do now? daniel bausch, md, mph&tm consultant clinical

The 2014-15 West Africa Ebola Outbreak:

What’s Different, What’s Not, and What do we

do now?

Daniel Bausch, MD, MPH&TM

Consultant

Clinical Management Team

WHO Geneva

ISTM

Quebec, CA

May 28, 2015

Email Contact: bauschd@who.int

Pandemic and Epidemic Diseases department

Financial Disclosures-None

Pandemic and Epidemic Diseases department

Ebola Epi Update: Confirmed, probable and suspected EVD cases worldwide (data up to 17 May 2015). WHO SitRep

CFR: 41%

New and total confirmed cases.17 May 2015

WHO Situation Report

Aspect Previous Outbreaks West Africa 2014-15Location Remote Central

Africa

More connected regions

of West Africa

No. cases Typically 100-200 ~27,000

No. countries

involved at a time

Usually 1 3 (plus ~26 imported)

Duration 2-4 months >18 months

Exported cases

outside area

Extremely rare Occasional

Community

cooperation

Occasional

resistance

Frequent resistance

Organizations

responding

5-10 >100

Urban areas Spared Heavily involved

No. ETUs Typically 1-2 > 50

No. Diagnostic

labs

Typically 1-2 > 50

Cost <$5 million >$1 billion

Pandemic and Epidemic Diseases department

Congo Guinea-Liberia-Sierra Leone

Population 68 million 22 million

Surface Area (Km2) 2.3 million 430,000

Population Density

(persons/ Km2)

30 51

200 miles

Monrovia (1 million)

Freetown (1.2 million)

Conakry (1.1 million)

ETU

ECUCommunity Care Unit

Home CareWith Distribution of Hygiene Kits/PPE

NOTHING

Decrease transmission

Increase supportive care

Decrease mortality

Approach to

patient care

Pandemic and Epidemic Diseases department

Ebola virus infections in HCWs

Country Cases Deaths

Guinea 178 91

Liberia 372 180

Sierra Leone 302 221

Total 852 492

3.4% of all EVD cases during the outbreak

Data are confirmed cases and deaths only, apart from deaths in Sierra Leone, which

include confirmed, probable, and suspected deaths. *Data as of 17 February.

Personal Protective Equipment

Clinical Observations

• Bleeding not a major component (“Ebola hemorrhagic fever” → “Ebola virus disease”)

• Volume loss and electrolyte imbalance appear to be major factors

Best Treatment Practices?

• What fluid and electrolyte

support?

• Anti-diarrheal agents?

• Antibiotic prophylaxis?

• Blood products/immune therapy?

• Antiviral agents?

Pandemic and Epidemic Diseases department

A new geographical distribution

Guinea

Sierra LeoneLiberia

Mali

Nigeria

SenegalDEU 4

FRA 2

ITA 1

NET 2

NOR 1

SPA 4

SWI 1

UK 1

USA 5

21 MEDEVAC

Ebola cases in USA and Europe

RDC

• Quality of care

• Intensity of surveillance

• Level of community cooperation

• Mode of transmission and inoculum size

• Host genetic differences

• Virus genetic differences

Factors that may relate to real and perceived

variability in EVD CFR across sites

Pe

rce

nt

Symptom

0

10

20

30

40

50

60

70

80

90

Symptoms Post-Ebola Virus Disease (%)

• Ocular complications: Uveitis, ↓visual acuity

• Mental health: PTSD, depression, stigma, loss of family

members, orphans

• Virus persistence: (~3 months) in selected immune

protected sites: male gonad/semen, chambers of the eye,

intrauterine contents in pregnancy? others?

• Risk of sexual transmission and reintroduction

EVD Survivors

Pandemic & Epidemic Diseases

Assist WHO governmental and non-governmental

partners in the coordination of plans for survivors of

Ebola virus disease (EVD), both in terms of service

provision (first priority) and scientific study (secondary).

The WHO ESSN is designed to contribute a value-

added non-duplicative service to the many ongoing

initiatives regarding post-EVD care and study to help

meet the heterogeneous needs across the three

epidemic countries in West Africa and elsewhere.

WHO Ebola Survivors

Support Network

Pandemic & Epidemic Diseases

22 |

WHO Emerging Disease Clinical Assessment and Response Network (EDCARN)

Strengthen global collaboration between clinicians,

researchers, medical NGO's, national health

authorities, WHO and other stakeholders in order to

improve clinical management of patients during

outbreaks of EIDs.

To accelerate production of scientific knowledge on

these diseases.

Catalyst of new dynamics of PED control – bench to

bed and beyond: Basic science → animal models →

regulatory mechanism → clinical trials → improved

patient care → public health policy

• This outbreak is not over!

• Systems have collapsed—“getting to zero,” recovery,

rebuilding health systems all still ahead

• Silver Lining: Scale and scrutiny of this tragedy have

brought about a sea-change in scientific and public

health application with potential for drastic

improvements in treatment and control

• The Future: More systematic approach and

evaluation of bench-to-beside applications for EVD

and other emerging diseases needed to inform best

practices.

Conclusions

American Society of Tropical Medicine and HygieneOctober 25-29, 2015

Philadelphia, PAhttp://www.astmh.org

Pandemic and Epidemic Diseases department

Tribute to Fallen Healthcare Workers

Bausch et al. (2014) A Tribute to Sheik Humarr Khan and all the Healthcare Workers in West

Africa who have Sacrificed in the Fight Against Ebola Virus Disease: Mae we hush. Antiviral Res

111:33–35