Ebola or Not? Evaluating the Ill Traveler From Ebola-Affected Countries in West Africa

Fairley, Jessica K.; Kozarsky, Phyllis E.; Kraft, Colleen S.; Guarner, Jeannette; Steinberg, James P.; Anderson, Evan; Jacob, Jesse T.; Meloy, Patrick; Gillespie, Darria; Espinoza, Tamara R.; Isakov, Alexander; Vanairsdale, Sharon; Baker, Esther; Wu, Henry M.

Twenty-five patients met inclusion criteria, with December 2014 as the peak month of presentation ( Figure 1 ). Most patients were male (64%), and the median age was 41 years (range, 23-73) ( Table 2 ). The most common country of travel was Liberia (44%), and the majority of patients had traveled for Ebola response work (68%). The median timing of presentation was 10 days after travel (range, 1-22). One patient who presented at day 22 was considered a PUI because symptoms had started within the 21day monitoring period. Most patients were evaluated in either the outpatient tropical medicine clinic (48%) or the ED (40%), and the majority had symptoms for 1 day or less (67%) ( Table 2) . None of the patients reported direct contact with a patient with EVD within the prior 21 days, and none met CDC criteria for high epidemiologic risk of EVD. Six patients (24%) were hospitalized after evaluation for management of a non-EVD diagnosis (3 with malaria, 2 with ILIs, and 1 with diabetic ketoacidosis [DKA]). One patient initially evaluated in the tropical medicine clinic and discharged with home quarantine was reevaluated at our ETU for Ebola testing 2 days later when fevers continued and an alternative diagnosis was not confirmed. This patient's epidemiologic risk was low, but given the persistent symptoms of undetermined cause, the patient was triaged to the ETU under an abundance of caution.