Ebola algorithm for the evaluation of the returned traveler

Ebola Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Ebola from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Algorithm for the Evaluation of the Returned Traveler
Emergency Department Evaluation
Case Definition
History and Symptoms
Physical Examination
Laboratory Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Hospital Preparedness
Checklists
Air Medical Transport
Monitoring and Movement Following Exposure
Primary Prevention
Future or Investigational Therapies
Postmortem Care
Postmortem Care
Case Studies
Case #1
Ebola algorithm for the evaluation of the returned traveler On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Ebola algorithm for the evaluation of the returned traveler All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Ebola algorithm for the evaluation of the returned traveler
CDC on Ebola algorithm for the evaluation of the returned traveler
Ebola algorithm for the evaluation of the returned traveler in the news
Blogs on Ebola algorithm for the evaluation of the returned traveler
Directions to Hospitals Treating ebola
Risk calculators and risk factors for Ebola algorithm for the evaluation of the returned traveler

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rim Halaby, M.D. [2]

Overview

The Centers for Disease Control and Prevention (CDC) has developed an algorithm for the evaluation of the returned traveler that can be used to stratify patients according to their risk of exposure, test them for Ebola when indicated, and triage them urgently to the appropriate level of care.

Algorithm For Returned Travelers

Shown below is the Centers for Disease Control and Prevention (CDC) algorithm for the evaluation of the returned traveler developed by the CDC. Click here to access the PDF version of the CDC algorithm and print it.

Is there a FEVER (subjective or ≥101.5°F or 38.6°C) or compatible EVD symptoms (headache, weakness, muscle pain, vomiting, diarrhea, abdominal pain or hemorrhage) in a patient who has traveled to an Ebola-affected area in the 21 days before illness onset?

Yes

No

1. Isolate patient in single room with a private bathroom and with the door to hallway closed 2. Implement standard, contact, and droplet precautions (gown, facemask, eye protection, and gloves) 3.Notify the hospital Infection Control Program and other appropriate staff 4. Evaluate for any risk exposures for EVD 5. IMMEDIATELY report to the health department

Report asymptomatic patients with high- or low-risk exposures in the past 21 days to the health department

Determine the risk of exposure

HIGH-RISK EXPOSURE

LOW-RISK EXPOSURE

NO KNOWN EXPOSURE

Percutaneous (e.g., needle stick) or mucous membrane contact with blood or body fluids from an EVD patient OR Direct skin contact with, or exposure to blood or body fluids of, an EVD patient OR Processing blood or body fluids from an EVD patient without appropriate personal protective equipment (PPE) or biosafety precautions OR Direct contact with a dead body (including during funeral rites) in an Ebola affected area without appropriate PPE

Household members of an EVD patient and others who had brief direct contact (e.g., shaking hands) with an EVD patient without appropriate PPE OR Healthcare personnel in facilities with confirmed or probable EVD patients who have been in the care area for a prolonged period of time while not wearing recommended PPE

Residence in or travel to affected areas without HIGH- or LOW-risk exposure

Review case with Health Department including: • Severity of illness • Laboratory findings (e.g., platelet counts) • Alternative diagnoses

Is EVD suspected?

Yes

No

TESTING IS INDICATED • The health department will arrange specimen transport and testing at a Public Health Laboratory and CDC. • The health department, in consultation with CDC, will provide guidance to the hospital on all aspects of patient care and management

TESTING IS NOT INDICATED If patient requires in-hospital management: • Decisions regarding infection control precautions should be based on the patient’s clinical situation and in consultation with hospital infection control and the health department • If patient’s symptoms progress or change, re-assess need for testing with the health department If patient does not require in-hospital management • Alert the health department before discharge to arrange appropriate discharge instructions and to determine if the patient should self-monitor for illness • Self-monitoring includes taking their temperature twice a day for 21 days after their last exposure to an Ebola patient

^{Algorithm adapted from the Centers for Disease Control and Prevention: Algorithm for Evaluation of the Returned Traveler.}