Monitoring of Travelers from Ebola-Affected Countries and US-Based Healthcare Workers: Maryland's Perspective

BACKGROUND:  On October 22, 2014, the Centers for Disease Control and Prevention (CDC) announced that travelers from Ebola-affected countries would be monitored by public health officials for 21 days; Maryland is the destination for 12% of these travelers. Maryland has a large diaspora population and numerous federal agencies whose employees support the Ebola response.  In addition, the National Institutes of Health (NIH) is home to a biocontainment unit used for treatment of Ebola patients; NIH healthcare workers providing Ebola care also require monitoring. Rapid implementation of a large-scale monitoring system was necessary.

METHODS:  The Maryland Department of Health and Mental Hygiene (DHMH) quickly set up a call center to contact travelers in the “Low but not zero” risk category daily to check for symptoms and travel plans.  Remote monitoring capabilities were ensured and legal agreements citing requirements and restrictions were drafted for individuals in the “Some” and “High” risk categories. DHMH partnered with certain federal agencies to jointly monitor individuals and coordinated with neighboring states to ensure comparable approaches.   As the need for better data management became apparent, a mobile phone application and a .Net web application with a SQL server backend were developed. When monitored individuals reported symptoms, clinical consultations and recommendations for testing were made.  

RESULTS:  DHMH began conducting active and direct active monitoring on October 27, 2014. Approximately 150-200 “Low but not zero” risk individuals are monitored on any given day. Thirty-two “Some” risk individuals have been monitored by DHMH or in collaboration with NIH or the US Public Health Service, often using programs such as Skype. A total of six monitored individuals reported symptoms and four were tested for Ebola; none were positive. The internet .Net application was launched on December 11, 2014 and facilitated data management between the call center, infectious disease epidemiologists, and local health departments as well as reporting to CDC. As of January 5, 2014, 836 individuals are in the DHMH database.  The mobile phone application will be launched in mid-January 2015.

CONCLUSIONS:  Maryland DHMH rapidly implemented a system to monitor a high volume of travelers and healthcare providers potentially exposed to Ebola, with incremental adjustments to solve issues such as the management of large amounts of data and coordination of activities. These endeavors have been successful as a result of communication and collaboration within DHMH, and between DHMH and other partners including local health departments, federal agencies and neighboring states.