The New Mexico Department of Health (NMDOH) reports that as part of its Ebola Virus Disease (EVD) response plan, it has completed active monitoring of travelers returning to New Mexico from countries in West Africa that were part of the largest EVD epidemic in history. The Centers for Disease Control and Prevention (CDC) says Ebola virus transmission has ceased in West Africa and therefore it is no longer necessary to actively monitor travelers.
EVD is a rare and deadly hemorrhagic (bleeding) disease caused by infection with one of the Ebola virus species that can cause disease in humans. Ebola virus was discovered in 1976 near the Ebola River in the Democratic Republic of the Congo. It affected multiple countries at that time.
The largest EVD outbreak in history began in West Africa in March 2014. The vast majority of cases and deaths occurred in three West African countries: Sierra Leone, Liberia, and Guinea. During this outbreak, other countries had locally acquired or imported Ebola cases (i.e., Nigeria, Senegal, Spain, United States, Mali, United Kingdom, and Italy).
During this epidemic, the CDC developed and periodically updated guidance for monitoring people potentially exposed to Ebola virus, and for evaluating any travel they intended, including applying movement restrictions when indicated. NMDOH applied the CDC guidelines and monitored returning travelers from Sierra Leone, Liberia, Guinea, and Mali from October 2014 through December 2015.
NMDOH’s procedures included contacting the returning traveler by the time they arrived in New Mexico to make them aware of state procedures, verifying the accuracy of the information received upon entry into the US, conducting a standardized interview to determine their risk category, and initiating 21 days of monitoring, the longest amount of time it could take for a person exposed to Ebola virus disease to become sick themselves. During monitoring, all individuals recorded their symptoms and temperatures twice a day and reported them every day to NMDOH. A 24/7 system was in place so that if an individual being monitored became ill, they could contact NMDOH and arrange for rapid and appropriate medical evaluation. Systems were in place to protect the person being monitored, healthcare personnel who might come in contact with that person, and the public.
NMDOH monitored 86 returning travelers, none of whom developed signs or symptoms suggestive of EVD. None of the monitored returning travelers required laboratory testing for EVD.
On average, NMDOH monitored about six returning travelers per month: 30 from Sierra Leone, 28 from Liberia, 25 from Guinea, and three from Mali. More than 70 percent of travelers arriving in New Mexico were US citizens returning home. Almost 60 percent of travelers were US government employees or government contractors assigned to perform various duties related to the EVD epidemic response. A small number (10 percent) were medical volunteers. Of the travelers who were residents of West Africa, more than 70 percent were Guineans. The majority of travelers (91 percent) were categorized as low risk and the remainder were classified as some risk. There were no travelers considered high risk.
As of January 3, 2016 the World Health Organization (WHO) reported a total number of 28,637 confirmed, probable and suspected cases of EVD, and 11,315 deaths. The West African countries involved in this outbreak may continue to experience cases or clusters of individuals with EVD related to re-emergence of Ebola virus that persists in previously infected persons. The West African governments, with support from partners including WHO and US CDC, have services and systems in place to prevent and identify transmission of EVD.
The NMDOH monitoring system worked well and accomplished its intended purpose to monitor returning travelers for illness that might represent Ebola virus disease, to assess and test any traveler for EVD if indicated, and to protect the public from exposure to any potential EVD. The Department continues to closely follow all EVD activity in West Africa, and to work with partners statewide on EVD preparedness. Lessons learned are being applied more broadly to prevention, detection, treatment and control of other emerging infectious diseases of importance to the health of the public.