Emerging Epidemics: Management and Control

Consequences of delays and imperfect implementation of isolation in epidemic control
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Each country had limited capacity to isolate and treat patients, and strategies to do so effectively and safely evolved over time.

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This strategy controlled outbreaks faster and supported the care of patients in remote areas, cutting the time to control outbreaks in half Figure 1 and doubling survival rates In addition to the efforts of partner organizations, CDC field teams included emergency risk communication specialists to generate and disseminate accurate information, address rumors, decrease stigma, reduce unsafe burial practices, and respond to community needs.

CDC staff in Liberia and Sierra Leone identified and promulgated burial practices that met community needs for culturally acceptable mourning, thus reducing resistance to safe burials 18 , In all countries, community engagement and effective communication were key strategies for successful outbreak control.

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CDC then advocated to increase involvement by the US government and the global community. Initially focused on researching treatments and vaccines and providing laboratory diagnostics, in September , DoD took the lead on constructing, supplying, and maintaining a field hospital to treat health care workers with Ebola in Liberia.

DoD also deployed 3, military personnel for logistics and coordination, provision of medical personnel to train health care workers, establishment of additional treatment centers in Liberia, and operation of 3 mobile medical laboratories The DART provided coordination to rapidly engage partners providing services and supporting response efforts; CDC staff served as the technical lead for health, public health, and medical issues within the DART.

A CDC model that projected the possible trajectory of the epidemic if the trend of rapid transmission through August continued unabated was key to increasing the speed and scale of the US and global response The worst-case scenarios of the model made clear the need for urgent action and helped stimulate a massive global response. Analysis from the model provided 4 key findings. First, cases were increasing exponentially, and the response needed was massive and urgent. CDC helped facilitate assistance, including from the African Union, which mobilized nearly 1, staff, including doctors, nurses, epidemiologists, and health educators Figure 2.

Estimated impact of delaying intervention on daily number of Ebola virus disease cases, Liberia, — The intervention modeled is as follows: starting on September 23, day in model , and Second, the model predicted a severe penalty for delay; case numbers at the peak roughly tripled for every month of delayed scale-up Figure 2. Thus, interventions isolation, treatment, and safe burials had to be rapid, with action and progress measured in hours and days rather than in weeks and months.

In each country, CDC encouraged national leaders, incident managers, health workers, the media, and communities to take action, immediately because even a rapid international response would not be fast enough.

Emerging Epidemics: Management and Control

Canadian Databases for Disease Vectors Mathematical modelling is a method of research that allows for simulations of the real world in a virtual space. Globalization has made the world more vulnerable to societal and economic impacts from infectious-disease outbreaks. Create capacity for trusted, influential private-sector employers to readily and reliably augment public messaging; manage rumors and misinformation; and amplify credible information to support emergency public communications. Kucharski, A. New Password. Global attention to Zika virus continues with new information and developments nearly every week. Brauer, F.

Third, the model identified a tipping point at which the epidemic would plateau and decline if enough i. In Liberia, experienced CDC public health specialists conducted detailed planning exercises with community, political, medical, and public health leaders in each county to identify where sick persons could be isolated until ETUs were constructed and how contacts could be monitored and cared for if they became ill.

Figure 3. Comparison of estimated weekly Ebola virus disease case rate for Liberia with intervention with actual weekly case rates for Liberia and Sierra Leone. The September modeled projection curve was based Figure 4. Comparison of the estimated impact of interventions on number of Ebola cases with actual cases reported, Liberia, — The September modeled projection curve was based on Figure 3 in Meltzer Fourth, the model predicted that when the tipping point was reached, transmission would decline rapidly. This prediction was shown to be accurate in the following months in Liberia and Sierra Leone Figure 3.

The predictions also closely matched the actual case trajectory after effective intervention. CDC worked with ministries of health and airport authorities in all 3 heavily affected countries, as well as in other affected countries, to establish screening of travelers leaving the country by air to prevent sick or exposed persons from boarding planes.

Emerging Infectious Diseases and Outbreaks

CDC staff also provided technical assistance on measures to reduce risk for spread through maritime ports and across land borders. CDC laboratory scientists implemented high-throughput laboratory capacity by using robotics and collaborated with private industry to promote development of lateral-flow assays to detect Ebola in point-of-care settings within 30 minutes after a finger stick or oral swab 6.

In addition to supporting the National Institutes of Health randomized controlled trials of Ebola treatment 27 and vaccines 28 , CDC staff worked with Sierra Leone authorities to implement a parallel Sierra Leone Trial to Introduce a Vaccine against Ebola STRIVE , an adaptive, phased-introduction trial of a vaccine candidate among health workers in that country 8 , 9.

In Nigeria, a cluster of Ebola cases in July resulted from a traveler from Liberia.

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With the Nigerian government and partners, CDC facilitated creation of an effective incident management system, using leadership and staff from the Nigerian Polio Eradication Program and support from the Bill and Melinda Gates Foundation. Although 19 secondary cases of Ebola occurred in 3 generations of spread in 2 cities, this rapid action controlled transmission, and Nigeria has been Ebola-free since this incident 3. CDC staff provided similar assistance in Mali after a child arriving from Guinea died of Ebola and again after a cluster of cases occurred from a person from the Mali—Guinea border who had previously undiagnosed Ebola 29 , and in Senegal after an incident of disease importation 4.

CDC also collaborated with WHO to increase preparedness in at-risk countries by helping establish EOCs, surveillance for hemorrhagic fever and clusters of deaths, training in contact tracing, laboratory specimen transport and testing, isolation capacity for patients suspected of having Ebola, health communication messages, and border health security.

Before diagnosis of the first case of Ebola imported to the United States, CDC alerted US health care providers to consider Ebola if compatible signs and symptoms manifested within 21 days after a traveler arrived from an affected country CDC also issued infection control guidance for hospitals 31 ; strengthened laboratory networks and existing surveillance systems; and disseminated recommendations for travelers on the CDC website, through social media channels, and at US international airports. The first case of Ebola diagnosed in the United States, imported by a traveler from Liberia, revealed gaps in hospital preparedness and response capabilities CDC provided assistance to the state and local health departments and to nearby hospitals.

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CDC subsequently strengthened recommendations for infection control, particularly training, supervision, and specifications of PPE. The second nurse who became ill was allowed to travel by air despite exposure that CDC should have categorized as high-risk to prevent the nurse from flying In turn, this measure would have reduced the number of travelers whose health was monitored and the work of public health personnel monitoring contacts.

Recognizing a need for enhanced preparedness and training, CDC staff then visited 81 facilities in 21 states and Washington, DC, helping 55 of these facilities qualify as Ebola Treatment Centers for patients with suspected or confirmed Ebola. CDC established Ebola Response Teams composed of CDC experts in infection control, clinical care, contact tracing, communications, environmental waste management, and other areas to support state and local health departments and to deploy to any hospital in the United States that has a patient under investigation for Ebola Travelers are met at the airport and provided with Check and Report Ebola CARE kits that include health education materials, a thermometer, and ways to connect with their state or local health department, including a prepaid cell phone.

Ebola was not diagnosed in any of these persons Health departments facilitated safe transport to a hospital ready to assess travelers for Ebola if the person developed fever or other symptoms of concern. Before initiation of the active monitoring program, 1 case of Ebola was detected by self-monitoring; rapid detection and isolation prevented further disease transmission. Every jurisdiction now monitors travelers arriving from the highly affected countries and reports to CDC. The Ebola epidemic in West Africa is unprecedented in size and geographic distribution; it spread in many areas unfamiliar with the disease, including the first large urban outbreaks of Ebola.

If the response in West Africa and global assistance had been implemented earlier, faster, and more effectively, far fewer cases and deaths and much less social and economic disruption would have occurred. The epidemic has shown that critical improvements are needed in 2 main areas. First, the ability of every country to quickly identify and respond to a health threat needs to be enhanced.

Second, the ability of the global community to rapidly respond to needs in a country overwhelmed by an epidemic must be improved. For months, the Ebola epidemic spread faster than the international community, including CDC, responded. Critical barriers in the affected countries include limited electronic connectivity 38 ; insufficient numbers of trained staff; inability to surge rapidly enough to provide needed case detection, education, contact tracing, and isolation services; and poorly functioning national health and public health systems with staff who often were unpaid, untrained, and poorly supervised.

Surveillance and data management systems were overwhelmed; solutions are needed to manage, track, and support large outbreaks and public health interventions.

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Stronger national and international systems for disease detection and control are needed. Paradoxically, the world is better prepared to find and stop emerging health threats than at any time in history, yet also is at greater risk for rapid spread of infectious diseases, which occur more frequently because of encroachment into forest areas, spread of antimicrobial-resistant organisms, and increasing ease of creation of dangerous pathogens, in the context of an increasingly mobile, interconnected, and urban world.

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Emerging Epidemics: Management and Control offers five topics of coverage: FUNDAMENTALS Epidemics fundamentals Disasters and epidemics Biosafety. Emerging Epidemics: Management and Control Emerging infectious diseases are newly identified or otherwise previously unknown.

Diagnostic proficiency and reporting of Lassa fever by physicians in Osun State of Nigeria. BMC Infect Dis ; Knowledge and application of infectious disease control measures among primary care workers in Nigeria: The Lassa fever example. Prevalence and risk factors of Lassa seropositivity in inhabitants of the forest region of Guinea: A cross-sectional study. Lassa fever: Epidemiology, clinical features, and social consequences. BMJ ; Genetic diversity among Lassa virus strains. J Virol ; Abuja: Federal Ministry of Health; Assessment of integrated disease surveillance and response strategy implementation in selected local government areas of Kaduna State.

Ann Niger Med ; An overview of disease surveillance and notification system in Nigeria and the roles of clinicians in disease outbreak prevention and control. Niger Med J ; Emerg Infect Dis ; Addressing the gap between public health emergency planning and incident response. Disaster Health ; World Health Organization.

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VHFC; Molecular diagnostics for Lassa fever at Irrua Specialist Teaching Hospital, Nigeria: Lessons learnt from two years of laboratory operation. Lassa fever practice challenges in Nigeria. Int J Infect Dis b; 16 Suppl 1:e Seller Inventory AAH Book Description Wileyand ;Blackwell, New Book. Shipped from UK. Established seller since Seller Inventory FW Book Description John Wiley and Sons.

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Management and Control

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Publisher: Wiley-Blackwell , This specific ISBN edition is currently not available. View all copies of this ISBN edition:. Synopsis About this title A global perspective on the management and prevention of emerging and re-emerging diseases Emerging infectious diseases are newly identified or otherwise previously unknown infections that cause public health challenges.

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