MTX, Humira, Ebola ..oh my

First off I will ask my dr when I see her next but I know there are a number of nurses and Heath care professionals on this site

My question is about being immuno compromised due to treatment and the possible exposure to level 3/4 pathogens?

With the resent outbreak of Ebola and the fear of a pandemic the discussion at work came up over who would be sent home from work my bosses response is pregnant women and immuno compermised Now I don’t have direct patient contact but I do deal with blood and body fluids. And our hospital is the designated site for treatment of any such outbreaks.

I am wondering if I need anything on my occupational Heath and safety record stating I am immuno compermised.

Any insite on how to handle this would be great

Hi Dakotasun, I'm not a medical professional, but in your situation, as long as there was no problem with the relationship with my boss, I would talk to them directly to ask what the process is. After all, the boss will be the person making the decision, or approving the process.

I don't imagine having a certificate from your Rheumy stating that you are immunocompromised would hurt, though I doubt it would be necessary - the prescription for the meds you take should be plenty of evidence for any medical professional.

I assume you are mostly thinking of other level 3/4 pathogens (but Ebola started of the discussion and thought train), because I'm here in West Africa and I'm pretty sure that consistent with all the advice from the Ebola experts, it won't spread the same way in any Western country, so there will not be an outbreak in your community (though there is about a one in 200 million chance of one or two patients in the hospital if someone actually makes it there on a flight).

The local community here has two wells, and 1000 people. For the WHO and CDC to get on world media and tell people Ebola in West Africa can be prevented by "simple" hygeine precautions like handwashing is truly ridiculous (what, you gonna walk 4km to the nearest well and back in 100F heat ten times per day to wash your hands?). And that's before we worry about the funeral rites where everyone in the family washes the body, and all the visitors hug it. And the fact that there is so much malaria, dengue, marburg, cholera, that all look just like Ebola in the early stages, that everyone in a medical facility assumes a presenting patient has one of those much more common illnesses, that are not infectious.

On this occasion, the WHO and CDC should take a good hard look at themselves and the way they initially treated the outbreak.

I'm going to take a deep breath now and get off my soapbox.

Apparently Influenza in droplets can last up to 24 hours on hard surfaces, so if you are worried about major pathogens, I'd think pretty hard about that one. I'd also guess you'd not want to be touching blood or body fluids from someone with weeping chicken pox or measles sores (now they KNOW Humira doesn't play nicely with either of those). So it sounds like a great idea to find out what the process is for any of those sorts of illnesses that will have a much bigger impact on you than on others.

I'd be really interested to hear what the outcome is once you find out - we are not in an Ebola country but are obviously prepping our workforce up for the possible spread here, so if you discover any medical rationale (different to the WHO advice) on risk management methods that you don't mind posting, can you reply here?

Please tell me these aren't medical people having this discussion. In a modern hospital you are exposed on a daily basis to as virulent pathogens as the pandemic possibilities . including those that are specifically high risk to tnf patients. BTW I work regularly in one of a very few Class IV NIH labs in the world.

Not minimizing anything here biy there are approx 219 million folks in the sub Saharah region living in the areas where ebola is problem. There have been 1000 deaths. Unlrss the sanitary problems are corrected, the dusease will flouridh. Its that simple.

By contrast in the USA where there are not sanitary issues (in most areas there was 39,000 deaths from seasonal flu in 2013. The death rate from tb in the US was statistically equal to deaths from ebola in west africa. There were over amillion tb deaths world wide and 10 million new cases.......

I worry more about tb. Its, ite high risk fot tnfs, and its prevlent where I live........I don't need direct contact witha patient ti get it or any of the 360 bajillion other infections I come in contact with. on a dily basis

I’m not really worry about Ebola. The likelihood of that presenting in my hospital I feel is rare. I’m more thinking about things like flu outbreaks such as H1N1. SARS We had an outbreak of measles last year. I’m relatively new to this process I guess I just want to protect myself as I feel I will get sicker is I were to get any of these now that I am on mtx/Humira then previous years.

You will not get "sicker" The point is you are being exposed to this stuff on a daily basis The management conversation you referred to in the beginning with your managers is at the least "odd" Technically you are NOT immunosuppressed except for a very narrow area on tnfs. Now were you taking a high dose of steroids or therapeutic doses of MTX, that would be different. Having PsA on the other hand is complicating.