3112021 What Is Ebola 1 Ebola is a

3/11/2021 • • What Is Ebola? 1 Ebola is a severe and often deadly disease that causes fever and other symptoms accompanied by bleeding. The virus is animal-borne. Although bats are the likely hosts/carriers, the direct species is unknown. How do you get the Ebola virus? Direct contact with a symptomatic patient through broken skin and/or unprotected mucous membranes such as eyes, nose, or mouth with: • Body fluids of a person who is sick with or has died of Ebola (blood, vomit, urine, feces, sweat, semen, other fluids) • Objects contaminated with the virus (needles, medical equipment) • Infected fruit bats or primates • Infected bush meat (contact made through hunting, butchering, or processing of meat). This is specific to regions where bush meat is consumed. Ebola Risk People with highest risk of getting sick are those that may come into direct contact with infected blood or bodily fluids of sick patients: • Care providers for Ebola patients in clinic, household, or community settings • Family and friends in close physical contact with Ebola patients • Individuals who physically handle remains of the deceased It is essential that those caring for infected persons and/or handling the deceased wear appropriate specialized personal protective equipment if and when available. You are NOT at risk if you have NOT had direct contact or exchanged bodily fluids with an infected and/or deceased person; or handled meat and/or have been exposed to animals that are infected with or deceased due to Ebola. http: //www. cdc. gov/vhf/ebola/about. html

3/11/2021 Ebola Symptoms Early Signs & Symptoms • • • 2 Low fever Weakness/fatigue Joint and muscle aches Severe headache Chills Loss of appetite Advanced Symptoms • High fever (greater than 38. 6 °C or 101. 5 °F) • • • Nausea and vomiting Raised rash Diarrhea (may be bloody) • • Chest pain and cough Stomach pain Severe weight loss Bleeding, usually from the eyes, and bruising (people near death may bleed from other orifices, such as ears, nose & rectum) • Internal bleeding http: //www. cdc. gov/vhf/ebola/symptoms/index. html Humans are not infectious until they develop symptoms. Following exposure, when would one feel sick? • Incubation period range: 2 -21 days from time of exposure to onset of symptoms • After 21 days without developing symptoms, a person is unlikely to become sick from that exposure. • Average incubation period: 8 -10 days from time of exposure to onset of symptoms • Simply because you don’t get infected from an initial exposure does not mean you are no longer at risk of infection with another exposure http: //www. who. int/mediacentre/factsheets/fs 103/en/

3/11/2021 Ebola Diagnosis & Treatment 3 Ebola Diagnosis Ebola infections are confirmed through laboratory testing of blood samples. Vaccine There is no vaccine for Ebola Treatment To date, there is no specific treatment for Ebola. Patients are given supportive care, the earlier the better, to help their immune system fight off the virus, including: • Providing intravenous fluids (IV) and oral rehydration care • Maintaining oxygen status and blood pressure • Treating of other comorbidities/infections when and/or if they occur. Recovery from Ebola depends on the patient’s immune response. When is someone able to spread the disease to others? (Ministries of Health should provide guidance about how to properly respond to exposures, provide care, and arrange for the disposal of bodies of Ebola patients) • • • Experimental Treatments • • • Patients are required to give informed consent for experimental treatments. ZMapp - currently not approved by United States FDA - has been used to treat infected patients. Additional treatments are under investigation. http: //www. cdc. gov/vhf/ebola/outbreaks/2014 -west-africa/qaexperimental-treatments. html • Humans are not infectious until they develop symptoms. People remain infectious as long as their blood and body fluids, including semen and breast milk, contain the virus. Ebola Virus remains in semen even after recovery, therefore sexual transmission has yet to be ruled out. Recovered men should abstain from all forms of sex or use condoms every time. Burial ceremonies in which mourners have direct contact with the body of an infected person can transmit Ebola. Volunteers should not participate in burials. http: //www. cdc. gov/vhf/ebola/treatment/index. html

3/11/2021 4 The Current West African Outbreak The hemorrhagic fever outbreak that began in 12/2013 was first confirmed to be Ebola in March 2014. It is the largest and most widespread outbreak that has occurred since the virus was identified in 1976. Liberia, Guinea, and Sierra Leone have been most heavily affected. Originating in Guinea, both exposure and infection have spread across land borders to Sierra Leone and Liberia, by air through travelers to Nigeria and the United. States, and by land to Senegal and Mali. International caregivers from Spain and the United States have been reported to be infected with Ebola. http: //www. cdc. gov/vhf/ebola/outbreaks/2014 -west-africa/distribution-map. html On August 8, the World Health Organization Director-General declared this outbreak a Public Health Emergency of International Concern. Currently, it is difficult to assess how much longer and how many more cases and deaths will be attributable to this outbreak. However, international emergency health response efforts are being employed in partnership with various ministries to mobilize and expand treatment, improve contact tracing/monitoring of exposures, and enhance preventative health education resources across the region. Official Numbers The number of confirmed, probable, and suspected cases changes daily. Visit http: //www. who. int/csr/disease/ebola/en/ for up-to-date information. http: //apps. who. int/ebola/en/current-situation

3/11/2021 Implications of Ebola for the Peace Corps 5 On July 30, 2014, the Peace Corps evacuated its volunteers from Liberia, Sierra Leone, and Guinea due to the increasing spread of Ebola. Volunteers and staff members who believe they are at risk for exposure to the Ebola virus are encouraged to: v Notify health officials (your Peace Corps Medical Officer) immediately if they become ill, and are to follow the PCMO's instructions for further evaluation or treatment. v Continue to practice safe hygiene and handwashing with warm water and soap, or water and bleach solution. v Avoid direct contact with any individual with an unexplained feverish illness. v Avoid bush meat, especially contact made through hunting, butchering, or processing of meat. This is specific to regions where bush meat is consumed. v Contact their PCMO if they feel unsafe at their site. http: //www. peacecorps. gov/resources/fafhealth/ebola/ Challenges of the Outbreak Health Care Workforce • Limited health care staff • Health care staff/ caregivers are being infected with the virus Stigma: • The stigma associated with Ebola infection results in a hidden caseload (patients not going to clinic for care) http: //www. who. int/csr/disease/ebola 6 -months/surprises/en/ Travel Considerations for Volunteers and Staff v State Department advises not to travel to Liberia, Guinea, Sierra Leone, or other countries identified as having an ongoing Ebola outbreak v Advised to review in-country re-entry regulations for individuals who have traveled to Ebola-affected countries

3/11/2021 How do I talk to my community about Ebola? Informing communities about how to protect themselves from the virus and what 6 to do if they or someone they know becomes infected requires intensive and coordinated messaging and education. The Peace Corps recommends that any information shared by Volunteers are aligned with your country-specific messages. If conducting education and preparedness activities around Ebola, consider the following: Be aware that some communities might… • • • Perceive corpses are treated poorly (images of poorly disposed body bags are seen as a culturally unacceptable/ disrespectful way to handle the deceased) Lack trust in Ebola treatment centers (viewed as a place where people go to die) Avoid going to treatment facilities because of insufficient space (not enough beds discourages individuals from seeking treatment) Challenges • • • Perceived risk of Ebola infection by communities is low Behavior change takes time Need consistent and persistent messaging, education, and awareness Some communities lack trust in government as a source of information Need for messages to be delivered through a mix of methods: community health workers, radio announcers, TV spots, theater/dramas, etc. High illiteracy rates require messaging techniques to be tailored accordingly. Recommendations for Ebola Education Efforts • • Use more graphic messaging & face-to-face prevention awareness & education. Generalized messages have been ineffective and lose credibility. Tailor messages to cultural norms, beliefs, and practices relevant to the audience being targeted. Educate religious/community leaders to dispel myths and rumors, and to address stigma or discrimination Utilize leaders and survivors to deliver messages because they help demystify the disease and break down stigma and discrimination Source: UNICEF Social Mobilization Guidelines

3/11/2021 7 Considerations for Peace Corps Volunteers Working in Health Facilities If Your Clinic Is Exposed Clinic Exposure: (Arrival of patient with sign/symptoms*) Do NOT touch/ work with patient in any way Follow any evacuation instructions Contact PCMO (PCMO will notify CD and follow other Embassy or Government protocols) If a Volunteer Is Exposed (You came in contact with fluids or blood of suspected Ebola case) Contact PCMO (PCMO will notify CD) Do Not return to clinic until advised Await confirmation of exposure from PCMO *Fever or headache, muscle pain, weakness, vomiting, diarrhea, abdominal pain, hemorrhage in a country with Ebola. http: //www. peacecorps. gov/resources/fafhealth/ebola/ If confirmed, isolate & take temperature twice/day for 21 days post-exposure Follow guidance from PCMO & country office Working with health facility staff on Ebola preparedness. Components of emergency preparedness plans that health facilities have included when designing their Ebola response Train/Detect Identify Patients: Understand signs and symptoms Understand screening criteria Designated triage/treatment area Identify patient transportation Information Management: - Understand/obtain in-country guidelines for prevention and control - Maintain awareness of cases in country Protect Equipment: Personal protective equipment (PPE) can reduce risk of transmission. Check with your facility leadership regarding local policies and availability. Environment: - Identify space to triage/isolate patients - Identify spaces to put on and remove PPE if available - Identify space and protocols to dispose and clean contaminated materials Response Hygiene: - Handwashing station Reporting: - Identify points of contact for health officials and staff - Identify reporting structure http: //www. cdc. gov/vhf/ebola/healthcare-us/index. html

3/11/2021 Ebola Resources 8 Given the evolving status of the Ebola outbreak, please note that these current resources and information may change. GENERAL INFORMATION U. S. Centers for Disease Control and Prevention: www. cdc. gov Peace Corps: http: //www. peacecorps. gov/resources/fafhealth/ebola/ WHO: http: //www. who. int/mediacentre/factsheets/fs 103/en/ http: //www. who. int/csr/disease/ebola/en/ UNICEF: http: //www. unicef. org/emergencies/ebola/ Department of State (Travel): http: //travel. state. gov/content/passports/english/go/Ebola. html COMMUNITY MOBILIZATION UNICEF: http: //www. unicef. org/cbsc/files/Ebola_Social_Mobilization_Training_Guidelines 2014. 7. 2. docx http: //www. unicef. org/cbsc/index_73157. html The Health Communication Capacity Collaborative: http: //ebolacommunicationnetwork. org/ Others: http: //1 millionhealthworkers. org/2014/08/21/chws-the-2014 -ebola-crisis-anopportunity-for-community-level-care/ http: //www. hrhebolaresources. org/ https: //www. devex. com/news/ebola-communication-what-we-ve-learned-so-far 84559 https: //www. devex. com/news/the-problem-with-ebola-communication-84283 OTHER RESOURCES Intra. Health: http: //www. hrhebolaresources. org/ CDC Resource Page: http: //www. cdc. gov/vhf/ebola/resources/index. html? s_cid=cs_021 Wired Online Educational Module: http: //www. wiredhealthresources. net/modebola. html Contact your country Peace Corps Medical Officer for additional support.