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Ebola virus 
disease 
2014 update: 
Opportunities 
and challenges 
Joseph M Reardon, MD 
North Durham Rotary 
With thanks to John Leander, MD, PhD; University of Arizona 
And S. Rizwan, MD; Madurai Medical College
AGENDA 
• History 
• Pathophysiology of Ebola virus disease 
• Transmission 
• Epidemiology 
• Local Preparedness 
• Current Organizations in the International Response 
• Future threats: Vaccine-resistant polio
1976 
Rizwan SA, VMCHRI
1976 
Rizwan SA, VMCHRI
1976 
Rizwan SA, VMCHRI
Geographic distribution 
• First outbreak occurred in 
Zaire (Congo) in 1976 
• Followed by several 
outbreaks, all in Africa 
(except one in Philippines, 
Italy, USA) 
• Latest on-going outbreak in 
west Africa started in 
March 2014 in Guinea 
Rizwan SA, VMCHRI
Natural History 
• Natural host - Fruit bats of 
Pteropodidae family 
• Reservoir – fruit bats 
• Sources – bush meat, Infected 
humans, fomites 
• Incubation period – 2 to 21 days 
• Communicability – high, virus 
isolated after 90 days of recovery 
• Case fatality – 50 to 90% 
• Immunity – long term not 
proven, deceased patients failed 
to produce immune response 
• No. of outbreaks – >30 
Rizwan SA, VMCHRI
Transmission cycle
2014 Epidemic 
• 2-year-old boy in 
Guéckédou, Guinea 
was first case 
• Rapid spread to city 
• MarchLiberia 
• JulyNigeria
“The Ebola epidemic ravaging parts 
of West Africa is the most severe 
acute public health emergency seen 
in modern times.” 
WHO, Sept 26, 2014
Ebola in the United States 
16000 
14000 
12000 
10000 
8000 
6000 
4000 
2000 
0 
Cumulative Ebola Cases as of 2 Nov 2014 
Africa United States 
Cumulative Ebola Cases as of 2 Nov 2014
Ebola Precautions in the United States 
CDC
Personal Protective Equipment
Treatment
Action Plan: Preventing Ebola in the 
United States
International Aid Organizations 
Ministries of Health
• Maintaining official statistics 
• Coordinating efforts
CDC 
• Coordination, data analysis 
• 283 Staff 
• Dozens of the 164 Epidemic Intelligence 
Service Officers
• 5,200 patients treated 
• 600 isolation beds 
• 263 international staff, 3084 local staff
• Establishing several community treatment 
and isolation centers in Liberia
• Operates a treatment center in Liberia
• Primarily distributing equipment 
• Post-exposure mental health counseling 
• Some isolation centers
• American Red Cross has deployed 169 
delegates 
• 7700 local volunteers 
• Primarily aimed at Ebola education
• Staff are being trained 
• 2 partner organizations identified 
• Mobilizing community members
• Involved with education 
• Planning to open a treatment center
ROTARY’S RESPONSE TO EBOLA 
• “Although Rotary has limited opportunities to respond at a 
corporate level, our strength as an organization is firmly 
rooted in the grassroots response of Rotary clubs and 
Rotarians.”
ROTARY CLUB OF MONROVIA, 
LIBERIA 
• Working directly with the Ministry of Health and 
Social Welfare 
• Solicited funds to buy locally available items 
(ie fuel, per diem, medicine, mattresses, 
buckets, etc.) and most importantly: community 
awareness. 
• Washing buckets and chlorine solution to 
communities. 
• Reading and activity packets for primary school 
children at home (schools are closed). 
• Also developing grants to support orphans, 
create ongoing local health sector scholarships, 
and restocking of hospital needs (also in 
cooperation with Medical Supplies Network).
IDEAS.ROTARY.ORG
Concerning outbreaks on the horizon…
Vaccine-Resistant Poliomyelitis 
“Robustness against serum neutralization of 
a poliovirus type 1 from a lethal epidemic 
of poliomyelitis in the Republic of Congo in 
2010” 
• 45% mortality 
• Those who died were already vaccinated

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Rotary - Ebola Virus Disease 2014 Update

  • 1. Ebola virus disease 2014 update: Opportunities and challenges Joseph M Reardon, MD North Durham Rotary With thanks to John Leander, MD, PhD; University of Arizona And S. Rizwan, MD; Madurai Medical College
  • 2. AGENDA • History • Pathophysiology of Ebola virus disease • Transmission • Epidemiology • Local Preparedness • Current Organizations in the International Response • Future threats: Vaccine-resistant polio
  • 6.
  • 7.
  • 8. Geographic distribution • First outbreak occurred in Zaire (Congo) in 1976 • Followed by several outbreaks, all in Africa (except one in Philippines, Italy, USA) • Latest on-going outbreak in west Africa started in March 2014 in Guinea Rizwan SA, VMCHRI
  • 9. Natural History • Natural host - Fruit bats of Pteropodidae family • Reservoir – fruit bats • Sources – bush meat, Infected humans, fomites • Incubation period – 2 to 21 days • Communicability – high, virus isolated after 90 days of recovery • Case fatality – 50 to 90% • Immunity – long term not proven, deceased patients failed to produce immune response • No. of outbreaks – >30 Rizwan SA, VMCHRI
  • 11. 2014 Epidemic • 2-year-old boy in Guéckédou, Guinea was first case • Rapid spread to city • MarchLiberia • JulyNigeria
  • 12.
  • 13. “The Ebola epidemic ravaging parts of West Africa is the most severe acute public health emergency seen in modern times.” WHO, Sept 26, 2014
  • 14. Ebola in the United States 16000 14000 12000 10000 8000 6000 4000 2000 0 Cumulative Ebola Cases as of 2 Nov 2014 Africa United States Cumulative Ebola Cases as of 2 Nov 2014
  • 15. Ebola Precautions in the United States CDC
  • 18. Action Plan: Preventing Ebola in the United States
  • 19. International Aid Organizations Ministries of Health
  • 20. • Maintaining official statistics • Coordinating efforts
  • 21. CDC • Coordination, data analysis • 283 Staff • Dozens of the 164 Epidemic Intelligence Service Officers
  • 22. • 5,200 patients treated • 600 isolation beds • 263 international staff, 3084 local staff
  • 23.
  • 24. • Establishing several community treatment and isolation centers in Liberia
  • 25. • Operates a treatment center in Liberia
  • 26. • Primarily distributing equipment • Post-exposure mental health counseling • Some isolation centers
  • 27. • American Red Cross has deployed 169 delegates • 7700 local volunteers • Primarily aimed at Ebola education
  • 28. • Staff are being trained • 2 partner organizations identified • Mobilizing community members
  • 29. • Involved with education • Planning to open a treatment center
  • 30. ROTARY’S RESPONSE TO EBOLA • “Although Rotary has limited opportunities to respond at a corporate level, our strength as an organization is firmly rooted in the grassroots response of Rotary clubs and Rotarians.”
  • 31. ROTARY CLUB OF MONROVIA, LIBERIA • Working directly with the Ministry of Health and Social Welfare • Solicited funds to buy locally available items (ie fuel, per diem, medicine, mattresses, buckets, etc.) and most importantly: community awareness. • Washing buckets and chlorine solution to communities. • Reading and activity packets for primary school children at home (schools are closed). • Also developing grants to support orphans, create ongoing local health sector scholarships, and restocking of hospital needs (also in cooperation with Medical Supplies Network).
  • 32.
  • 33.
  • 35. Concerning outbreaks on the horizon…
  • 36. Vaccine-Resistant Poliomyelitis “Robustness against serum neutralization of a poliovirus type 1 from a lethal epidemic of poliomyelitis in the Republic of Congo in 2010” • 45% mortality • Those who died were already vaccinated

Editor's Notes

  1. Presenter’s Notes The notes below and on each slide are intended for you, the presenter, to use as you deliver your presentation. These notes provide background information for the text on the slides as well as optional activities you can incorporate to make the presentation more interactive. Your audience may be your club, members of various clubs, or a single club that is not your own. Please adjust the language (our vs. your) to fit your audience. Activity Ask participants the following questions: What is your club like? Is it lively and fun? Is it diverse and open to new ideas? Are members actively involved? How can your club become more vibrant?
  2. Add image
  3. Yambuku village in Zaire, Belgian missionary, A Belgian nun taken ill, a Belgian doctor sent her blood sample to a Antwerp Belgium in a commercial flight in a passenger baggage. In the lab it was received by Dr. Peter Piot a clinical microbiologist,
  4. who under electron microscope saw this spagetti shaped virions, he did not know what they were, they looked like marburg virus, so he sent the foto to other experts in the world. They confirmed that it was not marburg virus. That was the moment of discovery for Piot. The nun died and several villagers were affected by similar illness and were dying. Piot travelled to Yambuku and
  5. Investigated the epidemic through detailed history taking and maps to make connections. In three months time they carried out extensive isolation of cases and contacts. They thought of naming the virus after the Yambuku village but thought that it would stigmatise the village, so they name the virus after the nearest river, the Ebola River.
  6. 2 to 21 days after exposure 8-10 days is most common. Lack of significant immune response to the virus at the time of death
  7. Cases in Italy and USA were due to lab monkeys exported from Philippines
  8. Transmission between natural reservoirs and humans is rare, and outbreaks are often traceable to a single case where an individual has handled the carcass of a gorilla, chimpanzee, or duiker.[5] The virus then spreads person-to-person, especially within families, hospitals, and during some mortuary rituals where contact among individuals becomes more likely. Consumption of bat soup. Transmission through air has not yet been confirmed. There is evidence of a carrier state but this has not yet been established. (3) Those at highest risk include Healthcare workers Family and friends of patients with Ebola
  9. Transmission between natural reservoirs and humans is rare, and outbreaks are often traceable to a single case where an individual has handled the carcass of a gorilla, chimpanzee, or duiker.[5] The virus then spreads person-to-person, especially within families, hospitals, and during some mortuary rituals where contact among individuals becomes more likely
  10. Each club should have a strategic plan with a vision statement that describes where it wants to be in three to five years, as well as long-range goals to support that vision. All club members should have an opportunity to provide input on the plan to maximize innovative and diverse ideas. Planning for the future keeps your club relevant to the community. It helps the club accomplish more significant projects over a longer period of time, with sustainable results. Activities Ask participants the following questions: What vision do you have for your club? What is special about your club? What does your club do well? Ask participants to think about what their vision for the club would be. Give participants copies of the Strategic Planning Guide to help members understand the idea of strategic planning and begin thinking about their clubs’ strategic plans.
  11. A strategic plan provides a “big picture” view of the club’s future. But for a club to achieve its long-range goals, it needs to break them down into smaller annual goals that can be achieved in each of the years covered by the plan. Rotary Club Central is a tool designed to help your club develop its annual goals. Setting goals ensures that your club is always striving to improve rather than simply accepting current practices. Activity Ask participants the following questions: What are your club’s annual goals? How were these goals set? Who is responsible for entering the goals in Rotary Club Central?
  12. Communicate club activities, news, and events on social media sites and club websites. Clubs can choose which methods to use, but they should keep the lines of communication open and establish a plan for sharing information. Club members’ needs should be known and expressed to club leaders and, at times, to district leaders. Likewise, district initiatives should be communicated to club leaders and members. Social media is growing in popularity and offers a great way to share information. Activities Ask participants the following questions: Why do you visit your club and district websites? What would you like to see on your club and district websites? Pair members who are familiar with social media (for example, Facebook and LinkedIn) with a member who is not. Have them discuss the benefits of social media and the types of information shared through online social networks, as well as how to create an account.
  13. Work together to compare your club’s current practices with each of the best practices listed in the guide. For areas that need improvement, think of new ideas and decide how to implement them. Implementation takes time, but it is worth the effort. Activity Ask participants the following questions: What other best practices should our club consider? What questions or comments do you have?