Preparing Latin America and the Caribbean for potential importations of Ebola
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Preparing Latin America and the Caribbean for potential importations of Ebola

CARIBBEAN/SINT MAARTEN - Although the United States is the only country to date that has registered cases of Ebola imported from the current outbreak in West Africa, countries in Latin America and the Caribbean are working with support from the Pan American Health Organization/World Health Organization (PAHO/WHO) to prepare for the potential importation of the disease.

Ebola is a serious disease for which there is currently no vaccine or cure. In the current outbreak, it has a 50% fatality rate. Given that the possibility of an imported case in Latin America or the Caribbean cannot be discarded, PAHO/WHO has been working with its member countries to ensure they can respond rapidly and effectively if such a case appears.

Health professionals from more than 30 countries in Latin America and the Caribbean have received training in clinical management of Ebola in three workshops sponsored by the Pan American Health Organization/World Health Organization (PAHO/WHO). The workshops were part of a series of PAHO/WHO actions intended to help countries strengthen their preparedness for potential cases of Ebola.

The "train-the-trainer" courses took place on 1-3 December in Antigua and Barbuda, for Caribbean health professionals, and on 3-5 and 9-11 December in Chile, for health personnel from Latin America. Participants in the three workshops are expected to train other health professionals in their home countries, with PAHO/WHO support.

"The goal of the workshops is to strengthen the clinical response capacity of doctors and nurses who have been assigned to treat Ebola patients," said Dr. Marcos Espinal, Director of PAHO/WHO's Department of Communicable Diseases and Health Analysis. "After this training, we'll have health staff who are better prepared to rapidly detect cases, isolate and treat them, and prevent the disease's spread."

Some trainees are also expected to participate in specialized international teams that could be mobilized by PAHO/WHO to provide support in clinical response and outbreak control to any country in the region that is affected by Ebola.

During each three-day workshop, participants learned about the history and epidemiology of Ebola virus disease and how to detect, isolate, and manage suspected cases. The training also covered diagnosis and clinical management, use of personal protective equipment, organization of specialized treatment units, and aspects of infection prevention and control.

Workshop facilitators are all professionals with experience in management of Ebola and other infectious diseases. In addition to PAHO/WHO staff, they include experts from the Carlos III Hospital in Spain; Emory University Hospital in Atlanta, Georgia, and St. Patrick's Hospital in Missoula, Montana, USA: the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. National Institutes of Health (NIH); and Brazil and Chile.

Trainees included health professionals from Argentina, Bahamas, Barbados, Bolivia, Colombia, Costa Rica, the Dominican Republic, Ecuador, El Salvador, Guatemala, Honduras, Jamaica, Mexico Paraguay, Peru, Trinidad and Tobago, and Uruguay, among other countries.

Participants were selected by their countries according to their professional medical and teaching experience, work in a national hospital, and willingness to serve as trainers in their own countries and support PAHO/WHO missions to other countries of the region.

Below are highlights of these efforts during 2014 in preparing the Caribbean and Latin America for the potential importation of Ebola virus disease:

1. Support missions
Teams of experts from PAHO/WHO and partner organizations travelled to some 20 countries in Latin America and the Caribbean to provide technical support as needed for Ebola preparedness efforts.

2. Training for Cuban medical brigades
Cuban healthcare workers received training from PAHO/WHO before travelling to West Africa to help with the Ebola response there.

3. Training in case management
Ebola virus is transmitted through body fluids (feces, urine, saliva, semen) from an infected person who has symptoms of the disease. PAHO/WHO has trained medical and nursing professionals in the epidemiology of Ebola and in case detection and management.

4. Safe use of personal protective gear
Proper use of personal protective equipment (PPE) is the most important measure for preventing transmission to health workers assigned to care for Ebola patients. Experts from the U.S. Centers for Disease Control and Prevention (CDC), the U.S. National Institutes of Health (NIH), and Spain's Carlos III Hospital in Madrid provided training for health professionals in how to put on and take off different types of PPE.

5. Health services organization 
Caring for patients with Ebola requires special units that have been designed or adapted specifically for this purpose. PAHO/WHO has shared best practices and provided technical support to help countries establish Ebola isolation units.

6. Clinical management simulation
Medical and nursing professionals from Latin America and the Caribbean participated insimulation exercises on clinical management of Ebola patients organized by PAHO/WHO, together with experts with experience in handling these cases. Participants in the exercise are expected to train others in their own countries.

7. Laboratory samples and protocols
Experts in laboratory diagnosis and management of biological risks were convened by PAHO/WHO to analyze procedures for safe management of Ebola and suspected Ebola samples and to define protocols for diagnosis and therapeutic monitoring.

8. Risk communication 
Clear and transparent communication by health authorities is critical for maintaining the public's trust, managing anxiety and promoting healthy behaviors. Ministry of health staff responsible for communication received PAHO/WHO training in principles of communication with the public during times of serious risks to human health.

9. Reliable information
A website devoted to Ebola virus disease was launched by PAHO/WHO to provide reliable and updated information to health officials, health professionals and the public.

10. Mobilizing resources for preparedness
PAHO/WHO is working to mobilize resources in the form of direct funds and lines of credit to support country efforts to prepare for Ebola. Such efforts are an investment in public health preparedness in general, and especially for diseases that can have serious health, economic and social impacts.

11. Support for the response in West Africa
Experts from various PAHO technical areas have supported WHO’s response to Ebola in West Africa. Controlling the outbreak at its roots is the top priority, both to save lives and to halt the disease's spread.

12. A window of opportunity
Efforts to prepare for the potential introduction of Ebola into Latin America or the Caribbean also help strengthen countries' capacities to respond to other disease outbreaks and epidemics. The framework for these efforts is the International Health Regulations (IHR), an agreement signed by WHO Member States to promote an effective response to public health emergencies of international concern.

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