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BACKGROUND: The 2014 outbreak of Ebola virus disease (EVD) in West Africa involved widespread transmission in both healthcare and community settings. This resulted in a potential for exposure among both residents and responders from other countries. To provide early detection and treatment of EVD in persons arriving in the United States from countries with widespread Ebola virus transmission, CDC released guidance on monitoring persons at risk for Ebola virus exposure. Guidance called for all jurisdictions to establish monitoring programs by early November.
METHODS: All travelers entering the United States from countries with widespread Ebola virus transmission (Guinea, Liberia, Sierra Leone) and later Mali were screened on arrival and classified in one of three risk categories: Low (but not zero), Some, High. Persons in the Low-risk category were placed under active monitoring (AM) by state, territorial, or local jurisdictions. AM included daily notification of health status to the appropriate health department. Jurisdictions reported to CDC weekly on travelers at Low risk. Reports included circumstances involving travelers unable to be contacted initially or for >48 hours during the monitoring period; additional information was obtained through phone consultation. Data on six weekly reporting periods (Monday–Sunday) during November 3–December 14 is described.
RESULTS: Cumulative numbers of travelers monitored during any reporting period ranged from 1622 (Week4) to 1745 (Week1) with no apparent temporal trend. Five jurisdictions (Georgia, Maryland, New York City, Pennsylvania, Virginia) monitored between 52.1% (Week3) and 57.4% (Week5) of travelers during any reporting period. Overall, 129 persons reported any symptom consistent with EVD: 11 (Week1), 10 (Week2), 17 (Week3), 19 (Week4), 31 (Week5), 41 (Week6). None were diagnosed with EVD. Ability to make initial contact was higher in the final four reporting periods than the first two: 96.2% (Week1), 96.2% (Week2), 98.2% (Week3), 99.3% (Week4), 98.6% (Week5), 99.4% (Week6). Once initial contact was made, monitoring was maintained with no breaks >48 hours for 99.1% of travelers. Major challenges in making and maintaining contact were inaccurate or incomplete contact information and individual mobility among households in communities of West African origin. During this time CDC began distributing inexpensive cellphones to arriving travelers subject to monitoring.
CONCLUSIONS: U.S. health departments monitored >1600 persons at Low risk for Ebola virus exposure each week during the final two months of 2014. Reports of symptoms requiring evaluation increased in the final reporting periods. Ability to initiate and maintain contact was high, and improved over time.