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GPs told to ‘suspect ebola’ in feverish patients who have visited West Africa

GPs are being advised to suspect ebola if a patient who has recently visited any of the areas affected by the West African outbreak presents with a high fever.

The guidance issued by Public Health England (PHE) said that while the risk of ebola spread to the UK remains low, GPs should be ‘vigilant’ of symptoms.

In a note issued to primary care professionals, PHE listed the main symptom of the disease as a fever over 38 degrees, or a history of fever in the last 24 hours in people who were known to have come into contact with the virus.

It also contained guidance on how to deal with patients at risk contacting GP practices, for example advising GP practices approached by telephone to tell patients not to come into the surgery. If a patient does present at the clinic they should be ‘isolated in a side room’ while viral experts are consulted and emergency services potentially brought in.

The guidance said: ‘There is an on-going outbreak of Ebola virus affecting countries in West Africa. This is the largest ever known outbreak of this disease prompting the World Health Organization (WHO) to declare a Public Health Emergency of International Concern in August 2014. Countries currently affected by the disease are Guinea, Liberia, Sierra Leone, Nigeria (Port Harcourt and Lagos) and Senegal (Dakar).’

‘It remains unlikely, but not impossible, that travellers infected in [these regions] could arrive in the UK while incubating the disease and develop symptoms after their return.’

It added: ‘Ebola can only be transmitted from one person to another through direct contact with blood or bodily fluids of an infected person. The incubation period of Ebola virus ranges
from 2 to 21 days. Although the risk of imported cases is low, primary care professionals in the UK should remain vigilant for those who have visited areas affected by this outbreak
and subsequently become unwell.’

Dr Paul Cosford, director of health protection at Public Health England, said: ‘The risk of travellers and people working in affected countries contracting Ebola remains low, but PHE continues to keep border staff and medical practitioners informed, and request they remain vigilant for unexplained illness in those who have visited these areas in West Africa. As part of contingency preparations, PHE has provided primary care and hospital healthcare workers with the latest information about the outbreak and actions to take in the event of a possible case.’

Identifying patients at risk of Ebola

Ebola should be suspected in patients presenting to primary care services who have a fever
of >38°C OR have a history of fever in the past 24 hours AND have recently visited any of the
affected areas within the previous 21 days.
Have a fever of >38°C OR have a history of fever in the past 24 hours AND have cared for /
come into contact with body fluids of / handled clinical specimens (blood, urine, faeces,
tissues, laboratory cultures) from an individual or laboratory animal known or strongly
suspected to have viral haemorrhagic fever (VHF).

A map of countries where VHFs are endemic can be found at:

Click here to read the full PHE guidance

Source: Public Health England

But Dr Brian McCloskey, director of global health at Public Health England, said that even if the virus did reach England it would not lead to an outbreak.

He said: ‘UK hospitals have a proven record of dealing with imported infectious diseases. If an Ebola case is repatriated to, or detected in, the UK they would receive appropriate treatment in an isolation unit, with all appropriate protocols promptly activated. Protective measures would be strictly maintained to minimise risk of transmission to healthcare workers treating the individual.’

‘It is important to remember that for Ebola to be transmitted from one person to another contact with blood or other body fluids are needed. As such, if England was to see a case of Ebola this will not result in an outbreak here.

The BMA today called for international efforts to provide the necessary protective equipment and infection control training in order to prevent cross contamination. It also called on the UK Government to take action to help stop the spread of the disease in affected regions, for example by allowing native West African doctors practising in the UK to return to their home countries for more than one month without fear of losing their UK work visa.

Speaking at a World Medical Association (WMA) conference today, BMA senior director Dr Vivienne Nathanson said: ‘We are hearing from doctors who have travelled to West Africa that a lack of training and a severe lack of resources are making the epidemic far more difficult to control.’

‘That is why today, the BMA has called on the WMA to urge the international community to provide the necessary protective equipment and infection control training in order to prevent cross contamination, to call on national and local governments to increase public communication about basic infection control practices, and to strongly urge all countries, especially those not yet affected, to strengthen infection control methods, disease surveillance and ensure we identify and diagnose those who may have come into contact with the disease, in order to prevent transmission within countries.’

‘It is also essential that we make it as easy as possible for doctors from West Africa working in the UK to be able to return to their home country for a defined period to assist with efforts to stem the spread of the epidemic. We urge the Government to make an exception to the immigration rules so that doctors are allowed to travel home for longer than one month without fear that their visa to work in the UK will be curtailed.’