Texas health officials today announced that a health worker who helped care for a Liberian man who recently died from Ebola is sick with the virus, based on preliminary tests, prompting an intensive investigation on how the worker and possibly others on the same medical team may have been exposed to the virus.
If confirmed, the illness would represent the first US transmission of Ebola, occurring 1 week after Spain reported the first transmission of the disease outside of West Africa, also in a health worker who had cared for a patient sickened in the outbreak region.
The healthcare worker was exposed to the patient, Thomas Eric Duncan, after Duncan was admitted to the hospital on Sep 28 and is not part of the initial group of 48 of Duncan's contacts that health authorities are currently monitoring, according to Texas health officials.
The Centers for Disease Control and Prevention (CDC) added that the worker cared for Duncan on multiple occasions and had extensive contact with him.
The Texas Department of State Health Services (TDSHS) said the worker reported a low-grade fever on Friday night and was isolated and referred for testing. The preliminary result that came back late Saturday from the state's public health lab in Austin was positive, and confirmation tests are under way at the CDC.
David Lakey, MD, commissioner of the TDSHS, said in the statement, "We knew a second case could be a reality, and we've been preparing for this possibility. We are broadening our team in Dallas and working with extreme diligence to prevent further spread."
Patient in stable condition
Texas Health Presbyterian Hospital in Dallas said in a statement today the patient was admitted and isolated within 90 minutes of reporting the fever and is in stable condition. A close contact of the health workers has also admitted to the hospital for isolation.
At media briefings today, health officials said so far only one person had contact with the health worker while he or she was symptomatic.
At a hospital briefing this morning, aired live on Dallas ABC affiliate WFAA, Dallas health officials said the Ebola detection in the health worker prompted a reverse 911 call to alert nearby neighbors that hazmat teams were outside the patient's apartment decontaminating the area. The patient apparently drove to the hospital, so the car and surfaces the patient may have touched have been decontaminated, as well.
Dan Varga, MD, the hospital's chief clinical officer and senior executive vice president, said the hospital's emergency department is on diversion, but it is still open and treating other patients. He said the worker was following full barrier and droplet precautions and that the hospital is monitoring a total of18 of its health workers who may have been exposed to the virus.
So far none of the 48 people identified earlier as Duncan's contacts have shown any symptoms, officials said.
Clay Jenkins, Dallas County judge, said the city has requested an additional epidemiology teams from the CDC to help investigate how the health worker was infected and ensure that all CDC infection control guidelines are being followed.
Deep concern at CDC
CDC Director Tom Frieden, MD, MPH, today at a media briefing today said the healthcare worker Ebola infection is deeply concerning. "We don't know what occurred in the care of the patient, but at some point there was a breach in protocol," he said. Testing in Texas shows that the worker's virus levels are low, consistent with the level of symptoms.
In response to the worker's infection, the CDC and its partners are making sure everything possible is done to care for the patient, assessing possible contacts, evaluating similar exposure that others on Duncan's care team may have had, and conducting a full investigation of the incident, he said.
One area investigators will focus on is potential exposure during kidney dialysis and intubation, two desperate measures that were undertaken to save Duncan's life, Frieden said. The two types of treatment are unusual for Ebola patients, he added.
Unfortunately, there may be other infections among health workers who had a breach of the same nature, Frieden warned.
Lakey said Texas officials have planned for the possibility of more infections and that contingency plans are under way, which include stepped-up monitoring of healthcare workers.
Though an Ebola infection in a healthcare worker is disappointing and frustrating, "I firmly believe we will stop it here," he said.
Frieden said the case points to a need for further training in the use of personal protective equipment during the care of Ebola patients, but health officials will be looking at more ways to minimize the risk, such as limiting blood draws to the bare minimum and having monitors in place in isolation units to make sure all steps are being meticulously followed.
Health officials will be looking at all options, including transferring all US Ebola patients to specialized care units, such as the ones at Emory University Hospital and Nebraska Medical Center.
He emphasized, however, that all hospitals need to know how to identify, isolate, and safely treat Ebola patients, because it's impossible to predict when and where the next case will turn up.
Oct 12 TDSHS statement
Oct 12 Texas Health Resources statement
Oct 12 CDC statement
Oct 6 CIDRAP News story "Spanish health worker contracts Ebola at Madrid hospital"