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