Transcript PIO Nov 12, 2014

EPI UPDATE
NOVEMBER, 2014
Jackie Dawson, PhD
Public Health Epidemiologist
Chelan, Douglas, Grant, Kittitas & Okanogan Counties
(509) 886-6428
[email protected]
Stephanie Snitily, RN, BSN
Communicable Disease Program Coordinator
Chelan-Douglas Health District
(509) 886-6417
[email protected]
SUCCESSFUL RESPONSE
Public Health
EMS
Healthcare
Law
Enforcement
EBOLA VIRUS LIFECYCLE
http://www.nejm.org/action/showMediaPlayer?doi=10.1056/NEJMp1410741&aid=NEJMp1410741_attach_1
DETECTION OF EBOLA VIRUS IN DIFFERENT
HUMAN BODY FLUIDS OVER TIME
EVD: EXPECTED DIAGNOSTIC TEST RESULTS
OVER TIME
Critical information: Date of onset of
fever/symptoms
IgM
IgG
viremia
0
3
10
days post onset of symptoms
Fever
RT-PCR
ELISA IgM
ELISA IgG
IgM: up to 3 – 6 months
IgG: 3 – 5 years or more (life-long persistance?)
6
EBOLA
• No direct flights from Mali to US
• Daily 15-20 people, begin itineraries
in Mali and transit through other
countries en route to the USA
www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/case-counts.html
LIBERIA
Half of Liberia’s Ebola cases
have been in or near the capital
of Monrovia with its population
of about 1.5 million.
 Since mid-Sept:
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73% decline in admissions to
Ebola Treatment Units
 58% decline in blood samples
testing positive for Ebola
 53% decline in body collections

www.cdc.gov/media/releases/2014/p1114-ebola-liberia.html
www.nytimes.com/interactive/2014/07/31/world/africa/ebola-virus-outbreak-qa.html?_r=1
EBOLA IN SIERRA LEONE, NOV 10, 2014
# of new cases jumped
dramatically
 Oct 5, 2014: 81 new cases of the
virus, but 121 deaths
 Nov 8, 2014: 45 new cases,
including 24 in the capital,
Freetown.
 New British army-built Ebola
hospital in Freetown.
 Nov 9, 2014:111 new cases the
highest daily rate since August
2014
 Nov 15, 2014: MD flown from
Sierra Leone to Nebraska
Medical Center
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US CASES
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Dallas patient died on October 8.
Contact tracing identified a total of 103 individuals, of whom 48 were close
unprotected contacts of the initial patient.
147 health care workers (including EMS) who cared for the patient or 2 nurses,
irrespective of PPE use, were actively monitored.
1 nurse had contact with 164 people including: 2 household members, 10 friends and
family members, and 60 persons at one store; 17 airline and airport personnel and 76
airline passengers monitored in Ohio
6 schools in Texas and Ohio were closed for disinfection because some students had
been on the same flight http://www.cdc.gov/vhf/ebola/children/index.html
Some contacts were brief, while others lasted several hours and included direct skinto-skin exposure.
As of November 7, all contacts of the three patients had finished active monitoring and
none of the contacts besides the 2 nurses themselves had developed Ebola.
www.cdc.gov/media/releases/2014/p1114-ebola-liberia.html
www.nytimes.com/interactive/2014/07/31/world/africa/ebola-virus-outbreak-qa.html?_r=1
NEW YORK
The quarantine of the doctor’s fiancée has now ended.
 The lifting of that quarantine should also mean the end
of concerns that the patient — who, while asymptomatic,
rode the subway, ran on the High Line, bowled in
Brooklyn, and ate West Village meatballs — might have
exposed thousands of New Yorkers to Ebola.

www.nejm.org/doi/full/10.1056/NEJMp1413816?query=featured_ebola
FACTORS IN HEALTH-CARE-WORKER INFECTIONS IN LIBERIA
inconsistent recognition/triage of Ebola patients
 overcrowding of hospitals/clinics
 limitations in physical layout of hospitals
 lack of training in PPE and inadequate supply of PPE
 limited supervision of and adherence to infection control

www.nytimes.com/interactive/2014/07/31/world/africa/ebola-virus-outbreak-qa.html?_r=1
DOCTORS WITHOUT BORDERS HAS SENT DOCTORS AND AID WORKERS FROM
AROUND THE WORLD TO EBOLA-STRICKEN COUNTRIES
NEW EBOLA TREATMENT CENTERS
FDA HAS GRANTED EXPANDED ACCESS TO SEVERAL EXPERIMENTAL DRUGS
www.cdc.gov/vhf/ebola/pdf/ambulatory-care-evaluation-of-patients-with-possible-ebola.pdf
EBOLA: AIRPORT SCREENING
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94% individuals screened:
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New York's JFK
Washington-Dulles
Newark
Chicago-O'Hare
Atlanta
LHJ MONITORING OF QUARANTINE
Twice daily temp and symptom check
 Address social needs
 Home disinfection kits
 Alternate housing if necessary
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WASHINGTON STATE
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Sample from Oregon patient tested at PHL.
Ebola Tx Center Hospitals:
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CHI Franciscan Health-Harrison Medical Center
MultiCare Tacoma General Hospital
Providence Regional Medical Center-Everett
Providence Sacred Heart Medical Center-Spokane
Seattle Children’s Hospital
Swedish Medical Center-Issaquah
Virginia Mason Medical Center
University of Washington (Harborview Medical
Center, UW Medical Center, Valley Medical Center)
Monitoring for 21 days
Poison Control Center will be used as a call center
http://www.cdc.gov/vhf/ebola/pdf/is-it-flu-or-ebola.pdf