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C228 Task 2 1 Task 2 Western Governors University International Outbreak A. 2014-2016 West Africa Ebola outbreak Viral hemorrhagic fever (VHF) refers to a group of illnesses caused by 4 distinct families of viruses. Their common features include sudden onset, fever, multisystem failure, and damage to the vascular system causing endothelial damage and bleeding. Ebola virus is one of 18 VHFs recognized by the CDC. It was first discovered in 1976 in what the Democratic Republic of Congo is now. (CDC; What is Ebola Virus, 2019). I will be discussing the 2014-2016 West Africa outbreak. B. Description of a chosen international outbreak Over the last 44 years, there have been multiple Ebola outbreaks. What came to be the first case in the 2014-2016 West Africa Outbreak was reported in December 2013. It set in motion the largest outbreak of Ebola in history that would last 2.5 years, involving 10 countries, and 3 continents. The first case of the 2014-2016 West African Ebola outbreak was reported at the end of December 2013, involving a 2-year-old boy from a small village in Guinea, West Africa. After 2 days of fever, bloody stools, and vomiting he died. His sister contracted Ebola on January 1, 2014 and died 4 days later. The boy’s mother, grandmother, and a friend from Sierra Leone became sick days later and
died within the week. The people infected by these initial cases spread the disease to other villages in Guinea. These first cases were initially thought to be caused by the Lassa virus. Ebola was not recognized until March. Dr. Pierre Formently heard there had been transmission following funerals and among health care workers. Dr. Formently requested the samples be sent to Geneva by the World Health Organization (WHO) to be tested for Marburg and Ebola. Those test samples were confirmed to be Ebola Zaire on March 21, 2014. On March 23, 2014, the WHO published an official notification on its website. (WHO: Ground zero in Guinea, n.d.) The outbreak spread quickly to Conakry, Guinea’s capital, a large urban city. Soon cases began showing up in the neighboring country of Liberia. By mid-April 2014 it was reported in four counties in Liberia. The outbreak then spread to Sierra Leone and progressed quickly. By July 17 th , 2014, the total number of suspected cases in the country was 442, exceeding the number in Guinea and Liberia combined. (WHO: Ebola Response Roadmap Update, 2014) As the outbreak progressed, cases were identified in Nigeria in July 2014, and Mali in October 2014. Although Senegal closed its borders to Guinea in March, they announced their first case at the end of August 2014. (WHO: Ebola Situation Reports: Archive, n.d.) The United Kingdom reported its first case in December 2014 when an infected British aid worker returned from Sierra Leone. (Carrell et al. 2014) Italy’s first case was reported in May 2015 when a nurse working in Sierra Leone tested positive after returning home. (Reuters Staff, 2015) Spain reported their first Ebola case in August 2014 when a missionary Priest volunteering in Liberia became infected. (Agencias, 2014) On September 30, 2014, the CDC declared its first case of Ebola when a man that became infected while traveling in Liberia came home to Dallas. He returned home on September 20, 2014, became ill September 26, 2014, tested positive on September 28, 2014, and died on October 28, 2014. (Botelho, Wilson, 2014)
B2. Route of Transmission Ebola is extremely contagious. Animal to animal transmission occurs when bats carrying this virus infect other animals. Animal to Human transmission (Spillover events) occur when humans come into contact with disease-ridden animals’ blood and body fluids. Human to human transmission occurs only through direct contact with infected body fluids It enters the body through broken skin, eyes, mouth, or other mucous membranes. It is not spread through the air or casual contact. There is a 2-21-day incubation period before the person is symptomatic. People infected with Ebola are not contagious until they begin having symptoms. People who have died from Ebola remain contagious after death. (ISDA. Ebola Facts, 2019) Human to human transmission occurs after contact with blood or bodily fluids of an infected person, by contact with the body of a person who had died of Ebola, or by contact with objects contaminated from an actively ill infected person. It is now known that Ebola can be spread through sexual contact in semen. Ebola can be present in semen for many months after recovery. (CDC: Transmission, 2019) As stated earlier, the human to human transmission of the 2014-2016 West Africa Ebola outbreak began with a 2-year-old boy in southeast Guinea and spread to some of his family members. Human to human transmission continued, and people visiting these parts of Africa who were infected, went home, taking the virus with them across international borders. Eventually, 10 countries were involved. In March 2016 the WHO lifted the ‘Public Health Event with International Concern’ status of this outbreak. A total of 28,616 cases of Ebola and 11,310 deaths were reported in Guinea, Sierra Leone, and Liberia. An additional 36 cases and 15 deaths occurred in other countries. According to the CDC, at this time Ebola poses little risk to travelers or the general public who have not cared for
or been in close contact (within 3 feet) with someone sick with Ebola. (CDC: Transmission, 2019) B3. Impact on Community As we have learned from the COVID:19 pandemic, an Ebola virus outbreak would have a profound impact on our lives on many levels. The loss of life would be staggering, leaving families shattered and children orphaned. In Africa, many of the long-held traditions, like burial practices, had to be altered to decrease the risk of exposure. As a nurse in the ICU during the COVID pandemic, I have seen patients left to die alone because visitors were not allowed in the hospitals. Social distancing and mandatory quarantines can lead to isolation, depression, and suicide. Schools would be closed down, requiring on-line education for some, and complete loss of education for others. Children that rely on school meals would be left without adequate nutrition. Parents of young children may not be able to work because of a lack of daycare. Closing down the economy leaves some people unemployed, without the ability to support their families. Even those that keep their jobs may be furloughed for some time depleting their PTO. The essential employees, like health care workers and cashiers, put themselves in the line of fire every day, causing anxiety about bringing the disease home to loved ones. It was unbelievable to see the lack of PPE and medical equipment that we experienced with COVID. Similar to the impact of COVID, the effects of an Ebola outbreak on our economy would be staggering, causing reduced productivity, Local restaurants, stores, and companies unable to compete with large corporations may be forced to close down, creating a snowball effect on unemployment. The most surprising thing to me about COVID has been the amount of anger and turmoil throughout
infection control nurse is responsible for completing the EDP1 reporting form and send it to the Roanoke City Health Department. The local health department will collect and examine information regarding the patient, dates, and history of the illness, symptoms experienced, and exposure history. They will initiate Contact Tracing. This is the process of identifying everyone who has come into direct contact with the patient. These contacts will be monitored for symptoms of Ebola for 21 days from the date of potential exposure. If this person develops symptoms, they will be isolated, tested and all people in direct contact will be monitored for 21 days. The WHO considers an outbreak over after 42 days have passed with no new infections. B5. Two Strategies to Prevent an Outbreak in My Community Education is the most important strategy for the prevention of Ebola outbreaks. Anyone that lives in or will be traveling to a region where the Ebola virus is present should know the facts. Avoid: -Contact with blood and body fluids of persons who are ill. -Contact with semen from a man who has recovered from the Ebola virus until testing verifies the virus is no longer in his semen. -Items that may have come into contact with an infected person’s blood or body fluids. -Funeral or burial rituals that require handling the body of someone who died from Ebola. -Contact with bats and nonhuman primates’ blood, fluids, or raw meat prepared from these animals. -Contact with the raw meat of an unknown source. -Wash hands frequently.
Healthcare workers caring for patients with Ebola must receive comprehensive training and demonstrate competency in performing Ebola-related infection control practices and procedures including proper PPE when in contact with any person with confirmed Ebola or any person under investigation for Ebola. The CDC has also created an algorithm for hospitals to follow when encountering anyone that has symptoms of Ebola and has traveled to an Ebola virus area or had contact with a sick person that has traveled to an Ebola virus area. After leaving an Ebola virus area, people should watch for changes in their health for at least 21 days. If they become symptomatic, they must seek medical care immediately. (CDC: Prevention and Vaccine, 2019) Another strategy for prevention is to get the vaccine if you will be in an Ebola virus area. The U.S. Food and Drug Administration (FDA) approved the Ebola vaccine rVSV-ZEBOV on December 19, 2019. It is a single dose vaccine that is safe and protective against ONLY the Zaire ebolavirus species of ebolavirus. (CDC: Prevention and Vaccine, 2019)
References
Centers for Disease Control and Prevention (CDC). “What is Ebola Virus Disease?” (2019, November 05). Retrieved September 12, 2020, from https://www.cdc.gov/vhf/ebola/about.html CDC. “2014-2016 Ebola Outbreak in West Africa.” (2019, March 08). Retrieved September 12, 2020, from https://www.cdc.gov/vhf/ebola/history/2014-2016- outbreak/index.html
CDC. “Signs and Symptoms.” CDC, 2019. Retrieved from https://www.cdc.gov/vhf/ebola/symptoms/index.html. ISDA. “Ebola Facts.” Www.Idsociety.Org. (5 Nov. 2019) Retrieved from https://idsociety.org/public-health/ebola/ebola-resourses/ebola-facts/. CDC. “Case for Ebola Virus Disease (EVD).” CDC, 2019. Retrieved from https://www.cdc.gov/vhf/ebola/clinicians/evaluating-patients/case- definition.html. CDC. “Prevention and Vaccine.” (2019, November 15). Retrieved September 14, 2020, from https://www.cdc.gov/vhf/ebola/prevention/index.html.
