DHS boosts screening for travelers from Ebola outbreak nations

In a step to further tighten checks on travelers from Ebola-stricken countries, the US Department of Homeland Security (DHS) announced today that all travelers whose flights originate in Guinea, Liberia, or Sierra Leone must enter the United States through one of five airports that are currently doing enhanced screening for the disease.

The new measures go into effect tomorrow at five airports that account for 94% of all travelers from the three outbreak countries: New York's JFK, Newark, Dulles, Atlanta, and Chicago O'Hare.

Though there are no direct, nonstop flights to the United States from the three outbreak countries, federal officials estimate that about 150 people from those locations fly into the United States each day.

Entry screening enhancements

The DHS said it already has a system to identify and screen anyone at land, sea, and airport entries to the United States who it believes has been in Guinea, Liberia, or Sierra Leone in the preceding 21 days.

DHS Secretary Jeh Johnson said in a statement that the department is working closely with airlines to implement the restrictions with minimal disruption. If airlines haven't made the changes to travelers' itineraries, a few passengers might have to contact the airlines for rebooking.

"We are continually evaluating whether additional restrictions or added screening and precautionary measures are necessary to protect the American people and will act accordingly," Johnson said in the statement.

Several members of Congress, both Democrats and Republicans, have called for a ban on travel to and from the affected region. Federal officials, however, have said a total ban may have unintended consequences, such as slowing outbreak response activities and the flow of needed supplies to West Africa.

Yesterday at a media briefing, US Centers for Disease Control (CDC) Director Tom Frieden, MD, MPH, said banning travel could undermine the ability to track people from the countries once they enter the United States. He has said, though, that government officials have an open mind to any ideas to enhance protection. "Protecting Americans is our top priority," Frieden said.

Federal health officials have specified that exit screening from affected countries is the best way to prevent travel-linked Ebola cases, and the CDC has helped the three countries set up departure screening, and the agency monitors its use.

WHO convenes emergency panel, posts checklist

The World Health Organization (WHO) said today that its emergency committee on Ebola will meet tomorrow for the third time to review the latest developments and assess if changes need to be made to current recommendations. In an e-mail to journalists, the WHO said it expects the discussions to last a day or two and that it will brief the media at the end of the meeting.

In early August, based on the committee's recommendation, WHO Director-General Margaret Chan, MD, MPH, declared that West Africa's Ebola outbreak is a public health emergency of international concern (PHEIC) under International Health Regulations. The group met for a second time on Sep 22, recommending that temporary recommendations from August be kept in place and identifying areas where more attention was needed.

In other WHO developments, the agency recently released an Ebola preparedness checklist for countries, based on input from global health groups, including the CDC. The WHO said all countries should be prepared to handle Ebola illnesses, especially those in the top two tiers of its four-tired risk group stratification.

The checklist covers 10 key components, with tasks to be completed by 30, 60, and 90 days from the Oct 17 publication of the list. The list of components includes, for example, rapid response teams, infection prevention and control, case management, and contact tracing.

Texas and Ohio news

In ongoing contact screening related to three Ebola infections in Texas, 15 more people have completed their 21-day monitoring period, bringing the total to 60, according to an update today from the Texas Department of State Health Services (TDSHS).

There are still 112 people who are being monitored for symptoms, according to the TDSHS. All have links to Thomas Eric Duncan, a Liberian man who died from Ebola at a Dallas hospital on Oct 8, and two of his nurses, whose illnesses were confirmed on Oct 11 and Oct 15.

Both nurses are being treated at infectious disease specialty units outside of Texas: Nina Pham at the National Institutes of Health Clinical Center in Bethesda, Md., and Amber Joy Vinson at Emory University Hospital in Atlanta.

In other Texas developments, Texas Health Presbyterian Hospital in Dallas, where Duncan was treated and the two nurses were infected and originally treated, announced yesterday the end of diversion for ambulance traffic. Health officials ordered the diversion in the wake of the Ebola cases, but it did not affect emergency department visits that didn't involve ambulance transport.

The hospital's parent company, Texas Health Resources, posted a letter on its Web site apologizing to the community for mistakes it made in handing Duncan's case. The Oct 19 letter, written by chief executive officer Barclay Berdan, said that although the institution is grateful to its care teams, it made mistakes in handling a difficult challenge, which includes not diagnosing Duncan's symptoms as Ebola on his first visit.

Berdan said the hospital had begun Ebola preparedness activities but had not fully deployed them when Duncan sought care.

He added that the investigation is still under way into what led to the nurses' infections, but so far indications show that the staff was following CDC recommendations that were in place at the time. He said in the meanwhile, the hospital is making all changes that are needed to make the environment safer for workers.

Meanwhile, the Ohio Department of Health (ODH) has identified 17 more people for Ebola contact tracing, raising the total to 159, according to an update today. The people may have had contact with Vinson, the second infected Dallas nurse. She had traveled by air to the Akron area in the days before her fever developed and may have had her first symptoms before she departed the state.

The number of people who are quarantined in Ohio remains at three.

Other developments

  • Emory University Hospital announced yesterday that a patient admitted for Ebola treatment on Sep 9 was discharged from the hospital on Oct 19. It said in a statement that tests showed that the man is free of the virus and doesn't pose a public health threat. It said he asked to remain anonymous, left the hospital for an undisclosed location, and will make a statement at a later date. The patient, the third to be treated for Ebola at Emory's special unit, is thought to be an American doctor who got sick with the virus while working for the WHO in West Africa.

  • Health officials from a Firestone rubber plantation in Liberia and their collaborators from the CDC today described how the company's health system responded to the Ebola outbreak, an experience that may yield lessons for other groups. The report appeared today in Morbidity and Mortality Weekly Report (MMWR). The company's plantation, located in Margibi County, employs 8,500 people in Liberia. The plantation's first Ebola case was detected at the end of March in a woman who had cared for a sick family member outside the plantation. Her illness triggered the company health group's incident management system to handle the response, which ranged from case identification to integrating recovered patients back into society. The plantation experienced a spurt of infections starting in early August. By Sep 23, 71 Ebola cases had been reported, 39 of them fatal. The authors wrote that Firestone's quick response limited the spread of the disease, and that several unique elements of the response might be useful in other settings—for example, managing contacts based on their exposure and allowing voluntary quarantine while providing educational materials, personal protective gear, and waste disposal equipment.

See also:

Oct 21 DHS statement

Oct 17 WHO Ebola preparedness checklist

Oct 21 TDSHS update

Oct 20 Texas Health Resource statement on end to ambulance diversion

Oct 19 Texas Health Resource letter

Oct 21 ODH contact update

Oct 20 Emory University Hospital statement

Oct 21 MMWR report

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