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Ebola Recommendations for Organizations

Recommendations for organizations sending US-based health care or emergency response workers to areas with Ebola outbreaks and predeparture assessment of any workers traveling from Ebola outbreak areas to the United States

This document was updated 10/3/2019 to include:

  1. Recommendation to perform a modified predeparture health and exposure screening for workers without likely occupational exposure to Ebola virus.
  2. Recommendation for NGOs to provide advance notification to ministries of health in other countries if workers will forward deploy to those countries within 21 days of leaving the outbreak area for the purpose of providing humanitarian aid.

Key Points

  • CDC recommends that organizations sending US-based workers to areas with Ebola outbreaks ensure the health and safety of those workers before, during, and after their deployment.
  • Pre-deployment recommendations include educating workers about Ebola, travel vaccines, healthy behaviors, personal protective equipment, and travel health insurance.
  • During-deployment recommendations include remaining in contact with all workers, periodically asking about any symptoms of or exposures to Ebola, and, for workers with potential occupational exposure to Ebola virus, contacting in advance the US state or local health departments that have jurisdiction in the areas where workers will be staying after arrival in the United States.
  • Post-deployment recommendations include staying in contact with all workers for 21 days after they leave the outbreak area while they self-monitor for symptoms of Ebola.
  • CDC recommends that all workers with potential occupational exposure to Ebola virus who are traveling to the United States undergo a health and exposure assessment before their departure from the outbreak area.

Audience

The audiences for this document are:

  • Organizations such as nongovernmental, faith-based, academic, or aid organizations that send US-based workers (employees, contractors, or volunteers) to areas where Ebola outbreaks are occurring.
  • Organizations whose non-US-based workers, such as locally employed personnel or US expatriates working in the outbreak area, intend to travel to the United States.

Definitions

For the purpose of these recommendations, workers with potential occupational health exposure to Ebola virus include those engaged in Ebola response activities (for example, clinical care or laboratory work in an Ebola treatment unit [ETU], burial work); those providing health care or performing clinical laboratory work in non-Ebola settings in the outbreak area; and anyone else whose duties place them at risk of exposure to Ebola.

Workers without likely occupational health exposure to Ebola virus include those whose routine activities are unlikely to result in exposure to a person sick with Ebola or to Ebola-contaminated body fluids, such as epidemiologists, contact tracers, emergency operations center workers, logisticians, and airport screeners.

Organization Responsibilities Before, During, and After Worker Travel to Ebola Outbreak Areas

Before Workers Travel to Outbreak Areas

Cholera in DRC

Cholera is endemic in DRC, particularly in the eastern provinces of South Kivu, North Kivu, Haut-Katanga, Tanganyika, Haut-Lomami, and Kasai-Oriental. Organizations sending people to any of these provinces should educate them about the risk of cholera, provide them with instructions on safe eating and drinking practices, and offer them pretravel cholera vaccination.

Other Health Risks in DRC

DRC requires proof of vaccination against yellow fever for all travelers entering the country. In addition, all travelers should be up-to-date on routine vaccines, including measles. The DRC Ministry of Health is reporting outbreaks of measles throughout the entire country. Other recommended vaccines include polio (or polio booster), hepatitis A and B, and typhoid. Travelers likely to have contact with animals may need rabies vaccine. All travelers should receive malaria prophylaxis.

The World Health Organization is also reporting outbreaks of chikungunya, monkeypox, and plague in DRC. These diseases are not vaccine preventable, so travelers should take steps to prevent insect bites and avoid animals.

 

  • Educate all workers about exposure risks, symptoms of Ebola, and the importance of monitoring themselves for fever and other symptoms during travel and for 21 days after leaving the outbreak area. Provide information about whom a worker should contact in the event of an exposure or if symptoms develop.
  • Encourage all workers to get routine and destination-specific vaccines, including cholera and yellow fever vaccines, before travel, to follow precautions (including food and water precautions) to stay healthy and safe during travel, and to take steps to avoid malaria (including preventing mosquito bites and taking preventive medication, when indicated) and other infectious diseases.
  • Discuss options for vaccination against Ebola. The National Institutes of Health (NIH), foreign ministries of health, the World Health Organization, and other partners are offering an investigational vaccine to priority populations such as frontline workers in Ebola response activities.
    • If employees choose to be vaccinated, vaccination before travel is recommended, if possible.
    • NIH has an open-label clinical trial, titled “Pre-Exposure Prophylaxis in Individuals at Potential Occupational Risk for Ebola Virus Exposure” or “PREPARE,” to vaccinate adult volunteers (including deploying health care workers and other responders) against Ebola. Study sites are at the NIH in Bethesda, MD, and Emory University in Atlanta, GA. The study has follow-up requirements that may need additional consideration and planning regarding the timing and duration of deployment.
  • Arrange for or help all workers obtain travel health and medical evacuation insurance. Everyone traveling to the outbreak area should have full health insurance coverage, including coverage for emergency medical evacuation.
  • Ensure workers with potential occupational exposure to Ebola virus have access to appropriate personal protective equipment (PPE). Provide training on the correct use of PPE and other infection control measures to prevent the spread of Ebola.

During Workers’ Stay in Outbreak Areas

Workers providing clinical care or testing patient specimens in non-Ebola settings in an area where Ebola is spreading may encounter patients (or specimens from patients) with undiagnosed Ebola. In such situations, workers may be at high risk of exposure to Ebola virus if they don’t recognize the potential risk and take steps, including using appropriate PPE, to protect themselves.

Remind health care workers in an Ebola outbreak area about the importance of remaining vigilant for patients with acute febrile illnesses and following appropriate procedures for isolation, testing, and notification of public health officials. Remind laboratory workers to follow routine safety protocols to avoid exposure to clinical specimens.

  • Remain in contact with all workers throughout their stay. Periodically ask about symptoms and potential exposures.
  • Ensure all workers are aware that CDC will not allow travel to the United States for anyone with unprotected (without use of appropriate and effective PPE) exposure to Ebola virus or Ebola-like symptoms, unless the travel is part of a coordinated medical evacuation or until they are medically assessed and determined not to have Ebola infection.
  • Coordinate with the nearest US embassy or health officials (country’s ministry of health) to facilitate timely medical evaluation and care of any symptomatic workers.
  • Contact CDC to discuss management of workers with unprotected exposures to Ebola virus and to coordinate safe return travel, if necessary, of symptomatic or exposed US-based workers.   

Before Workers Depart from Outbreak Areas and Travel to the United States

  • For workers without likely occupational exposure to Ebola virus based on assigned duties, confirm the following:
    • Occupational activities did not change in a way that could increase the risk of Ebola virus exposure
    • No known exposures to Ebola virus occurred in the previous 21 days
    • Worker remains asymptomatic
  • For workers with potential occupational exposure to Ebola virus:
    • Ensure workers undergo an exposure and health assessment before travel to the United States. Incorporate this activity into existing occupational health and safety protocols. See additional information and template tools below.
    • Contact the state or local health departments that have jurisdiction in the areas where workers will stay during their recommended 21-day self-monitoring period. CDC can help establish the initial contact between your organization and the health departments.
    • Establish points of contact between your organization, state and local health departments, and the returned worker.
    • Work with the health departments to develop processes for medical evaluation of workers exhibiting signs and symptoms of Ebola. Processes should include information about whom the worker should call first and expected next steps in evaluating the worker.

CDC recommends that workers self-monitor for 21 days after leaving an Ebola outbreak area under oversight by their employer or sponsoring organization. However, US state and local health departments have the authority to determine how they want monitoring conducted within their jurisdiction. Health departments may elect to accept self-monitoring with oversight by the sponsoring organization; they may also request updates from the sponsoring organization, or assume direct responsibility for oversight of self-monitoring.

After Workers Depart from the Outbreak Area

  • For all workers:
    • Ensure workers self-monitor for signs and symptoms of Ebola for 21 days after leaving the outbreak area.
    • Ensure that returned health care workers who intend to provide care to patients in US health care facilities during their 21-day self-monitoring period first notify the facility’s infection control or occupational health professional of their recent travel and self-monitoring activities.
    • Notify the state or local health department immediately if any worker located in the United States develops symptoms during the 21-day period. Health departments are responsible for coordinating a rapid and safe medical evaluation.
    • If workers intend to deploy to another country within 21 days after leaving the outbreak area for the purpose of providing humanitarian aid, notify the ministry of health of the destination country in advance of their arrival.
  • For workers with potential occupational exposure to Ebola virus:
    • Remain in contact with workers for a full 21 days after they leave the outbreak area to oversee self-monitoring activities.
    • Notify state and local health departments of workers’ travel plans during the 21-day period, including if workers plan to relocate to another state or leave the United States. Notify the state and local health departments at the new destination if workers plan to relocate to another state.

Predeparture Exposure and Health Assessment for Workers with Potential Occupational Exposure to Ebola Virus Traveling from Ebola Outbreak Areas to the United States

Before workers with occupational risk of exposure to Ebola virus (as described above) travel from Ebola outbreak areas to the United States, assess them for signs and symptoms compatible with Ebola and for possible unprotected exposures to Ebola virus.

CDC recommends a predeparture assessment for the following reasons:

  • To prevent the potential public health consequences of exporting a case of Ebola
  • To prevent workers who are symptomatic or who have had unprotected exposures to Ebola virus from traveling by commercial airline
  • To determine the appropriate level of monitoring based on the exposure risk level

For most workers, CDC recommends self-monitoring with oversight by the sponsoring organization. However, for workers with unprotected exposures to Ebola virus, CDC recommends monitoring by health officials while in the United States; other restrictions may also be considered.

At a minimum, the predeparture assessment should include the following elements:

  • Careful assessment for potential exposures to Ebola virus
  • Review of signs and symptoms compatible with Ebola
  • Determination that the worker appears well
  • Oral temperature measurement

Conduct the exposure assessment after the last possible occupational exposure and the health assessment within 24-48 hours of departure. For ETU workers, CDC recommends the ETU’s safety officer complete the exposure assessment and the organization’s medical supervisor complete the health assessment. Workers outside health care settings can complete their own exposure assessments for review by the organization’s medical supervisor; the medical supervisor should perform the health assessment.

CDC has developed template tools (Workers in Ebola Treatment Units (print only)) and Workers in non-ETU settings (print only)) that organizations can choose to use or modify to help structure the predeparture assessment. Organizations may also opt to develop their own forms.

While CDC does not request copies of predeparture assessment forms, it does recommend that both the sponsoring organization and the returning worker retain the documentation, in case it is requested by the state or local health department where the worker resides or is located.

Symptomatic or Exposed US Workers Located Overseas

CDC is available to provide consultation to organizations that identify

  • Workers with Ebola-compatible illness
  • Workers with unprotected exposures (i.e., without the use of appropriate and effective PPE) to
    • A person with Ebola or the person's body fluids
    • A person with Ebola-compatible illness in whom Ebola has not been ruled out or the person's body fluids
    • The body of a person who died of Ebola or Ebola-compatible illness or unknown cause

Ebola-compatible illness includes elevated body temperature (≥100.4°F or 38°C), subjective fever, or signs or symptoms of Ebola, including severe headache, fatigue, muscle pain, vomiting, diarrhea, abdominal pain, or unexplained bruising or bleeding.

CDC prohibits travel to the United States by commercial airline for any person with symptoms compatible with Ebola and potential exposure to Ebola virus, or any person with known unprotected exposure to Ebola virus even if the person is asymptomatic. CDC will assess such situations case by case and, if necessary, may use federal public health travel restrictions to safeguard the public’s health. CDC will support organizations or workers in requesting assistance from the US Department of Health and Human Services and the US Department of State for noncommercial transport to the United States.

Contacting CDC

For urgent consultations regarding symptomatic or potentially exposed workers, please call the CDC Emergency Operations Center (available 24/7) at 770-488-7100.

For questions about these recommendations or additional advice regarding predeparture exposure and health assessment, please email eocdgmqopschief@cdc.gov.

Resources

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