Aerial medical evacuation of health workers with suspected Ebola virus disease in Guinea Conakry-interest of a negative pressure isolation pod-a case series

Ebola virus disease (EVD) is often lethal, mortality rates range from 50% to over 90%, depending on the patient population, viral strain, and access to medical care. During pregnancy, the morbidity and mortality from the viral disease has been suggested to be among the highest of any affected patient population. According to the existing literature, which is confined to a few small case series in Africa, the risk of spontaneous fetal loss is high and there have been no known neonatal survivors. The mode of EVD transmission is well understood and evidence from the current and previous epidemics indicates that transmission can be interrupted by infection control measures. The central element of providing care to a patient suspected of Ebola is a three-step triage process: identify/isolate/inform. Once the diagnosis is confirmed, because of the potentially worse outcomes seen in pregnancy, specialized multidisciplinary care may be needed. In addition, especially in the obstetric setting, there is a high likelihood of exposure to a potentially deadly disease by health care workers. Therefore, these patients should be managed by anesthetic and obstetric providers in centers with expertise, protocols and training. Labor pain management, and the decision to proceed with cesarean delivery or other obstetric interventions will need to be considered on a case-by-case basis, weighing the risks and benefits to the mother, the fetus and the caregivers.

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Incorporating health workers’ perspectives into a WHO guideline on personal protective equipment developed during an Ebola virus disease outbreak

F1000Research ◽

10.12688/f1000research.12922.2 ◽

2018 ◽

Vol 7 ◽

pp. 45 ◽

Cited By ~ 1

Author(s):

Saskia Den Boon ◽

Constanza Vallenas ◽

Mauricio Ferri ◽

Susan L. Norris

Keyword(s):

Public Health ◽

West Africa ◽

Personal Protective Equipment ◽

Ebola Virus ◽

Expert Panel ◽

Health Workers ◽

Virus Disease ◽

Ebola Virus Disease ◽

World Health ◽

Protective Equipment

Background: Ebola virus disease (EVD) health facility transmission can result in infection and death of health workers. The World Health Organization (WHO) supports countries in preparing for and responding to public health emergencies, which often require developing new guidance in short timelines with scarce evidence. The objective of this study was to understand frontline physicians’ and nurses’ perspectives about personal protective equipment (PPE) use during the 2014-2016 EVD outbreak in West Africa and to incorporate these findings into the development process of a WHO rapid advice guideline. Methods: We surveyed frontline physicians and nurses deployed to West Africa between March and September of 2014. Results: We developed the protocol, obtained ethics approval, delivered the survey, analysed the data and presented the findings as part of the evidence-to-decision tables at the expert panel meeting where the recommendations were formulated within eight weeks. Forty-four physicians and nurses responded to the survey. They generally felt at low or extremely low risk of virus transmission with all types of PPE used. Eye protection reduced the ability to provide care, mainly due to impaired visibility because of fogging. Heat and dehydration were a major issue for 76% of the participants using goggles and for 64% using a hood. Both gowns and coveralls were associated with significant heat stress and dehydration. Most participants (59%) were very confident that they were using PPE correctly. Conclusion: Our study demonstrated that it was possible to incorporate primary data on end-users’ preferences into a rapid advice guideline for a public health emergency in difficult field conditions. Health workers perceived a balance between transmission protection and ability to care for patients effectively while wearing PPE. These findings were used by the guideline development expert panel to formulate WHO recommendations on PPE for frontline providers caring for EVD patients in outbreak conditions.

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Analyses of the performance of the Ebola virus disease alert management system in South Sudan: August 2018 to November 2019

PLoS Neglected Tropical Diseases ◽

10.1371/journal.pntd.0008872 ◽

2020 ◽

Vol 14 (11) ◽

pp. e0008872

Author(s):

Olushayo Oluseun Olu ◽

Richard Lako ◽

Sudhir Bunga ◽

Kibebu Berta ◽

Matthew Kol ◽

...

Keyword(s):

Management System ◽

Ebola Virus ◽

Health Workers ◽

Virus Disease ◽

South Sudan ◽

Case Definition ◽

Rapid Response ◽

Ebola Virus Disease ◽

Rapid Response Teams ◽

Cross Sectional

South Sudan implemented Ebola virus disease preparedness interventions aiming at preventing and rapidly containing any importation of the virus from the Democratic Republic of Congo starting from August 2018. One of these interventions was a surveillance system which included an Ebola alert management system. This study analyzed the performance of this system. A descriptive cross-sectional study of the Ebola virus disease alerts which were reported in South Sudan from August 2018 to November 2019 was conducted using both quantitative and qualitative methods. As of 30 November 2019, a total of 107 alerts had been detected in the country out of which 51 (47.7%) met the case definition and were investigated with blood samples collected for laboratory confirmation. Most (81%) of the investigated alerts were South Sudanese nationals. The alerts were identified by health workers (53.1%) at health facilities, at the community (20.4%) and by screeners at the points of entry (12.2%). Most of the investigated alerts were detected from the high-risk states of Gbudwe (46.9%), Jubek (16.3%) and Torit (10.2%). The investigated alerts commonly presented with fever, bleeding, headache and vomiting. The median timeliness for deployment of Rapid Response Team was less than one day and significantly different between the 6-month time periods (K-W = 7.7567; df = 2; p = 0.0024) from 2018 to 2019. Strengths of the alert management system included existence of a dedicated national alert hotline, case definition for alerts and rapid response teams while the weaknesses were occasional inability to access the alert toll-free hotline and lack of transport for deployment of the rapid response teams which often constrain quick response. This study demonstrates that the Ebola virus disease alert management system in South Sudan was fully functional despite the associated challenges and provides evidence to further improve Ebola preparedness in the country.

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Knowledge and practice of Ebola virus disease preventive measures among health workers in a tertiary hospital in Northern Nigeria

Archives of Medicine and Surgery ◽

10.4103/archms.archms_45_17 ◽

2018 ◽

Vol 3 (1) ◽

pp. 1 ◽

Cited By ~ 1

Author(s):

AhmadAyuba Umar ◽

MichaelAudu Sheshi ◽

Mu'awiyyahBabale Sufiyan ◽

AishaAhmed Abubakar

Keyword(s):

Ebola Virus ◽

Preventive Measures ◽

Health Workers ◽

Virus Disease ◽

Tertiary Hospital ◽

Ebola Virus Disease ◽

Northern Nigeria ◽

Knowledge And Practice

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A multi-site assessment of knowledge of Ebola virus disease among health workers in south-west Nigeria

Research Journal of Health Sciences ◽

10.4314/rejhs.v5i3.5 ◽

2017 ◽

Vol 5 (3) ◽

pp. 159

Author(s):

A.O. Joseph ◽

A.Y. Mohammed ◽

A Raji ◽

E Atolagbe ◽

A Joseph ◽

...

Keyword(s):

Ebola Virus ◽

Health Workers ◽

Virus Disease ◽

Ebola Virus Disease ◽

Site Assessment ◽

South West

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Enhancing Ebola Virus Disease Surveillance And Prevention In Counties Without Confirmed Cases In Rural Liberia: Experiences From Sinoe County During The Flare-Up In Monrovia, April To June, 2016

10.1101/139154 ◽

2017 ◽

Author(s):

Vera Darling Weah ◽

John S. Doedeh ◽

Samson Q. Wiah ◽

Emmanuel Nyema ◽

Siafa Lombeh ◽

...

Keyword(s):

Community Engagement ◽

Control Strategy ◽

Disease Surveillance ◽

Ebola Virus ◽

Health Workers ◽

Virus Disease ◽

Ebola Virus Disease ◽

Infection Prevention And Control ◽

Cross Sectional ◽

The Impact

AbstractIntroductionDuring the flare-ups of Ebola virus disease (EVD) in Liberia, Sinoe County reactivated the multi-sectorial EVD control strategy in order to be ready to respond to the eventual reintroduction of cases.This paper describes the impacts of the interventions implemented in Sinoe County during the last flare-up in Monrovia, from April 1 to June 9, 2016, using the resources provided during the original outbreak that ended one year back.MethodsWe conducted a descriptive study to describe the key interventions implemented in Sinoe County, the capacity available, the implications for the reactivation of the multi-sectoral EVD control strategy, and the results of the same. We also conducted a cross-sectional study to analyze the impact of the interventions on the surveillance and on infection prevention and control (IPC).ResultsThe attrition of the staff trained during the original outbreak was low, and most of the supplies, equipment, and infrastructure from the original outbreak remained available.With an additional US$1755, improvements were observed in the IPC indicators of triage, which increased from a mean of 60% during the first assessment to 77% (P=0.002). Additionally, personal/staff training improved from 78% to 89% (P=0.04).The percentage of EVD death alerts per expected deaths investigated increased from 26% to 63% (P<0.0001).DiscussionThe small attrition of the trained staff and the availability of most of the supplies, equipment, and infrastructure made the reactivation of the multi-sectoral EVD control strategy fast and affordable. The improvement of the EVD surveillance was possibly affected by the community engagement activities, awareness and mentoring of the health workers, and improved availability of clinicians in the facilities during the flare-up. The community engagement may contribute to the report of community-based events, specifically community deaths. The mentoring of the staff during the supportive supervisions also contributed to improve the IPC indicators.

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Incorporating health workers’ perspectives into a WHO guideline on personal protective equipment developed during an Ebola virus disease outbreak

F1000Research ◽

10.12688/f1000research.12922.1 ◽

2018 ◽

Vol 7 ◽

pp. 45 ◽

Cited By ~ 6

Author(s):

Saskia Den Boon ◽

Constanza Vallenas ◽

Mauricio Ferri ◽

Susan L. Norris

Keyword(s):

Public Health ◽

West Africa ◽

Personal Protective Equipment ◽

Ebola Virus ◽

Expert Panel ◽

Health Workers ◽

Virus Disease ◽

Ebola Virus Disease ◽

World Health ◽

Protective Equipment

Background: Ebola virus disease (EVD) health facility transmission can result in infection and death of health workers. The World Health Organization (WHO) supports countries in preparing for and responding to public health emergencies, which often require developing new guidance in short timelines with scarce evidence. The objective of this study was to understand frontline physicians’ and nurses’ perspectives about personal protective equipment (PPE) use during the 2014-2016 EVD outbreak in West Africa and to incorporate these findings into the development process of a WHO rapid advice guideline. Methods: We surveyed frontline physicians and nurses deployed to West Africa between March and September of 2014. Results: We developed the protocol, obtained ethics approval, delivered the survey, analysed the data and presented the findings as part of the evidence-to-decision tables at the expert panel meeting where the recommendations were formulated within eight weeks. Forty-four physicians and nurses responded to the survey. They generally felt at low or extremely low risk of virus transmission with all types of PPE used. Eye protection reduced the ability to provide care, mainly due to impaired visibility because of fogging. Heat and dehydration were a major issue for 76% of the participants using goggles and for 64% using a hood. Both gowns and coveralls were associated with significant heat stress and dehydration. Most participants (59%) were very confident that they were using PPE correctly. Conclusion: Our study demonstrated that it was possible to incorporate primary data on end-users’ preferences into a rapid advice guideline for a public health emergency in difficult field conditions. Health workers perceived a balance between transmission protection and ability to care for patients effectively while wearing PPE. These findings were used by the guideline development expert panel to formulate WHO recommendations on PPE for frontline providers caring for EVD patients in outbreak conditions.

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Show solidarity with the Congolese people in the 10th Ebola outbreak declared a health emergency of international concern: understand a qualitative study of variables of hospital activities on infection control practices in Kinshasa city

10.1101/19000539 ◽

2019 ◽

Author(s):

Guyguy Kabundi Tshima ◽

Kaleb Tshimungu Kalala

Keyword(s):

Qualitative Study ◽

Infection Control ◽

Ebola Virus ◽

Democratic Republic ◽

Health Workers ◽

Virus Disease ◽

The Other ◽

Ebola Virus Disease ◽

Republic Of The Congo ◽

North Kivu

AbstractHealth workers play an important role during epidemics, but there is limited research on hospital activities on infection control practices in the Democratic Republic of the Congo and how health workers can cope during a probable health epidemic in Kinshasa city. The determinants of the current Ebola Virus Disease in the geographical distribution remain poorly understood. The World Health Organization’s Health Regulation Committee decided on Wednesday July 17th, 2019 to declare the Ebola haemorrhagic fever epidemic in the provinces of North Kivu and Ituri as a health emergency of international concern. The country struggles to control it against a backdrop of a health system that is already overburdened. To test the influence of the challenges of a contamination in the context of an Ebola outbreak that may face health workers and their coping strategies in thirteen hospitals of reference in Kinshasa, we conducted a survey hoping to educate or remember good practices for health workers in Kinshasa that is also available for health workers in the East Area of the country in which the ongoing Ebola outbreak progress is spreading (North Kivu and Ituri). For the ongoing outbreak, we obtained data from the Ministère de la Santé Publique of the Democratic Republic of the Congo where cases are classified as suspected, probable, or confirmed using national case definitions. We found that the ongoing Ebola virus outbreak in the Democratic Republic of the Congo has similar epidemiological features to previous Ebola virus disease outbreak in Sierra Leone that was well described. For the qualitative study about the biosecurity in thirteen hospitals of reference in Kinshasa, we found that the Bondeko-Ngaliema Monkole group has occupied the first rank, while the group Kintambo-King Baudouin-Ndjili-Makala occupied the other end of the scale; the other health facilities occupied an intermediate position. Among the 7 hospitals which were placed at the top of this classification of biosecurity, 5 were massively subsidized by international NGO, which explains to a great extent their performances in one hand, another hand finding its explanation in the quality of their management. It is the case of Bondeko, Monkole, Kalembe-Lembe, St Joseph and Kingasani 2.Author summaryThe determinants of the transmission are poorly understood, but a growing body of evidence supports an important role of the lack of prevention in the dissemination of Ebola virus. The results of our study conducted in 13 hospitals of reference in Kinshasa suggest that the biosecurity measures—which were introduced in Kinshasa hospitals policies through prevention since Ebola outbreaks—have been respected by 75% and had 25% of parameters to be improved. Biosecurity is an important concept; it seems to be a vector for the prevention of Ebola Virus Disease. In addition, the lack of biosecurity observation may have a role in the contamination of Ebola Virus Disease in local populations found in invaded areas. This study provides knowledge into the preventive measures influencing Ebola Virus Disease populations, thereby determining in perspective a study on meat consumption of animals found dead in forests that will be a risk for human infection as the Democratic Republic of the Congo has many forests.

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‘Learn from the lessons and don’t forget them’: identifying transferable lessons for COVID-19 from meningitis A, yellow fever and Ebola virus disease vaccination campaigns

BMJ Global Health ◽

10.1136/bmjgh-2021-006951 ◽

2021 ◽

Vol 6 (9) ◽

pp. e006951

Author(s):

Julie Collins ◽

Rosie Westerveld ◽

Kate A Nelson ◽

Hana Rohan ◽

Hilary Bower ◽

...

Keyword(s):

South America ◽

Yellow Fever ◽

Ebola Virus ◽

Health Workers ◽

Virus Disease ◽

Ebola Virus Disease ◽

Local Health ◽

Structured Interviews ◽

High Coverage ◽

Vaccination Campaigns

IntroductionCOVID-19 vaccines are now being distributed to low- and middle-income countries (LMICs), with global urgency surrounding national vaccination plans. LMICs have significant experience implementing vaccination campaigns to respond to epidemic threats but are often hindered by chronic health system challenges. We sought to identify transferable lessons for COVID-19 vaccination from the rollout of three vaccines that targeted adult groups in Africa and South America: MenAfriVac (meningitis A); 17D (yellow fever) and rVSV-ZEBOV (Ebola virus disease).MethodsWe conducted a rapid literature review and 24 semi-structured interviews with technical experts who had direct implementation experience with the selected vaccines in Africa and South America. We identified barriers, enablers, and key lessons from the literature and from participants’ experiences. Interview data were analysed thematically according to seven implementation domains.ResultsParticipants highlighted multiple components of vaccination campaigns that are instrumental for achieving high coverage. Community engagement is an essential and effective tool, requiring dedicated time, funding and workforce. Involving local health workers is a key enabler, as is collaborating with community leaders to map social groups and tailor vaccination strategies to their needs. Vaccination team recruitment and training strategies need to be enhanced to support vaccination campaigns. Although recognised as challenging, integrating vaccination campaigns with other routine health services can be highly beneficial if well planned and coordinated across health programmes and with communities.ConclusionAs supplies of COVID-19 vaccines become available to LMICs, countries need to prepare to efficiently roll out the vaccine, encourage uptake among eligible groups and respond to potential community concerns. Lessons from the implementation of these three vaccines that targeted adults in LMICs can be used to inform best practice for COVID-19 and other epidemic vaccination campaigns.

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