1. Training on the Ebola Virus Disease (duration 3 days)
The idea of the project is to successfully promote safety for health workers and to achieve a good quality of work in the context of Ebola through practical training. It's more complicated than just the theory, but by the end we will have a way of successfully carrying out work effectively.
The logo is inspiration and a combination of a symbol for quality (African) and a symbol of a temple of knowledge (European).
Efficient by Edification – EFFO Ebola

2. Training structure EFFO Ebola Safety and good quality work
Module 1: Knowledge about Ebola Virus Disease
Module 2:
Community response
Module 3:
Standard pre-cautions
Module 4:
Triage & isolation
Module 5:
Personal protective equipment
Module 6:
Water, disinfection and cleaning
The structure of the training shows the logo of the project with the content. Module 1 to Module 6 are part of the training. The parameters in the base of the structure are essential for the success of the training, but these cannot be monitored by the project. The “roof” of the structure is the objective of the training.
Support from the community
Support from the hospital administration
Support from the population

3. Ebola virus disease (EVD) Module 1 (Part 1)

4. Learning objectives module 1 (part 1)
General objectives
To know general information on EVD and be motivated to practice to gain more confidence and skills when dealing with suspected Ebola patients.
Specific objectives
To know the epidemiology of the current outbreak
To recognise the modes of contamination and transmission of the Ebola virus
To know the incubation period
To recognise the symptoms of EVD
To know the differential diagnosis

5. Presentation outline Module 1
Part 1
INTRODUCTION
Epidemiological situation
Information about the Ebola virus
Modes of transmission and incubation period
Symptomatology
Differential diagnosis
Part 2
- Later -
The positive diagnosis: PCR, rapid tests
Pathophysiology of EVD
Care of cases
Work in the isolation area and the stress caused

6. The extraordinary situation
New situation:
Several affected countries
Very high number of cases
Failure of conventional measures for epidemic control
West Africa
1976
1995
2000
2003
2007
602 cases and 431 deaths in Sudan and the Democratic Rep. of Congo
Over cases and over deaths
Several less serious epidemics in Congo, Uganda, Democratic Republic of Congo

7. Ebola: the most affected areas
The epidemic
Guinea
Liberia
Sierra Leone
Total no. of cases:
Over
No. of deaths:
Over
(August 2015, WHO)
Current information at WHO
Source: WHO

8. Ebola has affected several countries
The most affected regions: Guinea, Sierra Leone and Liberia
Ebola can spread
Ebola also affected 7 other countries
United States
England
Spain
Mali
Nigeria
Senegal
Italy
There were isolated instances; the epidemic in these countries is over
Current information at WHO
The problem is that Ebola can destroy health structures and “ordinary” patients no longer receive treatment.

9. Health workers are at risk
“The patient scares me…?!”
More than 860 health workers were infected -> 500 deaths
You can protect yourself!
You must know how to and put it into practice.
Health workers are the most important people in the fight against Ebola!

10. Information about the Ebola virus (I)
“Ebola” is the name of a river in northern Zaire, where the virus was discovered in 1976.
Ebola is a filovirus (Filoviridae family).
There are 5 distinct species:
Bundibugyo (BDBV)
Zaire (EBOV)
Reston (RESTV)
Soudan (SUDV)
Taï Forest (TAFV)
The main outbreaks:
1976: Sudan and Democratic Republic
           Congo
1995: Democratic Republic of Congo
2000: Uganda
2003: Congo
2007: Democratic Republic of Congo
CDC/ Cynthia Goldsmith

11. Information about the Ebola virus (II)
The virus is wrapped. The wrapping makes the virus fragile, it does not offer protection.
The Ebola virus can easily be destroyed by:
heat
sunlight
bleach
detergents
-> several methods are combined for greater safety
-> more information in module 6
CDC/ Dr. Frederick A. Murphy

12. The Ebola virus in humans and animals
Source: RKI
1. Reservoir of the virus: likely fruit bats
2. Epizootic in primates and other mammals
3. Human primary infection
4. Secondary transmission by direct contact
In Africa, fruit bats are considered the natural hosts of Ebola.
The bat transmits the virus to wild animals or directly to humans by whatever mechanism.
In Africa, it was found that Ebola could be transmitted to humans when handling animals carrying the virus, living or dead: chimpanzees, gorillas, monkeys, bats of the genus Hypsignathus and Epomops, forest antelopes and porcupines.

13. Incubation period of the Ebola virus disease
The incubation period is the time between contamination and the appearance of the first symptoms of a disease.
The incubation period is individual and depends, for example, on the amount of infectious agents and the immune system.
In the case of Ebola:
No symptoms -> no risk of transmission
Incubation period: 2 to 21 days, on average 8 days
Warning: the incubation period is individual and 21 days are a rule. “As always" in medicine, exceptions cannot be ruled out.
Literature: Incubation period of Ebola hemorrhagic virus subtype Zaire. Eichner M1, Dowell SF, Firese N. (

14. Mode of transmission (what?)
The disease is highly contagious
It is transmitted by infected organs or biological fluids through damaged skin, mucosa and parenterally:
vomiting
faeces
blood
Urine
saliva
tears
sweat
sperm
breast milk

15. Mode of transmission (how?)
The disease is highly contagious
It is transmitted by infected organs or biological fluids through direct or indirect contact:
direct contact with sick or deceased persons
during care at home or in hospital
certain burial practices
contact with clothing, bed sheets, or other objects soiled with a patient`s fluids
The more the person is sick, the higher the risk of transmission.

16. The initial symptoms of EVD
Headache
High fever
Diarrhoea
Intense weakness
Muscle aches
Joint pain
Skin rash
Vomiting
Initially, the symptoms are similar to the symptoms of viral influenza or malaria.
Warning: fever is very typical, but there are also cases without fever.
EVD is individual.
The symptoms are typical, but not specific.

17. The phases of Ebola virus disease
1st phase: ~ D0 to D5
Sudden onset of fever, fatigue, headache, diffuse pain, hiccups, conjunctivitis
2nd phase: ~ D5 to D6
Diarrhoea, vomiting, skin rash
3rd phase: ~ D6 to D8
Multiple organ failure, shock, diffuse bleeding (<1/3 of cases, gums, gastrointestinal tract, puncture sites, vaginal bleeding, etc.), renal failure, encephalopathy
Death (~ 50%) or recovery

18. Which symptom is this?
Headaches
Image: cdc

19. Which symptom is this?
Fever
Image: cdc

20. Which symptom is this?
Fatigue
Image: cdc

21. Which symptom is this?
Diarrhoea
Image: cdc

22. Which symptom is this?
Haemorrhagic diarrhoea
Image: cdc

23. Which symptom is this?
Bleeding
Image: cdc

24. Which symptom is this?
Loss of appetite
Image: cdc

25. Which symptom is this?
Diffuse pain
Image: cdc

26. Which symptom is this?
Conjunctivitis
Image: cdc

27. Which symptom is this?
Skin rash
Image: cdc

28. Which symptom is this?
Abdominal pain
Image: cdc

29. Which symptom is this?
Vomiting
Image: cdc

30. Differential diagnosis
All these symptoms are common to other diseases
malaria
typhoid fever
meningitis
shigellosis
cholera
hepatitis
viral influenza
plague
leptospirosis
rickettsiosis
relapsing fever
other viral haemorrhagic fevers (Lassa)
The clinical symptoms of EVD are not specific.
The importance of the differential diagnosis varies in each country:
In Burkina Faso, the problem mainly occurs with: malaria, typhoid fever, meningitis, shigellosis, cholera, hepatitis

31. How to prevent transmission
What you should know…
What you should do…
Direct or indirect contact without protection can be very dangerous
Use personal protective equipment (PPE)
The Ebola virus is not spread by air like, e.g. measles
A distance of two metres is sufficient for protection
Transmission is also possible after clinical recovery through sexual contact (sperm)
Actual WHO recommendation (may 2015): semen testing by RT-PCR until semen tests negative for virus twice, with an interval of one week between tests.
Ebola survivors and their sexual partners should either (a) abstain from all types of sex or (b) observe safe sex through correct and consistent condom use until their semen has twice tested negative.
More information:
Watch out for the exception! Possible transmission after clinical recovery through sexual contact (sperm)
No symptoms, no transmission

32. Ambivalence towards a suspected case of EVD
Medical personnel should protect themselves. They must be careful and avoid contamination.
Patients should be cared for whether they are suspected of EVD or not. They must not be overlooked.
→ care in Personal Protective Equipment (PPE)

33. The correct use of PPE is important!
Train the use of each piece of equipment!
The most difficult elements for the majority are:
Hood
Goggles
Mask
gloves (removal)
After this slide, the difficult points of PPE will be practised.
The difficult points were identified through observation in the EFFO project.
Practising BEFORE the PPE-presentation (Module 5) is useful because participants already know the importance and have "felt" PPE -> demystification of PPE
Projet EFFO

34. Thank you for your attention!
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