Traveler Preferences for Reporting to State and Local Public Health Authorities As Part of Post-Arrival Monitoring during the 2014-2015 Ebola Epidemic

Theoretical Background and research questions/hypothesis:  During the Ebola epidemic in West Africa, CDC published “Interim U.S. Guidance for Monitoring and Movement of Persons with Potential Ebola Virus Exposure” which, after revision in October 2014, recommended that public health authorities conduct post-arrival monitoring program for travelers arriving from countries with Ebola outbreaks and others with potential exposure to Ebola virus (CDC, 2016). This guidance recommended these public health authorities have at least once-a-day communication with travelers for 21 days after the last potential exposure for travelers to report their temperature and symptoms. (CDC, 2016; Joseph, 2015). CDC did not specify how public health authorities should implement this monitoring; most states used telephone contacts to receive reports from travelers, though others used text messages, email, or other methods (Joseph, 2015). During the response, CDC conducted an evaluation to understand the modes through which travelers from countries with Ebola outbreaks preferred to report temperature and symptoms to public health authorities, and if one mode led to greater compliance. 

Methods:  From April to July 2015, we assessed perceptions of inbound travelers arriving at JFK International and Dulles International airports from countries with Ebola outbreaks (Prue et al., 2015). We developed a systematic convenience sample by inviting inbound travelers who completed enhanced entry risk assessment for Ebola to a voluntary in-person intercept interview. All intercept interview participants were asked to participate in two follow-up telephone interviews, one scheduled for 3 to 5 days following the intercept and a second within two days of the end of their 21-day monitoring period. During the second follow-up telephone interview, we measured compliance with post-arrival monitoring guidance through an index of five self-reported behavior items, including if participants reported their symptoms and temperature to the public health authority. We also asked participants what reporting mode they typically used and, finally, what mode they most preferred.

Results:  Of 317 participants, 279 (88.0%) reported using the telephone to report their temperature and symptoms to the public health authority, 25 (7.9%) used email, 13 (4.1%) reported in-person, and 2 used other means. We found no association between reporting method and self-reported reporting compliance. For preferred mode of reporting temperature and symptoms, of 316 participants, 138 (43.7%) preferred to speak to a live person by telephone, 48 (15.2%) preferred using text message, 47 (14.9%) preferred going to the health department directly, 31 (9.8%) preferred a website, 23 (7.3%) preferred having someone from the health department visit, 11 (3.5%) preferred reporting through an app on their smart phone, 3 (0.9%) preferred an automated telephone system, and 15 (4.7%) preferred other methods. 

Conclusions:  Of interest, nearly two-thirds (n=208, 65.8%) of participants preferred one-on-one contact (either by phone call or in-person visits) compared to using impersonal technology. This may be due to a desire for one-on-one contact to discuss questions, or due to privacy concerns about technology. Future work should investigate these possibilities. 

Implications for research and/or practice:  Understanding traveler preferences for communication, and which communication mode led to greatest compliance, would benefit public health authorities for preparing their communication strategies for future responses involving monitoring of travelers.