Table of Contents:
- Zika Virus Disease
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Zika Virus Disease
- NJ DOH - Read the Guidelines for Reporting, Testing and Preventing Infection in Travelers (1/14/16)
- NJ DOH - Updated Guidelines for Diagnostic Testing for Zika Virus (5/1316)
- NJ DOH - Guidelines for the Testing and Evaluation of Infants with Possible Congenital Zika (1/2916)
- NJ DOH - Zika Virus Update: Updated Information and Testing Guidelines (3/416)
- NJ DOH - Public Information Update/Phone Script (9/1916)
- NJ DOH - March 2016 Newsletter on the Zika Virus
- NJ DOH - Zika Virus Testing for New Jersey Patients
- NJ DOH -Zika Testing: Specimen Collection, Processing, Packaging and Shipping
- CDC - Key Messages (updated 5/17/17)
- CDC - Spanish Zika Virus Key Messages
- CDC - Fact Sheets and Posters in Different Languages
- CDC - Interim Travel Guidance Related to Zika Virus
- CDC - Interim Guidelines for Pregnant Women During a Zika Virus Outbreak - United States, 2016 (1/1916)
- CDC - Interim Guidelines for Prevention of Sexual Transmission of Zika Virus — United States, 2016 (4/1/16)
- CDC - Update: Interim Guidance for Health Care Providers Caring for Pregnant Women with Possible Zika Virus Exposure — United States (Including U.S. Territories), July 2017 — United States, 2017 (7/24/17)
- CDC Issues Updated Zika Recommendations
- COCA Website | COCA Calls/Webinars
- CDC - Interim Guidance for Interpretation of Zika Virus Antibody Test Results
- CDC - Possible Zika Virus Infection Among Pregnant Women — United States and Territories, May 2016. Morbidity and Mortality Weekly Report (MMWR). May 20, 2016/65
- CDC - Interim Guidance for Zika Virus Testing of Urine — United States, 2016. Morbidity and Mortality Weekly Report (MMWR). May 13, 2016/65(18); 474
- CDC - Update: Interim Guidelines for Healthcare Providers Caring for Infants and Children with Possible Zika Virus Infection — United States, February 2016. Morbidity and Mortality Weekly Report (MMWR). February 26, 2016/65(7); 182-187
- Zika and Blood Transfusion
- Zika Symptoms, Diagnosis, and Treatment
- Zika Travelers’ Health: Avoid Bug Bites
- Zika Virus and Sexual Transmission
- Tools for Healthcare Providers
- US Zika Pregnancy Registry
- Department of Health Deputy Commissioner to Provide Zika Virus Update at CompleteCare Health Network in Vineland
- Estimating Contraceptive Needs and Increasing Access to Contraception in Response to the Zika Virus Disease Outbreak - Puerto Rico, 2016
- CDC - Local Transmission of Zika Virus — Puerto Rico, November 23, 2015–January 28, 2016 (2/12/16)
- Reuters - CDC Issues Guidelines for Pregnant Women During Zika Outbreak (1/19/16)
- AMA’s online Zika Virus Resource Center
- Zika Outreach Guide
- Zika Flyer
- Promotion of Zika Activities Form
- CDC Concludes Zika Causes Microcephaly and Other Birth Defect
- Zika Virus: Information for Clinicians Slide Set
- HAN 402: Prolonged IgM Antibody Response in People Infected with Zika Virus: Implications for Interpreting Serologic Testing Results for Pregnant Women
- Widget: When Should Pregnant Women Be Tested?
- Clinical Guidance for Healthcare Providers Caring for Pregnant Women
- Clinical Guidance for Healthcare Providers Caring for Women of Reproductive Age
- Implementing CDC Guidelines for Infant and Placental Zika Virus Testing and Infant Head Ultrasound Tool
- Clinical Guidance for Healthcare Providers Caring for Infants & Children
- CDC Updates Zika Guidance for Miami-Dade County, Florida
- Guidance for Areas with Local Zika Virus Transmission in the Continental United States and Hawaii
- Zika Travel Information
- When to Test for Zika Virus
- Zika Pregnancy Screening Tool
- Zika Testing Algorithm for Symptomatic Pregnant Women
- Zika Testing Algorithm for Asymptomatic Pregnant Women
- Pretesting Counseling Guide for Asymptomatic Pregnant Women with Ongoing Exposure to Zika
- Pretesting Counseling Guide for Pregnant Women with Symptoms of Zika
- Pretesting Counseling Guide for Asymptomatic Pregnant Women without Ongoing Exposure to Zika
MSNJ STATEMENT ON ISOLATION OF INDIVIDUALS WITH OR AT RISK OF DEVELOPING EBOLA:
Recent events in the developing story around Ebola and the concerted medical and public health efforts to contain the epidemic in the United States have caused the Medical Society of New Jersey to review guidance issued by the federal and state governments and offer the position of the state’s physicians with respect to the isolation of patients and those asymptomatic individuals that are deemed to be at risk of developing Ebola. Examples of individuals at risk of acquiring Ebola include healthcare workers and others who provided direct care for Ebola patients or handled their infected waste.
New Jersey's population density and position as a hub for international travel makes it a logical location to implement efforts to contain the highly infectious Ebola virus. The best method of control of the Ebola virus is the identification and isolation of cases and potential cases of the disease. How the identification and isolation is accomplished is the province of state public health authorities.
Ebola virus is spread by direct contact with blood or body fluids from infected individuals. At present there is no evidence that casual contact with asymptomatic individuals poses a risk of spreading Ebola to others. At-risk individuals should self-monitor twice daily to detect fever or other symptoms for 21 days after their last exposure to Ebola; this monitoring should be effective to protect the public. It is the domain of public health officials to oversee this monitoring and determine if mandatory quarantine is necessary. If at-risk individuals develop fever or other symptoms compatible with Ebola, then prompt reporting to public health officials and isolation in specially trained and equipped healthcare facilities is warranted.
Healthcare workers and those caring for patients with Ebola virus are at the highest risk for infection. These individuals, both domestic and those serving in West Africa, deserve the utmost dignity when they are deemed to have had sufficient contact to warrant isolation. Healthcare workers should be advised on the isolation protocols and the clinical rationale underpinning those protocols in advance of their service.
How Should We Treat Patients with Possible Ebola Infection in the Office Setting?
MSNJ urges physicians to be prepared, even for the unexpected. Before your office is faced with a potential Ebola patient or someone with another dangerous infectious disease, you should review the CDC’s Ebola Preparedness Considerations for Outpatient/Ambulatory Care Settings and take steps to prepare your office and your staff.
Over the Phone:
Your first line of protection is your telephone.
- Ask each patient who calls your office for an appointment if s/he has symptoms of a febrile illness (fever, cough, nausea, vomiting, diarrhea, etc.)
- If a patient reports having a fever, next ask about the patient’s travel within the last 30 days, in accordance with CDC guidelines for the evaluation of returned travelers.
- If the patient’s travel history includes West Africa (Guinea, Liberia and Sierra Leone), within the past 21 days, the patient is in an Ebola risk group and s/he is potentially infected. The local emergency department (ED) is the proper place for evaluation.
- Tip: Give the patient specific dates, when evaluating travel history.
- Immediately contact your local ED about the patient and determine how the ED wants the patient to travel to and enter the facility. If the patient is self-transporting, ask where s/he should park.
- Give the patient specific instructions on how to get to and enter the ED. It is important that the patient not mingle with other waiting patients.
- Alternatively, you may also advise the patient to call 911. NJ 911 dispatchers, first responders, and the NJ State Police have all been trained in Ebola screening and handling of potentially infected individuals.
In the Office:
If a febrile patient has already presented in your office, ask staff to obtain a travel and exposure history.
If you feel the patient might have Ebola:
- Immediately isolate the patient.
- Contact your local ED for instructions on transferring the patient to the facility OR call 911 to arrange for transport of the patient to an equipped facility.
While waiting for patient transfer:
- Have the patient put on a mask, if s/he has a cough with expectoration.
- Have the patient perform hand hygiene with an alcohol-based product.
- For clinically stable patients, have all staff in contact with the patient wear a face shield and surgical face mask, impermeable gown, and 2 pairs of gloves.
- Assess the patient’s travel, disease, and exposure history.
- Make a list including contact information of everyone in the office (staff, patients, etc.) for further assessment by the local health department.
- Immediately notify your local health department.
- If unavailable, report the case to the New Jersey Department of Health at: (609) 826-5964, Monday through Friday 8:00AM – 5:00PM or (609) 392-2020 on weekends, evenings and holidays.
Reminder: Flu season is upon us. More of your patients are likely to contract the flu than Ebola. Remind your patients how important it is to get their flu vaccination this season.
Disclaimer: This guidance was adapted with permission from the Texas Medical Association. Ebola resources and guidance are constantly changing. Stay up to date by visiting the CDC and NJ DoH websites.
Download this guidance for your office staff.
Last Updated: 11/07/14
Personal Protective Equipment (PPE) Discounts
MSNJ, in conjunction with Medline and Cintas, is proud to announce a joint effort to offer discounts to all of our members on personal protective equipment (PPE). Access the discounts.
- NJ BME- Policy on Ebola: Board licensees have long adhered to a tradition of care. A licensee of this Board may not categorically refuse to treat a patient who has been diagnosed with Ebola, or who has not been diagnosed with Ebola but who is symptomatic of the disease, when the licensee possesses the skill and experience to treat the condition presented, and when the licensee has been appropriately trained in the proper care of such patients, and having been provided with, and trained in the use of, personal protective equipment ("PPE"). The Board, however, recognizes that certain health care workers with certain physical conditions may be unduly susceptible to the virus and should refrain from direct care of such patients. The Board will consider each case on an individual basis giving due consideration to any such extenuating circumstances. Even where such extenuating circumstances exist, however, the licensee retains the responsibility to make alternate arrangements for the proper care of the patient.
- Governor Christie's Ebola Preparedness Plan (10/22/14)
- Princeton Insurance, MSNJ Corporate Partner- Ebola Risk Management Advice
- NJ DOH- Ebola FAQ (08/14)
- NJ DOH- Clinical Guidelines for Initial Evaluation of Suspect Cases of Ebola (08/22/14)
- NJ DOH- Memo (08/13/14)
- NJ DOH- General Info Webpage
- NJ DOH- Technical Info Webpage
- NJ DOH- Video Information for New Jersey's West African communities on the Ebola virus (11/05/14)
- NJ DOH- Ebola Call Center for the General Public 1-800-962-1253
- NJ DOH- Clinical Considerations for the Evaluation of Ill Travelers from Liberia to the United States (6/22/15)
- NJ DOH- Updated Protocol for Activing Monitoring for Ebola Virus Disease (EVD) in Travelers from Guinea (12/29/15)
- CDC- Guidance: Identify, Isolate, Inform: Ambulatory Care Evaluation of Patients with Possible Ebola (11/05/14)
- CDC- Algorithm for Evaluation of the Returned Traveler
- CDC- Poster: Is it Flu or Ebola? (10/28/14)
- CDC- Poster: Difference between Infections Spread through Air or Droplets (10/27/14)
- CDC- Factsheet: Why Ebola is Not Likely to Become Airborne (12/01/14)
- CDC- Q&A: Ebola Food Safety
- CDC- Tightened Guidance for Healthcare Workers on Personal Protective Equipment for Ebola (10/20/14)
- CDC- Video: Donning and Doffing PPE (10/29/14)
- OCR- Bulletin on HIPAA Privacy in Emergency Situations
- OCR- Guidance on HIPAA in Emergency Situations: Preparedness, Planning, and Response
NJSPOTLIGHT- Health Commissioner: NJ Leads the Way on Ebola Precautions, Response (11/20/14)
NJ.com - Ebola Aid Groups Say Christie’s Quarantine Rules Hampering Relief Effort (11/18/14)
MSNJ in the News (11/04/14):
Ebola News (10/23/14)
CDC Intercepts Sick Passenger at Newark Liberty International-Cleared for Ebola (10/09/14)
On October 4 the CDC's Quarantine Public Health Officer met a flight from Europe to assess a sick passenger who had traveled from West Africa. The passenger was evaluated at a local hospital and later discharged from the emergency department. A full medical evaluation was conducted in coordination with federal, state, and local public health officials which found no evidence of Ebola. Read the press release.
Yesterday, the CDC announced that Ebola screenings will begin next week at Newark Airport. A non-contact thermometer will be used to screen for sick passengers. Read the CDC's statement.
First Ebola Case Diagnosed in the U.S (10/03/14)
The CDC has confirmed that the first case of Ebola was diagnosed in the United States. The patient developed symptoms about four days after arriving in the U.S. on September 20 after traveling from Liberia to Dallas, Texas. On September 24, the patient fell ill and sought medical care at Texas Health Presbyterian Hospital of Dallas on September 26. He developed symptoms consistent with Ebola and was admitted to the hospital on September 28. Based on the patients' travel history and symptoms the CDC suggested testing for Ebola. The medical facility isolated the patient and sent specimens for testing to the CDC and to a Texas lab participating in the CDC's Laboratory Response Network. The CDC and the Texas Health Department reported the laboratory test results to the medical center and informed the patient. A CDC team is being dispatched to Dallas to assist with the investigation. Read more. View updates on CDC's website.
Ebola Resources (09/19/14)
Read the NJ DOH Memo, CDC Update, CDC Key Messages, Clinical Guidelines for Initial Evaluation of Suspect Cases of Ebola, and a guidance document on unaccompanied children from the Southern U.S. border. The U.S. Military will send about 3,000 personnel to West Africa to battle the Ebola virus. Other important Ebola information can be found on the NJ DOH website.
Check out MSNJ's blog for more resources.
NJ Department of Health Guidance to Providers on Ebola (08/15/14)
[T]he NJDOH requests that all health care providers consider Ebola Virus Disease (EVD) in the differential diagnosis of febrile illness in persons with recent travel (within 21 days) to the affected countries in West Africa, currently including Guinea, Liberia, Sierra Leone and Nigeria. All persons with compatible symptoms and travel history should be isolated until clinical evaluation and/or diagnostic testing is completed. At this time, there have been NO reports of EVD in the U.S.
Reporting Reminder for Health Care Providers:
Confirmed or suspect cases of any viral hemorrhagic fever, including EVD, should be reported immediately to the local health department where the patient resides. [Memo dated August 13 to Local Health Departments, Health Care Providers, and Hospitals from Shereen Semple, MS, Epidemiologist, NJ DOH]
CDC Announces New Faster Lab Test for Enterovirus D-68
On October 14 the CDC announced that it has developed and begun to use a new, faster lab test for detecting enterovirus D-68. The test is "real time" reverse transcription polymerase chain reaction (rRT-PCR) and will identify all strains of EV-D68. About half of the specimens submitted to CDC between August 1 and October 10 were positive for EV-D68. While CDC believes that the EV-D68 infections are beginning to decline, the new test's ability to quickly confirm the virus may cause an uptick in the number of confirmed cases. Read more.
First Enterovirus D68 Death in New Jersey
Friday evening, October 3, 2014, the Centers for Disease Control & Prevention (CDC) notified the New Jersey Department of Health that a Mercer County child who died last week tested positive for enterovirus D68 (EV-68). CDC also confirmed a positive case of EV-68 in a Middlesex County child. The state currently has a total of nine confirmed cases in Camden, Burlington, Mercer, Middlesex, Morris, Essex, Passaic and Sussex counties. Read the NJ Department of Health’s Press Release. Visit its web site for more information.
The NJ Department of Health’s FAQ’s can be found here.
EV-D68 Cases Confirmed by CDC
On September 17, the CDC confirmed New Jersey’s first case of enterovirus D68 (EV-D68) and other cases have since been confirmed. Read the DOH FAQ below on confirming cases of EV-D68:
Can individual doctors and hospitals confirm cases of EV-D68?
EV-D68 can only be diagnosed by doing specific lab tests on specimens (samples) and that few laboratories are able to perform. While many hospitals and some doctor’s offices can test ill patients to see if they have an EV infection, very few can do specific testing to determine the type of EV, like EV-D68. There are over 100 EV infections and specific typing of specimens is needed to confirm whether the virus is D68. In order to make the final diagnosis of EV-D68, the CDC in Atlanta would have to confirm the test on the sample. Read more FAQ’s.
For additional information, visit the NJ Department of Health’s website and their recent press release.