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Washington State Ebola Response: From Identify, Isolate and Inform to
Frontline, Assessment and TreatmentScott Lindquist MD MPH State Communicable Disease Epidemiologist for Washington State
Region 9 Healthcare Coalition Ebola Symposium
• Ebola virus disease
• The current outbreak
• Monitoring travelers from Ebola-affected countries
• Healthcare facility and laboratory preparedness
Overview
• Virus of the family Filoviridae, genus Ebolavirus
• Discovered in 1976 near Ebola River (DRC)
• 4 of 5 subspecies cause disease in humans• Ebola virus (Zaire ebolavirus)
• Sudan virus (Sudan ebolavirus)
• Taï Forest virus (Taï Forest ebolavirus)
• Bundibugyo virus (Bundibugyo ebolavirus)
• Bats are most likely reservoir
• Occurs in animal hosts native to Africa
Ebolavirus
Source: CDC
• fever (>101.5°F)
• headache,
• muscle pain
• weakness
• diarrhea, vomiting
• abdominal pain
• lack of appetite
• rash
• red eyes
• cough, hiccoughs
• sore throat,
• chest pain
• difficulty breathing or swallowing,
• unexplained bleeding inside and outside of the body
Symptoms Typically Include Symptoms Can Include
Ebola Virus Disease Symptoms
Spread through direct contact--through broken skin or mucous membranes-- with:
•a sick person's blood or body fluids: urine, saliva, feces, vomit, and semen
•objects--such as needles that have been contaminated with infected body fluids
•infected animals
Transmission of EVD
• Supportive care
• balancing the patient’s fluids and electrolytes
• maintaining their oxygen status and blood pressure
• treating them for any complicating infections
• Experimental therapy
• ZMapp: monoclonal antibodies
• TKM-Ebola: RNA interference drug
• Human plasma
Treatment
Ebola Virus Outbreaks, 1976–2008
Current Outbreak in West Africa*
• Largest outbreak to date
• > 25,907cases• > 10,736 deaths
• Widespread transmission in Guinea, Liberia & Sierra Leone
• Healthcare workers and close contacts of cases at highest risk
• No definitive treatment or vaccine, only supportive care
Areas affected by 2014 outbreak
*As of November 14, 2014
Level 3 Warning:
Avoid Nonessential Travel
• Guinea
• Liberia
• Sierra Leone
CDC Travel Notices
• Exit screening in Ebola-affected countries
• Entry screening in 5 US airports
• Travelers need to enter US via these airports
• Completion of declaration form & temperature screen
• Distribution of “CARE” kits
• Contact information electronically transmitted to DOH
• Monitoring of travelers in Washington by LHJs
Travel Screening In Washington State
WA State Monitoring of Travelers
http://www.doh.wa.gov/Portals/1/Documents/5100/420-132-Ebola-LHJ-MonitoringGuide.pdf
Exposure Risk Category LHJ Type of Monitoring
Restrictions on Movement
High risk
(e.g., direct contact with infected body fluids)
Direct Active Monitoring Yes – Public Health Order for Restrictive Movement; involuntary home quarantine order if contact refuses to adhere to restrictions
Some risk
(e.g., close contact with a person showing symptoms of Ebola; direct contact with an Ebola patient in Africa while wearing appropriate PPE)
Direct Active Monitoring Not routinely unless risk assessment warrants additional restrictions.
See “some risk” letter template for further voluntary restrictions
Low but not zero risk
(e.g., been in a country with widespread Ebola transmission but no known exposures; direct contact with an Ebola patient in US while wearing appropriate PPE)
Direct Active Monitoring for US based healthcare workers
Active Monitoring for all others
No
• Travelers Monitored since September
• 196 (9 Spokane, 1 Lincoln, 1 Okanogan, 1 Stevens)
• Travelers currently being monitored
• 10
• Total tested for Ebola
• 1
WA State Monitoring of Travelers
• Outpatient / ambulatory care settings
• Rapidly identify, safely isolate & transfer patients
• Ebola assessment facilities
• Rapidly identify, isolate, evaluate & safely provide short-term care (if necessary) to patients
• Ebola treatment facilities (e.g., tertiary hospitals)
• Rapidly identify, isolate & safely provide ongoing care
• Need dedicated and adequate treatment areas, highly skilled and trained staff, appropriate equipment and excellent infection control procedures
Levels of Healthcare Facility Preparedness in Washington State
1. Treatment facilities– 3 hospitals
2. Assessment facilities– 8-9 hospitals
3. Screening and planning – all hospitals and clinics
Plan for Washington
1. CHI Franciscan Health (Harrison Medical Center – Bremerton campus)
2. Providence Regional Medical Center Everett
3. Providence Sacred Heart Medical Center and Children’s Hospital (Spokane)
4. Seattle Children’s Hospital
5. Swedish Medical Center (Issaquah)
6. Evergreen Hospital (Kirkland)
7. UW Medicine (Harborview, UW Medical Center)
8. Peace Health (Whatcom and Vancouver)
9. St. Mary’s (Walla Walla)
8 Hospital Systems Stepping Forward
• Performed validation testing for CDC Ebola PCR assay; performed risk assessment
• Trained staff to perform testing 24/7
• Distributed category A shippers to LHJs
• Trained labs and LHJs to package specimens
Testing for Ebola at the Washington State Public Health Laboratories
• Traveler from Liberia
• Designated as low risk
• Symptoms
• Abdominal pain
• Admitted to Hospital A (County A)
• Admitted to Hospital B (County B)
• Transfer to Hospital C (County C)
Scenario
Questions?
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