local challenges implementing state policy: evaluating the interim guidance for monitoring and...
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Local Challenges Implementing State Policy: Evaluating the Interim Guidance for Monitoring and Movement
of Persons with Potential Ebola Exposure in Southeast Texas—October-December, 2014
Joseph (Greg) RosenPublic Health Associate
Office for State, Tribal, Local and Territorial SupportCenters for Disease Control and Prevention
PHAP/PHPS Summer SeminarJune 1 – 5, 2015
Centers for Disease Control and Prevention
Office for State, Tribal, Local and Territorial Support
BACKGROUND
First Travel-Associated Ebola Case in the U.S. Confirmed on September 30, 2014 (Dallas, Texas)
Identified risk exposure categories for arriving West African travelers
Recommended public health actions based on traveler’s risk assessment and disposition
Specified active monitoring and disposition reporting duties for all jurisdictions
Texas Department of State Health Services (DSHS) Interim Guidance for Post-Arrival Active Monitoring
“Guidance: Monitoring and Movement of People with Potential Exposure to Ebola Virus Disease.” Texas Department of State Health Services, November 2014 <http://texasebola.org/pdfs/1505-Monitoring-Movement.pdf>.
“How to Take Your Temperature.” Centers for Disease Control and Prevention, October 2014 <http://www.cdc.gov/vhf/ebola/pdf/care-kit.pdf>.
Key Differences: CDC and Texas Interim Guidance
“Interim U.S. Guidance for Monitoring and Movement of Persons with Potential Ebola Virus Exposure.” Centers for Disease Control and Prevention, October 2014 <http://www.cdc.gov/vhf/ebola/exposure/monitoring-and-movement-of-persons-with-exposure.html>.
Persons under Monitoring (PUMs) in Health Service Region 6/5 South, by County, Oct – Dec 2014 (N=76)
Montgomery
Harris
Liberty
Jefferson
Galveston
Brazoria
Fort Bend
Chambers
Hardin
Orange
Walker
WallerAustin
Colorado
Wharton
Matagorda
PUMs in Health Service Region 6/5 South, by Date of Arrival in Texas, Oct – Dec 2014 (N=76)
0
5
10
15
20
25
30
Monitoring Date
Num
ber o
f Tra
vele
rs
|---------------------------November-----------------------------||-----------------------------December-----------------------------|
CDC announces e
nhanced entry
screening f
or trav
elers fro
m Mali Christmas Day
METHODSCourtesy of the Texas Department of State Health Services, Center for Health Statistics (Austin, TX)
Clarity & Comprehensiveness
Design
Inputs
Outputs
Outcomes
Context Resources
Semi-structured key informant interviews with local health department (LHD) staff
Testimony gathered on guideline implementation at the local level
Identification of a process-evaluation model
Evaluation Criteria
Evaluation Measures
Prog
ram
Per
form
ance
Indi
cato
rs
RESULTS
Courtesy of the Centers for Disease Control and Prevention, 2014 (Atlanta, GA)
Confusion over appropriate media for communicating with travelers and reporting results
Ambiguity of agency responsibility in reconciling errors in traveler manifests
Conflicting recommendations from public health and local emergency management
Clarity and Comprehensiveness
“Twice daily temperature checks at least 6 hours apart for 21 days after departure from country. Report daily monitoring outcomes to DSHS Emerging and Acute Infectious disease branch each day.”
DSHS regional presence to engage/support LHD monitoring activities
Rotating LHD active monitoring staff inhibited institutional memory
Home visits posed geographical and capacity-related challenges
Context
Recommended public health action for low-risk travelers, asymptomatic upon arrival in Texas:“Notification of LHD followed by in-home visit and risk interview within 12 hours of LHD notification”
Courtesy of Texas Department of State Health Services, Center for Health Statistics
Context
CDC post-arrival resources for travelers utilized inconsistently
Conducting risk assessments at airports for some/high-risk PUMs required interagency cooperation
High volume of travelers = inaccuracies in distributed traveler information
Resources
Recommended public health action for some/high-risk travelers, asymptomatic upon arrival in Texas:“Public health meets passenger at the airport, and retakes temperature, and interviews for risk factors.”
Resources
CONCLUSIONS AND RECOMMENDATIONSCourtesy of the Texas Department of State Health Services, 2015 (Austin,TX) <http://texasebola.org/>
Achieved maximum (100%) participation among LHDs
Guidelines unaligned with quantity of travelers and duration of active monitoring
Resources required to implement guidelines outweighed LHD capacity
Quantitative assessment of allocated resources and program outcomes
Consultations with LHDs necessary for maximizing adherence to response guidelines
Highlights importance of routine evaluation of responses involving local implementation
Summary of Findings and Implications for Practice
For more information, please contact CDC’s Office for State, Tribal, Local and Territorial Support
4770 Buford Highway NE, Mailstop E-70, Atlanta, GA 30341Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348E-mail: [email protected] Web: http://www.cdc.gov/stltpublichealth
The findings and conclusions in this presentation are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
Questions or Comments?Joseph (Greg) Rosen
[email protected] [email protected]
Centers for Disease Control and Prevention
Office for State, Tribal, Local and Territorial Support