Description of Persons Under Investigation for Ebola Virus Disease — New Jersey, August 2014–May 2015

Background: Since the escalation of the outbreak of Ebola virus disease (Ebola) in August 2014, the New Jersey Department of Health (NJDOH) has provided guidance to clinicians on the management of persons under investigation (PUIs) for Ebola. On October 27, 2014, the Centers for Disease Control and Prevention instituted a policy of active monitoring (AM), which involves daily temperature and symptom reporting, for all persons returning to the U.S. from Liberia, Sierra Leone, and Guinea. The purpose of this analysis was to describe the clinical management and outcomes of PUIs in New Jersey during August 1, 2014–May 15, 2015 and to determine what proportion of those under AM became PUIs.

Methods: A PUI was defined as a person who had signs or symptoms consistent with Ebola, including temperature ≥100.4 or subjective fever, headache, fatigue, myalgias, abdominal pain, vomiting, diarrhea, or unexplained hemorrhage, and epidemiologic risk for Ebola, including travel to a country with widespread transmission, within 21 days before symptom onset. Clinical information was obtained from public health partners and treating physicians. Because of the known possibility of falsely negative results early in the disease, the decision to perform specific Ebola testing was based on the degree of exposure and clinical assessment. NJDOH also maintains a record of all persons who undergo AM in the state.

Results: During August 1, 2014–October 26, 2014, 12 PUIs underwent evaluation. After the initiation of AM, during October 27, 2014–May 15, 2015, 11 additional PUIs were evaluated, representing 1.3% of all 862 persons who underwent AM. The most common diagnosis was malaria, seen in six (26%) persons. Other common diagnoses included gastroenteritis and influenza. No diagnosis was made for eight (35%) PUIs, in whom Ebola was excluded based on rapid symptomatic improvement. Ebola testing was performed for one PUI with higher exposure risk, and this was negative.

Conclusions: Immediate Ebola testing was not needed for PUIs with low exposure risk. Identifying other diagnoses and carefully following the clinical course of PUIs were effective management strategies. Also, only a small percentage of those under AM became PUIs, indicating that most returning travelers remained healthy.