ISTM Quebec, CA May 28, Contact:

Transcription

1 The West Africa Ebola Outbreak: What s Different, What s Not, and What do we do now? Daniel Bausch, MD, MPH&TM Consultant Clinical Management Team WHO Geneva ISTM Quebec, CA May 28, Contact: bauschd@who.int

2 Financial Disclosures-None Pandemic and Epidemic Diseases department

3 Ebola Epi Update: Confirmed, probable and suspected EVD cases worldwide (data up to 17 May 2015). WHO SitRep CFR: 41% Pandemic and Epidemic Diseases department

4 New and total confirmed cases. 17 May 2015 WHO Situation Report

5 Aspect Previous Outbreaks West Africa Location Remote Central Africa More connected regions of West Africa No. cases Typically ~27,000 No. countries Usually 1 3 (plus ~26 imported) involved at a time Duration 2-4 months >18 months Exported cases Extremely rare Occasional outside area Community Occasional Frequent resistance cooperation resistance Organizations 5-10 >100 responding Urban areas Spared Heavily involved No. ETUs Typically 1-2 > 50 No. Diagnostic labs Typically 1-2 > 50

6 Pandemic and Epidemic Diseases department

7 200 miles Congo Guinea-Liberia-Sierra Leone Population 68 million 22 million Surface Area (Km 2 ) 2.3 million 430,000 Population Density (persons/ Km 2) 30 51

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9 Monrovia (1 million) Conakry (1.1 million) Freetown (1.2 million)

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11 Approach to patient care Decrease transmission Increase supportive care Decrease mortality ETU ECU Community Care Unit Home Care With Distribution of Hygiene Kits/PPE NOTHING

12 Ebola virus infections in HCWs 3.4% of all EVD cases during the outbreak Country Cases Deaths Guinea Liberia Sierra Leone Total Data are confirmed cases and deaths only, apart from deaths in Sierra Leone, which include confirmed, probable, and suspected deaths. *Data as of 17 February. Pandemic and Epidemic Diseases department

13 Personal Protective Equipment

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15 Clinical Observations Bleeding not a major component ( Ebola hemorrhagic fever Ebola virus disease ) Volume loss and electrolyte imbalance appear to be major factors

16 Best Treatment Practices? What fluid and electrolyte support? Anti-diarrheal agents? Antibiotic prophylaxis? Blood products/immune therapy? Antiviral agents?

17 A new geographical distribution Ebola cases in USA and Europe 21 MEDEVAC DEU 4 FRA 2 ITA 1 NET 2 NOR 1 SPA 4 SWI 1 UK 1 USA 5 Senegal Mali Guinea Sierra Leone Liberia Nigeria RDC Pandemic and Epidemic Diseases department

18 Factors that may relate to real and perceived variability in EVD CFR across sites Quality of care Intensity of surveillance Level of community cooperation Mode of transmission and inoculum size Host genetic differences Virus genetic differences

19 Percent Symptoms Post-Ebola Virus Disease (%) Symptom

20 EVD Survivors Ocular complications: Uveitis, visual acuity Mental health: PTSD, depression, stigma, loss of family members, orphans Virus persistence: (~3 months) in selected immune protected sites: male gonad/semen, chambers of the eye, intrauterine contents in pregnancy? others? Risk of sexual transmission and reintroduction Pandemic & Epidemic Diseases

21 WHO Ebola Survivors Support Network Assist WHO governmental and non-governmental partners in the coordination of plans for survivors of Ebola virus disease (EVD), both in terms of service provision (first priority) and scientific study (secondary). The WHO ESSN is designed to contribute a valueadded non-duplicative service to the many ongoing initiatives regarding post-evd care and study to help meet the heterogeneous needs across the three epidemic countries in West Africa and elsewhere. Pandemic & Epidemic Diseases

22 WHO Emerging Disease Clinical Assessment and Response Network (EDCARN) Strengthen global collaboration between clinicians, researchers, medical NGO's, national health authorities, WHO and other stakeholders in order to improve clinical management of patients during outbreaks of EIDs. To accelerate production of scientific knowledge on these diseases. Catalyst of new dynamics of PED control bench to bed and beyond: Basic science animal models regulatory mechanism clinical trials improved patient care public health policy 22

23 Conclusions This outbreak is not over! Systems have collapsed getting to zero, recovery, rebuilding health systems all still ahead Silver Lining: Scale and scrutiny of this tragedy have brought about a sea-change in scientific and public health application with potential for drastic improvements in treatment and control The Future: More systematic approach and evaluation of bench-to-beside applications for EVD and other emerging diseases needed to inform best practices.

24 American Society of Tropical Medicine and Hygiene October 25-29, 2015 Philadelphia, PA

25 Tribute to Fallen Healthcare Workers Bausch et al. (2014) A Tribute to Sheik Humarr Khan and all the Healthcare Workers in West Africa who have Sacrificed in the Fight Against Ebola Virus Disease: Mae we hush. Antiviral Res 111:33 35 Pandemic and Epidemic Diseases department