title: Cluster of Ebola cases among Liberian and U.S. health care workers in an Ebola treatment unit and adjacent hospital -- Liberia, 2014.
abstract: The ongoing Ebola virus disease (Ebola) epidemic in West Africa, like previous Ebola outbreaks, has been characterized by amplification in health care settings and increased risk for health care workers (HCWs), who often do not have access to appropriate personal protective equipment. In many locations, Ebola treatment units (ETUs) have been established to optimize care of patients with Ebola while maintaining infection control procedures to prevent transmission of Ebola virus. These ETUs are considered essential to containment of the epidemic. In July 2014, CDC assisted the Ministry of Health and Social Welfare of Liberia in investigating a cluster of five Ebola cases among HCWs who became ill while working in an ETU, an adjacent general hospital, or both. No common source of exposure or chain of transmission was identified. However, multiple opportunities existed for transmission of Ebola virus to HCWs, including exposure to patients with undetected Ebola in the hospital, inadequate use of personal protective equipment during cleaning and disinfection of environmental surfaces in the hospital, and potential transmission from an ill HCW to another HCW. No evidence was found of a previously unrecognized mode of transmission. Prevention recommendations included reinforcement of existing infection control guidance for both ETUs and general medical care settings, including measures to prevent cross-transmission in co-located facilities.
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Forrester
authors.forename: Jennifer C
authors.initials: JC
authors.lastname: Hunter
authors.forename: Satish K
authors.initials: SK
authors.lastname: Pillai
authors.forename: M Allison
authors.initials: MA
authors.lastname: Arwady
authors.forename: Patrick
authors.initials: P
authors.lastname: Ayscue
authors.forename: Almea
authors.initials: A
authors.lastname: Matanock
authors.forename: Ben
authors.initials: B
authors.lastname: Monroe
authors.forename: Ilana J
authors.initials: IJ
authors.lastname: Schafer
authors.forename: Tolbert G
authors.initials: TG
authors.lastname: Nyenswah
authors.forename: Kevin M
authors.initials: KM
authors.lastname: De Cock
mesh_terms: D016000:Cluster Analysis; D058872:Epidemics / Q000517:prevention & control*; D006282:Health Personnel / Q000706:statistics & numerical data*; D019142:Hemorrhagic Fever, Ebola / Q000453:epidemiology* / Q000628:therapy; D006757:Hospital Units / Q000706:statistics & numerical data*; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D007988:Liberia / Q000453:epidemiology; D014481:United States