Prevention of Ebola infection

1. Prevention and Control of Ebola
virus
Prevention, the cornerstone
NO TREATMENT
NO VACCINE
"There's no treatment under the sky
There's only to suffer and die"
- Dr. Rajarshi Gupta

2. Dynamics of the 2014 outbreak- What's different?
For any infection of epidemic proportions we have the
standard SIR model
R(removed/dead) death/removal
rate
S(susceptible) I(infected)
Infection
rate
Longer the person
stays infected and
symptomatic,the
more he spreads

3. Major Zaire subtype outbreaks till
date
Place Year Cases Fatality %
Zaire 1976 318 88
Republic of
Congo
1995 315 81
(formerly
Zaire)
Gabon 1996 60 74
Republic of
2002 143 89
Congo
Republic of
Congo
2007 264 71

4. Dynamics of the 2014 outbreak
S(susceptible) I(infected) R(removed/dead)
Infection
rate
death/removal
rate
Longer the person stays
symptomatic, more he
spreads
2014 epidemic Zaire
subtype has a fatality
of 55.3%
Patient stays symptomatic
longer and transmits infection
to more people
2014 Guinea, Liberia,
Sierra Leone,
Nigeria
1603
case
s
887 deaths (55.3%)
Courtesy World Health Organization,as of August 6, 2014

5. Role of mass media - The public
panic dilemma
Also called " Infection of the mind"
OR
"Thought contagion"
Public panic fueled by mass media before adequate
prevention policies are laid down by bodies like
WHO/CDC, can cause epidemics to worsen by,
1. General mistrust of public in authorities
2. Measures taken by people themselves without adequate
knowledge

6. CITY A
(affected)
Premature panic
generated by mass
media, escape to safe
city
CITY B
(unaffected)
Symptomatic
Incubating +
Carriage of infection to susceptible
unaffected cities because
people in affected cities
panicked,
yet didn't know how to
prevent infection spread
from symptomatic
patients

7. OTHER HORRORS OF LACK OF
KNOWLEDGE THAT PREVENT
DISEASE CONTAINMENT
Dead bodies dumped into street in Liberia by panic stricken
relatives, to avoid identification by government and risk been
ostracized by community or kept in quarantine
Courtesy dailymail.co.uk

8. Patient isolation
Preferably a separate building
If not possible a separate place in same
building
Well ventilated
Strictly meant for authorised personnel only

11. Single patient self contained
isolation unit
Entry/Exit

12. Multiple patients' self contained
isolation unit
Entry/Exit

13. Personal Protective
Equipment(PPE)
Instructions as per the CDC guidelines
To be strictly adhered to
And the sequence to be followed exactly as
stated

14. Before attending to patient

17. Edge of the
second pair of
gloves should
be over the
cuff of the
gown

18. Normally, a triple layered facemask
to prevent splashes
HEPA filter masks or N95 masks
when performing aerosol generating
procedures eg. intubation

20. After attending to patient

22. Disinfect outer gloves in soapy water
and dispose them in waste buckets

28. • Remove inner layer of clothes and dress
in street clothes.
• Wash hands with soap and clean water
before leaving.

29. BLEACH SOLUTIONS
Ordinary bleach solution has a 5% chlorine
concentration.
1:10 bleach is a solution with 0.5%(w/v)
chlorine concentration.
1:100 bleach is a solution with 0.05%(w/v)
chlorine concentration.
* 0.5% chlorine is caustic and corrosive so
ordinarily not used in disinfection

30. Disinfect Reusable Supplies and
Equipment
With 1:100 bleach solutions prepared daily
Thermometer ( soak 10mins, then air dry)
Stethoscope ( wipe metal part for 30secs, then air dry)
Bedpans, buckets, utensils ( soak for 15 mins, then air dry,
wash with soap water)
Laundry itemslike gowns, sheets ( soak for 30 mins, then
soak overnight in soapy water, scrub,rinse and dry)

33. Disposal of non-reusable waste
Disinfect
Carry in secure containers to incineration site
Site should be away from populated areas
Burn in sufficient amount of fuel
Restrict access to children who might pick up things
Restrict access to animals who might spread waste
Deep burial of incineration ash(at least 2 metres)
Waste sharps to be shredded and disinfected or autocalved
Used disinfectants if not poured down drains, to be burnt
with waste

34. Dead body disposal
1. Place the body in a “body bag” (mortuary sack) and
close it securely. Spray the body bag with 1:10 bleach
solution.
2. Shortest route to burial site
3. Atleast 2 meters deep burial ground. Burial staff must
have Personal Protective Equipment(PPE).
4. Counsel family that body can't be viewed
5. Counsel family that only close members are allowed for
burial
* Driver need not wear protective clothing if he does not
come in contact with body

35. PPE while burial - CORRECT
People standing around - WRONG

36. Disinfection of vehicle after transporting patient

37. Contact tracing
Identify Patient’s Contacts and Travel History
Ask the patient (or a family member who can answer for the patient):
1.Where do you live?
2.When did the symptoms begin?
3.Who else is sick in your family (or village)?
4.Where have you travelled recently?
Use the answers to identify others who had contact with the
patient. Provide them with information about VHF and when to seek
care.

38. Identify Key Community Resources
Businesses
Schools
Sports clubs and other recreational clubs
Service organizations
Volunteer organizations and community service groups
Sports clubs and other recreational clubs
Service organizations
Volunteer organizations and community service groups.

39. Meet with Community Leaders and Assess the
current Situation

40. Describe the Target Population
Maps of the town
The size of the population
Major ethnic groups in the town
Locations of any special populations such as refugees or
squatter settlements where the risk of disease transmission
may be particularly high
How many people may be affected by the outbreak
The populations at greatest risk

41. Describe modes of transmission
Describe actions necessary
Develop specific messages
- Door to door
- Mass media
-Posters and banners
- Via churches, mosques, religious leaders

42. Some posters being used to demonstrate
prevention in community( CDC, WHO,
UNICEF)

49. Everything boils down to Standard
precautions
1. Hand hygiene
2. Gloves
3. Facial protection
4. Gown
5. Prevention of needle stick injuries and injuries from other
sharp instruments
6. Respiratory hygiene and cough etiquette
7. Environmental cleaning
8. Proper handling of linen
9. Biomedical waste management
10. Proper handling of patient care equipment
Courtesy World Health Organization, October 2007

50. Practical viewpoint: Precautions for
vascular access in Ebola patients
No additional precautions required
Standard precautions as per Occupational
Safety & Health Administration(OSHA) ie.
OSHA's Bloodborne Pathogens Standard

51. Monitoring and Movement of Persons
with Ebola Virus Disease(EVD) Exposure
High risk exposure
(needle stick injuries
infectious splash
lab work without PPE
Symptomatic
funeral rites without PPE)
Full evaluation
with infection
control
precautions for
EVD and
contact history
Air medical transport only, if
transport of patient is
clinically indicated
NO PUBLIC
TRANSPORT

52. Monitoring and Movement of Persons
with Ebola Virus Disease(EVD) Exposure
High risk exposure
(needle stick injuries
infectious splash
lab work without PPE
funeral rites without PPE)
Asymptomatic
or
symptoms
evaluated and
not likely to be
EVD
Conditional release and controlled movement
until 21 days after last known exposure

53. Monitoring and Movement of Persons
with Ebola Virus Disease(EVD) Exposure
Low risk exposure
(Household member,
casual contact with patient)
Conditional release and controlled movement
until 21 days after last known exposure

54. Conditional release:
Monitoring by public health authority;
Twice-daily self-monitoring for fever;
Notify public health authority if fever or
other symptoms develop

55. Controlled movement:
Notification of public health authority; no travel
by commercial conveyances (airplane, ship, and
train);
Local travel for asymptomatic individuals (e.g.
taxi, bus) should be assessed in consultation
with local public health authorities;
Timely access to appropriate medical care if
symptoms develop

56. Preventive steps in India
23063205
} Helpline made operational since
23061469
August 10, 2014 morning
23061302 Airport surveillance for symptomatic individuals
Preparing centres for management of possible
Ebola cases

57. Summary
• Ebola is a viral hemorrhagic fever normally
circulating in fruit bats and wild animals
• A BSL-4 pathogen, spreads through body fluid
contact
• High case fatality
• Humans are accidental host
• No treatment, no licensed vaccine
• Prevention is the only cure
• Active surveillance necessary to identify sources
and susceptibles

58. THANK YOU

59. References
• Infection Control for Viral Haemorrhagic Fevers in the African Health Care Setting;
World Health Organization, Centers for Disease Control and Prevention
• Interim Guidance for Monitoring and Movement of Persons with Ebola Virus Disease
Exposure, Centers for Disease Control and Prevention,August 2014
• Interim Recommendations for Hospitalized Patients with Known or Suspected Ebola
Hemorrhagic Fever in U.S. Hospitals, Centers for Disease Control and Prevention
• On the existence of a threshold for preventive behavioral responses to suppress
epidemic spreading
Faryad Darabi Sahneh, Fahmida N. Chowdhury & Caterina M. Scoglio
Scientific Reports 2, Article number: 632 Received 19 June 2012
doi:10.1038/srep00632 Accepted 25 July 2012 Published 05 September
• 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious
Agents in Healthcare Settings, Centers for Disease Control and Prevention