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Ebola - Guinea, Liberia, Sierra Leone und Mali

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Ebola in Westafrika - Verbot von Bushmeat in Elfenbeinküste

Beitragvon Birgitt » 22.04.2014 18:11

EBOLA VIRUS DISEASE - WEST AFRICA (23): COTE D'IVOIRE, BUSHMEAT BAN
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International Society for Infectious Diseases
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Date: Sun 20 Apr 2014
Source: New Tang Dynasty Television, AFP report [edited]
http://www.ntd.tv/en/news/world/middle- ... isine.html


Late in March [2014], Health Minister Raymonde Goudou Coffie called for her Ivorian compatriots to stop eating porcupines and agoutis, which look like large river-rats, "until we can be sure there are no risks". Bushmeat is known to be a vector of Ebola, the alarming haemorrhagic fever that has claimed at least 122 lives in Guinea, according to a UN World Health Organisation toll on 17 Apr 2014. Liberia, meanwhile, reports 13 deaths.

But last week, the minister's recommendation was still going unheeded or ignored by some traders and hunters in Bouake's main bushmeat market. A customer in his 40s who seemed slightly tipsy asked for "Ebola meat", meaning braised agouti. "Ebola can't survive alcohol or hot water," claimed the scarred [man], who had just eaten a large meal. [Not true. - Mod.JW]

But such scenes are swiftly becoming a thing of the past. An official ban on bushmeat -- including antelopes, chimpanzees and porcupines as well as agoutis -- has been enforced and a week later, the Bouake market was empty. [See comment below.] State officials from the water and forestry service and in the health sector are patrolling the whole country in search of offenders. They recently burned 200 kilos (440 pounds) of smoked game found in the capital Yamoussoukro.

Fear of the disease runs high in Cote d'Ivoire, another of Guinea's neighbours, though no cases have yet been reported. People have begun to listen to official warnings and instructions. "We like agouti very much, but we would rather save our lives," said a man in his 30s. "As an Ivorian, I appreciate this meat. But with the risk of Ebola, I've changed, I don't eat any more," [another person] agreed.

Not everybody plays by the rules. A restaurant owner, who asked to remain anonymous, said she had established a code with some of her most loyal customers, hardened eaters of bushmeat. "When they come in, those who can't do without agouti give me a secret signal and I make sure that other customers believe I am serving them beef," she explained. [Another restaurant owner], 48, whose restaurant used to specialise in game, has converted to beef and fish, but in the process she has lost customers and income. She is sceptical about the government's recommendations. "When I was born, my mother was in this line of work and there was never any disease," she said. "Bushmeat has nothing to do with Ebola."

On the other hand, the restrictions imposed by the Ebola outbreak could help wildlife to recover. A ban of game hunting has been in force since 1974, but remained largely ineffective because of the popularity of the meat. Agoutis, antelopes, chimpanzees, porcupines and other species are all in danger of extinction in Cote d'Ivoire, but today they have at least a few weeks' respite. Ironically, "Ebola is a good thing for the preservation of wildlife," said Colonel Jerome Ake, the Yamoussoukro regional director for water and forestry.

A break in hunting will also benefit the natural environment, since hunters flush out game by starting large brush fires, which they are not always able to keep under control. In the past 10 years, such blazes have killed 120 people and destroyed more than 5000 square kilometres (1900 square miles) of forest and other land, a region twice the size of Luxembourg. But in these days of Ebola, fewer fires are likely to be started.

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[While ebolaviruses have been isolated from duikers (small antelopes), chimpanzees and porcupines, so far agoutis have not been implicated. And the risk is to the hunter and vendor, unless the purchaser buys an animal that still has fresh blood on it. Cooked bushmeat is safe.

Nevertheless, it is encouraging that a ban on bushmeat can actually work, given the force of tradition, and that endangered species are being spared hunting and brush fires.

Photo of agouti: http://www.birdhike.com/CostaRica07/w_Agouti_banana.jpg
Photo of duiker: http://www.accuratereloading.com/ac23.jpg
Photo of porcupine: http://4.bp.blogspot.com/-IOiZGBqy78U/T ... 00/aaa.jpg
- Mod.JW]
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Ebola-Fieber in Westafrika

Beitragvon Birgitt » 23.04.2014 11:43

EBOLA VIRUS DISEASE - WEST AFRICA (24): LIBERIA, ZAMBIA AIRPORT SCREENING
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In this posting:
[1] Liberia
[2] Zambia: airport screening


*****
[1] Liberia
Date: Mon 21 Apr 2014
Source: UN Office for the Coordination of Humanitarian Affairs (OCHA), ReliefWeb, UN Children's Fund report [summ., edited]
http://reliefweb.int/report/liberia/uni ... april-2014


UNICEF -- Liberia Ebola outbreak: SitRep no. 18
-----------------------------------------------
Key Points
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The total number of suspected, probable, and confirmed Ebola [virus disease, EVD] cases stands at 27; Ebola-related deaths stands at 13; and confirmed Ebola cases stands at 6.

The Ministry of Health and Social Welfare (MoHSW) is in the midst of "cleaning" existing Ebola case data, including exclusion of cases that have tested negative for the virus. The Ebola statistics are likely to change accordingly in the coming days.

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[2] Zambia: airport screening
Date: Mon 21 Apr 2014
Source: Zambia Daily Mail [edited]
http://www.daily-mail.co.zm/index.php/c ... inst-ebola


National Airports Corporation Limited (NACL) has called on the country's 3 international airports to screen all passengers for the deadly contact-borne [ebolavirus]. The move is meant to stop the spread of the Ebola [virus disease] from West Africa, where it was first reported to central Africa.

NACL managing director Robinson Misitala said measures against Ebola have already been put in place to screen passengers passing through terminals at Kenneth Kaunda, Harry Mwaanga Nkumbula, and Simon Mwansa Kapwepwe international airports in Lusaka, Livingstone, and Ndola, respectively.

"Working with the Ministry of Health, a team has been put in place and awareness has been conducted with all the medical staff at the airport, airlines, and security staff and immigration department so that they are ready for any eventuality," he said. He also said all 3 airports have isolation areas for all the communicable diseases such as Ebola.

The World Health Organisation notes that once the Ebola breaks out, the fatality rate is up to 90 percent. [Note "up to", not always. -Mod.JW]

Mr Misitala said NACL has created desks to deal with any suspect at the airport with the Ministry of Health and the airport clinics. He said the Ministry of Health has plans to procure necessary protective clothing for medical staff. "Although at present Ebola is in West Africa and has not reached the southern part of Africa, we are very alert at NACL," he said.

Recently, the Ministry of Health in Livingstone urged all stakeholders such as airport staff, immigration, hotels, and lodges to be on high alert to prevent the deadly strain of ebolavirus. Acting Southern Province medical officer Emmanuel Kooma said the vulnerability of Livingstone is high as people want to visit the Victoria Falls and other tourist attractions. "There is need to strengthen the international health regulation of 2005 on public health disease surveillance," he said. Livingstone Tourism Association chairperson Alex Munthali has urged its members to be on high alert as this is the peak period for tourism and they should isolate suspected cases of Ebola.

[Byline: Nancy Mwape]

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[It is commendable that countries in West and southern Africa are taking precautions against the importation of EVD. All Sub-Saharan African countries would do well to prepare their own contingency plans.

I hope the Livingstone Tourism Association has been informed of the nearest hospitals to the national parks and other tourist spots where they can isolate suspected cases of Ebola. Those hospitals need to prepare isolation wards, have PPE (personal protection equipment) available, and staff trained in infection control. Victoria Falls are only 11 km [6.8 mi] from Livingstone, so presumably there is no problem there. - Mod.JW

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/170.]
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Ebola-Fieber in Westafrika

Beitragvon Birgitt » 24.04.2014 17:48

EBOLA VIRUS DISEASE - WEST AFRICA (25): WHO, MSF
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In this posting:
[1] WHO update
[2] Guinea and Liberia: MSF


******
[1] WHO update
Date: Tue 22 Apr 2014
Source: WHO Regional Office for Africa (WHO/AFRO) [edited]
http://www.afro.who.int/en/clusters-a-p ... -2014.html


Ebola virus disease, West Africa (situation as of 22 April 2014)
----------------------------------------------------------------
Guinea
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As of 18:00 on 20 Apr 2014, the Ministry of Health (MOH) of Guinea has reported a cumulative total of 208 clinical cases of Ebola virus disease (EVD), including 136 deaths. To date, 169 patients have been tested for ebolavirus infection and 112 cases have been laboratory confirmed, including 69 deaths. In addition, 41 cases (34 deaths) meet the probable case definition for EVD and 55 cases (33 deaths) are classified as suspected cases; 25 health care workers (HCW) have been affected (18 confirmed), with 16 deaths (12 confirmed).

Clinical cases of EVD have been reported from Conakry (53 cases, including 23 deaths), Gueckedou (122/87), Macenta (22/16), Kissidougou (6/5), Dabola (4/4), and Djingaraye (1/1). Laboratory confirmed cases and deaths have been reported from Conakry (37 cases, including 19 deaths), Gueckedou (60/38), Macenta (13/10), Kissidougou (1/1) and Dabola (1/1). These updated figures include 3 new cases isolated on 20 Apr 2014 from Conakry and Gueckedou, 2 of whom are laboratory confirmed. 5 new deaths have also been reported among existing cases; all 5 of them were patients with confirmed EVD. 21 patients were in isolation in Conakry (12), Gueckedou (8), and Macenta (1), while 16 patients who recovered from their illness were discharged from hospital.

Contact tracing activities continue in all affected areas. A total of 217 contacts are currently under medical observation and 92 have completed their 21 days of follow-up. The numbers of cases and contacts remain subject to change due to consolidation of cases, contact and laboratory data, enhanced surveillance and contact tracing activities and the continuing laboratory investigations. As the incubation period for EVD can be up to 3 weeks, it is likely that the Guinean health authorities will report new cases in the coming weeks and additional suspected cases may also be identified in neighbouring countries.

Liberia
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From 13 Mar 2014, the date of onset of the 1st laboratory confirmed case in Liberia, to 21 Apr 2014, the Ministry of Health and Social Welfare of Liberia has reported a total of 34 clinically compatible cases of EVD; 6 confirmed cases, including 6 deaths, 2 probable cases and 26 suspected cases. The date of onset of the most recent confirmed case was 6 Apr 2014 and the date of admission of the last confirmed case was 10 Apr 2014. The confirmed and probable cases were reported from Lofa and Margibi Counties, while suspected cases have been reported from Bong, Grand Cape Mount, Montserrado, and Nimba Counties as a result of enhanced surveillance and contact tracing activities.

The number of confirmed cases in HCWs has been adjusted down from 3 cases to 2 as data are reviewed against case definitions and laboratory results. The total number of deaths has also been revised from 13 to 11 as one of the deaths has been counted in the EVD statistics for Guinea and one death occurred in a discarded case. As laboratory tests have been conducted on 32 clinical samples overall, only 6 of which have tested positive for ebolavirus to date, it is anticipated that most of the suspected cases currently reported by Liberia will be reclassified as discarded and removed from the case count in the future.

Following data review, the number of contacts now stands at 162 in total; Foya district in Lofa County, the epicentre of the EVD outbreak in Liberia accounts for 72 per cent (116) of the total contacts followed by Margibi County (17 percent, 28 contacts); 59 contacts (36 per cent of the total) have completed 21 days follow up and have been discharged from medical observation.

Sierra Leone
------------
As of 22 Apr 2014, clinical samples from 19 clinically compatible cases of EVD have been tested at the Kenema Government Hospital. All 19 samples tested negative for ebolavirus. As part of enhanced surveillance activities, the Ministry of Health and Sanitation of Sierra Leone also decided to test for the presence of ebolavirus in samples from patients referred to the Lassa Fever Isolation Ward of the Kenema Hospital for the investigation of viral hemorrhagic fever-like illness who tested negative for Lassa fever virus infection. The additional 24 blood samples collected from 16 Mar 2014 onwards were analysed and all tested negative for ebolavirus.

WHO does not recommend that any travel or trade restrictions be applied to Guinea or Liberia based on the current information available for this event.

--
Communicated by:
ProMED-mail Rapporteur Mary Marshall

******
[2] Guinea and Liberia: MSF
Date: Tue 22 Apr 2014
Source: Medecins sans Frontieres (MSF) [edited]
http://www.msf.org/article/guinealiberi ... a-response


Guinea/Liberia: MSF continues Ebola response
--------------------------------------------
MSF is deploying more than 60 international staff and 270 Guinean and Liberian staff to respond to the Ebola [virus disease, EVD] outbreak in West Africa, which has so far claimed 135 lives according to official numbers [136 as of 22 Apr 2014, see [1] above]. MSF is supporting local health authorities by caring for infected patients and implementing measures to contain the outbreak in 3 locations in Guinea and 2 in neighbouring Liberia.

Strengthening the capacity to care for patients in Conakry
----------------------------------------------------------
In a treatment centre inside Donka hospital, MSF, in collaboration with the Ministry of Health and the World Health Organisation (WHO), is currently caring for 16 Ebola patients who are isolated in the centre. New patients arrive on a daily basis, which has prompted MSF to expand the capacity from 30 to 40 beds.

"Our priority is to continue to care for the people infected with the Ebola virus. From an epidemiological view it's too early to say which way the outbreak is going. For us, every new case is a challenge. We will continue to admit new patients until this outbreak is over," explains Henry Gray, emergency coordinator for MSF in Guinea.

Several patients have survived and recovered from the epidemic after being cared for by MSF medical teams. Ebola has a very high fatality rate, with up to 90 percent of infected patients dying from the disease [But see comment at end].

"When I was told I had the virus, the 1st thought in my head was -- am I going to die? But, thanks to the care I received, every day I felt better. By the grace of God, I survived the disease," says a Guinean patient who prefers to stay anonymous.

Continuation and reopening of activities in southeastern Guinea
---------------------------------------------------------------
MSF restarted activities last week [13-19 Apr 2014] in Macenta, after a few days suspension of activities following demonstrations by a small segment of the local population. MSF continues discussions with the local community to counter misunderstandings concerning the disease, and to ensure that they have the best possible understanding of how it is spread and the measures needed to contain it.

In Gueckedou, activities continue with 26 international staff and 156 Guinean staff who work together to fight the outbreak. MSF's centre, with a capacity of 20 beds, currently has 11 patients.

"We know our patients very well; their names, their age, their families, where they live, how they were infected. So when there are patients that survive the disease and can see our medical staff without the protective gear and shake our hands, it's really emotional," says Mano Canton, Field Coordinator for MSF in Gueckedou.

Positive cases in Liberia prompt extended response
------------------------------
Following reports of suspected cases in neighbouring Liberia, MSF has sent teams to Lofa and Margibi county and to the capital Monrovia.

In Foya Lofa, close to the Guinean border, 4 cases have been confirmed with EVD, of which all have died. MSF is currently constructing a centre to be able to isolate and care for cases in the area. MSF will also train local health staff, and make sure that alert systems are in place to refer suspected cases to the centre.

In the capital Monrovia, MSF supports the authorities and trains medical staff in JFK hospital and Elwa hospital. MSF has also constructed an isolation unit in JFK hospital.

In Margibi County, east of Monrovia, a small isolation unit has been built by a local company. MSF supports the unit with technical expertise and has organised training for local health staff. 2 cases in the county have been confirmed, both have died.

New strain of virus identified has no impact on medical response
----------------------------------------------------------------
A group of international doctors and scientists, among them 4 MSF epidemiologists, have conducted a study which suggests that a slightly different strain of the virus from the previously identified Zaire strain may have been circulating in the region for some time.

"These new findings, published in the New England Journal of Medicine, suggest that the virus was not brought in from any other part of Africa," says Hilde de Clerck, one of MSF's epidemiologists and contributor to the study. "However, this does do not have any medical implications for how MSF is responding to the Ebola outbreak in Guinea and Liberia."

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[The most important statement above is that the fact that this is a new strain of ebolavirus has no impact on the medical response.

This is an increase for Guinea of 5 cases and 7 deaths since WHO's last update of 19 Apr 2014 (see ProMED-mail archive no 20140422.2421188). Liberia has corrected its counts slightly downwards, Sierra Leone remains negative apart from the 2 cases reported earlier who contracted EVD in Guinea.

One has to wonder what hemorrhagic fever caused the clinical symptoms suspected to be EVD in the 24 patients who tested negative for both ebolavirus and Lassa virus in Sierra Leone.

A map showing graphically the numbers of cases and deaths can be seen at http://gmggranger.wordpress.com/2014/04 ... 3-apr-2014. It shows that the CFR (case fatality rate) ranges from below 50 per cent in Conakry and Liberia, up to 100 per cent in remote regions. - Mod.JW

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/54.]
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Ebola-Fieber in Westafrika

Beitragvon Birgitt » 28.04.2014 19:43

EBOLA VIRUS DISEASE - WEST AFRICA (26): WHO, MSF
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[1] WHO countering Ebola myths
Date: April 2014
Source: WHO Features [edited]
http://www.who.int/features/2014/ebola-myths/en


Busting the myths about Ebola is crucial to stop the transmission of the virus disease in Guinea
--------------------------------------------------------------------------------
Will eating raw onions once a day for 3 days protect me from Ebola? Is it safe to eat mangoes? Is it true that a daily intake of condensed milk can prevent infection with Ebola? These are just some of the questions posed to the health workers responding round the clock to calls received through the free Ebola hotline. With so many Ebola deaths to date, fear has allowed the spread of rumours and misinformation.

The Ministry of Health of Guinea set up Hotline 115 when it announced the country's Ebola outbreak on 21 Mar [2014]. Its main goal is to respond to people's concerns and to be able to quickly refer suspect cases to the isolation ward at Donka hospital in Conakry for further investigation. It currently receives between 200 and 300 calls per day.

"Some of the people who call the hotline are in panic and false rumours make it difficult to calm them down," says Dr Saran Tata Camara, one of the doctors who takes the calls. "But if we tell them that it is not easy to contract Ebola and that they can protect themselves if they respect some rules, they often understand."

Prevention facts
----------------
To prevent the transmission of Ebola virus disease from one person to another it is necessary to take the following precautions:
- Do not touch sick people who show symptoms of Ebola, including, for example, fever, diarrhoea, vomiting, headaches and sometimes heavy bleeding.
- Do not touch the dead bodies of suspected or confirmed Ebola patients.
- Wash your hands with water and soap regularly.

A month after the government announced the outbreak, the need for information remains high. To disseminate the messages more rapidly and reinforce their content, WHO and its partners have been engaging religious leaders, tribal leaders, traditional healers and community leaders to help with the outreach. "It was particularly important to start a dialogue with the traditional healers early as some patients prefer to see them instead of consulting the staff at a nearby health centre," says Julienne Anoko, an anthropologist from Cameroon who has been hired by WHO to help with the response to the outbreak. "As they see and touch many people with different symptoms, they are at high risk. They need to know how they and their patients can protect themselves and that quack cures can put lives in danger."

Risky rumours
-------------
Rumours can be very harmful. Recently, a team of Medecins Sans Frontieres (MSF) had to temporarily stop work at the isolation ward in Macenta in Guinee Forestiere, because the medical staff were falsely accused of having brought the virus to the country.

Accurate and timely information helps people to take precautions and take a more rational approach towards the disease. It ensures that people who fall sick with the typical Ebola symptoms are quickly brought to the hospital for testing and care and that families do not hide their sick family members. The Ministry of Health, WHO and its partners know that they will only win the fight against Ebola, if they also win the fight against myths and misconceptions.

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*******
[2] WHO travel update
Date: Mon 21 Apr 2014
Source: WHO Travel and Health [summ., edited]
http://www.who.int/ith/updates/20140421/en


West Africa - Ebola virus disease update
Travel and transport risk assessment: Recommendations for public health authorities and transport sector

--------------------------------------------------------------------------------
Template message for travellers and EVD
------------------------------
- Ebola virus disease is rare.
- Infection is by contact with blood or body fluids of an infected person or an animal infected or by contact with contaminated objects.
- Symptoms include fever, weakness, muscle pain, headache and sore throat. This is followed by vomiting, diarrhoea, rash, and in some cases, bleeding.
- Cases of Ebola have recently been confirmed in Guinea and Liberia.
- Persons who come into direct contact with body fluids of an infected person or animal are at risk.
- There is no licensed vaccine.
- Practice careful hygiene.
- Avoid all contact with blood and body fluids of infected people or animals.
- Do not handle items that may have come in contact with an infected person's blood or body fluids.
- If you stayed in the areas where Ebola cases have been recently reported, seek medical attention if you feel sick (fever, headache, achiness, sore throat, diarrhoea, vomiting, stomach pain, rash, or red eyes).

[The full WHO travel document is very long and contains detailed recommendations for port and airport authorities as well as for individual travellers. - Mod.JW]

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*******
[3] Appeals for aid
[As of 23 Apr 2014, international donors recognize that combating the outbreak will need ongoing support for some time yet. Media reports that the outbreak is coming under control are premature. - Mod.JW]

Pope appeals for international aid for the countries involved: http://allafrica.com/stories/201404230931.html
Plan International with ExxonMobil for Liberia: http://www.marketwatch.com/story/exxonm ... 2014-04-23
China sends support to Sierra Leone, which remains at high risk: http://allafrica.com/stories/201404241217.html

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*******
[4] MSF approach to control
Date: Mon 24 Mar 2014
Source: Medecins Sans Frontieres (MSF) [edited]
http://www.msf.org/article/guinea-%E2%8 ... s%E2%80%9D


How does MSF respond to Ebola epidemics, given that there is no treatment?
--------------------------------------------------------------------------
Although there is no cure for this disease, we can reduce its very high mortality by addressing the symptoms. This includes administering a drip to patients who have become dehydrated from diarrhoea and by confirming that they do not have a different disease, such as malaria or a bacterial infection like typhoid. Vitamins and anti-pain medication can also be useful. When the person loses consciousness and bleeds copiously, there is no hope. At that point, we ease the patient's pain and stay with him until the end.

In recent years, MSF has been involved in battling every Ebola epidemic. Once the 1st case is confirmed by a blood test, every person who cares for an infected patient must wear a hazmat suit, gloves, a mask and protective goggles and exercise extreme caution when administering treatment. Decontamination chambers are generally installed between the isolated patients and the external environment. To confine the epidemic, it is critical to trace the entire transmission chain. All individuals who have had contact with patients who may be contaminated are monitored and isolated at the 1st sign of infection. The affected communities must also be informed about the illness and the precautions to be taken to limit risks of contamination. Basic hygiene -- such as washing one's hands -- can significantly reduce the risk of transmission.

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[A new map of Guinea dated 21 Apr 2014 showing cases (both confirmed and suspected) and deaths (in red) by region, and the numbers but no map for Liberia, is at http://gmggranger.files.wordpress.com/2 ... 140421.png.

A useful WHO map of laboratories capable of diagnosing ebolaviruses worldwide is at http://www.who.int/csr/disease/ebola/EDPLN-labs.jpg. - Mod.JW

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/45.]
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Ebola-Fieber in Westafrika

Beitragvon Birgitt » 28.04.2014 19:45

EBOLA VIRUS DISEASE - WEST AFRICA (27): WHO UPDATE
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Date: Fri 25 Apr 2014
Source: WHO Regional Office for Africa (WHO/AFRO) [edited]
http://www.afro.who.int/en/clusters-a-p ... -2014.html


Ebola virus disease, West Africa (Situation as of 25 Apr 2014)

--------------------------------------------------------------
Guinea
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As of 18:00 on 23 Apr [2014], the Ministry of Health (MOH) of Guinea has reported a cumulative total of 218 clinical cases of Ebola virus disease (EVD), including 141 deaths. To date, 191 patients have been tested for ebolavirus infection and 115 cases have been laboratory confirmed, including 72 deaths. In addition, 42 cases (34 deaths) meet the probable case definition for EVD and 61 cases (35 deaths) are classified as suspected cases. A total of 26 health care workers (HCW) have been affected (18 confirmed), with 16 deaths (12 confirmed).

Clinical cases of EVD have been reported from Conakry (58 cases, including 24 deaths), Guekedou (127/91), Macenta (22/16), Kissidougou (6/5), Dabola (4/4) and Djingaraye (1/1). Laboratory confirmed cases and deaths have been reported from Conakry (37 cases, including 19 deaths), Guekedou (63/41), Macenta (13/10), Kissidougou (1/1) and Dabola (1/1). The date of onset of the most recent clinical case, a suspected case, is 23 Apr [2014] while the date of isolation of the most recent confirmed case is 22 April. Two new deaths have also been reported among existing cases; one of the deaths was a patient with confirmed EVD. A total of 13 patients are in isolation in Conakry (6 patients, 5 confirmed), Guekedou (7 patients, all confirmed). Contact tracing activities continue in all affected areas.

Overall, the epidemiological situation in Guinea has improved significantly over the last few weeks. The date of onset of the last reported case from Macenta was 24 days ago [1 Apr 2014] and a similar time has elapsed for Dabola (25 days), Kissigougou (26) and Djingaraye (31 days). Two incubation periods (42 days) without cases is the standard for declaring an EVD outbreak over in a particular location.

The focus of response activities at present includes clinical case management and ongoing training in hospital-based infection prevention and control (IPC). A documentary will be made on the Medecins Sans Frontieres (MSF) isolation facility in Guekedou. WHO, in collaboration with the Global Outbreak Alert and Response Network (GOARN), has mobilized a new medical team comprising of IPC and intensive care physicians in support of the clinicians at the Donka Hospital in Conakry.

The numbers of cases and contacts remain subject to change due to consolidation of case, contact and laboratory data, enhanced surveillance activities and contact tracing activities. The Centers for Disease Control and Prevention (CDC), Atlanta, United States, has arrived in Guinea to further strengthen diagnostic capacity for EVD by retesting patients who were polymerase chain reaction (PCR) negative by ebolavirus serology.

The cross-border meeting on EVD response between the governments of Guinea and Liberia was successfully hosted by the Guinean government, attended by 25 participants from delegations from both countries. The overall objective of the meeting was to strengthen epidemiological surveillance and the follow up of contacts along the borders of the two countries in order to stop transmission of EVD.

Key actions for implementation include: development of an action plan on the cross-border response to EVD; strengthening coordination of cross-border activities with engagement of local authorities; sharing information on the cross-border movement of suspected cases of EVD; reinforcing community awareness of EVD and ways to reduce personal and community risk of disease; and reinforcing active surveillance and contact tracing along the border as needed.

As the incubation period for EVD can be up to 3 weeks, it is likely that the Guinean health authorities will report new cases in the coming weeks and additional suspected cases may also be identified in neighbouring countries.

Liberia
-------
From 13 Mar [2014], the date of onset of the 1st laboratory confirmed case in Liberia, to 24 Apr [2014], the Ministry of Health and Social Welfare (MOHSW) of Liberia has reported a total of 35 clinically compatible cases of EVD; 6 confirmed cases, 2 probable cases and 27 suspected cases. The date of onset of the most recent confirmed case was 6 Apr [2014]. The MOHSW has started to reclassify suspected cases against their laboratory test results. Most of the suspected cases are expected to be discarded at the end of this process.

WHO, in collaboration with GOARN, is planning to replace experts who recently completed their missions in Liberia in the areas of case management, IPC and epidemiology.

Sierra Leone
------------
The Ministry of Health and Sanitation of Sierra Leone is currently investigating 3 patients with an illness compatible with a viral haemorrhagic fever (VHF) for EVD and Lassa fever (the latter is endemic in Sierra Leone). All rumours of EVD cases are being investigated and active case finding is also ongoing.

The laboratory at the Lassa fever isolation facility at the Kenema Government Hospital is now analysing all suspected cases of VHF for both Lassa fever and EVD. As of 24 Apr 2014, 98 samples collected have been tested; 10 samples tested positive for Lassa fever and the remaining 88 tested negative for both diseases. A total of 15 contacts have completed 21 days of follow up while 20 contacts remain under medical observation.

WHO does not recommend that any travel or trade restrictions be applied to Guinea, Liberia or Sierra Leone based on the current information available for this event.

--
Communicated by:
ProMED-mail Rapporteur Marianne Hopp

[Suspected cases continue to appear in Guinea and Liberia. - Mod.JW

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/45.]
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Ebola-Fieber in Westafrika

Beitragvon Birgitt » 28.04.2014 19:45

EBOLA VIRUS DISEASE - WEST AFRICA (28): CIDRAP
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Date: 25 Apr 2014
Source: CIDRAP News Scan [edited]
http://www.cidrap.umn.edu/news-perspect ... pr-25-2014


The overall epidemiologic status of Guinea's Ebola virus disease (EVD) outbreak is improving, with 4 of the 6 locations that have reported cases passing the 21-day incubation period with no new cases, according to an update from the World Health Organization (WHO) Regional Office for Africa; 2 incubation periods [42 days] need to pass before the outbreak can be declared over in a particular location.

Ten more cases and 5 more deaths have been reported in Guinea, pushing the country's outbreak total to 218 suspected or confirmed cases, 141 of them fatal; 3 more cases were confirmed by lab tests, raising that total to 115. The latest illness onset of a suspected case was 23 Apr 2014, and the isolation of the most recent confirmed case was 22 Apr 2014.

Liberia has reported one more illness clinically compatible with EVD, raising its total to 35; 6 are confirmed, 2 probable, and 27 suspected cases. The WHO said the country's health ministry is working on reconciling suspected cases with lab-confirmed cases and expects that most suspected cases will be ruled out.

Sierra Leone's health ministry is investigating 3 patients who have illnesses compatible with viral hemorrhagic fever for possible Lassa fever or EVD, the WHO said. So far, no Ebola outbreak cases have been detected in the country.

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[CIDRAP is the Center for Infectious Disease Research & Policy. Founded in 2001, CIDRAP is part of the Academic Health Center at the University of Minnesota http://www.cidrap.umn.edu.

If the isolation of the most recent confirmed case was 22 Apr 2014, and there are no more, Guinea could be declared free of Ebola on 7 Jun 2014. But there have been reports of people in Guinea concealing sick and dead family members, which could result in the outbreak continuing, so to speak, underground. - Mod.JW

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/45.]
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Ebola-Fieber in Westafrika - Gambia und Guinea

Beitragvon Birgitt » 29.04.2014 16:40

EBOLA VIRUS DISEASE - WEST AFRICA (29): CORRECTIONS, GUINEA
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In this update:
[1] Agoutis NOT
[2] Ebolaviruses from duikers?
[3] Gambia preparedness
[4] Guinea: Where are we?


******
[1] Agoutis NOT
Date: 27 Apr 2014
From: Luis Ruedas <ruedas@pdx.edu> [edited]


Note with respect to the post below that the animal identified as "agouti" most likely refers (for the English speaking members of the list) to the cane rat, _Thryonomys swinderianus_, a hystricomorph rodent of the family Thryonomyidae. Agouti more properly refers to the South American members of the genus _Dasyprocta_, which indeed is the animal illustrated in the link to the "photo of agouti."

Given the habitat of _Thryonomys swinderianus_, or other cane rats for that matter, it is unlikely that they would be associated with ebolavirus, but the reprieve noted on hunting is welcome.

--
Luis A. Ruedas
Director, Museum of Vertebrate Biology
Portland State University
<ruedas@pdx.edu>

[The cane rat lives by reed-beds and riverbanks in Sub-Saharan Africa. It can grow to nearly 2 ft (0.61 m) in length and weigh a little less than 19 lb (8.6 kg). They are nocturnal and make nests from grasses or burrow underground. Individuals of the species may live in excess of 4 years. If frightened, they grunt and run towards water.

As humans expanded into the cane rat's native habitats, the cane rats likewise expanded from their native reeds into the plantations, particularly the sugar cane plantations from which they derive their name. Their tendency to adopt plantations as habitat, where they feed on agricultural crops such as maize, wheat, sugar-cane, and cassava, often earns them the label of agricultural pest. However, the peoples of the region also utilize the cane rat as a food source (bushmeat), considering the meat a delicacy. Consequently, grasscutters (as they are often called in Ghana and other regions of West Africa) are beginning to be raised in cages for sale [excerpted from Wikipedia].

Photo of a cane rat:
http://en.wikipedia.org/wiki/File:Grand ... e_male.jpg. - Mod.JW]

******
[2] Ebolaviruses from duikers?
Date: 27 Apr 2014
From: David Quammen <dq@davidquammen.com> [edited]


Is it true that ebolaviruses have been isolated -- that is, live virus, not just detection of antibodies -- from duikers and porcupines, as stated in today's post? I would like to go to the paper.

--
David Quammen
<dq@davidquammen.com>

[No, they have not. See comment at end. - Mod.JW]

******
[3] Gambia preparedness
Date: 28 Apr 2014
Source: The Daily Observer, Banjul, Gambia [edited]
http://allafrica.com/stories/201404282430.html


Ever since the deadly Ebola virus broke out in neighbouring Guinea in Conakry, the Gambia government through its Ministry of Health and Social Welfare and partners have been on their toes and have been devising various strategies to prevent it from hitting the country.

As part of these strategies, the Ministry in collaboration with the UN system, through the World Health Organization (WHO) and the National Disaster Management Agency (NDMA), recently organised a training of trainers' synergy for health workers and non-health workers on ebolavirus disease preparedness and response. [Read more at Source URL.]

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******
[4] Guinea: Where are we?
Date: 28 Apr 2014
Source: GuineeConakry.info [in French, machine trans., edited]
http://www.guineeconakry.info/article/d ... ommes-nous


Is the fact that little is said about the outbreak of ebolavirus disease in recent weeks the result of the change made in the communication strategy? Or is it that the disease is really declining, as the Guinean authorities would have us believe? After the last newsletter produced by the Presidency of the Republic on Thu 24 Apr 2014, but only made public on Sat 26 Apr 2014, we realize that the answer lies among these 2 cases.

Indeed, while the previous communication strategy, taking into account also suspected deaths whose causes were not formally (clinically) connected to the ebolavirus, the latest [cleaned] statistics indicate that 72 people up to the date of 24 Apr 2014 have succumbed to the terrible virus out of a total of 115 confirmed cases.

Although these figures are deplorable as such, nevertheless, they are well below those previously available to the public. Particularly quick to highlight the "success stories" of the management of the epidemic, the Presidency of the Republic hastens to add that 21 people have survived after being tested positive for ebolavirus.

These lucky 21 are distributed as follows: 12 in Conakry, 7 in Guekedou and 2 in Macenta. In the same vein, the authorities also mention the fact that of 878 people under surveillance (contact persons), 588 did not show any signs of the disease after 21 days [the incubation period]. Therefore, their names were removed from the watch list. Good news, except that the remaining 290 are waiting also to be cleared.

Besides this relatively positive news, there is some about which we cannot rejoice, relating to the progression of the epidemic. Statistics from the Presidency of the Republic indicate that 6 new confirmed cases have been reported between 17-24 Apr 2014; 5 of these cases occurred in Gueckedo; this city in the south remains the main focus for the spread of the disease. But in this latest information, the most disturbing fact lies in the interval of time during which the new cases were recorded. This interval information in effect means that the chain of propagation is not yet controlled. However, it is at this level where the biggest challenge lies, hence the need to continue and intensify the fight.

[Byline: Pivi Bilivogui]

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[In relation to duikers and porcupines, I should not have used the word "isolated," but I did not write, nor mean to imply, that any of those animals are hosts or commonly infected. Partial sequences can be misleading, e.g. a North American "ebolavirus-like" L-sequence fragment was later, after full L gene sequence determination, shown to belong to a lyssavirus (rabies group). Similarly, antibodies can cross-react, although they usually indicate an encounter with a virus of the same group. - Mod.JW

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/45.]
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Ebola-Fieber in Guinea

Beitragvon Birgitt » 29.04.2014 16:41

EBOLA VIRUS DISEASE - WEST AFRICA (30): GUINEA
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Date: 28 Apr 2014
Source: WHO/AFRO [edited]
http://www.afro.who.int/en/clusters-a-p ... -2014.html


As of 18:00 on 26 Apr 2014, the Ministry of Health (MOH) of Guinea has reported a cumulative total of 224 clinical cases of Ebola virus disease (EVD), including 143 deaths. To date, 202 patients have been tested for ebolavirus infection, and 121 cases have been laboratory confirmed, including 74 deaths.

In addition, 41 cases (34 deaths) meet the probable case definition for EVD, and 62 cases (35 deaths) are classified as suspected cases. A revised number of 25 health care workers (HCW) have been affected (19 confirmed), with 16 deaths (12 confirmed); the number of HCW was previously reported as 26.

Clinical cases of EVD have been reported from Conakry (60 cases, including 24 deaths), Guekedou (131/93), Macenta (22/16), Kissidougou (6/5), Dabola (4/4) and Djingaraye (1/1). The 6 new cases reported since the WHO update of 25 Apr 2014 were diagnosed in Conakry (2 cases) and Guekedou (4 cases). All 6 cases are laboratory confirmed.

Cumulative total of laboratory confirmed cases and deaths to date
----------------------------------------------------------------------------------------
Conakry (39 cases, including 19 deaths); Guekedou (67/43); Macenta (13/10); Kissidougou (1/1); and Dabola (1/1). The date of isolation of the most recent confirmed cases is 26 Apr 2014 in Conakry and Guekedou; 13 patients are in isolation in Conakry (7, all confirmed), Guekedou (6, all confirmed). Contact tracing activities continue in Conakry and Guekedou. All the contacts from the other 4 outbreak locations have completed their 21 day medical surveillance period and have been discharged from follow-up.

The numbers of cases and contacts remain subject to change due to consolidation of case, contact and laboratory data, enhanced surveillance activities, and contact tracing activities.

As the incubation period for EVD can be up to 3 weeks, it is likely that the Guinean health authorities will report new cases in the coming weeks, and additional suspected cases may also be identified in neighbouring countries.

WHO does not recommend that any travel or trade restrictions be applied to Guinea based on the current information available for this event.

--
Communicated by:
ProMED-mail Rapporteur Mary Marshall

[This is an increase of 6 cases and 2 deaths in the 3 days between WHO updates. One confirmed case has been moved out of the HCW category. - Mod.JW

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/45.]
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Ebola-Fieber in Westafrika - Guinea

Beitragvon Birgitt » 04.05.2014 18:10

EBOLA VIRUS DISEASE - WEST AFRICA (31): GUINEA, REGION
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[1] Guinea
Date: 30 Apr 2014
Source: Medicalxpress.com [edited]
http://medicalxpress.com/news/2014-04-e ... uinea.html

The President of Guinea, Alpha Conde told reporters during a visit to Geneva, home of the World Health Organization (WHO), "There haven't been any new cases. But of those who remain in quarantine, there certainly will be some who will die."

No new cases have been recorded since Sunday [27 Apr 2014], although 4 people are receiving treatment in the capital Conakry, and 6 in Gueckedou, in the south, which has seen one of the most serious outbreaks.

But in a sign of subsiding concerns, Senegal, which had closed its border with Guinea, reopened the frontier on Tuesday [29 Apr 2014], Conde said.
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********
[2] Timeline
Date: 29 Apr 2014
Source: Wikipedia Commons
http://en.wikipedia.org/wiki/File:2014_ ... meline.jpg

[This is a useful chart. - Mod.JW]
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*******
[3] British Red Cross - 6 countries
Date: 30 Apr 2014
Source: British Red Cross [edited]
http://blogs.redcross.org.uk/emergencie ... g-outbreak


WEST AFRICA EBOLA CRISIS: AWARENESS CAMPAIGNS THE KEY TO HALTING OUTBREAK
This is a guest blog by Paul Jenkins, head of international partnership development at the British Red Cross.

The challenge for aid agencies, health officials and the authorities is that they must contain the Ebola virus without the aid of any vaccines to prevent its spread or medicines to treat those infected. With no treatment or vaccine available, prevention is the most effective way to stop transmission.

In the past, outbreaks have taken place in remote rural areas, and were short-lived once health workers could isolate them. This was the case when an outbreak hit Congo Brazzaville where I was deployed as desk officer for West and Central Africa for the British Red Cross in 2002. During my time there, I learnt that Ebola outbreaks can be contained. A lot of people who I saw die were linked, and had been in contact with each other. Typical for Ebola outbreaks, we saw that there was a chain of transmissions in families. To our advantage, we now know from other outbreaks that epidemics can be stopped. And the principle is always the same: you need to isolate suspected patients to prevent them from passing on the disease to people around them.

The Ebola virus spreads through contact with blood and other bodily fluids, so its essential people don't touch those infected or the bodies of the deceased. What eventually won out during the 2002 Central and East Africa outbreak was the employment of a concerted public awareness campaign. Our Red Cross teams, together with local and government authorities, community leaders and other aid agencies, took to the streets and villages educating the public on how to respond to the outbreak. Red Cross volunteers in Congo Brazzaville put messages on radio and TV stations and put posters around the community as part of a long-term programme to inform the public and help prevent further infections.

We need to move swiftly to support the communities in the affected regions of West Africa now, with proper information and medical aid in equal measure. In Sierra Leone, which borders Guinea, the Red Cross, in collaboration with the Ministry of Health and the telecoms company Airtel, is using an innovative system called the Trilogy Emergency Relief Application (TERA) in 4 districts bordering Guinea. A simple text messaging service, it seeks to help prevent the spread of the Ebola virus by sending messages containing advice and information direct to people's mobile phones.

The Red Cross has also launched emergency operations across 6 West African countries in response to the outbreak. In Guinea, the Red Cross has issued an emergency appeal to support more than 3 million people in at-risk communities. Funds have also been released from our disaster relief emergency fund to support awareness raising activities in the neighbouring countries of Liberia, Sierra Leone and Senegal. With a concerted effort, international support and diligence in our response to the current crisis, we should be able to contain the outbreak and learn new ways to avert future epidemics.

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[Border markets attended by traders from both sides of the frontier are a common route by which infection crosses between countries.

The comments by the Red Cross are very pertinent. - Mod.JW

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/45.]
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Ebola-Fieber in Westafrika - Guinea

Beitragvon Birgitt » 04.05.2014 18:11

EBOLA VIRUS DISEASE - WEST AFRICA (32): GUINEA
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Date: 2 May 2014
Source: CIDRAP News Scan [edited]
http://www.cidrap.umn.edu/news-perspect ... ay-02-2014


WHO: Two more Ebola cases in Guinea
-------------------------------------
2 new cases of Ebola virus disease (EVD) in Guinea and 6 more deaths as of last evening [1 May 2014] were reported today by the World Health Organization (WHO). That brings the cumulative total to 226, with 149 deaths.

Of 210 cases tested, 127 have been laboratory-confirmed; this includes 81 fatal cases. Another 44 cases with 34 deaths have been classified as probable, and 55 with 34 deaths have been classified as probable [sic - this is quite confusing. - Mod.JW].

Cases in healthcare workers stand at 25 with 18 confirmed, and deaths among this group are 16, with 11 of those in confirmed cases.

The geographic areas of Guinea with the most cases are Guekedou with 140 cases and 99 deaths, and Conakry, the capital, with 53 cases and 24 deaths. Tracing of contacts is continuing in these 2 areas.

The WHO states that because EVD's incubation period can be as long as 3 weeks, more cases are likely to be reported in coming weeks. It further notes that the recent availability of Ebola virus serology testing for use in patients with clinical disease but negative findings on polymerase chain reaction [PCR] tests may change the number of confirmed cases.

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[Each new confirmed case pushes the end of the outbreak another 6 weeks into the future [twice the incubation period]. - Mod.JW

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Ebola-Fieber in Westafrika

Beitragvon Birgitt » 04.05.2014 18:12

EBOLA VIRUS DISEASE - WEST AFRICA (33): WHO, GLOBAL THREAT
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[1] WHO/AFRO update
Date: Fri 2 May 2014
Source: WHO Regional Office for Africa (WHO/AFRO) [edited]
http://www.afro.who.int/en/clusters-a-p ... -2014.html


Ebola virus disease, West Africa (Situation as of 2 May 2014)
-------------------------------------------------------------
Guinea
------
As of 18:00 on 1 May 2014, the Ministry of Health (MOH) of Guinea has reported a cumulative total of 226 clinical cases of Ebola virus disease (EVD), including 149 deaths. Of 210 patients tested for ebolavirus infection, 127 cases have been laboratory confirmed by PCR, including 81 deaths. In addition, 44 cases (34 deaths) meet the probable case definition for EVD and 55 cases (34 deaths) are classified as suspected cases.

25 health care workers (HCW) have been affected (18 confirmed), with 16 deaths (11 confirmed). The median age of all clinical cases is 35 years (interquartile range 25-47 years). The female : male ratio remains unchanged at 1.2 : 1. 7 patients are in isolation facilities in Guinea; Conakry (4 patients, 2 confirmed) and Guekedou (3 patients, all confirmed).

The geographical distribution of clinical cases of EVD since the beginning of the outbreak is:
Conakry (53 cases, including 24 deaths),
Guekedou (140/99),
Macenta (22/16),
Kissidougou (6/5),
Dabola (4/4) and
Djingaraye (1/1).

The cumulative total of laboratory confirmed cases and deaths since the beginning of the outbreak is: Conakry (40 cases, including 20 deaths); Guekedou (72/49); Macenta (13/10); Kissidougou (1/1); and Dabola (1/1). The date of isolation of the most recent confirmed cases is 30 Apr 2014 in Conakry and Guekedou.

Contact tracing activities continue in Conakry and Guekedou. Experts in epidemiology and social mobilization will be deployed to strengthen contact tracing teams in Guekedou. All the contacts from the other 4 outbreak locations have completed their 21 day medical surveillance period and have been discharged from follow up.

The numbers of cases and contacts remain subject to change due to consolidation of case, contact and laboratory data, enhanced surveillance activities and contact tracing activities. The recent introduction of ebolavirus serology to test PCR negative clinical cases is also likely to change the final number of laboratory confirmed cases.

As the incubation period for EVD can be up to 3 weeks, it is likely that the Guinean health authorities will report new cases in the coming weeks and additional suspected cases may also be identified in neighbouring countries.

Liberia
-------
The Ministry of Health and Social Welfare (MOHSW) of Liberia has completed the process of revising clinical cases of EVD based on their final laboratory results. All cases which tested PCR positive or ebolavirus IgM positive have been reclassified as "confirmed acute" cases. PCR negative but ebolavirus IgG positive cases are considered "confirmed convalescent" cases.

Following the reclassification of suspected cases, as of 2 May 2014 the total number of clinical EVD cases reported in Liberia is 13 (6 confirmed, 2 probable and 5 suspected cases), including 11 deaths. There were 2 confirmed cases in HCWs, both of whom died. There have been no new clinical cases in Liberia since 6 Apr 2014.

The above criteria will be used to classify future cases of EVD in Liberia, should they occur. In addition, in the situation where neither PCR nor serological testing is carried out and/or the results of repeated testing remain equivocal, future clinical cases and deaths will classified as either probable or suspected based on the presence of a clinically compatible illness and evidence of epidemiological linkage to known confirmed case(s).

WHO does not recommend that any travel or trade restrictions be applied to Guinea or Liberia based on the current information available for this event.

--
Communicated by:
ProMED-mail Rapporteur Marianne Hopp

******
[2] Global threat
Date: Sat 3 May 2014
Source: Detroit Free Press, op-ed [edited]
http://www.freep.com/article/20140503/O ... break-risk


Why Ebola isn't just Africa's problem
-------------------------------------
A Canadian man returning from Liberia recently alarmed health officials with fears that he might have the Ebola virus. Although in good health when he traveled, the man was admitted to the intensive-care unit in Saskatchewan with classic symptoms of the disease.

That health scare, and others in recent weeks, were a wake-up call to those who saw the outbreaks as an "African problem." They remind us that people -- and their infections -- are not bound by borders. To those who claim we can't afford foreign aid, I respond that we can't afford to think of health threats as "foreign" and "domestic."

Ebola is a deadly viral infection that many people 1st learned about through novels like "The Hot Zone" and the film "Contagion," which featured the specter of a deadly uncontrollable outbreak wreaking global havoc.

As a physician from Nigeria now researching infectious diseases at the University of Michigan, USA, I'm not surprised by the Canadian scare -- which turned out to be a false alarm. If anything, I'm surprised it didn't happen sooner.

Ebola is spread when people come in direct contact with blood or secretions from an infected person, or when they are exposed to contaminated objects, such as needles. This means patients should be treated in isolation. Ebola victims suffer skin rash, fever and internal bleeding. The World Health Organization reports that Ebola outbreaks have a fatality rate of up to 90 percent.

Today, we live in a connected world ripe for an Ebola pandemic. The infected may appear healthy for up to 3 weeks while transmitting it to unsuspecting people. In this age of high-speed travel, that person could tour the world 3 times over -- all while unknowingly spreading the disease.

We've seen it before. In 2002, the deadly flu-like illness known as SARS broke out in China. Within a year, it killed nearly 800 people, including at least 8 in the United States. The U.S. fared even worse during the H1N1 swine flu pandemic of 2009. Of the nearly half a million deaths, nearly 12 500 were American. The death toll in the West African Ebola outbreak has risen to 142, and experts say it's a uniquely challenging outbreak.

We do not have effective drugs or a vaccine to fight Ebola. There is simply not much incentive for pharmaceutical companies to invest in medical solutions when there is little chance of a financial return. Where there is little private sector input, foreign aid can help. Unfortunately, many in the global north believe that foreign aid is not a good investment. A recent Kaiser Family Foundation survey showed that 61 percent of Americans thought that too much is being spent on foreign aid (incidentally, most people significantly over-estimate how much aid is given). But there is nothing "foreign" about foreign aid. When it comes to infectious diseases, aid can be about self-protection, not altruism. Take smallpox. Once a global threat, smallpox was eradicated by "foreign aid," which supported the development of the 1st universally successful vaccine.

With the same resolve, we can put an end to malaria, tuberculosis, HIV and even Ebola. By investing in research for early diagnosis, treatment and vaccines for "African" diseases such as Ebola, we can make the type of progress that we have made with heart disease, diabetes and cancer. After all, we are more connected than we realize.

[Byline: Utibe Effiong, a Nigerian physician and currently a research associate at the University of Michigan and a New Voices Fellow at the Aspen Institute]

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[Liberia has reclassified some of its cases.

The author of part [2] makes some good points. - Mod.JW

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/45.]
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Ebola-Fieber in Westafrika

Beitragvon Birgitt » 07.05.2014 18:06

EBOLA VIRUS DISEASE - WEST AFRICA (34): WHO
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Date: 5 May 2014
Source: WHO/AFRO [edited]
http://www.afro.who.int/en/clusters-a-p ... -2014.html


Ebola virus disease, West Africa (Situation as of 5 May 2014)
-------------------------------------------
Guinea
--------
As of 18:00 on 3 May 2014, the Ministry of Health (MOH) of Guinea has reported a cumulative total of 231 clinical cases of Ebola virus disease (EVD), including 155 deaths.

Confirmed:
There has been no change in the number of cases confirmed by ebolavirus PCR (127 cases) since the last update of 2 May 2014, but one additional death has been reported among confirmed cases (82 deaths).

Probable:
There have been 5 new probable cases and 5 new deaths among the probable cases of EVD since the last report (currently 49 cases, including 39 deaths).

Suspected:
In addition, 55 cases (34 deaths) are classified as suspected cases. As of 2 May 2014, 2 patients remain in isolation in Conakry and 3 in Guekedou. All of the new cases and deaths have been reported from Guekedou. The date of isolation of the most recent confirmed cases is 26 Apr 2014 in Conakry and 1 May 2014 in Guekedou.

The geographical distribution of clinical cases of EVD since the beginning of the outbreak is: Conakry (53 cases, including 24 deaths), Guekedou (145/105), Macenta (22/16), Kissidougou (6/5), Dabola (4/4) and Djingaraye (1/1). There have been no new cases of EVD in Kissidougou since 1 Apr 2014 or in Macenta since 9 Apr 2014. In Djingaraye and Dabola, no new cases have been reported since the end of March 2014.

The cumulative total of laboratory confirmed cases and deaths since the beginning of the outbreak is: Conakry (40 cases, including 20 deaths); Guekedou (72/50); Macenta (13/10); Kissidougou (1/1); and Dabola (1/1). The analysis of the epidemiological data during the last 3 weeks shows that the number of new cases is decreasing in Guekedou.

EVD prevention and control activities continue in Guekedou. These include: a suite of innovative community sensitisation and social mobilisation activities with community leaders, mining companies, banks, schools and universities and local non-governmental organisations; the dissemination of awareness messages through rural community radio and as posters; the screening of films on EVD; and providing education about EVD door-to-door in affected villages or neighborhoods.

The numbers of cases and contacts remain subject to change due to consolidation of case, contact and laboratory data, enhanced surveillance activities and contact tracing activities. The recent introduction of ebolavirus serology to test PCR negative clinical cases is also likely to change the final number of laboratory confirmed cases.

As the incubation period for EVD can be up to 3 weeks, it is likely that the Guinean health authorities will report new cases in the coming weeks, and additional suspected cases may also be identified in neighbouring countries.

Liberia
--------
There has been no change in the epidemiological situation in Liberia. The Ministry of Health and Social Welfare (MOHSW) of Liberia has reported that there are no current alerts of viral haemorrhagic fever (VHF)-like illness in Liberia. Active surveillance activities continue. As of 5 May [2014], 152 contacts have completed 21 days of follow-up and have been discharged from medical surveillance.

WHO and the Centers for Disease Control and Prevention (CDC), Atlanta, United States is facilitating training in the EpiInfo VHF application for MOHSW staff today [5 May 2014]. Training in active surveillance for county and district health officers is planned for Bong and Nimba Counties next week.

Sierra Leone
--------------
As of 3 May [2014], no cases of EVD have been confirmed in Sierra Leone. From 16 Mar to 2 May 2014, the Ministry of Health and Sanitation (MOHS) of Sierra Leone has tested 105 patients presenting with a VHF-like illness for EVD and Lassa fever. No cases of EVD have been detected using ebolavirus PCR assays, while 10 patients have been confirmed with a Lassa fever virus infection. Lassa fever is endemic in Sierra Leone.

Contacts:
35 contacts have been traced; 15 have completed 21 days of follow-up and have been discharged from medical surveillance.

EVD preparedness and response training has been provided to 375 health care workers, including senior district-level nursing staff, primary health care staff, senior hospital-based nurses and clinicians and hospital superintendents. Personal protective equipment has been prepositioned in all district hospitals, selected private and mission hospitals, and the Armed Forces hospital. Active surveillance activities continue, including the investigation of all rumours of VHF-like illness.

WHO response:
WHO continues to support the Ministries of Health of Guinea and Liberia in their EVD prevention and control activities. As of 5 May 2014, 112 experts have been deployed to assist in the response. This includes 68 experts deployed through the global WHO surge mechanism, 33 international experts from among partner institutions of the Global Outbreak Alert and Response Network (GOARN), and 10 externally recruited consultants. Expertise has been mobilised in the areas of coordination, medical anthropology, clinical case management, data management and health informatics, surveillance and epidemiology, infection prevention and control, laboratory services, logistics, risk communications, social mobilisation, finance and administration and resource mobilisation.

To date, 87 experts have been deployed to Guinea, 20 to Liberia, one to Sierra Leone, and 4 to the African Regional Office of WHO. An additional 12 deployments are in the pipeline in the disciplines of medical anthropology, clinical case management, surveillance and epidemiology, laboratory services, logistics and risk and media communications.

WHO does not recommend that any travel or trade restrictions be applied to Guinea or Liberia based on the current information available for this event.

--
Communicated by:
ProMED-mail Rapporteur Marianne Hopp

[New cases continue to occur in a trickle, each new one pushing the declaration of the end of the outbreak further into the future. - Mod.JW

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/6075.]
Birgitt
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Ebola-Fieber in Westafrika

Beitragvon Birgitt » 19.05.2014 19:57

EBOLA VIRUS DISEASE - WEST AFRICA (35): WHO, MSF, SENEGAL PREPAREDNESS
**********************************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

[1] WHO update as of 5 May 2014
Date: Thu 8 May 2014
Source: WHO Global Alert and Response, Disease Outbreak News [edited]
http://www.who.int/csr/don/2014_05_08_ebola/en


Ebola virus disease, West Africa -- update
------------------------------------------
Guinea
------
As of 18:00 on 5 May 2014, the Ministry of Health (MOH) of Guinea has reported a cumulative total of 235 clinical cases of Ebola virus disease (EVD), including 157 deaths. There has been no change in the number of cases confirmed by ebolavirus PCR (127 cases) since the last update of 2 May 2014, but there have been 2 additional deaths: one among the confirmed cases and the other among the probable cases. This brings the number of deaths to 83.

There have been no new probable or suspected cases. In addition, 55 cases (34 deaths) are classified as suspected cases. As of 7 May [2014], one patient remains in isolation in Conakry and one in Guekedou. The date of isolation of the most recent confirmed cases is 26 Apr [2014] in Conakry and 1 May [2014] in Guekedou.

The geographical distribution of clinical cases of EVD since the beginning of the outbreak is as follows: Conakry (53 cases, including 24 deaths), Guekedou (149/107), Macenta (22/16), Kissidougou (6/5), Dabola (4/4), and Djingaraye (1/1). There have been no new cases of EVD in Kissidougou since 1 Apr [2014], Macenta since 9 Apr [2014], or Conakry since 22 Apr [2014]. In Djingaraye and Dabola, no new cases have been reported since the end of March 2014.

The cumulative total of laboratory confirmed cases and deaths since the beginning of the outbreak is: Conakry (40 cases, including 20 deaths); Guekedou (72/51); Macenta (13/10); Kissidougou (1/1); and Dabola (1/1). The analysis of the epidemiological data during the last 3 weeks shows that the number of new cases is decreasing in Guekedou.

The numbers of cases and contacts remain subject to change due to consolidation of case, contact and laboratory data, enhanced surveillance activities, and contact tracing activities. The recent introduction of ebolavirus serology to test PCR negative clinical cases is also likely to change the final number of laboratory confirmed cases.

EVD prevention and control activities continue in Guekedou. These include: a suite of innovative community sensitization and social mobilization activities with community leaders, mining companies, banks, schools and universities, and local nongovernmental organizations; the dissemination of awareness messages through rural community radio and posters; the screening of films on EVD; and providing education about EVD door-to-door in affected villages or neighborhoods.

As the incubation period for EVD can be up to 3 weeks, it is likely that the Guinean health authorities will report new cases in the coming weeks and additional suspected cases may also be identified in neighbouring countries.

Liberia
-------
There has been no change in the epidemiological situation in Liberia. The Ministry of Health and Social Welfare (MOHSW) of Liberia has reported that there are no current alerts of viral haemorrhagic fever (VHF)-like illness in Liberia. Active surveillance activities continue.

As of 5 May [2014], 152 contacts have completed 21 days of follow-up and been discharged from medical surveillance.

Sierra Leone
------------
As of 7 May 2014, no cases of EVD have been confirmed in Sierra Leone. From 16 Mar to 7 May 2014, the Ministry of Health and Sanitation (MOHS) of Sierra Leone has tested 106 patients presenting with a VHF-like illness for EVD and Lassa fever. No cases of EVD have been detected using ebolavirus PCR assays while 10 patients have been confirmed with a Lassa fever virus infection. Lassa fever is endemic in Sierra Leone. 35 contacts [of EVD patients] have been traced; 15 have completed 21 days of follow-up and have been discharged from medical surveillance; and 20 are still under follow up.

EVD preparedness and response training has been provided to 375 health-care workers, including senior district-level nursing staff, primary health-care staff, senior hospital-based nurses and clinicians, and hospital superintendents. Personal protective equipment has been prepositioned in all district hospitals, selected private and mission hospitals, and the Armed Forces hospital. Active surveillance activities continue, including the investigation of all rumours of VHF-like illness.

WHO response
------------
WHO continues to support the Ministries of Health of Guinea and Liberia in their EVD prevention and control activities. As of 7 May 2014, 113 experts have been deployed to assist in the response. This includes 54 experts deployed through the global WHO surge mechanism, 33 international experts from among partner institutions of the Global Outbreak Alert and Response Network (GOARN), 10 externally recruited consultants and 16 WHO staff who were locally repurposed. Expertise has been mobilized in the areas of coordination, medical anthropology, clinical case management, data management and health informatics, surveillance and epidemiology, infection prevention and control, laboratory services, logistics, risk communications, social mobilization, finance and administration, and resource mobilization.

To date, 88 experts have been deployed to Guinea, 21 to Liberia, one to Sierra Leone, and 3 to the WHO Regional Office for Africa.

An additional 12 deployments are in the pipeline in the disciplines of medical anthropology, clinical case management, surveillance and epidemiology, laboratory services, logistics, and risk and media communications.

WHO does not recommend that any travel or trade restrictions be applied to Guinea or Liberia based on the current information available for this event.

This update has also been posted on the regional website of the WHO African Regional Office.

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

******
[2] MSF statement 6 May 2014
Date: Tue 6 May 2014
Source: Xinhua News Agency [edited]
http://news.xinhuanet.com/english/healt ... 314157.htm


Despite a remarkable reduction in the number of new EVD cases, the disease has not been totally eradicated in Guinea and medical teams are still alert to respond in case of any eventual outbreak, the communications officer for Medecins Sans Frontieres (MSF) Sam Taylor said on Monday [5 May 2014]. He said the search for people who had contact with Ebola patients was still going on.

"All stakeholders should continue to remain vigilant, ensuring that the population receive the correct information and that patients are rapidly taken to hospitals for medication," he added. He said medical teams were continuing to receive new patients in Conakry and Gueckedou, where MSF teams are working with officials from Guinea's health ministry to eradicate the disease. "We shall remain vigilant and will not say that the disease has been terminated," Taylor affirmed. EVD will only be declared as officially eradicated if there are no new cases reported within 42 days.

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

******
[3] Senegal preparedness
Date: Wed 7 May 2014
Source: Prensa Latina [edited]
http://www.plenglish.com/index.php?opti ... 1&Itemid=1


The Senegalese government today [7 May 2014] has declared it will maintain the maximum alert even though the EVD outbreak that has left about 100 people dead in Western Africa has been controlled [according to some reports]. Senegal's health minister Awa Marie Coll Seck has said the government cannot just assume is over, they have to remain alert, she said.

It not possible either to close the borders for months or years, the minister added, referring to the government's decision to open the country's borders, which had been closed due to the possible contagion coming from neighboring Guinea. However, this does not mean everyone can come and go with[out] the proper check-ups. Surveillance will remain in force at all land, maritime and air borders, she added.

Senegal has invested about USD 300 000 to fund an EVD prevention program, for the disease that appeared for the 1st time in Guinea earlier this year [2014] and expanded to Liberia and Sierra Leone.

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

[There have been no new probable or suspected cases reported from any of the 3 countries affected so far, so WHO updates are appearing at longer intervals than formerly -- the cut-off date for this one was 5 May 2014. But MSF said a day later that they are still admitting cases.

It is encouraging news that many contacts continue to be released from isolation after 21 days surveillance without showing symptoms.

I hope that serum specimens have been taken on discharge to be tested eventually for antibody indicating subclinical infection.

It is also encouraging to see that Senegal is taking preparedness seriously. - Mod.JW

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/45.]
Birgitt
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Ebola-Fieber in Westafrika

Beitragvon Birgitt » 19.05.2014 19:58

EBOLA VIRUS DISEASE - WEST AFRICA (36): WHO
*******************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

Date: 9 May 2014
Source: WHO [edited]
http://www.who.int/csr/don/don_updates/en/


Guinea
-------
As of 18:00 on 7 May 2014, the Ministry of Health (MOH) of Guinea has reported a cumulative total of 236 clinical cases of Ebola virus disease (EVD), including 158 deaths. Since the last update of 6 May 2014, there have been 2 new cases confirmed by ebolavirus PCR and one death among the confirmed cases, bringing the total number of confirmed cases to 129, including 84 deaths. Two new suspected cases have also been reported, with no new deaths in this group of patients (58 cases, 34 deaths) and no change in the number of probable cases or deaths (49 cases, 40 deaths).

As of 7 May 2014, there was one patient in isolation in Conakry and 2 in Guekedou. The date of isolation of the most recent confirmed case is 26 Apr 2014 in Conakry and 7 May 2014 in Guekedou.

Liberia and Sierra Leone
-----------------------
There have been no new alerts in Liberia or Sierra Leone. Liberia is preparing to host a cross-border meeting with Cote d'Ivoire and Sierra Leone.

--
Communicated by:
ProMED-mail Rapporteur Marianne Hopp

[This report was issued on 9 May 2014 with a cut-off date of 7 May 2014 and represents one more case and one more death. The rest of the report is essentially the same as in the 8 May 2014 WHO report with a cut-off of 5 May 2014.

The source URL appears to be the 8 May 2014 update. I cannot find this 9 May 2014 update on the WHO Disease Outbreak News website. - Mod.JW

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/45.]
Birgitt
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Ebola-Fieber in Westafrika - Mali

Beitragvon Birgitt » 19.05.2014 19:59

EBOLA VIRUS DISEASE - WEST AFRICA (37): MALI DIAGNOSTIC LABORATORY
******************************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

Date: Sun 11 May 2014
Source: Ravalli Republic (Montana, USA) [edited]
http://ravallirepublic.com/news/local/a ... f887a.html


A scientist for Rocky Mountain Laboratories in Hamilton [RML, Montana, USA] is calling on his scientific colleagues worldwide, including the US Centers for Disease Control & Prevention and the World Health Organization, to stop the long-distance shipment of diseased tissue and blood samples for testing and to start communicating the results immediately.

"Each continent should have its own testing lab, in fact, to reduce the need for long-distance shipments and to reduce the turnaround time on testing," said Dr Heinz Feldmann. "In an outbreak, it is essential for scientists to share their data real-time in the interest of public health."

Feldmann's recommendations were published last week in the New England Journal of Medicine, in the article "Ebola -- A Surprise in West Africa?"

Under existing procedures, a tissue or blood sample from a suspected patient is collected on site, packaged, and shipped to a testing laboratory, often in another country, where the diagnosis is made. There is often a significant time delay in both shipping and communicating the results back to the doctor working with the patient.

There is currently an ebolavirus disease (EVD) outbreak in Africa, mainly in Guinea and Liberia; Mali borders Guinea, so Mali is on watch. After a few suspected cases were reported there, Malian officials invited the National Institute of Allergy and Infectious Diseases to send scientists to help evaluate their isolation procedures and to test and handle patient samples.

Rocky Mountain Lab scientists Heinz Feldmann, MD, PhD, chief of NIAID's Laboratory of Virology, and Dave Safronetz, PhD, left Hamilton for Mali, Africa on 8 Apr 2014. Feldmann is an expert on ebolaviruses. He has worked on previous outbreaks in Africa and had traveled to Mali, but never for an Ebola outbreak. Safronetz does not work with Ebola, but does work with similar viruses in that region. He has expertise in organizing field research sampling. He travels to Mali frequently and has established contacts with people there. "We offered our help because we work there, we thought we could help them in this circumstance and this threatening situation to their not-so-well-functioning public health situation compared to ours," said Feldmann. "They do a pretty good job for what they have."

The Integrated Research Facility at RML was designed to assist with global emerging infectious disease outbreaks. They have assisted in 2009 (H1N1 influenza), in 2012 (ongoing MERS outbreak in the Middle East), and now with EVD in West Africa. Feldmann said the Centers for Disease Control and the World Health Organization would normally supply the expertise that was needed in Mali, but with events in Liberia their office was "stretched thin and they didn't have the manpower. They were happy we were going to help out." Feldmann and Safronetz were asked to set up a laboratory and train nationals to do the necessary testing. "Our job was to find the right place for the diagnostics, a safe place for the diagnostics, and train the people to do the job because it is not really going to help them if you do it for them and then leave," said Feldmann.

Setting up a laboratory was difficult, in that politics was very much involved in the process. Everyone wanted the fame of being the center for testing Ebola, but no one wanted to take the blame if things went wrong. Everyone worried about costs. Eventually they reached an agreement. The RML scientists brought all the diagnostic equipment with them that would be needed to test the samples and they selected the national scientists for training. "We chose these people to be trained," Feldmann said. "They were very well trained, very well educated, very bright, very smart. We felt comfortable."

Safronetz and Feldmann did not treat patients directly, stating that it is better for local physicians to take care of the patients -- not just because the patients speak French and neither of them does, but also so the rumor doesn't get circulated about white people bringing in Ebola. The testing of the cases began. "We tested all the suspect cases with them, and fortunately found them all to be negative," said Feldmann. "We tested for other pathogens, and they were negative as well." They still do not know what was making the people ill [with EVD-like symptoms]. But for Feldmann and Safronetz, the experience with the event taught them that changes need to be made.

Rather than shipping blood and tissue samples for testing, each continent should have its own testing lab, they said. And in an outbreak, it is essential for scientists to share their data real-time with colleagues, in the interest of public health. "For example in Mali, they originally sent the sample to CDC [USA] and it took almost 14 days to get to CDC," said Feldmann. "It's not the CDC [being late] in their response, they do it immediately, but they just don't get the samples. The samples get stuck at the airport, then at the next airport. ... There is response needed in a country and you are waiting for results. Results are blocked by bureaucracy or regulation and this is why this is not working. "If you don't have diagnostics in the field, it takes too long for the response efforts. As soon as sequences become known, they need to be made available to the people that provide diagnostic support at the very minimum."

Feldmann and Safronetz returned to Hamilton [Montana] on [19 Apr 2014] -- leaving the diagnostic equipment in Mali. "We brought over all the sophisticated diagnostic machinery that's required and we left that all in place for the Malians to continue to work, should there be more suspected cases popping up in country," said Safronetz. "The trained individuals are still ready. We still talk with them every little while to see if there is anything wrong or if they are experiencing problems or if any questions have come up. So far, they've had no issues at all.

"We worked with the Malian public health officials. We look forward to working with them in the future." Feldmann said he believes we are set up relatively well if a worldwide outbreak were to occur. "Whatever happens in our health care system is sufficient. If you go to a physician, they put gloves on and most likely that is already enough for preventing human to human transmission," he said. "By what we have established here we'll do quite well. It's not that the Africans don't want to put gloves on -- they just don't have anything to put on."

Making an impact on lives is an amazing opportunity that they didn't believe they would ever get to experience in their lifetime. The majority of work at RML is the basic science, and this trip allowed scientists to work with people and interact with people and see the final results on how their work affects lives.

[Byline: Michelle McConnaha]

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

[It is good to see another neighbouring country besides Senegal taking preparedness seriously. There is now a functioning ebolavirus diagnostic lab in Mali. Mali's capital, Bamako, is 900 km (560 mi) by road from Guinea's capital, Conakry, and 1160 km (720 mi) from Sierra Leone's capital, so if air transport is problematic, and if Mali would agree, perhaps sending specimens by bus would be practical.

But as far as each continent having its own testing lab, the Americans must have been misquoted, because flights within Africa can be subject to similar delays to those of flights out of Africa, and the same would apply to Asia. Regional labs would make sense -- West Africa already has 2: one in Dakar, Senegal and another in Franceville, Gabon -- and South Africa has one also, but how will labs for East and Central Africa be funded long term? The reagents will initially have to come from the USA and be paid for in US dollars, and because "Africans ... just don't have anything (gloves) to put on" -- due to inadequate health budgets -- the labs will need an outside source of protective equipment. - Mod.JW

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/50.]
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