Ebola Overview Template

8/10/2019 Ebola Overview Template

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2014 Ebola Outbreak, West Africa

This is the largest Ebolaoutbreak in history and thefirst Ebola epidemic theworld has ever known.

CDCs response to Ebola isthe largest internationaloutbreak response in CDCshistory.

Source: United Nations:http://www.un.org/Depts/Cartographic/map/profile/westafrica.pdf

Maps that incorporate the latest information on the 2014Ebola outbreak in West Africa can be found at:http://www.cdc.gov/vhf/ebola/resources/distribution-map-guinea-outbreak.html
http://www.un.org/Depts/Cartographic/map/profile/westafrica.pdfhttp://www.un.org/Depts/Cartographic/map/profile/westafrica.pdfhttp://www.cdc.gov/vhf/ebola/resources/distribution-map-guinea-outbreak.htmlhttp://www.cdc.gov/vhf/ebola/resources/distribution-map-guinea-outbreak.htmlhttp://www.cdc.gov/vhf/ebola/resources/distribution-map-guinea-outbreak.htmlhttp://www.cdc.gov/vhf/ebola/resources/distribution-map-guinea-outbreak.htmlhttp://www.un.org/Depts/Cartographic/map/profile/westafrica.pdfhttp://www.un.org/Depts/Cartographic/map/profile/westafrica.pdf


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Outbreak Challenges

Inefficient use ofstakeholders

Backlog of data

cleaning and entryNeed for completedataNeed to reportsuspected casesinstead of waitingfor lab confirmation


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Ebola Outbreak, West Africa

On August 8, the World Health Organization (WHO)declared that the current Ebola outbreak is a PublicHealth Emergency of International Concern (PHEIC)

The PHEIC declaration underscoresthe need for a coordinatedinternational response to containthe spread of Ebola


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Outbreak Challenges,

West AfricaPorous borders

High population mobility

Geographic breadth


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Outbreak Challenges:Lack of acceptance of Ebola

Not overcome by educationFear and superstition

Health posters

StigmaNeeding to share negative testresults to return to work

Distrust of outsidersBrought Ebola to make money

Role of war exposure


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Overall Goals inOutbreak Response

1. Patient CareExperienced and/ortrained staff

Strict use ofpersonal protectiveequipment (PPE)

2. Stop human tohuman transmission

Case identificationContact tracingInfection control


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Overall Goals in Outbreak Response

3. Community education Text messages, radio and video messages in local languages,fact sheets, health posters and pamphlets

Listen to Ebola radio health messages in local languages .
http://www.cdc.gov/vhf/ebola/outbreaks/guinea/radio-spots.htmlhttp://www.cdc.gov/vhf/ebola/outbreaks/guinea/radio-spots.htmlhttp://www.cdc.gov/vhf/ebola/outbreaks/guinea/print-resources-illustrations.html


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BACKGROUND


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Ebola is a rare anddeadly disease.

First discoveredin 1976 near theEbola River in theDemocratic Republic ofthe CongoOutbreaks occursporadically in AfricaFamily of zoonotic RNAviruses

Filoviridae


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Ebola Virus Disease

Previously called Ebolahemorrhagic fever 5 species of Ebolavirus

Zaire ebolavirus Bundibugyo ebolavirus Reston ebolavirus Sudan ebolavirus Tai Forest ebolavirus

All but Reston ebolavirus known to cause disease inhumans

Death rates for Ebola rangefrom 50%-90%


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Transmission

Ebola virus is spread through direct contact (throughbroken skin or unprotected mucous membranes) with:

A sick persons blood or body fluids, including but notlimited to urine, saliva, feces, vomit, and semenContaminated objects (like needles and syringes)Infected animals (by contact with their blood, fluids, orinfected meat)

Ebola virus has been detected in breast milk, but it isnot known if the virus can be transmitted from mothersto infants through breastfeeding


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Human to Human Transmission Two main points:

First, a person isinfectious WHEN theyare symptomatic.Second, there are control

measures which canprevent exposuresinfectious body fluidsand contaminatedobjects (like needles andsyringes)

Infectious body fluids:(time ranges are approximate)

Viremia/blood ~1-23 daysSaliva/Swab ~1-11 daysUrine ~1-25 days Tears/Conj. ~ 1-25 days

Semen ~17-105 daysSweat ~1-10 daysVaginal ~21-58 daysRectal/FecesMilk ~13-18 days


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SymptomsSigns of Ebola include fever and

symptoms such as:Severe headacheMuscle painVomitingDiarrheaAbdominal painUnexplained hemorrhage

The incubation period, fromexposure to when signs or symptoms appear, is 2 to 21days, but the average time is 8 to 10 days.

A person infected with Ebola virus is not contagious untilsymptoms appear.


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Prevention

There is no FDA-approved vaccine available for EbolaIf you must travel to or are in an area affected by theEbola outbreak, make sure to do the following:

Practice careful hygiene Wash your hands frequently with soap and water or an alcohol-based

hand sanitizer

Avoid contact with blood and body fluids Such as urine, saliva, feces, vomit and semen

Do not handle items that may have come in contact with aninfected persons blood or body fluids

Such as needles or other medical equipment

Avoid funeral or burial rituals that require handling the body ofsomeone who has died from Ebola


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Prevention, cont.

If you must travel to or are in an area affected by theEbola outbreak, make sure to do the following:

Avoid contact with bats and nonhuman primates or blood, fluids,and raw meat prepared from these animals

Avoid hospitals in West Africa where Ebola patients are beingtreated The U.S. Embassy or consulate is often able to provide advice on

healthcare facilities

Seek medical care immediately if you develop fever, headache,

muscle pain, diarrhea, vomiting, stomach pain, or unexplainedbruising or bleeding Tell your doctor about your recent travel and your symptoms before

you go to the office or emergency room Limit your contact with other people when you go to the doctor. Do

not travel anywhere else.


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Laboratories

CDC has developed interimguidance for laboratory workersand other healthcare personnelwho collect or handle specimensin the United States

This guidance includesinformation about theappropriate steps for collecting,transporting, and testingspecimens from patients who aresuspected to be infected withEbola virus.
http://www.cdc.gov/vhf/ebola/hcp/interim-guidance-specimen-collection-submission-patients-suspected-infection-ebola.htmlhttp://www.cdc.gov/vhf/ebola/hcp/interim-guidance-specimen-collection-submission-patients-suspected-infection-ebola.htmlhttp://www.cdc.gov/vhf/ebola/hcp/interim-guidance-specimen-collection-submission-patients-suspected-infection-ebola.htmlhttp://www.cdc.gov/vhf/ebola/hcp/interim-guidance-specimen-collection-submission-patients-suspected-infection-ebola.html


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Shipping Ebola Specimens

CDC recommends that U.S. healthcare workers contacttheir state and/or local health department and CDC todetermine the proper category for shipment of clinicalspecimens based on clinical history and riskassessment by CDCNo specimens should be shipped to CDC withoutconsultation with CDC and local/state healthdepartments


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Shipping Ebola Specimens

Ebola specimens should bepackaged following thebasic triple packing systemconsistent with

International Air TransportAssociation Category Aguidelines

This packing system consistsof a primary non-breakablereceptacle wrapped withabsorbent material, secondaryreceptacle (watertight, leak-proof), and an outer shippingpackage.


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Laboratory Testing Specimens

Ebola virus is detected in blood only after onset ofsymptoms, most notably fever

It may take up to 3 days post-onset of symptoms for the virus toreach detectable levels

Virus is generally detectable by real-time RT-PCR between 3 to 10days post-onset of symptoms, but has been detected for severalmonths in certain secretions (e.g., semen)Specimens ideally should be taken when a symptomatic patientseeks care and is suspected of having an Ebola exposure; however,

if the onset of symptoms is less than 3 days, a subsequentspecimen will be required to completely rule-out Ebola


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Treatment

No FDA-approved vaccine or medicine (e.g., antiviral drug) isavailable for EbolaSymptoms of Ebola are treated as they appear. The following basicinterventions, when used early, can significantly improve thechances of survival

Providing intravenous fluids and balancing electrolytes (bodysalts)Maintaining oxygen status and blood pressure Treating other infections if they occur

Experimental vaccines and treatments for Ebola are underdevelopment, but they have not yet been fully tested for safety oreffectiveness


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Patient Recovery

Recovery from Ebola depends on good supportive careand the patients immune responsePeople who recover from Ebola infection developantibodies that last for at least 10 years, and possiblylongerIt isnt known if people who recover are immune for lifeor if they can become infected with a different speciesof EbolaSome people who have recovered from Ebola havedeveloped long-term complications (joint and musclepain, and vision problems)


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Ebola Virus Disease Case Definition

Person Under InvestigationFever (>38.6C or 101.5F)AND symptomsAND epidemiologic risk factors within past

21 days prior to symptom onsetProbable Case

Person Under InvestigationAND low risk exposure OR high risk exposure

Confirmed CaseA case with laboratory-confirmed diagnostic evidence of Ebolavirus infection

Symptoms Severe headache Muscle pain Vomiting Diarrhea Abdominal pain

Unexplainedhemorrhage


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Risk

Healthcare workers caring for Ebola patients andthe family and friends in close contact with Ebolapatients are at the highest risk of getting sickbecause they may come in contact with the bloodor body fluids of sick patients

People also can become sick with Ebola aftercoming in contact with infected wildlife.

In Africa, Ebola may be spread as a result of handling

bushmeat (wild animals hunted for food) and contact withinfected bats


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Healthcare Providers in the United States

U.S. healthcare workers should follow CDCs InfectionPrevention and Control Recommendations forHospitalized Patients with Known or Suspected EbolaHemorrhagic Fever in U.S. Hospitals

CDC recommends standard, contact, and droplet precautions formanagement of hospitalized patients with known or suspectedEbola

These precautions can be found in 2007 Guideline for IsolationPrecautions: Preventing Transmission of Infectious Agents in HealthcareSetting at www.cdc.gov/hicpac/2007IP/2007ip_part3.html

Any U.S. hospital that is following CDC's infection controlrecommendations and can isolate a patient in a private room iscapable of safely managing a patient with Ebola virus disease
http://www.cdc.gov/hicpac/2007IP/2007ip_part3.htmlhttp://www.cdc.gov/hicpac/2007IP/2007ip_part3.html


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Infection Control

Early recognitionEarly recognition is critical for infection control

Patient PlacementPatients should be placed in a single patient room containing aprivate bathroom with the door closed

Only use a mattress and pillow with waterproof plastic or otherwaterproof covering

Protecting healthcare providersAll people entering the patient room should at least wear: gloves,gown (fluid resistant or impermeable), eye protection (goggles orface shield) and a facemaskHealthcare providers should frequently perform hand hygienebefore and after all patient contact, contact with potentiallyinfectious material, and before putting on and upon removal ofPPE, including gloves


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Environmental Infection Control

Daily cleaning and disinfection of hard, non-poroussurfaces should be done using a U.S. EnvironmentalProtection Agency (EPA)-registered hospitaldisinfectant with a label claim for a non-enveloped

virusStaff performing environmental cleaning anddisinfection should wear recommended PPE andconsider the use of additional barriers (e.g. , shoe and

leg coverings)Eye protection (face shield or goggles) and face mask should beworn when performing tasks such as liquid waste disposal that cangenerate splashes


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Patient Care

Dedicated medical equipment (preferably disposable)should be used for patient careAll non-dedicated, non-disposable medical equipmentused for patient care should be cleaned and disinfectedaccording to the manufacturers instructions andhospital policiesLimit the use of needles and other sharps as much aspossible

All needles and sharps should be handled with extreme care anddisposed in puncture-proof , sealed containers


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Travel to Affected CountriesPractice careful hygiene. Avoid contact with blood andbody fluids

Do not handle items that have come in contact with an infectedpersons blood or body fluids Avoid funeral or burial rituals that require handling the body ofsomeone who has died from EbolaAvoid contact with animals or raw meatAvoid hospitals where patients with Ebola are being treated

Pay attention to your health after you returnMonitor your health for 21 days

During the time that you are monitoring your health, you cancontinue your normal activities, including work


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Monitoring and Movement of People with Ebola

CDC has created guidance for monitoring peopleexposed to Ebola and for evaluating their travel,including the application of movement restrictionswhen indicated

Conditional release people are monitored by a public health

authority for 21 days after the last known Ebola virus exposure.People conditionally released should self-monitor for fever twicedaily and notify the public health authority if they develop fever orother symptoms .Controlled movement requires people to notify the public

health authority about their intended travel for 21 days after theirlast known potential Ebola virus exposure. They should not travelon commercial flights, ships, long-distance buses, or trains.

Documents

Ebola Overview Template