Tuesday, 1 December 2015

VIFM researchers devise protocols for managing Ebola on site or at a mortuary

The Victorian Institute of Forensic Medicine’s (VIFM, a part of the Department of Forensic Medicine in SPHPM) Dr Jodie Leditschke, Professor Stephen Cordner, Professor Noel Woodford and researchers from the Ontario Forensic Pathology Service have co-authored a publication addressing the development of a protocol to manage the Ebola virus disease when presented at either a scene or within the mortuary.

The Ebola virus disease, commonly known as Ebola is a fatal viral illness, belonging to the Filoviridae family of viruses. There have been five species of Ebola identified to date: Sudan; Reston; Bundibugyo; Zaire; and Tai Forest. While the origin of the virus is not clear, there is research indicating that fruit bats may be the host of the virus. The illness is fatal, with recorded death rates of 90 per cent. In the West African pandemic, the death rate has been just under 50 per cent.

Ebola is transmitted through contact with either secretions, blood, organs or other bodily fluids from the host species (fruit bat) or other infected animals (Ebola can also affect primates such as gorillas or chimpanzees). After a human is infected with Ebola, it can transmit to others through contact with the infected individual’s blood or other fluids. It can also be transmitted through a healthy individual’s contact with contaminated objects touching broken skin. Symptoms of Ebola include muscle pain, severe headache, weakness, onset of fever, and a sore throat. This can also lead to internal and external bleeding, vomiting, rash and poor liver or kidney function. Ebola is managed with intensive supportive care as there is no curative form of treatment. 

In areas of West Africa, which has faced a massive Ebola epidemic, effective management of the illness is paramount. However, these regions had limited access to resources and there was a dire need for health systems to create strategies and protocols in situations where Ebola cases are either suspected or yet to be confirmed.

Forensic pathology units are a critical factor in the implementation of public health services, most significantly in situations where there are reported cases of infectious disease. Departments are responsible for the identification of illness, notification to relevant organisations and bodies and communication with relevant agencies to monitor the disease.

While it is unlikely that Western countries will face an outbreak of Ebola, there is still a need for forensic pathology departments to create a protocol to ensure quick assessment of any suspected cases and also maintain a high safety standard for pathology and mortuary staff.

The researchers have created a collaborative protocol on the management of possible Ebola cases presented either in the mortuary or at the death scene of a suspected case within Australia:

•In management of an individual who is suspected to have the Ebola virus, all individuals who may be asked to remove or shift the body must wear full Personal Protective Equipment;

•In situations where the deceased individual is confirmed to have had the Ebola virus, the funeral director must be contacted immediately. All mortuary personnel are required to wear Personal Protective Equipment and specifically prepare the body bag for safe coffin transfer;

•Victorian Institute of Forensic Medicine staff will also organise a specific training session regarding protective measures that need to be adhered to regarding Ebola in case of an Australian outbreak and;

•Any individual who is suspected to have any exposure to bodily fluids, blood or other secretions from a deceased individual who was suspected to have Ebola must be referred for intensive medical care and surveillance.

The authors conclude that while there may be very rare cases of Ebola within developed regions, protocol development is imperative to ensure that forensic pathology departments are adequately trained and aware on dealing with any suspected cases due to the devastating and fatal nature of the illness. It is intended that this protocol, operating on both a trans-national and inter-departmental level will act as a platform for any similar future projects.

You can download the paper and protocols here.

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