General Infection Control

Ebola, Enteroviral, Adenoviral, Influenza, Herpetic and General Infection Control:

Ebola Infection and other infectious viral diseases- Optometry's role

The recent epidemic outbreak on Ebola Viral Disease (EVD) in West Africa and the associated publicity surrounding several confirmed cases in the United States underscore the importance for all health care providers to be educated about the disease and to have a clear understanding of the appropriate protocols to follow to prevent the spread of the disease if it is suspected in clinical practice.

Although patients with EVD may develop acute conjunctivitis, it is not a presenting sign of the disease and typically develops only after patients develop other signs and symptoms. The CDC has published information for clinicians about EVD and doctors are urged to check for current information about EVD as updates can occur. Although unlikely to present for optometric care, currently, patients meeting the criteria below warrant further evaluation:

A person who has both consistent signs or symptoms and risk factors as follows:

  1. Elevated body temperature or subjective fever or symptoms, including severe headache, fatigue, muscle pain, vomiting, diarrhea, abdominal pain, or unexplained hemorrhage; AND

  2. An epidemiologic risk factor within the 21 days before the onset of symptoms. (travel to a country in West Africa) with widespread Ebola Virus Transmission or direct contact with a patient with Ebola while that patient is symptomatic)

  3. Doctors are urged to check the following 2 page algorithm for travelers from countries with risk:   and review this one page risk assessment form for Ebola:

  4. Doctors are urged to direct patients and staff to APHA's Get Ready campaign Ebola fact sheet to help the public easily understand the risks of Ebola and how to stay safe.

If a diagnosis of Ebola is being considered, the patient should be isolated in a single room (with a private bathroom), and healthcare personnel should follow standard, contact, and droplet precautions, including the use of appropriate personal protective equipment (PPE). Infection control personnel, and if in an outpatient setting, Emergency Medical Services, should be contacted immediately. If Ebola is suspected, the local or state health department should be immediately contacted for consultation and to assess whether testing is indicated and the need for initiating identification of contacts.

Enteroviral infections- Far more common than EVD, non-polio enteroviral infection (Enterovirus D68) has caused a nationwide outbreak in 47 states and has been associated with severe respiratory illness. These infections are more common in younger patients and most patients develop fever, runny nose, cough and muscle aches. Some patients may develop severe respiratory symptoms. Patients with enteroviral infection occasionally develop a non-specific and self-limited conjunctivitis.

Adenoviral infections- A common cause of conjunctivitis which can be severe (Epidemic Keratoconjunctivitis), adenoviral infections cause respiratory, gastrointestinal and other systemic symptoms such as fever and malaise.

Influenza-Uncomplicated influenza illness is characterized by the abrupt onset of constitutional and respiratory signs and symptoms (e.g., fever, myalgia, headache, malaise, nonproductive cough, sore throat, and rhinitis). Among children, otitis media, nausea, and vomiting also are commonly reported with influenza illness. Uncomplicated influenza illness typically resolves after 3-7 days for the majority of persons, although cough and malaise can persist for >2 weeks. However, influenza virus infections can cause primary influenza viral pneumonia; exacerbate underlying medical conditions (e.g., pulmonary or cardiac disease); lead to secondary bacterial pneumonia, sinusitis, or otitis media; or contribute to co-infections with other viral or bacterial pathogens. Not typically associated with acute conjunctivitis, patients with influenza often experience excessive tearing. Patients with significant conjunctivitis are more likely to have adenoviral infections.

Herpetic infections- One of the most common viral infections with ocular manifestations, both herpes simplex and zoster viral infections can cause both conjunctivitis and keratitis. Clinicians should be alert to these infections in any patient with acute conjunctivitis.

To protect patients and staff from infectious diseases, sound hygiene practices should be followed, such as covering coughs using the inside of your forearm, washing hands with soap and warm water for at least 20 seconds several times a day, applying alcohol based hand sanitizer periodically and staying home when feeling unwell.

As a reminder, the CDC Advisory Committee on Immunization Practices (ACIP), and the Healthcare Infection Control Practices Advisory Committee (HICPAC) recommend that all U.S. health care workers, including optometrists and their assistants, get vaccinated annually against influenza. You can get the flu from patients and coworkers who are sick with the flu. If you get the flu, you can spread it to others even if you don't feel sick.

By getting vaccinated, you help protect yourself, your family at home, and your patients. Overall, final 2013-14 flu vaccination coverage among health care workers was 75.2%, however, among assistants/aides the rate of immunization dropped to 57.7%. Set an example and policy at your optometric office by encouraging everyone to be vaccinated against influenza.

People should seek medical attention if they are at higher risk, or if their symptoms become more severe.

To project against more common viral infections, please see the web sites listed below:

  1. Regarding general infection control and Guideline for Disinfection and Sterilization in Healthcare Facilities:

  2. Regarding common cold and flu:

To find the most up to date information on Ebola: