Ebola in Democratic Republic of the Congo - Transcript

Moderator: Kellee Waters and Jonathan Lynch

  • Mary Choi, M.D., M.P.H.
  • Shah Roohi, R.N., M.P.H.
  • Trevor Shoemaker, M.P.H.

Date/Time: June 19, 2019, 1 p.m. to 2 p.m. Eastern Time

Good afternoon. I’m Kellee Waters,a Senior Health Communication Specialist on the Emergency Partners Information Connection team in the CDC, Center for Preparedness and Response, Division of Emergency Operations. Thank you for joining us for today’s EPIC Webinar, titled, Ebola in Democratic Republic of the Congo.

Today, we will hear from Ebola experts in CDC’s National Center for Emerging and Zoonotic Infectious diseases. If you do not wish for your participation to be recorded, please exit at this time. You can earn continuing education by completing the webinar; instructions on how to earn continuing education can be found on our website, emergency.cdc. gov\epic. EPIC.

The course access code is epic, EPIC0619 with all letters capitalized. To repeat, the course access code, to receive continuing education units is, in all caps, EPIC0619. Today’s webinar is interactive.

To make a comment, click the chat button on your screen and then enter your thoughts. To ask a question, please use the Q&A button. The Q&A session will begin after our presenters finish.

Closed captioning is available for this webinar. The button to enable this function can be found either at the top or the bottom of your screen. We’re fortunate today to have three experts with us.

Dr. Mary Choi is a medical officer with CDC’s Viral Special Pathogens branch. She graduated from George Washington University’s School of Medicine in 1999, and completed her residency training, in Emergency Medicine, at the University of Michigan.

In 2010, she completed a fellowship in International Emergency Medicine at Columbia University, where she also received her Master of Public Health degree. She graduated from CDC’s Epidemic Intelligence Service in 2014. Mary has deployed to the Democratic Republic of Congo multiple times in response to this outbreak.

Mary will discuss the status of the current outbreak. Shah Roohi is a senior advisor for Preparedness and Response at the Division of Global Migration and Quarantine, he is a registered nurse with a Master of Public Health degree and has 30 years of experience in the health field. Shah’s areas of expertise include ill traveler and management, quarantine, isolation and public health preparedness.

He has served in various roles during previous CDC responses to outbreaks of Ebola, Zika, MERS and the H1N1 influenza pandemic. He is currently managing his division’s border health response for the 2018 DRC Ebola outbreak and also supports other emergency preparedness and response activities. Shah will discuss recommendations for organizations sending US-based healthcare or emergency response workers to areas with Ebola outbreaks.

Trevor Shoemaker is a senior epidemiologists with the CDC’s Viral Special Pathogens Branch, he currently focuses on enhancing surveillance and outbreak detection for viral hemorrhagic fevers internationally. He previously served six years as program director for the viral special pathogens branch in Uganda. He has been working in infectious disease epidemiology and public health for over 20 years.

Trevor will help answer questions during the Q&A session. Thank you Shah, Mary and Trevor for joining us today. Mary will be our first presenter.

Mary, please begin.

MARY CHOI: Hi. So thank you for that introduction. Next slide.

Ebola virus disease is a rare and deadly disease caused by infection with one of the six viruses within the genus ebolavirus. They are listed here. The ones highlighted in red have been known to cause disease in humans.

Next slide. Reston virus was isolated in monkeys that were being held at a monkey quarantine facility in Western Virginia. Bombali virus is the newest of the viruses in the group and was detected in bats in Sierra Leone.

Since its discovery in 1976, there have been 28 outbreaks of EVD, the current outbreak is the 10th in the Democratic Republic of the Congo. The natural reservoir host for Ebola viruses are unknown, but bats are the most likely reservoir. Next slide.

This is a depiction of how a virus and a bat can infect humans. In bats who carry the virus bats can spread the virus in their saliva, in the urine, and in the droppings. Uninfected bats can then become contaminated through contact with these infectious fluids.

Bats can then transmit the virus to humans in several different ways. Number one, humans can be contaminated through direct contact with the secretions of the bat, so either through a bite or being exposed to bat feces or urine. The other possibility is sometimes people will butcher bats for food, and then humans can be contaminated in that matter as well.

Humans can also be infected through intermediaries, such as monkeys. So, how does this happen? A bat who is infected with the viurus can feed on fruit. The fruit is then eaten by animals who then become infected by eating the contaminated fruit and become ill, hunters can catch these animals because they are sick and easier to catch.

Next slide. Ebola virus can be found in all bodily fluids of someone who is contaminated with the virus. So it can be found in the blood, feces/vomit, urine, tears, saliva, breast milk, amniotic fluid, vaginal secretions, sweat, and semen.

The virus is transmitted through contact, either through a break in the skin, eyes, mouth, or mucous membranes with body fluids of a person that is sick or has died from Ebola. Next slide. A person infected with Ebola virus is not contagious until symptoms appear.

The signs and symptoms of EVD include the following and are listed here. Bleeding is a rare finding in Ebola and happens in less than 50% of cases and is a late finding. As you can see, the signs and symptoms of Ebola are pretty vague and can be seen in many other diseases that are endemic in Africa, such as Malaria and Typhoid.

The lack of proper mnemonic signs and symptoms is one of the reasons why Ebola virus is so difficult to diagnose. Next slide. So now that we’ve talked about the signs and symptoms of Ebola, let’s talk about the progression of symptoms.

So following infection, the first period is the incubation period. During this period, the person has no signs and symptoms of Ebola. And they are not able to transmit the virus to anybody.

The incubation period lasts between 2 to 21 days, but on average, lasts between 8 to 9 days. Following the incubation period, the first symptoms that we will see are what we call dry symptoms, and these are symptoms such as fever, headache, body aches. At this point, with the development of signs and symptoms, the patient is contagious and can transmit the virus.

Following that, on or about day 4, patients will develop what we call wet symptoms, such as vomiting and diarrhea. At this point, the patient is very contagious, and the vomit and the diarrhea has very high levels of ebolavirus. Without treatment, death occurs about 7 to 10 days after illness onset, and at the time of death, the amount of ebolavirus in the body is at the highest.

So when you look at this spectrum of disease, what’s important to realize is that in order to stop transmission in the community, patients need to be isolated before the onset of wet symptoms. Next slide. There are no FDA approved treatments for EVD.

Studies have shown that early supportive care alone can significantly improve chances of survival. There are four experimental treatments approved for use in the DRC through a randomized clinical control trial, and they’re listed here. Both ZMapp and Remdesivir were used successfully in the 2014 West Africa outbreak, and mAb 114 is a monoclonic antibody that was actually developed in collobration with the Democratic Republic of Congo.

And that antibody was actually found in a survivor of the 1995 Kikwit Ebola outbreak. Next slide. There is a vaccine that’s currently being used in DRC, the vaccine is a live vaccine that contains a piece of the ebolavirus.

Because it only contains a piece of the virus, vaccination will not cause someone to develop Ebola. The vaccine is experimental and is given as a single dose. The other thing that is important to remember, is that this vaccine protects only against the Zaire species of ebolavirus.

For someone who has already been infected and is incubating, this vaccine will not prevent them from developing the disease. However, preliminary data has shown that individuals who are vaccinated and subsequently develop Ebola are more likely to survive than those individuals who are not vaccinated and develop Ebola. Currently, the vaccine is covered to contacts and contacts of contacts of EVD cases, through a ring vaccination strategy.

Frontline workers to include pregnant and lactating women. When I say ring vaccination strategy what does that mean? After a person is diagnosed with Ebola, the response team will talk to the patient and find out everyone they’ve had contact with while ill. These contacts will then be offered vaccination.

Then the response teams will talk to the contacts and identify who their contacts are, and then these contacts of contacts will be offered vaccination. Next slide. On August 1, 2018, the DRC Ministry of Health confirmed an outbreak of Ebola virus, species Zaire Ebola virus in the Eastern Congo.

On June 12, 2019 Uganda reported three cases of EVD in returning travelers from DRC. As of June 16, 2019, EVD cases have been reported in 22 health zones in the Democratic Republic of Congo this makes it the second largest EVD outbreak in history and the largest EVD outbreak ever to have occurred in the Democratic Republic of Congo. As of June 16, 2019, there were a total of 2,168 cases had been reported, and 1,431 deaths.

And a total of 119 healthcare workers have been infected. Next slide. The DRC Ministry of Health is leading response efforts with assistance from the local and the international partners, including the WHO and CDC.

Response activities are divided into pillars to include the following listed below. I will touch upon a few of these to explain what they are. The survellience pillar is responsible for investigating cases and determining epidemiologic links between patients.

They are also responsible for contact tracing. Points of entry is responsible for screening travelers, both land and water barriers, as well as at airports. The psychosocial and community engagement group is responsible for interfacing with the community, developing messaging, as well as supporting family members of suspect and confirmed cases and supporting survivors and helping them integrate back into society.

The safe and dignified burial teams are responsible for testing bodies for EVD and then safely burying those who have died of Ebola. The case management pillar they’re responsible for the management of patients inside Ebola treatments units as well as transport centers where suspect patients are being cared for. So the current outbreak is occuring in the setting of a complex humanitarian emergency.

This area is a mineral rich area and there has been many rebel groups fighting for control because of this. This has led to over 1 million internally displaced persons in DRC alone, as well as continuous movement of refugees to neighboring countries, including Uganda, Rwanda, and South Sudan. The response has also faced incidents of violence against response teams and pockets of community resistance.

In April a WHO epidemiologist was killed. In addition, there is alot of mistrutst between the community and emergency response workers. There is a rumor that Ebola is not real and they feel it is just a pretext to generate money for international partners.

In addition, Ebola has been used by politicians, so in the last election in December, voting was actually canceled in the affected areas. The reason that was given is that they were concerned that by holding elections, that would contribute to the spread of the disease, but the community felt that it was actually just a move for mass voter suppression. All of these factors have led to a high number of EVD deaths occurring outside an Ebola treatment unit and a low number of confirmed cases under surveillance at the time of notification.

Next slide. The U. S. Government, including CDC, is working with the DRC, Ministry of Health and other partners to provide technical assistance in the areas that are listed here. I will touch upon a few of our activities CDC has embedded with the survellience teams to help them analyze the epidemiologic data. We have also embedded with the data analysis team that is situated in DRC, and we’ve been working with them to analyze the data to ensure that he data analysis is used to guide response activities.

The infection control team at CDC has been working very closely with the Ministry of Health and other partners to develop standard operating procedures for infectious control. And to access infection control at healthcare facilities, and our communications team has been working very hard along with the Red Cross to analyze community feedback and develop messaging based on that feedback. As of June 11, 187 CDC staff have completed 278 deployments to both DRC, Uganda , South Sudan and Rwanda.

We have also deployed to Geneva to support the WHO operations there. On June 13th, CDC activated its emergency operations center at a level 3, the lowest level of activation. This allows the agency to provide increased operational support to meet the oubreaks evolving challenges.

Next slide. So as this outbreak continues healthcare workers and Hospitals will continue to see returning travelers who are ill. Healthcare workers should first contact local and state health departments for assistance in assessing a patient for Ebola.

CDC does have references on our website to help with this, and one of the links is listed here above. Thank you and now I will hand it over to my DGMQ colleague.

SHAH ROOHI: Hello, everyone. Thank you, Mary. This is Shah Roohi, I work for the CDC Division of Global Migration and Quarantine.

Thank you for the opportunity today to speak with you a little bit about border and travel health activities involving DRC and the Ebola outbreak area. First, let me start by saying our hearts go out to the people and communities in the eastern DRC region impacted by Ebola and also those in Uganda in a community about 15 miles from the border affected, by a imported case of cluster of three cases in a single family. We are thankful to the Ministries of Health and international partners for their heroic efforts and close coordination on the public health emergency response efforts to the Ebola outbreak.

As was mentioned a little bit earlier, this is the 10th Ebola out break in DRC since the virus was discovered in 1976 in that country. The current outbreak was declared about ten months ago. DRC has had interim successes while facing ongoing difficulties.

The outbreak has occured in an area intractable conflict among multiple armed groups at a given time of contentious national elections, as Mary mentioned. To help control this outbreak, CDC has deployed staff for the Ebola response to DRC and for Ebola preparedness in Uganda and surrounding countries. Ebola preparedness and response activities have been comprehensive, they include assisting with planning or undertaking disease tracking, case investigation, contact tracing, case management, safe burials, community engagement (?) mobilization.

Other activities have included communication and health education, behavioral science,labatory testing, border health, data management, preventative vaccinations of healthcare workers and logistics. The current epidemic is serious, but for context, it is smaller than the West African Ebola epidemic of 2014 to 2016 by an order of magnitude. Let me explain.

The former West Africa outbreak, caused more than 28,000 Ebola cases. Each of the countries involved in that outbreak had more cases than the DRC does today. For example, back in 2014, Sierra Leone had 14,000 plus cases.

Liberia had 10,000 plus cases and Guinea, had close to 4800 cases. These case counts are be attributed to the former West Africa outbreak between 2014 and 2016. Fast-forward to today.

We have more familiarity with the disease now than we did back in 2014 to 2016. Previously, the international community had fewer intervention tools to work with, and at that time the research was just beginning to test Ebola vaccines and other candidate drugs and analysis. The MERC vaccine now is being successful used in ring vaccination programs in DRC.

It has also been used for vaccination of healthcare workers in neighboring countries as a preparedness measure. DRC is a very large country, geographically. For context, it is about two-thirds the size of Western Europe or one quarter the size of the United States, and the current outbreak area in DRC is about 2,000 miles from Kinshasa, where the majority from the US travel from.

There are no direct flights from the DRC to the United States, and the number of travelers from there to the U. S is small. Population movement mapping and identification of high risk areas has led to a coordinated effort to screen travelers at points of entry and exit at internal points of control at DRC.

There is exit screening at the Goma airport and entry screening in Kinshasa for those arriving from the outbreak area. From the beginning of this outbreak, DRC has screened more than 67 million travelers at points of entry and exit and points of control. This averages to more than 200,000 travelers or more a day.

U. S bound Congalese refugees undergo a 21 day mandatory surveillance period, that includes daily health monitoring checks in a transit center prior to deporting for the United States. WHO’s assessment of the situation, is that the risk of spread nationally, in the DRC, and regionally are high, however the risk for transcontinental global spread at this time is still low.

The CDC and the international communities efforts are focused on the containment of the diseases at the source through contact tracing, vaccination, conduct monitoring and conducting more intensive traveler screenings in the affected area. Despite the high risk of regional spread, the only cases identified outside of North Kivu and provinces of Eastern DRC in the last ten months are three imported cases, identified about 15 miles inside of the Ugandian border in the district. These three individuals were infected with Ebola in the DRC and crossed the border to seek healthcare in a hospital in Uganda.

All three cases are epidemiologically linked to a single case in the DRC. The Ministry of Health and international partners they are closely following the exposed persons. Uganda has proven experience in managing previous Ebola outbreaks and was quick to detect and respond to the recent imported cases.

CDC is actively monitoring the situation in Uganda to assess the need for additional travel health precautions. There is no indication of Ebola transmission in Uganda at this time. We have no Ebola-specific recommendations for people traveling there.

However, travelers are still encouraged to stay healthy and safe by observing routine travel precautions mentioned on the CDC’s traveller’s health website for Uganda available at www. cdc. gov/travel.

Next slide, please. We believe the risk to the United States from the current Ebola outbreak in DRC remains low based on the travel volume and travel patterns from the outbreak areas to the United States as well as the implementation of border screening measures at key airports in the DRC and neighboring countries. CDC has issued a level 2 travel notice with recommendations for travelers to DRC, including for US healthcare and aid workers, and their sponsoring organizations, to ensure travelers and workers stay healthy during travel and when they return to the United States.

I want to emphasize that the risk of Ebola to most travelers to DRC is low. With potential increased risk to those travelers going in or near the outbreak area who may inadvertently come into close contact with people infected with the ebolavirus. Family and friends caring for people with Ebola and healthcare workers who do not use correct infection control precautions are at the highest risk.

Travelers can protect themselves by avoiding contact with other people’s blood or bodily fluid, and not handling items that have come into contact with a person’s blood or bodily fluid, such as clothes, bedding, needles or medical equipment. Avoiding contact with bats and nonhuman primates or blood, fluids and raw meat prepared from these animals, or any kind of bush meat or meat from an unknown source. We don’t recommend participating in a funeral or burial rights that require handling human remains.

And lastly, washing hands often or using hand sanitizers and avoiding touching eyes, nose, or mouth. Travelers and workers should seek medical care if they develop fever, headache, body aches, sore throat, diarrhea, weakness, vomiting, stomach pain, rash, or red eyes during or after travel. Travelers with symptoms suggestive of Ebola should not travel until they have been evaluated and cleared by public health officials.

Likewise, travelers with known exposure to ebolavirus should not travel commercially until they are no longer at risk for the infection. If necessary, US travelers can request assistance from the Department of Health and Human Services and Department of State in arranging for a medical evacuation back to the United States. For those who work in general health care in a hospital Ebola treatment unit, those that involved in burial work or laboratory work in the outbreak area, our recommendations are as follows.

We suggest wearing protective clothing, including masks, gloves, gowns, and eye protection whenever you are at risk of exposure to ebolavirus. Practicing proper infection control and discussing options for vaccination against Ebola with your employer or response organization. Beyond that, the DRC Ministry of Health, WHO and other partners are offering an investigational vaccine to priority populations, such as, frontline workers in the Ebola response activities.

If you choose to be vaccinated against Ebola, get the vaccine before travel, if possible. The National Institutes of Health has an open label clinical trial entitled “preexposure prophylaxis in individuals at potential occupational risk for Ebola virus exposure, or the prepare trial. To vaccinate adults and volunteers against Ebola, including deploying healthcare workers or other responders, study sites are at the NIH in Bethesda, Maryland, and Emory University in Atlanta, Georgia.

Upon returning to the United States, notify your healthcare facilities infection and control or occupational health professional of your recent travel and self monitoring activities, if you will be caring for patients in a US hospital facility during your 21-day monitoring period. Next slide. From the beginning of the outbreak, CDC has been in contact with eight organizations, sending US-based healthcare or Ebola response workers to the outbreak area to learn about their response-staffing plans and occupational health and monitoring programs for returning workers and to provide recommendations whenever necessary.

CDC recommends that organizations sending US-based workers to the area with Ebola outbreaks ensure the health and safety of those workers before, during, and after their deployment. Next slide. Predeployment, we recommend that organizations educate workers about Ebola, travel vaccines, and other recommended prophylaxis.

Example, for malaria, and other healthy behaviors, personal protective equipment, and travel health insurance, including coverage for medical evaluation. During deployment, recommendations include remaining in contact with workers, periodically asking about any symptoms of or exposure to Ebola, and contacting in advance the US state or local health departments that have jurisdiction in areas where workers will be staying after returning to the US. Before response workers depart from the infected areas, ensure they undergo an exposure and health assessment before travel to the United States.

At a minimum, the predeparture assessment should include a careful assessment for potential exposures to Ebola, review of signs and symptoms compatible with Ebola, a determination that the worker appears well, an oral temperature measurement. Post deployment recommendations include remaining in contact with workers for 21 days after they leave the outbreak area while workers self-monitor for symptoms of Ebola. For most workers, CDC recommends self-monitoring with oversight by the sponsoring organization.

However, for workers with unprotected exposures to the ebolavirus, CDC recommends monitoring by health officials while in the United States. Other restrictions may also be considered. Health departments have the authority to determine how monitoring will be done in their jurisdictions.

Next slide. CDC has developed template tools that organizations can choose to use or modify to help structure the predeployment assessment. PDF’s are available for download on the CDC website.

Next slide. Here are a couple of links, with resources, with additional information covered during today’s talk. Next slide.

For urgent consultations regarding symptomatic or potentially exposed travelers, please call the CDC emergency operations center, available 24/7, at 770-488-7100. For questions about these recommendations on travel, particularly for NGO workers, or additional advice regarding preexposure — predeparture exposure and health assessments, please email CDC at EOCDGMQOPSchief@cdc. gov and this address is available via the slide For general inquiries please contact 800 – 232-4636.

That concludes my talk today, and I thank you for this opportunity and I’ll turn it back to Jonathan.

MODERATOR: That’s what we’re going to do. We’re going to transition with the Q&A session now with Jonathan. Can you read the first question?

JONATHAN: I can. We’re getting quite a few questions. We have experts with a particular set of skills and knowledge.

Some of the questions may be outside of their purview. If you don’t get your question answered today, it’s probably for that reason, but you can send it to EPIC@cdc. gov and we can follow up with these experts or other experts.

Our first question comes from M. Morrison. Does the vaccine provide lifelong immunity?

MARY CHOI: All right. Thank you. That’s an excellent question.

We don’t quite know yet is the bottom line. The vaccines were developed very recently. There are studies that are ongoing to evaluate that very question, though.

Thank you.

JONATHAN: Thank you. Our next question comes from A Hager, who asks, how long after the death of a person is the ebolavirus viable?

MARY CHOI: Thank you for that question. Another excellent question. So again, there are some studies that shows that the virus which is an envelope virus does not survive very long, just in the dry environment, so like a doorknob, on the floor, the virus may be viable for a couple of hours.

However, when the virus is inside something wet or organic matter like a body or vomit or stool, we know it can last for much longer. Exactly how long, we don’t know. Thank you.

JONATHAN: And in general, there may be a lot of questions where the science just doesn’t have an answer yet, so that’s understandable. This next question comes from Karen, who asks, which species outside of bats and primates, have been found to have Ebola?

TREVOR: This is Trevor. I’ll take that one. Outside of bats and primates, as Mary mentioned in her presentation, bats are believed to be the reservoir host, which means the virus and the bat coexist without causing harm to that particular species.

We do know from previous outbreaks in Africa that primates and not even primates are very susceptible to the virus, just as humans are, so we don’t consider those to be hosts. We consider them to be more vunerable or susceptible populations. There has been anecdotal evidence of the virus being in other species, including small antelopes, but we don’t believe that to be very widespread, just isolated incidents.

JONATHAN: Okay. Thank you. Real quick, Stephanie, make sure they’re popping up.

The next question comes from Patrick Lathrop who asks; Is the vaccine safe for breast-fed babies? Is the vaccine safe for breast-fed babies?

MARY CHOI: Yes. So the data in that, the literature for breastfeeding is more limited than those who are not pregnant or who are not breastfeeding. However, for this outbreak, the WHO advisory committee that advises them on vaccination safety, the Sage recommendation has looked at the evidence and has recommended that the vaccine be used in pregnant and lactating women in this outbreak.

Thank you.

JONATHAN: I’m summarizing a question from Ayanna who is asking if; Is this outbreak connected to the previous large outbreak? in Africa?

TREVOR: I think the question is referring to the previous outbreak of 2018 in DRC. The current outbreak in North Kivu, we believe, is unrelated to that previous outbreak, but they are two independent outbreaks and I believe the genetic sequence of the two different viruses and outbreaks from these two different areas confirms that. Thank you.

JONATHAN: Our next question comes from Dr. Dewilde, who asks, what would be the recommendation for travelers to Zaire or neighboring countries, but not going in the hot zone?

SHAH ROOHI: As mentioned earlier, this is Shah, the vaccine is being recommended for frontline workers that are involved in ETU work, general healthcare work, burial work, et cetera. So at this time, that’s our current recommendation, but we suggest that you continue to follow CDC’s website for updated guidance. Thank you.

JONATHAN: Thank you. I’m summarizing a question from MNQ1, who is asking if it is ever possible for a person to be contagious and asymptomatic.

MARY CHOI: Thank you for that question. We have no evidence that shows that people who are asymptomatic are contagious. Thank you.

JONATHAN: Thank you. Nate Cunningham is asking why there is a belief that transcontinental global spread is not a very likely event.

SHAH ROOHI: This is a good question. The risk is not zero. It’s low.

So I want to clarify that. Even if you look at the trajectory of the current outbreak, the current outbreak was declared ten months ago, and in ten months with the number of cases in the forest borders, we have witnessed three cases Uganda 15 miles across the border. That question can’t be fully answered, but what I can tell you is the majority of population movement mapping that has been done has shown that the majority of people are traveling locally within 100 kilometers and they’re not air travelers.

Thank you.

JONATHAN: Thank you. The next question, is there a current need for additional workforce support?

TREVOR: I’ll take that one. I believe the current outbreak, CDC is working very closelty with out International partners, including WHO, other nongovernmental organizations and our ministry of health partners and other local organizations. I believe at this time unless you are affliated with one of those organization there is not an additional need from the general public or outside populations to assist with this outbreak — as Shah mentioned, it’s relatively geographically limited, even though the numbers are large, so we don’t anticipate any further spread beyond those particular areas at this time.

But we’re constantly reevaluating assessing those needs as we go on. Thank you. Jonathan: Thank you.

We’ve had multiple questions about screening, including screening of returning university students, screening, Shah, previously you had mentioned wanting to address that in general terms but in more specific terms that would be a question for a different set of experts, so if you send them to epic@cdc. gov, we can address them.

SHAH ROOHI: Just to clarify the question about What is involved in screening activities? Is that the gist of it? Currently screening within DRC, there’s screening of travelers that’s happening within DRC and the neighboring countries, so there is exit screening that’s being done for travelers leaving by air, leaving the outbreak area. That involves a temperature check, and a questionaire, a visual observation, if there are any symptoms in the individual. As travelers leave the outbreak area and arrive into Kinchasa which is the gateway where the majority of travelers come to the United States, they are entry screened by the Ministry of Health workers, again that includes a temperature check, visual observation, and a questionnaire to assess risk.

Additionally, we’re aware of entry screening activities for travelers that are occurring in Uganda, in south Sudan, Rwanda, Tanzania, so those activities are currently in place Jonathan: Great thank you, the next question comes from Steve who asks, how long after receiving the vaccine will you be protected?

MARY CHOI: Thank you for that question. We believe about 10 to 14 days after you receive the vaccine you should have protective antibodies. Thank you.

JONATHAN: A follow-up question, same topic, what percentage of people after being vaccinated may still acquire the disease?

MARY CHOI: Thank you for that question. So we believe that the vaccine efficacy is about 95%. But as I mentioned, if you have already been infected and are incubating the virus and then get vaccinated, the vaccine will not prevent you from developing the disease.

So we did see this in studies that were done when the vaccine was used in Guinea in 2014, towards the end of that outbreak. But when they looked at individuals who were vaccinated, how many then developed Ebola 10 days or more, that was zero for that study. So we feel that when the vaccine is given preexposure, so before they become exposed to the virus, that it’s very efficacious.

When it is given after, depending on whether or not you have already been exposed, that will determine, you know, whether or not you will develop the disease. Thanks. Jonathan: Thank you.

I’m going to summarize a question from Ryan Kinney, which is asking if a person, say, a family member, has been exposed by is not symptomatic. Should they be quarantined?

MARY CHOI: So we — yeah, the question is, if a person, a family member, has been exposed, should they be quarantined. No. That is not the strategy that we’ve been taking.

Because many, many people can be exposed, but only a small percentage will then develop the disease. So the strategy that they’re using in the Democratic Republic is, once you have a case and identify a contact, so therefore someone who has been exposed, in that case, that contact then is followed every single day for 21 days, which is the maximum incubation period. The idea is as soon as that person becomes symptomatic with fever, muscle aches, that sort of thing they are immediately taken to an Ebola treatment center where they can be evaluated and tested.

And we know that early treatment can improve survival. So it’s good not only the patient to get early care because it improves survival, but it also diminishes transmission within the community. Thank you.

JONATHAN: Does the vaccine for the Zaire strain improve outcomes for people infected with any strain?

MARY CHOI: Thank you for that question. So the vaccine currently being used is only effective against the Zaire ebolavirus, so the Zaire strain. It does not confer cross protection against any other species of Ebola and currently there are no vaccines in the advanced stages of development that can protect against all strains of Ebola.

Thank you. Jonathan: The next question comes from Susan Fitzgerald, what are the current CDC recommendations for US Ebola preparedness, including training recommendations for frontline staff?

SHAH ROOHI: So let me — currently, if the question, to clarify, if it is what kind of activity should be ongoing in the United States in terms of preparedness, CDC does have recommendations on its websites for planning, training, exercise, activities in the United States. We recommend an all-hazard approach, but there are specific Ebola recommendations that were made post outbreak of 2014-2016. Those are the general recommendations, the top ten tips, if you will, on our CDC website that you can follow, but they’re not special or specific precautions that are recommended at this time, exclusively and specifically related to the current outbreak.

These are general recommendations that we all should be doing in emergency response, always planning, training exercising.

JONATHAN: Thank you. The next question is this. Is the virus transmitted via insect bites?

TREVOR: Yes. Thank you for that question. We have no evidence at this time that ebolavirus is transmitted by insects.

Thank you.

JONATHAN: Okay. The next question asks about protection of surrounding countries. I understand — you don’t have to go into detail, but there are pretty fair protections for the surrounding countries.

SHAH ROOHI: CDC has been in close coordination with the neighboring countries that are specifically bordering the outbreak area and we’ve been working with them, standing up preparedness activities around the various areas that were mentioned during both Mary’s talk and mine, and I think one case example that we can give that our investments are paying off are the current activities and response that happened to the cluster of three cases in Uganda quickly those three cases were contained, isolated, and the vaccination was stood up. So a lot is happening in terms of epidemiology surveillance,preparedness , neighborhoods countries.

JONATHAN: The next question comes from eElizabeth from Oklahoma City. Can bite bats transmit or is there a specific bat that transmit the ebolavirus?

TREVOR: I’m not sure I understand the first part of the question.

JONATHAN: Can bite bats infect people? If they’re bitten by a bat, are they at risk of ebolavirus, and does species of bat matter.

TREVOR: Yes, bats can, technically, bite humans, and I think as Mary mentioned in her presentation, we don’t specifically know what species of bats carry ebolavirus. We suspect species of bats carry ebolavirus, but there are six different species of ebolavirus, and other viruses that are similar, we suspect it might be possible for multiple species of bats to carry different species of ebolavirus. So there could be many.

I think the close est representation that we have or the close else is Marburg virus, where we know that host is the Egyptian fruit bat, and that is a very specific species that carries the Marburg virus. It doesn’t specifically bite humans, but if you handle one of these bats, it potentially can bite you, and we do suspect if an infected bat does bite you, it could transmit the virus. That’s not probably the most likely form of transmission from these bats.

As Mary mentioned, it’s most likely through indirect exposure, the fruit that bats or humans will eat or other connection with urine or feces or other from infect bats. Thank you.

JONATHAN: PLI7 asks if cases are primarily clustered in households among those attending fluids or individuals who visited a healthcare setting or some other group.

MARY CHOI: Hi. In this outbreak, we are seeing both. We are definitely seeing people who are transmitting the virus to family members, and that certainly makes sense, you know.

When someone becomes ill, it’s the family members that are taking care of them. We are also seeing evidence that the virus is being transmitted at healthcare facilities, nosocomial infections. Jonathan: Another question I’ve seen more than once here, the question is, how safe is the EVD vaccine?

MARY CHOI: Thank you for that question. The vaccine has been seen in thousands of people in Africa and Europe. We have not seen any severe adverse affects.

There are side effects after you receive the vaccine, because as I mentioned, the vaccine is a live vaccine, so after the injection it’s common to have some soreness in the arm as well as fevers and muscle aches, but we have yet to see evidence of serious sever side effects from the vaccine. But as more and more people are vaccinated, we may see other side effects that we have not seen to date. Thanks.

JONATHAN: Thank you. Denise Jordan asks if there is a travel ban to DRC.

SHAH ROOHI: There is not currently a travel ban. Let me rephrase that by saying that CDC has travel health notices, and with three levels. Our current advisory is a level 2, which is observing enhanced precautions.

That means safe travel, safe passage as you travel, observe the recommendations of not coming in touch with people who are ill or bodily fluids with blood, et cetera, the topics that were covered in the talk earlier.

JONATHAN: Okay. Thank you. We have a question coming from Lisa Randolph, as a group traveling to Uganda soon.

She says, they are not going to be near the hot zone but wants to know if there would be any reason to seek out vaccination.

SHAH ROOHI: So I’d recommend that they — that this group visits our CDC travel health website for recommendations for travel to Uganda. Currently, we do not have specific Ebola recommendations for travel to Uganda, just general ones, as you would to any destination you’re traveling, we recommend you visit our website. Secondly, the vaccine is being offered to those who are responders and frontline workers.

JONATHAN: Summarize a question from Camilla, asking how some public health workers are doing their jobs in the face of security concerns in that area. In a general sense.

SHAH ROOHI: So the workers, there are very few US-based healthcare workers in the DRC outbreak area. And those protections for health, security, and safety, are assured through their nongovernmental organization or sponsoring organization that is — that they’re working through.

JONATHAN: Thank you. And I think we have time for one more question. And the question is going to come from — is CDC planning on updating the Ebola risk classifications that were used during the 2014-2016 outbreak?

SHAH ROOHI: If this is in reference to monitoring and movement guidance, currently, we have no specific requirements for monitoring and movement. We just recommend that returning travelers self-monitor and if they’re ill to seek care and let their provider or hospital that they are visiting know about their travel plans. If they’re a healthcare worker to work through their sponsoring organizations.

If there are any questions, you can call us at CDC. Jonathan: Kellee, it’s 2:00 now. Very sorry if we’re not able to get to your questions.

They just keep coming in. So if you send them to EPIC@cdc. gov, we can follow up directly.

MODERATOR: Thank you to our presenters and for everyone who joined on the call. If you have additional questions, as Jonathan said, please email them. We know there were several who did not get answers: As a remainder — as a reminder, this has been recorded and you can get continuing education credits.

The course access code is EPIC0619, and thank you again. Bye.

Page last reviewed: May 1, 2019