As the coordinated response to Ebola Virus Disease (EVD) in the United States has evolved over the past months, CDC and other federal officials have stuck by one important message: all health care workers, including pharmacists, who encounter a patient with fever or other signs of infection must ask the individual if he or she has been to West Africa in the past 21 days.
“If they’ve been in Liberia, Guinea, or Sierra Leone [and exhibit symptoms], then you need to get help, and we have an outline of what’s done in that situation,” said Thomas Frieden, MD, MPH, CDC Director.
With the public on alert about EVD, asking patients about their recent travel history remains an important question. Unless the patient has come from one of these countries where the virus is rampant or has had direct contact with blood or other bodily fluids of an infected person, the chances a patient has EVD are slim to nonexistent. In addition, officials said controlling the outbreak in West Africa remains the best way to stop the spread of EVD.
“I believe it is highly unlikely that the U.S. will have any sort of a widespread outbreak of EVD,” Andy Stergachis, PhD, BPharm, Director of the Global Medicines Program at the School of Public Health at University of Washington in Seattle, told Pharmacy Today. “Proper infection control combined with rapid public health action can limit the spread of the disease.”
Pharmacists have been active participants in controlling EVD in West Africa and, unfortunately, have even been among the Ebola fatalities of health care workers in Sierra Leone, according to the International Pharmaceutical Federation.
“In many countries, pharmacists are at the front line as the first point of contact with the health care system,” said Stergachis, who is also Editor-in-Chief of JAPhA.
Here in the United States, pharmacists are also the first point of contact for many patients and can play a part in the coordinated response to EVD. As such, said Stergachis, pharmacists need to be aware of EVD and its symptoms, and they need to ask patients who exhibit those symptoms about their recent travel history.
Early symptoms of EVD include fever, weakness, and muscle pain. However, EVD can quickly progress to vomiting, diarrhea, organ failure, and internal and external bleeding. Everyone should be reminded that EVD is not contagious before there are symptoms, and it only spreads by direct contact with blood, secretions, or other bodily fluids of infected people.
Stergachis said pharmacists need to know where to refer patients who exhibit signs and symptoms of EVD, and they should be prepared to answer questions the public has about the virus.
Pharmacists should participate in trainings that focus on infection control procedures if they work in a setting that might treat persons potentially infected.
More information is available from APhA at pharmacist.com.
After learning from the lapses that took place at Texas Presbyterian Hospital, where the first person diagnosed with EVD in the United States was treated, CDC revised its infection control guidance for health care workers caring for EVD patients.
The updated guidelines provide much more detail about how personal protective equipment (PPE) should be worn—including no skin exposure—and how PPE should be properly taken off, calling for a trained monitor to observe how each worker takes PPE on and off. CDC also stressed repeat training with PPE. The guidelines were updated with help from Doctors Without Borders, who have been on the ground in West Africa, as well as Emory University Hospital, Nebraska Medical Center, and the National Institutes of Health Clinical Center. All of these institutions have successfully treated EVD patients, most of them health care workers coming from West Africa.
“These guidelines are going to be implemented throughout the U.S.,” said Frieden. “But the number of people who screen positive or have symptoms and may come from one of the three countries and may have Ebola, that’s a very small number.”