DATE:

March 6, 2025

TO:

Healthcare  Providers, Hospitals, Diagnostic  and Treatment  Centers, Local Health
Departments

FROM:

New York State Department  of Health and  New York City Department  of Health  and
Mental  Hygiene (NYC Health  Department)

HEALTH ADVISORY: Viral Hemorrhagic Fever

Please distribute  immediately  to Hospital Epidemiologists,  Infection  Preventionist,  Emergency
Department  Directors, Infectious Disease Physicians, Medical Directors, Nursing Directors,
Risk Managers, Administrators,  Environmental  Services Directors, Laboratory  Directors

SUMMARY

•  Clinical providers and  healthcare  facilities in New York State (NYS) should be prepared  to triage
and evaluate  people  with possible viral hemorrhagic  fever (VHF), such as Ebola,  Marburg,  or
Lassa virus disease.

•  This advisory describes what NYS clinical providers should do if a person presents with

suspected VHF:

o  Evaluating  a person for possible  VHF
o  Testing for VHF at a public health  laboratory

•  This advisory also provides guidance  on the following  VHF readiness requirements  and

recommendations  for NYS healthcare  facilities:

Infection  prevention  and control

o  Signage
o  Patient  registration  and triage  screening protocols
o  Training
o  Exercises
o
o  Patient  placement
o  Reporting
o  Managing  regulated  waste
o  Environmental  infection  control and surface disinfection
o  Ongoing  patient  care
o  Shipping  of clinical specimens

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BACKGROUND

The purpose of this Health Advisory is to revise previously published  guidance  regarding  New York
State (NYS) healthcare  facility and clinical  provider readiness for a person with suspected or confirmed
viral hemorrhagic  fever (VHF). This advisory also broadens  the scope of recommendations  to include all
contagious  VHFs, including  but not limited  to Ebola,  Marburg,  Lassa, and  Crimean-Congo  hemorrhagic
fever.

In nearly all cases, individuals  with fever presenting  to NYS healthcare  facilities  have other  illnesses
and not VHF. However, outbreaks of VHF recur outside the United  States; therefore,  NYS healthcare
facilities  could encounter a patient  with compatible  symptoms, travel, or other exposures that would
result in suspicion for VHF.

This Health Advisory is specific to general  hospitals with emergency  departments,  off campus
emergency departments,  and rural emergency  hospitals, hereafter  referred to as healthcare  facilities.
However, all clinical settings, particularly  diagnostic and  treatment  centers, urgent care centers, and
other entities  that care for patients  with acute illnesses, should review this guidance  to determine  how
best to apply it to their settings.

This document  supersedes the NYS Department  of Health’s October 27, 2022,  HEALTH ADVISORY:
Ebola  Virus Disease (EVD) in Uganda.

CLINICAL GUIDANCE FOR HEALTHCARE PROVIDERS

Evaluating  a Person for Possible VHF

•  Healthcare  providers should not refer a person  with possible  VHF to a healthcare  facility without

first consulting  with the local health  department  (LHD) – see contact information  below.

o  This includes situations in which you speak to a patient  on the phone  but do not see them

in person.
If a patient  must immediately  be referred  to an emergency  department,  you must alert the
receiving emergency  department  and the LHD.

o

•  While  remaining  vigilant  for a VHF diagnosis,  conduct clinically appropriate  laboratory  testing  to
determine  an alternate  diagnosis  that may account for the patient’s  illness, such as common
respiratory illnesses (e.g., COVID-19, influenza),  malaria,  measles,  gastroenteritis,  and other
diseases that  affect both  travelers and non-travelers.

o  See NYS/NYC Guidance for Laboratory Testing and Management  of Persons Under
Investigation  for Viral Hemorrhagic  Fevers (VHF) in Non-Designated  Hospitals.

•  Whenever  there is concern about  VHF, providers must perform  a thorough  symptom and

exposure history based on recommendations  for the current outbreak  (if any) or endemic  area
and, if VHF remains  a concern, discuss the patient’s  case with the LHD where the patient
resides.

o  An appropriate  history includes both epidemiologic  and  clinical factors. Some

epidemiologic  factors may be outbreak-dependent,  but they typically involve more details
than simply travel to an involved  country, for example:

  Which specific areas of the country did they travel to and what were their activities?
  Did they have contact with a person with suspect or confirmed  VHF in the past 21

days?

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  Were they in an area with an active VHF outbreak  or where VHF is endemic in the

past 21 days?

o  Review the latest guidance,  typically from the Centers for Disease Control  and Prevention
(CDC), for the  outbreak in question  to determine  outbreak-specific  exposure criteria and
questions,  such as exact geographic  areas of concern.

o  Review the following:

  CDC Guide for Clinicians Evaluating  an Ill Person for VHF or Other High-

consequence Disease

  CDC Clinical Screening  and Diagnosis for VHFs
  Viral Hemorrhagic  Fever (VHF) 2025 Case Definition

•

If clinical and epidemiologic  risk factors support a suspicion of VHF:

o  Ensure the patient  has been  isolated  as described below (Patient  Placement).
o  Restrict access to the room in which the patient  is isolated.  Minimize  the number  of staff

who interact with the patient  and keep a list of staff who do.

o  Follow  all CDC recommended  infection  control  practices and correct PPE use as

described below  (Infection Prevention  and  Control).

o  Ensure that the patient  continues to receive standard medical  care, including  blood  draws
for alternate  diagnoses  (e.g., malaria)  and  necessary emergency procedural  interventions
(e.g., dialysis).

o  More detailed  information  on emergency  services is available at CDC Interim  Guidance

for Emergency Services.

•  Contact the LHD where the patient  resides for consultation  as soon as VHF is suspected.

o  LHD contact information  is as follows:

  Outside New York City (NYC):  LHD contact information  is at

https://www.nysacho.org/directory.  If unable  to reach the LHD, contact the NYS
Department  of Health’s Bureau  of Communicable  Disease Control  at 518-473-4439
during  business hours or 1-866-881-2809  evenings,  weekends, and holidays.
In NYC: Use the NYC Provider Access Line (866-692-3641)  to contact the NYC
Health  Department.



o  Additionally,  healthcare  facilities  should notify the LHD where the hospital  is located  and
the NYS Department  of Health,  either  directly or through  the LHD where the patient
resides.

o  When contacting  the LHD, be prepared  to:

  Describe the patient’s  travel history, including  dates and detailed  locations of travel
(including  areas within  a country of concern, if applicable)  and epidemiologic  risk
factors;

  Describe the patient’s  presenting  signs, symptoms, and  duration  of illness;
  Determine,  in consultation  with the LHD and the NYS Department  of Health,

whether  VHF testing will be conducted;

  Determine,  in consultation  with the LHD and the NYS Department  of Health,

whether  referral to a Special  Pathogen  Treatment  Center for further workup and
testing is indicated;

  Receive assistance to arrange  patient  transport,  if needed.

Testing for VHF at a Public Health Laboratory

•

If the patient  is suspected to have a VHF and  specimens are approved  for testing, the following
specimens should be collected:  two (2) plastic lavender  top blood  collection  tubes (EDTA

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anticoagulant)  containing  a minimum  of four (4) milliliters  (mL) per tube  per adult  and 1mL for
pediatric  samples.

•  Specimen  containers should  be disinfected  after  collection and before  they are packaged  for

transport by wiping  the outside  of the tubes with a U.S. Environmental  Protection Agency (EPA)-
registered  hospital  disinfectant  from List Q (for Ebola,  products from  List L can also be used).

o  Use cleaning  and disinfecting  products according to label  instructions.

•  Ensure that the patient  details  (full first and last name  and date of birth) remain  clearly visible on

the label.

•  These specimens should be transported  under  refrigeration.
•  Packaging and shipping  appropriate  for Category A infectious substances is required  for
specimens transported  for VHF testing. See below (Shipping  of Clinical Specimens).

READINESS FOR HEALTHCARE FACILITIES

Healthcare  facilities should  review the content of this guidance  with all appropriate  healthcare  personnel
(HCP). The content review should include  the facility’s required  training,  policies, procedures,  and
protocols related  to VHF, including  protocols for patient  registration  and triage,  general  and
environmental  infection  control,  managing  HCP exposures, use of personal  protective equipment
(PPE), and  management  of regulated  medical  waste.

Signage

Signage  directing  people  to report travel history and symptoms should  be posted  at patient  entryways,
reception  areas, and triage  locations. The signs should be written  in at least English,  French, Spanish,
Chinese, Russian, Italian,  Korean,  Haitian  Creole, and  other languages  appropriate  for the communities
served by the healthcare  facility.

Patient  Registration  and Triage Screening  Protocols
Healthcare  facilities should  have written  screening protocols for patient  registration  and triage  to identify
people  who require  immediate  isolation  and  medical evaluation  for possible VHF.

•  Protocols should require  that all people  presenting  for care be screened for recent travel history
and symptoms consistent with VHF, using passive signage  for all  people  and active screening as
clinically appropriate.

•  The healthcare  facility should provide  training  on patient  registration  and triage screening

protocols to HCP on all shifts whose job duties involve patient  registration  or triage.
•  Screening  protocols should be revised when  appropriate  according to the status of VHF

outbreaks throughout  the world.

Training
See CDC’s Guidance for Personal  Protective Equipment  (PPE). VHF PPE training  needs vary by the
type of healthcare  facility and the role  of the HCP.

•  For HCP at NYS Special Pathogen  Treatment  Centers who may provide  care to people  with

suspected or confirmed  VHF, the healthcare  facility should provide  in-person training  in donning
and doffing  of PPE.

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o  Healthcare  facilities should  provide this training  to these HCP on hire or upon  assuming
this role and at least every 6 months thereafter  in a setting like the one where patients
would be treated.

o  The PPE training  should consist of actual  donning  and doffing  of PPE by the trainees  and

observers.

o  The exact PPE combination  selected by the healthcare  facility for care of a patient  with

VHF should  be used.

o  Training  should not be replaced  by a video, lecture,  or other  demonstration  mechanism.
o  The healthcare  facility may limit the number  of HCP designated  to serve in this role as
long  as adequate  coverage can be maintained  when a patient  with suspected or
confirmed  VHF may present for care.

o  The healthcare  facility should develop  a staffing surge plan to provide additional  coverage

of staff that are competent  in donning  and doffing  PPE.

•  For HCP not working in Special Pathogen  Treatment  Centers who may provide  care to people
with suspected or confirmed  VHF, the healthcare  facility should have a plan  to provide  “just-in-
time”  training  that includes VHF infection  prevention  and control procedures and PPE training.
o  The PPE training  should include  actual donning  and  doffing  of PPE in a setting like that
where patients  would be encountered  or treated  and using the exact PPE combination
selected by the healthcare  facility for care of a patient  with VHF.

•  For HCP not expected to provide care to a person with suspected or confirmed  VHF (regardless
of healthcare  facility type): the healthcare  facility should  have a plan  to provide  “just-in-time"
training that  includes general  education  about  VHF, necessary infection prevention  and  control
precautions,  and patient  registration  and triage  protocols.
o  This group of HCP does not need  PPE training.

Exercises
All healthcare  facilities  should conduct exercises in managing  the encounter  and care of a person with a
VHF at least every 12 months.  These exercises should review situations that  are reasonably  likely to
occur at the healthcare  facility,  considering  such factors as whether a healthcare  facility has been
designated  as a Special Pathogen  Treatment  Center.

A written  after-action  report of the exercise, including  the items reviewed, number  of HCP included in
the exercise, gaps identified,  conclusions, and time  frame for corrective actions, should be maintained
and made  available  to the NYS Department  of Health  upon request.

Infection  Prevention  and Control

•  Healthcare  facilities should  review CDC’s Infection Prevention  and Control  Recommendations  for
Patients in U.S. Hospitals who are Suspected or Confirmed  to have Selected  Viral Hemorrhagic
Fevers (VHF). This document  reviews patient  placement,  PPE, patient  care equipment,  other
patient  care considerations,  aerosol generating  procedures, hand  hygiene,  environmental
infection  control, safe injection  practices, duration  of infection  control precautions,  and monitoring
and management  of healthcare  personnel,  and monitoring,  management,  and  training  of visitors.

•  Healthcare  facilities should  maintain  and  make accessible a supply of PPE that, at a minimum,

meets the specifications as described in CDC guidance  above. Healthcare  facilities should  equip
all HCP with all PPE that is appropriate  to their level of potential  exposure to a person who is
suspected or confirmed  to have VHF. CDC’s PPE guidance  is at:
o  PPE: Clinically  Stable Patients  Suspected to have VHF, or

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o  PPE: Confirmed  Patients and Clinically  Unstable Patients Suspected to have VHF

Patient  Placement

Healthcare  facilities should  identify and designate  a single-patient  isolation  room or care area with a
private bathroom  to house an individual  with suspected or confirmed  VHF. If a room with a private
bathroom  is not available,  a portable  commode  should be used.

•  The location  should have either  an anteroom  with doors that close or an area outside  the room

where staff can safely doff any PPE that  is not taken off in the patient  room.

•  The anteroom  or PPE doffing  area shall also provide access to handwashing  facilities.
•  There should  be additional  rooms available  for staff to don PPE.
•

If available,  there should  be a designated  location  in the healthcare  facility where  staff can
shower after removing  PPE.

•  When in use for a person suspected or confirmed  to have VHF, the area is to be secured from

access by unauthorized  staff and the public.

•  Consider posting  personnel  at the patient’s  door to ensure appropriate  and consistent use of

PPE by all people  entering  the patient’s  room, and to maintain  a list of staff entering  the room.

Reporting

Healthcare  facilities and providers must immediately  notify the LHD where a person resides if a person
is placed in isolation  for the medical  evaluation  of VHF. See contact information  above. Additionally,
healthcare  facilities  should notify the LHD where the hospital  is located  and the NYS Department  of
Health,  either directly or through  the LHD where the patient  resides.

As with all reportable  diseases, it is important  to protect the privacy of people  with VHF. Please refrain
from notifying  the general  public  that there is a person with suspected or confirmed  VHF in your
healthcare  facility.   VHFs are rare diseases in the U.S., and  that information  can be used to identify an
individual.  NYS Department  of Health  and LHDs will help  ensure that public  notifications  of suspected
or confirmed  VHF protect individuals’  privacy.

Managing  Regulated  Medical Waste

•  VHF pathogens  are typically classified as Category A infectious  substances.
•  Review the following  guidance  on VHF waste management:

o  CDC Guidance: Handling  VHF-Associated Waste
o  The NYS Department  of Health’s February  10, 2025, Ebola-associated  Waste

Management  Guidance

•  Most guidance  for Ebola  disease is applicable  to other  VHFs; pathogen-specific  guidance  will be

issued as needed.

•  Any item  that is (1) contaminated  or suspected of being  contaminated  with a Category A

infectious  substance, and (2) transported  offsite for disposal must be packaged  in accordance
with the U.S. Department  of Transportation's  (USDOT) special permit  DOT-SP 16279.
In addition,  the waste hauler  must hold  appropriate  approvals from New York State Department
of Environmental  Conservation and USDOT.

•

•  Healthcare  facilities are required  to develop  and implement  a waste management  plan that
includes written  protocols to safely handle,  contain,  store, and  dispose of regulated  medical
waste.

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Environmental  Infection  Control and  Surface Disinfection
Healthcare  facilities should  review CDC’s Interim Guidance  for Environmental  Infection  Control  in
Hospitals for training,  PPE use, and procedures for environmental  cleaning,  surface disinfection,  and
selection of surface disinfectants  when caring for a person with VHF.

Ongoing  Patient  Care

•  Healthcare  facilities must be prepared  to appropriately  stabilize and care for a person with

possible VHF until  the individual  is transferred or until  VHF is ruled out.

•  Healthcare  facilities that are not Special  Pathogen  Treatment  Centers should  have a written plan
for the isolation  and care of a person with suspected or confirmed  VHF for a limited  period,  until
transfer to another  facility for necessary testing and care, or until  VHF is ruled  out.

o  These healthcare  facilities  should develop  a written  transport protocol for the safe
transportation  of such patients to a Special  Pathogen  Treatment  Center and should
identify  an ambulance  service as well as the receiving facility.
In the event of a patient  requiring  transfer,  the NYS Department  of Health  or the NYC
Health  Department,  as appropriate,  may be available  to assist as needed.

o

o  The transport protocol  must include provisions requiring  prompt notification  to the

receiving healthcare  facility,  the LHD where patient  resides, the LHD where the healthcare
facility is located,  and the ambulance  service. Prompt  notification  will allow leadership  to
direct staff to use PPE and prepare  vehicles and receiving areas.

•  Healthcare  facilities designated  as Special Pathogen  Treatment  Centers, are additionally
required  to have a written plan  for providing  ongoing  care for patients  with suspected or
confirmed  VHF that includes  the following:

o  A roster of personnel  for the full  period of care required  for a patient  confirmed  to have a

VHF; this should include  at least one  staff member  on every shift who is primarily
responsible  for observing all staff providing  care to the patient  to ensure adherence  to
infection  control protocols and proper  use of PPE.

o  Provisions for the full range  of patient  care including  critical care and subspecialty

services.

Shipping  of Clinical  Specimens

•  Healthcare  facilities should  maintain  a readily available  inventory of Category A biohazard

shipping  containers for the safe transportation  of specimens to appropriate  laboratories  for VHF
testing.  Such containers must meet applicable  specifications,  see CDC’s VHF Clinical Specimen
Packaging and Shipping.

•  Healthcare  facilities should  develop a written biohazard  risk assessment and protocols for the

receipt, processing, and handling  of specimens from patients.

•  Ensure that HCP who are trained  and certified  in the packaging and  shipping  of infectious

substances (for the purpose of submitting  specimens for VHF laboratory  testing) are available  on
every shift.

•  Training  should cover classifying infectious  substances, proper  packaging of infectious

substances, and labeling  of packages to meet  regulatory requirements.

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QUESTIONS ABOUT THIS HEALTH ADVISORY

•  For questions concerning  general  hospitals with emergency departments,  off campus emergency

departments,  and rural emergency hospitals:

o  Bureau  of Healthcare Associated Infections at icp@health.ny.gov
•  For questions concerning  all other outpatient  and community  healthcare  facilities:
o  Bureau  of Communicable  Disease Control at bcdc@health.ny.gov

•  For emergency preparedness  and regulatory  concerns:

o  Office of Primary Care and Health  Systems Management  at

OPCHSMEmergencyPreparedness@health.ny.gov

•

In NYC, please call the Provider Access Line (866-692-3641)  to contact the NYC Health
Department.

LINKS TO REFERENCED WEB PAGES

New York State Department  of Health.  New York City Health. NYS/NYC Guidance for Laboratory
Testing and Management  of Persons Under  Investigation  for Viral Hemorrhagic  Fevers (VHF) in Non-
Designated  Hospitals.
https://www.health.ny.gov/diseases/communicable/ebola/providers/docs/laboratory_minimum_testing_c
apabilities.pdf  Accessed 2/20/2025.

Centers for Disease Control and Prevention.  Viral Hemorrhagic  Fevers. Guide for Clinicians  Evaluating
an Ill Person for VHF or other High-Consequence  Disease. https://www.cdc.gov/viral-hemorrhagic-
fevers/hcp/diagnosis-testing/evaluating-an-ill-person-for-vhf.html.  Accessed 2/20/2025.

Centers for Disease Control and Prevention.  Viral Hemorrhagic  Fevers (VHF). Clinical Screening  and
Diagnosis for VHFs. https://www.cdc.gov/viral-hemorrhagic-fevers/hcp/diagnosis-testing/index.html.
Accessed 2/20/2025.

Centers for Disease Control and Prevention.  National  Notifiable  Diseases Surveillance  System
(NNDSS) Viral Hemorrhagic  Fever (VHF) 2025  Case Definition.   https://ndc.services.cdc.gov/case-
definitions/viral-hemorrhagic-fever-vhf/.  Accessed 2/24/2025.

Centers for Disease Control and Prevention.  Viral Hemorrhagic  Fevers (VHF). Interim  Guidance for
Emergency Services. https://www.cdc.gov/viral-hemorrhagic-fevers/hcp/emergency-
guidance/index.html.
Accessed 2/20/2025.

Outside NYC: New York State Association of County Health  Officials. Contact Your County Health
Office. https://nysacho.org/directory/.  Accessed 2/20/2025.

Environmental  Protection Agency. Disinfectants for Emerging  Viral Pathogens  (EVPs): List Q.
https://www.epa.gov/pesticide-registration/disinfectants-emerging-viral-pathogens-evps-list-q.  Accessed
2/27/2025.

Environmental  Protection Agency. EPA’s Registered Antimicrobial  Products Effective Against Ebola
Virus . https://www.epa.gov/pesticide-registration/epas-registered-antimicrobial-products-
effective-against-ebola-virus-list-l.  Accessed 2/27/2025.

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Centers for Disease Control and Prevention.  Viral Hemorrhagic  Fevers (VHFs). Guidance  for Personal
Protective Equipment  (PPE). https://www.cdc.gov/viral-hemorrhagic-fevers/hcp/guidance/index.html.
Accessed 2/20/2025.
Centers for Disease Control and Prevention.  Viral Hemorrhagic  Fevers (VHF). Infection  Prevention  and
Control  Recommendations  for Patients  in U.S. Hospitals who are Suspected or Confirmed  to have
Selected  Viral Hemorrhagic  Fevers (VHF). https://www.cdc.gov/viral-hemorrhagic-fevers/hcp/infection-
control/index.html.  Accessed 2/20/2025.

Centers for Disease Control and Prevention.  Viral Hemorrhagic  Fevers (VHFs) PPE: Clinically  Stable
Patients Suspected to have VHF.
https://www.cdc.gov/viral-hemorrhagic-fevers/hcp/guidance/ppe-clinically-stable-puis.html  accessed
2/20/2025.

Centers for Disease Control and Prevention.  PPE: Confirmed  Patients  and Clinically Unstable Patients
Suspected to have VHF.
https://www.cdc.gov/viral-hemorrhagic-fevers/hcp/guidance/ppe-clinically-unstable.html.  Accessed
2/20/2025.

Centers for Disease Control and Prevention.  Viral Hemorrhagic  Fevers (VHFs). Handling  VHF-
Associated Waste https://www.cdc.gov/viral-hemorrhagic-fevers/hcp/infection-control/handling-vhf-
associated-waste.html  Accessed 2/20/2025.

New York State Department  of Health.  NYS Department  of Heath Ebola-Associated  Waste
Management  Guidance February 10, 2025.
https://www.health.ny.gov/diseases/communicable/ebola/docs/waste_management_guidance.pdf.
Accessed 2/20/2025.

U.S. Department  of Transportation.  DOT-SP 16279.
https://www.phmsa.dot.gov/hazmat/documents/offer/SP16279.pdf/2020124835/SP16279.  Accessed
3/6/2025.

Centers for Disease Control and Prevention.  Viral Hemorrhagic  Fevers (VHFs).  Interim  Guidance  for
Environmental  Infection  Control in Hospitals https://www.cdc.gov/viral-hemorrhagic-fevers/hcp/infection-
control/environmental-infection-control-hospitals.html.  Accessed 2/20/2025.

Centers for Disease Control and Prevention.  Viral Hemorrhagic  Fevers (VHF). VHF Clinical Specimen
Packaging and Shipping.  https://www.cdc.gov/viral-hemorrhagic-fevers/php/laboratories/specimen-
packing.html?CDC_AAref_Val=https://www.cdc.gov/vhf/ebola/laboratory-personnel/specimens.html.
Accessed 2/20/2025.

ADDITIONAL REFERENCES

Centers for Disease Control and Prevention.  Viral Hemorrhagic  Fevers (VHFs). About  Viral
Hemorrhagic  Fever. https://www.cdc.gov/viral-hemorrhagic-fevers/about/index.html.  Accessed
2/20/2025.

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Centers for Disease Control and Prevention.  Viral Hemorrhagic  Fevers (VHFs). Public Health
Management  of People  with Suspected or Confirmed  VHF or High-Risk Exposures
https://www.cdc.gov/viral-hemorrhagic-fevers/php/public-health-strategy/people-with-suspected-or-
confirmed-vhf-or-high-risk.html.  Accessed 2/20/2025.

The New York State Department  of Health Department’s  Ebola website:
What to Know: https://www.health.ny.gov/diseases/communicable/ebola/.
For Providers: https://www.health.ny.gov/diseases/communicable/ebola/providers/(signs  available)

Centers for Disease Control and Prevention.  Traveler’s Health. Travel Health Notices.
https://wwwnc.cdc.gov/travel/notices. Accessed 2/20/2025.

NYC Health Department’s  Infectious  Disease Readiness webpage:
https://www.nyc.gov/site/doh/providers/emergency-prep/communicable-disease-preparedness.page.

New York City Health Department.  Reporting  and Services.
https://www.nyc.gov/site/doh/providers/reporting-and-services-main.page.  Accessed 2/25/2025.

National  Emerging  Special Pathogens  Training and  Education Center:  https://netec.org

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