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2014-10-16

First Ebola transmission in US occurs in Dallas

By Judith Pannebaker BCC Editor

Editor's note: On Wednesday, Oct. 15, it was reported that a second nurse at Texas Health Presbyterian Hospital in Dallas has contracted Ebola.

Confirmatory tests revealed that a female nurse at the Texas Health Presbyterian Hospital in Dallas has contracted Ebola, according to Dr. David Lakey, commissioner of the Texas Department of State Health Services. The testing was completed at the Centers for Disease Control and Prevention in Atlanta, Georgia.
The critical care nurse, Nina Pham, 26, had cared for now deceased Ebola patient, Thomas Eric Duncan. The native of Liberia was diagnosed with Ebola after traveling to Dallas to visit family. During the later stages of the disease, Duncan was reported to have been on a ventilator and dialysis. Both procedures produce copious amounts of body fluids, exposure to which are thought to be the primary mode of Ebola transmission.
After reporting a low-grade fever the night of Friday, Oct. 10, Pham was isolated and referred for testing. A preliminary diagnosis of Ebola was received late Saturday.
According to news reports, CDC Director Tom Frieden, MD, has come under fire for originally assessing the transmission on a "breach of protocol," essentially blaming the victim herself. He made the statement during a Sunday, Oct. 12, news conference.
'Second case a reality'
"We knew a second case could be a reality, and we've been preparing for this possibility," said DSHS' Lakey, adding, "We are broadening our team in Dallas and working with extreme diligence to prevent further spread."
Health officials continue to monitor the contacts and potential exposures of the latest Ebola victim, based on the nature of the interactions and the potential that the contacts had been exposed to the virus. Supposedly, those infected are not contagious prior to symptoms developing.
According to Dr. Lauren Langford, a Courier contributor, the virus is thought to be spread through direct contact with body fluids or blood of a person infected with Ebola virus. Symptoms include fever over 101.5°F, severe headache, nausea, pain, vomiting, diarrhea, abdominal pain or unexplained hemorrhage.
Diagnosing Ebola in a person who has been infected for only a few days is difficult, because the early symptoms, including fever, are nonspecific to Ebola infection and are seen often in patients with more commonly occurring diseases, such as malaria and typhoid fever.
"Authorities believe the virus is contagious only if the patient is experiencing active symptoms. The illness has an average 8-10 day incubation period - although it ranges from two to 21 days," Langford wrote in an email.
Prep at Peterson
Closer to home, administrators with the Peterson Regional Medical Center have assured the community that Ebola preparations are currently in place at the Kerrville medical facility.
As the events unfolded in Dallas, Peterson Emergency Management Coordinator Mark Wilkinson, RN, met with medical center leaders to establish a hospital plan and protocol. The plan will utilize information provided by the Texas Department of State Health Services (TDSHS), CDC, American Hospital Association (AHA) and other reliable sources. Stakeholders who participated in the session included representatives from administration, nursing, medical staff services, the emergency department, community relations and marketing, safety, infection prevention, environmental services-housekeeping, facilities, materials management, laboratory, pharmacy and quality services. Hospital leaders outlined Expectations and needs were outlined, and a clear plan of action and protocol was put in place should a patient presenting symptoms of Ebola be admitted to the hospital.
Emergency exercise
A recent emergency management exercise strengthened a plan which will be activated should a patient arrive at Peterson suspected of having Ebola. Wilkinson expressed confidence that Peterson's emergency department would take the proper steps and precautions in treating a patient and "asking the right questions, while also protecting staff and other patients and their families."
He noted, "We have implemented education and procedures, and have the necessary equipment for initial care of infected patients. We have best practice protocols and checklists in place for healthcare workers in all roles. We continue to strengthen and develop our plan to detect, protect and respond to this and any additional threat to our community's health."
J. Patrick Murray, Peterson's president and CEO, emphasized the importance of a coordinated effort to help area residents understand the facts and risks associated with communicable diseases. "While we believe that the potential for an Ebola exposure in Kerr County is very slim, we also recognize that this is a good opportunity to inform our staff and the community about good public health practices," Murray said.
Peterson has created a webpage for specific updates on Ebola and other seasonal viruses and to house health resources and reports. The new Health Alert page can be found at www.petersonrmc.com/Community by selecting "Health Alert" on the Community main page.
Dallas dog okay
Dallas officials also emphasized that a dog belonging to the Dallas healthcare worker would not be euthanized as a precautionary measure.
A week ago health officials in Madrid, Spain summarily euthanized the pet companion of another healthcare worker who had become infected with Ebola - despite an online petition that reached 400,000 signatures requesting that the dog be quarantined rather than destroyed. That dog was killed as a precaution.
According to a CDC study, dogs can possibly be infected by the virus, making them, "... a potential source of human Ebola outbreaks and of virus spread during human outbreaks."
To date, however, no cases have been documented in which dogs transmitted the Ebola virus, according to reports.
According to Langford, Ebola virus has also been found in fruit bats, primates and pigs. Animals with an active Ebola viral load are believed to be the source of several outbreaks in humans. African fruit bats are thought to be the natural host of the virus.
In Africa, people have become infected through the handling of infected fruit bats, chimpanzees, gorillas, monkeys, forest antelope and porcupines found ill or dead or in the wild. Domesticated animals can also be affected by bushmeat. Bushmeat refers to meat from non-domesticated mammals, reptiles, amphibians and birds hunted for food in tropical forests. Dogs that live closest to an Ebola outbreak are more likely to have virus antigens, demonstrating that they were infected at one point, too.
As of press time, the Ebola epidemic has killed more than 4,500 people in West Africa, primarily in the countries of Liberia, Guinea and Sierra Leone.
(More information on Ebola is available at http://www.cdc.gov/vhf/ebola/index.html, https://www.dshs.state.tx.us/, http://www.bushmeat.org/bushmeat_and_wildlife_trade/what_is_the_bushmeat_crisis)