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Ebola/VHF
Topic Collection
November 5, 2019

Topic Collection: Ebola/VHF

The world watched as the 2014-2016 Ebola outbreak in West Africa exceeded the scope of previous outbreaks, killed and sickened thousands, overwhelmed health systems, and highlighted international gaps in infectious disease preparedness and response. For the first time, patients with Ebola were treated in American facilities, and we also saw the first secondary cases of Ebola in the U.S. (from a critically ill patient to two healthcare providers). The U.S. public health and healthcare systems mobilized quickly by conducting research, gathering promising practices, and drafting guidance for first responders, healthcare providers, and other stakeholders involved in screening, transporting, treating patients, and handling decontamination and waste management. Many healthcare facilities updated their plans with guidance as it was released, and pharmaceutical firms raced to create and test vaccines and specific therapies. The following resources highlight selected recent case studies, lessons learned, tools, and promising practices for planning for and responding to Ebola and viral hemorrhagic fever outbreaks.

Each resource in this Topic Collection is placed into one or more of the following categories (click on the category name to be taken directly to that set of resources). Resources marked with an asterisk (*) appear in more than one category.

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Ansumana, R., Jacobsen, K., Idris, M., et al. (2015). Ebola in Freetown Area, Sierra Leone A Case Study of 581 Patients. The New England Journal of Medicine. 372:587-588.
In this letter to the editor, the authors list treatment protocols used with patients who were admitted to an Ebola treatment center near Freetown, Sierra Leone, on or after September 20, 2014 (the date on which the first patients were admitted to that center). This center saw a 31% case fatality rate, lower than that of other studies.
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Beeching, N., Fenech, M., and Houlihan, C. (2014). Ebola Virus Disease. The British Medical Journal. 349.
In this article, the authors explain what causes Ebola, the disease’s pathophysiology, how to determine people at risk, infection control and prevention measures, symptoms, management, and recovery.
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Centers for Disease Control and Prevention. (n.d.). Ebola Virus Disease (Ebola) Algorithm for Evaluation of the Returned Traveler. (Accessed 7/5/2019.)
Healthcare professionals can follow the steps in this infographic to evaluate travelers returning from countries with widespread Ebola transmission.
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Centers for Disease Control and Prevention. (2018). Infection Prevention and Control Recommendations for Hospitalized Patients Under Investigation (PUIs) for Ebola Virus Disease (EVD) in U.S. Hospitals.
This webpage provides guidance for healthcare professionals regarding standard, contact, and droplet precautions when caring for an individual with suspected or confirmed Ebola.
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Centers for Disease Control and Prevention. (2018). Interim Guidance for U.S. Hospital Preparedness for Patients Under Investigation (PUIs) or with Confirmed Ebola Virus Disease (EVD): A Framework for a Tiered Approach.
This webpage provides guidance for state and local health department staff and those who work in emergency care settings regarding developing preparedness plans for patients who are under investigation for or with confirmed Ebola.
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Emory Healthcare (2014). Emory Healthcare Ebola Preparedness Protocols. (Requires registration.)
This website was designed to house protocols developed by Emory Healthcare, which are based on lessons learned from treating patients with Ebola. Materials are grouped in the following categories: triage and risk assessment, inpatient care, support documents, videos, presentations, and appendices. Information on treatment, hospitals and clinics, patients and visitors, and information for physicians are also available.
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Fairley, J., Kozarsky, P., Kraft, C., et al. (2016). Ebola or Not? Evaluating the Ill Traveler from Ebola-Affected Countries in West Africa. Open Forum Infectious Diseases. 3(1).
The authors describe the triage and evaluation of 25 travelers meeting the Centers for Disease Control and Prevention's case definition of a person under investigation at an emergency department, outpatient tropical medicine clinic, or Ebola treatment center. None had Ebola virus disease. The authors emphasize the importance of attention to infection control and considering other life-threatening conditions requiring urgent treatment, influenza vaccination, and other preventive measures for travelers.
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Madad, S., Cagliuso, N., Studer, S., and Dierberg, K. (2019). Special Pathogen Preparedness Webinar. NYC Health + Hospitals.
The Greater New York Hospital Association and NYC Health + Hospitals hosted this webinar where speakers: discussed the current (2019) Ebola outbreak and other special pathogens; highlighted planning guidance for the provision of initial care, and for decision-making regarding patient transfers for additional treatment; and shared information on additional considerations (e.g., pediatric patients, managing visitors and loved ones, and healthcare worker safety). The speakers also provided information on related training opportunities.
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Smith, C., Hughes, S., Karwowski, M., et al. (2015). Addressing Needs of Contacts of Ebola Patients During an Investigation of an Ebola Cluster in the United States - Dallas, Texas, 2014. MMWR Morbidity and Mortality Weekly Report. 64(5):121-123.
In this report, the authors discuss the importance of anticipating the nonclinical needs of those under public health surveillance (e.g., concerns about housing, transportation, education, employment, food, and other household needs). The report also stresses the importance of ensuring these types of support are addressed so that residents will be more likely to comply with quarantine orders, and the utility of community collaboration (with partners such as businesses, schools, community and faith-based organizations, and social services).
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Smith, P., Anderson, A., Christopher, G., et al. (2006). Designing a Biocontainment Unit to Care for Patients with Serious Communicable Diseases: A Consensus Statement. Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science. 4(4).
The authors synthesized consensus recommendations collected from a conference of civilian and military professionals who are involved in the various aspects of biocontainment patient care units. Appendices include in-depth information on medical care issues (e.g., staffing the units, pathology, housekeeping), infection control issues (e.g., personal protective equipment, dealing with infectious waste), facility issues (e.g., air-handling, communication), and psychosocial and ethical issues.
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Sterk, E. (2008). Filovirus Haemorrhagic Fever Guideline. Medecins Sans Frontieres.
These guidelines serve as a summary of the Medecins Sans Frontieres Ebola & Marburg Outbreak Control Guidance Manual. The author provides an overview of all intervention strategy components deemed necessary during a Medecins Sans Frontieres intervention in both types of outbreaks.
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U.S. Department of Health and Human Services Office of Inspector General. (2018). Hospitals Reported Improved Preparedness for Emerging Infectious Diseases After the Ebola Outbreak.
The Office of Inspector General conducted a nationwide, online survey of 368 hospitals followed by 40 interviews to determine whether actions taken to respond to the Ebola outbreak improved their preparedness for emerging infectious diseases. They found that 86% of hospitals reported they were prepared to receive an emerging infectious disease patient compared to only 29% in 2014. However, hospitals also reported challenges in sustaining their preparedness over time and balancing the need to prepare for emerging infectious diseases with other hazards.
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World Health Organization. (2017). Ebola Response – Key Technical Documents.
This one-pager lists and includes links to key technical documents to support the response to an Ebola outbreak. Included categories are: Strategy and Coordination; Surveillance, Contact Tracing and Laboratory; Case Management and Infection Prevention and Control; Vaccines; Community Engagement, Social Mobilization and Communication; Therapeutics; Safe and Dignified Burials; Travel and Points of Entry; and Training.
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Assessing and Testing

Association of Public Health Laboratories. (2014). Template for Public Health Laboratory Risk Assessment for Ebola Virus Disease (EVD) Testing.
Laboratory staff can download and tailor this template to meet their requirements. It includes comprehensive information on using enhanced precautions and personal protective equipment when handling high-risk Ebola specimens.
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Brainard, J., Pond, K., Hopper, L., et al. (2016). Presence and Persistence of Ebola or Marburg Virus in Patients and Survivors: A Rapid Systematic Review. PLoS Neglected Tropical Diseases. 10(2):e0004475.
In this study, the authors review and summarize 33 studies that examined evidence of presence and persistence of infectious virus in various body fluids compared to onset of Ebola or Marburg illness. Research consistently showed high viral loads in blood during illness, but rarely later than 16 days after illness onset. Filovirus was also found in non-blood body fluids of actively ill patients, but rarely found in survivors, with the exception of semen, which tested positive as late as 203 days after onset of illness.
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Centers for Disease Control and Prevention. (2016). Frequently Asked Questions on Screening for Ebola Virus Disease for Providers, Healthcare Facilities and Health Departments.
This webpage answers frequently asked questions on Ebola virus disease screening.
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Centers for Disease Control and Prevention. (2018). Guidance for Collection, Transport and Submission of Specimens for Ebola Virus Testing.
This guidance, synthesized by the Centers for Disease Control and Prevention, is intended to help laboratory workers safely collect, transport, and submit specimens for Ebola virus testing.
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Centers for Disease Control and Prevention. (2018). Guidance for U.S. Laboratories for Managing and Testing Routine Clinical Specimens When There is a Concern about Ebola Virus Disease.
This guidance is geared toward clinicians who are responsible for managing and testing clinical specimens for Ebola. Guidance covers the use of personal protective equipment, laboratory equipment, patient transport, decontamination, and other related topics.
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* Fairley, J., Kozarsky, P., Kraft, C., et al. (2016). Ebola or Not? Evaluating the Ill Traveler from Ebola-Affected Countries in West Africa. Open Forum Infectious Diseases. 3(1).
The authors describe the triage and evaluation of 25 travelers meeting the Centers for Disease Control and Prevention's case definition of a person under investigation at an emergency department, outpatient tropical medicine clinic, or Ebola treatment center. None had Ebola virus disease. The authors emphasize the importance of attention to infection control and considering other life-threatening conditions requiring urgent treatment, influenza vaccination, and other preventive measures for travelers.
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* Hill, C., Burd, E., Kraft, C., et al. (2014). Laboratory Test Support for Ebola Patients Within a High-Containment Facility. Laboratory Medicine. 45(3):e109-e111.
The authors (from Emory University) share the story of two U.S. nationals who contracted the Ebola virus while working in Africa. They list the instruments used to provide core assays and how they were used in the isolation facility.
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Iwen, P., Garrett, J., Gibbs, S., et al. (2014). An Integrated Approach to Laboratory Testing for Patients with Ebola Virus Disease. Laboratory Medicine. 45(4):e146-151.
This article describes the evolution of the Nebraska Medical Center's approach to laboratory testing in conjunction with its biocontainment unit, including adjustments made following the arrival of its first patient with Ebola virus disease.
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James, A., Todd, S., Pollak, N., et al. (2018). Ebolavirus Diagnosis Made Simple, Comparable and Faster than Molecular Detection Methods: Preparing for the Future. Virology Journal. 15(75).
The authors developed a rapid assay for detection of Ebola using recombinase polymerase amplification. They found their assay to be comparable to RT-PCR-based assays, with the same detection limit as PCR and highly specific for Ebola Zaire. They suggest the assay could be useful in low-resource settings lacking capacity for RT-PCR.
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* Madad, S., Cagliuso, N., Studer, S., and Dierberg, K. (2019). Special Pathogen Preparedness Webinar. NYC Health + Hospitals.
The Greater New York Hospital Association and NYC Health + Hospitals hosted this webinar where speakers: discussed the current (2019) Ebola outbreak and other special pathogens; highlighted planning guidance for the provision of initial care, and for decision-making regarding patient transfers for additional treatment; and shared information on additional considerations (e.g., pediatric patients, managing visitors and loved ones, and healthcare worker safety). The speakers also provided information on related training opportunities.
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Oza, S., Sesay, A., Russell, N., et al. (2017). Symptom- and Laboratory-Based Ebola Risk Scores to Differentiate Likely Ebola Infections. Emerging Infectious Diseases. 23(11):1792-99.
The authors reviewed retrospective data from both positive and negative Ebola patients in Sierra Leone to develop two risk scores on the likelihood of Ebola infection among patients with suspected or confirmed Ebola virus disease. The Ebola symptom-based risk (ESR) score was based on headache, diarrhea, difficulty breathing, nausea/vomiting, loss of appetite, and conjunctivitis. If available, laboratory test results for alanine transaminase, creatine kinase, creatinine, and total bilirubin were added to the ESR score to calculate the Ebola symptom- and laboratory-based (ESLR) score. Among suspected patients who tested positive for Ebola virus disease, the ESR score categorized more than 70% and the ESLR score categorized more than 90% as high risk. The risk scores may be useful in separating patients who meet the case definition by their likeliness of infection and implementing greater protections and directing more resources to those with higher risk scores while awaiting laboratory confirmation of disease.
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Southern, T., Racsa, L., Albarino, C., et al. (2015). Comparison of FilmArray and Quantitative Real-Time Reverse Transcriptase PCR for Detection of Zaire Ebolavirus from Contrived and Clinical Specimens. Journal of Clinical Microbiology. 53(9):2956-2960.
This study finds that emergency use authorization FilmArray panels are effective for detecting Ebola virus disease.
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Wadman, M., Schwedhelm, S., Watson, S., et al. (2015). Emergency Department Processes for the Evaluation and Management of Persons Under Investigation for Ebola Virus Disease. (Abstract only.) Annals of Emergency Medicine. 66(3):306-314.
This article describes testing procedures that can be used by emergency departments and clinics to evaluate persons under investigation for Ebola virus disease.
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Clinical Care

Ansumana, R., Jacobsen, K., Idris, M., et al. (2015). Ebola in Freetown Area, Sierra Leone A Case Study of 581 Patients. The New England Journal of Medicine. 372:587-588.
In this letter to the editor, the authors list treatment protocols used with patients who were admitted to an Ebola treatment center near Freetown, Sierra Leone, on or after September 20, 2014 (the date on which the first patients were admitted to that center). This center saw a 31% case fatality rate, lower than that of other studies.
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ASPR TRACIE. (2017). Step Care for Ebola/Viral Hemorrhagic Fever Patients: Guidance for International Field Hospitals. U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response.
This document is intended to help organizations who want to provide care for Ebola virus disease (EVD)/viral hemorrhagic fever (VHF) patients determine an appropriate level of medical care that they can provide and anticipate the supplies that may be needed. This guidance may be applicable to other diseases where dehydration and electrolyte imbalance are key contributors to mortality.
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Centers for Disease Control and Prevention. (2018). Interim Guidance for Management of Survivors of Ebola Virus Disease in U.S. Healthcare Settings.
This document provides guidance on sequelae and Ebola virus persistence in survivors and infection control recommendations for healthcare workers evaluating them.
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Centers for Disease Control and Prevention. (2018). Recommendations for Safely Performing Acute Hemodialysis in Patients with Ebola Virus Disease (EVD) in U.S. Hospitals.
The Centers for Disease Control and Prevention provide this guidance for individuals performing renal replacement therapy in patients with Ebola.
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* Connor, M., Kraft, C., Mehta, A., et al. (2015). Successful Delivery of RRT in Ebola Virus Disease. Journal of the American Society of Nephrology. 26(1):31-37.
The authors describe the first successful delivery of renal replacement therapy to an Ebola patient and offer safety considerations and clinical practice guidelines based on the experience.
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* Eriksson, C., Uyeki, T., Christian, M., et al. (2015). Care of the Child with Ebola Virus Disease. Pediatric Critical Care Medicine. 16(2):97-103.
The authors discuss considerations for the care of children with Ebola virus disease. They emphasize infection control practices to limit disease spread, and supportive care to treat patients.
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* Fairley, J., Kozarsky, P., Kraft, C., et al. (2016). Ebola or Not? Evaluating the Ill Traveler from Ebola-Affected Countries in West Africa. Open Forum Infectious Diseases. 3(1).
The authors describe the triage and evaluation of 25 travelers meeting the Centers for Disease Control and Prevention's case definition of a person under investigation at an emergency department, outpatient tropical medicine clinic, or Ebola treatment center. None had Ebola virus disease. The authors emphasize the importance of attention to infection control and considering other life-threatening conditions requiring urgent treatment, influenza vaccination, and other preventive measures for travelers.
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* Hill, C., Burd, E., Kraft, C., et al. (2014). Laboratory Test Support for Ebola Patients Within a High-Containment Facility. Laboratory Medicine. 45(3):e109-e111.
The authors (from Emory University) share the story of two U.S. nationals who contracted the Ebola virus while working in Africa. They list the instruments used to provide core assays and how they were used in the isolation facility.
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Kreuels, B., Wichmann D., Emmerich P., et al. (2014). A Case of Severe Ebola Virus Infection Complicated by Gram-Negative Septicemia. (Account required.) The New England Journal of Medicine. 371:2394-2401.
The authors describe the treatment of a patient who contracted Ebola (and multi-drug resistant, gram-negative sepsis) while working for the World Health Organization in Sierra Leone. The article provides a table that details the patient’s clinical variables (e.g., temperature and heart rate), fluid measurements (e.g., intravenous, diarrhea, urine), and laboratory values (e.g., hemoglobin, white cells, sodium) from days 10 through 27 of the patient’s illness.
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* Lamontagne, F., Fowler, R., Adhikari, N., et al. (2017). Evidence-Based Guidelines for Supportive Care of Patients with Ebola Virus Disease. The Lancet. 391(10121):700-708.
These evidence-based guidelines developed by a 34 member expert panel provide recommendations on the delivery of supportive care for patients in treatment units during a future Ebola outbreak. The panel used the Grading of Recommendations Assessment, Development, and Evaluation methodology to develop 8 clinical recommendations on oral rehydration, parenteral administration of fluids, systematic monitoring and charting of vital signs and volume status, serum biochemistry, staffing ratio, communication with family and friends, analgesic therapy, and antibiotics.
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Lyon, G., Mehta, A., Varkey, J., et al. (2014). Clinical Care of Two Patients with Ebola Virus Disease in the United States. The New England Journal of Medicine. 371:2402-2409.
The authors (from Emory University) present two case reports on two U.S. citizens who contracted the Ebola virus while working in Liberia. Line graphs detail laboratory values in both patients as they received ZMapp, an experimental treatment.
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* Madad, S., Cagliuso, N., Studer, S., and Dierberg, K. (2019). Special Pathogen Preparedness Webinar. NYC Health + Hospitals.
The Greater New York Hospital Association and NYC Health + Hospitals hosted this webinar where speakers: discussed the current (2019) Ebola outbreak and other special pathogens; highlighted planning guidance for the provision of initial care, and for decision-making regarding patient transfers for additional treatment; and shared information on additional considerations (e.g., pediatric patients, managing visitors and loved ones, and healthcare worker safety). The speakers also provided information on related training opportunities.
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Maganga, G., Kapetshi, J., Berthet, N., et al. (2014). Ebola Virus Disease in the Democratic Republic of Congo. The New England Journal of Medicine. 371:2083-2091.
This article highlights the authors’ studies of patients from July to October 2014 as they examined whether the outbreak in the Democratic Republic of Congo was related to the outbreak in West Africa.
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Moole, H., Chitta, S., Victor, D., et al. (2015). Association of Clinical Signs and Symptoms of Ebola Viral Disease with Case Fatality: A Systematic Review and Meta-Analysis. Journal of Community Hospital Internal Medicine Perspectives. 5(4).
The authors completed a meta-analysis of articles from 1976 to November 2014 describing the clinical features of Ebola virus disease and identify the following signs and symptoms that may be associated with higher mortality: bleeding, vomiting, diarrhea, abdominal pain, cough, sore throat, and conjunctivitis.
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Schieffelin, J., Shaffer, J., Goba, A., et al. (2014). Clinical Illness and Outcomes in Patients with Ebola in Sierra Leone. The New England Journal of Medicine. 371:2092-2100.
The authors provide a summary of clinical features and outcomes of Ebola patient care in the early phase of the response in Sierra Leone.
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Smith, P., Boulter, K., Hewlett, A., et al. (2015). Planning and Response to Ebola Virus Disease: An Integrated Approach. (Abstract only.) American Journal of Infection Control. 43(5):441-446.
Like any hazard, the response to Ebola calls for complex tasks to be carried out by people with specific skills. The authors describe a variation of incident command as a framework for providing Ebola virus disease patient care.
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* Sterk, E. (2008). Filovirus Haemorrhagic Fever Guideline. Medecins Sans Frontieres.
These guidelines serve as a summary of the Medecins Sans Frontieres Ebola & Marburg Outbreak Control Guidance Manual. The author provides an overview of all intervention strategy components deemed necessary during a Medecins Sans Frontieres intervention in both types of outbreaks.
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* Sueblinvong, V., Johnson, D., Weinstein, G., et al. (2015). Critical Care for Multiple Organ Failure Secondary to Ebola Virus Disease in the United States. Critical Care Medicine. 43(10):2066-2075.
The authors describe three Ebola patients with severe critical illness and secondary multiple organ failure. Two of the three patients died, showing that mortality rates may be high even with aggressive care among those with multiple organ failure.
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Tiffany, A., Vetter, P., Mattia, J., et al. (2016). Ebola Virus Disease Complications as Experienced by Survivors in Sierra Leone. Clinical Infectious Diseases. 62(11):1360-1366.
This research study confirms post-Ebola virus disease complications seen in previous outbreaks and recommends follow-up care begin during hospitalization and immediately following discharge to detect and treat complications before they cause long-term disability.
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Uyeki, T., Mehta, A., Davey, R., et al. (2016). Clinical Management of Ebola Virus Disease in the United States and Europe. New England Journal of Medicine. 374:636-646.
The authors review 27 Ebola virus disease patients treated in the United States or Europe, describing patient characteristics, clinical and laboratory findings, supportive clinical care, investigational therapies, results from virologic and immunologic examination, and outcomes.
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Vetter, P., Kaiser, L., Schibler, M., et al. (2016). Sequelae of Ebola Virus Disease: The Emergency Within the Emergency. The Lancet Infectious Diseases. 16(6):e82-e91.
The authors discuss current knowledge of Ebola virus disease sequelae, challenges to provision of care to survivors, and areas for future research.
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World Health Organization. (2016). Clinical Care for Survivors of Ebola Virus Disease: Interim Guidance.
This document is intended to provide guidance to primary care providers of those who have recovered from Ebola virus disease. Topics include planning for follow-up care, recommended evaluation and clinical management of common sequelae, considerations for children and pregnant women, monitoring for persistent infection, infection prevention and control, and risk communication.
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Decontamination and Waste Management

Centers for Disease Control and Prevention. (2019). Ebola-Associated Waste Management.
The information provided in this webpage is intended to help healthcare providers and facility staff safely handle, transport, and dispose of waste associated with the care of patients with suspected or confirmed Ebola virus disease.
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Fischer, R., Judson, S. Miazgowicz, K., et al. (2015). Ebola Virus Stability on Surfaces and in Fluids in Simulated Outbreak Environments. Emerging Infectious Diseases. 21(7):1243-1246.
The authors simulated environmental conditions and found that the Ebola virus remains active for a longer time on hospital surfaces than it does in African conditions. The virus also lives longer in liquid than it does in dried blood.
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Jelden, K., Gibbs, S., Smith, P., et al. (2015). Nebraska Biocontainment Unit Patient Discharge and Environmental Contamination after Ebola Care. (Abstract only.) American Journal of Infection Control. 43(3):203-205.
The authors describe the decontamination protocols to be taken by the staff at the Nebraska Biocontainment Unit in the event of the following: when a patient treated for Ebola is discharged, when a body of a patient with Ebola is removed, and when environmental decontamination of the isolation unit is required.
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Krishnan, J., Berry, J., Fey, G., and Wagener, S. (2006). Vaporized Hydrogen Peroxide-based Biodecontamination of a High-Containment Laboratory under Negative Pressure. Applied Biosafety. 11(2):74-80.
The authors examine the efficacy of vaporized hydrogen peroxide (VHP) as a formaldehyde alternative for decontaminating space in a containment level 3 laboratory suite. They found that VHP can be used (under negative pressure) to safely biodecontaminate a laboratory.
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Lowe, J., Gibbs, S., Schwedhelm, S. et al. (2014). Nebraska Biocontainment Unit Perspective on Disposal of Ebola Medical Waste. (Abstract only.) American Journal of Infection Control. 42(12):1256-1257.
The authors describe Ebola medical waste processing requirements and their impact on U.S. hospitals.
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Lowe, J., Hewlett, A., Iwen, P., et al. (2015). Surrogate Testing Suggests that Chlorine Dioxide Gas Exposure Would Not Inactivate Ebola Virus Contained in Environmental Blood Contamination. (Abstract only.) Journal of Occupational and Environmental Hygiene. 12(9):D211-215.
This study finds that decontamination with Chlorine Dioxide must be preceded by manually wiping down surfaces potentially contaminated by blood to inactivate bacteria present in blood.
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U.S. Army Medical Department, U.S. Army Public Health Command. (2014). Decontamination of Vehicles Used for Transportation of Potential Ebola Virus Disease (EVD) Patients or Related Equipment.
The authors provide guidance for decontaminating vehicles used to transport equipment or personnel in an Area of Operations impacted by Ebola.
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U.S. Army Medical Department, U.S. Army Public Health Command. (2014). Preparing and Measuring High Chlorine Concentration Solutions for Disinfection.
This “Technical Information Paper” shares specific measurements and contact time to achieve disinfection when using chlorine solution to disinfect surfaces contaminated with diseases including Ebola.
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U.S. Department of Labor, Occupational Safety and Health Administration. (2016). Cleaning and Decontamination of Ebola on Surfaces: Guidance for Workers and Employers in Non-Healthcare/Non-Laboratory Settings.
This factsheet provides guidance on Ebola cleaning and decontamination procedures for those who work in non-healthcare and non-laboratory settings. Links to information on disinfectants, waste disposal, and personal protective equipment are provided throughout the document.
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U.S. Department of Labor, Occupational Safety and Health Administration, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, and Environmental Protection Agency. (2016). Safe Handling, Treatment, Transport and Disposal of Ebola-Contaminated Waste.
This fact sheet provides a step-by-step summary of actions workers should take from the point Ebola-contaminated waste is generated through final disposal.
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U.S. Department of Transportation, Pipeline and Hazardous Materials Safety Administration. (2014). Procedural Guidance on the Proper Packaging of Ebola Suspected Waste.
This document includes general information on transporting Ebola-contaminated waste and links to related Department of Transportation guidance.
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U.S. Environmental Protection Agency. (2018). Disinfectants for Use Against the Ebola Virus.
The Environmental Protection Agency lists products that meet the Centers for Disease Control and Prevention’s criteria for use against the Ebola virus on hard, non-porous surfaces. Products are listed by name and indicate whether they are approved for use in hospital/healthcare facilities, institutions such as schools and offices, and residences.
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Various Federal Agencies. (2019). Managing Solid Waste Contaminated with a Category A Infectious Substance.
Based on extensive federal interagency coordination and stakeholder input, the guidance in this document can help those who work in healthcare facilities, medical transportation operations, and laboratories better understand infectious waste and how to manage it.
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Various Federal Agencies. (2019). Managing Solid Waste Contaminated with a Category A Infectious Substance: Summary.
This is a summary of a guidance document based on extensive federal interagency coordination and stakeholder input and designed to help those who work in healthcare facilities, medical transportation operations, and laboratories better understand infectious waste and how to manage it. Access the full report at https://www.phmsa.dot.gov/sites/phmsa.dot.gov/files/docs/transporting-infectious-substances/6821/cat-waste-planning-guidance-final-2019-08.pdf.
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Education and Training

ASPR TRACIE and NETEC. (2017). Highly Pathogenic Infectious Disease Exercise Planning for Health Care Coalitions.
The speakers in this webinar discussed exercise templates designed to help manage patients with highly pathogenic infectious diseases; explained how exercises support ASPR's regional, tiered approach; and shared their experiences planning and executing exercises for Ebola and other special pathogens.
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ASPR TRACIE and NETEC. (2017). Highly Pathogenic Infectious Disease Exercise Planning Tools.
Speakers share information on HSEEP-compliant exercise templates that test readiness for highly pathogenic infectious disease patients, and highlight how these exercises support ASPR’s regional, tiered approach and address unique challenges and situations.
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ASPR TRACIE and NETEC. (2018). Healthcare System Readiness for Highly Pathogenic Infectious Diseases.
In this joint NETEC-ASPR TRACIE webinar, speakers provided an overview of the current situation in the DRC; described the regional, tiered system established to manage patients suspected and known to be infected with EVD or other special pathogens; provided updates on current Ebola readiness and trends; reinforced the “Identify, Isolate, and Inform” response framework; and shared best practices and lessons learned from previous experience.
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Centers for Disease Control and Prevention. (n.d.). Ebola Virus Disease (Ebola) Algorithm for Evaluation of the Returned Traveler. (Accessed 7/5/2019.)
Healthcare professionals can follow the steps in this infographic to evaluate travelers returning from countries with widespread Ebola transmission.
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Centers for Disease Control and Prevention. (n.d.). Preparing Healthcare Workers to Work in Ebola Treatment Units (ETUs) in Africa: Training Toolkit. (Accessed 1/13/2020.)
This downloadable or hard copy training toolkit replaces the Centers for Disease Control and Prevention’s three-day, in-person training course for healthcare workers planning to work in Ebola Treatment Units in Africa. The course uses lectures, tabletop exercises, and hands-on interactive exercises to teach effective infection prevention and control before they receive additional follow-up training prior to deployment.
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City of St. Louis Department of Public Health. (n.d.). Ebola, Emerging, and Highly Infectious Diseases Portal. (Accessed 1/10/2020.)
This e-learning portal provides workforce education and training resources for clinicians and public health professionals. The portal includes links to a variety of training courses, resource documents, links to key governmental and non-governmental organizations, and conference materials.
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Department of Emergency Health Services. (n.d.). Emerging Infectious Diseases Videos for Prehospital Providers. (Accessed 1/9/2020.) University of Maryland Baltimore County.
This instructional series, comprised of nine modules, includes an introduction to infectious diseases, basic infection control concepts, considerations for personal protective equipment (including donning and doffing), personnel decontamination, patient transport, and transfer of patient care for patients with Ebola and other highly infectious diseases.
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* European Union, European Centre for Disease Prevention and Control. (2014). Safe Use of Personal Protective Equipment in the Treatment of Infectious Diseases of High Consequence: A Tutorial for Trainers in Healthcare Settings.
This training program provides information on the proper use of personal protective equipment at the point of care and shares information on procurement, preparedness, and capacity building.
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Evans, D. and del Rio, C. (n.d.). Ebola Virus Disease: An Evolving Epidemic. (Accessed 1/10/2020.) Emory University.
This online course provides an overview of various aspects of the Ebola epidemic.
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Federal Emergency Management Agency. (2015). Ebola Virus Disease Regional Network Coordination Table Top Exercise.
This exercise can help participants plan for coordinated transport of a person diagnosed with Ebola virus disease, between and within states, to the Regional Ebola Treatment Center in Texas.
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Federal Emergency Management Agency. (2015). TALON Ebola Preparedness Tabletop Exercise: Situation Manual.
This situation manual was developed for participants of the Ebola Virus Disease Regional Network Table Top Exercise. It includes scenarios and related questions, and several appendices, including links to helpful resources.
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* Gabriel, E., Randolph, J., Levy, D., et al. (2014). Ebola Preparedness for Emergency Medical Services. U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response.
This 55-minute webinar features speakers from the U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response, and Centers for Disease Control and Prevention. The presenters discuss the Detailed Emergency Medical Services Checklist for Ebola Preparedness, which highlights activities that EMS agencies and systems should consider to prepare for managing patients with Ebola and other infectious diseases.
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Love, C., Arneson, S., and Phillips, S. (2015). Ebola Outbreak Response: The Role of Information Resources and the National Library of Medicine. Disaster Medicine and Public Health Preparedness. 9(1):82-85.
The authors explain the functionality of the National Library of Medicine, and how it works with publishers to provide free access to many full-text articles from over 650 biomedical journals and 4,000 online reference books through the Emergency Access Initiative. They also highlight the “Ebola Outbreak 2014: Information Resources” webpage.
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* MESH Coalition. (2016). An Exercise in the Provision of Care for an Adult Patient under Investigation (PUI) for Ebola: A Patient Care Drill.
This simulation toolkit provides a situation overview, general information, simulation logistics, post-simulation and evaluation activities, and participant information and guidance along with appendices containing templates and forms for hospitals to test their established protocols for the provision of care to a patient with a suspect highly infectious disease. Multiple injects such as vomiting encourage testing a range of different procedures through the exercise.
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* Stout, T. and Garza, A. (2015). Emergency Medical Services (EMS) and Ebola. International Society for Disease Surveillance.
This one-hour webinar discusses how emergency medical services (EMS) in the U.S. and Canada responded to the threat of Ebola. It focuses on two main areas affecting EMS providers and their public health partners: EMS agency Ebola information sharing and best practices development, and EMS data surveillance approaches.
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Tennessee Department of Health. (2015). Ebola Virus Disease: TDH EVD Tabletop Exercise Situation Manual for Healthcare.
This PowerPoint presentation can be used by planners who are interested in carrying out tabletop exercises to bolster healthcare preparedness for infectious disease outbreaks. This particular exercise focuses on Ebola and begins with a scenario of a 23 year-old male reporting to the emergency department with a variety of symptoms.
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* The University of Nebraska Medical Center. (n.d.). HEROES Webpage. (Accessed 1/10/2020.)
The videos on this webpage feature step-by-step demonstrations of the doffing and donning of personal protective equipment (PPE), testing of powered air purifying respirator-level PPE, and the assembly and use of body sealers and ISOPODs.
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* U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2018). Exercise: Tranquil Terminus.
Safely moving patients with highly infectious diseases, like Ebola, to regional treatment centers takes teamwork, preparation, skill and training. Tranquil Terminus, the largest patient movement exercise in U.S. Department of Health and Human Services’ history, tested the nationwide ability to move patients with highly infectious diseases safely and securely to regional treatment centers.
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U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response, and the Centers for Disease Control and Prevention. (2014). Ebola Training Webinar for Healthcare Coalitions and Healthcare Workers.
This webinar presents lessons learned and other best practices for healthcare workers and coalitions as a result of the Ebola epidemic.
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University of Nebraska Medical Center. (n.d.). The Nebraska Ebola Method - For General Public. (Available only through iTunes.) (Accessed 1/13/2020.)
This course offers eight lessons geared toward educating the general public about the Ebola virus. The podcast summarizes Ebola issues, and the other lessons cover the medical center’s biocontainment unit, and provide information for children/families.
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West Virginia Hospital Association. (n.d.). Be Smart, Take Part – Emerging Infectious Disease Preparedness and Response for Frontline Healthcare Facilities. (Accessed 1/13/2020.)
This training program includes a training guide video for people or groups who may come in contact with an individual with a possible infectious disease. It also includes a free, downloadable, Homeland Security Exercise and Evaluation Program-compliant, no-notice drill template for frontline healthcare facilities. Upon registration, West Virginia providers may also access eight brief online courses to reinforce and test the concepts introduced in the training guide video.
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Emergency Medical Services

ASPR TRACIE. (2017). EMS Infectious Disease Playbook. U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response.
This playbook synthesizes multiple sources of information in a single planning document addressing the full spectrum of infectious agents to create a concise reference resource for emergency medical services (EMS) agencies developing their service policies. The information can be incorporated into agency standard operating procedures and reviewed by the EMS medical director.
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  • Tracy Miller Is there any way to order a printed and bound version?
    8/9/2018 5:16:09 PM
* Bratt, J., Robinson, A., and Alcorta, R. (n.d.). Strategies and Considerations for the Deployment of EMS Personal Protective Equipment in Response to an Ebola Outbreak. (Accessed 1/10/2020.) Maryland Institute for Emergency Medical Service Systems.
This article describes protection of emergency medical services personnel through personal protective equipment (PPE), including requirements, PPE cost (and how to estimate it), PPE deployment strategies, and personnel requirements.
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* Centers for Disease Control and Prevention (2018). Q&A's about the Transport of Pediatric Patients (< 18 years of age) Under Investigation or with Confirmed Ebola.
This webpage is intended to provide first responders with information to help protect themselves, younger patients, and patients’ family members by answering the most frequently asked questions.
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* Gabriel, E., Randolph, J., Levy, D., et al. (2014). Ebola Preparedness for Emergency Medical Services. U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response.
This 55-minute webinar features speakers from the U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response, and Centers for Disease Control and Prevention. The presenters discuss the Detailed Emergency Medical Services Checklist for Ebola Preparedness, which highlights activities that EMS agencies and systems should consider to prepare for managing patients with Ebola and other infectious diseases.
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InterAgency Board for Equipment Standardization and Interoperability. (2014). Recommendations on Selection and Use of Personal Protective Equipment for First Responders against Ebola Exposure Hazards.
The InterAgency Board for Equipment Standardization and Interoperability reviewed current U.S. government guidance related to personal protective equipment (PPE) in order to develop recommendations for first responders on PPE selection and decontamination. The recommendations include descriptions of PPE items for high and low risk exposures and detailed specifications/standards for recommended PPE.
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Lowe, J., Jelden, K., Schenarts, P., et al. (2014). Considerations for Safe EMS Transport of Patients Infected with Ebola Virus. (Abstract only.) Prehospital Emergency Care. 19(2):179-183.
The authors discuss the coordinated response between the Nebraska Biocontainment Unit (through the Nebraska Medical Center in Omaha) and Omaha Fire Department's EMS to transport patients with confirmed Ebola virus from West Africa from the airport to the high-level isolation unit. Three critical areas have been identified from their experience and are addressed in this article: ambulance preparation, appropriate selection and use of personal protective equipment, and environmental decontamination.
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* National Association of State EMS Officials. (2015). NASEMSO After Action Review: Lessons Learned, Best Practices and Recommendations - Ebola Disease Outbreak.
NASEMSO's Domestic Preparedness Committee prepared this document to highlight critical dates during the Ebola outbreak, provide background information on the disease, describe lessons learned from the response, identify best practices, and recommend actions to federal partners.
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New Hampshire Division of Public Health Services and New Hampshire Bureau of Emergency Medical Services. (2015). Ebola Preparedness for Emergency Medical Services.
This document is intended to provide interim guidance to EMS providers to prepare for a suspect Ebola virus disease patient. It includes information on steps that EMS personnel should take immediately as preventative measures, how to screen suspect cases, how to use personal protective equipment, and steps to take to environmentally clean ambulances and medical equipment.
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New York State Department of Health, and New York State Emergency Medical Services. (2014). Ebola Virus Disease (EVD) In-Service EMS Training Outline.
This document provides information on Ebola (e.g., how it is transmitted, signs and symptoms), and several recommendations to EMS personnel including use of personal protective equipment, cleaning EMS transport vehicles after transporting a patient with suspected or confirmed Ebola, follow-up and/or reporting measures by EMS personnel after caring for a suspected or confirmed Ebola patient, among others.
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* Stout, T. and Garza, A. (2015). Emergency Medical Services (EMS) and Ebola. International Society for Disease Surveillance.
This one-hour webinar discusses how emergency medical services (EMS) in the U.S. and Canada responded to the threat of Ebola. It focuses on two main areas affecting EMS providers and their public health partners: EMS agency Ebola information sharing and best practices development, and EMS data surveillance approaches.
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* U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2018). Exercise: Tranquil Terminus.
Safely moving patients with highly infectious diseases, like Ebola, to regional treatment centers takes teamwork, preparation, skill and training. Tranquil Terminus, the largest patient movement exercise in U.S. Department of Health and Human Services’ history, tested the nationwide ability to move patients with highly infectious diseases safely and securely to regional treatment centers.
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Virginia Department of Health. (n.d.). Ebola Virus Disease (EVD). (Accessed 1/13/2020.)
This webpage highlights guidance and other documents to assist emergency medical services (EMS) providers and agencies in understanding Ebola. It includes links to the plans and guidance of each Regional EMS Council in Virginia.
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Ethics

ASPR TRACIE. (2017). Lessons Learned on Crisis Standards of Care in Kenema.
In this video, Dr. Lewis Rubinson shares his personal experiences treating Ebola patients in Sierra Leone.
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Baker, M. (2015). Ebola Response in West Africa: My Experience. Alabama Department of Public Health.
The speaker for this one-hour, 23 minute video discusses his experience working in West Africa during the 2014-2015 outbreak. He is a pediatric physician, and discusses his experiences, including ethical challenges he experienced in the care of children with Ebola.
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Beca, J., Ndagije, H., Calain, P., et al. (2014). Ethical Considerations for Use of Unregistered Interventions for Ebola Viral Disease: Report of an Advisory Panel to WHO (World Health Organization). World Health Organization.
This report describes a consultation held in August 2014 to study and consider the ethical implications of using unregistered interventions on Ebola patients that have not yet been evaluated for safety and efficacy in humans.
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Bioethics Library at Georgetown University. (n.d.). The Ebola Outbreak: A Global Conversation and Resources. (Accessed 7/5/2019.)
This website includes links to Ebola-specific resources such as blogs, a training module, and organizations with pages or teams dedicated to the disease.
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Brito, A., Klitzman, R., Redlener, I., et al. (2015). Ethical Issues in Responding to a Global Disease Crisis: Ebola and Beyond. Columbia University, Earth Institute, National Center for Disaster Preparedness.
The speakers discuss ethical issues such as resource allocation and the pharmaceutical development process as they relate to Ebola and other global health threats.
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* Cohen, J. and Kupferschmidt, K. (2014). Ebola Vaccine Trials Raise Ethical Issues. Science. 346(6207):289-290.
The authors discuss the ethical concerns associated with having a control group when testing Ebola vaccines.
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Fauci, A.S., Chertow, D., and Wendler, D. (2014). NIH (National Institutes of Health) Clinical Center: Special Grand Rounds: (3) Ethical Issues Raised by the Ebola Crisis.
Starting in the 47th minute of the video, Dr. Wendler gives an overview of the ethical issues associated with the 2014 Ebola outbreak, with a focus on vulnerable individuals and groups.
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Fowler, R., Ogundiran, T., Saxena, A., et al. (2014). Ethics and the 2014 Ebola Outbreak. University of Toronto Joint Centre for Bioethics.
The speakers in this webinar discuss the ethical issues raised by the Ebola outbreak, key considerations that can inform an ethical response to an outbreak, and lessons learned about epidemics and ethics.
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Gutman, A., Wagner, J., Allen, A., et al. (2015). Ethics and Ebola: Public Health Planning and Response. Presidential Commission for the Study of Bioethics.
The authors emphasize that the U.S. must strengthen public health preparedness related to Ebola, including “ethics preparedness.” They also share seven recommendations related to policy and research design.
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Hick, J., Witte, C., Hanfling, D., and Raheem, M. (2018). Crisis Standards of Care-Panel Presentation.
The speakers provide a definition and legal overview of crisis standards of care (CSC), illustrate how the principles of CSC apply to disaster medical care, and share how to apply CSC into emergency planning. An overview of ethics and disaster response is also included, as are lessons learned from recent incidents (e.g., Hurricane Maria, the 2014 Ebola outbreak, and the earthquake that struck Haiti in 2010).
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Jecker, N., Dudzinski, D., Diekema, D., and Tonelli, M. (2015). Ebola Virus Disease: Ethics and Emergency Medical Response Policy. (Abstract only.) CHEST. 148(3):794-800.
The authors describe an ethics-based policy for healthcare professionals faced with resuscitation of patients with confirmed or suspected Ebola virus disease.
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Kass, N. (2014). Ebola, Ethics, and Public Health: What Next? Annals of Internal Medicine. 161(10):744-745.
The authors review several ethical public health questions surrounding actions taken during the 2014-2015 Ebola outbreak. The implications of highly experimental vaccination treatment, and the visibility of transporting infected health care workers from the affected regions is explored. Recommendations include developing clear public communications strategies to reduce rumors and prevent misconceptions.
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Mello, M., Merritt, M., and Halpern, S. (2015). Supporting Those Who Go To Fight Ebola. PLoS Medicine. 12(1):e1001781.
This article reviews the challenges and opportunities faced by health care providers and academic medical centers who volunteer to provide support to areas heavily impacted by the Ebola outbreak. The authors provide insight on the importance of supporting the moral and ethical duties of health care providers who volunteer to heal and treat those impacted by Ebola, while highlighting risks associated with prolonged provider absences, and ensuring the safety of both practitioners and institutions upon their return.
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Narasimhulu, D., Edwards, V., Chazotte, C., et al. (2015). Healthcare Workers' Attitudes Toward Patients With Ebola Virus Disease in The United States. Open Forum Infectious Diseases. 3(2):1-7.
This study tested healthcare workers' willingness to care for Ebola virus disease patients and employees' ethical beliefs about refusing to care for Ebola virus disease patients. Results showed that ethical beliefs influenced willingness to care, but were also balanced by concerns about the risks to personal and family safety.
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Presidential Commission for the Study of Bioethical Issues. (2016). Ethically Sound: Ethics and Ebola.
This resource provides a transcript and audio recording of a podcast discussion of Ethics and Ebola: Public Health Planning and Response, the Bioethics Commission's report that emphasizes the importance of including ethics preparedness in public health preparedness. Speakers discuss the actions taken by state governments to prevent potential spread of Ebola from healthcare workers returning from Africa during the 2014-2015 outbreak, and if the United States is prepared to ethically respond to public health emergencies.
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Rothstein, M. (2015). The Moral Challenge of Ebola. American Journal of Public Health. 105(1):6-8.
The authors highlight public health ethics and policy principles that should be considered in response to the international Ebola crisis. The principles discussed in this article can also be applied to other public health threats, and infectious disease outbreaks.
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Various Speakers. (2018). The Conduct of Clinical Trials of Treatments during Public Health Emergencies: A Health Policy and Bioethics Consortium. The Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School.
The speakers highlight the ethical considerations and lessons learned from evaluating treatments in emergency situations such as the 2014-2015 Ebola outbreak.
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Venkat, A., Wolf, L., Geiderman, J., et al. (2015). Ethical Issues in the Response to Ebola Virus Disease in US Emergency Departments: A Position Paper of the American College of Emergency Physicians, the Emergency Nurses Association and the Society for Academic Emergency Medicine. Journal of Emergency Nursing. 41(2):e5-e16.
The American College of Emergency Physicians, the Emergency Nurses Association and the Society for Academic Emergency Medicine jointly developed a position paper to share guidance with U.S. emergency physicians, emergency nurses, and other healthcare stakeholders on how to approach the ethical dilemmas posed by the Ebola outbreak.
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Williams, M., Silverman, R., and Duwve, J. (2014). Ebola Virus Disease: Legal and Ethical Considerations for Indiana. Indiana University, Center for Bioethics.
The authors explain the Ebola virus and associated legal and ethical considerations the Indiana State Department of Public Health should take into account when planning for Ebola and similar threats. These concerns can also be considered by other medical planners.
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World Health Organization. (2014). Meeting of the Ethics Working Group on Ebola Interventions.
Resources on this page include an agenda, list of participants, and a summary report of a 2014 meeting of the World Health Organization's Ethics Working Group on Ebola. The participants discussed ethical considerations associated with six case studies on trials on therapeutic interventions related to Ebola virus disease.
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World Health Organization. (2015). Ethics of Using Convalescent Whole Blood and Convalescent Plasma During the Ebola Epidemic.
This report highlights the ethical issues associated with using and researching the use of convalescent whole blood and convalescent plasma to treat patients with Ebola in both research and clinical settings.
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Fatality Management

Centers for Disease Control and Prevention. (2015). Guidance for Safe Handling of Human Remains of Ebola Patients in U. S. Hospitals and Mortuaries.
The Centers for Disease Control and Prevention provides step-by-step guidance for individuals responsible for performing postmortem care on Ebola patients in U.S. hospitals and mortuaries.
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World Health Organization. (2017). How to Conduct Safe and Dignified Burial of a Patient who has Died from Suspected or Confirmed Ebola or Marburg Virus Disease.
The World Health Organization developed a 12-step burial protocol for Burial Teams, beginning with their arrival to a village and ending with their return to the hospital or team headquarters.
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Hospital/Clinic Policies

* Centers for Disease Control and Prevention. (2018). Infection Prevention and Control Recommendations for Hospitalized Patients Under Investigation (PUIs) for Ebola Virus Disease (EVD) in U.S. Hospitals.
This webpage provides guidance for healthcare professionals regarding standard, contact, and droplet precautions when caring for an individual with suspected or confirmed Ebola.
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Centers for Disease Control and Prevention. (2018). Interim Guidance for U.S. Hospital Preparedness for Patients Under Investigation (PUIs) or with Confirmed Ebola Virus Disease (EVD): A Framework for a Tiered Approach.
This webpage provides guidance for state and local health department staff and those who work in emergency care settings regarding developing preparedness plans for patients who are under investigation for or with confirmed Ebola.
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Centers for Disease Control and Prevention (2018). Preparing U.S. Hospitals for Ebola.
This infographic highlights the differences between a frontline healthcare facility, an Ebola assessment hospital, and an Ebola treatment center.
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Emory Healthcare (2014). Emory Healthcare Ebola Preparedness Protocols. (Requires registration.)
This website was designed to house protocols developed by Emory Healthcare, which are based on lessons learned from treating patients with Ebola. Materials are grouped in the following categories: triage and risk assessment, inpatient care, support documents, videos, presentations, and appendices. Information on treatment, hospitals and clinics, patients and visitors, and information for physicians are also available.
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Herstein, J., Biddinger, P., Gibbs, S., et al. (2017). High-Level Isolation Unit Infection Control Procedures. (Abstract only.) Health Security. 15(5): 519-526.
The authors share results from a 2016 survey of the 56 original Centers for Disease Control and Prevention–designated high-level isolation units (64% response rate). Variables include written procedures and protocols for tasks such as decontamination, liquid waste disposal, personal protective equipment use, hand hygiene, and PPE use. The authors encourage continued rigorous training to minimize exposure risks.
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Koenig, L. (2014). Identify, Isolate, Inform: A 3-pronged Approach to Management of Public Health Emergencies. Concepts in Disaster Medicine. 9(1): 86-87.
The author describes a 3-pronged "Identify, Isolate, Inform" system that can help healthcare providers take the necessary action upon encountering a potential Ebola patient.
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Kortepeter, M., Smith, P., Hewlett, A., et al. (2014). Caring for Patients with Ebola: A Challenge in Any Care Facility. Annals of Internal Medicine. 162(1):68-69.
The authors recommend a network of referral centers, linked BSL-4 laboratories or quarantine stations as the preferred clinical option for Ebola patients.
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* Lamontagne, F., Fowler, R., Adhikari, N., et al. (2017). Evidence-Based Guidelines for Supportive Care of Patients with Ebola Virus Disease. The Lancet. 391(10121):700-708.
These evidence-based guidelines developed by a 34 member expert panel provide recommendations on the delivery of supportive care for patients in treatment units during a future Ebola outbreak. The panel used the Grading of Recommendations Assessment, Development, and Evaluation methodology to develop 8 clinical recommendations on oral rehydration, parenteral administration of fluids, systematic monitoring and charting of vital signs and volume status, serum biochemistry, staffing ratio, communication with family and friends, analgesic therapy, and antibiotics.
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New York City Department of Health and Mental Hygiene. (2014). NYC DOHMH Guidance Document for Development of Protocols for Management of Patients Presenting to Hospital Emergency Departments and Clinics with Potentially Communicable Diseases of Public Health Concern.
This document provides guidance for emergency departments and outpatient clinics to develop screening and isolation protocols for patients possibly infected with a highly communicable disease of public health concern. The document focuses on initial patient identification, initial infection control measures, notification and patient evaluation, and identification and management of exposed persons.
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Popescu, S. and Leach, R. (2019). Identifying Gaps in Frontline Healthcare Facility High-Consequence Infectious Disease Preparedness. (Abstract only.) Health Security. 17(2).
The authors discuss a gap analysis of a hospital system in Phoenix. They describe the difficulty in maintaining hospital preparedness for high consequence infectious diseases.
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* Redd, S., Smith, P., Hewlett, A., et al. (2014). Preparing for Ebola: What U.S. Hospitals Can Learn From Emory Healthcare and Nebraska Medical Center. (PowerPoint.) Centers for Disease Control and Prevention.
Speakers from the Centers for Disease Control and Prevention, the University of Nebraska Medical Center, Nebraska Biocontainment Unit, Emory’s Serious Communicable Disease Unit, and Emory Healthcare share their lessons learned on healthcare system preparedness and treating patients with Ebola.
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Smith, P., Anderson, A., Christopher, G., et al. (2006). Designing a Biocontainment Unit to Care for Patients with Serious Communicable Diseases: A Consensus Statement. Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science. 4(4).
The authors synthesized consensus recommendations collected from a conference of civilian and military professionals who are involved in the various aspects of biocontainment patient care units. Appendices include in-depth information on medical care issues (e.g., staffing the units, pathology, housekeeping), infection control issues (e.g., personal protective equipment, dealing with infectious waste), facility issues (e.g., air-handling, communication), and psychosocial and ethical issues.
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* Sterk, E. (2008). Filovirus Haemorrhagic Fever Guideline. Medecins Sans Frontieres.
These guidelines serve as a summary of the Medecins Sans Frontieres Ebola & Marburg Outbreak Control Guidance Manual. The author provides an overview of all intervention strategy components deemed necessary during a Medecins Sans Frontieres intervention in both types of outbreaks.
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Wu, H., Fairley, J., Steinberg, J., and Kozarsky, P. (2014). The Potential Ebola-Infected Patient in the Ambulatory Care Setting: Preparing for the Worst Without Compromising Care. Annals of Internal Medicine. 162(1):66-67.
The authors discuss implications of people with undiagnosed Ebola reporting to healthcare facilities. They worked with key stakeholders to develop a list of considerations for patient management, which is displayed in Table 1.
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Infection Control

Bausch, D., Towner, J., Dowell, S., et al. (2007). Assessment of the Risk of Ebola Virus Transmission from Bodily Fluids and Fomites. Journal of Infectious Diseases. 196(Suppl 2):S142-147.
The authors tested clinical specimens from 26 laboratory-confirmed cases of Ebola and describe how they were able to detect the virus by culture and/or reverse-transcription polymerase chain reaction in 16 of 54 clinical specimens (including saliva, stool, breastmilk, tears, and nasal blood).
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* Beam, E., Gibbs, S., Hewlett, A., et al. (2015). Clinical Challenges in Isolation Care. (Abstract only.) American Journal of Nursing. 115(4):44-49.
The authors note variation in personal protective equipment practices among nurses in a patient simulation and the potential impact on facility infection control.
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* Centers for Disease Control and Prevention. (2007). Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings (2007). U.S. Department of Health and Human Services.
This document provides infection control guidelines for healthcare settings across the continuum of care. It is intended to inform the development, implementation, and evaluation of infection control and prevention programs in healthcare settings.
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* Centers for Disease Control and Prevention. (2018). Infection Prevention and Control Recommendations for Hospitalized Patients Under Investigation (PUIs) for Ebola Virus Disease (EVD) in U.S. Hospitals.
This webpage provides guidance for healthcare professionals regarding standard, contact, and droplet precautions when caring for an individual with suspected or confirmed Ebola.
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Chughtai, A., Barnes, M., and MacIntyre, C. (2016). Persistence of Ebola Virus in Various Body Fluids During Convalescence: Evidence and Implications for Disease Transmission and Control. Epidemiology and Infection. 144(8):1652-1660.
The authors review articles examining persistence of Ebola virus disease in body fluids during the convalescent phase. They note that the virus persists in body fluids following clinical recovery and clearance from the blood and recommend additional study to quantify virus persistence and infectivity after the acute illness phase to better inform infection control guidelines.
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* Edmond, M., Diekema, D., and Perencevich, E. (2014). Ebola Virus Disease and the Need for New Personal Protective Equipment.. (Abstract only.) Journal of the American Medical Association. 312(23):2495-2496.
The authors discuss issues associated with personal protective equipment and highly contagious, multiple drug resistant organisms, including the Ebola virus.
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* Sterk, E. (2008). Filovirus Haemorrhagic Fever Guideline. Medecins Sans Frontieres.
These guidelines serve as a summary of the Medecins Sans Frontieres Ebola & Marburg Outbreak Control Guidance Manual. The author provides an overview of all intervention strategy components deemed necessary during a Medecins Sans Frontieres intervention in both types of outbreaks.
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Tang, J., Nicolle, A., Pantelic, J., et al. (2013). Different Types of Door-Opening Motions as Contributing Factors to Containment Failures in Hospital Isolation Rooms. PLoS One. 8(6):e66663.
The authors conducted experiments with different types of doors to assess which allowed the most air into and out of rooms to determine the type of door(s) that hospitals should use for isolation rooms. The effect of human movement on air flow when operating the doors was also examined. The authors contend that sliding doors are the most effective.
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Centers for Medicare and Medicaid Services. (2014). Emergency Medical Treatment and Labor Act (EMTALA) Requirements and Implications Related to Ebola Virus Disease (Ebola).
This memorandum shares information about the role of emergency department staff in complying with EMTALA with regards to screening and isolating patients suspected of having Ebola.
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* Kraemer, J., Siedner, M., and Stoto, M. (2015). Analyzing Variability in Ebola-Related Controls Applied to Returned Travelers in the United States. Health Security. 13(5): 295-306.
This study examines the various policies regarding entry screening and quarantine procedures in effect during the recent Ebola epidemic.
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Sunshine, G. and Ransom, M. (2015). Ebola and the Law: Legal Preparedness for Physicians and Hospitals. Centers for Disease Control and Prevention, Office for State, Tribal, Local and Territorial Support.
The authors synthesize the information they shared during the presentation “Ebola and Public Health Law” on the following topics: the duty to plan and comply with the plan, public health powers, disease investigation, isolation and quarantine, and medical guidance for Ebola patients.
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* U.S. Department of Health and Human Services. (2014). Ebola Virus Disease Vaccines. Federal Register.
In 2014, ASPR released this declaration under the Public Readiness and Emergency Preparedness Act. This document includes information on when a public health emergency is declared, liability immunity, and covered countermeasures.
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Lessons Learned

ASPR TRACIE. (2016). Lessons Learned in Developing an Effective Regional Ebola CONOPS. United States Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response.
The speakers in this webinar share lessons learned to assist regions in the development of their Ebola concept of operations.
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Beeching, N., Fenech, M., and Houlihan, C. (2014). Ebola Virus Disease. The British Medical Journal. 349.
In this article, the authors explain what causes Ebola, the disease’s pathophysiology, how to determine people at risk, infection control and prevention measures, symptoms, management, and recovery.
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Bell, B., Damon, I., Jernigan, D., et al. (2016). Overview, Control Strategies, and Lessons Learned in the CDC Response to the 2014-2016 Ebola Epidemic. MMWR Supplement. 65(3):4-11.
The authors provide a history of Ebola virus disease, discuss the response to the recent epidemic, and describe how to apply lessons learned to future outbreaks.
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* Bower, H. Grass, J., Veltus, E., et al. (2015). Delivery of an Ebola Virus-Positive Stillborn Infant in a Rural Community Health Center, Sierra Leone, January 2015. The American Journal of Tropical Medicine and Hygiene. 94(2):417-419.
The authors provide a case study of an Ebola virus (EBOV) RNA-negative pregnant woman who delivered an EBOV RNA-positive stillborn infant at a community health center in rural Sierra Leone. They also discuss the need for personal protective equipment in similar situations.
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Brolin Ribacke, K., Saulnier, D., Eriksson, A., and von Schreeb, J. (2016). Effects of the West Africa Ebola Virus Disease on Health-Care Utilization - A Systematic Review. Frontiers in Public Health. 4(222):1-12.
A review of the literature indicates non-Ebola related increases in morbidity and mortality in West Africa due to both a decrease in services available and a decrease in utilization of these services.
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* Connor, M., Kraft, C., Mehta, A., et al. (2015). Successful Delivery of RRT in Ebola Virus Disease. Journal of the American Society of Nephrology. 26(1):31-37.
The authors describe the first successful delivery of renal replacement therapy to an Ebola patient and offer safety considerations and clinical practice guidelines based on the experience.
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Decker, B., Sevransky, J., Barrett, K., et al. (2014). Preparing for Critical Care Services to Patients with Ebola. Annals of Internal Medicine. 161(11):831-832.
The authors summarize the risks and protective measures associated with providing care for a critically ill patient with Ebola based on National Institutes of Health guidance and lessons learned during the clinical care of patients at Emory University Hospital.
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Fielding, J., Allen, T., Chu, B., et al. (2016). Report of the Independent Panel on the U.S. Department of Health and Human Services (HHS) Ebola Response. Independent Panel on the U.S. Department of Health and Human Services (HHS) Ebola Response.
This report discusses the findings and recommendations of the independent panel established to examine the U.S. Department of Health and Human Services response to the 2014-2016 Ebola epidemic.
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Foote, M., Daver, R., and Quinn, C. (2017). Using “Mystery Patient” Drills to Assess Hospital Ebola Preparedness in New York City, 2014-2015. (Abstract only.) Health Security. Health Security. 15(5):500-508.
The authors analyzed after-action reports to describe the effectiveness of mystery patient drills to test rapid identification and isolation of potential Ebola cases in emergency departments located in New York City. Several gaps emerged (e.g., ensuring timely screening, staff competency with personal protective equipment, and ensuring staff understand notification procedures and roles). Findings will be used to create a national mystery patient program.
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Herstein, J., Biddinger, P., Kraft, C., et al. (2016). Initial Costs of Ebola Treatment Centers in the United States. Emerging Infectious Diseases. 22(2):350-352.
The authors describe the results of a survey of the 55 designated Ebola treatment centers on their organization and costs incurred to establish.
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Houlihan, C., McGowan, C., Dicks, S., et al. (2017). Ebola Exposure, Illness Experience, and Ebola Antibody Prevalence in International Responders to the West African Ebola Epidemic 2014-2016: A Cross-Sectional Study. PLOS Medicine. 14(5):e1002300.
The authors conducted an online survey and antibody testing of oral fluid samples from 268 international volunteers who returned to the United Kingdom and Ireland from West Africa after working during the Ebola outbreak. Samples from two individuals were reactive in initial testing, but follow-up plasma testing was negative, suggesting that asymptomatic infection in returning health workers is rare. Sixteen percent had potential exposures, but none reported receiving post-exposure prophylaxis or being medically evacuated. Of the 21% who reported febrile or diarrheal illness while in West Africa or within one month of return, only 30% were tested for Ebola virus disease. The authors suggest that review and standardization is needed of protocols for the management of possible exposure and illness.
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Jacobsen, K., Aguirre, A., Bailey, C., et al. (2016). Lessons from the Ebola Outbreak: Action Items for Emerging Infectious Disease Preparedness and Response. (Abstract only.) EcoHealth. 13(1):200-212.
The authors identify lessons learned from the Ebola outbreak and list research and policy priorities to prepare for future emerging infectious disease outbreaks. They focus on environmental conditions related to early warning systems, host characteristics related to public health, and agent issues to be addressed through laboratory science.
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Johnson, D., Sullivan, J., Piquette, C., et al. (2015). Lessons Learned: Critical Care Management of Patients with Ebola in the United States. (Abstract only.) Critical Care Medicine. 43(6):1157-1164.
The authors reviewed patient medical records to gather lessons learned from the preparations for and the provision of care of two patients with Ebola virus disease in the biocontainment unit at the University of Nebraska Medical Center.
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* Kamali, A., Jamieson, D., Kpaduwa, J., et al. (2016). Pregnancy, Labor, and Delivery after Ebola Virus Disease and Implications for Infection Control in Obstetric Services, United States. Emerging Infectious Diseases. 22(7):1156-1161.
The authors describe lessons learned through the treatment and delivery of a healthy infant to an Ebola survivor.
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* Madad, S., Cagliuso, N., Studer, S., and Dierberg, K. (2019). Special Pathogen Preparedness Webinar. NYC Health + Hospitals.
The Greater New York Hospital Association and NYC Health + Hospitals hosted this webinar where speakers: discussed the current (2019) Ebola outbreak and other special pathogens; highlighted planning guidance for the provision of initial care, and for decision-making regarding patient transfers for additional treatment; and shared information on additional considerations (e.g., pediatric patients, managing visitors and loved ones, and healthcare worker safety). The speakers also provided information on related training opportunities.
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Morgan, D., Braun, B., Milstone, A., et al. (2015). Lessons Learned from Hospital Ebola Preparation. (Abstract only.) Infection Control and Hospital Epidemiology. 36(6):627-631.
A survey was sent to over 250 healthcare institutions who are members of the Society for Healthcare Epidemiology of America to examine costs and challenges associated with hospital Ebola preparation.
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National Academies of Science, Engineering, and Medicine. (2017). Integrating Clinical Research into Epidemic Response: The Ebola Experience.
This report discusses conducting safe and rapid clinical trials of therapeutics and vaccines under development during an outbreak. Using the West African Ebola outbreak to describe lessons learned, the authors identify challenges to conducting research during an epidemic response and identify seven steps to successfully launch clinical trials during an outbreak.
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* National Association of State EMS Officials. (2015). NASEMSO After Action Review: Lessons Learned, Best Practices and Recommendations - Ebola Disease Outbreak.
NASEMSO's Domestic Preparedness Committee prepared this document to highlight critical dates during the Ebola outbreak, provide background information on the disease, describe lessons learned from the response, identify best practices, and recommend actions to federal partners.
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Office of the Assistant Secretary for Preparedness and Response. (2017). Regional Treatment Network for Ebola and Other Special Pathogens.
This report provides information on the regional treatment network established for the management of patients with Ebola and other special pathogens, its oversight and financing, the current state of preparedness, and planning and future considerations.
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Schwedhelm, M., Beam, E., Morris, R., et al. (2015). Reflections on Interprofessional Team-Based Clinical Care in the Ebola Epidemic: The Nebraska Medicine Experience. Nursing Outlook. 63(1):27-29.
This article identifies five key characteristics of an effective, interprofessional team in a high-risk, high-pressure situation: training persistence, a wide range of clinical expertise, joint problem solving and creativity, a commitment to learning, and courage.
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* Sueblinvong, V., Johnson, D., Weinstein, G., et al. (2015). Critical Care for Multiple Organ Failure Secondary to Ebola Virus Disease in the United States. Critical Care Medicine. 43(10):2066-2075.
The authors describe three Ebola patients with severe critical illness and secondary multiple organ failure. Two of the three patients died, showing that mortality rates may be high even with aggressive care among those with multiple organ failure.
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Toner, E., Shearer, M., Kirk Sell, T., et al. (2017). Health Sector Resilience Checklist for High Consequence Infectious Diseases—Informed by the Domestic US Ebola Response. Centers for Disease Control and Prevention.
The authors discuss the process they used to develop the checklist for isolated cases or limited outbreaks of high consequence infectious disease (e.g., Ebola, Marburg, Lassa, smallpox, SARS, MERS, and H5N1 influenza A). The checklist can help medical and public health authorities work with nongovernmental organizations and private industry, to assess and bolster community health sector resilience.
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U.S. Department of Health and Human Services Office of Inspector General. (2018). Hospitals Reported Improved Preparedness for Emerging Infectious Diseases After the Ebola Outbreak.
The Office of Inspector General conducted a nationwide, online survey of 368 hospitals followed by 40 interviews to determine whether actions taken to respond to the Ebola outbreak improved their preparedness for emerging infectious diseases. They found that 86% of hospitals reported they were prepared to receive an emerging infectious disease patient compared to only 29% in 2014. However, hospitals also reported challenges in sustaining their preparedness over time and balancing the need to prepare for emerging infectious diseases with other hazards.
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WHO Ebola Response Team. (2016). After Ebola in West Africa—Unpredictable Risks, Preventable Epidemics. New England Journal of Medicine. 375(6):587-96.
A high level review of the 2013-16 Ebola Viral Disease outbreak reveals that effective management of the next outbreak will require committing resources to both strengthen national health systems and sustain investment in the next generation of vaccines, drugs, and diagnostics.
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World Health Organization. (2017). Ebola Response – Key Technical Documents.
This one-pager lists and includes links to key technical documents to support the response to an Ebola outbreak. Included categories are: Strategy and Coordination; Surveillance, Contact Tracing and Laboratory; Case Management and Infection Prevention and Control; Vaccines; Community Engagement, Social Mobilization and Communication; Therapeutics; Safe and Dignified Burials; Travel and Points of Entry; and Training.
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Monitoring/Quarantine

Barbisch, D., Koenig, K., and Shih, F. (2015). Is There a Case for Quarantine? Perspectives from SARS to Ebola. (Abstract only.) Disaster Medicine and Public Health Preparedness. 9(5):547-553.
The authors emphasize the need for the public and medical professionals to better understand the meaning of quarantine and explain related terminology. They also provide a case study from Taiwan during the 2002-2003 severe acute respiratory syndrome outbreak. The authors include a quarantine and isolation decision tree that can help policy makers and public health officials in the event of an outbreak.
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Haas, C. (2014). On the Quarantine Period for Ebola Virus. PLoS Currents. 14(6).
The author examines the reasoning behind the 21-day Ebola quarantine period and compares older research to data collected during the first nine months of the 2014 outbreak.
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* Kraemer, J., Siedner, M., and Stoto, M. (2015). Analyzing Variability in Ebola-Related Controls Applied to Returned Travelers in the United States. Health Security. 13(5): 295-306.
This study examines the various policies regarding entry screening and quarantine procedures in effect during the recent Ebola epidemic.
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Smith, C., Hughes, S., Karwowski, M., et al. (2015). Addressing Needs of Contacts of Ebola Patients During an Investigation of an Ebola Cluster in the United States - Dallas, Texas, 2014. MMWR Morbidity and Mortality Weekly Report. 64(5):121-123.
In this report, the authors discuss the importance of anticipating the nonclinical needs of those under public health surveillance (e.g., concerns about housing, transportation, education, employment, food, and other household needs). The report also stresses the importance of ensuring these types of support are addressed so that residents will be more likely to comply with quarantine orders, and the utility of community collaboration (with partners such as businesses, schools, community and faith-based organizations, and social services).
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Sunshine, G., Pepin, D., Cetron, M., et al. (2015). State and Territorial Ebola Screening, Monitoring, and Movement Policy Statements United States, August 31, 2015. Morbidity and Mortality Weekly Report. 64(40):1145-1146.
This article provides a brief overview of the various policies and procedures regarding Ebola screening and monitoring for asymptomatic individuals.
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Pediatric Issues

American Academy of Pediatrics. (2014). Ebola FAQs.
This information is geared towards healthcare professionals who work with children. It explains how the Ebola virus presents in children, how it progresses, how it is transmitted and treated, and how parents can talk to children about Ebola.
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American Academy of Pediatrics. (2015). 2015 Report of the Committee on Infectious Diseases: Hemorrhagic Fevers Caused by Filoviruses: Ebola and Marburg.
This report provides a general clinical overview of Ebola and Marburg including transmission, diagnostic testing, and treatment options.
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American Academy of Pediatrics. (2019). Hemorrhagic Fevers Caused by Filoviruses: Ebola and Marburg. (Note that a paid subscription is required to access this resource.)
This Red Book® chapter is a summary of the epidemiology and clinical manifestations of Ebola and Marburg disease, and includes data from the 2014-2015 Ebola outbreak. (Note that a paid subscription is required to access this resource.)
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Centers for Disease Control and Prevention. (2018). Care of a Neonate Born to a Mother who is Confirmed to have Ebola, is a Person under Investigation, or has been Exposed to Ebola.
These guidelines pertain to U.S. hospitals and how to care for a neonate born to a mother who is confirmed to have Ebola, is a Person under Investigation (PUI), or has been exposed to the Ebola virus.
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* Centers for Disease Control and Prevention (2018). Q&A's about the Transport of Pediatric Patients (< 18 years of age) Under Investigation or with Confirmed Ebola.
This webpage is intended to provide first responders with information to help protect themselves, younger patients, and patients’ family members by answering the most frequently asked questions.
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Davies, H. and Byington, C. (2016). Parental Presence During Treatment of Ebola or Other Highly Consequential Infection. Pediatrics. 138(3):e20161891.
This clinical report from the American Academy of Pediatrics Committee on Infectious Diseases presents options for meeting the needs of patients and their families while posing the least risk to healthcare providers and facilities.
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* Eriksson, C., Uyeki, T., Christian, M., et al. (2015). Care of the Child with Ebola Virus Disease. Pediatric Critical Care Medicine. 16(2):97-103.
The authors discuss considerations for the care of children with Ebola virus disease. They emphasize infection control practices to limit disease spread, and supportive care to treat patients.
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Goodman, A., Meites, A., Anstey, E., et al. (2015). Clinical Inquiries Received by CDC Regarding Suspected Ebola Virus Disease in Children - United States, July 9, 2014-January 4, 2015. Morbidity and Mortality Weekly Report. 64(36):1006-1010.
The following article provides an overview of inquiries to the Centers for Disease Control and Prevention's Emergency Operations Center, which was activated to respond to the Ebola outbreak in West Africa. The Emergency Operations Center and a clinical consultation service were established to assist state and local health departments and health care providers evaluate persons possibly at risk for Ebola. A total of 89 inquiries were received and a discussion of the outcomes is provided.
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Kourtis, A., Appelgren, K., Chevalier, M., et al. (2015). Ebola Virus Disease: Focus on Children. Pediatric Infectious Disease Journal. 34(8):893-897.
The authors provide an overview of the Ebola virus, its epidemiology and transmission, clinical and laboratory manifestations, and treatment and infection control procedures. The authors also discuss what is known about the Ebola virus disease in the pediatric population since research in this area is underdeveloped.
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Olupot-Olupot, P. (2015). Ebola in Children: Epidemiology, Clinical Features, Diagnosis and Outcomes. Pediatric Infectious Disease Journal. 34(3):314-316.
The author looks at the current and past Ebola outbreaks and focuses on infection and how it presents, is diagnosed, and treated in children.
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Shah, T., Greig, J., van der Plas, L., et al. (2016). Inpatient Signs and Symptoms and Factors Associated with Death in Children Aged 5 Years and Younger Admitted to Two Ebola Management Centres in Sierra Leone, 2014: A Retrospective Cohort Study. The Lancet Global Health. 4(7):e495-501.
The authors described outcomes and symptoms relative to symptoms during admission in children five and younger. The study confirmed higher rates of death in children younger than two and those who presented with a high viral load.
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U.S. Department of Health and Human Services, Administration for Children and Families, Office of Human Services Emergency Preparedness and Response. (2014). Ebola: Planning Considerations for Human Services Programs.
In an effort to provide current and updated information regarding Ebola and children, the Administration for Children and Families created fact sheets to be used in early childhood settings, and help parents and caregivers deal with the possibilities of exposure.
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Personal Protective Equipment and Responder Safety

Balci, F. (2016). Isolation Gowns in Health Care Settings: Laboratory Studies, Regulations and Standards, and Potential Barriers of Gown Selection and Use. American Journal of Infection Control. 44(1):104-111.
The author discusses the lack of an isolation gown standard that considers end user desired attributes in addition to barrier resistance.
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* Beam, E., Gibbs, S., Hewlett, A., et al. (2015). Clinical Challenges in Isolation Care. (Abstract only.) American Journal of Nursing. 115(4):44-49.
The authors note variation in personal protective equipment practices among nurses in a patient simulation and the potential impact on facility infection control.
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* Bratt, J., Robinson, A., and Alcorta, R. (n.d.). Strategies and Considerations for the Deployment of EMS Personal Protective Equipment in Response to an Ebola Outbreak. (Accessed 1/10/2020.) Maryland Institute for Emergency Medical Service Systems.
This article describes protection of emergency medical services personnel through personal protective equipment (PPE), including requirements, PPE cost (and how to estimate it), PPE deployment strategies, and personnel requirements.
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* Centers for Disease Control and Prevention. (2007). Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings (2007). U.S. Department of Health and Human Services.
This document provides infection control guidelines for healthcare settings across the continuum of care. It is intended to inform the development, implementation, and evaluation of infection control and prevention programs in healthcare settings.
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Centers for Disease Control and Prevention (2016). Considerations for U.S. Healthcare Facilities to Ensure Adequate Supplies of Personal Protective Equipment (PPE) for Ebola Preparedness.
The CDC shares information on the current PPE supply situation, information on the duration of care certain types of facilities should be prepared to provide to Ebola patients, and how facilities can plan to share PPE supplies if necessary.
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Centers for Disease Control and Prevention. (2018). For U.S. Healthcare Settings: Donning and Doffing Personal Protective Equipment (PPE) for Evaluating Persons Under Investigation (PUIs) for Ebola Who Are Clinically Stable and Do Not Have Bleeding, Vomiting, or Diarrhea.
This document provides guidance to healthcare workers on donning and doffing personal protective equipment while evaluating a clinically stable person under investigation who does not have bleeding, vomiting, or diarrhea.
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Centers for Disease Control and Prevention. (2018). Guidance on Personal Protective Equipment to Be Used by Healthcare Workers During Management of Patients with Confirmed Ebola or Persons Under Investigation (PUIs) for Ebola Who are Clinically Unstable or Have Bleeding, Vomiting, or Diarrhea in U.S. Hospitals, Including Procedures for Donning and Doffing PPE.
This Centers for Disease Control and Prevention webpage includes guidance on the types of personal protective equipment (PPE) that should be used by those caring for patients with Ebola. It also includes steps for donning and doffing PPE as well as what trained observers should do to ensure these steps are followed.
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Centers for Disease Control and Prevention. (2019). Ebola Recommendations for Organizations. Centers for Disease Control and Prevention.
This webpage provides pre-, during-, and post-deployment recommendations to organizations sending U.S.-based response workers to geographic areas with Ebola virus disease outbreaks.
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* Edmond, M., Diekema, D., and Perencevich, E. (2014). Ebola Virus Disease and the Need for New Personal Protective Equipment.. (Abstract only.) Journal of the American Medical Association. 312(23):2495-2496.
The authors discuss issues associated with personal protective equipment and highly contagious, multiple drug resistant organisms, including the Ebola virus.
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* European Union, European Centre for Disease Prevention and Control. (2014). Safe Use of Personal Protective Equipment in the Treatment of Infectious Diseases of High Consequence: A Tutorial for Trainers in Healthcare Settings.
This training program provides information on the proper use of personal protective equipment at the point of care and shares information on procurement, preparedness, and capacity building.
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Kilmarx, P., Clarke, K., Dietz, P., et al. (2014). Ebola Virus Disease in Health Care Workers Sierra Leone, 2014. Morbidity and Mortality Weekly Report. 63(49):1168-1171.
The authors studied infection in healthcare workers and found that the incidence of infection peaked in August 2014. The authors also found that infected healthcare workers were less likely to have attended a funeral and more likely to have had contact with an Ebola positive patient in the month prior to symptom onset. They then stress the importance of infection control and protecting the health workforce.
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McLaws, M., Chughtai, A., Salmon, S., and MacIntyre, R. (2016). A Highly Precautionary Doffing Sequence for Health Care Workers after Caring for Wet Ebola Patients to Further Reduce Occupational Acquisition of Ebola. American Journal of Infection Control. 44(7):740-744.
The authors reviewed video guidelines to identify exemplary doffing, which they defined as no used personal protective equipment surface coming into contact with mucous membranes, face, or hair.
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* Redd, S., Smith, P., Hewlett, A., et al. (2014). Preparing for Ebola: What U.S. Hospitals Can Learn From Emory Healthcare and Nebraska Medical Center. (PowerPoint.) Centers for Disease Control and Prevention.
Speakers from the Centers for Disease Control and Prevention, the University of Nebraska Medical Center, Nebraska Biocontainment Unit, Emory’s Serious Communicable Disease Unit, and Emory Healthcare share their lessons learned on healthcare system preparedness and treating patients with Ebola.
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* Sterk, E. (2008). Filovirus Haemorrhagic Fever Guideline. Medecins Sans Frontieres.
These guidelines serve as a summary of the Medecins Sans Frontieres Ebola & Marburg Outbreak Control Guidance Manual. The author provides an overview of all intervention strategy components deemed necessary during a Medecins Sans Frontieres intervention in both types of outbreaks.
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* The University of Nebraska Medical Center. (n.d.). HEROES Webpage. (Accessed 1/10/2020.)
The videos on this webpage feature step-by-step demonstrations of the doffing and donning of personal protective equipment (PPE), testing of powered air purifying respirator-level PPE, and the assembly and use of body sealers and ISOPODs.
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United States Department of Labor, Occupational Safety and Health Administration. (2014). PPE Selection Matrix for Occupational Exposure to Ebola Virus.
The U.S. Department of Labor shares information on the type of personal protective equipment to be worn in various situations (e.g., normal work activities, casual interaction, providing medical and supportive care, cleaning and disinfecting environments, and dealing with waste).
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Plans, Tools, and Templates

Alabama Department of Public Health. (n.d.). Hospital Template for Serious Infectious Disease Procedures. (Accessed 1/9/2020.)
This eight-page template is for the use of hospital administration and planning personnel to identify and communicate key elements of the policy and procedures for screening, identification, and initial management of a suspected serious infectious disease patient. It is intended to be used as a tool to assist in the effective preparation for, implementation, and execution of facility serious infectious disease response plans.
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ASPR TRACIE. (2018). Hospital Personal Protective Equipment Planning Tool.
The Hospital Personal Protective Equipment (PPE) Planning Tool is designed to help hospitals determine approximate PPE needs based on special pathogen category and a number of facility specific variables. Calculators are included for Ebola Virus Disease/Viral Hemorrhagic Fever (EVD/VHF) as well as special respiratory pathogens such as Middle East Respiratory Syndrome/Severe Acute Respiratory Syndrome (MERS/SARS), and for pandemic influenza. Access the (non-compliant) PDF file at: https://files.asprtracie.hhs.gov/documents/aspr-tracie-hospital-ppe-planning-tool.pdf.
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Bellevue Hospital Center. (n.d.). Ebola Virus Disease Incident Response Guide. (Accessed 7/5/2019.)
This guide includes protocols developed by Bellevue (NY) Hospital Center for managing a suspected or confirmed Ebola virus disease patient.
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Bellevue Hospital Center. (n.d.). Ebola Virus Disease Incident Response Guide Exhibits. (Accessed 7/5/2019.)
This document contains exhibits associated with Bellevue's Incident Response Guide, including an overview, personal protective equipment Guidance Matrix, Health Alert Network alert, algorithms, checklists, forms, and educational materials.
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Centers for Disease Control and Prevention. (2016). Guidance for Developing a Plan for Interfacility Transport of Persons Under Investigation or Confirmed Patients with Ebola Virus Disease in the United States.
This document provides guidance on developing plans for interfacility air or ground transport of persons under investigation and Ebola patients.
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Chamberlin, M., Okunogbe,A., Moore, M., and Abir, M. (2015). Intra-Action Report A Dynamic Tool for Emergency Managers and Policymakers. RAND Corporation.
The authors coined the term “Intra-Action Report” and tracked and shared the challenges, successes, and lessons being learned and applied during the 2014 response to Ebola.
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Kansas Department of Health and Environment (2019). Ebola Virus Preparedness and Response Plan.
This attachment to the Biological Incident Annex of the Kansas Response Plan updates the department’s original standalone Ebola plan. The plan describes the state’s concept of operations and includes 9 appendices detailing specific response actions.
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* MESH Coalition. (2016). An Exercise in the Provision of Care for an Adult Patient under Investigation (PUI) for Ebola: A Patient Care Drill.
This simulation toolkit provides a situation overview, general information, simulation logistics, post-simulation and evaluation activities, and participant information and guidance along with appendices containing templates and forms for hospitals to test their established protocols for the provision of care to a patient with a suspect highly infectious disease. Multiple injects such as vomiting encourage testing a range of different procedures through the exercise.
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Minnesota Department of Health, Association for Professionals in Infection Control and Epidemiology - Minnesota, and Health Care Coalitions of Minnesota. (2019). High Consequence Infectious Disease (HCID) Toolbox for Frontline Health Care Facilities.
This toolbox includes a variety of resources to assist frontline facilities in their readiness activities related to patients with high consequence infectious diseases. Included are planning and training tools, exercise templates, and the components (e.g., screening guide, checklists, posters) to create a readiness binder.
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National Ebola Training and Education Center. (n.d.). NETEC Exercise Templates. (Accessed 1/7/2020.)
This web page includes links to various Homeland Security Exercise and Evaluation Program-compliant templates to assist healthcare coalitions, frontline facilities, assessment hospitals, state-designated Ebola treatment centers, regional Ebola and special pathogen treatment centers, and their respective response partners in the planning and conduct of exercises on the identification, assessment, treatment, management, transport, and transfer of high risk patients. The site includes templates for drills, tabletops, functional, and full-scale exercises. There is also a beginners guide to assist users new to exercise planning.
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New York City Department of Health and Mental Hygiene. (n.d.). Mystery Patient Drill Toolkit. (Accessed 1/7/2020.)
This toolkit is intended for use by hospital emergency departments, and tests how long it takes for a potential patient with a highly infectious disease to be identified and for staff to begin exposure mitigation procedures; how long it takes for a patient to be transferred to an isolation room; and the capability of the facility to make notifications internally and to the health department. The Toolkit includes scenarios for Ebola Virus Disease, Middle East Respiratory Syndrome, and Measles, but may be modified to suit healthcare facilities of any nature and any type of disease outbreak.
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New York City Health + Hospitals. (2019). Frontline Hospital Planning Guide: Special Pathogens.
This planning guide from New York City Health + Hospitals provides high-level planning information for frontline hospital multidisciplinary teams to support planning and training for the initial care of suspected special pathogen patients while determining whether and when they will be transferred to another facility for further assessment and treatment.
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Office of the Assistant Secretary for Preparedness and Response. (2017). Hospital Preparedness Program (HPP) Measure Manual: Implementation Guidance for Ebola Preparedness Measures.
This manual provides implementation guidance on performance measures for awardees receiving federal funds for Ebola preparedness and response through the Hospital Preparedness Program.
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State of Louisiana Governor’s Office of Homeland Security and Emergency Preparedness (2014). Louisiana Ebola Virus Disease Response Plan.
This plan serves as an annex to the state’s emergency operations plan and focuses on six specific goals: protect life and property, minimize exposure in a variety of settings, conduct medical and public health vigilance, identify steps for confirmed cases and their contacts, support effective and rapid response, and collect and share accurate information.
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The Society for Healthcare Epidemiology of America. (2017). Outbreak Response Training Program (ORTP).
This webpage contains links to four free toolkits that were developed to provide healthcare providers immediate access to key infectious disease outbreak information and resources. The toolkits contain guidance on incident management, emerging pathogens, horizontal strategies, communication, negotiation, and implementation. Each toolkit contains checklists, guidance documents, case studies, and fillable tables to meet the planning and response needs prior to or during an infectious disease outbreak.
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U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2016). U.S. Department of Health and Human Services Ebola Response Improvement Plan Based on Lessons Learned from the 2014-2016 Ebola Epidemic.
This improvement plan addresses the key findings and recommendations of the Report of the Independent Panel on the HHS Ebola Response.
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U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2019). National Health Security Strategy. U.S. Department of Health and Human Services.
The goal of the National Health Security Strategy (NHSS) is to strengthen and sustain communities’ abilities to prevent, protect against, mitigate the effects of, respond to, and recover from disasters and emergencies. This webpage includes links to the full text of the plan, an overview, the NHSS Implementation Plan, the NHSS Evaluation of Progress, and an NHSS Archive.
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Risk Communications

Covello, V., and Hyer, R. (2014). Top Questions On Ebola: Simple Answers Developed by the Association of State and Territorial Health Officials.
The authors worked with risk communication consultants and state health officials to develop messaging written at a 6th to 8th grade reading level. Questions are divided into the following categories: basic, preparedness, medicines and vaccines, healthcare response, quarantine and isolation, monitoring and contact tracing, mental health, travel and transport, and media.
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International Federation of Red Cross and Red Crescent Societies. (2014). Psychosocial Support During an Outbreak of Ebola Virus Disease.
Readers can use this document to learn about psychosocial aspects related to Ebola and supportive activities that can be implemented to address these challenges.
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World Health Organization, Pan American Health Organization. (2014). Risk Communication Plan for the First Case of Ebola.
This guidance is intended to help health officials communicate with their communities in the event that a resident is diagnosed with Ebola. The authors list communication goals, key assumptions to include in messaging, and a list of specific questions to prepare for. Risk communication principles are included along with sample communication outlets and audiences.
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Vaccine/Targeted Treatment

Choi, W., Hong, K, Hong, J., et al. (2015). Progress of Vaccine and Drug Development for Ebola Preparedness. Clinical and Experimental Vaccine Research. 4(1):11-16.
The authors examine the treatments being used and created to control the 2014 Ebola outbreak.
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* Cohen, J. and Kupferschmidt, K. (2014). Ebola Vaccine Trials Raise Ethical Issues. Science. 346(6207):289-290.
The authors discuss the ethical concerns associated with having a control group when testing Ebola vaccines.
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Gsell, P., Camacho, A., Kucharski, A., et al. (2017). Ring Vaccination with rVSV-ZEBOV Under Expanded Access in Response to an Outbreak of Ebola Virus Disease in Guinea, 2016: An Operational and Vaccine Safety Report. The Lancet. 17(12):1276-84.
The authors describe the first use of an Ebola vaccine in an outbreak setting outside of a clinical trial. More than 1500 individuals, including 303 children age 6 and older, were vaccinated in 4 rings. No confirmed cases were reported among vaccinees or within the rings once vaccination was completed. Mild adverse events were reported in 17% of those age 6-17; 36% of adults also reported adverse events, with 98% being mild. There were no reports of severe vaccine-related adverse events.
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Kreil, T. (2015). Treatment of Ebola Virus Infection with Antibodies from Reconvalescent Donors. Emerging Infectious Diseases. 21(3):521-523.
The author provides an overview of the Ebola treatment which involves administering plasma from a patient who survived Ebola to a newly-infected patient.
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Regules, J., Beigel, J., Paolino, K., et al. (2015). A Recombinant Vesicular Stomatitis Virus Ebola Vaccine Preliminary Report. The New England Journal of Medicine. 372:587-588.
The authors share results from two phase 1 trials of an attenuated, replication-competent, recombinant vesicular stomatitis virus (rVSV)-based Ebola prevention vaccine candidate.
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The PREVAIL II Writing Group for the Multi-National PREVAIL II Study Team. (2016). A Randomized, Controlled Trial of ZMapp for Ebola Virus Infection. The New England Journal of Medicine. 375:1448-1456.
A randomized, controlled trial involving 72 patients found that the experimental treatment ZMapp plus the current standard of care was superior to the current standard of care alone by a 91.2% posterior probability. While this is less than the 97.5% pre-study specified probability for superiority and therefore is an inconclusive result, the authors found the results to suggest a positive outcome from the addition of ZMapp to the current standard of care, identified a similar percentage of patients with serious adverse events in both groups, and argued that the study established the feasibility of conducting a randomized, controlled trial during a major public health emergency. Among the factors impacting the results were the inability to enroll the planned 200 patients, which resulted in wide 95% credible intervals, and the deaths of patients before they received all three infusions of ZMapp.
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* U.S. Department of Health and Human Services. (2014). Ebola Virus Disease Vaccines. Federal Register.
In 2014, ASPR released this declaration under the Public Readiness and Emergency Preparedness Act. This document includes information on when a public health emergency is declared, liability immunity, and covered countermeasures.
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Women's Health

Baggi, F., Taybi, A., Kurth, A. et al. (2014). Management of Pregnant Women Infected with Ebola Virus in a Treatment Centre in Guinea, June 2014. Eurosurveillance. 19(49).
The authors describe two cases where pregnant women presented with symptoms of Ebola at a clinic in Africa and the resulting complications to both the patient and the fetus.
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Black, B., Caluwaerts, S., and Achar, J. (2015). Ebola Virus Disease and Pregnancy. Obstetric Medicine. 8(3):108-113.
The authors provide an overview of the interaction between Ebola and pregnancy, current practices in the field, gaps in knowledge, and potential management strategies.
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* Bower, H. Grass, J., Veltus, E., et al. (2015). Delivery of an Ebola Virus-Positive Stillborn Infant in a Rural Community Health Center, Sierra Leone, January 2015. The American Journal of Tropical Medicine and Hygiene. 94(2):417-419.
The authors provide a case study of an Ebola virus (EBOV) RNA-negative pregnant woman who delivered an EBOV RNA-positive stillborn infant at a community health center in rural Sierra Leone. They also discuss the need for personal protective equipment in similar situations.
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Centers for Disease Control and Prevention. (2018). Guidance for Screening and Caring for Pregnant Women with Ebola Virus Disease for Healthcare Providers in U.S. Hospitals.
This webpage provides guidance for healthcare workers on screening, and treating suspected or confirmed cases of Ebola in pregnant women.
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Jamieson, D., Uyeki, T., Callaghan, W., et al. (2014). What Obstetricians-Gynecologists Should Know About Ebola: A Perspective From the Centers for Disease Control and Prevention. Obstetrics & Gynecology. 124(5):1005-1010.
This article provides general background information on Ebola and highlights what is known about Ebola virus disease in pregnancy and the implications for practicing obstetricians-gynecologists in the United States.
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* Kamali, A., Jamieson, D., Kpaduwa, J., et al. (2016). Pregnancy, Labor, and Delivery after Ebola Virus Disease and Implications for Infection Control in Obstetric Services, United States. Emerging Infectious Diseases. 22(7):1156-1161.
The authors describe lessons learned through the treatment and delivery of a healthy infant to an Ebola survivor.
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Agencies and Organizations

Centers for Disease Control and Prevention. Ebola: For Clinicians.
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Emory Healthcare Ebola Preparedness Protocols.
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National Ebola Training and Education Center.
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University of Nebraska Medical Center.
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World Health Organization. Ebola Virus Disease.
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This ASPR TRACIE Topic Collection was comprehensively reviewed in April 2015 by John Hick, MD, HHS ASPR and Hennepin County Medical Center.

Additional assistance provided by Alicia Livinski, Biomedical Librarian, HHS National Institutes of Health, and the following subject matter experts (listed in alphabetical order): James A. Geiling, MD, MPH, FCCM, Consultant and Professor of Medicine, Geisel School of Medicine at Dartmouth; Dan Hanfling, MD (Panel Chair, Editor) Contributing Scholar, UPMC Center for Health Security, Member, InterAgency Board, Attending Physician, BestPractices, Inc. (a division of EmCare), and Clinical Professor of Emergency Medicine, George Washington University; Nathaniel Hupert, MD, IPA Consultant, HHS-ASPR-BARDA and HPP, Associate Professor of Healthcare Policy and Research and of Medicine, Weill Medical College, Cornell University HHS ASPR; Aaron Resnick, Planning and Preparedness Manager, Northwest Healthcare Response Network; and Connie Savor Price, MD, Chief, Infectious Diseases, Medical Director, Infection Prevention, Denver Health and Hospital, Professor of Medicine, University of Colorado-Denver.
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