Ebola

An epidemic of ebolavirus in West Africa, which was first identified in March 2014, is now the largest Ebola Virus Disease (EVD) outbreak on record. On 8 August 2014, the WHO declared the Ebola outbreak in West Africa a Public Health Emergency of International Concern (PHEIC). As of 4 September 2014, Guinea, Liberia, Sierra Leone, and Nigeria have reported 3,707 cases (2,106 confirmed, 1,003 probable, and 598 suspected) of EVD with 1,848 deaths (50% case fatality) to the World Health Organization (WHO). Five U.S. citizens have contracted the viral disease – one LiberianAmerican and four medical-aid workers working in Ebola-afflicted countries.

Objective

To categorize and assess the international and domestic health impacts of the 2014 West African Ebola Virus Disease outbreak.

The 2014 Ebola outbreak in West Africa is one of the largest Ebola outbreaks in history. Early detection is critical for rapid initiation of treatment, infection control and emergency response plans. To facilitate clinicians’ ability to detect Ebola, various syndrome definitions have been developed.

Objective

To develop and validate an Ebola virus disease syndrome definition within the GUARDIAN (Geographic Utilization of Artificial Intelligence in Real-Time for Disease Identification and Alert Notification) surveillance system.

The 2014 outbreak of EVD is the largest and most complex Ebola outbreak since 1976 affecting several countries in West Africa. The mental health and psychosocial implications of the 2014 Ebola outbreak are serious and multifaceted, impacting survivors, families, communities, healthcare providers, and the public health response. In addition, psychosocial support is a key priority to the Ebola response. CDC’s Ebola Mental Health Team (EMHT) was activated in September 2014. This study has been conducted to support the CDC’s EMHT tasks.

Objective

To present the summary results of a literature review pertinent to mental health and psychosocial aspects of Ebola virus disease (EVD).

Public health practitioners endeavor to expand and refine their syndromic and other advanced surveillance systems that are designed to supplement their existing laboratory testing and disease surveillance toolkit. While much of the development and widespread implementation of these systems had been supported by public health preparedness funding, the reduction of these monies has greatly constrained the ability of public health agencies to staff and maintain these systems. The appearance of H3N2v and other novel influenza A viruses required agencies to carefully identify which systems provide the most cost-effective data to support their public health practice. Recent Enterovirus D68 outbreaks, along with the global emergence of influenza A (H7N9), the global emergence of influenza A (H7N9), Middle East Respiratory Syndrome Coronavirus (MERS-CoV), Ebola virus strains, and other viruses associated with high mortality, emphasize the importance of maintaining vigilance for the presence of emerging disease.

Objective

To identify and characterize challenges experienced by public health practitioners conducting surveillance for the presence of influenza, novel respiratory diseases, and globally emerging viruses in an era of limited resources.

Ebola virus disease (EVD) is a severe illness that spread in the human population through human-to-human transmission. In the past, EVD outbreaks occurred in the rural communities of Africa, near tropical rainforests, but the most recent outbreak in West Africa has also involved major urban areas and big cities, with air travel playing an important role in its spread.On July 23, 2014, the EVD outbreak was declared in Nigeria following the confirmation of EVD in a traveller, who arrived acutely ill at the international airport in Lagos, South Western Nigeria from Liberia .The outbreak subsequently filtered to a South Southern Nigeria city, by a symptomatic contact who escaped surveillance in Lagos and flew to the South Southern city.

Objective

This study describes the epidemiological characteristics and the transmission dynamics of the EVD outbreak in a South-Southern city of Nigeria.

Existing EVD surveillance strategies in Sierra Leone use a centralized live alert system to refer suspect cases from the community to Ebola treatment centers. As EVD case burden declined in Port Loko District, so did the number of reported alerts. As EVD presents similarly to malaria, the number of alerts reported are expected to remain consistent with malaria prevalence in malaria-endemic areas, irrespective of a reduction in true EVD cases. Declines in reported suspect cases from the community alluded to the possibility that individuals were returning to healthcare centers to seek treatment for malaria, and that PHUs were not adequately reporting suspect EVD cases. District surveillance officers (DSOs) were used to investigate the usage of PHUs by community members, as well as the mechanisms that health center staff used in recording patient visits. Surveillance methods specific to PHUs were introduced to increase the number of reported EVD alerts, as well as establish the foundation for future integrated disease surveillance response strategies.

Objective

A community-based EVD surveillance system with improved symptom recording and follow-up of malaria positive patients at PHUs was implemented during low EVD transmission. The rationale and methodology in implementing a PHU-focused approach to strengthen surveillance system sensitivity is described.

Since the largest epidemic of Zaire ebolavirus (EBOV) in recorded history began in Guinea in December 2013, the epidemic has spread to neighboring countries of Liberia and Sierra Leone resulting in an estimation of over 27,000 total cases and over 11,000 deaths to date. In response to the widespread social disruption caused by this epidemic in West Africa, President Obama committed approximately 2,000 US service members to deploy to the region and provide humanitarian aid. US military physicians were called upon to evaluate service members returning from West Africa (WA) to rule out EVD. The US military also has a considerable number of beneficiaries who travel to WA to visit friends and relatives placing them at risk for exposure to EBOV and the development of illness upon returning to the US.

We are conducting an expanded surveillance program that employs a standard questionnaire that all providers can use when evaluating a patient at-risk for EVD that will also capture information from historical encounters. The data collected from the questionnaire will be used to assess the frequency with which clinicians are called to evaluate patients for EVD and the resources required. However, we realize that many encounters may not be captured with this method, especially those that are not high enough risk to require consultation with infectious disease (ID) specialists, and are developing ways to screen the Electronic Health Record (EHR) to find additional patients.

Objective

To present methods of screening chief complaints and laboratory orders to find patients who presented for Ebola Virus Disease (EVD) screening, in order to determine the impact Ebola concern had on the Military Health System (MHS).

Port Loko District has had over 1400 confirmed EVD cases during this outbreak. However, transmission declined rapidly in early 2015; by mid-April, a few weeks had passed with no known cases. Simultaneously, reporting of sick persons had plummeted across the district and the number of deaths reported in some areas was fewer than expected. These circumstances signaled the need for the EVD surveillance system to broaden its focus from using district surveillance officers (DSOs) to respond to reports of ill and deceased persons (hereafter, “sick and death alerts”) to a more proactive and comprehensive system that relied strongly on community engagement and surveillance through existing structures such as Peripheral Health Units (PHUs), schools and local authorities. While the involvement of local authorities and the community had been central to reporting suspected EVD cases earlier in the outbreak, the decrease in alerts suggested that engagement was diminishing. The reopening of schools and reemergence of the primary healthcare system provided opportunities to decentralize surveillance and strengthen the involvement of these structures. The primary objective was improving EVD surveillance, but the effort was also used to bolster routine surveillance, in preparation for implementating Integrated Disease Surveillance and Reporting.

Objective

Describe the evolution of Ebola Virus Disease (EVD) surveillance from a largely reactive system structured primarily around responding to reports of illness and death, to one that was more methodical, proactive and comprehensive