1. Introduction a. The outbreaks of the Ebola virus in West Africa have generated significant concern due to the high death rate and contagious nature (Peters & LeDuc, 1999). b. Differences in the fatality rates in Ebola infection over the last decades probably are a reflection of advances in diagnostic accuracy, proficiency in acute care stages, and identification of infection sources (Laupland & Valiquette, 2014). c. Although cases are rare and primarily confined to West Africa, there is concern of a possible pandemic secondary to ease of international transport of contaminated people and goods. d. The transmission is through blood and body fluid between animals to humans and humans to humans and from the environment such as contaminated supplies in hospitals. e. Originating in fruit bats, humans and animals are secondary hosts. f. The outbreaks started in 1976; 2013 had 20 reported outbreaks with 2500 reported cases (WHO.int, 2014). g. Statement of the focus of the paper 2. Challenges Associated with Ebola Outbreaks a. High rate of fatalities i. Fatal in 66% of reported cases (WHO, 2014) b. infrastructure of medical care i. Hospitals were identified as areas of high levels of contamination and many were closed. 1. It is believed the first death resulted from a contaminated needle in a malaria patient (Bull World Health Organization, 1978). 2. During the 2014 Guinea outbreak, health care workers accounted for 54 percent of the reported fatalities from the infection. 3. 30% of the doctors treating patients and 10% of the nurses contracted the disease in Kikwit (Peters & LeDuc, 1999). ii. Care in areas of outbreak is hindered by lack of vehicles, reliable electricity, and methods to communicate with the public for education. iii. Stigma against the disease results in families secretly caring for patients, spreading the virus. c. Inability to recognize sporadic infections or initial cases in an outbreak i. Paper strip testing for Ebola antigens can detect infected animals and humans. 1. Barriers include manufacture, distribution, training, and shelf-life of the strips 2. Allows for rapid definitive diagnosis to contain spread of the disease 3. Key players in the Diagnosis, Treatment, and Control of Ebola Outbreaks a. Diagnosis i. Recognition of symptoms (WHO, 2008) 1. Diarrhea 2. Headache 3. Nausea 4. Vomiting 5. High temperature 6. Impairment of liver and kidney function 7. Rashes 8. Lethargy 9. Blank facial expression 10. Deep-set eyes 11. Internal and external bleeding 12. If the patient expires, it will be within 2 weeks of onset of symptoms ii. Laboratory testing 1. Reverse transcriptase-polymerase chain reaction identification 2. Antigen- or antibody-based 3. It is necessary for the testing to take place in a biosafety level 4 laboratory due to the high degree of biohazard risk. b. Treatment 1. No specific treatments currently recommended 2. Supportive care 3. Possible future use of treatment with immunotherapy or nucleic acids (Falzarano & Feldmann, 2014; Kuehn, 2013; Warren et al., 2014). c. Control i. Closing contaminated hospitals ii. Quarantine of patients in the homes iii. Training and supplies for health care workers in patient barrier techniques 1. After the Kikwit outbreak, workers reverted to previous ineffective techniques within three months due to inadequate methods of organizational change and dwindling lack of supplies (Peters & LeDuc, 1999). iv. Public education on transmission v. Detecting the location of contaminated patients 1. Re-evaluation of hospital records for missed diagnoses 2. Visiting the homes of patients for contamination of family members 3. Searching neighborhoods for unreported cases 4. Looking to local government agencies for assistance d. Key Players i. Current and potential patients ii. Government officials 1. Flow chart of chain of command iii. Health care providers 1. The only people contaminated by outside patients into the US were two nurses, who survived the illness. iv. Researchers 4. Conclusion
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