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MSF says French Ebola patient's repatriation far too slow

Thu Sep 18, 2014 8:12am EDT




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* Medivac plane had to come from U.S. to fly her out

* Patient repatriated 42 hours after being diagnosed

* Military hospital near Paris to treat patient

By John Irish

PARIS, Sept 18 (Reuters) - Medecins Sans Frontieres (MSF) on Thursday criticised the delay in repatriating a foreign health worker infected with Ebola in Africa after it took two days to fly out the infected French volunteer from Liberia.

A specially adapted aircraft was due in Monrovia on Thursday from the United States to take the female healthcare worker home to France after she was diagnosed with the deadly disease.

Operations director Brice de la Vigne said MSF wanted a medivac plane to be located in West Africa to deal with emergencies rather than having to arrange for one to fly over from the U.S. as it had to do in this case.

"It's been a while now that MSF has asked the European Union and other states to put in place an efficient evacuation system," he told a news conference.

"It's just too long when you see that it takes 42 hours from the moment when a case is detected to when they are repatriated."

De la Vigne declined to give details on the patient's condition, but said very strict protection protocols had been maintained. Any additional preventive measures would only be taken once a full investigation into how she had contracted the disease was completed, he said.

The volunteer, the first French national and MSF's first international staff member to catch the disease in the outbreak, was put in quarantine on Tuesday when early symptoms of the illness appeared.

She had been working directly in an isolation unit. She will be treated at a military hospital outside Paris, sources said.

2,000 MSF STAFF IN REGION

MSF is the leading organisation fighting the worst Ebola outbreak on record, with more than 2,000 staff members working across West Africa.

Healthcare workers account for hundreds of the infected in an outbreak that has already killed nearly 2,500 people and infected close to 5,000 across Guinea, Liberia, Nigeria and Sierra Leone.

But most cases have occurred in government healthcare centres, often due to a lack of vigilance or resources to buy the protective equipment against the highly contagious virus, which spreads through bodily fluids.

MSF President Joanne Liu had previously warned that infection among its own staff could exacerbate the outbreak by spreading it further among the healthy.

The U.N. Security Council will convene on Thursday to decide if Ebola is deemed a global threat. If it does it may help push a coordinated strategy to handle the spread of the disease.

"There is a problem that the main actors can't just intervene like that, so we have therefore asked armies who have a technical capacity to isolate cases and set up centres because bad centres make the epidemic worse," de la Vigne said.

The World Health Organization has previously warned that the number of cases in West Africa could climb as high as 20,000 as ill-equipped governments in one of the poorest regions of the world struggle to contain it.

U.S. President Barack Obama has called Ebola a major threat to global security and announced a major expansion of his country's role in stopping its spread, including deployment of 3,000 troops to the region.

"We are waiting for Europe which has been cautious until now," de la Vigne said. (Editing by Tom Heneghan)

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British Ebola survivor flies to United States for blood donation

Thu Sep 18, 2014 11:49am EDT




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(Reuters) - A British man who survived Ebola after being treated in London has flown to the United States to try to help another patient suffering from the virus, the Foreign Office in the United Kingdom said on Thursday.

Media reports said William Pooley planned to donate his blood, which likely contains protective antibodies that could help fight the disease, for an emergency transfusion to an Ebola patient in Atlanta.

An American doctor who worked for the World Health Organization is being treated at Emory University Hospital in Atlanta after he became infected with Ebola in Sierra Leone.

A spokesman for the Emory hospital would not confirm on Thursday whether the doctor, who has not been named, will be getting blood donated from the British man, citing patient privacy laws.

There are two Ebola patients being treated in the United States. A spokesman for the Nebraska hospital where another American is receiving care for the virus said the British man was not headed to that facility.

Pooley, 29, contracted the disease while working as a volunteer nurse in Sierra Leone. He was discharged earlier this month from a special isolation unit at the Royal Free Hospital in London after 10 days of treatment with the experimental ZMapp drug.

London's Evening Standard newspaper said Pooley and the doctor he is hoping to help were reported to be close friends after working together at the Ebola treatment center in Kenema, Sierra Leone.

The pair has the same blood type, which made Pooley the perfect donor, the newspaper said.

There is no proven cure for Ebola, a deadly virus that was discovered nearly 40 years ago in the forests of central Africa. The worst-ever outbreak on record of the virus, which has killed at least 2,630 people in West Africa, has triggered a scramble to develop the first drug or vaccine to treat it.

Earlier this month at the University of Nebraska Medical Center in Omaha, Dr. Rick Sacra received a plasma infusion from another American Ebola survivor, Dr. Kent Brantly. Brantly's blood likely contained protective antibodies that doctors said could help buy Sacra some time while his body worked to fight off the infection.

Brantly's blood type also turned out to be a match for his friend and fellow missionary Sacra.

(Reporting by Stephen Addison in London and Colleen Jenkins in Winston-Salem, North Carolina; Editing by Bill Trott)

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berry
the french nurse will be evacuated to france for treatment....but the native staff were apparenlty not...

French nurse for medical charity MSF contracts Ebola in Liberia

By John Irish and James Harding Giahyue

PARIS/MONROVIA Wed Sep 17, 2014 6:26pm EDT




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(Reuters) - A French volunteer working for Medecins Sans Frontieres in Liberia has contracted Ebola, the medical charity said on Wednesday, adding that seven local staff members have already fallen ill from the deadly virus.

The volunteer, the first French national and MSF's first international staff member to catch the disease in the outbreak, was put in quarantine on Tuesday when early symptoms of the illness appeared, according to an MSF statement.

She will be evacuated to France in a special medical plane in line with the country's evacuation plan, the French government said.

MSF is the leading organization fighting the worst Ebola outbreak on record, with more than 2,000 staff members working across West Africa.

Healthcare workers account for hundreds of the infected in an outbreak that has already killed nearly 2,500 people and infected close to 5,000 across Guinea, Liberia, Nigeria and Sierra Leone.

But most cases have occurred in government healthcare centers, often due to a lack of vigilance or resources to buy the protective equipment against the highly contagious virus, which spreads through bodily fluids.

"For this epidemic, seven national staffs contracted the virus and three of them died," MSF emergency coordinator Laurence Sailly told reporters in Liberia's capital, Monrovia, on Wednesday, revealing the extent of MSF's exposure for the first time.

She did not give further details on the other cases.

MSF said it applies very strict protection protocols for its staff and that it planned to launch an investigation into the French worker's case. Its Ebola treatment center in Monrovia known as ELWA 3 will not accept new patients until the probe was completed, Sailly added.

MSF President Joanne Liu had previously warned that infection among its own staff could exacerbate the outbreak by spreading it further among the healthy.

"One of our biggest things is that we do not want our staff to get infected. Because if this happens, then that is how things really collapse quickly," she said in an August interview.

The World Health Organization has previously warned that the number of cases in West Africa could climb as high as 20,000 as ill-equipped governments in one of the poorest regions of the world struggle to contain it.

U.S. President Barack Obama has called Ebola a major threat to global security and announced a major expansion of his country's role in stopping its spread, including deployment of 3,000 troops to the region.

(Additional reporting by Daniel Flynn; Writing by Emma Farge; Editing by Jonathan Oatis

berry
and if you were sitting in sierra leone or guinea or liberia wouldn't you want SOMETHING to protect you from ebola? at least they are trying to help themselves here, instead of just waiting to get ill and die...why not HELP SCREEN THE BLOOD and set up blood donation and screening sites to GIVE PEOPLE a chance  to survive this, I thought WHO already said it was a good idea to use survivors blood...or is that only for people in western hospitals...

Ebola patients buying survivors' blood from black market, WHO warns

updated 6:55 PM EDT, Thu September 18, 2014
Watch this video

Ebola survivor blood on black market

STORY HIGHLIGHTS

  • The Ebola outbreak in West Africa has killed at least 2,400 people

  • The WHO says it's working with affected nations to eliminate the black market trade of blood

  • Convalescent serum is said to have antibodies that can fight the deadly virus

  • Though unproven, desperate patients are doing whatever it takes

(CNN) -- As hospitals in nations hardest hit by Ebola struggle to keep up, desperate patients are turning to the black market to buy blood from survivors of the virus, the World Health Organization warned.

The deadliest Ebola outbreak in history has killed at least 2,400 people in Guinea, Liberia and Sierra Leone -- the countries most affected by the virus.

Blood from survivors, referred to as convalescent serum, is said to have antibodies that can fight the deadly virus. Though the treatment is unproven, it has provided some promise for those fighting a disease that's killing more than half of those it has infected.

U.S. steps up efforts in Ebola fight
Obama: Ebola threat could become 'global'
WHO: West Africa can't keep up with Ebola

"Studies suggest blood transfusions from survivors might prevent or treat Ebola virus infection in others, but the results of the studies are still difficult to interpret," the WHO said. "It is not known whether antibodies in the plasma of survivors are sufficient to treat or prevent the disease. More research is needed."

Convalescent serum has been used to treat patients, including American aid worker Rick Sacra, who is hospitalized in Omaha, Nebraska. He got blood from Kent Brantly, a fellow American who survived Ebola. Both got infected when they were helping patients in Liberia.

But unlike their situation, patients in affected nations are getting blood through improper channels. The illicit trade can lead to the spread of other infections, including HIV and other blood-related ailments.

"We need to work very closely with the affected countries to stem out black market trading of convalescent serum for two reasons," Margaret Chan, the WHO's director-general, said this week.

"Because it is in the interest of individuals not to just get convalescent serum without ... going through the proper standard and the proper testing because it is important that there may be other infectious vectors that we need to look at."

'Just sitting, waiting to die'

Heath experts have declared the disease a global emergency and criticized the international community for a lax response.

President Barack Obama on Tuesday announced the United States will send troops, material to build field hospitals, additional health care workers and community care kits to affected nations. The United States will also create a facility to help train thousands of health care workers to identify and care for Ebola patients.

'Not 1 bed' available for Ebola patients
Doctor 'improving' after Ebola diagnosis
Gates Foundation to donate $50 million

"Men and women and children are just sitting, waiting to die right now," Obama said.

Hospitals in affected nations are overwhelmed, and the WHO has described the outbreak as a "dire emergency with ... unprecedented dimensions" of human suffering.

"If the outbreak is not stopped now, we could be looking at hundreds of thousands of people infected with profound political and economic and security implications for all of us," Obama said.

What you need to know about the Ebola virus

There is also a concern that the virus could mutate into an even more dangerous form.

Ebola currently transmits only though contact with bodil
berry

UN declares Ebola threat to world peace and security, launches mission to combat disease

By Shruti Saxena | Last Updated: Friday, September 19, 2014 - 09:38

Zee Media Bureau/Shruti Saxena

New Delhi: The UN Security Council on Thursday declared the Ebola outbreak as 'a threat to international peace and security'.

As a global response to eradicate Ebola cases, the Security Council unanimously passed a resolution and has called upon countries to lend support to provide health personnel and supplies to the disease-hit areas Sierra Leone, Liberia and Guinea.

At the UNSC emergency meet, UN Secretary General Ban Ki-moon was quoted as saying: “The gravity and scale of the situation now requires a level of international action unprecedented for a health emergency”.

“Ebola matters to us all. The outbreak is the largest the world has ever seen,” Ban said, calling for a 20-fold increase in assistance. “The number of cases are doubling every three weeks. There will soon be more cases in Liberia alone than the four decade history of the disease.”

UN chief also announced the establishment of what is known as the United Nations Mission for Ebola Emergency Response, or UNMEER, which will work in coordination with the World Health Organization (WHO) to combat the disease.

The meeting comes after US President Barack Obama committed a deployment of 3,000 US troops and termed Ebola as a global threat which requires international response.

Till date, more than 2,600 people have died in the worst Ebola outbreak on record.

Ebola virus, which spreads through mucous and other body fluids or secretions such as stool, urine, saliva and semen of infected people, is believed to be very difficult to control at present.

who says ebola death toll at 2,630

berry

Death toll in West Africa Ebola epidemic reaches 2,630: WHO

LONDON/GENEVA Thu Sep 18, 2014 5:08pm EDT




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A Liberian woman stands as health workers wearing protective clothing prepare to carry an abandoned dead body presenting with Ebola symptoms at Duwala market in Monrovia August 17, 2014.  REUTERS/2Tango

A Liberian woman stands as health workers wearing protective clothing prepare to carry an abandoned dead body presenting with Ebola symptoms at Duwala market in Monrovia August 17, 2014.

Credit: Reuters/2Tang

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Analysis & Opinion

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Ebola epidemic

Quarantines and isolation units imposed to stop the spread of the worst Ebola outbreak in history.  Slideshow

(Reuters) - At least 2,630 people have died in the worst outbreak of Ebola virus in history, which has so far infected at least 5,357 people in West Africa, the World Health Organization (WHO) said on Thursday.

In an update on the epidemic, which is raging through Guinea, Sierra Leone and Liberia and has spread into Nigeria and Senegal, the WHO said there were no signs yet of it slowing.

"The upward epidemic trend continues in the three countries that have widespread and intense transmission - Guinea, Liberia and Sierra Leone," the United Nations health agency said.

Those three countries account for the vast majority of cases and deaths in the outbreak - 8 others have died in Nigeria, out of 21 cases, and one case has been confirmed in Senegal.

The WHO said a surge in Ebola in Liberia is being driven primarily by a continued increase in the number of cases reported in the capital, Monrovia, where 1,210 bed spaces were needed, five times the current capacity.

The WHO has said it hopes to be able to "bend the curve" in the almost exponential increase in cases within three months.

The latest data updated five days of data for Liberia and one day for the other countries, and showed no new deaths in Sierra Leone since the previous update.

The WHO said efforts to integrate various sources of data in Liberia would lead to many cases being reclassified and about 100 previously unreported cases had been found and would be included in later updates.

In a separate Ebola outbreak in the Democratic Republic of Congo, 40 deaths had been reported out of 71 cases by Sept. 15, the WHO said.

(Reporting by Kate Kelland and Tom Miles; Editing by John Stonestreet and Sonya Hepinstall)

berry

Sierra Leone to Start 3-Day Nationwide Lockdown to Stop Ebola

Sep 18, 2014, 1:17 PM ET
By SYDNEY LUPKIN
Sydney Lupkin More from Sydney »
Health Reporter
via World News
PHOTO: A sign reading Kill Ebola Before Ebola Kill You, is seen on a gate forming part of the countrys Ebola awareness campaign in the city of Freetown, Sierra Leone, Sept. 14, 2014.
A sign reading 'Kill Ebola Before Ebola Kill You', is seen on a gate forming part of the country's Ebola awareness campaign in the city of Freetown, Sierra Leone, Sept. 14, 2014.
Michael Duff/AP Photo

Sierra Leone is set to begin a three-day lockdown tonight at midnight to curb the spread of Ebola, according to Doctors Without Borders.

Government authorities have ordered the country's 6 million people to stay in their homes from Sept. 19 through Sept. 21, while volunteers go door-to-door to screen for Ebola and take infected people in hiding to Ebola facilities, according to Doctors Without Borders, which called the endeavor "coercive."

"Large-scale coercive measures like forced quarantines and lockdowns are driving people underground and jeopardizing the trust between people and health providers," Doctors Without Borders said in a statement to ABC News. "This is leading to the concealment of cases and is pushing the sick away from health systems."

Doctor Who Recovered From Ebola Calls Outbreak a 'Fire Straight From the Pit of Hell'

President Obama to Unveil Expanded Ebola Response

Full Coverage of Ebola Outbreak

The Ebola outbreak in West Africa has sickened at least 5,357 people since March, killing 2,630 of them, according to the latest data from the World Health Organization. This is the largest Ebola outbreak since the deadly virus was identified in 1976, and the virus has killed more people in the last six months than it had in the previous 38 years combined.

Doctors Without Borders said it will be "extremely difficult" for government health workers to screen patients in this way without proper expertise. And even if the effort was successful, there would be too many Ebola patients to fit into existing facilities.

"Without enough beds to treat patients who have Ebola we will fail to stop it spreading even further," Doctors Without Borders said. "What Sierra Leone and Liberia urgently need are more beds in case management centers, and they need them now."

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17 September 2014 Last updated at 16:38 ET

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Ebola could wreck W Africa economies, warns World Bank

Liberians watch removal of Ebola victim's body Residents of the Liberian capital, Monrovia, watch health workers remove the body of an Ebola victim

The Ebola outbreak could have a catastrophic impact on the economies of Guinea, Liberia and Sierra Leone, the World Bank says.

The organisation says the economic impact of the virus could "grow eight-fold" in the "already fragile states".

However, it says the cost can be limited if the epidemic - and the accompanying fear - is contained by a fast global response.

Ebola has killed 2,461 people in West Africa - the largest ever outbreak.

US President Barack Obama has called the latest outbreak "a threat to global security", and announced a larger US role in fighting the virus. The measures announced included ordering 3,000 US troops to the region and building new healthcare facilities.

The UN Security Council is to hold an emergency meeting on Thursday to discuss the epidemic.

It is expected to pass a resolution demanding a more forceful international response to the crisis, urging member countries to provide medical staff and field hospitals.

The resolution will also call for the lifting of travel restrictions that have prevented health workers from offering assistance. UN officials have described the outbreak as a health crisis "unparalleled in modern times".

The BBC's Umaru Fofana says frenetic shopping had been taking place ahead of Friday's lockdown

The World Bank's analysis said billions of dollars could be drained from West African countries by the end of next year if the virus continued to spread.

Under the worst-case scenario, the global development lender predicted that economic growth next year could be reduced by 2.3 percentage points in Guinea and 8.9 percentage points in Sierra Leone.

It predicted Liberia's economy would be hardest-hit, losing 11.7 percentage points off its growth next year.

The report emphasised the need to tackle the fear of the disease, as well as the virus itself. It said "aversion behaviour", arising from concerns about contagion, was having a bigger economic impact than the "direct costs" imposed by the epidemic.

The BBC takes a look at the scale of the challenge the Ebola outbreak presents to modern medicine

Productivity has dropped in sectors of the economy such as agriculture and mining as a result of quarantine measures, and because of fears about the spread of the disease. Many people are working less, and earning and spending less as a result, fuelling poverty.

"The primary cost of this tragic outbreak is in human lives and suffering, which has already been terribly difficult to bear," World Bank Group President Jim Yong Kim said.

"But our findings make clear that the sooner we get an adequate containment response and decrease the level of fear and uncertainty, the faster we can blunt Ebola's economic impact."

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Analysis: Andrew Walker, Economics correspondent

These are three poor and fragile countries to start with. But they have managed, to varying degrees, decent economic growth in the last few years. The World Bank's figures show the expected reduction in economic growth.

On the worst case for the spread of the disease, Liberia's economic activity would decline next year, fairly sharply. Guinea and Sierra Leone would still manage some growth, but it would be quite sluggish.

All three countries badly need to maintain their economic momentum to deal with a catalogue of problems and raise desperately low living standards. Moreover, the worst case impacts on Sierra Leone and Liberia would be more severe than a "normal" global recession, though not as large as the most devastating conflicts.

Both Sierra Leone and Liberia have had years during civil wars in which their economies contracted by more than 20%.

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In a statement released on Wednesday, Liberian President Ellen Johnson Sirleaf welcomed the US plan to combat Ebola, saying she hoped it would "spur the rest of the international community into action".

"This disease is not simply a Liberian or West African problem. The entire community of nations has a stake in ending this crisis," the statement said.

German Chancellor Angela Merkel has said her country will provide logistical aid to Liberia in the battle against Ebola. Ms Johnson Sirleaf had earlier written to Germany, appealing for help.

Campaigners warning of Ebola in Freetown, Sierra Leone Governments and global organisations say more must be done to spread awareness of Ebola

The IMF said on Wednesday that its executive board was due to consider a proposal to give Guinea, Liberia and Sierra Leone an additional $127m (£78m; 98m euros) to combat the economic impact of Ebola.

The organisation said its staff had estimated that growth was likely to slow in all three countries because of disruption in key sectors. It estimates that the countries will face a shortage of $300m in the next six to nine months.

Also on Wednesday, medical charity Medecins Sans Frontieres (MSF) reported that one of its workers had contracted Ebola in Liberia. The charity said the female employee, a French citizen, would be evacuated to a treatment centre in France.

The current outbreak is the deadliest since Ebola was discovered in 1976

Meanwhile in Guinea, a team of health officials was attacked on Tuesday during a visit to a village where were raising awareness of the illness.

People in Wamey, in the south of the country, threw stones at the team, which included WHO and Red Cross representatives. At least 10 officials were hurt, and several who escaped into the bush are still missing.

This is not the first such incident. There have been many reports of people in the region saying they do not believe Ebola exists, or not co-operating with health authorities, fearing that a diagnosis means certain death.

In Sierra Leone, people are preparing for a three-day lockdown ordered by the government in an attempt to stop the spread of Ebola.

The BBC's Umaru Fofana in the capital Freetown says many residents are stocking up on food. A number of aid agencies, including MSF, have criticised the lockdown, saying it would not help contain the virus.

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Cumulative deaths - up to 13 September
ebola cumulative death toll chart up to September 13 Figures are occasionally revised down as suspect or probable cases are found to be unrelated to Ebola
berry

Eight dead in attack on Ebola team in Guinea. ‘Killed in cold blood.’

By Abby Phillip September 18 at 6:06 PM



A worker disinfects a van at the Doctors Without Borders center in Conakry, Guinea. (Cellou Binani/AFP via Getty Images)

The bodies of eight people, including several health workers and three journalists, have been found days after they were attacked while distributing information about Ebola in a Guinean village near the city of Nzerekore, according to Reuters.

"The eight bodies were found in the village latrine," Albert Damantang Camara, a spokesman for Guinea's government, told Reuters on Thursday. "Three of them had their throats slit."

When the delegation arrived on Tuesday to do disinfection work and educate people about preventing Ebola, angry and fearful residents began throwing rocks and beating people in the group with clubs according to the Los Angeles Times, which cited Guinean radio reports. The delegation, which included one local politician, fled into the bush to escape the attackers.

One journalist who managed to escape told reporters that she could hear the people looking for her while she hid, according to the BBC.

On Thursday, the bodies were found in the septic tank of a primary school in the village, according to Camara. They had been "killed in cold blood by the villagers," he added, according to the BBC.

Throughout this epidemic, public health officials have battled widespread fear and even doubts that the virus exists at all. The deadly attack illustrates the danger that health workers face as they try to spread information about the virus in an effort to control the deadliest Ebola outbreak in history.

The attack occurred in an area near where riots broke out last month because people feared that workers disinfecting a market were contaminating people, according to the BBC.

Guinean radio reported that the attack came after the group tried to spray disinfectant to prevent the virus from spreading in public places, the LA Times reported.

Earlier, the governor of Nzerekore told the BBC that he believed the group was being held captive. A government delegation had been sent to the Wome (Wamey) village but was unable to gain access because the main bridge leading to the town was destroyed to prevent authorities from reaching it, the BBC reported.

The Ebola outbreak in West Africa began in a Guinea border town, Guéckédou, which is near where Tuesday's attack occurred. The spread of the virus in the country has not accelerated as quickly as it has in other affected countries, particularly Liberia.

But 33 percent of the cases in Guinea have been reported in the last three weeks, signaling that the outbreak is far from under control. According to the World Health Organization, at least 2,622 people have died and 5,335 have been infected in Guinea, Liberia, Sierra Leone, Nigeria and Senegal.

[This post has been updated multiple times.


Abby Phillip is a general assignment national reporter for the Washington Post. She can be reached at abby.phillip@washpost.com. On Twitter: @abbydphillip

CDC ebola checklist

berry
Detailed Hospital Checklist for Ebola Preparedness
The U.S. Department of Health and Human Services (DHHS), Centers for Disease Control and
Prevention (CDC), and Office of the Assistant Secretary for Preparedness and Response
(ASPR), in addition to other federal, state, and local partners, aim to increase understanding of
Ebola virus disease (EVD) and encourage U.S. hospitals to prepare for managing patients with
EVD and other infectious diseases. Every hospital should ensure that it can detect a patient with
ebola, protect healthcare workers so they can safely care for the patient, and respond in a
coordinated fashion. Many of the signs and symptoms of EVD are non-specific and similar to
those of many common infectious diseases, as well as other infectious diseases with high
mortality rates. Transmission can be prevented with appropriate infection control measures.
In order to enhance our collective preparedness and response efforts, this checklist highlights
key areas for hospital staff -- especially hospital emergency management officers, infection
control practitioners, and clinical practitioners -- to review in preparation for a person with EVD
arriving at a hospital for medical care. The checklist provides practical and specific
suggestions to ensure your hospital is able to detect possible EVD cases, protect your
employees, and respond appropriately.
While we are not aware of any domestic EVD cases (other than two American citizens who
were medically evacuated to the United States), now is the time to prepare, as it is possible
that individuals with EVD in West Africa may travel to the United States, exhibit signs and
symptoms of EVD, and present to facilities.
Hospitals should review infection control policies and procedures and incorporate plans for
administrative, environmental, and communication measures, as well as personal protective
equipment (PPE) and training and education. Hospitals should also define the individual work
practices that will be required to detect the introduction of a patient with EVD or other emerging
infectious diseases, prevent spread, and manage the impact on patients, the hospital, and staff.
The checklist format is not intended to set forth mandatory requirements or establish national
standards. In this checklist, healthcare personnel refers to all persons, paid and unpaid, working
in healthcare settings who have the potential for exposure to patients and/or to infectious
materials, including body substances, contaminated medical supplies and equipment, or
contaminated environmental surfaces.1
This detailed checklist for hospitals is part of a suite of HHS checklists currently in development.
CDC is available 24/7 for consultation by calling the CDC Emergency Operations Center
(EOC) at 770-488-7100 or via email at eocreport@cdc.gov.
1

Healthcare personnel includes, but is not limited to, physicians, nurses, nursing assistants, therapists, technicians, laboratory personnel, autopsy
personnel, students and trainees, contractual personnel and persons not directly involved in patient care (e.g., house-keeping, laundry).

 C=Completed; IP=In Progress; NS=Not Started
PREPARE TO DETECT
Review risks and signs and symptoms of EVD, and train all front-line clinical staff
on how to identify signs and symptoms of EVD:
http://www.cdc.gov/vhf/ebola/symptoms/index.html;

C IP

NS

C IP

NS

http://www.cdc.gov/vhf/ebola/exposure/index.html

Review CDC EVD case definition for guidance on who meets the criteria for a
person under investigation for Ebola Virus Disease,
http://www.cdc.gov/vhf/ebola/hcp/case-definition.html and proper specimen
collection and shipment guidelines for testing:
http://www.cdc.gov/vhf/ebola/hcp/interim-guidance-specimen-collectionsubmission-patients-suspected-infection-ebola.html
Ensure EMS Crews at hospitals and other agencies are aware of current
guidance: http://www.cdc.gov/vhf/ebola/hcp/interim-guidance-emergencymedical-services-systems-911-public-safety-answering-points-managementpatients-known-suspected-united-states.html
Review Emergency Department (ED) triage procedures, including patient
placement, and develop or adopt screening criteria (e.g. relevant questions:
exposure to case, travel within 21 days from affected West African country) for
use by healthcare personnel in the ED to ask patients during the triage process
for patients arriving with compatible illnesses.
Post screening criteria in conspicuous placements at ED triage stations, clinics,
and other acute care locations (see suggested screening criteria in Attachment
A).
Designate points of contact within your hospital responsible for communicating
with state and local public health officials. Remember: EVD is a nationally
notifiable disease and must be reported to local, state, and federal public health
authorities.
Ensure that all triage staff, nursing leadership, and clinical leaders are familiar
with the protocols and procedures for notifying the designated points of contacts
to inform 1) hospital leadership (infection prevention and control, infectious
disease, administration, laboratory, others as applicable), and 2) state and local
public health authorities regarding a suspected EVD case.
Conduct spot checks and inspections of triage staff to determine if they are
incorporating screening procedures and are able to initiate notification, isolation,
and PPE procedures for your hospital.
Communicate with state and/or local health department on procedures for
notification and consultation for EVD testing requests.
Ensure that laboratory personnel are aware of current guidelines for specimen
collection, transport, testing, and submission for patients with suspected EVD.
PREPARE TO PROTECT
Review and distribute the Guidelines for Environmental Infection Control in
Health-Care Facilities:
http://www.cdc.gov/hicpac/pdf/guidelines/eic_in_hcf_03.pdf.
Treat all symptomatic travelers returning from affected West African countries
as potential cases and obtain additional history.
Conduct a detailed inventory of available supply of PPE suitable for
2

 STANDARD, contact and droplet precautions. Ensure an adequate supply, for
all healthcare personnel, of:
ï‚· Impermeable gowns (fluid resistant or impermeable),
ï‚· Gloves,
ï‚· Shoe covers, boots, and booties, and
ï‚· Appropriate combination of the following:
o Eye protection (face shield or goggles),
o Facemasks (goggles or face shield must be worn with
facemasks),
o N95 respirators ( for use during aerosol-generating procedures)
ï‚· Other infection control supplies (e.g. hand hygiene supplies).
Ensure that PPE meets nationally recognized standards as defined by the
Occupational Safety & Health Administration (OSHA), CDC, Food and Drug
Administration (FDA), or Interagency Board for Equipment Standardization and
Interoperability: https://iab.gov/SELint.aspx.
Review plans, protocols, and PPE purchasing, with your community/coalition
partners, that promote interoperability and inter-facility sharing if necessary.
Ensure EVD PPE supplies are maintained in triage, ED, and all patient care
areas.
Verify that all of your healthcare personnel:
ï‚· Meet all training requirements in PPE and infection control,
ï‚· Are able to use PPE correctly,
ï‚· Have proper medical clearance,
ï‚· Have been properly fit-tested on their respirator for use in aerosolgenerating procedures or more broadly as desired, and
ï‚· Are trained on management and exposure precautions for suspected or
confirmed EVD cases: http://www.cdc.gov/vhf/ebola/hcp/infectionprevention-and-control-recommendations.html.
Encourage healthcare personnel to use a “buddy system” when caring for
patients and when putting on and removing PPE:
http://www.cdc.gov/vhf/ebola/pdf/ppe-poster.pdf and
http://www.cdc.gov/hicpac/2007IP/2007ip_part2.html
Spot-check frequently to be sure standard, contact and droplet infection control
and isolation guidelines are being followed, including safe putting on and
removing PPE.
Ensure all healthcare personnel entering the patient room should wear at least:
gloves, gown (fluid resistant or impermeable), eye protection (goggles or face
shield), and a facemask.
Ensure that non-clinical persons have limited access to suspected or confirmed
EVD patients’ rooms.
Review and update, as necessary, hospital infection control
protocols/procedures.
Review policies and procedures for screening, minimizing healthcare personnel
exposure, isolation, medical consultation appropriate for EVD exposure and/or
illness, and monitoring and management of potentially exposed healthcare
personnel.
Review and update, as necessary, all hospital protocols and procedures for
isolation of patients with suspected or confirmed infectious diseases.
Review your hospital’s infection control procedures to ensure adequate
implementation for preventing the spread of EVD
Review protocols for sharps injuries and educate healthcare personnel about
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 safe sharps practices to prevent sharps injuries.
Emphasize the importance of proper hand hygiene to healthcare personnel.
Post appropriate signage alerting healthcare personnel to isolation status, PPE
required, proper hygiene, and handling/management of infected patients and
contaminated supplies.
Develop contingency plans for staffing, logistics, budget, procurement, security,
and treatment.
Review plans for special handling of linens, supplies, and equipment from
suspected or confirmed EVD patients.
Review environmental cleaning procedures and provide education/refresher
training for cleaning healthcare personnel:
http://www.cdc.gov/vhf/ebola/hcp/infection-prevention-and-controlrecommendations.html.
Distribute guidelines concerning laboratory diagnostics and specimen handling
to all laboratory personnel, and post the guidelines conspicuously in your
hospital laboratory: http://www.cdc.gov/vhf/ebola/hcp/interim-guidancespecimen-collection-submission-patients-suspected-infection-ebola.html and
http://www.cdc.gov/ncezid/dhcpp/vspb/specimens.html.
Provide education and refresher training for healthcare personnel on sick leave
policies.
Review policies and procedures for screening and work restrictions for exposed
or ill healthcare personnel, and develop sick leave policies for healthcare
personnel that are non-punitive, flexible and consistent with public health
guidance.
Ensure that healthcare personnel have ready access, including via telephone,
to medical consultation.
Conduct education and refresher training with healthcare personnel on EVD for
special pathogen handling in the laboratory.
Ensure that all Airborne Infection Isolation Rooms (AIIR) are functioning
correctly and are appropriately monitored for airflow and exhaust handling.
Note: CDC recommends an AIIR room be used if aerosol-producing procedures
are absolutely necessary.
PREPARE TO RESPOND
Review, implement, and frequently exercise the following elements with firstcontact personnel, clinical providers, and ancillary staff:
ï‚· Appropriate infectious disease procedures and protocols, including PPE
donning/removal,
ï‚· Appropriate triage techniques and additional EVD screening questions,
ï‚· Disease identification, testing, specimen collection and transport
procedures,
ï‚· Isolation, quarantine and security procedures,
ï‚· Communications and reporting procedures, and
ï‚· Cleaning and disinfection procedures.
Review plans and protocols, and exercise/test the ability to share relevant
health data between key stakeholders, coalition partners, public health,
emergency management, etc.
Review, develop, and implement plans to provide safe palliative care, adequate
respiratory support, ventilator management, safe administration of medication,
sharps procedures, and reinforce proper biohazard containment and disposal
precautions.
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 Review roles of the infection control practitioner to:
ï‚· Ensure appropriate infection control procedures are being followed,
including for lab, food, environmental services, and other personnel,
and
Maintain updated case definitions, management, surveillance and
reporting recommendations.
Properly train healthcare personnel in personal protection, isolation
procedures, care of EVD patients.
Ensure that administrators are familiar with responsibilities during a public
health emergency.
Identify a communications/public information officer who:
ï‚· Develops appropriate literature and signage for posting within the
hospital (topics may include definitions of low-risk, high-risk and
explanatory literature for patient, family members and contacts),
ï‚· Develops targeted public health risk communication messages for use
in the event of a highly-suspected or confirmed EVD case in your
hospital,
ï‚· Develops internal messages for suspected and confirmed cases, and
internal and external messages for confirmed EVD cases,
ï‚· Contacts local- and state-identified EVD subject matter experts,
ï‚· Requests EVD-appropriate literature for dissemination to healthcare
personnel, patients, and contacts,
ï‚· Prepares written and verbal messages ahead of time that have been
approved, vetted, rehearsed and exercised,
ï‚· Works with internal department heads and clinicians to prepare and vet
internal communications to keep healthcare personnel and volunteers
informed, and
ï‚· Train subject-matter experts to become spokespersons and practice
sound media relations.
Plan for regular situational briefs for decision-makers, including:
ï‚· Suspected and confirmed EVD patients who have been identified and
reported to public health authorities,
ï‚· Isolation, quarantine and exposure reports,
ï‚· Supplies and logistical challenges,
ï‚· Personnel status, and
ï‚· Policy decisions on contingency plans and staffing.
Maintain situational awareness of reported EVD case locations, travel
restrictions and public health advisories, and update triage guidelines
accordingly.
Incorporate EVD information into educational activities, including physician
Grand Rounds, nursing educational meetings, and other healthcare system and
coalition healthcare personnel and management training opportunities:
http://emergency.cdc.gov/coca/.

Quick Resources List
CDC has produced several resources and references to help you prepare, and more
resources are in development. Information and guidance may change as experts learn more
about EVD. You should frequently monitor CDC’s EVD website and review CDC’s EVD
response guide checklists for:
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Clinician and healthcare workers
Healthcare facility information: Hospitals and Healthcare Settings

Stay informed! Subscribe to the following sources to receive updates about EVD:
ï‚· CDC Health Alert Network (HAN)
ï‚· CDC Clinician Outreach and Communication Activity (COCA)
ï‚· CDC National Institute for Occupational Safety and Health
 U.S. Department of Labor’s Occupational Safety & Health Administration Newsletter
Below are a few of the resources most relevant to healthcare preparedness:
ï‚· Ebola Virus Disease Information for Clinicians in U.S. Healthcare Settings
ï‚· Case Definition for Ebola Virus Disease. This case definition should be used for screening
patients and should be implemented in all healthcare facilities:
ï‚· Safe Management of Patients with Ebola Virus Disease in US Hospitals
ï‚· Infection Prevention and Control Recommendations for Hospitalized Patients with Known
or Suspected Ebola Hemorrhagic Fever in U.S. Hospitals. This document provides a
summary of the proper Personal Protective Equipment (PPE)
ï‚· Interim Guidance for Specimen Collection, Transport, Testing, and Submission for Patients
with Suspected Infection with Ebola Virus Disease
ï‚· Interim Guidance for Environmental Infection Control in Hospitals for Ebola Virus
ï‚· Sequence for Removing Personal Protective Equipment (PPE)
 National Guidance for Healthcare System Preparedness’ Capabilities, with particular
emphases on Capability #6 (Information Sharing) and Capability #14 (Responder Safety
and Health Capability)
ï‚· Interim Guidance for Emergency Medical Services Systems and 9-1-1 PSAPs.
CDC is available 24/7 for consultation by calling the CDC Emergency Operations Center
(EOC) at 770-488-7100 or via email at eocreport@cdc.gov.

Check CDC’s Ebola website regularly for the most current information. State and local health
departments with questions should contact the CDC Emergency Operations Center (770-4887100 or eocreport@cdc.gov).