The 2014 Ebola Epidemic: 

Public Health Preparedness

Kristen Mertz, MD, MPHAllegheny 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, 9-1-1– 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

Monitoring Restricted

Public ActivitiesRestricted Travel

HIGH riskDirect Active Monitoring Yes Yes

SOME risk Direct Active Monitoring

Case-by-case assessment

Case-by-case assessment

LOW risk

Active Monitoring for some; Direct Active Monitoring for others

No No

NO risk No No No

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 materialshttp://www.npr.org/blogs/goatsandsoda/2014/08/19/341412011/shadow-and-d-12-sing-an-infectious-song-about-ebola

• Supercourse