CHINESE CENTER FOR DISEASE CONTROL AND PREVENTION Epidemiology Investigation for Ebola Virus Disease Lei Zhou, MD, Epidemiologist Public Health Emergency Center, China CDC Dec. 2014, Bangkok, Thailand

CHINESE CENTER FOR DISEASE CONTROL AND PREVENTION Purposes and Objects of Investigation  Purposes of Investigation The history of exposure and possible source of infection Determine the close contacts  Objects of Investigation Suspected Case Confirmed Case

CHINESE CENTER FOR DISEASE CONTROL AND PREVENTION Investigation Methods  Observe in the field  Review medical records  Interview cases  Interview doctors  Interview key persons

CHINESE CENTER FOR DISEASE CONTROL AND PREVENTION  General Information: nationality, name, gender, age, address, Tel or  The Onset, Diagnosis and treatment: the clinical information is provided by hospitals  Possible sources of infection: To investigate the history of exposure within 21 days before illness onset. Including exposure to cases, suspicious animals, or laboratory.  Determine Close Contacts : to track the activity of cases after the onset, and to investigate the people contact cases The Content of Investigation

CHINESE CENTER FOR DISEASE CONTROL AND PREVENTION  Basic Principle: Territorial management  Implementation: set up and send the investigation team to field ASAP, set up the investigation plan, confirm the investigation objectives, determine the tasks and responsibilities of each team member, identify key interviewee  Cautions: appropriate PPE Organization and implementation

CHINESE CENTER FOR DISEASE CONTROL AND PREVENTION Information Analysis and Report  Progress working report from field to superiors level by level  Daily, weekly  County, prefecture, provincial, national level  Preliminary/Interim/Final analysis and report  Documentation and backup of investigation data/documents in a timely manner

CHINESE CENTER FOR DISEASE CONTROL AND PREVENTION The Source of Infection Investigation

CHINESE CENTER FOR DISEASE CONTROL AND PREVENTION  Focus on exposure history of cases within 21 days before illness onset Working, travel history contact history: exposed to the suspected/confirmed cases, suspected animals （ 1 ） （ 1 ） Investigate Exposure History

CHINESE CENTER FOR DISEASE CONTROL AND PREVENTION  Working history: Ask about the details of work, eg. place, type, etc the details  Travel history: the destination country or regions, no matter living or travelling, ask about the itinerary, eg. transit airport/city during travel  Relationship with EVD: west African countries where the EVD was epidemic Working and travel history

CHINESE CENTER FOR DISEASE CONTROL AND PREVENTION  Ask about the detailed exposure history of contact with similar patient within 21 days before the onset time of contact frequency of contact time of duration The ways of contact: contact the blood, secretion, excreta, skin of cases, or the gown and blanket which cases contaminated, or Treatment/care cases ; live In one room; take the same transport; Disposal corpse. Personal protective measures while contact, eg: wear a face mask, gloves, masks, protective clothing, goggles and wash your hands in a timely after contact （ 2 ） Contact history: exposed to cases

CHINESE CENTER FOR DISEASE CONTROL AND PREVENTION （ 3 ） （ 3 ） Diagnosis and Treatment  Ask about the detailed visiting history to the hospital or other medical facilities within 21 days before the illness onset Name of hospital Department of clinic Process of medical visit and treatment

CHINESE CENTER FOR DISEASE CONTROL AND PREVENTION  Ask about the exposure history of direct contact with the bat, chimpanzees and other primates and springbok (small antelope), within 21 days before illness onset in the EVD affected area the l health status of animal duration of contact contact ways and frequency protective measures while contact （ 4 ） C （ 4 ） Contact history: exposed to animals

CHINESE CENTER FOR DISEASE CONTROL AND PREVENTION Health management requirements for investigation staff  Basic principle: appropriate PPE  Accidental exposure during investigation Isolation and medical observation for 21 days since the last day of exposure  Not accidental exposure, with appropriate PPE Self monitoring and health management, testing temperature twice per day Once appear suspected symptoms such as fever, fatigue, should be isolated, diagnosed, treated and reported immediately Restrict activities in the public places, not to use the public transportation

CHINESE CENTER FOR DISEASE CONTROL AND PREVENTION Cautions during investigation  Setting an interviewee priority list: doctors, family members, friends, neighbors, the last is the case.  Carry out the supplemental investigation by telephone, limit the time of contact/exposure with the cases  Documents/questionnaires/records in the isolation room will be delivery by fax, avoid the possible transmission  If the illness of case is too critical to answer questions Interview other key persons, such as household member, relatives, colleagues, classmate, travel companion, etc Cross verify the information provided by the key persons, especially the onset time, activity after illness onset, close contacts

CHINESE CENTER FOR DISEASE CONTROL AND PREVENTION Preparedness of China Surveillance case epidemiological survey and risk evaluation  Risk evaluation  Making plan  Conducting health monitoring for PUI and the persons coming or returning to China  Setting designated hospitals;  Formulating schemes of EVD diagnosis and treatment, case transportation, epidemiological survey and case report  Training medical staff on prevention, control and diagnosis Laboratory testing Conducting Ebola virus test for PUI and making laboratory testing scheme.

CHINESE CENTER FOR DISEASE CONTROL AND PREVENTION Preparedness of China Clinical management ， Infection control and prevention Making technique guidance on EVD nosocomial infection control, person protection and hand hygiene; Making schemes of EVD PUI isolation and transportation Measures of public health emergency preparedness and international travel Making emergency plan of EVD prevention and control, and starting multiple ministries’ joint prevention and control mechanism Risk communication and social mobilization Communicating with media and disseminating knowledge about EVD; setting up special subject of EVD on some related websites.

CHINESE CENTER FOR DISEASE CONTROL AND PREVENTION

Thank you ！