The presenter has no potential or actual conflicts of interest and no relevant financial relationships to maters regarding or related to Ebola.

Transcription

1 Leonard A. Levy, DPM, MPH Associate Dean of Research and Innovation Director, Institute for Disaster and Emergency Preparedness Professor of Public Health/Family Medicine/Biomedical Informatics Nova Southeastern University College of Osteopathic Medicine Cecilia Rokusek, Ed.D., M.Sc., RDN Assistant Dean of Research and Innovation Director of the Center for Interprofessional Education and Practice Professor of Family Medicine, Public Health and Disaster & Emergency Preparedness Nova Southeastern University College of Osteopathic Medicine

2 The presenter has no potential or actual conflicts of interest and no relevant financial relationships to maters regarding or related to Ebola.

3 The first case of Ebola diagnosed in the U.S. and reported to the Centers for Disease Control and Prevention (CDC) by Dallas County Health and Human Services in Texas was on September 28, This index case had departed from Monrovia, Liberia, on September 19, arriving on September 20 in Dallas.

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5 This index case was asymptomatic during travel but upon arrival to the U.S., fell ill on September 24, causing him to seek care at Texas Health Presbyterian Hospital of Dallas September 26 where he was treated and released. On September 28 he returned to the same hospital and was admitted for treatment and died on October 8.

6 Ebola has the potential to substantially degrade a healthcare system, and even has the potential to destabilize countries. When a disease like Ebola gets out of control entire countries and regions are ground to a halt with serious ramifications from: disrupted or destructed trade extreme starvation stigma to restricted travel.

7 The Ebola outbreak highlighted significant gaps in US health care system, preparedness, and the need for rigorous infection control in hospitals. Two nurses who treated an Ebola patient in Dallas contracted the virus, which could have been prevented with the implementation of basic infection control safety procedures.

8 It is clear that the unlucky Dallas hospital that treated that first US-diagnosed Ebola patient was not well prepared for such a disease. It is also reasonable to assume that most US hospitals were also not optimally prepared then to take care of a patient with Ebola or another highly contagious and lethal disease. Source: Dr. Eric Toner, senior associate, University of Pittsburgh Medical Center, Center for Health Security.

9 Complacency is our worst enemy and is one of the major contributing factors to the declining commitment to public health preparedness. Although the US public healthcare system has achieved great success in squelching infectious disease, that success can lead to complacence.

10 It can be expected that with the current situation in West Africa regarding the Ebola epidemic compounded by the introduction of the disease in the U.S. and the fear that it has created, that patients who seek the care of a physician may ask questions about it. it is essential that physicians: avoid contributing to the fear that members of the community are feeling be knowledgeable about it, not pass on misinformation be able to respond to questions appropriately.

11 Even though the number of cases declined in West Africa, the number of deaths in Guinea linked to an outbreak on the border with Liberia and Sierra Leone hit 80 in February. As long as there are still patients affected by the disease, the United States and other parts of the world are potentially vulnerable even though currently there are no patients with Ebola in this country.

12 Ebola is caused by a virus and named after the Ebola River in Zaire initially occurring in 1976 and leading it to the death of hundreds of people. The virus is animal-borne with bats being the most likely reservoir. Since the initial occurrence of Ebola other outbreaks have occurred in West Africa, currently resulting in 24,282 cases and in the death of 9,976 people (WHO:8 March 2015).

13 Ebola deaths to 8 March 2015: >9,976 (probable, confirmed and suspected including one in the US and six in Mali) By country in West Africa: 4,162 Liberia 3,629 Sierra Leone 2,170 Guinea 8 Nigeria Source: WHO

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15 The index patient in the current West African outbreak was a one or two year old child, Emile Ouamouno, who died from the disease in the nation of Guinea in December 2013.

16 Much misinformation has been given as to how the disease is transmitted. First, compared to influenza, it is much more difficult to transmit since Ebola is not transmitted in the air (i.e. it is not aerosolized), in water, or in food. While it is possible for the virus to mutate and become aerosolized, this is highly unlikely.

17 The route of transmission is by touching a sick infected person and then making contact with their body fluids (e.g. blood, feces, vomit, saliva, semen, urine, tears, and sweat) or contact with objects such as needles, and syringes that have been contaminated with these fluids. The portal of entry can be a cut on one's skin and contact with mucus membranes (e.g. mouth, nose, anus, and vagina).

18 It is important to know that even among those who recovered from the disease their semen still shows evidence the presence of the virus for about six months. Breast milk in Ebola survivors also tests positive for the organism. Avoiding contact with infected persons as well as potentially infected corpses and their blood and body fluids is of paramount importance.

19 Director of the National Institute of Allergy and Infectious Disease (NIAID), Anthony S. Fauci, stated that people who die of Ebola probably remain infectious for at least a week after death underscoring the importance of safely handling and burying a victim s body. Infectious virus is found on internal organs for three days. *Rocky Mountain Laboratories of NIAID

20 If it is suspected that someone may have Ebola or who was exposed to the disease (e.g., recent trip to West Africa), do not send the patient away. Have them go into an unoccupied room and call your local health department. Sending them home or to an emergency room may result in someone with an active case potentially affecting those in the community or those in close contact. Patients with an Ebola exposure history and possible Ebola symptoms seeking care by phone should be advised to remain in place, minimize exposure of body fluids to others and given the number of the health department.

21 The clinical facility must inform the health department if there is a suspected Ebola case. In the event the incident is an emergency, the facility/patient should call 911 and advise them about the patient s Ebola risk factors so emergency personnel can arrive with proper personal protective equipment (PPE).

22 So long as the epidemic of Ebola continues in West Africa, the potential for additional people with the disease or infected by it coming to the U.S. continues and vigilance by health professionals must be observed. It is important to know that the disease is not transmissible if an infected person has no symptoms which can take in as few as two days after being infected but typically within eight to ten days. However it can take as long as 21 days after being infected for symptoms to occur.

23 Symptoms include fever (100.4 F), severe headache, muscle pain, fatigue, diarrhea, vomiting, abdominal pain, and unexplained hemorrhaging. People exposed to Ebola and asymptomatic should be instructed to monitor their health for the development of fever or symptoms for 21 days after exposure.

24 had direct contact with the blood and/or body fluids of an individual diagnosed with Ebola had close physical contact with an individual diagnosed with Ebola lived with or visited an Ebola-diagnosed patient while they were ill.

25 CDC Director Thomas Frieden, MD, MPH, at a news conference, in December 2014: "The bottom line is, there's been real momentum and real progress. I'm hopeful about stopping the epidemic (Ebola), but I remain realistic that this will be a long, hard fight.