Update on Ebola and response

Update on Ebola outbreak and
implications for nutrition
GNC Annual meeting
16-18 September 2014
Rome, Italy
• Over 2,200+ deaths and over 4,200
confirmed / probable cases in Guinea,
Sierra Leone, Liberia and Nigeria.
• The first case detected in March 2014.
50 % cases occurred in the past 3
• EVD peak not yet reached
Operational challenges
- Urban and rapid transmission
- Fragile and weak health systems
- Stigma undermining
• on nutrition programming itself
• on nutritional status of the population
Adapted guidance needed though limited evidence and
practical experience- “thinking outside the box”:
• IYCF, SAM/MAM, nutritional support for Ebola patients in
treatment and convalesence
• Other health guidelines: iccm, obstetric care, etc
Deterioration in underlying causes of malnutrition likely and
medium to long term view required.
Preparation and mitigation measures through multi- and
intersectoral collaboration critical.
1. IYCF in the context of Ebola
Key considerations:
• Ebola virus present in breastmilk & transmission is possible.
• The transmission mechanism is not clear.
• The risks of Ebola transmission and the related mortality seem
to outweigh the risks of not breastfeeding in the West African
• Application of IFE guidance around Code and replacement
feeding critical.
• Critical concern to not undermine IYCF in general population.
• Guidance and decision tree developed
• Social mobilization campaigns
• Sourcing and controlled distribution of RUIF
2. SAM and MAM treatment
Key considerations
• Collapse of the health system
• Reluctance of health workers to screen
• Concern of exposure with screening
• Under discussion
• No-touch options being explored (health workers
and others)
3. Nutritional support during
Ebola treatment and convalescence
Key considerations
• Nutritional needs unclear during and after treatment ends
• 2 presentations and variable presentation:
– Most with anorexia/trouble swallowing/diarrhea/vomiting
– Some able to eat
• In treatment- variable product options
• On discharge- for all or just those with low BMI?
• Need to balance operational feasibility, evidence and
preference, and not undermining other programmes using
those products
• Simple guidance under discussion (linked to the IYCF
Current operational guidance and discussion: en-net
• Infant feeding & Ebola guidance:
• IFE thread: http://www.en-net.org/question/1445.aspx
• Adult & child nutrition support thread: http://www.en-net.org/question/1465.aspx
• English: http://www.who.int/csr/disease/ebola/en/
• French: http://www.who.int/csr/disease/ebola/fr/
• English: http://www.cdc.gov/vhf/ebola/
• English (WA): http://www.cdc.gov/vhf/ebola/outbreaks/guinea/index.html
• French (WA): http://www.cdc.gov/vhf/ebola/outbreaks/guinea/french/index.html
Participate in the discussions
Many thanks to those already engaged in
sharing information and experience already!
• Contribute to the discussion through en-net
• Share information with colleagues
• Participate in side meeting at ENN technical
meeting on nutrition (7-9th Oct)
Moving ahead together

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