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Development and Implementation of the Ebola Traveler Monitoring Program and Clinical Outcomes of Monitored Travelers during October - May 2015, Minnesota.

Abstract In October 2014, the United States began actively monitoring all persons who had traveled from Guinea, Liberia, and Sierra Leone in the previous 21 days. State public health departments were responsible for monitoring all travelers; Minnesota has the largest Liberian population in the United States. The MDH Ebola Clinical Team (ECT) was established to assess travelers with symptoms of concern for Ebola virus disease (EVD), coordinate access to healthcare at appropriate facilities including Ebola Assessment and Treatment Units (EATU), and provide guidance to clinicians.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title plos one
Publication Year Start




PMID- 27907013
OWN - NLM
STAT- In-Data-Review
DA  - 20161201
LR  - 20161221
IS  - 1932-6203 (Electronic)
IS  - 1932-6203 (Linking)
VI  - 11
IP  - 12
DP  - 2016
TI  - Development and Implementation of the Ebola Traveler Monitoring Program and
      Clinical Outcomes of Monitored Travelers during October - May 2015, Minnesota.
PG  - e0166797
LID - 10.1371/journal.pone.0166797 [doi]
AB  - BACKGROUND: In October 2014, the United States began actively monitoring all
      persons who had traveled from Guinea, Liberia, and Sierra Leone in the previous
      21 days. State public health departments were responsible for monitoring all
      travelers; Minnesota has the largest Liberian population in the United States.
      The MDH Ebola Clinical Team (ECT) was established to assess travelers with
      symptoms of concern for Ebola virus disease (EVD), coordinate access to
      healthcare at appropriate facilities including Ebola Assessment and Treatment
      Units (EATU), and provide guidance to clinicians. METHODS: Minnesota Department
      of Health (MDH) began receiving traveler information collected by U.S. Customs
      and Border Control and Centers for Disease Control and Prevention staff on
      October 21, 2014 via encrypted electronic communication. All travelers returning 
      from Liberia, Sierra Leone, and Guinea during 10/21/14-5/15/15 were monitored by 
      MDH staff in the manner recommended by CDC based on the traveler's risk
      categorization as "low (but not zero)", "some" and "high" risk. When a traveler
      reported symptoms or a temperature >/=100.4 degrees F at any time during their
      21-day monitoring period, an ECT member would speak to the traveler and perform a
      clinical assessment by telephone or via video-chat. Based on the assessment the
      ECT member would recommend 1) continued clinical monitoring while at home with
      frequent telephone follow-up by the ECT member, 2) outpatient clinical evaluation
      at an outpatient site agreed upon by all parties, or 3) inpatient clinical
      evaluation at one of four Minnesota EATUs. ECT members assessed and approved
      testing for Ebola virus infection at MDH. Traveler data, calls to the ECT and
      clinical outcomes were logged on a secure server at MDH. RESULTS: During
      10/21/14-5/15/15, a total of 783 travelers were monitored; 729 (93%) traveled
      from Liberia, 30 (4%) Sierra Leone, and 24 (3%) Guinea. The median number
      monitored per week was 59 (range 45-143). The median age was 35 years; 136 (17%) 
      were aged <18 years. Thirteen of 256 women of reproductive age (5%) were
      pregnant. The country of passport issuance was known for 720 of the travelers.
      The majority of monitored travelers (478 [66%]) used a non-U.S. passport
      including 442 (61%) Liberian nationals. A total of 772 (99%) travelers were "low 
      (but not zero)" risk; 11 (1%) were "some" risk. Among monitored travelers, 43
      (5%) experienced illness symptoms; 29 (67%) had a symptom consistent with EVD.
      Two were tested for Ebola virus disease and had negative results. Most frequently
      reported symptoms were fever (20/43, 47%) and abdominal pain (12/43, 28%). During
      evaluation, 16 (37%) of 43 travelers reported their symptoms began prior to
      travel; chronic health conditions in 24 travelers including tumors/cancer,
      pregnancy, and orthopedic conditions were most common. Infectious causes in 19
      travelers included upper respiratory infection, malaria, and gastrointestinal
      infections. DISCUSSION: Prior to 2014, no similar active monitoring program for
      travelers had been performed in Minnesota; assessment and management of
      symptomatic travelers was a new activity for MDH. Ensuring safe entrance into
      healthcare was particularly challenging for children, and pregnant women, as well
      as those without an established connection to healthcare. Unnecessary inpatient
      evaluations were successfully avoided by close clinical follow-up by phone.
      Before similar monitoring programs are considered in the future, careful thought 
      must be given to necessary resources and the impact on affected populations,
      public health, and the healthcare system.
FAU - DeVries, Aaron
AU  - DeVries A
AD  - Infectious Disease Section, Minneapolis VA Medical Center, Minneapolis,
      Minnesota, United States of America.
AD  - School of Medicine and Public Health, University of Minnesota, Minneapolis,
      Minnesota, United States of America.
FAU - Talley, Pamela
AU  - Talley P
AD  - Epidemic Intelligence Service, Division of Science Education and Professional
      Development, Centers for Disease Control and Prevention, Atlanta, Georgia, United
      States of America.
AD  - Infectious Disease Epidemiology, Prevention and Control Division, Minnesota
      Department of Health, St. Paul, Minnesota, United States of America.
FAU - Sweet, Kristin
AU  - Sweet K
AD  - Infectious Disease Epidemiology, Prevention and Control Division, Minnesota
      Department of Health, St. Paul, Minnesota, United States of America.
FAU - Kline, Susan
AU  - Kline S
AD  - Infectious Disease Division, University of Minnesota Medical School, Minneapolis,
      Minnesota, United States of America.
FAU - Stinchfield, Patricia
AU  - Stinchfield P
AD  - Children's Hospitals and Clinics of Minnesota, St. Paul, Minnesota, United States
      of America.
FAU - Tosh, Pritish
AU  - Tosh P
AD  - Division of Infectious Disease, Mayo Clinic, Rochester, Minnesota, United States 
      of America.
FAU - Danila, Richard
AU  - Danila R
AD  - Infectious Disease Epidemiology, Prevention and Control Division, Minnesota
      Department of Health, St. Paul, Minnesota, United States of America.
LA  - eng
PT  - Journal Article
DEP - 20161201
PL  - United States
TA  - PLoS One
JT  - PloS one
JID - 101285081
PMC - PMC5132316
EDAT- 2016/12/03 06:00
MHDA- 2016/12/03 06:00
CRDT- 2016/12/02 06:00
PHST- 2016/02/11 [received]
PHST- 2016/11/03 [accepted]
AID - 10.1371/journal.pone.0166797 [doi]
AID - PONE-D-16-05647 [pii]
PST - epublish
SO  - PLoS One. 2016 Dec 1;11(12):e0166797. doi: 10.1371/journal.pone.0166797.
      eCollection 2016.

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