Skip directly to search Skip directly to A to Z list Skip directly to navigation Skip directly to page options Skip directly to site content

Assessment of Persons Under Investigation Having Low (But not Zero) Risk of Exposure to Ebola

Updated: December 29, 2015

Interim Guidance on the Assessment of Persons Under Investigation (PUIs) having Low (but not zero) Risk of Exposure to Ebola—Including Travelers from Countries with Widespread Transmission1 and Travelers from Countries with Former Widespread Transmission and Current, Established Control Measures2

Who this is for: State and local health department staff, infection prevention and control professionals, clinical healthcare providers, and healthcare workers who are coordinating the evaluation of PUIs (see Case Definitions).

How to use this guidance: Use this guidance to evaluate ill patients with low (but not zero) risk of exposure to Ebola based on a complete travel, exposure, and health history. The signs and symptoms of Ebola are non-specific, both in the early and advanced clinical course. Because Ebola is unlikely in people without recognized direct contact with the blood or body fluids of a symptomatic Ebola patient or direct contact with the body of a person who died from Ebola, other more common conditions should be considered in the differential diagnosis and treated accordingly.

Prior guidance: This guidance builds on the Interim Guidance for Monitoring and Movement of Persons with Ebola Exposure and on the Algorithm for Evaluation of the Returned Traveler, and is based on what is currently known about Ebola virus transmission. CDC will update this guidance as needed.

For any patient returning from Africa and presenting with non-specific signs and symptoms consistent with Ebola, providers should use clinical judgment, taking into account the patient epidemiological history, for management, diagnostic testing and treatment. Signs and symptoms consistent with Ebola include fever, severe headache, muscle pain, weakness, fatigue, diarrhea, vomiting, abdominal (stomach) pain, and unexplained hemorrhage (bleeding or bruising). The rapid identification of the cause of an acute illness in a PUI enables rapid treatment and resolution of symptoms.

Because no cases of Ebola among travelers with low (but not zero) risk of exposure who have been in a country with widespread Ebola virus transmission, or former widespread transmission, in the previous 21 days have been documented, other more common acute conditions consistent with the signs and symptoms should be considered and placed higher on the list of differential diagnoses, as appropriate, and diagnostic testing conducted to confirm the diagnosis. Travelers with low (but not zero) risk of Ebola exposure returning to the United States from Ebola affected countries over the past year, who had symptoms suggestive of Ebola, most often had malaria or respiratory infections.

For travelers with low (but not zero) risk of exposure returning from countries with widespread or formerly widespread Ebola virus transmission and current, established control measures, with signs and symptoms consistent with Ebola virus disease, healthcare providers should follow the guidance by country of travel.

For travelers from countries with widespread transmission

  • Place the patient in a private room with a private bathroom; patient can be removed from isolation after risk assessment is conducted and Ebola is determined not to be among the differential diagnoses
  • Use Ebola PPE
    • PUIs who have vomiting, diarrhea, or obvious bleeding includes: Single-use, impermeable gown or coverall; PAPR hood or NIOSH certified N-95 respirator; If using an N-95 respirator, a disposable surgical hood and disposable full face shield is needed; Two pairs of disposable examination gloves with extended cuffs; Disposable boot covers ; Disposable apron (optional)
    • PUIs who do not have vomiting, diarrhea, or obvious bleeding includes: Single-use, fluid-resistant gown; Face shield; Face mask; Two pairs of examination gloves where the outer gloves have extended cuffs
  • Conduct a thorough travel, Ebola virus exposure, and health history, including vaccination and prophylaxis compliance; diagnostic testing and treatment based on clinical judgment, taking into account the patient’s risk of exposure to Ebola virus
  • Evaluate the patient using clinical guidance and case definitions provided by CDC
  • Investigate other potential causes of the patient’s signs and symptoms without delay in patient care

For travelers from countries with former widespread transmission and current, established control measures3

For travelers from these countries with no signs and symptoms consistent with Ebola, follow standard hospital infection control practices/protocols.

  • Place the patient in a private room with a private bathroom; patient can be removed from isolation after risk assessment is conducted and Ebola is determined not to be among the differential diagnoses
  • Follow routine standard hospital infection control practices/protocols based on symptom presentation
  • Conduct a thorough travel, disease exposure including for Ebola virus, and health history, including vaccination and prophylaxis compliance for other infectious diseases. Ebola virus exposure assessment should include asking about contact with acutely ill persons, such as providing care in a home or healthcare setting; participation in funeral rituals such as preparation of bodies for burial; working in a laboratory where human specimens are handled; handling wild animals or carcasses that can carry Ebola virus (i.e. non-human primates and bats); and sexual history, specifically if the patient has had sexual contact with a man who has recovered from Ebola (for example, oral, vaginal, or anal sex).
  • Evaluate the patient using clinical guidance and case definitions provided by CDC
  • Follow routine standard hospital infection control practices/protocols for use of patient care and other medical equipment, medical procedures, environmental infection control, and laboratory testing
  • Investigate other potential causes of the patient’s signs and symptoms without delay in patient care

Healthcare providers should consider a few of the common acute syndromes for which persons under investigation have presented for evaluation, including the following:

  1. Acute febrile illnesses without localizing signs or symptoms. These can be manifested with or without localizing signs by acute fever (definition ≥ 100.4 degrees Fahrenheit for PUIs), constantly elevated temperature or intermittent fever, subjective fever, and chills. Because the causes of fever among PUIs can be systemic, bacterial, viral, or parasitic, appropriate tests for these causes should be used to establish an alternative diagnosis.
  2. Acute upper and lower tract respiratory illnesses. These can be manifested with or without fever by sneezing, nasal congestion or stuffiness, nasal discharge, sore throat, hoarseness, eye burning or tearing, cough, malaise, muscle aches, and headache. Because the causes of the common cold, sinusitis, pharyngitis, bronchitis, and pneumonia can be bacterial or viral, appropriate tests for these conditions should be used to establish an alternative diagnosis.
  3. Acute gastrointestinal (GI) illnesses. These can be manifested with or without fever by diarrhea, nausea, vomiting, abdominal pain, abdominal cramps, headaches, and rash. Because the causes of acute GI illness are likely to be due to enteric pathogens, hydration and empiric treatment should be considered, taking into account travel-associated etiologies. GI symptoms may also be associated with respiratory or systemic infections.

    Rapid tests for malaria, influenza, respiratory, and gastrointestinal pathogens are helpful. Proper interpretation of test results is needed as these rapid tests may not have the sensitivity or specificity necessary to rule out a pathogen. Molecular assays have much higher sensitivity than rapid screening tests.

References

  1. There are currently no countries in this category.
  2. This category includes countries that have experienced widespread Ebola virus transmission but are transitioning to being declared free of Ebola virus transmission. The World Health Organization (WHO) is responsible for determining when a country will be declared free of Ebola virus transmission. Public health authorities in these countries should maintain active surveillance for new cases of Ebola virus disease and identify, locate, and monitor any potential contacts.
  3. CDC changed the country classification for Guinea (December 29, 2015), Liberia (May 13, 2015), and Sierra Leone (November 10, 2015) to former widespread transmission and current, established control measures.
Top