ebola - middlesex-london health unit · ebola update october 24, 2014 dr. gayane hovhannisyan...
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Ebola Update October 24, 2014
Dr. Gayane Hovhannisyan
Associate Medical Officer of Health
Outline
• Overview: Ebola virus disease;
• Ebola outbreak in West Africa, Congo
and the US;
• Update from Public Health Agency of
Canada;
• Update from the MOHLTC
• Public Health Ontario: screening tools,
best practice guidelines
Ebola Virus Characteristics
• RNA virus (enveloped)
• Reservoir- fruit bats in
tropical rainforest;
• Highly infectious during
later stages of the
disease;
• Humans and non-human
primates can get infected.
Photo Credit: CDC/Cynthia Goldsmith PHIL ID #10816
Modes of transmission • Contact with the natural reservoir or
infected animals
• Direct contact with body fluids
– Mucous membranes
– Sexual intercourse
– Break or cut in the skin
• Nosocomial
– Needles, syringes
– Inadequate sterilization
Ebola virus disease • Incubation period 2-21 days
• Clinical picture
– Fever (87%), fatigue (76%), loss of appetite
(64%), vomiting (68%), diarrhea (66%),
headache (53%)
– Internal and external bleeding
– Multi-organ failure
– Death or recovery between 10-14 days after
the onset.
• Case-fatality-70%
Ebola vaccines and treatment
• No approved vaccines/treatment
• Experimental treatment
• Two experimental vaccines
– VSV-EBOV was developed in Canada
– Vaccine is not expected until
January/February 2015.
Ebola outbreak in Liberia
Ebola outbreak in Sierra Leone
Success story
• Travel related cases in Nigeria and
Senegal;
• Nigeria and Senegal were declared
Ebola free after 42 days of the last
reported case.
Situation in Democratic Republic of
Congo • Unrelated to the outbreak in West Africa;
• Equator province only;
• 66 cases (38 confirmed, 28 probable)
• 49 deaths have been reported, including
eight among HCWs;
• 1121 total contacts, 1116 have now
completed 21-day follow-up.
Ebola outbreak in the US
• One travel related case
– Asymptomatic during the travel;
– Felt sick on Sep 24 and was seen in ED on
Sep 26;
– Readmitted on Sep 28.
• Two secondary cases
– Most likely infected during the first few
days after readmission (Sep 28, 29, 30).
How concerned should we be?
• Community outbreak is extremely
unlikely in Canada.
• Sporadic travel related cases are
possible.
• Health care workers in hospitals and
EMS have the highest risk.
Updates from the MOHLTC – Creating Ebola Command table;
– Ontario Asking CMOH to issue directive to
hospitals;
– Designating 10 hospitals as referral hospitals to
treat confirmed cases of Ebola;
– Enhancing inventory and availability of PPE
especially N95 respirators;
– Testing Ebola specimens at PHO provincial labs;
– Assigning outfitted ambulances to transport
potential cases to designated hospitals for
treatment.
Is it airborne?
• NO
• Number of secondary cases
– R0= 1.71 for Guinea
– R0= 1.83 for Liberia
– R0= 2.02 for Sierra Leone
Ebola virus disease in West Africa-the first 9 months of the
epidemic and forward projections. NEJM. Sep 2014
How the outbreak in West Africa is
different from previous outbreaks?
• Cultural practices
– 70% of cases are attributed to burial
practices;
• Mobility;
• Lack of trust to the government and
international aid workers;
• Capital cities were affected.