Ebola Virus Disease Update Pre-Council. October 21, 2014 Juan Ortiz, EMC Vinny Taneja, TCPH Director

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1 Ebola Virus Disease Update Pre-Council October 21, 2014 Juan Ortiz, EMC Vinny Taneja, TCPH Director

2 What is Ebola? Ebola is a viral disease, previously known as Ebola Hemorrhagic fever First found in 1976 near Ebola River in Congo Affects Humans and Nonhuman Primates (monkeys, gorillas, chimpanzees) Current, major outbreak in Liberia, Sierra Leone and Guinea

3 Signs and Symptoms Symptoms of Ebola include fever, severe headache, muscle pain, Malaise (not feeling well) vomiting, diarrhea, stomach pain, and unexplained bleeding or bruising.

4 How is Ebola Spread?

5 Ebola Situation Overseas

6 Current Situation Locally We have NO Known cases of Ebola in Tarrant County and NONE in Texas 48 Contacts have finished their monitoring period on Monday and have come off the watch list. More will be coming off the list in coming days.

7 States with Ebola Cases

8 What is a case and what is contact? (RED) A person who is sick and has been diagnosed and Lab Confirmed to have Ebola, is called a Case. (YELLOW) A person who came in close proximity with a symptomatic Ebola Case is called a Contact. This person, without symptoms, is not infectious. (GREEN) A person, who lives with a Contact and has not exposed to an Ebola Case is considered a No Risk Person for transmission. This No Risk Person is often referred to as contactof-a- Contact. Since this person has not been exposed to Ebola, s/he cannot pass the disease to someone else. From a Public Health perspective, this individual may conduct normal daily activities.

9 How to understand Ebola? A person who lives with a Contact without symptoms has not been exposed to Ebola and therefore cannot transmit the disease. This individual is considered a No Risk Person often referred to as contact-of-a- Contact.

10 How do you STOP Ebola?

11 What happens during Contact Tracing/Monitoring? Minimum twice daily temperature/symptom check in 24 hours, minimum 6 hour apart (one check is conducted via phone with PH personnel, another check to be conducted in-person by PH personnel or visual check) Furlough from patient care duties Travel restrictions (via plane, ship, long-distance bus or train, use of public transportation, no travel outside of your country of residence) Immediate notification of development of fever (temperature > 38 C or F) to Texas Health Presbyterian 24/7 contact and minimize contact with others if fever develops Control Order may be issued if needed

12 What is Tarrant County doing? We are monitoring Contacts Disseminating Public Health Information Tarrant County Ebola Information hotline at Outreaching to our partners Hospital partners First responders, Fire/EMS, Local EM Charity Organizations Mayors council School Administration and Nurses Regular meetings/calls with CDC, State, internal

13 FORT WORTH AND TARRANT COUNTY PARTNERSHIP

14 Ebola Response Activities Incident Management Team Hospital Preparedness 911 Call Taker Screening EMS Procedures Response Algorithm Healthcare Activities Community Setting School Systems Pets and Animals Water/Wastewater Community Outreach

15 Hospital Preparedness Interim Hospital and Emergency Treatment Center Practices for Transport of Ebola Patients (DSHS ) Hospital Ebola Screening Questions Does the patient have a fever, severe headache, muscle pain, vomiting, diarrhea, abdominal pain, or unexplained bleeding? AND In the past 21 days has the patient: Been in contact with blood or body fluids of a patient known to have or suspected to have Ebola? Been in residence or travel to a West African country where Ebola outbreak is occurring? Had direct handling of bats or nonhuman primates from a disease-endemic area? Countries include: Guinea, Liberia, Sierra Leone If the patient meets the FEVER REQUIREMENT AND ANY ONE OF THE THREE QUESTIONS, then the patient should be considered as a Person Under Investigation for Ebola. ISOLATE THE PATIENT, Take CDC Recommended PPE Precautions and Contact Tarrant County Public Health If patient does not meet screening questions criteria, follow normal triage and treatment protocols

16 Interim 911 Call Taker (PSAP) Phone Screening Guide Interim 911 Call Taker (PSAP) Phone Screening Guide (DSHS ) 911 Call Center Ebola Screening Questions Does the patient have a fever, severe headache, muscle pain, vomiting, diarrhea, abdominal pain, or unexplained bleeding? AND In the past 21 days has the patient: Been in contact with blood or body fluids of a patient known to have or suspected to have Ebola? Been in residence or travel to a West African country where Ebola outbreak is occurring? Had direct handling of bats or nonhuman primates from a disease-endemic area? Countries include: Guinea, Liberia, Sierra Leone Should the caller answer Yes to the fever AND one of the contact questions Notify first responders of a possible Patient complaining of Ebola symptoms and exposure Contact Tarrant County Public Health

17 EMS Ebola Procedures Scene Safety Isolate Patient Minimize Exposure Avoid Contact with Body Fluid Patient Assessment Transport to Local Hospital Disinfect and Decontaminate Category A infectious substance. Infectious substance must be triple packed in a: Primary watertight receptacle Watertight secondary packaging Rigid outer packaging Medical Facility for Final Disposition

18 Fire, Police and Medstar Level of Personal Protective Equipment (PPE) Surgical mask, eye protection, gloves, shoe covers, gown, bonnet Review Protocols, guidelines and SOPs Refresher training, hands on drills Continuous monitoring Develop proper Response Algorithm

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20 Federal Ebola Assistance CDC Ebola Hospital Response Team Ebola Domestic Response Team 30 person team 72 hours response Flights from countries with Ebola will be routed through 5 specific airports in the U.S.

21 Healthcare Settings Quickly identifying and isolating patients with known or suspected Ebola Screening patients when they first enter the healthcare system Laying out facilities to make it easier to screen and diagnose suspected cases Implementing strict policies for visitation Closely monitoring healthcare workers for fever or other symptoms Implementing effective healthcare worker sickness notification and leave policies Protecting patients and healthcare workers Good hand hygiene practices Use of appropriate personal protective equipment (PPE) Following safe injection practices and drawing blood safely Cleaning up safely Performing environmental cleaning and disinfection Managing waste safely and appropriately Managing patients safely and compassionately Establishing and following protocols for notifying authorities about suspected Ebola patients Safe initial management of suspected Ebola cases while awaiting patient transport to another setting Communicating with patients to effectively and compassionately educate them about their suspected illness and what to expect during their treatment process

22 Community Settings Infection control measures in community settings include: Social distancing (avoiding physical contact with a person known or suspected to have Ebola) Frequent hand washing Providing care for ill family members safely Safe transport of Ebola patients or suspected patients

23 Independent School Districts TCPH urged schools to make science based decisions Only those who have a lab confirmed case of Ebola or those that are direct contacts of those showing symptoms are to be isolated Students who live with a contact that is asymptomatic is a no risk case and should continue to attend school At this time there is no reason to close a school or cancel classes

24 Ebola Pets and Animal Control No reports of cats or dogs becoming ill with Ebola. Human infections haven t been linked to dogs CDC will be issuing guideline for care of pets with possible Ebola exposure As a precaution, animals exposed to Ebola monitored for 21 days Texas Animal Health Commission lead agency for animals exposed to foreign diseases

25 Ebola in Water and Wastewater Ebola is not transmitted in water, food, or air (CDC, 2014a). Ebola is a blood borne illness only transmitted by direct contact with an infected person s bodily fluids (blood, vomit, feces). Humans cannot get Ebola from contact with treated water, including drinking water used for showering and cooking or other potable water usage. Disinfection is used by all drinking water and wastewater utilities in Texas to protect public health and the environment. Drinking water and sewage (wastewater) are disinfected with combinations of chlorine, sodium hypochlorite, UV, ozone and other processes to destroy viruses, bacteria and other microbes (McGuire, 2014; CDC, 2104c).

26 Ebola Community Outreach Plan Objective Raise community awareness of Ebola Virus Disease Promote and support Ebola prevention messages Audience General public Employees Visitors to City

27 Ebola Community Outreach Plan Message Ebola cannot spread until symptoms appear Ebola is spread through direct contact with bodily fluids You can protect yourself against Ebola Whole Communications Toolbox Print materials flyers, newspapers Web and social media

28 Ebola Community Outreach Plan Whole Communications Toolbox Public service announcements Direct outreach to Neighborhoods Businesses Festival / event organizers Homeless shelters CVB Other public venues/spaces

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30 Questions?