Clinical inquiries regarding Ebola virus disease received by CDC--United States, July 9-November 15, 2014

Abstract

Since early 2014, there have been more than 6,000 reported deaths from Ebola virus disease (Ebola), mostly in Guinea, Liberia, and Sierra Leone. On July 9, 2014, CDC activated its Emergency Operations Center for the Ebola outbreak response and formalized the consultation service it had been providing to assist state and local public health officials and health care providers evaluate persons in the United States thought to be at risk for Ebola. During July 9-November 15, CDC responded to clinical inquiries from public health officials and health care providers from 49 states and the District of Columbia regarding 650 persons thought to be at risk. Among these, 118 (18%) had initial signs or symptoms consistent with Ebola and epidemiologic risk factors placing them at risk for infection, thereby meeting the definition of persons under investigation (PUIs). Testing was not always performed for PUIs because alternative diagnoses were made or symptoms resolved. In total, 61 (9%) persons were tested for Ebola virus, and four, all of whom met PUI criteria, had laboratory-confirmed Ebola. Overall, 490 (75%) inquiries concerned persons who had neither traveled to an Ebola-affected country nor had contact with an Ebola patient. Appropriate medical evaluation and treatment for other conditions were noted in some instances to have been delayed while a person was undergoing evaluation for Ebola. Evaluating and managing persons who might have Ebola is one component of the overall approach to domestic surveillance, the goal of which is to rapidly identify and isolate Ebola patients so that they receive appropriate medical care and secondary transmission is prevented. Health care providers should remain vigilant and consult their local and state health departments and CDC when assessing ill travelers from Ebola-affected countries. Most of these persons do not have Ebola; prompt diagnostic assessments, laboratory testing, and provision of appropriate care for other conditions are essential for appropriate patient care and reflect hospital preparedness.

FIGURE 1

Number of clinical inquiries from health departments and health care providers regarding persons thought to be at risk for Ebola virus disease, by state — United States, July 9–November 15, 2014

FIGURE 2

Number of clinical inquiries from health departments and health care providers regarding persons thought to be at risk for Ebola virus disease (Ebola), by epidemiologic risk factor^* and epidemiologic week — United States, July 9–November 15, 2014 ^* Epidemiologic risk factors include contact with an Ebola patient or patient’s body fluids or travel to an Ebola-affected country within 21 days of symptom onset. Countries with widespread Ebola virus transmission include Guinea, Liberia, and Sierra Leone. Those with localized transmission included Senegal during August 29–September 26 and Nigeria during July 23–September 30. Since October 18, Mali has had cases in urban settings.