Received via email from the African Scientific Institute: Getting to Zero: Stopping Ebola Virus in West Africa- An AMEC Alert by Dr. Oveta Fuller Since first recognized in March 2014, the current epidemic of Ebola virus in three different countries of West Africa has killed 467 people of the 759 documented cases as of July 3, 2014. This is the largest ever, still not controlled outbreak of Ebola virus. It is “an unprecedented event” according to Dr. Anthony Fauci, the Director of the National Institute for Allergy and Infectious Diseases (NIAID of the NIH). Take Home Message: This strain of Ebola virus can be up to 90% fatal (current 61.5% fatality rate in West Africa epidemic). Ebola virus is transmitted NOT by air or aerosols. It IS transmitted by touching tissue and direct contact with any bodily fluids of an infected person. Barrier nursing techniques (see below) are critical to avoid virus transmission. The ONLY controls for Ebola virus transmission are knowing what NOT to do and using known barrier and isolation precautions for care of those who are sick or deceased. Health care workers, family members and morticians or those who clean or dress bodies and who care for the sick must understand and use the precautions needed to avoid infection with the quickly fatal virus. AMEC Alert This is an alert so that ALL clergy and AMEC leaders, officers and members can help to get out a clear understanding of critical messages about stopping Ebola virus. 1. This is a serious currently uncontained and unprecedented virus infection. • There has never been an Ebola virus outbreak before in West Africa. The 2014 epidemic has confirmed cases and deaths in 3 different countries at once- in Guinea, Sierra Leon and Liberia. (“Porous” borders between these countries are crossed often by family members and for commerce. This allows people who are infected to go to new areas before they know they are sick or to seek care from family members when they feel sick.) • The outbreak (759 cases and 467 deaths confirmed from Ebola virus) is happening in urban areas- in capital cities, instead of only in more rural areas as in previous epidemics. Typically in rural areas, people who are sick are more easily isolated and quarantine conditions are easier to set up by health officials. • Fear of the virus, mistrust of health officials and misconceptions of where the virus and sickness come from and how illness spreads ALL lead to not knowing or using practices required to spread understanding of how to avoid exposure and infection. • Standard barrier and isolation methods of the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) that have contained epidemics in the past (isolating disease centers and imposed control of direct contact with those who are sick)- are NOT working because of the urban nature and frequent movement of people across the borders of countries in West Africa. 2. Familiar social and cultural customs that are comforting and high priority in our society help transmit Ebola virus. Mainly virus is transmitted by family and community members and healthcare personnel as they care for those who are sick or those who die from Ebola virus infection. • Avoid being close to persons who are ill or deceased. For caregivers, health workers or morticians, safe direct contact requires protective gloves, simple barrier masks and avoidance of splashing liquids. (A link to a CDC manual developed for Africa is cdc.gov/vhf/ebola/prevention/index.html) • Seek counsel on how to use guidelines under conditions of your local area. 3. Clergy- bishops, presiding elders, ministers, church officers, ministerial alliances, mission workers and youth group leaders are KEY resources in taking the message throughout communities of how to control exposure to Ebola virus and what to look for as early signs of infection. A useful link on barrier protection and isolation is as follows: cdc.gov/vhf/ebola/prevention/index.html Summary of barrier nursing techniques include: • wear protective clothing (such as masks, gloves, gowns, and goggles) • use infection-control measures (such as complete equipment sterilization and routine use of disinfectant) • isolate of Ebola Hemorrhagic Fever (HF) patients from contact with unprotected persons. The aim is to avoid contact with the blood or secretions of an infected patient. If a patient with Ebola HF dies, it is equally important that direct contact with the body of the deceased patient be prevented. Clergy and community leaders can benefit from guidelines developed by CDC, in conjunction with the World Health Organization to help prevent and control the spread of Ebola HF. The resource found at this link cdc.gov/vhf/abroad/healthcare-workers.html is entitled Infection Control for Viral Hemorrhagic Fevers In the African Health Care Setting. The manual describes how to: • recognize cases of viral hemorrhagic fever (such as Ebola HF) • prevent further transmission in health care setting by using locally available materials and minimal financial resources. [Further reading- Optional to include in an initial alert or to send as a TCR follow-up] About Ebola virus and its Hemorrhagic Fever (HF) illness Ebola virus was discovered in 1976 in the Democratic Republic of Congo (DRC), formerly Zaire. It has caused 16 sporadic and isolated disease outbreaks since then, typically in communities of central Africa. Of more than 3,000 reported cases there are over 1,600 deaths since its discovery. The natural environmental source (reservoir) of Ebola virus is fruit bats. Bats spread the virus mainly to primates such as monkeys, chimpanzees, gorillas and humans. Humans are not required hosts for survival of the virus, but are incidental or dead-end hosts. The virus can spread from bats to humans, from primates to human or from human to human by direct contact with tissue or fluids. Symptoms of Hemorrhagic Fever (HF) Ebola and several other similar viruses cause hemorrhagic fever (HF). Disease symptoms of Ebola virus infection typically appear in 7-10 days, but this can range from 2-20 days from the initial contact with a source of virus. Often direct contact with a dead animal, a sick animal or a sick person is a recognized source of infection. There is typically a sudden onset of symptoms. The flu-like symptoms- fever, muscle ache, headache, stomach pain and a sore throat- are similar to symptoms of many common infections. Other indications of Ebola virus infection can be rash, hic-cups, chest pain, red eyes or difficulty in breathing. Symptoms then progress to uncontrollable vomiting, diarrhea, loss of kidney and liver function and internal and external bleeding. These body fluids contain high levels of infectious virus. Direct contact with any of these bodily fluids or with objects that have these fluids (fomites) must be avoided in order to prevent new infection. The virus reproduces rapidly in a wide range of human tissue types and is highly contagious. It is transmitted by direct contact. Without supportive care, death often occurs within 8-10 days from loss of fluids, major organ dysfunction and shock. Diagnosis, Treatment and Care There is no cure, vaccine or specific treatment for Ebola virus infection. The major care is to provide support for people who are sick through additional oxygen and hydration and treating any complicating infections. All Ebola illness should be immediately reported to the nearest clinic or health official, the person should be isolated and supportive care provided using barrier nursing protections. Although diagnostic tests are available for health officials to confirm Ebola virus presence, early and progressive symptoms and possible contact with a source of exposure in epidemic areas are highly predictive of infection. There is no cure and limited treatments have only been explored in animals. There are five known types of Ebola virus. The current West Africa epidemic is caused by the most virulent (deadly) strain. Virus Control and Importance of Containment Avoidance of contact with bodily fluids specifically by healthcare workers and family members of those who are sick along with isolation of patients are critical in control of Ebola virus epidemics. Previously, the spread of Ebola virus has been stopped by focused efforts of officials on isolation of whole communities and of persons who are sick. A natural factor in control is that usually people in more rural areas who are infected with Ebola virus feel too sick to travel. In previous epidemics, the virus infection has been recognized so that methods can be put in place. Those methods have worked to keep virus contained in recognized and defined locations. Infection and deaths have been minimized in the 16 known outbreaks since 1976. This 2014 West Africa epidemic brings both known old challenges and new challenges that we have not faced previously. Some of these challenges include: - fast spread of a highly fatal virus strain - infection of people who are highly mobile and of people in urban centers - lack of adequate healthcare infrastructure and trained personnel - a general lack of understanding and a high level of fear in communities - expected practice of the cultural customs of care, rituals and grieving norms - regional travel through, among and outside of West African countries Dr. Peter Piot, a microbiologist who is the co-discoverer of Ebola as a disease, in a recent CNN interview expresses concern about Ebola virus in West African countries. He states, “This is a mega-crisis in which a state of emergency likely will be needed to contain the disease.” In addition to concerted efforts by health officials and assistance by media to get out information and education, “getting control of this may mean bringing out the military to help with quarantine of people in affected areas and with limiting travel of people in the three countries and in another neighboring 7-8 bordering countries.” In a 2014 connected world with an ongoing Ebola virus infection in urban areas, mass transit that includes air travel and the context of cultural customs of care for sick family members or rituals for the deceased, Dr. Piot stated “there is no time to lose.” He is saying that we must take every available measure to stop Ebola virus spread. This includes engaging use of networks of informed religious leaders as an untapped resource. What does this mean outside of West Africa This is not the scenario in the fictitious movies Outbreak or Contagion. With action now, we hope to not be headed to spread of Ebola virus outside of West Africa. However, informed action is needed. This 2014 epidemic in West Africa is a situation where the methods and means of containment and control used previously are NOT working to stop Ebola virus spread. Education, intent and focused diligence to know and strictly follow guidelines as possible are required especially in the three countries where people are known to be affected. Surveillance by health officials in neighboring or nearby countries is necessary and is occurring. This includes informed engagement by religious leaders and networks of such leaders (e.g. the AMEC in the 14th Episcopal District and nearby areas) who have access and influence in communities. For those not in West Africa, be alert about travel to this region and stay informed. About the author: A. Oveta Fuller, Ph.D. is a tenured professor in Microbiology and Immunology, Associate Director of the African Studies Center at the University of Michigan, and ASI Fellow. She is an Itinerant Elder in the 4thEpiscopal District of the African Methodist Episcopal Church, a former pastor and a 2012-13 J. William Fulbright Scholar who resided in Zambia. She works with community partners on effective mobilization of interventions for HIV/AIDS elimination. At Payne Theological Seminary she teaches a required course, “What Effective Clergy Should Know about HIV/AIDS.” Contact Info: Email: [email protected], Office phone: 734 647-3830
Posted on: Sun, 20 Jul 2014 18:11:57 +0000
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