Ebola Treatment Unit Research Articles

Modeling in Real Time During the Ebola Response

To aid decision-making during CDC's response to the 2014-2016 Ebola virus disease (Ebola) epidemic in West Africa, CDC activated a Modeling Task Force to generate estimates on various topics related to the response in West Africa and the risk for importation of cases into the United States. Analysis of eight Ebola response modeling projects conducted during August 2014-July 2015 provided insight into the types of questions addressed by modeling, the impact of the estimates generated, and the difficulties encountered during the modeling. This time frame was selected to cover the three phases of the West African epidemic curve. Questions posed to the Modeling Task Force changed as the epidemic progressed. Initially, the task force was asked to estimate the number of cases that might occur if no interventions were implemented compared with cases that might occur if interventions were implemented; however, at the peak of the epidemic, the focus shifted to estimating resource needs for Ebola treatment units. Then, as the epidemic decelerated, requests for modeling changed to generating estimates of the potential number of sexually transmitted Ebola cases. Modeling to provide information for decision-making during the CDC Ebola response involved limited data, a short turnaround time, and difficulty communicating the modeling process, including assumptions and interpretation of results. Despite these challenges, modeling yielded estimates and projections that public health officials used to make key decisions regarding response strategy and resources required. The impact of modeling during the Ebola response demonstrates the usefulness of modeling in future responses, particularly in the early stages and when data are scarce. Future modeling can be enhanced by planning ahead for data needs and data sharing, and by open communication among modelers, scientists, and others to ensure that modeling and its limitations are more clearly understood. The activities summarized in this report would not have been possible without collaboration with many U.S. and international partners (http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/partners.html).

Psychological Distress among Ebola Survivors Discharged from an Ebola Treatment Unit in Monrovia, Liberia – A Qualitative Study

A consequence of the West Africa Ebola outbreak 2014-2015 was the unprecedented number of Ebola survivors discharged from the Ebola Treatment Units (ETUs). Liberia alone counted over 5,000 survivors. We undertook a qualitative study in Monrovia to better understand the mental distress experienced by survivors during hospitalization and reintegration into their community. Purposively selected Ebola survivors from ELWA3, the largest ETU in Liberia, were invited to join focus group discussions. Verbal-informed consent was sought. Three focus groups with a total of 17 participants were conducted between February and April 2015. Thematic analysis approach was applied to analyze the data. The main stressors inside the ETU were the daily exposure to corpses, which often remained several hours among the living; the patients' isolation from their families and worries about their well-being; and sometimes, the perception of disrespect by ETU staff. However, most survivors reported how staff motivated patients to drink, eat, bathe, and walk. Additionally, employing survivors as staff fostered hope, calling patients by their name increased confidence and familiarity, and organizing prayer and singing activities brought comfort. When Ebola virus disease survivors returned home, the experience of being alive was both a gift and a burden. Flashbacks were common among survivors. Perceived as contagious, many were excluded from their family, professional, and social life. Some survivors faced divorce, were driven out of their houses, or lost their jobs. The subsequent isolation prevented survivors from picking up daily life, and the multiple losses affected their coping mechanisms. However, when available, the support of family, friends, and prayer enabled survivors to cope with their mental distress. For those excluded from society, psychosocial counseling and the survivor's network were ways to give a meaning to life post-Ebola. Exposure to death in the ETU and stigma in the communities induced posttraumatic stress reactions and symptoms of depression among Ebola survivors. Distress in the ETU can be reduced through timely management of corpses. Coping mechanisms can be strengthened through trust relationships, religion, peer/community support, and community-based psychosocial care. Mental health disorders need to be addressed with appropriate specialized care and follow-up.

Ebola Laboratory Response at the Eternal Love Winning Africa Campus, Monrovia, Liberia, 2014-2015.

West Africa experienced the first epidemic of Ebola virus infection, with by far the greatest number of cases in Guinea, Sierra Leone, and Liberia. The unprecedented epidemic triggered an unparalleled response, including the deployment of multiple Ebola treatment units and mobile/field diagnostic laboratories. The National Institute of Allergy and Infectious Diseases and the Centers for Disease Control and Prevention deployed a joint laboratory to Monrovia, Liberia, in August 2014 to support the newly founded Ebola treatment unit at the Eternal Love Winning Africa (ELWA) campus. The laboratory operated initially out of a tent structure but quickly moved into a fixed-wall building owing to severe weather conditions, the need for increased security, and the high sample volume. Until May 2015, when the laboratory closed, the site handled close to 6000 clinical specimens for Ebola virus diagnosis and supported the medical staff in case patient management. Laboratory operation and safety, as well as Ebola virus diagnostic assays, are described and discussed; in addition, lessons learned for future deployments are reviewed.

Accuracy, Precision, Ease-Of-Use, and Cost of Methods to Test Ebola-Relevant Chlorine Solutions.

To prevent transmission in Ebola Virus Disease (EVD) outbreaks, it is recommended to disinfect living things (hands and people) with 0.05% chlorine solution and non-living things (surfaces, personal protective equipment, dead bodies) with 0.5% chlorine solution. In the current West African EVD outbreak, these solutions (manufactured from calcium hypochlorite (HTH), sodium dichloroisocyanurate (NaDCC), and sodium hypochlorite (NaOCl)) have been widely used in both Ebola Treatment Unit and community settings. To ensure solution quality, testing is necessary, however test method appropriateness for these Ebola-relevant concentrations has not previously been evaluated. We identified fourteen commercially-available methods to test Ebola-relevant chlorine solution concentrations, including two titration methods, four DPD dilution methods, and six test strips. We assessed these methods by: 1) determining accuracy and precision by measuring in quintuplicate five different 0.05% and 0.5% chlorine solutions manufactured from NaDCC, HTH, and NaOCl; 2) conducting volunteer testing to assess ease-of-use; and, 3) determining costs. Accuracy was greatest in titration methods (reference-12.4% error compared to reference method), then DPD dilution methods (2.4–19% error), then test strips (5.2–48% error); precision followed this same trend. Two methods had an accuracy of <10% error across all five chlorine solutions with good precision: Hach digital titration for 0.05% and 0.5% solutions (recommended for contexts with trained personnel and financial resources), and Serim test strips for 0.05% solutions (recommended for contexts where rapid, inexpensive, and low-training burden testing is needed). Measurement error from test methods not including pH adjustment varied significantly across the five chlorine solutions, which had pH values 5–11. Volunteers found test strip easiest and titration hardest; costs per 100 tests were $14–37 for test strips and $33–609 for titration. Given the ease-of-use and cost benefits of test strips, we recommend further development of test strips robust to pH variation and appropriate for Ebola-relevant chlorine solution concentrations.

Factors Underlying Ebola Virus Infection Among Health Workers, Kenema, Sierra Leone, 2014-2015.

Ebola virus disease (EVD) in health workers (HWs) has been a major challenge during the 2014-2015 outbreak. We examined factors associated with Ebola virus exposure and mortality in HWs in Kenema District, Sierra Leone. We analyzed data from the Sierra Leone National Viral Hemorrhagic Fever Database, contact tracing records, Kenema Government Hospital (KGH) staff and Ebola Treatment Unit (ETU) rosters, and burial logs. From May 2014 through January 2015, 600 cases of EVD originated in Kenema District, including 92 (15%) HWs, 66 (72%) of whom worked at KGH. Among KGH medical staff and international volunteers, 18 of 62 (29%) who worked in the ETU developed EVD, compared with 48 of 83 (58%) who worked elsewhere in the hospital. Thirteen percent of HWs with EVD reported contact with EVD patients, while 27% reported contact with other infected HWs. The number of HW EVD cases at KGH declined roughly 1 month after implementation of a new triage system at KGH and the opening of a second ETU within the district. The case fatality ratio for HWs and non-HWs with EVD was 69% and 74%, respectively. The cluster of HW EVD cases in Kenema District is one of the largest ever reported. Most HWs with EVD had potential virus exposure both inside and outside of hospitals. Prevention measures for HWs must address a spectrum of infection risks in both formal and informal care settings as well as in the community.

Viraemia and Ebola virus secretion in survivors of Ebola virus disease in Sierra Leone: a cross-sectional cohort study

In survivors of Ebola virus disease, clinical sequelae including uveitis, arthralgia, and fatigue are common and necessitate systematic follow-up. However, the infection risk to health-care providers is poorly defined. Here we report Ebola virus RT-PCR data for body site and fluid samples from a large cohort of Ebola virus survivors at clinic follow-up. In this cross-sectional cohort study, consecutive survivors of Ebola virus disease attending Kerry Town survivor clinic (Freetown, Sierra Leone), who had been discharged from the Kerry Town Ebola treatment unit, were invited to participate. We collected and tested axillary, blood, conjunctival, forehead, mouth, rectal, semen, urine, and vaginal specimens for presence of Ebola virus using RT-PCR. We regarded samples to be positive for Ebola virus disease if the cycle threshold was 40 or lower. We collected demographic data from survivors of their age, sex, time since discharge from the treatment unit, and length of acute admission in the Ebola treatment unit using anonymised standard forms. Between April 2, and June 16, 2015, of 151 survivors of Ebola virus disease invited to participate, 112 (74%) provided consent. The median age of participants was 21·5 years (IQR 14-31·5) with 34 (30%) participants younger than 16 years. 50 (45%) of 112 participants were male. We tested a total of 555 specimens: 103 from the axilla, 93 from blood, 92 from conjunctiva, 54 from forehead, 105 from mouth, 17 from the rectum, one from semen, 69 from urine, and 21 from the vagina. The median time from Ebola treatment unit discharge to specimen collection was 142 days (IQR 127-159). 15 participants had a total of 74 swabs taken less than 100 days from discharge. The semen sample from one participant tested positive for Ebola virus at 114 days after discharge from the treatment unit; specimens taken from the axilla, blood, conjunctiva, forehead, mouth, rectum, and urine of the same participant tested negative. All specimens from the other 111 participants tested negative. Patients recovering from Ebola virus disease who do not meet the case definition for acute disease pose a low infection risk to health-care providers 6 weeks after clearance of viraemia. Personal protective equipment after this time might be limited to standard barrier precautions, unless contact with fluids from sanctuary sites is envisaged. Save the Children International, Public Health England.

Clinical Presentation and Care of Patients with Ebola Virus Disease in the China Ebola Treatment Unit, Liberia.

In order to evaluate the clinical characteristics of confirmed Ebola Virus Disease (EVD) patients admitted to the China Ebola Treatment Unit (China ETU) between January 2015 and March 2015, we retrospectively analyzed clinical symptoms, treatment, and epidemiologic features of 5 patients with confirmed EVD, and reviewed the relevant medical literature. Of these, 3 patients survived, and 2 died. The time interval from the onset of symptoms to the negative PCR test for Ebola virus in the 3 survivors was 14-18 days. All survivors reported direct contact with confirmed EVD patients up to 21 days prior to admission. All patients developed a fever, fatigue, and anorexia. Fever was generally the first symptom to develop, followed by a gastrointestinal phase characterized by vomiting/nausea (3 cases, 60%), diarrhea (3 cases), and abdominal pain (4 cases, 80%). Three patients (60%) reported joint pain, muscle pain, and conjunctival hemorrhage, respectively, and 2 patients (40%) developed a headache. We concluded that strict isolation and interruption of the route of transmission were required for suspected or confirmed EVD patients. The main treatment strategies were supportive care, maintenance of blood volume and electrolyte balance, and the prevention of complications.

Improving health care workers' protection against infection of Ebola hemorrhagic fever through video surveillance

The purpose of this study was to investigate the importance of supervision through video surveillance in improving the quality of personal protection in preparing health care workers working in Ebola treatment units. Wardens supervise, remind, and guide health care workers' behavior through onsite voice and video systems when they are in the suspected patient observation ward and in the patient diagnosed ward of the Ebola treatment center. The observation results were recorded, and timely feedback was given to the health care workers. After 2 months of supervision, 1,797 cases of incorrect personal protection behaviors were identified and corrected. The error rate continuously declined. The declined rate of the first 2 weeks was statistically different from other time periods. Through reminding and supervising, nonstandard personal protective behaviors can be discovered and corrected, which can help health care workers standardize personal protection. The timely feedback from video surveillance can also offer psychologic support and encouragement promptly to ease psychologic pressure. Finally, this can ensure health care workers stay at a zero infection rate during patient treatment. Personal protective equipment protocol supervised by wardens through a video monitoring process can be used as an effective complement to conventional mutual supervision methods and can help health care workers avoid Ebola infection during treatment.

Post-Ebola Syndrome, Sierra Leone.

Thousands of persons have survived Ebola virus disease. Almost all survivors describe symptoms that persist or develop after hospital discharge. A cross-sectional survey of the symptoms of all survivors from the Ebola treatment unit (ETU) at 34th Regimental Military Hospital, Freetown, Sierra Leone (MH34), was conducted after discharge at their initial follow-up appointment within 3 weeks after their second negative PCR result. From its opening on December 1, 2014, through March 31, 2015, the MH34 ETU treated 84 persons (8-70 years of age) with PCR-confirmed Ebola virus disease, of whom 44 survived. Survivors reported musculoskeletal pain (70%), headache (48%), and ocular problems (14%). Those who reported headache had had lower admission cycle threshold Ebola PCR than did those who did not (p<0.03). This complete survivor cohort from 1 ETU enables analysis of the proportion of symptoms of post-Ebola syndrome. The Ebola epidemic is waning, but the effects of the disease will remain.

The healthcare workers’ clinical skill set requirements for a uniformed international response to the Ebola virus disease outbreak in West Africa: the Canadian perspective

Since December 2013, the Zaire Ebola virus disease (EVD) epidemic has ravaged West Africa. In collaboration with the Public Health Agency of Canada, healthcare workers (HCWs) and support staff from...

Academics are from Mars, humanitarians are from Venus: Finding common ground to improve research during humanitarian emergencies

In August 2014, just days after the World Health Organization (WHO) officially declared that the Ebola virus disease epidemic in West Africa was a public heath emergency of international concern, I received an email from International Medical Corps, a global humanitarian organization, asking me to join their initial emergency response team in Liberia. This was not my first emergency deployment with International Medical Corps; over the past 5 years, I have treated earthquake victims in Haiti, managed a trauma field hospital outside Misurata, Libya, and set up a refugee camp clinic in South Sudan. But launching an Ebola response would require a completely new set of skills. As the first medical coordinator for International Medical Corps’ first Ebola Treatment Unit, one of my tasks was to develop our protocols for clinical care for patients with suspected or confirmed Ebola. In doing so, I scoured the medical literature for clinical trials, diagnostic studies, or even observational studies that could help us develop evidence-based protocols for clinical care. My search came up largely empty. Even prior guidelines developed by WHO and Medecins Sans Frontieres (Doctors without Borders) contained only a handful of primary sources in their list of references. This dearth of research on the clinical management of Ebola virus disease, despite nearly 40 years of international experience responding to epidemics of Ebola in Africa, did not come as a surprise to me. It mirrors the lack of evidence on acute care and public health interventions in all types of humanitarian emergencies, from the management of crush injuries in earthquakes to gender-based violence in conflict settings, from acute malnutrition during famine to cholera outbreaks in refugee camps. Indeed, despite the steady rise in both ‘‘natural’’ and ‘‘man-made’’ emergencies (and the corresponding rise in funding for emergency response), humanitarian healthcare today looks a lot like the rest of medicine did 50 years ago—based largely on anecdote rather than evidence, with few high-quality research studies to guide practice. The model for responding to humanitarian crises in general, and Ebola outbreaks in particular, can be summarized as ‘‘see one, do one, teach one.’’ We respond to each new emergency with the same tools we used to manage the last one, never truly knowing whether any of it worked, or what alternative methods might work better. There certainly have been efforts in recent years to change this dynamic. The SPHERE guidelines (http:// www.sphereproject.org), developed in the 1990s after a cholera epidemic in the refugee camps of Goma in the former Zaire claimed over 30,000 lives, have helped to standardize humanitarian response. But the SPHERE guidelines, similar to those developed for Ebola, are only as good as the research that supports them, of which precious little has been conducted to date. More recent initiatives have been working to build that evidence base. Evidence Aid (http://www.evidenceaid.org), an offshoot of the prestigious Cochrane Collaborative, has done an impressive job of summarizing existing research on humanitarian and disaster response through high-quality systematic reviews and rapid release of pertinent data in response to major crises, including the recent Ebola epidemic. Perhaps even more important, it has done a significant amount of work to highlight the current gaps in the literature and highest priorities for disaster research. In addition, Enhancing Learning and Research for Humanitarian Assistance (ELRHA, http://www.elrha.org) is a UK-based initiative that has begun working in recent years to bridge the gap between research and practice in the humanitarian realm. They have

Clinical validation trial of a diagnostic for Ebola Zaire antigen detection: Design rationale and challenges to implementation

The current Ebola outbreak in West Africa has affected more people than all previous outbreaks combined. The current diagnostic method of choice, quantitative polymerase chain reaction, requires specialized conditions as well as specially trained technicians. Insufficient testing capacity has extended the time from sample collection to results. These delays have led to further delays in the transfer and treatment to Ebola Treatment Units. A sensitive and specific point-of-care device that could be used reliably in low-resource settings by healthcare workers with minimal training would increase the efficiency of triage and appropriate transfer of care. This article describes a study designed to validate the sensitivity and specificity of the ReEBOVTM Rapid Diagnostic Test using venous whole blood and capillary blood obtained via fingerprick. We present the scientific and clinical rationale for the decisions made in the design of a diagnostic validation study to be conducted in an outbreak setting. The multi-site strategy greatly complicated implementation. In addition, a decrease in cases in one geographic area along with a concomitant increase in other areas made site selection challenging. Initiation of clinical trials during rapidly evolving outbreaks requires significant cooperation on a national level between research teams implementing studies and clinical care providers. Coordination and streamlining of approval process are essential if trials are to be implemented in a timely fashion.

Moving Towards a More Aggressive and Comprehensive Model of Care for Children with Ebola

bola is a devastating illness for children, particularly those under 5 years of age. Although children are proportionally less affected than adults during outbreaks of Ebola, including in the current West Africa outbreak, it remains a major threat to child health in the affected nations and a neglected area of investigation and discussion. The threat is not only for those infected with Ebola, but for all children in the affected region because of the tremendous impact of this outbreak on national health care systems. In addition to what appears to be a different immunologic response to Ebola in children, the uniquely challenging bedside care of suspect and infected children plays a significant role in the increased morbidity and mortality in this age group. Little information has been published on efforts to care for children in Ebola treatment units (ETUs). We present a report of our experience caring for children at what was the largest ETU in Port Loko, Sierra Leone, and a discussion of our protocols for caring for children with Ebola, with the hope of stimulating an international dialogue regarding the care of children with this disease. These protocols represent the culmination of the accumulated experience and knowledge of our ETU health care staff. Although, admittedly, they reflect some shared insights from staff at other ETUs, themajority stem from the published literature with adaptations of standard pediatric therapy. The protocols represent the care we aspired to provide to each child at the time our ETU closed inMarch 2015 and serve as a starting point for future ETU providers and policymakers for the next Ebola epidemic. Because of resource limitations, a rigorous evidence-based demonstration of efficacy for all of these recommended interventions remains to be done. Thus, the protocols are well rooted in solid, biological rationale and clinical experience but as yet lack ideal empirical support.

The timeliness of the US military response to the 2014 Ebola disaster: a critical review

In the face of an unprecedented epidemic of Ebola Virus Disease, in September 2014, the US military began sending thousands of personnel to Liberia and supporting areas in Senegal in its largest deployment to the African continent in over two decades. In this review, media reports, published photographs and official statements are evaluated and summarized to identify and describe key time points in the US military response. Specific events include the initial establishment of the Monrovia Medical Unit and the buildup of forces for the expanded mission, which involved enhancement of laboratory testing capacity, construction of Ebola Treatment Units, and training of health care workers. The review concludes with a discussion and critical evaluation of the timeliness of this US military response in the context of the original expectations of the humanitarian community and government officials.

Being a Pediatrician in an Ebola Epidemic.

* Abbreviations: ETU — : Ebola treatment unit EVD — : Ebola virus disease PPE — : personal protective equipment I had the privilege of serving as a short-term Ebola clinician in Sierra Leone. I went as part of a team with the nongovernmental organization Partners in Health1 in January and February 2015. Sierra Leone is a country of 5.9 million people, with 41.7% <15 years old. Sierra Leone has a ratio of 0.022 physicians per 1000 people, or 1 physician for every 45 000 people.2 Pediatric care is provided by general practitioners and community health care workers. There is no pediatric specialty training available for physicians in the country. The most common causes of death for children <5 years old in Sierra Leone are pneumonia, diarrhea, and malaria.3 Against this background of an insufficiently equipped health care system, the Ebola epidemic hit West Africa, and cases in Sierra Leone peaked at 13 406 cases,4 the most of any country afflicted with Ebola. I trained as a combined internal medicine and pediatrics physician, and while working in the Ebola treatment unit (ETU) I was quickly assigned to the pediatric patients there. I was not the first or the only pediatrician to work in the ETU. I had the pleasure to meet … Address correspondence to Vijay Aswani, MD, PhD, Department of Internal Medicine & Pediatrics, Marshfield Clinic, 1000 N Oak Ave, Marshfield, WI 54449. E-mail: aswani.vijay{at}marshfieldclinic.org

Ebola or Not? Evaluating the Ill Traveler From Ebola-Affected Countries in West Africa.

Background. The 2014-2015 Ebola epidemic in West Africa had global impact beyond the primarily affected countries of Guinea, Liberia, and Sierra Leone. Other countries, including the United States, encountered numerous patients who arrived from highly affected countries with fever or other signs or symptoms consistent with Ebola virus disease (EVD). Methods. We describe our experience evaluating 25 travelers who met the US Centers for Disease Control and Prevention case definition for a person under investigation (PUI) for EVD from July 20, 2014 to January 28, 2015. All patients were triaged and evaluated under the guidance of institutional protocols to the emergency department, outpatient tropical medicine clinic, or Emory's Ebola treatment unit. Strict attention to infection control and early involvement of public health authorities guided the safe evaluation of these patients. Results. None were diagnosed with EVD. Respiratory illnesses were common, and 8 (32%) PUI were confirmed to have influenza. Four patients (16%) were diagnosed with potentially life-threatening infections or conditions, including 3 with Plasmodium falciparum malaria and 1 with diabetic ketoacidosis. Conclusions. In addition to preparing for potential patients with EVD, Ebola assessment centers should consider other life-threatening conditions requiring urgent treatment, and travelers to affected countries should be strongly advised to seek pretravel counseling. Furthermore, attention to infection control in all aspects of PUI evaluation is paramount and has presented unique challenges. Lessons learned from our evaluation of potential patients with EVD can help inform preparations for future outbreaks of highly pathogenic communicable diseases.

Preventive malaria treatment for contacts of patients with Ebola virus disease in the context of the west Africa 2014–15 Ebola virus disease response: an economic analysis

After the detection of an Ebola virus disease outbreak in west Africa in 2014, one of the elements of the response was to contact trace and isolate patients in specialised Ebola treatment units (ETUs) at onset of fever. We aimed to assess the economic feasibility of administering preventive malaria treatment to all contacts of patients with Ebola virus disease, to prevent the onset of febrile malaria and subsequent admission to ETUs. We used a decision tree model to analyse the costs of preventive malaria treatment (artemisinin-based combination treatment [ACT]) for all contacts of patients with Ebola virus disease (in terms of administration and averted ETU-stay costs) and benefits (in terms of averted ETU admissions) in west Africa, from a health-care provider perspective. The period of analyses was 1 year, which is roughly similar to the duration of the 2014-15 west Africa Ebola outbreak response. We calculated the intervention's cost per ETU admission averted (average cost-effectiveness ratio) by season (wet and dry), country (Liberia, Sierra Leone, and Guinea), and age of contact (<5 years, 5-14 years, and ≥15 years). We did sensitivity analyses to assess how results varied with malaria parasite prevalence (in children aged 2-10 years), daily cost of ETU stay (for Liberian malaria incidence levels), and compliance and effectiveness of preventive malaria treatment. Administration of ACTs to contacts of patients with Ebola virus disease was cost saving for contacts of all ages in Liberia, Sierra Leone, and Guinea, in both seasons, from a health-care provider perspective. In the wet season, preventive malaria treatment was estimated to reduce the probability of a contact being admitted to an ETU by a maximum of 36% (in Guinea, for contacts aged <5 years), and a minimum of 10% (in Guinea and Sierra Leone, for those aged ≥15 years). Assuming 85% compliance and taking into account the African population pyramid, the intervention is expected to be cost saving in contacts of all age groups in areas with malaria parasite prevalence in children aged 2-10 years as low as 10%. In Liberia during the wet season, malaria preventive treatment was cost saving even when average daily bed-stay costs were as low as US$5 for children younger than 5 years, $9 for those aged 5-14 years, and $22 for those aged 15 years or older. Administration of preventive malaria treatment to contacts of patients with Ebola virus disease should be considered by public health officials when addressing Ebola virus disease outbreaks in countries and seasons where malaria reaches high levels of transmission. Centers for Disease Control and Prevention.

Ebola Response in Liberia; Field Experiences, Challenges and Lessons Learnt during the Response, 2014-2015

The 2014-2015 Ebola Virus Disease (EVD) outbreaks which began in Guinea and later spread to Liberia, Sierra Leona and other countries have been responsible for a number of infections and deaths among the communities including health workers. The natural host of the EVD virus has not been identified even when scientific evidence points to bats as the natural reservoirs to similar strains of EVD virus. EVD male survivors have also been identified as a potential source of infection among the populations. Some of the reasons attributed to this rapid spread of EVD to other countries have been weak early warning systems to identify and notify health authorities of such diseases of high epidemic potential. Liberia has been one of the countries to be declared EVD free on two different occasions in 2015 each with a different epicenter. Despite a number of international organizations coming together to support control efforts in Liberia, the coordination of response activities by the Ministry of Health and Social Welfare and replicated at all levels of the surveillance systems was the key in suppressing the outbreak. Adoption of the Integrated Disease Surveillance and Response (IDSR) guidelines as recommended by World Health Organization (WHO/AFRO) was a positive step towards the structuring of response activities. Capacity building of health workers in infection control and prevention and surveillance was important to improve skills of health workers to triage EVD cases as recommended by WHO. Training community health volunteers in contact tracing and active case search was important in strengthening the Early Warning Disease surveillance system. Decentralization of response activities in addition to establishing Ebola Treatment units and Community Care Centers in all counties was vital in containing the spread of infection. Even when EVD was associated to high levels of stigma, community and individual counseling sessions led by community leaders enabled building community trust to refer cases for treatment. The EVD survivors distributed in different parts of the country are potential sources of new EVD infections. This will require strengthening early warning systems and response capacity at all levels.

Providing nursing care to Ebola virus disease patients: China Ebola Treatment Unit experience.

Providing nursing care to Ebola virus disease patients: China Ebola Treatment Unit experience.

CE: Inside an Ebola Treatment Unit: A Nurse's Report.

In December 2013, the first cases of the most recent outbreak of Ebola virus disease (formerly known as Ebola hemorrhagic fever) emerged in the West African nation of Guinea. Within months the disease had spread to the neighboring countries of Liberia and Sierra Leone. The international humanitarian aid organization Médecins Sans Frontières (MSF; known in English as Doctors Without Borders) soon responded by sending staff to set up treatment centers and outreach triage teams in all three countries. In August 2014, the World Health Organization declared the outbreak an international public health emergency.In September 2014, the author was sent by MSF to work as a nurse in an Ebola treatment unit in Liberia for five weeks. This article describes her experiences there. It provides some background, outlines the practices and teams involved, and aims to convey a sense of what it's like to work during an Ebola outbreak and to put a human face on this devastating epidemic.