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Appendix C: Ebola Virus Disease Preparedness in Germany: Expertise Focused in Specialized Laboratories, Competence, and Treatment Centers
Pages 87-104

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From page 87...
... and high-level isolation units (treatment centers) specialized in han dling these diseases.
From page 88...
... 3. A well-functioning public health sector with local health authorities be ing able early to detect and report highly contagious diseases in order to assure adequate clinical management of these cases and the necessary infection prevention and control measures.
From page 89...
... In the following, the preparedness measures are summarized regarding infection prevention and control as well as clinical management of EVD cases in Germany. CRITICAL ELEMENTS OF PREPAREDNESS Exit screening of travelers in affected West African countries provides a helpful element, if sensitive screening procedures are available.
From page 90...
... . PREPAREDNESS PLANNING IN GERMANY FOR EVD CASES RKI, as the German national public health institute, has developed a number of guidance documents relating to EVD, the most comprehensive of which is Framework Ebola Virus Disease (RKI, 2015)
From page 91...
... The document is primarily intended for public health authorities and health care workers in German hospitals, outpatient clinics, and emergency services to facilitate the detection, evaluation, and management of suspected and confirmed EVD cases in Germany. One of the most frequently cited elements of the EVD framework is a flowchart with specific advice for physicians/clinicians in Germany to help recognize probable cases of EVD if there is an initial suspicion for EVD (see next section, "Recognizing a Probable Case of EVD")
From page 92...
... Yes For initial anamnesis of suspected EVD patient keep a distance of >1 m to patient! For examination of the patient protective equipment should be used, such as gloves, goggles, disposable gown and FFP3 maska In the past 21 days prior to first symptoms: Not a Contactb with suspected or probable case confirmed EVD patient, including Yes Probable case deceased EVD patients (epidemic No Ebola virus- areas in Africa for possible Special protective specific protective contact are listed belowc)
From page 93...
... . MEASURES IN THE EVENT OF A PROBABLE CASE If a probable EVD case has been identified measures have to be taken in a whole range of areas by the physician, local hospital, local health authority, or competence and treatment center.
From page 94...
... Handling of this virus requires special containment facilities and barrier protection. Only if urgently needed should samples be taken outside of a high-level isolation unit and only after consultation with the local public health authority and the responsible competence and treatment center.
From page 95...
... Disinfection of contaminated surfaces needs to be done with approved disinfectants from the RKI disinfection list or the list by the Association for Applied Hygiene.7 PERMANENT WORKING GROUP OF COMPETENCE AND TREATMENT CENTERS In 2000 a national concept for the management and control of highly contagious life-threatening infectious diseases was established in Germany in order to be prepared for imported serious infections that might pose a threat to public health, including viral hemorrhagic fevers and other highly infectious life-threatening diseases, most of them caused by BSL-4 pathogens. A key element of this concept is a network called STAKOB (Gottschalk et al., 2009)
From page 96...
... , and the Federal Foreign Office. The treatment centers with their high-level isolation units gather specialized medical knowledge in infectious diseases, including highly contagious and potentially life-threatening ones, as well as skills in their clinical management, diagnosis, and hygiene management.
From page 97...
... The German Federal Foreign Office has led a project to transform a civil airplane into a kind of ambulance airplane to safely transport and treat EVD patients onboard. Plans were made for a high-level isolation unit installed within the airplane, allowing direct access to the patient and medical treatment.
From page 98...
... (bottom) Sketch of the high-level isolation unit onboard the German MedEvac.
From page 99...
... If rare, highly infectious and pathogenic agents are involved, the state and local health authorities appreciate additional support by providing information on the management of these diseases. During the 2014 Ebola outbreak, RKI gave extensive advice on early detection of probable EVD cases, infection prevention, and control measures as well as on the clinical management of EVD cases.
From page 100...
... Some local health authorities are left with only a limited number of staff. In the discussions and preparations in Germany during this Ebola outbreak in West Africa, the importance of a functional public health system became evident repeatedly; outbreaks like severe acute respiratory syndrome, Middle East respiratory syndrome coronavirus (MERS-CoV)
From page 101...
... Coverage on the local level should be complemented by an "infectious diseases casualty doctor," meaning a doctor trained both in emergency medicine and infectious diseases who could reach the periphery -- a home or health center -- in the event of clinical suspicion of a highly contagious and potentially life-threatening disease. EXPECTATIONS OF PUBLIC HEALTH INSTITUTIONS DURING AN EVD OUTBREAK The European national public health institutes were confronted with numerous questions and demands from almost all professional circles, including domestic and international aspects.
From page 102...
... 2015. Temporal and spatial analysis of the 2014-2015 Ebola virus outbreak in West Africa.
From page 103...
... 2014. Investigating the zoonotic origin of the West African Ebola epidemic.
From page 104...
... 2014. Ebola virus disease in West Africa -- the first 9 months of the epidemic and forward projections.


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