1. Transmission The virus is transmitted to people from wild animals and spreads in the human population through human-to-human transmission. Human-to-human transmission of the Ebola virus is primarily associated with direct or indirect contact with blood and body fluids. (to include saliva and sweat). Transmission to health-care workers has been reported when appropriate infection control measures have not been observed Standard precautions include the basic level of infection control— hand hygiene, use of personal protective equipment to avoid direct contact with blood and body fluids, prevention of needle stick and injuries from other sharp instruments, and a set of environmental controls. Fruit bats of the Pteropodidae family are considered to be the natural host of the Ebola virus. The incubation period, that is, the time interval from infection with the virus to onset of symptoms, is 2 to 21 days. Surgeon Force Health Protection Ebola Storyboard as of 180001OCT14 UNCLASSIFIED/FOUO Current Situation Ebola outbreak in coastal West Africa involves Guinea, Liberia, Sierra Leone, Nigeria and Senegal Total cases as of 28 Sep14: 7,157 with 3,330 deaths. Overall Mortality Rate (MR) =46.5% Guinea: 1,157 cases/710 deaths (MR=61.4%) Liberia: 3,696 cases/1,998 deaths (MR=54.1%) Sierra Leone: 2,304 cases/622 deaths (MR=27%) Nigeria (20 cases/8 deaths) ; Senegal (1 case) CASES in US (Total: 5) First US diagnosed case in Dallas, TX (30Sep14) Travel from Liberia (19Sep) (Brussels-Dulles- Dallas) arrives US (20Sep). Symptoms began (24Sep), sought care (26Sep) was treated and released. Condition worsened, admitted to isolation at Texas Health Presbyterian (28Sep). Ebola PCR test confirmed positive (30Sep). CDC sent Epi team to Dallas to assist State and County public health with contact tracing of exposed individual. His condition is serious (1Oct) Contacts: 13-18 estimated contacts in addition to Dallas Fire ambulance crew (3pax); includes 5 school aged children from 4 schools. EMS and the students are without symptoms and are being monitored at home. A close associate of the patient is being closely monitored for Ebola. ~Other cases~ One AMCIT evac’d to Emory (7SEP)-unknown One US MD with EVD infection transferred to Nebraska Med Ctr 5 Sep, discharged 25SEP Two AMCITS, with EVD infection treated and released from Emory University Hospital 21AUG Signs and Symptoms Severe acute viral illness often characterized by the sudden onset of fever, intense weakness, muscle pain, headache and sore throat. This is followed by vomiting, diarrhea, rash, impaired kidney and liver function, and in some cases, both internal and external bleeding. PREPARED by COL LISA BLACK Prevention and Treatment No specific treatment or vaccine is available for use in people or animals. Severely ill patients require intensive supportive care. Patients are frequently dehydrated and require oral rehydration with solutions containing electrolytes or intravenous fluids. Reducing the risk of wildlife-to-human transmission from contact with infected fruit bats or monkeys/apes and the consumption of their raw meat. Animals should be handled with gloves and other appropriate protective clothing. Animal products (blood and meat) should be thoroughly cooked before consumption. A New Ebola vaccine is being tested in humans at NIH following success in monkeys. ZMapp, being developed by Mapp Biopharmaceutical Inc., is an experimental treatment, for use with individuals infected with Ebola virus. 16SEP14: POTUS visit to CDC where he is expected to announce deployment of ~3,000 MILPER to West Africa and an AFRICOM GO to head a regional command in Monrovia, Liberia in support of Operation United Assistance. Support includes engineer construction of 17 treatment centers in Liberia, medical personnel to train local health care workers, and a new staging base. 16SEP14: Peoples Republic of China to dispatch a 59 person mobile lab team to Sierra Leone in addition to 115 Chinese medical staff already on the ground. 12SEP14: Government of Cuba to deploy 165 health care professionals to Sierra Leone in early October 2014. 9SEP14: PENTAGON announces deployment of a 25 bed hospital to Liberia designed to care for health care workers who will become ill. US Public Health Commissioned Corps will deploy 65 Officers to Liberia to manage and staff this hospital. 28AUG14: The WHO Ebola response roadmap highlighted the need for a massively scaled response to support effected countries. Mali