I called “Ann” for 21 days straight. Each time, we had the same conversation—how was I feeling, had I recorded my temperature, noticed any changes in my health? After a few minutes of discussion, we’d hang up.
Like all travelers returning to the U.S. after visiting West Africa, when I came back from Liberia I was required to report to the Massachusetts Department of Public Health (MDPH). Ann, my contact at the MDPH Bureau of Infectious Disease, asked that I stay in contact with her and utilize my “CARE Kit,” a packet from the Centers for Disease Control and Prevention (CDC) that contained a logbook, a cell phone, a thermometer, and a contact card. I was required to report my temperature and health status daily as symptoms for Ebola virus disease can manifest at any point during the 21-day incubation period.
Although a nuisance to remember each day, I knew how important it was to follow protocol, despite the fact that at the time that I was there Liberia was Ebola-free. While it was much safer to travel in West Africa than it had been a few months prior, Guinea and Sierra Leone were still reporting new cases, so there was still some risk. Just a few days after I’d completed my required reporting period, a handful of Ebola cases re-emerged in Liberia, emphasizing the importance of continuing precautionary measures.
Last December, my colleague, Brian VanDeBogert, Project Director of the Liberia Infection Prevention and Control Project, was one of the first travelers to test the Ebola active monitoring system in Massachusetts after returning from work in Liberia. Although Brian was a low-risk traveler, he reported a fever just a few days into his 21-day reporting period. Because of the monitoring program, Brian was quickly transported to Massachusetts General Hospital, placed in isolation, and provided appropriate evaluation and medical care. A few hours later, he was diagnosed with malaria, not Ebola, and immediately placed on medication. While he was not an Ebola-infected patient, his story demonstrates the effectiveness of the monitoring program and its role in coordinating care for at-risk travelers across the state.
In July, JSI assumed responsibility from the Massachusetts Department of Public Health to manage the monitoring process for those returning from Ebola-infected countries in West Africa. Under the Massachusetts Ebola Virus Monitoring Project, JSI currently monitors travelers with a low-risk for Ebola infection returning from Guinea and Sierra Leone. As of September 21st, the CDC removed Liberia from the list of countries requiring travelers to monitor their health for Ebola symptoms.
As of September 2015, JSI has actively monitored 225 travelers returning from West Africa, contacting each of them at least once a day. When the travelers arrive in the United States, they are categorized according to risk level based on their potential to have been exposed to Ebola. Low-risk travelers in Massachusetts are then contacted by a JSI team member and monitored for potential Ebola symptoms like fever, vomiting, and diarrhea for 21 days after their last opportunity for exposure to the virus. JSI works closely with other state health departments to coordinate monitoring for people who travel to other states, and with CDC for people who travel to other countries, during the 21 days.
This active surveillance system is designed to quickly identify travelers who develop potential Ebola symptoms, and to promptly transport them to an appropriate medical facility to minimize potential exposure to others and provide them with quick, effective diagnosis and treatment. Traveler monitoring is just one of a series of coordinated public health activities that are essential to stop and reverse the spread of Ebola and is a model that could be used for other infectious disease outbreaks.
Thankfully, the number of Ebola cases in West Africa continue to decrease. Yet, it is still important that countries worldwide take necessary precautions to prevent the spread of Ebola and other highly infectious diseases. Until Guinea and Sierra Leone are officially Ebola-free, travelers must remain vigilant, even when their risk of contracting the disease is low. Through programs like the Massachusetts Ebola Virus Monitoring Project, travelers can be sure that the reporting process goes as smoothly as possible so that they and their communities remain healthy.
More information about the national and international response to the Ebola epidemic and the most recent data can be found on the CDC website at www.cdc.gov/ebola.