Page 102 - Journal of Special Operations Medicine - Fall 2014

Treatment and Vaccination Disclaimer
Treatment of Ebola hemorrhagic fever is supportive in na- The views expressed in this publication are those of the
ture as no US Food and Drug Administration– approved author and do not reflect the official policy or position
therapy exists, although a therapy involving monoclonal of the Department of the Army, Department of Defense,
antibodies will likely soon be tried on humans infected in or the US Government.
the latest outbreak. No vaccines currently exist, though
human trials to test a vaccine in development are sched- Disclosure
uled to be tested in the fall of 2014.
The author has nothing to disclose.

Importance in a Deployed Setting Bibliography
Ebola hemorrhagic fever should be considered in the http://www.cdc.gov/vhf/ebola/.
differential diagnosis for any patient with a rapid-onset http://www.cdc.gov/vhf/ebola/outbreaks/guinea/qa
febrile illness encountered in countries where the disease -experimental-treatments.html.
is endemic, or in patients who have recently returned http://www.who.int/csr/disease/ebola/en/.
from those areas of Africa. Medical personnel should
make every effort to prevent contact with bodily flu-
ids of suspected cases, even if the patient is deceased. COL Burnett is currently the Area Support Group – Kuwait
They should also make every attempt to prevent host- Command Surgeon and is board certified in pediatrics and pe-
nation caregivers and family members from bodily fluid diatric infectious diseases. He has served overseas in Korea,
con tamination from the suspected case as this will po- Germany, Kosovo, Iraq, and Afghanistan and as the JSOTF-P
tentially prolong and widen outbreaks of the disease. Surgeon in the Philippines. He is a graduate of the University
of Wisconsin-Madison and the Medical College of Wisconsin.

The following is direct from the CDC • Percutaneous, e.g. the needle stick, or mucous mem-
(http://www.cdc.gov/vhf/ebola/hcp/case-definition.html). brane exposure to body fluids of EVD patient
• Direct care or exposure to body fluids of an EVD patient
Case Definition for Ebola Virus Disease (EVD) without appropriate personal protective equipment
Early recognition is critical for infection control. Healthcare (PPE)
pro viders should be alert for and evaluate any patients • Laboratory worker processing body fluids of confirmed
suspected of having EVD current as of 7 Aug 2014. EVD patients without appropriate PPE or standard bio-
Person Under Investigation (PUI) safety precautions
A person who has both consistent symptoms and risk fac- • Participation in funeral rites which include direct expo-
tors as follows: 1) Clinical criteria, which includes fever of sure to human remains in the geographic area where
greater than 38.6 degrees Celsius or 101.5 degrees Fahr- outbreak is occurring without appropriate PPE
enheit, and additional symptoms such as severe headache, Low risk exposures
muscle pain, vomiting, diarrhea, abdominal pain, or unex- A low risk exposure includes any of the following:
plained hemorrhage; AND 2) Epidemiologic risk factors • Household member or other casual contact with an
1
within the past 21 days before the onset of symptoms, EVD patient
such as contact with blood or other body fluids or human • Providing patient care or casual contact without high-
1
remains of a patient known to have or suspected to have risk exposure with EVD patients in health care facilities
EVD; residence in—or travel to—an area where EVD trans- in EVD outbreak affected countries *
mission is active*; or direct handling of bats, rodents, or No known exposure
primates from disease-endemic areas.
Persons with no known exposure were present in an EVD
*
Probable Case outbreak affected country in the past 21 days with no low
A PUI who is a contact of an EVD case with either a high or risk or high risk exposures.
low risk exposure (see below).
Notes: 1. Casual contact is defined as a) being within approximately 3
Confirmed Case feet (1 meter) or within the room or care area for a prolonged period of
time (e.g., healthcare personnel, household members) while not wearing
A case with laboratory confirmed diagnostic evidence of
recommended personal protective equipment (i.e., droplet and contact
ebola virus infection. precautions–see Infection Prevention and Control Recommendations); or
b) having direct brief contact (e.g., shaking hands) with an EVD case while
Contacts of an EVD Case not wearing recommended personal protective equipment (i.e., droplet and
Contacts of an EVD case have different levels of exposure contact precautions–see Infection Prevention and Control Recommenda-
tions). At this time, brief interactions, such as walking by a person or moving
risk, as follows:
through a hospital, do not constitute casual contact.
High risk exposures *Outbreak affected countries include Guinea, Liberia, Sierra Leone, and
A high risk exposure includes any of the following: Lagos, Nigeria, as of 4 August 2014.

94 Journal of Special Operations Medicine Volume 14, Edition 3/Fall 2014