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