Ebola in Westafrika

Beitrag von **Birgitt** » Di 9. Sep 2014, 13:01

EBOLA VIRUS DISEASE - WEST AFRICA (155): HOSPITAL SHIPS, MILITARY MEDICAL
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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] USA: hospital ship
[2] USA: to deploy military to combat EVD
[3] Liberia: Welcomes US Military Role in EVD Fight
[4] Sierra Leone: UK military/civilian treatment centre

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[1] USA: hospital ship
Date: 9 Sep 2014
From: Leonard Peruski <lperuski@iun.edu> [edited]

If the USA deployed a hospital ship to West Africa, it would likely be USNS Comfort from Norfolk, Virginia. Comfort is currently docked at her berth, and I am not aware of any scheduled deployments.

As for the number of days it would take to deploy a hospital ship to West Africa, these ships (Comfort and Mercy) are set up to depart 5 days after receiving orders. Given their speed (a maximum of 17 knots/hour), it would take roughly 15-17 days for Comfort to arrive in a port in West Africa.

--
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>

[ProMED thanks Dr Peruski for his knowledgeable communication. - Mod.JW]

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[2] USA: to deploy military to combat EVD
Date: 7 Sep 2014
Source: Washington Post [edited]
http://www.washingtonpost.com/world/nat ... story.html

President Obama said Sunday [7 Sep 2014] that the U.S. military will begin aiding what has been a chaotic and ineffective response to the EVD epidemic in West Africa, arguing that it represents a serious national security concern.

The move significantly ramps up the U.S. response and comes as the already strained military is likely to be called upon further to address militant threats in the Middle East. The decision to involve the military in providing equipment and other assistance for international health workers in Africa comes after mounting calls from some unlikely groups -- most prominently the international medical organization Doctors Without Borders [MSF] -- demonstrating to the White House the urgency of the issue.

The epidemic, which has killed at least 2100 people in 5 African countries, is unlikely to spread to the USA in the short term, Obama said Sunday [7 Sep 2014] on NBC's "Meet the Press." But if the USA and other countries do not send needed equipment, public health workers and other supplies to the region, that situation could change, and the virus could mutate to become more transmissible, he said. "And then it could be a serious danger to the United States," Obama said.

"We're going to have to get U.S. military assets just to set up, for example, isolation units and equipment there," he said, "to provide security for public health workers surging from around the world." Even so, he warned that it would still take months to control the epidemic.

Experts say the U.S. Air Force would be well suited to supply transport flights and personnel, as well as warehousing and logistics support at the airport. ...

[Byline: Lena H. Sun and Juliet Eilperin]

--
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[3] Liberia: Welcomes US Military Role in EVD Fight
Date: 8 Sep 2014
Source: VOA News [edited]
http://www.voanews.com/content/liberia- ... 42108.html

Liberia's Defense Minister Brownie Samukai has welcomed President Barack Obama's announcement that the U.S. military will help in the fight against the Ebola virus disease. Samukai, who is currently in the USA, said his visit is part of his government's effort to bring to the attention of the international community the scale of EVD and to solicit their support. Samukai said Liberia looks forward to U.S. cooperation.

"We had discussions at the US Department of Defense on the issues of utilizing and requesting the full skill of United States capabilities, both on the soft side and on the side of providing logistics and technical expertise... And, we as a country are extremely pleased with the announcement that we have heard, and we look forward to that cooperation as expeditiously as we can," he said. ...

[Byline: James Butty]

--
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[Finally, a country has asked for military medical aid, and is welcoming it. - Mod.JW]

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[4] Sierra Leone: UK military/civilian treatment centre
Date: 8 Sep 2014
Source: UK Government Press Release [edited]
https://www.gov.uk/government/news/uk-t ... erra-leone

British military and humanitarian experts will set up a medical treatment centre for victims of the EVD outbreak in Sierra Leone, International Development Secretary Justine Greening announced today [8 Sep 2014].

The 62 bed facility will be purpose built and operated by military engineers and medical staff. The initial phase of the facility will be constructed and operational within 8 weeks. The UK's support follows a direct request from the World Health Organization and the government of Sierra Leone for assistance in containing the outbreak. British military personnel will begin to survey and assess the site later this week [8-13 Sep 2014]. Based near the capital Freetown, the facility will treat victims of the disease, including local and international health workers and medical volunteers. The UK government is working with Save the Children to design a long term plan to manage and operate the facility after it has been fully set up.

In rural Freetown, Sierra Leone, Save the Children, with support from the UK government, is leading a community sensitisation programme where community leaders are trained on how to spread the word about preventing EVD.

When complete, the facility will comprise:

- a 50 bed medical unit staffed by international health workers and Sierra Leonean medical staff, providing treatment to victims of the disease.

- a specialist 12 bed treatment centre for health workers, including any local or international medical volunteers, providing high quality specialist care to ensure essential health workers can continue to respond to the disease as safely and efficiently as possible [This will hopefully avoid the enormous cost of medevac-ing international staff who contract EVD back to their home countries for specialist treatment. The cost of repatriation of the 1st American doctor to the USA and his treatment were reportedly around USD 2 million. - Mod.JW].

The health facility is in addition to the UK's GBP 25 million [USD 40 million] package of support to contain and control the disease. This includes multilateral support as well as direct funding to aid agencies operating on the ground. ...

--
Communicated by:
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[The good news is that military medical and logistical aid has been requested by 2 of the affected countries and will be provided by the USA, UK and China.

The bad news is that even if the USNS Comfort with its 1000 beds -- which would cover the current shortfall in beds, according to MSF -- sails this week from the USA, during the 3 weeks it would take to reach West Africa, the estimated bed deficit will have doubled to 2000.

Large capacity field hospitals will be needed in addition. The USA has announced that it would send a 25-bed field hospital to Liberia at a cost of USD 22 million, so just imagine the cost of setting up several regional field hospitals, each one with 10 times that capacity. - Mod.JW]

[For a map showing the locations of Ebola virus disease cases, see http://healthmap.org/ebola/.- Mod.MPP]

Beitrag von **Birgitt** » Di 9. Sep 2014, 13:06

EBOLA VIRUS DISEASE - WEST AFRICA (156): SIERRA LEONE, LIBERIA, NIGERIA, UNICEF
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A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

In this update:
[1] Sierra Leone: another US doctor infected
[2] Liberia: situation report
[3] India: returning nationals
[4] UN/OCHA maps
[5] Sierra Leone: Canadian lab team returns
[6a] & [6b] Vaccine trial, shipment delayed
[7] Nigeria: strike threat
[8] Prevention & suspected cases
[9] Sierra Leone: UNICEF relief

[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]

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[1] Sierra Leone: another US doctor infected
Date: 8 Sep 2014
Source: ABC News [edited]
http://abcnews.go.com/Technology/wireSt ... t-25356031

A 4th American who contracted EVD in West Africa was expected to arrive in the USA for care Tue [10 Sep 2014] and will be treated at Emory University Hospital, Atlanta where 2 other aid workers successfully recovered from the disease, the hospital said Mon [9 Sep 2014]...

The World Health Organization, however, said one of its doctors, who has been working in an EVD treatment center in Sierra Leone, has tested positive for the disease. It said the doctor was in stable condition Mon 9 Sep 2014 in Freetown and will be evacuated. The State Department said the doctor was from the USA.

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

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[2] Liberia: situation report
Date: 8 Sep 2014
Source: WHO News [edited]
http://www.who.int/mediacentre/news/ebo ... er-2014/en

Situation assessment - 8 Sep 2014

***Many thousands of new cases are expected in Liberia over the coming 3 weeks. [ProMED emphasis] As soon as a new EVD treatment facility is opened, it immediately fills to overflowing with patients, pointing to a large but previously invisible caseload.

Transmission of the ebolavirus in Liberia is already intense, and the number of new cases is increasing exponentially. The investigative team worked alongside staff from the Ministry of Health, local health officials, and other key partners working in the country. All agreed that the demands of the EVD outbreak have completely outstripped the government's and partners' capacity to respond; 14/15 of Liberia's counties have now reported confirmed cases. Some 152 health care workers have been infected, and 79 have died. When the outbreak began, Liberia had only one doctor to treat nearly 100 000 people in a total population of 4.4 million people. Every infection or death of a doctor or nurse depletes response capacity significantly.

Of all Ebola-affected countries, Liberia has the highest cumulative number of reported cases and deaths, amounting, on 8 Sep 2014, to nearly 2000 cases and more than 1000 deaths. The case-fatality rate, at 58 percent, is also among the highest.

In Montserrado county, which includes Liberia's capital, Monrovia, the team estimated that 1000 beds are urgently needed for the treatment of currently infected EVD patients. At present, only 240 beds are available, with an additional 260 beds either planned or in the process of being put in place. These estimates mean that only half of the urgent and immediate capacity needs could be met within the next few weeks and months. The number of new cases is moving far faster than the capacity to manage them in EVD-specific treatment centres... WHO estimates that 200 to 250 medical staff are needed to safely manage an Ebola treatment facility with 70 beds...

The John F Kennedy Medical Center in Monrovia, which was largely destroyed during Liberia's civil war, remains the country's only academic referral hospital. The hospital is plagued by electrical fires and floods, and several medical staff were infected there and died, depleting the hospital's limited workforce further.

The fact that early symptoms of Ebola virus disease mimic those of many other common infectious diseases increases the likelihood that EVD patients will [unknowingly] be treated in the same ward as patients suffering from other infections, putting cases and medical staff alike at very high risk of exposure.

In Monrovia, taxis filled with entire families, including some members who are thought to be infected with the ebolavirus, crisscross the city searching for a treatment bed. There are none. As WHO staff in Liberia confirm, no free beds for EVD treatment exist anywhere in the country. According to a WHO staff member who has been in Liberia for the past several weeks, motorbike-taxis and regular taxis are a hot source of potential ebolavirus transmission, as these vehicles are not disinfected at all, much less before new passengers are taken on board.

When patients are turned away at Ebola treatment centres, they have no choice but to return to their communities and homes, where they inevitably infect others, perpetuating constantly higher flare-ups in the number of cases. Other urgent needs include finding shelters for orphans and helping recovered patients who have been rejected by their families or neighbours.

Last week, WHO sent one of its most experienced emergency managers to head the WHO office in Monrovia. Coordination among key partners is rapidly improving, aiming for a better match between resources and rapidly escalating needs.

Conclusions
--------------
The investigation in Liberia yields 3 important conclusions that need to shape the EVD response in high-transmission countries.

1) Conventional EVD control interventions are not having an adequate impact in Liberia, though they appear to be working elsewhere in areas of limited transmission, most notably in Nigeria, Senegal, and the Democratic Republic of Congo.

2) Far greater community engagement is the cornerstone of a more effective response. Where communities take charge, especially in rural areas, and put in place their own solutions and protective measures, EVD transmission has slowed considerably.

3) Key development partners who are supporting the response in Liberia and elsewhere need to prepare to scale up their current efforts by 3-4-fold...

WHO and its Director-General will continue to advocate for more EVD treatment beds in Liberia and elsewhere, and will hold the world accountable for responding to this dire emergency with its unprecedented dimensions of human suffering.

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

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[3] India: returning nationals
Date: 8 Sep 2014
Source: Mumbai Mirror [edited]
http://www.mumbaimirror.com/articleshow/41971160.cms?

A total of 1011 Indians, who have returned from EVD-affected areas, are being tracked for the virus, the heath ministry said on Sun [8 Sep 2014]. Most of those being tracked are from Maharashtra, Kerala, Tamil Nadu, Gujarat, West Bengal and Delhi. During the past 24 hours, 201 passengers from the affected countries have arrived at the airports of Mumbai (88), Delhi (58), Chennai (24), Bangalore (15), Kochi (11), Thiruvananthapuram (4) and Kolkata (1). The health ministry said that while no passenger has been isolated at the quarantine facility on Sun [7 Sep 2014], 16 531 passengers have been screened to date. All respective state governments have been provided with the details.

--
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[4] UN/OCHA maps

- West Africa: Ebola Virus Disease (EVD) Outbreak (as of 3 Sep 2014)
http://reliefweb.int/map/liberia/west-a ... 3-sep-2014

- West Africa: Ebola Crisis: Quality of Core Services: Safe Burials (as of 3 Sep 2014) http://img.static.reliefweb.int/sites/r ... k=42--pCeg [pdf 1.8 MB]

- Guinea Humanitarian Operational Presence Against Ebola Epidemic (as of 28 Aug 2014)
http://reliefweb.int/map/guinea/guinea- ... 8-aug-2014

- Sierra Leone: Humanitarian Operational Presence Against Ebola Epidemic (as of 3 Sep 2014)
http://reliefweb.int/map/sierra-leone/s ... 3-sep-2014

- Liberia: Ebola Crisis: Quality of Core Services: Contact Tracing (as of 3 Sep 2014)
http://reliefweb.int/map/liberia/ebola- ... -sept-2014

- Liberia: Humanitarian Operational Presence Against Ebola Epidemic (as of 1 Sep 2014)
http://reliefweb.int/map/liberia/liberi ... 1-sep-2014

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[5] Sierra Leone: Canadian lab team returns
Date: 6 Sep 2014
Source: CBC Canada [edited]
http://www.cbc.ca/news/health/ebola-out ... -1.2758283

The Public Health Agency of Canada said the team left Sat [6 Sep 2014] to resume running a lab that supports an EVD treatment centre at Kailahun, in eastern Sierra Leone. Canada has had a continuous laboratory presence in the West African outbreak zone since June [2014], with 3-person teams typically spending a month in operation before being spelled off. ...

--
Communicated by:
Ryan McGinnis
<ryan@bigstormpicture.com>

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[6a] Vaccine trial, shipment delayed
Date: 7 Sep 2014
Source: BBC [edited]
http://www.bbc.com/news/health-29076371

Vaccinated monkeys have developed "long-term" immunity to the ebolavirus, raising a prospect of successful human trials, say scientists. The experiments by the US National Institutes of Health showed immunity could last at least 10 months. Human trials of the vaccine started this week in the USA and will extend to the UK and Africa.

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Communicated by:
Ryan McGinnis <ryan@bigstormpicture.com>

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[6b] Vaccine trial, shipment delayed
Date: 3 Sep 2014 [note date]
Source: Reuters [edited]
http://www.reuters.com/article/2014/09/ ... healthNews

Canada's experimental EVD vaccine was stuck in the government lab that developed it as officials puzzled over how to safely transport it, 3 weeks after it was offered to Africa to fight the deadly epidemic. Ottawa said on 12 Aug 2014 that it would donate between 800 and 1000 doses of the vaccine to the World Health Organization for use in Africa, where more than [2000] people have died from the disease. The vaccines are being held at Canada's National Microbiology Laboratory in Winnipeg. "We are now working with the WHO to address complex regulatory, logistical and ethical issues so that the vaccine can be safely and ethically deployed as rapidly as possible," Health Canada spokesman Sean Upton said in a statement. "For example, the logistics surrounding the safe delivery of the vaccine are complicated." One challenge is keeping the vaccine cool enough to remain potent, Upton said. Canadian officials were trying to define proper storage and transportation procedures, and they could not estimate when the vaccines would leave the lab.

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

[It sounds like a very fragile product, difficult to deploy in the field in this week's 30+ C (79+ F) heat in Monrovia, Liberia. - Mod.JW]

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[7] Nigeria: strike threat
Date: 6 Sep 2014
Source: Premium Times Nigeria [edited]
https://www.premiumtimesng.com/headline ... xv5Ww.dpbs

Dozens of volunteers at the Infectious Disease Hospital, IDH, of the Yaba Mainland Hospital, Lagos, where patients down with Ebola virus disease (EVD) are receiving treatment, have threatened to stop reporting to their duty posts over non-payment of their emoluments by the Nigerian government.

Premium Times investigations revealed that the volunteers are being owed over 2 weeks of their daily entitlements by government.

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

[If this report is true, this is not the way to obtain cooperation in an emergency. - Mod.JW]

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[8] Prevention & suspected cases

Senegal: Vigilante "border guards" keeping EVD out of Senegal
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7 Sep 2014: (AFP) A dozen Guineans await deportation at a Senegalese frontier police post, stopped in their tracks by the foot soldiers of an informal battalion of villagers at the forefront of a fight to keep Ebola out. These new vigilante "border guards" are becoming an increasingly common sight since a Guinean student brought the deadly epidemic raging across west Africa into Senegal just before the border closed on 21 Aug 2014. He remains the only case in the country, in part, say these villagers, because of the vigilance they have shown. "They were trying to cross the border. We arrested them with the help of the villagers. We are waiting for the order to send them back," said a policeman in Dialadiang, one of the last towns before the frontier. "Last week, we sent back a Cameroonian and 2 Sierra Leoneans. Villagers arrested them for us to send them back," the officer added at the town's decrepit police post. [Communicated by Ryan McGinnis <ryan@bigstormpicture.com>]
http://news.yahoo.com/vigilante-border- ... 57030.html

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Sierra Leone: lockdown
-------------------------
6 Sep 2014: (InvestmentWatch) Sierra Leone imposes 4-day countrywide "lockdown" beginning on 18 Sep 2014 to stop EVD spread... No one allowed to leave their homes. Doctors Without Borders calls "lockdown" a mistake... "Lockdowns and quarantines do not help control EVD, as they end up driving people underground and jeopardising the trust between people and health providers. This leads to the concealment of potential cases and ends up spreading the disease further." ...
http://investmentwatchblog.com/breaking ... -a-mistake

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Kenya/Ghana
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6 Sep 2014: (By Robert Alai Onyango on Facebook) The port health services JKIA [Jomo Kenyatta International Airport-Nairobi] have been notified by WHO of an EVD suspect[ed case] who flew in one hour ago [12 noon local time] on board flight KQ503. The passenger had been isolated in Accra, Ghana, and was supposed to be subjected to series of confirmatory tests which he has not undergone as required. The passenger is a Sierra Leone passport holder. He claims to be a CNN reporter based in Nairobi. He said that he was arriving back after covering an EVD case in Sierra Leone. Kenya Airways [KQ] was supposed to park the aircraft in remote parking to facilitate port health personnel to carry out prompt action. KQ bosses are refusing to heed this. (Source at KAA [Kenya Airports Authority])

[Communicated by Ryan McGinnis. On 19 Aug 2014, the Kenyan government temporarily suspended passengers from EVD-affected countries including Sierra Leone, Guinea and Liberia, from entering the country. - Mod.JW]

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Liberia: quarantine
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6 Sep 2014: (Malawi24) Liberian officials today confirmed that a police barracks in central Monrovia was shut down after the wife of one of the officers died of EVD. Information Minister Lewis Brown said the officers decided to "self-quarantine." About 35 officers live in the barracks with their families, said Abraham Kromah, deputy director of the national police force. Liberian Christian leaders planned to convene about 100 "prayer warriors" at ... Providence Baptist Church, where Liberia's declaration of independence was signed in 1847. A state of emergency in Liberia restricts public gatherings, though church services have largely continued unimpeded.
http://malawi24.com/ebola-deaths-pass-2 ... aICNH.dpuf

[On the one hand, 35 police families in one block self-quarantine. On the other, 100 people plan to congregate in a church. Does that make sense? - Mod.JW]

--
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[9] Sierra Leone: UNICEF relief
Date: 8 Sep 2014
Source: AllAfrica [edited]
http://allafrica.com/stories/201409081192.html

A cargo plane of UNICEF medical supplies including protective equipment and essential medicine has just landed in Sierra Leone, part of the UN children's agency's continued drive to tackle the EVD outbreak in West Africa. The 48 metric tonnes of supplies, including latex gloves, body bags, intravenous tubes, antibiotics and other essential medicines, and coveralls to protect health workers, will be provided to health teams, including those from the Ministry of Health and non-governmental organizations working to contain the outbreak. This latest airlift brings up to 402 metric tons [MT] the overall quantity of essential items UNICEF has delivered to the 3 major EVD-affected countries in 32 shipments since early August [2014]. Of the total, 70.6 MT were flown in to Guinea, 213.8 MT to Liberia and 117.7 MT to Sierra Leone.

Topping the list is protective equipment like latex gloves and masks for health workers, concentrated chlorine disinfectant, antibiotics, pain relief medicines and intravenous fluids and equipment. Next week, UNICEF will begin sending 50 000 household protection kits to Liberia. The kits are designed for families caring for their relatives at home and contain a range of protective items such as sprayers, chlorine, gloves and garbage bags.

[There is no mention of masks in the household protection kits. While the other items will help, the big problem will be carers touching their faces with contaminated gloves to wipe away sweat and tears or to scratch itches. There needs to be eye, nose and mouth protection as well, as ebolavirus can enter the body by touching them with contaminated hands or gloves. Also, the outsides of garbage bags will become contaminated after being handled by gloves used on a patient or to clean up after them. - Mod.JW]

--
Communicated by:
ProMED-mail from HealthMap Alerts
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[A map showing the locations of the Ebola virus disease cases can be found at http://www.healthmap.org/ebola.-Mod.MPP]

Kuno · Beitrag von **Kuno** » Di 9. Sep 2014, 13:36

Ist es nur mein erster Eindruck oder meldet man nur die negativen Punkte zu Ebola?

Aus Nigeria konnte man heute lesen, dass von den ca. 20 bekannten Krankheitsfaellen deren 10 auf dem Wege der Besserung sind und eine Person bereits als geheilt entlassen werden konnte.
Nebst den tausenden von Faellen in Liberia faellt die Meldung aus Nigeria natuerlich nicht so ins Gewicht. Wenn man sich aber ueberlegt, dass die Nigerianer offensichtlich die Chance nutzen und des ihnen zu gelingen scheint, die Verbreitung der Krankheit zu verhindern, dann waere dies druchaus auch eine Meldung wert!

Kuno · Beitrag von **Kuno** » Di 9. Sep 2014, 18:32

Aus der NZZ von heute: http://www.nzz.ch/international/ebola-l ... 1.18380203

"Es gibt nur wenige Flüge nach Monrovia, und die Flugzeuge sind offenbar ziemlich leer. Das jedenfalls berichtet eine Hilfswerksmitarbeiterin, die am Freitag nach Liberia flog. «Sonst sind in Notlagen die Flüge voll von Helfern und Journalisten. Nicht hier, nicht jetzt. Die Leute haben Angst.» "

Ich kann mir gut vorstellen, dass die ueblichen "Katastrophentouristen" aktuell von einer Reise in die Ebolagebiete nichts wissen wollen. Aber mal Hand aufs Herz: Wer von den Forumsmitgliedern wuerde sich gerne freiwillig nach Monrovia melden? Wahrscheinlich weniger als die Haelfte...

"Die WHO schreibt, es brauche dreimal oder viermal so viel Mittel wie bisher, um die Ebola-Seuche in Liberia wirksam zu bekämpfen. Verschiedene Staaten signalisieren ihre Bereitschaft zu einem verstärkten Einsatz. Die USA erwägen laut der Agentur DPA, militärisches Personal zu entsenden, um in Westafrika Quarantäne-Stationen aufzubauen und internationale Helfer zu schützen. Die Europäische Union hat ihre Hilfe für Guinea, Liberia, Sierra Leone und Nigeria in der vergangenen Woche von 11,9 auf 144 Millionen Euro aufgestockt."

Super. Kaum geht es mal wieder irgendwo in die Hose ruft gleich alles nach dem "boesen Satan USA". Und noch die Frage: Warum soll jemand aus Europa nach Nigeria geld schicken? Die haben doch Oel wie nicht grad sonstwer...

Beitrag von **Alexander** » Di 9. Sep 2014, 18:44

Neun Monate nach dem ersten Ebolafall sieht Obama jetzt die Zeit gekommen, wie Kuno schon schreibt, das Militär einzusetzen. Man fürchtet, dass das Virus mutieren und auf weitere Länder übergreifen könnte.

Die Militärhilfe stößt allerdings nicht überall auf Gegenliebe. MSF sieht keine Notwendigkeit die Hilfsstationen militärisch schützen zu lassen. Es würde eher Unruhe in der Bevölkerung verursachen.

Über eins ist man aber einig. Der WHO und anderen Hilfsorganisationen hat es an Geld und Kapazitäten gefehlt. Offensichtlich hat man den Ebolaausbruch auch unterschätzt. Man kannte die Epidemien nur aus der DR Kongo und dort waren sie immer nur lokal begrenzt. Das hat sich nun geändert, evtl. wurde man aber auch von der Intensität des Ausbruchs überrascht.

Umstrittener Plan: Mit Soldaten gegen Ebola

Grüsse
Alexander

Beitrag von **Birgitt** » Mi 10. Sep 2014, 12:26

EBOLA VIRUS DISEASE - WEST AFRICA (157): WHO UPDATE, PPE, NIGERIA, BUSHMEAT
***************************************************************************
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] WHO update
[2] PPE: proper procedures
[3] Nigeria: syringe attack at Lagos Airport
[4] Ghana: bushmeat

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[1] WHO update
Date: 9 Sep 2014
Source: BBC News [edited]
http://www.bbc.com/news/world-africa-29131065

The EVD outbreak in West Africa has killed 2288 people, with half of them dying in the last 3 weeks, the World Health Organization (WHO) says. It said that 47 percent of the deaths and 49 percent of the total 4269 cases had come in the 21 days leading up to 6 Sep 2014. The health agency warned that thousands more cases could occur in Liberia, which has had the most fatalities.

In Nigeria, 8 people have died out of 21 cases, while one case of EVD has been confirmed in Senegal, the WHO said in its latest update.

On Mon [9 Sep 2014], the agency called on organisations combating the outbreak in Liberia to scale up efforts to control the outbreak "3-4 fold."

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

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[2] PPE: proper procedures
Date: 9 Sep 2014
Source: Johns Hopkins Medicine [excerpted, edited]
http://www.hopkinsmedicine.org/news/med ... ts_caution

A team of American infectious disease and critical care experts is alerting colleagues caring for EVD patients that how they remove their personal protective gear can be just as crucial as wearing it to prevent exposure to the deadly virus.

In a commentary published online on 26 Aug 2014 in the Annals of Internal Medicine, the physician-specialists from Johns Hopkins and the University of North Carolina say rigorous steps exist -- and must be taken -- to avoid "inadvertent" contact of frontline caregivers' exposed skin and mucous membranes to infected body fluids.

Personal protective equipment [PPE], including goggles or face shields, gloves and gowns, are effectively decreasing West African caregivers' exposure to infected bodily fluids, but workers are still at risk "if removal of protective clothing that is contaminated with infectious bodily fluids is not done in a manner that prevents exposure," say the authors...

"The physical exhaustion and emotional fatigue that come with caring for patients infected with Ebola may further increase the chance of an inadvertent exposure to bodily fluids on the outside of the personal protective equipment, leading to unwanted contact when the gear is removed," the authors say. "The impulse to wipe away sweat in the ever-present hot, humid environment during personal protective equipment removal may lead to inadvertent inoculation of mucous membranes" in and on the nose, mouth and eyes.

Despite the challenges of preventing inadvertent exposure from improper personal protective equipment removal, they say that health care workers are generally aware of and are using proper precautions. For example, treatment sites in Africa administered by Medecins Sans Frontieres [MSF, Doctors Without Borders], a medical humanitarian organization, has established a systematic process to mitigate the risks associated with removal of personal protective equipment, including a buddy system in which health care workers walk each other through each step of the removal process to help ensure safety...

"... Providing an adequate supply of personal protective equipment, along with a ritualized process for donning and doffing personal protective equipment, are desperately needed to prevent further unnecessary infection and loss of life among the heroic health care workers who are on the front lines of this war," the authors write in the commentary.

--
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[Doctors Without Borders (MSF) has never lost an international staff member to EVD in 30 years of combating EVD in Africa. - Mod.JW]

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[3] Nigeria: syringe attack at Lagos Airport
Date: 9 Sep 2014
Source: Homeland Security Newswire [edited]
http://www.homelandsecuritynewswire.com ... os-airport

An American federal air marshal was placed in quarantine in Houston, Texas yesterday [8 Sep 2014] after being attacked Sunday night [8 Sep 2014] at the Lagos, Nigeria airport. The assailant ... was able to inject an unknown substance into the back of one of the air marshal's arms. The marshal was able to board the United Airlines flight to Houston, USA where he was met by FBI agents and health workers from the Centers for Disease Control & Prevention (CDC)...

The air marshal, who was in Nigeria with a team of other marshals, was attacked when the group was in an unsecured area of the airport terminal in Lagos... ABC News also reports that while the unknown assailant escaped, Nigerian officials said the other air marshals on the team secured the needle and brought it on the flight for testing in the United States... Officials noted that US air marshals travel undercover in plain clothes, and an attacker would not be able to identify his target as an American law enforcement agent.

--
Communicated by:
ProMED-mail
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[A reminder that westerners are not universally welcome in the EVD zone. - Mod.JW]

******
[4] Ghana: bush meat
Date: 8 Sep 2014
Source: Ghana Web [edited]
http://www.ghanaweb.com/GhanaHomePage/N ... ?ID=324896

An estimated 28 000 straw-coloured fruit bats [scientific name _Eidolon helvum_], valued at Ghc 256 000 [USD 6.00 each], are sold annually in Ghana as bush meat, Dr. Joseph Somuah Akuamoah, Executive Member of Good Life Ghana, has said. He said the bats were sold in just a 400 km radius, an indication of the role bush meat, which is a source of Ebola virus disease (EVD) infection, could play in the spread of the disease in case of an outbreak in [Ghana]. He has, therefore, re-echoed calls for the reduction of bushmeat consumption, with a stern caution to hunters against dead animals they find during hunting, since the game might have died of EVD due to infection in one of the affected countries.

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

[A ProMED-mail HealthMap for West Africa is available at http://healthmap.org/promed/p/40192.

An up to date make showing the locations of Ebola virus cases can be found at http://www.healthmap.org/ebola.]

Beitrag von **Birgitt** » Do 11. Sep 2014, 12:32

EBOLA VIRUS DISEASE - WEST AFRICA (158): URGENT CALL FOR VOLUNTEERS
*******************************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

[ProMED is brought to you through the good auspices of ISID, the International Society for Infectious Diseases, based in Brookline, Massachusetts, USA. Now ISID has been asked to spread the call for volunteer clinicians to go to West Africa to coordinate isolation units and supervise local staff in their care for patients with EVD.
We start with an e-mail from the hot zone. - Mod.JW]

[1]
Date: Tue 9 Sep 2014
From: Oliver Johnson <oliver.johnson@kcl.ac.uk> [edited]

Re: International Society of Infectious Diseases (ISID) request for how they can help
----------------------------------------------------------------------
The situation in Freetown [Sierra Leone] is rapidly deteriorating as there simply aren't enough isolation beds to contain suspected or confirmed cases. The country's 2 treatment centres are full so we are unable to refer confirmed cases out of isolation units to free up space. As a result suspected cases are now staying at home in their communities -- this will quickly lead to an exponential increase in cases. At Connaught (the government's main referral hospital) today [9 Sep 2014] our isolation unit is full with adult and paediatric cases and we have suspected cases in the waiting area and emergency room that we can't isolate -- I don't know how much longer the hospital will be able to stay open in these circumstances.

King's is working to urgently set up new isolation units and train local staff. We're working round-the-clock trying to set up a new unit every 48 hours, but we are the only partner undertaking this work and we simply won't be able to keep up with demand.

What we most need right now are international clinicians willing to come out and volunteer to help coordinate these units and supervise local staff in the larger isolation units. We can train them here [Freetown] when they arrive. If anyone can help advertise volunteering opportunities in the USA or UK that would be hugely helpful. The international response to the outbreak remains virtually non-existent, in terms of actual impact on the ground.

--
Dr Oliver Johnson
Programme Director
King's Sierra Leone Partnership
2nd Floor Admin, Connaught Hospital, Freetown
Sierra Leone
2.13 Weston Education Centre, London SE5 9RJ
United Kingdom
<oliver.johnson@kcl.ac.uk>

[King's Sierra Leone Partnership (http://www.kslp.org.uk) is an initiative of King's College London UK. - Mod.LM]

******
[2]
Date: Tue 9 Sep 2014
From: Daniel Lucey <daniel.lucey8@gmail.com> [edited]

Dr Lewis Rubinson (cc), the incoming WHO doctor in Kenema, was delayed in transit in Guinea from Paris and his baggage was misplaced; however, hopefully he arrives in Freetown [Sierra Leone] today [9 Sept 2014]. He is aware of the WHO-Geneva announcement that the WHO doctor he is replacing in Kenema has tested positive for Ebola...You perhaps know more in Freetown...

Last evening [8 Sep 2014] I was fortunate to be able to talk with 3 senior persons in the International Society for Infectious Diseases ISID), a large global organization of clinicians. They asked what they can do as an organization to help in some way with the EVD crisis.

One of the 3 suggestions I made was to contact persons like yourselves in West Africa who are directly involved with the crisis, and ask you for your ideas on how they can help.

Dr Larry Madoff of ISID and Editor of the Program for Monitoring Emerging Diseases (ProMED-mail) is copied here, and he or his colleague (Dr Britta Lassman) will contact you.

Already Larry, Jack Woodall, and ProMED have posted on ProMED-mail letters by 3 of you: Noa Freudenthal and Sara Hommel (29 Aug 2014) [archive no 20140829.2735183] and Vanessa Wolfman (31 Aug 2014) [archive no 20140831.2738054]. Perhaps the Connaught team would want to post a communication from Sierra Leone.

My 2nd suggestion to ISID was to work with the US CDC to advertise and endorse the new Ebola PPE [personal protective equipment] and treatment training course that CDC will offer 22-24 Sep 2014 in the state of Alabama (not as hot as Sierra Leone but good simulation for wearing PPE there). My understanding is that the training will be for volunteers who then are interested in either coming to West Africa and/or forming an 'Ebola response team' for their own US hospitals. I anticipate the official CDC announcement today (9 Sep 2014) about this program.

My 3rd suggestion to ISID was to contact directly other organizations globally and their leaders, to share ideas on how to respond and help during this long-lasting EVD crisis. For example, the head of Public Health England (PHE), Dr David Heymann (cc), who worked during multiple EVD outbreaks in Africa such as the initial one in 1976, and was himself a leader in the response to the 1995 Kikwit outbreak. (He also led the WHO global response to SARS). PHE also has sent physicians to Freetown, such as Dr Emma Aarons (cc) who worked in mid-August 2014 initiating the PPE training for the MOH in the auditorium near the Sports stadium. Emma, Dr Jattu Navo, Joseph, Doris (all from Sierra Leone), and I together helped train about 160 nurses and doctors in 9 days.

Andrew Hall from King's College London (KCL) has by now likely trained the same number of persons at Connaught hospital by himself over the past 2+ weeks. Marta and Oliver have trained many people at Connaught before they have gone into work in the Ebola Testing and Isolation Unit.

Yesterday [8 Sep 2014] I received from MSF the contract to go to Liberia for 6 weeks, departing Washington DC on 28 Sep 2014 and finishing in Monrovia on 10 Nov 2014. Let's stay in contact in the coming days and weeks and interact with colleagues wherever they might be in the world who are willing to help.

--
Daniel Lucey MD, MPH
Georgetown University Medical Center
Washington DC, USA
<daniel.lucey8@gmail.com>

******
[3]
Date: Tue 9 Sep 2014
From: Colin Brown <colinbrown@doctors.net.uk> [edited]

As Oliver says the situation on the ground in Freetown is near unbelievable with international response/rhetoric not translating into boots on the ground. Now I'm back in London and we have treated a case here; we were talking about the different resources we had available. What first registers is not the availability of ZMapp, or the ability to measure viral load and blood parameters, but the sheer volume of staff we had available to treat one patient versus the exceptional job that Oliver and the team are doing to both work clinically and operationally, given such limited human resources. That they have managed to stay afloat is a testament to their professionalism, but as Oliver says they urgently need help.

I've spoken a lot over the past weeks to ID fellows in the UK who want to contribute but feel they can't get time off given constraints with their rotas [schedules]. As this call will go to many senior physicians, that is, the leave granters, rota coordinators, and powers that be, could we include a line urging them to do whatever they can to facilitate anyone in their employ who wishes to volunteer to be relieved from clinical commitments.

--
Dr Colin Brown BSc MSc MBChB MRCP FRCPath
Infectious Diseases Lead,
King's Sierra Leone Partnership
<colin.1.brown@kcl.ac.uk>

[Please note the call to senior physicians to facilitate the granting of leave to subordinates. - Mod.LM]

[For a harrowing report from the field by an international physician who has returned from Sierra Leone's only pediatric hospital, read http://www.spiegel.de/international/wor ... 90464.html

They had 150 beds, 3 children to a bed, being treated for malaria and other diseases, but had to close the hospital last month (August 2014) and send the sick children back home when they discovered one of them had EVD. - Mod.JW]

[For a map showing the countries where EBV cases have been reported in West Africa, see http://www.healthmap/ebola. - Mod.MPP

Beitrag von **Birgitt** » Do 11. Sep 2014, 12:35

EBOLA VIRUS DISEASE - WEST AFRICA (159): WHO, TRAVEL, CONTACTS, SERUM, RATES
****************************************************************************
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] WHO short update
[2] Travel restrictions
[3] USA: contacts evacuated
[4] Convalescent serum therapy
[5] Recalculating the case fatality rate

******
[1] WHO short update
Date: Wed 10 Sep 2014
Source: WHO Ebola Response Roadmap http://apps.who.int/iris/bitstream/1066 ... g.pdf?ua=1

WHO Ebola Response Roadmap Update, 8 Sep 2014
[This phone app from WHO has the same figures as of 6 Sep 2014 posted by ProMED in this thread (157) on 6 Sep 2014: 4269 cases and 2288 deaths. - Mod.JW]

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

******
[2] Travel restrictions
Date: Wed 10 Sep 2014
Source: Forum for Expatriate Management [edited]
http://totallyexpat.com/global-immigrat ... strictions

Ebola virus triggers travel and immigration restrictions
--------------------------------------------------------
The outbreak of the deadly Ebola virus [disease] in West Africa has prompted numerous national responses affecting travel and immigration rules and procedures around the world. The disease has infected an estimated [4269] people and claimed [2288] lives as of [6 Sep 2014], according to the most recent World Health Organization figures ... [Read details of the restrictions at URL above.]

[USA restrictions effective until 27 Feb 2015. - Mod.JW]

--
Communicated by:
ProMED-mail
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******
[3] USA: contacts evacuated
Date: Tue 9 Sep 2014
Source: Yahoo News [edited]
http://news.yahoo.com/us-ebola-evacuati ... 26831.html

EVD evacuations to USA greater than previously known
----------------------------------------------------
Transports have included patients exposed to virus, air ambulance operator says. An undisclosed number of people who've been exposed to the ebolavirus -- not just the 4 patients publicly identified with diagnosed cases -- have been evacuated to the US by an air ambulance company contracted by the State Department.

"We moved a lot of other people who had an exposure event," said Dent Thompson, vice president of Phoenix Air Group. "Many times these people are just fine, they just had an exposure. But you have to treat it as though the disease is present." ...

Thompson said Phoenix Air has flown 10 Ebola-related missions in the past 6 weeks.... "Not everything we do is [related to] a sick person," he said, adding that the company has also flown supplies. "We do basically whatever needs to be done."

The Centers for Disease Control and Prevention [CDC], which is operating an around-the-clock EVD emergency operations center, did not immediately respond to an email seeking information about the exposure patient transports....

Phoenix Air's modified Gulfstream III jets are "literally intensive care units with wings," Thompson said. He said even evacuees without a confirmed EVD diagnosis are placed in an isolation chamber for the 12-14-hour flight from West Africa to the USA. Thompson declined to say where patients who have just been exposed to EVD have been flown to in the USA. "They all go to a hospital and they monitor them," he said.

[Byline: Jason Sickles]

--
Communicated by:
ProMED-mail Rapporteur Kunihiko Iizuka

Ryan McGinnis
http://bigstormpicture.com

******
[4] Convalescent serum therapy
Date: Fri 5 Sep 2014
Source: CIDRAP (Center for Infectious Disease Research and Policy) News [edited]
http://www.cidrap.umn.edu/news-perspect ... cines-fall

WHO on EVD: Blood may offer help now
------------------------------------
"We agreed that whole blood and convalescent serum may be used to treat Ebola virus disease and that all efforts must be directed to help affected countries use them safely," Marie-Paule Kieny, PhD, the WHO's assistant director-general, told reporters in a press teleconference from Geneva.... Kieny said experts at the WHO meeting discussed the use of both whole blood and purified plasma. "There was a consensus that this has a good chance to work and can be produced now from the [affected] countries themselves," she said, adding that the countries will need help establishing the capacity to use the approach safely....

Kieny said whole blood transfusions have been used to treat EVD in the past, but she couldn't say in how many cases. "We'll try to get a better idea about these data in coming weeks," she added." ... [more]

[Byline: Robert Roos]

[The teleconference is available at: http://who.int/mediacentre/multimedia/v ... 4.pdf?ua=1. - Mod.JW]

Date: Mon 8 Sep 2014
Source: Pathogen Perspectives [edited]
http://www.pathogenperspectives.com/201 ... at-my.html

Q. Is there a minimum time to wait between complete EVD recovery and harvesting blood from a survivor for passive therapy?

Dr. C.J. Peters: This is not known for EVD, but blood/serum from a survivor won't help here anyway. There's no evidence that it will help, but strong evidence that it won't help. For other viruses it can be critical, such as for the arenavirus Junin [cause of Argentinean hemorrhagic fever], for which it is used effectively on a regular basis. But for ebolaviruses it's just not effective. For Junin, they wait until 3 months after illness to harvest serum for therapy, but they don't know that 3 months is required, they just know that 3 months works.

(I was one of the 1st to suggest that passive immune therapy might help with this epidemic and I was surprised at this, but now have a better understanding. Because this is currently making headlines, I will be addressing it in a post soon.)

[An opposing view. We await further details from C.J., one of CDC's pre-eminent hemorrhagic fever experts. There was a considerable discussion about the use of survivor blood towards the end of WHO's virtual press briefing of 8 Sep 2014: http://who.int/mediacentre/multimedia/v ... 4.pdf?ua=1. - Mod.JW]

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

******
[5] Recalculating the case fatality rate
Date: Wed 10 Sep 2014
Source: Disease Daily [excerpt]
http://www.healthmap.org/site/diseaseda ... reak-91014

Estimating the fatality of the 2014 West African Ebola outbreak
---------------------------------------------------------------
"Case fatality rate" -- or CFR -- is a term that's been tossed around a lot lately in the context of the 2014 West African Ebola outbreak. But what does it really mean? ...

It tells us the probability of dying after infection. If estimated properly in the middle of an outbreak, it can even help us examine the efficacy of interventions as they take place.... Based [on] the WHO's most recent report, it seems that only about 53 percent of reported EVD cases thus far have ended in death since the 2014 outbreak began. However ... that 53 percent isn't really a CFR; it's actually the proportion of fatal cases -- or PFC.... PFC doesn't account for the lag between when a case is reported and when a case dies -- approximately 16 days for this outbreak. What this means is that the 2296 deaths reported as of 8 Sep 2014 were all likely reported as cases by 23 Aug 2014.

Adjusting PFC for this lag-time gives us a much better approximation of CFR well before the outbreak ends. [See chart in source] ... The lag-adjusted PFC -- about 80-85 percent -- is significantly higher than the unadjusted PFC but is consistent with recent fatality estimates by Medecins Sans Frontieres [MSF]. This finding reiterates the magnitude of this outbreak -- not only in terms of scale, but also lethality. In light of this new estimate, a stronger global effort is all the more imperative.

[Byline: Maia Majumder]

[I recommend reading the whole article and studying the chart. These calculations suggest that the current CFR is actually close to 90 percent of the original ebolavirus Zaire strain. - Mod.JW]

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

[Re survivors: on Wed 10 Sep 2014, Gregory Kelly <gka25@sfu.ca> wrote, "There needs to a system for non-medically trained personnel to either volunteer on the ground or in the home countries of those that are volunteering on the ground, to help ease their absence. Surely there are things that non-medically trained personnel can do (other than fund-raising)."

Agreed. Ideally, survivors of laboratory-confirmed infections, as they are immune to reinfection, should be recruited in the affected West African countries. They are stigmatised, so cannot work in community education, but they could bring missing face-to-face human contact in isolation hospitals. However, the 1st priority must be clinicians who can ensure strict infection control procedures.

Re death rates: On the one hand, recalculation of these suggests they are much higher than the latest figures. On the other, a lot of the suspected and probable cases have very likely been due to malaria, Lassa fever and other tropical diseases, so in reality the reported case numbers may be vastly exaggerated. Perhaps reported cases of fatal malaria and Lassa are way down from the norm for the time of year.

In any case, transporting blood samples for hours over muddy tracks requires vehicles and fuel which they do not have, and may mean that many samples arrive at the lab in untestable condition and can never be confirmed.

Re Sierra Leone's planned 3-day lockdown: MSF warns that this will just ensure that anybody who has a sick person in the house hides them. Will the health workers have police powers to do a room-by-room search? And anything more than plastic gloves to protect themselves from contamination by the patients they will have to forcibly remove to hospital, and also from fomites in infected households?

A good map with the latest case locations and counts is at http://healthmap.org/ebola. - Mod.JW]

Beitrag von **Birgitt** » So 14. Sep 2014, 17:39

EBOLA VIRUS DISEASE - WEST AFRICA (160): SENEGAL, LIBERIA, TESTS, MEDIA
***********************************************************************
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] Senegal: 2 new suspected cases
[2] Liberia: 1st person report
[3] Diagnostic tests
[4] ECDC case definition for Ebola virus disease in Europe
[5] Media reports

******
[1] Senegal: 2 new suspected cases
Date: Wed 10 Sep 2014
Source: IOL (Independent Online, South Africa) [summ., edited]
http://www.iol.co.za/news/africa/senega ... BGKp_m3OPN

A total of 33 people are being kept in quarantine after a 21-year-old student from neighbouring Guinea came to stay there at his uncle's house a fortnight ago. With him, he brought the deadly Ebola virus [disease]. The student is now in isolation in a Dakar hospital, his condition improving, according to the health ministry. So far, no other Ebola cases have been confirmed, but the World Health Organization said on Tue [9 Sep 2014] that 2 new suspected cases had been detected in Senegal. It provided no further details...

Those quarantined inside the house include a 2-month-old baby. People under surveillance are being tested morning and night for fever, Senegalese authorities say. It was not immediately clear if the WHO's 2 suspected cases were among this group... [They could be among the health workers who treated him initially after he denied any contact with an EVD case. If they are confirmed, Senegal faces the same scenario as Nigeria. - Mod.JW]

Doctor Mamadou Ndiaye, director of prevention in Senegal, said the student travelled by "bush taxi" -- typically, old Peugeot 504 estate cars transporting 7 passengers jammed together for hours, sweating in the heat. An initial test of the student by Senegalese doctors came out negative, a diplomat said. But a 2nd test, revealed to ministry officials in the early hours of 29 Aug 2014, was positive and health minister Seck announced it that morning. Yet even the day after the announcement, a Reuters witness at the house said there was no surveillance in place. Neighbours say a young woman slipped away under cover of darkness last week [week of 1 Sep 2014], though a police officer monitoring the site denied this.

Though his health has improved, the student still tested positive for the virus in a check up on 3 Sep 2014 and he remains in isolation. - more

[Byline: Emma Farge, Andrew Oberstadt]

--
Communicated by:
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******
[2] Liberia: 1st person report
Date: Thu 11 Sep 2014
Source: BBC News [summ., edited]
http://www.bbc.com/news/world-africa-29147797

"Flights into disaster zones are usually full of aid workers and journalists. Not this time. The plane was one of the 1st in after some 10 airlines stopped flying to Liberia because of EVD, and still it was empty...

A colleague tells me she has just lost a family member about to give birth. It was a normal pregnancy, but she was turned away by every hospital as staff were too afraid to take her in case she had EVD. She did not have the virus, but she died because of delivery complications. Her baby at least survived... [For how long? - Mod.JW]

Heavy rains lash down over the weekend -- I shudder to think of Medecins Sans Frontieres and health ministry workers and patients battling under plastic sheeting in such rains...

They tell us about a survivor in their community. He came back from the treatment centre, but despite testing negative for the virus he infected his girlfriend, who died. The semen of male Ebola survivors remains contagious for a minimum of 7 weeks after infection. The villagers ask if survivors can be isolated...

The doctor at the empty hospital we visit says they suspect any patient who comes with fever, diarrhoea, or stomach pains as having Ebola. "Guilty until proven otherwise" is the motto -- and people are sent away as medical staff do not have the facilities to cope with the virus...

One of the joys of working for Unicef is children, picking up babies, playing with them. Here we dare not touch babies; there are no handshakes, no hugs. It's simply too risky.

[What it's like on the ground there now -- well worth reading the full report. - Mod.JW]

--
Communicated by:
ProMED-mail Rapporteur Kunihiko Iizuka

******
[3] Diagnostic tests
Date: Tue 9 Sep 2014
Source: The Washington Post [summ., edited]
http://www.washingtonpost.com/national/ ... story.html

The death toll has climbed to at least 2296 in West Africa, WHO announced Tue [9 Sep 2014]. The new figure, current through Sat [6 Sep 2014], shows a staggering spike of nearly 200 new deaths recorded in one day. West Africa has 4293 total cases of confirmed, probable and suspected Ebola infections, a number that could rise as high as 20 000, WHO has warned.

More than half of the epidemic's deaths (1224) and nearly half of all cases (2046) have been in Liberia. The country has become so overwhelmed that only 31 percent of EVD cases in Liberia have been lab confirmed through blood tests, WHO said. Another 47 percent of Liberia's cases have been deemed "probable," which means they have been evaluated by a clinician, according to WHO. Probable cases also include people who had suspected cases and died and had a link to someone with a confirmed case.

Several factors account for why so many Liberian cases aren't confirmed by labs, WHO spokesman Daniel Epstein said Tue [9 Sep 2014]. Among them are the sheer volume of cases in that country, poor infrastructure, and the limited number of EVD labs and staff throughout West Africa.

[Byline: Lena H Sun. Elahe Izadi contributed to this report]

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

----
Date: Sun 7 Sep 2014
From: David Thomson <dthomson@naqia.gov.pg> [edited]

[Re: ProMED-mail Ebola virus disease - West Africa (152): region, UN, Nigeria, tests 20140906.2753389]
----------------------------------------------------------------------
Regarding "[5] Faster diagnostic test" in the post, I agree that the diagnostic system needs to be validated against the 'gold standard' and also that it may turn out to be very useful, so warrants genuine attention.

Bottom line, however, is that any new diagnostic technologies usually also require significant attention to the entire diagnostic process and system associated with them, particularly if trying to introduce them into a chronically under-resourced environment that is currently under quite extreme immediate operational stress. Under such circumstances, it is rarely easy to introduce any significant change, such as a new field rapid screening test strip/card system, let alone a more sophisticated machine-based molecular diagnostic system.

These types of diagnostic technologies can be useful in developing countries, largely because they are often 'simpler' and 'less expensive' to operationalize than some others (that is, to put into labs and to train comparatively untrained or unexposed people to use effectively, repeatably, and predictably, they are often less expensive and/or easier to maintain or replace, etc.), and because once operationalized, they may be able to produce results for the field faster, and (with a lot of luck) it may be possible to operationalize them closer to the point of service delivery.

They may not, however, always be quite as useful as superficially might appear to the uninitiated just because they use less costly or less sophisticated equipment or processes. This reality often stems from issues associated with handling of specimens during their preparation -- for example, a diagnostic system that runs in a small, simple, battery-powered bench-top device may not be as useful if a large electricity-powered Class 3 laminar flow hood or containment cabinet is the minimum needed to safely prepare specimens for testing (particularly from symptomatically suspect or confirmed patients). For molecular tests, there is usually also the need for a particularly clean specimen preparation, processing, and testing environment because cross-contamination and over-contamination can be quite significant issues -- hence their more typical application within 'clean room' laboratory environments (Class 3 or 3+ in this case) that are, themselves, usually in very short supply within developing countries.

--
Dr David Thomson
General Manager Operations
National Agriculture Quarantine & Inspection Authority (NAQIA)
Papua New Guinea
<dthomson@naqia.gov.pg>

[However, PCR tests in the (few) field labs are producing same-day results. - Mod.JW]

******
[4] ECDC case definition for Ebola virus disease in Europe
Date: Wed 10 Sep 2014
http://www.ecdc.europa.eu/en/press/news ... 68&ID=1062

A case definition (http://www.ecdc.europa.eu/en/healthtopi ... fault.aspx) for reporting cases of Ebola virus disease in the EU has been released by the European Centre of Disease Prevention and Control (ECDC). The definition aims to classify cases for epidemiological reporting and not to guide investigation or clinical management of cases.

Although developed in response to the outbreak of Ebola virus disease currently affecting West Africa, the case definition is broad enough to apply to any case of EVD.

Only confirmed cases are to be reported at the European level, although the newly published case definition does include a 'probable case' definition.

Algorithms for laboratory diagnosis (http://www.ecdc.europa.eu/en/healthtopi ... fault.aspx) of EVD and for the initial assessment and management of patients (http://www.ecdc.europa.eu/en/healthtopi ... fault.aspx) have also been released. To offer further support to healthcare professionals possibly faced with a situation where the management of patients suffering from EVD becomes necessary, the algorithms are accompanied by a directory of guidance (http://www.ecdc.europa.eu/en/healthtopi ... fault.aspx) from national institutes and other public health bodies. These guidance documents provide more detailed steps for the management of any EVD patient.

By releasing the case definition and related algorithms, ECDC works to support EU Member States in their preparedness for a quick and effective response to any situation that may potentially involve an EVD case.

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

[Unlike Europe, West Africa does not have the capacity to test its thousands of suspected and probable cases, nor are samples (especially from long-dead bodies) always obtainable in good enough condition to be tested. - Mod.JW]

******
[5] Media reports

Donation: Gates foundation
--------------------------
10 Sep 2014: The Bill & Melinda Gates Foundation today [10 Sep 2014] announced that it will commit USD 50 million to support the scale up of emergency efforts to contain the EVD outbreak in West Africa and interrupt transmission of the virus... To date, the Gates Foundation has committed more than USD 10 million of the USD 50 million to fight the Ebola outbreak, including USD 5 million to WHO for emergency operations and R&D [research & development] assessments and USD 5 million to the US Fund for UNICEF to support efforts in Liberia, Sierra Leone, and Guinea to purchase essential medical supplies, coordinate response activities, and provide at-risk communities with life-saving health information. An additional USD 2 million will also be committed immediately to the Centers for Disease Control and Prevention [CDC] to support incident management, treatment, and health care system strengthening.
http://www.gatesfoundation.org/Media-Ce ... e-to-Ebola

--
Nigeria: school reopening concerns, airport screening
-----------------------------------------------------
11 Sep 2014: (Lindaikeji's Blog) It seems a lot of mums are against the resumption of primary and secondary schools on 22 Sep 2014... [one writes]

"I am yet to receive information about confirmed (not advised/suggested) nationwide measures that have been put in place to ensure the safety of our children from the Ebola virus [disease] upon resumption at school in 2 weeks." ...

"I ask what control measures against EVD have been put in place in ALL schools, particularly the government and state schools? I visited a private school in Abuja and before we could go in, our temperatures were taken. We should remember that even if private schools are well catered for, the children of our drivers, domestic help, and "junior staff" attend public schools...

[J]ust before boarding planes (in Lagos and Abuja), passengers (adults and children) are given a rub-down. The officials checking our bodies were wearing gloves. However, the same gloves were worn while touching a good number of people. The officials were protected, but how about the passengers being touched with the gloves that had been used to touch many others? On arrival at the Abuja airport, the temperature of every passenger was taken before entry was granted into the Federal Capital Territory. Of concern is that on departure from Abuja, this was not the case. Worse still, Lagos State that had the index case of EVD welcomed us without any precautionary measures of any kind... - more
http://lindaikeji.blogspot.co.uk/2014/0 ... a-and.html

[There appears to be a need for standardization of prevention measures in schools and for domestic flights. - Mod.JW]

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

[A good map with the latest case locations and counts is available at http://healthmap.org/ebola. - Mod.JW]

Beitrag von **Birgitt** » So 14. Sep 2014, 17:42

EBOLA VIRUS DISEASE - WEST AFRICA (161): HOSPITAL SHIPS, MILITARY MEDICAL AID
*****************************************************************************
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] Africa Mercy, charity hospital ship
[2] USNS Hospital ships
[3] Hospital ships for EVD outbreak
[4] Military medical aid
[5] USA pleads lack of military expertise

******
[1] Africa Mercy, charity hospital ship
Date: 8 Sep 2014
From: Thomas Farrell <farrell.thomas@att.net> [edited]

During the hospital ship discussion, there was no mention of Africa Mercy, an NGO modern facility that does medical work in Africa. I'm not sure whether it is readying to go.

--
Thomas C. Farrell, Jr MD MS
San Diego, CA
<farrell.thomas@att.net>

[Africa Mercy is the world's largest charity hospital ship. The floating hospital includes 5 state-of-the-art operating rooms as well as intensive care and ward bed space for up to 82 patients 65946213.1410271551.14 10271551.1410271551.1&__utmb=1.4.10.1410271551&__utmc=1&__utmx=-&__utmz=1.14 10271551.1.1.utmcsr=google|utmccn=(organic)|utmcmd=organic|utmctr=(not%20provided)&__utmv=-&__utmk=167606718">https://www.mercyships.org/ships/africa ... __utma=1.3 65946213.1410271551.14 10271551.1410271551.1&__utmb=1.4.10.1410271551&__utmc=1&__utmx=-&__utmz=1.14 10271551.1.1.utmcsr=google|utmccn=(organic)|utmcmd=organic|utmctr=(not%20provided)&__utmv=-&__utmk=167606718. But it is not set up for infectious disease or isolation beds, and there are lots of crew members' children on board (with a school for them). - Mod.JW]

******
[2] USNS Hospital ships
Date: 9 Sep 2014
From: Thomas Farrell <farrell.thomas@att.net> [edited]

The USNS Comfort is no longer treated as a 1000-bed unit, as it is too hard to reach the upper racks. All chemical [warfare] cases must be decontaminated before entering the hull. Except for smallpox, most bioweapons are not contagious person to person.

--
Thomas C. Farrell, Jr MD MS
San Diego, CA
<farrell.thomas@att.net>

[Tom tells me they are 4-decker bunks. With vomit and excrement coming down from upper bunks and having to sponge down contaminated mattresses, it is impractical. So there are only 250 practical beds. And in the 3 weeks it would take the Comfort to get there, the bed shortage would have long passed 250 (currently almost 200 new cases in just one day according to the WHO). I can see no point in deploying, with its obligatory high upkeep support and security flotilla. - Mod.JW]

******
[3] Hospital ships for EVD outbreak
Date: 11 Sep 2014
From: Thad Zajdowicz <trzajdowicz@gmail.com> [edited]

Regarding the discussions on ProMED about dispatch of a Navy hospital ship to the EVD outbreak area, as a retired Navy ID physician, and obviously in no official capacity, I doubt their utility, except as sending a message that help is being sent. The ships are configured to treat primarily surgical cases, and there are, so far as I am aware, no isolation facilities aboard. Additionally, ventilation and air handling aboard ship are always interesting issues that don't lend themselves to such reconfiguration.

This said, the military does have assets that would undoubtedly be useful on the ground in the affected countries.

--
Thad Zajdowicz, MD, MPH (CAPT, MC, USN retired)
MMES Corporation, Rockville, Maryland
<trzajdowicz@gmail.com>

******
[4] Military medical aid
Date: 9 Sep 2014
From: Gregory Kelly <gka25@sfu.ca> [edited]

Regarding the comment in ProMED-mail posting Ebola virus disease - West Africa (155): hospital ships, military medical ["Finally, a country has asked for military medical aid, and is welcoming it. - Mod.JW"], not everyone believes the military is a welcome addition to this fight, as they cause enormous damage elsewhere and have caused economic deprivation to programs that could have stopped this virus sooner.

If you are going to post comments in favor of the military, you owe equal time to criticisms of the military; otherwise, you are politicizing the list. There seems to be a complete absence of examination as to why the military is the only organization that can respond. The outcome will be:

1) The military will succeed (eventually) in containing EVD (or the virus will run out of infectives and give the appearance of the military succeeding);
2) There will be reinforcement of the belief that only the military can solve problems;
3) The military will get additional funding;
4) Alternatives will not be funded;
5) There will be another crisis somewhere else, and permanent solutions will not be undertaken because "now is not the time" to do so (but it is never the time to do so).

The money should go to the people on the ground and to pay for supplies manufactured at an at-cost price and bring manufacturing equipment to the ground and train the people to make more supplies. We can do this for a fraction of what the military will cost, do it peacefully, and create enormous goodwill. Yes, people will die, and likely more people than with a military operation, but probably not that many more, and down the road, a whole lot fewer people will die from secondary effects (like being bombed). The payoff is what we build long term.

So my point would be that if you want to report the news, do so without offering commentary, or offer links to alternative viewpoints to balance it.

--
Gregory Kelly
<gka25@sfu.ca>

[ProMED does not intend to start a discussion of the pros and cons of military support to the EVD struggle when the immediate need is for aid from whatever quarter is offered and acceptable. We have given time above to adverse criticism. What is needed now is constructive criticism. - Mod.JW]

******
[5] USA pleads lack of military expertise
Date: 9 Sep 2014
Source: Washington Post [edited]
http://www.washingtonpost.com/national/ ... story.html

Despite President Obama's call for increased involvement of the U.S. military in the fight against the rapidly escalating EVD epidemic in West Africa, the USA is hamstrung by a lack of military medical personnel with expertise dealing with the deadly virus, a top official in charge of coordinating the U.S. response said on Tue [9 Sep 2014]. "There isn't an existing cadre of people who have experience in treating this epidemic other than the aid group Doctors Without Borders," said Nancy Lindborg of the U.S. Agency for International Development.

The Pentagon announced on Mon [8 Sep 2014] that it would set up a 25-bed field hospital in Liberia to help provide medical care for health workers responding to the epidemic, prompting criticism from international aid groups and global health advocates who said the action was paltry compared with the need in the hardest-hit countries, Guinea, Liberia and Sierra Leone. Lindborg said on Tue [9 Sep 2014] that the hospital is intended to provide health care for foreign workers, not Liberians. The goal of the hospital is to "provide assurance that there will be quality health care available for health workers" who have or might volunteer to go to any of the affected countries, she said.

The World Health Organization has said the outbreak is "increasing exponentially" in Liberia. In Montserrado County alone -- where the capital, Monrovia, is located -- there is a need for 1000 treatment beds; only 240 exist.

The Defense Department has provided some equipment, supplies and staff in the region since the outbreak began months ago. But the expectation was that Obama's remarks on Sun [7 Sep 2014] would produce more substantive action and that the U.S. military, with its enormous logistical capacity, extensive air operations, and highly trained medical corps, could address gaps in the response quickly. But the USA does not have a workforce trained in the special protocols for EVD, Lindborg said. WHO is currently training 500 new workers in Liberia, and the U.S. government is supporting that effort, she said.

[This is not an excuse. If WHO can train 500 educationally disadvantaged Africans in a week, it should be possible to train at least 500 US college graduate military medical specialists in that time. - Mod.JW]

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

[The good news is that military medical and logistical aid has been requested by 2 of the affected countries and will be provided by the USA, UK and China. The bad news is that even if the USNS Comfort with its 250 practicable beds were to sail this week from the USA, during the 3 weeks it would take to reach West Africa, the estimated bed deficit will have far surpassed that. So it seems pointless to send hospital ships, whether military or civilian.

Therefore, large capacity field hospitals will be needed. The USA has announced that its 25-bed field hospital would cost USD 22 million to send to Liberia (including operating costs for how long?), so just imagine the cost of setting up several field hospitals, each with 10 times the capacity.

UIMIL (United Nations Mission in Liberia), as of 30 Jun 2014, had 6020 total uniformed personnel (including 4460 troops, 126 military observers, and 1434 police), 398 international civilian personnel, 860 local staff, and 288 UN Volunteers. It also has vehicles that could help right away with transporting patients, health workers and lab specimens.

A ProMED HealthMap map with the latest case locations and counts is available at http://healthmap.org/ebola. - Mod.JW]

Beitrag von **Birgitt** » So 14. Sep 2014, 17:47

EBOLA VIRUS DISEASE - WEST AFRICA (162): WHO, VOLUNTEERING, PROTECTION
**********************************************************************
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] WHO: EVD Response Roadmap Situation Report 3 as of 7 Sep 2014
[2] WHO interview: Dr Ian Norton
[3] Volunteering
[4] Protection: health workers
[5] Media online

******
[1] WHO: EVD Response Roadmap Situation Report 3 as of 7 Sep 2014
Date: Fri 12 Sep 2014
Source: WHO [edited]
http://apps.who.int/iris/bitstream/1066 ... g.pdf?ua=1

Cases/deaths as at end 7 Sep 2014
---------------------------------
Guinea 861/557 - 65 percent
Liberia 2081/1137 - 55 percent
Sierra Leone 1424/524 - 37 percent
Total 4366/2218 - 51 percent

Nigeria 21/8 - 38 percent
Senegal 3/0 - 0 percent

[Note the discussion of death rates in ProMED post: Ebola virus disease - West Africa (159): WHO, travel, contacts, serum, rates 20140910.2764881. - Mod.JW]

--
Communicated by:
ProMED-mail Rapporteur Kunihiko Iizuka

******
[2] WHO interview: Dr Ian Norton
Date: Fri 12 Sep 2014
Source: ABC News, Australia [excerpts, edited]
http://www.abc.net.au/pm/content/2014/s4086777.htm

Mark Colvin: As chief of foreign medical teams with the World Health Organization, Dr Ian Norton will be contributing to ABC news coverage of the EVD [Ebola virus disease] crisis. He is racing against time to build 3 massive field hospitals in Monrovia [Liberia], and his goal is to get them ready in just 3 weeks. He spoke to me a short time ago....

Ian Norton: This is new for everybody. The only team that have ever done anything like a field hospital for EVD treatment before have been MSF, Medecins Sans Frontieres. And their standard operations are for 40 people. Now, here in Monrovia they've already constructed a 200-bed facility, the biggest in the world, and they're about to expand to 300 and then, perhaps, to 400. And we, the WHO, are building five 100-bed facilities. So even that alone is almost 3 times as much as anything that's ever been constructed prior to this particular outbreak.

MC: And what about the number of actual medical staff to look after people? Is that even remotely keeping up?

IN: Not at the moment. No. What we have here is a call to foreign medical teams across the world to come and assist. And we're not looking for huge numbers of foreign doctors and nurses and logistics but at least a core group of 30 to 40 who would help manage these large centres and then work alongside national medical staff and nursing. And EVD care is all about the nursing care.

MC: And are there enough nurses in the local area, or are you having to recruit nurses from around Africa and, indeed, around the world?

IN: Some of the countries affected have amongst the lowest rates of nursing and doctor ratios in the world. What's really tragic here in Liberia, where I am now, they were already 4th-last in the world ranking for numbers of doctors per population and they've lost almost 20 doctors. They only produce 10 doctors per year in a medical class.

MC: So they've lost 2 years' worth of doctors just in a few weeks to EVD?

IN: Correct. Also, there's only a couple of thousand nurses in the country and we know that at least 90 have died from the infection and another 50 or 60 have survived.... They've lost a lot of other ancillary healthcare worker staff. Tragically, we have 3 ambulance workers infected now, here in Monrovia. And so the impact on the healthcare workers is huge....

With better care, and certainly with the new EVD treatment centres and with the right number of staff treating them, we can gradually escalate care. And I'll give you examples that are coming out of Guinea for several months now. With good supportive care they can bring the mortality rate down to 30 to 50 per cent at most. So we can see a several-fold improvement in survival if we can just get the teams in here and we can just get these EVD treatment centres up and running ... [more]

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

[The Liberian government will allow erection of these field hospitals in Monrovia's football stadium. FIFA, which built the stadium, will guarantee its restoration after it is no longer needed. - Mod.JW]

******
[3] Volunteering
Date: Wed 10 Sep 2014
From: Kathleen Harriman <Kathleen.Harriman@cdph.ca.gov> [edited]

Re: Ebola virus disease - West Africa (158): urgent call for volunteers
-----------------------------------------------------------------------

For clinicians interested in volunteering to assist in the Ebola response in West Africa, here are three links that may be useful:

1) USAID medical volunteer website at: http://www.usaid.gov/ebola/volunteers
2) King’s Sierra Leone Partnership Ebola response volunteer website at: http://kslp.org.uk/get-involved/lend-yo ... olunteers/
3) Medicins Sans Frontieres: http://www.msf.org/work-msf/working-in-the-field

--
Kathleen Harriman, PhD, MPH, RN
Chief, Vaccine Preventable Diseases Epidemiology Section
Immunization Branch
California Department of Public Health
<kathleen.harriman@cdph.ca.gov>

----
Date: Thu 11 Sep 2014
From: Fasina, Folorunso Oludayo <dayo.fasina@up.ac.za> [edited]
Cross-posted from Nigerian Biomedical and Life Scientists Yahoo Group

I am still at a loss about calls for doctors from all over the world to come and assist in emergency medicine in Liberia, Guinea and Sierra Leone, whereas the West African postgraduate college (for Medicine) and other such institutions have not even released a piece to call on their fellows and members to come and assist.

--
Fasina, Folorunso Oludayo, DVM, MSc, PhD
Senior Lecturer, Section of Swine Health
Department of Production Animal Studies
University of Pretoria
Onderstepoort 0110
South Africa

[In fact, the African Union has promised to find 100 volunteer clinicians and a donor has offered to pay their airfares to the EVD-affected countries. - Mod.JW]

******
[4] Protection: health workers
Date: Tue 9 Sep 2014
Source: The Lancet, vol. 384, issue 9946, p. 856, 6 Sep 2014; published online 29 Aug 2014 [excerpts, edited]
http://www.thelancet.com/journals/lance ... X/fulltext

Is respiratory protection appropriate in the Ebola response?
------------------------------------------------------------
Jose M Martin-Moreno, Gilberto Llinas, Juan Martinez Hernandez
Related to "Lives at risk under global Ebola guidelines -- experts"

We write to express our concern about one aspect of the response to the current epidemic of EVD that has, so far, received little attention, lacks an evidence base, and might be counterproductive.

The primary mode of transmission of ebolavirus is through contact with infected patients' secretions (such as blood, vomit, or faeces) directly and indirectly (for example, from contaminated needles). This transmission occurs via close family contact or in health-care settings, particularly when placing orotracheal intubation or when caring for a patient who is vomiting or bleeding. Ebolavirus is rarely transmitted via an airborne route. Although these routes of transmission are well known, most agencies, including governmental agencies responsible for repatriating western patients, apply infection-control measures appropriate for airborne diseases.

Excessive precautions could offer reassurance to those responding to EVD, yet complete respiratory protection is expensive, uncomfortable, and unaffordable for countries that are the most affected. Worse, such an approach suggests that the only defence is individual protective equipment, which is inaccessible to the general population. Moreover, the image of workers with spectacular protective clothing might contribute to the panic in some communities. If this leads people to flee affected areas it could increase the spread of infection. It also reinforces the view that some lives are more valuable than others, already engendered by decisions about the use of experimental EVD drug ZMapp.

We contend that the systematic application of precautionary measures that protect health-care personnel and others from direct contact (i.e., gloves and waterproof smocks, goggles, masks, and individual rooms or wards in the hospital) are sufficient to manage most patients (who do not experience haemorrhage or vomiting). In fact, goggles and masks might not even be necessary to speak with conscious patients, as long as a distance of 1-2 metres is maintained (the maximum distance that infectious droplets might reach)....

In western Africa now there is a need for rational and efficient use of protective equipment. This can only be achieved by communicating a consistent message that the disease is essentially transmitted through direct contact. In control of infectious diseases, more is not necessarily better and, very often, the simplest answer is the best.

--
Communicated by:
ProMED-mail Rapporteur Kunihiko Iizuka

----
Date: Tue 9 Sep 2014
Source: Yahoo News, International Business Times report [excerpts, edited]
https://uk.news.yahoo.com/ebola-outbrea ... 45357.html

The WHO recently voiced concern over the "unprecedented" number of healthcare workers hit by the [EVD] outbreak, with more than 120 workers dead and over 240 others infected....

In a co-authored editorial in the International Journal of Nursing Studies, Raina MacIntyre, a professor of Infectious Diseases Epidemiology at the University of New South Wales [Australia] said the recommendations for staff treating EVD patients to wear masks and goggles were not enough to curb the spread of infection. "I have conducted the world's largest randomised control trial of respirators and surgical masks, and it is concerning to me that we are dealing with a disease which has a fatality rate of up to 90 percent and yet we are not taking the most cautious approach," she said. "If our healthcare workers die we have no hope of controlling the outbreak. There has been no criticism of the guidelines but lots of commentary supporting them. But they're playing Russian roulette with frontline health workers' lives."

MacIntyre highlights that laboratory researchers working on the virus were required to wear full protective clothing, but goggles and face masks were deemed suitable for healthcare workers.... MacIntyre said the guidelines suggested scientists had one set of guidelines, while health workers had another. "It's like they have no concept of what the clinical setting is like," she said. "The hospital is an unpredictable, highly contaminated setting which poses higher risk of EVD transmission. Healthcare posts had to shut because people are scared to go to work. That's a really troubling thing, because of a lack of skilled healthcare workers in the 1st place."

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

******
[5] Media online

3rd US EVD patient showing 'remarkable improvement'
---------------------------------------------------
11 Sep 2014: (Reuters) The 3rd American to be treated for EVD in the USA is showing "remarkable improvement" after receiving an infusion of plasma from US EVD survivor Dr. Kent Brantly, as well as an undisclosed experimental drug, his doctors said on Thursday [11 Sep 2014]. Dr. Rick Sacra, 51, who is being treated in a special biocontainment unit at the University of Nebraska Medical Center in Omaha, received 2 doses of plasma from Brantly, which doctors are calling a convalescent serum, and has been given nightly doses of an undisclosed experimental drug, Dr. Phil Smith, one of Sacra's doctors, said in a news briefing. "I don't know how much of his recovery is due to the drug, how much is due to the convalescent serum and how much to the aggressive intravenous fluids," Smith said. Brantly's blood likely contains protective antibodies that may help buy Sacra some time while his body tries to fight off the infection, Smith said. The hospital tried a number of potential donors, but Brantly's blood type turned out to be a match for his friend and fellow missionary Sacra.
http://www.reuters.com/article/2014/09/ ... F220140911

Cuba responds to EVD crisis
---------------------------
12 Sep 2014: (WHO) WHO welcomes the commitment from the Government of Cuba to provide 165 health professionals to support EVD care in west Africa. The newly announced support includes physicians, nurses, epidemiologists, specialists in infection control, intensive care specialists and social mobilization officers, and will be concentrated in Sierra Leone.... The health professionals will deploy to Sierra Leone the 1st week in October [2014] and stay for 6 months. They have all worked previously in Africa ... [more]
http://who.int/mediacentre/news/stateme ... doctors/en

UNHAS gets USD 4 million to support operations in West Africa
-------------------------------------------------------------
11 Sep 2014: (India Blooms News Service) To help offset disruptions in aid delivery caused by travel restrictions on EVD-affected countries, the top United Nations relief official on Wednesday [10 Sep 2014] approved an emergency allocation of nearly USD4 million for the UN Humanitarian Air Service (UNHAS) to support operations in West Africa ... [more]
http://indiablooms.com/ibns_new/health- ... frica.html

Serum, convalescent, black market
---------------------------------
12 Sep 2014: (Forbes) Dr. Chan [WHO Director-General] confirmed reports that a black market is emerging in the sale of convalescent serum. While not providing specifics on countries and areas where such sales are occurring, she warned that these supplies carry no assurances that they were collected appropriately and are free of [ebola]virus ... [more]
http://www.forbes.com/sites/davidkroll/ ... erra-leone
[It could also contain hepatitis, HIV and/or other dangerous pathogens. - Mod.JW]

Nigeria: false alarm
--------------------
12 Sep 2014: (Daily Post Nigeria) The Minister of Health, Prof. Onyebuchi Chukwu, said that a South African woman earlier quarantined at the Murtala Mohammed International Airport in Lagos over EVD has tested negative to the disease. The South African national, who showed symptoms of EVD was earlier quarantined in Lagos. Mr. Onyebuchi's Special Assistant on Media, Dan Nwomeh, disclosed this via his Twitter (at DanNwomeh).
http://dailypost.ng/2014/09/12/ebola-so ... s-negative
[Earlier reports said she had arrived from Casablanca by Air Marok and been arrested. There have been no reports of EVD in Morocco, so quarantine was an unnecessary over-reaction. - Mod.JW]

Liberia: Mary's Meals responds to EVD crisis
--------------------------------------------
12 Sep 2014: Mary's Meals is delivering food aid to thousands of people affected by the EVD outbreak in Liberia -- including patients infected by the deadly virus -- following the launch of a new emergency relief effort.

The Mary's Meals crisis response has already seen around 10 000 children receive emergency food rations in their homes and is focused on 2 counties, Grand Cape Mount and Bomi -- both of which have been cut off from the capital Monrovia by military blockade. The state of emergency declared by Liberian President Ellen Johnson Sirleaf has led to the establishment of quarantined zones and the restriction of people's movements. As a result, there have been widespread reports of soaring food prices, increased hunger and a general rise in food insecurity across the region ... [more]
http://www.marysmeals.org.uk/marys-meal ... st-africa/

USA: State Dept. orders 160 000 hazmat suits for EVD
----------------------------------------------------
Christopher J. Ryan, President and Chief Executive Officer of Lakeland Industries, said, "With the US State Department alone putting out a bid for 160 000 suits, we encourage all protective apparel companies to increase their manufacturing capacity for sealed seam garments so that our industry can do its part in addressing this threat to global health." ... [more]
http://investmentwatchblog.com/breaking ... for-ebola/

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

[I am not seeing any discussion of the need to protect the whole face -- eyes, nose and mouth -- from touching by contaminated gloves, particularly when removing protective gear, when the urge to wipe away sweat or tears or scratch an itch may be overwhelming. Face shields should be preferred to scary masks and goggles, allowing patients to see the face of the health worker attending to them.

It is also important to note that incident investigators seem to be coming to the conclusion that the international staff who became infected were probably contaminated outside the hospitals and labs, perhaps at their hotels, where, although they may not have touched anyone, they may have contacted a contaminated surface or fomite.

A HealthMap/ProMED-mail map with the latest case locations and counts is available at http://healthmap.org/ebola. - Mod.JW]

Beitrag von **Birgitt** » So 14. Sep 2014, 17:54

EBOLA VIRUS DISEASE - WEST AFRICA (163): VOLUNTEERS, SIERRA LEONE, LIBERIA
**************************************************************************
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] Volunteers: CDC course
[2] Sierra Leone: Dutch contacts to be evacuated
[3] Liberian president appeals to US President
[4] Liberia: Senate wants EVD hospital outside capital
[5] Liberia: child health impacted
[6] Liberia: fake death certificates
[7] Prevention
[8] Funding
[9] Inbox

******
[1] Volunteers: CDC course
Date: Fri 12 Sep 2014
From: Marcelle Layton <mlayton@health.nyc.gov> [edited]

CDC course for volunteers going to Africa
-----------------------------------------
There is info on the CDC website about how to sign up [1st course closing date 15 Sep 2014]:
http://www.cdc.gov/vhf/ebola/hcp/safety ... index.html

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

[It is not clear from the MSF website that EVD volunteers are being sent out to West Africa for 6-week tours, not the longer periods they mention. - Mod.JW]

*******
[2] Sierra Leone: Dutch contacts to be evacuated
Date: Fri 12 Sep 2014
Source: Reuters [edited]
http://af.reuters.com/article/liberiaNe ... K120140912

Netherlands to evacuate 2 doctors who had contact with Ebola victims
--------------------------------------------------------------------
Authorities in the Netherlands are preparing to evacuate 2 Dutch doctors who had unprotected contact in Sierra Leone with patients who later died of EVD, a Dutch public health official said on Friday [12 Sep 2014]. The 2 doctors have shown no symptoms of the virus but authorities believe there is cause for concern because they were not wearing full protective clothing when they came into contact with the patients, who had not yet been diagnosed with EVD.

"The 2 doctors' personal protection should be considered inadequate. They could potentially have been exposed," said Jaap van Dissel, director of the Dutch Centre for Infectious Disease Control. The 2 doctors will be evacuated on a special flight to minimise the risk of contagion to other passengers and monitored closely on arrival, according to media reports. "It's only contagious if they have a fever," van Dissel said, and added that if symptoms developed, the 2 would be placed in quarantine in a university hospital.

Dutch public television said the case was discovered when the doctors came to the Netherlands' nearest embassy in Ghana after the patients they had been in contact with at the Lion Heart Medical Centre in Yele town died of EVD. The clinic, which normally deals with cases of malaria, which has symptoms similar to Ebola, has since been shut down by authorities in Sierra Leone [because it is now EVD-infected - Mod.JW].

[Byline: Thomas Escritt; editing by Sonya Hepinstall]

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

[Ghana will be safe as long as they don't break a fever before leaving the airport -- the incubation period can be as short as 2 days. They will need to be quarantined for 21 days on arrival in the Netherlands. - Mod.JW]

******
[3] Liberian president appeals to US President
Date: Sat 13 Sep 2014
Source: Reuters [edited]
http://uk.reuters.com/article/2014/09/1 ... QN20140913

Liberian President Ellen Johnson Sirleaf has appealed to US President Barack Obama for urgent aid in tackling the worst recorded outbreak of the deadly Ebola virus [disease], saying that without it her country would lose the fight against the disease.

The outbreak, which was 1st discovered in March [2014], has now killed more than 2400 people mostly in Liberia, neighboring Guinea and Sierra Leone, as understaffed and poorly resourced West African healthcare systems have been overrun. The World Health Organization (WHO) has warned that the epidemic is spreading exponentially in Liberia, where more than half of the deaths have been recorded. It has said that thousands are at risk of contagion in the coming weeks. Medical charity Medecins Sans Frontieres (MSF) has set up several treatment centers in the affected countries but has also repeatedly warned it has reached the limits of its capacity and appealed for foreign governments to intervene.

In a letter dated 9 Sep 2014 seen by Reuters, Johnson Sirleaf appealed to Obama to build and operate at least one EVD treatment unit in the capital Monrovia, saying that US civilian and military teams had experience in dealing with biological hazards. With the Liberian government due to open a 100-bed treatment center and MSF scaling up its EVD facility in Monrovia to 400 beds, Johnson Sirleaf said there was still a shortfall of 1000 beds in the capital as well as a need for 10 new centers in the rest of the country. "Without more direct help from your government, we will lose this battle against EVD," Johnson Sirleaf, who won the Nobel Peace Prize for her work on women's rights, wrote to Obama.

The US government has committed around USD 100 million to tackle the outbreak by providing protective equipment for healthcare workers, food, water, medical and hygiene equipment. The US military said this week it would build a 25-bed field hospital in Liberia to care for infected health workers but it would hand this to Liberians to run. [Other reports say this was to be reserved for international patients. - Mod.JW]

On Friday [12 Sep 2014], the US Ambassador to Liberia, Deborah Malac, said Washington would train security forces in isolation operations, after a boy was shot dead last month [August 2014] when Liberian soldiers opened fire on a crowd protesting a quarantine in a Monrovia neighborhood.

Worst threat since civil war
----------------------------
Liberian officials have called the outbreak the greatest threat to national stability since a 1989-2003 civil war, which killed nearly 250 000 people. Many ordinary people in Liberia, a nation founded by descendants of freed American slaves, look for help to the USA.

Cuba on Friday announced that it would deploy 165 medical personnel to Sierra Leone next month [October 2014], the largest contingent of foreign doctors and nurses committed so far.

[But with no firm date for arrival. As of 2 Sep 2014, roughly 100 US government personnel have been deployed and are working in the affected countries responding to the outbreak, this includes more than 70 CDC staff deployed in Guinea, Liberia, Nigeria, and Sierra Leone assisting with various vital response efforts such as surveillance, contact tracing, database management, and health education (but no clinicians). However, many American doctors and health workers are in those countries working with missions and NGOs -- not forgetting other foreign nationals, e.g., the 2 Dutch doctors mentioned in section [2] above and the British nurse who recently became ill with EVD, was repatriated and recovered. - Mod.JW]

Johnson Sirleaf said that EVD treatment centers were full and were being forced to turn away the sick. "We are sending them home where they are a risk to their families and the communities. I am being honest with you when I say that at this rate, we will never break the transmission chain and the virus will overwhelm us," she wrote. "Only governments like yours have the resources and assets to deploy at the pace required to arrest the spread," Johnson Sirleaf wrote to Obama, a fellow Nobel Peace Prize laureate.

In a country with large numbers of unemployed former child soldiers, Johnson Sirleaf said the outbreak threatened civil order. With healthcare workers staying away from work, after dozens of their colleagues contracted the virus, citizens were also dying of other, treatable illnesses, she said.

Johnson Sirleaf asked the USA to assist in restoring services in at least 10 non-EVD hospitals. Liberia also asked for US help in establishing an air bridge to transport personnel and equipment after all but 2 private airlines have canceled their flights.

[Byline: Daniel Flynn; editing by Dominic Evans]

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

******
[4] Liberia: Senate wants EVD hospital outside capital
Date: Thu 11 Sep 2014
Source: Daily Observer [edited]
http://www.liberianobserver.com/politic ... tside-city

A 3-member Senate committee yesterday [10 Sep 2014] presented to the Senate plenary an "Ebola Coordinated Response Plan," which it noted would help restore hope, rebuild the image of Monrovia and improve the situation in other counties. In the first of 3 plans, the committee is calling for the creation of a secluded and well guided [sic] [probably "guarded"] hospital outside of the capital city ... [more]

[Byline: J. Burgess Carter]

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

[This will be much more expensive in terms of transporting patients, staff, equipment and supplies and only marginally more secure than erecting a field hospital in the Monrovia football stadium, as suggested the following day by the president of FIFA (International Federation of Association Football): http://www.abc.net.au/news/2014-09-12/m ... fa/5738710. - Mod.JW]

******
[5] Liberia: child health impacted
Date: Fri 12 Sep 2014
Source: UNICEF [edited]
http://www.unicef.org/media/media_75860.html

Ebola crisis in Liberia hits child health and well-being
--------------------------------------------------------
As efforts to halt the spread of the Ebola virus [disease] intensify, UNICEF warns of its far-reaching impact on children. In Liberia, EVD has severely disrupted health services for children, caused schools to close and left thousands of children without a parent. Children are dying from measles and other vaccine preventable diseases and pregnant women have few places to deliver their babies safely ... [more]

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

******
[6] Liberia: fake death certificates
Date: Fri 12 Sep 2014
Source: The New Dawn [edited]
http://www.thenewdawnliberia.com/index. ... &Itemid=59

Who's issuing fake death certificates?
--------------------------------------
Health authorities in Monrovia have embarked on inspection of health facilities, vowing to probe public concern that "fake death certificates" are being issued to the families of deceased EVD victims to allow them carry on burials. Since the outbreak across West Africa that is badly hit, governments in the subregion have been urging citizens against concealing sick or dead persons. In Liberia, families are ordered to get a non-EVD death certificate for deceased relatives before burial. But the head of the Medical and Dental Council of Liberia, Dr. George Mulbah, told UNMIL Radio's Coffee Break on Wednesday that "Some people are concerned that people are dying of EVD, but are getting certificate of non-EVD deaths." [UNIMIL is the UN Mission in Liberia.] "We are going to probe this," said Dr. Mulbah, who warned that the council will apply the code of ethics against those carrying on such practice.

Besides the issue of fake death certificates allegedly being issued here under this EVD crisis, he said the council was carrying on inspection of drug stores and health centers to know who were providing services there. He feared that in some health facilities, individuals who have not been authorized to render health services could be operating, especially in unauthorized health centers. As such, Dr. Mulbah said others who are not trained in handling cases could be infecting themselves and increasing the number of health workers infected with the Ebola virus, though they may not be legitimate health practitioners. The Ebola death toll in Liberia continues to rise above other infected West African countries, and the World Health Organization or WHO has not seen any decline yet in this outbreak ... [more]

--
Communicated by:
ProMED-mail Rapporteur Kunihiko Iizuka

[If this is true, it not only means the real number of EVD deaths is under-reported, but also conceals the true number of contacts. - Mod.JW]

******
[7] Prevention
Date: 13 Sep 2014
Source: Standard Digital, Kenya
http://www.standardmedia.co.ke/article/ ... ertificate

Travellers told to produce EVD certificate
------------------------------------------
Some European and Middle East countries have placed a quiet 'ban' on people arriving from sub-Saharan and West Africa, requesting an EVD clearance certificate. According to documents seen by The Standard on Saturday [13 Sep 2014], individuals from these countries travelling to Germany, Netherlands and Dubai were asked for an EVD clearance certificate as a travel requirement. Sources at the Kenya Medical Research Institute (Kemri) confirmed that individuals travelling to these destinations had gone seeking to get tested and be issued with the document but were turned away. "We only receive samples for testing, not the individuals themselves," a source at Kemri said.

However, Health Cabinet Secretary James Macharia termed such a requirement a diplomatic breach, adding that they should refer the matter to the Ministry of Foreign Affairs. "There is no such clearance. If they do not want travellers in their country they should clearly say so," the CS told The Standard on Sat [13 Sep 2014] by phone. Director of Medical Services Nicholas Muraguri said he was not aware of the travel restriction and denied that the ministry had received similar requests.

A delegation travelling to Germany in a fortnight [2 weeks] for a conference are among those urged to produce a clearance certificate indicating they are free from EVD. "We received a phone call from one of the organisers detailing that the health requirement should be adhered to otherwise we will not be allowed beyond the airport in Germany if we proceed with the trip," one of the travellers who requested not to be named said.

Others travelling to Dubai had an 'Ebola test' listed in red ink as one of the requirements. An invitation letter to a Kenyan invited to attend a conference in Dubai, which we have redacted due to the sensitivity of the matter, reads in part, "We would like to take this opportunity to inform you that the Dubai.... will be sponsoring you for this occasion.... please RSVP and send the following documents to arrange travel. 1. Passport size photo 2. Passport copy 3. Ebola test."

Another team travelling to the Netherlands were informed that their trip, scheduled for early next month, had been cancelled in what they termed "travel restrictions." "These are prevention measures to avoid contamination risks and also to limit problems in case of frontiers or airports sudden closure. We therefore deeply regret to inform you that the visit to the Netherlands cannot take place as scheduled until the travel embargo is lifted," read the letter.

One of the travel agents who spoke on condition of anonymity said a majority of companies are insisting on an EVD test especially for those seeking a working visa. "Most of the companies in Dubai are insisting on the EVD test. If you just want a visiting Visa then you are not likely to have that problem," she said ... [more]

--
Communicated by:
ProMED-mail Rapporteur Kunihiko Iizuka

[Besides being illegal, this is also meaningless. This is not like HIV/AIDS testing, because any test for ebolavirus would miss a person developing viremia between when they were tested and when the visa was issued. But it seems to be aimed only at applicants for work visas -- and countries should welcome workers with antibody, showing that they are not infectious. - Mod.JW]

******
[8] Funding
Date: 9 Sep 2014
From: Deb Hensley <Deborah.Hensley@flhealth.gov>

Credit from World Bank?
-----------------------
It appears to me there may be an opportunity here to "rapidly" deploy field hospitals and, to offset a small portion of our national debt. Why not deploy 2/3rds of our Federal Medical Stations to the most needed locations and request "credit" from the World Bank or our creditors for providing international aid to this global disaster? How would one push this idea forward for vetting?

--
Deb Hensley, MPH, MHA
Epidemiology and Public Health Preparedness
Florida Department of Health in Pasco County
13941 15th Street
Dade City, Florida 33525
USA
<Deborah.Hensley@flhealth.gov>

----
Date: 13 Sep 2014
Source: Reuters
http://www.reuters.com/article/2014/09/ ... G720140913

AfDB offers USD 150 million to help West Africa handle EVD fallout
------------------------------------------------------------------
The African Development Bank (AfDB) told West African countries hardest hit by an EVD epidemic they were willing to give USD 150 million to help balance their public finances, but they must 1st show they are doing everything possible to improve their health systems.

Economic growth in Liberia and Sierra Leone could decline by almost 3.5 percentage points and Guinea 1 percentage point, exposing financing gaps totaling USD 100 million to USD 130 million in each of the 3 countries, the IMF said on Thu [11 Aug 2014].... AfDB announced in August [2014] it would donate USD 60 million to help train medical workers and purchase supplies to fight the EVD outbreak ... [more]

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

******
[9] Inbox

Sierra Leone medical workers strike
-----------------------------------
http://www.telesurtv.net/english/news/S ... -0022.html

13 Sep 2014: (TeleSur, Venezuela) Health Workers at Sierra Leone's Kenema Government hospital went on strike Fri [12 Sep 2014], citing overcrowding at the facility's EVD ward and lack of pay. Around 80 workers crowded around the entrance to the hospital and walked off the job, bringing the operations at the EVD treatment center to a standstill. Several other smaller job actions, with staff protesting poor working conditions and infection rates have led up to this one. Workers say their rates of pay do not add up to the risks they are taking in treating patients who have contracted EVD. The health professionals, who were recruited to boost staff numbers, operate inside high risk zones to treat the sick, decontaminate equipment, clean excrement, vomit and blood as well as remove the dead to bury them.

"I started working here one month ago and we have been paid nothing for the last 2 weeks," said Umaru, a hygienist. "We have stopped everybody from working until we receive our risk incentive." Staff are supposed to be paid USD 110 (500 000 SLL) per week but have been working for free the past 2 weeks. Many workers have left their posts because of the high risk of contracting EVD and lack of pay. Over 38 doctors and nurses have been infected and died since the outbreak [began].

The facility is already over capacity by some 80 patients with new cases arriving daily. Despite the World Health Organization (WHO) suggesting that the facility take no new admissions, 14 suspected patients were admitted to the high risk zone on Wed [10 Sep 2014] alone. "This illustrates the problem in this country," said Nyka Alexander, spokesperson for WHO in Sierra Leone. "We suggest no further admissions but if people are sick compassion will compel you to admit them. But there are not enough beds."

Support staff said they faced stigmatization for simply caring for infected patients. "They say we are infected, they provoke us in the street, they think we are the carriers of EVD," said 25-year-old nurse Donnell Tholley, who expects the government, the United Nations and the WHO to negotiate with the workers on Mon [15 Sep 2014].

----
Date: 11 Sep 2014
From: Oyewale Tomori <oyewaletomori@yahoo.com> [edited]
Cross-posted from <nigerianbiomedicalandlifescientists@yahoogroups.co.uk>

I was going through my archives and saw the [refs. below]. Also looks like [the ebolavirus] is not new to Liberia:

Ebola virus outbreaks in the Ivory Coast and Liberia, 1994-1995. Le Guenno B, Formenty P, Boesch C.
WHO Collaborating Center for Arboviruses and Haemorrhagic Fevers, Institut Pasteur, Paris, France.
Curr Top Microbiol Immunol. 1999;235:77-84. PMID: 9893379 [PubMed - indexed for MEDLINE]

--
Communicated by:
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[It has been suggested to me that an African would have most credibility in West Africa as global coordinator of the anti-EVD struggle, being more likely to understand the political and cultural constraints on the ground. Kofi Annan of Ghana, former Secretary-General of the United Nations and a skilled negotiator, was still active as the UN-Arab League Joint Special Representative for Syria until August 2012. He may already have been approached.

A HealthMap/ProMED-mail map with the latest case locations and counts is available at http://healthmap.org/ebola. - Mod.JW]

kro · Beitrag von **kro** » So 14. Sep 2014, 19:58

Kuno hat geschrieben:Ist es nur mein erster Eindruck oder meldet man nur die negativen Punkte zu Ebola?

Hat denke ich auch einfach zu tun, das der hauptsächliche Content hier im Thread die von Birgitt geposteten ProMed-Mails sind. Und ProMed ist eben ein Warndienst, und daher per Definition üblicherweise kein Überbringer von guten Nachrichten.

Andererseits gibt es leider momentan auch wirklich nicht viele gute Nachrichten - außer der von dir angesprochenen Tatsache das Nigeria es allen Anscheins nach geschafft hat die Verbreitung von Anfang an stark einzudämmen und nur (relativ) wenige Verluste zu melden hatte, fällt mir da auch nicht viel ein.

Hoffe natürlich auf ähnlich gute Nachrichten aus Senegal, und so bald wie möglich auch aus den anderen 3 betroffenen Ländern!

Felix

Beitrag von **Birgitt** » Di 16. Sep 2014, 12:32

EBOLA VIRUS DISEASE - WEST AFRICA (164): SIERRA LEONE, EVACUATION, INFECTION CONTROL, SUSPECTS
**********************************************************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

In this update:
[1] Sierra Leone: 4th doctor dies
[2] Aeromedical evacuation: constraints
[3] Infection control is not working
[4] Suspected cases & false alarms

******
[1] Sierra Leone: 4th doctor dies
Date: 14 Sep 2014
Source: NBC News [edited]
http://www.nbcnews.com/storyline/ebola- ... ho-n202991

Sierra Leone has lost a 4th doctor to EVD after a failed effort to transfer her abroad for medical treatment, a government official said Sun [14 Sep 2014], a huge setback to the impoverished country that is battling the virulent disease amid a shortage of health care workers. Dr. Olivet Buck died late Sat [13 Sep 2014], hours after the World Health Organization said it could not help medically evacuate her to Germany, Chief Medical Officer Dr. Brima Kargbo confirmed to The Associated Press. Sierra Leone had requested funds from WHO to transport Buck to Europe, saying the country could not afford to lose another doctor.

WHO had said that it could not meet the request but instead would work to give Buck "the best care possible" in Sierra Leone, including possible access to experimental drugs. EVD is spread through direct contact with the bodily fluids of sick patients, making doctors and nurses especially vulnerable to contracting the virus that has no vaccine or [specific] treatment. More than 300 health workers have become infected with EVD in Guinea, Liberia and Sierra Leone. Nearly half of them have died, according to WHO.

--
Communicated by:
ProMED-mail Rapporteur Mary Marshall

[It rather looks as though it was already too late by the time the request was made. The difference between WHO's response to this case and to that of the Senegalese doctor who was evacuated to Germany is probably due to the latter having been employed by WHO and covered by WHO health insurance, which pays for air evacuation and hospitalization. (I declare that I was a WHO employee for 14 years until my retirement). - Mod.JW]

******
[2] Aeromedical evacuation: constraints
Date: 18 Aug 2014 [note date]
Source: FedBizOpps.gov [edited] https://www.fbo.gov/?s=opportunity&mode ... e&_cview=0

Emergency Aeromedical Evacuation Services
-------------------------------------
Solicitation Number: SAQMMA14C0155
Agency: Department of State
Office: Office of Acquisitions
Location: INL Support
Copy the URL [above] for a direct link to this page.
Notice Details Packages
Original Synopsis 3 Sep 2014 2:13 pm
Solicitation Number: SAQMMA14C0155
Notice Type: Justification and Approval (J&A)
J&A Statutory Authority: FAR 6.302-2 - Unusual and compelling urgency
Contract Award Date: 18 Aug 2014
Contract Award Number: SAQMMA14C0155
Synopsis: Added: 3 Sep 2014 2:13 pm

This requirement is in response to the Department of State's diplomatic mission overseas to provide movement of emergency response personnel into and out of hazardous/non-permissive environments and medical evacuation of critically ill/injured patients, including those infected with unique and highly contagious pathogens. This is an immediate response to the Ebola virus crisis.

--
Communicated by:
ProMED-mail
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[This USD 4.9 million dollar contract covers 3 evacuations per month for 6 months. According to details in the Sole Source (Rush) Justification (which is well worth reading), the 2 jets available were equipped with biosafety level 4 isolation units under a CDC contract years ago and mothballed in 2011 when the CDC could no longer afford to keep them on standby. But they are not permitted to over-fly or land in most [mainland] European Union countries or refuel there and are only authorized to refuel at a US base in the Azores islands (which belong to Portugal, in the Atlantic Ocean, 900 miles west of it and 2000 miles east of the USA) and, therefore, can only be used to evacuate people to military bases in the USA.

Mexico, Japan, UK, Canada, UAE, UN and WHO had already tried to get exclusive contracts with the provider. However, an EVD-infected British nurse was evacuated from Sierra Leone in a similarly equipped Royal Air Force jet to a military air base in the UK and transferred to an isolation suite in a UK hospital. He recovered. See ProMED-mail post "Ebola virus disease - West Africa (152): region, UN, Nigeria, tests 20140906.2753389." - Mod.JW]

******
[3] Infection control is not working
Date: 14 Sep 2014
From: Bjorg Marit Andersen <bomarand@hotmail.com> [edited]

Infection control concerning EVD is not working, especially when more than 240 [now 300] healthcare personnel have been infected, and more than 120 workers have died. Guidelines used to control SARS in 2003 should be used, not "contact and droplet protection of 1-2 meters," as is still recommended by WHO.

Personal protective equipment (PPE) for contact and airborne infections should be used because of
a) respiratory symptoms,
b) a big distance -- up to 9 meters -- for droplets when coughing and sneezing (Bourouiba et al. J Fluid Mechanics 2014;745:537-563.),
c) re-aerolization from the environment, bed clothes etc.,
d) long survival of the virus outside the body, and
e) high lethality.

Healthcare workers (HCW) and helpers should be protected with PPE as they were during the SARS epidemic. The SARS epidemic was an infection control success by the healthcare system of some countries in Asia in 2003. But WHO should not repeat the same failure as was done during the early phase of the SARS-epidemic by using "contact and droplet isolation." Separate hospitals for EVD should be built, like in China (1000 beds in 8 days for SARS), and only patients with laboratory documented EVD should be cohorted. Suspected cases should be isolated separately.

HCW and helpers should be trained and especially observed concerning [putting] PPE on and taking [it] off. The observers should also use PPE. During the SARS epidemic, HCW were re-contaminated by not knowing how to take off PPE.

Exposed people and patients with other diseases should be treated in professional triages to reduce the population's fear of being EVD-infected during contact with healthcare. Exposed people should be taken care of by professional helpers.

There is a need for a lot of resources, especially concerning infection control work.

--
Bjorg Marit Andersen, MD, PhD
Professor in Hygiene and Infection Control
Speciality: Medical Microbiology
Former chief, Department of Hospital Infections
Oslo University Hospital - Ulleval
Gaustadveien 1a 0372 Oslo, Norway
<bomarand@hotmail.com>

[The above directions are perfectly correct. Unfortunately, investigators are concluding that health worker infections are occurring outside the hospitals. - Mod.JW]

******
[4] Suspected cases & false alarms

13 Sep 2014: From Bernice Staub <bernice.staub@vtxfree.ch>
Re: Nigeria: false alarm [Ebola virus disease - West Africa (162): WHO, volunteering, protection Archive No. 20140912.2770539]
------------------------
ProMED commented: "There have been no reports of EVD in Morocco, so quarantine was an unnecessary over-reaction."
But as Air Morocco is the only airline flying a regular schedule to the affected countries, it is reasonable. There were statements that she worked before in Guinea and Sierra Leone, so she might have used Casablanca as a hub to get out of the region.

[That is a possibility. Perhaps her passport showed she had recently been in those countries, in which case it was a reasonable precaution. - Mod.JW]

--
Ghana: suspected case
---------------------
14 Sep 2014: (Ghanaweb) Health workers at the Achimota Hospital in Accra [capital of Ghana] have reportedly abandoned the facility over a suspected EVD case Sun [14 Sep 2014]. A patient was rushed to the hospital Sunday morning showing symptoms of the deadly disease that is sweeping West Africa. Other patients at the hospital have been left to their fate, local station Citi FM is reporting. StarrFMOnline.com understands that the suspected EVD patient is a Nigerian and is battling severe fever. According to the Head of Disease Surveillance at the Ghana Health Service, Dr Badu Sakordie, the case is being investigated.
http://www.ghanaweb.com/GhanaHomePage/N ... ?ID=325800

--
China: false alarm
-----------------
11 Sep 2014: (Roll Sohu) A case of malaria was reported in a Wuhan patient who had returned from a tour in Africa (Niger, not Nigeria), in mid-August [2014]. He was fearful that he might have contracted EVD and would be placed in isolation. He withheld his travel history for 5 days while being treated for cold/flu. After revealing that he was in Africa, he was tested and found to have malaria.
http://roll.sohu.com/20140911/n404222113.shtml [in Chinese, trans. Dan Silver]

[There are no reports of EVD in Niger. This kind of suppression of travel history may be occurring frequently and could lead to large numbers of contacts by a real case. - Mod.JW]

--
Italy: Suspected EVD case in Italy suffers from malaria.
---------------------------------
9 Sep 2014: (Xinhua) A Nigerian woman hospitalised on Tue [9 Sep 2014] in Italy with suspected symptoms of EVD was suffering from malaria, hospital authorities said. The results did not yet rule out a possible EVD infection...
http://news.xinhuanet.com/english/healt ... 968293.htm

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

[ProMED thanks Ryan McGinnis http://bigstormpicture.com and ProMED-mail Rapporteur Mary Marshall for contributing some of the reports above.

A HealthMap/ProMED-mail map with the latest case locations and counts is available at http://healthmap.org/ebola. - Mod.JW]

Beitrag von **Birgitt** » Di 16. Sep 2014, 12:34

EBOLA VIRUS DISEASE - WEST AFRICA (165): LIBERIA, SIERRA LEONE, CHINA AID, 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] Liberia: Sitrep. No. 119
[2] Sierra Leone: update
[3] Liberia, Sierra Leone: African Union volunteers
[4] China: medical & other aid
[5] Prevention

******
[1] Liberia: Sitrep. No. 119
Date: 15 Sep 2014
Source: Reliefweb [edited]
http://reliefweb.int/report/liberia/lib ... rep-no-119

Report from Government of Liberia Published on 11 Sep 2014
---------------------------------------
HIGHLIGHTS

NIMBA COUNTY
- 1 probable death in Glarlay Old Town Zoe- Geh
- 2 probable deaths in Seikinpa and Flowin, both in Sanniquelle Mah District. Burials have taken place.
- 57 new contacts listed collectively in Zoe- Geh, Saclepea Mah and Sanniquellie Mah Districts
- Conducted District Stakeholders Training
- 2 deaths occurred in the quarantine unit and 1 suspected death in the community
- 14 patients presently in the holding center
- There is ongoing spraying [with bleach] of homes where suspected/probable cases resided.
- 12 orphans currently in Bomi as a result of EVD.

GRAND CAPE MOUNT
- 2 contacts in Robertsport who were showing symptoms like fever and headache are responding to treatment, ACT drugs, PCM, and ORS.
- Active case search is ongoing at all levels

LOFA COUNTY
- Total number of patients in Foya Case management center (FCMC) = 30
- Total probable cases = 22
- Total confirmed cases = 8
- Total number of deaths = 3 (2 confirmed, 1 Probable)
- Total number of discharges = 7 (3 survivors, 4 negative results)
http://reliefweb.int/report/liberia/lib ... rep-no-119

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

******
[2] Sierra Leone: update
Date: 16 Sep 2014
Source: Ministry of Health and Sanitation, Sierra Leone, Facebook [edited]
https://www.facebook.com/pages/Ministry ... 4805403702

DISCHARGED CASES
- Total Survived and Released Patients = 324

NEW CASES
- New Confirmed cases = 49, as follows:
Kailahun = 0, Kenema = 10, Kono = 0, Bombali = 0, Kambia = 0, Koinadugu = 0, Port Loko = 31, Tonkolili = 1, Bo = 0, Bonthe = 0, Moyamba = 0, Pujehun = 0, [Freetown:] Western Area Urban = 5, Western Area Rural = 2

CUMULATIVE CASES
- Cumulative confirmed cases = 1,503, as follows:
Kailahun = 518, Kenema = 408, Kono = 15, Bombali = 82, Kambia = 3, Koinadugu = 0, Port Loko = 143, Tonkolili = 32, Bo = 76, Bonthe = 1, Moyamba = 17, Pujehun = 10, [Freetown:] Western Urban = 114, Western Rural = 53

CUMULATIVE DEATHS
- Total cumulative confirmed deaths [are] 468, as follows:
Kailahun = 192, Kenema = 223, Kono = 2, Bombali = 6, Kambia = 1, Koinadugu = 0, Port Loko = 16, Tonkolili = 2, Bo = 16, Bonthe = 1, Moyamba = 6, Pujehun = 1, [Freetown:] Western Area Urban = 3, Western Area Rural = 2
- Probable cases = 37
- Probable deaths = 37
- Suspected cases = 105
- Suspected deaths = 11

IMPORTANT NOTE!
Koinadugu [pop. 265 765 (2004), a heavily forested district with the lowest population density in the country. - Mod.JW] still remains the only district that has not registered confirmed cases of EVD in Sierra Leone.

IMPORTANT NOTE
Ebola Emergency Account Details:
Account Number (Leones): 003001118285030109
Account Number (USD): 003001014138030145

The Ebola Emergency Account is audited by Chartered Accountants from the KPMG Accounting and Auditing Firm at the Emergency Operations Centre (EOC).

All Cash Donations are deposited at the Ebola Emergency Account managed by the EOC, and donations [in kind] (Medicines, Equipment, Supplies, etc.) are held at the Government Medical logistics stores, Freetown, by the Ebola Logistics team, for processing, storage and equitable distribution as required throughout the country.

ISSUED BY:
The Ebola Viral Situation Report, Ministry of Health and Sanitation
For more information, please contact:
District level: District Health Management Team
National level: Directorate of Disease Prevention and Control,
E-mail: <dpcsurveillance@gmail.com>
Website: http://www.health.gov.sl
Mobile: 117 (Toll free)

--
Communicated by
ProMED Rapporteur Kunihiko Iizuka

******
[3] Liberia, Sierra Leone: African Union volunteers
Date: 15 Sep 2014
Source: Bella Naija [edited]
http://www.bellanaija.com/2014/09/15/af ... erra-leone

The African Union (AU) promised on Mon [15 Sep 2014] in Addis Ababa to send a team of 30 health workers and other specialists to help fight the Ebola virus [disease] outbreak in West Africa. Mustapha Kaloko, the AU Commissioner for Social Affairs, said that the volunteers are epidemiologists, clinicians, public health specialists and communications personnel. He said they would be deployed to Liberia, the country hardest hit by the virus, from 17 Sep 2014.

Kaloko said a 2nd batch of volunteers would be deployed to Sierra Leone in the next few weeks. "This is the time for Africa to show solidarity with the affected countries," he said.

[Byline: Moremi Amuta]

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

******
[4] China: medical & other aid
Date: 15 Sep 2014
Source: All Africa [edited]
http://allafrica.com/stories/201409152536.html

Mr. Xu Zhou, spokesman of the Chinese Embassy, announced in Freetown on Mon 15 Sep 2014 that China will send a China Center for Disease Control (CDC) medical expert team comprising 59 personnel and a mobile laboratory to Sierra Leone on Wed 17 Sep 2014 by chartered airplanes to strengthen Sierra Leone's endeavour to contain EVD.

He indicated that this was a decision made ... upon the request of the Sierra Leonean government... He noted that this is the 3rd batch of China's humanitarian aid to support Sierra Leone in fighting against EVD. Previously, China provided 2 batches of emergency medical materials valued at 11 million RMB Yuan [USD 1.8 million] to Sierra Leone and sent 2 teams of medical experts to the country.

He added that China announced on 12 Sep 2014 a further 200 million Yuan [USD 32.54 million] package of humanitarian aid including food, supplies for disease control, emergency treatment facilities and capital support to African countries and international organizations to help control EVD. In addition, China will also promote long-term medical cooperation with African countries to help them raise their disease control and response abilities and improve public health systems.

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

******
[5] Prevention

Dutch doctors to stay in quarantine over EVD fears
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15 Sep 2014: (Dutch News) Two Dutch doctors who have returned to the Netherlands after being exposed to the ebolavirus while working in Sierra Leone are being looked after in a special quarantine unit at Leiden University's teaching hospital. Neither doctor is showing any symptoms of the disease, but they have opted not to return to their homes until they are absolutely certain they have not picked it up. The doctors, who worked for a Dutch charity, are soon to move to another secret location to wait out the maximum incubation period, Dutch media said on Mon [15 Sep 2014].
http://www.dutchnews.nl/news/archives/2 ... _quara.php

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South Africa ready for EVD threat
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14 Sep 2014: (News24) While neighbouring Mozambique is on a list of 15 countries at risk of animal-to-human transmission of Ebola, South Africa is not. This follows a study by the University of Oxford in England, whose list also includes Nigeria, Cameroon, Central African Republic, Ghana, Liberia, Sierra Leone, Angola, Togo, Tanzania, Ethiopia, Burundi, Equatorial Guinea, Madagascar and Malawi. "The reason South Africa is not on the Oxford list is because the country is extremely ready. Every port of entry into the country is on high alert. The border officials are equipped to detect anything and everything and deal with it," said national health spokesperson Joe Maila on Fri [12 Sep 2014]. Maila said Mpumalanga, which borders Mozambique, was also ready to deal with any incident. "We have already identified 11 hospitals throughout the country, including Rob Ferreira Hospital [in Mbombela] and have prepared them to deal with any kind of a haemorrhaging fever," Maila said.
http://www.news24.com/SouthAfrica/News/ ... t-20140914

[It is excellent that ports and airports are on high alert, but what about hospitals? Remember 1996? See: Ebola - South Africa (10) Archive No. 19961129.1992. The EVD carrier arrived from Gabon with no symptoms, and the hospital didn't know there was an epidemic there. - Mod.JW]

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Malaysia to send 20 million rubber gloves to fight EVD
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15 Sep 2014: (Reuters) Malaysia will send more than 20 million medical rubber gloves to 5 African nations battling the deadly Ebola virus, addressing a crucial shortage faced by overwhelmed health workers, the country's Prime Minister Najib Razak announced on Mon [15 Sep 2014].

The Southeast Asian nation is a leading manufacturer of rubber gloves, producing about 60 percent of the world's supply of latex medical gloves. Health authorities say that a shortage of rubber gloves in affected African nations has led to more deaths and raised risks that the virus will spread among doctors and nurses.
http://uk.reuters.com/article/2014/09/1 ... RF20140915

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Sierra Leone: impact of lockdown on mining
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15 Sep 2014: (Reuters) Minerals group Sierra Rutile Ltd said its operations would be restricted during the 3-day countrywide lockdown to halt the spread of Ebola across Sierra Leone and that it would optimize operations in the lead-up to mitigate overall impact of the disruption. The company, which mines rutile in the southwest of Sierra Leone, said export of products to customers would not be affected and that essential services such as the power plant and a health clinic would continue to operate as normal [The main uses for rutile (one of the 5 forms of titanium dioxide found in nature) are the manufacture of refractory ceramic, as a [very white] pigment, and for the production of titanium metal. - Wikipedia]. The West African country will restrict residents to the areas around their homes for 3 days from 19 Sep 2014 in a bid to halt new infections and help health workers track down people suffering from the disease.
http://www.reuters.com/article/2014/09/ ... FR20140915

[Lockdown "around their homes" is very different from "in their homes." Presumably, many workers live near the mine and will also be able to attend work and the health clinic. - Mod.JW]

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Nigeria: Ilorin University to screen returning students for EVD symptoms
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15 Sep 2014: (Africa 5 News) The Vice-Chancellor of the University of Ilorin, Prof. AbduGaniyu Ambali, says all students will be screened for the Ebola virus disease before entering the campus. Ambali stated this on Mon [15 Sep 2014] while unveiling preventive kits worth N1.2 million [USD 7300] at the university's health centre. "The procurement of the anti-EVD kits is part of the university's preparedness to tackle the epidemic headlong," the vice chancellor said. The kits, he said, included face masks, boots, gloves, automatic soap dispensers, infrared thermometers, and disposable bed spreads. ...
http://omojuwa.com/2014/09/unilorin-to- ... a-symptoms

[See map of Nigeria; Ilorin is north of Lagos in Kwara state in the west: http://www.apin.harvard.edu/images/map- ... -small.jpg. - Mod.JW]

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Cotonou [Benin] port authorities issue anti-EVD measures
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Following the outbreak of the Ebola virus [disease] in West Africa, Cotonou port authorities have taken several preventive measures to fight the spread of the virus. For all vessels calling on Cotonou port, Benin, the agent is required to send to the Harbor Master office a port of call list mentioning the last 10 ports of calls 3 days prior to arrival. All vessels arriving from or which have called at a port in one of the countries infected by EVD should have on board prevention equipment (gloves, masks, sanitizing gel, etc.). In addition, all vessels arriving from or which have called at a port in one of the countries infected by EVD, and which have prevention equipment onboard, must stay at anchorage and receive FREE PRATIQUE from port health authorities prior to pilot boarding. (Boat transportation cost for embarkation/disembarkation of port health authorities are on the vessel's account and the same is to be arranged by the agent). It is also mandatory for all crew and anyone boarding such vessels to wear masks and gloves throughout the entire port stay
http://www.marinelink.com/news/preventi ... 77086.aspx.

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

[This last provision is overkill if it means crew who stay on board and do not disembark are supposed to wear masks and gloves. There is zero danger of airborne transmission from ship to shore. Cotonou is close to Lagos, Nigeria on the West African coast; see map at http://www.beekeeping.com/countries/nigeria_map.jpg.

A CDC map of the EVD situation in Guinea, Sierra Leone and Liberia as of 4 Sep 2014 is at:
http://www.cdc.gov/vhf/ebola/resources/ ... break.html. - Mod.JW

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

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