Public Health Management of People with Suspected or Confirmed VHF or High-Risk Exposures

Overview

• This page outlines recommendations for public health management of people with certain suspected or confirmed VHFs with risk of person-to-person transmissionA.
• It also provides guidance for management of people with high-risk exposures to these VHFs.
• The guidance on this page applies to people located in or intending to travel to the United States.

Definitions

Suspected VHF case

The combination of signs and symptoms compatible with a VHF AND an epidemiological risk factor within the incubation period of the virus before the onset of symptoms, before confirmatory testing occurs. See Viral Hemorrhagic Fever (VHF) 2022 Case Definition.

Confirmed VHF case

Confirmed cases are those that meet confirmatory laboratory criteria for diagnosis. See Viral Hemorrhagic Fever (VHF) 2022 Case Definition.

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 while working in a VHF treatment unit or associated facility (e.g., laboratory) or while taking care 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

Isolation

Separation of a person or group of people, reasonably believed to be infected with a communicable disease and potentially infectious, from those who are not infected to prevent the spread of the communicable disease. Persons could be reasonably believed to be infected if they display the signs or symptoms of the communicable disease of concern and there is some epidemiologic reason to believe that an exposure had occurred. Isolation for public health purposes may be voluntary or compelled by a federal, state, tribal, local, or territorial public health order.

Quarantine

Separation of a person or group of people, reasonably believed to have been exposed to a communicable disease, but not yet infectious, from others who have not been so exposed, to prevent the possible spread of the communicable disease.

Public health orders

Legally enforceable directives issued under the authority of a relevant federal, state, tribal, local, or territorial entity that, when applied to a person or group, may place restrictions on the activities undertaken by that person or group, potentially including movement restrictions or a requirement for monitoring by a public health authority, for the purposes of protecting the public's health. Federal public health orders may be issued to enforce isolation, quarantine, or conditional release. The list of quarantinable communicable diseases for which federal public health orders are authorized is defined by Executive Order and includes viral hemorrhagic fevers.

People with suspected or confirmed VHF

People with suspected or confirmed VHF should remain in isolation at a healthcare facility until they have been determined not to have VHF (if suspected) or to be no longer infectious (if confirmed). CDC has published clinical guidance for assessing VHF risk in an international traveler.

If a diagnosis of a VHF is considered, state, tribal, local, or territorial public health officials should coordinate with CDC to ensure appropriate precautions are taken to help prevent potential spread of VHF and to arrange for testing. As a resource for public health departments, CDC's Viral Special Pathogens Branch (VSPB) is available 24/7 for consultations regarding suspected VHF cases by calling the CDC Emergency Operations Center (EOC) at 770-488-7100 and requesting VSPB's on-call epidemiologist, or by emailing spather@cdc.gov.

People with high-risk exposures

For the duration of the incubation period of the virus after their last potential high-risk exposure, a person should be:

• Quarantined
• Monitored daily
  • Monitoring can be conducted by phone, video conferencing, other electronic means (e.g., text message, email, app, web form), or in person, according to resources available in that jurisdiction.
• Restricted from traveling by commercial transport

CDC requests notification regarding any individuals identified with high-risk exposures. To make these notifications, health departments should call CDC's EOC (770-488-7100) and ask to speak to the on-call epidemiologist for VSPB, or email spather@cdc.gov.

Use of public health orders

Quarantine or isolation may be voluntary or under public health orders. State, tribal, local and territorial authorities have primary jurisdiction for isolation and other public health orders within their borders. Federal public health authority primarily extends to international arrivals at ports of entry and to preventing interstate spread of communicable diseases.

CDC recognizes that decisions and criteria regarding when and how to use such public health measures may differ by jurisdiction. Consistent with principles of federalism, state, tribal, local, and territorial jurisdictions may choose to make decisions about the use of public health orders for isolation or quarantine, monitoring, and other precautions that provide a greater level of public health protection than is recommended in federal guidance.

Travel by people with suspected or confirmed VHF or high-risk exposures

People with suspected or confirmed VHF, and asymptomatic people with high-risk exposures, are not permitted to travel by commercial transport into, within, or out of the United States until cleared by public health officials. Health departments may request use of federal public health travel restrictions for people with high-risk exposures, or suspected or confirmed VHF, if they intend to travel before being cleared to do so by public health authorities. The request can be made by contacting the CDC Port Health Station with jurisdiction for the area where the person is located.

If travel is necessary (e.g., to obtain medical care that is not available locally), transportation should be conducted in a manner that does not expose operators (e.g., air crews, bus drivers) or other travelers. The mode of transportation (e.g., ground vs. air transportation) should be determined by distance to final destination as well as the clinical condition of the traveler (i.e., whether medical care may be needed en route). Health departments assisting travelers in arranging alternative transportation should coordinate with one another.

• People with suspected or confirmed VHF should be transported only by medical transport (i.e., ground or air ambulance) with infection control precautions in place to protect medical personnel.
• CDC has issued separate guidance for air medical transport for patients with suspected or confirmed VHF.
• For more information on developing interfacility transport plans of patients with suspected or confirmed VHF: Guidance for Developing a Plan for Interfacility Transport of Persons Under Investigation or Confirmed Patients with Ebola Virus Disease in the United States.
• Options for transport of asymptomatic people with a high-risk exposure to a VHF are private vehicle or chartered or private aircraft with precautions in place to protect air crews. In these instances, the health department should ensure communication occurs with counterparts in receiving jurisdiction.

International air transport of a person with suspected or confirmed VHF or high-risk exposure to a destination within the United States

Per CDC regulations (42 Code of Federal Regulations, Part 71: Foreign Quarantine), the aircraft operator must notify CDC in advance through the CDC Port Health Station with jurisdiction for the port of entry or the CDC Emergency Operations Center (770-488-7100 or eocreport@cdc.gov).

The aircraft operator should also coordinate with the following to ensure compliance with all applicable laws and regulations:

• U.S. embassy or consulate and health authorities for the country where the individual is located or for any stops en route to the U.S.
• Federal Aviation Administration
• U.S. Customs and Border Protection
• Appropriate state, tribal, local, and territorial governments
  • CDC can facilitate communications with U.S. jurisdictions as needed.