Ebola Virus Disease Update for ECI Leadership Forum

Ebola Virus Disease
Update for ECI Leadership Forum
Image source: Centers for Disease Control and Prevention, Office of the Associate Director for Communications, Division of Public Affairs
What is Ebola?
• Viral Haemorrhagic Fever
• A severe and often fatal viral infection
• Five Ebola strains; four known to cause
infection in humans
Ebola ecology
Image source: Centers for Disease Control and Prevention, Office of the Associate Director for Communications, Division of Public Affairs
Yambuku, Zaire – 1976
Image source: Centers for Disease Control and Prevention, Office of the Associate Director for Communications, Division of Public Affairs
Ebola outbreaks
Image source: Centers for Disease Control and Prevention
How is Ebola transmitted?
• Ebola is spread through direct contact
• This means contact through broken skin or mucous
membranes (e.g. eyes, nose, or mouth) with:
– blood or body fluids (including urine, saliva, sweat, faeces,
vomit, breast milk, and semen) of an Ebola patient
– objects (like needles and syringes) that have been
contaminated with the virus
– infected fruit bats or primates (apes and monkeys)
• Ebola is not spread through the air or by water
Early symptoms
Ebola can only be spread to others after symptoms begin.
Symptoms usually appear after 8-10 days; rarely up to 21 days
•
•
•
•
•
Fever
Severe headache
Muscle pain
Lethargy
Anorexia
•
•
•
•
Diarrhea
Vomiting
Abdominal pain
Unexplained bleeding or
bruising *
Ebola update to 1 March
Cumulative
Past 21 days
14 333
384
Probable
2556
*
Suspected
7045
*
23 934
384
Confirmed
Total
132 new EVD cases reported in • Liberia: no new confirmed
cases this week
the week to 1 March
• An increase on the previous • Sierra Leone: transmission
remains widespread
week (99 new cases)
• Increases in Sierra Leone and • Guinea: Forecariah and
Conakry reported marked
Guinea
increase in cases
Data source: World Health Organisation (4 March 2015)
Current Ebola outbreak in West Africa
Image source: World Health Organisation (4 March 2015)
Screening in affected countries
Image source: US CDC (http://www.cdc.gov/vhf/ebola/hcp/international/managing-patient-flow.html )
Medical evacuations
Image source: European Centre for Disease Control (ECDC)
Ebola
Preparedness
in NSW
Image source: Western Sydney LHD. Available at: http://www.wslhd.health.nsw.gov.au/News-room/Westmead-Hospitalconducts-ebola-training-sessions
Prevention of Ebola
 No vaccine available yet but development being fast tracked
by WHO
 Enhanced border screening and advice for travellers
 Detailed advice for healthcare workers developed regarding
– High-level PPE and infection control
– Patient isolation
– Laboratory infection control
– Safe linen and waste disposal
– Safe management of the deceased
 Contact identification and management
Border measures
 Exit screening in Ebola affected
countries
 Enhanced border screening in
place in Australia – contact public
health if any concern
 1 800 number on all incoming
passenger cards
Image Sources: Australian Department of Health
(top) and Australian Customs and Border
Protection Service (bottom)
Surveillance
National and State Public Health Guidelines
 Immediate notification of any person with clinical
and/or epidemiological evidence of possible EVD
to NSW Health (HQO/CDOnCall)
 NGOs provide updates on returning healthcare or
aid workers from affected countries
 Active public health monitoring of any person with
potential EVD exposure for 21 days
Image Source: Australian Department of Health
Public Health Laboratory Guidelines
 Collection, transport & testing of specimens
Surveillance and public health monitoring in NSW
 Airport arrivals screened
– >350 arrivals from west Africa screened for EVD
– Now mostly humanitarian workers, including HCWs
 Public health risk assessments at airport
– 7 travellers returning from west Africa had raised skin temps
– 5 cleared after public health assessment from NSW Health staff
– 2 transferred to Westmead Hospital and tested EVD negative
 Public health home monitoring for EVD
– Continues for the 21 day period post departure
– Health care workers have daily calls
– Casual contacts have weekly calls
Response planning – Health Services
 Viral Hemorrhagic Fever
Contingency Plan
– How to conduct a risk assessment
– Infection control measures
– Diagnostic procedures and tests
– Management of people with no
known exposure, increased
possibility of disease or confirmed
cases
 Designated hospitals
 Designated laboratories
Response planning – Hospitals/EDs
Response planning – Primary health care
 Remain alert to possibility of
EVD in travelers returning
from West Africa
– GP algorithm
– Community health algorithm
 Engagement with AMA,
RACGP and Medicare Locals
 Travel posters available on
NSW Health website
Resources - Personal Protective Equipment (PPE)
Education and training – Infection Control & PPE
Infection Control Practitioner
(ICP) Train the Trainer Program
– Face to face training in
donning/doffing PPE
– Role of trained observer
– Environmental cleaning
resources
– Competency assessment and
credentialing
– Regular auditing every week
during preparedness phase
Image Source: Clinical Excellence Commission private YouTube Channel
Exercises
 Public Health Units
 Designated Hospitals Westmead Adults and
Children’s Hospitals
 Ambulance Service NSW re:
patient transfer
 Border screening – SES LHD,
Police and Air Services
Communications
Public information
 Regularly update
NSW Health
Ebola webpage
 Ebola factsheets
Summary of preparedness
 Risk is low, but consequences are serious
 Comprehensive planning at National, State and Local levels
 Key measures:
– Early case finding and isolation
– Protection of staff: PPE
– Clear management protocols
– Exercises
– Communication