ebola virus disease (evd) outbreak 2014 (template slide set designed to be edited to meet vamc...

Ebola Virus Disease (EVD)Outbreak 2014(Template slide set designed to be edited to meet VAMC needs)

DATE/MONTH 2014

VETERANS HEALTH ADMINISTRATION

2014 West Africa Outbreak

• The 2014 Ebola outbreak is the largest Ebola outbreak in history and the first in West Africa.

• The current outbreak is affecting multiple countries in West Africa.

• Insert Current Case Counts http://www.cdc.gov/vhf/ebola/outbreaks/guinea/index.html

2Current as of 10/2/2014


• On September 30, CDC confirmed the first travel-associated case of Ebola to be diagnosed in the United States in a person who had traveled to Dallas, Texas from Liberia. The patient did not have symptoms when leaving West Africa, but developed symptoms approximately five days after arriving in the U.S. (arrived Sept. 20).

• Contact tracing, a standard public health procedure, is immediately employed in order to identify and monitor those who may have been potentially exposed to a sick patient.

• Even with the first U.S. confirmed case, Ebola does not pose a significant risk to the United States.

Impact on United States

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General EVD Background

• Ebola Virus Disease (EVD) is one of numerous viral hemorrhagic fevers (VHFs).

• The first Ebola virus species was discovered in 1976 in what is now the Democratic Republic of the Congo near the Ebola River. Since then, outbreaks have appeared sporadically in Africa.

• EVD is often severe in humans, with case fatality rates reaching 50-90% in developing countries.

• After an incubation period of a few days, symptoms usually begin abruptly.

• The natural reservoir host of Ebolaviruses remains unknown. However, evidence suggests it is a zoonosis (animal-borne) with bats being the most likely reservoir. Four of the five subtypes occur in an animal hosts native to Africa.

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General EVD Transmission• Because the natural reservoir of Ebola viruses has not yet been clearly

demonstrated, the manner in which the virus is first introduced in to the human population at the start of an outbreak is not well understood. It appears the first patient becomes infected through direct contact with the body fluid of an infected animal.

• Ebola virus is spread from one person to another through direct contact with:o Ebola-infected blood or body fluids, such as, but not limited to, urine, saliva, feces,

vomit, and semeno Objects, such as needles, that have been contaminated with infected body fluids

• Healthcare workers, family and friends, and others who come into close contact with Ebola-infected patients (including corpses of those who expired due to EVD) have the highest risk of exposure.

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General EVD Transmission

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• Symptoms may appear anywhere from 2 to 21 days after exposure to Ebola virus, although 8-10 days is most common.

• Only symptomatic Ebola-infected patients are able to transmit EVD; Patients without symptoms who are infected with Ebola virus are not contagious.

General EVD Presentation

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• Timely diagnosis and treatment of EVD is important but challenging because the disease is difficult to diagnose clinically in the early stages of infection.

• Because early symptoms, such as headache and fever, are nonspecific to EVD, cases of EVD may be initially misdiagnosed.

• It is important to obtain an accurate and complete history of travel or potential contact with an Ebola case from a patient exhibiting Ebola-like symptoms.

General EVD Assessment

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Excerpt from CDC checklist for Patients Being Evaluated for EVD in US


General EVD Treatment

• There is no specific cure for Ebola virus infection.• There are currently no specific vaccines to prevent Ebola

infection.• There are no specific medications (e.g., antiviral drug) that

have been proven to be effective against Ebola.• Symptoms of Ebola are treated supportively, as they appear.

The following basic interventions, when used early, can increase the chances of survival.• Providing intravenous fluids and balancing electrolytes (body salts)• Maintaining oxygen status and blood pressure• Treating other infections if they occur

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Development of Treatments and Vaccines

• A number of potential candidate drugs and vaccines are in development.

• The CDC maintains a FAQ on current candidates at: http://www.cdc.gov/vhf/ebola/outbreaks/guinea/qa-experimental-treatments.html

• For further information on drug development, approval process, and research please contact the appropriate agency:

FDA media office: [email protected] media office: [email protected] media office: [email protected] media office: [email protected]

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Infection Prevention and Control Recommendations

• CDC recommends standard, contact, and droplet precautions for management of hospitalized patients with known or suspected Ebola Viral Disease (EVD).

• Generally, VHA follows the most up-to-date CDC guidance, which is periodically updated and can be found at: http://www.cdc.gov/vhf/ebola/hcp/index.html.

• Though these recommendations focus on the hospital setting, the recommendations for personal protective equipment (PPE) and environmental infection control measures are applicable to any healthcare setting.

• VA-specific guidance, including any deviations from CDC guidance, will be issued to VA facilities, as appropriate.

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Current VA PPE Recommendations• All persons entering the patient room

should wear at least:o Gloveso Gown (fluid resistant or impermeable)o Eye protection (goggles or face shield)o Facemask

• Additional PPE might be required in certain situations (e.g., copious amounts of blood, other body fluids, vomit, or feces present in the environment), including but not limited to: o Double glovingo Disposable shoe coverso Leg coveringso Head covering

Donning PPE

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Doffing PPE

• To prevent self-contamination, it is important to remove the most contaminated PPE first.

• This will help to prevent contaminants from spreading to other places as additional PPE items are removed.

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Potential VHA ImpactsScenario 1An individual presents to local VA emergency/urgent care with a fever of 102°F (38.9°C) and recent travel to Africa where he may have been in an area experiencing EVD cases.

Scenario 2A VA employee has a concern about EVD based on epidemiological history (i.e. recent travel to high-risk countries and/or contact with a known of suspected EVD patient), but is asymptomatic.

Additional discussion of these scenarios was transmitted to VHA September 16th, 2014:

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EVD Scenarios


• Ebola Fact Sheet

• Ebola Update (as of August 2014)

For Additional Information


For Additional Information

For VA Questions: contact the VHA National Infectious Diseases Service at 513-246-0270 or Aaron Eagan in the VHA Office of Public Health via email at

[email protected]

For general information: • Centers for Disease Control and Prevention (CDC)

http://www.cdc.gov/vhf/ebola/index.html• World Health Organization (WHO)

http://www.who.int/csr/disease/ebola/en/

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