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.

We believe that the CDC case definition for persons under investigation for EVD was appropriately sensitive, given the nonspecific initial symptoms of EVD and potentially severe consequences of undiagnosed EVD for patients and staff. The screening and triage protocols that were implemented in our EDs and clinics [14] [15] [16] were critical for the prompt identification and management of these patients. Using epidemiologic screening and decision trees developed by the CDC and Emory [7, 15] , the majority of patients were determined to be of low risk for EVD, and they did not require specific Ebola virus testing. Routine Ebola virus testing for all PUI was not practical; furthermore, the imperfect sensitivity of Ebola virus testing in the first 3 days of illness [20] would have limited its utility in ruling out EVD with certainty in the majority of the patients, because most presented within 1 day after onset of symptoms. Given these limitations, the decision of whether or not to perform Ebola virus testing was individually made for each PUI, considering the epidemiologic risk, symptomatology, and duration of symptoms. Therefore, our clinical approach was to carefully evaluate each PUI, rule out other potentially lifethreatening conditions, and use Ebola testing judiciously. Because patients who recovered were considered ruled out for EVD, diagnosis and prompt treatment of other suspected or confirmed causes of infection was particularly important during the monitoring period. Although none of our patients were empirically treated for malaria, this might be considered in situations in which the patient is clinically unstable and there is limited ability to perform malaria rapid diagnostic testing.