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  • >> Good afternoon.

  • I'm Commander Ibad Khan and I'm representing the Clinician

  • Outreach and Communication Activity, COCA,

  • with the emergency risk communication branch

  • at the Centers for Disease Control and Prevention.

  • I'd like to welcome you to today's COCA call,

  • update on Ebola diagnostics at the state

  • and federal levels in the United States.

  • You may participate in today's presentation via webinar

  • or you may download the slides if you are unable

  • to access the webinar.

  • The PowerPoint slides and the webinar link can be found

  • on our COCA webpage at emergency.cdc.gov/coca.

  • Again that web address is emergency.cdc.gov/coca.

  • Once you reach the webinar page,

  • the PowerPoint slides can be found

  • under the call materials tab.

  • Free continuing education is offered for this webinar.

  • Instructions on how to earn continuing education will be

  • provided at the end of the call.

  • In compliance with continuing education requirements, CDC,

  • our planners, our presenters, and their spouses'/ partners wish

  • to disclose they have no financial interests

  • or other relationships with the manufacturers

  • of commercial products,

  • suppliers of commercial services,

  • or commercial supporters.

  • Planners have reviewed content to ensure there is no bias.

  • The presentation will not include any discussion

  • of the unlabeled use of product or a product

  • under investigational use.

  • CDC did not accept commercial support

  • for this continuing education activity.

  • After the presentation, there will be a Q&A session.

  • You may submit questions at any time during the presentation

  • through the Zoom webinar system by clicking the Q&A button

  • at the bottom of your screen.

  • And then type in your question.

  • Please do not ask a question using the chat button.

  • Questions regarding the webinar should be entered using only the

  • Q&A button.

  • For those who have media questions,

  • please contact CDC media relations at 404-639-3286,

  • or send an email to media@CDC.gov.

  • If you're a patient please refer your questions

  • to your healthcare provider.

  • At the conclusion of today's webinar,

  • participants will be able to accomplish the following.

  • Discuss procedures for assessing ill travelers returning

  • from the outbreak area, including consultation

  • with the relevant public health authorities.

  • Describe CDC's role in providing technical support

  • and testing approval for persons under investigation

  • for Ebolavirus infection.

  • Review the procedure for reporting and consulting

  • on a suspected case of Ebola in the United States.

  • Discuss considerations and limitations for domestic use

  • of novel rapid diagnostic tests for Ebola.

  • And discuss how to coordinate between clinicians,

  • state health departments, and CDC as it pertains

  • to domestic Ebola preparedness and diagnostics.

  • I would now like to introduce our presenters

  • for today's webinar.

  • Our first presenter is Captain Joel Montgomery.

  • Capt. Montgomery is the chief

  • of the Viral Special pathogens Branch at CDC.

  • He oversees a diverse portfolio

  • of public health research response

  • and partner country capacity enhancement

  • to high consequence pathogens such as Ebola.

  • Capt. Montgomery brings many years

  • of in-depth global experience as a laboratorian, microbiologist,

  • and epidemiologist to his role.

  • Where he is responsible for coordinating scientific efforts

  • in 10 global disease detection country offices.

  • And implementing technical aspects

  • of the global health security agenda.

  • Our second presenter is Dr. Julie Villanueva.

  • Dr. Villanueva is the chief of the Laboratory Preparedness

  • and Response Branch at CDC.

  • In this role, she oversees the biological component

  • of the laboratory response network,

  • which is an integrated domestic and international network

  • of laboratories designed to respond quickly to biological,

  • chemical, and radiological threats

  • and other high priority public health emergencies.

  • I'll now turn it over to Capt.

  • Montgomery.

  • Capt. Montgomery, you may begin.

  • >> Thanks Commander Khan.

  • Thank you for the opportunity to speak with you all today.

  • As Commander Khan mentioned, I'm Dr. Joel Montgomery Chief

  • of the Viral Special Pathogens branch.

  • In today's presentation Dr. Julie Villanueva

  • and I will cover the following topics.

  • First, we'll provide a historical overview of Ebola

  • and give an update on the current outbreak in the DRC,

  • or Democratic Republic of the Congo.

  • We'll also provide guidance and a step-by-step process on how

  • to acquire a laboratory diagnosis of Ebola in a person

  • or persons under investigation.

  • We'll provide an overview and functions

  • of the US Laboratory Response Network or LRN.

  • And finally, we'll provide a description

  • of the current FDA approved Ebola Rapid Diagnostic Test

  • developed by OraSure and its intended use, limitations,

  • and considerations for testing of persons under investigation

  • or suspect Ebola cases patients.

  • Ebolavirus disease is a rare and deadly disease caused

  • by infection with one of the species in the genus Ebolavirus.

  • Four of these species can cause disease in humans,

  • and other can cause disease in nonhuman primates and pigs.

  • And one species is not known

  • to cause disease in humans or animals.

  • I'll describe these in more detail in subsequent slides.

  • Ebolavirus was first discovered in 1976, near the Ebola River

  • in what is now known

  • as the Democratic Republic of the Congo.

  • Since then outbreaks have appeared sporadically in East,

  • Central, and West Africa.

  • There have been 28 independent outbreaks recorded in humans

  • in Africa since that time,

  • including this most recent outbreak in DRC.

  • This is 10th Ebola outbreak in DRC on record.

  • Based on evidence and nature of other similar viruses,

  • we believe that Ebola is an animal-borne or zoonotic disease

  • with bats being the most likely animal reservoir

  • or primary source for the initial introduction

  • or spillover into human populations.

  • The spillover event from the natural reservoir,

  • presumably a bat, is thought to occur through direct contact

  • with a bat, such as through hunting or through contact

  • with bat excretions and/or bodily/fluids such as urine,

  • feces, saliva, or blood.

  • Once the initial introduction into a human,

  • known as the index case has taken place,

  • subsequent transmission from person-to-person may occur

  • in healthcare settings

  • and resource constrained settings often due

  • to a breakdown in proper infection prevention

  • and control procedures.

  • Additional transmission within the general community may

  • and often does occur, as in the current situation

  • in DRC frequently as a result of poor access to healthcare.

  • The current outbreak in eastern DRC is the second largest

  • Ebola outbreak ever recorded.

  • And the largest outbreak DRC has experienced to date.

  • Currently, there are 6 known

  • and recognized species of Ebolavirus.

  • Zaire ebolavirus, Sudan ebolavirus,

  • Bundibugyo ebolavirus, Tai Forest ebolavirus,

  • Reston and Bombali ebolaviruses.

  • Local transmission, outbreaks, and/or imported cases

  • of Zaire ebolavirus on the continent

  • of Africa have occurred in the DRC Republic of Congo, Gabon,

  • Guinea, Sierra Leone, Liberia, Mali, Senegal,

  • Nigeria, and South Africa.

  • For Sudan ebolavirus, outbreaks have been restricted

  • to South Sudan and Uganda.

  • Bundibugyo ebolavirus has occurred in DRC and Uganda.

  • And finally, Tai Forest ebolavirus outbreaks

  • or cases have occurred only in Cote d'Ivoire or Ivory Coast.

  • All species, other than Reston and Bombali are known

  • to cause human disease.

  • The latter two species have only been associated

  • with either nonhuman primate and/or pig outbreaks,

  • that is Reston ebolavirus in Reston Virginia and Texas.

  • With some evidence of transmission to humans

  • with no overt disease.

  • While Bombali ebolavirus has only been identified

  • in the Angolan free-tailed bat and little free-tailed bat.

  • First in Sierra Leone, and later, in Guinea and Kenya.

  • Ebola spreads through direct contact.

  • Through broken skin or unprotect mucous membranes

  • with any or all the following.

  • Blood or bodily fluids such as urine, saliva, sweat, feces,

  • vomits, semen, breast milk, and vaginal fluids from someone

  • who is sick with, or has died from Ebola.

  • Through fomite contact contaminated

  • with infected bodily fluids.

  • For example, needles, syringes, bedding.

  • Contact with infected animals, as I mentioned previously,

  • such as fruit bats, and/or nonhuman primates.

  • And from semen from an individual

  • who has recovered from Ebola.

  • The signs and symptoms often grouped

  • as either dry or wet symptoms.

  • May include the following.

  • Fever, severe headache, fatigue,

  • muscle pain, rash, abdominal pain.

  • The so-called dry symptoms.

  • These are often followed by the wet symptoms.

  • Including vomiting, diarrhea, unexplained bleeding,

  • and in females, miscarriage.

  • It's important to note and reemphasize

  • that a person infected with Ebolavirus is not contagious

  • until symptoms appear.

  • The progression of Ebolavirus disease begins

  • with the incubation period.

  • The time from exposure to when signs and symptoms first appear.

  • Incubation for EBD is 2-21 days with an average

  • of 8-10 days for most cases.

  • Again, a person infected

  • with Ebola cannot spread the virus prior to symptom onset.

  • Wet symptoms generally develop approximately four days

  • into the course of illness.

  • And patients with Ebolavirus disease become increasingly

  • contagious or infectious, as the illness advances.

  • Without treatment, supportive care,

  • or therapeutic intervention, generally, death occurs within 7

  • to 10 days after illness onset.

  • Finally, the concentration of the virus

  • in the body is the greatest at the time of death.

  • And the point when an individual is most infectious to others.

  • The current outbreak in the DRC was confirmed in August 2018.

  • And on September 26, 2018, the US Agency

  • for International Development

  • or USAID activated a disaster assistance response team,

  • co-led by CDC.

  • On 13 June 2019, due to the unabated progression

  • of the outbreak, increasing complexity of CDC engagement,

  • and a confirmed case in neighboring Uganda,

  • CDC activated its emergency operation center.

  • It's the first urban outbreak in DRC occurring

  • in a highly insecure, densely populated area near

  • international borders

  • with extensive cross-border movement and trade.

  • From 20 November to 10 December,

  • there have been 42 confirmed cases in 4 health zones of DRC.

  • The outbreak does show signs of slowing, however,

  • upticks of violence, insecurity,

  • and stability have hampered the response activities.

  • I'll discuss this in more detail in subsequent slides.

  • But as you can see from the maps, the current outbreak

  • in DRC is affecting very remote areas of the country,

  • including North Kivu and the three provinces shown in detail

  • on a map on the left-hand side.

  • The map on the right shows just how distant the current Ebola

  • transmission zone is from Kinshasa, the capital of DRC.

  • The outbreak zone is approximately 1600 km,

  • or 1000 miles by air, or 3000 km or 1900 miles by ground.

  • Therefore, the ease of population movement or movement

  • of an individual outside of these areas

  • to other locations including the United States,

  • via Kinshasa is very difficult but not impossible.

  • It is also very distant from other large cities in the region

  • such as Kampala, Uganda.