Good Day Everyone, Since it has been now a year since the first Ebola case started. IG medical GmbH would like to remind everyone about this massive tragedy and what the people of West Africa passed through in 2014. The information we are sharing are published in the World Health Organisation official website. We would like to take you into a series of 14 papers that take an in-depth look at West Africa’s first epidemic of Ebola virus disease. Today we are sharing PAPER 8: WHO technical support – a lasting impact? Here you can find the link for the article: who.int/csr/disease/ebola/one-year-report/technical-support/en/ CHAPTER 8 - Shortly after confirmation of Guinea’s outbreak, WHO updated and revised its technical guidance in the full range of areas needed for a multi-pronged response. By the end of April, some 26 guidelines for field staff had been issued on topics ranging from correct laboratory procedures for testing and confirming cases, to steps to follow to ensure safe burials, to measures to prevent and control infections in households and health care facilities. Diagnostic guidance: not always followed Not all of this advice has been followed. For example, WHO recommends repeat testing, after a negative initial result, at least 48 hours later. Many patients initially test negative, especially when samples are taken early in the course of infection. Test results can also vary according to how the samples were collected. Two negative tests, taken at least 48 hours apart, are needed before a suspected case can be safely discarded or a patient can be released with confidence from a treatment facility. Laboratory diagnosis is challenging, as it requires specialized facilities and equipment, a high level of biosafety, and trained and experienced staff. When a country diagnoses its first case, WHO recommends that samples be sent to a WHO-approved laboratory for confirmatory tests. WHO is aware of several instances where a suspected case, clinically compatible with Ebola, was detected in a new country, and then discarded by health officials within hours following “negative test results”, with no alternative diagnosis confirmed. Several such instances have occurred in countries with inadequate diagnostic capacity, calling into question the validity of test results. Moreover, no laboratory in the world can reliably exclude a suspected Ebola case in a matter of hours. Personal protective equipment: the most visible form of protection On 31 October, WHO updated its guidance on the use of personal protective equipment in the Ebola response. The guidelines were developed using an accelerated yet scientifically rigorous methodology that drew on both available scientific evidence and field experience. This was done in collaboration with a large group of experts, including staff from the US CDC, MSF, and the Infection Control Africa Network. If you think you may have been exposed to Ebola, minimize close contact with others. Ebola messages for the general public, WHO The objective was to introduce standardized and effective options for protecting health care workers and patients from a lethal and highly contagious virus. The guidelines were strongly driven by concern about the many infections in health care workers among national staff and foreign medical teams in affected countries, and hospital staff who became infected in the US and Spain. The experts agreed that it was most important to have equipment that protects the mouth, nose, and eyes from contaminated droplets and fluids, for example, through face masks and eye protection. Given that hands are known to transmit pathogens to other parts of the body, as well as to other people, hand hygiene and gloves were judged essential. Gowns or coveralls with apron, protective foot wear, and head cover were also considered essential to reduce the risk of transmission. The guidelines stress that personal protective equipment, though the most visible of all measures for infection prevention and control, is the least effective. More important are administrative controls, such as those that provide for barrier nursing and guide the organization of work, and environmental controls that ensure the safety of water, sanitation, and waste management. A fundamental principle guiding the selection of different options was the need to balance the best possible protection against infection with the best possible patient care, allowing staff to work with maximum ease, dexterity, and comfort and minimal heat-associated stress. Because of this heat-associated stress, which can reduce concentration when care is delivered and lead to mistakes, MSF and WHO recommend that personal protective equipment be worn for no more than 45 minutes at a time. Equally important is supervised training in putting on and taking off equipment according to rigorous standardized procedures, properly decontaminating equipment after use, and safely disposing of equipment that cannot be reused. In preparing the guidelines, the experts had to contend with a lack of solid evidence about what works best on a sustainable basis. Lack of evidence is a problem confronting many other dimensions of the Ebola response. Although the disease has been known for nearly four decades, the comparatively short duration of past outbreaks and their location in largely remote rural areas worked to discourage the degree of scientific research that is now so urgently needed. A protocol for safe and dignified burial You cannot get infected with Ebola by talking to people, walking in the street, or shopping in the market. Ebola messages for the general public, WHO During the first week of November, WHO issued a new protocol for the safe and dignified burial of people who died from Ebola. Ancestral rites performed during funerals and burials have long been recognized as a major driver of Ebola virus transmission, and technical guidance on safe burials had been available from WHO for decades. What was new in the protocol was the emphasis on dignified burials that respect religious rituals in both Christian and Muslim funerals. That emphasis, in turn, responded to mounting evidence that a failure to respect these traditions was a major reason why patients continued to be cared for in homes and bodies continued to be buried unsafely and in secret, even when sufficient treatment beds and burial teams were available. The protocol takes burial teams through 12 critical steps needed to ensure that burials are dignified, respectful, and safe for families and mourners as well as team members. Illustrations are used to demonstrate the equipment and other supplies needed and their proper use, also for the management of hazardous wastes. In line with advice from religious leaders, the 12 steps include opportunities for engaging families in the digging of graves and the performance of dry ablution and shrouding rituals. Families and local clergy are also given opportunities to plan the burial in line with cultural traditions and personal wishes. Advice ranges from the use of white body bags for Muslim funerals, to the need for burial teams to listen to the family’s concerns – face-to-face, before donning protective gear – to the importance of letting relatives decide on how they want the grave to be marked. The protocol was developed by an interdisciplinary team at WHO, in collaboration with medical anthropologists and in partnership with the International Federation of Red Cross and Red Crescent Societies and faith-based organizations, including the World Council of Churches, Islamic Relief, Caritas Internationalis, and World Vision. A lasting impact? Some of the direct technical support provided by WHO and GOARN is likely to have a lasting impact on the capacity of the three countries to deliver stronger health services for multiple other diseases and conditions. Two examples illustrate this potential. First, as the year evolved, more laboratories were added and their services gradually got better and faster, reducing some of the delays that fuelled community transmission and caused considerable anxiety among patients and their families, who were forced to wait days for test results. In providing this support, WHO drew on another network of partners, the Emerging and Dangerous Pathogens Laboratory Network. Mobile laboratories, generously donated by several governments and economic consortiums worldwide, proved to be the fastest and most flexible solution, as these can be transported as smaller component parts and then set up and functioning within 48 hours. A review of the evolution of laboratory services in Sierra Leone is particularly instructive – and encouraging. By year end, the country had 11 functioning laboratories equipped and staffed to safely process patient samples and diagnose Ebola virus disease. Many were strategically placed to support the government’s Western Area Surge that began in mid-December. Together, these laboratories were able to process 700 samples per day, with a surge capacity of up to 1,100 samples per day. Three of the laboratories were also staffed and equipped to perform haematology investigations and biochemistry testing, thus upgrading the quality of support available to guide clinical decisions and improve patient care and survival rates. Waiting times for test results shrank considerably, reaching times that compare well with diagnostic services in countries with advanced health systems. In Sierra Leone, if a patient arrives for testing in the morning, results will be ready that same evening. Having international laboratory experts, deployed by WHO, in the country proved important for a second reason. In Kono district, staff discovered that a diagnostic test that had not been evaluated for safety and performance and had not been approved by WHO was nonetheless being used, with likely risks to both patients and laboratory technicians alike. The next steps for early 2015 include introduction of a web-based platform for real-time analysis of laboratory results and feedback to laboratories on their performance as a contribution to quality control, and improvements in the ability to perform differential diagnosis. The latter is needed to assure safety during routine services, such as surgery and childbirth, where medical staff risk managing a patient with undiagnosed Ebola virus disease. Improvements in these areas can help restore public and professional confidence in general health services. WHO further plans to integrate services, such as those needed to support its global malaria program, into the laboratory structures and procedures set up for the emergency response to Ebola. Yet another immediate objective is to increase the number of laboratories able to perform additional tests that help clinicians fine-tune their management strategies, ideally bringing down case fatality rates closer to those seen when foreign medical staff are evacuated and treated in advanced hospital settings. A similar story has been unfolding since clinical trials of convalescent therapies, involving the transfusion of whole blood or blood plasma from Ebola survivors, began in December in Guinea and Liberia. The training, equipment, and facilities needed to conduct these trials have already upgraded the safety, quality, and range of modern blood services that can be offered. The list of common and severe health problems that benefit from safe and well-functioning blood services is long. It ranges from the treatment of malaria, dengue, Lassa fever, yellow fever, and many other diseases to the management of complications of childbirth and injuries following accidents and traffic crashes. Both of these initiatives can jump-start the provision of essential health services, which had nearly ceased to function, and get them back into operation – at a higher level of quality.
Posted on: Tue, 27 Jan 2015 08:55:40 +0000
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