Disaster medicine and public health preparedness
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Disaster Med Public Health Prep · Feb 2015
Triage management, survival, and the law in the age of Ebola.
Liberia, Sierra Leone, and Guinea lack the public health infrastructure, economic stability, and overall governance to stem the spread of Ebola. Even with robust outside assistance, the epidemiological data have not improved. Vital resource management is haphazard and left to the discretion of individual Ebola treatment units. ⋯ In particular, the WHO has been severely compromised by post-2003 severe acute respiratory syndrome (SARS) staffing, budget cuts, a weakened IHR treaty, and no unambiguous legal mandate. Population-based triage management under a central authority is indicated to control the transmission and ensure fair and decisive resource allocation across all triage categories. The shared responsibilities critical to global health solutions must be realized and the rightful attention, sustained resources, and properly placed legal authority be assured within the WHO, the IHR, and the vulnerable nations.
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Disaster Med Public Health Prep · Feb 2015
Ebola triage screening and public health: the new "vital sign zero".
During public health emergencies of international concern such as the 2014 Ebola event, health care leaders need to educate clinicians on the front lines to make uncomfortable, but real triage decisions that focus on optimization of population health outcomes over individual care. Health care workers must consider their own protection first before direct contact with potentially contagious patients. In an era of globalization and emerging infectious disease, routine triage including evaluation of the standard vital signs must shift to include public health considerations with immediate consequences. A new "vital sign zero" should be taken at the time of initial patient evaluation to assess for risk and exposure to potentially contagious infectious diseases.
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The size of the world's largest Ebola outbreak now ongoing in West Africa makes clear that further exportation of Ebola virus disease to other parts of the world will remain a real possibility for the indefinite future. Clinicians outside of West Africa, particularly those who work in emergency medicine, critical care, infectious diseases, and infection control, should be familiar with the fundamentals of Ebola virus disease, including its diagnosis, treatment, and control. ⋯ We review the pathophysiology and clinical features of the disease, highlighting diagnosis, treatment, and hospital infection control issues that are relevant to practicing clinicians. We reference official guidance and point out where important uncertainty or controversy exists.
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Disaster Med Public Health Prep · Feb 2015
The Ebola threat: China's response to the West African epidemic and national development of prevention and control policies and infrastructure.
There is growing concern in West Africa about the spread of the Ebola hemorrhagic fever virus. With the increasing global public health risk, a coordinated international response is necessary. The Chinese government is prepared to work in collaboration with West African countries to assist in the containment and control of the epidemic through the contribution of medical expertise and mobile laboratory testing teams. Nationally, China is implementing prevention programs in major cities and provinces, the distribution of Ebola test kits, and the deployment of a new national Ebola research laboratory.
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Disaster Med Public Health Prep · Feb 2015
Favipiravir: a new medication for the Ebola virus disease pandemic.
The purpose of this report is to advocate speedy approval and less stringent regulations for the use of experimental drugs such as favipiravir in emergencies. Favipiravir is a new antiviral medication that can be used in emerging viral pandemics such as Ebola virus, 2009 pandemic influenza H1N1 virus, Lassa fever, and Argentine hemorrhagic fever. Although favipiravir is one of the choices for the treatment of patients with Ebola virus, several concerns exist. ⋯ Second, favipiravir has a risk for teratogenicity and embryotoxicity. Therefore, the Ministry of Health, Welfare and Labor of Japan has approved this medication with strict regulations for its production and clinical use. However, owing to the emerging Ebola virus epidemic in West Africa, on August 15, 2014, the Minister of Health, Welfare and Labor of Japan approved the use of favipiravir, if needed.