Responding to Ebola: Tracking Travelers Jessica L. Silvaggio, MPH CDC/ CSTE Applied Epidemiology Fellow

Initial EVD Cases Treated in the US: Case 1: September 30, CDC confirmed the first laboratory-confirmed case of Ebola to be diagnosed in the US in a man who had traveled to Dallas, Texas from Liberia 1 CDC 2015 Case 1 09/30/2014

Initial EVD Cases Treated in the US: Case 1: September 30, CDC confirmed the first laboratory-confirmed case of Ebola to be diagnosed in the US in a man who had traveled to Dallas, Texas from Liberia Case 2: October 10, Healthcare worker (HCW) at Texas Presbyterian Hospital who provided care to Case 1 tested positive for Ebola 2 CDC 2015 Case 1 09/30/2014 Case 2 10/10/2014

Initial EVD Cases Treated in the US: Case 1: September 30, CDC confirmed the first laboratory-confirmed case of Ebola to be diagnosed in the US in a man who had traveled to Dallas, Texas from Liberia Case 2: October 10, Healthcare worker (HCW) at Texas Presbyterian Hospital who provided care to Case 1 tested positive for Ebola Case 3: October 15, A second HCW who provided care to Case 1 at Texas Presbyterian Hospital tested positive for Ebola 3 CDC 2015 Case 1 09/30/2014 Case 2 10/10/2014 Case 3 10/15/2014

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Initial EVD Cases Treated in the US: CDC, WHO, and global partners were invited by ministries of health of Guinea, Liberia, and Sierra Leone Requested Assistance in developing and implementing exit screening procedures Since August 2014, 80,000 travelers have departed by air from 3 EACs Procedures implemented to deny boarding to ill travelers and persons who report high risk of exposure No international air travelers from an EAC has been reported as symptomatic with EVD since these procedures were implemented 5 CDC 2014

CDC Deployment Division of Global Migration and Quarantine Primary responsibilities: – Maintained operations, data management processes, quality checks, follow- up – Developed data reports for CDC leadership and White House – Maintained accuracy and efficiency of the Department of Homeland Security (DHS) data – Processed traveler information from US airports and DHS systems to states within 4 hours of flight arrival 6

Incident Command System 7

Incident Command System: Domestic Assistance Team 8

Entry Screening in the US 9 PBS, 2014

Entry Screening in the US 10 PBS, 2014 Zero direct flights to LAX

Primary screening Screening Process 11

Primary screening Secondary screening Airport Exit and Entry Screening for Ebola 12

Primary screening Secondary screening Tertiary screening Airport Exit and Entry Screening for Ebola 13

Primary screening Secondary screening Tertiary screening Entry Screening Data 14

Traveler Notification Process from CDC to Los Angeles 15

Traveler Notification Process from CDC to Los Angeles 16

Traveler Notification Process from CDC to Los Angeles 17

 First 3 Month Review Preliminary Analysis  Total number of monitored travelers assessed by LAC DPH: 63  Active monitoring: 56 (89%)  Never active: 7 (11%) Los Angeles County: Monitoring Travelers 18

EVD Traveler Monitoring by Week 19

 43 (77%) assessments completed by DPH  13 (23%) of travelers transferred prior to close of incubation period  5 (9%) left US  8 (14%) transferred within the US (outside and inside CA)  Low risk: 53 (95%)  Some risk: 3 (5%, 2 transferred to another state)  Age: 39 yo (mean), 3 children < 5 yo  Sex: 35 (63%) males Los Angeles County: Traveler Assessments and Demographics 20

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Los Angeles County: Ebola Call Team 10/10/2014 – 01/08/ calls Most common reasons for calling included: 22

 August 2014, survey sent to infection preventionists to assess hospitals who would voluntarily receive a possible Ebola patient  50% response rate; approximately 11 indicated “yes” to receiving a possible Ebola patient  Health officer sent a letter sent to 100% of acute care facilities Los Angeles County: Priority #1 Hospital Preparedness 23

 Outreach initiated: October 23, 2014  Liaison public health nurses ed all LAC infection preventionists  Purpose: to provide guidance during EVD planning and preparedness  71 acute care facilities with emergency departments  ACDC collaborated with 50 (70%) of facilities Los Angeles County: Prioritizing Hospital Preparedness 24

ActivityNo. of facilities to have completed activity Emergency department visit, walk-through45 Ebola Virus Disease drill29 Ebola Virus Disease policy/ procedures review34 Los Angeles County Hospital Preparedness Preliminary Findings 25

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Acknowledgements Dawn Terashita, MD MPH Laurene Mascola, MD MPH Moon Kim, MD MPH Jeffrey Gunzenhauser, MD MPH Healthcare Outreach Unit Alison Itano, MPH Curtis Croker, MPH Mike Tormey, MPH Aaron Aranas, MBA Kate Shaw, PhD Domestic Assistance Team Los Angeles County Department of Public Health Centers for Disease Control and Prevention Council of State and Territorial Epidemiologists Publication acknowledgement: This report was supported in part by an appointment to the Applied Epidemiology Fellowship Program administered by the Council of State and Territorial Epidemiologists (CSTE) and funded by the Centers for Disease Control and Prevention (CDC) Cooperative Agreement Number 1U38OT

Questions: 1) To facilitate a more collaborative approach, what would you as infection preventionists and hospital epidemiologists like to see from Los Angeles County Department of Public Health for future similar situations? 2) What are ways GLA APIC chapter members can collaborate with the Los Angeles County Department of Public Health to support emerging infectious disease preparedness efforts? 28

Thank you! Jessica L. Silvaggio, MPH Los Angeles County Department of Pubic Health Council of State and Territorial 29

Roundtable 30

Questions: 1) To facilitate a more collaborative approach, what would you as infection preventionists and hospital epidemiologists like to see from Los Angeles County Department of Public Health for future similar situations? 2) What are ways GLA APIC chapter members can collaborate with the Los Angeles County Department of Public Health to support emerging infectious disease preparedness efforts? 31