1. Latest WHO Update (22 Sept. 2014) Estimates 20k cases by 2 Nov. CDC says 1.4 M by Jan. 20 Up to 70% fatality rate Ages 14 – 44, older are most fatal Most who die, do so within 4 days Those who live, leave care in 11 days ? Those who receive care live longer 300 HCW’s infected with 50% CFR

2. Epidemiology (cont.) Index case– 2 yo ♂ Guinea 12/2013 Then Guinea confirmed cluster 03.14 Then spread to Liberia and Sierra Leone Then recently to Nigeria via air travel Then to Senegal WHO Public Health Emergency of International Concern – 08/2014

3. Air Traffic Connections From West African Countries to the Rest of the World

4. DRC (Congo) Outbreak (aka Zaire) Zaire strain but not related to West Africa outbreak 70 cases, 42 deaths, lab 30 (7 HCWs) as of Sept. 29, 2014

5. WHO Ebola Response Roadmap Released August 28, 2014 Reverse the trend in new cases and infected areas within 3 months, stop transmission in capital cities and major ports, and stop all residual transmission within 6-9 months. Estimation of Costs: US $490m Really over $600m+

6. Cases Underestimated? ( by x 2.5) 1. Patients hidden by families 2. Denial of the disease 3. In rural areas, corpses are burned before identification/dx. 4. Invisible caseloads of patients 5. “Shadow Zones”

7. Modes of Transmission There are 3 modes of infection: 1.Objects contaminated with the virus (Unsterilized needles, medical equipment) 2.Suboptimal healthcare conditions ( Lack of PPE ) 3.Personal contact with diseased humans ( blood vomit, urine, feces, sweat, semen, breast milk, sputum ) or infected animal meat/bushmeat http://www.ecplanet.com/pic/2003/12/1071257871/ebola.jpg

8. Chlorinated Hand Wash Station

9. West Africa Ebola Outbreak

12. Transporting Suspected Ebola Patient—Sierra Leone

13. Public Health Actions Notifications to healthcare professionals with education/info on patient care and disease prevention Education/information to the public Negate misinformation/myths

16. Latest USG Response (Sept. 16, 2014) 3000 US military for medical and logistics support -Train 500 health care workers a week; -Erect 17 health care facilities in the region with 100 beds each; -Set up a joint command to coordinate between US and international relief efforts; -Provide home health care kits to hundreds of thousands of households; -Carry out a home- and community-based campaign to train local populations on how to handle exposed patients.

17. Preventive Measures-Africa Stop the consumption of animal meat Isolate the sick Prompt disposal of victim’s bodies Trace those who had contact with infected Disinfect homes of the dead and the sick Protective clothing for HCW, and anyone handling infected animals

18. Contact Tracing

19. Infection Prevention and Control Recommendations Standard contact & droplet precautions including gloves, fluid-resistant gowns, eye protection, face mask, and additional PPE as needed Single patient room with private bathroom, door closed, restrict visitors Avoid aerosol generating procedures Invoke specific environmental controls http://www.cdc.gov/vhf/ebola/hcp/infection-prevention-and-control-recommendations.html

20. Isolation Unit

21. Isolation Ward- Cohorting