DIVISION OF PUBLIC HEALTH
1 WEST WILSON STREET
P O BOX 2659
MADISON WI 53701-2659
Scott Walker
Governor
State of Wisconsin
608-266-1251
FAX: 608-267-2832
Department of Health Services
dhs.wisconsin.gov
Kitty Rhoades
Secretary
TO:
Directors, Local Health Departments, Tribal Health Agencies
FROM: James Kazmierczak, DVM, MS, State Public Health Veterinarian, Bureau of Communicable
Diseases and Emergency Response, Division of Public Health
RE:
UPDATE - Travelers returning from West Africa – new CDC guidance
DATE: October 27, 2014
Several weeks ago, DPH provided recommendations to local public health officers regarding the monitoring
of persons who recently traveled to countries in West Africa where Ebola Virus Disease (EVD) is occurring.
We want to thank you for your efforts in this matter. To date, 41 travelers to Wisconsin have been monitored
and have passed their 21 day observation period.
Now that every traveler from Ebola-affected countries is being screened upon entry in the U.S., the CDC has
recently issued updated guidance on this topic. These can be found at
http://www.cdc.gov/media/releases/2014/p1022-post-arrival-monitoring.html . The most pertinent part of
this guidance is excerpted here:
“Specifically, state and local authorities will require travelers to report the following information
daily: their temperature and the presence or absence of other Ebola symptoms such as headache,
joint and muscle aches, weakness, diarrhea, vomiting, stomach pain, lack of appetite, or abnormal
bleeding; and their intent to travel in-state or out-of-state. In the event a traveler does not report in,
state or local public health officials will take immediate steps to locate the individual to ensure that
active monitoring continues on a daily basis.
In addition, travelers will receive a CARE (Check And Report Ebola) kit at the airport that contains
a tracking log and pictorial description of symptoms, a thermometer, guidance for how to monitor
with thermometer, a wallet card on who to contact if they have symptoms and that they can present to
a health care provider, and a health advisory infographic on monitoring health for three weeks.”
Fortunately, we in Wisconsin have been actively monitoring travelers since August, so complying with these
new requirements should not be too burdensome. However, the new recommendations differ from our
prior guidance to you in the following ways:
1) DPH will learn about virtually all travelers of interest via the airport screenings.
2) Note that Nigeria is no longer considered a country in which Ebola is circulating.
3) The monitoring of travelers’ health status is now required to be done on a DAILY basis by the local
health department. This includes weekends and holidays. Please document your daily contacts with
travelers. This can be done using WEDSS contact investigations for “Hemorrhagic fever, Ebola”
and/or by using a separate tracking sheet which is sent as an attachment to this email. This tracking
form can be scanned into the WEDSS file cabinet.
4) The traveler should be instructed to notify their LHD if they have plans to travel during their
observation period. If travel is planned, please contact the Communicable Disease Epidemiology
Section at 608/267-9003 to discuss the advisability of permitting travel and making contact with the
jurisdiction to which the person is traveling.
Wisconsin.gov
Page 2 – Wisconsin Division of Public Health, 10/24/14
5) Health departments are now charged with attempting to locate travelers who fail to check in daily to
ensure monitoring continues.
6) Because of these changes in guidance, note that the form on the last page of this memo has
changed. Please discard the prior sets of guidance that were sent and dated 8/19/14 and 9/4/14
and use this current one.
Thank you for your assistance in this matter. Please direct any questions to the CDES staff at 608/267-9003.
Detailed information on the Ebola outbreak and guidance for clinicians, hospitals, and laboratories can be
found on the DHS website at
http://www.dhs.wisconsin.gov/communicable/diseasepages/ViralHemorrhagicFevers.htm
Page 3 – Wisconsin Division of Public Health, 10/24/14
Ebola Virus Disease: Questions for persons with recent travel to West Africa
Instructions:
Obtain the information below and confirm the countries and dates of travel.
Traveler’s name _________________________________________ Date of Birth ________________
Address ____________________________________________________________________________
Phone (home and cell) ________________________________________________________________
Workplace / School __________________________________________________________________
Emergency contact and phone __________________________________________________________________
Country visited ___________________________________
From ____/____/____ to ____/____/____
If the traveler did not visit Guinea, Sierra Leone, or Liberia*, or if travel occurred over 21 days ago, the
interview can be terminated and the traveler reassured that they are unlikely to have been infected with
Ebola Virus. Contact the Division of Public Health to let us know this person does not require monitoring.
If the traveler did visit one of these countries within the past 21 days, please complete the rest of this form.
List potential exposures that occurred in West Africa (check all that apply):
 Contact with a possible case of EVD
 Worked as health care worker
 Participated in funeral
 Household contact of a possible EVD case
 Direct contact with bats or non-human primates
 None of the above
Other (describe)__________________________________________________________________________
Is traveler currently ill?
Y
N
If yes, date of illness onset ____/____/____
highest measured temp __________o
Fever
Y
N
Headache Y N
Vomiting
Y
N
Diarrhea
Skin rash
Y
N
Unusual or unexplained bleeding Y N
Y N
Other (describe)__________________________________________________________________________
Has traveler seen a medical provider ? Y N
If yes, name & location of provider and date of visit _______________________________________________
Did anyone else travel with you? If yes, note names and their contact information on a separate page.
Interviewer’s name and phone # ______________________________________________________
*Check CDC website ( http://www.cdc.gov/vhf/ebola/ ) for most current list of countries with active EV transmission.
-- more --
Page 4 – Wisconsin Division of Public Health, 10/24/14
Follow up Actions After Completing Interview
IF TRAVELER IS NOT ILL AND HAS NONE OF THE POTENTIAL RISK FACTORS:
1) Inform traveler that your agency will need to monitor him/her through 21 days after traveler left the
endemic country. This should be done daily via telephone. Instruct the traveler to monitor their
temperature twice daily (morning and evening) and to report any fever or illness to your agency
immediately.
2) Inform traveler that these daily check-ins are not optional and that if your attempts to contact him/her
are unsuccessful, you are obligated to make attempts to locate the traveler via workplace, schools,
neighbors, etc.
3) Instruct traveler that he/she is currently under no movement restrictions, but will need to inform you
of any travel plans to ensure that the daily check-ins can continue. If traveler has plans for out of
state travel, inform DPH.
4) The LHD should document the results of the daily check-ins. This can be done using WEDSS contact
investigations for “Hemorrhagic fever, Ebola” (see the “Ebola monitoring” tab) and/or by using a
separate tracking sheet which can be found on the last page of this form. This tracking sheet can be
scanned into the WEDSS file cabinet.
IF TRAVELER IS NOT ILL BUT HAS ANY OF THE POTENTIAL RISK FACTORS:
1) Consult with DPH regarding the need to impose restrictions on the traveler’s movements.
2) The daily monitoring as described above will still be necessary.
IF TRAVELER IS ILL:
1) Obtain a brief description of the traveler’s symptoms, when illness began, and presence of fever.
2) Ask traveler where they would go if a medical evaluation was indicated.
3) If, in your opinion, the illness constitutes an emergency, let the person know that 911 should be
contacted. The LHD should call 911 to ensure that the 911 operator is told that transport is required
for a patient with potential Ebola virus disease.
4) If emergency transport is not required, instruct the person to remain at home where he will be
contacted soon by DPH staff for further instructions.
5) Notify the DPH IMMEDIATELY about an ill traveler. Phone 608/258-0099 (24/7 emergency
answering service) and ask to speak to the communicable disease person who is on-call. You may be
asked to suggest a regional facility at which the traveler can be medically evaluated.
Name:
End of 21-day monitoring period
(date):
Last exposure date:
WEEK 1
Day: DAY 1
DAY 2
Date:
AM
PM
AM
Time of check:
Temperature (°F or °C)
Other symptoms (circle Y for Yes or N for No)
Headache
Y N Y N Y N
Joint or muscle aches
Y N Y N Y N
Weakness
Y N Y N Y N
Diarrhea
Y N Y N Y N
Vomiting
Y N Y N Y N
Stomach pain
Y N Y N Y N
Lack of appetite
Y N Y N Y N
Rash
Y N Y N Y N
Red eyes
Y N Y N Y N
DAY 3
DAY 4
DAY 5
DAY 6
DAY 7
PM
AM
PM
AM
PM
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PM
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PM
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Y
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WEEK 2
Day: DAY 8
DAY 9
Date:
AM
PM
AM
Time of check:
Temperature (°F or °C)
Other symptoms (circle Y for Yes or N for No)
Headache
Y N Y N Y N
Joint or muscle aches
Y N Y N Y N
Weakness
Y N Y N Y N
Diarrhea
Y N Y N Y N
Vomiting
Y N Y N Y N
Stomach pain
Y N Y N Y N
Lack of appetite
Y N Y N Y N
Rash
Y N Y N Y N
Red eyes
Y N Y N Y N
DAY 10
DAY 11
DAY 12
DAY 13
DAY 14
PM
AM
PM
AM
PM
AM
PM
AM
PM
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PM
Y
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WEEK 3
Day: DAY 15
DAY 16
Date:
AM
PM
AM
Time of check:
Temperature (°F or °C)
Other symptoms (circle Y for Yes or N for No)
Headache
Y N Y N Y N
Joint or muscle aches
Y N Y N Y N
Weakness
Y N Y N Y N
Diarrhea
Y N Y N Y N
Vomiting
Y N Y N Y N
Stomach pain
Y N Y N Y N
Lack of appetite
Y N Y N Y N
Rash
Y N Y N Y N
Red eyes
Y N Y N Y N
DAY 17
DAY 18
DAY 19
DAY 21
PM
AM
PM
AM
PM
AM
PM
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PM
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PM
Y
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Health department name and contact:
Phone (daytime):
DAY 20
Phone (night/weekend):
N
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