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EBOLA VIRUS DISEASE - WEST AFRICA (179): LIBERIA, PROTECTION, AEROSOL, PREVENTION
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ProMED-mail is a program of the
International Society for Infectious Diseases
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In this update:
[1] Liberia: survivor, ZMapp reaction
[2] PPE challenge
[3] Aerosols again
[4] Prevention & false alarms

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[1] Liberia: survivor, ZMapp reaction
Date: 1 Sep 2014 [note date]
Source: France24 [excerpts]
http://observers.france24.com/content/2 ... p-epidemic


'How I survived Ebola'
----------------------
Doctor Senga Omeonga is doing better. Much better; 3 weeks ago, FRANCE 24 interviewed this Congolese doctor who contracted the ebolavirus while working in Monrovia, Liberia. At the time, he was wasting away in the hallway of a hospital, without any treatment or food. Today, while he still feels weak, he no longer has the virus...

Omeonga and 2 other doctors in Liberia were given Zmapp, a drug that was tested for the 1st time in early August [2014] on 2 American health workers, who have since recovered from the virus. However, this experimental treatment hasn't cured everyone: one of the doctors in Liberia who was given ZMapp as treatment died last Sunday [31 Aug 2014]...

Omeonga has worked for the 5 years at the John Fitzerald Medical Centre in Monrovia, the capital of Liberia. He is originally from the Democratic Republic of Congo [where there is currently an unrelated outbreak of EVD -- see ProMED Hot Topics - Mod.JW]...

The 1st few days at that hospital were a real nightmare. There was not nearly enough staff or medical supplies. Since there were no rooms available, I had to wait in a hallway, lying on the ground, for a week. There was only one toilet for several dozen patients. A friend of mine came every day to give me food. In these conditions, I thought I would never survive; people around me were dying like flies. A bed finally opened up, and a doctor treated me with ZMapp. He administered it to me 3 times. I believe my status as a doctor working internationally worked in my favour in getting me this drug. Still, it was risky -- the 3rd dose of ZMapp almost killed me, since I had a strong allergic reaction to it and went into anaphylactic shock...

Since I've left the hospital, it's been interesting to see that some of my friends are a bit scared of me, at least those that don't have any medical knowledge. Many of them refuse to come visit me, thinking I may still be carrying the virus. In Liberia, people living in regions touched by the epidemic have gone into a sort of mass psychosis leading to very irrational acts... -- more

[Byline: Gregoire Remund]

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[Many people do not realize that in many underdeveloped countries, not only in Africa, with under-funded hospitals, it is customary to not only bring food to relatives in hospital, but also stay there and provide nursing care for them, to help overworked staff.

This is the 1st report I've seen of an adverse reaction to ZMapp. For further details about ZMapp, see: http://www.cdc.gov/vhf/ebola/outbreaks/ ... ments.html. - Mod.JW]

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[2] PPE challenge
Date: Fri 26 Sep 2014
Source: USAID [excerpts, edited]
http://blog.usaid.gov/2014/09/a-grand-c ... ight-ebola


A Grand Challenge to Help Health Care Workers Fight Ebola
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Announced at the Global Health Security Summit in Washington, DC, this Grand Challenge for Development will unite the global community in the quest for ingenious ideas that deliver practical and cost-effective innovations in a matter of months, not years.

We need new ideas to help ensure that treatment sites, communal transport units, and burial sites do not become infection sources. We need new solutions that strengthen the safety and increase the comfort of the suits, from improving fabric design to measuring a health worker's temperature and heart rate.

We need new ways to simplify clinical processes, including point-of-care diagnostics. And we need new tools that continue to create a safer clinical environment, including improving infection control and waste disposal. Taken together, these innovations will enable health workers to provide better care for those who are suffering.

Together with our international partners, we will translate the expertise and ingenuity of scientists, innovators, engineers, and students from across the globe into real solutions. With your bold thinking and engagement, we can give health workers the tools they need to win this fight.

To get involved, please visit: http://www.usaid.gov/grandchallenges/ebola.

[Posted by USAID Administrator Rajiv Shah]

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[Fabric that allows air to penetrate also allows contaminated fluids to do so. Wearable temperature and heart rate monitors already exist -- but I don't think they are disinfectable. "Our goal is to get them to the field in a matter of months, to help the people working in West Africa right now. We can do this." But there is an admission that this is not going to happen right now, or even this year, while the case and death numbers continue to increase. - Mod.JW]

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[3] Aerosols again
[This refers to the previous discussion of aerosols on ProMED posted 20 Sep 2014 (Archive 20140920.2789476). - Mod.JW]
Date: 16 Sep 2014
Source: Global Biodefense [edited]
http://globalbiodefense.com/2014/09/16/ ... -bad-idea/


Suggesting Airborne Precautions for Ebola Health Care Workers Is a Really Bad Idea
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Contributing author Heather Lander, Ph.D. provides insight into why implementing airborne precautions in the EVD epidemic isn't the right strategy to prevent infection of health care workers.

[See photo at source URL of Ebola response worker wearing a respirator and no gloves! (WHO) - Mod.JW]

Recently, on ProMED [Ebola virus disease - West Africa (164): Sierra Leone, infect. control, susp. 20140914.2773490], we saw a Professor in Hygiene and Infection Control put out a call for more stringent personal protective equipment (PPE) for the Ebola epidemic. He specifically called for the implementation of airborne protection as was used during the SARS outbreak in 2003.

While I can understand why he thinks this will help -- he outlined it clearly in the email -- I strongly believe this strategy will not only not work, but will make matters worse by directing efforts away from the real problem that is causing health care workers to get infected with EVD in the 1st place.

Ebola is not airborne. [1;2] This we know. Laboratory experiments designed to study the potential of filoviruses as bioweapons have clearly shown that Ebola and Marburg are highly aerosol infectious. [3;4;5;6] However, there is absolutely no evidence that they are spread/transmitted by an airborne route and the preponderance of health care workers (HCW) getting infected is not because they are not protected against airborne ebolavirus, so implementing that kind of PPE won't help.

Contact and droplet PPE are all that is needed for ebolavirus. [7;8] The problem is that HCW in this epidemic either don't have PPE at all, only have some of it or have it, but are not properly trained in its use. In addition, there are not enough people for the work that needs to be done. But instead of quitting to get rest, food or relief from the extreme heat, these doctors and nurses are powering through, because they are looking into the eyes of those who are suffering with no one else to turn to.

They need more people. They need more PPE. They need more training. To effectively prevent HCW from getting infected, these are the problems that must be addressed. Telling people that airborne precautions will prevent their infection will actually make this situation worse: they will rely on respirators and continue not using or misusing the PPE they actually need to protect themselves.

The SARS outbreak was, in general, a success in epidemic control, but the circumstances were strikingly different, and not only because of airborne precautions. [9] ... If you want an outbreak from which to draw conclusions about how to prevent HCW infection with ebolavirus don't look at SARS, look at the 1995 Kikwit Ebola outbreak. I discuss this at length in a recent blog post. Everything we need to know, we have learned.

The problem is not that we aren't recommending the right PPE. The problem is the situation: no resources human or otherwise, no infrastructure, no training, and no hope in sight. But giving false hope by suggesting that respirators will prevent infection is irresponsible. I guarantee that if you say that the reason HCW are getting infected is because they are not implementing airborne precautions, then what they hear (and rightly so) is that airborne precautions alone will prevent infection.

Clearly, this is not the message we need to be sending to a population already failing catastrophically in proper PPE use.... The people fighting this war need education on how ebolavirus is actually transmitted and how to effectively don and remove contact/droplet PPE so they can actually protect themselves. Unfortunately, without more people to help and more PPE to wear, no amount of education or training will help.

--
Heather Lander has a Ph.D. in Experimental Pathology with a concentration in arenavirus pathogenesis. She is the editor of Pathogen Perspectives, a blog providing insights on highly pathogenic biothreats. You can also reach her on Twitter @PathogenPhD or by email.

References
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1. J. Alimonti, A. Leung, S. Jones, J. Gren, X. Qiu, L. Fernando, B. Balcewich, G. Wong, U. Stroher, A. Grolla, J. Strong, and G. Kobinger, Evaluation of transmission risks associated with in vivo replication of several high containment pathogens in a biosafety level 4 laboratory. Sci. Rep. 4 (2014).

2. D.G. Bausch, J.S. Towner, S.F. Dowell, F. Kaducu, M. Lukwiya, A. Sanchez, S.T. Nichol, T.G. Ksiazek, and P.E. Rollin, Assessment of the risk of Ebola virus transmission from bodily fluids and fomites. The Journal of infectious diseases 196 Suppl 2 (2007) S142-7.

3. L. Borio, T. Inglesby, C.J. Peters, and et al., Hemorrhagic fever viruses as biological weapons: Medical and public health management. JAMA 287 (2002) 2391-2405.

4. D.S. Reed, M.G. Lackemeyer, N.L. Garza, L.J. Sullivan, and D.K. Nichols, Aerosol exposure to Zaire ebolavirus in three nonhuman primate species: differences in disease course and clinical pathology. Microbes and Infection 13 (2011) 930-936.

5. E.E. Zumbrun, A characterization of aerosolized Sudan virus infection in African green monkeys, cynomolgus macaques, and rhesus macaques. Viruses 4 (2012) 2115-2136.

6. N.B. Bazhutin, [The effect of the methods for producing an experimental Marburg virus infection on the characteristics of the course of the disease in green monkeys]. Voprosy virusologiĭ 37 (1992) 153-156.

7. S.F. Dowell, R. Mukunu, T.G. Ksiazek, A.S. Khan, P.E. Rollin, and C.J. Peters, Transmission of Ebola Hemorrhagic Fever: A Study of Risk Factors in Family Members, Kikwit, Democratic Republic of the Congo, 1995. Journal of Infectious Diseases 179 (1999) S87-S91.

8. J.J. Muyembe-Tamfum, M. Kipasa, C. Kiyungu, and R. Colebunders, Ebola Outbreak in Kikwit, Democratic Republic of the Congo: Discovery and Control Measures. Journal of Infectious Diseases 179 (1999) S259-S262.

9. M. Raponi, [Public health management of influenza and SARS in industrialized countries: strengths, weaknesses and future prospects as evaluated through Health Impact Assessment]. Igiene e saniata pubblica 68 (2012) 533-553.

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[4] Prevention & false alarms


Cote d'Ivoire to resume flights & sea traffic to countries struck by EVD
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Ivory Coast president Alassane Ouattara said on Friday [26 Sep 2014] his country will lift the controversial suspension of flights to countries stricken by EVD to show solidarity with the nations affected by the lethal outbreak.

He said the initial decision to suspend flights was prompted by uncertainty about the threat, which he called a terrible problem for the people of west Africa.... "Now that everything is under control -- there is no case of EVD in Cote d'Ivoire (Ivory Coast) -- I have decided that next week we will lift the suspension of flights and the maritime suspension." In addition, he said Ivory Coast has opened a "humanitarian corridor" so that people who want to enter Ivory Coast can be checked. The country has also contributed USD 1 million to the international anti-EVD effort.... "You can count on the government not to hide a single case of Ebola. If there is a case of Ebola, we'll say that there is a case." ... International health officials had said flight suspensions and the closure of sea ports and borders were not needed.
http://www.theguardian.com/world/2014/s ... ion-lifted

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Cuba: to send 300 more health workers
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26 Sep 2014 (You, South Africa): Cuba said it will send nearly 300 more doctors and nurses to west Africa to help fight the EVD epidemic. This will raise to 461 the number of Cuban medical personnel that the country will send to battle the disease. The Cubans will work in Sierra Leone, Guinea and Liberia, said Regla Angulo, head of the Cuban medical relief agency. Until now Cuba had pledged 165 doctors and nurses for Sierra Leone. The staff are undergoing intense training ahead of their deployment, working in a mock field hospital of the kind they expect to find in Africa.
http://you.co.za/news/cuba-sends-300-mo ... ight-ebola

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France: suspect case ex Guinea
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26 Sep 2014 (Journal du Dimanche): A young Guinean presented himself Friday [26 Sep 2014] to the General Council of Haute-Garonne, Toulouse, claiming to be infected by the ebolavirus, which would have devastated his family. Suspicion was finally lifted. According to information from the Depeche du Midi, the 18-year-old arrived in France under conditions that remain unknown. "His grandmother funded his trip to France so he could escape the epidemic, " said the Toulouse daily.
http://www.lejdd.fr/Societe/Sante/La-su ... use-689848 [in French, machine transl., edited]

[I think he was allowed in because France is not blocking entry of West Africans unless they have fever, and he doesn't. But I hope they contact his home every day for the next 3 weeks to check whether anybody there has fallen ill. It was good of him to turn himself in. - Mod.JW]

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India: airport screening
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Recently, former journalist and activist Ketan Tirodkar filed ... an allegation that India is not yet fully ready to prevent EVD spread, as several people coming back from EVD hit countries are arriving at airports in Pune and Nagpur where EVD screening facilities are not available. Following that, the Bombay High Court passed an order, directing the Maharashtra Government to arrange proper screening facilities in Pune and Nagpur, similar to those existing at Mumbai and Delhi airport.... Rui Rodrigues, counsel for the Central Government, informed Bombay High Court bench ... that the scanners have been shifted from Hyderabad and Goa airports to Nagpur and Pune airports. The government confirmed that these thermal scanners would be functional within a week ... -- more
http://news.oneindia.in/india/nagpur-pu ... 29343.html

[I suppose taking prevention measures away from one airport to serve another makes sense if the numbers of passengers arriving from West Africa is greater in the other. - Mod.JW]

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Liberia: mass delivery of EVD protection kits starts
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A mass delivery of almost half a million household kits to help stop the spread of the deadly ebolavirus in West Africa began on Thursday [25 Sep 2014] with the 1st batch of 9000 packages.... The kits contain protective gowns, gloves and masks, as well as soap, chlorine and a sprayer, along with instructions on the use and safe disposal of materials. The United States Agency for International Development (USAID) plans to distribute kits to up to 400 000 households across Liberia, which is the worst hit country with over 3280 cases and 1677 deaths according to the latest WHO figures. Sheldon Yett, representative of the United Nations Children's Fund (UNICEF) in Liberia, said about 50 000 kits will arrive in the next few months to provide a temporary solution until more treatment centres are built and staff trained....

Gayle Smith, the White House's senior director for global development on the National Security Council, said officials have identified 400 000 of the most vulnerable households and are working with community leaders to deliver health care kits. Funding for the 1st 50 000 kits has been provided by USAID and the US-based philanthropic organisation Paul G. Allen Family Foundation, which has committed a USD3.6 million matching contribution to UNICEF to support the airlift ... -- more
http://allafrica.com/stories/201409260413.htm

[If it will take a few months to deliver just over 10 percent of the kits, how long to distribute the rest? - Mod.JW]

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[A useful 4-page pamphlet has just been updated by Public Health England:

Information for humanitarian aid workers working in Ebola-affected countries in West Africa Updated 26 September 2014
https://www.gov.uk/government/uploads/s ... orkers.pdf

For an interactive map with statistics, go to: http://healthmap.org/ebola. - Mod.JW]

EBOLA VIRUS DISEASE - WEST AFRICA (177): VACCINE, CORRECTION
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Date: 27 Sep 2014
From: Thomas Hoenen <thomas.hoenen@nih.gov> [edited]


Regarding your commentary in ProMED post "Ebola virus disease - West Africa (177): WHO, quarantine, vaccine, Liberia, survivors - [4] Vaccine delivery dilemma," in which you write: "Furthermore, the vaccine is a live one, and reversion and breakthroughs have been known to happen with other live vaccines." To me, it is not clear whether you mean to suggest with this statement that the VSV-EBOV vaccine that is referred to in this post might revert to a wild-type VSV [vesicular stomatitis virus] genotype and/or cause breakthrough VSV infection, or whether you are suggesting that the vaccine might actually cause EVD itself.

It is important to note that the VSV-EBOV vaccine is NOT a live attenuated Ebola virus, in which case, reversion to a virulent phenotype or breakthrough Ebola virus infection would theoretically be possible. Rather, the vaccine consists of a live recombinant VSV, in which the VSV glycoprotein gene has been exchanged against the Ebola virus glycoprotein gene (GP). In other words, the vaccine contains less than 10 percent of the genetic information of Ebola virus. Therefore, there is absolutely no conceivable possibility that reversion of this vaccine to a virulent Ebola virus genotype or a breakthrough-infection causing EVD could occur. Furthermore, exchange of the VSV glycoprotein gene against the Ebola virus glycoprotein gene has led to an attenuation of the VSV vector itself (which, even in its non-attenuated form, does not cause significant human disease to start with http://www.phac-aspc.gc.ca/lab-bio/res/ ... it-eng.php), and, consequently, this vaccine is safe not only in healthy non-human primates but even in severely immunocompromised non-human primates http://www.ncbi.nlm.nih.gov/pubmed?orig ... m=19043556).

Given the high reputation and the reach of ProMED in the scientific and medical community, and potentially also among volunteers getting ready for work in West Africa, such an unclear statement has the potential to cause unsubstantiated concerns with serious consequences. Therefore, it might be a good decision to clarify the point that VSV-EBOV is not a live attenuated Ebola virus and that there is absolutely no risk (also not as a consequence of reversion or breakthrough-infection) of it causing EVD.

--
Thomas Hoenen, PhD
Disease Modelling and Transmission Section
Laboratory of Virology, NIAID, NIH Rocky Mountain Laboratories,
2A120A 903 S 4th St.
Hamilton, MT
USA
<thomas.hoenen@nih.gov>

[My comment was seriously wrong. I thank Dr Hoenen for his clarification, which I hope will be widely disseminated to dispel any misunderstanding of Dr Taylor's reported statement, quoted by ProMED, that: "It is a live, attenuated virus, so that means it has to be kept at a certain temperature throughout, or it kills the virus and it's inactive." The live part is a low pathogenic (for humans) strain of vesicular stomatitis virus (VSV), from a disease of horses, mules, cattle and pigs.

Once again, it is NOT made from live or attenuated ebolavirus. I regret the error. - Mod.JW]

hallo

Nigerias Präsident Goodluck Jonathan hat sein Land für Ebola-frei erklärt. Zu früh, meinen Experten und warnen davor, voreilig ein Ende des Virus in dem Staat zu verkünden.

http://www.faz.net/aktuell/gesellschaft ... 72634.html
gruss matthias

Endlich schickt die Bundeswehr nach langen Diskussionen unserer Bundesregierung die erste Transall nach West Afrika.
Wie marode unsere Bundeswehr ausgerüstet ist, zeigt sich auch in diesem Einsatz. Die Transall kam nicht an, denn sie befindet sich jetzt wegen eines technischen Defekts auf Gran Canaria. Eine weitere Transall ist nun auf dem Weg nach Gran Canaria, mit Ersatzteilen für das Schwesterflugzeug...

Die diesjährige Pilgerfahrt nach Mekka dürfte ebenfalls von der Ebolaepidemie beeinträchtigt werden. Ich gehe davon aus, dass die Veranstalter besondere Sicherheitsvorkehrungen treffen werden oder die Hadsch deutlich weniger Besucher dieses Jahr zählen wird.

Grüsse
Alexander

In den USA wurde jetzt der erste offiziell bestätigte Ebola Fall registriert. Der Texaner, der aus Liberia ausgereist war, hatte sich dort vermutlich den Virus eingefangen.

Die Behörden versuchen nun mögliche Kontaktpersonen zu identifizieren.

http://www.huffingtonpost.de/2014/09/30 ... ir=Germany

Grüsse
Alexander

EBOLA VIRUS DISEASE - WEST AFRICA (180): SIERRA LEONE, LIBERIA, USA, DRUGS, GUINEA
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A ProMED-mail post
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ProMED-mail is a program of the
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In this update:
[1] Sierra Leone: 16-hour drive to nearest treatment center
[2] Liberia: situation faced by health workers
[3] USA: exposed doctor repatriated
[4] New drugs
[5] Guinea: EVD job vacancy - UNICEF

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[1] Sierra Leone: 16-hour drive to nearest treatment center
Date: 26 Sep 2014
Source: VOA News [edited]
http://www.voanews.com/content/sierra-l ... 63697.html


Dozens of very sick people sat on the floor in an empty university building in central Sierra Leone. They waited in filthy conditions. With the nearest treatment center a 16-hour drive away in Kailahun, there is no way to treat the sick, despite the likelihood they are infected with Ebola. According to Osman Bah, the Makeni government hospital director, Ebola cases have spiked in recent weeks.

"More than 100, 150 cases, because we have sent 56 patients to Kailahun," he said. "This morning [26 Sep 2014], we have had more than 100-110 patients."

This university complex is being used as a makeshift holding facility because the sick people have nowhere else to go. Highly contagious patients lie in the open. One woman sat on the floor, too sick to stand. Other victims huddled together on beds. One young child was laying alone. They waited and hoped for a space in the next ambulance.

Growing numbers of Ebola outbreak hotspots are emerging in new locations across the country. "We get phone calls every day from districts over the whole country, and those districts are absolutely overwhelmed," said Axelle Vandoornick, a medical field coordinator for Doctors Without Borders.

There is no way of telling which patients are Ebola-positive. Despite this, they are kept together. "99 percent of the cases that we have isolated are positive for Ebola," said Bah, the medical director.

Medical staff at the containment center have little training or experience dealing with Ebola. Protective equipment is inadequate. One makeshift ward was empty. Beds were filthy. Pill packets sat among piles of clothes left by a departing patient.

25 confirmed Ebola patients left for Borders treatment center in Kailahun one recent night. Four died during the 16-hour journey. Doctors Without Borders' [MSF's] Vandoornick said numbers are increasing. "Every day we have ambulances arriving, and when we open the door, there are dead bodies inside the ambulance alongside non-cases, potentially," Vandoornick said. "So that is the 1st source of contamination."

When 2 new patients were brought in to the center, one young boy showed symptoms of Ebola. Despite the risk, his mother would not leave his side. "It's too much," said Karimo Konteh, an ambulance driver. "Every day, I pick up 10, 15, 14, 12 patients, everyday..." Vandoornick said some districts have no Ebola treatment facilities of their own.

"They don't have [enough] capacity of Ebola centers in their district, so basically, they are trying to send their patients to us," Vandoornick said.

Bah, the medical director, said he is not hopeful the situation will improve. "For now, the situation is not under control," he said. "We are hoping it will be better. But I am afraid, maybe it will get worse."

[Byline: Adam Bailes]

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[The logistical challenges are formidable; imagine driving for 16 hours over muddy roads in the pouring rain with a load of patients in pain with diarrhea and vomiting - Mod.JW]

******
[2] Liberia: situation faced by health workers
Date: 26 Sep 2014
Source: WBUR, USA [edited]
http://www.wbur.org/2014/09/26/ebola-collapse-system


The chief medical officer at Partners In Health, Dr. Joia Mukherjee, was in Monrovia, Liberia, last week... WBUR's Sacha Pfeiffer spoke with Dr. Mukherjee and asked about reports of EVD deaths happening in the streets of some west African communities.

JM: You see that in isolated areas, maybe in one neighborhood of the city or maybe in one village. I mean, the city itself looks like a normal African city. It's bustling. People are going to work. They're in the market. So you don't see sickness everywhere you go, but there is a sense of foreboding. At every major public building and private building, such as a government hospital or a private hotel, there's a hand-washing station outside. No one is shaking hands; people will just bump elbows and stand at the requisite couple of meters away from one other. So you do see the presence of the fear and the infection control that people are trying to do, but you don't right now see this kind of rampant death.

SP: When you talked about infection control like hand-washing stations, is that accompanied by a lot of either billboards or public service announcements that get the word out that people need to try to follow certain protocols so it won't spread even more?

JM: Yes, there's a lot of public education campaigns going on, a lot of posters. When you use your cell phone, a message comes up about Ebola. Initially, there was a lack of acceptance about Ebola even being real, so a lot of the education is about that, but I think it's less about that now than just trying to instruct people on how to stay as safe as possible.

SP: Despite those measures, the virus is still spreading. What do you think it will take to stop that spread?

JM: I think part of the problem with public education campaigns in a very poor setting is less about people not understanding than about not having any alternative. So, for example, if you're a mother or a wife and your husband falls ill, you're going to take care of the person in your family. And if you were able to say, okay, there's a number I can call or a community member who can go alert an ambulance who will come and immediately take this person, you can limit infection. But right now, that mechanism to remove people from their homes or their communities as soon as they're sick is just not sufficient.

SP: We've heard many reports of people who go to hospitals for treatment and are turned away because they can't accommodate them. Is that happening in Liberia?

JM: Absolutely, absolutely. Every day. What's happening is the general collapse of the health care system because physicians and nurses and other health workers are staying home. They feel unprotected and unprepared to deal with this, and they are. They're correct. So one of the efforts of Partners In Health is going to be to try to do general health system strengthening and try to help [at] the district hospital level [so that] even before people walk in, the health workers have the proper protection; they have triage at the gate, can move people with suspect Ebola out of the general hospital environs to an Ebola treatment unit, and take in the people who need treatment for malaria or need treatment for an obstetrical emergency, because right now, it is very difficult for health workers to do their jobs. They're very afraid, and they're very, very unprotected for the threat.

SP: I understand that at the CDC-sponsored training you were doing this week, there was a session designed to "orient participants to the unstructured situation and empower them to refuse to do things they are not equipped or prepared to do or to work in [an] unsafe environment." Can you tell us more about what that means?

JM: Yeah, I mean, I think many of us physicians, nurses, we take an oath; we're very serious about our commitment to patients and to really care for them. But if you're not properly protected and someone is very sick with Ebola, particularly if they're vomiting or they're in the later stages where we know the excretion and the shedding of virus is very high, it is an extremely dangerous situation for the health care worker. And so it's not advisable to provide care until you're in the proper protective gear.

SP: So doctors need to be comfortable saying, "I cannot help you now because I don't have the proper equipment?"

JM: That's right. So if I saw a child, for example, in my normal life who was throwing up blood and unstable, I would rush in and try to stabilize that child. And what we're learning is you can't really do that with Ebola without putting on the proper protective gear lest you become infected. It's that infectious.

[Byline: Sacha Pfeiffer and Lynn Jolicoeur]

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[3] USA: exposed doctor repatriated
Date: 27 Sep 2014 updated: 28 Sep 2014
Source: Politico [edited]
http://www.politico.com/story/2014/09/n ... 11374.html


An American physician exposed to EVD while caring for patients in West Africa has arrived at the National Institutes of Health in Bethesda, Maryland, USA. The Associated Press reported on Sunday [28 Sep 2014] that the NIH had confirmed the doctor's arrival. NIH said on Saturday [27 Sep 2014] that the physician had been volunteering services at an Ebola treatment unit in Sierra Leone. The individual was to be admitted to the NIH Clinical Center for observation as well as enrolled in a research study.

"Out of an abundance of caution," the NIH announcement noted, the patient will be admitted to a "special clinical studies unit that is specifically designed to provide high-level isolation capabilities and is staffed by infectious diseases and critical care specialists." Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, stressed on Saturday [27 Sep 2014] that just because a person is exposed to the virus does not mean he or she will become infected with it.

Two U.S. hospitals have treated medical missionaries who fell ill with Ebola from West Africa, where the Ebola outbreak has now claimed nearly 3100 lives. Physician Kent Brantly and aid worker Nancy Writebol recovered at Emory University Hospital in Atlanta and were discharged in August [2014]. Physician Rick Sacra was just released from Nebraska Medical Center in Omaha. All 3 were infected while stationed in Liberia. Another patient, who news reports have suggested could be a physician with the World Health Organization, remains a patient at the Emory hospital.

Earlier this month [September 2014], NIH launched one of the 1st clinical trials on an experimental Ebola vaccine. Fauci said on 17 Sep 2014 that half of the expected 20 volunteers had already received a dose with "no red flags" raised.

[Byline: Susan Levine]

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******
[4] New drugs
Date: 27 Sep 2014
Source: Japan Times [edited]
http://www.japantimes.co.jp/news/2014/0 ... vigan-drug


Fujifilm Corp. said that its influenza medicine Avigan is being given to an EVD patient at a French hospital along with another experimental drug, the latest treatments to be deployed in the global push to curtail the deadly virus.

The French National Agency for Medicines and Health Products Safety asked for the drug, and the female patient has been given the combination since 19 Sep 2014, the Japanese company said in a statement on Fri [26 Sep 2014]... With no approved Ebola medicines, doctors and international agencies have been forced to test experimental drugs.

The Fujifilm treatment, also called Favipiravir, was discovered by Yousuke Furuta at the Toyama Chemical unit of Tokyo-based Fujifilm in 1998. It targets polymerase, an enzyme that viruses use to replicate inside the body, to stop the viruses from spreading. We're getting many requests from other countries, international organizations, and medical organizations as well," Fujifilm spokesman Takahiro Taguchi said. As Avigan is originally a flu drug, the company has the capability to produce the drug continuously and deal with a rapid increase in demand, he said. The company has enough stock for 20 000 Ebola patients.

Fujifilm's US partner, MediVector Inc. in Boston, is in talks with the Food and Drug Administration to submit an application to use the drug in humans for EVD, a US Department of Defense spokeswoman said in August [2014]. Favipiravir is in the final stages of human studies in the USA as a treatment for flu. A US late-stage trial of the treatment for flu is scheduled to be completed around next March [2015], the company said earlier this year [2014]. The medicine won Japanese approval in March [2014] for government stockpiling for pandemic flu. Fujifilm is running a trial and is in discussion with Japanese regulators to get marketing approval to sell it for seasonal influenza, Kouichi Yamada, senior operations manager of Fujifilm's drug products division, said in an interview in July 2014.

The French woman [a nurse] working for Doctors Without Borders [MSF] was repatriated from Liberia last week after she became infected, the French Health Ministry said on 17 Sep 2014. She's being treated at a military hospital in Saint-Mande, outside of Paris. Health Minister Marisol Touraine authorized the use of several experimental treatments for EVD patients, including Avigan, according to a French government decree published on 19 Sep 2014. Her situation is stable, and she's in good spirits, Touraine said in an interview on BFM TV.

--
Communicated by:
Mark Liao
UC Davis School of Medicine, Class of 2015

******
[5] Guinea: EVD job vacancy - UNICEF
Date: 26 Sep 2014


UNICEF Monitoring and Evaluation Specialist for Ebola Response
-----------------------------------------------
Job from FHI 360 Closing date: 15 Oct 2014
FHI 360 is a nonprofit human development organization dedicated to improving lives in lasting ways by advancing integrated, locally driven solutions... We are currently seeking qualified candidates for the position of: Monitoring and Evaluation Specialist for Ebola Response SEOCC in Conakry, Guinea (6-12 months)... more
http://reliefweb.int/job/695227/monitor ... a-response

--
Communicated by:
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[For an interactive map with statistics, go to: http://healthmap.org/ebola. - Mod.JW]

EBOLA VIRUS DISEASE - WEST AFRICA (181): LIBERIA, EUROPE, SENEGAL, SEA LAW
**************************************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

[Readers may have noticed that starting yesterday [28 Sep 2014], I have given up changing "Ebola" and "Ebola virus" to the technically correct EVD and ebolavirus, because media reports ignore the distinction, and it just takes too long to do, even using Search & Replace (because of all the "-ebola-" in URLs that have to be exempted), resulting in me filing late and keeping ProMED copy-eds. on duty past the end of their late shift. - Mod.JW]

In this update:
[1] ECOWAS 7 point communique
[2] Liberia: US troops face challenging circumstances
[3] Europe: an open letter to governments
[4] Senegal opens airport for EVD aid
[5] Maritime Law and EVD
[6] Online reports

******
[1] ECOWAS 7 point communique
Date: 28 Sep 2014
Source: GNA [edited]
http://vibeghana.com/2014/09/28/ecowas- ... ting-ebola


The ECOWAS Assembly of Ministers of Health has issued a 7-point communique developed by the coordinating ministerial group for the implementation of the operational plan on the Ebola virus disease.

The communique, which was read by Mrs Olubunmi Ojo, Director, Disease Surveillance/International Health Regulations, called for immediate deployment of West Africa Health Organisation delegations to affected countries and the organisation of high level missions to neighbouring nations.

It called for organsiation of multi-sectoral missions to Cote d'Ivoire and Senegal to discuss immediate implementation of humanitarian, economic and health corridors in accordance with rules adopted by the Technical Monitoring and Surveillance Group.

It called for preparation and dissemination of harmonised sensitisation and information messages targeting [populations] in an effort to stop the spread of the epidemic.

The communique also requested the ECOWAS Commission for the mobilisation of the armed and security forces to strengthen regional response against the Ebola virus epidemic and provide, among other things, medical personnel and logistics as well as mobilise the support of the military engineers' regiments in setting up treatment centres.

It called for the provision of adequate financial incentives for national health personnel already on the ground and finalisation of the Ebola Regional Operation Plan and its submission to the President of the ECOWAS Commission.

Ghana's Minister of Health, Dr Kwaku Agyemang-Mensah, called for harmonisation of individual country's efforts to avoid panicking, which could thwart the community's efforts at dealing with the disease which had claimed more than 2000 lives in the region.

--
Communicated by:
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[It would be very helpful if one of the military engineers' 1st tasks could be to fix roads and bridges that have been washed away in the recent rains; see [6] below. - Mod.JW]

******
[2] Liberia: US troops face challenging circumstances
Date: 28 Sep 2014
Source: WSJ USA [edited]
http://wsj.com/articles/u-s-troops-batt ... 1411948064


On Sat [27 Sep 2014], a handful of troops from the US Navy's 133rd Mobile Construction Battalion led a bulldozer through thigh-high grass outside Liberia's main airport, bottles of hand sanitizer dangling from their belt loops. They had been digging a parking lot in the East African nation of Djibouti this month [September 2014] when they received a call to build the 1st of a dozen or more tent hospitals the U.S. intends to construct in this region. The soldiers started by giving the land a downward slope for water runoff -- "to keep out any unwanted reptiles," said Petty Officer Second Class Justin Holsinger. While this team levels the earth, superiors hash out the still-uncertain details of the American intervention here...

"There is no argument the disease is out in front of the response," said Ken Isaacs, vice president of programs and government relations for Samaritan's Purse, who, as an expert in humanitarian assistance, is leading. In terms of response, he added, "where we are today is where we should have been 60 to 90 days ago." Now, some of that help has arrived, partly in the form of a rare -- if not unprecedented -- U.S. effort. So far, that assistance largely involves leveling swampy grassland, unloading supplies and setting up tents.

And yet if 70 percent of Ebola patients aren't cared for in a treatment center or other setting where they can't transmit the disease to others, then the epidemic in both countries could worsen, the CDC said. On 16 Sep 2014, President Barack Obama ordered 3000 U.S. soldiers into West Africa. In a speech at the United Nations on Thu [25 Sep 2014], Mr. Obama criticized the international response thus far and said other donors -- governments and organizations -- need to step up quickly with aid.

"Right now, everybody has the best of intentions, but people are not putting in the kinds of resources that are necessary to put a stop to this epidemic," he said. More nations urgently need to contribute goods and services like health-care workers, equipment and air transport, he said. Several countries and organizations have donated money and technical assistance, from the World Bank to Cuba, which is sending 165 [now 461] doctors, nurses and other health specialists to the region. But more are needed, particularly because the health systems in Liberia, Sierra Leone and Guinea have been overwhelmed.

Other help is beginning to arrive. On Sunday morning [28 Sep 2014], a privately contracted 747 cargo plane landed with 2016 rolls of plastic sheeting from the U.S. government, one of the materials needed to build an Ebola clinic. It would take hours to unload the plane, the crew said. Liberia's airport, built in 1942, has just 3 small forklifts. U.S. Air Force personnel will also have to repair the runway, or, for the time being, just paint it so planes don't land on parts in disrepair. "Some companies would rather go to Afghanistan than come here," said the plane's loadmaster, Felix Curtis. In the cockpit, a nervous 1st officer was wearing surgical gloves, a medical mask on his seat. He shared a pen with a Liberian, then darted to the bathroom to wash his hands: "Am I going to be OK?" he asked.

The files on most of Liberia's Ebola cases are stored in 3-ring binders on a shelf in an abandoned World War II-era chimpanzee testing lab, filled with bats. That is where the U.S. Army Medical Research Institute of Infectious Diseases [USAMRIID] conducts blood tests for Ebola [for the government]. A small 3-ring binder holds all the case files from 15 Apr-12 Aug 2014. A binder twice that size holds the files from just 5 days in late September 2014. "Well," said Alec Hail, the doctor who supervises the testing, "that's remarkable."

Even with the U.S. response, the CDC fears thousands more lives may still be lost. New centers are filling up as quickly as they are built. On 21 Sep 2014, the World Health Organization opened its 2nd clinic in Monrovia, Liberia's capital. By evening, every bed was taken. "I don't think we can open them any faster," said head clinician Anne Deborah Omoruto Atai. Near the doctor's office, a fierce rainstorm was flooding part of the clinic.

Meanwhile, the embattled Liberian government is struggling to manage a response to the disease. Last week, an official at the health ministry -- the focal point for the Ebola effort -- died of Ebola. Other workers abandoned the building, which on Thu [25 Sep 2014] was being sprayed with chlorine. The next morning, the chief medical officer placed herself under 21-day quarantine, on concerns that she had been exposed. That situation has created a desperate groundswell of support for the U.S. military mission here. "We want the U.S. Army to take over this entire situation," said Sarka Weah, among a group of men watching the naval unit bulldoze the field. "Yes!" screamed the others.

The clinic will only hold 25 beds, and not for ordinary Liberians: just health workers. U.S. officials hope it will entice other countries to send their own nurses and doctors. "It's hard to know where they'll all come from," said Frank Mahoney, who heads the CDC's Ebola response in Liberia.

This month [September 2014], the U.S. Agency for International Development [USAID] helped Liberia's government convert an unused conference room in a telecommunications building into a war room. The U.S. aid agency had 12 wooden tables built and helped restore running water to the toilets and brought in filing cabinets from the U.S. Embassy, said people involved in that effort. Last Tuesday evening [23 Sep 2014], James Dorbah Jallah, the national coordinator of Liberia's Ebola Task Force, sat in the war room trying to get bottled water delivered to an Ebola clinic that had run out. "It's not possible," said the supervisor of the government's motor pool over speakerphone. "Everybody's gone home."

[Byline: Drew Hinshaw, Betsy McKay]

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

[There seems to be a lack of urgency in the response to Liberia's Ebola Task Force efforts, and a severe lack of heavy equipment at the airport. - Mod.JW]

******
[3] Europe: an open letter to governments
Date: 26 Sep 2014
Source: The Lancet, Early Online Publication [edited]
http://www.thelancet.com/journals/lance ... 1/fulltext

Ebola: an open letter to European governments
----------------------------------------------------------
Jose M Martin-Moreno, Walter Ricciardi, Vesna Bjegovic-Mikanovic, Peggy Maguire, Martin McKee, on behalf of 44 signatories

After months of inaction and neglect from the international community, the Ebola epidemic in west Africa has now spiraled utterly out of control. Today, the virus is a threat not only to the countries where the outbreak has overwhelmed the capacity of national health systems, but also to the entire world. We urge our governments to mobilise all possible resources to assist west Africa in controlling this horrific epidemic. Based on our expertise in public health and emergency response, we believe the following measures would be particularly effective... - more

--
Communicated by
ProMED Rapporteur Kunihiko Iizura

******
[4] Senegal opens airport for EVD aid
Date: 27 Sep 2014
Source: AP [edited]
http://www.haveeru.com.mv/world/56846


Senegal, which closed its border to Guinea to stave off EVD last month [August 2014], said Sat [27 Sep 2014] it has now opened up a humanitarian corridor at an airport to help speed aid to stricken countries. A plane carrying workers with the UN's World Food Programme arriving from the Guinean capital Conakry landed at the designated humanitarian air corridor on a military air base near Dakar, AFP reported. Senegalese Health Minister Awa Marie Coll Seck said Dakar had reached an agreement with international aid groups and western states to use an air corridor "to send equipment, medicines, and to support human resources in order to save human lives."

Coll Seck, speaking alongside Senegalese, UN and NGO officials, told journalists the airport access was opened up "in the context of international solidarity." A Senegalese official said the corridor had been operational for 2 days but was still being set up.

[Civilian airports are apparently still closed to flights from neighboring countries. - Mod.JW]
--
Communicated by
Ryan McGinnis http://bigstormpicture.com

******
[5] Maritime Law and EVD
Date: 29 Sep 2014
Source: Law Gazette UK [excerpted, edited]
http://www.lawgazette.co.uk/law/practic ... 72.article


At this stage, it is far from clear how long the Ebola outbreak will last or which further countries it will affect. This leads to a great deal of uncertainty in the shipping industry, which must take precautions for the current situation but anticipate that greater quarantine and preventive measures may come into force in the future. As there is no immediate prospect of the outbreak coming to an end, it is advisable to take steps now to minimise exposure to potential risks, including those set out in this article. This includes drafting appropriate charterparty and/or bill of lading clauses.

Most importantly, it is essential to keep up to date with warnings and guidance issued by port authorities, national and international authorities, and industry leaders, so that protective measures are implemented in a timely and consistent manner.

[Byline: Edward Hicks]

--
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******
[6] Online reports

Ghana: UN mission to combat Ebola opens
----------------------------------------
29 Sep 2014: (AP) The UN mission to combat Ebola opened its headquarters on Mon 29 Sep 2014 in Ghana, where it will coordinate aid for the accelerating West African crisis...

Liberia: Despite massive promises of aid in recent weeks, many areas have grossly inadequate resources. For instance, Nimba County, one of the places Ebola has hit hardest in Liberia outside the capital, has only one ambulance, and it is often broken down, the county's medical officer, Collins Bowah, said Monday [29 Sep 2014]. Nimba natives who live in the capital of Monrovia have started a fundraiser to help out those back home...
http://www.cbc.ca/news/health/un-s-ebol ... -1.2781142


--
Rains complicate delivery of Ebola supplies in West Africa
-------------------------------------------------
29 Sep 2014: (Reuters) The rainy season in West Africa is compounding difficulties in getting supplies delivered and new treatment centers built as donors rush to isolate people infected with the deadly Ebola virus and stop its rapid spread, U.S. officials said... The July to September rainy season is coming toward its end, but October is known for heavy thunderstorms that can drench the region and turn roads to mud. Eric Talbert, executive director of Emergency USA, which has opened a 22-bed Ebola treatment center in Goderich, outside the capital of Freetown in Sierra Leone, said the downpours complicate getting supplies along unpaved roads; "We are talking about dirt roads that are single track. The rains wash them out... Rains are not only going to escalate the logistical difficulties, but Ebola will spread if we cannot reach people and treat them."
http://uk.reuters.com/article/2014/09/2 ... SL20140929


--
Liberia's newest, largest treatment clinic already over capacity
-----------------------------------------
29 Sep 2014: (CBC News) When it opened [on 21 Sep 2014], there were 120 beds available. Within hours, the clinic was already stretched, every space available filled with the city's most frightened and seriously ill. Somehow, room was made for more patients, and currently, by adding beds and sofas where possible, staff estimate the total number is likely closer to 200. The World Health Organization funded the clinic and handed it over to Liberia's Ministry of Health and Social Welfare, while UNICEF, the World Food Programme and USAID have joined the WHO in donating supplies and support...
http://www.cbc.ca/news/health/ebola-out ... -1.2780845

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

[For an interactive map with statistics, go to: http://healthmap.org/ebola. - Mod.JW]

EBOLA VIRUS DISEASE - WEST AFRICA (182): VACCINE, ORPHANS, SIERRA LEONE, PREVENTION
***********************************************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

In this update:
[1] Vaccines: who will get them first?
[2] Orphans: UNICEF
[3] Sierra Leone: deaths recount
[4] Prevention & suspect cases

*******
[1] Vaccines: who will get them first?
Date: Mon 29 Sep 2014
Source: Science Insider, American Association for the Advancement of Science (AAAS) [edited]
http://news.sciencemag.org/africa/2014/ ... hers-claim


[excerpts]
... At the WHO meeting today and tomorrow [29-30 Sep 2014], experts are discussing the many thorny issues that will arise if one or both of the vaccines successfully pass their phase I trials. From then on, they should be distributed widely in the affected countries, says Jeremy Farrar, an epidemiologist and head of the Wellcome Trust research charity in London. "I think the big question now is how do we do this while gathering sufficient safety and efficacy data to be confident that we are doing good," Farrar says.

[Anthony Fauci, director of NIAID in Bethesda, Maryland,] believes that a randomized, controlled trial, in which people receive either the actual Ebola vaccine or an unrelated shot such as the hepatitis B vaccine, will be needed. "If you are going to deploy a vaccine widely within a country, you better be sure it's effective," he says. But others don't see the use of placebos as an option. "You create a group of people who are not vaccinated and they don't know it," Kobinger says. "If I were a volunteer, I would not be comfortable with this personally."

Farrar agrees; what's more, a placebo-controlled study just isn't feasible, he says. "We are talking about a totally destroyed health care system across Liberia and, to an extent, Sierra Leone," Farrar says. "We just have to be practical." That doesn't mean scientists will be unable to say if the vaccine works, he says. Urban areas like Monrovia will inevitably receive the vaccine before it reaches other, more rural parts of the country; scientists can compare the incidence of Ebola in both areas, in a so-called step-wedge study design. "If you have a 90 percent effective vaccine, you will see that immediately."

Supply is likely to be a problem. GSK [GlaxoSmithKline] has pledged to produce about 10 000 doses by the end of the year [2014], paid for by the Wellcome Trust and others. The company is already working on how to scale up production, however, if data from the 1st volunteers show that the vaccine does not cause harm and their immune systems have responses similar to what protected monkeys in experiments that attempted to infect them with Ebola virus. 1st signs of that could be available in less than a month, Ballou says. "We would not start producing very large numbers unless we had some evidence that the vaccine has a potential to work," he says.

Production of the [Canadian-developed] VSV vaccine is already being ramped up. The more than 800 vials now stored in Winnipeg could yield a few thousand doses, Kobinger says, depending on the exact amount needed per dose. "We're manufacturing additional supply as we speak," Wiley says. "And we expect to have the capacity to manufacture tens of thousands of doses by the end of the year [2014]." 2 other vaccines, another one based on VSV and one using a modified poxvirus, are a few months behind in development.

At this week's meeting, experts will again discuss who gets the vaccine first. Most participants at an earlier ethics meeting said health workers should have priority, because they are essential in fighting Ebola while also at a high risk of contracting it. Moreover, the protection of a vaccine could help convince doctors and nurses to work in the affected countries. The vaccine would also be given to others involved in the outbreak, such as cleaners, ambulance drivers, or burial teams, Farrar says.

But offering the vaccine to patients' families could increase the likelihood that they come forward, which would help detection and control. Participants at the earlier panel agreed that children and pregnant women were particularly vulnerable and should also be prioritized.

Another question is which country to concentrate on. Should early doses be sent to Liberia, where the epidemic seems to be growing the fastest, or to Guinea, which has been on the verge of containing Ebola at least twice? "You could make a good case for either one," says Brian Greenwood, an epidemiologist specializing in vaccines at the London School of Hygiene & Tropical Medicine, who is chairing a session at the meeting. "These are all very difficult questions, and this is why you do need to get a lot of brains together of the people that really know about this from different aspects and try to come to some sort of a consensus."

[Byline: Kai Kupferschmidt]

--
Communicated by:
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[These are not easy decisions on who should get priority for the vaccine(s). - Mod.JW]

******
[2] Orphans: UNICEF
Date: Tue 30 Sep 2014
Source: BBC News Africa [edited]
http://bbc.com/news/world-africa-29424919


At least 3700 children in Guinea, Liberia, and Sierra Leone who have lost one or both parents to Ebola this year [2014] face being shunned, the UN has said. Carers were urgently needed for these orphans, Unicef said. A basic human reaction like comforting a sick child has been turned "into a potential death sentence", it added.

The figure on the number of Ebola orphans follows a 2-week assessment mission by the UN children's agency to the 3 countries worst-affected by the outbreak. An earlier version of this story said that 4900 children had lost parents but the correct figure is 3700. It found that children as young as 3 or 4 years old were being orphaned by the disease. Children were discovered alone in the hospitals where their parents had died, or back in their communities where, if they were lucky, they were being fed by neighbours -- but all other contact with them was being avoided. "Thousands of children are living through the deaths of their mother, father, or family members from Ebola," Unicef's Manuel Fontaine said in statement about his 2-week visit to the region. "These children urgently need special attention and support; yet many of them feel unwanted and even abandoned," he said. "Orphans are usually taken in by a member of the extended family, but in some communities, the fear surrounding Ebola is becoming stronger than family ties."

The number of Ebola orphans has spiked in the past few weeks and preliminary reports suggest that it is likely to double by mid-October [2014], Unicef said. There was an urgent need to establish a system for identifying and caring for Ebola orphans, it said. Unicef will be holding a meeting on the issue in Sierra Leone next month [October 2014] but before then it wants potential carers to come forward. "Ebola is turning a basic human reaction like comforting a sick child into a potential death sentence," Mr Fontaine said. "We cannot respond to a crisis of this nature and this scale in the usual ways. We need more courage, more creativity, and far, far more resources."

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

******
[3] Sierra Leone: deaths recount
Date: Mon 29 Sep 2014
Source: Awareness Times (Sierra Leone News & Information) [edited]
http://news.sl/drwebsite/publish/articl ... 6287.shtml


[Dr Sylvia Blyden is the Special Executive Assistant to the Sierra Leone President, who regularly engages citizens on social media.]

In response to the numerous queries, Dr Blyden on Sat 27 Sep 2014 took time to write the following, which instantly went viral as it, for the 1st time, comprehensively showed cause of under-estimates.

Update by Dr Sylvia Blyden [edited]
-----------------------------------
Let me thank all who have posed observations and questions to me about the incomprehensible difference in totals of announced lab-confirmed cases versus number of survivors and number of deaths. You are all quite right that the difference is currently like 1000 and clearly, such a large number of over 1000 Ebola patients, are not to be found in health centers around the country. You are quite correct! So, where are these compatriots?

The fact is that a few of these unaccounted-for numbers are currently admitted in Ebola centers but I can categorically state today [27 Sep 2014] that the vast majority of the [over] 1000 patients are already dead and lying in their graves.

As some have repeatedly stated for months now, the numbers we are being given from Health Ministry as official Ebola death figures are incorrect. Before going further, let me state that the initial appearance of the hitherto unknown Ebola disease was a strange situation for us to handle and as can be perfectly understood, we had a tough learning curve during which we, as a country, made a series of blunders. One such blunder is the reason behind the erroneous death figures.

Let me explain. The erroneous death figures within the laboratory-confirmed category, are NOT caused by deliberate massaging but a flight of common sense; probably caused by the stress of what was unfolding on us. What am I saying here? Please read the following explanation carefully...

Now, most of the missing patients not currently accounted for, have resulted from a policy where sick patients blood samples are collected from them in their villages and towns and these samples taken to the lab in Kenema, Kailahun, or Freetown for testing whilst the patients were left behind in their communities, waiting for their results. By the time the results were available as confirmed positive and health officials prepared and went back to the villages/towns with ambulances to collect the patients, only a few were met still alive. Many of these patients (most of whom had been seriously ill), had already died in their communities and been buried. May their souls rest in perfect peace.

Now here comes the 'interesting' part. Former Health Minister Miatta Kargbo and former World Health Organisation Representative Dr Jacob Mufunda, had ordered that only deaths inside clinical facilities were to be recognised as "confirmed deaths" to be announced. So, all those laboratory positive patients who died in their towns and villages before they could be collected in ambulances for treatment at Ebola Centers, were never announced as deaths though already announced amongst number of laboratory positive cases. These unannounced deaths of our compatriots, ran up to hundreds of deaths of laboratory confirmed cases.

This is the simple reason behind the incorrect death figures in the laboratory confirmed categories. Sierra Leone was not counting our compatriots who died outside of health facilities.

This grave error that resulted in skewed death figures, was immediately picked up by the new Health Minister, Dr Abu Bakarr Fofanah, on assuming office and, in a poignant presentation to the Presidential Task Force on Ebola which included all top international diplomats, opposition party leaders, SLMDA [Sierra Leone Medical & Dental Association] doctors and key civil society members, the Health Minister Dr Abu Bakarr Fofanah carefully explained what had been happening under the watch of his predecessor. You just need to read the US Embassy's Facebook updates posted after that Presidential Task Force meeting. (Check 8 Sep and 10 Sep 2014 US Embassy updates. They speak volumes).

So, based on analytic presentation of the new Health Minister, it is now a Government policy that the death figures being announced for laboratory confirmed cases, should be reviewed -- eventually. The Health Minister has already informed the CDC and the WHO on this.

As you can well imagine, after impending review, the death rates, case fatality rate (CFR), and other attendant aspects will be significantly changed and a better understanding of the serious gravity of what is unfolding in Sierra Leone, will be known by the whole world. Please brace yourselves. The news is not good. However, rest assured that working together, we can overcome Ebola.

In addition, the review will also ensure proper inclusion of all suspected and probable deaths as per World Health Organisation definitions. Keen observers might have noticed that it is only recently, in last one month, that an attempt has been made to include suspected and probable deaths in the death numbers being announced.

Fellow Citizens and Friends of Sierra Leone, let us continue to keep our beautiful country's Ebola crisis in the mainstream of the world's attention. We have a very, very serious situation on our hands.

We made a lot of mistakes in the early stages because we had a steep learning curve. However, we can no longer blame a steep learning curve for any more mistakes. Let us gear up against Ebola!

--
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******
[4] Prevention & suspect cases

Germany: Ebola mission stranded in Gran Canaria
-----------------------------------------------
29 Sep 2014 (Treehugger): Germany's military transport planes are causing embarrassment for yet another Bundeswehr [armed forces] mission. The military's much-heralded delivery to help Ebola-stricken countries in western Africa has stalled in Gran Canaria [Canary Islands, refueling stop [see map at http://media.treehugger.com/assets/imag ... -smart.jpg]... -- more
http://www.thelocal.de/20140929/germany ... d-in-spain


Ghana: 1st Ebola treatment center almost ready: health minister
---------------------------------------------------------------
29 Sep 2014 (Xinhua): Ghana is almost through with constructing its 1st Ebola treatment center, the country's Minister of Health Kwaku Agyemang-Mensah told Xinhua [Mon 29 Sep 2014]... the site for the facility [is] located close to the Tema General Hospital, about 38 km [24 mi] east of the capital, and work was almost complete. "What the facility is now waiting for are beds to be fitted in the wards," the minister noted, adding that the country was putting in every effort to ensure that it was fully prepared for any eventuality related to the Ebola virus disease (EVD).

The minister disclosed that every hospital facility in the country had identified an isolation facility that would be used in case of suspected cases while the government was making efforts to build 3 treatment centers; 2 other facilities, which are expected to be converted into 2 more treatment centers in Kumasi, 270 km [168 mi] north of the capital and Tamale, 658 km [409 mi] north of the capital, have been handed over to the Field Engineers Regiment of the Ghana Armed Forces.

"We have had 98 suspected Ebola cases so far and all of them have tested negative and so there is no Ebola in Ghana," the minister declared. In an agreement signed here Mon [29 Sep 2014], China said it would support Ghana with 5 million yuan or USD 833 000 worth of anti-Ebola equipment.
http://news.xinhuanet.com/english/afric ... 683047.htm

[Numbers of beds are not specified. It would be helpful to public health authorities in West Africa to divulge the final diagnosis of the false alarm cases: malaria, Lassa fever, or other infections? - Mod.JW]


Guinea: Air France flies to Ebola-hit Guinea out of solidarity, Hollande to Conde
----------------------------------------------------------------------
30 Sep 2014 (AllAfrica, RFI English): Air France is maintaining flights to Ebola-hit Guinea in a show of France's "solidarity", French President Francois Hollande said on Mon [29 Sep 2014] during a visit to Paris by Guinea's President Alpha Conde. Although the airline suspended services to neighbouring Sierra Leone, which is also suffering from the Ebola outbreak, it has continued flights to Conakry... -- more
http://allafrica.com/stories/201409301318.html


Liberia: Ganta to lockdown
--------------------------
29 Sep 2014 (The New Dawn): As part of efforts in the fight against the deadly Ebola virus, Nimba County in Central Liberia is concluding plans to shut down its commercial city, Ganta, for 5 days to allow health workers conduct intensive testing of residents. Nimba County health team headed by Medical Director Collins Boah, said during the 5 days, a robust house-to-house search will be conducted to locate people that are sick and in hiding. Dr Boah said no one will be allowed to enter or leave Ganta during the lockdown... -- more
http://www.thenewdawnliberia.com/index. ... e&id=12815


Liberia: AmeriCares sends 60 000 lbs of Ebola Aid to Liberia
------------------------------------------------------------
29 Sep 2014 (ReliefWeb): More than 60 000 lbs of medical aid from AmeriCares arrived today [29 Sep 2014] in Liberia for health workers battling the worst Ebola outbreak in history. It includes 80 000 pairs of gloves, 61 000 masks, and 23 000 protective gowns for frontline medical personnel, along with intravenous fluids to treat approximately 1600 Ebola patients. The aid delivery was part of a humanitarian flight organized by AirLink, a Washington, DC-based nonprofit that connects aid organizations with free passenger and cargo transportation. Airlink has established an air bridge to streamline transportation of critically needed supplies to combat the Ebola outbreak in West Africa... -- more
http://reliefweb.int/report/liberia/ame ... id-liberia


USA lets Liberians stay amid Ebola crisis
-----------------------------------------
26 Sep 2014 (Newsmax, Associated Press): Liberian immigrants living in the United States without a visa won't be sent back to the epicenter of the Ebola crisis in West Africa for at least another 2 years, the Obama administration said [Fri 26 Sep 2014]. President Barack Obama signed a memo extending a legal protection called "deferred enforced departure" that continues a protection from deportation that has been in place for more than a decade... - more
http://www.newsmax.com/Newsfront/US-imm ... /id/597198


USA: Texas Health Presbyterian Hospital of Dallas monitoring patient possibly infected with Ebola virus
----------------------------------------------------------------------
29 Sep 2014 (The Dallas Morning News, Associated Press): Texas Health Presbyterian Hospital of Dallas is carefully evaluating a patient who may have Ebola virus disease. Based on the patient's symptoms and recent travel history, the patient has been admitted into "strict isolation," said spokeswoman Candace White in a prepared statement. Preliminary test results are expected [Tue 30 Sep 2014]. The hospital is following Centers for Disease Control and Texas Department of Heath recommendations to ensure the safety of patients, staff, volunteers, physicians, and visitors, White said... -- more
http://thescoopblog.dallasnews.com/2014 ... ebola.html


World Bank to increase Ebola money to USD 400 million
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29 Sep 2014 (AllAfrica, The New Dawn): Following alarming evidence of the spread of the Ebola epidemic in West Africa, the World Bank Group on [Thu 25 Sep 2014] announced that it will nearly double its financing to USD 400 million to help the worst-affected countries address the emergency and build stronger health systems for the years to come... -- more
http://allafrica.com/stories/201409292030.html

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[A HealthMap showing the distribution of EVD cases and deaths can be seen at http://healthmap.org/ebola/. - Mod.JW]

EBOLA VIRUS DISEASE - WEST AFRICA (183): GREAT APES AS SENTINELS
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Date: Wed 24 Sep 2014
Source: Voice of America [edited]
http://www.voanews.com/content/ebola-gr ... 60717.html


While efforts continue to contain the Ebola outbreak among people in West Africa, researchers have a new technique to study Ebola among the Great Apes. Thousands of the primates are believed to have died from the disease in recent decades. The research could help predict where Ebola outbreaks might occur among humans.

Researchers have been studying Ebola in the wild for 30-years, but they say there's still much they do not know. It's difficult to safely capture wild animals in Africa's rainforests, let alone take blood and tissue samples from them.

Dr Kenneth Cameron is a Wildlife Conservation Society field veterinarian, who took part in the research. He spoke from the Republic of Congo capital Brazzaville:

"We've been doing Ebola ecology studies for a long period of time trying to further determine where Ebola comes from. How it spills over from presumed reservoir species to Great Apes in particular. And what effect it has specifically on those Great Ape populations. We know that it has some pretty devastating effects on Great Ape populations. We believe well in excess of 80-percent mortality when there is an Ebola epidemic amongst Great Apes."

In the current West Africa Ebola outbreak, fruit bats are the prime suspect for being the source of the virus. Fruit bats are known as a reservoir species. That is, they can carry the Ebola virus and yet not get sick. Cameron said it's not the same with Great Apes.

"We believe that Ebola virus has killed probably tens of thousands of Great Apes in the past 20 to 30 years in Central Africa. So it's those populations that we're concerned about. And what we wanted to find out is what individuals among those species and what populations of gorillas and chimpanzees have actually been exposed to Ebola virus," he said.

Researchers believe Great Apes can become infected by being in close quarters with other animals that have similar feeding habits -- animals that may carry the virus.

"They'll be eating out of the same tree at the same time, for example. We typically call those trees magnet trees. Because when a magnet tree starts fruiting -- for example, a ficus tree -- the figs that are produced attract all kinds of animals. So many different species, including both the reservoirs and the susceptible hosts for Ebola virus. That is to say the fruit bats and gorillas and chimps," said Cameron. Infected bats may contaminate the tree's fruit with their saliva and spread the virus through urine and feces on the ground.

Researchers said that "understanding Ebola's distribution in space and time is a matter of great importance to both human health and conservation communities."

So, what is the new technique to study Ebola among Great Apes? The answer: studying fecal samples -- primate droppings.

Cameron said, "What we're looking for is just feces, fresh feces, that have been dropped by Great Apes. Great Apes move around feeding and what not throughout the day. They obviously drop their feces as they go. We typically send teams out in what we call directed reconnaissance swab surveys. So it's just a survey where they go and they just wander through the forest looking for the feces in areas where we know there are Great Apes -- or they use GPS coordinates, compass coordinates, to direct themselves from one point to the next looking for feces as they go." Depending how fresh it is -- it's considered fresh if it's 12 to 24 hours old -- the fecal sample is frozen and sent for testing back in the United States.

"Unfortunately," Cameron said, "we're not set up to be running the testing here in country. Our partners in developing this technique at the National Institutes of Health would run them in their laboratory. So, from the time of collection to the time of testing to know whether or not they had been exposed is usually weeks. We're hoping to transfer that technology to our laboratory here in Brazzaville in Republic of Congo where we can do the testing in a much more timely basis."

Apes, like humans and other vertebrate species, develop antibodies during a viral infection. It's not known how long those antibodies remain in apes that survive infection or whether they can protect an ape from future outbreaks. But the samples may help predict potential Ebola hot zones. "A lot of disease projections -- where diseases may erupt -- come out of mathematical epidemiological models that are conducted. We need more data to feed into these models. If we don't have good data fit into them the results that we get out are not going to be meaningful. The data that we're collecting here can feed into those mathematical models. It can help us predict where Ebola may occur next by determining which Great Apes have already been infected. So we know Ebola has been in a given region," he said.

The Wildlife Conservation Society field veterinarian said typically in Central Africa human Ebola outbreaks follow epizootic outbreaks. Contaminated bushmeat is usually to blame. Cameron said when researchers found evidence of Ebola among dead Great Apes they educated local communities about the disease -- and asked them to report any wildlife carcasses they found so they could be examined for Ebola. Health officials were also notified. Studying fecal samples could create a better early warning system.

[Byline: Joe DeCapua]

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[Wild populations of gorillas and chimpanzees are threatened by a diverse array of virulent pathogens, including ebolaviruses, which have caused massive die-offs of gorillas and chimpanzees. Over the last 2 decades the Zaire strain of ebolavirus has killed roughly 1/3 of the world's gorilla population and only a slightly smaller proportion of the world's chimpanzees (see http://www.plosone.org/article/info%3Ad ... ne.0029030).

Wild great apes can serve as sentinels of infectious diseases. Using the information that can be provided by feces is an excellent non-invasive tool to monitor their health. - Mod.PMB

Map of range of African great apes:
http://www.grida.no/graphicslib/thumbs/ ... a_611b.jpg

EBOLA VIRUS DISEASE - WEST AFRICA (184): USA (TEXAS) FIRST CASE ex LIBERIA
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USA: 1st case to fall ill in the USA (Texas), imported
--------------------------------------------------------
Date: 30 Sep 2014 [Breaking news alert published at 5:50 p.m. ET]
Source: (CNN) [edited]
http://www.cnn.com/2014/09/30/health/eb ... ?hpt=hp_t1

A person traveling from Liberia to the United States has been diagnosed with Ebola, Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention, told reporters Tue [30 Sep 2014]. The person, whose identity was not released, left Liberia on 19 Sep 2014 and arrived in the USA on 20 Sep 2014, he said. At that time, the person did not have symptoms. "But 4 or 5 days later" that person began to show symptoms, Frieden said. The person was hospitalized and isolated Sun [28 Sep 2014] at a hospital in Texas, he said.

[Original story published at 5:42 p.m. ET]

A patient being treated at a Dallas, Texas, hospital is the 1st person diagnosed with Ebola in the USA. Several other Americans were diagnosed in West Africa and then brought to the USA for treatment. The person who first tested positive for Ebola in the USA is a patient at Texas Health Presbyterian Hospital in Dallas, hospital spokesman Stephen O'Brien said Tue 30 Sep 2013.

The adult patient developed symptoms days after returning to Texas from West Africa, and was admitted into isolation on Sun [28 Sep 2014], according to the Texas Department of State Health Services. The CDC was expected to provide more details on the case in a press conference at 5:30 p.m.
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*******

[It was bound to happen sooner or later, with an incubation period of 21 days. He had no symptoms on the plane or on arrival, so there was no risk to fellow passengers, aircrew or airport personnel, and his contacts since he came down with fever will be followed up, as CDC does routinely for other infections.

A HealthMap showing the distribution of EVD cases and deaths can be seen at http://healthmap.org/ebola/. - Mod.JW]

Ebola und wie man damit Geld macht. Für die Pharmaindustrie war Ebola in der Vergangenheit kein Thema. Es gab keinen Markt. Jetzt steigen die Aktienkurse der Pharmariesen. Die Investoren dürften die Infizierten in Afrika wohl kaum interessieren.


Amerika zwischen Gier und Panik

Trotzdem: Aktien von Luftfahrtgesellschaft gaben nach Bekanntwerden des Falls in den USA nach, und Aktien von Pharmafirmen klettern. Ein Journalist beim Wirtschaftssender Bloomberg brachte die Freude der Börsianer auf den Punkt: Ebola ist jetzt auf dem Weg ein Geschäft zu werden. Das war nicht immer so.

Obwohl es bereits mindestens 30 Ebola-Ausbrüche seit 1995 gegeben hat, blieben die großen Pharmafirmen untätig. Aus einfachem Grund, wie Sina Bavari, Ärztin im US Army Medical Research Institute for Infectious Diseases, dem Sender NBC News noch vor wenigen Wochen anvertraute: Geld. „Ich kann nicht erkennen, warum sich irgendjemand außer der US-Regierung mit Ebola befassen sollte“, sagte sie. „Es ist einfach kein Markt.“ mehr...

Grüsse
Alexander

Alexander - es ist leider so, dass es immer Leute gibt, die von sich ändernden Situationen profitieren. Allerdings glaube ich schon, dass es da Unterschiede zu beachten gilt: Auch der griechische Hotelier hat in den letzten paar Jahren von der Unsicherheit, die in Nordafrkia zur Zeit herrscht profitieren können, indem einfach mehr Leute bevorzugten, in Europa zu bleiben und dort Ferien zu machen.

Im Moment scheint es, als würde sich Ebola auf die bisher betroffenen Länder beschränken - auswirkungen kann so eine Krankheit aber ganz schnell auch in anderen Bereichen zeigen. Heute las man in Schweizer Zeitungen zum Beispiel: "Das Ebola-Virus in Westafrika bereitet Schweizer Schokolade-Herstellern Sorgen: Breitet es sich aus, könnte die ganze Produktion in Gefahr sein." Dummerweise wächst in dEr Schweiz der Kakao nicht richtig gut. Wenn die Produktion nun heruntergefahren werden muss, dann werden die Preise für Schokolade praktisch zwangsläufig steigen und der Artikel wird vielleicht wieder zu einem Luxusprodukt. Vielleicht können sogar Zwischenhändler, die noch auf einem vollen Lager von Kakao sitzen einen kurzfristigen Mehrgewinn verbuchen - aber verlieren werden die Arbeitnehmer in den Schokoladenfabriken in der Schweiz (obwohl die noch vom Sozialsystem aufgefangen werden), vor allem aber die Kakaofarmer und deren Arbeiter in den Produktionsländern. Und das könnte die Misere noch beschleunigen... wenn weniger Geld eingenommen wird, dann wird am Ende halt auch weniger Geld für Krankenhäuser da sein.

EBOLA VIRUS DISEASE - WEST AFRICA (185): WHO, CDC, LIBERIA, VACCINE
*******************************************************************
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In this update:
[1] WHO: Ebola Response Roadmap Situation Report 1 October 2014
[2] CDC: numbers
[3] Liberia: UN staff fatality
[4] Vaccine: Canada

*******
[1] WHO: Ebola Response Roadmap Situation Report 1 October 2014
Date: 1 Oct 2014
Source: WHO [ediurted]
http://apps.who.int/iris/bitstream/1066 ... g.pdf?ua=1

Overview
-------------
The total number of probable, confirmed and suspected cases (see Annex 1) in the current outbreak of Ebola virus disease (EVD) in West Africa reported up to 28 September 2014 is 7178, with 3338 deaths. Countries affected are Guinea, Liberia, Nigeria, Senegal and Sierra Leone. Figure 1 shows the total number of confirmed and probable cases in the three high-transmission countries (Guinea, Liberia, and Sierra Leone) reported in each epidemiological week between 30 December 2013 (start of epidemiological week 1) and 28 September 2014 (end of epidemiological week 39). For the second week in a row the total number of reported new cases has fallen. It is clear, however, that EVD cases are under-reported from several key locations. Transmission remains persistent and widespread in Guinea, Liberia and Sierra Leone, with strong evidence of increasing case incidence in several districts. There are few signs yet that the EVD epidemic in West Africa is being brought under control... - more
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[2] CDC numbers
Source: CDC Ebola virus early release MMWR [edited]
http://www.cdc.gov/mmwr/preview/mmwrhtm ... 63e030a1_e

Ebola Virus Disease Outbreak -- West Africa, September 2014
-----------------------------------------------------------------
CDC is assisting ministries of health and working with other organizationsto control and end the ongoing outbreak of Ebola virus disease (Ebola) inWest Africa (1). The updated data in this report were compiled from ministryof health situation reports and World Health Organization (WHO) sources.Total case counts include all suspected, probable, and confirmed cases asdefined by each country (2). These data reflect reported cases, which makeup an unknown proportion of all actual cases. The data also reflect reporting delays that might vary from country to country.

According to the latest WHO update (2), a total of 6574 Ebola cases had been reported as of 23 September 23 from 5 West Africa countries (Guinea, Liberia, Nigeria, Senegal, and Sierra Leone) (Figure 1). The highest reported case counts were from Liberia (3458 cases), Sierra Leone (2021), and Guinea (1074)... - more

[See cumulative totals as of 29 Sep 2914 of 7178 cases with 3338 deaths in [1] above. - Mod.JW]
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[3] Liberia: UN staff fatality
Date: 1 Oct 2014
Source: Yahoo! News (AFP) [edited]
http://news.yahoo.com/un-worker-dies-su ... 06896.html


The United Nations mission in Liberia announced on Wednesday the 1st suspected victim among its employees of the deadly Ebola epidemic ravaging the impoverished west African nation. "It is a sad reminder of the ever-present risk, and sobering for us as a mission and as the UN family," she said, giving no further details on the staffer. "UNMIL [UN Mission in Liberia, a military & police mission] will continue to strengthen the measures we put in place to protect our staff, and to remind them to protect themselves and their families outside working hours." Landgren said the mission had taken steps since then to educate personnel and help them protect themselves against the virus, describing staff safety as her "top priority"... - more
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[4] Vaccine: Canada
Date: 1 Oct 2014
Source: Reuters [edited]

http://www.reuters.com/article/2014/10/ ... healthNews

Canada vaccine shipped to Geneva, U.S. hospitals as precaution
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Canada has shipped small amounts of its experimental vaccine for the Ebola virus to hospitals in Geneva [Swizerland] and Atlanta, Georgia USA for possible use by exposed health care workers, Canadian chief public health officer Greg Taylor said on Wed [24 Sep 2014].

Taylor said Canada "pre-shipped" some vaccine to Geneva some time ago, but that its donation to the World Health Organization of 800-1,000 doses remains in a Canadian government lab. Canada also shipped some vaccine to Atlanta's Emory University Hospital and is considering shipping some of the vaccine to Canadian hospitals as a precaution as well.
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Communicated by:
Claudinne Roe <claudinne.r.roe@ugov.gov>

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[A HealthMap showing the distribution of EVD cases and deaths can be seen at http://healthmap.org/ebola/#timeline - Mod.JW

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

EBOLA VIRUS DISEASE - WEST AFRICA (186): WHO, CUBAN HEALTH CARE WORKERS ARRIVE, PREVENTION
******************************************************************************************
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ProMED-mail is a program of the
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In this update:
[1] WHO Ebola Response Update 3 Oct 2014
[2] Cuba: 162 medics arrive in Sierra Leone
[3] Prevention & false alarms

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[1] WHO Ebola Response Update 3 Oct 2014
Date: 3 Oct 2014
Source: WHO [excerpt]
http://apps.who.int/iris/bitstream/1066 ... g.pdf?ua=1

Countries with widespread and intense transmission
--------------------------------------------------------------------
7470 (probable, confirmed and suspected) cases and 3431 deaths up to the end of 1 Oct 2014.
[Table 1 has details]... more

[This is almost 300 new cases & almost 100 more deaths in the 3 days since the previous WHO update as of 28 Sep. - Mod.JW]
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[2] Cuba: 162 HCWs arrive in Sierra Leone

Date: 2 Oct 2014
Source: Politico SL [edited]
http://politicosl.com/2014/10/162-cuban ... erra-leone

As the fight against Ebola intensifies with infection rates and deaths spiking, international response is gathering pace. Just days after an 85-member team of British military medics and engineers arrived to respond to the epidemic, 162 Cuban doctors and nurses will arrive today, according to deputy health minister, Madina Rahman. She said an advance team had already been here and that the arrival of the bulk today would help bolster the fight to beat back the disease which has claimed over 600 lives.

Cuba is reputed to have some of the best-trained medics in the world especially in infectious diseases. With Britain and China setting up treatment centres across the country in the coming weeks and sending medics as well, it is hoped Ebola would be put under control earlier than feared.

In addition to those already in country the Cuban will consist of 100 nurses, 50 doctors, 3 epidemiologists, 3 intensive care specialists, 3 infection control specialist nurses and 5 social mobilisation officers, all overseen by epidemiologist Dr. Jorge Juan Delgado Bustillo. WHO says all of the Cuban health workers have more than 15 years' experience and have worked in other countries facing natural disasters and disease outbreaks. Some of the workers have already been working in Sierra Leone and in Guinea for some years and are willing to continue their service. They will stay around for 6 months, working in shifts in smaller teams in Ebola treatment centres and community clinics.

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[3] Prevention & false alarms

Mali struggles to filter passengers from Ebola-hit Guinea
-------------------------------------------------------
4 Oct 2014: (Reuters) - At a Mali border post in Kouremale about 130 km (80 miles) south of the capital Bamako, 5 health workers stand under a thatched roof, directing passengers arriving from Guinea to wash their hands. Their temperatures are then taken with digital guns to check for fever, one of the early symptoms of the deadly Ebola virus that originated in Guinea and has spread to its southern neighbours Sierra Leone and Liberia. Mali is the only country that has not closed its border with Guinea. For regional health officials, this has narrowed the risk of potentially infected people slipping through in to Mali. So far, no case of Ebola has been recorded in Mali. But the operation at the border post to keep Ebola out poses logistical challenges at this remote point in the West African scrubland. The hand-washing water has to be trucked in from a village 15 km (9 miles) away in steel barrels and there is a lack of chairs in the waiting area. The main difficulty for Mali to keep the disease out, however, is that is that many travellers simply avoid the official border crossing - the lone paved road connecting the two West African countries - altogether... - more
http://in.mobile.reuters.com/article/id ... 4?irpc=932
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[A HealthMap showing the distribution of EVD cases and deaths can be seen at http://healthmap.org/ebola/#timeline
A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/54. - Mod.JW]

EBOLA VIRUS DISEASE - WEST AFRICA (187): UN, AID, SIERRA LEONE, ECDC, LIBERIA
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In this update:
[1] West Africa: UN mission to send helicopters, vehicles
[2] Sierra Leone: Canada sends 2nd mobile lab & team
[3] West Africa: Israel to send 3 mobile emergency clinics to the region
[4] ECDC Rapid Risk Assessment
[5] Liberia: transmission by 'concubine' kills 8

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[1] West Africa: UN mission to send helicopters, vehicles
Date: 4 Oct 2014
Source: Reuters [edited]
http://af.reuters.com/article/topNews/i ... 04?sp=true

The United Nations Mission for Ebola Emergency Response [UNMEER] will bring 5 helicopters, vehicles and motorcycles to transport patients and reach communities in West Africa in stepped up efforts to combat the epidemic, the head of the mission said on Fri [3 Oct 2014]... - more
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Communicated by:
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[2] Sierra Leone: Canada sends 2nd mobile lab & team
Date: 5 Oct 2014
Source: CBC Canada [edited]
http://www.cbc.ca/news/health/ebola-out ... -1.2787817

The lab and 2 additional agency scientists were deployed Sat [4 Oct 2014] and join a Canadian team set up previously in the district of Kailahun in eastern Sierra Leone, near the borders of Guinea and Liberia, the Public Health Agency of Canada said. A 3rd scientist will leave on Tue [7 Oct 2014]. The team already on the ground will continue to provide rapid diagnostic support to help local health-care workers, producing results within hours. The 2nd team will work with Medecins Sans Frontieres (MSF -- Doctors Without Borders) to monitor the effectiveness of infection prevention measures, such as hand-washing stations, face masks and disposal sites... - more
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[3] West Africa: Israel to send 3 mobile emergency clinics to the region
Date: 5 Oct 2014
Source: Jerusalem Post [edited]
http://www.jpost.com/Israel-News/Israel ... ola-378074

The Foreign Ministry's Mashav department, which is the Agency for International Development Cooperation, has decided to increase Israel's contribution to the international effort ... in response to the requests by UN Secretary-General Ban Ki-moon, the World Health Organization, many governments and Israeli and international aid organizations. The clinics, which were manufactured here, were built in accordance with the WHO's standards and guidelines for the treatment of Ebola. A staff of medical experts to be attached to each clinic is to train local medical staffers in its operation and equipment. In addition, staff training is to focus on preventing the spread of the disease and raising awareness among populations with high potential for infection.

An Israeli team has already been sent to Cameroon, where it was favorably received by the local authorities. The ministry sent emergency equipment to the government of Sierra Leone, and in recent weeks, it shipped personal protection equipment to teams of the African Union.
[By Judy Siegel-Itzkovich]
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[4] ECDC Rapid Risk Assessment
Date: 29 Sep 2014
Source: ECDC
http://ecdc.europa.eu/en/publications/P ... ssment.pdf

Outbreak of Ebola virus disease in West Africa, 5th update, 29 Sep 2014
---------------------------------------------------------------
The options for risk reduction are:

- to reduce the risk of infection by avoiding non-essential travel into the affected areas and strictly following the EVD prevention measures in communities. As there is an increased risk of infection in healthcare facilities, visitors to the EVD affected countries should identify appropriate in-country healthcare resources prior to travelling;
- to reduce the risk of importation of Ebola viruses from affected countries into the EU, the WHO recommendations related to the declaration of a Public Health Event of International Concern (PHEIC) should be applied. Screening at the point of departure (exit screening) in the affected countries is likely to be more effective and less costly than screening of passengers at point of entry in EU/EEA countries (entry screening). Therefore, entry screening in the EU should be considered only for direct flights originating from EVD-affected countries where there is no evidence of effective exit screening; and
- to reduce the risk of transmission within the EU following importation of Ebola viruses, the following options are available: enhance information and communication to travellers departing from EVD-affected countries, raise awareness and sensitise healthcare providers in the EU about EVD, and support them with resources that will help them to identify and manage potential EVD patients.

The following resources support health providers in the EU in the identification and management of potential EVD patients:

- Assessment and planning for medical evacuation by air to the EU of patients with Ebola virus disease and people exposed to Ebola virus: http://www.ecdc.europa.eu/en/publicatio ... rt-EVD.pdf
- Case definitions for Ebola patients in the EU: http://ecdc.europa.eu/en/healthtopics/e ... fault.aspx
- Algorithm for the laboratory diagnosis of Ebola virus disease:
http://ecdc.europa.eu/en/healthtopics/e ... fault.aspx
- Algorithm for the initial assessment and management of patients with Ebola virus disease: http://ecdc.europa.eu/en/healthtopics/e ... fault.aspx
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Communicated by:
ProMED Rapporteur Kunihiko Iizuka

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[5] Liberia: transmission by 'concubine' kills 8
Date: 3 Oct 2014
Source: Liberian Observer [edited]
http://www.liberianobserver.com/news/eb ... 8-soldiers

Ebola kills 8 soldiers -- Kesselly Barracks deserted
----------------------------------------------------------
At least 8 soldiers, among them 2 commissioned officers and 2 medical staff, have reportedly lost their lives to the deadly Ebola virus disease (EVD), the Daily Observer has reliably learnt...

The deceased, according to our source, contracted Ebola recently at the Edward Binyan Kesseley (EBK) Barracks when a lady unsuspected of carrying the disease, visited one of the victims. The 'concubine' who visited the late soldier has also been victimized by the disease... "When she slept at the EBK, it was thereafter the soldiers contracted the disease, and could not survive despite "intensive treatment" at the various Ebola Treatment Units in Monrovia," our source disclosed.

This latest setback among the rank and file of the already sparse number of soldiers has reportedly created panic among them, to the extent that some of them have begun to desert the various barracks across the country.
Based on this information, the Daily Observer yesterday contacted Defense Assistant Minister for Public Affairs, David K. Dahn, who neither confirmed nor denied the report...

The latest deaths of the soldiers sadly add to several para-military and other security personnel, including officers of the Liberian National Police (LNP), that have died. Others, including close family members, had been quarantined and subsequently released, having completed their 21 days isolation.
[By: C.Y. Kwanue]
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Communicated by:
Ryan McGinnis
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[

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/46, http://healthmap.org/promed/p/54.]