1. E PI U PDATE N OVEMBER, 2014 Jackie Dawson, PhD Public Health Epidemiologist Chelan, Douglas, Grant, Kittitas & Okanogan Counties (509) 886-6428 Jacqueline.Dawson@cdhd.wa.gov Stephanie Snitily, RN, BSN Communicable Disease Program Coordinator Chelan-Douglas Health District (509) 886-6417 Stephanie.Snitily@cdhd.wa.gov

2. S UCCESSFUL RESPONSE EMS Healthcare Law Enforcement Public Health

3. E BOLA V IRUS L IFECYCLE http://www.nejm.org/action/showMediaPlayer?doi=10.1056/NEJMp1410741&aid=NEJMp1410741_attach_1

5. D ETECTION OF E BOLA V IRUS IN D IFFERENT H UMAN B ODY F LUIDS OVER T IME

6. viremia 3 IgM ELISA IgM 010 IgG IgM: up to 3 – 6 months ELISA IgG IgG: 3 – 5 years or more (life-long persistance?) days post onset of symptoms RT-PCR Critical information: Date of onset of fever/symptoms Fever EVD: E XPECTED DIAGNOSTIC TEST RESULTS OVER TIME 6

7. E BOLA www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/case-counts.html No direct flights from Mali to US Daily 15-20 people, begin itineraries in Mali and transit through other countries en route to the USA

8. L IBERIA Half of Liberia’s Ebola cases have been in or near the capital of Monrovia with its population of about 1.5 million. Since mid-Sept: 73% decline in admissions to Ebola Treatment Units 58% decline in blood samples testing positive for Ebola 53% decline in body collections www.cdc.gov/media/releases/2014/p1114-ebola-liberia.html www.nytimes.com/interactive/2014/07/31/world/africa/ebola-virus-outbreak-qa.html?_r=1

9. E BOLA IN S IERRA L EONE, N OV 10, 2014 # of new cases jumped dramatically Oct 5, 2014: 81 new cases of the virus, but 121 deaths Nov 8, 2014: 45 new cases, including 24 in the capital, Freetown. New British army-built Ebola hospital in Freetown. Nov 9, 2014:111 new cases the highest daily rate since August 2014 Nov 15, 2014: MD flown from Sierra Leone to Nebraska Medical Center

10. US CASES Dallas patient died on October 8. Contact tracing identified a total of 103 individuals, of whom 48 were close unprotected contacts of the initial patient. 147 health care workers (including EMS) who cared for the patient or 2 nurses, irrespective of PPE use, were actively monitored. 1 nurse had contact with 164 people including: 2 household members, 10 friends and family members, and 60 persons at one store; 17 airline and airport personnel and 76 airline passengers monitored in Ohio 6 schools in Texas and Ohio were closed for disinfection because some students had been on the same flight http://www.cdc.gov/vhf/ebola/children/index.htmlhttp://www.cdc.gov/vhf/ebola/children/index.html Some contacts were brief, while others lasted several hours and included direct skin- to-skin exposure. As of November 7, all contacts of the three patients had finished active monitoring and none of the contacts besides the 2 nurses themselves had developed Ebola. www.cdc.gov/media/releases/2014/p1114-ebola-liberia.html www.nytimes.com/interactive/2014/07/31/world/africa/ebola-virus-outbreak-qa.html?_r=1

11. N EW Y ORK The quarantine of the doctor’s fiancée has now ended. The lifting of that quarantine should also mean the end of concerns that the patient — who, while asymptomatic, rode the subway, ran on the High Line, bowled in Brooklyn, and ate West Village meatballs — might have exposed thousands of New Yorkers to Ebola. www.nejm.org/doi/full/10.1056/NEJMp1413816?query=featured_ebola

12. F ACTORS IN HEALTH - CARE - WORKER INFECTIONS IN L IBERIA inconsistent recognition/triage of Ebola patients overcrowding of hospitals/clinics limitations in physical layout of hospitals lack of training in PPE and inadequate supply of PPE limited supervision of and adherence to infection control www.nytimes.com/interactive/2014/07/31/world/africa/ebola-virus-outbreak-qa.html?_r=1

13. D OCTORS W ITHOUT B ORDERS HAS SENT DOCTORS AND AID WORKERS FROM AROUND THE WORLD TO E BOLA - STRICKEN COUNTRIES

14. N EW E BOLA T REATMENT C ENTERS

15. FDA HAS GRANTED EXPANDED ACCESS TO SEVERAL EXPERIMENTAL DRUGS

16. www.cdc.gov/vhf/ebola/pdf/ambulatory-care-evaluation-of-patients-with-possible-ebola.pdf

17. E BOLA : A IRPORT S CREENING 94% individuals screened: New York's JFK Washington-Dulles Newark Chicago-O'Hare Atlanta

18. LHJ MONITORING OF QUARANTINE Twice daily temp and symptom check Address social needs Home disinfection kits Alternate housing if necessary

19. W ASHINGTON S TATE Sample from Oregon patient tested at PHL. Ebola Tx Center Hospitals: CHI Franciscan Health-Harrison Medical Center MultiCare Tacoma General Hospital Providence Regional Medical Center-Everett Providence Sacred Heart Medical Center-Spokane Seattle Children’s Hospital Swedish Medical Center-Issaquah Virginia Mason Medical Center University of Washington (Harborview Medical Center, UW Medical Center, Valley Medical Center) Monitoring for 21 days Poison Control Center will be used as a call center

20. http://www.cdc.gov/vhf/ebola/pdf/is-it-flu-or-ebola.pdf