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BACKGROUND: In October 2014, Pennsylvania was advised by the Centers for Disease Control and Prevention (CDC) that persons entering the United States from Liberia, Sierra Leone and Guinea (and later Mali) would be screened for Ebola risk at entry airports. Names and screening information were sent to travelers’ destination states. Persons traveling to Pennsylvania were categorized according to CDC’s national risk level criteria and monitored daily for 21 days following arrival in the US.
METHODS: Pennsylvania entered information provided by CDC in a spreadsheet, prepared tracking forms specific to each traveler, and distributed the tracking forms to jurisdictions in which travelers planned to reside. Low (but not zero) risk (“Low risk”) travelers were called daily to obtain temperatures and any other signs or symptoms of Ebola (“active monitoring”), while those assessed as “some risk” were additionally visualized once daily by video telecommunication applications or in person (“direct active monitoring”). Data were entered into an online tool and analyzed using SAS software.
RESULTS: In 2014, Pennsylvania received the names of 655 passengers for monitoring. One hundred fifty (23%) were transferred to or from a jurisdiction other than the one indicated on original flight lists. Of those with known citizenship, 78% were not US citizens. Travelers came from Liberia (63%), Sierra Leone (13% ), Guinea (10%) and Mali (10%); most monitored persons (79%) stayed in a large West African community located in Philadelphia and an adjacent Pennsylvania county. Overall, 648 persons were identified as “low risk.” Seven persons, all returning health care workers, were identified as “some risk” and no “high risk” travelers were identified. Travelers were initially contacted an average of 1.5 days after arrival. We could not contact 13 (2%) travelers despite multiple attempts. At least nine persons being monitored were hospitalized for a variety of reasons, but only three were tested for Ebola and all were negative. Pennsylvania encountered a number of unique circumstances in the course of monitoring travelers, including one vaginal and one cesarean birth, and consideration of surgical procedures for several other persons being monitored.
CONCLUSIONS: The Pennsylvania Department of Health was able to quickly establish procedures for monitoring travelers from Ebola-affected countries. Public health staff contacted travelers daily and data were entered and analyzed daily. Pennsylvania’s experience in monitoring travelers from West Africa was unique in that the vast majority of travelers being monitored were visitors to the US with many unprecedented circumstances.