SCREENING AND TRIAGE FOR

EBOLA VIRUS DISEASE

Credits to:
Dr. Marie Rose De Los Reyes
Department of Health Research
Institute for Tropical Medicine
 SCREENING AND
TRIAGE FOR EBOLA
VIRUS DISEASE
Learning objectives:
At the end of the session, the participants should be able to:
Understand the importance of screening and triage
Define triage, isolation or holding area
Conduct rapid identification and assessment of PUI
Classify suspect cases and isolate them promptly
Identify the symptoms of EVD
 SCREENING AND
TRIAGE FOR EBOLA
VIRUS DISEASE
Screening for EVD
Screening for EVD is the first step
It is simple and based on travel history (Since EVD is not
in the Philippines)
Have you arrived from overseas in the last 21 days?
If Yes, Have you been to countries with Ebola in the last
21 days? For example, Guinea, Liberia and Sierra
Leone?
Any positive reply to this last question from clients are
sent for triage
 SCREENING AND
TRIAGE FOR EBOLA
VIRUS DISEASE
Who does screening?
Done by security people at entrance to facility
Done at entry to ER or OPD clinics
Notices around the facility
If person is sick, provide him/her a surgical mask to wear
 SCREENING AND
TRIAGE FOR EBOLA
VIRUS DISEASE
Triage area
All health care facilities MUST designate a triage area
which should be located as near as possible to the
entrance of the hospital to prevent patients from gaining
access to the whole hospital facility.
 SCREENING AND
TRIAGE FOR EBOLA
VIRUS DISEASE
Triage area
It should be separate from the general emergency room
to prevent potential transmission of Ebola to other
patients and hospital staff
The area should have adequate ventilation and room air
exchange
 SCREENING AND
TRIAGE FOR EBOLA
VIRUS DISEASE
Triage (Key principles)
Rapid identification and risk assessment of persons with
symptoms of Ebola by asking targeted screening
questions, which includes history of recent travel or close
contact with an Ebola case and history of fever or other
compatible symptoms
 SCREENING AND
TRIAGE FOR EBOLA
VIRUS DISEASE
Upon arrival at the triage area, quickly identify and assess
risk for EVD
Fill-up the triage checklist and assess for:
Travel history countries with widespread transmission
of Ebola in the past 21 days (Liberia, Guinea, Sierra
Leone)
Exposure history with Ebola patient, dead or sick
animals in the past 21 days.
 SCREENING AND
TRIAGE FOR EBOLA
VIRUS DISEASE
Upon arrival at the triage area, quickly identify and assess
risk for EVD
Fill-up the triage checklist and assess for:
Symptoms such as;
Fever (subjective or 38.0C
Headache
Weakness
Muscle pain
Diarrhea
Abdominal pain
Hemorrhage
 SCREENING AND
TRIAGE FOR EBOLA
VIRUS DISEASE
Triage screening form
TRIAGE SCREENING FORM.docx
 SCREENING AND
TRIAGE FOR EBOLA
VIRUS DISEASE
Guidelines in testing and disposition of patients
Any
Travel Contact Testing
symptoms Assessment Disposition
history history present for EVD

_ + _
Sent
home and
+ _ _ PUI No Monitor
for 21
days
+ + _
 SCREENING AND
TRIAGE FOR EBOLA
VIRUS DISEASE
Public Health Action for PUIs
Falls into three general areas
Monitoring
Activity restrictions
Travel restrictions
 SCREENING AND
TRIAGE FOR EBOLA
VIRUS DISEASE
Public Health Action for PUIs
The higher the category of risk, the more intense is
monitoring and higher are restrictions on activity and
travel
Unprotected contact with confirmed EVD case = high
risk
HCWs employed in Ebola Treatment Center (ETC) =
some risk
 SCREENING AND
TRIAGE FOR EBOLA
VIRUS DISEASE
Public Health Action for PUIs
The higher the category of risk, the more intense is
monitoring and higher are restrictions on activity and
travel
Laboratory scientist doing diagnostic testing = low
risk
Person visiting countries with intense and widespread
transmission but no contact with EVD = low risk
 SCREENING AND
TRIAGE FOR EBOLA
VIRUS DISEASE
Monitoring
Checking temperature, other symptoms and signs at
least once a day for 21 days from last contact with EVD
case
Maybe by health professional or Self monitoring
If self monitoring, use phone monitoring with daily check
in
High risk contact checked by HCW twice a day
Low risk self monitoring with phone checking
 SCREENING AND
TRIAGE FOR EBOLA
VIRUS DISEASE
Monitoring of PUIs
The following persons are NOT at risk of getting Ebola:
Those who have been in a country with widespread
Ebola transmission (Guinea, Sierra Leone, Liberia) or
Mali
Since MORE THAN 21 days ago
With NO symptoms of Ebola since leaving any of
these countries
 SCREENING AND
TRIAGE FOR EBOLA
VIRUS DISEASE
Monitoring of PUIs
The following persons are NOT at risk of getting Ebola:
Aircraft or ship crew members who did not leave the
immediate area of the airplane/ship and had no direct
contact with anyone from the community during the
entire time that they were present in a country with
widespread EVD transmission
 SCREENING AND
TRIAGE FOR EBOLA
VIRUS DISEASE
Monitoring of PUIs
The following persons are NOT at risk of getting Ebola:
Contact with a healthy person with NO symptoms
who had contact with a person with Ebola
Contact with a person with Ebola BEFORE the
person developed symptoms
Those who have been in places WITHOUT
widespread EVD transmission (Spain, Texas, New
York)
 SCREENING AND
TRIAGE FOR EBOLA
VIRUS DISEASE
Monitoring of PUIs
People with MODERATE RISK:
Direct contact, while using appropriate PPE, with a
person with Ebola who has symptoms, or with the
persons body fluids.
Directly took care of patients in other health care
facilities
 SCREENING AND
TRIAGE FOR EBOLA
VIRUS DISEASE
Monitoring of PUIs
People with MODERATE RISK:
With close contact in households, health care
facilities, or the community, WITHOUT appropriate
PPE, with a person with Ebola who has symptoms.
Close contact means being within approximately 3
feet (1 meter) of a person with Ebola for a long time
 SCREENING AND
TRIAGE FOR EBOLA
VIRUS DISEASE
Monitoring of PUIs
People at HIGH RISK
Exposed to blood or body fluids of a person with
Ebola who has symptoms, through broken skin (like a
wound or a needle prick) or mucus membranes (such
as splashes to the eyes, nose or mouth)
Exposed to the blood or body fluids (including but not
limited to feces, saliva, sweat, urine, vomit, breast
milk and semen) of a person with Ebola who has
symptoms while not wearing appropriate PPE.
 SCREENING AND
TRIAGE FOR EBOLA
VIRUS DISEASE
Monitoring of PUIs
People at HIGH RISK
Processed blood or body fluids of a person with
Ebola who has symptoms without appropriate PPE or
standard biosafety precautions.
Direct contact with a dead body without appropriate
PPE.
Those who live in the immediate household and
provided direct care to a person with Ebola who has
symptoms.
 SCREENING AND
TRIAGE FOR EBOLA
VIRUS DISEASE
Activity and travel restrictions options
Restricted public activities
Total quarantine in a designated place
Home quarantine
Total no movement outside home
Partial no public gatherings, but can walk in
parks on isolated streets alone
 SCREENING AND
TRIAGE FOR EBOLA
VIRUS DISEASE
Activity and travel restrictions options
Restricted travel
No travel at all
No air travel
No travel on public transport
No moving away from district of quarantine
Free to move
 SCREENING AND
TRIAGE FOR EBOLA
VIRUS DISEASE
Monitoring of PUIs
PUI symptomatic suspect isolate admit
Isolation precaution at once
Isolate yourself inside a room
No kissing, hugging or laying of hands
Avoiding contact with body fluids
Immediately place all used clothes and linens in a
plastic bag. DO NOT dispose of this yourself, but
inform DOH regarding its disposal.
Inform DOH immediately.
 SCREENING AND
TRIAGE FOR EBOLA
VIRUS DISEASE
Guidelines in testing and disposition of patients
Any
Travel Contact Testing
symptoms Assessment Disposition
history history present for EVD

_ + + Admit to
single
Suspect room.
+ _ + Yes
EVD case Manage
appropriat
+ + + ely
 SCREENING AND
TRIAGE FOR EBOLA
VIRUS DISEASE
Isolation/Holding area
This is the area where patients wait while transfer to the
referral hospital is being coordinated
Provide surgical masks to the patients and as much as
possible minimize contact with tem unless deemed
necessary
Should be a separate room located near the triage area
to ensure quick transfer of suspects and to minimize
contact with other hospital patients
 SCREENING AND
TRIAGE FOR EBOLA
VIRUS DISEASE
Person Under Investigation (PUI)
Any person arriving in the Philippines from any of the
following countries in West Africa, namely; Guinea,
Liberia, Sierra Leone in the past 21 days

OR

Contact of probable or confirmed case

 SCREENING AND
TRIAGE FOR EBOLA
VIRUS DISEASE
What is significant contact?
Exposure to a suspect/probable/confirmed EVD case in
at least one of the following ways:
Sleeping in the same household
Direct physical contact (while alive, during illness or
after demise)
Touched blood or body fluids during the illness
Touched the clothes/line of the case during his/her
illness
 SCREENING AND
TRIAGE FOR EBOLA
VIRUS DISEASE
What is significant contact?
Exposure to a suspect/probable/confirmed EVD case in
at least one of the following ways:
Being breastfed
Direct handling of bats, rodents, or primates from
disease-endemic areas
Direct contact with specimens collected from an EVD
patient or animal
Has worked in a hospital where EVD cases are being
treated
 SCREENING AND
TRIAGE FOR EBOLA
VIRUS DISEASE
Suspect case
PUI + signs and symptoms during 21-day period
Fever (actual or reported) Difficulty swallowing or sore
Headache throat
Nausea/vomiting Difficulty in breathing
Anorexia/loss of appetite Drowsiness or lethargy
Intense fatigue Bleeding (from different sites
Diarrhea such as gums, skin, eyes,
Abdominal pain urine, etc.
Muscle pain hiccups
 SCREENING AND
TRIAGE FOR EBOLA
VIRUS DISEASE
Probable case
Any suspected case evaluated by a
clinician/epidemiologist having an epidemiological link
with a confirmed case (where it was possible to collect
specimen for laboratory confirmation)

OR

Any deceased suspected case (where it was not

possible to collect specimen for laboratory confirmation)
having an epidemiological link with a confirmed case
 SCREENING AND
TRIAGE FOR EBOLA
VIRUS DISEASE
Confirmed case
A suspected or probable EVD case with laboratory
confirmation of infection with Ebola
 SCREENING AND
TRIAGE FOR EBOLA
VIRUS DISEASE
Discard/Non EVD case
A suspected case with a negative laboratory result that
was from a blood specimen collected 72 hours after
onset of symptoms
 SCREENING AND
TRIAGE FOR EBOLA
VIRUS DISEASE
Symptoms of Ebola Virus Disease (1)
Initial symptoms are non specific and may include fever,
chills, myalgia and malaise
Patient can progress to develop gastrointestinal
symptoms
Severe watery diarrhea, nausea, vomiting, abdominal
pain
Other symptoms include:
Chest pains, shortness of breath, headache or
confusion, conjunctival injection, hiccups, seizures or
cerebral edema
 SCREENING AND
TRIAGE FOR EBOLA
VIRUS DISEASE
Symptoms of Ebola Virus Disease (2)
The most common symptoms reported during the current
outbreak are:
Fever (87%)
Fatigue (78%)
Vomiting (68%)
Diarrhea (66%)
Loss of appetite (65%)
Patients with fatal disease develop more severe clinical
signs early and die between 6 and 16 days of
complications (mean is 7.5 days)
 SCREENING AND
TRIAGE FOR EBOLA
VIRUS DISEASE
Symptoms of Ebola Virus Disease (3)
Bleeding is not universally present but can manifest later
as petechiae, ecchymosis, bruising or oozing. Frank
hemorrhage is less common
Some patients develop diffuse maculopapular rash that
can desquamate
In non fatal cases, patients may have fever for several
days and improve within 6 days
The case fatality rate in West Africa is about 70%
 SCREENING AND
TRIAGE FOR EBOLA
VIRUS DISEASE
Stages of EVD EARLY SYMPTOMS
8-12 days after exposure,
patient develops fever,
INCUBATION chills, fatigue, muscle pain,
Virus invades cells throughout the body weakness, and becomes
and replicates contagious

EXPOSURE
Virus enters through nose,
mouth, eyes, ears, breaks in
skin
SPREAD
In the West African outbreak, each
person with Ebola infects 1.7-2
others. Ebola patients are most
contagious at and near death
SYMPTOMS
Survivors (30% in 2014) improve
WORSEN
after 6 days of symptoms Around 2 weeks after
exposure, patients
develop diarrhea,
vomiting, abdominal
DEATH pain, rash, red eyes,
6-16 days after symptoms begin (avg. 7.5 in 2014), bleeding
damage to blood vessels causes drop in blood
pressure and organ failure
 SCREENING AND
TRIAGE FOR EBOLA
VIRUS DISEASE