Thursday, October 30, 2014

CDC Guidance: Considerations For Discharging Persons Under Investigation For Ebola


CDC Infographic: Is it flu, or Ebola?


# 9268


As has already been demonstrated, while a fair number of people may be initially suspected of having Ebola, few will actually end up being infected with the virus. The CDC has fielded calls on scores of `suspected’ Ebola cases from hospitals around the country – performed testing on dozens – and yet only small handful have tested positive for the virus. 


Today the CDC has issued guidance on the steps hospitals and clinicians should take when deciding whether to discharge someone who is (or was) a  PUI (Patient Under Investigation) for Ebola infection.


As you will see, Ebola cannot be ruled out by laboratory testing early in the symptomatic phase of the illness. It can take as long as 72 hours after symptoms appear for rt-PRC testing to pick up the virus. Which explains why some patients have been isolated – and retested – for 2 or 3 days before a final determination can be made. 


A negative test or no test conducted, and a change in symptoms inconsistent with Ebola infection, however, can be used – assuming the patient can be properly monitored after discharge.  

Considerations for Discharging Persons Under Investigation (PUI) for Ebola Virus Disease (Ebola)

The decision to discharge a patient being evaluated as a Person Under Investigation (PUI) for Ebola 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.

Health care providers evaluating a PUI should consider these criteria when deciding to discharge a PUI:
  1. In the clinical judgment of the medical team, the PUI’s illness no longer appears consistent with Ebola.
  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 Ebola (e.g., 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 Ebola, or those that could be consistent with Ebola 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 persons 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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