Ebola Virus Disease (EVD):
Implications for Schools
Melissa McMasters, RN, MSN
Coordinator, Immunization and
Infectious Disease Programs
Objectives
• Describe the clinical presentation of potential
pediatric patients with EVD
• Recommendations for schools
• Recommendations for colleges and
universities
• How to talk to children about EVD
Current West African Outbreak
Source: Anthony England; @EbolaPhone
Case Counts
Country
Total cases
Lab-confirmed
Deaths
Guinea
1667
1409
1018
Liberia
6535
2515
2413
Sierra Leone
5338
3778
1510
13540
7702
4941
EVD in Children
• Suspected index case in current outbreak: 2
year old who died in Guinea in December
2013
• Data in pediatric patients is lacking
• In Guinea, 18% were children
• Of 4 originally affected countries, 13.8% were
younger than 15
EVD in Children
• Children and adolescents represent a small
number of documented cases
• Cultural practice is to keep children away from
sick family members
Progression of EVD (Adults)
Fever and
Malaise
Gastroenteritis
Viral Sepsis
Clinical Presentation of US Cases
• 3 phases of Ebola Virus Disease (EVD)
1. Fever and Malaise (days 2-4)
» Achy
» Chills and Sweats
» Flu like symptoms
2. Gastroenteritis (days 5-9)
»
»
»
»
»
»
»
Nausea
Vomiting (projectile)
Diarrhea (explosive)
Significant fluid loss (4-12 L/day)
Vascular leaking
Oozing
Nose and gum bleeds
Clinical Presentation Cont’d
3. Viral Sepsis
»
»
»
»
»
»
»
Acute, critical phase
Multi- organ failure
ARDS
Dialysis
Mechanical ventilation
Encephalopathy
Death
Course of Illness
• Average of 28 days hospitalized
• Range of illness from moderate to severe
• All patients discharged reporting consistent
and persistent generalized weakness and
fatigue
• Criteria: 2 negative PCR’s from blood and
asymptomatic
Presentation in Children
• Non specific presentation similar to other
pediatric infectious diseases
• Fever, headache, myalgia followed by diarrhea
and vomiting
– 100% Febrile
• Differential Diagnoses
– Malaria
– Measles
– Typhoid Fever
Treatment of EVD Pediatric Patients
• Key is supportive care of complications
– Hypovolemia
– Electrolyte abnormalities
– Nutritional supplementation
– And then acute, critical care if progression to
septic phase
Pregnancy and Neonates
• Pregnant women are not more susceptible
• But do have increased risk for severe illness
and death
• Increased risk for spontaneous abortion and
hemorrhaging
• No known neonates have survived
Monitoring Travelers
• Currently MCPHD monitors all travelers from
West Africa
• Travelers from Sierra Leone, Guinea, and Liberia
can only enter through 1 of 5 quarantine stations
1. John F. Kennedy New York
2. Dulles Washington D.C.
3. Liberty New York
4. O’Hare Chicago
5. Hartsfield-Jackson Atlanta
Risk Levels for Travelers
1. Symptomatic individuals in the high, some, or
low(but not zero) risk categories
2. Asymptomatic in high risk category
3. Asymptomatic in some risk category
4. Asymptomatic in the low (but not zero) risk
category
5. No identifiable risk category
Active vs. Direct Active Monitoring
Active Monitoring
Direct Active Monitoring
• Local public health
authority assumes
responsibility
• Daily communication
• Assess for symptoms and
fever
• Minimum: Daily reporting
of measured temperatures
and symptoms to LHD and
notify immediately if
symptoms or fever develop
• Local public health
authority assumes
responsibility
• Direct observation
• Assess for symptoms and
fever
• Minimum: Twice daily
communication with one
being observed and must
notify LHD immediately if
symptoms for fever develop
Monitoring and Restrictions
Risk Category
Monitoring
Travel Restrictions
1. Symptomatic
Medical Evaluation
Federal public health travel
restrictions
2. Asymptomatic High Risk
Direct Active
Controlled movement
Federal public health travel
restrictions
No commercial travel
3. Asymptomatic Some Risk Direct Active
Local and State will
consider
4. Asymptomatic Low Risk
Active
Allowed; must assure
uninterrupted monitoring
5. No Risk
N/A
N/A
For Schools
• Asymptomatic low risk will be monitored by
health department for 21 days and will be
allowed to attend school
• Asymptomatic some risk will be monitored by
health department for 21 days and will not be
allowed to attend school
– How will their educational needs be addressed?
– Plans for e-learning, etc.
Caution
• Issues of prejudice and discrimination
• Last week 2 Senegalese boys (born in America)
were allegedly attacked and beaten after one
of them sneezed in the cafeteria
– http://newyork.cbslocal.com/2014/10/27/nycleaders-say-african-children-bullied-at-school-inwake-of-ebola-scare/
Colleges and Universities
• Level 3 Travel Warning for Liberia, Guinea, and
Sierra Leone
• Avoid non-essential travel
• Postpone education-related travel
• CDC reports a minimum of 6 months to get
outbreak under control but could be much
longer
Why?
• The health care systems in these countries are
severely strained
• Risk is not only EVD but routine emergency
health care needs of visiting US citizens will
likely not be met
– Car accident yet nearest hospital is overwhelmed
treating EVD patients
Returning Students, Faculty and Staff
• At this point, these individuals would fall
under our active monitoring protocol
• Student health centers should follow CDC
recommendations that apply to all US
healthcare settings
• CDC does not recommend quarantining or
isolating anyone based on travel history alone
• Work with local health department
References
• CDC Ebola Website
– Outbreak in West Africa
http://www.cdc.gov/vhf/ebola/outbreaks/2014west-africa/index.html
– Monitoring Travelers
http://www.cdc.gov/vhf/ebola/exposure/monitori
ng-and-movement-of-persons-with-exposure.html
– Schools
http://www.cdc.gov/vhf/ebola/children/index.ht
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