Africa and international spread BWTC meeting 05 August 2014 - - PowerPoint PPT Presentation

Pandemic and Epidemic Diseases department - 1

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BWTC meeting

05 August 2014 Geneva, Switzerland

Ebola virus in West Africa and international spread

Pandemic and Epidemic Diseases department - 2

Ebola in West Africa, International spread

• Ebola, the disease, its

transmission and outbreak control strategy

• Assessment of the situation : an

international public health issue

• The way forward

Pandemic and Epidemic Diseases department - 3

Ebola virus disease

The virus, the disease its mode of transmission and

• utbreak control strategy

Pandemic and Epidemic Diseases department - 4

• Mononegavirides, Filoviridae, Filoviruses :
• 5 distinct Ebola strains
• 2 lineages for Marburg
• BSL 4
• Incubation 2-21 days
• Case Fatality Ratio 24-89%
• No specific treatment available, careful

rehydration, supportive, intensive care,

• Vaccines in development

Ebola and Marburg virus disease

Pandemic and Epidemic Diseases department - 5

Ebola virus disease transmission

• Ebola Infection of index case(s) : Animal found dead in the

forest: chimpanzes (6), gorillas (4), monkeys (4), forest antelopes (3), fruit bats (1), porcupine.(1)...

• UNKNOWN for 13/23 Ebola events
• H2H Transmission : familial and nosocomial
• Most human infections due to direct or indirect contact

with skin, mucous membranes, body fluids of infected patients (blood, saliva, vomitus, urine, stool, semen)

• Amplification
• Hospital: health care workers, in-patients, care givers,

unsafe injections

• Community: contacts when caring for ill, funeral

216 HCW / 1872 Ebola

Pandemic and Epidemic Diseases department - 6

General strategy to CONTROL Ebola outbreak

• Strong leadership of Minister of Health, WHO

coordinating international support

• Stop transmission chains and stop human source of

infection (link with animal surveillance)

• Active investigation and registration of new cases, contacts and
• deaths. Detailed database
• Follow up of contacts for 21 days by mobile teams (isolate if

ill). Follow-up virus persistence during recovery (semen)

• Prevention: promote the adoption of culturally-

sensitive practices that reduce the risk of transmission within the community

Pandemic and Epidemic Diseases department - 7

Psycho- social support

Control of vectors and reservoirs in nature

Triage In/out Barrier nursing Clinical trials Ethics committee Organize funerals Anthropological evaluation Specimens Laboratory testing Follow-up

• f contacts

Active case-finding

Infection control

Social and Epidemiological mobile teams Security Police Lodging Food Formal and informal modes of communication Search the source Database analysis Finances Salaries Transport Vehicles

Epidemiological investigation, surveillance and laboratory Logistics Clinical case Management Behavioural and social interventions Ethical aspects

Duty of care Research

Coordination

Medias

Communication Press Journalists Social and Cultural practices Women, associations Traditional healers Opinion leaders

General strategy to CONTROL Ebola outbreak

Pandemic and Epidemic Diseases department - 8

Ebola virus disease in West Africa and international spread, 2014.

Assessment of the situation : an international public health issue

Pandemic and Epidemic Diseases department - 9

Ebola outbreak in Guinea, Liberia and Sierra Leone, Epicurve by week

• f onset, December 2013 to June 2014 (n=1257). As of 31 July

Alert 13 March 15 cases inc. 9 deaths

Sierra Leone (533 cases) Liberia (274 cases) Guinea (450 cases)

Alert from Méliandou 26 January 5 death w diarrhoea Laboratory Confirmation 21 March

Outbreak response operations started

Since 24 March, 1148 cases in 3 countries + Nigeria

Alerts: Canada, Ghana, Côte- d'Ivoire, Mali, Morocco, Senegal, Spain, USA.

Pandemic and Epidemic Diseases department - 10

Geographical distribution of Ebola outbreak(s) in West Africa January to June 2014. As of 31 July 2014.

Dinguiraye Télimélé

Conakry Freetown Monrovia

Boffa Dubréka Foya

Côte d'Ivoire Mali Guinée Bissau Sénégal

Dabola Guéckédou Macenta Boké

Guinée Liberia Sierra Leone

Margibi

Bamako Dakar Banjul

Port Loko Kambia

Bissau

Kailahou Kouroussa

Locality reported Ebola cases Capital city EDPLN - Ebola Laboratory Ongoing Ebola transmission Locality with Ebola Treatment Center

Yamoussoukro

Main roads

Kenema Daru Voinjoma Nzérékoré Bo Kissidougou

Cases Deaths HCW Guinea 493 360 33 (20) Liberia 471 257 60 (35) Sierra Leone 646 273 49 (25)

Gambia

Total 1610 cases including 890 deaths

Gha

145 cases 80 deaths

Siguiri Bong

Abidjan

Pandemic and Epidemic Diseases department - 11

Distribution of Cases and Contacts in Africa

Countries with Ebola transmission: countries that are reporting EVD cases and documented human-to-human transmission. Countries with potential exposure: countries that are reporting presence of contact of EVD cases In Africa: 17 cities in 13 countries In addition: Dubai in United Arab Emirates Khartoum in Sudan New Delhi in India Ongoing Ebola transmission

Pandemic and Epidemic Diseases department - 12

Outbreak response summary

• Deployment of several mobile laboratories and

development of national lab capacities

• Over 200 experts deployed in the 3 countries by

WHO and GOARN partners (epidemiologists, clinicians, anthropologist, communication experts, logisticians, …)

• Outbreak logistics: timely shipment of needed

PPEs and others medical supplies

• Information products published (Website AFRO

and HQ) daily

Pandemic and Epidemic Diseases department - 13

Outbreak risk assessment

• Serious public health event that threatens global

public health security

• First large Ebola outbreak in West Africa
• Weakness of surveillance
• Failure of social interventions: strong community

resistance, strong traditional beliefs & cultural practice

• Mix of Ebola transmission documented: rural,

urban, and cross-border.

• High number of HCW among cases (health care

facilities serving as amplification places for Ebola)

Pandemic and Epidemic Diseases department - 14

Critical Issues

• Cross-border infections & travelers

Nigeria Ill travelers testing negative Coordination & contact tracing

• Many partners at limits of capacity

Ongoing weaknesses in operations

• Socio-economic impact

Pandemic and Epidemic Diseases department - 15

Mano River Union: 3 rings

1. Treat Guéckédou-Kenema-Foya triangle as unified unit Public health measures to reduce movement in / out 2. Guinea, Sierra Leone, Liberia and Nigeria Intensify current measures 3. Others countries in Africa and beyond Steps to reduce international spread

Pandemic and Epidemic Diseases department - 16

IHR Emergency Committee

• 6 & 7 August
• Assess situation
• Two main questions
• Is this a public health emergency of international

concern

• If yes, guidance to DG on temporary

recommendations

• Summary report will be made public
• Press briefing following day