do now? daniel bausch, md, mph&tm consultant clinical
TRANSCRIPT
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: [email protected]
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