EBOLA & OTHER VIRUSES IN THE NEWS EBOLA VIRUS, CHIKUNGUNYA VIRUS, & ENTEROVIRUS D68

PRESENTERS Patricia Quinlisk, MD, MPH, Medical Director /State Epidemiologist Samir Koirala, MBBS, MSc Epidemic Intelligence Service Officer Assigned to IDPH Ann Garvey, DVM, MPH, MA, State Public Health Veterinarian & Deputy State Epidemiologist

VIRUSES IN THE NEWS Ebola Chikungunya Enterovirus D68

EBOLA VIRUS Ebola poses very little risk to the U.S. general population. Spread through direct contact to bodily fluids of an infected person. Early treatment efforts may decrease risk of serious disease and death. The mortality rate is currently around 60 percent.

EBOLA VIRUS INCUBATION & INFECTIOUS PERIODS Symptoms appear 8 to 10 days after exposure fever, headache, joint and muscle aches, weakness, diarrhea, vomiting, stomach pain and lack of appetite, and in some cases bleeding (about 50%) Individuals who are well (no symptoms) are NOT contagious. Body after death is infectious.

EBOLA VIRUS TREATMENT Timely treatment of Ebola is important. Supportive treatment only No proven specific medicine/treatment known Experimental prevention and treatments (antibodies and vaccines) are being tested but at this time no specific recommendations.

EBOLA VIRUS RISK TO IOWA Ebola virus poses very little risk to the U.S. & Iowa No reported cases in the U.S. Casual contact does not spread the virus Contact with bodily fluid from an ill person is needed for transmission of the virus! Measures to prevent travelers from bringing Ebola to the U.S. Level 3 travel warnings Liberia, Sierra Leone, Guinea Airports in Liberia, Sierra Leone, and Guinea are screening all outbound passengers for Ebola symptoms Guidelines and procedures for airlines Guidelines and infection control recommendations for healthcare providers in the U.S.

EBOLA VIRUS AND PUBLIC MESSAGING Exotic Viruses are: Exciting for the media Confusing for the public Rely on science-based facts and key messages Key Messages: 1. Ebola does not pose a significant risk to Iowans/US 2. If traveling outside the U.S. (especially to exotic locales), check the CDC web site for travel advisories and vaccine/preventive medicine recommendations. 3. The most likely diseases travelers get (and bring back), are the common diseases like flu, malaria and measles. 4. Travelers must always take action to protect against these much more common diseases.

Situation in West Africa 10

Early September 11

Late September 12

CASES AND DEATHS (AS OF SEPT. 14, 2014) Country Suspected and confirmed cases Suspected and confirmed case deaths Laboratory confirmed cases Guinea 942 601 750 Liberia 2710 1459 812 Sierra Leone 1673 562 1513 Nigeria 21 8 19 Senegal 1 0 1 Total 5347 2630 3095 13

DR. KOIRALA S WORK IN SIERRA LEONE 14

GENERAL INFORMATION Officially known as Republic of Sierra Leone. Borders: Northeast Guinea Southeast Liberia Southwest Atlantic Ocean Population : 6,190,280 Official Language : English 15

EBOLA IN SIERRA LEONE First case of Ebola was reported in May 2014. Number of cases and deaths have been increasing since. 1673 suspected and confirmed cases and 562 deaths. 19

PREPARATION FOR DEPLOYMENT Orientation on Ebola outbreak in West Africa Training on Viral Hemorrhagic Fever Database (for implementation in Africa) Training on preventive measures; including personal protective equipment (PPEs) How to report on daily basis about our activities and health status to CDC (continued until back in US for 21 days) 20

IN SIERRA LEONE Deployed from 3 rd August 27 th Aug. Began by meeting with the Government officials and international partners (WHO, MSF, Public Health England) to assess the situation understand need and resources Identified three districts with most cases Decided to split into groups of two epidemiologists and go to those three districts 21

WORK IN SIERRA LEONE Assisted the Government with setting up surveillance system Implemented and trained people to use the database to coordinate control measures Set up and started training of contact tracers and their supervisors Important in control to know; Who is ill Who has been exposed Follow-up with exposed for 21 days to be sure they don t get ill and expose others Began community practices to stop or slow spread of the virus 25

CHALLENGES Poor healthcare system and infrastructures (limited testing and isolation entities) Limited manpower and resources (only a few hospitals set up for Ebola patients) Fear among healthcare workers (without education and access to personal protection very unwilling to care for patients) Lack of trust between healthcare providers and the community (information not getting back to families about ill loved ones) Stigma of having Ebola RESULTS: People escaping and hiding ill family members 29

WHAT IS CDC DOING IN THE US? Activated Emergency Operations Center (EOC) to help coordinate technical assistance and disease control activities with internal and external partners Providing guidance for US health care How to test and diagnosis Ebola How to treat patients (experimental and supportive) How to prevent spread Providing guidance and resource support to public health for coordination of testing, prevention of spread, etc. International coordination to prevent spread (at airports etc.) Deploying teams of public health experts to the West Africa region. 33

ENTEROVIRUS D68 10 to 15 million illnesses annually in US 100 different types of enteroviruses D68 is one of those 100 types Activity peaks in late summer early fall What is different about this year? Seems to be more activity in certain parts of the US this year.

ENTEROVIRUS D68 Symptoms Runny nose Cough Sneezing Body and muscle aches Fever (possibly) Spreads Person to-person through coughing and sneezing or touching contaminated surfaces. Children and teenagers most likely to get infected. Immunity from previous exposures in adults. Most people will have mild illness and recover at home with rest and fluids. Some people, especially children with a history of asthma or respiratory condition, could develop more severe illness and be hospitalized.

ENTEROVIRUS D68 No specific treatment- supportive care Prevention (No vaccine available): Wash hands often with soap and water for 20 seconds. Avoid touching eyes, nose and mouth with unwashed hands. Avoid kissing, hugging, and sharing cups or eating utensils with people who are sick. Disinfect frequently touched surfaces, such as toys and doorknobs, especially if someone is sick. No special exclusion recommendations

Chikungunya Mosquito borne illness starts 3-7 days after mosquito bite 72% 97% have symptoms when infected Fever, joint pain (often multiple joints in hands and feet), headache, muscle pain, rash, conjunctivitis, nausea and vomiting Fatality rare, but can occur in older adults. No specific treatment, supportive care.

CHIKUNGUNYA EPIDEMIOLOGY

CHIKUNGUNYA RISK TO IOWA Current mosquito vectors for Chikungunya: Aedes aegypti Aedes albopictus Thrive in tropical/subtropical climates but poorly adapted to the climate and landscape in Iowa Based upon current transmission of Chikungunya, the risk of local transmission of Chikungunya in Iowa is extremely unlikely Iowan s who travel to areas of ongoing transmission MUST take action to prevent mosquito bites

PUBLIC HEALTH & CHIKUNGUNYA Iowa will likely see more imported cases of Chikungunya 2 imported cases in Iowa so far this year Both traveled to the Caribbean Several more cases being tested Prevention measures include: Using mosquito nets if in areas where there are no screens on windows. Using mosquito repellant, always follow the label instructions carefully (i.e., some products can not be used on young children).

QUESTION & ANSWER SESSION Please type questions into the comments box on your computer Participant phone lines will remain muted throughout the question & answer session