1. Office of Global Health and HIV (OGHH) Volunteer Information on Ebola Ebola Education Toolkit

2. What do you already know or think about Ebola? Opening Activity What about your friends and family back home? What are your concerns? What about your friends and family?

3.  Using lecture notes, participants define Ebola, list modes of transmission and signs and symptoms of the disease, and explain the steps Volunteers should take to avoid exposure and protect themselves from Ebola, including what steps to take if they believe they may have been exposed.  Individually and using information from this session, participants share examples of how they might address common concerns and misconceptions around Ebola from friends and family back home. Learning Objectives

4. The Ebola virus causes a disease that is acute, severe, and often deadly which leads to fever and other symptoms accompanied by bleeding. What Is Ebola?

5. Ebola Transmission Cycle http://www.cdc.gov/vhf/ebola/pdf/ebola_ecology_800px.pdf

6. How do you get Ebola? Those most at risk are those that have direct contact with:

7. Assessing Ebola Risk Who is at the highest risk of contracting Ebola? 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.

8. Assessing Ebola Risk, continued You are NOT at risk if you have NOT had direct contact with: Blood or bodily fluids (including but not limited to urine, saliva, feces, vomit, and semen) of a person who is infected with and/or died from Ebola. Sharp objects (like needles and syringes) that have been contaminated with the Ebola virus and with surfaces and materials (e.g., bedding, clothing) contaminated with these fluids. Infected animals (most likely infected bats or primates). The corpse of a person who died of Ebola. Remember that under no circumstances should Volunteers be involved with the delivery of care to Ebola patients.

9. Ebola Symptoms Advanced Symptoms Early Symptoms Low fever Weakness/fatigue Joint and muscle aches Severe headache Chills Loss of appetite

10. Ebola Symptoms, continued Advanced Symptoms High fever 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

11. Ebola Symptoms, continued Following exposure, when would you feel sick? Incubation period range: 2-21 days from time of exposure Average: 8-10 days from time of exposure If after 21 days following exposure a person does not develop symptoms, he/she is unlikely to become sick from that exposure.

12. Once a person develops symptoms they remain infectious as long as their blood and bodily fluids, including semen and breast milk, contain the virus. Men can still carry the virus through their semen even after recovering from Ebola. However, scientists are working to define if Ebola can be spread through sexual transmission and are recommending that survivors not have sex (oral, anal or vaginal). Those who have sex should use a condom correctly and consistently every time. Once a person dies of Ebola their body remains infectious. Participation of family/community members in burial ceremonies has played a major role in the spread of Ebola. When can it be spread to others? HUMANS ARE NOT INFECTIOUS UNTIL THEY DEVELOP SYMPTOMS

13. Ebola Diagnosis & Treatment for Host Country Nationals Diagnosis Ebola infections are confirmed through laboratory testing of blood samples. To date, there is no specific treatment or vaccine for Ebola. Symptomatic Treatment

14. Ebola Diagnosis & Treatment 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 for their effectiveness. Experimental Treatments The effectiveness of the experimental treatments has not yet been proven, and they are not yet approved for general use.

15. Ebola Prevention Ministries of Health in each country should provide guidance about how to properly respond to exposures, provide care, and arrange for the disposal of bodies of Ebola patients. Advanced Symptoms If in an Ebola-affected area, individuals should: Practice careful hygiene, i.e., wash your hands often with soap and water Avoid contact with blood and bodily fluids Do not handle items that may have come in contact with an infected person’s blood or bodily fluids Avoid funeral or burial rituals of someone who has died from Ebola Avoid contact with bats and nonhuman primates or their bodily fluids Avoid facilities where Ebola patients are being treated http://www.cdc.gov/vhf/ebola/prevention/index.html

16. What can be done to control Ebola? 2 Case management 1 Case isolation 3 Contact tracing 4 Safe burials

17. Implications for the Peace Corps On July 30, 2014, the Peace Corps evacuated its volunteers from Liberia, Sierra Leone, and Guinea due to inability to provide Medevacs/safe medical facilities The Peace Corps has enjoyed long partnerships with the government and people of Liberia, Sierra Leone, and Guinea, and is committed to continuing Volunteers’ work there. A determination on Volunteers’ re-entry will be made at a later date. Peace Corps Diagnosis Country directors will notify (Embassy/RSO), the Region and PC/Washington teams if there is a confirmed case in their country. Despite working in countries with Ebola, no PCV has ever contracted or tested positive for Ebola.

18. Travel Advisory Travel Considerations for Volunteers and Staff:  State Department has travel warnings to Liberia, Guinea, Sierra Leone or other countries identified as having an ongoing Ebola outbreak. (All should defer to safety and security guidelines from each post).  Advised to review in-country re- entry regulations for individuals who have traveled to Ebola- affected countries.

19.  Notify the Peace Corps Medical Officer immediately if you become ill, and follow the PCMO's instructions for further evaluation or treatment.  Avoid direct contact with any individual with an unexplained feverish illness.  Avoid bush meat, especially contact made through hunting, butchering, or processing of meat). This is specific to regions where bush meat is consumed.  Continue to practice safe hygiene and handwashing with warm water and soap, or water and bleach solution.  Avoid health facilities that are treating Ebola patients.  Avoid activities associated with Ebola risk, such as funerals.  Contact your Peace Corps Medical Officer if you feel unsafe at your site. The safety and security of Volunteers is of utmost importance. If Ebola occurs in your country of service and you believe you are at risk for exposure, you should:

20. for Volunteers Working in Health Facilities Special Considerations

21. Possible Volunteer Exposure Exposed | Direct contact with a patient presenting symptoms Contact PCMO | Immediately Await Instructions | Take Temperature | Follow Up | Follow any guidance from PCMO and Country Offices If confirmed take twice daily, reporting results to PCMO From the PCMO regarding confirmation of the exposure If a PCV is exposed to Ebola

22. Possible Clinic Exposure SELF QUARANTINE | Stay at home and avoid social interactions Clinic Exposure | Arrival of patient with Ebola symptoms Contact PCMO | Immediately Do Not Touch Patient | or work with patient in any way Do Not Return to Clinic | Until advised to do so Follow Up | Follow any guidance/instructions from PCMO or Country Office If clinic is exposed to Ebola

23. Please reach out to your PCMO and country support team if you have additional questions regarding Ebola risk in your country of service. The health, safety, and security of Volunteers is of utmost importance to the Peace Corps and continues to be an essential portion of a successful service. The End!