Division of Bacterial Diseases (DBD) News Bulletin

Rana Hajjeh, Division Director, Division of Bacterial Diseases

Response Lead, Guinea, 3/23/2015–4/26/2015

I was in Guinea for 5 weeks (March–April 2015) as the lead of the CDC response team. We were doing everything: providing support for the national Emergency Operations Center, surveillance, contact tracing and other epidemiologic activities, laboratory capacity, multiple rapid diagnostics building and evaluation, quarantine and border efforts, strengthening infection control capacity, communications, coordinating with multiple partners and closely working with the Ministry of Health (MOH), and a lot more. It was extremely busy and we often worked 18 to 20 hour days, but we had a great team that kept going and understood the importance of its mission.

I was based in Conakry, but I often went to the field, as it was important to check the epidemiologic situation firsthand and follow up with many of our staff in the provinces. Together with the MOH, CDC helped plan the first door-to-door awareness campaigns that were critical to improving case finding and contact tracing.

My best memories are from these field visits, whether by car (long rides due to terrible traffic and bad road conditions) or preferably by helicopter (with the United Nations). I remember one day meeting an Ebola survivor while visiting one of the rural health departments. She had come back with a huge container of cooked rice that she presented as a gift to the staff who took her to the Ebola treatment center when she became sick. I was very touched by this woman, who lost her husband, mother-in-law, and son, but was back to thank the healthcare workers!

Another great field visit was to the Ebola treatment unit that was set up by the French military to treat all Guinean and other healthcare workers who develop Ebola. It was a state of the art unit (the best I have seen in the region) that provided great care (survival rate of about 70%!) and it was very heartwarming to see such care provided to these workers who were putting their lives on the line each day.

Another lasting memory from all my Ebola assignments is that I got to work and meet many wonderful colleagues from all over CDC that I would not have worked with otherwise. We truly have a great workplace!

Heidi Soeters, EIS Officer, Meningitis and Vaccine Preventable Diseases Branch

Healthcare Infection Prevention Team, Guinea, 11/7/2014–12/10/2014

As a member of the Healthcare Infection Prevention Team, I had two main roles: 1) to help develop a curriculum and conduct infection control trainings for healthcare workers, and 2) to conduct infection control assessments at health facilities. I spent the majority of my deployment in southeastern Guinea in the prefectures of N’Zérékoré and Macenta, where we trained more than 700 frontline healthcare workers, including everyone from doctors and nurses to janitors and ambulance drivers. The training included classroom sessions and hands-on exercises in handwashing, triaging patients, putting on and taking off personal protective equipment, and cleaning up contaminated fluids.

I will never forget how eager the healthcare workers were for training, support, and basic infection control supplies. Two particular moments stick out in my mind. One was on our first day of training in N’Zérékoré, were we had 80 students enrolled and were astonished to find that more than 200 had shown up, pleading to have a spot in the course. The second moment was when a training day ran late and the classrooms without electricity grew dark. I expected people to be tired and want to go home, but they pulled out flashlights and refused to leave until all of the material was covered. The first time this happened, it was a big surprise, but these late sessions became a daily occurrence.

As this was my first international emergency response, I learned a lot from watching how everyone came together as one big team. On a daily basis, we were working side-by-side with local healthcare staff, the Ministry of Health, CDC, the World Health Organization (WHO), the United States Agency for International Development (USAID), the United Nations Children’s Fund (UNICEF), Catholic Relief Services, the United Nations Mission for Ebola Emergency Response (UNMEER), Médecins Sans Frontières (MSF, or Doctors Without Borders), World Food Program, and many others. The collaboration and mutual support was incredible, and I left the experience with many lasting friendships.

Stephanie Schrag, Epi Team Lead, Respiratory Diseases Branch

STRIVE Team Lead, Atlanta, GA, 12/8/2014–ongoing

On the Ebola Vaccine Task Force, I served as the U.S. co-principal investigator (PI) for STRIVE, which is the Sierra Leone Trial to Introduce a Vaccine against Ebola. There was another CDC co-PI (Marc-Alain Widdowson from the Influenza Division) and a PI in Sierra Leone (Mohamed Samai from the College of Medicine and Allied Health Sciences, University of Sierra Leone), plus a team of people from across CDC working in Atlanta and Sierra Leone. As co-PI, one of my main responsibilities was writing the study protocol, including developing and implementing a vaccine safety monitoring plan.

My most memorable experience was probably coming in and changing the study design as the epidemic evolved and making sure all the study partners were on board to make that change. When I came onto the trial, the decision was to do a design called a stepped wedge and everybody was referring to the trial as "the stepped wedge trial." But that’s not a very common design and as I learned more about it, it became apparent that it wasn't going to be a good fit for what we needed to do in the field―both for the scientific objectives but also for the field realities. So we had to come up with a way to shift the design that the leadership would feel comfortable with and all the communication messages to Sierra Leone would remain relatively consistent despite the fact that we needed to change how we were approaching the trial. So we changed it to an individually randomized design, which still did not use a placebo. You can learn more about the trial and its design.

I’ve learned so many things. Overall, I learned how to work on something when the landscape keeps changing and nobody in the agency has done something quite like this before in a setting that has no experience ever doing this kind of study. The fact that we have launched a trial and enrolled around 8,500 people and vaccinated about half of them as of mid-August is a real testament to the dedication of Sierra Leone to rise to this very unusual occasion and to the dedication to all of the partners to help support them and make it happen. This has been a once in a lifetime opportunity.