Ebola or Not? Evaluating the Ill Traveler From Ebola-Affected Countries in West Africa

Fairley, Jessica K.; Kozarsky, Phyllis E.; Kraft, Colleen S.; Guarner, Jeannette; Steinberg, James P.; Anderson, Evan; Jacob, Jesse T.; Meloy, Patrick; Gillespie, Darria; Espinoza, Tamara R.; Isakov, Alexander; Vanairsdale, Sharon; Baker, Esther; Wu, Henry M.

The 2014-2015 Ebola outbreak was an unprecedented public health crisis in the West African countries of Guinea, Liberia, and Sierra Leone with global impact [1] . As of December 2015, in these 3 most affected countries, there have been 28 601 cases (confirmed, suspected, and probable) and 11 300 deaths [2] . Several other countries also managed patients with Ebola virus disease (EVD), either patients with confirmed EVD transported out of West Africa [3] [4] [5] or those diagnosed after departure from outbreak-affected countries. Because the incubation period of EVD may be as long as 21 days [6] , state health departments and the US Centers for Disease Control and Prevention (CDC) implemented active monitoring policies for travelers from affected areas, with the goal of rapidly identifying individuals who meet the CDC case definition for "persons under investigation" for EVD (PUI) [7] . Because PUI may also unexpectedly present to urgent care or emergency department (ED) settings, it is important for frontline healthcare institutions to consider their capabilities and local public health resources as they develop preparedness plans. To facilitate safe and effective assessments of PUI, CDC developed a 3-tiered strategy that identifies hospitals as frontline healthcare facilities, Ebola assessment hospitals, and Ebola treatment centers [8] .