Tuesday, November 11, 2014

ECDC: New Public Health Management Guidelines On Ebola

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The ECDC has released a pair of technical reports today on the public health management of Healthcare workers returning from Ebola-affected nations, and on anyone who might have been exposed to Ebola while in the EU.  We’ve seen similar guidance issued by the CDC, PHAC, Public Health England, and other government agencies – and while similar in many ways – each approaches the topic a bit differently.

 

A few excerpts follow, but download both PDFs to read them in their entirety. First stop is a 7-page report called:

 

Public health management of healthcare workers returning from Ebola-affected areas

7 November 2014

Proposed options

All healthcare workers (HCW) returning from affected areas should be provided with information upon their return. In addition they should undergo an individual exposure assessment as early as possible upon returning.  Additional measures can be considered on the basis of the results of the exposure assessment,  using the guidance in the table below.

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The second document is an update to one we examined on October 23rd (see ECDC: Management Of Contacts Of Ebola Virus Disease Cases In The EU) that seeks to quantify the difference between `low risk’ and `high risk’ Ebola exposure, and to set a path on how to deal with both.

 

 

Public health management of persons having had contact with Ebola virus disease cases in the EU


7 November 2014

(EXCERPT)

Definition of contact persons


A contact person of an EVD case is a person not currently presenting symptoms, who has or may have been in contact with an EVD case, bodily fluids from a case, or a soiled environment. The associated risk of infection depends on the level of exposure which will, in turn, determine the type of monitoring.


1. Definition of contact persons with low-risk exposure:


Casual or physical contact with a feverish but ambulant and self-caring EVD case (e.g. sharing a seating
area or public transportation, including airplane transport; receptionist tasks; etc.)

Close, face-to-face or physical contact with a case (not coughing or vomiting)

Household, classroom or office contact.

2. Definition of contact persons with high-risk exposure2:

  • Close face-to-face contact (e.g. within one metre) without appropriate personal protective equipment (including eye protection) with a probable or confirmed case who is coughing, vomiting, bleeding, or has diarrhoea.
  • Direct contact with bodily fluids or any materials soiled by bodily fluids from a probable or confirmed case.
  • Percutaneous injury (e.g. with a needle) or mucosal exposure to bodily fluids, tissues or laboratory
    specimens of a probable or confirmed case.
  • Participation in funeral rites having direct contact with human remains (including bodily fluids) of a case in or from an area experiencing community transmission without appropriate personal protective equipment.
  • Having had unprotected sexual contact with a case within three months of the case recovering from EVD.
  • Having had direct contact with bushmeat, bats or primates, living or dead, from affected areas.

<SNIP>

• Contact with low-risk exposure:
− Self-monitoring for EVD symptoms, including fever of any grade, for 21 days after last exposure. Public
health authorities may do more, depending on the specific situation.
• Contact with high-risk exposure:
− Active monitoring for EVD symptoms, including fever of any grade, for 21 days after last exposure by public
health authorities;
− No travel abroad;
− Remaining reachable for active monitoring;
− Restriction of contacts (voluntary self-quarantine or imposed) to be considered in the event of very high-risk
exposure.


Contact persons should immediately self-isolate and contact health services in the event of any symptom appearing within 21 days. If no symptoms appear within 21 days of last exposure the contact person is no longer considered to be at risk of developing EVD.

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