Distributed by e-mail August 12, 2014
Management of Ebola- Health Care Provider Update- August 12, 2014
The WHO has updated its Ebola guidance. Also, you will find the Public Health Ontario guidance related to Viral Hemorrhagic Fevers, including Ebola, on the Public Health Ontario's Viral Hemorrhagic Fever web page.
The most important thing from a clinical perspective is that management is essentially the same as for MERS. Any patient with relevant symptoms and travel to a place of transmission should be treated as possibly infected until proven otherwise: appropriate infection control measures should be implemented and public health should be contacted.
In short, if a patient has fever AND travel within the preceding 3 weeks to Guinea, Liberia, Nigeria, or Sierra Leone, then:
- Isolate with droplet and contact precautions AND
- Notify public health immediately (in Middlesex-London, this would be 519 663-5317 ext 2330)
If a patient has the above AND a condition that may generate aerosols (e.g. cough, vomiting, diarrhea or hemorrhage), then:
- Use above precautions plus airborne precautions (e.g. N95 mask, eye protection, and negative pressure isolation if available).
Once we are contacted, we will work with you through the appropriate testing and management, which are likely to change over time as more is learned about the virus.
While the situation in Africa is serious and tragic, the risk in Ontario remains low. Contributors to the current outbreak in Africa include widespread poverty and marginal nutrition, lack of education, lack of basic infrastructure, a deficit of healthcare workers, and specific cultural practices not common in Canada. In recorded history, there has been perhaps only one case of Ebola that was ever acquired outside of Africa (a lab accident), and no outbreaks.
The following is an Ebola Update for Ontario Physicians sent by the Ontario Medical Association on August 12, 2014
Ebola Virus Disease Outbreak in West Africa- Update for Physicians Regarding International Status and Provincial Preparedness
On August 8, 2014, the World Health Organization (WHO) declared the Ebola virus disease (EVD) outbreak in West Africa a public health event of international concern. As of August 11, the cumulative number of cases attributed to EVD in the four affected countries (Guinea, Liberia, Nigeria, and Sierra Leone) stands at 1,848, including 1,013 deaths. The WHO has issued a statement with recommendations for countries to reduce the international spread of EVD. (http://www.who.int/mediacentre/news/statements/2014/ebola-20140808/en/)
Ontario is addressing the WHO advice with respect to countries without cases and not bordering on any affected countries. Although the WHO made this important declaration to ensure a co-ordinated international response to stop the international spread of EVD, it is important to remember that the risk to Ontarians from this outbreak remains low. To date, there are no confirmed cases in Canada nor has there ever been a case of EVD in Canada. On August 10, Minister of Health and Long-Term Care Eric Hoskins confirmed that a recent case at Brampton Civic Hospital tested negative for EVD. The patient recently travelled to Canada from West Africa and presented with symptoms such as fever, headache, muscle pain and malaise. The testing was done as a precautionary measure.
There have been recent media reports of health care workers travelling to affected countries and becoming infected. A recent WHO Risk Assessment notes that for healthcare workers in affected countries, there is a risk, especially if involved in caring for EVD patients. However, “if the recommended level of precaution for such settings is implemented, transmission of the disease should be prevented. The risk level can be considered very low to low unless these precautions are not followed (e.g., no personal protective equipment, needle stick injury, etc.).” (http://www.who.int/ith/updates/20140421/en/)
Public Health Ontario continues to maintain a website with information about Viral Hemorrhagic Fever (VHF – Ebola), including an update for clinicians (symptoms, infection and control practices, etc.) and laboratory testing requirements. Health workers should review the information and resources on this website to ensure they are prepared to detect, investigate and manage cases of EVD. (http://www.publichealthontario.ca/en/BrowseByTopic/InfectiousDiseases/Pages/Viral-Hemorrhagic-Fevers.aspx#.U-jym_ldVjQ)
As of August 9, 2014, the Public Health Agency of Canada (PHAC) has issued Travel Health Notices related to travel to the EVD outbreak in West Africa. All Canadians are advised to practice special precautions if traveling to Nigeria and are advised to avoid all non-essential travel to Guinea, Liberia and Sierra Leone.
The Ontario Ministry of Health and Long-Term Care (MOHLTC) continues to monitor the EVD situation overseas and has taken measures to ensure the province’s health sector is prepared should a returning traveller from a country where EVD is circulating be suspected of having the disease. You can contact the MOHLTC on a 24/7 basis through the Health Care Provider Hotline at 1.866.212.2272.