1. UNCLASSIFIED USAPHC’s Response to Ebola Robert Cohen, MD, MPH Preventive Medicine Physician Disease Epidemiology Program Army Institute of Public Health

2. U.S. Army Public Health CommandUNCLASSIFIED The views expressed herein are those of the speaker and do not necessarily reflect the views of the Army, the US Government, or USAPHC. Disclaimer 2

3. U.S. Army Public Health CommandUNCLASSIFIED What is Ebola? History of Ebola Current Outbreak in West Africa Operation United Assistance –Pre-deployment activities –During/After deployment activities –Domestic Preparedness Future Outline 3

4. U.S. Army Public Health CommandUNCLASSIFIED What is Ebola? 4 Smallpox Influenza Herpes Coronavirus (SARS) HIVEbola Rabies Hendra

5. U.S. Army Public Health CommandUNCLASSIFIED A Brief History of Ebola 5 http://www.abc.net.au/news/2014-07-30/map-showing-ebola-outbreaks-in-africa-since-1976/5635152

6. U.S. Army Public Health CommandUNCLASSIFIED Current Outbreak in West Africa 6 WHO Ebola Response Team. NEJM 2014 Case Count (as of 8 Dec 2014) Cases Deaths Liberia: 7,690 3,161 Sierra Leone: 7,635 1,660 Guinea: 2,192 1,366 Total: 17,517 6,187

7. U.S. Army Public Health CommandUNCLASSIFIED Stabilization in Liberia and Guinea, not Sierra Leone 7 The Economist, 4 Dec 2014

8. Led by 101 st Airborne Division, in collaboration with US Army Africa Beginning Sep 2014 Up to 3000 US Army troops will be sent over 12+ months Mission: Build 10 Ebola Treatment Units (ETUs) with 50 beds each in Liberia President Obama Orders Operation United Assistance (OUA) U.S. Army Public Health CommandUNCLASSIFIED 8

9. -(U) Confirmed EVD Cases: - Average 10 new cases per day - Sierra Leone: 75 per day - Guinea: 15 per day -(U) UNDP EVD Program Visit 4 Dec: - Lack of feedback on relatives enrolled in ETUs -Secret burials still occurring, increasing transmission of EVD -LNP conducing night patrols to reduce secret burials -(U) Army Labs -3 of 4 labs operational -(U) UNMIL Soldier positive for EVD -Nigerian -Currently treated at MMU -Will be flown to Netherlands OUA INTSUM, 20141206 OUA SITREP, 20141207 Sources: Liberian Lab Proposed Army Lab Mobile Medical Lab (MML) Forward Logistical Base Monrovian Medical Unit Operational ETU In Progress ETU USG Supported LEGEND (Capability Status as of 18 Nov 2014) Sinje Liberia Gbediah U.S. Army Public Health CommandUNCLASSIFIED 9

10. HQDA Mission HQDA establishes a Force Protection Plan of action for Army Forces deploying in response to the EVD epidemic in West Africa and provides information and education to the Soldiers, DA Civilians (DAC), Army Families, deploying contractors, and their communities in order to provide properly trained and equipped forces in support of Operation United Assistance. MEDCOM Mission On order (O/O), MEDCOM leverages medical personnel, materiel, research and technology, and subject matter expertise in support of Operation UNITED ASSISTANCE (OUA). PHC Mission PHC leverages public health subject matter expertise in support of Operation UNITED ASSISTANCE (OUA). U.S. Army Public Health CommandUNCLASSIFIED 10 Operation United Assistance

11. USAPHC is a unique organization within DoD, well-suited to advise units on: 1) Pre-Deployment (Prepare Soldiers and Reassure Families) 2) During Deployment and Re-Deployment (Protect and Return Soldiers) 3) Domestic Preparedness Three Areas of USAPHC OUA Response U.S. Army Public Health CommandUNCLASSIFIED 11 http://healthdecide.orcahealth.com/2014/08/01/ori gins-growing-spread-ebola-virus/

12. Risk assessments and risk communication Information video for deploying Soldiers and Families FAQ sheets Training Packages (e.g. PPE) Other Africa-specific public health training Pre-Deployment: Prepare Soldiers and Reassure Families U.S. Army Public Health CommandUNCLASSIFIED 12 https://www.youtube.com/watch?v=677xOF9Iua4

13. Personal Protective Equipment (PPE) guidance Hazardous waste management guidance Review of difficult scientific questions (e.g. how long can Ebola survive outside the human body?) SME support to deployed units During Deployment: Protecting Soldiers 13

14. Controlled monitoring for 21 days Domestic Preparedness for MTFs Ebola Rapid Action Team (~12 people) –Mix of clinical/non-clinical experts –Risk Communication –Waste Management –Contact Tracing DoD Ebola Mission Support Team (30 people) Example: returning Air Force Officer with vomiting to Ft. Bliss –Grounded the crew and plane for 72 hours –Isolated Officer –Used as an exercise Post-Deployment: Returning Soldiers and Domestic Preparedness U.S. Army Public Health CommandUNCLASSIFIED 14

15. Ongoing OUA Support Efforts (JPEO-CBD) Ebola Biosurveillance Portal The Ebola Biosurveillance Portal is a new information technology tool supporting international efforts to stop the Ebola Virus outbreak in West Africa. It leverages several DoD systems in development into a single integrated system for Ebola situational awareness Ebola Virus Diagnostic Assays Two DoD developed Ebola Virus diagnostic assays have received Emergency Use Authorizations from the FDA. These assays have been fielded to both CDC and DoD labs Ebola Virus Therapeutics and Vaccines The DoD and the NIH are utilizing a “whole - of - government” approach to accelerate the development of promising vaccine and anti-viral drug candidates that are targeted against Filoviruses Presidential Grand Challenge JPEO-CBD is participating in the Presidential Grand Challenge to procure or develop improved personal protective equipment (PPE) for Ebola Virus. The goal is to reduce the thermal burden associated with current PPE on health care providers U.S. Army Public Health CommandUNCLASSIFIED 15

16. More Ongoing OUA Support Efforts (JPEO-CBD) Contaminated Human Remains Pouch Transportation Isolation System JPEO-CBD and the Defense Threat Reduction Agency are developing an isolation system to evacuate service members in the event they become infected by the Ebola Virus. They system will hold up to 12 service members In response to a Joint Urgent Operational Needs Statement (JUONS), JPEO- CBD is developing a human remains pouch medical, transport and processing personnel from individuals that have died from Ebola U.S. Army Public Health CommandUNCLASSIFIED 16

17. There will be another Ebola outbreak in Africa Or another disease outbreak We will be better prepared We may even be able to help prevent We must try to help prevent Future http://www.globalchange.umich.edu/globalchange2/current/lectures/deforest/deforest.htmlhttp://landsat.gsfc.nasa.gov/?p=510 U.S. Army Public Health CommandUNCLASSIFIED 17