Latest WHO Update (22 Sept. 2014)

1. Latest WHO Update(22 Sept. 2014) • Estimates 20k cases by 2 Nov. • CDC says 1.4 M by Jan. 20 • Up to 70% fatality rate • Ages 14 – 44, older are most fatal • Most who die, do so within 4 days • Those who live, leave care in 11 days • ? Those who receive care live longer • 300 HCW’s infected with 50% CFR

2. Epidemiology (cont.) • Index case– 2 yo ♂ Guinea 12/2013 • Then Guinea confirmed cluster 03.14 • Then spread to Liberia and Sierra Leone • Then recently to Nigeria via air travel • Then to Senegal • WHO Public Health Emergency of International Concern – 08/2014

3. Air Traffic Connections From West African Countries to the Rest of the World

4. DRC (Congo) Outbreak (aka Zaire) • Zaire strain but not related to West Africa outbreak • 70 cases, 42 deaths, lab 30 (7 HCWs) as of Sept. 29, 2014

5. WHO Ebola Response Roadmap • Released August 28, 2014 • Reverse the trend in new cases and infected areas within 3 months, stop transmission in capital cities and major ports, and stop all residual transmission within 6-9 months. • Estimation of Costs: US $490m • Really over $600m+

6. Cases Underestimated?( by x 2.5) 1. Patients hidden by families 2. Denial of the disease 3. In rural areas, corpses are burned before identification/dx. 4. Invisible caseloads of patients 5. “Shadow Zones”

7. Modes of Transmission There are 3 modes of infection: • Objects contaminated with the virus (Unsterilized needles, medical equipment) • Suboptimal healthcare conditions (Lack of PPE) • Personal contact with diseased humans (blood vomit, urine, feces, sweat, semen, breast milk, sputum) or infected animal meat/bushmeat http://www.ecplanet.com/pic/2003/12/1071257871/ebola.jpg

8. Chlorinated Hand Wash Station

9. West Africa Ebola Outbreak

11. West Africa Ebola Outbreak

12. Transporting Suspected Ebola Patient—Sierra Leone

13. Public Health Actions • Notifications to healthcare professionals with education/info on patient care and disease prevention • Education/information to the public • Negate misinformation/myths

16. Latest USG Response(Sept. 16, 2014) • 3000 US military for medical and logistics support • -Train 500 health care workers a week;-Erect 17 health care facilities in the region with 100 beds each;-Set up a joint command to coordinate between US and international relief efforts;-Provide home health care kits to hundreds of thousands of households;-Carry out a home- and community-based campaign to train local populations on how to handle exposed patients.

17. Preventive Measures-Africa • Stop the consumption of animal meat • Isolate the sick • Prompt disposal of victim’s bodies • Trace those who had contact with infected • Disinfect homes of the dead and the sick • Protective clothing for HCW, and anyone handling infected animals

18. Contact Tracing

19. Infection Prevention and Control Recommendations • Standard contact & droplet precautions including gloves, fluid-resistant gowns, eye protection, face mask, and additional PPE as needed • Single patient room with private bathroom, door closed, restrict visitors • Avoid aerosol generating procedures • Invoke specific environmental controls http://www.cdc.gov/vhf/ebola/hcp/infection-prevention-and-control-recommendations.html

20. Isolation Unit

21. Isolation Ward- Cohorting