Active Tracing and Monitoring of Contacts Associated With the First Cluster of Ebola in the United States

Chung, Wendy; Smith, Jeffery S.; Weil, Lauren M.; Hughes, Sonya M.; Joyner, Sibeso N.; Hall, Emily M.; Ritch, Julia; Srinath, Divya; Goodman, Edward L.; Chevalier, Michelle; Epstein, Lauren; Hunter, Jennifer C.; Kallen, Alexander J.; Karwowski, Mateusz P.; Kuhar, David T.; Smith, Charnetta L; Petersen, Lyle R.; Mahon, Barbara E.; Lakey, David; Schrag, Stephanie J.

doi:10.7326/m15-0968

Cited by 19 publications

(17 citation statements)

References 11 publications

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“…Furthermore, we are aware of no framework that considers the implementation setting as a factor for intervention choice or performance, despite its obvious importance. Indeed, the US CDC implicitly recognized the value of implementation setting by differentiating its international response, where quarantine was performed (14), and its domestic response, where symptom monitoring was recommended (15,16).…”

mentioning

confidence: 99%

Comparing nonpharmaceutical interventions for containing emerging epidemics

Peak

Childs

Grad

et al. 2017

Proc. Natl. Acad. Sci. U.S.A.

252

290

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Strategies for containing an emerging infectious disease outbreak must be nonpharmaceutical when drugs or vaccines for the pathogen do not yet exist or are unavailable. The success of these nonpharmaceutical strategies will depend on not only the effectiveness of isolation measures but also the epidemiological characteristics of the infection. However, there is currently no systematic framework to assess the relationship between different containment strategies and the natural history and epidemiological dynamics of the pathogen. Here, we compare the effectiveness of quarantine and symptom monitoring, implemented via contact tracing, in controlling epidemics using an agent-based branching model. We examine the relationship between epidemic containment and the disease dynamics of symptoms and infectiousness for seven case-study diseases with diverse natural histories, including Ebola, influenza A, and severe acute respiratory syndrome (SARS). We show that the comparative effectiveness of symptom monitoring and quarantine depends critically on the natural history of the infectious disease, its inherent transmissibility, and the intervention feasibility in the particular healthcare setting. The benefit of quarantine over symptom monitoring is generally maximized for fast-course diseases, but we show the conditions under which symptom monitoring alone can control certain outbreaks. This quantitative framework can guide policymakers on how best to use nonpharmaceutical interventions and prioritize research during an outbreak of an emerging pathogen.epidemiology | quarantine | active symptom monitoring | contact tracing | infectious disease dynamics

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mentioning

confidence: 99%

Comparing nonpharmaceutical interventions for containing emerging epidemics

Peak

Childs

Grad

et al. 2017

Proc. Natl. Acad. Sci. U.S.A.

252

290

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“…HCW-I and HCW-J became infected on 11 and 14 October, respectively, but did not report unprotected exposures with the index patients and had been categorized as low EVD risk. How these two HCWs contracted Ebola virus infection remains unknown [11]. They complained, however, of having being obliged to have worked at the hospital in chaotic surroundings with ill-prepared nurses who received little guidance on how to treat Ebola and protect themselves (http://res.dallasnews.com/interactives/nina-pham/).…”

Section: Resultsmentioning

confidence: 99%

Ebola Virus Infection among Western Healthcare Workers Unable to Recall the Transmission Route

Petti

Protano

Messano

et al. 2016

BioMed Research International

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Introduction. During the 2014–2016 West-African Ebola virus disease (EVD) outbreak, some HCWs from Western countries became infected despite proper equipment and training on EVD infection prevention and control (IPC) standards. Despite their high awareness toward EVD, some of them could not recall the transmission routes. We explored these incidents by recalling the stories of infected Western HCWs who had no known directly exposures to blood/bodily fluids from EVD patients. Methodology. We carried out conventional and unconventional literature searches through the web using the keyword “Ebola” looking for interviews and reports released by the infected HCWs and/or the healthcare organizations. Results. We identified fourteen HCWs, some infected outside West Africa and some even classified at low EVD risk. None of them recalled accidents, unintentional exposures, or any IPC violation. Infection transmission was thus inexplicable through the acknowledged transmission routes. Conclusions. We formulated two hypotheses: inapparent exposures to blood/bodily fluids or transmission due to asymptomatic/mildly symptomatic carriers. This study is in no way intended to be critical with the healthcare organizations which, thanks to their interventions, put an end to a large EVD outbreak that threatened the regional and world populations.

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“…being in close contact with a person with EVD while wearing appropriate personal protective equipment) underwent direct active monitoring involving daily in-person visits or video-teleconference conversation between the monitor and traveler in order to directly observe the taking of temperatures and reporting symptoms. All monitoring continued for 21 days after the traveler had left Guinea, Liberia, or Sierra Leone [10]. …”

Section: Methodsmentioning

confidence: 99%

Development and Implementation of the Ebola Traveler Monitoring Program and Clinical Outcomes of Monitored Travelers during October – May 2015, Minnesota

et al. 2016

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BackgroundIn October 2014, the United States began actively monitoring all persons who had traveled from Guinea, Liberia, and Sierra Leone in the previous 21 days. State public health departments were responsible for monitoring all travelers; Minnesota has the largest Liberian population in the United States. The MDH Ebola Clinical Team (ECT) was established to assess travelers with symptoms of concern for Ebola virus disease (EVD), coordinate access to healthcare at appropriate facilities including Ebola Assessment and Treatment Units (EATU), and provide guidance to clinicians.MethodsMinnesota Department of Health (MDH) began receiving traveler information collected by U.S. Customs and Border Control and Centers for Disease Control and Prevention staff on October 21, 2014 via encrypted electronic communication. All travelers returning from Liberia, Sierra Leone, and Guinea during 10/21/14–5/15/15 were monitored by MDH staff in the manner recommended by CDC based on the traveler’s risk categorization as “low (but not zero)”, “some” and “high” risk. When a traveler reported symptoms or a temperature ≥100.4° F at any time during their 21-day monitoring period, an ECT member would speak to the traveler and perform a clinical assessment by telephone or via video-chat. Based on the assessment the ECT member would recommend 1) continued clinical monitoring while at home with frequent telephone follow-up by the ECT member, 2) outpatient clinical evaluation at an outpatient site agreed upon by all parties, or 3) inpatient clinical evaluation at one of four Minnesota EATUs. ECT members assessed and approved testing for Ebola virus infection at MDH. Traveler data, calls to the ECT and clinical outcomes were logged on a secure server at MDH.ResultsDuring 10/21/14–5/15/15, a total of 783 travelers were monitored; 729 (93%) traveled from Liberia, 30 (4%) Sierra Leone, and 24 (3%) Guinea. The median number monitored per week was 59 (range 45–143). The median age was 35 years; 136 (17%) were aged <18 years. Thirteen of 256 women of reproductive age (5%) were pregnant. The country of passport issuance was known for 720 of the travelers. The majority of monitored travelers (478 [66%]) used a non-U.S. passport including 442 (61%) Liberian nationals. A total of 772 (99%) travelers were “low (but not zero)” risk; 11 (1%) were “some” risk. Among monitored travelers, 43 (5%) experienced illness symptoms; 29 (67%) had a symptom consistent with EVD. Two were tested for Ebola virus disease and had negative results. Most frequently reported symptoms were fever (20/43, 47%) and abdominal pain (12/43, 28%). During evaluation, 16 (37%) of 43 travelers reported their symptoms began prior to travel; chronic health conditions in 24 travelers including tumors/cancer, pregnancy, and orthopedic conditions were most common. Infectious causes in 19 travelers included upper respiratory infection, malaria, and gastrointestinal infections.DiscussionPrior to 2014, no similar active monitoring program for travelers had been performed in Minnesota; assess...

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Active Tracing and Monitoring of Contacts Associated With the First Cluster of Ebola in the United States

Abstract: None.

Cited by 19 publications

References 11 publications

Comparing nonpharmaceutical interventions for containing emerging epidemics

Comparing nonpharmaceutical interventions for containing emerging epidemics

Ebola Virus Infection among Western Healthcare Workers Unable to Recall the Transmission Route

Development and Implementation of the Ebola Traveler Monitoring Program and Clinical Outcomes of Monitored Travelers during October – May 2015, Minnesota

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