U.S. response to Ebola crisis continues to evolve

Pharmacists remain integral part of help here and abroad

The Obama administration said it will release new guidelines later this week for health care workers returning from Ebola virus disease (EVD)-stricken areas of West Africa after news that a U.S. medical aid worker fell ill with the virus last week in New York City. The physician had been treating EVD patients in Guinea with the humanitarian aid group Doctors Without Borders.

Meanwhile, health officials have stuck by their message that controlling the outbreak in West Africa remained the best way to stop the spread of EVD. Last week, the West African nation of Mali reported its first EVD case.

According to CDC and the World Health Organization (WHO), the reported number of EVD cases in West Africa now stands at 10,114. Of those cases, 4,912 patients have died. In addition, 27 travel-associated or localized transmission cases—10 resulting in death—have occurred in Mali, Senegal, Nigeria, Spain, and the United States. China and India have begun preparing their countries’ medical systems for possible cases.

Pharmacists’ role

Pharmacists have been active participants in controlling EVD in West Africa. RADM Scott F. Giberson, BSPharm, PhC, NCPS-PP, MPH, ScD (Hon), U.S. Public Health Service, who is Acting U.S. Deputy Surgeon General, has been in Liberia helping to support hundreds of American civilians fighting EVD in the region; last week, Giberson was shown on CNN. U.S. military personnel are constructing EVD treatment units in Liberia, where the disease is most rampant.

Here in the United States, pharmacists are also the first point of contact for many patients and are playing a part in the coordinated response to EVD.

Officials continue to advise all U.S. health care workers, including pharmacists, of the protocols and updated guidelines for dealing with cases that could still turn up in the United States. They said the main question U.S. health care workers need to ask a patient they encounter with a fever or other signs of EVD infection is if the individual has been to West Africa in the past 21 days. Unless that’s the case, or the patient has had direct contact with blood or other bodily fluids of an infected person, the chances a patient has EVD are slim to nonexistent.

“I believe it is highly unlikely that the U.S. will have any sort of a widespread outbreak of EVD,” said Andy Stergachis, PhD, BPharm, Director of the Global Medicines Program at the School of Public Health at the University of Washington in Seattle. “Proper infection control combined with rapid public health action can limit the spread of the disease.”

Resources for pharmacists

Like all health care providers, 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.

The early signs of EVD include fever greater than 101.5° Fahrenheit, severe headache, muscle pain, vomiting, diarrhea, abdominal pain, and unexplained hemorrhage. If these symptoms are present, the patient should be asked if they have traveled to West Africa in the past 21 days; if they’ve had contact with blood or other bodily fluids of a patient with known or suspected EVD; or if they’ve directly handled a bat or nonhuman primate from a disease-endemic area.

Stergachis, who is also Editor-in-Chief of JAPhA, said pharmacists need to know where to refer patients who exhibit signs and symptoms of EVD, and they should be prepared to answer any questions the public has about the virus.

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. EVD is not airborne, like influenza, which is known to kill thousands every season.

In addition, Stergachis said pharmacists should participate in trainings that focus on infection control procedures if pharmacists work in settings that might treat persons potentially infected.

While it’s unlikely that a symptomatic patient with EVD will present to a pharmacy, the nonprofit group Rx Response had outlined steps specifically for pharmacists.

They also have a guide for pharmacy owners, with steps on how to safely clean up bodily fluids, as well as information on making sure that disinfection and personal protective equipment (PPE) are on hand and that contact with a local health department is established beforehand.

On its website, CDC also has a new fact sheet for health professionals to use in determining “could it be Ebola?”

CDC revises guidelines

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 into how PPE should be worn—including no skin exposure—and how PPE should be worn, calling for a trained monitor who will watch 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 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.

CDC has also released recommendations for performing acute hemodialysis in hospitals for patients with EVD, as well as updated guidance on waste management for Ebola-contaminated materials.

EVD vaccine still in the works

According to WHO, EVD vaccine trials will begin in December, 1 month earlier than expected. If all goes well, several hundred thousand doses could be ready by July 1. The trials are expected to take place in Liberia, Sierra Leone, and Guinea, where the disease is most rampant. If early results suggest the vaccines are safe to use, doses might be given to high-risk groups, such as frontline health care workers in these afflicted areas.