CDC updated its
Interim U.S. Guidance for Monitoring and Movement of Persons with Potential Ebola Virus Exposure.
How did the updated guidelines change from the old guidelines?
The updated guidance has 4 key changes:
•New risk levels are given for people who may have been exposed to Ebola and for those not at risk for the disease.
•The guidance recommends stricter actions for the High, Some, and Low risk levels based on the type of exposure to Ebola.
•State and local public health departments are advised to use active monitoring or direct active monitoring for Ebola symptoms rather than allowing people to monitor themselves.
•Specific guidance is given about monitoring healthcare workers who have taken care of patients with Ebola.
What are examples of a High risk of exposure?
Some examples of exposures in the High risk level include:
•direct contact with body fluids, from a person sick with Ebola and showing symptoms, through: ◦a needle stick
◦splashes to eyes, nose, or mouth
◦getting body fluids directly on skin
•touching a dead body while in a country with a large Ebola outbreak without wearing recommended personal protective equipment (PPE) or not wearing PPE correctly
•both living with and taking care of a person sick with Ebola
What are examples of Some risk of exposure?
Some examples of people who are in the Some risk level include:
•close contact (within 3 feet) of a person sick with Ebola for a long time
•Direct contact with a person sick with Ebola (such as in a hospital) in a country with a large Ebola outbreak even while wearing PPE correctly
What are examples of Low (but not zero) risk of exposure?
Some examples of people who are in the Low risk level include:
•having been in a country with a large Ebola outbreak within the past 21 days with no known exposure (such as NO direct contact with body fluids from a person sick with Ebola)
•being in the same room for a brief period of time with a person sick with Ebola
•brief direct contact, like shaking hands, with someone sick with Ebola
•direct contact with a person sick with Ebola in the United States while wearing PPE correctly
•traveling on an airplane with a person sick with Ebola
What are examples of No risk of exposure?
Assuming there are no other risk factors from previous categories, some examples of No risk of exposure are:
•having contact with a healthy person who had contact with a person sick with Ebola
•having contact with a person sick with Ebola before he or she had any symptoms
•someone who left a country with a large Ebola outbreak more than 21 days ago and has not been sick with Ebola since leaving that country
•having been in a country where there have been Ebola cases, but no large Ebola outbreak (for example, Spain)
What are the stricter public health actions in the updated guidance?
CDC is now recommending active monitoring for all people with any level of potential exposure to Ebola. This means that public health workers are responsible for checking at least once a day to see if people in these risk levels have a fever or other symptoms of Ebola. In addition, people being monitored must take their temperature two times each day and watch themselves for symptoms. Active monitoring must take place until 21 days after the last possible exposure and can occur on a voluntary basis or be required by legal order.
For all people in the High and Some risk levels, and some people in the Low risk level, public health workers will make a direct observation at least once a day to see if people have a fever or other symptoms. This is called direct active monitoring. An example of direct observation is an in-person visit. A second follow-up can be done by telephone.
Travelers coming from countries with a large Ebola outbreak will be given a CARE (Check and Report Ebola) Kit at the airport to help watch themselves for Ebola symptoms.
For people in the High risk levels, there are additional restrictions on travel and public activities. These restrictions may also apply to people in the Some risk level depending on their individual situation, such as how they were exposed to Ebola, the number of days since they might have been exposed, and whether they have followed the requirements for direct active monitoring.
Are people at risk for Ebola allowed to travel?
People at High risk of exposure to Ebola are not allowed to travel on long-distance or local public transportation even if they are well. The reason for this is to prevent possible spread of Ebola if the person develops fever or other symptoms during travel. Those who have Some risk of exposure need to discuss all of their travel plans with their state or local health department, and may not be allowed to travel. People on travel restrictions might be allowed to travel by private plane or car as long as they continue to be monitored during travel. However, they would need to make sure the health department knows their plans and will be able to check in with them every day.
In the updated guidance, people in the Some risk level of exposure who do not have symptoms of Ebola may be subject to additional public health orders. Who makes this decision?
Public health workers at your local health department will decide if people who are in the Some risk level of exposure will need public health orders in addition to direct active monitoring. These public health orders could stop a person at risk from traveling on long-distance or local public transport, such as a plane, ship, train, bus, or subway. They could also stop a person from being in public places like movie theaters or going to work. Public health workers will make these decisions separately for each individual based on their history, including how they were exposed to Ebola, the number of days since they might have been exposed, and if they are following the requirements for direct active monitoring.
Federal communicable disease regulations, including public health orders, apply to arriving international travelers and to interstate travel. State and local public health officials have primary authority for public health orders within their borders. Thus, CDC recognizes that state and local public health departments may make decisions about isolation, other public health orders, and active (or direct active) monitoring that may be more restrictive than what is recommended by federal guidance, and that these decisions may vary by location.
How will active monitoring be implemented?
The state and local health departments will decide how individuals with High, Some, or Low (but not zero) risk levels of exposure will be monitored.
CDC is providing tools and resources to assist state and local public health departments with active monitoring. All travelers who enter the United States from countries with a large Ebola outbreak will receive a CARE (Check and Report Ebola) Kit at the airport. The kit includes:
•a health advisory on monitoring for Ebola symptoms for 21 days
•pictorial description of symptoms,
•a thermometer with instructions for how to use it, and
•a wallet-sized card that reminds travelers to monitor their health and provides information about who to call if they have symptoms
The CARE Kits will also be available to the state and local health departments.
What does active monitoring mean to my health and movement?
A person who is under active monitoring will have to do a health check two times per day. The heath check will include taking your temperature and watching for other symptoms of Ebola (severe headache, fatigue, muscle pain, vomiting, diarrhea, stomach pain, or unexplained bruising or bleeding). People under active monitoring will need to talk to the health department at least once per day to tell them what their temperature is and if they have any symptoms. The state or local health department will decide if a person under active monitoring will need to call to report this information or will wait to be called by the health department worker. Your state or local health department will help you if you have questions about how to take your temperature or check for symptoms.
People under direct active monitoring will have direct observation from the state or local health department at least once per day to review symptoms and check temperature. An example of direct observation is an in-person visit. A second follow-up can be done by telephone. Direct active monitoring includes talking about plans to work, travel, take public transportation, or go to busy public places to determine whether these activities are allowed.
Is it safe for me to be around others if I am actively monitored?
It is safe for you to be around others while under active monitoring as long as you do not have fever or other symptoms of Ebola. However, some states may choose to be very careful and will not allow you to be around others if you are in the High risk level of exposure, and, in some cases if you are in the Some risk level of exposure. For people in the Some risk level of exposure, public health workers will make these decisions separately for each individual based on their history, including how they were exposed to Ebola, the number of days since they might have been exposed, and if they are following the requirements for direct active monitoring as required.
How long will I be actively monitored?
The active monitoring period lasts for 21 days after the last possible Ebola exposure. For travelers who have been in a country with a large Ebola outbreak, this is 21 days after leaving that country.
If I am under “active monitoring” am I considered contagious?
No. Active monitoring does not mean you are contagious. You are only contagious if you have been infected by Ebola AND have symptoms. Active monitoring only means that public health workers are watching your health more closely because you may have been exposed to Ebola. Active monitoring allows public health workers to recognize more quickly if you become ill and make sure you get immediate care. Early care can be very helpful in treating Ebola and in limiting contacts to others.
Will CDC provide medical documentation to my employer if I am not allowed to go to work?
State or local public health workers can work with you if medical documentation is needed for your employer.
Why are we putting movement and travel restrictions on U.S. citizens but not on people from West Africa coming into the United States?
The public health actions described in the updated guidance apply equally to all people located in the United States who might have been exposed to Ebola, regardless of whether they are U.S. citizens or citizens of other countries. This includes people exposed in the United States to a person with Ebola and anyone traveling from countries with a large Ebola outbreak to the United States.
Will this guidance affect U.S. troops once they return from fighting Ebola in West Africa?
Under CDC’s guidance, all travelers should be assessed when returning to the United States to determine their health status and their risk status in regards to Ebola. However, the Department of Defense will determine how to implement CDC’s guidance for U.S. troops and can choose to implement policies that are stricter than what CDC recommends.
Why are healthcare workers who treat Ebola patients in the U.S. and use personal protective equipment (PPE) correctly in the Low (but not zero) risk level, and the healthcare workers who treat Ebola patients in countries with large Ebola outbreaks and use PPE correctly in the Some risk level?
In countries with large Ebola outbreaks, there are more possible sources of exposure to Ebola virus than in the U.S. This includes the potential for healthcare workers to be exposed to Ebola in other areas of the hospital, like patient triage areas, to be exposed in the community, the possibility that decontamination procedures are not done correctly, or that they were wearing PPE incorrectly without knowing it. Therefore, it is more likely that healthcare workers treating Ebola patients in a country with a large Ebola outbreak will be exposed to Ebola and not know it than healthcare workers treating Ebola patients in the U.S.
However, if a healthcare worker in a U.S. healthcare facility who was believed to be wearing PPE correctly is diagnosed with Ebola, then all other healthcare workers taking care of the Ebola patient in that facility will be considered in the High risk category. This is because it would no longer be certain that healthcare workers were using PPE correctly. Public health workers will also review all infection control practices at that facility and retrain workers to make sure that all workers correctly follow infection control requirements.
What would happen if a healthcare worker who helped treat an Ebola patient, wore the recommended personal protective equipment (PPE), and did not have any breaches in protocol wanted to travel internationally? Would that be allowed?
For a healthcare worker treating an Ebola patient in the U.S., international travel may be allowed. However, public health workers would need to make sure that direct active monitoring continues during the travel period.
Also, it is important to note that if symptoms of Ebola do develop while the person is outside of the country, they may not be allowed to return to the United States except by air ambulance.
Healthcare workers who treated Ebola patients in a country with a large Ebola outbreak are in the Some risk category and might have extra restrictions, such as not being allowed to travel. Public health workers will make these decisions separately for each individual based on their history, including how they were exposed to Ebola, the number of days since they might have been exposed, and if they are following the requirements for direct active monitoring as required.
Some countries may have policies that would not allow someone who has cared for an Ebola patient to enter the country during the 21 day monitoring period. Healthcare workers who are being monitored for Ebola and have been approved to travel by their own public health workers should also check with the embassy of their destination country prior to travel.
Healthcare workers treating Ebola patients in countries with large Ebola outbreaks are heroes. Why are some returning healthcare workers being treated poorly?
Returning health care workers are, indeed, heroes. They are worthy of being treated with dignity and respect. Their efforts, along with civilian and military personnel helping to fight Ebola in the region, are what will ultimately control the outbreak at its source and eliminate the threat of additional domestic Ebola cases.
Any use of public health orders, like restricted public activity and travel restrictions, should be fair and ethical. Before such restrictions are made, public health departments and other authorities should plan carefully. Those plans should consider providing shelter, food, and if people will lose wages if they are not able to work. They should also be made on an individual basis taking into account the person’s history and if they have been following the requirements of direct active monitoring.
Page last reviewed: November 1, 2014
Page last updated: November 1, 2014
中文翻译：numa
本文地址：http://www.wjbb.com/know/836
原文出处：http://www.cdc.gov/vhf/ebola/exposure/qas-monitoring-and-movement-guidance.html
