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Military personnel returning to US pose low risk for Ebola transmission
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Research published in MMWR suggests United States military members who support Ebola control efforts in Liberia pose little risk for Americans upon their return.
“In response to the unprecedented Ebola virus disease outbreak in West Africa, the U.S. government deployed approximately 2,500 military personnel to support the government of Liberia. Their primary missions were to construct Ebola treatment units (ETUs), train health care workers to staff ETUs, and provide laboratory testing capacity for Ebola.” Todd J. Vento, MD, a military physician at San Antonio Military Medical Center, and colleagues wrote. “Service members were explicitly prohibited from engaging in activities that could result in close contact with an Ebola-infected patient or coming in contact with the remains of persons who had died from unknown causes.”
U.S. military personnel in Liberia were monitored twice daily. Any service member with a temperature above 100.4°F or with any Ebola exposure or displaying symptoms were taken to a Department of Defense medical facility for further assessment, according to the researchers. Liberian government employees also screened U.S. service members for fever at various controlled access points. These monitoring and assessment steps were approved by U.S. and Liberian health officials.
Todd J. Vento, MD
When departing Liberia, service member records were checked for monitoring compliance, and service members received an exit screening. Upon return to the U.S., they were monitored for 3 weeks at segregated locations on military bases, the researchers wrote. While 1.8% of these deployed service members experienced illness while in Liberia (including 33% gastrointestinal, 22% respiratory and 20% dermatologic), researchers estimated one febrile illness per 9,100 person-days in Liberia, and no one tested positive for Ebola virus.
“Having been in a country with widespread transmission, deployed service members would be categorized, by CDC criteria, as low (but not zero) risk upon return to the United States,” Vento and colleagues wrote. “However, based on their non-Ebola care mission and stringent activity restrictions while deployed, they might be at lower risk for exposure than returning U.S. travelers who spent time in Liberia without such restrictions. A report of U.S. airport entry screenings of 1,993 travelers from Ebola-affected countries found that 86 (4%) were referred to CDC public health officers for medical evaluation, seven developed Ebola-compatible symptoms, and none had Ebola.”
In a related study published in MMWR, researchers found that all 50 states, the District of Columbia, Puerto Rico, and other territories and freely associated states were efficient at following CDC guidance on movement and monitoring for travelers coming into the U.S. and health care workers in the U.S. caring for Ebola patients domestically. Within 7 days of the guidance, all of these jurisdictions had effective programs in place, according to Tasha Stehling-Ariza, PhD, MPH, epidemic intelligence service officer at the CDC, and colleagues.
From Nov. 3, 2014 to March 8, 2015, 10,344 people were monitored effectively ( > 99%) for up to 3 weeks. The overwhelming majority (91.9%) were travelers at low risk, while only 3% were considered to be of moderate or greater risk, according to the researchers. None of those monitored tested positive for Ebola.
“These results provide evidence of successful U.S. monitoring for Ebola ... ” they wrote. “Given the complexity and amount of coordination of effort required, the Ebola monitoring program in the United States provided systemic evidence of the capability of state, territorial, and local health departments to ensure and protect the health of the U.S. public.” – by David Jwanier
Disclosure: The researchers report no relevant financial disclosures.
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