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