Combating Infectious Diseases Takes a Community: Lessons From the Ebola Epidemic

Transcription

1 Combating Infectious Diseases Takes a Community: Lessons From the Ebola Epidemic May 1, 2015 Nahid Bhadelia, MD, MA Director of Infection Control and Medical Response, National Emerging Infectious Diseases Laboratories Section of Infectious Diseases, Boston University School of Medicine Combating (Emerging) Infectious Diseases Takes (an International) Community: Lessons From the Ebola Epidemic May 1, 2015 Nahid Bhadelia, MD, MA Director of Infection Control and Medical Response, National Emerging Infectious Diseases Laboratories Section of Infectious Diseases, Boston University School of Medicine 1

2 Learning Objectives Define the arc of the Ebola epidemic Identify the role of different elements of the health systems and international response that aided or hindered the fight Elaborate on current and upcoming challenges Outline what the international community can do to prevent the next emerging infectious diseases outbreak Disclosures None Viewpoints are my own 2

3 cdc.gov Number of Cases: cdc.gov 3

4 Why couldn t the outbreak be contained earlier in West Africa? How did the equatorial African countries control their epidemics? What s different about the West African context? Where there unique missed opportunities and mistakes made in this response? Advantages of Experience in Equatorial African countries High clinical suspicion due to prior cases A healthcare staff who knows the drill in terms of lab handling and infection control Laboratory capacity Governments who understand the importance of quick public health response Understanding of risk among population Potential increased immunity in population? World Health Organization, Ebola in West Africa: 12 months on 4

5 Critical Ebola Response Activities Public health policy Health education Contact tracing Case triage Infection control Appropriate waste management Laboratory support Case management Safe burials Breitbart News, Sept 30, 2014 The West African context High population mobility and porous borders Contact tracing across borders is difficult Human cases spillover and spillback Systems elements propagating cases Weaknesses in road systems, transportation services, telecommunications that greatly delayed the transportation of patients to treatment centres and of samples to laboratories, the communication of alerts, reports, and calls for help, and public information campaigns. Poor designed and supported response systems World Health Organization, Ebola in West Africa: 12 months on 5

6 The West African context Healthcare worker shortages Made worse by infections in nosocomial settings Propagated in community transmission Strikes among HCWs Cultural practices Burial practices accounted for 60% and 80% of cases in Guinea and SL, respectively Role of secret societies Resistance from communities World Health Organization, Ebola in West Africa: 12 months on Early Challenges to Health Delivery Dearth of human resources: clinical management, case finding, health education Lack of volunteers Lack of training for volunteers High nursing needs of patients Limits of personal protective equipment (PPE) Lack of systems to respond to healthcare worker illness in national and international staff Strikes among national staff from lack of payment 6

7 Early Challenges to Health Delivery Inability to get timely laboratory results Poor data quality A difference in virus and disease features? Lack of physical resources PPE and other medical equipment, treatment beds Lack of knowledge regarding the clinical course, treatment Early Challenges to Health Delivery Lack of consensus among major players regarding guidelines Often detrimental international response Inability to import staff and equipment due to lack of commercial shippers Lack of support of international volunteers in many countries Community and patient distrust 7

8 What have we accomplished? More organized response Better staffing Better training More auditing of practice More physical resources (distribution remains an issue) Improved laboratory capacity Clinical care for healthcare workers Chris Welch Road to Zero: Where are we now? New challenges from lifting of movement restrictions Opening of hospitals and clinics and risk of Ebola patients presenting to care Economic challenges of recruiting healthcare workers back into non Ebola care Corruption plagues response and recovery Political instability? 8

9 Ebola Survivors: Opportunities As donors As helpers As advocates As source of information about disease Epstein, J et al, Nature, Dec 17, 2014 Training and Empowering Survivors 9

10 Ebola Survivors: Heartbreaking Consequences of EVD Post Ebola syndrome Financial fall Loss of identity Loss of assets Loss of social status Loss of safety networks 10

11 What will happen with the epidemic moving forward? Continued smaller case clusters Change in approach? Integrating surveillance Need for behavior change How do we leverage the new infrastructure and resources? Trained ancillary workers, international staff Physical spaces such ETUs? How do we prove effectiveness of vaccines and treatments as cases dwindle? How do we keep this from happening again? New Philosophical Questions for International Community How do we: make health safety policies and procedures when the scientific knowledge regarding a biological threat is itself evolving? create public health agenda for responding to the crises as we are learning about the pathogen itself? prioritize research questions as resources are being mobilized for the field? ethically conduct research and interpret data in an outbreak setting? 11

12 How do we prevent the next one? Good governance Building better health systems Regional and international response organizations Resource sharing and political agreements Training programs for clinicians, infection control and laboratory workers Ready roster of volunteers Surveillance networks including among animal reservoirs Lab capacity Continued health education Investment in research infrastructure in developing countries An interdisciplinary ethics committee that sits outside anyone non governmental or governmental body A Model For Integrating Surveillance for Emerging Pathogens in Struggling Health Systems A national CDC Providing ready and trained medical/infection control and prevention (IPC) teams Lab capacity: Room for public/academic partnerships Active surveillance program District level Strengthening of IPC training and PPE stocks Placement of rapid tests Surveillance officers Swing isolation wards Use of community health workers Disease and death surveillance Improving general IPC education Bhadelia and Dhillon, White Paper,

13 THANK YOU! QUESTIONS? Rebecca Rollins 13