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First diagnosed case of Ebola in the U.S., What now?
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STONY BROOK, NY, OCTOBER 1, 2014 – A patient being treated at a Dallas hospital is the first person to be diagnosed with Ebola in the United States, health officials announced yesterday. According to the Centers for Disease Control and Prevention (CDC), the unidentified man left Liberia on September 19 and arrived in the United States on September 20. At that time, the individual did not have symptoms, but several days later, he began to feel ill. He went to a local emergency department, but was discharged and went home. As he continued to be symptomatic, he went to the emergency department of Texas Health Presbyterian Hospital where is was admitted and isolated on Sunday.

Now that the first case has been reported, what does this all mean for the rest of the country, and what types of precautions should Americans take? Two Stony Brook Medicine infectious disease experts explain.

“The health care infrastructure in this country is much better then what they have in West Africa and we are more prepared to handle something like this,” said Susan V. Donelan, M.D., Medical Director, Healthcare Epidemiology Department, Stony Brook University Hospital. “Hospitals across the country, including here at Stony Brook, are on high alert and if a patient shows up with flu like symptoms they immediately ask if they have been out of the country recently. So while having a case of Ebola here in the United States is definitely serious, I don’t believe its cause for major concern.”

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“Procedures are in place and being followed at airports to identify other travelers as they leave affected countries or arrive here in the U.S., these include questionnaires and temperature screens,” says Saul Hymes, M.D., Assistant Professor, Department of Pediatrics, Stony Brook Children’s Hospital who specializes in Pediatric Infectious Disease. “We may see other imported cases like this from other travelers but all we can do is remain vigilant. In particular, doctors at local hospitals should remain aware that CDC guidance is to isolate anyone with a febrile illness traveling from affected countries.”

According to the CDC, Ebola causes viral hemorrhagic fever, which can affect multiple organ systems in the body and is often accompanied by bleeding. Early symptoms include sudden onset of fever, weakness, muscle pain, headaches and a sore throat, each of which can be easily mistaken early on for other ailments like malaria, typhoid fever and meningitis.

The patient in Dallas is believed to have had a handful of contacts with people after showing symptoms of the virus, and before being isolated, according to the CDC.

Dr. Hymes explains that Ebola is only transmitted by direct contact with secretions from an infected person. “Of concern would be contact with substances like vomit, stool, urine, blood, respiratory secretions, and you need direct contact with the fluid,” says Dr. Hymes. “If someone sneezes in your face that could transmit it. However, the much more common transmission is in people who process the dead bodies, or who care for the sick.”

The Ebola outbreak has been centered in the West African countries of Guinea, Sierra Leone and Liberia, though there have been concerns about international air travel and other factors -- including the fact the symptoms might not appear until two to 21 days after one is infected -- may contribute to its spread.

More than 3,000 people in West Africa have died after being infected with Ebola, according to a World Health Organization report from last week. The same report stated that there had been 6,553 cases of the virus overall, though the number is suspected to be much higher, given difficulties in tracking and reporting the disease.

“The big problem with transmission in Africa is they don’t have as many resources in terms of protective equipment, they have old practices and care practices that sometimes involve coming into contact with bodily fluids,” said Dr. Hymes.  “Here we’ve got modern equipment ought of protective mechanisms so it’s a very sought of different beast.”

“It was inevitable that it would come here to the U.S.; we are a global society,” said Dr. Donelan.

The CDC has been working with airport authorizes in Liberia, Sierra Leone, Guinea and Lagos, to screen passengers getting on planes for fever. If someone presents with fever, they are pulled out of the line, assessed for Ebola and will not fly unless Ebola is ruled out.

“It is important that we are prepared, and ready for what is out there in the world. Awareness and preparedness are key,” said Dr. Donelan. “We actually have in place since the H1N1 Pandemic a robust influenza like illness triage process. Every patient that comes to our emergency department at Stony Brook with any complaints of influenza like illness, we also ask about travel history throughout 21 days or contact history with someone who is ill for the last 21 days. So we think our scope is robust.”

Both Stony Brook doctors say, for Americans reading the reports of this outbreak, don't panic! “The CDC is very good at this kind of source control and outbreak control and I think they've got this,” said Dr. Hymes.