Ebola detection and testing rapidly expands in Uganda and US

A presentation slide showing the location of the 2022 Sudan ebolavirus outbreak. The speaker is shown to the right.

Ebola detection and testing rapidly expands in Uganda and US

By Melanie Padgett Powers, writer

A partnership between Uganda and US public health professionals was instrumental in responding to the 2022 Ebola outbreak in Africa. Furthermore, lessons learned from that response helped update guidance on how the US would respond to suspected Ebola cases arriving on US shores.

Ebola is a highly transmissible disease with a mortality rate of 50 to 90 percent without treatment. When people hear “Ebola,” it’s usually referring to the Zaire ebolavirus, explained Trevor Shoemaker, PhD, MPH, at the 2023 APHL Annual Conference May 23 session, “Preparedness and Response Domestically and Abroad—the 2022 Ebola Outbreak” in Sacramento, CA. Shoemaker is team lead, epidemiology, surveillance, clinical and health education, Viral Special Pathogens Branch, US Centers for Disease Control and Prevention (CDC).

The Zaire virus has been responsible for the majority of Ebola outbreaks in recent years and is one of four ebolaviruses known to cause human infection. However, when Ebola broke out in Uganda in September 2022, it was the Sudan ebolavirus.

For the past 12 years, the CDC has been supporting Uganda’s Viral Hemorrhagic Fever (VHF) Surveillance System. “But we’ve been engaged in Uganda ever since the first Sudan virus outbreak detected in the year 2000,” Shoemaker said. For the VHF program, the CDC assisted Uganda’s Ministry of Health, through the Uganda Virus Research Institute, to establish a laboratory to perform in-country diagnostics and enhance the epidemiological and clinical surveillance in the country.

“Most of the things we helped implement were to improve reporting capability, improve the laboratory capacity, detect incident cases very rapidly and report those to the national level so they could take action,” Shoemaker said. “We improved the capability to respond, so this would be quick outbreak investigation and containment.”

They also trained Ugandan health workers on how to properly don personal protective equipment, take a blood specimen for testing, fill out the case report form and safely ship samples to the national laboratory.

The program, which has tested over 20,000 clinical samples, has greatly increased the detection of VHF outbreaks in Uganda and the region, Shoemaker said. Since the program began, it has detected more outbreaks than in the previous 10 years. “It has also reduced the time between initial report of suspected outbreaks and laboratory confirmation by quite a number of days,” he said. The laboratory can provide results within six to 12 hours of receiving the sample and can do confirmatory testing within 24 hours.

In the 2022 Ebola outbreak, there were 164 total cases in nine Ugandan districts, with 77 deaths, which is a 47 percent case fatality rate.

Ebola preparation in the US

Although the risk of Ebola being imported to the US last year was considered low, Shoemaker said, the CDC activated its emergency response structure. CDC Ebola Response Teams were ready to travel to states if needed. CDC updated its guidance for health care workers in the US for suspected Ebola cases. The APHL Biosafety and Biosecurity Committee also updated its Ebola guidance, which was from 2015.

In the US, the CDC oversees the Laboratory Response Network (LRN), a system of approximately 120 US laboratories—including all 50 state public health laboratories—that detect and respond to biological threats.

Before the 2022 Uganda Ebola outbreak, only eight LRN laboratories had the capability to test for the Sudan ebolavirus. Within a month, that was expanded to 27 LRN laboratories, as well as 10 regional emerging special pathogen treatment centers, Shoemaker said. Now, there are 34 laboratories able to test for Sudan virus (as well as the Marburg virus, another severe viral hemorrhagic fever).

To test for the Sudan ebolavirus, the LRN laboratories use the commercial product BioFire FilmArray and the Warrior Panel, which was approved by the US Food and Drug Administration in 2017. CDC uses a real-time reverse transcription–polymerase chain reaction (RT-PCR) assay, similar to what many LRN laboratories already have to test for the Zaire virus. The CDC’s Sudan test is currently undergoing approval to send out to LRN laboratories.

In 2022 in the US, the CDC had clinical consultations for 35 ill returning travelers from the outbreak region and performed tests on three people. All were negative. Compare that to January 2017 to December 2021, Shoemaker said, when there were seven Ebola virus outbreaks and the US performed testing on only nine ill travelers.

Melanie Padgett Powers is a freelance writer and editor specializing in health care and public health.

The post Ebola detection and testing rapidly expands in Uganda and US appeared first on APHL Blog.

Project Firstline Reaches Frontline Healthcare Workforce with Infection Control Training

The COVID-19 pandemic has highlighted long-standing gaps in infection control knowledge and understanding among the frontline healthcare workforce. Since the onset of the pandemic, healthcare-associated infections and antibiotic-resistant infections have increased, reversing national progress made before 2020.

Infectious disease threats like Ebola, COVID-19, and antibiotic resistance will continue to emerge. It’s more important than ever that we equip our nation’s healthcare workforce with the infection control knowledge they need to protect themselves, their patients, and their communities.

One year ago, this month, CDC launched Project Firstline. Project Firstline provides engaging, innovative, and effective infection control education and training for U.S. frontline healthcare workers.

Meeting the Needs of the Diverse Healthcare Workforce

Project Firstline’s innovative content is designed for all healthcare workers, regardless of their previous training or educational background. The program’s training and educational materials provide critical infection control information in a format that best meets healthcare workers’ needs.

During its first year, Project Firstline and its partners hosted more than 300 educational events on infection control and developed more than 130 educational products. The products are accessible on a variety of digital platforms, including Facebook, Twitter, and CDC and partner websites. Products currently available on the CDC Project Firstline site include:

Maximizing Impact through Partnerships

Project Firstline brings together academic, public health, and healthcare partners plus 64 state, local, and territorial health departments to provide infection control educational resources to healthcare workers nationwide.

Our partners have used a diverse range of products and activities to reach healthcare workers with tailored infection control information during the COVID-19 pandemic. Some of these activities include Twitter chats, podcasts, videos,  and virtual training events simulcast and translated into multiple languages.

Additionally, Project Firstline launched the Community College Collaborative in partnership with the American Hospital Association and the League of Innovation in the Community College. The program is integrating enhanced infection control content into the health programs of community college classrooms. The program was piloted this summer with faculty cohorts from 16 participating colleges across a range of community college settings. Faculty came together to tailor the infection control curriculum for each professional area, with a plan to phase it into their coursework. Professional areas included:

  • emergency medical services
  • respiratory care
  • nursing
  • practical nursing and nursing assistants
  • medical assisting

This effort will help ensure that the future healthcare workforce starts their careers with key infection control knowledge to protect themselves and their patients.

The Future of Project Firstline

Project Firstline aims to become the go-to resource for infection control among healthcare workers. It will focus on building a strong culture of infection control within all healthcare facilities.

Using insights learned during its first year, the program will create a new suite of readily available and easy-to-consume education materials. The new materials will be designed to help strengthen infection prevention and control capacities beyond the COVID-19 pandemic.

 

Thanks in advance for your questions and comments on this Public Health Matters post. Please note that CDC does not give personal medical advice. If you are concerned you have a disease or condition, talk to your doctor.

Have a question for CDC? CDC-INFO (http://www.cdc.gov/cdc-info/index.html) offers live agents by phone and email to help you find the latest, reliable, and science-based health information on more than 750 health topics.

Other Diseases Did Not Rest During COVID-19

Protecting Health in 2020. NCEZID Progress Report.

The COVID-19 response is the largest and longest in CDC history. But the virus that causes COVID-19 wasn’t the only infectious disease that CDC responded to last year. Diseases like those caused by the Marburg virus and antibiotic-resistant bacteria didn’t go away because of the pandemic.

The National Center for Emerging and Zoonotic Infectious Diseases (NCEZID) deployed 1,736 staff who devoted 1.35 million hours to the COVID-19 response in 2020. At the same time, the center worked to protect people in other important areas. NCEZID details its activities in the Protecting Health in 2020 NCEZID Progress Report.

The COVID-19 response

The magnitude of CDC’s COVID-19 response was reflected in last year’s raw data. People viewed CDC’s COVID-19 webpages over 2.3 billion times. They used the Coronavirus Self-Checker over 40 million times.

About 1,500 staff, including members of NCEZID, deployed nearly 3,000 times to about 250 cities in the United States and other countries. NCEZID also set records in the amount of funding it awarded. It gave $11 billion to 64 public health departments to help fight the spread of COVID-19.

An NCEZID lab ran 6,417 pathology tests to study COVID-19’s damage on a cellular level. The Advanced Molecular Detection (AMD) program built a national network of more than 600 scientists to track COVID-19’s spread using genetic data while keeping track of new variants.

Over the course of years, NCEZID successfully encouraged 90 percent of U.S. health departments to switch to electronic laboratory reporting. This has paid off during the pandemic response by enabling health departments to send more COVID-19 testing and other data more quickly to CDC.

Other threats

Scientists think that the virus that causes COVID-19 likely circulated in bats before making its way to humans. NCEZID scientists monitor bats for emerging disease threats. Last year, they found an especially deadly strain of Marburg virus circulating in fruit bats in Sierra Leone. Marburg virus disease causes hemorrhaging and other Ebola-like symptoms but is often deadlier than Ebola.

Melioidosis, a life-threatening bacterial disease, infected a few people in the United States last year. Catching it in the country is unusual. Infected people usually get the disease on trips abroad. NCEZID researchers found evidence that melioidosis could be an emerging threat in the U.S.

Other researchers used genetic sequencing data to explore why gastric cancer caused by bacteria afflict Alaskan Native people more than other people.

Years of public health and healthcare measures have reduced infections with antibiotic-resistant germs, but they are still a threat. CDC is spearheading an action plan in communities where infections are on the rise.

The threat of Ebola typifies NCEZID’s dual mission of preparing for and responding to disease threats. Last year, two outbreaks were declared over. Now, two new outbreaks threaten two African countries. Experience gained in last year’s responses will help prepare this year’s Ebola responses.

About NCEZID

NCEZID is one of the national centers, institutes, and offices that together make up CDC. NCEZID protects people from domestic and global health threats, including:

  • Foodborne and waterborne illnesses
  • Infections that spread in hospitals
  • Infections that are resistant to antibiotics
  • Deadly diseases like Ebola and anthrax
  • Illnesses that affect immigrants, migrants, refugees, and travelers
  • Diseases caused by contact with animals
  • Diseases spread by mosquitoes, ticks, and fleas

NCEZID has led efforts to prepare for and respond to infectious disease outbreaks. Its staff includes subject matter experts in bacterial, viral, and fungal pathogens and infectious diseases of unknown origin.

 

Thanks in advance for your questions and comments on this Public Health Matters post. Please note that the CDC does not give personal medical advice. If you are concerned you have a disease or condition, talk to your doctor.

Have a question for CDC? CDC-INFO (http://www.cdc.gov/cdc-info/index.html) offers live agents by phone and email to help you find the latest, reliable, and science-based health information on more than 750 health topics.

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Responding to Emergencies One Behavior at a Time

A group of Ebola response volunteers in Nigeria.

To improve the health and safety of people in the United States and around the world, we have to influence and change behaviors. It can be difficult to try new things, or stop old things as behaviors range from simple to complex, but one way to consider behavior change is to think of any change as a passive or active choice.

Public health practitioners must think about interventions in terms of the behaviors they are asking people to adopt, stop or continue. What would encourage someone to change what they are currently doing? Before you can influence someone’s behavior or change their choices about a behavior (risky or protective) you need to know how their judgments and decisions are made about that behavior in the first place.

Behaviors are rooted in traditions

During the Ebola response behavior change was critical to prevent people from getting sick and ultimately stop a disease threat. In the wake of the outbreak, communities in West Africa were encouraged to give up or change their traditional burial practices. Some of these longstanding rituals, like washing the body, proved dangerous because the virus can live on the skin of a victim after death. Communicators developed public health messaging to help change social norms and customs for burials. It was important to understand behavioral science and anthropology in order to communicate about safe burial practices in a way that would make people choose to change a behavior that was ingrained in their culture.

Behaviors are rooted in social 7 Things to Consider When Communicating About Health. Trust: Will people trust the information? Who is the best source to put the information out? Information: What information is necessary, and how will people find it? How much is enough, or too much? Motivation: How relevant is the information to the people we’re trying to reach? Environment: What are the conditions that surround and affect the audience? Capacity: What is people’s ability to act on the information? Are there barriers? Perception: What will the audience think about the information? What will inspire them to act on it? Response: How will people respond? What can we do to stay engaged with them and give them support as they take action?norms

The 2016 Zika virus outbreak is the first time in more than 50 years that a virus has been linked to serious birth defects. Due to the impact of Zika virus infection during pregnancy, social norms and perceptions around provider visits had to be addressed to alleviate concerns about the cost of screening. Clinicians were educated about the risks associated with Zika virus, how to prevent infections, and reporting suspected cases to their state, local, or territorial health departments and women were offered free clinical services, education, and access to Zika prevention kits.

Behaviors are rooted in beliefs

The fight to eradicate polio teaches us the importance of beliefs in behavior change during a response to a public health threat. Creating an effective polio vaccine was only the first step in the effort to eradicate polio. Of course an effective vaccine was necessary to prevent polio virus infections, but getting communities to accept the vaccine was equally important. Public health practitioners created messages that build on cognitive, developmental, and social psychology to persuade parents to bring their children into clinics to get vaccinated.

Behaviors inform preparedness and response

Responding to emergencies effectively requires combined expertise in many fields, including behavioral science. Epidemiology, for example, allows us to understand how many people have a disease and characterize the disease, while behavioral science identifies the role of human behavior and psychosocial factors. Behavioral science expertise can identify methods to communicate and design campaigns to change behavior that are culturally and socially acceptable.

It is important that we maintain humility when we try to understand why people do or think what they do. We often assume that we understand human behavior, but we must remain open-minded when working with people from all different backgrounds and cultures. Who’s to say that what our culture considers right and true necessarily translates to the same belief systems elsewhere? Thus public health ethics is also an important consideration when suggesting behavioral change interventions. When we are in situations that are particularly dangerous or stressful, our assumptions about other people’s behavior can lead to recommendations or actions that seem counterintuitive or wrong to them. Careful application of behavioral science is critical to any mission that seeks to improve public health and safety, here and around the world.

The Communication Research and Evaluation blog series highlights innovative research and evaluation methods used at CDC to improve behavior change campaigns.