Compliance in Daily Reporting for Persons Under Active Monitoring for Ebola in Georgia, 2014-2015

BACKGROUND: The West African Ebola virus disease (EVD) epidemic of 2014-15 resulted in a recommendation by the Centers for Disease Control and Prevention that all travelers to the U.S. from Ebola-affected countries undergo active monitoring for 21 days, allowing for early detection of potential imported EVD and timely isolation and treatment to reduce the potential for spread. The Georgia Department of Public Health (DPH) developed the web-based Ebola Active Monitoring System (EAMS) to manage active monitoring. Travelers undergoing active monitoring were required to record their temperature and  EVD-compatible symptoms twice daily and report to DPH daily using either the EAMS online tool, email/SMS, or telephone. We aimed to determine whether travelers reporting online had better compliance and were more likely to report symptoms than those reporting by email/SMS or telephone.

METHODS: We reviewed characteristics, reporting compliance, and symptom reporting for low-risk (no known exposure to a person with EVD) travelers under active monitoring during October 11, 2014­­–November 1, 2015. “Non-compliance” was defined as failing to report to DPH by noon at any time during the 21-day monitoring period. Reported symptoms included any self-reported symptoms of illness or fever ≥100 F. We estimated odds ratios (OR) and 95% confidence intervals (CI) for non-compliance and symptom reporting using logistic regression; reporting compliance, traveler’s sex, age, whether deployed by CDC, nationality, and need for translation services were included in the model.

RESULTS: Among 2175 low-risk travelers monitored, 212 (10%) were non-compliant, and 1986 (91%) did not report symptoms. Reporting preferences included 1285 (60%) online, 204 (9%) by email/SMS, and 672 (31%) by telephone. Compared to 4% non-compliance among online users, 14% (OR: 2.51, CI: 1.44–4.37) of email/SMS users, and 15% (OR: 3.53, CI: 2.29–5.46) of telephone users were non-compliant. Compared to 88% of online users not reporting symptoms, 94% of email/SMS users (OR: 1.43, CI: 0.73­–2.77), and 97% of telephone users did not report symptoms (OR: 1.93, CI: 1.08–3.47).

CONCLUSIONS: Travelers who completed their daily reports online were significantly less likely to be non-compliant with reporting requirements than travelers reporting by email/SMS or telephone, and were more likely to report symptoms than travelers reporting by telephone. This may be due to the improved ease, simplicity, and perceived anonymity of online reporting.  When building self-reporting surveillance systems, public health jurisdictions should consider incorporating and encouraging the use of online reporting to maximize compliance and symptom reporting.