Transcript ACHD Planning Committee Meeting

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, 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 Activities
Restricted
Travel
HIGH risk
Direct 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 materials
http://www.npr.org/blogs/goatsandsoda/2014/08/19/341412011/shadow-and-d-12-sing-an-infectioussong-about-ebola