Ebola Screening: Hey CDC! Is it an AND or an OR?

Like many of you, we've all been assisting with Ebola planning for the past several months. Just today, Mike and I were in another planning meeting and the subject of our screening algorithm came up. Mike had noticed that the September 4th CDC Definition of Person Under Investigation (PUI) that we've been using: "fever of greater than 38.6 degrees Celsius or 101.5 degrees Fahrenheit, AND additional symptoms such as severe headache, muscle pain, vomiting, diarrhea, abdominal pain, or unexplained hemorrhage" is now different in the PDF algorithm that the CDC posted on October 2nd. It now says "FEVER OR EVD symptoms." I've included the relevant portion of the PDF algorithm above.

This may seem like a minor change, but for many facilities it will be a big deal. To go from a relatively sensitive "fever AND" to a very sensitive "fever OR" is not a small change. This may require EDs and clinics to screen additional patients and result in a large increase in laboratory tests being sent for Ebola diagnosis. I think that CDC meant to suggest that fever is enough to prompt a travel history, but now anyone with feverheadache, weakness, muscle pain, vomiting, diarrhea, abdominal pain or hemorrhage will also need to be asked a travel history. In practice this will mean that every patient that walks into an ED or clinic should be asked a travel history first and then asked about symptoms. I'm not convinced this should happen and feel much more comfortable with having symptoms guide travel history. But since almost any general complaint is now included, we may be left with no other choice but to ask travel history first. And of course, we don't know what CDC wants us to do since both documents are live and offer conflicting advice.

So, which is it CDC?  Is it an AND or an OR?


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