Ebola ex Afrika - Ebolafälle außerhalb Afrikas

[Birgitt]

Der aus Liberia stammende Ebola-Patient im US-Bundesstaat Texas ist tot [...] Der 42-Jährige war der erste Ebola-Patient, bei dem das Virus in den USA festgestellt worden war. Er hatte sich in seinem Heimatland Liberia mit Ebola infiziert. Der Erreger wurde aber erst diagnostiziert, nachdem er zu einem Familienbesuch nach Texas gereist war. Nach einer Ansteckung vergehen bis zu 21 Tage, bis erste Zeichen der Krankheit wie Fieber und Übelkeit auftreten. Zunächst hatte die Klinik den Kranken wieder nach Hause geschickt, erst zwei Tage später wurde er aufgenommen und isoliert. Dutzende Menschen, mit denen der Patient in den Wochen vor seiner Krankenhauseinweisung Kontakt hatte, wurden unter Beobachtung gestellt. Zehn Personen kamen in seine Nähe, als die Krankheit bei ihm bereits ansteckend war.

Erster Ebola-Patient in USA gestorben
08.10.2014 - tagesschau

Gruß
Birgitt

[Kuno]

Und in den Medien von heute empoert man sich dass der Hund der spanischen Ebola-Patientin eingeschlaefert wurde...

Waehrend in Westafrika tausende Menschen sterben regt man sich in Europa wegen einem Hund auf. Ich hoffe, dass es diese Meldung nicht in eine Westafrikanische Zeitung schaft.

[Alexander]

Während die Nevern immer mehr blank liegen, Serbien steckte z.B. 708 Personen vorsorglich in Quarantäne, macht ein Amerikaner an Bord eines Flugzeuges geschmacklose Scherze:


Nicht lustig: Ebola-Witz in Passagierflugzeug löst Seuchenalarm aus

"Ich habe Ebola, ihr seid alle geliefert"

Der enorm unlustige Ebola-Gag eines Passagiers hat an Bord eines Urlauberjets der US Airways für Beklemmung gesorgt. Weil der Mann behauptet hatte, an der Seuche erkrankt zu sein, kamen nach der Landung Experten in Schutzanzügen an Bord. mehr...

Grüsse
Alexander

[Alexander]

In den USA hat sich eine weitere Person außerhalb Afrikas mit Ebola infiziert.
Ein Krankenpfleger, der einen Ebolapatienten behandelt hatte, der dem Virus erlegen war, wurde jetzt "positiv" getestet.
Jetzt wird nach weiteren Kontaktpersonen gesucht.

Krankenpfleger positiv auf Ebola getestet

Grüsse
Alexander

[julandchigo]

http://dietagespresse.com/nach-kontakt- ... ola-panik/

Jetzt ist es auch bei uns soweit: Österreich hat seinen ersten bestätigten Fall von Ebola-Panik. Bei der Patientin handelt es sich um die 72-jährige Sieglinde M. aus Wien-Donaustadt. Sie infizierte sich offenbar an........

[Birgitt]

EBOLA VIRUS DISEASE - ex AFRICA (08): USA DEATH, CONCERN REGARDING SPREAD, TRAVEL BAN
*************************************************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

In this update:
[1] USA: Ebola, Texas death
[2] USA: Experts worry Ebola may spread more easily than assumed
[3] USA: Travel ban?

******
[1] USA: Ebola, Texas death
Date: 8 Oct 2014
Source: Texas Department of State Health Services
https://www.dshs.state.tx.us/


Texas Department of State Health Services 8 Oct 2014 10:23 A.M.
---------------------------
"The past week has been an enormous test of our health system, but for one family it has been far more personal. Today [8 Oct 2014], they lost a dear member of their family. They have our sincere condolences, and we are keeping them in our thoughts. The doctors, nurses and staff at Presbyterian provided excellent and compassionate care, but Ebola is a disease that attacks the body in many ways. We'll continue every effort to contain the spread of the virus and protect people from this threat."

[Dr. David Lakey, Commissioner, Texas Department of State Health Services]

--
Thomas G. Benoit
Professor of Biology
McMurry University
Abilene, Texas 79697
<tbenoit@mcm.edu>

[See also: http://edition.cnn.com/2014/10/08/healt ... ef=edition and
http://www.nbcdfw.com/news/local/Dallas ... t_DFWBrand. - Mod.JW]

******
[2] USA: Experts worry Ebola may spread more easily than assumed
Date: 8 Oct 2014
Source: Tribune News Service from Detroit Free Press [edited]
http://www.freep.com/story/news/world/2 ... n/16879009


Dr. C.J. Peters said he would not rule out the possibility that Ebola spreads through air. "We just don't have the data to exclude it," said Peters...

There is no proof that an infected person without symptoms could not spread the virus. "It's really unclear," said Michael Osterholm, "None of us know."

Health officials say Ebola is spread only through physical contact or bodily fluids. Yet some scientists say such assurances are premature...

--
Communicated by:
ProMED-mail Rapporteur Kunihiko Iizuka

[It is impossible for good scientists like Mike and CJ to guarantee what a virus will or will not do. But let's not speculate too much, because the media fuels public paranoia by adding sensational headlines to what we say. The public is quite worried enough already.

It should be obvious that this strain of ebolavirus is NOT currently airborne like the flu, otherwise, there would already be far more cases than there appear to be now.

As for spread by people without symptoms, there is no way to test that without human volunteers and no practical way to avoid that if it in fact ever occurs, other than self-quarantine/isolation. - Mod.JW]

******
[3] USA: Travel ban?
Date: 7 Oct 2014
Source: National Geographic [edited]
http://news.nationalgeographic.com/news ... alth-world


It seems so obvious: To keep Ebola out of the United States, simply keep anyone who has the deadly disease from getting in...

Many public health experts who oppose the travel ban argue that it's simply not practical. That includes Columbia University's Morse, who describes himself as a "fence-sitter" on the issue but doesn't support a travel ban right now because people with financial means can travel to an intermediate country before entering the United States. West Africa's many porous borders make such travel even easier, he said.

It wouldn't make sense to ban people who fly out of Senegal, where, like the United States, there has been only one case of Ebola, Morse said. But if one person with Ebola made it there [from Guinea], others could, too.

A ban could also encourage people to lie about where they have been, Morse said: "One of the real concerns is that if you outlaw [travel], it will discourage people from coming forth with the truth."

--
Communicated by:
Ryan McGinnis
http://bigstormpicture.com

[A ban would be unenforceable. How does an immigration officer know whether a person arriving from Europe has been in an EVD country in the last 3 weeks? Do the airports in the EVD countries stamp passports on exit? In any case, West Africans have visa-free travel to neighboring countries. They could go to any of them that are EVD-free with no entry stamp in their passport and leave from them. Or they may live in Europe or elsewhere overseas and have been on extended travel.

The USA won't allow profiling people of color, although there are other countries that would have no hesitation and aggravate many African-Americans in doing that. In any case, how will you detect dual citizens who depart West Africa on their West African passports and arrive in the US on their unstamped US passports? Or African-Americans who are returning after extended travel through West Africa? It would extend passport examination time enormously, and arriving passengers would self-segregate in the waiting lines, not to mention airline passengers self-segregating in departure lounges and asking to be reseated away from passengers of color on board. The complications multiply.

I read somewhere that the temperature that triggers quarantine for a passenger is 101.5 F. If that is true, the deceased Liberian reportedly had only 101.1 F on his 1st visit to the hospital. - Mod.JW

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/106.]

[Birgitt]

EBOLA VIRUS DISEASE - ex AFRICA (09): WHO, SPAIN, AUSTRALIA, CANADA, USA
************************************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

In this update:
[1] WHO: Ebola virus disease - Spain
[2] Spain: more quarantined individuals
[3] Australia: nurse tested for Ebola
[4] Canada: Ebola screening on arrival
[5] USA: airport cleaners strike

******
[1] WHO: Ebola virus disease - Spain
Date: Thu 9 Oct 2014
Source: WHO Global Alert and Response, Disease Outbreak News [edited]
http://www.who.int/csr/don/09-october-2014-ebola/en/


On 6 Oct 2014, the World Health Organization (WHO) was informed of the 1st confirmed autochthonous case of Ebola virus disease (EVD) in Spain. This case represents the 1st human-to-human transmission of EVD outside Africa.

The case is a female healthcare worker with no travel history to West Africa but who participated in the medical care of an EVD case in a Spanish citizen, who had been infected in Sierra Leone and evacuated to Madrid, Spain on 22 Sep 2014 and who died on 25 Sep 2014. She was in contact with the repatriated EVD case twice; on 24 and 25 Sep 2014. On both occasions she is reported to have worn appropriate personal protection equipment (PPE).

Following the Spanish national protocol for EVD cases, the healthcare worker was considered a low risk contact and monitored accordingly. The female case developed a fever on 29 Sep 2014 and was admitted into isolation on 6 Oct 2014 at Alcorcon Hospital in Madrid. The case was then transferred to La Paz-Carlos III Hospital in Madrid and is being treated under isolation. Samples were collected and sent for testing to the National Reference Laboratory on 6 Oct 2014. Results were positive for Ebola virus on the same day.

The Spanish public health authorities are conducting an investigation to elucidate the mode of transmission. Identification of close contacts for daily monitoring for 21 days after exposure is underway for the recent case and is continuing for contacts of the Spanish citizen who was treated in Spain.

As for all countries reporting EVD cases, future WHO updates on EVD in Spain will not be posted on the Disease Outbreak News. Further information will be available in WHO's Ebola situation reports which provide regular updates on the WHO response: http://www.who.int/csr/disease/ebola/si ... reports/en.

WHO does not recommend any travel or trade restrictions to be applied by countries except in cases where individuals have been confirmed or are suspected of being infected with EVD or where individuals have had contact with cases of EVD. Contacts do not include properly protected health-care workers and laboratory staff.

Temporary recommendations from the Emergency Committee with regard to actions to be taken by countries can be found at:
IHR Emergency Committee on Ebola outbreak in West Africa
http://www.who.int/mediacentre/news/sta ... 0140808/en

--
Communicated by:
ProMED-mail Rapporteur Marianne Hopp

[For the HealthMap/ProMED map of Spain, see < http://healthmap.org/promed/p/43>. - Mod.MPP]

******
[2] Spain: more quarantined individuals
Date: Thu 9 Oct 2014
Source: The Telegraph [edited]
http://www.telegraph.co.uk/news/worldne ... short.html


3 more health workers quarantined in Spain
------------------------------------------
The health of a Spanish nurse with Ebola worsened on Thursday [9 Oct 2014] as one of the doctors who initially treated her at a local hospital said the protective suit he wore while attending her was ineffective. Dr Juan Manuel Parra complained that the protective suit he was given to treat [the nurse] had sleeves which were too short for him, leaving his bare skin exposed.

The health of [the nurse], the 1st person known to have caught Ebola outside of Africa, has deteriorated, according to the Madrid hospital where she is being treated....

Officials said that they would disinfect [her] home on Thursday [9 Oct 2014], a day after her dog Excalibur was removed from the property and put down as a precautionary measure, despite furious protests by animal rights activists.... -- more

[Byline: Fiona Govan]

--
Communicated by:
ProMED-mail from HealthMap Alerts
<promed@promedmail.org>

[Sad comment. Exposed skin should always be covered, at least by tape. From another report, German Ramirez, the doctor attending her, said the nurse may have contracted the virus when she was taking off her protective equipment. He said he had spoken to her several times and she had suggested she may have touched her face with her gloves while taking off her protective suit. He added that health professionals were supervised whenever they were taking off or putting on their protective equipment. What does her supervisor say? - Mod.JW]

******
[3] Australia: nurse tested for Ebola
Date: Thu 9 Oct 2014
Source: The New York Times [edited]
http://www.nytimes.com/2014/10/10/world ... ebola.html


Australian nurse, returning from Sierra Leone, tested for Ebola
---------------------------------------------------------------
An Australian nurse who worked for the International Red Cross in Sierra Leone treating patients suffering from Ebola has developed a fever and been admitted to a hospital in Cairns, in northeast Australia. The chief health officer for the state of Queensland, Dr. Jeannette Young, said on Thursday [9 Oct 2014] that the woman had returned over the weekend from a month of work in Sierra Leone. She landed in Brisbane, the state's capital and most populous city, and then traveled to her home in Cairns. "Importantly, she has reported that while in Sierra Leone strict personal protective equipment, or PPE, procedures were followed at all times and were not breached at any stage," Dr. Young said in a statement issued by the state government's Health Department.... -- more

[Byline: Michelle Innis]

--
Communicated by:
Ryan McGinnis
http://bigstormpicture.com

[You can't be too careful at this stage of the epidemic. - Mod.JW]

[For the HealthMap/ProMED map of Australia, see < http://healthmap.org/promed/p/186>. - Mod.MPP]

******
[4] Canada: Ebola screening on arrival
Date: Thu 9 Oct 2014
From: Ronald K. St. John, MD, MPH <ronaldstjohn@gmail.com> [edited]


Today, 9 Oct 2014, Health Canada announced that it would increase screening measures at unspecified points of entry to identify travellers who might be bringing Ebola from the affected West African countries. Other than targeted temperature screens, the details of these measures are not revealed.

However, one can guess what they might be since there are only 3 screening measures that can be implemented at a point of entry.
- 1st, a questionnaire about any symptoms and their country of origin can be mandatory for arriving passengers.
- 2nd, a so-called thermal scanning machine can be installed to try to detect arriving passengers who might have a fever.
- 3rd, someone like an authorized quarantine officer can assess any passenger who is actually ill on arrival on the spot. (This measure had been in place in Canada since the SARS epidemic.)

Here is the challenge. We will try to find a few people who might have Ebola among the huge number of people entering Canada by air alone. How big is this number? According to Statistics Canada, in July this year [2014] there were 2.6 million passengers arriving on Air Canada and Westjet across the country. In June, the number was 2.3 million; in other words, a very large number of people month after month come to Canada (http://www.statcan.gc.ca). At Toronto [Ontario]'s Pearson Airport, there are approximately 86 000 passengers in and out of this airport every day (http://www.torontopearson.com/en/Airport_Fact). Finding that one infected person among all these people is the proverbial "needle in a haystack."

Memories are sometimes short. We have already tried this in Canada during SARS in 2003. Here are the data:

- A questionnaire with 3 questions was mandatory for all incoming passengers. A total of 678 000 questionnaires were filled out, and 2478 people answered yes to one or more of the questions. A specially trained nurse referred each one of these people for in-depth questioning and temperature measurement. The result? None of the 2478 people had SARS.
- Thermal scanning machines were installed in the 6 major airports that handle approximately 94-96 percent of all international arrivals. The results from the Toronto and Vancouver airports? Among the 468 000 people who were screened, 95 were referred to a nurse for further assessment. None of these people actually had an elevated temperature, and all were cleared.

The total cost for implementing these procedures was approximately CAD 17 million [about USD 15.2 million] over a period of approximately 9 months.

What are the take away messages from the SARS experience?

1. Finding the "needle in the haystack" is very difficult. There is a mathematical/epidemiological reason why this is so. Suffice it to say that a passenger with Ebola who arrives in Canada will be a rare event, and the screening measures that are available will not detect it.
2. Screening incoming passengers for an infectious disease is very costly given the limited measures available.
3. Passengers can be perfectly well on arrival but be incubating an infectious disease. Such was the case with the Ebola-infected man in Texas [USA]. The available measures will not detect someone who is incubating the illness.
4. Since border screening is ineffective, we need to recognize that the point of entry for a dangerous infectious disease will be a Canadian hospital. This is where a person who becomes ill after arrival will go for treatment. This is where appropriate screening must take place to identify anyone with a serious infectious disease.
5. Screening at the point of departure (exit screening) in the affected countries is likely to be more effective and less costly than screening of passengers at point of entry (http://ecdc.europa.eu/en/publications/P ... ssment.pdf).

We published our Canadian SARS experience, and for more detail please review the following:
St. John, RK, King, A, et al. Border Screening for Severe Acute Respiratory Syndrome (SARS), Journal of Emerging Infectious Diseases, Vol. 11, No. 1 January 2005.

--
Ronald K. St. John, MD, MPH
Former Director General
Centre for Emergency Preparedness and Response
Public Health Agency of Canada
<ronaldstjohn@gmail.com>

[Re: "Screening at the point of departure (exit screening) in the affected countries is likely to be more effective and less costly...." Only if supervised (by internationals). Need to check batteries of scanners and query low readings, ambient temperatures, etc. No way to detect if the traveller has taken a febrifuge. Could check hand baggage for opened containers or foil strips of aspirin etc. -- but not foolproof.

On the other hand, public health can't trust arriving passenger contact declarations of addresses/phone numbers and promises to self-test temperatures twice a day for 21 days -- even with a strong incentive to turn oneself in to get early treatment (improving survival rate) because of implications for quarantine of family, etc. - Mod.JW]

[Reply by Ron:]
I agree fully with your comments. During SARS, we discussed the very pitfalls you list. In fact, I was totally surprised that anyone ever answered "yes" to our questionnaire since it meant considerable loss of time in a "secondary assessment". If they had known this, then they might have taken some Tylenol and answered "no" to everything, as you point out. Then there was the expense of translation since we targeted flights from Asia, and on and on with a huge amount of logistical details. I had some interesting discussions with airport managers regarding thermal scanners!

Your commentary will clearly reinforce what we know. You just can't stop ID at the borders, unless you stop all airlines. Remember 9/11? Within hours of the event, both Canada and the USA closed their air space with huge logistic and economic problems. I had to help 45 000 Americans who got stranded in the eastern provinces when their planes had to land somewhere. Just not feasible to do this kind of thing anymore.

--
Ronald K. St. John

******
[5] USA: airport cleaners strike
Date: Thu 9 Oct 2014
Source: RT [edited]
http://rt.com/usa/194596-ebola-laguardia-airport-strike


Ebola scare: LaGuardia on strike, 58 percent of Americans want to ban flights from W. Africa
--------------------------------------------------------------------------------
Airplane cabin cleaning crews at New York's LaGuardia International Airport began a 24-hour strike on Wednesday [8 Oct 2014], citing, in part, possible exposure to the Ebola virus. Meanwhile, a poll found most Americans want flights banned from Ebola-ravaged areas.

Around 200 Air Serv employees who work on domestic flights to LaGuardia began their strike on Wednesday evening. The group is seeking to unionize, and they said health and safety issues on the job -- including exposure to blood, feces, and vomit without protective gear -- are the main reasons. They are also concerned about possible exposure to the Ebola virus, which claimed its 1st victim in the United States on Wednesday. Cabin cleaners per plane at LaGuardia have been reduced by up to half, and the time to clean planes has been cut down to as little as 5 minutes, workers said, as reported by CBS New York....

A new poll found a majority of Americans want flights banned from West African nations, where the latest Ebola outbreak is centered. 58 percent of Americans supported the flight ban, according to a poll conducted in a collaboration between NBC News and SurveyMonkey; 20 percent of respondents did not support a travel ban from the likes of Guinea, Liberia, and Sierra Leone. As of earlier this week, neither the World Health Organization nor the White House endorsed an all-out travel ban to the US from affected nations.... -- more

--
Communicated by:
ProMED-mail Rapporteur Kunihiko Iizuka

[Birgitt]

EBOLA VIRUS DISEASE - ex AFRICA (10): WHO, UN, LIBERIA, MEDEVAC, SIERRA LEONE, USA
**********************************************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

In this update:
[1] WHO Roadmap 8 Oct 2014
[2] UN chief: 20 times more Ebola aid needed
[3] Liberia: US airlift, UK airport screening, Ugandan doctor dies
[4] Liberia: German military evacuation problem
[5] Liberia: optimistic assessment, CDC
[6] Sierra Leone: UK sending 750 troops
[7] Sierra Leone: Sweden joins Ebola fight
[8] USA: airport screening to start
[9] More non-sensational Ebola coverage

******
[1] WHO Roadmap 8 Oct 2014
Date: Wed 8 Oct 2014
Source: WHO [edited]
http://apps.who.int/iris/bitstream/1066 ... g.pdf?ua=1


The total number of confirmed, probable, and suspected cases (see Annex 1) in the West African epidemic of Ebola virus disease (EVD) reported up to the end of 5 Oct 2014 (epidemiological week 40) is 8033 with 3865 deaths [mortality rate 48 percent - Mod.JW]. Countries affected are Guinea, Liberia, Nigeria, Senegal, Sierra Leone, and the United States of America. A confirmed case of EVD has been reported in Spain, but because the case was confirmed during the week ending 12 Oct 2014 (epidemiological week 41), information on this case will be included in the next Ebola Response Roadmap update.... -- more

--
Communicated by:
Ryan McGinnis
http://bigstormpicture.com

[The WHO later said 3865 people had died by the end of 5 Oct 2014, not 3879 as it said on Wed 8 Oct 2014. This does not change the mortality rate. The figures represent the total of Ebola deaths notified by the countries hit by the virus, but the WHO says the figures are under-reported and the true totals are much higher (http://reuters.com/article/idUSL6N0S43S ... 9?irpc=932). So the change is not significant. - Mod.JW]

******
[2] UN chief: 20 times more Ebola aid needed
Date: Thu 9 Oct 2014
Source: Associated Press (AP) [edited]
http://hosted2.ap.org/APDEFAULT/bbd8255 ... 2a1b3c515e


[See source URL for photo: Guinean President Alpha Conde, center, flanked by World Bank President Jim Yong Kim, left, and United Nations Secretary General Ban Ki-moon, right, joins an international forum to discuss the Ebola outbreak and what help is needed by the West African nations that are stricken with the outbreak, at the World Bank in Washington, Thursday, 9 Oct 2014. (AP Photo/J. Scott Applewhite) (1 of 5)]

The presidents of 3 Ebola-stricken West African nations sought an immediate outpouring of money, doctors and hospital beds, and representatives nations gathered at a World Bank meeting Thursday [9 Oct 2014] promised to send more aid quickly, including a pledge of medical evacuations for health care responders who catch the virus.

"Our people are dying," said President Ernst Bai Koroma, speaking by video from Sierra Leone to an Ebola summit at the annual meeting of the International Monetary Fund and World Bank in Washington....

A World Bank report this week estimated that the economic toll of the largest Ebola outbreak in history could reach USD 32.6 billion if the disease continues to spread in West Africa through next year [2015]. "Every dollar spent now may well be worth more than USD 20 or USD 30 spent in 2 months' time," said David Nabarro, the United Nations special envoy on Ebola. "This is a moment when there must be no postponement of financing decisions, no postponement of action." ... -- more

[Byline: Connie Cass]

--
Communicated by:
Ebola News Digest
http://eboladigest.blogspot.com

******
[3] Liberia: US airlift, UK airport screening, Ugandan doctor dies
Date: Fri 10 Oct 2014
Source: Bloomberg Businessweek [edited]
http://www.businessweek.com/ap/2014-10- ... rvation#p2


US military planes arrive at epicenter of Ebola
-----------------------------------------------
6 U.S. military planes arrived Thursday [9 Oct 2014] at the epicenter of the Ebola crisis, carrying more aid and American Marines into Liberia, the country hardest hit by the deadly disease that has devastated West Africa and stirred anxiety across a fearful world.

At a World Bank meeting in Washington DC, the presidents of several West African countries struggling with Ebola pleaded for help, with one calling the epidemic "a tragedy unforeseen in modern times." "Our people are dying," Sierra Leone President Ernest Bai Koroma lamented by videoconference. He said the world is not responding fast enough as children are orphaned and infected doctors and nurses are lost to the disease. Alpha Conde of Guinea said the region's countries are in "a very fragile situation." "This disease is today an international threat and deserves an international response," he said, speaking through a translator. Tom Frieden, director of the U.S. Centers for Disease Control and Prevention, said he was reminded of the start of the AIDS epidemic. We have to work now so this is not the next AIDS," Frieden said.

The fleet that landed outside the Liberian capital of Monrovia consisted of 4 MV-22 Ospreys and 2 KC-130s. The 100 additional Marines bring to just over 300 the total number of American troops in the country, said Maj. Gen. Darryl A. Williams, the commander leading the U.S. response.

UK airport screening
--------------------
Meanwhile, British authorities said they would introduce "enhanced" screening of travelers for Ebola at Heathrow and Gatwick airports and Eurostar rail terminals. Prime Minister David Cameron's office said passengers arriving from West Africa would be quizzed about their travels and contacts. Some people could be given a medical assessment and advice on what to do if they develop symptoms....

The U.S. military is working to build medical centers in Liberia and may send up to 4000 soldiers to help with the Ebola crisis. Medical workers and beds for Ebola patients are sorely lacking....

British Defense Secretary Michael Fallon said his country would provide more than 750 troops to help build treatment centers and an Ebola "training academy" in Sierra Leone. Army medics and helicopters will provide direct support. Britain will also contribute an aviation support ship. British troops are expected to arrive next week in Sierra Leone, where they will join military engineers and planners who have been there for nearly a month helping to construct medical centers....

The German military, which has already been flying material such as protective clothing from Senegal to the worst-hit countries, planned to start a wider deployment of aid in mid-November [2014]. The military is expected to set up a clinic for 50 patients.

Sierra Leone officials finally released a shipping container filled with medical gear and mattresses that had been held up at the port for more than a month. Ibrahim Bangura, an official who handles medical supplies, said the container's contents were finally in his possession on Thursday [9 Oct 2014]....

Guinea: "massive" influx of cases
---------------------------------
In Guinea, where the 1st Ebola cases were confirmed back in March [2014], Doctors Without Borders warned on Thursday [9 Oct 2014] of a "massive" influx of cases in the capital. The aid group's center in Conakry received 22 patients on Monday [6 Oct 2014] alone, including 18 from the same region 50 km [about 31 miles] east of the city, the group said, adding that its facilities were reaching their limits.

Uganda doctor dies
------------------
A Uganda-born doctor, John Taban Dada, died Thursday [9 Oct 2014] of Ebola at a treatment center on the outskirts of Monrovia. His death brings to 4 the number of doctors who have died in Liberia since the outbreak. More than 90 health workers, including nurses and physician assistants, have also died.... In Germany, a man infected in Liberia arrived Thursday [9 Oct 2014] at a hospital for treatment -- the 3rd Ebola patient to be flown to the country. The St. Georg Hospital in Leipzig said the patient works for the United Nations in Liberia.... -- more

--
Communicated by:
Ryan McGinnis
http://bigstormpicture.com

******
[4] Liberia: German military evacuation problem
Date: Thu 9 Oct 2014
Source: Breitbart [edited]
http://www.breitbart.com/Breitbart-Lond ... e-Minister


The parlous state of Germany's military, which is plagued by broken, undeployable equipment and a shortage of spare parts, has led to the admission that the nation doesn't even have the capacity to evacuate Ebola-infected German soldiers, despite promises made last month [September 2014]....

When the Bundeswehr appealed for volunteers from among its ranks in September [2014], it was on the condition that any soldier who contracted Ebola in the course of delivering aid to West Africa would be immediately airlifted back to Germany for treatment, reports The Local. Despite 5000 men volunteering to go, the defence minister Ursula von der Leyen has been forced to admit Germany would be unable to undertake evacuations after a month of embarrassing failures for the Bundeswehr exposed the diminished capacity of the force.... Germany now has so few working transport aircraft, it had to borrow a Dutch military transport ... but that too broke down.

--
Communicated by:
ProMED-mail from HealthMap Alerts
<promed@promedmail.org>

[I am sure Germany's other NATO allies, e.g. France, Spain, and the UK, which have properly equipped military planes, would be glad to help with evacuation. - Mod.JW]

******
[5] Liberia: optimistic assessment, CDC
Date: Wed 8 Oct 2014
Source: Science [edited]
http://news.sciencemag.org/africa/2014/ ... rn-liberia

CDC epidemiologist sees hope for controlling Ebola in southeastern Liberia
--------------------------------------------------------------------------
Adam Bjork, an epidemiologist with the U.S. Centers for Disease Control and Prevention (CDC) in Atlanta [Georgia, USA], spent the last 2 weeks in the southeastern corner of the country [Liberia], which has seen relatively few Ebola cases.

Bjork worked with local health officials to piece together the chain of transmission and to help mount an effective response. Despite the bleak situation, he's still optimistic about the Ebola outbreak in the remote area. "They could get in front of it out there," Bjork says.

During his 2-week stay, Bjork worked with a team in Fish Town to do contact tracing. He was surprised by how well-organized the effort was already. "I came with a template to make sure they had initiated the tracing, but what they'd done had covered the vast majority of it," Bjork says. But they were short on motorbikes and vehicles to do the fieldwork. "They know what to do, but they don't have the resources," he says. "And they need to communicate with nearby communities so they're accepted there to do it."

At 1st, the contact tracers were met with some hostility; one town threatened to burn the ambulance some of the workers were traveling in. The team held a community meeting with town leaders. "I've never seen a large-scale community gathering change its mood like that after getting information delivered and being heard," he says. "By the end, they were OK with it."

Bjork says he saw a lot of signs that the international response to the epidemic is being ramped up. Welthungerhilfe, a German nongovernmental organization, was helping build a community care center at a local school that would isolate suspected Ebola patients and provide some medical treatment. Samaritan's Purse, the missionary group, flew a team in by helicopter to start building a more sophisticated Ebola treatment center. The World Health Organization and the Liberian ministry of health sent in trainers to teach health care workers how to safely do their jobs.

[Byline: Jon Cohen]

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******
[6] Sierra Leone: UK sending 750 troops
Date: Wed 8 Oct 2014
Source: BBC News [edited]
http://www.bbc.com/news/uk-29542129


Ebola outbreak: UK sending 750 troops to Sierra Leone
-----------------------------------------------------
The UK is sending 750 military personnel to Sierra Leone to help deal with the deadly Ebola outbreak, Foreign Secretary Philip Hammond has confirmed. The UK will also send medical ship the Royal Fleet Auxiliary Argus and 3 Merlin helicopters. The personnel will be deployed next week [12-18 Oct 2014]. It comes as Health Secretary Jeremy Hunt said it was "now entirely possible that someone with Ebola will come to the UK either by one route or another". The latest figures show 3879 people have died in the West African epidemic. The vast majority of deaths have been in Guinea, Liberia and Sierra Leone, where 879 have died.

Brigadier Paul Gibson: "They've been planning this mission for some time and part of that planning will be extensive training of personnel." British troops will help to establish treatment centres and a training academy, with the ship and helicopters providing support.

[clip]

It is estimated the measures will help the country treat nearly 8800 patients over 6 months.

Mr Hammond said: "This disease is an unprecedented threat that knows no borders. We have to get ahead of this disease. If we get ahead of it and rise to the challenge, we can contain it and beat it." Philip Hammond and John Kerry urged all nations to boost their response to combat the virus. He said the UK had committed more than USD 200 million (GBP 125 million) to the programme in Sierra Leone.... 40 British military engineers have already travelled to the country to set up the facilities, said BBC defence correspondent Jonathan Beale.

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******
[7] Sierra Leone: Sweden joins Ebola fight
Date: Thu 9 Oct 2014
Source: The Local [edited]
http://www.thelocal.se/20141009/sweden- ... bola-fight


Sweden announced it was sending a team of doctors to Sierra Leone on Wednesday [8 Oct 2014], following criticism that it was not doing as much to help tackle the virus as its European neighbours. 12 people will travel to west Africa, according to Ann-Charlotte Zachrisson, Director of Operations at Sweden's National Agency for Safety and Preparedness; 5 of them are understood to be specialist doctors. One Swedish doctor is already working alongside a Danish team in Sierra Leone and some Swedes are volunteering for non-profit organisations across the affected countries.... -- more

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******
[8] USA: airport screening to start
Date: Wed 8 Oct 2014
Source: The Washington Post [edited]
http://www.washingtonpost.com/news/post ... s-airports


Travelers from West African countries will face stronger Ebola screening at U.S. airports
--------------------------------------------------------------------------------
Enhanced screening measures aimed at finding travelers infected with Ebola will be utilized at 5 of the busiest international airports in the United States, federal authorities said Wednesday [8 Oct 2014].

Travelers originating in the 3 West African countries hit hardest by the disease will be given questionnaires and have their temperatures taken at these U.S. airports, the Centers for Disease Control and Prevention and Department of Homeland Security announced Wednesday.

The new screening will begin at John F. Kennedy International Airport in New York on Saturday [11 Oct 2014]. Next week [week of 13 Oct 2014], it will be expanded to Washington Dulles International Airport outside Washington, D.C.; O'Hare International Airport, in Chicago [Illinois]; Hartsfield-Jackson International Airport in Atlanta [Georgia]; and Newark Liberty International Airport [New Jersey] outside New York.... Any travelers with fever, other symptoms or worrisome answers on a health questionnaire will be checked out at a CDC quarantine station. Travelers who do not require additional checking or quarantine will be asked to leave their contact information and check their temperature every day.... -- more

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[There are serious problems involved with airport screening -- see comments in Ebola virus disease - ex Africa (08): US death, concern re spread, travel ban 20141008.2843902 and part [4] in Canada: Ebola screening on arrival in Ebola virus disease - ex Africa (09): WHO, Spain, Australia, Canada, USA 20141009.2848352, but pressure from the public has forced its implementation.

A major problem is with setting the fever level at 101.5 F (38.6 C). Both the Texas and Madrid cases were initially turned away from hospitals because their temperatures were lower. But a lower threshold would catch large numbers of people with the sniffles and minor conditions. - Mod.JW]

******
[9] More non-sensational Ebola coverage
Date: Wed 8 Oct 2014
From: Luca Zinzula PhD <lucazinzula@unica.it> [edited]


Re: your email of 7 Oct 2014, subtitle [4] "Where to find non-sensational Ebola coverage" [Ebola virus disease - ex Africa (07): Europe cases, USA quarantine stations Archive No. 20141007.2840925], I would like to kindly bring to your attention the existence of FILOVIR (http://www.filovir.com), a website entirely dedicated to provide updated, authoritative scientific information on filoviruses.

FILOVIR, of which I am owner and editor, is non-profit, it was created in 2008 and mainly -- but not exclusively -- relies on collaboration with 3rd-party databases and web resources. Moreover, all information provided is previously subjected to in-depth analysis for accuracy and completeness before sharing.

FILOVIR has also a Twitter space which is specifically intended for sharing news provided by non-scientific media.

Please, if you believe it worthy, I would be glad that FILOVIR would be diffused via your ProMED email as a valuable web resource for people interested in finding good, precise, non-sensational coverage on this topic.

--
Dr. Luca Zinzula, PhD
University of Cagliari
Dept. of Life and Environmental Sciences
Laboratory of Molecular Virology
Cagliari
Italy
<lucazinzula@unica.it>
<lucazinzula@gmail.com>
http://www.unica.it/pub/english

[We have looked at this and it appears to be a reliable website. - ProMED]

[HealthMap/ProMED-mail map of Liberia at: http://healthmap.org/promed/p/54.

HealthMap/ProMED-mail map of Sierra Leone at: http://healthmap.org/promed/p/46. - Mod.JW]

[Birgitt]

EBOLA VIRUS DISEASE - ex AFRICA (11): EUROPE, THREAT TO NORTH AMERICA, RECURRENCE
*********************************************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

In this update:
[1] Ebola: 14 cases have been treated outside West Africa
[2] Spain: nurses quit
[3] Prevention & false alarms
[4] Threat to North America
[5] USA: Dallas case had high fever at 1st visit
[6] Recurrent cases

******
[1] Ebola: 14 cases have been treated outside West Africa
Date: Updated 8 Oct 2014
Source: New York Times [edited]
http://www.nytimes.com/interactive/2014 ... ak-qa.html


Ebola Facts: How many patients are being treated outside West Africa?
---------------------------------------------------------------------
At least 14 Ebola cases have been treated outside of West Africa in the current outbreak. Most of these involve health and aid workers who contracted Ebola in West Africa and were transported back to their home country for treatment; 2 cases were diagnosed outside of West Africa: A Liberian man began showing symptoms 4 days after arriving in Dallas [Texas], and a Spanish nurse became ill after treating a missionary in a Madrid hospital. These cases are compiled from reports by the federal Centers for Disease Control and Prevention [CDC], the World Health Organization, Doctors Without Borders [MSF] and other official agencies.... -- more, with graphic

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******
[2] Spain: nurses quit
Date: Fri 10 Oct 2014
Source: Guardian UK [edited]
http://www.theguardian.com/world/2014/o ... quit-ebola


Carlos III hospital treating virus-hit nurse suffers staff shortage amid concerns over training and safety
--------------------------------------------------------------------------------
Concerns about a lack of training and safety standards have left some staff refusing to attend to possible Ebola cases at Madrid's Carlos III hospital, where the 1st known person to contract the disease outside west Africa is being treated. 14 people are in quarantine at the hospital, including 4 health workers who treated the Spanish nurse who contracted the virus after treating an Ebola patient repatriated from Sierra Leone. 7 people, including 2 hairdressers who had given Romero a beauty treatment before she was diagnosed, entered the isolation unit on Thursday [9 Oct 2014]. None has tested positive for the disease except [the nurse], whose condition was described by the hospital as serious but stable. Her treatment has included injections with antibodies extracted from the blood of Ebola survivors....

While no official numbers were available, Elvira Gonzalez of the SAE nurses' union said fear of Ebola had caused some staff to refuse to treat certain patients, while others had resigned. One health worker told the newspaper El Pais that many staff members were making excuses to avoid work.... Others worry about being stigmatised. "Their children aren't being invited to birthday parties and their friends are cancelling joint holiday plans," Juan Jose Cano, a member of the Satse nursing union, told El Pais. "They've become known as the Ebola nurses. And it's not fair." ... -- more

[Byline: Ashifa Kassam in Madrid]

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******
[3] Prevention & false alarms

USA: Ebola victim's belongings burned in Port Arthur
----------------------------------------------------
10 Oct 2014: (AP) A Texas incinerator has destroyed drums loaded with items believed to have been contaminated by a man with Ebola. Veolia North America says the drums taken from a Dallas apartment where D became ill were destroyed Friday [10 Oct 2014] at the company's incinerator in Port Arthur [Texas]. Veolia says its incineration process destroyed viruses and pathogens with temperatures ranging from 1500 to 2100 degrees F [816-1129 C]. A crew of 15 people spent 4 days at the apartment where [he] had been staying when he developed Ebola-related symptoms such as vomiting and diarrhea. They wore protective suits with gas masks while filling about 140 barrels with mattresses [Reportedly, he slept in all the beds. - Mod.JW], [his] sheets and carpet from the entire apartment.... -- more
http://www.macon.com/2014/10/10/3356426 ... .html?rh=1

--
How not to catch Ebola
----------------------
7 Oct 2014: (BBC) "If an infected droplet does get on to your skin, it can be washed away immediately with soap and water or an alcohol-based hand sanitiser. The eyes are a different matter. A spray of droplets from a sneeze directly into the eye, for example, could let the virus in. Similarly, the mucous membranes of the mouth and inside of the nose are vulnerable areas, as is broken skin.... The virus can't breach protective gear, such as gloves, a mask, goggles, a full body suit and tough rubber wellington boots, but too few have access to state-of-the-art kit.... Those who do get to wear it should keep changing it every 40 minutes to be safe. Inside the suit it can get up to about 40C [104F -- fever temperature]. Getting into the kit takes about 5 minutes. Taking it off again takes the wearer and a designated helper "buddy" about 15 minutes. This is one of the most dangerous times for contamination and people are sprayed with chlorine as this happens." ...
[Byline: Michelle Roberts]
http://www.bbc.com/news/health-29518703

--
Protective Ebola Suit -- Interactive Graphic
--------------------------------------------
10 Oct 2014: (BBC) [Look way down page; start at Gloves, then counterclockwise] ... -- more
http://www.bbc.com/news/world-europe-29531671

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Canada advises citizens to leave Ebola-hit countries
----------------------------------------------------
10 Oct 2014: (NDTV) The Canadian government advised its citizens on Friday [10 Oct 2014] to leave the West African countries hardest hit by Ebola, while taking measures at its own borders to screen for potentially exposed travelers. "We are asking Canadians living in Sierra Leone, Guinea and Liberia to consider leaving by commercial means while they are still available," Health Minister Rona Ambrose said. The minister also said that anyone traveling to Canada from the countries affected by the epidemic will be screened at airports.... -- more
http://ndtv.com/article/world/canada-ad ... ies-605121

--
USA: CDC could quarantine U.S. citizens for weeks if they refuse Ebola screenings
--------------------------------------------------------------------------------
10 Oct 2014: (Yahoo) U.S. citizens who refuse to undergo the new screenings for Ebola at 5 major American airports could find themselves held in quarantine for up to 3 weeks, officials told Yahoo News on Thursday [9 Oct 2014]. Non-citizens who refuse the screenings could be quarantined or turned away from U.S. soil by U.S. Customs and Border Protection. The Obama Administration announced on Wednesday [8 Oct 2014] that it would soon require passengers from Guinea, Liberia, and Sierra Leone -- the countries at the epicenter of the deadly outbreak in West Africa -- to answer questions about their potential exposure to the illness and to have their temperature taken upon arrival.
[Byline: Oliver Knox]
https://www.yahoo.com/travel/cdc-could- ... 50657.html
[Screening starts today, Sat 11 Oct 2014 at JFK airport, and on Mon 13 Oct 2014 at the other 4 airports. - Mod.JW]

--
USA: Some facilities run elaborate drills as others merely hand out flyers
--------------------------------------------------------------------------
10 Oct 2014: (Yahoo) A few days before the Ebola-infected D arrived in Dallas-Fort Worth Airport to reunite with his fiancee, the Centers for Disease Control and Prevention released a sternly worded alert to the nation's hospitals. "Now is the time to prepare," the memo said in bolded letters at the beginning of a detailed 6-page checklist of steps that hospitals should take to ready themselves for a patient like D. "Every hospital should ensure that it can detect a patient with Ebola." As is clear now, Texas Health Presbyterian Hospital in Dallas was not ready to detect Ebola -- they sent D home with antibiotics after he showed up with a fever and abdominal pain, and acknowledged he had recently been in Liberia. He came into contact with dozens of people after that -- including schoolchildren -- before his disease worsened and he returned to the hospital in an ambulance. On Wednesday [8 Oct 2014], he died.... But in the decentralized U.S. health care system, hospitals don't necessarily have to take the CDC's advice -- and federal funding streams to help them do so have been slashed in recent years. The result is a health care system where some hospitals are running intense, life-like drills featuring hypothetical Ebola patients and others are just now beginning to send around memos on the topic.... -- more
http://news.yahoo.com/ebola-outbreak-re ... 29813.html
[Even if you don't live in the USA, why not check what your local hospital is doing? - Mod.JW]

--
Number of Ebola false alarms mounts as panic grows
--------------------------------------------------
10 Oct 2014: (Mail Online) From American airliners to British buses, number of Ebola false alarms mounts as panic grows over spread of deadly disease:
- Australia: a plane made emergency landing when passenger vomited blood.
- Czech Republic: Tests show man with symptoms of Ebola does not in fact have virus.
- Taiwan: woman tested negative for Ebola after showing symptoms of virus.
- UK: Scare at Liverpool coach station after passenger collapsed and vomited, medical staff boarded coach in protective gear and removed the woman. Doctors at Royal Liverpool Hospital confirmed she did not have Ebola.
- USA: Another scare when man yelled 'I have Ebola!' on flight from Philadelphia; 4 Hazmat officers rushed onto US Airways plane to Dominican Republic (joke!).
- USA: CDC is handling more than 800 false alarms a day from worried Americans. Dallas County sheriff tested negative after being in D.'s flat.... -- more
[Byline: Annabel Grossman]
http://www.dailymail.co.uk/news/article ... sease.html

--
Brazil: probable false alarm
----------------------------
10 Oct 2014: (Independent UK) Ebola crisis: Man in Brazil hospitalised with symptoms of deadly virus. Brazil is treating a 47-year-old man who has become the country's 1st suspected case of the deadly Ebola virus. The man, originally from Guinea in West Africa, has been placed into isolation at a hospital in the city of Cascavel, where Brazil's ministry of health have sent specialists to provide additional help and care. He arrived in Brazil on 19 Sep 2014 and is believed to have travelled from Guinea. On Thursday [9 Oct 2014] afternoon the man went to the emergency department at the hospital with a fever. His case is being treated by medics as suspicious as his symptoms have developed within the maximum incubation period for Ebola, which is 21 days.

Brazil's health officials said the man ... will be transferred to the National Institute of Infectious Diseases at the Evandro Chagas hospital in Rio de Janeiro, in accordance with security protocols in place for suspected cases of Ebola. Health officials are now attempting to identify people who may have come into contact with the patient while displaying any symptoms, Brazilian newspaper O Globo reported....

Brazil's health surveillance agency, Anvisa, said that any ships known to have docked in Ebola-affected countries within the last 21 days will need to provide thorough medical records and logs of medicines used before receiving clearance to dock at Brazilian ports.
[Byline: Loulla-Mae Eleftheriou-Smith]
http://www.independent.co.uk/news/world ... 86559.html

[Cascavel is a city and municipality in western Parana state, Brazil -- see map: http://cac-php.unioeste.br/eventos/symp ... google.jpg. The Brazil health ministry reported the 1st test was negative Sat 11 Oct 2014, the 2nd test would be out in 48 hrs. - Mod.JW]

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United Nations USD 1 billion Ebola appeal severely underfunded: UN officials
----------------------------------------------------------------------------
11 Oct 2014: (Reuters) A USD 1 billion United Nations appeal to fight Ebola has only been 25 percent funded and senior U.N. officials warned on Friday [10 Oct 2014] that no country was safe as the world faced a crisis with staggering potential. "It is the most extraordinary challenge that the world could possibly face..." said Dr. David Nabarro, who is heading the U.N. response to the Ebola epidemic. Nabarro has said a "20-fold increase" in the global response is needed compared to efforts at the end of August [2014]. The United Nations has established a special mission, known as UNMEER, to coordinate efforts to stop the spread of Ebola.... -- more
[Byline: Michelle Nichols]
http://in.reuters.com/article/2014/10/1 ... HS20141010

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http://bigstormpicture.com
& ProMED-mail Rapporteur Kunihiko Iizuka

******
[4] Threat to North America
Date: Wed 8 Oct 2014
Source: US Department of Defense, DoD News [edited]
http://www.defense.gov/news/newsarticle ... &id=123359


US Marine Corps Gen. John F. Kelly on Ebola
-------------------------------------------
The potential spread of Ebola into Central and Southern America is a real possibility, the commander of U.S. Southern Command told an audience at the National Defense University here yesterday [7 Oct 2014]. "By the end of the year, there's supposed to be 1.4 million people infected with Ebola and 62 percent of them dying, according to the [CDC -- Centers for Disease Control and Prevention]," Marine Corps Gen. John F. Kelly said. "That's horrific. And there is no way we can keep Ebola [contained] in West Africa."

If it comes to the Western Hemisphere, many countries have little ability to deal with an outbreak of the disease, the general said. "So, much like West Africa, it will rage for a period of time," Kelly said. This is a particularly possible scenario if the disease gets to Haiti or Central America, he said. If the disease gets to countries like Guatemala, Honduras or El Salvador, it will cause a panic and people will flee the region, the general said. "If it breaks out, ... there will be mass migration into the United States," Kelly said. "They will run away from Ebola, or if they suspect they are infected, they will try to get to the United States for treatment." Also, transnational criminal networks smuggle people and those people can be carrying Ebola, the general said. Kelly spoke of visiting the border of Costa Rica and Nicaragua with U.S. embassy personnel. At that time, a group of men "were waiting in line to pass into Nicaragua and then on their way north," he recalled. "The embassy person walked over and asked who they were and they told him they were from Liberia and they had been on the road about a week," Kelly continued. "They met up with the network in Trinidad and now they were on their way to the United States -- illegally, of course." Those men, he said, "could have made it to New York City and still be within the incubation period for Ebola." ... -- more

[Byline: Jim Garamone]

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******
[5] USA: Dallas case had high fever at 1st visit
Date: Fri 10 Oct 2014
Source: New York Times [edited]
http://www.nytimes.com/2014/10/11/us/th ... -show.html


Dallas Ebola patient was initially sent home despite high fever, records show
-----------------------------------------------------------------------------
Medical records unveiled Friday [10 Oct 2014] of the Liberian man who died of the Ebola virus have raised new questions about the treatment he received when he 1st came to at a Dallas emergency room. The patient, Duncan, had a high fever -- his temperature was 103 degrees F [39.4 C] -- during his initial visit to the emergency room of Texas Health Presbyterian Hospital on 25 Sep 2014, according to 1400 pages of medical records that Duncan's family provided to AP. Despite the fever, the hospital sent Duncan home, even after learning that he had recently arrived from West Africa. Duncan returned to the emergency room on 28 Sep 2014, and was immediately hospitalized. He died of Ebola on Wednesday [8 Oct 2014] -- the only person to die from the disease in the United States.

Previously, the hospital said that Mr. Duncan had a temperature of 100.1 degrees F [37.8 C] when he 1st arrived and that his symptoms were not severe. The hospital said Duncan had told them that he had been having abdominal pain for 2 days, a headache and decreased urination. According to the medical records provided to AP, Duncan reported severe pain -- rating it an 8 on a scale of 10. Doctors gave him CT scans to rule out appendicitis, stroke and numerous other serious ailments. Ultimately, he was prescribed antibiotics and told to take Tylenol, then he returned to the apartment where he was staying with a Dallas woman and 3 other people. A physician's note dated 26 Sep 2014 said Mr. Duncan was "negative for fever and chills," according to the medical records. "I have given patient instructions regarding their diagnosis, expectations for the next couple of days, and specific return precautions," according to the emergency room physician's note. "The condition of the patient at this time is stable." ... -- more

[Byline: Manny Fernandez & Kevin Sack]

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******
[6] Recurrent cases
Date: Thu 9 Oct 2014
Source: Eurosurveillance, Volume 19, Issue 40 [edited]
http://www.eurosurveillance.org/ViewArt ... leId=20924


Rapid communications
Describing Readmissions to an Ebola Case Management Centre (CMC), Sierra Leone, 2014
--------------------------------------------------------------------------------
[Authors: G Fitzpatrick, F Vogt, O B Moi Gbabai, B Black, M Santantonio, E Folkesson, T Decroo, M Van Herp]

Case management centres (CMCs) are part of the outbreak control plan for Ebola virus disease (EVD). A CMC in Sierra Leone had 33 percent (138/419) of primary admissions discharged as EVD negative (not a case). 15 of these were readmitted within 21 days, 9 of which were EVD positive. All readmissions had contact with an Ebola case in the community in the previous 21 days indicating that the infection was likely acquired outside the CMC.

Between 26 Jun and 1 Sep 2014, 138 patients were discharged from the Kailahun Ebola case management centre (CMC) in Sierra Leone, as non-Ebola virus disease (EVD) cases, because they tested negative for the virus by polymerase chain reaction (PCR). Of these, 15 returned to the CMC within 21 days of their 1st admission and subsequently 9 tested positive for Ebola virus. This raised the question as to whether CMCs could be acting as potential amplifiers of infection even though appropriate infection control measures are being followed. Such a question is of public health importance to the overall future control of the EVD outbreak, which is ongoing in West Africa. To our knowledge, there is no literature available which describes the evolution of readmissions to Ebola CMCs during an outbreak and this paper addresses that deficit.... -- more

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[I would not have called the 9 cases recurrent. They had compatible symptoms on 1st admission, which may have been due to malaria or something else -- the labs don't have time to try other tests. They subsequently came down with ebolavirus infection within the incubation period and returned far enough into their infection to have converted to PCR-positive. Of course they could have caught EVD while waiting to be admitted along with actual positives in the CMC -- but they were not confirmed cases that had been discharged after they went negative and returned positive once more, which would have been recurrence. (Unless they were lab labeling errors, which are not unknown in stressful lab conditions). - Mod.JW]

[Birgitt]

EBOLA VIRUS DISEASE - ex AFRICA (12): IN HOSPITAL MANAGEMENT CHALLENGES
***********************************************************************
A ProMED-mail post
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ProMED-mail is a program of the
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http://www.isid.org

Date: Sat 11 Oct 2014
Source: Infectious Diseases Society of America (IDSA)/IDWeek 2014 [edited]
http://www.magnetmail.net/actions/email ... d=22381830


We write to provide a summary of the presentation at IDWeek by Dr. Bruce Ribner on caring for Ebola patients in the US [1]. Dr. Ribner led the team at Emory University that cared for 2 patients with Ebola virus disease (EVD) in August 2014. In light of the recent Ebola cases in Dallas and Spain, he agreed that a summary could be provided to assist ID specialists in their ongoing preparedness efforts.

Planning for the care of patients
----------------------------
This involves the entire institution, and needs many sections to coordinate their work. EMS services were an important coordination point for the transport of the 2 patients to Emory. On the medical staff, many types of expertise were needed for clinical management: ID [infectious diseases], critical care, anaesthesiology and several other sub-specialties. Nursing, environmental management, facilities, security and media relations were all intensively involved ahead of time so that expected roles were defined. Even so, there were times when questions arose after the patients arrived.

Clinical Care
------------
Ebola patients in Africa have only limited clinical evaluations and essentially no laboratory testing due to the lack of any infrastructure to support this. The Emory team was able to make careful clinical evaluations over time in their 2 patients, and Dr. Ribner summarized the main points as follows:

Despite weight gains of 15-20 kg, the patients were profoundly hypovolemic due to their low serum albumin and vascular leak with 3rd spacing. Fluid losses in their patients were 5-10 L/day. Electrolyte losses were significant and included profound hyponatremia, hypokalemia and hypocalcemia. At initial assessment at Emory, the patients were one week into illness, yet these were their 1st laboratory determinations. Arrhythmias were noted, and both intravenous and oral electrolyte repletion was necessary. Nutritional depletion was evident as well.

Ebola virus RNA was detected in blood, urine, vomitus, stool, endotracheal suctioning and semen and on skin. It was not detected in dialysate. Environmental testing in the patient rooms had no detection of viral RNA and included many high touch surfaces such as bed rails and surfaces in the bathroom.

Intensive 1:1 nursing care was necessary around the clock. Patients were monitored continuously, and this level of nursing care allowed for rapid response to clinical changes. Nursing and other team members provided emotional support, and as the patients improved, help with self-care and physical therapy.

Experimental Interventions
---------------------------
While there are no approved vaccines or treatments for EVD, the WHO has noted that it is ethically acceptable to consider use of experimental agents. Categories of agents under study include candidate vaccines, whole blood and immune serum, and novel therapeutic agents (monoclonal antibodies, antivirals and RNA-based drugs). Most have not been evaluated in phase 1 human studies and are in limited supply. The Emory team engaged the FDA, CDC and pharmaceutical manufacturers in active discussions as they weighed additional interventions.

Laboratory Testing and Diagnostics
-----------------------------------
Differences in guidance for laboratory testing were noted between CDC and ASM [American Society for Microbiology]. The CDC guidance indicates that testing can be performed in a main lab with attendant infection control and analyzer safeguards that are specified by the instrument's manufacturer, while the ASM guidance specified that point of care (POC) instruments located very close to the patient should be used. The reality the Emory team noted was that if a specimen from one of their EVD patients spilled in the main lab, it would be closed for hours to accomplish decontamination, thus impacting function of the entire hospital. There was realistic concern that technologists would not perform testing on EVD blood. These considerations prompted the Emory team to set up a POC testing area adjacent to the patient care unit [2]. Lab testing was kept to a minimum.

Surprises in Shipping
-------------------
Ebola virus is considered a category A agent, which requires special packaging and shipping arrangements for clinical specimens. Despite meeting these requirements, the Emory team learned that commercial carriers refused to transport the specimens even when the carriers were licensed for Category A agents.

Staff and Environmental Safety
-------------------------------
The hospital safety officer needed to navigate multiple regulatory requirements at the federal, state and local level. Familiarity with the regulatory documents and jurisdiction was necessary.

Personal Protective Equipment [PPE]
------------------------------------
Their staff was trained in the use of PPE that included impermeable body protection (gown, leg and shoe covers), face mask or N95, eye and face protection (goggles and face shield) and gloves. Practical considerations led them to use full body suits and PAPRs [powered air purifying respirators]. Their decision was based on the need to work for extended periods of time using PPE, the aim of decreasing physical discomfort working in multi-component PPE and the avoidance of difficulties like fogged faceshields. The donning and doffing of PPE was always observed by another staff member, and the importance of adhering to safe removal of PPE was emphasized.

Unexpected Adventures in Waste Management
-------------------------------------------
Although the CDC guidance indicates that sanitary sewers are acceptable for patient waste, the local water authority disagreed. The Emory team had to disinfect all patient liquid waste with bleach or quaternary detergents for 5 minutes before it could be flushed. The hospital's waste disposal contractor would only pick up materials that were certified as free of Ebola virus. As a consequence, the hospital had to dedicate an autoclave and move it to process all materials used in clinical care in order for it to be accepted for disposal as regulated medical waste. By the end of the patients' stay the autoclaved and boxed materials filled several trailers.

Media and Communications
-------------------------
Three key messages were used to manage the tsunami of media attention: 1st, that the Emory team had expertise in treating serious infectious diseases; 2nd, that the staff and hospital were trained and prepared to care for the patients; and 3rd, that the preparations included protection of Emory patients, staff and the community. Patient confidentiality was also underscored. For the hospital staff, multiple communications were done, using town hall meetings, email and other modes. For inpatients and all new admissions, letters were given that explained the situation and reiterated the key messages, and senior administrative leaders delivered the messages as well answered questions. No decrease in admissions or elective surgeries at the hospital was noted.

Lessons Learned
----------------
Patients with EVD can be safely cared for in developed countries with appropriate safeguards. This opportunity affords close clinical observation and experience in clinical management that could be relayed to facilities with lesser infrastructure. Communication, both internal and external, is critical to manage the situation surrounding a hospitalized EVD patient.

The Society [IDSA] thanks Dr. Ribner and his team for their astute observations, their compassion and their willingness to share what they have learned.

References
--------
1. Ribner BS. Treating patients with Ebola virus infections in the US: lessons learned. Presented at IDWeek, October 8, 2014. Philadelphia PA

2. Hill CE, Burd EM, Kraft CS, et al. Laboratory test support for Ebola patients within a high-containment facility. Lab Medicine 2014:45(3):e109-111.

[Byline: Marguerite A. Neill, MD FIDSA, Chair, Rapid Communications Task Force, IDSA]

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[The above news release from the Infectious Diseases Society of America (IDSA) is a summary of a presentation on the challenges of caring for patients infected by ebolavirus in a tertiary care U.S. hospital (Emory University Hospital, Atlanta). The presentation was given by Dr. Bruce Ribner at the Society's annual meeting this past week in Philadelphia. He emphasized the importance of supportive care, in particular, fluid and electrolyte replacement, as well as coordination of many different types of hospital services and overcoming the infection control challenges, such as the disposal of large amounts of contaminated waste. - Mod.ML

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/106.]

[Birgitt]

EBOLA VIRUS DISEASE - ex AFRICA (13): USA NEW CASE, SPAIN, MORE QUARANTINED, FEVER
**********************************************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

In this update:
[1] USA: Another Texas nurse positive
[2] USA: Every health care facility must be able to handle a case
[3] Fever not reliable as indicator of infection
[4] Spain: 3 more placed in quarantine, Madrid

******
[1] USA: Another Texas nurse positive
Date: 12 Oct 2014
Source: CDC [edited]
http://www.cdc.gov/media/releases/2014/ ... orker.html


Today [12 Oct 2014], the Centers for Disease Control and Prevention (CDC) confirmed test results reported late last night by the Texas Department of State Health Services' public health laboratory showing that a healthcare worker at Texas Presbyterian Hospital is positive for Ebola. The healthcare worker, who provided care for the Dallas index patient, was isolated soon after symptoms started and remains so now. On Fri 10 Oct 2014, the healthcare worker reported a low-grade fever overnight and was referred for testing. The healthcare worker had been self-monitoring for fever and symptoms. As a precaution, after identification of fever, the healthcare worker was isolated, and CDC staff interviewed the patient to determine additional contacts or potential exposures. At this time, one close contact has been identified and is being monitored. The hospital and patient were notified of the preliminary and confirmatory test results. Treatment decisions will be made by the patient and hospital.

This development is understandably disturbing news for the patient, the patient's family and colleagues and the greater Dallas community. The CDC and the Texas Department of State Health Services remain confident that wider spread in the community can be prevented with proper public health measures, including ongoing contact tracing, health monitoring among those known to have been in contact with the index patient, and immediate isolations if symptoms develop.

Careful monitoring of all healthcare workers who had interaction with the index patient and this 2nd patient is warranted, including those who cared for the index patient between the time he was isolated in the hospital on 28 Sep 2014 through the time of his death on 8 Oct 2014, and they will now be considered patient contacts for follow-up monitoring.

Ebola is spread through direct contact with body fluids of a sick person or the remains of someone who has died of Ebola, or exposure to objects such as needles that have been contaminated. The illness has an average 8-10 day incubation period (although it could be from 2 to 21 days), and, therefore, CDC recommends monitoring exposed people for symptoms a complete 21 days. People are not contagious before symptoms such as fever develop.

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******
[2] USA: Every health care facility must be able to handle a case
Date: 12 Oct 2014
Source: NY Times [edited]
http://www.nytimes.com/2014/10/13/us/te ... ebola.html


"Every U.S. health care facility needs to have the capability to initially handle a case," Abbigail Tumpey, a spokeswoman for the CDC, said. "Even if the patient is going to be transferred to another facility, they need to be able to handle the 1st moments of interacting with a patient."

Ms. Tumpey said the CDC would issue more specific instructions and explanations for how health care workers should properly put on and take off protective equipment. Among other things, the agency will urge nurses and doctors to enlist a co-worker or buddy to watch them handle protective clothing in a safe way. Proper handling of the equipment is crucial, Dr. Frieden said, because if the gear is contaminated, workers can infect themselves by touching it with bare hands.

Two other areas being examined, he said, were kidney dialysis and respiratory intubation of Ebola patients. Both procedures are considered high risk and may spread contaminated material...

[Byline: Manny Fernandez, Denise Grady]

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[The index case in Texas was intubated and on dialysis. - Mod.JW]

******
[3] Fever not reliable as indicator of infection
Date: 12 Oct 2014
Source: LA Times [edited]
http://www.latimes.com/nation/la-na-101 ... tml#page=1


For public health workers screening more than 1000 air travelers who arrive each week in the United States from Ebola-stricken West Africa, one symptom above all others is supposed to signal danger: fever. So long as an individual's temperature does not exceed 101.5 F [38.6 C] and there are no visible symptoms of Ebola [infection], health authorities say it should be assumed the person is not infectious...

[Byline: David Willman]

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[This is a discussion of Ebola outbreaks in Africa where up to 15 percent of confirmed cases were afebrile (without fever). But the amount of virus excreted increases in proportion to a fever, so at less than 101.5 degrees F, transmission is probably not very efficient. - Mod.JW]

******
[4] Spain: 3 more placed in quarantine, Madrid
Date: 12 Oct 2014
Source: NY Times [edited]
http://www.nytimes.com/2014/10/13/us/te ... .html?_r=1


Three more people who helped treat a nurse struck down with Ebola at a hospital in Spain have been placed in quarantine. The government confirmed that 16 people are now under observation at the hospital in Madrid after showing possible signs of the deadly virus.

The nurse, who is the 1st person to have contracted the disease outside of West Africa, is currently in a stable condition at Carlos III hospital. She had been part of the team treating 69-year-old Spanish priest MGV, who died of Ebola on 25 Sep 2014. Health officials believe the 16 people in isolation may have been in close contact with the nurse and could be infected too.

The 3 people placed in quarantine today [12 Oct 2014] are one of the nurses of the 1st infected nurse, a hairdresser who served her [before she was hospitalized], and a hospital cleaner.

[Byline: Levi Winchester]

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[There has been interchangeable use of the terms quarantine and isolation in many of the reports available on the internet. As a reminder:
"Isolation separates sick people with a contagious disease from people who are not sick.
Quarantine separates and restricts the movement of people who were exposed to a contagious disease to see if they become sick."
http://www.cdc.gov/quarantine/.

According to this media report it is not clear whether they are asymptomatic in quarantine or showing symptoms, in which case they should be in isolation. - Mod.MPP]

[ProMED thanks Sukie Crandall for sending a news report of the new Texas case.

A HealthMap map of the USA is at http://healthmap.org/promed/p/106 and for Spain at http://healthmap.org/promed/p/43. - Mod.JW]

[Birgitt]

EBOLA VIRUS DISEASE - ex AFRICA (14)
************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

In this update:
[1] Ethiopia
[2] USA: 2nd Texas case
[3] USA: Prevention in Yale
[4] USA: Prevention in New Jersey

******
[1] Ethiopia
Date: Mon 13 Oct 2014
Source: Hara Ethiopia [edited]
http://haraethiopiadotcom.wordpress.com ... al-airport


Ethiopia. 4 suspected cases
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Ethiopia's Ministry of Health on Sun [12 Oct 2014] disclosed establishing a modern laboratory center in a bid to control the deadly Ebola virus after 4 reported cases of EVD in Addis Ababa. The facility will start operating on Mon [13 Oct 2014] for testing of 4 suspected cases of Ebola. A disease that medical doctors believe is Ebola appears to be suspected in the Ethiopian capital. One western African origin diplomat has been admitted for flu-like symptoms in Saint Yared General Hospital; 3 more people have been also admitted to the Black Lion hospital, with reported cases of bleeding and fever. Doctors in Black Lion hospital, speaking anonymously because of the sensitivity of the issue ... are saying it is Ebola.

The World Health Organization (WHO) has classified Ethiopia and Kenya as "high-risk" countries for the spread of the deadly ebolavirus. [A suspected Ebola case at the Jomo Kenyatta International Airport ( JKIA) who died on arrival from Juba, South Sudan was reported to have tested negative for Ebola virus disease on 12 Oct 2014 (http://www.standardmedia.co.ke/health/a ... s-negative). - Mod.ML] Ethiopia and Kenya are vulnerable because [they are] major transport hubs, with many flights from West Africa, a WHO official said. This is the most serious warning to date by the WHO that Ebola could spread to East Africa. The WHO's country director for Kenya, Custodia Mandlhate, said the East African states were "classified in group 2, at high risk of transmission."

The Ethiopian and Kenyan governments said that they would not ban flights from the 4 countries hit by Ebola. Ethiopia's and Kenya's national carriers are major airlines connecting countries across Africa and have on their part been pursuing the usual flights into West Africa. Bole international airport [Addis Ababa, Ethiopia] and Jomo Kenyatta International Airport (JKIA) [Nairobi, Kenya] so far haven't any infrared thermometers or non-contact thermometers to measure body temperature of in-bound and out-bound passengers for possible Ebola symptoms.

--
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******
[2] USA: 2nd Texas case
Date: Sun 12 Oct 2014
Source: Dallas News [excerpted, edited]
http://www.dallasnews.com/news/metro/20 ... dallas.ece


...Even before the news conference at Presbyterian Hospital, a Dallas County hazardous materials team had decontaminated the public areas of the nurse's apartment complex in the M Streets off Lower Greenville Avenue and the parking lot at Presbyterian where she'd parked, along with her car. Officials sent a "reverse 911 call" to every telephone line within 4 blocks of the apartment, and police officers and others knocked on every door in the neighborhood to explain the situation and leave information about Ebola. "We had this plan in place last week," Rawlings said. "So when we got this phone call, which we thought we might get, we put an action team in place, and they have been working all this [prior] evening so that as people are waking up, they know that they are safe."

Arrangements were in the works to take care of the Presbyterian staffer's dog, which was in the apartment. By Sunday afternoon [12 Oct 2014], a decontamination team was working in the apartment. The speed of the response was in marked contrast to what happened after Duncan was diagnosed with Ebola. It took officials days to figure out how to clean the apartment where he'd been staying and to dispose of contaminated materials.

Rawlings and Dallas County Health Director Zachary Thompson were among several people walking the nurse's neighborhood, answering questions and distributing information. "You have to be honest with people," the mayor said. "If you are honest with them on the bad stuff, they will believe you about the good stuff."

The new case sets a new 21-day clock for watching for additional cases. People infected with Ebola can develop symptoms as long as 21 days after their 1st exposure. Only Presbyterian staffers were exposed to Duncan after he was hospitalized on 28 Sep 2014. The last day a Presbyterian staffer could have been exposed was when Duncan died last Wed [8 Oct 2014].

[Byline: Jeffrey Weiss]

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Communicated by:
Mark A. Jensen <maj@fortinbras.us>

[There are some excellent graphics, including an interactive map of the infected countries in West Africa and a timeline for Texas.

The last day on which anyone who came into contact with Duncan will be monitored is 19 Oct 2014. The last day on which anyone who came into contact with the nurse will be monitored is 31 Oct 2014. - Mod.JW]

*******
[3] USA: Prevention at Yale
Date:Thu 2 Oct 2014 [note date]
Source: Yale Daily News [edited]
http://yaledailynews.com/blog/2014/10/0 ... om-liberia


Two graduate student researchers at the Yale School of Public Health preparing to return from Liberia [in early October 2014] have agreed to sequester themselves for 3 weeks as a precautionary measure in case they have contracted Ebola.

"They were helping set up a computer system for the Liberian Ministry of Health to monitor the West African Ebola outbreak and track contact tracing, according to the email. "The email also noted that the students had no direct contact with Ebola patients and are currently asymptomatic. "...[YSPH Dean Paul] Cleary said the researchers' preventative measures against Ebola have even extended beyond what is required by the CDC or urged by YSPH. "The researchers volunteered to stay away from their office because of concerns raised by some staff; even though national guidelines do not suggest such an action," Cleary said. "I did not ask them to do that." ...

[Byline: Phoebe Kimmelman & Stephanie Rogers]

--
Communicated by:
Jonathan Ezekiel <jezekiel@his.com>

******
[4] USA: Prevention in New Jersey
Date: Sat 11 Oct 2014
Source: Morning Call [edited]
http://www.mcall.com/news/breaking/mc-e ... story.html


New Jersey health officials have ordered into mandatory quarantine an NBC News crew that worked with an American cameraman who contracted Ebola in Liberia, though the group has no symptoms, its health department said on Saturday [11 Oct 2014]. Freelance cameraman AM is receiving treatment at Nebraska Medical Center in Omaha, which said on Fri [10 Oct 2014] that he had shown modest improvement and was in stable condition...

The NBC News crew had agreed with New Jersey health officials to sequester themselves upon return to the United States but then failed to do so, Donna Leusner, a spokeswoman for the New Jersey Department of Health, said in a statement. The mandatory quarantine was issued late on Fri [10 Oct 2014] and will ensure the group remains confined until 22 Oct 2014, the end of a 21-day maximum incubation period for Ebola, Leusner said. "The NBC crew remains symptom-free, so there is no reason for concern [about] exposure to the community," she said. She declined to provide additional details about the crew, its size and what led to the mandatory order being issued, citing patient privacy.

[Byline: Tina Susman]

--
Communicated by:
Jonathan Ezekiel <jezekiel@his.com>



[Maps:
Ethiopia: http://healthmap.org/promed/p/95]

[Birgitt]

Der Ebola-Patient in Leipzig ist tot. Wie das Klinikum St. Georg mitteilte, ist der Mann in der Nacht zum Dienstag gestorben. "Trotz intensiv-medizinischer Maßnahmen und höchsten Anstrengungen des medizinischen Personals erlag der 56-jährige UN-Mitarbeiter der schweren Infektionskrankheit", hieß es in der Mitteilung [...] Nach Angaben des Sozialministeriums soll der Tote zügig eingeäschert werden [...] Beim Umgang mit der Leiche greift laut Ministerium ein festgelegtes Verfahren. Wer an Ebola-Fieber stirbt, wird demnach desinfiziert, in eine flüssigkeitsdichte Plastikhülle gelegt und in einem speziell präparierten Sarg aufbewahrt. Die Maßnahmen seien vom Robert Koch-Institut vorgegeben, sagte Schreiber. Der Sarg muss demnach in einem separaten und gesicherten Kühlraum stehen und gekennzeichnet sein. Die Bestatter würden über das Infektionsrisiko aufgeklärt.

Leipziger Klinik kann Ebola-Patient nicht retten
14.10.2014 - mdr


Aktuellste News betr. der Ausbreitung der Ebola-Epidemie
im Ebola-News-Ticker des Focus

Gruß
Birgitt

[Birgitt]

EBOLA VIRUS DISEASE - ex AFRICA (15): UN DOCTOR DIES, USA, PREVENTION
*********************************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

In this update:
[1] UN doctor dies in Germany
[2] USA: Texas contact quarantined
[3] Prevention & false alarms

******
[1] UN doctor dies in Germany
Date: Tue 14 Oct 2014
Source: NBC News [edited]
http://www.nbcnews.com/storyline/ebola- ... ny-n225151


A United Nations medical worker [originally from Sudan] who was infected with Ebola in Liberia has died despite "intensive medical procedures," authorities said Tue [14 Oct 2014]. The St. Georg hospital in Leipzig said the 56-year-old man, whose name has not been released, died overnight of the infection. It released no further details. The man tested positive for Ebola on 6 Oct 2014, prompting Liberia's UN peacekeeping mission to place 41 staff members who had possibly been in contact with him under "close medical observation." He arrived in Leipzig for treatment on 9 Oct 2014, where he was put into a special isolation unit...

--
Communicated by:
Ryan McGinnis
<ryan@bigstormpicture.com>

******
[2] USA: Texas contact quarantined
Date: Tue 14 Oct 2014
Source: Star Telegram [excerpted, edited]
http://www.star-telegram.com/2014/10/14 ... .html?rh=1


"The lone person believed to have had direct contact with the Ebola [nurse] works at Fort Worth-based Alcon and was admitted to Texas Health Presbyterian Hospital with no symptoms," a company spokeswoman said...

Alcon is a medical company that specializes in eye care products. The Alcon employee is being hospitalized as a precaution, the statement said, adding: "The Alcon associate has not shown any signs or symptoms of the Ebola virus. After consultation with the Texas Department of Health, we are confident that there is no risk for Alcon associates. We are working closely with the Centers for Disease Control and Prevention and the Texas Department of Health to ensure we are following proper public health measures." ...

[Byline: Gordon Dickson]

--
Communicated by:
Jonathan Ezekiel <jezekiel@his.com>

******
[3] Prevention & false alarms

Belgium: No Ebola checks at Brussels Airport after flights from Liberia
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Mon 13 Oct 2014: (NBC News) It's the classic airport scene: a man hugs his wife and 2 daughters at arrivals. But in this case, the traveler had just stepped off a plane from the Ebola-stricken Liberian capital of Monrovia, meaning that some might shy away from such embraces. "I've been screened before getting on the plane," he pointed out before heading for the exit. The twice-weekly flight from Monrovia to Brussels is now the only air link from that city to the European continent and is the route most Americans would likely travel on their way home. Thomas Eric Duncan, who died in a Dallas hospital last week, traveled to the U.S. from Liberia via Brussels... http://www.nbcnews.com/storyline/ebola- ... ia-n223581

[Byline: Carlo Angerer & Becky Bratu]

[The link shows Ebola advice posters at Monrovia airport. - Mod.JW]

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Brazil: Man suspected of carrying Ebola tested negative again.
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Mon 13 Oct 2014: (WSJ) A man suspected of carrying the ebolavirus was tested negative for the 2nd time, Brazil's Health Ministry said Mon [13 Oct 2014]. The test eliminates the possibility of Ebola, Health Minister Arthur Chioro told reporters. The man, identified by authorities as a 47-year-old from Guinea, one of the 3 countries hardest hit by the Ebola outbreak, was isolated at a Rio de Janeiro hospital... Doctors were still monitoring for other possible diseases, even after Ebola had been ruled out... Two blood tests were made, following standard protocol to deal with the deadly virus. Dozens of people who had contact with the man were monitored, but now they are no longer under watch, he said. The minister said the case showed Brazil is ready to deal with the epidemic. He also said that the risk of contagion in the country is low. http://online.wsj.com/articles/in-brazi ... 1413231294

[Byline: Paulo Trevisani]

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Kenya ex South Sudan: passenger dies, Ebola negative
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Mon 13 Oct 2014: (Hara Ethiopia) Anxiety has gripped Kenya after a female passenger from South Sudan died on Saturday night [11 Oct 2014] from Ebola-like symptoms after arriving in the country. Health officials at Kenya's Jomo Kenyatta International Airport (JKIA) told Xinhua on Sun [12 Oct 2014] that the female passenger on board the Kenya Airways flight alighted at 6:45 p.m. with high fever and bleeding from the openings of her body. "We have not established what exactly caused the death, but medical officials including the director of medical services are carrying out tests to establish the cause," an official who sought anonymity told Xinhua by telephone.

The official said the female passenger who had arrived from Juba was later rushed to the hospital but died in the evening... The incident caused panic at the busy airport, which was immediately deserted for hours after the death of the passenger... Kenya is vulnerable because it is a major transport hub, with many flights from West Africa, a WHO official said...
http://haraethiopiadotcom.wordpress.com ... al-airport

[The passenger tested negative for Ebola virus disease: http://www.standardmedia.co.ke/health/a ... s-negative.

The Ethiopian and Kenyan governments said that they would not ban flights from the 4 countries hit by Ebola. Ethiopia's and Kenya's national carriers are major airlines connecting countries across Africa and have on their part been pursuing the usual flights into West Africa. Bole international airport [Addis Ababa] and Jomo Kenyatta International Airport (JKIA) [Nairobi] so far haven't any infrared thermometers or non-contact thermometers to measure body temperature of in-bound and out-bound passengers for possible Ebola symptoms. - Mod.JW]

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Nigeria: 850 solders returning from peacekeeping in Liberia [in March 2015] to be quarantined.
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Mon 13 Oct 2014: (BellaNaija) Ever since the World Health Organization (WHO) declared Nigeria Ebola-free, the government has been doing everything within its power to ensure that status is maintained. As a result, precautionary measures are being taken as 850 Nigerian soldiers who are on a peace-keeping mission in Liberia, where the Ebola epidemic is rampant, return to Nigeria in March 2015. Arrangements are already being made to quarantine the soldiers in Gwagwalada, Abuja for 28 days before they rejoin their respective platoons, The Stream reports. http://www.bellanaija.com/2014/10/13/eb ... arantined/

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Sierra Leone: peacekeepers bound for Somalia quarantined over Ebola
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Tue 14 Oct 2014 (Reuters) A battalion of 800 Sierra Leone soldiers awaiting deployment as peacekeepers in Somalia has been placed in quarantine after one of its members tested positive for the deadly ebolavirus, military officials said on Tue [14 Oct 2014]. The soldiers were due to relieve the West African nation's contingent already deployed with Somalia's African Union peacekeeping mission, known as AMISOM. However, they will now be subject to a 21-day isolation period, a senior officer in Sierra Leone's army told Reuters, asking not to be named. Colonel Michael Samoura, spokesman of the Republic of Sierra Leone Armed Forces, confirmed that a member of the battalion had tested positive for the disease. He said the soldier was infected after leaving the military camp where the force is based without permission... http://www.reuters.com/article/2014/10/ ... 1420141014

[Byline: Umaru Fofana]

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USA: Texas nurse's dog quarantined
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Mon 13 Oct 2014: (ABC News) Officials say a one-year-old King Charles Spaniel has been taken from the Dallas apartment of an Ebola-infected nurse and will be cared for at an undisclosed location. [The nurse's] apartment is being thoroughly cleaned after tests over the weekend confirmed she is infected. Dallas County Judge Clay Jenkins said Monday evening [13 Oct 2014] that the dog would be cared for in an "undisclosed location in a humane, caring way." City spokeswoman Sana Syed says the dog named Bentley will be comfortable and have toys to play with while he is monitored away from people. http://abcnews.go.com/US/wireStory/dall ... g-26166242

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[A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/106.]

[Alexander]

In Texas hat sich ein weiterer Krankenpfleger mit Ebola angesteckt.

Ebola in den USA: Zweite Pflegekraft infiziert

Es ist bereits die zweite Infektion innerhalb der USA: In Texas hat sich eine weitere Pflegekraft mit Ebola angesteckt. Ein Ende der Epidemie ist nicht in Sicht. Die WHO erwartet in den nächsten Monaten weltweit bis zu 10.000 Ebola-Fälle pro Woche. mehr...

Grüsse
Alexander