Ebola Epidemic in Coastal West Africa – Overall Situation

1. Ebola Epidemic in Coastal West Africa – Overall Situation Report given at Caritas Internationalis Briefing Meeting 05 November 2014 Dr and Deacon Timothy Flanigan MD Professor of Medicine and Infectious Diseases Brown University Medical School, USA Volunteer in Monrovia, Liberia

2. Ebola in West Africa

3. Transmission by direct contact with body fluids from a sick person, soiled clothes, or a dead body Population at risk: Patient's family (home care, burial) and health staff

4. How Ebola Outbreaks Start • First human cases start with infection by an animal • Chimpanzes, gorillas, monkeys, forest antelopes, fruit bats, porcupine... • How current outbreak started in unknown, but killing and preparing bush meat can spread other viral illnesses • Infection from person-to-person creates an outbreak • Direct or indirect physical contact with body fluids of a sick infected person (blood, saliva, vomitus, urine, stool, semen) • Well known locations where transmission occurs • Hospital: • Health care workers, other patients, unsafe injections • Houses and Communities: • Family, friends, contacts caring for ill, through funeral practices

5. Ebola virus disease • Incubation 2-21 days (usually 6-10 days) • Deadly Disease: Case Fatality Ratio 24-89% • Survivors recover completely • Treatment is supportive • rehydration, intensive care, • Some potential specific treatment • Blood or plasma from recovered persons • Monoclonal antibodies (Zmap): Limited supply and little data • Candidate drugs also in early stages of testing • Vaccines look promising and in development

6. Critical Issues • First large Ebola outbreak in West Africa • Serious national & global health security threat • Underlying weakness in health systems • Lack of preparedness • Surveillance, health care, communications … • Health worker infections & inadequate infection control & prevention • Effect of fear • Strong community resistance in places ……..

7. Update of Ebola Situation as of 27 October 2014 • There have been 13 703 EVD cases, with 4 920 deaths, up to the end of 27 October. •  All districts in Liberia and Sierra Leone are now affected. • Cases/Deaths: • Guinea - 1906/997 • Liberia: 6535/2413 • Sierra Leone: 5235/1500 • Five countries (Mali, Nigeria, Senegal, Spain, and the United States of America) have now reported a case or cases imported from a country with widespread and intense transmission

8. Controling the epidemic To manage the patients: early diagnostic, symptomatictreatment To stop the transmission in the community: Identification and medicalfollow up of the contacts Safe management of the patients Safe management of the corpses Control at the borders Behavioral and social interventions

9. An informed and engaged population to best protect individuals, families and communities Population needs to know: - What is Ebola, how does it spread - What behaviors to change or adopt to best protect them selves and their families - Where they can get additional information Critical that communities receive these messages from local trusted leaders, in language and voices they can relate to and understand Without community involvement: - People will continue to hide sick people and treat them at home - Dead bodies will be taken back to the community for unsafe burials - Social conflicts will severely impact control efforts

10. Outbreaks in Communities can increase and decrease

11. Six Strategic Objectives (STEPP) and Actions in Addressing Ebola Virus Disease Outbreaks • Stop the outbreak • Identify and trace people with Ebola • Safe and dignified burials • Effective sanitation, hygiene and infection control • Treat the infected • Care for the persons with Ebola and Infection Control • Medical Care for Responders Ebola Virus Disease Outbreak: Overview of Needs and Requirements, compiled by OCHA, WHO, UN partner agencies, and other key responders, September 2014.

12. Six Strategic Objectives (STEPP) and Fifteen Mission Critical Actions in Addressing Ebola Virus Disease Outbreaks • Ensure essential services • Provision of food security and nutrition • Access to basic (including non-Ebola Health) services • Cash incentives for Workers • Recovery and Economic Development • Preserve stability • Reliable supplies of materials and equipment • Transport and fuel • Social mobilization and community engagement • Messaging

13. Six Strategic Objectives (STEPP) and Fifteen Mission Critical Actions in Addressing Ebola Virus Disease Outbreaks • Prevent outbreaks in countries currently unaffected • Multi-faceted approach to strengthen preparedness of all countries for rapidly detect and response to an Ebola exposure, especially those sharing land borders with areas of active transmission and those with international transportation hubs. • Research into treatment and vaccines • Research which makes available effective treatments for and vaccines to prevent outbreaks and cases in most affected areas.

14. 'Complementary Strategies' Massive scale-up of community engagement is essential to reduce the intensity of transmission

15. Community Training in Dolotown which was hard hit by Ebola