Surveillance for Ebola Virus Disease — New York City, 2014

BACKGROUND:  The 2014 Ebola virus disease (Ebola) outbreak in West Africa has resulted in importation of persons with Ebola into the U.S. through travelers and returning healthcare workers. In August 2014, the New York City Department of Health and Mental Hygiene (DOHMH) established enhanced passive surveillance to rapidly detect and isolate persons with Ebola presenting to healthcare settings in order to stop transmission.

METHODS:  DOHMH defined persons under investigation (PUIs) as having temperature >101.5ºF plus severe headache, muscle pain, vomiting, diarrhea, abdominal pain, or unexplained bleeding within 21 days of being in an Ebola-affected area: later guidance removed the fever requirement. Clinicians were asked to collect travel and exposure history and to isolate PUIs and report them to DOHMH immediately. Testing for other travel-related infections was recommended. Ebola testing was prioritized for PUIs with known exposures or with highly suggestive symptoms or laboratory results. Some persons with milder symptoms were monitored at home. One hospital was designated to manage potential cases.

RESULTS:  By October 26, 2014, providers had reported 173 persons: only 20 (12%) met PUI criteria. Providers cited concerns about Ebola when reporting non-PUIs. Of 20 PUIs, one had a known Ebola exposure and tested positive for Ebola. Of 19 PUIs without known exposures, one tested negative for Ebola and others were not tested: diagnoses included malaria (8 patients), diabetes (1 patient), and renal failure (1 patient); nine improved without an identified (or known) diagnosis.

CONCLUSIONS:  DOHMH identified one person with Ebola. Most reported persons had not been in an Ebola-affected area or did not have Ebola-compatible symptoms, reflecting concerns about Ebola and the challenges of identifying a rare infection with non-specific presenting symptoms.