Embed Size (px)
Citation preview
Ebola Response 2014
Nicole Mazur, MPHNew Jersey Department of Health Communicable Disease Service
Department of Health Structure
DOH
Public Health
Services
EEOHS
CDSEpidemiology & Surveillance
CDS ROLE
• Assist LHD with case investigations and contact tracing • Guidance on disease epidemiology (transmission, incubation period, etc.)• Clinical consultation on suspected cases• Liaison with CDC and other states on inter-jurisdictional cases• Provide technical guidance and resources for case evaluation &
management• Provide health education materials • Coordination and consulting with other agencies • Guidance on surveillance and monitoring• Coordination of active monitoring of those with low but not no risk• Monitoring persons with high, some, or low risk
NJDOH CDS Ebola Response Team
• Administration• Clinical• Epidemiology • Laboratory Testing • Communications• IT Support
EVD Affected areas
As of October 29th
Widespread TransmissionGuineaSierra LeoneLiberia
Travel-associated Case(s) and Localized Transmission Nigeria*Spain^United States^
Travel-associated Case(s) OnlyMaliSenegal*^
*No longer risk of transmission in these countries^Persons traveling to these countries should not be considered to be at risk for exposure
EVD Response and Preparedness• Airport Screening:
• NYC- JFK• Chicago- O’Hare• Newark• Atlanta• Washington, DC- Dulles
• 94% of flights from affected areas come through these airports• Nearly half come through JFK
• Active Monitoring began at airports on October 16 (JFK earlier Oct 11)
CDC Care kit
Active Monitoring• New Jersey Department of Health, Communicable Disease
Service• Recommendations for Follow Up of Ebola Virus Disease ‐
(EVD) • Low (but not zero) Exposure*• Reported from the CDC Division of Global Migration and
Quarantine (DGMQ)
• *Low (but not zero) exposure is defined as having been in a country in which an EVD outbreak occurred in the past 21 days and having had no exposure.
LHD Responsibilities• LHD will provide a contact number for the person to report
both daily temperature readings and possible symptoms
• LHD will provide a 24/7 contact number to the person being monitored, should symptoms or questions arise.
• The LHD should provide the name and location of hospital(s) near the person’s home or work.
• Temperature reports will be entered into CDRSS, as well as any symptoms that arise
Traveler Responsibilities
• Individuals being monitored will need to consult with the LHD if there is any
• planned travel out of the area for an extended period of time.
• If symptoms arise or a recorded temperature of ≥100.4⁰F (38⁰C) is noted; individuals should:
• Immediately isolate themselves (from people and pets), • CALL 9-1-1 to seek medical evaluation at a nearby hospital**• (persons should travel to the hospital via ambulance)
• IMPORTANT!!• **Alert 911 to symptoms and recent travel to an Ebola affected area**‐
Active monitoring
Reporting
Persons presenting to health care providers with fever or any other ebola symptoms AND travel to EVD-affected area within past 21 days should be IMMEDIATELY reported to the LOCAL HEALTH DEPARTMENT where the patient resides. If the local health department is unavailable please call New Jersey Department of Health- Communicable Disease Service.
Contact Information• If you suspect EBOLA…. CALL PUBLIC HEALTH IMMEDIATELY!
• How do you reach Local Health?• http://www.nj.gov/health/lh/documents/lhdirectory.pdf• Know your Local Public Health’s phone # and keep it on hand.
• How do you reach State Health?609-826-5964 Daily Monday - Friday609-392-2020 Nights, Weekends and Holidays (Emergencies Only, Immediately Reportable Diseases)
Outside of CDS
• For questions pertaining to other issues not related to the Communicable Disease Service, Please call:
• Office of Local Public Health• 609-292-4993• [email protected]
• Consumer, Environmental & Occupational • Health Service
609-826-4920
• EMS• 609-633-7777• [email protected]
Resources
• CDC website • http://www.cdc.gov/vhf/ebola/
• NJDOH website http://www.state.nj.us/health/cd/vhf/index.shtml
Public Health Response to Ebola• Surveillance• Follow up for possible exposures• Public Information • Quarantine: Restriction of activities of well persons
who have been exposed to a case of a communicable disease during its period of communicability
• Isolation: The separation and confinement of individuals known or suspected to be infected with an infectious disease to prevent them from
transmitting the disease to others• Contact Tracing
The CDC “CARE” Kit—Check and Report Ebola--distributed to arriving air passengers
Public Health ResponseLayered, Graduated, Risk-based
• “Active Monitoring”—Local Health Departments will be checking in with people who have arrived from West Africa (usually by phone) for 21 days after arrival to see whether they develop symptoms (low risk travelers)
• “Direct Active Monitoring” LHD visits or Skypes traveler to monitor for symptoms for 21 days (“some risk”) travelers. There MAY be restrictions on travel or public activities for that person. (partial quarantine)
• “Direct Active Monitoring with Activity Restrictions and Travel Restrictions” LHD visits or Skypes traveler with high risk exposure for 21 days (Quarantine)
Law Enforcement support of Public Health• NJSA 26: 4-2 and NJAC 8:57-1.1 give the Local Board of
Health and the Health Officer the power to enforce these restrictions, and specify that they can call on local law enforcement to assist.
• We may ask your assistance in locating and observing the location of a person under quarantine.• We are not asking you to arrest them.• We are not asking you to do anything that will expose you to the
virus• Remember, a person under quarantine is not contagious (We are
watching them to make sure they don’t become contagious– the firewall between those who are sick and the general public)
“But what if they don’t cooperate?”
• Inform the person they may be in violation• Document the action that the subject is taking• This is a civil court case, not an arrest
• Call your Local Health Officer right away for additional guidance
• Reality Check: a person who has a contagious case of Ebola is not going anywhere
• Side note: Make our job easier--minimize the number of people who have contact with the person under quarantine
Note:• This guidance will evolve as we learn more about this
disease• Different diseases (i.e. TB) have different thresholds for
Quarantine, depending on how it is spread• It’s the Health Officer’s statutory responsibility to take
appropriate steps to stop the spread of communicable disease in the community• A historic and recognized power, with due process and right of appeal
EBOLAWHAT YOU SHOULD KNOW TO PROTECT YOUR COMMUNITY
PERSONAL PROTECTIVE EQUIPMENT
DOUGLAS J. VORNLOCKERDIRECTOR
SOMERSET COUNTY OFFICE OF EMERGENCY MANAGEMENT
OSHA 1910.132 – Personal Protective Equipment
1910.1020 – Bloodborne PathogensExposure Control Plan
1910.134 – Respiratory Protection
RECOMMENDED PPENJDOH PPE Recommendations for EVD
3 Levels: Basic – Middle – HighBuddy System for Donning & Doffing –
Trained ObserverDevelop Checklists that are specific to your
needs and PPERigorous and Repeated TrainingNo skin exposure when PPE is worn
Availability is currently a limiting factor
BASIC LEVELMinimum PPE when providing direct care to
sick traveler who came from a country with an Ebola outbreakGlovesFull face shield or gogglesSurgical maskLong sleeve waterproof gownShoe covers or waterproof boots
MIDDLE LEVELHealthcare Workers caring for EHF patients with
potential contact with infected fluids and/or workers who can be splashed with blood/body fluids Full face shield with N-95 NIOSH approved respirator
or higherLong sleeve waterproof gown or coveralls with
integrated hoodImpermeable shoe coversWaterproof boots2 pair of disposable nitrile gloves – extended cuffsSingle use impermeable apron covering torso to mid
calf
HIGH LEVELHealthcare workers caring for EHF patients with
severe respiratory involvement or undergoing aerosol-generating procedures (includes EMS workers if intubation is a possibility)Powered Air Purifying Respirator with P-100
cartridges and hoodLong sleeve waterproof gown or coveralls (with
integrated hood if using N-95 APR)Impermeable shoe covers or waterproof boots2 pair of disposable nitrile gloves – extended cuffsSingle use impermeable apron covering torso to mid
calf
PREPAREDNESSReview OSHA Regulations and Achieve ComplianceDetermine Response Protocols and Procedures Based
on Your Level of Potential ExposureCompare Your Inventory Against NJDOH & CDC
RecommendationsAcquire (at least order) PPETrainTrainTrain
These are perishable skills that you will lose if you don’t practice
Revise Your Response Protocols and Procedures
TRAININGThe Somerset County Emergency Services
Training Academy is developing a PPE Considerations for Medical First Responders course. This course will include a section on the Rutgers School of Public Health’s Ebola PPE Training
Courses will begin running during the week of 11/9/14
