Training on the Ebola Virus Disease(duration 3 days)

Efficient by Edification – EFFO Ebola

01.08.2015

Training structure

Safety and good quality work

Module 1: Knowledge about Ebola Virus Disease

Support from the communitySupport from the hospital administrationSupport from the population

Module 3:

Standard pre-cautions

Module 2:

Community response

Module 6:

Water, disinfection and cleaning

Module 5:

Personal protective equipment

Module 4:

Triage & isolation

EFFO Ebola

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Ebola virus disease (EVD)Module 1 (Part 1)

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Learning objectives module 1 (part 1)

General objectivesTo know general information on EVD and be motivated to practice to gain more confidence and skills when dealing with suspected Ebola patients.

Specific objectives1. To know the epidemiology of the current outbreak2. To recognise the modes of contamination and transmission of

the Ebola virus3. To know the incubation period4. To recognise the symptoms of EVD5. To know the differential diagnosis

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Presentation outline Module 1

Part 1INTRODUCTIONI. Epidemiological situationII. Information about the

Ebola virusIII. Modes of transmission

and incubation periodIV. SymptomatologyV. Differential diagnosis

Part 2- Later -

I. The positive diagnosis: PCR, rapid tests

II. Pathophysiology of EVD

III. Care of casesIV. Work in the

isolation area and the stress caused

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The extraordinary situation

West Africa 2013-2015

1976 2013-2015

Several less serious epidemics in Congo, Uganda, Democratic Republic of Congo

602 cases and 431 deaths in Sudan and the Democratic Rep. of Congo

Over 28 000 cases and over 11 000 deaths

New situation: • Several affected countries• Very high number of cases• Failure of conventional

measures for epidemic control

200320001995 2007

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Ebola: the most affected areas

The epidemic 2013-2015

• Guinea• Liberia• Sierra Leone

Total no. of cases:Over 28 000

No. of deaths: Over 11 000

(August 2015, WHO)

Source: WHO

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Ebola has affected several countriesThe most affected regions: Guinea, Sierra Leone and Liberia

Ebola can spread

Ebola also affected 7 other countries- United States- England- Spain- Mali- Nigeria- Senegal- Italy

There were isolated instances; the epidemic in these countries is over

The problem is that Ebola can destroy health structures and “ordinary” patients no longer receive treatment.

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Health workers are at risk

More than 860 health workers were infected -> 500 deaths You can protect yourself! You must know how to and put it into practice. Health workers are the most important people in the fight

against Ebola!

“The patient scares me…?!”

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Information about the Ebola virus (I)

“Ebola” is the name of a river in northern Zaire, where the virus was discovered in 1976.

Ebola is a filovirus (Filoviridae family).

The main outbreaks:

1976: Sudan and Democratic Republic Congo1995: Democratic Republic of Congo2000: Uganda2003: Congo2007: Democratic Republic of Congo

There are 5 distinct species:

- Bundibugyo (BDBV)- Zaire (EBOV)- Reston (RESTV)- Soudan (SUDV)- Taï Forest (TAFV)

CDC/ Cynthia Goldsmith

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Information about the Ebola virus (II)

The virus is wrapped. The wrapping makes the virus fragile, it does not offer protection.

The Ebola virus can easily be destroyed by:

- heat- sunlight- bleach- detergents

-> several methods are combined for greater safety

-> more information in module 6CDC/ Dr. Frederick A. Murphy

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The Ebola virus in humans and animals

1. Reservoir of the virus: likely fruit bats

2. Epizootic in primates and other mammals

3. Human primary infection

4. Secondary transmission by direct contact

Source: RKI

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Incubation period of the Ebola virus disease

The incubation period is the time between contamination and the appearance of the first symptoms of a disease.

The incubation period is individual and depends, for example, on the amount of infectious agents and the immune system.

In the case of Ebola: • No symptoms -> no risk of transmission• Incubation period: 2 to 21 days, on average 8 days

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Mode of transmission (what?)

It is transmitted by infected organs or biological fluids through damaged skin, mucosa and parenterally:

The disease is highly contagious

• vomiting

• faeces

• blood

• Urine

• saliva

• tears

• sweat

• sperm

• breast milk

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Mode of transmission (how?)

It is transmitted by infected organs or biological fluids through direct or indirect contact:

• direct contact with sick or deceased persons• during care at home or in hospital• certain burial practices• contact with clothing, bed sheets, or other objects soiled

with a patient`s fluids• The more the person is sick, the higher the risk of

transmission.

The disease is highly contagious

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The initial symptoms of EVD

• Headache• High fever• Diarrhoea• Intense weakness• Muscle aches• Joint pain• Skin rash• Vomiting

EVD is individual.The symptoms are typical, but not specific.

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The phases of Ebola virus disease

• 1st phase: ~ D0 to D5 Sudden onset of fever, fatigue, headache, diffuse pain, hiccups,

conjunctivitis

• 2nd phase: ~ D5 to D6 Diarrhoea, vomiting, skin rash

• 3rd phase: ~ D6 to D8 Multiple organ failure, shock, diffuse bleeding (<1/3 of cases,

gums, gastrointestinal tract, puncture sites, vaginal bleeding, etc.), renal failure, encephalopathy

• Death (~ 50%) or recovery

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Which symptom is this?

Image: cdc

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Which symptom is this?

Image: cdc

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Which symptom is this?

Image: cdc

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Which symptom is this?

Image: cdc

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Which symptom is this?

Image: cdc

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Which symptom is this?

Image: cdc

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Which symptom is this?

Image: cdc

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Which symptom is this?

Image: cdc

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Which symptom is this?

Image: cdc

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Which symptom is this?

Image: cdc

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Which symptom is this?

Image: cdc

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Which symptom is this?

Image: cdc

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Differential diagnosis

All these symptoms are common to other diseases

• malaria

• typhoid fever

• meningitis

• shigellosis

• cholera

• hepatitis

• viral influenza

• plague

• leptospirosis

• rickettsiosis

• relapsing fever

• other viral haemorrhagic

fevers (Lassa)

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How to prevent transmission

Use personal protective equipment (PPE)

Direct or indirect contact without protection can

be very dangerous

The Ebola virus is not spread by air like, e.g.

measles

A distance of two metres is sufficient for protection

No symptoms, no transmission

Watch out for the exception! Possible transmission after clinical recovery through sexual contact

(sperm)

What you should do…

What you should know…

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Ambivalence towards a suspected case of EVD

Medical personnel should protect themselves. They must be careful and avoid contamination.

Patients should be cared for whether they are suspected of EVD or not. They must not be overlooked.

→ care in Personal Protective Equipment (PPE)

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The correct use of PPE is important!

Train the use of each piece of equipment!

The most difficult elements for the majority are:

Hood

Goggles

Mask

gloves (removal)

Projet EFFO

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Thank you for your attention!

Copyright Images

© leremy – Fotolia.com

01.08.2015