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October 17, 2014

West Coast gears up for Ebola

The West Coast District Health Board is ensuring it is prepared for Ebola, in line with national and international preparations in case the disease reaches New Zealand.

West Coast DHB hospital physician Dr Paul Holt and Community and Public Health Medical Officer of Health Dr Cheryl Brunton say it is still very unlikely that an Ebola case would be present in New Zealand, and it's important people don't panic.

"In the health system our job is to make sure we're ready for anything, and our teams are getting prepared and ensuring they have the right equipment and know the correct procedures," Dr Holt says.

The West Coast has been working closely with the Christchurch Hospital team, Community and Public Health, Canterbury Health Laboratories, Primary Care, the Ministry of Health, St John, and other DHBs. Community and Public Health has also been working with Christchurch Airport Border Agencies.

If a suspected case were to present in New Zealand, given the location and frequency of international flight arrivals, it is most likely that they would present in Auckland, Wellington or Christchurch where they would be identified by border agencies, who already are asking people about their travel history (passive screening).

"Contact tracing and management by our public health team is a key aspect of the response, and this has already been shown to be effective in containing the outbreak in Nigeria and other parts of West Africa," Dr Brunton says.

Dr Holt says the West Coast community and its health agencies will no doubt recall the preparation a few years ago for SARS (Severe Acute Respiratory Syndrome) and swine flu scares.

"The general principles applied for pandemic influenza - keep it out (border control) - stamp it out (cluster control) - manage it - recover from it - still apply for Ebola.

"Our border agencies are already identifying people who may have come from an area of concern and are working closely with health to ensure that any suspect cases would be quickly transported (by St. John's ambulance) and isolated by the infectious disease team at Christchurch Hospital.

"These staff (both hospital and ambulance) have practised and are skilled at infection control. They have all the expertise and equipment they require should a suspect Ebola case present at the airport."

At this stage, all cases of Ebola will come from one of five countries in West Africa - New Zealand only issues about 30 visas a year from these countries.

"Christchurch's closest link with that part of the world is Dubai, but all agencies are aware that a suspect case may arrive from any part of the world and are taking appropriate precautions to identify people's travel history," Dr Brunton says.

"Evidence from West Africa shows that Ebola can be contained where contact tracing and contact management is carried out effectively, and in New Zealand this is the responsibility of the public health units."

Community and Public Health plans to isolate contacts until the results of testing a suspect index case become available - three days - or for 21 days (Ebola's incubation period) in the unlikely event of a suspect case confirming positive. Should any contact develop symptoms during these times they would be appropriately cared for in a dedicated isolation unit at Christchurch hospital.

Any traveller who feels unwell after returning home should telephone their General Practice team and say where they have been travelling.

"While the West Coast DHB shares the Ministry of Health's stated position that an Ebola case in New Zealand in 2014 remains a very unlikely possibility, we are nevertheless preparing right now to deal with suspect cases should one happen to present," Dr Brunton says.

A West Coast ebola governance group has been set up to work with a transalpine group. The West Coast group consists of Dr Holt, Dr Brunton, General Manager Grey Westland Mark Newsome, Director of Nursing and Midwifery Karyn Bousfield, Clinical Nurse Specialist - Infection, Prevention and Control Julie Ritchie, Nurse Manager Clinical Services Julie Lucas, Lesley Holmwood, Emergency Planner and Senior Communications Advisor Lee Harris. They will be meeting regularly to ensure staff are given guidance and kept updated with any national or international information.

What is Ebola?

Ebola (or Ebola virus disease, EVD) is a severe viral haemorrhagic disease that can cause severe bleeding (haemorrhage), organ failure and is fatal in 70 per cent of cases, though quality supportive care, such as that provided in countries like New Zealand, may improve the survival rate. It is important to understand that early symptoms are very similar to many other viral infections and are non-specific, such as fever vomiting and diarrhoea. Bleeding develops later in the course of the disease. Ebola virus is native to Central Africa, where sporadic outbreaks have occurred for decades. African Fruit bats are considered to be the likely host of the Ebola virus but transmission in this outbreak is between humans.

Ebola is a severe illness but spread can largely be prevented though standard infection control processes.

How is it spread?

Ebola can spread from humans to humans through contact with the body fluids of someone who is sick with Ebola e.g. blood, saliva, faeces (poos), urine, sweat; and through contact with soiled linen of a sick person or contaminated needles.

Ebola Virus is not as infectious as the ‘flu or measles. You cannot get Ebola just from sitting next to someone on a bus or plane.

At this stage it is highly unlikely that an Ebola case would not be identified as they came into New Zealand. However, should a suspected Ebola case present to a primary care facility anywhere in the region they would be placed in a single room, or if they present to hospital they would be placed in the negative pressure isolation room. The Medical Officer of Health would be immediately notified and arrangements would be made to have the patient transferred to a tertiary facility (Christchurch Hospital infectious disease unit) where they would be assessed by senior clinicians.
The Ministry of Health is also operating an Ebola Readiness Incident Management Team (IMT) that will provide advice, support and coordination. The Ebola Readiness IMT will be able to call on additional expert advice from the Ministry's EVD Technical Advisory Group (ETAG).

People are not infectious before symptoms appear

Signs and symptoms of Ebola infection appear between two and 21 days after exposure, most commonly between five and 10 days of infection.

The West Coast DHB has received the Ministry of Health checklist/guidelines for preparedness, which are currently being worked through and we are working in partnership with our South Island Alliance DHB colleagues and primary care to formulate detailed plans and protocols to ensure the safety of other patients, hospital staff and the general public. There are very clear guidelines that have been developed by the Ministry of Health around how to handle a suspected case.

Although Ebola awareness is increasing and planning for it is important, the West Coast Health System remains vigilant around monitoring a range of potentially serious infectious diseases that travellers can bring into the region. Our staff are trained to manage such infectious diseases, including Ebola and ongoing training is continuing.


For more information please contact:

Lee Harris,
Senior Communications Advisor
West Coast District Health Board
t: +64 27 836 1528

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