Advice on assessment of patients with suspected Ebola

Practices have been issued with advice to prepare for the ‘unlikely but not impossible’ risk of a patient infected with Ebola presenting in primary care.

Although the risk of imported cases of Ebola is unlikely, it is not impossible that travellers or returning healthcare workers infected in West Africa could arrive in the UK while incubating the disease, develop symptoms after their return and present to primary care.

There have been more than 13,500 cases in Guinea, Liberia or Sierra Leone since the current outbreak started, with more than 4,900 deaths.

The incubation period for Ebola, a viral haemorrhagic fiver (VHF), is usually 5-7 days, but can range from 2-21 days. Fever in people who have travelled to Ebola transmission areas is more likely to be caused by malaria or typhoid fever, but primary care professionals should remain vigilant, says Public Health England.

PHE advises that Ebola should be suspected in patients who have a fever of >38°C (or history of fever in past 24 hours) AND have visited any of the affected areas within the past 21 days, OR have cared for/come into contact with body fluids of/handled clinical specimens from an individual or laboratory animal known or strongly suspected to have VHF.

Patients who meet the above criteria who contact the surgery by phone should be told not to visit the surgery, but to stay home and wait for assistance: the primary care clinician is responsible for ensuring they are referred appropriately.

Patients who identify themselves to receptionists as being unwell and having visited an affected area should not sit in the waiting room, but be isolated in a side room to limit contact.

Unless the patient also has symptoms of vomiting, diarrhoea or bleeding, the surgery does not need to be closed but the room in which they are assessed should not be used before discussion with the local Health Protection Team.

Information for Primary Care: Managing patients who require assessment for Ebola virus disease, October 2014