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.

Atlanta is notable for having numerous internationally active public health institutions and businesses, a busy international airport that is the first point of entry for many travelers from West Africa, and a large West African immigrant population. This contributed to a relatively large number of PUI evaluated at Emory, and it provided the opportunity to systematically evaluate the patients using standardized protocols. Approximately half of the patients in this series were evaluated in an outpatient setting without requiring admission to the ED, hospital, or ETU. None of the patients had EVD, and an alternative etiologic diagnosis was established in most. However, 16% of patients had potentially life-threatening non-EVD diagnoses that required urgent treatment, including 3 patients diagnosed with P falciparum malaria and 1 with DKA. With careful risk stratification and triage, only 4 PUI were evaluated in our ETU, although the ETU laboratory was used in the testing of an additional 4 PUI evaluated in the ED. Our experience demonstrates how other Ebola assessment centers may evaluate PUI with low suspicion of EVD, even when the center does not have full ETU capacity.