EBOLA VIRUS DISEASE - WEST AFRICA (135): WHO, NIGERIA, RECOVERY, MORE
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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] Nigeria: 2 new cases
[3] WHO underestimation
[4] Questions about recovery
[5] Change in strategy?
[6] Prevention
[7] False alarms
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[1] WHO update
Date: Fri 22 Aug 2014
Source: WHO Global Alert and Response, Disease Outbreak News [edited]
http://www.who.int/csr/don/2014_08_22_ebola/en/
Ebola virus disease update -- west Africa
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Confirmed, probable, and suspect cases and deaths from Ebola virus disease in Guinea, Liberia, Nigeria, and Sierra Leone, as of 20 Aug 2014: Total cases 2615, deaths 1427.
Between 19-20 Aug 2014, a total of 142 new cases of Ebola virus disease (laboratory-confirmed, probable, and suspect cases) as well as 77 deaths were reported from Guinea, Liberia, Nigeria, and Sierra Leone.
[A] new draft budget is being reviewed by partners. The increase in needed resources is based on improved data and understanding of the situation on the ground in the affected countries. The new estimation of costs is derived using a unit-cost model, built for the most intense transmission areas and reflects the average operational costs based on the current situation in the affected countries. The major assumptions for the cost estimates will be announced towards the end of next week.
WHO continues to receive reports of rumoured or suspected cases from countries around the world and systematic verification of these cases is ongoing. Countries are encouraged to continue engaging in active surveillance and preparedness activities. As of today, no new cases have been confirmed outside of Guinea, Liberia, Nigeria, or Sierra Leone [but see Nigeria's 2 new cases in [2] below].
WHO does not recommend any travel or trade restrictions be applied except in cases where individuals have been confirmed or are suspected of being infected with EVD or where individuals have had contact with cases of EVD. (Contacts do not include properly-protected health-care workers and laboratory staff.) Temporary recommendations from the Emergency Committee with regard to actions to be taken by countries can be found at:
IHR Emergency Committee on Ebola outbreak in west Africa
http://www.who.int/mediacentre/news/sta ... 0140808/en
[Table: Confirmed, probable, and suspect cases and deaths from Ebola virus disease in Guinea, Liberia, Nigeria, and Sierra Leone, as of 20 Aug 2014.
This shows for Nigeria: 16 cases with 5 deaths, one fatal case confirmed. - Mod.JW]
The total number of cases is subject to change due to ongoing reclassification, retrospective investigation, and availability of laboratory results. Data reported in the Disease Outbreak News are based on official information reported by Ministries of Health.
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ProMED-mail Rapporteur Marianne Hopp
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[2] Nigeria: 2 new cases
Date: 22 Aug 2014
Source: SaharaReporters [edited]
http://saharareporters.com/2014/08/22/s ... -infection
Spouses of 2 Nigerians killed by EVD admitted to hospital with full blown infection
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Nigeria's Minister of Health, Professor Onyebuchi Chukwu, on Friday [22 Aug 2014] confirmed what SaharaReporters had consistently reported, that 2 more people have been infected with Ebola virus disease (EVD), bringing the number of current established cases to 4. Chukwu, who made the confirmation during an interaction with journalists, said the latest EVD victims are spouses of 2 of the 5 people earlier killed by the disease ... [more]
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[3] WHO underestimation
Date: Fri 22 Aug 2014
Source: WHO Situation Assessment [edited]
http://www.who.int/mediacentre/news/ebo ... t-2014/en/
Why the EVD outbreak has been underestimated
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The magnitude of the EVD outbreak, especially in Liberia and Sierra Leone, has been underestimated for a number of reasons. Many families hide infected loved ones in their homes. As EVD has no cure, some believe infected loved ones will be more comfortable dying at home. Others deny that a patient has EVD and believe that care in an isolation ward -- viewed as an incubator of the disease -- will lead to infection and certain death. Most fear the stigma and social rejection that come to patients and families when a diagnosis of EVD is confirmed.
These are fast-moving outbreaks, creating challenges for the many international partners providing support. Quantities of staff, supplies, and equipment, including personal protective equipment, cannot keep up with the need. Hospital and diagnostic capacities have been overwhelmed. Many treatment centres and general clinics have closed. Fear keeps patients out and causes medical staff to flee. In rural villages, corpses are buried without notifying health officials and with no investigation of the cause of death. In some instances, epidemiologists have travelled to villages and counted the number of fresh graves as a crude indicator of suspected cases.
In parts of Liberia, a phenomenon is occurring that has never before been seen in an EVD outbreak. As soon as a new treatment facility is opened, it is immediately filled with patients, many of whom were not previously identified. This phenomenon strongly suggests the existence of an invisible caseload of patients who are not being detected by the surveillance system. For example, in Monrovia, Liberia's capital, an EVD treatment centre with 20 beds, which opened last week [week ending 15 Aug 2014], was immediately overwhelmed with more than 70 patients.
An additional problem is the existence of numerous "shadow-zones." These are villages with rumours of cases and deaths, with a strong suspicion of EVD as the cause, that cannot be investigated because of community resistance or lack of adequate staff and vehicles. In some areas, most notably Monrovia, virtually all health services have shut down. This lack of access to any form of health care contributed to the mobbing incident on Saturday at an EVD holding facility in the West Point township, Liberia's most disease-prone slum. Rumours spread that the holding facility, hastily set up by local authorities in an abandoned schoolhouse, was actually a clinic for general health care. People from other communities brought their ailing family members there, where they were housed together with suspected EVD patients. The presence of patients from these other communities was resented by the West Point community, and this resentment contributed to the riot and subsequent looting, in which potentially contaminated materials were carried into these communities.
WHO epidemiologists in Sierra Leone and Liberia are working with other agencies, including Medecins Sans Frontieres (Doctors without Borders) and the US Centers for Disease Control and Prevention, to produce more realistic estimates and thus communicate the true magnitude of needs.
WHO media contacts:
Gregory Hartl
Telephone: +41 22 791 4458
Mobile: +41 79 203 6715
Email: <
hartlg@who.int>
Fadela Chaib
Telephone: +41 22 791 3228
Mobile: +41 79 475 55 56
Email: <
chaibf@who.int>
Tarik Jasarevic
Mobile: +41 793 676 214
Tel: +41 22 791 5099
E-mail: <
jasarevict@who.int>
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Communicated by:
ProMED-mail Rapporteur Mary Marshall
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[4] Questions about recovery
Date: Thu 21 Aug 2014
Source: National Public Radio (NPR), USA [edited]
http://www.npr.org/blogs/goatsandsoda/2 ... dr-brantly
We Answer Your Questions About EVD Recovery
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Dr. Kent Brantly announced his recovery from Ebola virus disease, with his wife, Amber Brantly, during a press conference at Emory University Hospital Thursday [21 Aug 2014] in Atlanta [Georgia, USA]. Brantly got sick at the end of July [2014]. Brantly and Nancy Writebol went through "a rigorous course of treatment and thorough testing for treatment," before they were released, said Emory's Dr. Bruce Ribner, at a press conference Thursday. He is confident that their release posed no threat to the public, Ribner added.
But still, the news of Brantly's and Writebol's release generated a flurry of questions from our readers -- and our team members. To answer some of the most frequently asked ones, we reached out to Dr. Barbara Knust, an epidemiologist at the Centers of Disease Control and Prevention.
She responded through a CDC spokesperson via email. We've edited her responses for clarity and space.
Can a survivor pass the ebolavirus on to someone else through, for example, a hug or a kiss?
EVD is spread only by people exhibiting symptoms and through direct contact with bodily fluids. Once a person recovers from EVD, he or she is no longer shedding virus, and thus is not contagious. In past EVD outbreaks, follow-up studies of patients who have recovered from EVD and their contacts found no evidence that the ebolavirus was spread from a recovered patient to their close contacts.
We've read that the virus still lingers in semen and breast milk after recovery. Is that true?
The World Health Organization states that ebolavirus has been found in male semen up to 7 weeks after recovery. They also cite a specific instance when ebolavirus was found in the semen of a man 61 days after recovery. Therefore, male survivors of EVD are advised to avoid having sex for 3 months or to use condoms. (In an earlier interview, Knust also said that women are instructed to wean any children who have been breast-feeding.) Semen and breast milk are not the primary means by which EVD is transmitted. The virus is primarily transmitted via blood, sweat, feces and vomit. As you may have heard today from Emory officials and Dr. Brantly, neither Brantly nor Writebol are completely sure how or where they contracted the virus. But each knows they either treated EVD patients or were in close contact with those who treated EVD patients. In either case, we just don't know what bodily fluid may have been the vessel of transmission.
Can there be long-term damage to a person's organs after recovering from EVD?
There could be, though CDC isn't aware of any. EVD is a severe disease, and recovery can take a long time. Long-term damage would depend on the clinical course the disease took.
Does a survivor suffer any irreversible damage?
We don't have data on this. In a previous interview, Dr. Darin Portnoy, of Doctors Without Borders, said renal, kidney, liver or lung function can take some time to recover in some cases. If the patient goes into shock, it can also damage the heart muscle, which may not ever recover. A shock-like state can also decrease blood flow to the brain and cause some irreversible damage. Each case is different, Portnoy stressed.
Would it be safe for Brantly to go back to Africa?
That would be a question for the medical team that treated him. Whether Dr. Brantly returned to Africa would be a decision made by him and his employer.
[He should be immune to re-infection for a number of months, at least. We hope that long-term African survivors are now being tested for their levels of immunity to ebolaviruses. His return would be a big morale-booster for other health workers in the field. - Mod.JW]
Is there any risk of relapse?
This is a viral disease, and testing conducted by the CDC indicated the virus is no longer inside Dr. Kent Brantly or Nancy Writebol. There has been no risk of relapse reported.
Is Brantly now immune to all strains and species of ebolavirus, or just the strain that he caught?
Most likely, his immune system developed antibodies against the Zaire species of ebolavirus that infected his body. Certainly, he has some immunity against that type of ebolavirus. But it's uncertain how long that immunity will last and whether he now has immunity against the other known ebolavirus species.
[Byline: Linda Poon]
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[5] Change in strategy?
Date: Fri 22 Aug 2014
Source: Forbes [edited]
http://www.forbes.com/sites/scottgottli ... las-spread
Have World Leaders Abandoned Hope Of Stemming EVD's Spread?
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Is the current strategy to let the virus burn itself out [in that region of western Africa], while officials focus efforts on containing EVD's geographic migration? While this assessment may overstate the shifting tactics, there's an unmistakable change in the strategy for confronting the unprecedented outbreak.
Efforts to stem continued spread in the 3 most heavily struck nations seem to be giving way to a strategy aimed at containing it within those regions. If this strategy continues to unfold, it will represent a historic failure of public health agencies to respond effectively to this evolving crisis. Having been slow to focus resources on this region, the shift may signal that they believe they're too late. This is an unmistakable impression created by the tactics being instituted in the 3 most heavily struck nations -- Guinea, Liberia and Sierra Leone. Those nations are now confining people to the affected regions, restricting who can enter and leave. In the latest such move, this week [week of 18 Aug 2014] the World Health Organization called on countries affected by EVD to check people departing at international airports, seaports and major border crossings and stop any people with signs of illness from traveling ... [more]
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[6] Prevention
Gabon
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22 Aug 2014: On Friday [22 Aug 2014], the Central African country of Gabon announced it was barring all flights and ships from EVD-stricken countries.
http://www.sfgate.com/news/medical/arti ... 705416.php
Airline cancellations
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22 Aug 2014: Airlines have cancelled more than 1/3rd of international flights to 3 west African countries over fears that an outbreak of the Ebola virus disease could spread, as more African countries introduce measures to block visitors from affected areas. Of 590 monthly flights scheduled to Guinea, Liberia and Sierra Leone, 216 have been cancelled, according to OAG, an airline data provider. Although 14 cases of Ebola have been reported in Nigeria, flights to and from that country have not been affected.
http://www.theguardian.com/society/2014 ... erra-leone
Closed borders and travel bans hurt
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22 Aug 2014: Closed borders and travel bans in EVD-stricken countries are exacerbating food shortages and leading to preventable deaths, a Red Cross aid worker says.... "We're unable to bring international staff in. We've had staff not be able to get clearance to leave their country or that we've had to isolate for 3 weeks after they've worked for us somewhere else before they're able to travel back to their own countries" ... [more]
The Red Cross has launched the EVD Outbreak 2014 Appeal.
http://www.radioaustralia.net.au/intern ... hs/1360092
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[7] False alarms
Europe
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Fear and false alarms as Ebola puts Europe on alert. There has been only one confirmed Ebola case in Europe since the epidemic broke out in Africa, but a string of false alarms has provoked jitters and charges of overreaction. From Austria to Ireland, Spain to Germany, there have been at least a dozen cases of west Africans with mild flu symptoms being isolated until it was established that they were not suffering from Ebola. The only recorded case involved a Spanish missionary who contracted the virus in Liberia and died after he had returned to Spain. In Spain, worries over EVD have resulted in 3 false alarms in as many days ... [more]
http://www.theguardian.com/society/2014 ... alse-alarm
[It is not over-reacting to take extreme precautions in the circumstances. - Mod.JW]
Ireland
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22 Aug 2014: The HSE has confirmed a Donegal man at the centre of an EVD scare did NOT die as a result of the virus. Dessie Quinn, a father of one, from Mountcharles, became ill on his return from Sierra Leone, where he worked as an engineer. He was being treated for malaria before his death yesterday morning [21 Aug 2014]. There were fears he had contracted EVD as Sierra Leone is one of the countries in West Africa where the virus is rampant. Mr. Quinn worked with K N Network Services, which is based in Clondalkin in Dublin. The company won a contract last January to provide 600 km of digital cabling and wi-fi in Sierra Leone to the borders of Guinea and Liberia. All 3 countries as well as Nigeria are at the centre of the EVD scare with more than 370 deaths in Sierra Leone. KN Network Services earlier today [22 Aug 2014] released a statement saying that they had returned all their Irish staff from Sierra Leone as a precaution. While tests carried out on Mr. Quinn's body in Letterkenny General Hospital have ruled out EVD, the cause of death has yet to be revealed.
http://oceanfm.ie/2014/08/22/breaking-n ... have-ebola
Myanmar
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22 Aug 2014: The Ministry of Health has announced that the man who arrived at Yangon International Airport on 19 Aug 2014 suffering from fever has malaria, not EVD, according to blood tests taken while he was under quarantine along with 4 travel companions. The 5 were quarantined as a precaution to prevent the virus that has affected 4 nations in West Africa from reaching Myanmar. The patient had returned from West Africa via Bangkok and was sent to Waibargi Infectious Disease Hospital's intensive care after he was found to be suffering from fever and fatigue at immigration control. "He was infected with malaria and is being treated for malaria. None of the 4 persons who returned with him were infected with EVD, according to tests at the National Health Laboratory," an official from ministry said, adding that they were still waiting for test results from a lab in India to completely rule out that the 5 people quarantined had been infected with ebolavirus.
http://www.nationmultimedia.com/aec/Fev ... 41539.html
UK (England)
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22 Aug 2014: A police station closed a block of 22 police cells and sent all new prisoners to other stations after an African woman from EVD-stricken Guinea being held there came down with a mild fever that officers feared may be the deadly ebolavirus. Devon and Cornwall Police were unable to use the custody block in Exeter city centre for at least 8 hours while cells were cleaned and staff given health checks.
http://www.telegraph.co.uk/news/worldne ... hours.html
[There is no mention of a blood test, nor whether she had contact with anyone in or from Guinea, or even been there within the last 3 weeks. But it shows an encouragingly high level of awareness in England. - Mod.JW]
UK (Wales)
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22 Aug 2014: A woman living in Wales who was quarantined as a [contact] of EVD has been given the all clear. The woman alerted health officials after she returned to her home in Cardiff after visiting an infected country in West Africa. The Welsh national told doctors she "may have been exposed" to the deadly virus which has killed hundreds across Liberia, Sierra Leone, Nigeria, Guinea.
http://www.itv.com/news/wales/update/20 ... -officials
USA (California)
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21 Aug 2014: Health officials announced Thursday night [21 Aug 2014] that a patient in Sacramento [California] who was thought to have been exposed to ebolavirus after traveling to West Africa has tested negative and does not have the disease ... [more]
http://www.sfgate.com/bayarea/article/S ... 704866.php
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[New cases continue to overwhelm health facilities. - Mod.JW
A HealthMap/ProMED-mail map can be accessed at:
http://healthmap.org/promed/p/54.]
