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Key Topics
- Question:
- Answer:
- Introduction to the scenario
- Background of study
- Affected population
- The goals of the city or state
- The initial plan
- Events selected for monitoring
- Cross-sectional survey
- Semi-Structured Interviews
- The time period for data collection
- The process for collecting data
- Calculation of rates and analysis of data
- Evaluation of the plan
- Conclusion
- Reference List
Question:
Write a report on "Infection Prevention Plan for Ebola"
Answer:
Introduction to the scenario
Ebola virus disease or EVD has been considered as severe viral disease which presents with the fever as well as it is ensuing bleeding diathesis which is remarked through the very high mortality within human as well as non-human primates. It has been found that Ebola virus generally emerge as the menace for the population in West Africa and it has been considered as the global consequences through the risk of imported infections. It is also weapon of biological terrorism.
In this study, a research has been performed on the basis of understanding of EVD and transmission dynamics in case of community compliance for country yards in Southern California. This project is thus based upon the interactions which is essential as the interventions were considered as effective in near future as the outbreaks in community. For this, mixed method has been performed in this study for exploring the factors within the rural village and that has been experienced in sustained EVD transmission in Southern California.
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Background of study
The first outbreak of Ebola has been occurred in mid of 2014 in remote village of Southern California when this place has been declared by the state of emergency by the government. In Kailahun, another remote village in California has been found affected in mid of December in 2014. It is situated within the region of Sierra Leone. It has been declared as the disease happened due to the human to human transmission and thus by January 2015, that district has declared free from Ebola infection by the Ministry of Health and Sanitation or MoHS. As per the report from MoHS, there are 2758 confirmed cases on EVD cases in the population and thus the attack rate id 29.2 % which includes 2758 deaths where the fatality rate (CFR) is about 51% (Caleo, et al., 2018).
From some evidence-based interventions regarding control of EVD includes the prior detection in the cases for which the effective surveillance as well as the contract tracing was occurred. It also includes admission of the symptomatic cases of EMCs for which the staff adhere with high standards infection control processes by the trained teams. They also checked the safe burial process. It has been further rechecked through quarantine measures for widely implementation and so by-laws imposed with the inclusion for travel restrictions as well as the penalties in case of hiding the suspected cases.
Affected population
The affected population belongs to the median aged villagers and this it can be understandable that those lives which would preclude outbreaks with Ebola where the estimated population is 465,048 in that village. From MoHS report, it can be confirmed that 9446 cases of EVD have been found within the village. 2758 death cases have been found by the affected disease (Cenciarelli, et al., 2015).
data available and verification of outbreak existence
The verification of the outbreaks has been performed through several measures and tests. There is a mixed method of study has been performed which has ensured the outbreaks in the village. As per the sources the number of cases as well as deaths has been determined and as per WHO, the progressive report for the duration of epidemic 10 ±4 days in which the time has been conducted in 15 weeks.
From the above figure, there is a sharpest increment in case of death evidences and those trends are growing as per the report issued by WHO.
It has also been found that both the structures for the management as well as the treatment for EVD together with the laboratories for the purpose of clinical as well as molecular analysis, there is a substantial lack for capability for response in Sierra Leone (Team, 2014).
The goals of the city or state
As per the goals set up, some preventive along with the control measures have been taken place for the ecological niche modeling on behalf of potential spread of Ebola in the village. The local as well as the international health community have been found unprepared at the first time. For Ebola diffusion, during the first week of outbreak, has been found to be unnoticed while the first serious symptomatology and some spontaneous deaths have been appeared. As soon as the threat has been identified, also the Ministry of Health with the collaboration of WHO along with other partners have given some hard works for implementing the measures to control the outbreak and also took some measures for the purpose of preventing further spread for infection (Feldmann & Geisbert, 2011).
The initial plan
For the purpose of evaluation there is the geographical spread for EVD epidemic and the report has been issued in the same dates which have been already taken for the account to determine the cases as well as the deaths through WHO together with the Centers for Disease Control and Prevention (CDC) have been used. Thereafter, the affected village from bursting till the mid of 2014 in Sierra Leone have been divided with respect of the administrative areas. The whole area has been divided into 12 districts plus within urban as well as the rural west areas which were additionally subdivided in another two additional districts (Gire, Sealfon, Park, Kanneh, & Wohl, 2014).
The health care workers were found unprepared for the first time and therefore training programs were arranged for increasing the awareness on EVD and some essential steps were being taken for the sake of outbreak there is a response plan along with a contact tracing. The Ministries of Health for the affected countries are found to be released in public communications for increasing the people awareness on the virus transmission as well as the prevention with promotion of collaboration with the health teams that are deployed in that village. Moreover, the medical supplies along with the personal protective equipment has been provided for the hospital workers along with the teams associated with WHO, CDC, United Nations High commissioner for Refugees (UNHCR) and also others. The meeting between the Cross borders within the authorities of the countries has been involved for the outbreak which is coordinated with the aim for finding the agreement in the mission of common plan for reducing the spread of the disease. The information has been shared in the cross border movements with the suspect of the cases as well as the awareness of the EVD. That diagnostic capability has found to be increased with the installation of Real time Ebola which is virus specific PCR together with Lassa virus causing the yellow fever. Other virus called Marburg virus PCR is also diagnosed in the Metabiota Laboratory situated in Kenema of Sierra Leone (Sullivan, Sanchez, Rollin, Yang, & Nabel, 2000).
Events selected for monitoring
In case of enabling the assessment for the behavior adaption over the time, the data has been used from MSF EMC patient those are registered for selecting the village in the district which is experienced with very protracted of outbreak of EVD. The mixed methods thus conducted for the sake of this study which is combined with the data gathered through cross sectional survey as well as the semi-structured interviews in village. Therefore, the survey data thus have been used for reconstructing the dynamic of the transmission. The semi-structured interviews thus have been used for the document for the community perception and for the adaptation for the response of the strategies. The survey as well as the interview data thus has been triangulated through the data gathered from safe burial as well as MoHS surveillance databases for the verification of the reconstruction with the transmission of EVD. The changes in this transmission along with the behavior over time have been examined and explained (Sanchez, 2001).
Cross-sectional survey
The cross-sectional survey was thus conducted for all the consenting households within village which have included the cross sectional for household survey. In this respect, the trained MSF team is utilized for the validation of instruments with household mortality with the studies along with the EVD case for household members, deaths, births, illness or the arrivals which includes the sign along with symptoms for compatibility with the symptomatic in case of Ebola. The briefing has been performed on the basis of the verbal consent of the participation which has been obtained under the head of every household as per the aim of survey, duration of the questionnaires as well as the questionnaires.
The household survey thus was conducted in the mid-month of April 2015, and the responses between the dates of first reported EVD case which is distinct for the date for survey. The local events calendars thus were developed with the aid for recall. The MSF-EMC patient thus been registered was being utilized for verifying the date of the admission along with the symptoms as well as the laboratory confirmation through EVD pertaining to the outcomes from patients who got admission in EMC. In case of every household in the village has enumerated as well as listed with random selection of the households in sake of the semi-structured interview.
The Geographic positioning system or GPS data were also utilized for mapping the village layout as well as the location for those households (Caleo, et al., 2018).
Semi-Structured Interviews
After the cross-sectional survey there are the semi structured interviews were thus conducted with the community of key for informants as well as the selection of the households. The households are thus divided in between two groups which depended on whether they would experience at the least one of EVD case as well as non EVD cases. Total number of 20 questions has been performed for the random selection in case of interview.
All kind of interviews were thus performed in local language where the interpreter as well as the translator was found to work in collaboration. Some local events were being developed for the sake of household survey for the purpose of semi-structured interviews. There were topic guides which were also found as directed in the interviewers as related with the EVD response activities (Cenciarelli, et al., 2015).
The time period for data collection
The interviews were thus conducted in the period of two months following the activities of the suspect cases which was defined for the person or alive or dead, suffered from sudden onset when symptoms of high fever as well as the contact of the portable as well as confirmed EVD . Other symptoms like, headaches, diarrhea, and aching muscles or the joints, lethargy, vomiting or difficulty in swallowing or the inexplicable and sudden death have been found in case of Ebola infections. Thereby, for inspecting the symptoms, the patients were keeping under at least two weeks of observations.
The process for collecting data
The Cox proportional hazards of regression models were thus observed for estimating the hazard rations or (HRs) as well as there were 95% of confidence of intervals which was associated with EVD in the portable as well as the confirmed areas. In this respect, the crude mortality rate or CMR along with the EVD specific mortality rate were thus estimated for deaths per 100 per day. There is the attributable risk percentage and as well as the population of the attributable risk percent was thus utilized for estimating the excess for mortality risk due to EVD with exposition of the households as well as the village level respectively.
Calculation of rates and analysis of data
At the initial stage, the interviews are conducted in 240 households and within 1161 individuals. All the heads of those households were thus provided the other consent to participate in the examinations. There is the median age of villagers which are 18 years of the interquartile range from 5 to 55 years and other 44.4% of Youngers within 15 years of age. The half of the villagers was female and the percentage came as 52.7% and the household size has been ranged from 1to 17 people within the median age of size 5.
Evaluation of the plan
Transmission dynamics
The overall, 31 EVD cases where 15 were confirmed and also 16 were portable were thus identified and the overall attack rate has been found as 2.7%. Also, the index case for the adult male who was the resident in the village was known as the EVD hotspot in the month of June-July 2014. Additionally, in the late part of July 2014, there was symptomatic and they are travelled back for the village for the origin. The table below has provided the possible routes of EVD transmission which were reported in the household as well as the key informants.
Figure: The geographical distribution over the weeks of 29 to 45
From the above figure, it has been found a strong evidence of the clustered of EVD for p<0.0001. There are 15 of 240 households has been observed and the 32 percent of the cases has been occurred in the households. There were most secondary cases where the affected households are found as 30% or 9/30. The median of seven members were thus marked as IQR 6-8.
From the above table it has been found to be associated with the older age as well as the household size which are unadjusted analysis of the associations and the stronger has been adjusted. The aged between 5 to 55 and the CI level is found as 19.64 to 162.73.
Conclusion
Therefore, from the above test result, the perception for EVD thus held with the villagers has been changed and information was received from contact tracers as well as the MSF health promotion team for consistent with that of the villagers. Also the transmission was thus maintained in the small number for the large households and the outbreak was also controlled in that community for prolonged transmission as well as high death toll. Finally, key recommendation was also emerged from the findings that ensured in the large households. There was prioritized in purpose of the control for prevention of activities.
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Caleo, G., Duncombe, J., Jephcott, F., Mills, C., Looijec, E., Theoharaki, F., . . . Squire, J. (2018). The factors affecting household transmission dynamics and community compliance with Ebola control measures: a mixed-methods study in a rural village in Sierra Leone. BMC Public HealthBMC series, 18-248.
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Cenciarelli, O., Pietropaoli, S., Maliza, A., Carestia, M., D'Amico, F., Sassolini, A., . . . Palombi, L. (2015). Ebola Virus Disease 2013-2014 Outbreak in West Africa: An Analysis of the Epidemic Spread and Response. International Journal of Microbiology, 1-12.
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Feldmann, H., & Geisbert, T. W. (2011). Ebola haemorrhagic fever. The Lancet, 849-862.
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Gire, S. K., Sealfon, R. S., Park, D. J., Kanneh, L., & Wohl, S. (2014). Genomic surveillance elucidates Ebola virus origin and transmission during the 2014 outbreak. science, 1259657.
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Sanchez, A. (2001). Ebola viruses. New York: John Wiley & Sons, Ltd.
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Sullivan, N. J., Sanchez, A., Rollin, P. E., Yang, Z. Y., & Nabel, G. J. (2000). Development of a preventive vaccine for Ebola virus infection in primates. Nature, 605.
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Team, W. E. (2014). Ebola virus disease in West Africa—the first 9 months of the epidemic and forward projections. . New England Journal of Medicine, 1481-1495.
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