For SEIU Nurse Alliance of California: Infectious Disease Update from Mark Catlin
“Fever is a major symptom in the WHO Ebola case definition, and thermometers have been used widely by healthcare workers and government officials to screen for EVD cases among persons in hospitals, shops, and airports and at road check points. However, as many as a third of the patients at the Moyamba ETC had no fever at admission. Several other reports have also noted the lack of fever among EVD patients, and there are indications that fever has been present in fewer EVD patients during the 2013–2016 West Africa outbreak compared with previous outbreaks. Most patients (61%) referred to the Moyamba ETC had negative Ebola PCR results, indicating that the WHO case definition is not sufficiently specific in identifying EVD.” – M. Catlin
BOTTOM LINE: While the article abstract describes some facts, figures, and links, the important take away for nurses is a call for vigilance when reviewing charts, handling patients upon intake, especially those who have traveled outside the US to known at-risk regions of the world.
A Source Article Abstract: “The 2013–2016 outbreak of Ebola virus disease (EVD) in West Africa infected >28,000 people, including >11,000 who died, and disrupted social life in the region. We retrospectively studied clinical signs and symptoms and risk factors for fatal outcome among 31 Ebola virus–positive patients admitted to the Ebola Treatment Center in Moyamba District, Sierra Leone. We found a higher rate of bleeding manifestations than reported elsewhere during the outbreak. Significant predictors for death were shorter time from symptom onset to admission, male sex, high viral load on initial laboratory testing, severe pain, diarrhea, bloody feces, and development of other bleeding manifestations during hospitalization. These risk factors for death could be used to identify patients in need of more intensive medical support. The lack of fever in as many as one third of EVD cases may have implications for temperature-screening practices and case definitions.” (SOURCE: http://wwwnc.cdc.gov/eid/article/22/9/15-1621_article#suggestedcitation )
Figure 1. Survival analysis for patients with confirmed Ebola virus disease admitted to the treatment center in Moyamba District, Sierra Leone, December 19, 2014–February 17, 2015. Survival among A) all patients; B) male and female patients; C) patients with and without bleeding manifestations at admission; and D) patients with initial PCR results showing high- and low-level viremia, as defined by cycle thresholds of <22 and >22, respectively.
(SOURCE: http://dx.doi.org/10.3201/eid2209.151621 )
Figure 2. Ebola viral load for patients with confirmed Ebola virus disease admitted to the treatment center in Moyamba District, Sierra Leone, December 19, 2014–February 17, 2015. Viral loads were determined by semiquantitative PCR and are expressed as cycle thresholds for patients with fatal (n = 18) and nonfatal (n = 13) disease. (SOURCE: http://dx.doi.org/10.3201/eid2209.151621 )