NMTC Talk Cohen

NMTC Talk Cohen

USAPHCs Response to Ebola Robert Cohen, MD, MPH Preventive Medicine Physician Disease Epidemiology Program Army Institute of Public Health UNCLASSIFIED Disclaimer The views expressed herein are those of the speaker and do not necessarily reflect the views of the Army, the US Government, or USAPHC. U.S. Army Public Health Command UNCLASSIFIED 2 Outline

What is Ebola? History of Ebola Current Outbreak in West Africa Operation United Assistance Pre-deployment activities During/After deployment activities Domestic Preparedness Future U.S. Army Public Health Command UNCLASSIFIED 3 What is Ebola? Smallpox Influenza Herpes

Rabies Coronavirus (SARS) HIV Hendra Ebola U.S. Army Public Health Command UNCLASSIFIED 4 A Brief History of Ebola http://www.abc.net.au/news/2014-07-30/map-showing-ebola-outbreaks-in-africa-since-1976/5635152 U.S. Army Public Health Command UNCLASSIFIED 5

Current Outbreak in West Africa Case Count (as of 8 Dec 2014) Cases Deaths Liberia: 7,690 3,161 Sierra Leone: 7,635 1,660 Guinea: 2,192 1,366 Total: 17,517 6,187 WHO Ebola Response Team. NEJM 2014 U.S. Army Public Health Command UNCLASSIFIED 6 Stabilization in Liberia and Guinea, not Sierra Leone

The Economist, 4 Dec 2014 U.S. Army Public Health Command UNCLASSIFIED 7 President Obama Orders Operation United Assistance (OUA) U.S. Army Public Health Command UNCLASSIFIED Led by 101st Airborne Division, in collaboration with US Army Africa Beginning Sep 2014

Up to 3000 US Army troops will be sent over 12+ months Mission: Build 10 Ebola Treatment Units (ETUs) with 50 beds each in Liberia 8 LEGEND Liberia (Capability Status as of 18 Nov 2014) Mobile Medical Lab (MML) Proposed Army Lab -(U) Confirmed EVD Cases: - Average 10 new cases per day - Sierra Leone: 75 per day - Guinea: 15 per day

Liberian Lab Forward Logistical Base Monrovian Medical Unit Operational ETU In Progress ETU -(U) UNDP EVD Program Visit 4 Dec: - Lack of feedback on relatives enrolled in ETUs - Secret burials still occurring, increasing transmission of EVD - LNP conducing night patrols to reduce secret burials USG Supported Sinje -(U) Army Labs - 3 of 4 labs operational Gbediah -(U) UNMIL Soldier positive for EVD - Nigerian - Currently treated at MMU

- Will be flown to Netherlands Sources: OUA INTSUM, 20141206 OUA SITREP, 20141207 U.S. Army Public Health Command UNCLASSIFIED 9 Operation United Assistance HQDA Mission HQDA establishes a Force Protection Plan of action for Army Forces deploying in response to the EVD epidemic in West Africa and provides information and education to the Soldiers, DA Civilians (DAC), Army Families, deploying contractors, and their communities in order to provide properly trained and equipped forces in support of Operation United Assistance. MEDCOM Mission On order (O/O), MEDCOM leverages medical personnel, materiel, research and technology, and subject matter expertise in support of Operation UNITED ASSISTANCE (OUA). PHC Mission PHC leverages public health subject matter expertise in support of Operation UNITED ASSISTANCE (OUA).

U.S. Army Public Health Command UNCLASSIFIED 10 Three Areas of USAPHC OUA Response USAPHC is a unique organization within DoD, well-suited to advise units on: 1) Pre-Deployment (Prepare Soldiers and Reassure Families) 2) During Deployment and Re-Deployment (Protect and Return Soldiers) 3) Domestic Preparedness http://healthdecide.orcahealth.com/2014/08/01/ origins-growing-spread-ebola-virus/

U.S. Army Public Health Command UNCLASSIFIED 11 Pre-Deployment: Prepare Soldiers and Reassure Families Risk assessments and risk communication Information video for deploying Soldiers and Families FAQ sheets Training Packages (e.g. PPE)

Other Africa-specific public health training U.S. Army Public Health Command https://www.youtube.com/watch?v=677xOF9Iua4 UNCLASSIFIED 12 During Deployment: Protecting Soldiers Personal Protective Equipment (PPE) guidance Hazardous waste management guidance

Review of difficult scientific questions (e.g. how long can Ebola survive outside the human body?) SME support to deployed units 13 Post-Deployment: Returning Soldiers and Domestic Preparedness Controlled monitoring for 21 days Domestic Preparedness for MTFs Ebola Rapid Action Team (~12 people) Mix of clinical/non-clinical experts Risk Communication Waste Management

Contact Tracing DoD Ebola Mission Support Team (30 people) Example: returning Air Force Officer with vomiting to Ft. Bliss Grounded the crew and plane for 72 hours Isolated Officer Used as an exercise U.S. Army Public Health Command UNCLASSIFIED 14 Ongoing OUA Support Efforts (JPEO-CBD) Ebola Biosurveillance Portal Ebola Virus Diagnostic Assays The Ebola Biosurveillance Portal is a new information technology tool supporting international efforts to stop the Ebola Virus outbreak in West Africa. It leverages

several DoD systems in development into a single integrated system for Ebola situational awareness Ebola Virus Therapeutics and Vaccines The DoD and the NIH are utilizing a whole - of government approach to accelerate the development of promising vaccine and anti-viral drug candidates that are targeted against Filoviruses U.S. Army Public Health Command Two DoD developed Ebola Virus diagnostic assays have received Emergency Use Authorizations from the FDA. These assays have been fielded to both CDC and DoD labs Presidential Grand Challenge JPEO-CBD is participating in the Presidential Grand

Challenge to procure or develop improved personal protective equipment (PPE) for Ebola Virus. The goal is to reduce the thermal burden associated with current PPE on health care providers UNCLASSIFIED 15 More Ongoing OUA Support Efforts (JPEO-CBD) Contaminated Human Remains Pouch In response to a Joint Urgent Operational Needs Statement (JUONS), JPEOCBD is developing a human remains pouch medical, transport and processing personnel from individuals that have died from Ebola U.S. Army Public Health Command Transportation Isolation System

JPEO-CBD and the Defense Threat Reduction Agency are developing an isolation system to evacuate service members in the event they become infected by the Ebola Virus. They system will hold up to 12 service members UNCLASSIFIED 16 Future There will be another Ebola outbreak in Africa

Or another disease outbreak We will be better prepared We may even be able to help prevent We must try to help prevent http://www.globalchange.umich.edu/globalchange2/current/lectures/deforest/deforest.html U.S. Army Public Health Command UNCLASSIFIED http://landsat.gsfc.nasa.gov/?p=510 17

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