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.

And we have and are seeing movement

of individuals across the borders.

The current outbreak

and in eastern DRC is the second largest

of all outbreak ever recorded.

And the largest outbreak DRC has experienced to date.

As of 18 December, there have been more than 3300 cases