Ebola outbreak response guidelines

Response guidelines for Ebola outbreaks are continuously updated as more is learned about the disease and how best to contain and treat it. The primary goal in any outbreak event is to dramatically reduce transmission within the immediate community and prevent the spread of infection to surrounding regions and countries. In so doing, control can be gained over transmission chains and the risk of further infections eradicated.

Within an outbreak area, governments aim to grant those with the disease sufficient access to high quality medical care which also offers added safety to all in the area (infected patients, healthcare workers and community at large).

It has been identified during more recent outbreaks that a coordinated response effort between international authorities can achieve the rapid containment of Ebola and provide sufficient healthcare for those affected – preserving as much life as possible.

The WHO has developed 6 response pillars for the handling of confirmed outbreak events ⁽¹³⁾

1. Coordination and operations support

• Activation of EOCs (Emergency Operations Coordination) – on a district, provincial and national level.
• Identifying and establishing logistics hubs where supplies can be sent.
• Establishing access routes for the safe transportation of healthcare personnel, equipment and supplies – all modes of transport, including vehicles (cars and trucks), helicopters and other aircraft and boats (ships).
• Establishing reliable channels of communication between involved authorities and for case reporting purposes.
• Establishing safety and security measures.
• Arranging for the mobilisation of affected individuals, as well as the financial resources required for their care.
• Identifying and arranging for sufficient numbers of required healthcare staff within the immediate outbreak area, as well as within neighbouring regions (including cities and remote towns and villages).

2. Surveillance case management and contact tracing

• Arranging dedicated resources for surveillance and contact tracing within health facilities.
• Compiling records of all known deaths and suspected cases associated with Ebola in the immediate area (province where an outbreak has occurred).
• Implementing active search operations for suspected exposure cases within the community at large.
• Identifying any possible exposure risk cases and implementing daily surveillance (monitoring) of individuals for at least 21 days (in case Ebola symptoms develop).
• Compiling daily (status) reports on case incidences and the distribution of confirmed / suspected infections.
• Setting up surveillance management teams at all entry points and borders within the affected area to monitor civilian movements (individuals entering or leaving the affected area or country), thereby gaining further control of disease transmission.

3. Case management and infection prevention control

• Establishing dedicated ETCs (Ebola Treatment Centres) for the treatment of infected individuals. Treatment centres, clinics or hospitals are allocated hot and cold zones. A hot zone is a ‘contaminated area’ where patients receive treatment. A cold zone is a ‘non-contaminated’ area Personnel are only permitted in the cold zone if they have not entered the hot zone or have safely removed all PPE once exiting the hot zone. Clean PPE can be put on in the cold zone before entering the hot zone.
• Establishing specific triage and isolation (quarantine) facilities.
• Implementing safe transportation services (to and from the set up ETCs) for suspected and confirmed Ebola virus patients.
• Implementing high-level hygiene and biosecurity measures within ETCs in order to control infection.
• Assisting with ensuring safely managed and dignified burials (or cremations) for those who have died from Ebola, as well as the efficient decontamination of community households.

4. Community engagement, social mobilisation and psycho-social support

• Developing and distributing public risk communication materials to the community at large through reliable channels, ensuring that the public is made well aware of the outbreak, what to do and where to go should assistance be required.
• Implementing on-the-ground teams to enable social mobilisation and encourage community engagement.
• Forming teams to provide psychological and social support to affected communities and families.
• Providing training to community leaders who can assist with channelling awareness information and proving support.

5. Mobile laboratories and the strengthening of diagnostic capabilities

• Setting up well equipped mobile laboratories to assist with confirming suspected Ebola cases (diagnosis).
• Ensuring that laboratory units have sufficient numbers of qualified personnel and technicians who are also equipped with PPE.
• Ensuring the safe transportation of infection case samples from ETCs to the mobile laboratories.

6. Research response

• Implementing an emergency ring-vaccination strategy if vaccines (even if these are still experimental and not yet officially licensed) are made available.
• Providing access to experimental antiviral medications if made available.
• Implementing facilitated mechanisms to assist with coordinating information which may be useful for current and future research efforts for Ebola.
• Noting any developments during diagnosis and treatment procedures which may be useful for research efforts.

Reference:

^{13. World Health Organization. 10 May 2018. Disease outbreak - Donor Alert (Democratic Republic of the Congo - Ebola Virus Disease): http://www.who.int/emergencies/crises/cod/drc-donor-alert-ebola-10may2018.pdf?ua=1 [Accessed 23.05.2018]}