CDC issues interim guidelines for treatment of Ebola survivors

The CDC released interim guidelines for the treatment of Ebola survivors who have fully recovered and seek subsequent care.

Special consideration is merited for procedures that create the opportunity for contact with certain bodily fluids and tissues in which Ebola virus may persist, the CDC said. These include:

obtaining and handling cerebrospinal fluid from an Ebola survivor with central nervous system symptoms;
performing an invasive ophthalmologic procedure on an affected eye in a patient with ocular disease such as uveitis or cataract; and
procedures involving exposure to semen, such as infertility evaluations and invasive procedures on the testes, prostate gland or seminal vesicles.

Nine of the 11 Ebola patients who were managed in U.S. health care facilities during 2014 and 2015 survived, according to the CDC. The agency said it is possible some Ebola survivors from the outbreak in West Africa that killed more than 11,300 people and infected nearly 29,000 could seek treatment in the U.S.

Although most patients who have fully recovered do not experience a relapse of Ebola associated with systemic illness, survivors can experience complications, including fatigue, joint pain, muscle aches and headaches, that vary in onset, severity and duration, the CDC said.

No current evidence exists that routine clinical care of Ebola survivors poses special risk to health care personnel when it involves contact with intact skin, sweat, tears, conjunctivae, saliva or cerumen, according to the CDC. Thus, adherence to standard precautions and correct waste management when treating survivors should remain in effect, the agency said. It also said health care personnel are not at risk for exposure through phlebotomy when Ebola survivors are fully recovered and are afebrile.

The CDC said Ebola survivors who become pregnant after recovery should receive “routine prenatal care.”

“Standard precautions and correct waste management should be used during labor and delivery with attention paid to splash prevention,” the agency said. “In the absence of neurologic symptoms, regional anesthesia should not pose a risk to hospital staff.”

The CDC included instructions for health care facilities and clinicians concerning activities —such as lumbar puncture and spinal anesthesia (including in pregnant women) — that might involve contact with a bodily fluid that may contain the virus. They include:

arranging expert consultation in advance or on an urgent basis as needed (for example, through the state health department and/or CDC);
assessing capabilities of the facility, including ability to correctly implement and maintain infection control such as contact precautions, environmental hygiene and infectious waste management as needed (including in consultation with CDC in advance or on an urgent basis);
assessing the readiness, training and competence of all staff — including diagnostic and imaging personnel, and environmental services staff — potentially involved in care, and their willingness to remain part of the care team knowing the risk for virus persistence; and
determining appropriate personal protective equipment based on a risk assessment of potential exposure during any procedures and related care and ensuring training on its use.

“Based on these assessments, and in consultation with public health authorities, safe care delivery can be arranged either at the original facility or, at the discretion of local and state public health authorities and in consultation with CDC, at an appropriate referral facility,” the CDC said.

Reference: CDC. Interim guidance for management of survivors of Ebola virus disease in U.S. health care settings. http://www.cdc.gov/vhf/ebola/healthcare-us/evaluating-patients/guidance-for-management-of-survivors-ebola.html. Accessed March 22, 2016.

Ebola Resource Center

CDC issues interim guidelines for treatment of Ebola survivors