Ebola monitoring and movement of persons following exposure

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rim Halaby, M.D. [2]

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.

Postexporure Management

Postexposure management among patients with close contact to Ebola may include:

• Conditional release
• Controlled movement
• Self-monitoring

Close contact is defined as:

• Being within approximately 3 feet (1 meter) of an EVD patient or within the patient’s room or care area for a prolonged period of time (e.g., health care personnel, household members) while not wearing recommended personal protective equipment (i.e., standard, droplet, and contact precautions); or
• having direct brief contact (e.g., shaking hands) with an EVD patient while not wearing recommended personal protective equipment.

• Brief interactions, such as walking by a person or moving through a hospital, do not constitute close contact.

Conditional Release

Conditional release means that people are monitored by a public health authority for 21 days after the last known potential Ebola virus exposure to ensure that immediate actions are taken if they develop symptoms consistent with EVD during this period. People conditionally released should self-monitor for fever twice daily and notify the public health authority if they develop fever or other symptoms.

Controlled Movement

Controlled movement requires people to notify the public health authority about their intended travel for 21 days after their last known potential Ebola virus exposure. These individuals should not travel by commercial conveyances (e.g. airplane, ship, long-distance bus, or train). Local use of public transportation (e.g. taxi, bus) by asymptomatic individuals should be discussed with the public health authority. If travel is approved, the exposed person must have timely access to appropriate medical care if symptoms develop during travel. Approved long-distance travel should be by chartered flight or private vehicle; if local public transportation is used, the individual must be able to exit quickly.

Quarantine

Quarantine is used to separate and restrict the movement of persons exposed to a communicable disease who don’t have symptoms of the disease for the purpose of monitoring.

Self-Monitoring

Self-monitoring means that people check their own temperature twice daily and monitor themselves for other symptoms.

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.

Recommendations for Evaluating Exposure Risk to Determine Appropriate Public Health Actions

Exposure Level	Clinical Criteria	Public Health Actions
High Risk Percutaneous (e.g., needle stick) or mucous membrane exposure to blood or body fluids of EVD patient Direct skin contact with, or exposure to blood or body fluids of, an EVD patient 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 where an EVD outbreak is occurring	Fever OR other symptoms consistent with EVD without fever	Consideration as a probable case Medical evaluation using infection control precautions for suspected Ebola, consultation with public health authorities, and testing if indicated If air transport is clinically appropriate and indicated, only air medical transport (no travel on commercial conveyances permitted) If infection control precautions are determined not to be indicated: conditional release and controlled movement until 21 days after last known potential exposure
	Asymptomatic	Conditional release and controlled movement until 21 days after last known potential exposure
Some Risk of Exposure Household contact with an EVD patient Other close contact with an EVD patient in health care facilities or community settings	Fever WITH OR WITHOUT other symptoms consistent with EVD	Consideration as a probable case Medical evaluation using initial infection control precautions for suspected Ebola, consultation with public health authorities, and testing if indicated If air transport is clinically appropriate and indicated, air medical transport only (no travel on commercial conveyances permitted) If infection control precautions are determined not to be indicated: Conditional release and controlled movement until 21 days after last known potential exposure
	Asymptomatic or clinical criteria not met	Conditional release and controlled movement until 21 days after last known potential exposure
No Known Exposure Having been in a country in which an EVD outbreak occurred within the past 21 days and having had no exposures	Fever WITH other symptoms consistent with EVD	Consideration as a person under investigation (PUI) Medical evaluation and optional consultation with public health authorities to determine if movement restrictions and infection control precautions are indicated If movement restrictions and infection control precautions are determined not to be indicated: travel by commercial conveyance is allowed; self-monitor until 21 days after leaving country
	Asymptomatic or clinical criteria not met	No movement restrictions Travel by commercial conveyance allowed Self-monitor until 21 days after leaving country