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From: WorldHealthOrganizationNews@who.int
To: undisclosed-recipients@null, null@null
Subject: WHO statement: WHO issues "roadmap" to scale up international response to the Ebola outbreak in West Africa
Date: Aug 28, 2014 6:01 AM
WHO issues "roadmap" to scale up international response to the Ebola outbreak in West Africa
Statement WHO/07
28 August 2014
GENEVA ¦ 28 August 2014 - The World Health Organization is today issuing a "roadmap" to guide and coordinate the international response to the outbreak of Ebola virus disease in West Africa.
The aim is to stop ongoing Ebola transmission worldwide within 6–9 months, while rapidly managing the consequences of any further international spread. It also recognizes the need to address, in parallel, the outbreak’s broader socioeconomic impact.
It responds to the urgent need to dramatically scale up the international response. Nearly 40% of the total number of reported cases have occurred within the past three weeks.
The roadmap was informed by comments received from a large number of partners, including health officials in the affected countries, the African Union, development banks, other UN agencies, Médecins Sans Frontières (MSF), and countries providing direct financial support.
It will serve as a framework for updating detailed operational plans. Priority is being given to needs for treatment and management centres, social mobilization, and safe burials. These plans will be based on site-specific data that are being set out in regular situation reports, which will begin this week.
The situation reports map the hotspots and hot zones, present epidemiological data showing how the outbreak is evolving over time, and communicate what is known about the location of treatment facilities and laboratories, together with data needed to support other elements of the roadmap.
The roadmap covers the health dimensions of the international response. These dimensions include key potential bottlenecks requiring international coordination, such as the supply of personal protective equipment, disinfectants, and body bag.
The WHO roadmap will be complemented by the development of a separate UN-wide operational platform that brings in the skills and capacities of other agencies, including assets in the areas of logistics and transportation. The UN-wide platform aims to facilitate the delivery of essential services, such as food and other provisions, water supply and sanitation, and primary health care.
Resource flows to implement the roadmap will be tracked separately, with support from the World Bank.
For more information please contact:
Fadéla Chaib
Communications Officer, World Health Organization
Telephone: +41 22 791 32 28
Mobile: +41 79 475 55 56
E-mail: chaibf@who.int
Tarik Jasarevic
Communications Officer, World Health Organization
Telephone: +41 22 791 50 99
Mobile: +41 79 367 62 14
E-mail: jasarevict@who.int
----------------------------------------
GOAL
To stop Ebola transmission in affected countries within 6-9 months and prevent international spread.
CONTEXT
The 2014 Ebola Virus Disease (EVD, or “Ebola”) outbreak continues to evolve in alarming ways, with the severely affected countries, Guinea, Liberia, and Sierra Leone, struggling to control the escalating outbreak against a backdrop of severely compromised health systems, significant deficits in capacity, and rampant fear.
To accelerate actions on EVD in West Africa, a Ministerial meeting was convened in July in Accra, Ghana, and an operations coordination centre established in Conakry, Guinea. The escalating scale, duration and mortality of the outbreak led the Governments of Guinea, Liberia, and Sierra Leone and WHO to launch an initial Ebola Virus Disease Outbreak Response Plan on 31 July 2014, which outlined the main pillars for action based on the situation at that time and an initial estimate of resource requirements. Since then the outbreak has been further complicated by spread to Lagos, Nigeria.
In August 2014, an Emergency Committee was convened by the Director-General of WHO under the International Health Regulations (2005) [IHR 2005], which informed the Director-General’s decision on 8 August 2014 to declare the Ebola outbreak a Public Health Emergency of International Concern and issue several Temporary Recommendations to reduce the risk of international spread.
As of 27 August 2014, the cumulative number of Ebola cases in the affected countries stands at more than 3000, with over 1400 deaths, making this the largest Ebola outbreak ever recorded, despite significant gaps in reporting in some intense transmission areas. An unprecedented number of health care workers have also been infected and died due to this outbreak.
National authorities in the affected countries have been working with WHO and partners to scale-up control measures. However, the EVD outbreak remains grave and transmission is still increasing in a substantial number of localities, aggravating fragile social, political and economic conditions in the sub-region and posing increasingly serious global health security challenges and risks.
The Ebola response activities to date have generated significant knowledge on the effectiveness and limitations of current approaches, highlighting key areas for course corrections. Clearly, a massively scaled and coordinated international response is needed to support affected and at-risk countries in intensifying response activities and strengthening national capacities. Response activities must be adapted in areas of very intense transmission and particular attention must be given to stopping transmission in capital cities and major ports, thereby facilitating the larger response and relief effort.
This updated and more comprehensive roadmap builds on current, country-specific realities to guide response efforts and align implementation activities across different sectors of government and international partners.
PURPOSE OF DOCUMENT
To assist governments and partners in the revision and resourcing of country-specific operational plans for Ebola response, and the coordination of international support for their full implementation.
OBJECTIVES
1. To achieve full geographic coverage with complementary Ebola response activities in countries with widespread and intense transmission
2. To ensure emergency and immediate application of comprehensive Ebola response interventions in countries with an initial case(s) or with localized transmission
3. To strengthen preparedness of all countries to rapidly detect and respond to an Ebola exposure, especially those sharing land borders with an intense transmission area and those with international transportation hubs
MAJOR ASSUMPTIONS
This Roadmap builds on nearly 40 years of experience gained in EVD control, and is rooted in the fundamental strategies that have been proven effective in the context of previous outbreaks. However, it incorporates new experience gained, particularly over the past 3 months, in urban and widespread transmission settings. This experience is unique in the history of EVD and clearly indicates that in such areas with very intense transmission, combined with fragile and very weak health systems, the standard Ebola strategies must be complemented by new approaches. These approaches must allow for the rapid scaling of control activities when the case load outstrips currently available resources, and include a fundamental role for communities and their leaders in strategy implementation.
This Roadmap assumes that in many areas of intense transmission the actual number of cases may be 2-4 fold higher than that currently reported. It acknowledges that the aggregate case load of EVD could exceed 20,000 over the course of this emergency. The Roadmap assumes that a rapid escalation of the complementary strategies in intense transmission, resource-constrained areas will allow the comprehensive application of more standard containment strategies within 3 months. This plan recognizes that a number of currently unaffected countries could be exposed to EVD, but assumes that the emergency application of the standard control strategies will stop any new transmission within 8 weeks of the index case.
Fundamental to the Roadmap is the strengthening of laboratory, human resource, and response capacities, all of which are on the critical pathway for short- and long-term EVD control, as well as strengthening of the public health infrastructure against future threats. Some areas require particularly urgent action, such as infection control training.
It is expected that solutions to the current limitations on air traffic to and from the worst affected countries will be addressed within 2 weeks, and that by the end of September, a comprehensive, UN-led plan will be launched to complement the Ebola Response Roadmap by providing a common operational platform for enhancing response activities and for addressing the broader consequences of the outbreak. The UN-led plan is expected to underpin support for the increasingly acute problems associated with food security, protection, water, sanitation and hygiene, primary and secondary health care, and education, as well as the longer-term recovery effort that will be needed. That plan will also need to address the complex social consequences of this emergency, such as the increasing number of children who have been orphaned.
Course corrections to this Roadmap will be driven by the availability of human and financial resources for its implementation, the evolving epidemiology, and the broad context in which this outbreak is evolving.
PRIORITY ACTIVITIES
OBJECTIVE 1: To achieve full geographic coverage with complementary Ebola response activities in countries with widespread and intense transmission
Key Milestones: Reverse the trend in new cases and infected areas within 3 months, stop transmission in capital cities and major ports, and stop all residual transmission within 6-9 months.
PRIORITY ACTIVITIES
Apply full Ebola intervention package to the extent of available resources
• Case management: Ebola treatment centres with full infection prevention and control (IPC) activities; Ebola referral/isolation centres; referral processes for primary health care facilities
• Case diagnosis: by a WHO-recognized laboratory
• Surveillance: contact tracing and monitoring
• Burials: supervised burials with dedicated expert burial teams
• Social mobilization: full community engagement in contact tracing and risk mitigation
Develop and apply complementary approaches for intense transmission areas
• Case management: community-based care supported by intensified IPC and appropriate PPE
• Case diagnosis: by epidemiologic link to case confirmed by WHO-recognized laboratory
• Surveillance: monitoring for new transmission chains (i.e. in infected areas)
• Burials: trained and PPE-equipped community burial teams
• Social mobilization: community engagement to implement complementary approaches
Assess short-term extraordinary measures to limit national spread
• Implement specific programmes to ensure continuity of essential and supportive services in containment areas (e.g. primary health care, psychosocial support, food)
• If non-essential movement in and out of a containment area is stopped, ensure that essential movement (e.g. for response providers, essential services) continues unhindered
• To facilitate EVD response, defer mass gatherings until intensity of transmission is reduced
Implement WHO’s Temporary Recommendations under IHR to prevent international spread
• Prohibit travel of all Ebola cases and contacts (except for medical evacuation)
• Implement and monitor exit screening at international airports, seaports and major land crossings
• Align practices of all international airline carriers with national travel policy
Ensure essential services and lay the foundation for health sector recovery and strengthening of national core capacities for outbreak response
• Establish short-term capacity to address critical gaps in essential services (including health, food, education, protection, WASH [water, sanitation and hygiene]) through national service providers, NGOs, UN agencies, humanitarian organizations and other partners, based on needs assessment and gap analysis
• Develop a medium-term investment plan to strengthen health services that includes syndromic surveillance and laboratory networks to diagnose relevant pathogens
• Introduce a fast-track training programme for priority health worker gaps (including surveillance)
OBJECTIVE 2: To ensure emergency and immediate application of comprehensive Ebola response interventions in countries with an initial case(s) or with localized transmission
Key Milestone: Stop all transmission within 8 weeks of index case.
PRIORITY ACTIVITIES
Initiate emergency health procedures
• Immediately communicate the case and relevant information through the IHR contact point in the relevant WHO Regional Office
• Establish an emergency operations centre and activate relevant national disaster/emergency management mechanisms
• Coordinate operations and information across all partners, and the information, security, finance and other relevant sectors
• Initiate public crisis/risk communications plan
Immediately activate Ebola response protocols and facilities, in keeping with WHO IPC guidance and universal precautions
• Immediately isolate all suspect and confirmed cases in designated Ebola treatment centre with full IPC
• Secure access to diagnostic capacity in a WHO-recognized laboratory
• Fully implement contact tracing and monitoring
• Ensure safe burials
• Implement public communications strategy to facilitate case identification, contact tracing and risk education
Implement IHR Temporary Recommendations to prevent international spread
• Prohibit travel of all Ebola cases and contacts (except for medical evacuation)
OBJECTIVE 3: To strengthen preparedness of all countries to rapidly detect and respond to an Ebola exposure, especially those sharing land borders with areas of active transmission and those with international transportation hubs
Key Milestone: Full Ebola surveillance preparedness and response plan established in areas sharing a land border with an Ebola-infected country and at all major international transportation hubs within one month.
PRIORITY ACTIVITIES
In all unaffected countries
• Provide advice to travellers to Ebola-affected areas with relevant information on risks, measures to minimize those risks, and steps to take following a potential exposure
• Identify an isolation unit where any suspect Ebola case could be properly investigated and managed
• Verify access to diagnostic capacity in a WHO-recognized laboratory
• Establish a strategy for identifying and monitoring the contacts of any suspect Ebola case
• Where appropriate, ensure that preparedness activities include contingency planning for health centres, schools and other vital infrastructure and services
In all unaffected countries sharing a land border with an Ebola-infected area
• Establish active surveillance for clusters of unexplained deaths or febrile illness in areas bordering Ebola-affected countries and in major cities
• Provide the general public with accurate and relevant information on the neighbouring Ebola outbreak and measures to reduce the risk of exposure
• Establish a protocol for managing travellers who arrive at major land crossing points with unexplained febrile illness
• Identify and prepare an isolation unit where any suspect Ebola case can be properly investigated and managed
• Arrange a process for rapidly shipping diagnostic specimens to a WHO-recognized laboratory
• Engage international support team(s) if/as required to accelerate the development, implementation and assessment of preparedness measures
In all unaffected countries with an international transportation hub
• Reinforce the capacity to manage travellers who arrive at international airports with unexplained febrile illness and potential exposure to Ebola
• Ensure a protocol, and identify an isolation unit, for the investigation and management of any suspect Ebola case
MAJOR ISSUES IN OPERATIONALIZING THE EBOLA RESPONSE ROADMAP
Human Resources for Strategy Implementation: mobilizing and sustaining sufficient human resources to implement Ebola response interventions requires a comprehensive approach to their remuneration, training, equipment, physical security, and access to health care. Implementation of Ebola response activities to date have highlighted a number of specific considerations that must be addressed to operationalize fully the Ebola Roadmap:
• National staff considerations:
o Remuneration: Governments must rapidly establish a comprehensive package that defines the salary, hazard pay and – where appropriate – insurance/death benefit available to each category of worker required to implement the national strategy (e.g. physicians, nurses, physicians assistants, laboratory workers, cleaners, burial teams, surveillance officers). If necessary, UN (e.g. WHO) or partner agencies should assist Governments as needed in implementing this package.
o Training & Equipment: a specific accelerated training programme must be developed for each category of worker that is adaptable to the district/treatment centre level and places particular emphasis on IPC and proper use of PPE. Consideration must be given to particularly vulnerable groups such as cleaners and to the needs of women, who constitute a significant proportion of care providers. All Ebola workers must have access to sufficient quantities of the appropriate PPE.
• International staff considerations:
o Mobilization of International Expertise: WHO and partners will continue intensive outreach to all international medical NGOs, humanitarian organizations (i.e. the Red Cross Movement), Global Health Cluster partners, foreign medical teams and Global Outbreak & Alert (GOARN) Partners to mobilize sufficient medical expertise to support the staffing of all Ebola Treatment Centres in countries with intense and widespread transmission. For newly infected countries, Rapid Response Teams should be deployed within 72 hours, if requested, to provide expert support to the establishment and staffing of new case management facilities.
o Accelerated Training of Supplementary International Expertise: WHO will establish a specific programme to identify, train and deploy an extended roster of international health care workers to provide clinical care in Ebola treatment centres and Ebola referral/isolation centres. Particular emphasis will be given to implementing protocols for health care worker protection, based on WHO IPC Guidance and the WHO Care Management Handbook.
• Medical Care of Health Workers: WHO will continue its work with the international community on a two-pronged approach to ensuring the best possible care of exposed health care workers through a combination of specialized medical referral centres in affected countries (for national and international health care workers) and medical evacuation where necessary and appropriate.
more....
To: undisclosed-recipients@null, null@null
Subject: WHO statement: WHO issues "roadmap" to scale up international response to the Ebola outbreak in West Africa
Date: Aug 28, 2014 6:01 AM
WHO issues "roadmap" to scale up international response to the Ebola outbreak in West Africa
Statement WHO/07
28 August 2014
GENEVA ¦ 28 August 2014 - The World Health Organization is today issuing a "roadmap" to guide and coordinate the international response to the outbreak of Ebola virus disease in West Africa.
The aim is to stop ongoing Ebola transmission worldwide within 6–9 months, while rapidly managing the consequences of any further international spread. It also recognizes the need to address, in parallel, the outbreak’s broader socioeconomic impact.
It responds to the urgent need to dramatically scale up the international response. Nearly 40% of the total number of reported cases have occurred within the past three weeks.
The roadmap was informed by comments received from a large number of partners, including health officials in the affected countries, the African Union, development banks, other UN agencies, Médecins Sans Frontières (MSF), and countries providing direct financial support.
It will serve as a framework for updating detailed operational plans. Priority is being given to needs for treatment and management centres, social mobilization, and safe burials. These plans will be based on site-specific data that are being set out in regular situation reports, which will begin this week.
The situation reports map the hotspots and hot zones, present epidemiological data showing how the outbreak is evolving over time, and communicate what is known about the location of treatment facilities and laboratories, together with data needed to support other elements of the roadmap.
The roadmap covers the health dimensions of the international response. These dimensions include key potential bottlenecks requiring international coordination, such as the supply of personal protective equipment, disinfectants, and body bag.
The WHO roadmap will be complemented by the development of a separate UN-wide operational platform that brings in the skills and capacities of other agencies, including assets in the areas of logistics and transportation. The UN-wide platform aims to facilitate the delivery of essential services, such as food and other provisions, water supply and sanitation, and primary health care.
Resource flows to implement the roadmap will be tracked separately, with support from the World Bank.
For more information please contact:
Fadéla Chaib
Communications Officer, World Health Organization
Telephone: +41 22 791 32 28
Mobile: +41 79 475 55 56
E-mail: chaibf@who.int
Tarik Jasarevic
Communications Officer, World Health Organization
Telephone: +41 22 791 50 99
Mobile: +41 79 367 62 14
E-mail: jasarevict@who.int
----------------------------------------
GOAL
To stop Ebola transmission in affected countries within 6-9 months and prevent international spread.
CONTEXT
The 2014 Ebola Virus Disease (EVD, or “Ebola”) outbreak continues to evolve in alarming ways, with the severely affected countries, Guinea, Liberia, and Sierra Leone, struggling to control the escalating outbreak against a backdrop of severely compromised health systems, significant deficits in capacity, and rampant fear.
To accelerate actions on EVD in West Africa, a Ministerial meeting was convened in July in Accra, Ghana, and an operations coordination centre established in Conakry, Guinea. The escalating scale, duration and mortality of the outbreak led the Governments of Guinea, Liberia, and Sierra Leone and WHO to launch an initial Ebola Virus Disease Outbreak Response Plan on 31 July 2014, which outlined the main pillars for action based on the situation at that time and an initial estimate of resource requirements. Since then the outbreak has been further complicated by spread to Lagos, Nigeria.
In August 2014, an Emergency Committee was convened by the Director-General of WHO under the International Health Regulations (2005) [IHR 2005], which informed the Director-General’s decision on 8 August 2014 to declare the Ebola outbreak a Public Health Emergency of International Concern and issue several Temporary Recommendations to reduce the risk of international spread.
As of 27 August 2014, the cumulative number of Ebola cases in the affected countries stands at more than 3000, with over 1400 deaths, making this the largest Ebola outbreak ever recorded, despite significant gaps in reporting in some intense transmission areas. An unprecedented number of health care workers have also been infected and died due to this outbreak.
National authorities in the affected countries have been working with WHO and partners to scale-up control measures. However, the EVD outbreak remains grave and transmission is still increasing in a substantial number of localities, aggravating fragile social, political and economic conditions in the sub-region and posing increasingly serious global health security challenges and risks.
The Ebola response activities to date have generated significant knowledge on the effectiveness and limitations of current approaches, highlighting key areas for course corrections. Clearly, a massively scaled and coordinated international response is needed to support affected and at-risk countries in intensifying response activities and strengthening national capacities. Response activities must be adapted in areas of very intense transmission and particular attention must be given to stopping transmission in capital cities and major ports, thereby facilitating the larger response and relief effort.
This updated and more comprehensive roadmap builds on current, country-specific realities to guide response efforts and align implementation activities across different sectors of government and international partners.
PURPOSE OF DOCUMENT
To assist governments and partners in the revision and resourcing of country-specific operational plans for Ebola response, and the coordination of international support for their full implementation.
OBJECTIVES
1. To achieve full geographic coverage with complementary Ebola response activities in countries with widespread and intense transmission
2. To ensure emergency and immediate application of comprehensive Ebola response interventions in countries with an initial case(s) or with localized transmission
3. To strengthen preparedness of all countries to rapidly detect and respond to an Ebola exposure, especially those sharing land borders with an intense transmission area and those with international transportation hubs
MAJOR ASSUMPTIONS
This Roadmap builds on nearly 40 years of experience gained in EVD control, and is rooted in the fundamental strategies that have been proven effective in the context of previous outbreaks. However, it incorporates new experience gained, particularly over the past 3 months, in urban and widespread transmission settings. This experience is unique in the history of EVD and clearly indicates that in such areas with very intense transmission, combined with fragile and very weak health systems, the standard Ebola strategies must be complemented by new approaches. These approaches must allow for the rapid scaling of control activities when the case load outstrips currently available resources, and include a fundamental role for communities and their leaders in strategy implementation.
This Roadmap assumes that in many areas of intense transmission the actual number of cases may be 2-4 fold higher than that currently reported. It acknowledges that the aggregate case load of EVD could exceed 20,000 over the course of this emergency. The Roadmap assumes that a rapid escalation of the complementary strategies in intense transmission, resource-constrained areas will allow the comprehensive application of more standard containment strategies within 3 months. This plan recognizes that a number of currently unaffected countries could be exposed to EVD, but assumes that the emergency application of the standard control strategies will stop any new transmission within 8 weeks of the index case.
Fundamental to the Roadmap is the strengthening of laboratory, human resource, and response capacities, all of which are on the critical pathway for short- and long-term EVD control, as well as strengthening of the public health infrastructure against future threats. Some areas require particularly urgent action, such as infection control training.
It is expected that solutions to the current limitations on air traffic to and from the worst affected countries will be addressed within 2 weeks, and that by the end of September, a comprehensive, UN-led plan will be launched to complement the Ebola Response Roadmap by providing a common operational platform for enhancing response activities and for addressing the broader consequences of the outbreak. The UN-led plan is expected to underpin support for the increasingly acute problems associated with food security, protection, water, sanitation and hygiene, primary and secondary health care, and education, as well as the longer-term recovery effort that will be needed. That plan will also need to address the complex social consequences of this emergency, such as the increasing number of children who have been orphaned.
Course corrections to this Roadmap will be driven by the availability of human and financial resources for its implementation, the evolving epidemiology, and the broad context in which this outbreak is evolving.
PRIORITY ACTIVITIES
OBJECTIVE 1: To achieve full geographic coverage with complementary Ebola response activities in countries with widespread and intense transmission
Key Milestones: Reverse the trend in new cases and infected areas within 3 months, stop transmission in capital cities and major ports, and stop all residual transmission within 6-9 months.
PRIORITY ACTIVITIES
Apply full Ebola intervention package to the extent of available resources
• Case management: Ebola treatment centres with full infection prevention and control (IPC) activities; Ebola referral/isolation centres; referral processes for primary health care facilities
• Case diagnosis: by a WHO-recognized laboratory
• Surveillance: contact tracing and monitoring
• Burials: supervised burials with dedicated expert burial teams
• Social mobilization: full community engagement in contact tracing and risk mitigation
Develop and apply complementary approaches for intense transmission areas
• Case management: community-based care supported by intensified IPC and appropriate PPE
• Case diagnosis: by epidemiologic link to case confirmed by WHO-recognized laboratory
• Surveillance: monitoring for new transmission chains (i.e. in infected areas)
• Burials: trained and PPE-equipped community burial teams
• Social mobilization: community engagement to implement complementary approaches
Assess short-term extraordinary measures to limit national spread
• Implement specific programmes to ensure continuity of essential and supportive services in containment areas (e.g. primary health care, psychosocial support, food)
• If non-essential movement in and out of a containment area is stopped, ensure that essential movement (e.g. for response providers, essential services) continues unhindered
• To facilitate EVD response, defer mass gatherings until intensity of transmission is reduced
Implement WHO’s Temporary Recommendations under IHR to prevent international spread
• Prohibit travel of all Ebola cases and contacts (except for medical evacuation)
• Implement and monitor exit screening at international airports, seaports and major land crossings
• Align practices of all international airline carriers with national travel policy
Ensure essential services and lay the foundation for health sector recovery and strengthening of national core capacities for outbreak response
• Establish short-term capacity to address critical gaps in essential services (including health, food, education, protection, WASH [water, sanitation and hygiene]) through national service providers, NGOs, UN agencies, humanitarian organizations and other partners, based on needs assessment and gap analysis
• Develop a medium-term investment plan to strengthen health services that includes syndromic surveillance and laboratory networks to diagnose relevant pathogens
• Introduce a fast-track training programme for priority health worker gaps (including surveillance)
OBJECTIVE 2: To ensure emergency and immediate application of comprehensive Ebola response interventions in countries with an initial case(s) or with localized transmission
Key Milestone: Stop all transmission within 8 weeks of index case.
PRIORITY ACTIVITIES
Initiate emergency health procedures
• Immediately communicate the case and relevant information through the IHR contact point in the relevant WHO Regional Office
• Establish an emergency operations centre and activate relevant national disaster/emergency management mechanisms
• Coordinate operations and information across all partners, and the information, security, finance and other relevant sectors
• Initiate public crisis/risk communications plan
Immediately activate Ebola response protocols and facilities, in keeping with WHO IPC guidance and universal precautions
• Immediately isolate all suspect and confirmed cases in designated Ebola treatment centre with full IPC
• Secure access to diagnostic capacity in a WHO-recognized laboratory
• Fully implement contact tracing and monitoring
• Ensure safe burials
• Implement public communications strategy to facilitate case identification, contact tracing and risk education
Implement IHR Temporary Recommendations to prevent international spread
• Prohibit travel of all Ebola cases and contacts (except for medical evacuation)
OBJECTIVE 3: To strengthen preparedness of all countries to rapidly detect and respond to an Ebola exposure, especially those sharing land borders with areas of active transmission and those with international transportation hubs
Key Milestone: Full Ebola surveillance preparedness and response plan established in areas sharing a land border with an Ebola-infected country and at all major international transportation hubs within one month.
PRIORITY ACTIVITIES
In all unaffected countries
• Provide advice to travellers to Ebola-affected areas with relevant information on risks, measures to minimize those risks, and steps to take following a potential exposure
• Identify an isolation unit where any suspect Ebola case could be properly investigated and managed
• Verify access to diagnostic capacity in a WHO-recognized laboratory
• Establish a strategy for identifying and monitoring the contacts of any suspect Ebola case
• Where appropriate, ensure that preparedness activities include contingency planning for health centres, schools and other vital infrastructure and services
In all unaffected countries sharing a land border with an Ebola-infected area
• Establish active surveillance for clusters of unexplained deaths or febrile illness in areas bordering Ebola-affected countries and in major cities
• Provide the general public with accurate and relevant information on the neighbouring Ebola outbreak and measures to reduce the risk of exposure
• Establish a protocol for managing travellers who arrive at major land crossing points with unexplained febrile illness
• Identify and prepare an isolation unit where any suspect Ebola case can be properly investigated and managed
• Arrange a process for rapidly shipping diagnostic specimens to a WHO-recognized laboratory
• Engage international support team(s) if/as required to accelerate the development, implementation and assessment of preparedness measures
In all unaffected countries with an international transportation hub
• Reinforce the capacity to manage travellers who arrive at international airports with unexplained febrile illness and potential exposure to Ebola
• Ensure a protocol, and identify an isolation unit, for the investigation and management of any suspect Ebola case
MAJOR ISSUES IN OPERATIONALIZING THE EBOLA RESPONSE ROADMAP
Human Resources for Strategy Implementation: mobilizing and sustaining sufficient human resources to implement Ebola response interventions requires a comprehensive approach to their remuneration, training, equipment, physical security, and access to health care. Implementation of Ebola response activities to date have highlighted a number of specific considerations that must be addressed to operationalize fully the Ebola Roadmap:
• National staff considerations:
o Remuneration: Governments must rapidly establish a comprehensive package that defines the salary, hazard pay and – where appropriate – insurance/death benefit available to each category of worker required to implement the national strategy (e.g. physicians, nurses, physicians assistants, laboratory workers, cleaners, burial teams, surveillance officers). If necessary, UN (e.g. WHO) or partner agencies should assist Governments as needed in implementing this package.
o Training & Equipment: a specific accelerated training programme must be developed for each category of worker that is adaptable to the district/treatment centre level and places particular emphasis on IPC and proper use of PPE. Consideration must be given to particularly vulnerable groups such as cleaners and to the needs of women, who constitute a significant proportion of care providers. All Ebola workers must have access to sufficient quantities of the appropriate PPE.
• International staff considerations:
o Mobilization of International Expertise: WHO and partners will continue intensive outreach to all international medical NGOs, humanitarian organizations (i.e. the Red Cross Movement), Global Health Cluster partners, foreign medical teams and Global Outbreak & Alert (GOARN) Partners to mobilize sufficient medical expertise to support the staffing of all Ebola Treatment Centres in countries with intense and widespread transmission. For newly infected countries, Rapid Response Teams should be deployed within 72 hours, if requested, to provide expert support to the establishment and staffing of new case management facilities.
o Accelerated Training of Supplementary International Expertise: WHO will establish a specific programme to identify, train and deploy an extended roster of international health care workers to provide clinical care in Ebola treatment centres and Ebola referral/isolation centres. Particular emphasis will be given to implementing protocols for health care worker protection, based on WHO IPC Guidance and the WHO Care Management Handbook.
• Medical Care of Health Workers: WHO will continue its work with the international community on a two-pronged approach to ensuring the best possible care of exposed health care workers through a combination of specialized medical referral centres in affected countries (for national and international health care workers) and medical evacuation where necessary and appropriate.
more....
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