EBOLA VIRUS DISEASE - WEST AFRICA (171): LOCKDOWN, SERUM, AEROSOL, GUINEA TEAM KILLED
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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 update:
[1] Sierra Leone: lockdown begins
[2] Convalescent serum therapy
[3] Aerosol controversy
[4] Guinea: outreach team killed
[5] Media online
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[1] Sierra Leone: lockdown begins
Date: 18 Sep 2014
Source: Agence France-Presse [excerpted, edited]
http://www.globalpost.com/dispatch/news ... a-lockdown
Sierra Leone prepared Thu [18 Sep 2014] for an unprecedented 3-day nationwide lockdown to contain the deadly spread of the ebolavirus in a controversial move which experts claimed could worsen the epidemic. The population of 6 million will be confined to their homes from midnight (0000 GMT) going into Fri [19 Sep 2014] as almost 30 000 volunteers go door-to-door uncovering patients and bodies hidden in people's homes... "Ose to Ose Ebola Tok" -- "house-to-house Ebola talk" in the widely-spoken Krio language -- will see more than 7000 volunteer teams of 4 visiting the country's 1.5 million homes. They will hand out bars of soap and information on how to prevent infection, as well as setting up "neighbourhood watch"-style community EVD surveillance teams.
Teams will not enter homes nor collect patients or bodies
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The government has said the teams will not enter people's homes and are not tasked with collecting patients or bodies, but will call emergency services or burial teams "if by chance the teams happen to bump into such situations". Extra beds have been set up at schools and hospitals across the country, including 200 around Freetown, with the government projecting a 15 to 20 percent upsurge of cases as new patients are discovered... The ministry of health has enlisted 14 burial teams across the Western Area, which includes the capital, and a fleet of motorcyclists to bike specimens from dead bodies straight to laboratories.
Community activists and civil society leaders have been recruited to help thousands of police and soldiers enforce the curfew. Health workers, the emergency services and other security forces will be exempt, along with the media and other professionals deemed key workers, while air passengers have been given special dispensation to get to Freetown's airport...
Experts warned, however, that coercive measures to stem the epidemic, such as confining people to their homes, could backfire badly and would be extremely hard to implement effectively.
Jean-Herve Bradol, a former director of medical aid group Medecins sans Frontiers (MSF) and an emergency physician with experience of working in Africa, said the goal seemed "highly unrealistic. The country doesn't have the capacity to visit every household in just 3 days," he told AFP. MSF, known in the English-speaking world as Doctors Without Borders, said health workers would find it extremely difficult to accurately identify cases through door-to-door screening... "This leads to the concealment of potential cases and ends up spreading the disease further," it said in a statement.
However, the shutdown has broadly been welcomed by community leaders and local residents of Freetown. "We shall be praying that the operation will end the scourge. We support the government," said 60-year-old Samuel Johnson, a father-of-3 who recently lost a daughter to EVD.
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Communicated by:
ProMED Rapporteur Kunihiko Iizuka
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[2] Convalescent serum therapy
Date: 17 Sep 2014
Source: Heather Lander, Pathogen Perspectives [edited]
http://www.pathogenperspectives.com/201 ... magic.html
As mentioned in my Q&A with Dr. C.J. Peters [see ProMED Ebola virus disease - West Africa (159): WHO, travel, contacts, serum, rates Archive No. 20140910.2764881], for some viruses such as Junin, the virus that causes Argentine hemorrhagic fever, we know that convalescent serum is very effective and is used on a regular basis (1-3). But what do we really know about the use of convalescent plasma or serum for EVD patients?
Well what's been touted as hard evidence in the media lately are 2 specific instances in which EVD patients were given convalescent serum and survived. Let's take a closer look at these cases... [clip]...
But there is a lot more evidence that this strategy won't work including: During the Kikwit [Zaire] outbreak, convalescent serum from EVD survivors was given to cynomolgus macaques, and it failed to protect any of the monkeys from challenge with EBOV. (unpublished data C.J. Peters., 1995) and 5 more -- published -- examples...
So when Dr. Peters said that there wasn't much evidence to support that EVD convalescent serum would be effective but that there was quite a bit of evidence to support that it would not be, what I've outlined above is what he meant. And Tom Geisbert's group summed it up very nicely in their 2007 paper (13): "However, the results of the present study, which used immune primate blood, join the preponderance of published study results suggesting that immunotherapy will not be a shortcut to the solution. Given these discouraging results and the risks of transmitting infection, whole blood transfusions, even under desperate epidemic conditions, seem unwarranted."
As desperate as we are for a way to help these patients, we simply have no solid platform from which to proclaim EVD survivor blood as effective therapy.
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Communicated by:
ProMED-mail Rapporteur Mary Marshall
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[3] Aerosol controversy
Date: 17 Sep 2014
Source: CIDRAP [excerpted, edited]
http://www.cidrap.umn.edu/news-perspect ... tion-ebola
Commentary: Health workers need optimal respiratory protection for Ebola
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Lisa M Brosseau, ScD, and Rachael Jones, PhD
Editor's Note: Today's [17 Sep 2014] commentary was submitted to CIDRAP by the authors, who are national experts on respiratory protection and infectious disease transmission. In May [2014] they published a similar commentary on MERS-CoV. Dr Brosseau is a Professor and Dr Jones an Assistant Professor in the School of Public Health, Division of Environmental and Occupational Health Sciences, at the University of Illinois at Chicago, USA.
Direct injection and exposure via a skin break or mucous membranes are the most efficient ways for Ebola to transmit. It may be that inhalation is a less efficient route of transmission for Ebola and other filoviruses, as lung involvement has not been reported in all non-human primate studies of Ebola aerosol infectivity. However, the respiratory and gastrointestinal systems are not complete barriers to Ebola virus. Experimental studies have demonstrated that it is possible to infect non-human primates and other mammals with filovirus aerosols.
Altogether, these epidemiologic and experimental data offer enough evidence to suggest that ebolaviruses and other filoviruses may be opportunistic with respect to aerosol transmission. That is, other routes of entry may be more important and probable, but, given the right conditions, it is possible that transmission could also occur via aerosols.
Guidance from the CDC and WHO recommends the use of facemasks for healthcare workers providing routine care to patients with Ebola virus disease and respirators when aerosol-generating procedures are performed. (Interestingly, the 1998 WHO and CDC infection-control guidance for viral hemorrhagic fevers in Africa, still available on the CDC Web site, recommends the use of respirators.)
Facemasks, however, do not offer protection against inhalation of small infectious aerosols, because they lack adequate filters and do not fit tightly against the face. Therefore, a higher level of protection is necessary...
Implications for protecting health workers in Africa
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Healthcare workers have experienced very high rates of morbidity and mortality in the past and current Ebola virus outbreaks. A facemask, or surgical mask, offers no or very minimal protection from infectious aerosol particles. As our examples illustrate, for a risk group 4 organism like ebolavirus, the minimum level of protection should be an N95 filtering facepiece respirator.
This type of respirator, however, would only be appropriate only when the likelihood of aerosol exposure is very low. For healthcare workers caring for many patients in an epidemic situation, this type of respirator may not provide an adequate level of protection...
For a risk group 4 organism, any activity that has the potential for aerosolizing liquid body fluids, such as medical or disinfection procedures, should be avoided, if possible. Our risk assessment indicates that a PAPR with a full facepiece (APF = 50) or a hood or helmet (APF = 25) would be a better choice for patient care during epidemic conditions.
We recognize that PAPRs present some logistical and infection-control problems. Batteries require frequent charging (which requires a reliable source of electricity), and the entire ensemble requires careful handling and disinfection between uses. A PAPR is also more expensive to buy and maintain than other types of respirators. On the other hand, a PAPR with a loose-fitting facepiece (hood or helmet) does not require fit testing. Wearing this type of respirator minimizes the need for other types of PPE, such as head coverings and goggles. And, most important, it is much more comfortable to wear than a negative-pressure respirator like an N95, especially in hot environments.
A recent report from a Medecins Sans Frontieres healthcare worker in Sierra Leone notes that healthcare workers cannot tolerate the required PPE for more than 40 minutes. Exiting the workplace every 40 minutes requires removal and disinfection or disposal (burning) of all PPE. A PAPR would allow much longer work periods, use less PPE, require fewer doffing episodes, generate less infectious waste, and be more protective. In the long run, we suspect this type of protection could also be less expensive.
Adequate protection is essential
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To summarize, for the following reasons we believe that Ebola could be an opportunistic aerosol-transmissible disease requiring adequate respiratory protection:
- Patients and procedures generate aerosols, and Ebola virus remains viable in aerosols for up to 90 minutes.
- All sizes of aerosol particles are easily inhaled both near to and far from the patient.
- Crowding, limited air exchange, and close interactions with patients all contribute to the probability that healthcare workers will be exposed to high concentrations of very toxic infectious aerosols.
- Ebola targets immune response cells found in all epithelial tissues, including in the respiratory and gastrointestinal system.
- Experimental data support aerosols as a mode of disease transmission in non-human primates.
- Risk level and working conditions suggest that a PAPR will be more protective, cost-effective, and comfortable than an N95 filtering facepiece respirator.
[Surgical masks are not designed for use as particulate respirators and do not provide as much protection as an N95 respirator. Most surgical masks do not effectively filter small particles from air and do not prevent leakage around the edge of the mask when the user inhales. Surgical masks are adequate for use on a patient to contain droplets and prevent spread of infectious particles. N95 & PAPR masks for use by health workers are discussed above.
http://www.cdc.gov/niosh/npptl/topics/r ... psars.html
Photos:
N95 respirator with goggles:
http://fluarmour.com/images/surgical-tieon-mask.jpg
N95 respirator with eyeshield:
http://www.mountainside-medical.com/med ... _21765.jpg
Photo of PAPR respirator:
http://www.cdc.gov/niosh/npptl/topics/r ... primg1.jpg
- Mod.JW]
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Communicated by:
ProMED-mail
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promed@promedmail.org>
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Scientists see risk of mutant airborne ebolavirus as remote
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19 Sep 2014: (Reuters) Ben Neuman, a Reading [UK] virologist who has been monitoring the EVD epidemic since it began in Guinea, noted that under carefully controlled laboratory conditions, scientists have shown it is feasible to make ebolavirus transmit through air, but added: "So far, there is no solid evidence that it actually happens out there in the real world. One clue is how slow the virus is spreading," he told Reuters. "Compared to this EVD outbreak, the H1N1 swine flu had already spread to an estimated 10 000 times as many people in its 1st 10 months." - more
http://www.reuters.com/article/2014/09/ ... O320140919
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19 Sep 2014: (Vox) [Most] infectious disease experts remain very skeptical that ebolavirus will ever become airborne. "This is way down on the list of possible futures for ebolaviruses and in all probability will never happen," said Ian Jones, a virologist with the University of Reading [UK], in an interview with Reuters on this exact topic. "We've never seen a human virus change the way it is transmitted."
But why are experts so confident [this] ebolavirus won't become airborne? It's worth reading this long post by Vincent Racaniello, a virologist at the College of Physicians and Surgeons at Columbia University
http://www.virology.ws/2014/09/18/what- ... bola-virus. He goes into detail about how viruses mutate, but here's his bottom line:
"When it comes to viruses, it is always difficult to predict what they can or cannot do. It is instructive, however, to see what viruses have done in the past, and use that information to guide our thinking. Therefore, we can ask: has any human virus ever changed its mode of transmission?" [He gives examples. - Mod.JW] The answer is no. We have been studying viruses for over 100 years, and we've never seen a human virus change the way it is transmitted."
I am fully aware that we can never rule out what a virus might or might not do. But the likelihood that Ebola virus will go airborne is so remote that we should not use it to frighten people. We need to focus on stopping the epidemic, which in itself is a huge job.
This jibes with what Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, told the Senate earlier this week: "Very, very rarely does [a virus] completely change the way it's transmitted."
http://www.vox.com/2014/9/19/6543157/eb ... o-airborne.
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Communicated by:
ProMED-mail
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promed@promedmail.org>
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[4] Guinea: outreach team killed
Date: 19 Sep 2014
Source: AllAfrica [edited]
http://allafrica.com/stories/2014091915 ... ?viewall=1
http://www.washingtonpost.com/news/to-y ... -attacked/
The Guinean government said it is stopping EVD education activities in the country's southeast after 7 missing health workers and journalists were murdered there this week; 2 other workers remain missing [one more died and others escaped. - Mod.JW].
In Guinea's southeastern town of Wome, the bodies of 4 EVD campaigners and 3 local journalists traveling with them were discovered Thursday [18 Sep 2014] in a mass grave. They had been missing since angry residents attacked their convoy Tue [16 Sep 2014]. The victims were traveling with a government delegation to Wome to raise awareness on EVD. Villagers attacked the convoy with stones and weapons and destroyed 6 vehicles. Other members of the delegation were beaten but managed to escape.
A local reporter told VOA by telephone that villagers accused the delegation of spreading lies about EVD. The delegation was trying to educate locals about EVD, said Guinea's prime minister, Mohamed Said Fofanah. Villagers in Wome, as in other places, are still "intoxicated by information making them believe this sickness does not exist or was created to eliminate them." Outreach activities have become "impossible" in the southeast, said Dr. Fanta Kabba, permanent secretary at the Ministry of Health. She said efforts there will now focus just on treating the sick. "We are waiting for more details" and trying to figure out why locals resist, she said. "... Putting in place the strategies to fight Ebola has become impossible. We cannot act when we are being prevented from acting."
This is 3rd major attack on health workers in southeastern Guinea since the regional outbreak began there early this year [2014]. Minister of Communication Alucine Makanera, who was in Wome, told VOA the murdered workers had marks indicating they were attacked with machetes and stones. "We have the state prosecutor with us to find out the cause of the attack," Makanera said. "He has already opened judicial investigations, and within a few days or weeks we should know more."
Many residents of Wome fled following the attack, he said, and security forces are deployed there now. Authorities have arrested at least 6 people in connection with the murders. The incident has sent shock waves through the country, with many Guineans calling for strong sanctions against the culprits.
(Some information for this report was drawn from Reuters and the Associated Press).
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Communicated by:
Ryan McGinnis
http://bigstormpicture.com
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[5] Media online
China offers more aid
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18 Sep 2014: (AllAfrica) China committed 200 million yuan, or about USD 33 million, in new emergency aid to the UN, targeted to containing the EVD epidemic, the Associated Press reported. The country also offered USD 2 million to the World Health Organization and the African Union to fight the disease. A team of 59 Chinese laboratory specialists arrived in Sierra Leone on Thu [18 Sep 2014] to assist with testing. To date, China has sent 174 medical experts to the region.
http://allafrica.com/stories/2014091915 ... ?viewall=1 [in the same report as the one in [4] above. - Mod.JW]
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Malta denies entry to ship amid EVD fears
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19 Sep 2014: (World Maritime News) Bulk carrier MV/Western Copenhagen has been denied entry into Maltese territorial waters amid suspicion that one of the crew has been infected by the ebolavirus. The Hong Kong-flagged ship was en route from Guinea to Ukraine. However, as one of the crew, a Filipino national, had taken ill, the captain requested to dock in Malta where the ill crew member could be provided the necessary medical assistance.
Maltese Prime Minister Joseph Muscat said the ship was turned away since the patient's symptoms were similar to EVD, adding that the decision was morally and legally correct, writes the BBC. As explained by the Maltese health officials, the country does not have adequate facilities to treat EVD patients... - more
http://worldmaritimenews.com/archives/1 ... bola-fears
[The last statement would be true of most seaports worldwide. - Mod.JW]
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Russian vaccine in test
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19 Sep 2014: (Tass) A Russian vaccine against the ebolavirus is passing systematic tests, Deputy Prime Minister Olga Golodets told reporters on the sidelines of the Sochi International Investment Forum on Fri [19 Sep 2014]. "Russian doctors are working successfully in the area of the EVD outbreak (West Africa). Positive steps were made to develop a vaccine. Now it is passing systematic tests," the deputy prime minister said. No EVD cases were reported in Russia, she said. "There are no threats for Russians. We have several barriers of protection," Golodets pledged.
http://en.itar-tass.com/world/750270
[ProMED would be interested to hear further details and the projected availability date. - Mod.JW]
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Communicated by:
ProMED-mail
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promed@promedmail.org>
[CDC has posted an 18 Sep 2014 update of the latest developments on EVD at
http://www.cdc.gov/vhf/ebola/outbreaks/guinea. It includes a distribution map of the situation as of 14 Sep 2014, and the following report:
"CDC returned a staff member from West Africa by charter flight after the employee had low-risk contact with an international health worker who recently tested positive for EVD. This CDC staff member is not sick and does not show symptoms of EVD. Friends, family, co-workers, and the public are not at risk of getting EVD from this person."
A HealthMap/ProMED-mail map can be accessed at
http://healthmap.org/ebola. - Mod.JW]
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