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The Ebola Outbreak

What you need to know to protect yourself and your practice

JASON SMITH, O.D., M.S., F.A.B.C.O., FORTY FORT, PA.

According to the CDC and the World Health Organization, Ebola Viral Disease kills 47% of people infected. As we go to press, almost 5,000 people have died worldwide, including Thomas Eric Duncan, the first patient diagnosed in the United States after returning from Liberia.

Earlier this month, the Associated Press reported that several top infectious disease experts, who ran disease outbreak simulations for the news organization, predicted as few as one or two additional infections by the end of 2014 to a worst-case scenario of 130 in the United States.

As a reference for practitioners, the AOA has issued a formal advisory outlining optometry’s role in Ebola and other infectious diseases (See http://bit.ly/1x0ivqg).

Here, I provide an overview of the virus and ways optometrists can help protect themselves and their practices from Ebola.

Overview

According to the CDC, the virus is named after the Ebola River, where the first human outbreaks occurred in 1976 in Northern Zaire, now the Democratic Republic of the Congo. Subsequent outbreaks have appeared sporadically in Africa. Though there have been reported cases in other countries, the current outbreak is concentrated in West Arica, namely Guinea, Liberia and Sierra Leone.

While the natural host has not been identified, scientists believe that Ebola is animal-borne and that bats are the most likely reservoir. Thus, transmission can occur via contact with an infected animal, such as a fruit bat or primate (apes and monkeys).

Symptoms of the Ebola virus include weakness, headaches, sore throat, fever, aches, diarrhea, rash, vomiting and stomach pain. Additional signs and symptoms may include rash, red eyes, chest pain, difficulty breathing and swallowing and internal bleeding. As the disease progresses, decreased liver and kidney function develops, and external bleeding, such as from the eyes and ears, may become an ominous sight.

Symptoms usually appear within eight to 10 days after exposure, and the current incubation period is anywhere from two to 21 days, though this may change as we learn more about this virus.

Transmission

Ebola is extremely infectious: A very small amount of Ebola can cause illness that can lead to death. However, the virus is considered mildly contagious because it is not transmitted through the air like a cold, measles or flu virus.

According to the CDC, person-to-person transmission occurs when one comes in direct contact with the blood or bodily fluids of an infected person, including, but not limited to, urine, saliva, sweat, feces, vomit, breast milk and semen.

In addition, Ebola transmission can occur through objects that have been contaminated with the virus, such as syringes and needles.

A suspicious, symptomatic patient must be isolated in order to confirm the diagnosis. Anyone who came in contact with the suspected patient may be subject to quarantine as a preventive measure in order to identify possible additional cases and limit the potential spread from an initial carrier.

Treatment

No Ebola virus-specific treatment is currently available. Survival is improved by early supportive care with hydration and symptomatic treatment, such as the oral or intravenous management of pain, nausea, fever and anxiety. According to a study published in Viruses, anti-malarial medications and antibiotics are often used before the diagnosis is confirmed, although there is no evidence to suggest that these help in any way.

Vaccine progress

A fast-tracked study conducted in Great Britain is assessing the safety of an experimental Ebola vaccine. The study is expected to be completed by December. The pace of the trial, which began on September 17, has been dictated by the alarming spread of the deadly virus, says Professor Adrian Hill, a lead researcher and director of the Jenner Institute at the University of Oxford. He and his team are conducting tests of the Ebola vaccine, developed by GlaxoSmithKline with the National Institutes of Health, on healthy volunteers. According to Hill, the purpose of the vaccine is not to be sold, but rather to be used in an emergency setting in the affected countries in West Africa.

Wearing masks and gloves during examiniations protects both you and your patients.

Protecting yourself

Practitioners must be on guard in their offices and clinics to protect themselves, their staff, their patients and their families from Ebola transmission. To accomplish this:

• Update your questionnaire. New questions that may now be added to your case history may include, “Have you recently travelled to Western Africa?” “Have you cared for a person with Ebola?” or “Have you come in contact with an Ebola patient?”

• Perform careful screenings. As bodily fluids are a main source of transmission for many illnesses, not just Ebola, eyecare professionals must take extreme care in treating patients. Gloves and masks may be worn when treating and examining patients, with the understanding that it is for everyone’s protection. In addition, frequent hand washing is recommended.

• Employ single-use instruments. Single-use instruments should be used whenever possible. Non-disposable instruments must be properly sterilized before being used again.

• Clean equipment. Cleaning equipment with hydrogen peroxide, bleach, alcohol-based antiseptics and extra-strength antibacterial soaps is critical to minimize risk of transmission.

• Reschedule sickly patients. If you have an encounter with a patient you feel is “not healthy,” ask the patient to return when he or she is feeling better. Check with your state and local associations, as well as your lawyer, to be sure of your rights and responsibilities to you, as well as to the patient.

• Speak up. If you feel that a patient is exhibiting signs and symptoms of the Ebola virus, call your local or state health department immediately for further instruction.

Ebola FAQs

Though the risk of contracting Ebola in the U.S. is low, it is still important to arm yourself and your patients with information on transmission, symptoms and precautionary measures. In an advisory statement, the AOA urged doctors to direct both patients and staff to the American Public Health Association (APHA)’s “Ebola: What you need to know if you live in the U.S.” fact sheet, which includes frequently asked questions. The fact sheet (below) can be downloaded for free on the APHA website: www.getreadyforflu.org/EbolaFacts.htm.

Remain in the know

Ebola may be present in one form or another for some time. If circumstances change, and as new information about Ebola is learned, there may be new medical guidelines distributed through local and national governmental agencies, such as the National Institutes of Health and the CDC. Local, state and national optometric associations may have to enact new guidelines to protect patients, doctors and the public. Also, expect CE courses about Ebola being made available very soon, which may be an added requirement to renewing your license. Until then, employ the steps listed above to help protect yourself, your practice and your patients. OM

Dr. Smith is in private practice in Forty Fort, Pa. He is a prolific writer on several optometry-related topics. Send comments about this article to optometricmanagement@gmail.com.