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CDC Issues Revised Guidance for Monitoring Persons With Potential Ebola Exposure

Returning medical workers should not be quarantined, agency says

The Centers for Disease Control and Prevention (CDC) has issued revised interim guidelines for the monitoring and movement of persons potentially exposed to the Ebola virus. This guidance provides new information that public health authorities and other partners can use to determine appropriate public health actions based on Ebola exposure risk factors and clinical presentation, according to the agency. It also includes criteria for monitoring exposed people and for when movement restrictions may be needed.

The CDC announced last week that public health authorities will begin active post-arrival monitoring of travelers whose travel originates in Liberia, Sierra Leone, or Guinea and arrive at one of the five airports in the U.S. doing enhanced screening. The revised interim guidance is intended to guide state and local health officials with decisions about managing the movement of individuals being monitored, including travelers from the countries with widespread transmission and others who may have been exposed in the U.S.

Active post-arrival monitoring means that travelers without febrile illness or symptoms consistent with Ebola will be contacted daily by state and local health departments for 21 days from the date of their departure from Liberia, Sierra Leone, or Guinea. Six states (New York, Pennsylvania, Maryland, Virginia, New Jersey, and Georgia), where approximately 70% of incoming travelers are headed, started active monitoring on October 27, and the remainder of the states will start in the days following.

The revised guidance also outlines appropriate public health actions for individuals classified as being at “some risk.” These include health care workers who are providing direct care to Ebola patients in West Africa or others, such as observers, who enter an Ebola treatment area where Ebola patients are being cared for.

In a conference call with reporters, CDC director Dr. Tom Frieden warned against turning doctors and nurses who are working to tackle Ebola in West Africa before it spreads more widely into “pariahs.”

According to a related report from Reuters, the CDC considers health care workers tending to Ebola patients at U.S. facilities as being at “low but non-zero” risk.

The revised CDC guidance recommends that public health authorities determine on an individual case-by-case basis whether additional restrictions, such as controlled movement, workplace exclusions, or restrictions on other activities, are appropriate. This daily health consultation will give “additional confidence” to the community that a returning health care worker is asymptomatic and therefore not contagious, the CDC says.

According to Reuters, a growing chorus of critics, including public health experts, the United Nations, medical charities, and even the White House, has denounced mandatory quarantines as scientifically unjustified and an obstacle to fighting the disease at its source in West Africa.

Sources: CDC; October 27, 2014; and Reuters; October 27, 2014.

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