UNCLASSIFIED

USAPHC’s Response to Ebola

Robert Cohen, MD, MPHPreventive Medicine PhysicianDisease Epidemiology ProgramArmy Institute of Public Health

U.S. Army Public Health Command UNCLASSIFIED 2

The views expressed herein are those of the speaker and do not necessarily reflect the views of the Army, the US Government, or USAPHC.

Disclaimer

U.S. Army Public Health Command UNCLASSIFIED 3

• What is Ebola?

• History of Ebola

• Current Outbreak in West Africa

• Operation United Assistance

– Pre-deployment activities

– During/After deployment activities

– Domestic Preparedness

• Future

Outline

U.S. Army Public Health Command UNCLASSIFIED

What is Ebola?

4

Smallpox Influenza Herpes

Coronavirus (SARS) HIV Ebola

Rabies

Hendra

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A Brief History of Ebola

http://www.abc.net.au/news/2014-07-30/map-showing-ebola-outbreaks-in-africa-since-1976/5635152

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Current Outbreak in West Africa

WHO Ebola Response Team. NEJM 2014

Case Count (as of 8 Dec 2014) Cases Deaths

Liberia: 7,690 3,161Sierra Leone: 7,635 1,660Guinea: 2,192 1,366Total: 17,517 6,187

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Stabilization in Liberia and Guinea, not Sierra Leone

The Economist, 4 Dec 2014

• Led by 101st Airborne Division, in collaboration with US Army Africa

• Beginning Sep 2014

• Up to 3000 US Army troops will be sent over 12+ months

• Mission: Build 10 Ebola Treatment Units (ETUs) with 50 beds each in Liberia

President Obama Orders Operation United Assistance(OUA)

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-(U) Confirmed EVD Cases:- Average 10 new cases per day - Sierra Leone: 75 per day- Guinea: 15 per day

-(U) UNDP EVD Program Visit 4 Dec:- Lack of feedback on relatives

enrolled in ETUs- Secret burials still occurring,

increasing transmission of EVD- LNP conducing night patrols to

reduce secret burials

-(U) Army Labs- 3 of 4 labs operational

-(U) UNMIL Soldier positive for EVD- Nigerian- Currently treated at MMU- Will be flown to Netherlands

OUA INTSUM, 20141206OUA SITREP, 20141207

Sources:

Liberian Lab

Proposed Army Lab

Mobile Medical Lab (MML)

Forward Logistical Base

Monrovian Medical Unit

Operational ETU

In Progress ETU

USG Supported

LEGEND(Capability Status as of 18 Nov 2014)

Sinje

Liberia

Gbediah

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HQDA MissionHQDA establishes a Force Protection Plan of action for Army Forces deploying in response to the EVD epidemic in West Africa and provides information and education to the Soldiers, DA Civilians (DAC), Army Families, deploying contractors, and their communities in order to provide properly trained and equipped forces in support of Operation United Assistance.

MEDCOM MissionOn order (O/O), MEDCOM leverages medical personnel, materiel, research and technology, and subject matter expertise in support of Operation UNITED ASSISTANCE (OUA).

PHC MissionPHC leverages public health subject matter expertise in support of Operation UNITED ASSISTANCE (OUA).

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Operation United Assistance

USAPHC is a unique organization within DoD, well-suited to advise units on:

1) Pre-Deployment (Prepare Soldiers and Reassure Families)

2) During Deployment and Re-Deployment (Protect and Return Soldiers)

3) Domestic Preparedness

Three Areas of USAPHC OUA Response

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http://healthdecide.orcahealth.com/2014/08/01/origins-growing-spread-ebola-virus/

• Risk assessments and risk communication

• Information video for deploying Soldiers and Families

• FAQ sheets

• Training Packages (e.g. PPE)

• Other Africa-specific public health training

Pre-Deployment: Prepare Soldiers and Reassure Families

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https://www.youtube.com/watch?v=677xOF9Iua4

13

• Personal Protective Equipment (PPE) guidance

• Hazardous waste management guidance

• Review of difficult scientific questions (e.g. how long can Ebola survive outside the human body?)

• SME support to deployed units

During Deployment: Protecting Soldiers

• Controlled monitoring for 21 days• Domestic Preparedness for MTFs• Ebola Rapid Action Team (~12 people)

– Mix of clinical/non-clinical experts– Risk Communication– Waste Management– Contact Tracing

• DoD Ebola Mission Support Team (30 people)

• Example: returning Air Force Officer with vomiting to Ft. Bliss– Grounded the crew and plane for 72 hours– Isolated Officer– Used as an exercise

Post-Deployment: Returning Soldiers and Domestic Preparedness

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Ongoing OUA Support Efforts (JPEO-CBD)Ebola Biosurveillance Portal

The Ebola Biosurveillance Portal is

a new information technology tool

supporting international efforts to stop the Ebola Virus outbreak in West

Africa. It leverages several DoD systems in

development into a single integrated system for Ebola

situational awareness

Ebola Virus Diagnostic Assays

Two DoD developed Ebola Virus diagnostic assays have received

Emergency Use Authorizations from the FDA. These assays have been fielded to both CDC and DoD labs

Ebola Virus Therapeutics and Vaccines

The DoD and the NIH are utilizing a “whole - of -

government” approach to accelerate the development of

promising vaccine and anti-viral drug candidates that are targeted

against Filoviruses

Presidential Grand Challenge

JPEO-CBD is participating in the Presidential Grand Challenge to procure or

develop improved personal protective equipment (PPE) for Ebola Virus. The goal is

to reduce the thermal burden associated with

current PPE on health care providers

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More Ongoing OUA Support Efforts (JPEO-CBD)

Contaminated Human Remains Pouch Transportation Isolation SystemJPEO-CBD and the

Defense Threat Reduction Agency are developing an isolation system to evacuate service members in the

event they become infected by the

Ebola Virus. They system will hold up

to 12 service members

In response to a Joint Urgent Operational Needs

Statement (JUONS), JPEO-CBD is developing a human

remains pouch medical, transport and processing

personnel from individuals that have died from Ebola

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• There will be another Ebola outbreak in Africa• Or another disease outbreak• We will be better prepared• We may even be able to help prevent• We must try to help prevent

Future

http://www.globalchange.umich.edu/globalchange2/current/lectures/deforest/deforest.html http://landsat.gsfc.nasa.gov/?p=510

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