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BACKGROUND: The 2014–2015 Ebola Virus Disease (EVD) outbreak in West Africa was declared by the World Health Organization as a Public Health Emergency of International Concern. All travelers arriving in the United States from countries with widespread Ebola transmission and US healthcare workers providing care for EVD patients are to be monitored for 21 days after last potential exposure. In response to EVD threats in the state, the Nebraska Department of Health and Human Services (NDHHS) identified a need to implement systems to efficiently monitor potentially exposed individuals.
METHODS: The Nebraska Electronic Disease Surveillance System (NEDSS) provides the infrastructure for reportable disease surveillance in the state; local Health Departments (LHD) are provided on-line access. Using the NEDSS page-builder module, we created an electronic EVD monitoring investigation form based on CDC-issued guidance for monitoring potentially exposed persons. Information captured includes an individual's travel or exposure history, established level of risk, date(s) of potential exposure(s), and daily symptom follow up. The form was quickly deployed and adopted by all Nebraska LHDs for monitoring potentially exposed persons. SAS was used to extract information directly from the NEDSS data tables providing real-time line-level data for all persons under monitoring.
RESULTS: Uniform and complete patient monitoring has occurred for all travelers in compliance with CDC guidance. Access to real-time patient monitoring data allows NDHHS epidemiologists to quickly assess status of all persons under observation across multiple LHD jurisdictions. Built-in functionality to attach documents to this NEDSS page-builder form allows secure sharing and storage of confidential information pertaining to patient monitoring. This project created the infrastructure for Nebraska to more efficiently track over multiple LHD jurisdictions travelers potentially at risk for EVD.
CONCLUSIONS: The existing NEDSS Base System was readily modified to collect information on persons potentially at risk for EVD. The NEDSS system has been an effective and efficient means of both collecting and sharing monitoring data between LHDs and the state health department in Nebraska. By rapidly deploying this tool for LHD use, we dramatically enhanced monitoring efficiency and economized on human resources needed to track the at-risk population. The software developed for this project is readily transferrable to the other 21 jurisdictions utilizing the NEDSS Base System, and can be adapted to other emerging public health threats.