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BACKGROUND: The 2014 Ebola epidemic in West Africa is the largest in history. Because of the risk of imported disease by infected travelers, in mid-October, CDC recommended that all travelers to the US from Ebola-affected countries undergo enhanced screening and post-arrival monitoring for 21days. The Georgia Department of Public Health (DPH) began active monitoring on October 25 by rapidly developing a web-based Ebola Active Monitoring System (EAMS) within the existing notifiable disease reporting system.
METHODS: DPH epidemiologists create an account for each traveler in EAMS, then enroll them in the online system via a scripted telephone interview. Low-risk travelers assent to a legal agreement then electronically report their temperature and any symptoms twice daily. When travelers log into EAMS, they select the day and time and enter their measured temperature. Travelers indicate Ebola-specific symptoms using pictorial selection boxes, or other symptoms in a free text box. Travelers also enter details of any travel planned during their monitoring period. Travelers who do not report daily are flagged as non-compliant and contacted by DPH staff. If travelers report any symptoms, the Ebola epidemiology team is notified immediately by automated email. The system dashboard displays a quick view of traveler information used in case management. EAMS is also used by DPH staff to manage direct (video/in-person) monitoring of some- or high-risk travelers.
RESULTS: To date, 530 travelers have been actively monitored in Georgia, including 37 children. Georgia is currently monitoring 129 travelers. Cumulatively, thirteen travelers have been referred for medical evaluation. Four were diagnosed with viral upper respiratory infections, five with influenza A, two with traveler's diarrhea, one with a diabetes-related complication, and one with malaria. Five travelers were tested for Ebola—all were negative. A total of 12 healthcare workers assessed to have some or high risk have been directly monitored; all have been asymptomatic.
CONCLUSIONS: Active monitoring allows early detection of Ebola cases, appropriate medical evaluation, and rapid isolation to prevent its spread. EAMS makes it possible for two epidemiologists to monitor over 100 travelers each day. This is imperative given Georgia’s large number of travelers and limited staff resources. Automated notices of any reported symptoms facilitate rapid risk assessment and response. The success of EAMS also reflects the preparedness investment DPH has made in retaining IT staff to work with epidemiologists to meet an immediate need.