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PostPosted: Thu Aug 28, 2014 6:39 am 
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WHO issues an Ebola road map to stop transmission over next 6-9 months (estimate of 20,000 cases)

http://apps.who.int/iris/bitstream/1066 ... ?ua=1&ua=1

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PostPosted: Thu Aug 28, 2014 6:40 am 
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WHO issues roadmap for scaled-up response to the Ebola outbreak

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 roadmap aims 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.

The roadmap 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 bags.

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.

This is a fast-moving outbreak with a number of unprecedented dimensions. The roadmap being issued today is sufficiently flexible to accommodate rapid changes in the outbreak’s epidemiology and the needs this creates.

http://www.who.int/csr/disease/ebola/eb ... oadmap/en/

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PostPosted: Thu Aug 28, 2014 6:44 am 
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EBOLA RESPONSE
ROADMAP
28 August 2014

GOAL
To stop Ebola transmission in affected countries within 6-9 months and prevent international spread.

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PostPosted: Thu Aug 28, 2014 7:26 am 
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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.

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PostPosted: Thu Aug 28, 2014 7:28 am 
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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

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PostPosted: Thu Aug 28, 2014 7:29 am 
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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.

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PostPosted: Thu Aug 28, 2014 7:35 am 
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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)

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PostPosted: Thu Aug 28, 2014 7:37 am 
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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)

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PostPosted: Thu Aug 28, 2014 7:43 am 
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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

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PostPosted: Thu Aug 28, 2014 7:49 am 
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Table 5 – Breakdown of Ebola treatment centre bed capacity required*
Areas affected Ebola treatment centre ETC beds
Guinea
Conakry Conakry (Donka Hospital) 50
N'zerekore Gueckedou 100
Total Guinea 150
Liberia
Bong Bong county 50
Lofa Foya, Lofa county 100
Montserrado Monrovia, ELWA 3 240
Monrovia, JFK Hospital 100
Monrovia, (5x100 bed complementary treatment centres) 500
Nimba Nimba county 50
Total Liberia 1040
Sierra Leone
Eastern Kailahun 100
Kenema Hospital 50
Kenema Field Hospital ETC 50
Northern Bombali / Makeni 50
Southern Bo 25
Western Freetown / Laka 50
Total Sierra Leone 325
Total 1,515
*Note: the Ebola treatment centre locations and bed capacity are currently being assessed and will be updated as the
situation evolves

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