October 16, 2014
Canterbury Health System preparing for Ebola
With the alert on Ebola being stepped up internationally, there’s been a rapid response within the Canterbury Health
System in preparing for the disease if it was to reach our shores.
Dr Nigel Millar, Canterbury DHB Chief Medical Officer, says the Christchurch Hospital team have been working in
partnership with Community and Public Health, Canterbury Health Laboratories, Primary Care, the Ministry of Health, St John, and other DHBs, including the West Coast, on Ebola preparedness and planning. Community and Public Health has
also been working with Christchurch Airport Border Agencies.
“We are prepared for a suspected case should one arise,” Dr Nigel Millar says.
“While it is still very unlikely that an actual Ebola case would be present in New Zealand, we may expect that an
occasional traveller may meet the suspect case definition for Ebola and would require management until laboratory
testing ruled out Ebola.”
Dr Millar says 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 Millar says the Canterbury community and its health agencies are well practised and understand the principles of
containing infectious disease.
“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 our
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, Dr Millar says.
“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,” he 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.”
Dr Alistair Humphrey, Canterbury Medical Officer of Health, says 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, he says.
“Border agencies are already identifying travellers from areas of concern, but any traveller who feels unwell after
returning home should telephone their General Practice team and say where they have been travelling,” Dr Humphrey says.
“While the Canterbury 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 prepared right now to deal with suspect cases should one happen
to present,” Dr Humphrey says.
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
such as 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 Canterbury DHB’s 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 Canterbury Health System remains vigilant
around monitoring a range of potentially serious infectious diseases that travellers can bring into Canterbury. Our
staff are trained to manage such infectious diseases, including Ebola and ongoing training is continuing.
ENDS