2015 APHA Annual Meeting & Expo

Home Events & Meetings Annual Meeting Schedule & Program

Recorded Annual Meeting Presentations (RAMP) are now available for purchase.
Only $90 for presenters, $140 for registered attendees and $200 for non-attendees.

Online Program

333482
Ebola Response in the District of Columbia: A Model for an Urban Setting


Sunday, November 1, 2015

Andrew Hennenfent, DVM, MPH, The Center for Policy, Planning and Evaluation (CPPE), District of Columbia Department of Health, Washington, DC
Mark Grant, MD, MPH, The Center for Policy, Planning and Evaluation (CPPE), District of Columbia Department of Health, Washington, DC
Kenan Zamore, MPH, The Center for Policy, Planning and Evaluation (CPPE), District of Columbia Department of Health, Washington, DC
Keith Li, MPH, The Center for Policy, Planning & Evaluation, District of Columbia Department of Health, Washington, DC
Kossia Dassie, MPH, The Center for Policy, Planning and Evaluation (CPPE), District of Columbia Department of Health, Washington, DC
John Davies-Cole, PhD, MPH, The Center for Policy, Planning & Evaluation, District of Columbia Department of Health, Washington, DC
BACKGROUND: The Centers for Disease Control and Prevention (CDC) announced in October 2014 the start of enhanced monitoring for travelers arriving in the US from countries undergoing widespread transmission of Ebola virus disease (EVD). With this enhanced effort, six epidemiologists within the same division of the District of Columbia (DC) Department of Health (DOH) were tasked with managing all responsibilities related to EVD monitoring for travelers arriving in the District, compared to other jurisdictions where responsibilities were shared between local and state agencies. The following describes a small team approach in implementing an infectious disease active monitoring program in the nation’s capital.

METHODS: DOH epidemiologists actively followed Persons Under Monitoring (PUM) after performing initial interviews to determine hotel stays in DC, household contacts, interstate travel plans, and EVD exposure risk. Through gained experience this expanded to include pet ownership, personal vehicle access, malaria prophylaxis, and determination of mandatory travel/work restrictions. “Low (but not zero) risk” PUM reported temperature, symptoms, and antipyretic use twice daily by telephone, text messages, or emails. “Some risk” PUM reported using videoconferencing programs for one of the two daily contacts. An EVD telephone hotline and webpage were created and distributed to recent travelers, healthcare providers, and the community.

RESULTS: From 10/17/2014 through 2/10/2015, over 90% (205/226) of recent travelers who completed all or a portion of their monitoring in DC were successfully contacted. The highest successful contact rate was achieved in October 2014 (1/1, 100%) and February 2015 (30/30, 100%), the lowest in December 2014 (73/86, 84.9%). Five travelers required direct active monitoring with seven mandated to work/travel restrictions. DOH was consulted on 18 persons seeking medical care at a DC healthcare facility. Collaboration between the treating hospital, DOH, and CDC determined EVD testing was necessary for six of these individuals with none ultimately testing positive.

CONCLUSIONS: The small size of the DC Ebola response team created a situation where six epidemiologists closely collaborated in managing all monitoring, situations where PUM sought medical attention and development of polices and protocols. This allowed for an overall high successful contact rate that improved over time as polices evolved from gained experience. This unified small team approach to surveillance and individual case management can serve as a model for future outbreak scenarios within the District and other urban settings.

Learning Areas:

Epidemiology

Learning Objectives:
Describe the successes and challenges of a small team of epidemiologists in the planning and implementation of a large scale infectious disease surveillance system in an urban setting.

Keyword(s): Epidemiology, Surveillance

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been directly involved in the development of direct active monitoring policies, individual case management for medical evaluations, and both the direct active and active monitoring for recently returned travelers from countries with active Ebola virus disease cases since the initiation of efforts in the fall of 2014. I started my fellowship at the DC Department of Health in August of 2014, before monitoring was initiated in the District. These efforts are ongoing.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 2065.0: Poster Session - Infectious Disease Epidemiology