1. Ebola preparedness in Belgium Erika Vlieghe, MD PhD Nationale Ebola Coordinator, FOD Volksgezondheid Departement Klinische Wetenschappen, ITG Antwerpen Dienst Tropische Ziekten, UZA

2. Today Madrid, tomorrow Brussels…?

3. Brussels Airlines’ destinations… 3

4. Preparing for an epidemic in Belgium… 2-4 languages… New government Changing/fragmented competences Private and public partners Syndical unrest

5. Airport Community Tertiary hospital Regional hosp. Ships Trains Fedasil employers Local authoritiesSchools GP’s Ambulances Army beds drugs labs Funerary services PRIORITY FIELD FOR ACTIONS

6. 6

7. Partners & interactions Federal and regional governments Institute of Tropical Medicine University hospitals Regional ( non-university) hospitals Superior Health Council GP’s (Para)medical professional organisations MSF Belgian army Brussels Airlines and Brussels Airport Fedasil/DVZ Trade unions, Customs, Police … 7

8. ‘Entry points’ for the country… Temperature screening Safer cleaning procedures Procedures in case of ill traveler Exercises

9. Family doctors, asylum centers, hospitals Over- versus underdiagnosis Procedures Seminars & meetings Website with learning tools

10. 10 www.info-ebola.be

11. Triaging and case finding in Belgium

12. Patient transport according to the needs & circumstances ‘Dry’ case in stable situation: in his/her own car…? Transport with dedicated ‘empty’ ambulance after 112 call, triaged and discussed (civil protection + fire brigade 1/province) Inter-hospital transport: army ambulance with ‘Iso-ark’

13. Network of reference hospitals for Ebola cases

14. Diagnosis 3/2014 – 2/2015: 11 genuine ‘probable cases’  all tested negative (many more ‘suspect’ but not meeting all criteria)

15. Clinical care of Ebola patients SAFETY FIRST Supportive care  which interventions? Specific treatment  access, evidence,… – Antivirals – Vaccines – Antibodies – … Expert team of 3 reference hospitals Frequent tele-conferences ‘Administratief besluit’ 14 november 2014

16. Taking care of returning HCW and contacts… No blanket ‘quarentaine’ But procedures for high risk exposure  PEP

17. Centralised communication FOD/SPF GP Referring hospital NGO/employer Asylum centre Airport Public health dr Reference hospital press cabinet ITM

18. Ebola is about challenging balances Individual health >< public health Effective treatment >< Staff safety Pragmatism >< maximal safety Overdiagnosis >< underdiagnosis

19. What does 2015 bring…? ‘go for zero….’

20. … but also preparing for the next epidemic Build on existing structures and agreements Integrate experiences from former outbreaks or threats ‘Strengthen health system’  long-lasting capacity for high risk isolation Coordination & communication in a fragmented country… Ad hoc collaboration  national and international clinical networks

21. Thank you for your attention!