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BACKGROUND: In September 2014, Texas had the first case of Ebola diagnosed in the United States. Two secondary cases occurred in healthcare workers. One of the healthcare workers traveled by commercial airline twice before her diagnosis. Public health agencies in Texas were tasked with monitoring 177 household, healthcare, community contacts as well as 165 plane passengers and crew. Nine of the plane passengers were residents of central Texas.
METHODS: Plane passengers were categorized as being in the contact zone or out of contact zone. Passengers were considered in the contact zone if they sat within three feet of the healthcare worker. All passengers were monitored by public health for symptoms until 21 days after their flight. Passengers in the contact zone were also asked to voluntarily stay at home throughout the incubation period.
RESULTS: Despite no cases of Ebola being identified in central Texas, the initiation of contact monitoring here triggered several unintended community consequences especially among residents with school age children. Some of the consequences included parents refusing to send their kids to school in unimpacted areas, a school refusing to allow the children of contacts to return to school, a school closing for cleaning because students were identified as low risk contacts, and a school refusing to allow children from Africa to register. Most of the passengers monitored in central Texas isolated themselves at home even when this exceeded health department recommendations.
CONCLUSIONS: These unintended consequences highlight a few challenges public health faces: 1) more public education on basic infectious disease transmission principles is needed, 2) real or perceived threats to children heighten public anxiety, 3) public health needs to engage schools much sooner in response efforts, and 4) the public impact of a novel disease outbreak is much larger geographically than the actual threat area or investigation area.