EBOLA VIRUS DISEASE - WEST AFRICA (107): WHO, CHINA & UK NOT, NIGERIA, AIRLINES
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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 posting:
[1] WHO update
[2] China (HK), UK passengers NOT infected
[3] Nigeria: correction
[4] Nigeria: interview
[5] Airline/airport precautions: CDC
[6] USA-Mexico border
[7] USA: precautions
[8] UK: precautions
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[1] WHO update
Date: Tue 29 Jul 2014
Source: WHO/AFRO [edited]
http://www.afro.who.int/en/clusters-a-p ... -2014.html
Ebola virus disease, West Africa -- update 29 Jul 2014
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The World Health Organization (WHO) continues to monitor the evolution of the Ebola virus disease (EVD) outbreak in Sierra Leone, Liberia, Guinea and Nigeria. The Ebola epidemic trend in Sierra Leone, Liberia, and Guinea remains precarious, with continuing community and health-facility transmissions of infection.
Between 24-27 Jul 2014, a total of 122 new cases (suspect, probable, and laboratory-confirmed cases) as well as 57 deaths were reported from Liberia, Sierra Leone, Guinea and Nigeria.
- Guinea, 12 new cases including 5 deaths;
- Liberia, 25 new cases including 2 deaths;
- Sierra Leone, 71 new cases including 5 deaths.
These numbers include laboratory-confirmed, probable and suspect cases of, and deaths from, EVD.
As of 27 Jul 2014, the cumulative number of cases attributed to EVD in the 4 countries stood at 1323 including 729 deaths.
The distribution and classification of the cases are as follows:
- Guinea, 460 cases (336 confirmed, 109 probable, and 15 suspected) including 339 deaths;
- Liberia, 329 cases (100 confirmed, 128 probable, and 101 suspected) including 156 deaths;
- Sierra Leone, 533 cases (473 confirmed, 38 probable, and 22 suspected) including 233 deaths;
- Nigeria, 1 probable case who died.
[There is a table in the source showing: Confirmed, probable, and suspect cases and deaths from Ebola virus disease in Guinea, Liberia, Sierra Leone and Nigeria as of 27 Jul 2014.]
The surge in the number of new EVD cases, especially in Liberia, Sierra Leone and Guinea, calls for concentrated efforts by all to address the identified problems such as health facility transmission and effective contact tracing.
In Nigeria, IHR focal person report confirms that the probable case notified was symptomatic at the time of arrival in Nigeria and that 59 contacts (15 from among the airport staff and 44 from the hospital) have been identified so far. The report also confirms that the patient travelled by air and arrived in Lagos, Nigeria, on 20 Jul 2014 via Lome, Togo and Accra, Ghana.
The sample from this case is yet to be sent to the WHO Collaborating Centre at the Institute Pasteur in Dakar, Senegal, due to refusal by courier companies to transport this sample. Though only one probable case has been detected so far in Nigeria, Ebola virus infection in this country represents a significant development in the course of this outbreak. The national authorities in Nigeria, Togo and Ghana continue to work closely with WHO and partners in identification of contact and contact tracing as well as in preparing response plans.
WHO does not recommend any travel or trade restrictions is applied to Guinea, Liberia, Sierra Leone or Nigeria, based on the current information available for this event.
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Communicated by:
ProMED-mail Rapporteur Marianne Hopp
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[2] China (HK), UK passengers NOT infected
Date: Wed 30 Jul 2014
Source: Quartz [edited]
http://qz.com/242342/passengers-are-bei ... and-the-uk
2 sick passengers were tested for Ebola in Hong Kong and the UK
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Update: Both the Hong Kong and Birmingham [UK] patients have tested negative for Ebola virus disease [EVD].
[Byline: Adam Pasick]
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[See full details at source URL above. The passenger to Hong Kong arrived there from Kenya and the one to Birmingham from Nigeria -- see ProMED-mail archive 20140730.2645280. A 2nd British passenger has also been tested and found negative -- see [7] below (unless that was confused with the Hong Kong passenger). - Mod.JW]
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[3] Nigeria: correction
Date: Wed 30 Jul 2014
Source: Vanguard, Lagos [edited]
http://www.vanguardngr.com/2014/07/envo ... agos-govt/
[Excerpt]
"We wish to correct the error that Nigeria's Ambassador to Liberia, Mrs. Chigozie Obi-Nnadozie, was one of the persons that had contact with the late Liberian with [Ebola disease] virus, who died in Lagos last Friday [25 Jul 2014] after flying into the country from Monrovia [Liberia]. We have since learnt that the official who travelled to Nigeria with the victim and who was mistaken for the Nigerian Ambassador to Liberia was actually a representative of the ECOWAS [Economic Community of West African States] President."
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[4] Nigeria: interview
Date: Wed 30 Jul 2014
Source: Vanguard, Lagos [edited]
http://www.vanguardngr.com/2014/07/ebol ... y-science/
[Excerpts]
EVD: Nigeria is not out of the woods yet -- Prof. Tomori
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Since the confirmation and subsequent death of a Liberian man who was the 1st to be diagnosed with the Ebola virus disease [EVD] on Nigerian soil, anxiety, shock and fear have been expressed by a wide section of the populace. Although several assurances have been given by officials of the Federal and state governments, the generality of Nigerians remain worried and doubtful about their safety.
Foremost virologist and Vice-Chancellor of Redeemer's University, President of the Nigeria Academy of Science, Prof. Oyewale Tomori, is of the view that Nigeria's effort in containing the 1st reported EVD case was commendable. However, Tomori, who is currently the regional virologist with the World Health Organisation's Africa Region and a Fellow of the Nigeria Academy of Science, the College of Veterinary Surgeons of Nigeria and the Royal College of Pathologists of the United Kingdom, warns that as far as EVD is concerned, Nigeria is not yet out of the woods. He speaks to Sola Ogundipe.
Q. What should be the best step for monitoring passengers entering Nigeria by air, land and sea from EVD affected countries? Do they need to be quarantined?
T: Not necessarily. The Port Health staff needs to screen passengers coming into Nigeria from EVD affected countries, by checking for anyone ill with fever plus signs and symptoms of EVD. The screening can be done using a prepared investigation form for taking details of the passenger -- name, age, contact address, travel history (which countries visited, for how long and which part of the country, etc.), plus any history of illness or sickness over the last 2-3 weeks. Those who are sick, like the Liberian case, must be taken for observation to a hospital with isolation facilities. Others must be let off, but monitored and contacted DAILY by phone to check if they fall sick over the next 3 weeks covering the incubation period of EVD infection. They should be carefully monitored by competent health staff.
Q. From what we have witnessed in the handling of the 1st EVD victim, is Nigeria in any way up to the task of containing a possible outbreak of EVD?
T: I will say that the health staff -- federal, state, the hospital where the case was admitted and the laboratory staff -- have performed creditably well. However, the detection of the case was purely fortuitous and not because we had our preparedness machinery in place. We should count ourselves lucky that the Liberian case came into Nigeria already sick and landed in Lagos too sick to continue his journey to Calabar.
He arrived at a time when our government hospitals were operating at "half mast" because the doctors were on strike. We might have had a bigger problem in our hands, assuming this case was well enough to get to Calabar (in which case he would have mingled with more passengers at the local airport and in Calabar) or that government hospitals were in full operation (in which case he would not have been admitted into a private hospital, where there are fewer contacts). So, I am saying we were able to detect the case through fortuitous circumstances and not because of our preparedness. We were simply lucky. In spite of our national penchant for declaring ourselves always on top of the situation, we were plain lucky on this occasion, not because we were prepared. Next time, we may not be so lucky.
We must, however, commend staff of the Federal and State Ministries of Health and of the private hospital where the case was admitted for being alert and taking prompt action as soon as suspicion was raised. Another point about this issue which made me proud was the laboratory support within the country. The lab in LUTH [Lagos University Teaching Hospital] under Prof Omilabu received samples on 22 Jul 2014 and the next day provided results of a pan-filovirus family diagnosis, that is evidence of presence of a virus belonging to the family of ebolaviruses (including Marburgvirus, Ebola-Zaire, Ebola-Sudan, Bundibugyo virus, Reston virus, and Tai Forest virus). Samples were also sent to Prof. Happi's lab at the Redeemer's University (RUN), late on 23 Jul 2014. The Happi team tested and confirmed that the virus was the specific Ebola-Zaire type early on 25 Jul 2014. All this happened before confirmation came in from Dakar [Senegal, Institut Pasteur]. I understand the RUN lab will commence sequencing studies pretty soon. My congratulations to our colleagues in LUTH and RUN for a great job.
Q. What should we be doing currently that we are not in terms of (a) preparedness (b) response?
T: We are certainly not out of the woods yet, until we ensure that we monitor and ascertain that every of his contacts is free from infection. We must trace all the passengers in the plane that brought him to Nigeria, to those in contact with him at the Lagos airport, and all those who attended to him in the hospital where he was treated. Every such person must be monitored for the duration of the incubation period of EVD infection, that is up to 21 days from point of contact. We must get in touch with them on a daily basis to find out if they fall sick with fever and showing the signs and exhibiting the symptoms of viral hemorrhagic fever. This must be carried out thoroughly, efficiently and rapidly. I repeat, we are not out of the woods yet.
One other issue we should take note of is to find out the itinerary of the ASKY flight that brought the case to Nigeria. Did the flight come direct from Liberia or were there stops on the way, say, Lome, etc., and who had contact with the case?
[Fortunately for Nigeria, the flight had stopovers in Accra, Ghana and a plane change in Lome, Togo, giving time for the victim's symptoms to appear before landing in Lagos and preventing him from taking an onward flight to Calabar, Nigeria. - Mod.JW]
We need to contact other countries where ASKY might have landed and is still landing. I hear also that other airlines -- Arik does direct Abuja-Monrovia-Freetown flights. If that is so, then we must also mount our surveillance not only on Lagos, but also on Abuja, not forgetting Idi-Iroko, Seme borders.
[ASKY and Arik have suspended their flights -- but we have not yet heard of any precautions being taken at Accra airport in Ghana. - Mod.JW]
Q. In the event of detection of subsequent confirmed cases of EVD, what would be the implication and how should we respond to such?
T: Any suspected case arising from newcomers into Nigeria or should any of the contacts of the Liberian case become ill, the case should be admitted immediately into a hospital with isolation facilities and barrier nursing instituted. This is why the monitoring at the border must not be scaled down. So long as we are still having people coming in from the affected West African countries, we must be on top alert with our border monitoring.
Q. Are there any issues regarding the hospital where the victim was admitted and eventually died?
T: I am very pleased to say that the staff of the private hospital acted professionally in every aspect of the treatment and eventual containment of the case. I understand that the hospital has been decontaminated and closed for a period of time.
Q. What is your last word on this?
T: As I mentioned earlier, the detection of the case was purely fortuitous and not because we had our preparedness machinery in place. We should have had our border monitoring in place soon after we learnt of the 1st case in Guinea. Again, so long as ASKY or any other airlines are bringing in passengers from Liberia, Sierra Leone or Guinea, our border monitoring must remain in place until the countries are declared free and for another 2-3 weeks after the declaration.
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[5] Airline/airport precautions: CDC
Date: Tue 29 Jul 2014
Source: CDC [edited]
http://www.cdc.gov/quarantine/air/manag ... onnel.html
CDC: Interim Guidance about EVD Virus Infection for Airline Flight Crews, Cleaning Personnel, and Cargo Personnel
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[This should be consulted at the source URL. - Mod.JW]
Additional Information
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- Infection control on aircraft: see CDC Infection Control Guidelines for Cabin Crew Members on Commercial Aircraft.
- EVD infections: see EVD Hemorrhagic Fever.
- Hemorrhagic fevers and precautionary measures: see Viral Hemorrhagic Fever Disease Information.
- Situational updates about outbreaks: see World Health Organization Disease Outbreak News.
- Travel recommendations and updates: see CDC's Travelers' Health.
- How to find a doctor while abroad.
[The above are live links in the source and can be accessed there. - Mod.JW]
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[I should think double-gloving ought to be recommended -- otherwise when you've taken one off, your bare hand comes into contact with the contaminated surface of the glove on the other hand.
Map showing 35 countries one flight away from Ebola-affected countries:
http://qz.com/242388/here-are-all-the-3 ... -countries. - Mod.JW]
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[6] USA-Mexico border
Date: Tue 29 Jul 2014
Source: WGSO Radio, WND report, USA [edited]
http://wgso.com/could-ebola-sneak-acros ... r-wnd-com/
[Excerpts]
Could EVD Sneak Across US Border?
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In 2012, the UN Office on Drugs and Crime released a report confirming, "Central Americans are not the only ones being smuggled through Mexico to the United States. Irregular migrants from the Horn of Africa (Eritrea, Somalia, and Ethiopia), as well as South Asia (Bangladesh, Nepal, India), China, and other African and Asian states are being smuggled through Central America. "Border Patrol agents in our sector have in the past apprehended aliens from Iraq, Ethiopia, Eritrea, Israel and from many other nations," Spratte continued. "People think this is just about Mexico and Central America, but it isn't. People from all over the world are trying to sneak into the United States." Several health experts are already sounding the alarm over a rash of diseases crossing America's southern border with the recent flood of illegal immigrants.
Despite Department of Homeland Security assurances that it has "health controls in place to minimize any possible health risks," including health screenings for detainees, US Border Patrol sources reveal those screenings only come after processing, exposing the agents themselves to any diseases the detainees may be carrying.... Chris Cabrera, a spokesman for the National Border Patrol Council, for example, is concerned about the spread of scabies among both immigrants and those working with them. "A lot of people [are] coming in with the disease," Cabrera told a local TV station, "and it seems to be spreading, not just within the McAllen [Texas] station, but throughout the [Rio Grande] Valley and to some of our agents."
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[Scabies infections show that border agents have close contact with immigrants and their clothing. In view of the number of unaccompanied minor children reported to be crossing the border, "Child care facilities also are a common site of scabies infestations" -- see CDC information on scabies at
http://www.cdc.gov/parasites/scabies/epi.html.
Although illegal African immigrants must spend more than EVD's incubation period of 21 days to arrive at the US-Mexico border, therefore will have died en route, their contacts could be arriving, so the concerns of one US senator that EVD could arrive were not ridiculous, as the news media made out -- but they are vanishingly small. - Mod.JW]
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[7] USA: precautions
Date: Wed 30 Jul 2014
Source: Vox, USA [edited]
http://www.vox.com/2014/7/30/5948995/wh ... in-america
What would happen if Ebola came to the United States?
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The world is currently experiencing the worst Ebola virus disease [EVD] outbreak in history -- it's in West Africa and has killed about 672 people as of 23 Jul 2014. But what would happen if the disease came to America?
The scenario isn't as far-fetched as it might sound. With air travel as common as it is, borders don't mean all that much when it comes to disease. It's entirely possible -- though by no means certain -- that at some point, someone infected with EVD could get on a plane and land in the United States. And then what?
As it turns out, experts say, we'd probably be able to contain an EVD outbreak here pretty quickly. But it's worth exploring why that is. The outbreak in West Africa is so severe for a number of key reasons, including a lack of resources, inadequate infection control measures, and mistrust of health workers. The United States, by contrast, has far better public-health infrastructure. And that makes all the difference. So here's a detailed look at how Ebola in America might go down:
1) The 1st 24 hours: identify the outbreak
The most likely way for EVD to arrive in the United States would be an infected person flying from West Africa who has EVD but doesn't even know it. Ebolaviruses can hide in a person's body from 2 days to 3 weeks before symptoms emerge. And people don't transmit Ebola during that incubation time -- they're only contagious once they show symptoms.
Once an initial EVD patient starts feeling sick, she'll probably seem at 1st like she has the flu or traveler's diarrhea. (Some of the more famous symptoms of EVD, like bleeding from orifices, don't tend to come on until later -- and bleeding doesn't even happen in about half of cases.) Although the patient would now be contagious, that doesn't mean that it's exceptionally easy to catch. It's not. Ebolaviruses don't spread through the air [with the possible exception of Ebola-Reston from the Philippines, which can infect but not sicken or kill humans. - Mod.JW]. And it's harder to catch than things like the flu. You can't get it from a cough, sneeze, or just being on the same plane or in the same public space. The only way to get EVD is to touch a patient's bodily fluids, like vomit, diarrhea, or blood. [Or touch a surface contaminated by those fluids. - Mod.JW]
Now would be when speed and public awareness play a big role, no matter where in the world an EVD patient is. The patient or someone around her will have to figure out:
(1) This is something that looks like the flu or diarrhea and
(2) This person was just in a country that has EVD.
If people realize that this might be EVD early on, they should be able to avoid getting infected by keeping away from the patient's bodily fluids. But if that doesn't cross their minds for a while, people will be more likely to get the virus by accident. In that 1st day of symptoms, every hour counts.
2) The next step: isolate the patient
In US hospitals, any suspected case of EVD would be treated as a potential risk until tests come back negative. This means that standard procedures to protect other patients and health-care workers from the patient's bodily fluids would be put into place. Because ebolaviruses don't spread through the air, hospital workers wouldn't have to wear respirators or what you might think of as full "Outbreak" gear. However, they would protect their body and face from fluids that might splash on them, using things like gowns or full body suits, masks, gloves, and goggles. Anything that touches the patient would be sterilized or disposed of in a safe manner -- and if the patient dies, the body would be carefully handled so that it wouldn't be a danger to anyone, either.
Better adherence to these safety guidelines is one reason why the virus wouldn't spread as quickly in the United States as it has in West Africa. For example, over there, some health-care workers have gotten infected, most likely because the rules weren't followed as closely. There's actually a reason for that -- people who are supposed to wear protective suits in 100 deg. F [38 deg. C] weather [more inside the suit] will get extremely hot and might cut corners, says Michael Osterholm, of the Center for Infectious Disease Research and Policy at the University of Minnesota, USA. But US hospitals are more climate controlled, he says, and even that small difference makes a breach less likely.
3) Track down other potential patients
Detective work is a major part of controlling a disease like EVD. Experts would interview the patient, her relatives, and other potential close contacts to monitor them and make sure that they don't spread the disease to others. Officials will then suggest various options for these people, depending on the level of risk, including watching and waiting, isolation at home, and testing for infection. Tracking down contacts has been especially problematic in West Africa in ways that unlikely to happen in the USA. An editorial in the major medical journal The Lancet says, "The geographical spread of cases and movement of people in and between the 3 countries presents a huge challenge in tracing those who might be infected." The World Health Organization says that "low coverage of contact tracing" is one key problem it uncovered in a recent assessment the EVD response in Liberia.
4) Keep patients in hospital until they're not a threat
It's important to remember that about 40 percent of the [hospitalized] patients in this EVD outbreak have survived. There's no specific pill or shot that will make an EVD infection go away, but doctors can try to make the patient comfortable, give IV fluids, and treat symptoms. To prevent EVD from spreading, health authorities shouldn't release a patient from the hospital until it's clear that she won't be a danger to others. This might seem intuitive, but it hasn't always happened in West Africa. For example, the BBC reports that there are several missing patients in Sierra Leone -- where some people don't trust that medical care will help them. That, obviously, increases the odds that the outbreak will spread.
The best case scenario and the worst case scenario
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To sum up, the best case scenario is that someone coming back from, say, Guinea, realizes that she might possibly have EVD as soon as she starts feeling sick. Everyone makes sure not to touch her vomit or diarrhea or other fluids. And the outbreak ends with just one patient.
The worst case scenario is that this person is ill for days and in contact with a whole lot of people before anyone realizes that something unusual is going on and brings her to a hospital. But it's still unlikely that EVD will get farther than a local problem in one city or town. Even in the worst case scenario, "I don't think we'll have a serious public health threat in any of the developed countries," Osterholm says.
[Byline: Susannah Locke]
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[8] UK: precautions
Date: Wed 30 Jul 2014
Source: The Telegraph, UK [edited]
http://www.telegraph.co.uk/science/scie ... Brits.html
Royal Air Force 'on standby' to bring back infected Brits
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The Royal Air Force's Infection Prevention Control Team is likely to be placed on standby to collect UK citizens and return them to Britain in quarantine conditions if they are infected with Ebola virus disease [EVD] from West Africa.
David Cameron has said that the EVD outbreak is a 'very serious threat' to the UK and the UK foreign secretary, Philip Hammond, is preparing to chair an emergency meeting today [30 Jul 2014] on how to tighten Britain's defences against the virus. Major Thomas Fletcher, of the Royal Army Medical Corps, said it was likely the meeting would discuss putting the military on alert to 'repatriate' Britons infected with the disease. The Royal Air Force's Infection Prevention Control Team is likely to be placed on standby to collect UK citizens and return them to Britain in quarantine conditions.
The 'Deployable Air Transportable Isolator Team' is made up of military doctors and specialists from the London Royal Free Hospital. The team was last deployed in 2012 and has been used 5 times over-all for the repatriation of 3 suspected cases of Lassa fever, 1 suspected case of multi-drug resistant tuberculosis, and 1 case of Crimean-Congo hemorrhagic fever.
Speaking to The Telegraph, Major Fletcher, a consultant on infectious diseases who has been seconded to the World Health Organization to help with the outbreak, said: "The UK has a close relationship with West Africa, and there will be British citizens in those countries. The COBRA [Cabinet Office Briefing Room A] meeting is probably discussing the possibility of the Royal Air Force offering assistance to UK nationals aboard who may become infected and who need to be repatriated. There is no doubt about it that this outbreak is going to last for many months, so it is a big deal. It is the largest and most complicated outbreak we have ever seen and it is clearly not under control yet. With the advent of global travel there is increasing risk of importing Ebola into the UK. The main risk is of contact with an EVD sufferer who has the disease but hasn't begun to show symptoms. There is also a risk from healthcare workers coming back. That is why the passenger who died in Nigeria is clearly a concern as it is highly likely he was infectious during the flights he took and potentially there are people out there who are also now infected."
The disease, which can be fatal for up to 90 per cent of infected victims, has now killed more than 670 people across Guinea, Liberia and Sierra Leone. Public Health England has issued an urgent warning to British doctors to watch for signs of the lethal disease after an infected man was allowed to travel through an international hub. They said the virus was 'clearly not under control.' The government's Chief Scientific Advisor Sir Mark Walport has said that the increasingly 'interconnected' world was placing Britons at risk. Another health expert has warned [that EVD] could spread to Britain in the same way that AIDS did in the 1980s. Dr Derek Gatherer, a specialist in the evolution of viruses from Lancaster University, warned that the virus was as easy to catch as flu and passengers on flights from infected areas risked catching the deadly disease.
[This is wrong -- it is much more difficult to catch because ebolaviruses are not transmitted between people through the air. If this epidemic were airborne, it would by now have sickened thousands of people in West Africa. Masks are worn to protect against traces of blood or vomit getting into the nose and mouth, not to filter the air. - Mod.JW]
American Patrick Sawyer died in Lagos, Nigeria, after being allowed on several flights despite showing symptoms of the disease. The airline he flew with is attempting to contact dozens of passengers who came into contact with him over fears they may also be infected. Dr Gatherer said, "AIDS spread from Central Africa to the western world in the 1980s -- EVD could do the same. Anyone on the same plane could have become infected because EVD is easy to catch." [Wrong -- see comment above. - Mod.JW]
"It can be passed on through vomiting, diarrhoea or even from simply saliva or sweat -- as well as being sexually transmitted. That is why there is such alarm over Mr Sawyer because he became ill on the flight so anyone else sharing the plane could have been infected by his vomit or other bodily fluids. Only about 10 per cent recover. The outlook is pretty bleak. They will need to trace everyone on the passenger list and isolate them as a precaution. I believe they have contacted about half so far but the others could be anywhere else in the world now."
2 Britons have already been tested for the disease in London and Birmingham after reporting symptoms, but neither had the disease. Mr Hammond said no British national so far had been affected by the outbreak, and there had been no cases in the UK, but he would be chairing the Government's COBRA emergencies committee later today [30 Jul 2014] to assess the situation. "As far as we are aware, there are no British nationals so far affected by this outbreak and certainly no cases in the UK. However, the Prime Minister does regard it as a very serious threat, and I will be chairing a COBRA meeting later today to assess the situation and look at any measures that we need to take either in the UK, or in our diplomatic posts abroad in order to manage the threat," he told Sky News. "We are very much focused on it as a new and emerging threat which we need to deal with."
Symptoms begin with fever, muscle pain and a sore throat, then rapidly escalate to vomiting, diarrhoea and internal and external bleeding. The incubation period can be up to 21 days.
[Byline: Sarah Knapton]
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ProMED-mail Rapporteur Mary Marshall
[The reports above indicate that if a traveler arrives with EVD-like symptoms from a country suffering an EVD epidemic, s/he is likely to be rapidly transferred to an isolation hospital, after a variable degree of contact with other travelers, and it may not be possible to contact all fellow passengers.
If an infected traveler does not show any symptoms on arrival, but falls ill within 3 weeks with EVD-like symptoms and tells their doctor they had been in a country suffering an EVD epidemic, they should be sent to an isolation hospital. Although they may have had dozens of contacts before becoming too ill to circulate in public places, none of those contacts would have been at risk.
If the sick person is classified as a suspect case, the family who cared for the victim and used the same bathroom facilities, and any domestic cleaners, should immediately start wearing disposable gloves and using 1:100 bleach solution to clean all surfaces touched or contaminated by the patient. - Mod.JW
A HealthMap/ProMED-mail map can be accessed at:
http://healthmap.org/promed/p/62.]
