Ebola

First responders guard the apartment of a healthcare worker Sunday, Oct. 12, 2014, in Dallas. The healthcare worker, who was caring for Ebola patient Thomas Eric Duncan, tested positive for the disease in preliminary tests. If the preliminary diagnosis is confirmed, it would be the first known case of the disease being contracted or transmitted in the U.S. (AP Photo/Brandon Wade)

DALLAS (AP) — A Texas health care worker has tested positive for Ebola even though she wore full protective gear while caring for a hospitalized Ebola patient who later died, health officials said Sunday. If the preliminary diagnosis is confirmed, it would be the first known case of the disease being contracted or transmitted in the U.S.

Dr. Tom Frieden, head of the Centers for Disease Control and Prevention, said the diagnosis shows there was a clear breach of safety protocol and all those who treated Thomas Eric Duncan are now considered to be potentially exposed.

A barrel for disposal of hazardous waste stands outside the residence of a health care worker who tested positive for Ebola, Sunday, Oct. 12, 2014, in Dallas. The worker, who was caring for Ebola patient Thomas Eric Duncan, tested positive for the disease in preliminary tests. If the preliminary diagnosis is confirmed, it would be the first known case of the disease being contracted or transmitted in the U.S. (AP Photo/The Dallas Morning News, Louis DeLuca)

The worker wore a gown, gloves, mask and shield while she cared for Duncan during a second visit to Texas Health Presbyterian Hospital, said Dr. Daniel Varga of Texas Health Resources, which runs the hospital. Frieden said the worker has not been able to identify a specific breach of protocol that might have led to her being infected.

Duncan, who arrived in the U.S. from Liberia to visit family on Sept. 20, first sought medical care for fever and abdominal pain on Sept. 25. He told a nurse he had traveled from Africa, but he was sent home. He returned Sept. 28 and was placed in isolation because of suspected Ebola. He died Wednesday.

Texas health officials have been closely monitoring nearly 50 people who may have had contact with Duncan.

The emergency entrance to Texas Health Presbyterian hospital, Sunday, Oct. 12, 2014, in Dallas, Texas. Hospital officials have said they are no longer accepting new patients at this time after a healthcare worker, who was caring for Ebola patient Thomas Eric Duncan, tested positive for the disease in preliminary tests. (AP Photo/Brandon Wade)

Varga says the health care worker reported a fever Friday night as part of a self-monitoring regimen required by the CDC. He said another person she had contact with is in isolation, and the hospital has stopped accepting new emergency room patients.

“We knew a second case could be a reality, and we’ve been preparing for this possibility,” said Dr. David Lakey, commissioner of the TexasDepartment of State Health Services. “We are broadening our team in Dallas and working with extreme diligence to prevent further spread.”

But Frieden on Sunday raised concerns about a possible breach of safety protocol and told CBS’ “Face the Nation” that among the things CDC will investigate is how the workers took off that gear — because removing it incorrectly can lead to contamination. Investigators will also look at dialysis and intubation, procedures with the potential for spreading infectious material.

“We have the ability to prevent the spread of Ebola by caring safely for patients … We’ll conduct a full investigation of what happens before health workers go in, what happens when they’re there, and what happens in the taking out, taking off their protective equipment because infections only occur when there’s a breach in protocol,” Frieden said.

Health officials have interviewed the health care worker and are identifying any contacts or others who may have been exposed.

A medical practitioner wearing protective clothing stands next to an isolated patient on the sixth floor of the the Carlos III hospital in Madrid, Spain, Saturday, Oct. 11, 2014. A Spanish hospital official says Teresa Romero, the nursing assistant infected with Ebola is “stable,” hours after authorities described her condition as critical. She is the first person known to have caught the disease outside the outbreak zone in West Africa. Romero contracted the virus while helping treat a Spanish missionary who became infected in West Africa, and later died. (AP Photo/Daniel Ochoa de Olza)

Officials said they also received information that there may be a pet in the health care worker’s apartment, and they have a plan in place to care for the animal. They do not believe the pet has signs of having contracted Ebola.

More than 4,000 people have died in the ongoing Ebola epidemic centered in West Africa, according to World Health Organization figures published Friday. Almost all of those deaths have been in the three worst-affected countries, Liberia, Sierra Leone and Guinea.

Health care workers treating Ebola patients are among the most vulnerable, even if wearing protective gear. A Spanish nurse assistant recently became the first health care worker infected outside west Africa during the ongoing outbreak: she helped care for a missionary priest who was brought to a Madrid hospital. More than 370 health care workers in west Africa have fallen ill or died in west Africa since epidemic began earlier this year.

Karsiah Duncan, son of ebola patient Eric Duncan, after a news conference in Dallas. (AP Photo/Tim Sharp)

Ebola spreads through close contact with a symptomatic person’s bodily fluids, such as blood, sweat, vomit, feces, urine, saliva or semen. Those fluids must have an entry point, like a cut or scrape or someone touching the nose, mouth or eyes with contaminated hands, or being splashed. The World Health Organization says blood, feces and vomit are the most infectious fluids, while the virus is found in saliva mostly once patients are severely ill. The whole live virus has never been culled from sweat.

Duncan, the first person in the U.S. diagnosed with Ebola, came to Dallas to attend the high-school graduation of his son, who was born in a refugee camp in Ivory Coast and brought to the U.S. as a toddler when his mother successfully applied for resettlement.

The trip was the culmination of decades of effort, friends and family members said. But when Duncan arrived in Dallas, though he showed no symptoms, he had already been exposed to Ebola. His neighbors in Liberia believe Duncan become infected when he helped a pregnant neighbor who later died from it. It was unclear if he knew about her diagnosis before traveling.