Ebola Virus Disease Crisis in Western Africa Dr Marcos Espinal Director, Communicable Diseases and Health Analysis Washington DC, 24 September 2014

What is Ebola? A rare and deadly disease caused by infection with one of Ebola virus strains. It was discovered in 1976 near the Ebola River in what is now the Democratic Republic of Congo

The United Nations Security Council declared the Ebola crisis in West Africa to be a threat to international peace and security Resolution 2177 (18 September 2014)

As of 22 September 5800 cases have been reported and 2800 known deaths

Status of Ebola Outbreak 2014 West and Central Africa, as of 22 September 2014 Unprecedented Dynamic situation rapidly deteriorating Capacity of the international response being exceeded Unrelated simultaneous outbreak in DRC

Distribution of Ebola cases by week of onset West Africa, as of 22 September 2014

Multiple countries and multiple hotspots Capitals/large urban areas affected Cross border movement

National leadership and risk communication Outbreak control measures to stop transmission: Clinical Management and Infection Prevention Control Epidemiological investigation, surveillance and laboratories Behavioral and social interventions Logistics Strategy for the control of Ebola outbreaks Need for Complementary, community-led approaches essential and non conventional interventions

Public Health Emergency of International Concern (PHEIC) determined by WHO Director General on 8 August 2014 Temporary Recommendations States with Ebola transmission States with a potential or confirmed Ebola case, and unaffected States with land borders with affected States All States IHR Emergency Committee regarding the 2014 Ebola Outbreak in West Africa

WHO Ebola Response Roadmap WHO Ebola Response Roadmap

Strengthen preparedness in all countries to rapidly detect and respond to an Ebola exposure 1.Establish active surveillance for clusters of unexplained deaths or febrile illness 2.Provide the public with accurate and relevant information to reduce the risk of exposure - importance of risk communication 3.Establish a protocol for managing travelers who arrive at major land crossing points with unexplained febrile illness 4.Identify isolation units where suspected Ebola cases can be properly investigated and managed 5.Arrange a process for rapidly shipping diagnostic specimens to the WHO-recognized laboratories (US and Canada) What needs to be done in the Americas?

Considerations for the American Region (1) PAHO Actions: Preparedness activities 1.Director creates a strategic high level Task Force on Ebola* 2.An operational technical Working Group led by the Communicable Diseases Department 3.Alert & Response Team (24/7) 4.Virtual meetings with Ministry of Health personnel and PAHO Country Offices at weekly basis 5.Technical documents and guidelines for preparedness activities (surveillance, laboratory, points of entry, etc.) have been disseminated 6.Select country visits 7.Acquisition of supplies and personal protective equipment to assist priority countries 8.Close interaction\collaboration with sister agencies 9.Support to pre-deployment training to affected countries * Department Directors and PAHO Country Representatives

Considerations for the American region (2) Objective of ongoing public health efforts and preparedness activities: To contain and prevent establishment of local transmission of Ebola following the introduction of a case in a country previously free of the disease

Considerations for the American Region (3) Collaboration with international organizations -Travel and Transport Task Force: WHO, the International Civil Aviation Organization (ICAO), World Tourism Organization (UNWTO), Airports Council International (ACI), International Air Transport Association (IATA) and World Travel and Tourism Council (WTTC), OAS Inter American Committee on Ports -ICAO Electronic Bulletin -Facilitation of transport by air of infectious substances and infectious patients -Facilitation of relief flights undertaken in response to the emergency -Joint letter WHO-ICAO

Considerations for the American region (4) Preparedness activities Core capacities to meet the International Health Regulations requirements: Members States should build on existing Preparedness and Response mechanisms using the temporary Recommendations issued by the IHR Emergency Committee as basis to refine actions

Concluding Remarks 1.PAHO would like to stress the importance for Governments to support the implementation of the IHR not only involving Ministries of Health but also inter sectorial partners, such as airport and port authorities, customs and transport departments, civil defense, etc. 2.PAHO is working closely with its Member States regarding Ebola preparedness activities including activation of the national IHR and Health Emergency Plans. 3.Countries of the Americas must focus their activities on strengthening capacity to manage Ebola events at both Points of Entry and Health Care Facilities including isolation facilities, provision of Personal Protection Equipment and specimen sampling & shipping procedures.

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