Development and Implementation of the Ebola Traveler Monitoring Program and Clinical Outcomes of Monitored Travelers during October - May 2015, Minnesota

• Published in: PloS one 2016-12, Vol.11 (12), p.e0166797-e0166797
• Main Authors: DeVries, Aaron, Talley, Pamela, Sweet, Kristin, Kline, Susan, Stinchfield, Patricia, Tosh, Pritish, Danila, Richard
• Format: Article
• Language: English
• Subjects: Abdominal Pain - diagnosis; Abdominal Pain - physiopathology; Adolescent; Adult; Analysis; Biology and life sciences; Border patrol; Border stations; Cancer; Care and treatment; Child; Child, Preschool; Children; Clinical outcomes; Customs; Disease control; Disease prevention; Ebola hemorrhagic fever; Ebola virus; Ebolavirus; Endemic Diseases; Epidemics; Epidemiological Monitoring; Epidemiology; Evaluation; Female; Fever; Fever - diagnosis; Fever - physiopathology; Guinea - epidemiology; Health care; Hemorrhagic Fever, Ebola - epidemiology; Homeland security; Humans; Infections; Infectious Disease Incubation Period; Infectious diseases; Liberia - epidemiology; Malaria; Medicine and Health Sciences; Middle Aged; Minnesota; Minnesota - epidemiology; Monitoring; National security; Pain; People and places; Planning; Pregnancy; Prevention; Public health; Public Health Surveillance - methods; Risk assessment; Sierra Leone - epidemiology; Travel; Tumors; Vector-borne diseases; Viral diseases; Viruses; Wellness programs
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0166797

In October 2014, the United States began actively monitoring all persons who had traveled from Guinea, Liberia, and Sierra Leone in the previous 21 days. State public health departments were responsible for monitoring all travelers; Minnesota has the largest Liberian population in the United States. The MDH Ebola Clinical Team (ECT) was established to assess travelers with symptoms of concern for Ebola virus disease (EVD), coordinate access to healthcare at appropriate facilities including Ebola Assessment and Treatment Units (EATU), and provide guidance to clinicians. Minnesota Department of Health (MDH) began receiving traveler information collected by U.S. Customs and Border Control and Centers for Disease Control and Prevention staff on October 21, 2014 via encrypted electronic communication. All travelers returning from Liberia, Sierra Leone, and Guinea during 10/21/14-5/15/15 were monitored by MDH staff in the manner recommended by CDC based on the traveler's risk categorization as "low (but not zero)", "some" and "high" risk. When a traveler reported symptoms or a temperature ≥100.4° F at any time during their 21-day monitoring period, an ECT member would speak to the traveler and perform a clinical assessment by telephone or via video-chat. Based on the assessment the ECT member would recommend 1) continued clinical monitoring while at home with frequent telephone follow-up by the ECT member, 2) outpatient clinical evaluation at an outpatient site agreed upon by all parties, or 3) inpatient clinical evaluation at one of four Minnesota EATUs. ECT members assessed and approved testing for Ebola virus infection at MDH. Traveler data, calls to the ECT and clinical outcomes were logged on a secure server at MDH. During 10/21/14-5/15/15, a total of 783 travelers were monitored; 729 (93%) traveled from Liberia, 30 (4%) Sierra Leone, and 24 (3%) Guinea. The median number monitored per week was 59 (range 45-143). The median age was 35 years; 136 (17%) were aged