Transcript EBOLA VIRUS DISEASE - WEST AFRICA (122): SIERRA LEONE

2014 EBOLA VIRUS DISEASE
Jackie Dawson, PhD
Public Health Epidemiologist
Chelan, Douglas, Grant, Kittitas and Okanogan Counties
509-886-6428
[email protected]
Arenaviridae Bunyaviridae
Filoviridae Flaviviridae
Junin
CrimeanCongo H.F.
Ebola
Kyasanur
Forest
Disease
Machupo
Hantavirus
Marburg
Omsk H.F.
Sabia
Rift Valley fever
Guanarito
Yellow Fever
Dengue
Lassa
Center for Food Security and Public Health
Iowa State University - 2004
October 2, 1989: 100 crab-eating macaques flown from the
Philippines to New York City and trucked to Reston, VA.
 By November 1: 29 monkeys died
 Vet dissected one of the dead monkeys searching for the cause of
death. There was blood in the intestines
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 Diagnosed as simian hemorrhagic fever virus
 Frozen samples wrapped in tin foil & shipped to United States Medical
Research Institute of Infectious Diseases (USAMRIID). By the time the
samples reached the lab, they had thawed out and were dripping
fluids.
 Diagnosis = EBOLA
Marburg roused no glow in the monkey cells; the Ebola-Sudan
made them glow a little; the Ebola-Zaire lit them up like light
bulbs.
 “The idea that a filovirus might burn through a warehouse 10 miles
from the capital greatly disturbed the army scientists.”
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http://ispub.com/IJPRM/2/1/12768
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November 28, 1989: 6 weeks after monkeys began dying in
Reston, USAMRIID verified the Ebola finding.
Because of the threat that Ebola might spread to staff, Reston and
the greater Washington, DC community, the Army determined
that all remaining monkeys would be immediately euthanized.
COL Gerald “Jerry” Jaax was in charge of eradicating the virus. An
initial entry team examined the buildings layout, entrances, exits,
and unprotected openings.
LTC Nancy Jaax (wife of COL Jaax), a veterinarian and pathologist,
conducted a walkthrough to determine the condition of the
monkeys and what problems an operations team might
encounter: blood, body fluids, as well as excited monkeys.
Hazelton staff and animal handlers were still working in the
building without hazmat suits and most were unaware of the
grave danger that they were in.
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November 30, 1989: LTC Nancy Jaax and another officer donned Hazmat
suits and began to euthanizing 65 monkeys.
By late afternoon, the monkeys were dead & the remains were triplebagged for incineration.
450 monkeys remained alive.
December 5, a group of 91 animal care specialists broken up into 2person teams entered the facility.
Consisting of mostly young soldiers, most were unfamiliar with
encapsulating suits, the tools they would be working with, the behavior
of monkeys or of the full potential of the medical problem they were
facing.
One of the monkeys escaped. Efforts to net the animal were
unsuccessful and only agitated the other monkeys. Shooting it was out of
the question for fear that a loose round would end up somewhere
unwanted. And, no one had thought of bringing a dart gun or other
immobilizing device. Ultimately, it was decided to let the monkey roam
freely and to try again the next day.
“Several of us spent the better part of a day
trying to catch it. When we talk about the Reston
incident, we compare the frustration of that day
with the Hollywood version in the movie
‘Outbreak,’ in which an infected monkey was
coaxed from a tree and captured within minutes.
It is a great example of reality vs. Hollywood”.
 Finally the escapee was caught after it had
jammed itself into a crevice leaving only its rump
exposed. The creature was quickly euthanized.
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Dec 6th: building decontamination efforts began─
chipping, scrubbing and bleaching.
 This continued for 11 days, followed by the
introduction of Bacillus subtilis niger.
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 Strains of the species Bacillus subtilis (spores) are used for
sterilization control.
 Their death presumes all bacteria and viruses to be dead.
About 6:00 p.m. on December 18, electric fry pans, set
on high, volatized the formaldehyde crystals. For
three days, the building was cooked. Finally it was
determined that the building was decontaminated.
 Reston’s three month ordeal with Ebola was over.
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While the cleanout of the monkey house was
going on, 2 out of 4 monkey care takers were
hospitalized -both survived.
Conclusion: new species of Ebola virus, which
they named Ebola-Reston.
The new virus was highly pathogenic in
monkeys but apparently not in humans.
www.cdc.gov/vhf/ebola/resources/distribution-map-guinea-outbreak.html
Ebola “subtypes”
•Zaire
•Sudan
•Tai Forest (Ivory Coast)
•Bundibugyo (Uganda)
•2014 West Africa:
97% identical to Zaire
ebolavirus) identified
earlier in the
Democratic Republic of
the Congo and Gabon.
Symtoms
appear most
commonly 810 days after
exposure
 Fever of
>38.6o Celsius
(101.5o F)
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www.cdc.gov/vhf/ebola/outbreaks/guinea/qa.html
http://www.cdc.gov/vhf/ebola/pdf/west-africa-outbreak-infographic.pdf
WHO believes that fruit bats may be the
natural host of the Ebola virus in Africa
 In Africa, Ebola may be spread as a result
of hunting, processing, and consuming
infected animals (e.g., bushmeat).
 New York City, home to nearly 77 000
West Africans (most of them in the
Bronx), is the epicenter of the bushmeat
trade in the U.S.
 One recent study estimated that 273 tons
of bushmeat is imported into Charles de
Gaulle Airport on Air France carriers every
year. From France, the imported goods
often travel on to America.
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Ebola Cases and Deaths (West Africa)
August 28, 2014
Suspected and Confirmed Case Count: 3069
Suspected Case Deaths: 1552
Laboratory Confirmed Cases: 1752
Updates on cases and deaths can be found on the CDC website:
http://www.cdc.gov/vhf/ebola/outbreaks/guinea/index.html
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WHO: >240 health-care
workers have developed
the disease and > 120
have died
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In the current outbreak, the
majority of Ebola virus
disease cases are a result
of:
 human-to-human
transmission and
 failure to apply appropriate
infection prevention/control
measures in:
▪ home care
▪ clinical settings
▪ burial rituals
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Virus is believed to be able to survive for
some days in liquid outside an infected
organism,
Disinfection:
 Chlorine
 Heat
 direct sunlight
 soaps and detergents
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Early recognition is critical for infection control. Healthcare providers
should be alert for and evaluate any patients suspected of having EVD
who have (see EVD case definition):
A fever of greater than 38.6 degrees Celsius or 101.5 degrees Fahrenheit,
and additional symptoms such as severe headache, muscle pain,
vomiting, diarrhea, abdominal pain, or unexplained hemorrhage;
AND
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Risk factors within the past 3 weeks before the onset of symptoms, such
as contact with blood or other body fluids of a patient known to have or
suspected to have EVD; residence in—or travel to—an area where EVD
transmission is active; or direct handling of bats, rodents, or primates
from disease-endemic areas.
Malaria diagnostics should also be a part of initial testing.
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Follow standard, contact, and droplet precautions, including the following recommendations:
Isolate the patient: Patients should be isolated in a single patient room (containing a private
bathroom) with the door closed.
Wear appropriate PPE: Healthcare providers entering the patients room should wear: gloves, gown
(fluid resistant or impermeable), eye protection (goggles or face shield), and a facemask. Additional
protective equipment might be required in certain situations (e.g., copious amounts of blood, other
body fluids, vomit, or feces present in the environment), including but not limited to double gloving,
disposable shoe covers, and leg coverings.
Restrict visitors: Avoid entry of visitors into the patient's room. Exceptions may be considered on a
case by case basis for those who are essential for the patient's wellbeing. A logbook should be kept to
document all persons entering the patient's room. See CDC's infection control guidance on procedures
for monitoring, managing, and training of visitors.
Avoid aerosol-generating procedures: Avoid aerosol-generating procedures. If performing these
procedures, PPE should include respiratory protection (N95 or higher filtering facepiece respirator)
and the procedure should be performed in an airborne infection isolation room.
Implement environmental infection control measures: Diligent environmental cleaning and
disinfection and safe handling of potentially contaminated materials is of paramount importance, as
blood, sweat, vomit, feces, urine and other body secretions represent potentially infectious materials
should be done following hospital protocols.
http://www.cdc.gov/vhf/ebola/hcp/patient-management-us-hospitals.html
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Use a U.S. Environmental Protection
Agency (EPA)-registered hospital
disinfectant with a label claim for a nonenveloped virus (e.g., norovirus, rotavirus,
adenovirus, poliovirus) to disinfect
environmental surfaces in rooms of
patients with suspected or confirmed Ebola
virus infection.
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Avoid contamination of reusable porous
surfaces that cannot be made single use.
Use only a mattress and pillow with plastic or
other covering that fluids cannot get through.
Do not place patients with suspected or
confirmed Ebola virus infection in carpeted
rooms and remove all upholstered furniture
and decorative curtains from patient rooms
before use.
•PPE is hot and cumbersome
•Some doctors work beyond their
physical limits, trying to save lives in
12-hour shifts, every day of the week.
•Staff who are exhausted are more
prone to make mistakes
http://www.cdc.gov/vhf/ebola/pdf/ppe-poster.pdf
http://www.cdc.gov/vhf/ebola/pdf/ppe-poster.pdf
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Ebola Virus Disease Information for Clinicians in U.S. Healthcare Settings
http://www.cdc.gov/vhf/ebola/hcp/clinician-information-us-healthcare-settings.html
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Interim Guidance for Emergency Medical Services (EMS) Systems and 9-1-1 Public Safety Answering Points (PSAPs) for Management of
Patients with Known or Suspected Ebola Virus Disease in the United Stateshttp://www.cdc.gov/vhf/ebola/hcp/interim-guidance-emergencymedical-services-systems-911-public-safety-answering-points-management-patients-known-suspected-united-states.html
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Guidance for Safe Handling of Human Remains of Ebola Patients in U. S. Hospitals and Mortuaries
http://www.cdc.gov/vhf/ebola/hcp/guidance-safe-handling-human-remains-ebola-patients-us-hospitals-mortuaries.html
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Health Alert Network (HAN) INFOService: CDC Ebola Response Update
http://emergency.cdc.gov/han/han00367.asp
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Case Definition for Ebola Virus Disease (EVD)
http://www.cdc.gov/vhf/ebola/hcp/case-definition.html
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Interim Guidance for Monitoring and Movement of Persons with Ebola Virus Disease Exposure
http://www.cdc.gov/vhf/ebola/hcp/monitoring-and-movement-of-persons-with-exposure.html
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Factsheet: Interim Guidance for Specimen Collection, Transport, Testing, and Submission for Patients with Suspected Infection with Ebola
Virus Disease
http://www.cdc.gov/vhf/ebola/pdf/ebola-lab-guidance.pdf
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Interim Guidance for Environmental Infection Control in Hospitals for Ebola Virus
http://www.cdc.gov/vhf/ebola/hcp/environmental-infection-control-in-hospitals.html
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Sequence for Putting On and Removing Personal Protective Equipment (PPE)
http://www.cdc.gov/vhf/ebola/pdf/ppe-poster.pdf
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Interim Guidance about Ebola Infection for Airline Crews, Cleaning Personnel, and Cargo Personnel
http://www.cdc.gov/quarantine/air/managing-sick-travelers/ebola-guidance-airlines.html
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Advice for Colleges, Universities, and Students about Ebola in West Africa
http://wwwnc.cdc.gov/travel/page/advice-for-colleges-universities-and-students-about-ebola-in-west-africa
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Experimental:
 Zmapp= 3 different monoclonal antibodies
 BioCryst Pharmaceuticals-unlike a vaccine BCX-
4430 is being developed as a post-exposure
treatment
 NIH/GlaxoSmithKline vaccine takes a single protein
from the ebolavirus and pairs it with a chimpanzee
cold virus
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FDA can authorize access through an
emergency Investigational New Drug (IND)
application.
http://www.cdc.gov/vhf/ebola/outbreaks/guinea/qa-experimental-treatments.html