1. Robert B. Knowles CAPT, U.S. Public Health Service Regional Director, ATSDR, Region 9 Agency for Toxic Substances and Disease Registry (ATSDR) Division of Community Health Investigations Agency for Toxic Substances and Disease Registry R9 Regional Response Team Meeting Reno, Nevada 11/5/2014

2. Ebola Response Activities Background Overview of CDC Activities Overview of U.S. Public Health Service Activities The contents of this presentation have not been formally vetted by the Centers for Disease Control and Prevention or the Agency for Toxic Substances and Disease Registry and should not be construed to represent any agency determination or policy.

3. Background on Ebola Ebola, also known as Ebola hemorrhagic fever, is a rare and deadly disease caused by one of five Ebola virus species Ebola viruses are found in several African countries The first Ebola virus was discovered in 1976 near the Ebola River in the Democratic Republic of the Congo Based on evidence, researchers believe Ebola is animal- borne (zoonotic) Bats are the most likely reservoir, but it has also been found in primates and swine

4. Transmission of Ebola Ebola virus is spread through direct contact with blood or bodily fluids (blood, saliva, sweat, urine, vomit, semen) of a person who is sick The virus can enter to body through broken skin or unprotected mucous membranes (i.e eyes, nose, mouth) Virus can spread through contact with objects like needles & syringes that have been contaminated Ebola is NOT spread through the air or by water May be spread in food (primarily as a result of handling bushmeat) No evidence of mosquito transmission

5. Transmission of Ebola Evidence of transmission in mammals (humans, bats, monkeys and apes) Ebola virus can be killed with hospital grade disinfectants The virus can survive from hours to days on surfaces at room temperature The incubation period from exposure to when symptoms appear is 2 to 21 days (average 8-10) Genetic analysis of current outbreak is closely related to the variant identified in the Democratic Republic of Congo

6. Signs & Symptoms Fever greater than 101.5 F or 38.6 C Headache, muscle pain, vomiting, diarrhea, abdominal pain, or unexplained hemorrhage (bleeding or bruising) Early symptoms mimic influenza or other common illness, thus it is critical to know about potential contact with infected persons

7. Prevention & Treatment Practice careful hygiene & infection control procedures Do not handle items that have come into contact with an infected persons blood or body fluids If you anticipate contact wear the proper personal protective equipment (PPE) CDC has prevention guidelines for travelers and healthcare workers on its website There is no FDA approved vaccine or anti-viral drug There are several experimental vaccines or treatments – Zmapp is one experimental treatment – Blood transfusions have also shown some success

8. CDC Ebola Response On August 8 th, WHO declared the current Ebola outbreak is a Public Health Emergency of International Concern The 2014 Ebola epidemic is the largest in history Primary countries currently affected are Guinea, Liberia and Sierra Leone In September WHO reported the Ebola Outbreak in Nigeria was contained CDC released an MMWR article on September 23 rd estimating the future number of cases in the Ebola epidemic

9. CDC Ebola Response CDC estimated that without intervention cases of Ebola in Liberia and Sierra Leone could rise to between 550,000 to 1.4 million CDC’s response to Ebola is the largest international outbreak response in CDC’s history USAID continues to lead the U.S. overseas response to outbreak, while DOD, CDC, Department of State and other agencies are supporting U.S. Africa Command has set up a command in Monrovia Liberia to facilitate and expedite transportation of equipment supplies and personnel Ebola treatment units are being established

10. CDC Ebola Resources CDC Ebola (Ebola Virus Disease) website – http://www.cdc.gov/vhf/ebola/index.htmlhttp://www.cdc.gov/vhf/ebola/index.html The website provides information on – Sign & symptoms – Transmission & Risk of exposure – Outbreaks – Guidelines for healthcare workers – Prevention & Diagnosis – Treatment

11. U.S. Public Health Service Response Activities The USPHS has deployed approximately 70 Officers to Monrovia The mission is staff the Monrovia Medical Unit, a 25 bed treatment unit being assembled by DOD The MMU is for treatment of NGO and Liberian National healthcare workers The USPHS is expected to staff the MMU for at least six months The MMU is expected to open on November 11th

12. DOD and USPHS Response NBC Video – http://www.nbcnews.com/watch/nightly- news/liberian-president-on-ebola-quarantine-we- understand-the-fear-349134403766 http://www.nbcnews.com/watch/nightly- news/liberian-president-on-ebola-quarantine-we- understand-the-fear-349134403766 Photo Credit: USAF Air Mobility Command

13. Priority Treatment Facilities for U.S. Ebola Cases Primary U.S. Hospitals with bio-containment units – Emory University Hospital, Atlanta, Georgia – NIH Clinical Center, Bethesda, Maryland – St. Patrick Hospital, Missoula, Montana – Nebraska Medical Center, Omaha, Nebraska California Hospitals – UC Medical Centers – Davis, Irvine, Los Angeles, San Diego and San Francisco

14. Ebola Airport Screening Enhanced Ebola Screening implemented at 5 U.S. Airports by CDC and CBP JFK, Washington-Dulles, Chicago-O’Hare, Newark, and Atlanta-Hartsfield All passenger arriving from one of the affected West African countries will be routed through one of these airports Health Questionnaire and New Tracking Program - (CARE)

15. CDC Quarantine Stations Stations located at 20 points of entry Staffed with Medical & Public Health Officers Hours and contact info provided on CDC website

16. CDC Resources in States CDC Career Epidemiology Field Officer (CEFO) Program - 27 assignees, 23 locations Epidemic Intelligence Officers (EIS) – CDPH has an Epi Officer assigned

17. Other Resources/Contacts Assistant Secretary for Preparedness & Response, Region 9 – CAPT Brad Austin, Regional Emergency Coordinator Email: Brad.Austin@hhs.govBrad.Austin@hhs.gov Phone: 202-407-3908 – CAPT Kevin Sheehan, Hospital Preparedness Program Email: Kevin.Sheehan@hhs.govKevin.Sheehan@hhs.gov Phone: 415-209-4633

18. Thank You Questions? Contact Information: – CAPT Robert Knowles Phone: (415) 947-4317 Email: rknowles@cdc.govrknowles@cdc.gov – 1-800-CDC-INFO Web site (www.atsdr.cdc.gov)www.atsdr.cdc.gov The findings and conclusions in this presentation have not been formally disseminated by the Agency for Toxic Substances and Disease Registry and should not be construed to represent any agency determination or policy.