The 2014 Ebola Epidemic: Public Health Preparedness Kristen Mertz, MD, MPH Allegheny County Health Department December 5, 2014

How to stop Ebola outbreaks Recognize suspected cases (symptoms and exposure) Isolate patients with Ebola Use personal protective equipment (PPE) Sterilize equipment and disinfect surfaces Identify and monitor contacts

Source: New York Times

West Africa: >17,000 cases

EVD Cases (United States) Index patient – Developed symptoms Sept 24, went to Dallas hospital Sept 26, admitted Sept 28, tested positive Sept 30, died Oct 8. TX Healthcare Worker, Case 2 – Cared for index patient, developed fever and diagnosed Oct 10, released from NIH Clinical Center Oct 24. TX Healthcare Worker, Case 3 – Cared for index patient, developed low-grade fever and diagnosed Oct 15, released from Emory University Hospital Oct 28. NY Medical Aid Worker, Case 4 – Worked with Ebola patients in Guinea, developed fever and diagnosed Oct 24, released from Bellevue Hospital on Nov 11. 6

Role of local/state health depts Prepare for case Respond to suspect cases Monitor travelers Identify and monitor contacts Combat fear, stigma

Preparing for a case CDC conference calls, guidelines Calls with other states, cities Staff updates, exercises

Preparing for a case Communication with local agencies –Hospitals –EMS, –Outpatient clinics (urgent care, FQHCs, etc) –Private physicians –Colleges, universities –School nurses –Airport –Business community –County Council Communication with general public –Media –Phone inquiries

Responding to possible cases Assess based on testing criteria –Travel in epidemic area in previous 21 days –Exposure ( HIGH, SOME, LOW but not zero risk) –Symptoms: T>38C (100.4F) Review infection control measures Begin contact tracing

Monitoring travelers Screening upon departure in Guinea, Sierra Leone, Liberia, Mali Screening upon arrival at 5 major US airports Daily monitoring by state and local health departments –Temperature twice a day –Home visits for HIGH or SOME risk and HCWs –Phone calls for LOW risk

Monitoring travelers Travel restricted if HIGH risk (sometimes if SOME risk) Excluded from public places and congregate gatherings if HIGH risk (sometimes for SOME risk) No travel/movement restrictions if LOW risk Required to report symptoms immediately to health department Referred to hospital if appropriate

Airport CARE kits

CDC’s Interim Guidance for Monitoring and Movement of Persons with EVD Exposure RISK LEVEL PUBLIC HEALTH ACTION MonitoringRestricted Public Activities Restricted Travel HIGH riskDirect Active MonitoringYes SOME riskDirect Active Monitoring Case-by-case assessment Case-by-case assessment LOW risk Active Monitoring for some; Direct Active Monitoring for others No NO riskNo

Issues with monitoring Each state has different rules Some travelers lost to followup Thermometers don’t always work Mild illness causes panic

Contact tracing: Dallas and NYC experience Interview patient Identify all contacts Monitor all community contacts Monitor all health care workers involved in care

New York City Ebola Command Center Source: New York Times, Nov 12, 2014

Combatting stigmatization West Africans and health care workers and their families may be ostracized even if not at risk Sharing accurate information may help to counteract stigmatization

CDC Response in West Africa Surveillance Contact tracing Safe burials Data management Lab testing Health education

Resources CDC’s Ebola webpage PA Department of Health’s Ebola webpage Allegheny County Health Department webpage Supercourse Johns Hopkins/USAID Ebola Communications Network Education materials song-about-ebola Supercourse