Lecture 19 - Ebola in Liberia Flashcards
Family Filoviridae is divided into what 2 genera?
MARV and EBOV
T/F: The MARV genus contains single species.
TRUE
What are the 5 distinct species in the EBOV genus?
- BEBOV
- CIEBOV
- REBOV
- SEBOV
- ZEBOV
What does Filoviridae look like under a light microscope?
Thick, string-like
T/F: Cases of filovirus are due to the importation of cases that occur in places where the disease is endemic to
TRUE
In 2014-2015, the largest outbreak of Ebola recorded was due to what species?
ZEBOV
Where did the largest ebola outbreak begin?
Began in Guinea in late 2013 and spread to Liberia, Sierra Leone, Nigeria, Senegal, and Mali
What was the total number of laboratory confirmed, probable and suspected, cases attributed to EBOV?
28,616 of which 11,310 have been fatal
How is ebola transmitted?
Transmitted in body fluid of infected patients
- blood, feces, vomit
- possible through urine and semen too but less common
T/F: Risk of transmission related directly to amount of virus in the fluids
True, low in early illness but increases with time
Natural history of ebola
- Human and primates are end hosts, not reservoirs
- Bats might be hosts bc antibodies present in blood but no infectious viral particles isolated
- could be pigs too
What are the possible transmissions of ebola? (4)
- Animal to animal: bats carry virus and can spread to other animals, like apes, monkeys, and antelopes, as well as to humans
- Spillover event: when an animal or human becomes infected with Ebola virus through contact with reservoir host – ex: hunting or preparing animal’s meet for eating
- Human to human: once Ebola has infected first human, transmission of virus from one human to another can occur through contact with the blood and body fluids of sick people or with bodies of those who have died of Ebola
- Survivor: feel tiredness and muscle aches, can face stigma as they re-enter their communities
What are the clinical symptoms of ebola?
Nonspecific
- sudden onset fever, malaise, myalgia
- GI upset (vomiting, diarrhea)
- headache, fatigue, arthralgia in healing phase
- coagulation disorders
Hemorrhage seen in 20% of cases
Ebola in West Africa
- 1st reported human case in 2013-2016 epidemic involving 2 yr old in village of Meliandou
- thought to have originated from bats
- patient zero became ill 12/26/13
- family subsequently became ill
Which organizations became involved in trying to help control Ebola in West Africa?
- Guinea Ministry of Health, Ministry of Health, WHO AFRO, MSF
- WHO played a big role
What were the factors aiding to the spread of Ebola? (3)
- Ebola was not familiar to West Africa Health Practitioners up until this point (no lab experience, no govt experience)
- Equatorial Africa is familiar with the disease (lab and healthcare infrastructure present, disease normally happens in rural areas and is quickly contained)
- Widely porous borders with mobile populations (allowed virus to reach densely populated capital cities)
Why was Liberia at risk for Ebola? (5)
- Commodity rich country
- Difficult recent history given recent civil war
- Poor infrastructure in hospitals and transportation system
- Mobile populations
- Porous borders with neighboring countries
JFK Memorial Center in Monrovia
- severely damaged in the civil war
- poorly trained staff
- no isolation wards
- no protective equipment (gloves)
Why was Monrovia at great risk for Ebola virus? (4)
- city unprepared for arrival of virus
- spread quickly through slums
- treatment beds quickly filled up
- Liberia lost 200 medical professionals, the most of any country
MSF in Liberia
- Doctors without Borders (MSF) were first to respond to Ebola epidemic
- at its peak sent 4,000 national staff and over 325 international staff were sent to Guinea, Liberia, and Sierra Leone
- Ebola management centers were built (included psychological support, health promotion, surveillance, and contact tracing)
What are the protective equipment required when dealing with Ebola?
- Medical mask
- respirator
- overalls
- apron
- boots
- surgical cap
- goggles
- scrubs
- double gloves
MSF Triangle
Top to bottom
- one emergency coordinator
- one medical coordinator
- one physician
- two epidemiologists
- two water and sanitation specialist
Treatment center team and groups involved in MSF Liberia
Inside circle:
- physicians, nurses, pharmacists, psycho-social counselors
Outside circles:
- epidemiologists, PHW, field HR officers, anthropologists, military guards
Work Team Characteristics for Ebola outbreak in Liberia (7)
- Shared team goal: to reduce the spread, morbidity, and mortality of the disease
- Shared responsibility for achieving said goal: successes and failures with each patient in the treatment center were shared, reflected in case rates
- Defined membership: membership and roles in the treatment center are understood and clear
- Authority for taking action to achieve the goal: each member of the team has the training and authority to take action within their scope of practice, granted permission to work in Liberia
- Interdependency of team members: each person is responsible for their specialty, and buddy system used to make sure one person is not alone on a task
- Absence of independent sub-groups: no autonomy within subgroups – each decision made affected entire group that was volunteering
- Accountability to a larger organization: Doctors without Borders, WHO, MOH of Liberia
Operation United Assistance
- declared in 2014 to build 17 hospitals in Liberia
- first US military operation to support a disease-driven foreign humanitarian assistance mission
