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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EAccording to the US Centers for Disease Control and Prevention, the 2014 Ebola outbreak in West Africa is the largest Ebola outbreak in history and the first to be classified as an epidemic. This article reviews the clinical characteristics of patients infected with Ebola, as well as reviews the global response in tracking and managing the outbreak and provided an overview of potential therapeutic options.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EViral Infections\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EScreening \u0026amp; Prevention\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EViral Infections\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EScreening \u0026amp; Prevention\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EAccording to the US Centers for Disease Control and Prevention (CDC), the 2014 Ebola outbreak in West Africa is the largest Ebola outbreak in history and the first to be classified as an epidemic. As of September 25, 2014, \u0026gt; 6200 cases had been reported, with Liberia and Sierra Leone accounting for \u0026gt; 83% of the cases [CDC, September 25, 2014]. At the time of the 2014 Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC), no cases had been reported in the United States except for four patients who contracted the disease in West Africa and were transferred emergently to the United States.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003ETo address this critical public health issue, three speakers discussed various aspects of the epidemic. Barbara Knust, DVM, PMH, CDC, Atlanta, Georgia, USA, began by presenting basic facts about the virus itself. Ebola is a zoonotic virus of the \u003Cem\u003EFiloviridae\u003C\/em\u003E family that is transmitted from infected animals to humans or nonhuman primates, and is taken over by human-human transmission. The virus is not transmitted through the air; rather, it is transmitted by direct contact with body fluids from a symptomatic, infected person or animal, or an object contaminated with infected body fluids (ie, syringe).\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EDr Knust reviewed the clinical characteristics of patients infected with Ebola, which typically starts as a nonspecific, flu-like febrile illness (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E). After a few days, however, the predominant clinical syndrome is a severe gastrointestinal illness with vomiting and diarrhea. Volume depletion with a range of metabolic disorders ensues, and hypovolemic shock ultimately occurs. Because no approved therapies currently exist, early intervention and supportive care are the mainstays of treatment [Clark DV et al. \u003Cem\u003EViruses\u003C\/em\u003E. 2012].\u003C\/p\u003E\u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/11850\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/11850\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11850\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-5\u0022 class=\u0022first-child\u0022\u003EClinical Presentation of Patients with the Ebola Virus\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-6\u0022\u003EAlthough symptoms may appear anywhere from 2 to 21 days after initial exposure, the average onset is 8 to 10 days. According to Dr Knust, the most important effort in stopping the West African outbreak has been to admit those identified in the early stages of the disease to a designated \u201cEbola treatment center.\u201d This requires effective diagnostic screening in the field or a regional laboratory to differentiate between patients infected with Ebola and other tropical diseases such as malaria and typhoid fever that do not require the same rigorous control measures. It is also important to find the patient\u0027s close contacts and follow them for 21 days, because they are the next likely to develop the disease.\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EAfter reviewing the epidemiologic pattern of the virus throughout West Africa since March 2014, Dr Knust reviewed the barriers to containing the outbreak. The primary reasons are due to the high level of mobility across the borders in this geographic area as well as a general mistrust of interventions implemented by the government. Another important challenge is the resistance of the local populations to abandon ritual burial practices, which include holding and bathing the corpse. Dead bodies infected with Ebola carry a high level of the virus in body fluids and on the skin, which puts loved ones at risk. There are also insufficient numbers of healthcare workers, medical supplies, and personal protective equipment (PPE). At the time of the ICAAC presentation, there had been \u0026gt; 260 healthcare workers diagnosed with Ebola, typically related to a lack of PPE, insufficient training, and sanitary measures.\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EDr Knust closed her talk with a list of CDC activities related to this Ebola outbreak. These activities include data management, contact tracing and case finding, health education, infection control, laboratory diagnosis support, and coordination with other responding agencies. She emphasized the importance of reinforcing efforts to implement infection control methods and safer burial practices to prevent this outbreak from advancing to a humanitarian crisis and an overall collapse of the healthcare system in West Africa.\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EGary Kobinger, PhD, National Microbiology Laboratory, Winnipeg, Manitoba, Canada, reviewed the global response in tracking and managing the outbreak and provided an overview of potential therapeutic options. He first showed epidemiologic data demonstrating that after an initial downturn in cases reported in Guinea, two subsequent outbreaks occurred\u2014a trend never previously observed (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E).\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/28\/29\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022West Africa Combined Epidemiologic Curves, Weeks 1\u0026#x2013;35\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-635396705\u0022 data-figure-caption=\u0022West Africa Combined Epidemiologic Curves, Weeks 1\u0026#x2013;35\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/28\/29\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/28\/29\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/28\/29\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11849\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-10\u0022 class=\u0022first-child\u0022\u003EWest Africa Combined Epidemiologic Curves, Weeks 1\u201335\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003ESource: World Health Organization, September 5, 2014.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-11\u0022\u003EDr Kobinger also described the work of 7 field laboratories in breaking the chain of Ebola transmission. Symptomatic patients are brought onsite to a treatment center where a PCR-based, rapid diagnostic test is performed. This differentiates among patients that harbor the Ebola virus vs other agents that cause similar symptoms such as malaria, cholera, or Lassa fever. Patients with Ebola can then be positively identified and managed accordingly. The goal of the field laboratories is to identify the causative agent within 3 hours from receipt of the sample.\u003C\/p\u003E\u003Cp id=\u0022p-12\u0022\u003EDr Kobinger went on to discuss the future of therapeutic options to treat Ebola. One option continues to be the use of convalescent plasma from patients recovering from the infection; this strategy has been effective in treating other viruses, including H1N1 influenza [Hung IF. \u003Cem\u003EClin Inf Dis.\u003C\/em\u003E 2011]. Based on work with nonhuman primates, monoclonal antibodies (mAbs) appear to be another promising option. Among 21 critically ill macaques infected with Ebola, all 18 who received 3 doses of mAbs (ZMapp) cleared the virus from the circulation when given the drug within 5 days of the viral challenge. The three animals that did not receive the drug died [Qiu X et al. \u003Cem\u003ENature\u003C\/em\u003E. 2014]. At the time of the ICAAC presentation, this treatment had been provided to 7 patients during this outbreak, although the treatment is not currently approved anywhere in the world for commercial use. Two of these patients have died. Dr Kobinger also reviewed several other therapeutics and vaccines under development.\u003C\/p\u003E\u003Cp id=\u0022p-13\u0022\u003EAneesh Mehta, MD, Emory University Hospital, Atlanta, Georgia, USA, then spoke of his perspectives as a member of the team caring for two American patients who had been infected with Ebola in Liberia and subsequently admitted to Emory University Hospital in August 2014 by air ambulance. He reviewed lessons learned in five areas\u2014clinical care of patients, laboratory testing and diagnostics, staff and environmental safety, waste management, and communications management.\u003C\/p\u003E\u003Cp id=\u0022p-14\u0022\u003EDr Mehta described the layout of the hospital\u0027s serious communicable diseases (SCD) unit, which includes dedicated laboratory space, isolated patient rooms with private baths, and separate staff shower and changing rooms. He emphasized that while a dedicated laboratory is not required to care for patients with SCDs, such a facility does allow for immediate results and less impact among hospital and laboratory staff [Hill CE et al. \u003Cem\u003ELab Med\u003C\/em\u003E 2014].\u003C\/p\u003E\u003Cp id=\u0022p-15\u0022\u003EDr Mehta then described the CDC recommendations for taking precautions to prevent transmission of the Ebola virus (CDC. \u003Cem\u003EEbola Virus Disease\u003C\/em\u003E 2014). These include recommendations regarding the necessity of placing patients in single rooms with private baths; using disposable medical equipment when possible; the proper use of PPE, including gloves, gowns, eye protection, face-masks, and disposable shoe coverings; management of aerosol-generating procedures; and monitoring of potentially exposed personnel. The CDC has also issued interim guidance for environmental infection control related to patients who have Ebola virus (\u003Ca id=\u0022xref-table-wrap-2-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T2\u0022\u003ETable 2\u003C\/a\u003E).\u003C\/p\u003E\u003Cdiv id=\u0022T2\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/11851\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/11851\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11851\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 2.\u003C\/span\u003E \n            \u003Cp id=\u0022p-16\u0022 class=\u0022first-child\u0022\u003EEnvironmental Infection Control for Hospitals Treating Patients With Suspected or Confirmed Ebola Virus\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-19\u0022\u003EIn addition to the clinical and environmental considerations, Dr Mehta emphasized the importance of implementing a coordinated operations and communications effort that keeps all stakeholders apprised of events prior to or as they occur. This would include hospital administration and personnel; local, state, and federal government agencies; service providers; and the media. According to Dr Mehta, the primary goal of these communication efforts is to assure all stakeholders that (1) the hospital has expertise in serious infectious diseases, (2) the staff is trained and prepared to care for these patients, and (3) the hospital will protect its patients, staff, and communities at all costs.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/28\/29.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzosqp\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzosqp\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzosqp\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}