From one home to another: my experience with the Ebola crisis

From one home to another: my
experience with the Ebola crisis in
Liberia
By
Margaret A. Tandoh MD FACS
OBJECTIVES
• DESCRIBE THE TIMELINE OF THE EPIDEMIC IN
WEST AFRICA
• DESCRIBE WHAT I DID
• DISCUSS CURRENT UPDATES ON THE DISEASE
DISCLOSURE
OUTLINE
• Why did I go?
• What did I do?
• What did I learn?
Majid Sadigh, MD
Historical landmarks
• 1967: Marburg north of Frankfort
– Severe febrile syndrome with
generalized bleeding and shock
– All worked on Ugandan green monkeys
in preparation of polio vaccine
• 25 Primary infections/7 dead
• 6 Secondary cases/0 death
– All had direct contact, usually blood, with a primary case.
Both doctors infected through accidental skin pricks
when drawing blood from patients
• Over all mortality: 20%
Historical landmarks
• 1976: Zaire
– AKA Democratic
Republic of Congo
and Sudan
– Ebola virus
Historic Perspective: 1976
• Mabelo Lokela presented with fever
• Nurse thought he had malaria: gave him quinine
shot
• He died at home, his family conducted a traditional
African funeral
• Most of the women in his family died soon
• Nurses in hospital reused same needle to inject
other medicines into other patients
• Nosocomial outbreak broke in local hospital
• They called Dr. Ngoy Mushola, area director for
help
Historical Perspective
• 1976: In Summer, Ngoy
Mushola from Bumba in
Zaire, traveled to
Yambuku a town on
shores of Ebola River. At
local hospital he
recorded first clinical
description of new
disease that was killing
almost all of the patients
“… The illness is characterized with a high
temperature of about 38 C, hematemesis, diarrhea
with blood, retrosternal and abdominal pain,
prostration with heavy articulations, and rapid
evolution of death after a mean of three days. “
Ngoy Mushola
Summer of 1979
318 people contracted the virus and
almost 90% of them died before the
epidemic was successful contained
Historic Perspective
• Hundreds of miles
away, Maridi and
Nzara, in Sudan,
doctors witnessing an
outbreak, describing
patients with high
fevers, aches,
nausea, bleeding,
delirium
• Termed “mask-like” or
“ghost-like” face
• 284 infected, over half
died
Ebola-Ivory Coast
• 1994, a Swedish scientist became ill after
conducting an autopsy on a wild
chimpanzee
Ebola Outbreaks Before 2014
• Multiple, mostly limited outbreaks over the years
since then
– Over 25 outbreaks since the first in 1976
– Only 5 with more than 100 cases
Virology
• 80 nm in diameter and
800 to 1100 nm in length,
branching forms
• Single negative sense
RNA strand of 19 kb
• High mutation rate
Pathogenesis - Transmission
• Fastest incubation period has been reported
associated with needle stick injury
• Viral load may correlate with disease severity
and survival
• Only spread by direct contact with blood and
body fluids; not airborne
Survival of Ebola Virus
• Few hours on dry surfaces, doorknobs
• Several hours on surfaces, latex glove
• Several days in puddles or other collections of
body fluid at room temperature
• US experience: after patients were discharged all
environmental samples were negative
Key Ebola Virus Disease Facts
• Incubation 2-21 days; usually 8-10 days
• Only infectious when symptomatic
– Increasingly infectious as get sicker
• Fastest incubation period has been reported
associated with needle stick injury
• Viral load may correlate with disease severity
and survival
Case study: patient zero
• Ebola outbreak patient Zero, 2-year-old boy who
died on Dec. 6, 2013, a few days after falling ill
in a village in Guéckédou, SE Guinea
• Bordering Sierra Leone and Liberia, at
intersection of 3 nations, disease found an easy
entry point to the
region
Case study: patient zero
• A week later, it killed the boy’s pregnant
mother, then his 3-year-old sister, then his
grandmother. All had fever, vomiting and
diarrhea, but no one knew what had sickened
them
Case study: patient zero
• Two mourners at the grandmother’s funeral
took the virus home to their village. A health
worker carried it to still another, where he died,
as did his doctor. They both infected relatives
from other towns.
TIMELINE OF THE EBOLA CRISIS
•
•
•
•
•
•
•
•
12/6/13: 2y/o dies in Guinea(mom, sis, etc)
3/22/14: Guinea confirms Ebola, 59 dead
3/28/14: 2 Ebola cases in Liberia(came from Guinea)
4/1/14: MSF warns spread is “unprecedented”, WHO says
“relatively small”
5/26/14: Ebola in Sierra Leone
6/17/14: Ebola in Monrovia
7/20/14: Liberian official collapses in Nigeria, dies 5 days late
of Ebola
7/30/14: Liberia shuts schools
TIMELINE OF THE EBOLA CRISIS
• 8/2/14: US doctor with Ebola flown to Atlanta
• 8/5/14: US nurse flown to Atlanta
• 8/8/14: WHO declares Ebola “international health
emergency”
• 8/12/14: death toll > 1,000
• 8/27/14: MSF calls international response “irresponsible”
• 9/5/14: 2,100 dead, >4000 infected
• 9/16/14: Obama promises 3,000 US troops
• 9/23/14: CDC predicts 550,000-1.4 million will be infected by
January
• 9/26/14: 3,091 dead, >6500 infected
TIMELINE OF THE EBOLA CRISIS
•
•
•
•
•
•
•
•
9/30/14:1st case of Ebola dx’ed in US
10/3/14: WHO: 3439 dead, 7492 cases
10/9/14: WHO: 3865 dead, 8033 cases
10/10/14: WHO: 4033 dead, 8399 cases
10/12/14: Dallas nurse tests positive
10/15/14: 2nd Dallas nurse also positive
10/17/14: WHO: 4546 dead, 9191 cases
10/25/14: WHO: 4922 dead, 10141 cases
WHY GO?
WHAT DID I DO?
Ebola, 48 h pre-mortem
Photo is courtesy of Colebunders
IV Site Bleeding
EBOLA UPDATES
• Liberia declared Ebola-free on May 9, 2015
• June 29, Ebola death confirmed in Margibi
county
• As of July 12, 6 confirmed cases of Ebola in
Liberia, 2 deaths. All contacts negative so far
• Very promising vaccine results tested in
Guinea
• Promising rapid detection test
EBOLA UPDATES
• Liberia declared Ebola free for the second
time on September 3
• Sierra Leone was declared Ebola free on
November 7
• 2 persons now with the re-infection: one with
uveitis, and one with meningitis
• Ebola can persist in semen up to 9 months
EBOLA UPDATES
• Guinea declared Ebola free on December 29,
2015
• 90 day enhanced surveillance to end March
27, 2016.
• Since March 17, 5 people have died in one
area.
LESSONS LEARNED
EDUCATION IS CRITICAL
GRATITUDE
The Division of Trauma Surgery
• Dr. John Fortune
• Dr. Bill Charash
• Dr. Gino Trevisani
• My Critical Care colleagues:
– Dr. Patrick Bender
– Dr. Chris Greene
– Dr. Mark Hamlin
THE DEPARTMENT OF SURGERY
The Office of Diversity and
Inclusion
• Ms. Tiffany Delaney
• Dr. Debra Leonard
• The Dean’s Advisory Committee for Diversity
and Inclusion(DACDI)
REFERENCES
• Thanks to Dr. Majid Sadigh for the slides on
the historical perspectives
• WHO Ebola situation reports
QUESTIONS????????