Training on the Ebola Virus Disease (duration 3 days) The idea of the project is to successfully promote safety for health workers and to achieve a good quality of work in the context of Ebola through practical training. It's more complicated than just the theory, but by the end we will have a way of successfully carrying out work effectively. The logo is inspiration and a combination of a symbol for quality (African) and a symbol of a temple of knowledge (European). Efficient by Edification – EFFO Ebola 01.08.2015

Training structure EFFO Ebola Safety and good quality work Module 1: Knowledge about Ebola Virus Disease Module 2: Community response Module 3: Standard pre-cautions Module 4: Triage & isolation Module 5: Personal protective equipment Module 6: Water, disinfection and cleaning The structure of the training shows the logo of the project with the content. Module 1 to Module 6 are part of the training. The parameters in the base of the structure are essential for the success of the training, but these cannot be monitored by the project. The “roof” of the structure is the objective of the training. Support from the community Support from the hospital administration Support from the population 01.08.2015

Ebola virus disease (EVD) Module 1 (Part 1) 01.08.2015

Learning objectives module 1 (part 1) General objectives To know general information on EVD and be motivated to practice to gain more confidence and skills when dealing with suspected Ebola patients. Specific objectives To know the epidemiology of the current outbreak To recognise the modes of contamination and transmission of the Ebola virus To know the incubation period To recognise the symptoms of EVD To know the differential diagnosis 01.08.2015

Presentation outline Module 1 Part 1 INTRODUCTION Epidemiological situation Information about the Ebola virus Modes of transmission and incubation period Symptomatology Differential diagnosis Part 2 - Later - The positive diagnosis: PCR, rapid tests Pathophysiology of EVD Care of cases Work in the isolation area and the stress caused 01.08.2015

The extraordinary situation New situation: Several affected countries Very high number of cases Failure of conventional measures for epidemic control West Africa 2013-2015 1976 1995 2000 2003 2007 2013-2015 602 cases and 431 deaths in Sudan and the Democratic Rep. of Congo Over 28 000 cases and over 11 000 deaths Several less serious epidemics in Congo, Uganda, Democratic Republic of Congo 01.08.2015

Ebola: the most affected areas The epidemic 2013-2015 Guinea Liberia Sierra Leone Total no. of cases: Over 28 000 No. of deaths: Over 11 000 (August 2015, WHO) Current information at WHO http://apps.who.int/ebola/ http://apps.who.int/ebola/en/ebola-situation-reports Source: WHO 01.08.2015

Ebola has affected several countries The most affected regions: Guinea, Sierra Leone and Liberia Ebola can spread Ebola also affected 7 other countries United States England Spain Mali Nigeria Senegal Italy There were isolated instances; the epidemic in these countries is over Current information at WHO http://apps.who.int/ebola/ The problem is that Ebola can destroy health structures and “ordinary” patients no longer receive treatment. 01.08.2015

Health workers are at risk “The patient scares me…?!” More than 860 health workers were infected -> 500 deaths You can protect yourself! You must know how to and put it into practice. Health workers are the most important people in the fight against Ebola! 01.08.2015

Information about the Ebola virus (I) “Ebola” is the name of a river in northern Zaire, where the virus was discovered in 1976. Ebola is a filovirus (Filoviridae family). There are 5 distinct species: Bundibugyo (BDBV) Zaire (EBOV) Reston (RESTV) Soudan (SUDV) Taï Forest (TAFV) The main outbreaks: 1976: Sudan and Democratic Republic            Congo 1995: Democratic Republic of Congo 2000: Uganda 2003: Congo 2007: Democratic Republic of Congo CDC/ Cynthia Goldsmith 01.08.2015

Information about the Ebola virus (II) The virus is wrapped. The wrapping makes the virus fragile, it does not offer protection. The Ebola virus can easily be destroyed by: heat sunlight bleach detergents -> several methods are combined for greater safety -> more information in module 6 http://www.cdc.gov/vhf/ebola/resources/audio.html#ui-id-21 CDC/ Dr. Frederick A. Murphy 01.08.2015

The Ebola virus in humans and animals Source: RKI 1. Reservoir of the virus: likely fruit bats 2. Epizootic in primates and other mammals 3. Human primary infection 4. Secondary transmission by direct contact In Africa, fruit bats are considered the natural hosts of Ebola. The bat transmits the virus to wild animals or directly to humans by whatever mechanism. In Africa, it was found that Ebola could be transmitted to humans when handling animals carrying the virus, living or dead: chimpanzees, gorillas, monkeys, bats of the genus Hypsignathus and Epomops, forest antelopes and porcupines. 01.08.2015

Incubation period of the Ebola virus disease The incubation period is the time between contamination and the appearance of the first symptoms of a disease. The incubation period is individual and depends, for example, on the amount of infectious agents and the immune system. In the case of Ebola: No symptoms -> no risk of transmission Incubation period: 2 to 21 days, on average 8 days Warning: the incubation period is individual and 21 days are a rule. “As always" in medicine, exceptions cannot be ruled out. Literature: Incubation period of Ebola hemorrhagic virus subtype Zaire. Eichner M1, Dowell SF, Firese N. (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3766904/). 01.08.2015

Mode of transmission (what?) The disease is highly contagious It is transmitted by infected organs or biological fluids through damaged skin, mucosa and parenterally: vomiting faeces blood Urine saliva tears sweat sperm breast milk 01.08.2015

Mode of transmission (how?) The disease is highly contagious It is transmitted by infected organs or biological fluids through direct or indirect contact: direct contact with sick or deceased persons during care at home or in hospital certain burial practices contact with clothing, bed sheets, or other objects soiled with a patient`s fluids The more the person is sick, the higher the risk of transmission. 01.08.2015

The initial symptoms of EVD Headache High fever Diarrhoea Intense weakness Muscle aches Joint pain Skin rash Vomiting Initially, the symptoms are similar to the symptoms of viral influenza or malaria. Warning: fever is very typical, but there are also cases without fever. EVD is individual. The symptoms are typical, but not specific. 01.08.2015

The phases of Ebola virus disease 1st phase: ~ D0 to D5 Sudden onset of fever, fatigue, headache, diffuse pain, hiccups, conjunctivitis 2nd phase: ~ D5 to D6 Diarrhoea, vomiting, skin rash 3rd phase: ~ D6 to D8 Multiple organ failure, shock, diffuse bleeding (<1/3 of cases, gums, gastrointestinal tract, puncture sites, vaginal bleeding, etc.), renal failure, encephalopathy Death (~ 50%) or recovery 01.08.2015

Which symptom is this? http://www.cdc.gov/vhf/ebola/resources/infographics.html Headaches Image: cdc 01.08.2015

Which symptom is this? Fever Image: cdc 01.08.2015

Which symptom is this? Fatigue Image: cdc 01.08.2015

Which symptom is this? Diarrhoea Image: cdc 01.08.2015

Which symptom is this? Haemorrhagic diarrhoea Image: cdc 01.08.2015

Which symptom is this? Bleeding Image: cdc 01.08.2015

Which symptom is this? Loss of appetite Image: cdc 01.08.2015

Which symptom is this? Diffuse pain Image: cdc 01.08.2015

Which symptom is this? Conjunctivitis Image: cdc 01.08.2015

Which symptom is this? Skin rash Image: cdc 01.08.2015

Which symptom is this? Abdominal pain Image: cdc 01.08.2015

Which symptom is this? Vomiting Image: cdc 01.08.2015

Differential diagnosis All these symptoms are common to other diseases malaria typhoid fever meningitis shigellosis cholera hepatitis viral influenza plague leptospirosis rickettsiosis relapsing fever other viral haemorrhagic fevers (Lassa) The clinical symptoms of EVD are not specific. The importance of the differential diagnosis varies in each country: In Burkina Faso, the problem mainly occurs with: malaria, typhoid fever, meningitis, shigellosis, cholera, hepatitis 01.08.2015

How to prevent transmission What you should know… What you should do… Direct or indirect contact without protection can be very dangerous Use personal protective equipment (PPE) The Ebola virus is not spread by air like, e.g. measles A distance of two metres is sufficient for protection Transmission is also possible after clinical recovery through sexual contact (sperm) Actual WHO recommendation (may 2015): semen testing by RT-PCR until semen tests negative for virus twice, with an interval of one week between tests. Ebola survivors and their sexual partners should either (a) abstain from all types of sex or (b) observe safe sex through correct and consistent condom use until their semen has twice tested negative. More information: http://www.who.int/reproductivehealth/topics/rtis/ebola-virus-semen/en/ Watch out for the exception! Possible transmission after clinical recovery through sexual contact (sperm) No symptoms, no transmission 01.08.2015

Ambivalence towards a suspected case of EVD Medical personnel should protect themselves. They must be careful and avoid contamination. Patients should be cared for whether they are suspected of EVD or not. They must not be overlooked. → care in Personal Protective Equipment (PPE) 01.08.2015

The correct use of PPE is important! Train the use of each piece of equipment! The most difficult elements for the majority are: Hood Goggles Mask gloves (removal) After this slide, the difficult points of PPE will be practised. The difficult points were identified through observation in the EFFO project. Practising BEFORE the PPE-presentation (Module 5) is useful because participants already know the importance and have "felt" PPE -> demystification of PPE Projet EFFO 01.08.2015

Thank you for your attention! Copyright Images © leremy – Fotolia.com 01.08.2015