Ebola in West Africa 2014

WHO August 8 2014: Declared public health emergency of international concern

Ebola in w Africa: A Perfect Storm - an epidemic fueled by poverty

• Virus first discovered 1976 in Zaire/DRC• Outbreak controlled by tracing, isolating infected

• Many outbreaks since then, always contained• Poorest countries, fewest doctors/pop, low life expectancy,

substantial urbanization

• Contemporary west africa: A perfect Storm• Guinea, Sierra Leone, Liberia• urbanization, mobility, broken health systems, recent civil

war/mistrust, and corruption

The disease• Symptoms/disease

Nonspecific Prodrome: Fever, body aches, headache, vomiting, diarrhea etc

+/- Haemorrhagic Fever symptoms (bleeding)• Extremely high case fatality rate = 50% to 90%

• Clearly better outcomes when excellent supportive care

• Spread only effective in empoverished settings

Spread of Ebola: Zoonosis origin to exponential Human-Human transmission

Index Case?Fell ill Dec 6, 2013In Guinea

Migrating batsRo = 2 (2 new cases from each infected (avg)Generation time: 15 days (average)Doubling of cases each month

Early Oct 2014:>7000 cases>3300 deaths…and more

Severity of pandemics/threats

Transmissibility (Ro) of various pandemics and threats

Societal and Environmental Factors Explaining Effective Spread of Ebola

– Traditional burial practices– Lack of knowledge of risks re bodily fluids– Increased local, international mobility– Fragile health system cannot isolate, treat, track cases– Urbanization (pop density)– No sanitation/infrastructure to safely dispose of infected

bodies, secretions– People mistrusting doctors, authorities, foreigners helping– Lack of health intrastructure (hospitals, HCWs)– Poor (and worsening) economy–

Medical and non-medical interventions to halt spread

• Medical– Supportive care (BP, O2, fluids)– No specific treatment

• few doses of experimental antiviral

– No vaccine…..yet• Non-medical– Contract tracing, isolation of infected and suspect – Quarantine of ”hot zones”(controversial)– Travel restrictions (controversial)– School closures

What Can Be Done?• Epidemiological: to limit spread

• Contract tracing• Isolation of suspect/confirmed cases• MUST ACT FAST !!!

• Medical: to treat cases, limit mortality• Build clinics, import health care workers• Personal protective equipment supply• Lab testing capabilities• No specific drugs, no vaccine, only supportive care

• Educational: social scientists needed• Reduce/avoid physical contact /use PPE• Address local suspicion, mistrust, violence

– Clinic attacked, Ebola response killed

Good News: Nigeria outbreak containedBad News: Guinea, SL, Liberia uncontrolled

Bad news – uncontrolled epidemic with exponential growth in W Africa

United States 1st Case in DallasTimeline….. 4 days before case patient isolated