1. Update on Ebola outbreak and implications for nutrition GNC Annual meeting 16-18 September 2014 Rome, Italy

2. Over 2,200+ deaths and over 4,200 confirmed / probable cases in Guinea, Sierra Leone, Liberia and Nigeria. The first case detected in March 2014. 50 % cases occurred in the past 3 weeks. EVD peak not yet reached Operational challenges -Urban and rapid transmission -Fragile and weak health systems -Stigma undermining detection/treatment Overview

3. Implications Impacts: on nutrition programming itself on nutritional status of the population Adapted guidance needed though limited evidence and practical experience- “thinking outside the box”: IYCF, SAM/MAM, nutritional support for Ebola patients in treatment and convalesence Other health guidelines: iccm, obstetric care, etc Deterioration in underlying causes of malnutrition likely and medium to long term view required. Preparation and mitigation measures through multi- and intersectoral collaboration critical.

4. 1. IYCF in the context of Ebola Key considerations: Ebola virus present in breastmilk & transmission is possible. The transmission mechanism is not clear. The risks of Ebola transmission and the related mortality seem to outweigh the risks of not breastfeeding in the West African context. Application of IFE guidance around Code and replacement feeding critical. Critical concern to not undermine IYCF in general population. Response: Guidance and decision tree developed Social mobilization campaigns Sourcing and controlled distribution of RUIF

5. 2. SAM and MAM treatment Key considerations Collapse of the health system Reluctance of health workers to screen Concern of exposure with screening Response Under discussion No-touch options being explored (health workers and others)

6. 3. Nutritional support during Ebola treatment and convalescence Key considerations Nutritional needs unclear during and after treatment ends 2 presentations and variable presentation: – Most with anorexia/trouble swallowing/diarrhea/vomiting – Some able to eat In treatment- variable product options On discharge- for all or just those with low BMI? Need to balance operational feasibility, evidence and preference, and not undermining other programmes using those products Response Simple guidance under discussion (linked to the IYCF recommendations)

7. Resources Current operational guidance and discussion: en-net Infant feeding & Ebola guidance: http://www.ennonline.net/infantfeedinginthecontextofebola2014 http://www.ennonline.net/infantfeedinginthecontextofebola2014 IFE thread: http://www.en-net.org/question/1445.aspxhttp://www.en-net.org/question/1445.aspx Adult & child nutrition support thread: http://www.en-net.org/question/1465.aspxhttp://www.en-net.org/question/1465.aspx WHO: English: http://www.who.int/csr/disease/ebola/en/http://www.who.int/csr/disease/ebola/en/ French: http://www.who.int/csr/disease/ebola/fr/http://www.who.int/csr/disease/ebola/fr/ CDC: English: http://www.cdc.gov/vhf/ebola/http://www.cdc.gov/vhf/ebola/ English (WA): http://www.cdc.gov/vhf/ebola/outbreaks/guinea/index.htmlhttp://www.cdc.gov/vhf/ebola/outbreaks/guinea/index.html French (WA): http://www.cdc.gov/vhf/ebola/outbreaks/guinea/french/index.htmlhttp://www.cdc.gov/vhf/ebola/outbreaks/guinea/french/index.html

8. Participate in the discussions Many thanks to those already engaged in sharing information and experience already! Contribute to the discussion through en-net thread Share information with colleagues Participate in side meeting at ENN technical meeting on nutrition (7-9 th Oct)

9. Moving ahead together