Frequently Asked Questions on Screening for Ebola Virus Disease for Providers, Healthcare Facilities and Health Departments

What are the clinical features and risk factors for Ebola Virus Disease?

Signs and symptoms associated with Ebola virus disease are non-specific and are similar to many other common causes of febrile illness in returning travelers. Acutely ill patients who have traveled to a country experiencing a wide-spread EVD outbreak during the previous 21 days should be assessed for Ebola virus exposure and other conditions listed on the CDC Traveler’s Health website and specifically for malaria, which is the most likely diagnosis in a febrile traveler. Important risks for  exposures to Ebola virus  include: contact with blood or bodily fluids of acutely ill persons with suspected or confirmed Ebola virus disease, such as providing care in a home or healthcare setting; participation in funeral rituals,  including preparation of bodies for burial or touching a corpse at a traditional burial ceremony; working in a laboratory where human specimens are handled; handling wild animals or carcasses that may be infected with Ebola virus (primates, fruit bats, duikers); and sexual history, specifically if the patient has had contact with the semen from a man who has recovered from Ebola virus disease (for example, oral, vaginal, or anal sex).

What healthcare screening questions should be asked of recent travelers from countries with former widespread transmission of Ebola virus who have no signs or symptoms of Ebola virus disease?  

No specific enhanced screening is required and travelers to these countries  should be treated similarly to any other patients who have recently traveled internationally.

What screening questions should be asked during intake for ill persons at healthcare systems and their various departments, emergency departments, and urgent care facilities?

Because of the constant risk for travel-associated diseases (such as malaria, dengue, vaccine-preventable diseases) and emerging pathogens (MERS-CoV, chikungunya, Zika virus, etc.), a travel history should remain part of routine patient evaluation, including during entry to the facility. Obtaining a travel history is an important part of ensuring rapid triage and prompt isolation of patients and/or starting infection control measures to minimize the spread of infectious diseases to other patients or healthcare providers (such as placing a facemask over the patient’s nose and mouth for those with respiratory illness). Questions of the patient should be guided by the type and background of the patients served by the facility. In addition to the healthcare provider  asking questions of the patient, facilities should consider posting visual alerts (signs, posters) at the entrance and in strategic places (waiting areas, elevators, cafeterias) to provide patients with clear instructions, in appropriate languages, about infection control precautions and the importance of notifying healthcare providers of their travel history. Facilities and providers can stay up-to-date on active travel notices by consulting CDC’s Travelers’ Health website.

If a traveler has fever, vomiting, or diarrhea, but has not been exposed to Ebola virus, can Ebola virus disease be eliminated from the differential diagnoses?*

Healthcare providers should conduct a thorough travel and health history for all acutely ill patients whose clinical presentation suggests a communicable disease, including vaccination history and prophylaxis compliance for infectious diseases such as malaria, when relevant.  Following the travel and health history, if it is clear that there has been no exposure to Ebola virus, Ebola virus disease can be eliminated from the differential diagnosis. Diagnostic testing** and differential diagnosis should focus on those conditions consistent with the patient’s signs and symptoms, with special consideration of:

  1. Acute febrile illnesses. These can manifest with or without localizing signs or symptoms with acute fever [defined as ≥ 100.4 degrees Fahrenheit, constantly elevated temperature or intermittent fever, subjective fever, and/or chills). Because fever among patients can be the result of viral, bacterial, fungal, parasitic, or non-infectious causes, appropriate tests for these causes should be used to establish an underlying diagnosis.
  2. Acute upper and lower tract respiratory illnesses. These can manifest with or without fever, and with symptoms including sneezing, nasal congestion or stuffiness, nasal discharge, sore throat, hoarseness, eye burning or tearing, cough, malaise, muscle aches, and headache. Because the common cold, sinusitis, pharyngitis, bronchitis, and pneumonia can be caused by bacterial or viral infections, appropriate tests for these conditions and clinical judgement should be used if needed to establish a diagnosis and whether treatment is indicated.
  3. Acute gastrointestinal (GI) illnesses. These can manifest with or without fever, and with symptoms including diarrhea, nausea, vomiting, abdominal pain, abdominal cramps, headaches, and rash. Because acute GI illness in the returning traveler may 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.

*Note: Testing for EVD is still available in the U.S. and if determined testing is needed, please reach out to your local/state health department for approval and coordination.

**Note:  It may be helpful to perform rapid diagnostic tests for malaria, influenza, respiratory, and gastrointestinal pathogens for evaluating an ill traveler depending upon the history, signs, and symptoms. Proper interpretation of test results is needed because these rapid tests may not have the sensitivity or specificity necessary to rule out a pathogen.