Active monitoring versus direct active monitoring for Ebola virus disease in the United States: experiences and perceptions of former persons under monitoring in the District of Columbia and Indiana

A Hennenfent; S McGee; J Clayton; C Feaster; D Nichols; A Billman; N Hearon; K Dassie; J Grant; K Li; K Zamore; J Davies-Cole

doi:10.1016/j.puhe.2019.04.021

Active monitoring versus direct active monitoring for Ebola virus disease in the United States: experiences and perceptions of former persons under monitoring in the District of Columbia and Indiana

Public Health. 2019 Aug:173:9-16. doi: 10.1016/j.puhe.2019.04.021. Epub 2019 Jun 14.

Authors

A Hennenfent¹, S McGee², J Clayton³, C Feaster³, D Nichols³, A Billman³, N Hearon³, K Dassie², J Grant², K Li², K Zamore², J Davies-Cole²

Affiliations

¹ DC Department of Health, Center for Policy, Planning and Evaluation, 899 North Capitol Street NE, Washington, DC 20002, USA. Electronic address: hennenfe@gmail.com.
² DC Department of Health, Center for Policy, Planning and Evaluation, 899 North Capitol Street NE, Washington, DC 20002, USA.
³ Indiana State Department of Health, Epidemiology Resource Center, 2 North Meridian Street, Indianapolis, IN 46204, USA.

PMID: 31207426
DOI: 10.1016/j.puhe.2019.04.021

Abstract

Objectives: During the 2014-2016 West Africa Ebola outbreak, the Centers for Disease Control and Prevention recommended daily monitoring and surveillance of persons arriving in the United States (US) from impacted areas through either active monitoring (phone calls, online platforms, and so on) or direct active monitoring (in-person or electronic visualization). Intensiveness of policies implemented by state/local jurisdictions varied markedly. To study the experiences and perceptions of active monitoring versus direct active monitoring on former persons under monitoring (FPUMs) in the US, we compared two jurisdictions that utilized distinct polices: the District of Columbia (DC) and Indiana (IN).

Study design: Retrospective assessment survey of FPUMs.

Methods: FPUMs from both jurisdictions (DC 826 and IN 246) monitored from October 2014 to September 2015 were surveyed regarding their overall perception of monitoring, communications with jurisdictional staff, negative consequences experienced, and risk for and concern about Ebola virus disease. A total of 294 DC FPUMs and 52 IN FPUMs responded.

Results: Directly actively monitored FPUMs in IN were more likely to report monitoring was difficult (P < 0.01), not being allowed to return to work (P = 0.01), and faster response times when reaching out to their assigned health department (P < 0.01). Overall all FPUMs, regardless of the monitoring method they underwent, perceived little risk and reported they felt monitoring protected public health.

Conclusions: Our results display that while FPUMs preferred active monitoring, both polices equally reduced their concern, suggesting that less intensive polices achieve the same level of perceived effectiveness by those monitored while also reducing the amount of negative consequences they may face.

Keywords: Check and report Ebola (CARE) phone; Enhanced airport entry screening; United States Ebola virus disease active monitoring program.

MeSH terms

Africa, Western / epidemiology
Centers for Disease Control and Prevention, U.S.
Communication
Disease Outbreaks / prevention & control*
District of Columbia / epidemiology
Female
Health Policy
Hemorrhagic Fever, Ebola / epidemiology
Hemorrhagic Fever, Ebola / prevention & control*
Humans
Indiana / epidemiology
Male
Population Surveillance / methods*
Public Health
Public Health Surveillance / methods*
Retrospective Studies
Risk Assessment
Surveys and Questionnaires
Travel*
United States