Ebola research: Fever not a surefire sign of infection

[merilynRN]

http://www.latimes.com/nation/la-na-1012-ebola-fever-20141012-story.html#page=1

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For public health workers screening more than 1,000 air travelers who arrive each week in the United States from Ebola-stricken West Africa, one symptom above all others is supposed to signal danger: fever.

So long as an individual's temperature does not exceed 101.5 degrees and there are no visible symptoms of Ebola, health authorities say it should be assumed the person is not infectious.

Yet the largest study of the current outbreak found that in nearly 13% of "confirmed and probable" cases in Liberia, Sierra Leone, Guinea and elsewhere, those infected did not have fevers.

The study, sponsored by the World Health Organization and published online late last month by the New England Journal of Medicine, analyzed data on 3,343 confirmed and 667 probable cases of Ebola.

2nd Ebola case in Texas caused by breach in protocol, CDC chief says Kurtis Lee, Michael A. Memoli

The finding that 87.1% of those infected exhibited fever-but 12.9% did not-illustrates the challenges confronting health authorities as they struggle to contain the epidemic.

[suzil]

Of course the hospital, the CDC is going to say the worker had a breach. How predictable to blame it on the nurse! The case has NOT even been investigated and they are already blaming the nurse.

[merilynRN]

According to this article it looks like the nurses taking care of Mr. Duncan were in standard isolation garb before the positive blood test came back. "Only then did staff treating Duncan trade their gowns and scrubs for hazmat suits, and the room was cleaned with bleach."

No wonder they are expecting more health care workers to test positive. Projectile vomiting. Explosive diarrhea. Yet no hazmat suits until after the results came in.

Texas healthcare worker tests positive for Ebola - LA Times

— On Sept. 25, Duncan came to the ER complaining of a headache and abdominal pain. At one point, he registered a fever of 103 and told the hospital he had been in West Africa. He was sent home with a prescription for antibiotics.

Texas Health Presbyterian Hospital Dallas, where Ebola patient Thomas Eric Duncan was treated, is shown. A healthcare worker who participated in his care has been diagnosed with the virus. (LM Otero / Associated Press)

— His condition worsened dramatically, and on Sept. 28, he returned to the hospital in an ambulance shortly after 10 a.m.

— Doctors admitted him and put him in isolation. By evening, he was projectile vomiting, having explosive diarrhea and running a temperature of 103.1 degrees.

— On Sept. 29, as his condition worsened, Duncan asked the nurse to put him in a diaper.

— On Sept. 30, tests results confirmed Duncan had Ebola. Only then did staff treating Duncan trade their gowns and scrubs for hazmat suits, and the room was cleaned with bleach.

— On Oct. 8, Duncan died.

[Sippie]

I think this is the original research paper. It is on the JAMA website. Dig around a little and you can see that 87.1 % of ebola patients in this study presented with a fever.

MMS: Error

[merilynRN]

It would be that 13% that do not present with a fever, that present a screening challenge.