Abstract
We describe the inquiries regarding Ebola virus disease (EVD) received by the Department of Public Health Alerts of the Community of Madrid between April and December 2014. A total of 242 inquiries were received. Consultations were initiated most frequently by hospital clinicians (59 inquiries, 24%), private citizens (57 inquiries, 24%) and primary care physicians (53 inquiries, 22%). The most frequent topic of inquiry was possible EVD in a patient (215 inquiries, 89%). Among these, 31 persons (14%) presented both EVD-compatible symptoms and epidemiological risk factors, and 11 persons (5%) fulfilled the criteria for a person under investigation. Recent travel abroad was reported in 96 persons (45%), but only 32 (15%) had travelled to an EVD-affected area. Two high-risk and one low-risk contact were identified through these inquiries. Low specificity of the EVD symptoms led to many difficulties in protocol application. Ineffective communication with healthcare professionals and unfamiliarity with the EVD protocols caused many case classification errors. A rapid consultation service by telephone is essential for providing qualified advice during emergencies. Our experience may help other countries dimension their activities and resources for managing similar exceptional outbreaks in the future.
Highlights
The ongoing outbreak of Ebola virus disease (EVD) in West Africa is the largest registered outbreak of this disease in history
On 22 September, a second Spanish healthcare worker who was suffering from EVD was repatriated from Sierra Leone and admitted to the same reference hospital, where he died on 25 September
The EVD alerts and EVD-related inquiries are reported via one of the three following paths: (i) The Border Health Control physician reports a person under investigation [14,15] directly to the Department or SARSP who activate the alert protocol and transport the patient to the designated hospital (La Paz-Carlos III Hospital Complex); (ii) Persons who present symptoms compatible with EVD and call the free emergency telephone number 112 are transferred to the medical coordinators of SUMMA 112 who carry out the initial evaluation and report the person to the Department or SARSP for further epidemiological evaluation; (iii) Primary care or hospital clinicians report their suspicion of a patient
Summary
The ongoing outbreak of Ebola virus disease (EVD) in West Africa is the largest registered outbreak of this disease in history. The World Health Organization first announced the EVD outbreak at the end of March 2014 [9], and the Spanish Ministry of Health, Social Services and Equality (MoH) issued the initial Ebola virus public health warning on 1 April 2014 [10]. On 7 August 2014, the Spanish government decided to repatriate a Spanish healthcare worker from Monrovia (Liberia), who had tested positive for the Ebola virus. On 22 September, a second Spanish healthcare worker who was suffering from EVD was repatriated from Sierra Leone and admitted to the same reference hospital, where he died on 25 September. On 6 October, the Spanish National Reference Laboratory confirmed the first human-tohuman transmission of EVD outside of Africa in one of the healthcare workers who provided care for the second repatriate [4,11,12]
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