Lassa Fever /1/17. Reporting Requirements. Timeline. Timeline Continued NICOLE L. MAZUR, MPH EPIDEMIOLOGIST NEW JERSEY DEPARTMENT OF HEALTH

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1 Reporting Requirements Cases should be reported by phone to the local health department where the patient resides. Lassa Fever 2015 NICOLE L. MAZUR, MPH EPIDEMIOLOGIST NEW JERSEY DEPARTMENT OF HEALTH Call NJDOH for immediately reportable diseases (609) {M-F 8am-5pm} (609) {After 5pm and Holidays} Ebola Active Monitoring was implemented in NJ on October 16 th. Any Traveler coming from Liberia, Guinea or Sierra Leone would be under active monitoring for 21 days. Timeline Timeline Continued 1

2 NJDOH Regional Epidemiology Response Four regional epidemiologists(reps) were assigned to three onsite response areas as points of contact: Hospital A and Hospital B (1 REP assigned to each) Identification of occupational health exposures Exposure risk classification (high, low, no known risk) NJDOH liaison with CDC CERT Team Notification of LHDs where workers resided Monitoring of symptom/temperature compliance Newark Department of Health & Human Services (2 REPs assigned) Contact Tracing 217 potential contacts identified from all involved facilities and the community 33 (15.4%) no risk 214 contacted and interviewed 166 (77.6%) low risk 15 (7.0%) high risk Types of Exposure Laboratory Workers Healthcare Workers Family Members Environmental and Dietary Tranporters Hospital A Response Working with NJDOH and assigned REP developed plan for notification, communications, and monitoring Contact identification 95 identified contacts No Risk (not under monitoring): 14 Low Risk: 81 High Risk: 0 2

3 Hospital A Contacts Laboratory Workers Healthcare Workers Environmental Dietary Transport Notification to all Employees Administration held Department Head Meetings Letters also sent out to staff Townhall Meetings On different shifts, open to all Copy of letter, FAQs, and other guidance posted on internal website Rounds done by Infection Control, especially to impacted floors Pulled records for all interactions that staff may have had with case High Risk Low Risk No Risk Active Monitoring of Contacts Low Risk contacts: active monitoring (reporting once per day to report twice daily temperatures) No travel restrictions Symptomatic individuals assessed at frontline hospitals if need arose High Risk contacts: direct active monitoring (reported twice per day with at least one visual observation) DNB and travel restrictions applied Symptomatic individuals assessed at Ebola assessment facilities if need arose High Risk Classification & Response Exposure: Direct, unprotected contact (skin/mucosal) with potentially infectious material (vomitus, excreta, blood or body fluids) Including mouth-to-mouth kissing or sexual contact Response: Direct active monitoring for 21 days 2x daily temperature readings, 1 directly observed Exclusions Young children excluded from daycare; no other work/school restrictions No airline travel, no commercial conveyances Out of state travel case-by-case basis 3

4 Low Risk Classification & Response Exposure: Casual contact (skin to skin, sharing room/vehicle) or protected close contact (healthcare, cleaning/laundry, lab) with PPE (no contact with blood/body fluids) Response: Active monitoring for 21 days 2x daily self-monitored temperature readings, reported 1x daily to LHD with any symptoms Exclusions Young children excluded from daycare; no other work/school restrictions International travel case-by-case basis Occupational Health Risk assessment done by employees, reviewed Both High and Low risk individual to report to Occupational Health Assigned staff to reporting groups to ease burden Low Risk: once a day, to report AM and PM temperature, any symptoms High Risk: twice a day, with one observed temperature Daytime and after-hours numbers provided in case of symptoms Active Monitoring of Contacts By June 19, 2015 all contacts had completed their 21 days of active or direct active monitoring Total, there were 3 incidents where persons were evaluated for Lassa fever during monitoring 1 was tested at CDC on two separate occasions Lassa fever ruled out No secondary cases Recommendations Healthcare providers should always consider other travel associated infectious diseases beyond Ebola in order to remain vigilant Stakeholders should address stigma associated with being traveler or citizen from Ebola-effected countries Health departments should consider using Ebola monitoring systems and protocols for investigations requiring large-scale contact tracing 4

5 Recommendations, Continued Expand education and messaging to include emerging infectious diseases Emphasize preparedness Use mechanisms already in place to support response to other events Reduce stigma to reporting travel history Don t Recreate the Wheel Ebola designated assessment facility used for case s medical care Ebola Active Monitoring Protocol used Ebola PUI protocol used for Lassa PUI s Ebola Situational Report (SitRep) used for situational awareness THANK YOU! Nicole L. Mazur, MPH Nicole.mazur@doh.nj.gov