HEALTH chiefs have advised all clinicians in Scotland to obtain a detailed travel history from patients when there is a suspicion they might have the ebola virus, in an attempt to combat the deadly outbreak which is starting to move beyond Africa to other parts of the world.
The acting chief medical officer of Scotland, Dr Aileen Keel, has issued a memo informing all NHS boards in Scotland and directors of public health that a case in the USA had "emphasised the importance of taking a full travel history when assessing relevant patients".
Thomas Duncan travelled from Liberia to Texas. He was treated for a fever, vomiting and abdominal pain - all symptoms of ebola. But he was sent home with antibiotics and was not screened for the virus.
He later tested positive for ebola and died on Wednesday after eight days in hospital.
The decision to investigate patients' travel histories in Scotland will allow staff to find out not just if there was any possibility people had visited countries affected by the virus, but also whom they saw and what they did, to establish clearly the risks.
Keel's memo stressed the importance of securing a full travel history from all patients who have a fever or other symptoms compatible with having the ebola virus.
In Spain, seven more people were admitted to a Spanish hospital unit monitoring possible ebola cases where nurse Teresa Romero, the first person to contract the deadly virus outside West Africa, lies seriously ill. It brings to 14 the number under observation.
Keel said the health service "needs to remain vigilant for cases imported to Scotland" and added clinicians should ensure travel history information is "subsequently acted upon as part of any ebola virus disease (EVD) clinical assessment".
She said increasing case numbers and "extended geographical spread may increase the risk for UK residents engaged in humanitarian aid and healthcare delivery in the affected areas".
Keel said it was "unlikely but not impossible" that people infected in Sierra Leone, Guinea and Liberia could arrive in the UK while incubating the disease, then develop symptoms after their return. The incuabtion period for ebola ranges from two to 21 days.
The outbreak of ebola, a form of viral haemorrhagic fever, was first reported in March and continues in Sierra Leone, Guinea, and Liberia.
In addition to these countries which Keel said were experiencing "widespread and intense transmission", others, including Nigeria, Senegal and USA, have had cases.
Most human infections result from direct contact with the bodily fluids or secretions of infected patients, particularly in hospitals, and as a result of unsafe burial procedures, use of contaminated medical devices including syringes, and unprotected exposure to contaminated bodily fluids.
"Viral haemorrhagic fever should be suspected in individuals with a fever (greater than 38 degrees centigrade) or history of fever in the previous 24 hours who have visited an affected area within 21 days (or who have cared for or come into contact with body fluids or clinical specimens from a live or dead individual or animal known or strongly suspected to have viral haemorrhagic fever)," Keel advised.
Meanwhile, the Scottish Government has dismissed the idea that entry screening will help tackle the virus while Prime Minister David Cameron defended the decision to introduce enhanced screening for ebola at major airports and terminals, saying it had been taken on "medical advice".
The Scottish Government went further, with a spokesman saying: "There is no evidence that entry screening increases the possibility of identifying cases.
"This is because of ebola's long incubation period which means that an infected person may be asymptomatic and screen negative and the fact that travellers can arrive via different countries where there is no outbreak.
"However, there is stronger evidence to support effective exit screening, together with existing guidance on how to manage symptomatic passengers en route and at ports."
Scotland has four infectious disease units with routine 24/7 consultant cover. These are in NHS Glasgow, NHS Lothian, NHS Lanarkshire and NHS Grampian.
In addition, there are many general hospital isolation units throughout Scotland.
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