scholarly journals A Methodology for Determining Which Diseases Warrant Care in a High-Level Containment Care Unit

Viruses ◽  
2019 ◽  
Vol 11 (9) ◽  
pp. 773 ◽  
Author(s):  
Theodore J. Cieslak ◽  
Jocelyn J. Herstein ◽  
Mark G. Kortepeter ◽  
Angela L. Hewlett
Keyword(s):  
Western Europe ◽  
Ebola Virus ◽  
Virus Disease ◽  
The United States ◽  
Reproductive Number ◽  
Traditional Management ◽  
Infectious Dose ◽  
Hemorrhagic Fevers ◽  
Viral Hemorrhagic Fevers ◽  
High Level

Although the concept of high-level containment care (HLCC or ‘biocontainment’), dates back to 1969, the 2014–2016 outbreak of Ebola virus disease (EVD) brought with it a renewed emphasis on the use of specialized HLCC units in the care of patients with EVD. Employment of these units in the United States and Western Europe resulted in a significant decrease in mortality compared to traditional management in field settings. Moreover, this employment appeared to significantly lessen the risk of nosocomial transmission of disease; no secondary cases occurred among healthcare workers in these units. While many now accept the wisdom of utilizing HLCC units and principles in the management of EVD (and, presumably, of other transmissible and highly hazardous viral hemorrhagic fevers, such as those caused by Marburg and Lassa viruses), no consensus exists regarding additional diseases that might warrant HLCC. We propose here a construct designed to make such determinations for existing and newly discovered diseases. The construct examines infectivity (as measured by the infectious dose needed to infect 50% of a given population (ID50)), communicability (as measured by the reproductive number (R0)), and hazard (as measured by morbidity and mortality). Diseases fulfilling all three criteria (i.e., those that are highly infectious, communicable, and highly hazardous) are considered candidates for HLCC management if they also meet a fourth criterion, namely that they lack effective and available licensed countermeasures.

scholarly journals Use of the Syrian Hamster as a New Model of Ebola Virus Disease and Other Viral Hemorrhagic Fevers

Viruses ◽  
2012 ◽  
Vol 4 (12) ◽  
pp. 3754-3784 ◽  
Author(s):  
Victoria Wahl-Jensen ◽  
Laura Bollinger ◽  
David Safronetz ◽  
Fabian de Kok-Mercado ◽  
Dana Scott ◽  
...  
Keyword(s):  
Syrian Hamster ◽  
Ebola Virus ◽  
Virus Disease ◽  
Ebola Virus Disease ◽  
New Model ◽  
Hemorrhagic Fevers ◽  
Viral Hemorrhagic Fevers

scholarly journals U.S. Ebola Treatment Center Clinical Laboratory Support

2016 ◽  
Vol 54 (4) ◽  
pp. 1031-1035 ◽  
Author(s):  
Katelyn C. Jelden ◽  
Peter C. Iwen ◽  
Jocelyn J. Herstein ◽  
Paul D. Biddinger ◽  
Colleen S. Kraft ◽  
...  
Keyword(s):  
Ebola Virus ◽  
Clinical Laboratory ◽  
Virus Disease ◽  
Point Of Care ◽  
The United States ◽  
Treatment Center ◽  
Local Health ◽  
State And Local ◽  
Safety Considerations ◽  
High Level

Fifty-five hospitals in the United States have been designated Ebola treatment centers (ETCs) by their state and local health authorities. Designated ETCs must have appropriate plans to manage a patient with confirmed Ebola virus disease (EVD) for the full duration of illness and must have these plans assessed through a CDC site visit conducted by an interdisciplinary team of subject matter experts. This study determined the clinical laboratory capabilities of these ETCs. ETCs were electronically surveyed on clinical laboratory characteristics. Survey responses were returned from 47 ETCs (85%). Forty-one (87%) of the ETCs planned to provide some laboratory support (e.g., point-of-care [POC] testing) within the room of the isolated patient. Forty-four (94%) ETCs indicated that their hospital would also provide clinical laboratory support for patient care. Twenty-two (50%) of these ETC clinical laboratories had biosafety level 3 (BSL-3) containment. Of all respondents, 34 (72%) were supported by their jurisdictional public health laboratory (PHL), all of which had available BSL-3 laboratories. Overall, 40 of 44 (91%) ETCs reported BSL-3 laboratory support via their clinical laboratory and/or PHL. This survey provided a snapshot of the laboratory support for designated U.S. ETCs. ETCs have approached high-level isolation critical care with laboratory support in close proximity to the patient room and by distributing laboratory support among laboratory resources. Experts might review safety considerations for these laboratory testing/diagnostic activities that are novel in the context of biocontainment care.

scholarly journals U.S. High-Level Isolation Unit Clinical Laboratory Capabilities Update

2017 ◽  
Vol 56 (2) ◽  
Author(s):  
Jocelyn J. Herstein ◽  
Peter C. Iwen ◽  
Katelyn C. Jelden ◽  
Paul D. Biddinger ◽  
Shawn G. Gibbs ◽  
...  
Keyword(s):  
Ebola Virus ◽  
Clinical Laboratory ◽  
Virus Disease ◽  
Occupational Exposures ◽  
The United States ◽  
Specific Test ◽  
Laboratory Equipment ◽  
Public Health Authorities ◽  
Electronic Spreadsheet ◽  
High Level

ABSTRACT In late 2014, 56 hospitals in the United States were designated by state and federal public health authorities as specially designed high-level isolation units (HLIUs) equipped with advanced infrastructure, laboratory capabilities, and trained staff to care for patients with highly hazardous communicable diseases (HHCDs), such as Ebola virus disease. This survey describes the clinical laboratory support capabilities of U.S. HLIUs, including the specific test menus that HLIUs have identified to safely manage HHCD patients and the locations where such testing would be performed. In spring 2016, a survey was electronically distributed, as a fillable pdf file, to the 56 U.S. HLIUs. Site representatives completed the surveys, and data were coded and analyzed in an electronic spreadsheet, using descriptive statistics. Thirty-six HLIUs (64%) responded, and 33 completed the laboratory capabilities section. Thirty-one HLIUs (94%) had performed risk analyses for all laboratory procedures and equipment. Twenty-nine (88%) had decontamination procedures specified for all laboratory equipment used for patients with suspected or confirmed HHCDs. On-site laboratories in 27 HLIUs (81%) had the capacity to inventory and to securely store HHCD patient specimens. Ten HLIUs (31%) had at least one test they would conduct within the patient isolation room. The high-risk nature of HHCDs and the occupational exposures that may occur in clinical laboratories demand advanced preparation and risk assessment of work practices, laboratory equipment, and instrumentation by HLIU laboratories. Although risk analyses of clinical laboratory testing and equipment that HLIUs have conducted have likely focused on those for Ebola virus, HLIUs must be prepared to revise their current procedures for other HHCDs.

scholarly journals Ebola virus disease: Case management in the Institute of Infectious Diseases, University Hospital of Sassari, Sardinia, Italy

2016 ◽  
Vol 10 (05) ◽  
pp. 537-543 ◽  
Author(s):  
Giulia Bertoli ◽  
Marco Mannazzu ◽  
Giordano Madeddu ◽  
Riccardo Are ◽  
Alberto Muredda ◽  
...  
Keyword(s):  
Infectious Diseases ◽  
Ebola Virus ◽  
Virus Disease ◽  
Developed Countries ◽  
The United States ◽  
Ebola Virus Disease ◽  
University Hospital ◽  
Governmental Organization ◽  
Medical Division ◽  
Disease Case

Since the onset of the worst epidemic of Ebola virus disease in December 2013, 28,637 cases were reported as confirmed, probable, or suspected. Since the week of 3 January 2016, no more cases have been reported. The total number of deaths have amounted to 11,315 (39.5%). In developed countries, seven cases have been diagnosed: four in the United States, one in Spain, one in the United Kingdom, and one in Italy. On 20 July 2015, Italy was declared Ebola-free. On 9 May 2015, an Italian health worker came back to Italy after a long stay in Sierra Leone working for a non-governmental organization. Forty-eight hours after his arrival, he noticed headache, weakness, muscle pains, and slight fever. The following day, he was safely transported to the Infectious Diseases Unit of University Hospital of Sassari. The patient was hospitalized for 19 hours until an Italian Air Force medical division transferred him to Rome, to the Lazzaro Spallanzani Institute. Nineteen people who had contacts with the patient were monitored daily for 21 days by the Public Health Office of Sassari and none presented any symptoms. So far, neither vaccine nor treatment is available to be proposed on an international scale. Ebola is considered a re-emerging infectious disease which, unlike in the past, has been a worldwide emergency. This case study aimed to establish a discussion about the operative and logistic difficulties to be faced and about the discrepancy arising when protocols clash with the reality of facts.

Serosurvey on healthcare personnel caring for patients with Ebola virus disease and Lassa virus in the United States

2020 ◽  
Vol 41 (4) ◽  
pp. 385-390
Author(s):  
Colleen S. Kraft ◽  
Aneesh K. Mehta ◽  
Jay B. Varkey ◽  
G. Marshall Lyon ◽  
Sharon Vanairsdale ◽  
...  
Keyword(s):  
Infection Control ◽  
Ebola Virus ◽  
Virus Disease ◽  
Adenovirus Type ◽  
The United States ◽  
Ebola Virus Disease ◽  
University Hospital ◽  
Healthcare Personnel ◽  
Lassa Virus ◽  
Serum Samples

AbstractObjective:Healthcare personnel (HCP) were recruited to provide serum samples, which were tested for antibodies against Ebola or Lassa virus to evaluate for asymptomatic seroconversion.Setting:From 2014 to 2016, 4 patients with Ebola virus disease (EVD) and 1 patient with Lassa fever (LF) were treated in the Serious Communicable Diseases Unit (SCDU) at Emory University Hospital. Strict infection control and clinical biosafety practices were implemented to prevent nosocomial transmission of EVD or LF to HCP.Participants:All personnel who entered the SCDU who were required to measure their temperatures and complete a symptom questionnaire twice daily were eligible.Results:No employee developed symptomatic EVD or LF. EVD and LF antibody studies were performed on sera samples from 42 HCP. The 6 participants who had received investigational vaccination with a chimpanzee adenovirus type 3 vectored Ebola glycoprotein vaccine had high antibody titers to Ebola glycoprotein, but none had a response to Ebola nucleoprotein or VP40, or a response to LF antigens.Conclusions:Patients infected with filoviruses and arenaviruses can be managed successfully without causing occupation-related symptomatic or asymptomatic infections. Meticulous attention to infection control and clinical biosafety practices by highly motivated, trained staff is critical to the safe care of patients with an infection from a special pathogen.

International Monetary Fund

1954 ◽  
Vol 8 (4) ◽  
pp. 577-582
Keyword(s):  
International Monetary Fund ◽  
Western Europe ◽  
The United States ◽  
Balance Of Payments ◽  
Fiscal Year ◽  
Monetary Policies ◽  
Board Of Governors ◽  
Domestic Capital ◽  
General Improvement ◽  
High Level

The Annual Report of the Executive Directors of the International Monetary Fund for the fiscal year ended April 30, 1954, was transmitted to the Chairman of the Board of Governors on July 1, 1954. During the period under review, the report noted, important steps toward currency convertibility had been taken in several countries, notably Belgium, Luxembourg, Germany, the Netherlands, and United Kingdom; restrictions on dollar imports had been lightened, exports of domestic capital had been freer, and more reliance had been placed on the regulative powers of the price mechanism. The easing of restrictions had gone hand in hand with an improvement in the world balance of payments equilibrium, and a reversal, during 1953, of the downward trend in the volume of world trade which had appeared early in 1952. Sound fiscal and monetary policies had improved the competitive position of Europe which had experienced more stable prices and less inflationary pressure; the report cautioned that the coincidence, up to mid-1953, of a high level of business activity in the United States with slack demand conditions in western Europe had been a purely fortuitous aid in improving the latter's balance of payments position. Progress toward convertibility had been made possible by a general improvement in economic conditions; however, problems would be involved in taking further steps toward convertibility. Among these were: 1) the problem of controlling international movements of capital, and 2) the importance of having countries whose balance of payments position was weak, as well as those with a stronger position, move concurrently towards convertibility.

scholarly journals Ebola Virus: a Clear and Present Danger

2014 ◽  
Vol 53 (1) ◽  
pp. 4-8 ◽  
Author(s):  
Eileen M. Burd
Keyword(s):  
United States ◽  
Ebola Virus ◽  
Virus Disease ◽  
The United States ◽  
Ebola Virus Disease ◽  
Burial Practices ◽  
Western Africa ◽  
Medical Facilities ◽  
Risk Patients ◽  
Clear And Present Danger

An epidemic of Ebola virus disease is occurring in Western Africa on a scale not seen before, particularly in the countries of Guinea, Liberia, and Sierra Leone. The continued spread is facilitated by insufficient medical facilities, poor sanitation, travel, and unsafe burial practices. Several patients diagnosed with Ebola virus disease in Africa have been evacuated to the United States for treatment, and several other patients have been diagnosed in the United States. It is important for laboratories to be aware of available tests, especially those granted emergency use authorization, as hospitals prepare protocols for the diagnosis and management of high-risk patients.

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