Ebola virus control and prevention
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Transcript of Ebola virus control and prevention
Ebola 2014Control and Prevention
Dr Prith VenkatesanConsultant in Infectious Diseases
‘Collateral damage’Break down of normal healthcareBreak down of schoolingEconomic impact : World Bank estimates2014 growth rates
Pre-epidemic
October
November
GuineaLiberiaSierra Leone
4.5%6.8%8.9%
2.4%1%
7.7%
0.5%3%-2%
Control and Prevention1
R0 = 6 R0 = 0.5
6 3
Maganga et al (2014)Democratic Republic of Congo
Equateur Province26.7.14 – 7.10.1469 cases
DRC 20141 21
R0 = 21 R0 = 0.84
West Africa, Sept 2014 (WHO)
Ro calculations
Guinea 1.83 (95% CI, 1.44-2.01)Liberia 1.20 (95% CI, 0.67-1.96)Sierra Leone 2.02 (95% CI, 1.79-2.26)
Pre-symptomat
ic
Symptomatic
Convalescent
Infectious dose of 1-10 viral particles
Pre-symptomat
ic
Symptomatic
Convalescent
Chertow (2014)
Phase of illness
Time Clinical features
Early febrile 0-3 days Fever, malaise, fatigue, myalgia
Gastrointestinal 3-10 days
Epigastric pain, N,V &DPersistent fever, asthaenia, headache, conjunctival injection, chest pain, abdo pain, arthralgia, myalgia, hiccups, delirium
Shock or recovery
7-12 days
Shock, oliguria, tachypnoea, reduced GCS, Recovery : resolution of GI symptoms
Late complications
> 10 days
GI haemorrhage, secondary infections, meningoencephalitis, persistent neurocognitive abnormalities
Gulu, Uganda, 2000-01 (Towner, 2004)424 cases, 224 deaths
ControlSafe burials
Contact tracing
Early isolation
Travel restriction
WHO Situation Report 26.11.14
% Cases Isolated
Guinea
Liberia
Sierra Leone
75%
20%
19%
Potential Ebola suspects in UK
Indigenous travellersEx-patriatesHumanitarian aid workersMilitary personnel
Potential Ebola suspects in UK
1. Unwell2. Within 21 days of return from3. Current epidemic countries4. Or contact with a known case
Local preparations
Regional co-ordinationInformation management
Patient journeyPatient careProtection of staffEnvironment and waste
Control movement
HOMEPHE
GP Surgery / NEMS /
Walk-in centre
ED QMC
City Campus
Patient Care
Check for other diagnosesEbola PCR
If Ebola positive Transfer to Royal Free, London
Protection of StaffTransmission
Mucous membranes or broken skinNo information on infection through intact skin
Contact with patient, blood, environmentEnvironment
Ebola can survive in liquid or dried material for a number of daysEnveloped virusDecontamination• Susceptible to standard disinfectants
Aerosol transmission?Not confirmed in human to human transmissionEpidemiological evidence quoted
Household contacts in same room do not acquire infection, unless physically in contact with patient
Would require presence of virus in respiratory secretions and aerosolisation of these
proceduresAnimal experiments
Infection ControlFrom patient
Body fluidsDirect contact
From environmentEspecially blood stained areas
Contact protectionDouble glovesCoverallsBoots
Respiratory protection
Stryker Flyte helmet and hoods
Risk probably greatest when degowning
Day RoomToilet / Shower
Office
Toilets
SluiceToilet / Shower
SinksSide-roomSide-roomSide-room
Empty ward at City Campus
Office
Toilets
SluiceToilet / Shower
SinksSide-roomSide-roomSide-room
Clean gowning
area
Degowning and decontamination
area
Empty ward at City Campus
Day RoomToilet / Shower
Thank you