Handling Human Remains Only personnel trained in handling infected human remains, and wearing PPE,...
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Handling Human Remains • Only personnel trained in handling infected human remains, and wearing PPE, should touch, or move, any Ebola-infected remains. • Handling of human remains should be kept to a minimum. • Autopsies on patients who die of Ebola should be avoided. If an autopsy is necessary, the state health department and CDC should be consulted regarding additional precautions. http://www.cdc.gov/vhf/ebola/hcp/guidance-safe-handling-human-remains-ebola-patients-us-hospitals-mortuaries.html
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Transcript of Handling Human Remains Only personnel trained in handling infected human remains, and wearing PPE,...
Handling Human Remains
• Only personnel trained in handling infected human remains, and wearing PPE, should touch, or move, any Ebola-infected remains.
• Handling of human remains should be kept to a minimum.• Autopsies on patients who die of Ebola should be avoided.
If an autopsy is necessary, the state health department and CDC should be consulted regarding additional precautions.
http://www.cdc.gov/vhf/ebola/hcp/guidance-safe-handling-human-remains-ebola-patients-us-hospitals-mortuaries.html
US Clinical Information
• http://www.cdc.gov/vhf/ebola/hcp/clinician-information-us-healthcare-settings.html
• http://www.scientificamerican.com/article/ebola-doctor-reveals-how-infected-americans-were-cured/
Detailed Hospital Checklist for Ebola Preparedness
http://www.cdc.gov/vhf/ebola/pdf/hospital-checklisk-ebola-preparedness.pdf
Ebola Testing Recommendations• Conduct only essential lab testing
and take appropriate precautions
• Include malaria ddx since it is the most common cause of fever in persons travelling in the affected area
• Do not use pneumatic tubes to collect blood
Patient TestingTimeline of Infection Diagnostic tests available
Within a few days after symptoms begin
•Antigen-capture enzyme-linked immunosorbent assay (ELISA) testing•IgM ELISA•Polymerase chain reaction (PCR)•Virus isolation
Later in disease course or after recovery
•IgM and IgG antibodies
Retrospectively in deceased patients
•Immunohistochemistry testing•PCR•Virus isolation
Follow up recommendations for those negative for EVD
• Self-monitor twice daily for fever and other symptoms for 21 days from last exposure
• Seek medical eval at first sign of illness
Treatment of Ebola
• No specific therapy approved• Need supportive care -Balancing the patients' fluids and electrolytes
-Maintaining their oxygen status and BP
-Treating them for any complicating infections
• Investigational therapeutics of limited availability
• Preventive vaccines in development
ZMAPP Therapeutic
• Mapp Biopharmaceutical Inc., San Diego -- 2003
• National Institutes of Health and the Defense Threat Reduction Agency involved in development
• 3-mouse monoclonal antibody but can also be made from tobacco plants
Other Therapeutics
• Investigational Tekmira-Ebola therapeutic
• Began in 2010 using RNAi therapeutics in non-human primates
• Small interfering RNAs (siRNAs) targeting the Zaire Ebola virus (ZEBOV) RNA polymerase L protein
• 100% protection in non-human primates
• Phase 1 trial began Jan. 2014
• FDA recently put trial on hold—needs info
Chinese Treatment
• Sept. 2: JK-05 in development for past 5 years
• Academy of Military Sciences
• Has manufacturing approval for emgx use
• Inhibits viral replication
Japanese Treatment
• Favipiravir (T-705)
• Discovered in 1998 to tx flu
• Also tx: Yellow Fever, Flavivirus, WNV, WEE, Norovirus
• Blocks RNA polymerase
• Phase III in US for flu tx
Other Therapeutics
• BCX4430 BioCryst new anti-RNA polymerase—in development (Aug. 2014)
Vaccines
• In June, 2005 scientists at Fort Detrick, Maryland announced that they had successfully vaccinated monkeys against the deadly Ebola virus
• In March 2014, the NIH awarded a five-year $28 million grant to establish a collaboration between researchers from 15 institutions
• NIH EBOV testing in Sept. 2014 by GSK
Vaccines (cont.)
• Oxford University Jenner Institute starting vaccine trials in Oxford then Gambia and Mali (Sept. ‘14)
• Canadian VSV-EBOV has shown effectiveness as vaccine and after being exposed to the virus
--vaccine sent to Canadian
hospitals, WHO Geneva,
Emory Hospital
Why Ebola worries the Defense Department
http://www.washingtonpost.com/blogs/worldviews/wp/2014/08/05/why-ebola-worries-defense-department/
A Liberian military policeman holds his rifle with gloves to avoid contact with the deadly Ebola virus during the burial of several Ebola victims in the Johnsonville community outside Monrovia.
Bioterrorism/Warfare• Airborne transmission of Ebola Zaire has
been demonstrated in monkeys in a controlled laboratory experiment
• Boko Harem stronghold near Ebola outbreak area
• U.S. Army Medical Research Institute for Infectious Diseases and U.S. Department of Defense’s Joint Project Manager Transformational Medical Technologies Office interested in defense needs
An Opportunity to Do More
• WHO ineffective so far—no $$$• International Health Systems Fund-- “A dedicated International Health Systems Fund at WHO would
rebuild broken trust, with the returns of longer, healthier lives
and economic development far exceeding the costs. This fund
would encompass both emergency response capabilities and enduring health-system development.” L. O. Gostin. Lancet. Sept. 2014
►Multi-billion $ international
investment similar to PEPFAR
and Global Fund to Fight AIDS,
Tb, and Malaria
Conclusions
• Even though scientists have recently made breakthroughs there is still need for extensive research to find vaccines and therapeutics for this deadly virus.
• Best efforts are directed towards preventing the spread of the disease by determining
its source.
► Need International Health Systems Fund or
similar to prevent/respond to future
incidents
Contact Information
John J. Lanza, MD, PhD, MPH, FAAP
Florida Department of Health in
Escambia County
850/528-5201
www.EscambiaHealth.com
