Learn about the evolving Ebola epidemic and its various aspects including disease prevention, management and treatment, response to the epidemic, ethical considerations, and the post-Ebola global health landscape.
CDC Response to Ebola Epidemic
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來自 Emory University 的課程
埃博拉病毒：疫情发展
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Prevention, Treatment, and Response
Upon completion of this module, learners will be able to: List the different types of therapeutics for Ebola Virus Disease. Recognize the factors critical to the creation of a successful Ebola vaccine. Define plasma and recognize its importance in the Ebola treatment process. Discuss the response of various international actors to the Ebola epidemic. Recognize the role of communications both in terms of community level in West Africa, as well as at Emory University.
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Dabney P. Evans, PhD, MPHAssistant Professor
Hubert Department of Global Health. Rollins School of Public Health. Director, Center for Humanitarian Emergencies.
Carlos del Rio, MDChair
Department of Global Health at the Rollins School of Public Health
Hi, it's good to be here with you today.
I'm Inger Damon.
I'm the Director of the Division of High-Consequence Pathogens and Pathology
at the Centers for Disease Control and Prevention in Atlanta, Georgia.
I'll be talking to you today about CDC's role
in the West Africa response to Ebola in 2014 and 2015.
I served as the incident manager for
CDC's emergency operation center from the end of July
of 2014 through the end of March of 2015.
Our work was with multiple partners.
It had both international and domestic components.
We worked with classic partners who've been involved in Ebola
responses in the past, such as WHO, the World Health Organization,
Medicins Sans Frontieres, or Doctors Without Borders,
The Red Cross, the International Federation of the Red Cross.
But, also multiple partners as the extent of this outbreak
was larger than any Ebola response we've seen in the past.
And numerous non-governmental organizations and
government organizations convened together to respond to this outbreak.
The goals of the outbreak response were the classic goals that have been in any
Ebola outbreak response.
They were to stop human to human transmission, which is the major nitus for
the extent of disease transmission.
So through early case identification, and then isolation and care of patients.
Some of the limitations in the late summer and fall
in 2014 were the lack of the available Ebola treatment unit,
beds, and often interim strategies need to be developed.
Contact tracing is a key component.
So identifying contacts of cases, following them, and looking for
any early signs and symptoms of disease and educating them about the disease,
as well as infection control and safe burials.
Both are areas in hospital settings or
clinic setting where disease can be transmitted.
Or in burial practices where touching the body where there may be high levels of
virus at the time of death can lead to infection of others.
Health communications was also key to the response in terms of educating people and
getting messages out about how to avoid disease and
what to do if you did suspect disease.
And, coordination of all these efforts in terms of all these multiple areas of
activity which needed to be accomplished as well as the activities of multiple
partners who are involved in these activities.
And so that was the use of emergency operation systems and
incident management systems.
As well, the improvement of patient care was critical so triaging.
The use of experience staff and the strict use of personal protective equipment.
So CDC staff participated in multiple aspects
of these classic roles in an Ebola outbreak response.
So we deployed staff to West Africa to assist with surveillance,
contact tracing, data management, laboratory testing,
incident management, Emergency Operation Center development,
safe isolation of cases, border control, and health education.
CDC staff also deployed to non-affected border countries to conduct assessments of
Ebola preparedness with the World Health Organization.
We conducted numerous trainings both in West Africa and
also in the United States to help prepare health workers and volunteers, and others.
And we worked under the auspices of the Disaster Assistance Response Team
in West Africa after August 2014,
as disasters were declared in Guinea, Sierra Leone, and Liberia.
And this enabled us to work with partners from the United States Agency for
International Development and OFDA.
So, we've deployed nearly a thousand public health experts to Guinea,
Liberia and Sierra Leone to help with these aspects of the outbreak response and
we've had nearly 2,000 deployments to get the staff overseas.
We've trained over 690 master trainers and
23,000 front line healthcare staffed in West Africa and conducted more than
230 facility assessments for infection control triage capacity.
And we've staffed laboratories,
including one in Sierra Leone that has tested more than 12,000 samples.
We've provided health care workers preparation to work in West Africa,
and this was initially an opportunity we recognized as was needed
in late summer, early fall in 2014.
As the Ebola treatment units in West Africa were rapidly becoming full and
the need to engage additional staff both to build Ebola treatment units and
staff them.
So, the course was held in the United States.
The goals of the course were to provide the basics about epidemiology and
transmission of Ebola virus disease,
to provide the basics of infection prevention and control practices as they
pertain to working in Ebola treatment units in Africa.
And also demonstrate the skills needed to work safely and
efficiently in a well-designed Ebola treatment unit.
We educated and evaluated personnel, in terms of also information about
the environmental safety within an Ebola treatment unit environment and provided
guidance on clinical care and management of patients with Ebola virus disease.
So to date, the last course closed in the end of March of 2015,
over 600 US-based healthcare workers and other international staff
planning to deploy to West Africa have gone through the course.
This has also been the course where the United States Public Health Service
has trained their personnel to work in the Monrovia medical unit, an Ebola
treatment unit specifically designed for the safe treatment of health care workers,
who might acquire disease during their occupational work.
Currently the training materials are in
an Ebola Training Toolkit which was posted on the web.
This was posted on the web in early April of 2015 and in the past eight
days over 40 individuals have downloaded the toolkit and its contents.
And so the materials here enable organizations to use these materials
to train health care workers preparing to work in Ebola treatment units in Africa.
Work that CDC staff has done on surveillance and
contact tracing has been critical to controlling the spread of disease.
So the CDC together with WHO, other partners including MSF,
have improved the quality of contact tracing and follow-up.
In Liberia, the intense contact tracing on the last case in Liberia,
which appears to have been identified in late March of 2015, have followed these
contacts and provided safe facilities for them to stay to be observed.
No subsequent cases have now been detected from that last case.
In Guinea and Sierra Leone the proportion of cases from known contacts has increased
compared to prior weeks,
indicating that the quality of contact tracing is improving.
And that the ability to identify cases and
to isolate them quickly is one that's achieving success.
So Guinea had 43% of cases from known contacts, while Sierra Leone had
67% of cases identified from known contacts as of mid-March.
One of the outstanding success stories has been in Lagos, Nigeria,
where a single traveler from Liberia caused a cluster of cases among
healthcare workers and others in the community in July of 2014.
So the combined use of the Emergency Operation Center,
which had been developed to support the polio eradication effort,
the trained field epidemiology trainee
personnel in country and trained epidemiologist in country, in concert with
CDD staff assistance was able to successfully quell the spread of disease.
So, only 19 confirmed cases and one probable case.
Rapid action controlled the spread of disease.
And this included the coordinated identification of more than 800 contacts,
follow up of those contacts, education of them and
19,000 visits to homes to evaluate those contacts.
Laboratory work has also been an area where CDC was critically involved.
So, we collaborated globally with the EU consortium and
many others, including from Germany, France, Italy, Belgium, Netherlands,
United Kingdom, Nigeria, Canada, South Africa, China, and Russia.
We supported real time PCR testing in the three affected countries both with
reagents, test kits, capacity and equipment.
We also staffed and operated a field lab in Bo,
Sierra Leone which is the primary area where our staff actually worked,
although we did contribute as well in the Liberia laboratory efforts.
So really I think one of the novel findings is that we
could in austere environment increase through put use robotic capacity.
And more than 2,000 samples in a three week period were processed and
tested at the height of the country's epidemic in Sierra Leone.
And over 12,000 sample over all have been tested since the beginning of
the outbreak.
It really has served as a model for a field lab producing reliable results and
maintaining high quality standards.
Infection control efforts in West African countries
aim to prevent the spread of Ebola and other dangerous infections.
And to provide general infection control training
in non-Ebola treatment unit settings.
So, in general clinics or a hospital.
So, training people on identifying and isolating patients
suspected to have Ebola virus disease or persons under investigation.
So, using the concepts of triage, protecting patients and healthcare
workers, cleaning up safely and managing patients safely and compassionately.
There's more information and CDC guidance on the CDC website.
We also worked with partners on safe burials
in terms of how to do sensitive and safe burials.
Communication and anthropologic experts were also involved in Liberia and
Sierra Leone to identify burial team practices that were viewed negatively by
communities and to change those so
that burial teams would be more accepted to permit safe burials and prevent disease
spread through the touching of the body during the burial practices.
We've also extensively worked on communications, working with country
embassies, with UNICEF, with the World Health Organizations,
ministries of health, and Non-Governmental Organizations to develop public health
campaigns and messages and implement social mobilization activities.
So, multiple channels of health communications and
education efforts were employed.
Materials from print materials, radio messages,
T-shirts, public service announcements, text,
TV information were all used and evaluated through the use of knowledge,
attitudes, and practices studies, most extensively in Sierra Leone and Liberia.
In the United States, our activities were really educating U.S.
healthcare workers and isolating patients and preventing infection.
We tightened our previous infection control guidance for
healthcare workers caring for patients with Ebola in October of 2014 after
the nosocomial infection of two health care practitioners with Ebola disease,
while working in the United States.
We also changed our guidance from recommending that any
hospital could take care of an Ebola patient safely with appropriate training.
To really trying to limit where individuals would be treated for Ebola,
should they become ill.
And so this led to the development of the Ebola Treatment Center concept as
well as assessment hospitals, which would be assessed and evaluated for
their ability to safely triage and take care of an individual who may have Ebola.
More than 80% of travelers coming from West Africa now
are within 200 miles of an Ebola Treatment Center, and
Rapid Ebola Preparedness teams were deployed to facilities to assess readiness
for the care of Ebola patients in these treatment centers.
They've made recommendations and also staff from the Emory and
Nebraska biocontainment units were involved in those evaluations.
Currently there's 55 Ebola Treatment Centers identified by the states
as being ones that they've assessed to take care of Ebola patients.
We've responded to the domestic challenges in a number of ways.
So in addition to assessing and helping hospitals be ready to be
prepared to take care of an Ebola patient or assess a patient for possible Ebola.
We’ve rostered teams across the agency and also using experts from across the U.S.
to staff what we call Ebola response teams.
So these are teams of individuals of both clinicians, epidemiologists,
infection control specialists, who are ready to go and
help in any area of the United States within 24 hours to help take
care of an Ebola patient and follow those who are involved in patient care.
We updated our personal protective equipment guidance in mid-October and so
the focus is really on training, supervision,
and the complete coverage of skin.
We've done extensive outreach to the public health and
health care system, through calls, answering questions both from state and
local health departments, as well as the patient care COCLA calls.
We've trained over 840,000 healthcare workers through online training courses
and almost 6,500 healthcare workers have been trained in person.
Currently as well in laboratory capacity in the United States,
there's now 56 Laboratory Response Network labs which have been approved to test for
Ebola in the United States.
Border control has also been an area, both internationally and
in the U.S., where we've focused efforts.
So, in terms of exit screening, we've supported countries in assessing
individual travelers for signs and symptoms of Ebola and getting them tested,
should they have any signs or symptoms and limiting their ability to travel.
And we've also implemented entry screening at five U.S. airports where all travelers
now returning from the highly affected West African countries return to.
So travelers are monitored by a state or local health department.
They're either requested to send in records of temperature and
signs and symptoms of any illness,
or there's also in some cases direct active monitoring if an individual's
considered to be high risk on entrance into the United States and
screening at the point of entry airport or maritime entrance.
Travelers receive a check and report Ebola care kit which provides
information on Ebola, tools to help check for temperature, such as a thermometer,
a cell phone so that they can call in, and also so
that they can be reached directly by state and local health departments
with any inquiries about signs and symptoms of disease.
So in addition to entry screening, which is also meant to educate returning
travelers about Ebola disease and to give them information about where to go and
a point of contact should they develop any signs or symptoms of disease.
We've stratified individuals into what potential risk of Ebola they may be in,
so some risk individuals are ones who have potentially worked
in a health care setting with appropriate protective personal equipment, but
may have been taking care of Ebola patients, and these individuals are asked
to be directly actively monitored and are followed carefully.
High risk individuals, who may have had direct contact with blood or
body fluids from an Ebola patient or been to a funeral and
touched the body of an Ebola patient are discouraged from commercial travel and
are encouraged to take private conveyances.
And additionally, these risk stratifications allow for
an individual who has any signs or symptoms consistent
with Ebola to be followed and evaluated in appropriate manner.
So, looking for alternative diagnoses, more commonly malaria or influenza.
To date in the United States, over a thousand travelers have returned since
we've instituted the entry screening and movement and monitoring guidance changes.
None of those have been found to have Ebola.
Many of them have been found to have malaria, influenza, or
other causes of febrile or GI illnesses such as gastroenteritis.
So finally we're in the final phases we hope of the Ebola
response in West Africa in getting to zero.
And in this case speed is paramount.
And so the ability to rapidly identify cases, new clusters of cases and
move teams of individuals to help with the safe isolation, contact tracing,
case management, and reporting of these cases is critical to get to zero.
So, thank you.
For the most current information on Ebola from the Centers of Disease Control and
Prevention, please visit this website.
