View source for Ebola monitoring and movement of persons following exposure

__NOTOC__
{{Ebola}}
{{CMG}}; {{AE}} {{Rim}}

==Overview==
Early recognition is critical to controlling the spread of Ebola virus. Health care providers should be alert for and evaluate any patients with symptoms consistent with Ebola virus disease (EVD) and potential exposure history. Standard, contact, and droplet precautions should be immediately implemented if EVD is suspected.  Both clinical presentation and level of exposure should be taken into account when determining appropriate public health actions, including the need for medical evaluation or monitoring and the application of movement restrictions when indicated.<ref name=CDC1>{{cite web |url=http://www.cdc.gov/vhf/ebola/exposure/monitoring-and-movement-of-persons-with-exposure.html |title=Interim U.S. Guidance for Monitoring and Movement of Persons with Potential Ebola Virus Exposure|last1= |first1= |last2= |first2= |date=October 27 2014 |website=www.cdc.gov |publisher=Centers for Disease Control and Prevention (CDC) |accessdate=October 28 2014}} </ref>

==Active and Direct Active Monitoring==
*Active monitoring means that the state or local public health authority assumes responsibility for establishing regular communication with potentially exposed individuals, including checking daily to assess for the presence of symptoms and fever, rather than relying solely on individuals to self-monitor and report symptoms if they develop.<ref name=CDC1>{{cite web |url=http://www.cdc.gov/vhf/ebola/exposure/monitoring-and-movement-of-persons-with-exposure.html |title=Interim U.S. Guidance for Monitoring and Movement of Persons with Potential Ebola Virus Exposure|last1= |first1= |last2= |first2= |date=October 27 2014 |website=www.cdc.gov |publisher=Centers for Disease Control and Prevention (CDC) |accessdate=October 28 2014}} </ref> 
*Direct active monitoring means the public health authority conducts active monitoring through direct observation.<ref name=CDC1>{{cite web |url=http://www.cdc.gov/vhf/ebola/exposure/monitoring-and-movement-of-persons-with-exposure.html |title=Interim U.S. Guidance for Monitoring and Movement of Persons with Potential Ebola Virus Exposure|last1= |first1= |last2= |first2= |date=October 27 2014 |website=www.cdc.gov |publisher=Centers for Disease Control and Prevention (CDC) |accessdate=October 28 2014}} </ref>

The purpose of active (or direct active) monitoring is to ensure that, if individuals with epidemiologic risk factors become ill, they are identified as soon as possible after symptom onset so they can be rapidly isolated and evaluated. Active (or direct active) monitoring could be either conducted on a voluntary basis or compelled by legal order. Active (or direct active) monitoring and prompt follow-up should continue and be uninterrupted if the person travels out of the jurisdiction.<ref name=CDC1>{{cite web |url=http://www.cdc.gov/vhf/ebola/exposure/monitoring-and-movement-of-persons-with-exposure.html |title=Interim U.S. Guidance for Monitoring and Movement of Persons with Potential Ebola Virus Exposure|last1= |first1= |last2= |first2= |date=October 27 2014 |website=www.cdc.gov |publisher=Centers for Disease Control and Prevention (CDC) |accessdate=October 28 2014}} </ref>

===Active Monitoring===
Active monitoring should consist of, at a minimum<ref name=CDC1>{{cite web |url=http://www.cdc.gov/vhf/ebola/exposure/monitoring-and-movement-of-persons-with-exposure.html |title=Interim U.S. Guidance for Monitoring and Movement of Persons with Potential Ebola Virus Exposure|last1= |first1= |last2= |first2= |date=October 27 2014 |website=www.cdc.gov |publisher=Centers for Disease Control and Prevention (CDC) |accessdate=October 28 2014}} </ref>:
*Daily reporting of measured temperatures and symptoms consistent with Ebola (including severe headache, fatigue, muscle pain, fatigue or weakness, diarrhea, vomiting, abdominal pain, or unexplained hemorrhage) by the individual to the public health authority. 
*Temperature should be measured using an FDA-approved thermometer (e.g. oral, tympanic or noncontact). 
*People being actively monitored should measure their temperature twice daily, monitor themselves for symptoms, report as directed to the public health authority, and immediately notify the public health authority if they develop fever or other symptoms. *Initial symptoms can be as nonspecific as fatigue. 
*Clinical criteria for required medical evaluation according to exposure level have been defined (see Table below), and should result in immediate isolation and evaluation. Medical evaluation may be recommended for lower temperatures or nonspecific symptoms based on exposure level and clinical presentation.

===Direct Active Monitoring===
For direct active monitoring, a public health authority directly observes the individual as follows:<ref name=CDC1>{{cite web |url=http://www.cdc.gov/vhf/ebola/exposure/monitoring-and-movement-of-persons-with-exposure.html |title=Interim U.S. Guidance for Monitoring and Movement of Persons with Potential Ebola Virus Exposure|last1= |first1= |last2= |first2= |date=October 27 2014 |website=www.cdc.gov |publisher=Centers for Disease Control and Prevention (CDC) |accessdate=October 28 2014}} </ref>:
*At least once daily to review symptom status and monitor temperature
*A second follow-up per day may be conducted by telephone in lieu of a second direct observation. 
*Direct active monitoring should include discussion of plans to work, travel, take public conveyances, or be present in congregate locations. Depending on the nature and duration of these activities, they may be permitted if the individual has been consistent with direct active monitoring (including recording and reporting of a second temperature reading each day), has a normal temperature and no symptoms whatsoever, and can ensure uninterrupted direct active monitoring by a public health authority.

For healthcare workers under direct active monitoring<ref name=CDC1>{{cite web |url=http://www.cdc.gov/vhf/ebola/exposure/monitoring-and-movement-of-persons-with-exposure.html |title=Interim U.S. Guidance for Monitoring and Movement of Persons with Potential Ebola Virus Exposure|last1= |first1= |last2= |first2= |date=October 27 2014 |website=www.cdc.gov |publisher=Centers for Disease Control and Prevention (CDC) |accessdate=October 28 2014}} </ref>:
*Public health authorities can delegate the responsibility for direct active monitoring to the healthcare facility’s occupational health program or the hospital epidemiologist. 
*Facilities may conduct direct active monitoring by performing fever checks on entry or exit from the Ebola treatment unit and facilitate reporting during days when potentially exposed healthcare workers are not working.
*The occupational health program or hospital epidemiologist would report daily to the public health authority.

==Controlled Movement==
Controlled movement limits the movement of people.<ref name=CDC1>{{cite web |url=http://www.cdc.gov/vhf/ebola/exposure/monitoring-and-movement-of-persons-with-exposure.html |title=Interim U.S. Guidance for Monitoring and Movement of Persons with Potential Ebola Virus Exposure|last1= |first1= |last2= |first2= |date=October 27 2014 |website=www.cdc.gov |publisher=Centers for Disease Control and Prevention (CDC) |accessdate=October 28 2014}} </ref> 

*For individuals subject to controlled movement, travel by long-distance commercial conveyances (e.g., aircraft, ship, bus, train) should not be allowed; if travel is allowed, it should be by noncommercial conveyance such as private chartered flight or private vehicle, and occur with arrangements for uninterrupted active monitoring.<ref name=CDC1>{{cite web |url=http://www.cdc.gov/vhf/ebola/exposure/monitoring-and-movement-of-persons-with-exposure.html |title=Interim U.S. Guidance for Monitoring and Movement of Persons with Potential Ebola Virus Exposure|last1= |first1= |last2= |first2= |date=October 27 2014 |website=www.cdc.gov |publisher=Centers for Disease Control and Prevention (CDC) |accessdate=October 28 2014}} </ref> 
*Federal public health travel restrictions (Do Not Board) may be used to enforce controlled movement. For people subject to controlled movement, use of local public transportation (e.g., bus, subway) should be discussed with and only occur with approval of the local public health authority.<ref name=CDC1>{{cite web |url=http://www.cdc.gov/vhf/ebola/exposure/monitoring-and-movement-of-persons-with-exposure.html |title=Interim U.S. Guidance for Monitoring and Movement of Persons with Potential Ebola Virus Exposure|last1= |first1= |last2= |first2= |date=October 27 2014 |website=www.cdc.gov |publisher=Centers for Disease Control and Prevention (CDC) |accessdate=October 28 2014}} </ref>

==Isolation==
Isolation means the separation of an individual or group who is reasonably believed to be infected with a quarantinable communicable disease from those who are not infected to prevent spread of the quarantinable communicable disease. An individual could be reasonably believed to be infected if he or she displays the signs and symptoms of the quarantinable communicable disease of concern and there is some reason to believe that an exposure had occurred.<ref name=CDC1>{{cite web |url=http://www.cdc.gov/vhf/ebola/exposure/monitoring-and-movement-of-persons-with-exposure.html |title=Interim U.S. Guidance for Monitoring and Movement of Persons with Potential Ebola Virus Exposure|last1= |first1= |last2= |first2= |date=October 27 2014 |website=www.cdc.gov |publisher=Centers for Disease Control and Prevention (CDC) |accessdate=October 28 2014}} </ref>

==Quarantine==
Quarantine in general means the separation of an individual or group reasonably believed to have been exposed to a quarantinable communicable disease, but who is not yet ill (not presenting signs or symptoms), from others who have not been so exposed, to prevent the possible spread of the quarantinable communicable disease.<ref name=CDC1>{{cite web |url=http://www.cdc.gov/vhf/ebola/exposure/monitoring-and-movement-of-persons-with-exposure.html |title=Interim U.S. Guidance for Monitoring and Movement of Persons with Potential Ebola Virus Exposure|last1= |first1= |last2= |first2= |date=October 27 2014 |website=www.cdc.gov |publisher=Centers for Disease Control and Prevention (CDC) |accessdate=October 28 2014}} </ref>

==Use of Public Health Orders==
Equitable and ethical use of public health orders includes supporting and compensating persons who make sacrifices in their individual liberties and freedoms for public good. Specifically, considerations must be in place to provide shelter, food and lost wage compensation, and to protect the dignity and privacy of the individual. Persons under public health orders should be treated with respect and dignity. Considerable thoughtful planning is needed to implement public health orders properly.<ref name=CDC1>{{cite web |url=http://www.cdc.gov/vhf/ebola/exposure/monitoring-and-movement-of-persons-with-exposure.html |title=Interim U.S. Guidance for Monitoring and Movement of Persons with Potential Ebola Virus Exposure|last1= |first1= |last2= |first2= |date=October 27 2014 |website=www.cdc.gov |publisher=Centers for Disease Control and Prevention (CDC) |accessdate=October 28 2014}} </ref>

==Early Recognition and Reporting of Suspected Ebola Virus Exposures==
Early recognition is critical to controlling the spread of Ebola virus. Health care providers should be alert for and evaluate any patients with symptoms consistent with EVD and potential exposure history. Standard, contact, and droplet precautions should be immediately implemented if EVD is suspected. Both clinical presentation and level of exposure should be taken into account when determining appropriate public health actions, including the need for medical evaluation or monitoring and the application of movement restrictions when indicated.<ref name=CDC1>{{cite web |url=http://www.cdc.gov/vhf/ebola/exposure/monitoring-and-movement-of-persons-with-exposure.html |title=Interim U.S. Guidance for Monitoring and Movement of Persons with Potential Ebola Virus Exposure|last1= |first1= |last2= |first2= |date=October 27 2014 |website=www.cdc.gov |publisher=Centers for Disease Control and Prevention (CDC) |accessdate=October 28 2014}} </ref>

==Recommendations for Specific Groups and Settings==
===Healthcare Workers===
For the purposes of risk exposure to Ebola, regardless of country, direct patient contact includes doctors, nurses, physician assistants and other healthcare staff, as well as ambulance personnel, burial team members, and morticians. In addition, others who enter into the treatment areas where Ebola patients are being cared for (such as observers) would be considered to potentially have patient contact and be at risk. Healthcare workers who have no direct patient contact and no entry into active patient management areas, including epidemiologists, contact tracers, airport screeners, as well as laboratory workers who use appropriate PPE, are not considered to have an elevated risk of exposure to Ebola, i.e., are considered to be in the low (but non-zero) risk category. The high toll of Ebola virus infections among healthcare workers providing direct care to Ebola patients in countries with widespread transmission suggests that there are multiple potential sources of exposure to Ebola virus in these countries, including unrecognized breaches in PPE, inadequate decontamination procedures, and exposure in patient triage areas. Due to this higher risk, these healthcare workers are classified in the some risk category, for which additional precautions are recommended upon their arrival in the United States (see Table).<ref name=CDC1>{{cite web |url=http://www.cdc.gov/vhf/ebola/exposure/monitoring-and-movement-of-persons-with-exposure.html |title=Interim U.S. Guidance for Monitoring and Movement of Persons with Potential Ebola Virus Exposure|last1= |first1= |last2= |first2= |date=October 27 2014 |website=www.cdc.gov |publisher=Centers for Disease Control and Prevention (CDC) |accessdate=October 28 2014}} </ref>

Healthcare workers who provide care to Ebola patients in U.S. facilities while wearing appropriate PPE and with no known breaches in infection control are considered to have low (but not zero) risk of exposure because of the possibility of unrecognized breaches in infection control and should have direct active monitoring.<ref name=CDC1>{{cite web |url=http://www.cdc.gov/vhf/ebola/exposure/monitoring-and-movement-of-persons-with-exposure.html |title=Interim U.S. Guidance for Monitoring and Movement of Persons with Potential Ebola Virus Exposure|last1= |first1= |last2= |first2= |date=October 27 2014 |website=www.cdc.gov |publisher=Centers for Disease Control and Prevention (CDC) |accessdate=October 28 2014}} </ref> 

*As long as these healthcare workers have direct active monitoring and are asymptomatic, there is no reason for them not to continue to work, including in hospitals and other patient care settings, nor is there a reason for them to have restrictions on travel or other activities.<ref name=CDC1>{{cite web |url=http://www.cdc.gov/vhf/ebola/exposure/monitoring-and-movement-of-persons-with-exposure.html |title=Interim U.S. Guidance for Monitoring and Movement of Persons with Potential Ebola Virus Exposure|last1= |first1= |last2= |first2= |date=October 27 2014 |website=www.cdc.gov |publisher=Centers for Disease Control and Prevention (CDC) |accessdate=October 28 2014}} </ref> 
*Review and approval of work, travel, use of public conveyances, and attendance at congregate events are not indicated or recommended for such healthcare workers.<ref name=CDC1>{{cite web |url=http://www.cdc.gov/vhf/ebola/exposure/monitoring-and-movement-of-persons-with-exposure.html |title=Interim U.S. Guidance for Monitoring and Movement of Persons with Potential Ebola Virus Exposure|last1= |first1= |last2= |first2= |date=October 27 2014 |website=www.cdc.gov |publisher=Centers for Disease Control and Prevention (CDC) |accessdate=October 28 2014}} </ref>


Healthcare workers taking care of Ebola patients in a U.S. facility where another healthcare worker has been diagnosed with confirmed Ebola without an identified breach in infection control are considered to have a higher level of potential exposure (exposure level: high risk). A similar determination would be made if an infection control breach is identified retrospectively during investigation of a confirmed case of Ebola in a healthcare worker.<ref name=CDC1>{{cite web |url=http://www.cdc.gov/vhf/ebola/exposure/monitoring-and-movement-of-persons-with-exposure.html |title=Interim U.S. Guidance for Monitoring and Movement of Persons with Potential Ebola Virus Exposure|last1= |first1= |last2= |first2= |date=October 27 2014 |website=www.cdc.gov |publisher=Centers for Disease Control and Prevention (CDC) |accessdate=October 28 2014}} </ref>
* These individuals would be subject to restrictions, including controlled movement and the potential use of public health orders, until 21 days after the last potential unprotected exposure.<ref name=CDC1>{{cite web |url=http://www.cdc.gov/vhf/ebola/exposure/monitoring-and-movement-of-persons-with-exposure.html |title=Interim U.S. Guidance for Monitoring and Movement of Persons with Potential Ebola Virus Exposure|last1= |first1= |last2= |first2= |date=October 27 2014 |website=www.cdc.gov |publisher=Centers for Disease Control and Prevention (CDC) |accessdate=October 28 2014}} </ref>


In U.S. healthcare facilities where an unidentified breach in infection control has occurred, assessment of infection control practices in the facility, remediation of any identified deficiencies, and training of healthcare workers in appropriate infection control practices should be conducted. Following remediation and training, asymptomatic potentially exposed healthcare workers may be allowed to continue to take care of Ebola patients, but care of other patients should be restricted. For these healthcare workers, the last potential unprotected exposure is considered to be the last contact with the Ebola patient prior to remediation and training; at 21 days after the last unprotected exposure, they would return to the low (but not zero) risk category under direct active monitoring. Healthcare workers whose first Ebola patient care activities occur after remediation and training are considered to be in the low (but not zero) risk category.<ref name=CDC1>{{cite web |url=http://www.cdc.gov/vhf/ebola/exposure/monitoring-and-movement-of-persons-with-exposure.html |title=Interim U.S. Guidance for Monitoring and Movement of Persons with Potential Ebola Virus Exposure|last1= |first1= |last2= |first2= |date=October 27 2014 |website=www.cdc.gov |publisher=Centers for Disease Control and Prevention (CDC) |accessdate=October 28 2014}} </ref>

===Crew on Public Conveyances===
Crew members on public conveyances, such as commercial aircraft or ships, who are not subject to controlled movement are also not subject to occupational restriction and may continue to work on the public conveyance while under active monitoring.<ref name=CDC1>{{cite web |url=http://www.cdc.gov/vhf/ebola/exposure/monitoring-and-movement-of-persons-with-exposure.html |title=Interim U.S. Guidance for Monitoring and Movement of Persons with Potential Ebola Virus Exposure|last1= |first1= |last2= |first2= |date=October 27 2014 |website=www.cdc.gov |publisher=Centers for Disease Control and Prevention (CDC) |accessdate=October 28 2014}} </ref>

===People with Confirmed Ebola Virus Disease===
For people with confirmed Ebola, isolation and movement restrictions are removed upon determination by public health authorities that the person is no longer considered to be infectious.<ref name=CDC1>{{cite web |url=http://www.cdc.gov/vhf/ebola/exposure/monitoring-and-movement-of-persons-with-exposure.html |title=Interim U.S. Guidance for Monitoring and Movement of Persons with Potential Ebola Virus Exposure|last1= |first1= |last2= |first2= |date=October 27 2014 |website=www.cdc.gov |publisher=Centers for Disease Control and Prevention (CDC) |accessdate=October 28 2014}} </ref>

==Recommendations for Evaluating Exposure Risk to Determine Appropriate Public Health Actions<ref name=CDC1>{{cite web |url=http://www.cdc.gov/vhf/ebola/exposure/monitoring-and-movement-of-persons-with-exposure.html |title=Interim U.S. Guidance for Monitoring and Movement of Persons with Potential Ebola Virus Exposure|last1= |first1= |last2= |first2= |date=October 27 2014 |website=www.cdc.gov |publisher=Centers for Disease Control and Prevention (CDC) |accessdate=October 28 2014}} </ref>==
{| style="cellpadding=0; cellspacing= 0; width: 1200px;"
|-
| style="padding: 0 5px; font-size: 150%; background: #4682B4; color: #FFFFFF;" align=center | <br>'''Exposure Category'''<br><br> || style="padding: 0 5px; font-size: 150%; background: #4682B4; color: #FFFFFF;" align=center |<br>'''Clinical Criteria''' <br><br>|| style="padding: 0 5px; font-size: 150%; background: #4682B4; color: #FFFFFF;" align=center |<br>'''Public Health Actions'''<br><br>
|-
|style="font-size: 100; padding: 0 5px; background: #E6E6FF" align=left valign=top rowspan=2 |<center><span style="color:blue"><span style="font-size:150%"><br>'''High Risk'''</span></span></center> <br>
* Percutaneous (e.g., needle stick) or [[mucous membrane]] exposure to [[blood]] or body fluids of a person with Ebola while the person was symptomatic
* Exposure to the blood or body fluids (including but not limited to feces, saliva, sweat, urine, vomit, and semen) of a person with Ebola while the person was symptomatic  without appropriate personal protective equipment (PPE)
* Processing blood or body fluids of a confirmed EVD patient without appropriate PPE or standard biosafety precautions
* Direct contact with a dead body without appropriate PPE in a country with widespread Ebola virus transmission
* Having lived in the immediate household and provided direct care to a person with Ebola while the person was symptomatic
|style="font-size: 100; padding: 0 5px; background: #E6E6FF" align=left |[[Fever]] (subjective fever or measured temperature ≥ 100.4 °F or 38 °C) OR any of the following<sup>+</sup>:
*Severe [[headache]]
*Muscle pain
*[[Vomiting]]
*[[Diarrhea]]
*Stomach pain
*Unexplained [[bruising]] or [[bleeding]]
|style="font-size: 100; padding: 0 5px; background: #E6E6FF" align=left |
* Implement rapid isolation with immediate contact of public health authorities to arrange for safe transport to an appropriate healthcare facility for Ebola evaluation
* Medical evaluation is required
**Isolation orders may be used to ensure compliance
**Air travel is permitted only by air medical transport
*If medically evaluated and discharged with a diagnosis other than Ebola, conditions as outlined for asymptomatic individuals in this exposure category will apply
|-
|style="font-size: 100; padding: 0 5px; background: #E6E6FF" align=left |Asymptomatic (no fever or other symptoms consistent with Ebola)
|style="font-size: 100; padding: 0 5px; background: #E6E6FF" align=left |
*Direct active monitoring
*Public health authority will ensure, through orders as necessary, the following minimum restrictions:
**Controlled movement: exclusion from all long-distance and local public conveyances (aircraft, ship, train, bus and subway)
**Exclusion from public places (e.g., shopping centers, movie theaters), and congregate gatherings
**Exclusion from workplaces for the duration of the public health order, unless approved by the state or local health department (telework is permitted)
*Non-congregate public activities while maintaining a 3-foot distance from others may be permitted (e.g., jogging in a park)
*Federal public health travel restrictions (Do Not Board) will be implemented to enforce controlled movement
*If travel is allowed, individuals are subject to controlled movement
**Travel by noncommercial conveyances only
**Coordinated with public health authorities at both origin and destination
**Uninterrupted direct active monitoring
|-
|style="font-size: 100; padding: 0 5px; background: #E6E6FF" align=left valign=top rowspan=2 |<center><span style="color:blue"><span style="font-size:150%"><br>'''Some Risk'''</span></span></center> <br>
* In countries with widespread Ebola virus transmission: direct contact while using appropriate PPE with a person with Ebola while the person was symptomatic
*Close contact in households, healthcare facilities, or community settings with a person with Ebola while the person was symptomatic
**Close contact is defined as being for a prolonged period of time while not wearing appropriate PPE within approximately 3 feet (1 meter) of a person with Ebola while the person was symptomatic
|style="font-size: 100; padding: 0 5px; background: #E6E6FF" align=left |[[Fever]] (subjective fever or measured temperature ≥ 100.4 °F or 38 °C) OR any of the following<sup>+</sup>:
*Severe [[headache]]
*Muscle pain
*[[Vomiting]]
*[[Diarrhea]]
*Stomach pain
*Unexplained [[bruising]] or [[bleeding]]
|style="font-size: 100; padding: 0 5px; background: #E6E6FF" align=left |
* Implement rapid isolation with immediate contact of public health authorities to arrange for safe transport to an appropriate healthcare facility for Ebola evaluation
* Medical evaluation is required
**Isolation orders may be used to ensure compliance
**Air travel is permitted only by air medical transport
*If medically evaluated and discharged with a diagnosis other than Ebola, conditions as outlined for asymptomatic individuals in this exposure category will apply
|-
|style="font-size: 100; padding: 0 5px; background: #E6E6FF" align=left |Asymptomatic (no fever or other symptoms consistent with Ebola)
|style="font-size: 100; padding: 0 5px; background: #E6E6FF" align=left |
*Direct active monitoring
*The public health authority, based on a specific assessment of the individual’s situation, will determine whether additional restrictions are appropriate, including:
**Controlled movement: exclusion from all long-distance and local public conveyances (bus, subway)
**Exclusion from public places (e.g., shopping centers, movie theaters), and congregate gatherings
**Exclusion from workplaces for the duration of the public health order, unless approved by the state or local health department (telework is permitted)
*Non-congregate public activities while maintaining a 3-foot distance from others may be permitted (e.g., jogging in a park)
*Other activities should be assessed as needs and circumstances change to determine whether these activities may be undertaken
*Any travel will be coordinated with public health authorities to ensure uninterrupted direct active monitoring
*Federal public health travel restrictions (Do Not Board) may be implemented based on an assessment of the particular circumstance
**For travelers arriving in the United States, implementation of federal public health travel restrictions would occur after the traveler reaches the final destination of the itinerary
|-
|style="font-size: 100; padding: 0 5px; background: #E6E6FF" align=left valign=top rowspan=2 |<center><span style="color:blue"><span style="font-size:150%"><br>'''Low (but not zero) Risk'''</span></span></center> <br>
* Having been in a country in which an EVD outbreak occurred within the past 21 days and having had no exposures
*Having brief direct contact (e.g., shaking hands), while not wearing appropriate PPE, with a person with Ebola while the person was in the early stage of disease
*Brief proximity, such as being in the same room for a brief period of time, with a person with Ebola while the person was symptomatic
*In countries without widespread Ebola virus transmission: direct contact while using appropriate PPE with a person with Ebola while the person was symptomatic

*Traveled on an aircraft with a person with Ebola while the person was symptomatic
|style="font-size: 100; padding: 0 5px; background: #E6E6FF" align=left |[[Fever]] (subjective fever or measured temperature ≥ 100.4 °F or 38 °C) OR any of the following<sup>+</sup>:
*[[Vomiting]]
*[[Diarrhea]]
*Unexplained [[bruising]] or [[bleeding]]
|style="font-size: 100; padding: 0 5px; background: #E6E6FF" align=left |
* Implement rapid isolation with immediate contact of public health authorities to arrange for safe transport to an appropriate healthcare facility for Ebola evaluation
* Medical evaluation is required
**Isolation orders may be used to ensure compliance
**Air travel is permitted only by air medical transport
*If medically evaluated and discharged with a diagnosis other than Ebola, conditions as outlined for asymptomatic individuals in this exposure category will apply
|-
|style="font-size: 100; padding: 0 5px; background: #E6E6FF" align=left |Asymptomatic (no fever, vomiting, diarrhea, or unexplained bruising or bleeding)
|style="font-size: 100; padding: 0 5px; background: #E6E6FF" align=left |
*No restrictions on travel, work, public conveyances, or congregate gatherings
*Direct active monitoring for:
**U.S.-based healthcare workers caring for symptomatic Ebola patients while wearing appropriate PPE
**Travelers on an aircraft with, and sitting within 3 feet of, a person with Ebola
*Active monitoring for all others in this category
|-
|style="font-size: 100; padding: 0 5px; background: #E6E6FF" align=left valign=top rowspan=2 |<center><span style="color:blue"><span style="font-size:150%"><br>'''No Identifiable Risk'''</span></span></center> <br>
*Contact with an asymptomatic person who had contact with person with Ebola
*Contact with a person with Ebola before the person developed symptoms
*Having been more than 21 days previously in a country with widespread Ebola virus transmission
*Having been in a country without widespread Ebola virus transmission and not having any other exposures as defined above
*Traveled on an aircraft with a person with Ebola while the person was symptomatic
|style="font-size: 100; padding: 0 5px; background: #E6E6FF" align=left |Symptomatic (any)
|style="font-size: 100; padding: 0 5px; background: #E6E6FF" align=left |
*Routine medical evaluation and management of ill persons, as needed
|-
|style="font-size: 100; padding: 0 5px; background: #E6E6FF" align=left |Asymptomatic
|style="font-size: 100; padding: 0 5px; background: #E6E6FF" align=left |
*No actions needed
|}
<sup>Table adapted from the "Centers for Disease Control and Prevention - Interim U.S. Guidance for Monitoring and Movement of Persons with Potential Ebola Virus Exposure".<ref name=CDC1>{{cite web |url=http://www.cdc.gov/vhf/ebola/exposure/monitoring-and-movement-of-persons-with-exposure.html |title=Interim U.S. Guidance for Monitoring and Movement of Persons with Potential Ebola Virus Exposure|last1= |first1= |last2= |first2= |date=October 27 2014 |website=www.cdc.gov |publisher=Centers for Disease Control and Prevention (CDC) |accessdate=October 28 2014}} </ref></sup>

<sup>+</sup>The temperature and symptoms thresholds provided are for the purpose of requiring medical evaluation. Isolation or medical evaluation may be recommended for lower temperatures or nonspecific symptoms (e.g., fatigue) based on exposure level and clinical presentation.


Additional restrictions, such as use of public health orders, may be warranted if an individual in the some or low (but not zero) risk categories fails to adhere to the terms of active (or direct active) monitoring. Such noncompliance could include refusal by an individual with documented travel from a country with widespread transmission, or other potential contact with a symptomatic Ebola patient, to participate in a public health assessment. Without such information, public health authorities may be unable to complete a risk assessment to determine if an individual has been exposed to, or has signs or symptoms consistent with, Ebola. For travelers from a country with widespread transmission who refuse to cooperate with a public health assessment and appear ill, medical evaluation will be required and isolation orders issued.<ref name=CDC1>{{cite web |url=http://www.cdc.gov/vhf/ebola/exposure/monitoring-and-movement-of-persons-with-exposure.html |title=Interim U.S. Guidance for Monitoring and Movement of Persons with Potential Ebola Virus Exposure|last1= |first1= |last2= |first2= |date=October 27 2014 |website=www.cdc.gov |publisher=Centers for Disease Control and Prevention (CDC) |accessdate=October 28 2014}} </ref>

==Considerations for Discharging Persons Under Investigation (PUI) for Ebola Virus Disease==
The decision to discharge a patient being evaluated as a Person Under Investigation (PUI) for Ebola who has not had a negative [[RT-PCR]] test for Ebola (RT-PCR testing for Ebola virus infection has not yet been performed or RT-PCR test result on a blood specimen collected less than 72 hours after onset of symptoms is negative) should be based on clinical and laboratory criteria and on the ability to monitor the PUI after discharge, and made by the medical providers caring for the PUI, along with the local and state health departments.<ref name=CDC>{{cite web |url=http://www.cdc.gov/vhf/ebola/hcp/considerations-discharging-pui.html|title=Considerations for Discharging Persons Under Investigation (PUI) for Ebola Virus Disease (Ebola)|last1= |first1= |last2= |first2= |date=October 30 2014 |website=www.cdc.gov |publisher=Centers for Disease Control and Prevention (CDC) |accessdate=October 31 2014}}</ref>

===Health care providers evaluating a PUI should consider these criteria when deciding to discharge a PUI===

*In the clinical judgment of the medical team, the PUI’s illness no longer appears consistent with Ebola.<ref name=CDC>{{cite web |url=http://www.cdc.gov/vhf/ebola/hcp/considerations-discharging-pui.html|title=Considerations for Discharging Persons Under Investigation (PUI) for Ebola Virus Disease (Ebola)|last1= |first1= |last2= |first2= |date=October 30 2014 |website=www.cdc.gov |publisher=Centers for Disease Control and Prevention (CDC) |accessdate=October 31 2014}}</ref>

*The PUI is afebrile off antipyretics for 24 hours, or there is an alternative explanation for fever.<ref name=CDC>{{cite web |url=http://www.cdc.gov/vhf/ebola/hcp/considerations-discharging-pui.html|title=Considerations for Discharging Persons Under Investigation (PUI) for Ebola Virus Disease (Ebola)|last1= |first1= |last2= |first2= |date=October 30 2014 |website=www.cdc.gov |publisher=Centers for Disease Control and Prevention (CDC) |accessdate=October 31 2014}}</ref>

*All symptoms that are compatible with Ebola (e.g., diarrhea or vomiting) have either resolved or can be accounted for by an alternative diagnosis.<ref name=CDC>{{cite web |url=http://www.cdc.gov/vhf/ebola/hcp/considerations-discharging-pui.html|title=Considerations for Discharging Persons Under Investigation (PUI) for Ebola Virus Disease (Ebola)|last1= |first1= |last2= |first2= |date=October 30 2014 |website=www.cdc.gov |publisher=Centers for Disease Control and Prevention (CDC) |accessdate=October 31 2014}}</ref>

*The PUI has no clinical laboratory results consistent with Ebola, or those that could be consistent with Ebola have been otherwise explained.<ref name=CDC>{{cite web |url=http://www.cdc.gov/vhf/ebola/hcp/considerations-discharging-pui.html|title=Considerations for Discharging Persons Under Investigation (PUI) for Ebola Virus Disease (Ebola)|last1= |first1= |last2= |first2= |date=October 30 2014 |website=www.cdc.gov |publisher=Centers for Disease Control and Prevention (CDC) |accessdate=October 31 2014}}</ref>

*The PUI is able to self-monitor (or to monitor a child, if the PUI is a child) and comply fully with active monitoring and controlled movement.<ref name=CDC>{{cite web |url=http://www.cdc.gov/vhf/ebola/hcp/considerations-discharging-pui.html|title=Considerations for Discharging Persons Under Investigation (PUI) for Ebola Virus Disease (Ebola)|last1= |first1= |last2= |first2= |date=October 30 2014 |website=www.cdc.gov |publisher=Centers for Disease Control and Prevention (CDC) |accessdate=October 31 2014}}</ref>

*There is a plan in place for the PUI to return for medical care if symptoms recur, which has been explained to the PUI, and the PUI understands what to do if symptoms recur.<ref name=CDC>{{cite web |url=http://www.cdc.gov/vhf/ebola/hcp/considerations-discharging-pui.html|title=Considerations for Discharging Persons Under Investigation (PUI) for Ebola Virus Disease (Ebola)|last1= |first1= |last2= |first2= |date=October 30 2014 |website=www.cdc.gov |publisher=Centers for Disease Control and Prevention (CDC) |accessdate=October 31 2014}}</ref>

*Local and state health departments have been engaged and concur.<ref name=CDC>{{cite web |url=http://www.cdc.gov/vhf/ebola/hcp/considerations-discharging-pui.html|title=Considerations for Discharging Persons Under Investigation (PUI) for Ebola Virus Disease (Ebola)|last1= |first1= |last2= |first2= |date=October 30 2014 |website=www.cdc.gov |publisher=Centers for Disease Control and Prevention (CDC) |accessdate=October 31 2014}}</ref>

*Active monitoring and controlled movement still apply for persons who have had Ebola virus exposures and are under follow-up as contacts for the full 21-day period following their last exposure.<ref name=CDC>{{cite web |url=http://www.cdc.gov/vhf/ebola/hcp/considerations-discharging-pui.html|title=Considerations for Discharging Persons Under Investigation (PUI) for Ebola Virus Disease (Ebola)|last1= |first1= |last2= |first2= |date=October 30 2014 |website=www.cdc.gov |publisher=Centers for Disease Control and Prevention (CDC) |accessdate=October 31 2014}}</ref>
===Important information about RT-PCR testing for Ebola virus===
*A negative RT-PCR test result for Ebola virus from a blood specimen collected less than 72 hours after onset of symptoms does not necessarily rule out Ebola virus infection.<ref name=CDC>{{cite web |url=http://www.cdc.gov/vhf/ebola/hcp/considerations-discharging-pui.html|title=Considerations for Discharging Persons Under Investigation (PUI) for Ebola Virus Disease (Ebola)|last1= |first1= |last2= |first2= |date=October 30 2014 |website=www.cdc.gov |publisher=Centers for Disease Control and Prevention (CDC) |accessdate=October 31 2014}}</ref><br>
**If the patient is still symptomatic after 72 hours, the test should be repeated.<ref name=CDC>{{cite web |url=http://www.cdc.gov/vhf/ebola/hcp/considerations-discharging-pui.html|title=Considerations for Discharging Persons Under Investigation (PUI) for Ebola Virus Disease (Ebola)|last1= |first1= |last2= |first2= |date=October 30 2014 |website=www.cdc.gov |publisher=Centers for Disease Control and Prevention (CDC) |accessdate=October 31 2014}}</ref><br>
**If the patient has recovered from the illness that brought them to medical attention, a repeat test is not required.<ref name=CDC>{{cite web |url=http://www.cdc.gov/vhf/ebola/hcp/considerations-discharging-pui.html|title=Considerations for Discharging Persons Under Investigation (PUI) for Ebola Virus Disease (Ebola)|last1= |first1= |last2= |first2= |date=October 30 2014 |website=www.cdc.gov |publisher=Centers for Disease Control and Prevention (CDC) |accessdate=October 31 2014}}</ref>

*A negative RT-PCR test result for Ebola virus from a blood specimen collected more than 72 hours after symptom onset rules out Ebola virus infection.<ref name=CDC>{{cite web |url=http://www.cdc.gov/vhf/ebola/hcp/considerations-discharging-pui.html|title=Considerations for Discharging Persons Under Investigation (PUI) for Ebola Virus Disease (Ebola)|last1= |first1= |last2= |first2= |date=October 30 2014 |website=www.cdc.gov |publisher=Centers for Disease Control and Prevention (CDC) |accessdate=October 31 2014}}</ref><br>
**Positive Ebola virus RT-PCR results are considered presumptive until confirmed by CDC.<ref name=CDC>{{cite web |url=http://www.cdc.gov/vhf/ebola/hcp/considerations-discharging-pui.html|title=Considerations for Discharging Persons Under Investigation (PUI) for Ebola Virus Disease (Ebola)|last1= |first1= |last2= |first2= |date=October 30 2014 |website=www.cdc.gov |publisher=Centers for Disease Control and Prevention (CDC) |accessdate=October 31 2014}}</ref>

==References==
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[[Category:Mononegavirales]]
[[Category:Viral diseases]]
[[Category:Biological weapons]]
[[Category:Zoonoses]]
[[Category:Hemorrhagic fevers]]

[[Category:Disease]]
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