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.

The diagnoses observed in this case series highlight the importance of influenza vaccination and routine preventative advice for international travelers [21] . Given the relatively short incubation period of influenza and other respiratory virus infections, it is likely that many of the respiratory infections were acquired after arrival in the United States. The 2014-2015 North American influenza season peaked locally in the Atlanta area in December [22] , and influenza A contributed to the peak of PUI evaluated during that month (Figure 1 ). Although several patients developed influenza A infection despite immunization with the seasonal influenza vaccine (consistent with reports of limited vaccine efficacy during the 2014-2015 influenza season [23] ), the number of influenza cases observed strongly supports influenza vaccination for all travelers who do not have contraindications whenever the vaccine is available. In addition to risks of seasonal transmission in the United States, influenza is among the most common vaccine-preventable travel-related infections among international travelers [24] and can circulate year-round in tropical areas [21] . Prophylactic oseltamivir for returning travelers from Ebola-affected areas during influenza season may even be considered to reduce the chance of acute influenza illness during the 21-day monitoring period, particularly when the traveler is exposed to close contacts diagnosed with influenza.