Monitoring of Health Care Workers Participating in Ebola Virus Disease Patient Care, New York City, 2014

BACKGROUND:   The first case of Ebola Virus Disease (EVD) diagnosed in New York City (NYC) was admitted to a local public hospital on October 23, 2014. The interim Centers for Disease Control and Prevention guidelines that recommended active monitoring of all health care workers (HCW) caring for EVD patients were not yet in place but were issued three days after the NYC EVD patient’s admission. We describe the NYC Department of Health and Mental Hygiene (DOHMH)’s experience conducting HCW surveillance and active monitoring.

METHODS:   DOHMH worked with the hospital and CDC to establish criteria for persons requiring monitoring, identify workers meeting these criteria, and collect and transmit names, contact information and dates of exposure to DOHMH.  A DOHMH call center contacted each HCW every day to obtain and track temperature and symptom data.

RESULTS:   Although an initial log identified >150 HCW for monitoring, only 106 ultimately met criteria. They were monitored until 21 days after the earlier of their last exposure to the patient or the patient’s last date of infectiousness.  No EVD infections occurred.  Challenges to implementing monitoring included a) the initial lack of established and operationalizable criteria for which HCW required monitoring, especially laboratory workers, b) obtaining accurate HCW contact information, c) lack of notification procedures for HCW travel, and more stringent monitoring or quarantine policies faced by HCW in other jurisdictions, d) absence of pre-existing tools and systems for data collection, transmission and storage, and e) lack of protocols for managing HCW with fever or symptoms or who were non-adherent with monitoring.  

CONCLUSIONS:   Despite the ultimate development of a successful surveillance system for HCW Ebola infections, unexpected challenges arose during implementation of HCW surveillance and monitoring for Ebola virus infection for the first case in NYC.  Health departments and hospitals preparing to care for EVD patients should collaborate  and devote resources to planning for HCW monitoring, with special attention to developing clear and operationalizable criteria for which HCW require monitoring, preparing rosters of HCW who may meet those criteria, including accurate and up to date contact information, developing protocols for management of ill or non-adherent HCW, and anticipating issues (including notification of other jurisdictions) related to HCW travel.  Communication with and training of HCW regarding monitoring is critical and ideally done in advance of admitting an EVD patient. CDC should clarify criteria for HCW monitoring, especially for laboratory workers.