Ebola Virus Disease: the Facts, Response & the Way Forward. Dr. Abraham Idokoko Ebola Emergency Operations Centre (EEOC), Lagos.
2
Yearly trend of Emergence of New Infectious Diseases Globally, an average of one new infectious disease has emerged each year. Most are zoonoses 3
WHO HAZARD GROUP 4 VIRUSES OF CONCERN TODAY EBOLA MARBURG LASSA They are naturally zoonotic Transmitted directly from person to person Persons at high risk are workers engaged in the diagnosis of the disease and the care of patients HEALTH WORKERS
Evolution of the current EVD Outbreak 2 December 2013 Guekedou, Guinea 17-31 March 2014 Monrovia, Liberia 17 th April, 2014 Freetown, S/Leone 26 August 2014 Democratic Republic of Congo 20 July 2014, Lagos & Port Harcourt, Nigeria 30 August 2014 Senegal 65 sites within 6 months Vast spatial distribution
EVD SitRep as at 22 September 2014 Country TOTAL HCW Cases Deaths CFR (%) Cases Deaths CFR (%) Guinea 1008 632 62.7 67 35 52.2 Liberia 3022 1578 52.2 174 85 48.9 Sierra Leone 1813 593 32.7 96 61 63.5 Nigeria 20 8 40.0 11 5 45.5 Senegal 1 0 0 0 0 0 Congo DR 68 41 60.2 8 8 100 Total 5864 2852 48.6 356 194 54.5
Who is an Ebola Contact? A person without any symptoms who has had physical contact with a case or the body fluids of a case within the last three weeks. The notion of physical contact may be proven or highly suspected such as having shared the same room/bed, cared for a patient, touched body fluids, or closely participated in a burial (physical contact with the corpse).
A Suspected Ebola Case Definition Any person, alive or dead, who has (or had) sudden onset of high fever and had contact with a suspected, probable or confirmed Ebola case, or a dead or sick animal OR Any person with sudden onset of high fever and at least three of the following symptoms: headache, vomiting, anorexia / loss of appetite, diarhoea, lethargy, stomach pain, aching muscles or joints, difficulty swallowing, breating difficulties, or hiccups; OR Any person with unexplained bleeding OR Any sudden, unexplained death The distinction between a suspected case and a probable case in practice relatively unimportant as far as outbreak control is concerned.
A Probable Ebola Case Definition Any suspected case evaluated by a clinician OR Any person who died from suspected Ebola and had an epidemiological link to confirmed case but was not tested and did not have laboratory confirmation of the disease The distinction between a suspected case and a probable case in practice relatively unimportant as far as outbreak control is concerned.
A Confirmed Ebola Case Definition A probable or suspected case is classified as confirmed when a sample from that person test positive for Ebola Virus in the Laboratory The distinction between a suspected case and a probable case in practice relatively unimportant as far as outbreak control is concerned.
Challenges of this Outbreak First complex mix transmission pattern : Rural, Urban, Cross-border outbreaks Unusual number of health care workers among the cases and deaths [health facilities serving as amplifier of the EVD] Community resistance, strong traditional beliefs and cultural practices fuelling the outbreak
The Facts about Ebola Virus Disease?
Virus: Begins in animals Infect humans Human-to-human infection (outbreak) Ebola Virus Discovery in 1976 Yambuku, Zaire along Ebola River 14
Reservoir Unknown Bats? Birds? Insects? Plants? Primates
Where Does it Come From? Not entirely clear, but likely bats 16
Where Does it Come From? Bats may infect other animals 17
Where Does it Come From? Any of these can infect humans 18
Where Does it Come From? Once a human is infected, it can spread from this person to other human beings 19
Quiz Please, answer TRUE or FALSE? Can Ebola be passed from person to person through the air? 20
Quiz Answer Answer = FALSE! Ebola is only transmitted through: Touching body fluids (blood, urine, vomitus, sweat, saliva, breastmilk, semen, etc.) of a person who is sick with or has died from Ebola Touching or using objects contaminated with Ebola 21
Human to Human Transmission Ebola is transmitted through Touching body fluids of a person who is sick with or has died from Ebola, Touching or using objects contaminated with Ebola 22
Signs of Ebola Virus Disease Signs generally begin 2-21 days after contact with a person who is sick with Ebola Most commonly 1-2 weeks People who do not show signs of disease cannot spread the disease 23
Signs of Ebola Virus Disease General: Fever, headache, chills, weakness, tiredness Gastrointestinal symptoms: Vomiting, diarrhea, abdominal pain Possible other symptoms: Sore throat, hiccups 24
Other signs of Ebola Virus Disease Redness in the whites of the eyes Rash on the trunk Bleeding in 45% of cases (historically) Mild: nose bleed, bruising Severe: gastrointestinal bleeding, shock 25
Ebola shares symptoms with many diseases! Malaria Typhoid fever Cholera Hepatitis Meningitis Shigellosis plague Other viral hemorrhagic fevers (e.g., Lassa, YF) Most people sick with fever, vomiting, and diarrhea do not have Ebola 26
Care of Ebola Patients Not all patients with Ebola will die! Several Nigerian Patients have survived Patients who recognize the symptoms early and seek immediate medical care have a better chance of recovery Ebola treatment centres provide the best care for patients with Ebola Friends and Family should alert health authorities immediately Ebola infection is suspected On no account should anyone attempt to care for Ebola patients on their own without the health authorities 27
Recovering patients Remain weak for a long time & will need rest Need good food, safe water, love and the support of family, friends and the community Once a doctor determines that a patient has recovered, it is safe for the patient to go home and return to work! 28
Handling of the Dead Do not touch dead bodies if you think they died of Ebola You can easily get Ebola from the bodies of people who have died from Ebola This is unacceptable & Fatally dangerous 29
Health authorities work with the communities in handling the dead bodies To ensure Safe Burial rites & Safe burial kits
The EVD Response in Nigeria: A peep into Emergency Operations Centre
32
POE Operational Research Ebola Emergency Operations Centre (EEOC) Epidemiology, Contact Tracing and Surveillance Case Management, Infection Control & Prevention Social Mobilization and Communicatio ns
34
Moving Forward in Nigeria
EVD Realities in Nigeria as at Today NO known confirmed case within our borders No suspected case No probable case All known contacts are under surveillance No localised community transmission All known cases and contacts linked to the imported index case The only cause for concern remain the deteriorated situation in Liberia, Sierra Leone, Guinea and DRC 36
Moving Forward: What must we do? Maintain Alertness, Awareness and re-enforce key messages among the general public Sustain Surveillance of EVD in all our communities Strengthen Port health Capacity at all POE Strengthen the Infection Control and prevention practices of Health care workers Research.! Research.!! Research..!!! 37
For further information on EVD or to report a suspected case, please contact: 0800 EBOLA HELP 0800 32652 4357 Ebola.mobilizers@gmail.com www.ebolaalert.org
Email: abrahamidokoko@yahoo.co.uk
Acknowledgements All material owned by the partners on the EEOC FMOH NCDC WHO CDC MSF UNICEF UNFPA