David P. Dillard







Ebola Virus. United States. Selected State Government Websites



This document is available at this web address




Information on Reporting of Suspect Ebola Patients
Laboratory Testing
Specimen Handling, Packaging and Shipping
Infection Control
Community Mitigation
Other Available Guidances and Tools
General Information
Specimen Collection, Testing and Shipping Guidelines
Information for Specific Groups
Information for Health Care Workers

Other Available Guidances and Tools

The CDC poster “Sequence for putting on and removing Personal Protective Equipment”,
available at: This updated poster emphasizes
guidance to perform hand hygiene between steps if hands become contaminated and immediately
after removing all PPE.

There are multiple acceptable sequences and methods for removing PPE. Regardless of the
sequence or method used, the important principles are that the most contaminated items are
removed first, and that the person removing PPE does not contaminate themselves or others
during the process. If two pairs of gloves are used, the most contaminated outer gloves can be
removed first and the inner gloves last, in order to limit additional contamination of remaining
PPE during removal. Performing hand hygiene between steps, and especially prior to removal
of a mask or respirator, can help prevent contaminating one’s eyes and/or mucous membranes
while removing the mask or respirator. Healthcare personnel should familiarize themselves and
practice methods of donning and removal of any PPE used, in advance of the time when PPE
will be needed..

Availability of PPE supplies, hand hygiene, and appropriate waste containers at the point needed
can be facilitated by placing any suspect EVD patient in a room with an anteroom. An anteroom is
particularly helpful if airborne isolation is implemented and respirators must be removed after
leaving the patient room and closing the door. If a room with an anteroom is unavailable, a suspect
EVD patient can be placed in a room that is spatially separated from other occupied patient rooms
in a low traffic area (e.g., at the end of a hallway), with a designated area for hand hygiene and
waste containers outside the room and separate from other patient care areas.

CDC “Interim Guidance for Environmental Infection Control in Hospitals for Ebola Virus,”
available at:

Although the role of the environment in transmission of Ebola virus has not been established, in
this guidance CDC recommends higher levels of precaution to reduce the potential risk posed by
contaminated surfaces in the patient care environment “given the apparent low infectious dose,
potential of high virus titers in the blood of ill patients, and disease severity.” Disinfection products
with higher potency than what is normally required for an enveloped virus such as Ebola are
therefore now recommended. Such products include Environmental Protection Agency-registered
hospital disinfectants with a label claim for a non-enveloped virus (e.g., norovirus, rotavirus,
adenovirus, poliovirus), and would also include bleach solution. In addition, the new guidance
recommends that porous surfaces that cannot be made single use (e.g., carpeting, upholstered
furniture and curtains) should be avoided in rooms of suspect EVD patients, and that potentially
contaminated textiles (e.g. linens, non-fluid-impermeable pillows or mattresses, and privacy curtains)
be discarded as regulated medical waste.

CDC” Interim Guidance for Emergency Medical Services (EMS) Systems and 9-1-1 Public Safety
Answering Points (PSAPs) for Management of Patients with Known or Suspected Ebola Virus Disease
in the United States”, available at

This CDC guidance recommends PSAPs question callers about risk factors and signs and symptoms of
Ebola “when risk of Ebola is elevated in their community (e.g., in the event that patients with confirmed
Ebola are identified in the area).” Please note that the risk of Ebola in California communities is not
elevated, but Ebola infections might occur in persons in California who recently traveled to West Africa
where an Ebola outbreak is occurring. PSAPs should therefore:

Question all callers who report fever (with or without additional symptoms of severe headache, muscle
pain, vomiting, diarrhea, abdominal pain, or unexplained bleeding) regarding history of travel during
the 21 days prior to onset of fever to a region where an Ebola outbreak is occurring.

Question all callers reporting fever and travel history consistent with potential Ebola exposure regarding
contact with blood or body fluids of a person with known or suspected Ebola.

CDC also recommends PSAPs alert first responders and EMS personnel prior to arrival on scene regarding
any person with possible Ebola. If responding at an airport or other port of entry to the United States, the
PSAP should notify the CDC Quarantine Station for the port of entry. Contact information for CDC
Quarantine Stations can be accessed at the following link:

In addition to CDC recommendations for PPE to be used by EMS personnel responding to a call regarding
a person with possible Ebola, EMS personnel may opt to wear a N95 respirator (or equivalent) if the patient
is vomiting or having copious diarrhea or bleeding, particularly if occurring in an enclosed and less controlled
environment (e.g., moving vehicle). The CDC guidance outlines additional recommendations for EMS transfer
of patients with suspected Ebola to healthcare facilities, including inter-facility transport considerations

“Guidance for Safe Handling of Human Remains of Ebola Patients in U.. S. Hospitals and Mortuaries”,
available at



About Ebola Virus Disease
Ebola Updates from the CDC
Information for the Public
Symptoms of Ebola
To protect yourself from Ebola
Information for Providers
Physicians are required to contact their local health department or the state Communicable Disease Branch
(919-733-3419) as soon as Ebola or any other hemorrhagic fever virus infection is reasonably suspected.


Has the North Carolina Division of Public Health (NC DPH) been preparing for a patient with Ebola to
arrive in our state?

Yes, the NC DPH has been working closely with public health partners and healthcare providers statewide
since July to prepare for the possibility of Ebola virus infections in North Carolina.

How are public health departments, healthcare providers and other partners preparing?

Extensive guidance has been provided by the CDC and the NC DPH to health departments, healthcare providers,
hospitals and laboratories on evaluation of patients with recent international travel and on management of
suspected cases. These partners are continuing to work together to develop plans to ensure that an Ebola patient
can be safely managed in their communities. The most current guidance can be found here

What else is the NC DPH doing?

We are actively monitoring for cases using a variety of methods, including real time surveillance of hospital
emergency department visits and a network of hospital-based Public Health Epidemiologists in the state's
largest hospital systems.

Are first responders prepared to assist an Ebola patient?

Yes, the NC DPH is working with the Office of Emergency Medical Services to assist local EMS agencies with
triage and treatment protocols for potential Ebola patients.

What will happen if a hospital or healthcare provider thinks someone has Ebola?

Local health departments and the NC DPH are available 24 hours a day, 7 days a week for consultation
for healthcare providers with concerns about Ebola or other communicable diseases. If Ebola is suspected
by a healthcare provider, the NC DPH will work with the healthcare facility and the local health department
to evaluate and safely manage the patient.

Where will testing for Ebola be done?
The State Laboratory of Public Health (SLPH) has successfully established the capability to rapidly detect
Ebola infection. The SLPH can provide technical consultation to clinical laboratories on specimen collection,
transport, and safety procedures while evaluating patients with recent international travel.

What will the NC DPH do if we do have a case of Ebola in North Carolina?

If a case occurred in North Carolina, state and local public health professionals would rapidly identify
everyone who was potentially exposed and take immediate measures to prevent further spread.
Our public health professionals have extensive training and experience with this type of investigation and

Press Releases
Additional Information
Communicable Disease Branch

Telephone: (919) 733-3419
(main number; 24 hours)
Website: North Carolina Communicable Disease Branch

Media Inquiries
Telephone: (919) 855-4840
Email: news@...



The 2014 Ebola epidemic is the largest in history, affecting multiple countries in West Africa.
Although the risk of an Ebola outbreak in the United States is very low, federal, state, and local
partners are preparing and taking precautions to prevent this from happening. Below is a compilation
of Ebola guidance documents and resources for the community, first responders, healthcare providers,
and laboratories. Residents seeking general information about Ebola and associated symptoms should
check the Communities tab below. Anyone with recent travel to West Africa and who may be showing
symptoms should contact their physician for instructions.,4579,7-186-69879---,00.html

For a daily update list of Ebola resources from the Centers for Disease Control (CDC), check the
"What's New" section of the CDC website. For current information about the ongoing outbreak and
complete information for specific groups, visit the CDC's Ebola website at



Now that someone in the U.S. has been diagnosed with Ebola, am I at a higher risk?

No. The only way to get infected with Ebola is to directly come into contact with an infected person’s
blood or body fluid. The nation’s top health experts are continuing to monitor the outbreak, including
the recent situation in Dallas, and are working with health care providers, hospitals and others to make
sure that everyone is prepared to handle another case of Ebola if it were to occur in the U.S.

What are the symptoms of Ebola?

The disease usually starts with an abrupt fever, possibly with headache and joint and muscle aches.
Other symptoms may include:

Stomach pain
Lack of appetite

Some patients may also experience:

Red eyes
Sore throat
Chest pain
Problems breathing
Problems swallowing
Bleeding inside and outside the body

When do symptoms first appear?

Symptoms usually appear eight to 10 days after exposure but may appear anywhere
from two to 21 days after exposure.

How serious is Ebola?

The severity of the disease varies, but over 50% of patients with Ebola have died during past outbreaks.
Researchers do not fully understand why some people who become sick with Ebola recover while others do not.

How is Ebola treated?

There is no known effective medication for Ebola infection. Treatment focuses on supportive care and
may require intensive care unit support. There is no vaccine for Ebola.

Can Ebola infection be prevented?

Measures to stop the disease from spreading include

Quickly identifying people who might be infected with Ebola virus

Following infection control guidelines in health care facilities (i.e. sterilizing medical equipment and
wearing appropriate personal protective equipment )

Isolating Ebola patients from contact with uninfected people.




What is Ebola Virus Disease?
What is VDH doing to protect the public?
What are the symptoms of Ebola?
How soon after exposure do symptoms usually occur?
Symptoms may appear anywhere from 2 to 21 days after exposure to Ebola, but the average is 8 to 10 days.
How is Ebola spread?
Can Ebola be spread by insects?
Can the Ebola virus mutate and become airborne?
Can Ebola be transmitted by contact with contaminated surfaces or objects?
Can you get Ebola from pets?
How long can Ebola live outside the body?
How do I know if I have been exposed to Ebola?
What countries/areas* have been affected by the Ebola outbreak in West Africa?
What should I do if I traveled to one of the affected areas and think may have been exposed to Ebola?
What if I get sick after I come back from an area with an Ebola outbreak?

BEFORE you go to the doctor’s office or emergency room, call ahead and tell your doctor about your
recent travel to West Africa or contact with a person who was sick with Ebola and your symptoms.
Calling before visiting the doctor will help the medical staff care for you and protect other people who
may be in the doctor’s office or emergency room. When traveling to get medical care, limit your contact
with other people. This includes avoiding public transportation.

What is “close contact”?
Can someone with Ebola spread the virus if they don’t have symptoms of illness?
Can my local hospital care for a patient with Ebola?
Is there a cure for Ebola?
Is Ebola guidance available for airline staff?
Am I at risk if I am on a flight with a person who has Ebola?
Is Ebola guidance available for emergency responders?
Should I be concerned about Ebola coming to Virginia?
What is happening at airports in the United States to prevent Ebola?
What is being done in Virginia to prevent the spread of Ebola?
Where did the Ebola virus come from?
If I have to travel to an area affected by the Ebola outbreak, how do I protect myself while I am there?

The Virginia Department of Health Office of Emergency Medical Services also has information
on Ebola on its website:

Now that someone in the U.S. has been diagnosed with Ebola, am I at a higher risk?



Algorithm for evaluating returning travelers for EVD New

Sequence for putting on Personal Protective Equipment (PPE) New
Memo from Department of Health and Human Services - Healthcare Resources
for Suspected Cases of Ebola Virus Disease

Ebola Information for EMS Providers - Information provided by the Office of Emergency Medical Services

Interim Guidance for Emergency Medical Services (EMS) Systems and 9-1-1 Public Safety Answering Points
(PSAPs) for Management of Patients with Known or Suspected Ebola Virus Disease in the United States

Detailed Emergency Medical Services (EMS) Checklist for Ebola Preparedness (ASPR and CDC guidance)

Guidance on Air Medical Transport for Patients with Ebola Virus Disease (CDC)

Commissioner to the EMS Community - Ebola Virus Update - October 3, 2014



How DPH Is Responding to Ebola in the U.S.
DPH Guidance for Clinicians
DPH Guidance for Clinicians
General Information About Ebola Virus




Department of Health
Port Authority
Metropolitan Transportation Authority
Public Safety
Commissioner’s Order
Training for Health Care Workers



Information for Health Professionals

Since the Ebola virus outbreak began in Africa, DHS has been assisting health care partners
by providing guidelines for monitoring individuals returning from affected West African countries,
and ensuring that all providers are ready with the appropriate infection control protocols and required
precautions for managing an Ebola patient. DHS will continue to provide the latest information on this page:

Prevention of Ebola Virus Disease (EVD) Transmission in Healthcare Settings (slides) (PDF, 961 KB) (October 14, 2014)

EVD testing in Wisconsin - Wisconsin State Laboratory of Hygiene

Interim guidance for Wisconsin clinicians on possible EVD among travelers
from West Africa P-00812 (PDF, 68 KB)

Quick guide - Infection control measures for patients hospitalized with suspected
EVD P-00812A (PDF, 72 KB)

Response to travelers returning from West Africa - guidance for local health department

CDC - Interim guidance: EMS services and 9-1-1 PSAPs:
Management of patients in the US - CDC
(Updated October 1, 2014)

CDC - Algorithm for evaluating returned travelers for EVD (PDF, 838 KB) (Updated October 1, 2014)

CDC - Checklist for patients being evaluated for EVD (PDF, 117 KB) (Updated October 1, 2014)

CDC - Basic information for providers - EVD information for clinician in U.S. health care settings

CDC - Detailed hospital checklist for Ebola preparedness

Created by the US Department of Health and Human Services and partner agencies.

This is a valuable resource for ensuring your facilities are able to safely manage patients
with suspected or confirmed EVD.

CDC - HAN (Health Alert Network) INFOService messages
Subscribe to directly receive alerts as they are issued.

CDC - How U.S. clinical laboratories can safely manage specimens from persons
under investigation for EVD

CDC - Infection prevention and control recommendations for hospitalized patients
with known or suspected Ebola in U.S. hospitals - full guidance

CDC - Interim guidance for specimen collection, transport, testing and submission
for patients suspected with EVD







BALTIMORE, MD (October 17, 2014) – Governor Martin O’Malley led a team of hospital
and other health officials to update the public on the Maryland’s efforts to protect its communities
against infectious diseases, including the Ebola virus.

To date, there have been no cases of Ebola diagnosed in Maryland.

“We are not taking this situation lightly,” said Governor O’Malley. “We are working together across
agencies, with our federal and local government and community partners, and with Maryland hospital
officials to prepare aggressively so that we can keep Marylanders safe.”

At the briefing, Maryland officials reviewed preparations, guidance, and training for the emergency
management system, medical offices, emergency departments, and inpatient facilities. Hospital officials
from Johns Hopkins and the University of Maryland provided updates on efforts underway throughout
their institutions.

“We must support the safety of front line healthcare workers as we prepare for a possible new case
of Ebola virus infection,” said Dr. Joshua M. Sharfstein,
Secretary of Maryland’s Department of Health and Mental Hygiene (DHMH).

In September, Secretary Sharfstein issued an order requiring communication and coordination between
healthcare providers and the health departments on all suspected cases of Ebola. DHMH has one of 13 labs
authorized by the U.S.. Centers for Disease Control and Prevention to test for Ebola. Maryland also receives
detailed data from Emergency Departments and absenteeism data from its schools to continually monitor
trends in health.

The Maryland Emergency Management Agency (MEMA) is coordinating the State’s overall Ebola response.
MEMA has established a virtual joint information center so information and guidance can be shared across
state agencies including Transportation, Corrections, and State Police. Governor O'Malley brought various
agencies together to conduct a tabletop exercise in August, and MEMA is convening regular meetings to
review the latest information and plan for a wide range of possible scenarios. Earlier this week,
Governor O'Malley, DHMH officials, the Maryland Secretary of State, and representatives from various
congressional offices met with leaders of the African diaspora community to discuss solutions, including
efficient information-sharing and efforts to combat the disease in Africa.

DHMH has launched a website devoted to Ebola at and DHMH
Secretary Sharfstein has written all state employees with basic information about the virus.



"Texas Gov. Rick Perry has joined calls for an air travel ban from countries hit the hardest by Ebola.

Perry said Friday that air travel is how Ebola crosses borders and that's how it arrived in Texas,
so an air travel ban is the right policy."

ABC News Associated Press (AP)


Rick Perry's Ebola Test. The Texas Governor and Ebola FROM Politico


"At first, Perry seemed to have everything under control. When a man in Dallas was diagnosed
with the deadly virus, Perry held an Oct. 1 news conference, assuring the public that “there are
few places in the world better equipped to meet the challenges posed by this case.” When more
people were quarantined, he launched a task force and told Texans to “rest assured our system
is working as it should.

But then he left Sunday for a long-planned 7-day trip designed to burnish his foreign policy credentials.
During his absence, two more cases of Ebola were confirmed, both of them involving Texas nurses
who had dealt with the first patient.

The governor cut his trip short and rushed home on Thursday, only to encounter criticism for leaving
in the first place; Democrats charged that he was more focused on looking presidential overseas than
on fixing a big problem at home. And even some Republicans say Perry, who has been trying for
months to rehabilitate his image in the wake of his disastrous 2012 campaign, may have missed
an important moment."




General Public
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Emergency Medical Services (EMS)
Healthcare Providers
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Ebola Virus Disease - October 9, 2014
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