Guide for clinicians evaluating an ill person for Ebola disease

Guide for Clinicians Evaluating an Ill Person for Ebola Disease

Print this guide [PDF – 1 page] for help in evaluating an ill person for Ebola disease.

In the healthcare facility

To assess an ill person presenting to a healthcare facility for an Ebola disease exposure risk, ask the patient if they have been in contact with a person with suspected or confirmed Ebola disease in the past 21 days, or been to an area with an active Ebola outbreak in the past 21 days?

If the patient is not reporting exposures compatible with Ebola disease, continue with routine evaluation and care. If concern remains, consult the State, Tribal, Local, or Territorial Public Health Department for additional guidance.

If an exposure risk IS identified, ask about signs or symptoms compatible with Ebola disease. Is the patient experiencing fever (100.4°F/38.0°C) without use of antipyretics and any of the following symptoms?

  • Aches and pains, such as severe headache and muscle and/or joint pain
  • Weakness and fatigue
  • Sore throat
  • Loss of appetite
  • Gastrointestinal symptoms, including abdominal pain, diarrhea, and vomiting
  • Unexplained hemorrhaging, bleeding or bruising, including bleeding outside a normal menstrual cycle
  • Red eyes, skin rash, and hiccups

If the patient IS NOT reporting signs and symptoms compatible with Ebola disease, continue with routine evaluation and care. If concern remains, consult the State, Tribal, Local, or Territorial Public Health Department for additional guidance.

If an exposure risk has been identified and the patient IS experiencing symptoms compatible with Ebola disease, follow these recommended infection prevention and control (IPC) precautions for preventing Ebola transmission.

  • Isolate patient at a healthcare facility in a single room with private bathroom/covered bedside commode
  • Adhere to IPC procedures to prevent transmission, including wearing appropriate personal protective equipment (PPE)
  • Use only essential healthcare workers trained in their designated roles and keep a log of all people entering the patient’s room
  • Perform only necessary tests and procedures
  • Notify facility’s IPC program

Consultation with State, Tribal, Local, or Territorial Public Health Department for testing recommendations of patients with an exposure risk and symptoms compatible with Ebola disease

Once the patient is safely isolated, consult the State, Tribal, Local, or Territorial Public Health Department for testing recommendations. During this consultation, an in-depth public health interview will be conducted to review detailed travel and epidemiologic history and clinical course of the patient. Questions related to risk exposure, like these below, can help inform testing recommendations.

Did the patient:

  • Have contact with a symptomatic person with suspected or confirmed Ebola disease, or any objects contaminated by their body fluids?
  • Experience a breach in IPC precautions that result in the potential for contact with body fluids of a patient with suspected or confirmed Ebola disease?
  • Have contact with semen from a man who has recovered from Ebola disease?
  • Participate in any of the following activities while in an area with an active Ebola disease outbreak?
    • Contact with someone who was sick or died, or any objects contaminated by their body fluids
    • Attend/participate in funeral rituals, including preparation of bodies for funeral/burial
    • Work in a healthcare facility or laboratory
    • Visit a healthcare facility or traditional healer
    • Contact with bats or wild animals
    • Work or spend time in a mine/cave

As a resource for State, Tribal, Local, or Territorial public health departments, CDC is available 24/7 for consultation 770-488-7100.

Testing algorithm

Through the consultation process, if the decision is made to test for ebolavirus, testing for other causes of illness should continue (refer to Performing routine diagnostic testing for patients with suspected Ebola disease for guidance). In addition, a determination should be made on whether the patient requires transfer to a higher tier facility. If the decision is made NOT to test for ebolavirus, a follow up clinical consultation is recommended to review the patient’s clinical status and laboratory test results and to discuss discontinuation of Ebola specific IPC measures.

When the decision has been made to test the patient, the following testing algorithm can be used:

If a sample is collected less than 72 hours after symptom onset and tests positive, the patient is considered a confirmed Ebola case*. If the sample tests negative and the patient is still symptomatic, the test should be repeated 72 hours after symptom onset as the test can produce a false negative if the specimen is collected less than 72 hours after symptom onset. The patient must remain under strict isolation precautions during this time.

If the test is repeated 72 hours after symptom onset and the test is positive, the patient is considered a confirmed Ebola case*. If the test is negative, a follow up clinical consultation is recommended to review the patient’s clinical status and laboratory test results and to discuss discontinuation of Ebola specific IPC measures.

If the initial sample is collected over 72 hours after symptom onset and the test is positive, the patient is considered a confirmed Ebola case*. If the test is negative, a follow up clinical consultation is recommended to review the patient’s clinical status and laboratory test results and to discuss discontinuation of Ebola specific IPC measures.

* Positive and negative ebolavirus results received on the Biofire Warrior panel are considered presumptive. All ebolavirus laboratory test results must be confirmed by CDC.