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3 Global Preparedness and Response Efforts
Pages 23-44

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From page 23...
... Over the course of the epidemic, MSF has trained staff from several organizations and more than 4,000 West African nationals, he said. MSF opened 19 Ebola treatment units (ETUs)
From page 24...
... The first priority in Ebola outbreak intervention is to contain the virus, and MSF takes a multipronged approach to this objective. "In the community we carry out health promotion campaigns to try to change community infection behaviors and interrupt disease transmission, and in health care facilities we reinforce infection control to try and prevent transmission within the health structures," Sprecher said.
From page 25...
... ) , as described later by Heinz Feldmann of the National Institute of Allergy and Infectious Diseases' (NIAID's)
From page 26...
... simultaneously secured and hindered those delivering Ebola care, Sprecher noted. PPE standards set by MSF may be excessive, he said, "but until we actually have better evidence we won't be able to scale back." Meanwhile, health workers can only wear PPE for 40 to 60 minutes without risking heat stress, he observed; thus, a worker in an ETU is only able to work under biosafe conditions for 2 to 3 hours per shift, drastically limiting contact time with the patients.
From page 27...
... However, this should not be interpreted as a lack of effect of intravenous rehydration, but the recognition that under similar conditions, the benefit might be modest. Over nearly two decades of responding to Ebola outbreaks, no MSF staff member had ever become infected -- until the West African epidemic, in which 28 staff members became ill and 14 died, Sprecher said.
From page 28...
... The Outbreak in Context Building on Bausch's description of the region in which the epidemic originated, where the borders of Guinea, Sierra Leone, and Liberia meet, Fair observed that these divisions were imposed by colonization on long-standing tribal territories that have far greater influence over routes of travel and trade. He also noted that the tri-state region is hyperendemic for Lassa fever, which has been the subject of ongoing disease surveillance in Sierra Leone funded by a consortium of U.S.
From page 29...
... Getting to Zero While the West African Ebola epidemic appeared to be on the wane at the time of the workshop, Fair (among others) reminded participants that much work remained before all transmission chains were extinguished.
From page 30...
... RESAOLAB is part of the GABRIEL (Global Approach to Biological Research, Infectious Disease, and Epidemics in Low-Income Countries) Network, which encourages the sort of international health collaboration that will be necessary to address epidemic and pandemic diseases, Fair explained.
From page 31...
... "We stayed healthy," he reported, but he warned that deadly mistakes are bound to occur, given enough time. Bringing It Home Bucks then turned to the challenge of translating successful elements of West African Ebola care to hospitals such as his home facility in the United States.
From page 32...
... Many of the signs and symptoms of Ebola are nonspe cific and similar to those of many common infectious diseases, as well as other infectious diseases with high mortality rates. Transmission can be prevented with appropriate infection control measures.
From page 33...
... In particular, he -- echoing other workshop participants -- argued for the establishment of infection control standards for people and institutions that treat emerging infectious diseases. To illustrate this point, he compared the SARS experience in Toronto, where the first imported cases to enter a hospital were not immediately isolated and a major outbreak ensued, and, simultaneously, in Vancouver, where such a case was quickly isolated and infection control stepped up, extinguishing transmission.
From page 34...
... THE U.S. PUBLIC HEALTH RESPONSE Inger Damon of the CDC described her agency's multifaceted response to the Ebola epidemic in West Africa, which involved activities within that region, as well as domestic training for outbreak responders, planning for the care of patients returned to the United States, and preparations for outbreak control in the event of an Ebola introduction.
From page 35...
... The CDC has also instructed nearly 700 master trainers to conduct infection control training programs at West African health facilities, and they have assisted with the creation of technical materials used to train more than 23,000 frontline health care workers in Africa. Fulfilling its more traditional role in international outbreak response, the CDC, together with the World Health Organization (WHO)
From page 36...
... The CDC's Domestic Response Anticipating the possibility of Ebola importation into the United States, and in response to the infection of two nurses who cared for an Ebola patient in a Dallas hospital, the CDC acted to educate U.S. health care workers about isolating Ebola patients and preventing infection, tightened previous infection control guidance for health care workers caring for such patients, and updated PPE guidance, Damon stated.
From page 37...
... The Emory Serious Communicable Diseases Unit team, which Ribner directs, has treated more patients with Ebola, and at high risk for Ebola infection, than any other facility in the resource-rich world, he stated. Thus, it was his institution that was selected to receive the first cases from the West African epidemic to enter the United States, in early August 2014.
From page 38...
... Were it not for the West African Ebola epidemic, he said, the program would likely have been disbanded in 2015. Instead, federal funding has been granted to support one regional ETU for each U.S.
From page 39...
... "I have been very fortunate in that our administration has underwritten this project for untold dollars," he said, noting that few community hospitals are likely to possess such resources. Inpatient Care Ribner noted that Ebola care protocols in U.S.
From page 40...
... response to the West African Ebola epidemic, according to Sylvain Aldighieri, who coordinates the IHR, Alert and Response and Epidemic Diseases Unit, jointly with the WHO. In 2014, 13 of the 22 countries represented by PAHO had, by self-report, achieved compliance with IHR core public health capacities; thus, a significant component of regional preparedness involved identifying and filling gaps in public health functions necessary to prevent local transmission of Ebola, if it were introduced to the region.
From page 41...
... At the time of the workshop, Germany's association with the West African Ebola epidemic was primarily one of assistance in the affected countries, according to Burger; however, like other Western countries, Germany's public health officials anticipated the possibility of imported cases, and had also accepted 5   Technical guidelines are available at www.paho.org/ebola (accessed November 3, 2016)
From page 42...
... Six of the seven centers are equipped not only to treat and isolate patients with dangerous infectious diseases but also to manage a spectrum of support services for disease control, including hospital hygiene and decontamination, transportation, and public information, Burger reported. The treatment centers, known by their German acronym, STAKOB,6 are prepared for any highly contagious agent, he said; currently they can accommodate 50 patients, and they are staffed by dedicated personnel who train regularly.
From page 43...
... RKI generally communicates with professionals involved in infectious disease control to provide advice, analysis, and technical support, but in the case of a crisis, the institute also provides public information, he noted. "These efforts depend very much on political support," he noted -- and particularly that of Chancellor Angela Merkel, whom he characterized as both interested in and well informed about Ebola.


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