Ebola Response 2014
Nicole Mazur, MPH
New Jersey Department of Health
Communicable Disease Service
Department of Health Structure
DOH
Public
Health
Services
EEOHS
CDS
Epidemiology
& Surveillance
CDS ROLE
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Assist LHD with case investigations and contact tracing
Guidance on disease epidemiology (transmission, incubation period, etc.)
Clinical consultation on suspected cases
Liaison with CDC and other states on inter-jurisdictional cases
Provide technical guidance and resources for case evaluation & management
Provide health education materials
Coordination and consulting with other agencies
Guidance on surveillance and monitoring
Coordination of active monitoring of those with low but not no risk
Monitoring persons with high, some, or low risk
NJDOH CDS Ebola Response Team
• Administration
• Clinical
• Epidemiology
• Laboratory Testing
• Communications
• IT Support
EVD Affected areas
As of October 29th
Widespread Transmission
Guinea
Sierra Leone
Liberia
Travel-associated Case(s) and
Localized Transmission
Nigeria*
Spain^
United States^
Travel-associated Case(s) Only
Mali
Senegal*^
*No longer risk of transmission in these countries
^Persons traveling to these countries should not be considered to be at risk for exposure
EVD Response and
Preparedness
• Airport Screening:
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NYC- JFK
Chicago- O’Hare
Newark
Atlanta
Washington, DC- Dulles
• 94% of flights from affected areas come through these airports
• Nearly half come through JFK
• Active Monitoring began at airports on October 16 (JFK earlier Oct
11)
CDC Care kit
Active Monitoring
• New Jersey Department of Health, Communicable Disease
Service
• Recommendations for Follow‐Up of Ebola Virus Disease
(EVD)
• Low (but not zero) Exposure*
• Reported from the CDC Division of Global Migration and
Quarantine (DGMQ)
• *Low (but not zero) exposure is defined as having been in a
country in which an EVD outbreak occurred in the past 21 days
and having had no exposure.
LHD Responsibilities
• LHD will provide a contact number for the person to report
both daily temperature readings and possible symptoms
• LHD will provide a 24/7 contact number to the person being
monitored, should symptoms or questions arise.
• The LHD should provide the name and location of hospital(s)
near the person’s home or work.
• Temperature reports will be entered into CDRSS, as well as any
symptoms that arise
Traveler Responsibilities
• Individuals being monitored will need to consult with the LHD if there is
any
• planned travel out of the area for an extended period of time.
• If symptoms arise or a recorded temperature of ≥100.4⁰F (38⁰C) is noted;
individuals should:
• Immediately isolate themselves (from people and pets),
• CALL 9-1-1 to seek medical evaluation at a nearby hospital**
• (persons should travel to the hospital via ambulance)
• IMPORTANT!!
• **Alert 911 to symptoms and recent travel to an Ebola‐affected area**
Active monitoring
Reporting
Persons presenting to health care
providers with fever or any other ebola
symptoms AND travel to EVD-affected area
within past 21 days should be
IMMEDIATELY reported to the LOCAL
HEALTH DEPARTMENT where the patient
resides. If the local health department is
unavailable please call New Jersey
Department of Health- Communicable
Disease Service.
Contact Information
• If you suspect EBOLA…. CALL PUBLIC HEALTH IMMEDIATELY!
• How do you reach Local Health?
• http://www.nj.gov/health/lh/documents/lhdirectory.pdf
• Know your Local Public Health’s phone # and keep it on hand.
• How do you reach State Health?
609-826-5964 Daily Monday - Friday
609-392-2020 Nights, Weekends and Holidays (Emergencies Only,
Immediately Reportable Diseases)
Outside of CDS
• For questions pertaining to other issues not related to the Communicable
Disease Service, Please call:
• Office of Local Public Health
• 609-292-4993
• dutyofficer@njlincs.net
• Consumer, Environmental & Occupational
• Health Service
609-826-4920
• EMS
• 609-633-7777
• ems@doh.state.nj.us
Resources
• CDC website
• http://www.cdc.gov/vhf/ebola/
• NJDOH website
http://www.state.nj.us/health/cd/vhf/index.shtml
Public Health Response to Ebola
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Surveillance
Follow up for possible exposures
Public Information
Quarantine: Restriction of activities of well persons
who have been exposed to a case of a communicable
disease during its period of communicability
• Isolation: The separation and confinement of
individuals known or suspected to be infected with an
infectious disease to prevent them from
transmitting the disease to others
• Contact Tracing
The CDC “CARE” Kit—Check and Report
Ebola--distributed to arriving air passengers
Public Health Response
Layered, Graduated, Risk-based
• “Active Monitoring”—Local Health Departments will be
checking in with people who have arrived from West
Africa (usually by phone) for 21 days after arrival to see
whether they develop symptoms (low risk travelers)
• “Direct Active Monitoring” LHD visits or Skypes
traveler to monitor for symptoms for 21 days (“some
risk”) travelers. There MAY be restrictions on travel or
public activities for that person. (partial quarantine)
• “Direct Active Monitoring with Activity Restrictions and
Travel Restrictions” LHD visits or Skypes traveler with
high risk exposure for 21 days (Quarantine)
Law Enforcement support
of Public Health
• NJSA 26: 4-2 and NJAC 8:57-1.1 give the Local Board of
Health and the Health Officer the power to enforce these
restrictions, and specify that they can call on local law
enforcement to assist.
• We may ask your assistance in locating and observing the
location of a person under quarantine.
• We are not asking you to arrest them.
• We are not asking you to do anything that will expose you to the
virus
• Remember, a person under quarantine is not contagious (We are
watching them to make sure they don’t become contagious– the
firewall between those who are sick and the general public)
“But what if they don’t cooperate?”
• Inform the person they may be in violation
• Document the action that the subject is taking
• This is a civil court case, not an arrest
• Call your Local Health Officer right away for additional
guidance
• Reality Check: a person who has a contagious case of
Ebola is not going anywhere
• Side note: Make our job easier--minimize the number of
people who have contact with the person under
quarantine
Note:
• This guidance will evolve as we learn more about this
disease
• Different diseases (i.e. TB) have different thresholds for
Quarantine, depending on how it is spread
• It’s the Health Officer’s statutory responsibility to take
appropriate steps to stop the spread of communicable
disease in the community
• A historic and recognized power, with due process and right of appeal
DOUGLAS J. VORNLOCKER
DIRECTOR
SOMERSET COUNTY OFFICE OF EMERGENCY MANAGEMENT
OSHA
 1910.132 – Personal Protective Equipment
 1910.1020 – Bloodborne Pathogens
 Exposure Control Plan
 1910.134 – Respiratory Protection
RECOMMENDED PPE
 NJDOH PPE Recommendations for EVD
 3 Levels: Basic – Middle – High
 Buddy System for Donning & Doffing – Trained
Observer
 Develop Checklists that are specific to your needs and
PPE
 Rigorous and Repeated Training
 No skin exposure when PPE is worn
 Availability is currently a limiting factor
BASIC LEVEL
 Minimum PPE when providing direct care to sick
traveler who came from a country with an Ebola
outbreak
 Gloves
 Full face shield or goggles
 Surgical mask
 Long sleeve waterproof gown
 Shoe covers or waterproof boots
MIDDLE LEVEL
 Healthcare Workers caring for EHF patients with
potential contact with infected fluids and/or workers
who can be splashed with blood/body fluids
 Full face shield with N-95 NIOSH approved respirator or
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higher
Long sleeve waterproof gown or coveralls with
integrated hood
Impermeable shoe covers
Waterproof boots
2 pair of disposable nitrile gloves – extended cuffs
Single use impermeable apron covering torso to mid calf
HIGH LEVEL
 Healthcare workers caring for EHF patients with
severe respiratory involvement or undergoing aerosolgenerating procedures (includes EMS workers if
intubation is a possibility)
 Powered Air Purifying Respirator with P-100 cartridges
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and hood
Long sleeve waterproof gown or coveralls (with
integrated hood if using N-95 APR)
Impermeable shoe covers or waterproof boots
2 pair of disposable nitrile gloves – extended cuffs
Single use impermeable apron covering torso to mid calf
PREPAREDNESS
 Review OSHA Regulations and Achieve Compliance
 Determine Response Protocols and Procedures Based on
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Your Level of Potential Exposure
Compare Your Inventory Against NJDOH & CDC
Recommendations
Acquire (at least order) PPE
Train
Train
Train
 These are perishable skills that you will lose if you don’t
practice
 Revise Your Response Protocols and Procedures
TRAINING
 The Somerset County Emergency Services Training
Academy is developing a PPE Considerations for
Medical First Responders course. This course will
include a section on the Rutgers School of Public
Health’s Ebola PPE Training
 Courses will begin running during the week of 11/9/14