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Minnesota Ebola Community Risk Assessment Purpose It is important that Minnesota is prepared to evaluate patients at risk for Ebola infection and to care for persons with Ebola Virus Disease (EVD). Ensuring the preparedness of Minnesota’s healthcare system is the responsibility of the Minnesota Department of Health (MDH). This document provides a current Minnesota Ebola community risk assessment. This information is important for decisions about Minnesota’s healthcare preparedness. Minnesota’s traveler monitoring program Monitoring of travelers began on Oct. 27, 2014 and since then, 292 who have entered the monitoring program (as of Jan. 16, 2015). In Minnesota, among the 292 returned travelers the countries of exposure include: Guinea, 13, 4% Sierra Leone, 18, 6% Current risk of Ebola globally • Current countries with widespread EVD are Sierra Leone, Liberia, and Guinea. • Activity in the three affected countries has decreased since November 2014 based on WHO reports. • Previously affected countries with localized transmission but with no current risk include Mali, Nigeria, Senegal, Spain, United States, and United Kingdom. Number of Confirmed Cases Mali, 2, 1% Liberia, 259, 89% Ninety percent resided in the seven-county metropolitan area (64% Hennepin, 10% Ramsey, 8% Anoka, 6% Dakota, 1% Washington, 1% Carver, and <1% Scott). Additional counties include Cottonwood, Mower, Stearns, Sherburne, Rice, Itasca, and Wright. Number of Confirmed Ebola Cases by Week: Nov. 8, 2014 to Jan. 30, 2015 700 600 Nearly 65 percent of the returned travelers had passports from Liberia, 33 percent from the United States and 2 percent from Sierra Leone. 500 400 300 200 100 0 45 46 47 48 49 50 51 52 53 Week 2014-2015 Guinea Liberia 1 2 3 Sierra Leone Average number of weekly confirmed cases over last three months: Average confirmed cases per week Guinea Liberia Sierra Leone Nov. 8 - Dec. 6, 2014 119 71 513 Dec. 7, 2014 - Jan. 3, 2015 120 72 319 Jan. 4 - 31, 2015 34 7 123 For Liberia, there has been a tenfold decrease in the number of confirmed cases from December 2014 to January 2015. 4 Ebola assessment and treatment facilities Four Ebola assessment and treatment facilities have been established in Minnesota. All have received visits from the CDC/MDH Rapid Ebola Preparedness (REP) team. Each facility made recommended changes to their facilities and have developed EVD-specific protocols that address preparation and receiving of EVD Persons Under Investigation (PUI) and EVD cases. Capacity exists for multiple beds serving pediatric patients, adults, and pregnant women. They include: • Mayo Clinic, Saint Marys Hospital – Rochester • Children’s Hospital, St. Paul Campus – St. Paul • University of Minnesota Fairview, Riverside Campus – Minneapolis • Allina Health Systems, Unity Hospital – Fridley (2/2015) Page 1 of 2 Minnesota Ebola Community Risk Assessment Proximity to an Ebola assessment and treatment facility Of the 292 returned travelers to date: • 94% live within 30 miles of one of the four hospitals • 98% live within 45 miles of one of the four hospitals Clinical assessment by MDH The MDH Clinical Ebola Team provides 24-7 clinical consultation to travelers being monitored via telephone if they have health concerns. Other states have chosen to refer all monitored travelers with clinical concerns to a healthcare facility, thus increasing the number of encounters and admissions to an Ebola assessment and treatment facility. MDH Clinical Ebola Team: • Protects resources at Ebola assessment and treatment facilities from unnecessary use, • Directs patients entering the healthcare system to the most appropriate location in a coordinated fashion, and • Provides additional health and exposure information when in-person health care is needed, to care for patients more efficiently. Because of the information MDH receives as part of the traveler monitoring program, MDH fields many calls from healthcare facilities and is able to inform them that a patient is unlikely to be at risk for Ebola because there was no known exposure. MDH Clinical Ebola Team efforts by the numbers Since the start of the traveler monitoring program, there have been no cases of EVD in Minnesota; however, the MDH Clinical Ebola Team has been contacted about many travelers. Of these many travelers: • 30 had some symptoms consistent with possible EVD • 9 were less than 18 years old • 21 were 18 years or older • 3 were pregnant • 21 were evaluated only as outpatients, o 9 were managed by the Clinical Team without in-person health care o 12 had outpatient care only • 9 were admitted to a hospital for more than 24 hours • 2 were tested for Ebola; both were negative Some of the diagnoses/clinical concerns among travelers to Ebola affected countries since the start of the outbreak included: • • • • Malaria Salmonella Typhi Dehydration Peri-menopausal hot flashes • Congestive heart failure • • • • Constipation Enterovirus Lassa Fever Chronic kidney disease • Respiratory syncytial virus • • • • Dementia Pregnancy Anxiety C-Section pre-term delivery • Urinary tract infection Expected future needs It is difficult to predict future travel patterns. In general, the number of persons being monitored has remained stable in the past 8 weeks. At this time, there are no large groups expected to return from the affected countries that would increase the number of persons requiring monitoring. Current Ebola clinical care capabilities and expected clinical need for the future Minnesota is well positioned to meet the medical needs of the returning travelers from the affected countries. Liberia accounts for almost 90 percent of all returning travelers and the tenfold decrease in EVD frequency means that the risk of traveler’s symptoms attributable to EVD continues to decrease. Continued training and preparation is needed to ensure that the healthcare system is prepared to meet the needs of monitored returning travelers. The four Ebola assessment and treatment facilities are well prepared to meet the needs of our returning travelers. Minnesota Department of Heath Infectious Disease Epidemiology, Prevention, and Control Division PO Box 64975, Saint Paul, MN 55164-0975 651-201-5414 or 1-877-676-5414 www.health.state.mn.us (2/2015) Page 2 of 2