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Considerations for Discharging People Under Investigation (PUIs) for Ebola Virus Disease (EVD)

Page Summary

Who this is for: Healthcare providers caring for patients under investigation (PUIs) for Ebola virus disease (EVD).

What this is for: Guidance on factors to consider in the decision to discharge a PUI for EVD.

How to use: Use this information in deciding to discharge a PUI for EVD. The decision to discharge a PUI who has not had a negative RT-PCR test for Ebola (RT-PCR testing for Ebola virus infection has not yet been performed or RT-PCR test result on a blood specimen collected less than 72 hours after onset of symptoms is negative) should be based on clinical and laboratory criteria and on the ability to monitor the PUI after discharge, and made by the medical providers caring for the PUI, along with the local and state health departments.

Healthcare providers evaluating a PUI should consider these criteria when deciding to discharge:

  1. In the clinical judgment of the medical team, the PUI’s illness no longer appears consistent with EVD.
  2. The PUI is afebrile off antipyretics for 24 hours, or there is an alternative explanation for fever.
  3. All symptoms that are compatible with EVD (for example, diarrhea or vomiting) have either resolved or can be accounted for by an alternative diagnosis.
  4. The PUI has no clinical laboratory results consistent with EVD, or those that could be consistent with EVD have been otherwise explained.
  5. The PUI is able to self-monitor (or to monitor a child, if the PUI is a child) and comply fully with active monitoring and controlled movement.
  6. There is a plan in place for the PUI to return for medical care if symptoms recur, which has been explained to the PUI, and the PUI understands what to do if symptoms recur.
  7. Local and state health departments have been engaged and concur.
  8. Active monitoring and controlled movement still apply for people who have had Ebola virus exposures and are under follow-up as contacts for the full 21-day period following their last exposure.

Important information about RT-PCR testing for Ebola virus:

  • A negative RT-PCR test result for Ebola virus from a blood specimen collected less than 72 hours after onset of symptoms does not necessarily rule out Ebola virus infection.
    • If the patient is still symptomatic after 72 hours, the test should be repeated.
    • If the patient has recovered from the illness that brought them to medical attention, a repeat test is not required.
  • A negative RT-PCR test result for Ebola virus from a blood specimen collected more than 72 hours after symptom onset rules out Ebola virus infection.
  • Positive Ebola virus RT-PCR results are considered presumptive until confirmed by CDC.
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