Ebola in Westafrika

[Wüstenkind]

Nein, tut mir leid.
Da muss ich passen. Wir (mein Partner und ich) haben unseren Westafrikaurlaub dieses jahr geknickt. Zuviel Angst, das macht mit Ebola keinen Sinn.
Wünsche dir sehr viel Erfolg und riskiere lieber nichts.

[Birgitt]

EBOLA VIRUS DISEASE - WEST AFRICA (149): NIGERIA SPREAD
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A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

Date: 3 Sep 2014
Source: AAAS Science [edited]
http://news.sciencemag.org/africa/2014/ ... ak-spreads


The hopes that Nigeria's EVD outbreak could be quickly stamped out have evaporated.

The World Health Organization (WHO) this afternoon [3 Sep 2014] issued its 1st detailed report of the spread of the virus in Port Harcourt, Nigeria's oil hub. Last week, authorities announced that a doctor there had died of the disease, after secretly treating a diplomat who had been infected in Lagos by a traveler from Liberia.

The doctor had close contact with family, friends, and health care workers during his illness, but he did not disclose his previous exposure to the virus. His infection wasn't confirmed until 5 days after his death. Experts are now following hundreds of the doctor's contacts, 60 of which had "high-risk or very high-risk exposure," WHO says.

The diplomat had been instructed to stay in Lagos in quarantine. Instead he flew to Port Harcourt, where he was treated -- in a hotel room -- by the doctor from 1-3 Aug 2014. The diplomat survived and returned to Lagos, presenting himself again to health authorities, who confirmed he was no longer infected. He did not tell them that he had sought treatment in Port Harcourt.

The doctor who treated him became ill on 11 Aug 2014. He continued treating patients at his private clinic for 2 days, operating on at least 2 of them. Between 13-16 Aug 2014, he was ill enough that he stayed home, but, according to the WHO report, he received multiple visitors who came to celebrate the birth of a baby. On 16 Aug 2014, he was hospitalized. He did not tell doctors there that he had been exposed to Ebola.

The WHO report is grim: "During his 6-day period of hospitalization, he was attended by the majority of the hospital's health care staff," it says, and members of his church community visited and performed a healing ritual that apparently involved laying on of hands. "On 21 Aug 2014, he was taken to an ultrasound clinic where 2 physicians performed an abdominal scan. He died the next day."

It was not until 27 Aug 2014 that tests confirmed he was infected with Ebola.

His wife (who is also a doctor) and another patient at the hospital where he sought treatment are also infected. 21 trained teams are monitoring more than 200 contacts, and a 26-bed isolation facility has been set up. WHO says that 2 decontamination teams and a burial team "are equipped and operational."

The diplomat, associated with the Economic Community of West African States, may face manslaughter charges, according to Nigerian press reports.

Given the current Ebola outbreak, unprecedented in terms of number of people killed and rapid geographic spread, Science and Science Translational Medicine have made a collection of research and news articles on the viral disease freely available to researchers and the general public.

[Byline: Gretchen Vogel]

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[This is a complete disaster. Anybody who has followed the breakdown of hospitals, health services, and social order in the original 3 countries affected by EVD will realize what is likely to happen now. - Mod.JW

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/62.]

[Birgitt]

In Nigeria droht eine neue Welle von Ebola-Erkrankungen. In der Hafenstadt Port Harcourt im Südosten des Landes seien bisher drei Fälle bestätigt, teilte die Weltgesundheitsorganisation (WHO) mit. Entscheidend für die Verbreitung war demnach die Infektion eines Arztes, der nach seiner Erkrankung noch Patienten operierte und vermutlich mit Dutzenden Menschen Körperkontakt hatte.

Nigeria - WHO rechnet mit neuer Ebola-Welle
04.09.2014 - Handelsblatt

Ärger auf einem Wochenmarkt in der liberianischen Hauptstadt Monrovia: Ein Mann brach am Montag aus einer Quarantänestation für Ebola-Patienten aus - und suchte auf dem Markt nach Essen.

Ebola-Patient flüchtet aus Klinik auf Markt
02.09.2014 - Stern Video

Dieses Video und auch mein Posting vorher betr. Nigeria zeigen ziemlich eindrücklich, weshalb Ebola im dicht besiedelten Westafrika nicht aufzuhalten ist ...

Gruß
Birgitt

[Lenaw]

Unfassbar schlimm! Das zerreisst einem das Herz!

[Kuno]

Bis jetzt war Ebola eine exotische Krankheit, weit weg von mir. Leider muss ich mich jetzt doch etwas naeher dmait beschaeftigen und bin etwas ueber die Angaben zur Ueberlebenswahrscheinlichkeit verwirrt: An einigen Stellen heisst es, dass die Sterbensrate bei 90% liege - gestern hat man mir jedoch erklaert, dass sie tatsaechlich bei etwa 50% sei. Welche Angabe ist hier realistisch?

[Alexander]

Hallo Kuno,

es gibt vier Stämme des Ebolavirus: Tai Forest Ebolavirus, Sudan Ebolavirus, Zaire Ebolavirus und Bundibugyo Ebolavirus.

Abhängig vom Stamm beträgt die Sterblichkeitsrate 50% bis 90 %.
Der Zaire Ebolavirus ist dabei der gefährlichste mit einer Letalitätsrate von 60% bis 90 %

Grüsse
Alexander

[Birgitt]

EBOLA VIRUS DISEASE - WEST AFRICA (150): GUINEA, MILITARY AID, VACCINE
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A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

In this update:
[1] Guinea: new area affected
[2] CDC: window for bringing EVD under control is closing fast
[3] Military medical help called for, rejected
[4] USA: Military help premature
[5] Vaccine trial UK

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[1] Guinea: new area affected
Date: 3 Sep 2014
Source: Reuters [edited]
http://www.foxnews.com/health/2014/09/0 ... ew-region/


Guinea's government said on Wed [3 Sep 2014] that EVD had spread to a previously unaffected region of the country, as US experts warned that the worst ever outbreak of the deadly virus was spiraling out of control in West Africa.

Guinea, the 1st country to detect the hemorrhagic fever in March [2014], had said it was containing the outbreak, but authorities announced that 9 new cases had been found in the southeastern prefecture of Kerouane. The area, some 750 km (470 miles) southeast of the capital Conakry, lies close to where the virus was 1st detected deep in Guinea's forest region. ... The 9 confirmed cases were in the town of Damaro in the Kerouane region, with a total of 18 people under observation, the health ministry said in a statement. The latest outbreak started after the arrival of an infected person from neighboring Liberia, the ministry said. ...

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[2] CDC: window for bringing EVD under control is closing fast
Date: 2 Sep 2014
Source: Washington Post [edited]
http://www.washingtonpost.com/national/ ... story.html


A man who left an Ebola quarantine center in Monrovia in search of food was jeered by an angry and fearful crowd at a local market. The man was subsequently chased down by doctors and forced into an ambulance. Leading international health officials said Tuesday [2 Sep 2014] that the EVD epidemic in West Africa is accelerating, and the window for getting it under control is closing.

"Six months into the worst EVD epidemic in history, the world is losing the battle to contain it," Joanne Liu, international president of medical charity Doctors Without Borders [Medecins Sans Frontieres (MSF)], said in a briefing at the United Nations. She faulted world leaders for failing to recognize the severity of the crisis sooner and said charities and West African governments alone do not have the capacity to stem the outbreak.

The US Centers for Disease Control and Prevention [CDC] director Tom Frieden, who returned on Mon [12 Sep 2014] from a week-long trip to the countries hardest hit by the epidemic -- Liberia, Sierra Leone and Guinea -- said he was shocked by how rapidly the disease is spreading.

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[3] Military medical help called for, rejected
Date: 2 Sep 2014
Source: Ottawa Citizen [edited]
http://www.ottawacitizen.com/health/cal ... story.html?


International president of Medecins Sans Frontieres [MSF, Doctors Without Borders] Dr Joanne Liu recently returned from touring treatment facilities MSF is operating in Guinea, Sierra Leone and Liberia, which are engulfed in the worst EVD outbreak on record. ... It is ... indicative of how dire conditions are in West Africa that Liu called on governments to deploy [military] expertise on Tue [3 Sep 2014] when she addressed a special EVD briefing for the United Nations.

***Without this help, Liu said, this outbreak will not stop. [ProMED emphasis]

"To curb the epidemic, it is imperative that states immediately deploy civilian and military assets with expertise in biohazard containment," she told the UN. "I call upon you to dispatch your disaster response teams, backed by the full weight of your logistical capabilities. ... Without this deployment, we will never get the epidemic under control."

Desperate times call for desperate measures. "This just tells you the extraordinary scale of this outbreak on the ground," says Dr Ross Upshur, an ethicist and global health expert who teaches at the University of Toronto's Dalla Lana School of Public Health. "If MSF is willing to countenance assistance from military sources with the provisos they've already put in place, that just tells you how serious the situation is on the ground."

***The caveats Liu laid out were that any military assets and personnel deployed to the EVD zone should not be used for quarantine, containment, or crowd control measures. [ProMED emphasis]

Michael Osterholm, head of the Center for Infectious Diseases Research and Policy at the University of Minnesota, applauded the MSF call, saying the military expertise with logistics, supply chains, transportation of goods and personnel are needed in this situation. "MSF continues to provide the most honest, blunt and informed assessment of where we're at, not just in terms of how bad it is, but what do we actually really need to do to contain it," Osterholm says.

Should Canada deploy DART, its Disaster Assistance Response Team, which is often sent in response to natural disasters abroad? As of late last week, sources suggested a DART deployment was not being considered. And late Tue [2 Sep 2014], the government suggested it hadn't been asked for this type of help, "at least not by countries battling EVD. Canada has not received a request from affected countries to send in the Disaster Assistance Response Team," department spokeswoman Beatrice Fenelon said via email. Stephen Cornish, executive director of MSF Canada, says the organization had been in ongoing discussions with the Canadian government about assistance it could offer. It and others must step up their efforts, he insists.

***And that means countries that have medically staffed field hospitals with isolation units should send them to West Africa. [ProMED emphasis]

The EVD outbreak needs a stronger response than UN and non-governmental organizations are able to provide, Cornish says. "It needs the response of states to have such independent capacities, and it needs their buy-in, their action, as well as the WHO's overall vision in order to co-ordinate this across West Africa. And we're really not seeing that," he says. MSF has been calling for assistance for some time. The treatment facilities it has opened have been overwhelmed, treating far more patients than they have beds. The organization has said it can't staff more facilities and has asked others to step into the breach. So far it is still waiting.

Few countries have offered assistance, and those that have, like Canada, are providing support services such as running diagnostic labs. Useful, welcome, but not enough, Cornish says. "We don't only need diagnostics, and we don't only need education."

***"We need increased bed capacity now. We're turning away patients who are sick because they're not sick enough, because the wards are overflowing with patients," he says. [ProMED emphasis]

In some MSF treatment centres, medical personnel are no longer able to provide intravenous medication and can only offer palliative care. "This is far from enough," Cornish says. "It's unjust to those who are sick; it's unfair to the medical personal that we're putting on the front line, and it will be completely ineffective in getting ahead of this epidemic."

The World Health Organization says there have been at least 3070 cases of EVD in this outbreak and 1552 deaths. Those figures exceed all previous known Ebola cases and deaths combined.

[byline: Helen Branswell]

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[4] USA: Military help premature
Date: 3 Sep 2014
Source: Fox News [edited]
http://www.foxnews.com/health/2014/09/0 ... ew-region/


A senior US official rebutted a call from medical charity Medecins Sans Frontieres (MSF) for wealthy nations to deploy specialized biological disaster response teams to the region. MSF on Tue [2 Sep 2014] had warned that 800 more beds for EVD patients were urgently needed in the Liberian capital Monrovia alone.

"I don't think at this point deploying biological incident response teams is exactly what's needed," said Gayle Smith, special assistant to the president and senior director for development and democracy on the National Security Council. She said the US government was focusing efforts on rapidly increasing the number of EVD treatment centers in affected countries, providing protective equipment and ensuring local staff received training.

"We will see a considerable ramp-up in the coming days and weeks. If we find it is still moving out of control, we will look at other options," Smith told a conference call.

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[5] Vaccine trial UK
Date: 3 Sep 2014
Source: IFL Science [edited]
http://www.iflscience.com/health and medicine/why we need volunteers first human ebola trials


... At the Jenner Institute in Oxford [UK], we will run the 1st phase I trial of a vaccine targeted at the Zaire strain of ebolavirus that is causing the current outbreak. The main purpose of this 1st-in-humans trial in the UK is to establish a detailed safety profile of the vaccine and assess the type of immune responses it induces before it could be considered for widespread use. A further goal is to identify the most suitable dose of the vaccine. The vaccine is being co-developed with GlaxoSmithKline (GSK) and the US National Institutes of Health, who are running parallel human phase I trials in the USA. Our trial is being funded with a GBP 2.8 million [USD 4.6 million] grant from the Wellcome Trust, the Medical Research Council, and the UK Department for International Development.

The candidate vaccine in question uses a chimpanzee adenovirus (a type of respiratory virus) as a means to expose or prime the immune systems of volunteers to a specific protein that exists on the surface of the ebolavirus. The vaccine contains some genetic material but not the entire ebolavirus genome so it cannot cause an EVD infection. As with the US trial, the adenovirus also will not replicate but instead prompts the person vaccinated to express an ebolavirus vaccine that the immune system will later recognise if the person became infected.

Previously, it has been tested in animal models and has demonstrated impressive effectiveness at protecting against infection and promoting recovery from animals later exposed to ebolavirus. Just a single dose was required to induce very high levels of protective efficacy. Chimpanzee adenoviruses have been used extensively in clinical trials for malaria, hepatitis C and other infections, but no vaccine of this type has been licensed as yet. In the 25 clinical trials of chimpanzee adenoviruses that have taken place, the safety profile of this type of vaccine has been good.

At present, ethical and regulatory approvals are being prioritised so that the trials may begin in the UK in September 2014. This will be run in parallel with a cohort in the USA and extended to The Gambia and Mali thereafter, subject to agreements on ethical and clinical protocols. At the same time, 10 000 vaccine doses will be stockpiled by GSK in order that, should the vaccine meet safety requirements, it may be deployed without any further delays.

The candidate vaccine will be tested in 60 healthy volunteers over the age of 18 who we will shortly begin recruiting. During the trial, volunteers will be administered a single dose of the vaccine into the muscles of the upper arm, and blood samples will be taken at specific time points. In all, volunteers will be expected to attend for a total of 9 clinic visits over 6 months. Clinical trials are an essential part of the vaccine development process and invaluable tools when it comes to understanding and ultimately improving the processes that provide vaccine-mediated protection from disease. In order to gain the upper hand over EVD, we need all the help we can get.

[byline: Claire Tully, Adrian Hill]

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[***MSF says it can't staff more facilities and has asked others to step into the breach. So far it is still waiting. "We need increased bed capacity NOW. We're turning away patients who are sick because they're not sick enough, because the wards are overflowing with patients." With the latest spread in Nigeria, it looks as though any delay in aid may come too late. Volunteers need at least 3 weeks preparation before deployment for vaccinations against tropical diseases to take effect and for orientation and briefing.

TO VOLUNTEER, go to: http://www.doctorswithoutborders.org/wo ... plying-msf and see [5] EVD information for volunteers in http://www.promedmail.org/direct.php?id=2725060.

***Daniel Lucey MD MPH, Connaught volunteer, says: "Persons cured of EVD are underappreciated. Many persons have been cured: some could help care for the ill." This is a very important observation. He also says: "[There is need for] more testing and isolation centres, and they need more beds NOW. There are ZERO treatment centres in Freetown." - Mod.JW

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

[Alexander]

Sierra Leona verhängt eine viertägige Ausgangssperre. Niemand darf die Häuser verlassen. Mit dieser drastischen Massnahme versucht das Land die Ebolaseuche unter Kontrolle zu bekommen.

Sierra Leone verhängt viertägige Ausgangssperre

Sierra Leone trifft im Kampf gegen die Ebola-Seuche eine drastische Maßnahme: Vier Tage lang müssen die Bürger des westafrikanischen Landes zu Hause bleiben. Soldaten und Polizei sorgen für die Einhaltung der Ausgangssperre. mehr...

Grüsse
Alexander

[Alexander]

Ebola hat München erreicht!

Wirklich? Natürlich nicht. Gestern geisterte diese Meldung durch die Münchner Presse. Ein Somali hatte sich am Münchner Hauptbahnhof erbrochen. Irgendjemand hatte einer Redaktion die Nachricht geschickt, dass am Bahnhof ein Ebolainfizierter aufgetaucht sei. Aus welcher Quelle die Falschinformation stammt, war nicht mehr nachvollziehbar. Der Bahnhof wurde vollständig abgesperrt.

Eine Falschnachricht scheint sich schneller zu verbreiten als Ebola selbst. Der Virus ist gefährlich. Das wissen wir. Noch gefährlicher aber sind Falschinformationen und Panik.

Grüsse
Alexander

[Birgitt]

EBOLA VIRUS DISEASE - WEST AFRICA (151): WHO, UN, AFRICAN UNION
***************************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

[This is by no means a complete roundup of "all the news that's fit to print" about EVD, but a selection from the avalanche of reports of what this moderator considers most important from a public health point of view. - Mod.JW]

In this update:
[1] WHO update
[2] WHO detailed situation report 5 Sep 2014
[3] UN press conference: 3 key points
[4] African Union to deploy humanitarian mission
[5] Call for leadership
[6] Liberia: doctor evacuated to USA
[7] Media reports

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[1] WHO update
Date: 4 Sep 2014 [as of 31 Aug 2014]
Source: WHO Disease outbreak news [edited]
http://who.int/csr/don/2014_09_04_ebola/en


Recognizing the demand for updated numbers from this outbreak, the following information is being released in advance of the 2nd update of this situation report.

As of 31 Aug 2014, 3685 (probable, confirmed and suspected) cases and 1841 deaths have been reported in the current outbreak of Ebola virus disease by the Ministries of Health of Guinea, Liberia and Sierra Leone [about 600 new cases and 300 more deaths, or 100 new cases per day in the 5-6 days since the last WHO update (dated 28 Aug 2014 with data as of 26 Aug 2014). Note that the media tend to note the release date rather than the "as of" date. - Mod.JW].

- Nigeria, 21 cases and 7 deaths
- Senegal, one case has been confirmed, and there have been no EVD deaths or further suspected cases.

Data reported in the Disease Outbreak News are based on official information reported by ministries of health. These numbers are subject to change due to ongoing reclassification, retrospective investigation and availability of laboratory results; widespread and intense transmission as of 31 Aug 2014.

[Table with detailed country data here]

Note: A separate outbreak of Ebola virus disease, which is not related to the outbreak in west Africa, was laboratory-confirmed on 26 Aug 2014 by the Democratic Republic of Congo (DRC). Information on this outbreak is provided in separate editions of the Disease Outbreak News [and in a separate ProMED thread: EVD - Central Africa].

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[WHO, in its latest report issued on Fri 5 Sep 2014 afternoon, said the total number of EVD cases now stands at 3944 and deaths recorded at 1759 in Guinea, Liberia and Sierra Leone, countries identified as "those with widespread and intense transmission". The fatality rate is 53 per cent. It ranges from 39 per cent in Sierra Leone to 64 per cent in Guinea. - Mod.JW]

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[2] WHO detailed situation report 5 Sep 2014
Date: 5 Sep 2014
Source: WHO [edited]
http://www.who.int/csr/disease/ebola/5- ... 014-en.pdf


[This full of useful maps, charts and graphs. Excerpts follow...]

The outbreak continues to expand geographically. For the 1st time since the outbreak began, the majority of cases (55.3 per cent) have been reported outside Gueckedou and Macenta (Guinea); Lofa (Liberia), and Kenema and Kailahun (Sierra Leone); 3 districts in Guinea have been affected for the 1st time.

The outbreak continues to escalate. Most cases are concentrated in only a few places: more than 80 per cent of cases have occurred in 9 out of the 42 districts in Guinea, Liberia, and Sierra Leone that have reported cases... The overall case fatality rate (ratio of deaths to cases) is 53 per cent. It ranges from 39 per cent in Sierra Leone to 64 per cent in Guinea.

There are still critical shortages of EVD treatment beds in Guinea, Liberia, and Sierra Leone, the 3 countries that have intense and widespread transmission. In the past week, an additional 40 beds have been established by Medecins Sans Frontieres (MSF) in Monrovia; a further 40 beds will soon be available in Bong, Liberia. Total EVD Treatment Centre bed capacity for these 3 countries are: Guinea, 130; Liberia, 314; and Sierra Leone, 130. Another 170 beds are expected to be available soon in Sierra Leone.

Based on current capacity and needs, an additional 980*** EVD treatment centre beds are required, with 760 of these in Monrovia alone. [ProMED-mail emphasis]

In Nigeria, contact tracing is under way, with more than 400 contacts being followed in both Lagos and Port Harcourt; 3 cases are currently in isolation. All cases and contacts can be traced back to the initial case.

In Senegal, the identified case is currently in isolation, with 67 contacts being followed.

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<ryan@bigstormpicture.com>

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[3] UN press conference: 3 key points
Date: 3 Sep 2014
Source: UN [edited]
http://unfoundationblog.org/un-press-co ... e-to-ebola


On Wed [3 Sep 2014], senior leaders from the United Nations updated media on the response by the UN and its agencies to the EVD crisis, which has caused about 1900 deaths in West Africa. Dr Margaret Chan, director-general of the World Health Organization (WHO), Dr David Nabarro, senior UN system coordinator for Ebola [virus] disease, and Dr Keiji Fukuda, WHO's assistant director-general for health security provided information on WHO's Ebola [Virus Disease] Response Roadmap and what needs to be done to bring the outbreak under control and save lives.

Here are 3 key points on the response:

1. This is a complex, multi-faceted challenge that requires a robust response. Dr Chan began the press conference by noting that this outbreak is the largest, most complex, and most severe in EVD's history. To respond, affected countries need
- more trucks and motorcycles to transport patients,
- more beds to host them,
- more protective materials and equipment,
- and particularly, more health care workers to treat patients.

In addition, steps need to be taken to strengthen the economies and primary health care systems in countries where they are strained because of EVD.

2. The EVD crisis is a global problem that requires a global solution. In our connected world, disease outbreaks don't stop at borders. The countries affected by EVD are leading the response to contain the outbreak, but the international community must step up its efforts to support them now. Additional technical expertise and resources are desperately needed. The price tag for the response is estimated to cost USD 600 million and may go higher.

In addition, we need to make sure EVD patients and EVD-affected countries aren't stigmatized and isolated. Measures like stopping flights to and from countries with widespread transmission are counterproductive, making it hard for aid [including aid workers] to get to where it's needed.

3. The EVD outbreak can be stopped, but the response must be urgently scaled up. UN leaders believe EVD can be stopped, and the roadmap released by WHO aims to stop transmission in 6-9 months. But the international community must act now to increase the global response. As Dr. Nabarro said, we can't afford to lose a day.

[byline: Jenni Lee]

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[4] African Union to deploy humanitarian mission
Date: 3 Sep 2014
Source: All Africa [edited]
http://allafrica.com/stories/201409031603.html


In an unprecedented step, the 1st of its kind in the history of the African Union (AU), the Peace and Security Council (PSC) has decided to deploy a humanitarian mission to help end the outbreak of the deadly ebolavirus, ... mandating "the immediate deployment of an AU-led military and civilian humanitarian mission, comprising medical doctors, nurses and other medical and paramedical personnel, as well as military personnel, as required for the effectiveness and protection of the mission." ...

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[5] Call for leadership
Date: 4 Sep 2014
Source: Washington Post editorial [excerpted, edited]
http://www.washingtonpost.com/opinions/ ... story.html


We are about to witness a human catastrophe that could destroy large portions of a continent and pose a global threat. And the response of the world, including the USA, is feeble, irresponsible and disrespectful of nature's lethal perils. ...

Once the growth of an outbreak becomes exponential, the tools normally at the disposal of health officials have limited value. It may require military airlifts just to deliver sufficient rubber gloves, aprons, soap and buckets to highly affected areas. Doctors Without Borders [MSF] is calling for the deployment of civilian and military medical teams to provide triage centers, field hospitals with isolation wards, mobile diagnostic labs and systems for the management of corpses. But who will direct and implement such an effort? The WHO is not an emergency response organization. ... The United Nations has no epidemic response force comparable to its peacekeeping operations (though perhaps it should). It is hard to imagine a coordinated effort on a sufficient scale that is not organized by the USA. ...

This is what should be happening: The White House should be instructing officials at the US Agency for International Development [USAID], the Centers for Disease Control and Prevention [CDC], and the National Institutes of Health [NIH] to come up with an ambitious plan on a blank chalkboard. The Office of Management and Budget [OMB] should be approaching House Republican leaders with a proposal to fund that plan, and the White House should be cultivating congressional champions for the measure. A continuing resolution to fund the government will be put together this month [September 2014]. If the Obama administration does not act quickly, it will lose its best chance at securing resources until December [2014]. But, so far, there is no ambitious plan. The OMB has not indicated it will ask for additional resources. ...

Health officials are near their wit's end. "I don't see any pathway that is easy to implement," one told me. Easy or hard, it is time for the United States to blaze a path out of this valley of death.

[byline: Michael Gerson]

[The situation is desperate. Let us hope this call is heeded. - Mod.JW]

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[6] Liberia: doctor evacuated to USA

3 Sep 2014: (Times Free Press) The 3rd US aid worker sickened with EVD is a Boston-area doctor who decided to return to Liberia after the 2 other [Americans] fell ill with the deadly virus, the president of his missionary group said Wed [3 Sep 2014]. Dr Rick Sacra went back to Liberia about a month ago and was not caring for EVD patients, instead delivering babies at the missionary group's hospital in Liberia, Serving in Mission (SIM) president Bruce Johnson said at a news conference. Sacra followed all protocols to protect himself. ...
http://www.timesfreepress.com/news/2014 ... rker-ebola

4 Sep 2014: (UNMC) The US State Department has asked for assistance from the Nebraska Medical Center and the University of Nebraska Medical Center in caring for an American doctor who was working in West Africa when he tested positive for ebolavirus.

Officials expect this patient to arrive in Omaha on Friday morning [5 Sep 2014] and to begin treatment in the Biocontainment Patient Care Unit located inside The Nebraska Medical Center. ...
[by: Taylor Wilson, Nebraska Medical Center; http://www.unmc.edu/news.cfm?match=15636]

3 Sep 2014: (Macleans) Experts say any fully-equipped hospital that follows the latest safety protocols could prevent a US outbreak while caring for an EVD patient, but there are 4 high-level isolation units in the USA designed especially to handle dreaded infectious diseases. The largest of the 4, with 10 beds, is at the Nebraska Medical Center in Omaha. Hospital officials there have been told to be ready to receive a patient. The 2 Americans were previously evacuated to Emory University Hospital in Atlanta and survived. The other 2 units are National Institutes of Health facilities in Maryland and Montana. http://www.macleans.ca/news/world/hospi ... d-to-ebola [excerpted]

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[7] Media reports

CDC: Press Briefing Transcript
---------------------------
2 Sep 2014: CDC telebriefing on the update on EVD outbreak in West Africa, Audio recording Audio/Video file [MP3, 9.15 MB]
http://www.cdc.gov/media/releases/2014/ ... break.html


Liberia: Asian workers
----------------------
4 Sep 2014: (CNA) Dr Yasuki Kato, [recently] returned from a 17-day mission in Monrovia as a member of the WHO mission ... said: "Generally, travellers cannot get infected with ebolavirus. But I notice Asian people working [in construction] in Liberia, including Chinese and Vietnamese...
http://www.channelnewsasia.com/news/jap ... 46598.html

[Although travellers and construction workers may not be in contact with patients, they are in daily contact with the local population, which includes people with fever who may be in the 1st stage of EVD. - Mod.JW]


UK: British nurse makes full recovery and leaves hospital
---------------------------------------------------------
3 Sep 2014: (The Week) William Pooley, who was given the experimental drug ZMapp, has been discharged from a London hospital. The 1st Briton to be infected with the deadly ebolavirus [in Sierra Leone], has made a full recovery according to his doctors. ...
http://www.theweek.co.uk/world-news/ebo ... z3CL2B02nn


Kenya: 2 suspected cases negative
---------------------------------
4 Sep 2014: (Xinhua) A patient was isolated on Wednesday night [3 Sep 2014] when reports claimed there was a passenger with EVD inside a Kenya Airways plane from DR Congo. ... A 10 year old Liberian boy was admitted at a hospital in Nakuru, about 180 km south west of Nairobi, with fever-like symptoms. ... Nakuru County chief officer for health Samwel Mwaura said that the tests conducted were both negative.
http://news.xinhuanet.com/english/afric ... 621667.htm

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["As Dr Nabarro said, we can't afford to lose a day." (UN press conference, above). Not now, with an average of 100 new cases and 50 deaths every day.

The case count passed the
- 1000 mark on 17 Jul 2014,
- 2000 mark on 13 Aug 2014 and
- 3000 mark on 26 Aug 2014.

In other words, it took 4 weeks for the 2nd 1000 cases to appear, but only 2 weeks for the next 1000. It's accelerating.

Plus, who knows how many are dying from other causes because they are frightened of going to hospital, or like one Indian missionary, for being turned away for lack of hospital floor space? WHO estimates 980 EVD treatment centre beds are required, with 760 of them in Monrovia alone.

Also, one estimate is that up to 4 times as many EVD sick are being cared for in homes and buried secretly from there. Given the need for 700 more EVD treatment beds in Monrovia, and the fall-off in trade by sea to its port, could not an empty warehouse be cleaned up and converted into a giant ward, as was done during the 1918-1919 Spanish flu epidemic in Europe? See photo: http://www.offthegridnews.com/wp-conten ... -flu-1.jpg. - Mod.JW

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/40192.]

[Birgitt]

EBOLA VIRUS DISEASE - WEST AFRICA (152): REGION, UN, NIGERIA, TESTS
*******************************************************************
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http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

[This is by no means a complete roundup of "all the news that's fit to print" about Ebola virus disease (EVD), but a selection from the avalanche of reports of what this moderator considers most important from a public health point of view. - Mod.JW]

***[Correction: WHO, in its latest report issued on Fri 5 Sep 2014 afternoon, said the total number of EVD cases then stood at 3944 and deaths at 1759 in Guinea, Liberia and Sierra Leone. But in the WHO Situation Report No. 2, also dated Fri 5 Sep 2014, the table titled "Total number of probable, confirmed, and suspected cases in Guinea, Liberia, and Sierra Leone as at 5 Sep 2014" shows total deaths as 2097. Thanks to Kunihiko Iizuka and another ProMED-mail subscriber for pointing this out. - Mod.JW]

In this update:
[1] EVD situation in West Africa
[2] UN statement
[3] Nigeria: containment essential
[4] Nigeria: Fake diagnostics, remedies
[5] Faster diagnostic test
[6] Prevention and suspected cases
[7] Media reports

******
[1] EVD situation in West Africa
Date: September 2014
Source: USAID [edited]
http://www.usaid.gov/ebola


How can I help?
---------------
The ongoing Ebola virus disease outbreak in West Africa is the largest and most protracted ever recorded and it shows no signs of waning as the affected countries have been unable to control the outbreak on their own.

Medical volunteers
------------------
We are appealing to the medical community in the USA for assistance with the West Africa Ebola virus disease outbreak. If you are a qualified medical professional and want to volunteer to work in West Africa, click here [http://www.usaid.gov/ebola/volunteers] to contact reputable organizations who are active in the EVD response through the Center for International Disaster Information (CIDI).

Donations
---------
If you wish to donate money to organizations responding to the West Africa Ebola outbreak, you can give to the Global Giving Ebola Epidemic Relief Fund [http://www.globalgiving.org/projects/eb ... lief-fund/].

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[Map of situation as of 3 Sep 2014 (before the case imported from Guinea to Senegal), showing functional and non-functional Ebola Treatment Centers and much other detail of labs, etc.: http://www.usaid.gov/sites/default/file ... 090314.pdf.

This appeal should go out to all countries, missionary societies and NGOs with qualified medical professionals, who can volunteer through the MSF (Medecins Sans Frontieres; Doctors Without Borders) website in their own country. - Mod.JW]

******
[2] UN statement
Date: Fri 5 Sep 2014
Source: UN [edited]
http://www.un.org/apps/news/story.asp?NewsID=48651


Secretary-general Ban Ki-moon today [5 Sep 2014] vowed to mobilize the United Nations in every possible way to respond to the EVD outbreak in West Africa and issued an "international rescue call" for a massive surge in assistance, warning that "the world can no longer afford to short-change global public health. The next few weeks will be crucial. The people of Guinea, Liberia and Sierra Leone in particular are looking to us for support. They are counting on us for a massive surge in assistance: more doctors, nurses and beds; more equipment, trucks and other vehicles."

The World Health Organization (WHO) announced today [5 Sep 2014] that experts taking part in a 2-day discussion on potential EVD therapies and vaccines identified several therapeutic and vaccine interventions that should be the focus of priority clinical evaluation at this time, including 2 "promising" EVD vaccines.

WHO assistant director-general Marie-Paule Kieny told a press conference in Geneva on the outcome of the experts meeting that it was not yet known if the therapies are 100 per cent safe or whether they will be effective. He added that their safety will be known in November 2014 and will be available for use in countries shortly after. Dr Kieny also noted that blood from EVD survivors might help those who are still infected and still sick to fight the virus. "We have agreed that whole blood therapies and convalescent serums may be used to treat Ebola virus disease," Dr Kieny told reporters. "This can be done in EVD-affected countries now," WHO tweeted, citing Dr Kieny.

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******
[3] Nigeria: containment essential
Date: Tue 2 Sep 2014
Source: AllAfrica, The Guardian report [edited]
http://allafrica.com/stories/201409040352.html


Nigeria: EVD management -- why virus must be contained in Rivers, by WHO
--------------------------------------------------------------------
If the Ebola virus disease (EVD) is not contained in Port Harcourt, Rivers State, there is a very high risk that it would spread rapidly to other parts of Nigeria and neighbouring countries, WHO has warned. Meanwhile, the state government said the EVD emergency response team has established contact with almost 96 per cent of people who had primary and secondary contact with the index cases, Mr Koye Olu-Ibukun and the late Dr Ike Enemuo. WHO country representative, Mr Rui Vaz, who is in Rivers State to assess its preparedness to combat the scourge and to offer technical assistance, told newsmen during a visit to the commissioner for health, Sampson Parker, that the biggest challenge at the moment was how to contain the spread.

According to him, EVD can be contained with the cooperation of everyone. Vaz, who was accompanied by other WHO officials, described Rivers as a very important economic point and one of the leading states in Nigeria that requires special attention. Vaz explained that right from the 1st day that WHO got wind of the outbreak in the state, a team of experts with vast knowledge in tackling virulent diseases was deployed to assist in setting up the EVD emergency operation centre -- now operational at Oduoha in Emohua local council [Rivers state]. According to him, WHO officials are presently in Rivers to help strengthen the surveillance system to ensure contract tracing and as well to help develop local capacity to tackle the outbreak. "The most important aspect in EVD control is early diagnosis of any suspect and to take necessary precautions in terms of the isolation needed and other measures that can stop the chain of transmission," he said. Vaz disclosed that WHO has commenced the process of training private hospital operators to ensure proper management of any case, noting that the training had become imperative because 69 per cent of the cases in Lagos were medical workers ... [more]

[byline: Kelvin Ebiri]

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[Reportedly, 50 contacts have already left Rivers state and are now in neighbouring Abia state. - Mod.JW]

******
[4] Nigeria: Fake diagnostics, remedies
Date: Thu 4 Sep 2014
Source: International SOS [edited]
https://www.internationalsos.com/ebola/ ... age_id=ENG


Health officials in Lagos have warned the public not to rely on ebolavirus testing kits available in the market. It has been found that fake testing kits are being sold that claim to show very quick results (in about 10 minutes). Officials also clarified that as of now, ebolavirus testing kits are not being manufactured. Reliable testing can be done only at officially designated diagnostic centres.

[It's a sad situation, profiteering from an epidemic. - Mod.JW]

Date: Thu 4 Sep 2014
Source: The Sun News [edited]
http://sunnewsonline.com/new/?p=80264


A consultant at the Lagos University Hospital (LUTH), Idi-Araba, Professor Adebukola Ositelu, has said Ewedu, ‎which is known in English as the long-fruited vegetable, is capable of preventing and curing the Ebola virus disease (EVD) by boosting the immune system ... [more]

[byline: Azoma Chikwe]

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[This kind of statement, by a professor of ophthalmology, is not only irresponsible but dangerous, because it gives gullible people false hope and may lead them to ignore proper precautions. - Mod.JW]

******
[5] Faster diagnostic test
Date: Tue 2 Sep 2014
Source: International Business Times [edited]
http://www.ibtimes.com/ebola-outbreak-j ... us-1675502


Japanese scientists said Tuesday [2 Sep 2014] that they have developed a new test that could detect the ebolavirus in 30 minutes, with the help of a technology they claim is faster and cheaper than the current method being used in West Africa.... Eiken Chemical Co., along with researchers at Nagasaki University, reportedly created the new testing method, which can be conducted with a "small, battery-powered warmer," making it ideal for use in places without an adequate power source, the scientists claimed. The current test requires "[expensive] dedicated equipment and a stable supply of electricity," according to a local report.

"The new method is simpler than the current one and can be used in countries where expensive testing equipment is not available," Jiro Yasuda, a professor at Nagasaki University, told Agence France-Presse (AFP). "We have yet to receive any questions or requests, but we are pleased to offer the system, which is ready to go," he reportedly said. Yasuda and his team at the university have reportedly created what they called a "primer," which magnifies only those genes specific to ebolavirus found in a blood sample or any other fluid in the body. If ebolavirus is present, the action of the primers distinguishes DNA specific to the deadly virus in 30 minutes.

Currently, a technique called polymerase chain reaction, or PCR, is being used to detect the ebolavirus. The PCR method takes up to 2 hours as doctors need to heat and cool the blood samples repeatedly to complete the procedure. "The ... entire system costs just tens of thousands of yen [a few hundred USD], which developing countries should be able to afford," Yasuda said, according to AFP.

[byline: Suman Varandani@suman09]

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[This system needs to be independently validated in the field in direct comparison with the PCR test. - Mod.JW]

******
[6] Prevention and suspected cases


Guinea-Bissau: weakness of preventive measures
----------------------------------------------
3 Sep 2014: (ANGOP) Inhabitants of the eastern regions of Guinea-Bissau are concerned about the "weakness of measures" to prevent the ebolavirus in the zone where authorities.... The concern was reported on Wednesday [3 Sep 2014] by a RDN (state broadcaster) citing cases where people have recently entered the border at Burumtuma, a Guinea locality situated a few meters from the Guinea-Conakry border. "A military officer who was on duty in Guinea ... entered Guinea-Bissau at Burumtuma, where he rented a car for Gabu, giving a ride to a lady," said the correspondent RDN, Adulai Bobo Cisse. According to the journalist, in Bafata, another eastern city, people are reporting situations of people in the border paying a "bribe" to border guards to let them pass, contrary to government guidelines. The people and the military officer who traveled from Burumtuma to Gabu are in quarantine in a space outside the regional hospital, said the journalist Bobo Cisse. The hospital director says there is not enough space in the hospital. "This quarantine that is not quarantine is worrying. From the back of the house where they were placed there's a makeshift market selling goats. About 20 meters away there is a place where they sell food and drink," a person from Gabu reported to Bobo Cisse. The house where 3 people were placed in "quarantine" has no drinking water, no bathroom and the bedroom windows have no glass. Another person says that the individuals can receive family visits.
http://www.portalangop.co.ao/angola/pt_ ... 85f22.html [in Portuguese, machine trans., revised by Mod.JW]

[If the above report is true, Guinea-Bissau is very vulnerable to importation of EVD. See map at http://geology.com/world/guinea-bissau-map.gif. - Mod.JW]

Cambodia: tightened control measures for visitors at international borders
------------------------------------------------------------------
2 Sep 2014: (DAP News) The Cambodian Ministry of Health has tightened its control measures for all visitors to Cambodia at international borders to prevent the transmission of ebolavirus ...
http://www.dap-news.com/2011-06-14-02-3 ... 26-05.html [in Khmer, transl., edited]

Israel
------
5 Sep 2014: (IBT) Medical officials in Israel were testing a Nigerian woman for a possible case of Ebola Friday [5 Sep 2014] after she was admitted to a hospital with a fever. The woman, identified as a health worker in Nigeria, arrived in Israel several days ago, Reuters reports. Doctors have placed her under quarantine as a precaution ... [more]
http://www.ibtimes.com/ebola-israel-nig ... ne-1680058

Italy: negative and suspected
-----------------------------
3 Sep 2014: 2 people have been quarantined in the northern Italian city of Padua.... An Italian woman was cleared of EVD in Turkey (26 Aug 2014).
http://www.thelocal.it/20140903/ebola-t ... d-in-padua

Kenya: 2 suspected cases negative
---------------------------------
4 Sep 2014: (Xinhua) A patient was isolated on Wednesday night [3 Sep 2014] when reports claimed there was a passenger with EVD inside Kenya Airways plane from DR Congo.... A 10 year old Liberian boy was admitted at a hospital in Nakuru, about 180 km [about 112 miles] south west of Nairobi, with fever-like symptoms.... Nakuru County chief officer for health Samwel Mwaura said that the tests conducted were both negative.
http://news.xinhuanet.com/english/afric ... 621667.htm

Poland
------
5 Sep 2014: (Xinhua) Polish press (PAP) reported on Friday evening [5 Sep 2014] about a suspected case of ebolavirus in the Polish seaside town of Gdynia. The man suspected of being infected had the symptoms of the disease, but he seems to have malaria instead. The man, who is of Nigerian origin, has been living in Poland for 10 years, but recently travelled to his native country. He reported to the Gdynia University Center for Maritime and Tropical Medicine and was taken to the Hospital for Infectious Disease soon after. The case cannot be ultimately confirmed until all of the necessary patient's examinations results are assessed ... [more]
http://www.shanghaidaily.com/article/ar ... ?id=239647

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******
[7] Media reports


CDC: press briefing transcript
------------------------------
2 Sep 2014: CDC telebriefing on the update on EVD outbreak in West Africa
Audio recording [MP3 file]
http://www.cdc.gov/media/releases/2014/ ... break.html

Liberia: Asian workers
----------------------
4 Sep 2014: (CNA) Dr Yasuki Kato, has returned from a 17-day mission in Africa. He was based in the Liberian capital of Monrovia as a member of the WHO mission.... When asked about the possibility of EVD reaching Asia, he said: "EVD is transmitted through direct contact with blood and body fluids of patients. Generally, travellers cannot get infected with ebolavirus. But I notice Asian people working in Liberia, including Chinese and Vietnamese. They're taking part in the construction of power plants, bridges and roads in Liberia. If they return to their home countries and develop a fever, we should be vigilant." Dr Kato himself is under observation and needs to take his temperature every day.
http://www.channelnewsasia.com/news/jap ... 46598.html

[Although travelers and construction workers may not be in contact with patients, they are in daily contact with the local population, which includes people with fever who may be in the 1st stage of EVD. - Mod.JW]

UK: British nurse makes 'full recovery' and leaves hospital
-----------------------------------------------------------
3 Sep 2014: (The Week) William Pooley, who was given the experimental drug ZMapp, has been discharged from a London hospital. The 1st Briton to be infected with the deadly ebolavirus [in Sierra Leone] has made a full recovery, according to his doctors. The 29 year old nurse from Suffolk was being treated in a specialist isolation centre in north London's Royal Free Hospital. His doctors say he is no longer infectious and poses "no risk to the wider community in any way". Doctors are still unable to determine whether [ZMapp] was directly responsible for his recovery, as patients can get better naturally. However, "levels of the virus in his bloodstream did fall significantly" following the treatment, reports the BBC's health editor James Gallagher ... [more]
http://www.theweek.co.uk/world-news/ebo ... s-hospital

West Africa: border controls hinder cocoa harvest
-------------------------------------------------
5 Sep 2014: (BBC) It is almost harvest time for cocoa in West Africa, a crop that plays a major role in some of the region's big economies -- most notably that of Ivory Coast [Cote d'Ivoire] and Ghana. However, the current EVD outbreak has meant the border between Liberia and Ivory Coast has been closed. This is causing a problem for Ivory Coast's cocoa farmers because many of the workers who harvest the cocoa come from Liberia.
http://www.bbc.co.uk/news/business-29079735

[This will push up the world price of chocolate -- only a minor consideration in world commodity markets. - Mod.JW]

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A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/62.]

[Birgitt]

EBOLA VIRUS DISEASE - WEST AFRICA (153): HOSPITAL SHIPS
*******************************************************
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Date: Sat 6 Sep 2014
From: Gerhard Boecken <gerhard.boecken@t-online.de> [edited]


Thanks a lot for these always valuable summaries and comments on the Ebola catastrophe! Appreciated!

I know this is not a discussion group, but I would like to comment on the following:

The suggestion from MSF [Medecins Sans Frontieres] -- an organization which always avoided cooperation with the military in the field -- to bring in military medical support is a striking paradigm shift and it shows again the gravity of the situation.

The window of opportunity to contain the outbreak is closing fast -- as somebody commented quite impressively, but the international community is not reacting appropriately. Everybody is staring at the IS [Islamic State] terror and the Ukraine crisis, probably also because there is not the usual dramatic media coverage with shocking reports as the press people simply fear to go to the scenes [in West Africa] or are not allowed to, or simply can't go due to missing transport options.

I remember very well the international reaction to the tsunami in Banda Aceh [Indonesia] in 2004 where, after the wave was through, rapid deployable military field hospitals were falling over themselves in order to help the few injured survivors. After 4 weeks even the US Navy hospital ship Mercy arrived with 1000 beds.

As efficient NGOs like MSF are surrendering on the ground, pleading for more help, this disaster can only be stopped by military medical services, highly organized with rapid deployment capabilities, effective and fast logistics, command and control and the material ready to be deployed.

Medical services of western defense forces could enter under a humanitarian aid mandate of the UN. For example, the German Military Medical Service has been training its personnel for 15 years in barrier nursing, [and would] easily able to increase the capacity, political willingness permitting. [Also,] the US Navy hospital ships Mercy and Comfort could provide the urgently needed beds while dropping anchor at one of the iron piers in Monrovia [Liberia] harbor or ashore in Freetown [Sierra Leone].

Is anybody discussing these options? If not, why not? Does anybody have other proposals?

--
Dr Gerhard Boecken
Regional Medical Advisor
German Foreign Office
German Embassy Nairobi/Kenya
<gerhard.boecken@t-online.de>

[A good map of the Ebola virus disease (EVD) situation in West Africa as of 3 Sep 2014 (before the case imported from Guinea to Senegal), showing functional and non-functional Ebola Treatment Centers and much other detail of labs, etc, is at http://www.usaid.gov/sites/default/file ... 090314.pdf.

I believe ProMED should make an exception and start a discussion on rapid response to the EVD pandemic (still euphemistically referred to as just an "outbreak" in some places). Many health authorities worldwide are subscribed to ProMED, and maybe we could hear all the reasons why field hospitals and hospital ships haven't been deployed weeks ago, besides "We haven't been asked". It would be valuable training for biodefense responders. - Mod.JW (My personal view, not necessarily that of all the ProMED team)

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/40192.]

[kro]

Bis jetzt war Ebola eine exotische Krankheit, weit weg von mir. Leider muss ich mich jetzt doch etwas naeher dmait beschaeftigen und bin etwas ueber die Angaben zur Ueberlebenswahrscheinlichkeit verwirrt: An einigen Stellen heisst es, dass die Sterbensrate bei 90% liege - gestern hat man mir jedoch erklaert, dass sie tatsaechlich bei etwa 50% sei. Welche Angabe ist hier realistisch?

Ist schwer über einen Kamm zu scheren um eine "einfache" Antwort zu geben. Es hängt von einer Vielzahl an Faktoren ab:

- Virus-Stamm (wie von Alexander bereits angemerkt)
- Allgemeine Gesundheit (Ein so oder so geschwächtes Immunsystem, z.B. durch HIV oder andere Krankheiten, hohes Alter etc, wird kaum in der Lage sein, den Ebola-Virus zu bekämpfen)
- (möglichst frühe Erkennung und) Behandlung - auch wenn es gegen das Virus selbst kein (bestätigtes/zugelassenes) Gegenmittel gibt, kann durch symptomatische Behandlung (fiebersenkende Mittel, Rehydrierung notfalls auch per Tropf) erreicht werden, das die körpereigene Abwehr mit dem Virus klarkommt.

Bei der WHO gibt es faktische Zahlen in den "Situation Reports", z.B. der aktuellste hier. Insgesamt ist die Sterberate bei der aktuellen Epidemie in Westafrika bisher 53% (also 47% Überlebende), mit regional starken Unterschieden.

Königsweg ist wie immer die Vermeidung einer Ansteckung - anders als oft in den Medien kolportiert wird ist es gar nicht so einfach sich mit Ebola anzustecken. Als durchreisender Tourist müsste man sich schon sehr anstrengen...

Gruß,
Felix

[Kuno]

Dankeschoen, Felix. Deine Angaben sind sehr hilfreich.
Aus Nigeria wurde heute gemeldet, dass 10 Krankheitsfaelle wieder geheilt sind.

[Birgitt]

EBOLA VIRUS DISEASE - WEST AFRICA (154): HOSPITAL SHIPS, MILITARY LOGISTICS
***************************************************************************
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In this update:
[1] Military transport, logistics
[2] Hospital ships

******
[1] Military transport, logistics
Date: 6 Sep 2014
From: Laurie Garrett <lgarrett@cfr.org> [edited]


Re: Ebola virus disease - West Africa (153): hospital ships
-------------------------------------
Some of the issues in this post are discussed in today's Foreign Policy [6 Sep 2014]: http://www.foreignpolicy.com/articles/2 ... ganization.

As you know, the AU [African Union] is sending in military personnel, though numbers and skills are unknown. The Canadian military has declined. DoD [US Dept. of Defense] is still mulling its role. There are many reasons for hesitation on the US's part, some of which I alluded to in the above cited piece.

--
Laurie Garrett
Senior Fellow for Global Health
Council on Foreign Relations
58 East 68th Street, New York, New York 10065
<lgarrett@cfr.org>

[Excerpts: "Nearly all commercial airlines and air delivery companies have stopped flights to and from the 3 Ebola-stricken nations, and many have halted services across all of West Africa. As a result, personnel and supplies cannot get into the area, and exhausted health volunteers desperate for a break cannot get out. ... Happily, the government of Ghana has agreed to make Kotoka International Airport in Accra an air bridge for Ebola responses, allowing large aircraft from all over the world to land at Kotoka and smaller planes to shuttle personnel and supplies in and out of areas of need in the region. The WHO will assure that screening is in place at all of the region's airports to ensure that no ailing individuals fly to Ghana."

"While this is a long-overdue beginning, the air bridge -- if it is to come close to meeting the needs in the Ebola-stricken areas -- will require military-scale logistics and support. Having landing rights is only step one: Knowing where to warehouse goods, tracking their fate, loading secondary aircraft with proper destinations, and ensuring absence of theft are massively complex activities; just ask FedEx. Given the positive relations between Washington and Accra, it seems logical that the U.S. Air Force should supply transport flights and personnel, as well as warehousing and logistics support at Kotoka. ..."

"It seems unlikely that hundreds of commercial pilots, cargo handlers, and flight crew will volunteer to fly in and out of Liberia, Sierra Leone, Guinea, and even, if conditions worsen, Nigeria. Military pilots and crew, in contrast, often volunteer for dangerous missions. Supplies of everything from basic food for the people of Monrovia's slums to advanced medical equipment are desperately needed, and demand for everything will grow in tandem with the size of the epidemic. The U.S. military has the most sophisticated mobile response capacity and experience in the world. ... MSF can see the benefits of putting those medical boots on the ground. Washington officials say off the record that options for U.S. military assistance are under consideration and may be announced in a few days."

"But beyond bringing in military personnel to handle the logistics and air bridge support, the presence of uniformed foreign military personnel risks feeding conspiracy theories that already surround this epidemic. The classic canard of every modern epidemic -- that the germ was made or distributed by the CIA -- is already circulating in these countries. The existing "uniform" of hoods, gloves, goggles, and protection suits has already sparked anger and suspicion. A visible foreign military presence could not only fuel further suspicion but fan Islamist claims in Nigeria that infidels are contaminating vaccines."

"Any non-indigenous military use must be carefully considered, weighing the tremendous professional skills and experience combat medics could bring to the epidemic fight against potential blowback from conspiracy-mongers and Islamists."

The whole article is well worth reading. Garrett makes a strong case for military intervention by the USA with transport and logistics, while mentioning some of the potential problems with it. There are also formidable political constraints. - Mod.JW]

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******
[2] Hospital ships
Date: Sun 7 Sep 2014
From: Leonard Peruski <lperuski@iun.edu> [edited]


Re: Ebola virus disease - West Africa (153): hospital ships
---------------------------------------
Dr Boecken makes a good point about the MSF request for military medical support along with an "air bridge" for logistics and triage. As a former officer in the US Navy, here are a few points for practical consideration:

1st for hospital ships, only 2 nations have ocean-going and operational hospital ships: the USA (USNS Mercy and USNS Comfort) and China (PLAN Daishandao). Mercy and Comfort have 1000-1200 beds each; Daishandao has about 300-400 beds.

The next consideration is security and permission from the host countries. The military forces of Europe and North America are capable of medical support but do not deploy unless there is a request from the host nation desiring the aid and will not deploy without a significant security force. There are similar requirements for the military medical forces of Russia, China, Australia and Japan. To the best of my knowledge, such a request has not been sent by any nation affected by the outbreak.

A final consideration is which nations can conduct a sustained "air bridge" for logistics and medical triage. At this juncture, there is only a single nation with sufficient resources and "lift capacity" to conduct such a sustained mission, and again, this would require a considerable security force to be on the ground in the nations affected by this tragedy.

--
Leonard F. Peruski, PhD, MSc
Regional Director, Division of Global Health Protection
Director, Global Disease Detection Regional Center
US Centers for Disease Control and Prevention
Central American Region Office (CDC-CAR)
Guatemala
<lperuski@cdc.gov>

[USNS Mercy arrived in San Diego, California, USA from Hawaii on 9 Aug 2014: http://www.marinetraffic.com/pt/ais/det ... USNS_MERCY. Perhaps Dr Peruski could tell us where its next port of call will be, and the date, and if rescheduled, how many weeks it would take to reach Monrovia or Liberia?

What has been mentioned already in the media, but not yet as the deal-breaker, is that the key to controlling Ebola is changing human behaviors. As Garrett writes in [1] above: "There are 2 factors contributing to the rate of spread: the genetic capacities of the virus itself and the behaviors of human beings that put them in contact with one another, thereby passing the virus."

These include the attitude towards disease (witchcraft, denial), trust in herbal and other useless remedies, distrust of government and foreign aid workers (blamed for introducing the disease in the 1st place), ritual burial practices, attitude towards quarantine of apparently healthy contacts, and culpable irresponsibility of people who know they are infected but go around contaminating others (even doctors).

These can't be changed overnight. And before blaming uneducated Africans living in interior forest areas for those attitudes, many of the same attitudes are shown by westerners; for example: failure by householders of dengue-infected countries to clean up mosquito breeding sites on their property (Cuba eradicated dengue -- twice -- by enforcing that measure), refusal of childhood vaccination, trust in herbal medicines, and unproven "cancer cures."

But what is needed right now are measures to change the game overnight.

When the 1st few cases slip past quarantine into communities in the USA or Europe, the outpouring of huge amounts of money to take care of the situation, if spent earlier on more beds and health workers (and paying their salaries to avoid the current strikes) in West Africa, might have turned the situation there around (my personal view, not necessarily that of all the ProMED team). - Mod.JW

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/40192.]