Ebola Virus Disease
Suffolk Business Continuity Forum
26 November 2014
Dr Hamid Mahgoub FFPH
Anglia Health Protection Team
Dr Mary Orhewere FFPH
Suffolk Public Health
2
Infectious disease is in
the UK National Risk
Register
(Pan Flu is at the top)
Epidemiology & experience
•
Ebola virus disease (EVD), formerly Ebola haemorrhagic fever, is a severe viral
haemorrhagic fever (VHF) caused by a virus of the filovirus family.
•
Principal mode of transmission:
•
Initially: direct contact with infected animals
•
Subsequently: person-to-person spread by contact with bodily fluids (including blood,
diarrhoea, vomit and urine)
•
There is no risk of transmission during the incubation period and only low risk of
transmission in the early phase of symptomatic patients
•
Airborne transmission has not been documented during previous EVD outbreaks
•
In a household study, secondary transmission took place only if direct physical contact
occurred - No transmission was reported without this direct contact
•
EVD does not survive well in the environment and is readily destroyed by washing with
soap and water and common disinfectants (hypochlorite), including alcohol gels;
3
Current Situation
23 March 2014, WHO confirmed an outbreak of Ebola virus disease (EVD) in
South-eastern Guinea, the first time in this part of Africa - now the largest
known outbreak of this disease.
21st November (source: WHO 16 Nov):
•
Affected countries: Guinea, Liberia, Sierra Leone, Mali, Spain & the USA
•
15,145 confirmed, probable, and suspected cases of EVD reported
•
5,420 deaths.
•
WHO Ebola Response Roadmap structure: country reports fall into two
categories: 1) those with widespread and intense transmission (Guinea,
Liberia, and Sierra Leone); and 2), those with an initial case or cases,
and/or with localized transmission (Mali, Spain, and the USA).
WHO link: http://www.who.int/csr/disease/ebola/situation-reports/en/
4
Current Situation
5
Symptoms of Ebola virus disease
6
•
The incubation period, that is, the time interval from infection with the virus
to onset of symptoms is 2 to 21 days. Humans are not infectious until they
develop symptoms.
•
It can be difficult to distinguish EVD from other infectious diseases such as
malaria, typhoid fever and meningitis from clinical symptoms alone.
•
First symptoms are the sudden onset of fever, fatigue, muscle pain,
headache and sore throat. This is followed by vomiting, diarrhoea, rash,
symptoms of impaired kidney and liver function, and in some cases, both
internal and external bleeding (e.g. oozing from the gums, blood in the
stools).
•
Laboratory findings include low white blood cell and platelet counts and
elevated liver enzymes.
Ebola infectivity
• Ebola virus is spread among people through close and direct
physical contact with infected body fluids
• People infected with Ebola can only spread the virus to other people
once they have developed symptoms. In the early stages these
include fever, headache, joint and muscle pain, sore throat, and
intense muscle weakness.
• Ebola virus is not spread through routine, social contact (such as
shaking hands or sitting next to someone) with people who do not
have visible symptoms
• When people have no or very mild symptoms (just a low fever) the
level of virus is very low and unlikely to pose a risk to others
7
Ebola infectivity
• Once people are unwell, then all body fluids (such as blood, urine,
faeces, vomit, saliva and semen) are infectious, with blood, faeces
and vomit being the most infectious
• When someone reaches the point at which they are most infectious,
they are unlikely to be in any condition to move or interact socially.
The most risk is to people involved in their care and not the general
public
• Skin is almost certainly contaminated in late stage disease because
of the impossibility of maintaining good hygiene, but other people
are not at risk unless they are directly involved in caring for a person
with advanced disease and without wearing personal protective
equipment.
• Semen can remain infectious for up to three months after recovery.
8
Ebola infectivity
9
Presentation title - edit in Header and Footer
Infectivity: R0
Values of R0 of well-known infectious diseases[1]
10
Disease
Transmission
R0
Measles
Airborne
12–18
Pertussis
Airborne droplet
12–17
Smallpox
Airborne droplet
5–7
Polio
Fecal-oral route
5–7
Rubella
Airborne droplet
5–7
HIV/AIDS
Sexual contact
2–5
Influenza
(1918 pandemic
strain)
Airborne droplet
2–3[3]
Ebola
(2014 Ebola outbreak)
Bodily fluids
1.5-2.5 [4]
Prevention and control
Reducing the risk of human-to-human transmission
•
Ensuring those travelling to and working within affected countries know what to
do if they develop symptoms
•
Case identification: ensuring suspect cases receive immediate medical
attention and are isolated
•
Use of PPE, hand hygiene, case management and maintaining a clean
environment
•
Conducting prompt and safe burials of the dead
Surveillance and contact tracing
11
•
Identifying people who may have been in contact with someone infected with
Ebola
•
Monitoring the health of contacts for 21 days
•
separating the healthy from the sick the importance of good hygiene.
Preparing the health system response
Raising awareness & knowledge of health care providers
•
Sensitise staff working at “points of entry”, in healthcare settings or involved
in first response - early and advanced symptoms of viral haemorrhagic fever
•
Emphasise systematic questioning and recording of travel history of those
with relevant symptoms and consider the possibility of EVD in person
coming back from affected areas
Putting procedures in place to deal with suspected cases
•
Follow the standard algorithms and diagnostic procedures for EVD and for
common differential diagnoses at an early stage
Diagnosing and managing confirmed cases
•
12
Follow the protocol for notification to Public Health England (Health
Protection Team) at an early stage if an EVD case is suspected.
Rapid access - screening and monitoring
Enhanced screening
•
Screening and monitoring UK-bound air passengers, identified by the
Border Force, coming on to the main routes from Liberia, Sierra Leone and
Guinea
•
Heathrow, Gatwick and St Pancras (Eurostar), Manchester and Birmingham
Assessment and monitoring
13
•
Passengers identified as high risk of Ebola with a raised temperature and/or
other symptoms will undergo clinical assessment and, if necessary, transfer
to hospital
•
Those identified as at an increased risk, but without symptoms will be given
advice and contact details. PHE will ensure that there is daily contact with
individuals at higher risk of developing disease.
Key messages
14
•
Overall risk of Ebola in the UK remains low
•
UK has robust systems to deal with infectious diseases
•
Awareness has been raised at all levels of the Health Care System and
with relevant Agency dealing with port of entry to the country (Border
Agency and Port Health)
•
Enhanced screening has been implemented at main airports AND
other points of entrance (St. Pancreas Eurostar station) in the UK
•
Ebola can only be transmitted from an infected individual to another
when there is direct contact with the body fluids (blood, urine, vomit
and diarrhoea) with the unprotected mucosa or broken skin (i.e.
abrasions, wounds) of another person