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Wednesday, August 6, 2014

Patients’ travel history becomes more important to doctors as Ebola, other diseases spread

There is no Ebola virus loose in the U.S., and it would not spread easily even if it did arrive here – but publicity about an outbreak in West Africa has grown so much that the state and the city of Nashua released alerts Tuesday about the disease.

One major point of the alerts is to ensure that health-care providers question sick people about their recent travel history. The early symptoms of the disease caused by the Ebola virus resemble the symptoms of many diseases, which means learning about recent exposure in parts of West Africa is often the best way to diagnose it quickly. ...

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There is no Ebola virus loose in the U.S., and it would not spread easily even if it did arrive here – but publicity about an outbreak in West Africa has grown so much that the state and the city of Nashua released alerts Tuesday about the disease.

One major point of the alerts is to ensure that health-care providers question sick people about their recent travel history. The early symptoms of the disease caused by the Ebola virus resemble the symptoms of many diseases, which means learning about recent exposure in parts of West Africa is often the best way to diagnose it quickly.

“Any patient that presents to an emergency room or doctors office with a fever … it’s generally good for them to ask about travel because of all the different questions about infectious issues that have come up in the past,” said Dr. Benjamin Chan, New Hampshire state epidemiologist.

“Anyone who comes in to a primary care provider with a fever – five years ago you’d go through the questions about urinary symptoms, cough, maybe not be as focused on travel. Now you’re going to ask that question about travel history,” said Dr. Richard Boehler, CEO of St. Joseph Hospital in Nashua.

Questions about travel are increasingly important in health care as more diseases from tropical regions show up in the U.S. because of globalization and changing climate. The recent discovery of the chikungunya virus in New Hampshire and dengue fever in Massachusetts are examples – although both those diseases can be spread by mosquitoes, unlike Ebola.

Ebola is an extremely deadly type of hemorrhagic fever, or fever associated with persistent and extreme bleeding. It has a fatality rate of up to 90 percent, and there is no vaccination or proven treatment, although the two American patients appear to be responding to an experimental therapy.

Ebola does not spread easily between people, since it cannot be spread through the air or via infected water or infected food. It requires contact with bodily from an infected person who is already showing symptoms.

“We equate it to a lot like HIV. It requires bodily fluid contact,” Boehler said.

News coverage about an outbreak in of Ebola three West African countries – Liberia, Guinea and Sierra Leone – and the fact that two American aid workers became infected and were brought back to the U.S. for treatment, has fueled many rumors about the disease.

Fear about Ebola has arisen in relation to proposed settlement of refugees from the African nation of Congo in Dover, even though Congo is more than 1,000 miles away from the current outbreak. The name of the virus causing the disease comes from the Ebola River in Congo, where the disease was first recognized.

The Centers for Disease Control has advised Americans not to travel to those three countries without good reason, and protocols have been put into place for arrivals from there.

“Ebola does not pose a significant risk to the U.S. public at this time,” says an advisory sent out to health care providers by Nashua as part of the Greater Nashua Public Health Network. “Individuals who are not showing symptoms of being ill are not contagious. In order for the virus to be transmitted, an individual would have to have direct contact with an individual who is experiencing symptoms.”

New Hampshire Department of Health and Human Services sent out an alert Tuesday over its statewide network concerning what is officially known as Ebola virus disease.

“EVD is characterized by sudden onset of fever and malaise, accompanied by other non-specific signs and symptoms, such as myalgia (muscle pain), headache, vomiting, and diarrhea. Patients with severe forms of the disease may develop hemorrhagic symptoms and multi-organ dysfunction, including hepatic damage, renal failure, and central nervous system involvement, leading to shock and death,” said the alert. “In outbreak settings, Ebola virus is typically first spread to humans after contact with infected wildlife and is then spread person-to-person through direct contact with bodily fluids such as, but not limited to, blood, urine, sweat, semen, and breast milk. The incubation period is usually 8-10 days, but ranges from 2-21 days.”

All of the state’s acute care hospitals and many other facilities have isolation rooms ready for contagious patients and protocols in place about such things as the use of gowns, gloves and protective eyewear when dealing with patients.

Southern New Hampshire Medical Center, in a statement replying to a Telegraph query, said that its staff “is well versed in the use of these types of precautions for diseases other than Ebola and they are practiced on a daily basis,” noting that Infection Prevention staff “participated in a national conference call this afternoon on this topic.”

In that call, the hospital statement said, Dr. David Kuhar, medical officer for CDC’s National Center for Emerging and Zoonotic Infectious Diseases said: “There have been outbreaks of Ebola since the 1970s. The mode of transmission of this virus is known. Every hospital is capable of caring for an Ebola patient.”

Boehler of St. Joseph Hospital reiterated preparedness.

“We learned universal precautions a long time ago,” Boehler said.

The most important tool used by health care these days may be communication, he added.

“We have come a long way about getting information out about what’s happening. … We have a must better infrastructure to alert providers. We report what we have to them centrally. There’s a good distribution system in the state to alert us to trends or patterns in infectious disease,” he said.

David Brooks can be reached at 594-6531 or dbrooks@nashua
telegraph.com. Also, follow Brooks on Twitter (@GraniteGeek).