Clinical Inquiries for Ebola Virus Disease Received By CDC — United States, July 9–November 15, 2014

BACKGROUND:  Early recognition is critical to controlling the spread of Ebola virus disease (Ebola) from West Africa, where more than 18,000 cases have been diagnosed. Domestic case finding relies on clinicians and health departments to identify persons with compatible clinical presentations and travel or exposure history, and to contact CDC regarding conducting Ebola testing. To improve case finding, we reviewed domestic clinical inquiries to CDC about testing for Ebola.

METHODS:  We performed a descriptive analysis of clinical inquiries received by CDC from Emergency Operations Center activation on July 9, 2014 through November 15. Inquiries originated from clinicians and health departments concerning persons in the United States in whom a diagnosis of Ebola was considered.

RESULTS:  CDC received inquiries about 650 persons in 49 states. Overall, 490 (75%) persons had no risk factor; of 138 (21%) who traveled to an affected country and 22 (3%) who had contact with a domestic Ebola case, 118 (74%) had at least one sign or symptom consistent with Ebola. Based on CDC recommendation or health department request, 61 persons were tested. Four Ebola cases were diagnosed between September 30 and October 24; two were travel-related. Number of weekly inquiries averaged 10 (range 1–25) through September and peaked at 227 in mid-October, decreasing to 32 in early November.

CONCLUSIONS:  Coordinated, national surveillance facilitating early detection of Ebola is an important defense against transmission within the United States. All domestic Ebola cases thus far were identified through inquiries to CDC. Variability in inquiry volume highlights the need for a rapidly scalable system that meets fluctuating needs. Likelihood of Ebola, even among symptomatic travelers returning from affected countries, is very low.