Clinical Inquiries Received by CDC Regarding Suspected Ebola Virus Disease in Children — United States, July 9, 2014–January 4, 2015

Abstract

The 2014–2015 Ebola virus disease (Ebola) epidemic is the largest in history and represents the first time Ebola has been diagnosed in the United States. On July 9, 2014, CDC activated its Emergency Operations Center and established an Ebola clinical consultation service to assist U.S. state and local public health officials and health care providers with the evaluation of suspected cases. CDC reviewed all 89 inquiries received by the consultation service during July 9, 2014– January 4, 2015, about children (persons aged ≤18 years). Most (56 [63%]) children had no identifiable epidemiologic risk factors for Ebola; among the 33 (37%) who did have an epidemiologic risk factor, in every case this was travel from an Ebola-affected country. Thirty-two of these children met criteria for a person under investigation (PUI) because of clinical signs or symptoms. Fifteen PUIs had blood samples tested for Ebola virus RNA by reverse transcription–polymerase chain reaction; all tested negative. Febrile children who have recently traveled from an Ebola-affected country can be expected to have other common diagnoses, such as malaria and influenza, and in the absence of epidemiologic risk factors for Ebola, the likelihood of Ebola is extremely low. Delaying evaluation and treatment for these other more common illnesses might lead to poorer clinical outcomes. Additionally, many health care providers expressed concerns about whether and how parents should be allowed in the isolation room. While maintaining an appropriate level of vigilance for Ebola, public health officials and health care providers should ensure that pediatric PUIs receive timely triage, diagnosis, and treatment of other more common illnesses, and care reflecting best practices in supporting children’s psychosocial needs.

Medical mistrust in the context of Ebola: Implications for intended care-seeking and quarantine policy support in the United States

“…These items were included because care for Ebola patients was provided in hospital settings (Sugalski et al, 2015), and people who avoid care settings are at risk of infecting others. Moreover, people were screened, evaluated, and tested for Ebola in hospital settings in the US (Goodman et al, 2015; Karwowski et al, 2014; Sugalski et al, 2015). Yet, some guidelines instructed people to call healthcare providers before seeking care in person (CDC, (2015).…”

Summary of Notifiable Infectious Diseases and Conditions — United States, 2014

“…At risk travelers and health care workers were required to complete a 21-day active monitoring period (17,18). In addition, CDC responded to inquiries from state and local health officials and health care providers and facilitated testing of persons under investigation (20,21).…”

Establishing a Hospital Response Network Among Children's Hospitals

“…Questions related to the management of pediatric patients under investigation provided the impetus for this forum; from July 2014 to January 2015, CDC received 89 clinical inquiries regarding pediatric patients suspected to have Ebola, 32 of whom met the case definition of a person under investigation. 6 The forum was established and facilitated by the CDC and the AAP, with the conversations driven by hospital administrators, pediatric clinicians, and infection control experts from across the country. Participating hospitals were located in states and territories that account for over 70% of the US population under 15 years of age (Figure 1).…”