for patients planning travel for greater than four weeks to countries with ongoing poliovirus transmission. The May 5 WHO statement names 10 such countries, three designated as “exporting wild poliovirus” (Cameroon, Pakistan and Syria [Syrian Arab Republic]) that should “ensure” recent (4 to 52 weeks before travel) polio boosters among all departing residents and long-term travelers (of more than 4 weeks), and an additional seven countries “infected with wild poliovirus” (Afghanistan, Equatorial Guinea, Ethiopia, Iraq, Israel, Somalia and Nigeria) that should “encourage” recent polio vaccination boosters among residents and long-term travelers. At this time, CDC is  not aware of what specific steps will be taken by these 10 countries to comply with the PHEIC declaration.  U.S. citizens who plan to travel to any of the polio infected countries should have documentation of a polio booster in their yellow International Certificate of Vaccination in order to avoid delays in transit. Background Currently 10 countries have active transmission of wild poliovirus (WPV) that could spread to other countries through international travel. From January through April 2014, months normally considered the low-transmission season for polio, the virus already has been carried to three countries: from Pakistan to Afghanistan, from Syria to Iraq, and from Cameroon to Equatorial Guinea. WHO considers this an “extraordinary event” and a public health risk to other countries. If the current spread of WPV continues, cases could multiply considerably as the high-transmission season has already begun. The consequences of further international spread are particularly acute today given that several countries with complex humanitarian emergencies or other major challenges are bordering the infected countries. Recommendations Because of the substantial progress of the polio eradication initiative in 2012–2013, and in order to harmonize CDC recommendations with WHO recommendations, CDC now recommends an adult inactivated poliovirus (IPV) booster dose for travelers to countries with active WPV circulation. Countries are considered to have active WPV circulation if they have ongoing endemic circulation, active polio outbreaks, or environmental evidence of active WPV circulation. Travelers working in health care settings, refugee camps, or other humanitarian aid settings in these countries may be at particular risk. Domestic clinicians should provide the following information to their patients planning international travel to countries experiencing polio outbreaks/active transmission: Travelers to polio-affected areas should receive polio vaccination or a booster polio vaccination prior to travel following the guidance at http://wwwnc.cdc.gov/travel/yellowbook/2014/chapter-3-infectious-diseases-related-to-travel/poliomyelitis. Travelers also may be impacted by new WHO Polio Vaccination Recommendations in countries with ongoing poliovirus transmission: For travel to Pakistan, Cameroon, and Syria (countries exporting WPV) These governments have been asked to ensure that all residents and long-term visitors (of more than 4 weeks) receive an additional dose of oral polio vaccine (OPV) or inactivated poliovirus vaccine (IPV) between 4 weeks and 12 months prior to any international travel and have the dose documented. Residents and long-term visitors who are currently in those countries who must travel with fewer than 4 weeks’ notice and have not been vaccinated with OPV or IPV within the previous 4 weeks to 12 months receive a dose at least by the time of departure. These measures should be maintained until at least 6 months have passed without new exportations with documentation that there is strong surveillance for the virus and that people are being vaccinated in all infected and high-risk areas; without such documentation, these measures should be maintained until at least 12 months have passed without new exportations. At this time, CDC has not seen documentation from any of these three countries specifying how these new requirements will be implemented. For travel to Afghanistan, Equatorial Guinea, Ethiopia, Iraq, Israel, Somalia, and Nigeria (In countries that currently have ongoing poliovirus transmission but have not exported WPV to another country in the past 6 months) These governments are encouraged to ensure that residents and long-term visitors receive an additional dose of OPV or IPV 4 weeks to 12 months prior to each international journey; current residents of those countries undertaking travel with fewer than 4 weeks’ notice who have not been vaccinated with a dose of OPV or IPV within the previous 4 weeks to 12 months should be encouraged to receive a dose by the time of departure and have the dose documented. These measures should be maintained until at least 6 months have passed without the detection of WPV transmission in the country from any source. At this time, CDC has not seen documentation from any of these seven countries specifying how these new requirements will be implemented. Travelers should also be aware that in the event of new international spread from any one of these seven infected countries, that country would be asked to immediately implement the vaccination requirements for ‘States currently exporting wild poliovirus.’ Travelers to or from all 10 countries should be given a WHO/IHR International Certificate of Vaccination or Prophylaxis (http://www.who.int/ihr/ports_airports/icvp/en/) to record and serve as proof of their polio vaccination. Guidance CDC routinely recommends that anyone planning travel to a polio-affected country be fully vaccinated against polio and that, in addition, adults should receive a one-time booster dose of polio vaccine. Because of the recent PHEIC declaration, anyone staying in any of the polio-affected countries for more than four (4) weeks may be required to have a polio booster shot within the 4 weeks to twelve months prior to departure from that country.  This booster should be documented in the yellow International Certificate of Vaccination in order to avoid delays in transit or forced vaccination in country.  Either oral poliovirus vaccine (OPV) or inactivated poliovirus vaccine (IPV) may be used for this booster, however only IPV is currently available in the United States. For more information: http://www.polioeradication.org/Portals/0/Document/Emergency/PolioPHEICguidance.pdf Contact Steven Wassilak, MD, at axj3@cdc.gov or 404-488-7100 (available 24 hours). The Centers for Disease Control and Prevention (CDC) protects people's health and safety by preventing and controlling diseases and injuries; enhances health decisions by providing credible information on critical health issues; and promotes healthy living through strong partnerships with local, national, and international organizations.

    Infection Prevention and Control Recommendations for Hospitalized Patients with Known or Suspected Ebola Hemorrhagic Fever in U.S. Hospitals (content)

    Standard, contact, and droplet precautions are recommended for management of hospitalized patients with known or suspected Ebola hemorrhagic fever (Ebola HF), also referred to as Ebola Viral Disease (EVD).

 

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