Recommendations for organizations sending U.S.-based healthcare or emergency response personnel to areas with viral hemorrhagic fever (VHF) outbreaks

At a glance

Organizations sending U.S.-based personnel to areas where viral hemorrhagic fever (VHF) outbreaks may be occurring, are responsible for supporting the health and safety of those personnel before, during, and after their deployment.

Overview

  • This page outlines recommendations for organizations such as nongovernmental, faith-based, academic, or aid organizations that send U.S.-based personnel (employees, contractors, trainees, or volunteers) to areas with outbreaks of VHF with risk of person-to-person transmission A.
  • Pre-deployment, during-deployment, predeparture, and post-deployment recommendations are outlined.
  • Examples of tools that can be utilized to conduct exposure risk and health assessments before personnel depart the outbreak area are included.

Definitions

High-risk exposures

These include:

  • Percutaneous (i.e., piercing the skin), mucous membrane (e.g., eye, nose or mouth), or skin contact with blood or other body fluidsB of a person with a confirmed or suspected VHF
  • Physical contact with a person who has a confirmed or suspected VHF, without the use of recommended personal protective equipment (PPE)C
  • Providing health care to a patient with a confirmed or suspected VHF without use of recommended PPE or experiencing a breach in infection control precautions that results in the potential for percutaneous, mucous membrane, or skin contact with the blood or other body fluids of a patient with a VHF
  • Physical contact (without using recommended PPE) with a body of a person who died of confirmed or suspected VHF, or any dead body in an area with a declared VHF outbreak, or experiencing a breach in infection control precautions while handling such a dead body
  • Living in the same household as a person with confirmed or suspected VHF while that person was symptomatic

Situations with additional exposure potential

The following situations have potential for unrecognized VHF exposures:

Nonoccupational

  • Visiting a health care facility or traditional healer in an outbreak areaD
  • Attending a funeral or burial in an outbreak areaD
  • Having exposure to a person with acute febrile illness in an outbreak areaD

OccupationalE

  • Providing health care or environmental cleaning in an VHF treatment unit (VTU)
  • Entering a patient care area of an VTU for any reason
  • Providing health care in an outbreak areaD to acutely ill patients not known to have a VHF
  • Cleaning in a non-VTU healthcare facility in an outbreak areaD
  • Performing clinical laboratory work associated with a VTU or other healthcare setting in an outbreak areaD
  • Participating in burial work in an outbreak areaD

Organization responsibilities

  • Consider designating one or more safety officers responsible for health and safety of personnel before, during, and after deployment. Having safety officers in the outbreak country and in the U.S. will facilitate coordination.
    • Several factors may warrant designation of safety officers exclusively devoted to the full spectrum of VHF prevention and control activities (e.g., increased number of staff members being deployed, a high-intensity VHF outbreak, deployers working in clinical care settings designated for patients with known VHF or in areas with VHF transmission).

Pre-deployment: before personnel travel to outbreak areas

During deployment: while personnel are present in outbreak areas

  • Remain in contact with all personnel throughout their stay. Ask regularly about symptoms and potential exposures.
  • Ensure all personnel are aware that travel back to the U.S. is not allowed except as part of a coordinated medical evacuation, if they:
    • have confirmed VHF infection, until they are determined by health authorities to be no longer infectious;
    • had a high-risk VHF exposure (see definition) and are within one incubation period of the virus following the last high-risk exposure (for example in the case of Ebola virus, the previous 21 days), even if they are asymptomatic; or
    • have symptoms consistent with VHF and are within one incubation period of the virus following any potential VHF exposure, unless they are medically assessed by local health officials (with concurrence by U.S. health officials) and determined not to have VHF.
  • Coordinate with the nearest U.S. embassy and local health officials to facilitate timely medical evaluation and care of any symptomatic personnel.
  • Contact CDC to discuss management of personnel with high-risk exposures to viruses that cause VHFs and, if necessary, to coordinate safe return travel of symptomatic or exposed U.S.-based personnel.

Predeparture: before personnel depart from outbreak areas and travel to the United States

Before personnel travel from VHF outbreak areas to the United States, assess them for signs and symptoms compatible with VHF and for possible high-risk VHF exposures.

At a minimum, the predeparture assessment should include the following:

  • Screening for situations with additional exposure potential (see definition) within one incubation period of the virus
    • Conduct a careful assessment of high-risk VHF exposures (see definition) for anyone reporting additional exposure potential
  • Review of signs and symptoms compatible with VHF
  • Determination that the worker appears or feels well
  • Measurement of oral temperature

For those with potential occupational exposures, conduct the occupational exposure assessment after the last possible occupational exposure. All personnel should be assessed for potential nonoccupational exposures and have a health assessment within one day before departure to the United States.

CDC has developed template tools (Workers in VTUs) and (Workers in non-VTU settings) that organizations can choose to use or modify to help structure the comprehensive predeparture assessment. Organizations may also opt to develop their own forms.

While CDC does not request copies of predeparture assessment forms, it does recommend that both the sponsoring organization and the returning worker retain the documentation in case it is requested by the state or local health department where the worker will be located during the monitoring period.

Post-deployment: after personnel depart from the outbreak area

Monitoring:

  • Ensure personnel self-monitor for signs and symptoms of VHF for one incubation period of the virus after leaving the outbreak area and know how to reach the organization and their health department if they become symptomatic.
  • Monitor personnel for symptoms if they have a history of being in occupational or nonoccupational situations with additional exposure potential (see definition). Monitoring can be intermittent (for example weekly or every few days) or as otherwise directed by the health department.
  • For personnel with no history of situations with additional exposure potential, self-monitoring with a single follow-up at the end of one incubation period of the virus to confirm the outcome of self-monitoring is sufficient.
  • Monitoring may be conducted by phone, video conferencing, other electronic means (e.g., text message, email, app, web form), or in person, according to resources available.
  • Notify the state or local health department immediately if any individual located in the United States develops symptoms during the monitoring period. Health departments are responsible for coordinating a rapid and safe medical response. On-call contact numbers for state and large jurisdiction health departments are available for this purpose.
    • Contact CDC if you are unable to contact the state or local health department of jurisdiction.
  • Notify state and local health departments of an individual's travel plans during the monitoring period, including if a worker intends to relocate to another state or leave the United States.

Additional recommendations:

  • Ensure that returned healthcare personnel who intend to provide care to patients in U.S. healthcare facilities during one incubation period of the virus after leaving the outbreak area first notify the facility's infection control or occupational health professional of their recent travel and self-monitoring activities.
  • For additional guidance on healthcare providers' return to work in the United States after caring for a patient with suspected or confirmed VHF infection abroad, see Infection Prevention and Control Recommendations for Patients in U.S. Hospitals who are Suspected or Confirmed to have Selected Viral Hemorrhagic Fevers (VHF).
  • If personnel intend to deploy to another country within one incubation period of the virus after leaving the outbreak area for the purpose of providing humanitarian aid, notify the ministry of health of, and the U.S. Embassy in, the destination country, in advance of their arrival.

Symptomatic or exposed U.S. personnel located overseas

CDC is available to provide consultation to organizations that identify personnel with illness compatible with a VHF or high-risk exposures (see definition).

CDC has published separate guidance for public health management of people with suspected or confirmed viral hemorrhagic fever (VHF) or high-risk exposures.

Contacting CDC

For urgent consultations regarding symptomatic or potentially exposed personnel, please call the CDC Emergency Operations Center (available 24/7) at 770-488-7100 and ask to speak to the on-call epidemiologist for the Viral Special Pathogens Branch (VSPB). Consultations to VSPB can also be made by emailing spather@cdc.gov.

Resources

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Content Source:
National Center for Emerging and Zoonotic Infectious Diseases (NCEZID)
  1. Ebola disease, Marburg virus disease, Lassa, Lujo, Crimean Congo Hemorrhagic Fever (CCHF) and the South American Hemorrhagic Fevers (i.e., those caused by Junin, Machupo, Chapare, Guanarito and Sabia viruses).
  2. Body fluids include but are not limited to feces, saliva, sweat, urine, vomit, sputum, breast milk, tears, amniotic fluid, and semen.
  3. Recommended PPE should be sufficient to prevent skin or mucous membrane exposure to blood or body fluids.
  4. Given the potential for unrecognized cases outside of a defined outbreak area, particularly in countries with inadequate public health infrastructure and surveillance systems, these situations should also be taken into consideration when assessing people who were present in a country where an outbreak is occurring but outside of the defined outbreak area.
  5. These occupational exposure situations assume correct and consistent use of recommended PPE. Correct and consistent use of PPE during situations with occupational exposure risk is highly protective and prevents transmission to healthcare or other personnel. However, unrecognized errors during the use of PPE (e.g., self-contaminating when removing contaminated PPE) may create opportunities for transmission to personnel.