Marburg Virus Disease Healthcare Worker Monitoring 2024

Form Approved

OMB Control No: ####-####

Exp. Date: XX/XX/XXXX

INSTRUCTIONS:

CDC is collecting aggregate data for monitoring of healthcare workers (HCWs) and other travelers who were present in a healthcare facility (including outpatient settings or traditional healers) in Rwanda during the previous 21 days.

State health departments (and local health departments that have indicated to CDC that they will submit this information separately) are requested to complete and submit the form below twice a week, on Tuesdays and Fridays, by 1pm ET.

State health departments should submit in aggregate on behalf of any local health departments (other than those submitting separately) or other organizations (e.g., NGOs, employers) to whom they have delegated monitoring.

Local health departments that have indicated they will submit separately are listed in the dropdown below. Data submitted by local health departments listed in the dropdown list below should not be duplicated in state totals. If local health departments not listed in the dropdown wish to submit separately, they should notify their state health department and contact CDC at [email protected] to request addition to the list.

For each data submission, the number of Travelers listed should reflect the total number monitored on the previous calendar day. The data are intended to represent a "snapshot in time" for the number of Travelers under monitoring each Monday and Thursday (i.e., on XX date, we were monitoring YY number of HCWs).

• Data submitted each Tuesday by 1pm ET should reflect the total Travelers monitored on Monday during 12:00am-11:59 pm local time.

• Data submitted each Friday by 1pm ET should reflect the total Travelers monitored on Thursday during 12:00am-11:59 pm local time.

Health departments that are not currently monitoring any Travelers should not complete the form.

For questions or issues related to this information request, please email [email protected].  

Questions

1. For which jurisdiction are you submitting data? 

2. Date for which you are submitting data.

3. How many HCWs were under monitoring in your jurisdiction on the date for which you are submitting data?

4. How many other travelers are you monitoring who were in a patient care area in a Rwandan healthcare facility?

5. How many other travelers are you monitoring who were in a Rwandan healthcare facility but not in patient care areas? (even if not contacted on that day)

6. Are you having any problems contacting travelers? Y/N

   1. If yes, what problems are you experiencing?

      1. Incorrect or incomplete info

      2. Lack of traveler response

      3. Wrong jurisdiction assigned

      4. Other

7. Please use comment field to provide more information as needed.

IMPORTANT - PLEASE READ

CDC requests notification regarding any individuals identified with high-risk exposures.

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.

In either of these situations, CDC's Viral Special Pathogens Branch (VSPB) is available 24/7 for consultations by calling the CDC Emergency Operations Center (EOC) at 770-488-7100 and requesting VSPB's on-call epidemiologist, or by emailing [email protected].

Additional resources:

Marburg Virus Disease: Interim Recommendations for Public Health Management of U.S.-based Healthcare Personnel Returning from Rwanda | Viral Hemorrhagic Fevers (VHFs) | CDC

Public Health Management of People with Suspected or Confirmed VHF or High-Risk Exposures | Viral Hemorrhagic Fevers (VHFs) | CDC

Public reporting burden of this collection of information is estimated to average 5 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering, and maintaining the data needed, and completing and reviewing the collection of information.  An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number.  Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC, Reports Clearance Officer, 1600 Clifton Rd., MS H21-8, Atlanta, GA 30333, ATTN:  PRA (0920-XXXX).