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Ebola virus disease2014 update:Opportunities and challenges
Joseph M Reardon, MDNorth Durham RotaryWith thanks to John Leander, MD, PhD; University of ArizonaAnd S. Rizwan, MD; Madurai Medical College
• History• Pathophysiology of Ebola virus disease• Transmission• Epidemiology• Local Preparedness• Current Organizations in the International Response
• Future threats: Vaccine-resistant polio
AGENDA
1976
Rizwan SA, VMCHRI
1976
Rizwan SA, VMCHRI
1976
Rizwan SA, VMCHRI
Geographic distribution
• First outbreak occurred in Zaire (Congo) in 1976
• Followed by several outbreaks, all in Africa (except one in Philippines, Italy, USA)
• Latest on-going outbreak in west Africa started in March 2014 in Guinea
Rizwan SA, VMCHRI
Natural History
• Natural host - Fruit bats of Pteropodidae family
• Reservoir – fruit bats• Sources – bush meat, Infected
humans, fomites• Incubation period – 2 to 21 days• Communicability – high, virus
isolated after 90 days of recovery• Case fatality – 50 to 90%
• Immunity – long term not proven, deceased patients failed to produce immune response
• No. of outbreaks – >30
Rizwan SA, VMCHRI
Transmission cycle
2014 Epidemic
• 2-year-old boy in Guéckédou, Guinea was first case
• Rapid spread to city• MarchLiberia• JulyNigeria
“The Ebola epidemic ravaging parts of West Africa is the most severe
acute public health emergency seen in modern times.”
WHO, Sept 26, 2014
Ebola in the United States
Africa United States0
2000
4000
6000
8000
10000
12000
14000
16000
Cumulative Ebola Cases as of 2 Nov 2014
Cumulative Ebola Cases as of 2 Nov 2014
Ebola Precautions in the United States
CDC
Personal Protective Equipment
Treatment
Action Plan: Preventing Ebola in the United States
International Aid Organizations
Ministries of Health
• Maintaining official statistics• Coordinating efforts
CDC
• Coordination, data analysis• 283 Staff• Dozens of the 164 Epidemic Intelligence
Service Officers
• 5,200 patients treated• 600 isolation beds• 263 international staff, 3084 local staff
• Establishing several community treatment and isolation centers in Liberia
• Operates a treatment center in Liberia
• Primarily distributing equipment• Post-exposure mental health counseling• Some isolation centers
• American Red Cross has deployed 169 delegates
• 7700 local volunteers• Primarily aimed at Ebola education
• Staff are being trained• 2 partner organizations identified• Mobilizing community members
• Involved with education• Planning to open a treatment center
• “Although Rotary has limited opportunities to respond at a corporate level, our strength as an organization is firmly rooted in the grassroots response of Rotary clubs and Rotarians.”
ROTARY’S RESPONSE TO EBOLA
ROTARY CLUB OF MONROVIA, LIBERIA
• Working directly with the Ministry of Health and Social Welfare
• Solicited funds to buy locally available items (ie fuel, per diem, medicine, mattresses, buckets, etc.) and most importantly: community awareness.
• Washing buckets and chlorine solution to communities.
• Reading and activity packets for primary school children at home (schools are closed).
• Also developing grants to support orphans, create ongoing local health sector scholarships, and restocking of hospital needs (also in cooperation with Medical Supplies Network).
IDEAS.ROTARY.ORG
Concerning outbreaks on the horizon…
Vaccine-Resistant Poliomyelitis
“Robustness against serum neutralization of a poliovirus type 1 from a lethal epidemic of poliomyelitis in the Republic of Congo in 2010” • 45% mortality• Those who died were already vaccinated