Upload
matthew-rollosson
View
840
Download
2
Tags:
Embed Size (px)
DESCRIPTION
This is a presentation I gave to the Pierce County Medical Reserve Corps October 6, 2014
Citation preview
Matthew Rollosson, RN, MPH&TM 6 October 2014
Arenaviridae ◦ Argentine, Bolivian, Brazilian, Chapare, Venezuelan
hemorrhagic fevers ◦ Lassa fever
Bunyaviridae ◦ Crimean-Congo hemorrhagic fever ◦ Hantaviruses ◦ Rift Valley Fever
Filoviridae ◦ Ebola ◦ Marburg
Flaviviridae ◦ Dengue ◦ Yellow fever
Filo: thread ◦ Three genera:
Ebolavirus
Cuevavirus (Spain)
Marburgvirus (Germany)
◦ Ebola
Five species
Bunbidugyo (Uganda)
Reston (Virginia, U.S.)
Sudan
Taï Forest (Côte d’Ivoire)
Zaïre (Congo)
CDC/Frederick A. Murphy
CDC/NIAID
1968, Germany and Yugoslavia ◦ Laboratory workers exposed to blood and tissue of
African green monkeys from Uganda
Secondary transmission to family and other health care workers
◦ 31 people infected
7 deaths (case fatality 23%)
◦ Sporadic outbreaks in Africa
Case fatality as high as 90%
1989, Reston, Virginia, U.S. ◦ Cynomolgus macaques imported from the
Philippines
◦ Highly lethal to primates
Also infects pigs
◦ Not pathogenic to humans
Lab workers showed serological evidence of infection, but did not become ill
1976, Yambuku, Zaïre (now the Democratic Republic of the Congo) ◦ Near the Ebola River
Occurred at the same time as first identified outbreak of Sudan ebolavirus
◦ Species that causes most Ebola outbreaks
Current outbreak in West Africa
Fruit bats are most likely the natural reservoir for the virus ◦ Outbreaks frequently associated with mining
Infects monkeys and apes ◦ Large die-offs of chimpanzees and gorillas ◦ Taï Forest ebolavirus
One human infection Acquired during autopsy of a chimpanzee
Outbreaks may be associated with hunting or butchering animals or eating infected meat ◦ Bat soup ◦ Bushmeat
Direct contact with blood or body fluids of a symptomatic person ◦ Skin
Cuts, abrasion
◦ Mucous membranes
◦ Parenteral
Reusing unsterilized needles
◦ Funeral ceremonies
Respiratory droplets? ◦ Not airborne
Not effectively transmitted by fomites
Incubation period ◦ 2 to 21 days
Mean 4 to 10 days
◦ Not infectious until symptom onset
Sudden onset ◦ Fever
◦ Muscle pain
◦ Fatigue
◦ May be a transient maculopapular rash
Vomiting, diarrhea
Liver failure
Abdominal pain
Bleeding disorders ◦ Gastrointestinal bleeding
◦ Bleeding from venipuncture sites
◦ Mucous membranes
Renal failure
Neurological symptoms
Death or recovery ◦ 7 to 14 days after symptom onset
◦ Prolonged convalescence
◦ Immunity
Convalescent serum as treatment?
◦ Virus may be present in semen up to 7 weeks after recovery
Rehydration and supportive care improve survival
March 22 ◦ First cases reported
◦ Guinea: 49 people
August 31 ◦ 3,685 cases
September 23 ◦ 6,574 cases
Liberia: 3,458 cases
Sierra Leone: 2,021 cases CDC, 2014c
CDC, 2014c
Liberia ◦ Doubling every 15-
20 days
Sierra Leone ◦ Doubling every 30-
40 days
CDC estimates that cases may be underreported by a factor of 2.5
Cumulative number of Ebola virus disease cases reported – five countries, West Africa, March 29 – September 20, 2014
CDC, 2014d
July 20 ◦ Ill patient travels from Liberia to Lagos, Nigeria
Nigeria
Most populous country in Africa
Lagos
Most populous city in Africa
Air, ground, and sea transit hub
July 23 ◦ Ebola Incident Management Center (EOC) activated
CDC, 2014b
Contact tracing ◦ 894 contacts identified
◦ 18,500 face-to-face visits conducted
Isolation of suspected cases ◦ No transmission within isolation wards
Hospitalization of confirmed cases
Coordination of donors, partner organizations, and response teams
19 laboratory-confirmed cases, 1 probable ◦ 8 deaths (40%)
No new cases since August 31
CDC, 2014b
September 20 ◦ Passenger arrives in Dallas from Liberia
September 24 ◦ Patient became ill
September 26 ◦ Patient seen at hospital
◦ Discharged
September 28 ◦ Patient admitted with symptoms consistent with
EVD
October 2 ◦ Court-ordered home isolation of contacts
CDC does not recommend quarantining asymptomatic contacts of Ebola cases
October 3 ◦ 50 contacts identified
10 with high risk exposures
Daily fever monitoring
October 20 ◦ ?
According to the CDC, ◦ Any U.S. hospital that is following CDC’s infection
control recommendations and can isolate a patient in their own room with a private bathroom is capable of safely managing a patient with Ebola
◦ Health care professionals in the U.S should immediately report to their state or local health department any person being evaluated for EVD if the medical evaluation suggests that diagnostic testing may be indicated
◦ CDC is NOT recommending that asymptomatic contacts of EVD patients be quarantined, either in facilities or at home
CDC has consulted state and local health departments on over 100 people with travel history and symptoms that suggested EVD
◦ 14 considered to be truly at risk
13 tested for Ebola
All were negative
Doctors Without Borders ◦ www.doctorswithoutborders.org
International Medical Corps ◦ https://internationalmedicalcorps.org
Partners in Health ◦ www.pih.org
USAID ◦ www.usaid.gov/ebola/volunteers
Bausch, D. G., Towner, J. S., Dowell, S. F., Kaducu, F., Lukwiya, M., Sanchez, A., et al. (2007). Assessment of the risk of Ebola virus transmission from bodily fluids and fomites. Journal of Infectious Diseases, 196(Supple. 2), S142-S147.
Blumberg, L., Enria, D., & Bausch, D. G. (2014). Viral hemorrhagic fevers.
In J. Farrar, P. J. Hotez, T. Junghanss, G. Kang, D. Lalloo, & N. J. White (Eds.) Manson's tropical diseases, 23rd Ed. [Electronic version]. Elsevier.
Centers for Disease Control and Prevention. (2014). CDC and Texas
Health Department confirms first Ebola case diagnosed in the U.S. http://www.cdc.gov/media/releases/2014/s930-ebola-confirmed-case.html.
Centers for Disease Control and Prevention. (2014). Ebola virus disease
outbreak – Nigeria, July-September, 2014. Morbidity and Mortality Weekly Report, 63(39), 867-872. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6339a5.htm.
Centers for Disease Control and Prevention. (2014). Ebola virus disease outbreak – West Africa, September, 2014. Morbidity and Mortality Weekly Report, 63(39), 865-866. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6339a4.htm.
Centers for Disease Control and Prevention. (2014). Estimating the
future number of cases in the Ebola epidemic – Liberia and Sierra Leone, 2014-2015. Morbidity and Mortality Weekly Report, 63(3), 1-14. http://www.cdc.gov/mmwr/preview/mmwrhtml/su6303a1.htm.
Centers for Disease Control and Prevention. (2014). 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.
Centers for Disease Control and Prevention. (2014). Questions and
answers on Ebola. http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/qa.html.
Center for Infectious Disease Research and Policy. (2014). Texas contact tracing identifies 50 for Ebola fever monitoring. http://www.cidrap.umn.edu/news-perspective/2014/10/texas-contact-tracing-identifies-50-ebola-fever-monitoring.
Center for Infectious Disease Research and Policy. (2014). Texas issues
Ebola home isolation court order. http://www.cidrap.umn.edu/news-perspective/2014/10/texas-issues-ebola-home-isolation-court-order.
Frieden, T. (2014). Why U.S. can stop Ebola in its tracks.
http://www.cnn.com/2014/10/02/opinion/frieden-ebola-first-patient/index.html.
Geisbert, T. W. (2014). Marburg and Ebola hemorrhagic fevers
(Filoviruses). In J. E. Bennett, R. Dolin, & M. J. Blaser (Eds.). Mandell, Douglas, and Bennett's principles and practice of infectious diseases, 8th Ed. [Electronic version]. Elsevier.
Hartman, A. L. (2013). Ebola and Marburg virus infections. In, A. J. Magill, D. R. Hill, T. Solomon, & E. T. Ryan (Eds.) Hunter's tropical medicine, 9th Ed. [Electronic version]. Elsevier.
World Health Organization. (2014). Ebola virus disease. Retrieved 1 October 2014 from http://www.who.int/mediacentre/factsheets/fs103/en.
Tanzania, August 2014