EVD Traveler Monitoring October 30, 2014 BCDC, NYSDOH

Outline Process of Notifying Local Health Department (LHD) of Traveler Follow Up By LHD Tools for LHD Follow Up (CDESS) Quarantine Order vs. Temperature Monitoring Questions

Process of Notifying LHDs of Traveler BCDC receives flight manifests BCDC enters traveler into CDESS to generate a CDESS serial number – Viral Hemorrhagic Fever, EVD Traveler Monitoring /Phone notification to Regional Office/LHDs (provide CDESS serial number) LHD follows up and enters information into CDESS

Expectations for LHD Follow Up Reassess traveler’s risk category – Symptoms – Exposure Ascertain future travel plans – Includes commuting and modes of transportation Conduct daily 21 day temperature monitoring – Includes weekends Note and update disposition Update CDESS daily – Includes weekends Volume – 150/day entering US – ~11/day entering NYS (from all airports) 208 NYC residents since 10/11/14 14 NYS outside of NYC residents since 10/11/14

Tools Available Blank questionnaire under “CDESS Help” – Blank Forms EVD Traveler Monitoring CDESS disease code – Viral Hemorrhagic Fever EVD Traveler Monitoring 2014

CDESS Core BCDC staff populate (to extent available) Traveler name DOB Address Phone numbers Gender Investigation Status=Unknown Outbreak=Sporadic Case

CDESS Supplemental Clinical Information – Language(s) spoken at home – Exposure window prepopulated based on entry date – Best times of day for contact – Temperature and symptom grid

CDESS Supplemental Exposure Assessment – Reassess individual to categorize them into High risk, Some risk, Low but not zero risk, or no identifiable risk Risk LevelDefinitionAction *High risk (direct contact) Contact with Ebola/sick individual’s body fluids Quarantine for 21 days Monitor for 21 days (in person) *Some risk (direct contact) Within 3 feet of an Ebola/sick individual Quarantine for 21 days Monitor for 21 days (in person) Low, but not Zero riskIn one of three impacted countries, but no direct contact Monitor for 21 days (can be remote) No identifiable riskDid not travel to impacted country No movement restrictions * If entering through JFK, LHD notified if Quarantine Order issued upon entry

CDESS Supplemental Travel History – Location (BCDC populates) – Departure date from US – Return date into US (BCDC populates) – Airport of entry (BCDC populates) – Date of entry into US (BCDC populates – prepopulates exposure window) – Reason to travel to impacted country – If not US resident, reason to travel to US

CDESS Supplemental Travel Plans – Employment Place of Employment/School Address of Employer Mode(s) of Transportation – Plans to travel prior to end of 21 day monitoring period Includes vacation, day trips, holidays, relocation Dates of Travel Mode(s) of Transportation – For visitors to US, date of departure back to West Africa

CDESS Supplemental Disposition – Status Medical Evaluation Required Conditional Release Self Monitoring 21 days monitoring completed Comments field Remember to click “Update” for changes to register

CDESS DEMONSTRATION

Quarantine Order Vs. Traveler Monitoring Quarantine Order – High and Some Risk 21 days from last direct contact – Low, but not Zero Risk 21 days from leaving country Traveler Monitoring – 21 days from leaving impacted country

Example Person travels to country on 10/1/14 and has direct contact until 10/8/14 Travels in country from 10/8/14-10/15/14 with no direct contact Leaves country on 10/15/14 for US Arrives at JFK on 10/16/14 Quarantine Order for high or some risk in effect from 10/16/14-10/29/14 Move to low, but not zero risk from 10/29-11/6 Temperature Monitoring from 10/16-11/6 10/1 10/810/15 10/16 10/29 11/6 Direct Contact Travel in country No direct contact Departs Country Arrives at JFK Quarantine Order Temperature Monitoring

Final Note If you find out information that would put someone in the high or some risk categories – Contact NYSDOH immediately prior to issuing a quarantine order

QUESTIONS