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EPI UPDATE NOVEMBER, 2014
Jackie Dawson, PhDPublic Health EpidemiologistChelan, Douglas, Grant, Kittitas & Okanogan Counties(509) [email protected]
Stephanie Snitily, RN, BSNCommunicable Disease Program CoordinatorChelan-Douglas Health District(509) [email protected]
SUCCESSFUL RESPONSE
EMS
HealthcareLaw Enforcement
Public Health
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
viremia
3
IgM
ELISA IgM
0 10
IgG
IgM: up to 3 – 6 months
ELISA IgG
IgG: 3 – 5 years or more (life-long persistance?)
days post onset of symptoms
RT-PCR
Critical information: Date of onset of fever/symptoms
Fever
EVD: EXPECTED DIAGNOSTIC TEST RESULTS OVER TIME
6
EBOLA
www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/case-counts.html
• 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
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: 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
US CASES
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 skin-to-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
94% individuals screened: 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
WASHINGTON STATE Sample from Oregon patient tested at PHL. Ebola Tx Center Hospitals:
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
