Responding to Ebola: Tracking Travelers Jessica L. Silvaggio, MPH CDC/ CSTE Applied Epidemiology...
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Responding to Ebola: Tracking Travelers Jessica L. Silvaggio, MPH CDC/ CSTE Applied Epidemiology Fellow
Transcript of Responding to Ebola: Tracking Travelers Jessica L. Silvaggio, MPH CDC/ CSTE Applied Epidemiology...
Responding to Ebola: Tracking Travelers
Jessica L. Silvaggio, MPHCDC/ CSTE Applied Epidemiology Fellow
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Initial EVD Cases Treated in the US:
• Case 1: September 30, 2014- 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
CDC 2015
Case 109/30/2014
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Initial EVD Cases Treated in the US:
• Case 1: September 30, 2014- 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, 2014- Healthcare worker (HCW) at Texas Presbyterian Hospital who provided care to Case 1 tested positive for Ebola
CDC 2015
Case 109/30/2014
Case 210/10/2014
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Initial EVD Cases Treated in the US:
• Case 1: September 30, 2014- 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, 2014- Healthcare worker (HCW) at Texas Presbyterian Hospital who provided care to Case 1 tested positive for Ebola
• Case 3: October 15, 2014- A second HCW who provided care to Case 1 at Texas Presbyterian Hospital tested positive for Ebola
CDC 2015
Case 109/30/2014
Case 210/10/2014
Case 310/15/2014
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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
CDC 2014
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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
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Incident Command System
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Incident Command System: Domestic Assistance Team
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Entry Screening in the US
PBS, 2014
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Entry Screening in the US
PBS, 2014
Zero direct flights to LAX
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Primary screening
Screening Process
All
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Primary screening
Secondary screening
Airport Exit and Entry Screening for Ebola
All
CBP
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Primary screening
Secondary screening
Tertiary screening
Airport Exit and Entry Screening for Ebola
All
CBP
CDC
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Primary screening
Secondary screening
Tertiary screening
Entry Screening Data
All
CBP
CDC
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Traveler Notification Process from CDC to Los Angeles
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Traveler Notification Process from CDC to Los Angeles
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Traveler Notification Process from CDC to Los Angeles
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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
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Oct Nov Dec Jan0
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10
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First 3 Months 2014-2015, Los Angeles County
Transferred before IP done
Completed IP
Date Monitoring Initiated
# of
Tra
vele
rs
*IP = incubation period
2014 2015
EVD Traveler Monitoring by Week
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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
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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
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Outreach initiated: October 23, 2014 Liaison public health nurses emailed 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
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Activity No. of facilities to have completed activity
Emergency department visit, walk-through 45
Ebola Virus Disease drill 29
Ebola Virus Disease policy/ procedures review 34
Los Angeles County Hospital Preparedness Preliminary Findings
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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 1U38OT000143-02.
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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?
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Thank you!
Jessica L. Silvaggio, MPHEmail: [email protected]
Los Angeles County Department of Pubic HealthCouncil of State and Territorial Epidemiologists
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Roundtable
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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?
