Ebola in Westafrika

[Kuno]

Die letzte Meldung im Blick:"GENF - Im Genfer Universitätsspital (HUG) wird ein ausländischer Krankenpfleger behandelt, der in Sierra Leone im Einsatz war. Er war von einem an Ebola erkrankten Kind gebissen worden."

Ich bin gespannt, wie lange es geht, bis es dem Visurs gelingt über einen Kontinent zu "hüpfen" - Nach Indien wäre wahrscheinlich nicht unrealistisch oder, falls dei UN Militär einsetzen sollte via einem bangladeschianischen UN Soldaten nach Bangladesh. Aber richtig Schlagzeilen würde es machen, wenn es in ein Europäisches Land kommen würde.

[kro]

Aber richtig Schlagzeilen würde es machen, wenn es in ein Europäisches Land kommen würde.

Schlagzeilen gewiss... Aber die Auswirkungen wären minimal.
Die Ansteckungsherde schlechthin:

• traditionelle Bestattungen (Mit Körperkontakt zum Verstorbenen)
• unkooperative (weil der westlichen Medizin gegenüber skeptisch eingestellte) Patienten
• mangelnde Hygiene in dicht besiedelten Gebieten, Krankenhäusern etc.
• wenig, und schlecht ausgebildetes Pflege- und Behandlungspersonal (1 Arzt pro 100'000 Bürger in Liberia und Sierra Leone zu normalen Zeiten, von denen zwischenzeitlich etliche verstorben sind)

würden hier kein Problem darstellen, außerdem haben soweit ich weiß so ziemlich alle Krankenhäuser inzwischen eine Notfallprozedur eingeführt, sollte unerwarteterweise doch ein Fall auftreten. Damit fällt auch der Überraschungsmoment bis auf die Ersthelfer weg.

Ich wiederhole mich zwar, empfehle aber nach wie vor die Schlagzeilen eben solche sein zu lassen und für weniger sensationslüsterne Informationen die Primärquellen (WHO, MSF, spezialisierte Verteiler wie promedmail & Co) zu Rate zu ziehen.

[Kuno]

Du hastwahrscheinlich das kleine Wörtchen "würde" in meinem Satz übersehen?

[kro]

gesehen habe ich es - aber vielleicht nicht genug Bedeutung beigemessen?

Felix, Schlagzeilenvermeider

[kro]

Passend zum Thema: ein interessanter Artikel wie aus "patient zero" eine Epidemie wurde.

As the Ebola epidemic rages, two questions have emerged: How did the deadly virus escape detection for three months? And why has a massive international effort failed to contain it? Traveling to Meliandou, a remote Guinean village and the likely home of Patient Zero, Jeffrey E. Stern tracks the virus’s path—and the psychological contagion that is still feeding the worst Ebola outbreak in history.

http://www.vanityfair.com/politics/2014 ... ontainment

[kro]

Und auf der anderen Site der Grenze, in Sierra Leone:

http://www.who.int/csr/disease/ebola/eb ... -leone/en/

[Kuno]

Aber richtig Schlagzeilen würde es machen, wenn es in ein Europäisches Land kommen würde.

Schlagzeilen gewiss... Aber die Auswirkungen wären minimal.

Manchmal geht es schneller als man denkt:

"In der Schweiz ist ein Ebola-Verdachtsfall aufgetreten. Ein Guineer, der sich seit Dienstag im Universitätsspital Lausanne befindet, erfüllt die Kriterien für einen Ebola-Verdachtsfall, wie das Bundesamt für Gesundheit (BAG) am Dienstag mitteilte.
Infografik Ebola

Der Jugendliche war vor rund einer Woche in der Asyl-Empfangsstelle Vallorbe VD angekommen. Laut seinen Angaben war er zwei Tage zuvor aus seiner Heimat nach Frankreich abgeflogen."

Aber wahrscheinlich hat der Jugendliche aus Guinea, der ein Familienmitglied hat, welches an Ebola gestorben ist nur eine leichte Grippe und deswegen auch etwas Fieber...

[Alexander]

Gute Nachrichten für die Schweiz:


Patient in der Schweiz wahrscheinlich nicht an Ebola erkrankt
Bern - Der erste mögliche Ebola-Patient in der Schweiz ist in ersten Labortests negativ auf die Viruserkrankung getestet worden. «Dies deutet darauf hin, dass die Person nicht an Ebola erkrankt ist», teilte das Bundesamt für Gesundheit (BAG) am Mittwoch mit. mehr...

Grüsse
Alexander

[Birgitt]

EBOLA VIRUS DISEASE - WEST AFRICA (172): SIERRA LEONE, VOLUNTEERS, SENEGAL FREE
*******************************************************************************
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: missionary to be evacuated to Spain
[2] Sierra Leone: lockdown problems
[3] Liberia: declaration by national front line health worker
[4] Volunteering: British front line health worker speaks
[5] Region: critical hospital staff shortage
[6] Senegal now EVD-free

******
[1] Sierra Leone: missionary to be evacuated to Spain
Date: Sat 20 Sep 2014
Source: Yahoo News, AFP (Agence France-Presse) report [edited]
http://news.yahoo.com/spain-fly-back-mi ... 52954.html


Spain to fly back missionary with EVD from Sierra Leone
-------------------------------------------------------
Spain is sending a plane to fly a Catholic missionary infected with the deadly ebolavirus home from Sierra Leone, officials said Saturday [20 Sep 2014]. Brother MGV, 69, director of a hospital in the Sierra Leonean town of Lunsar, "has tested positive (for EVD) and has expressed his desire to be transferred to Spain", the health ministry said in a statement. He is the 2nd Spaniard to contract EVD in the current outbreak. "In the coming hours a medical plane from the defence ministry will set off for Sierra Leone, carrying 2 doctors and 3 nurses with all the equipment necessary to protect the personnel and maintain the treatment of the patient," it said. It said the risk to public health in Spain from the patient was "practically nil".... The ministry said late Saturday that his repatriation would take place "in the coming hours" and he would be taken straight to Madrid's La Paz-Carlos III hospital.

In August [2014] a 75-year-old Spanish priest became the 1st European to die from EVD during the current outbreak in west Africa, the worst since the disease was 1st discovered 4 decades ago. That missionary, Miguel Pajares, was infected in Liberia, where he worked with EVD patients ... [more]

[Another blow to the international volunteers. It is rather important to find out how and where the break in protection occurred. - Mod.JW]

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

******
[2] Sierra Leone: lockdown problems
Date: Sat 20 Sep 2014
Source: Euronews [edited]
http://www.euronews.com/2014/09/20/thou ... erra-leone


Thousands of people have defied Sierra Leone's 3-day lockdown to combat the ebolavirus
--------------------------------------------------------------------------------
... by crossing the border into Guinea without going through health controls. Health officials in Guinea said people were coming "in waves" through the bush, fearing [knowing - Mod.JW] they would be taken away if they were found to have the disease. Nearly 30 000 health workers, teachers and volunteers are going house to house until Sunday [21 Sep 2014] to educate people about EVD and isolate the sick.

A UN emergency response force to tackle the disease will be anchored in West Africa -- with headquarters in Accra, Ghana and offices in Guinea, Liberia and Sierra Leone ... [more]

[Unintended importation of cases into Guinea has probably resulted. - Mod.JW]

----
20 Sep 2014 (Interaksyon): In Freetown, teams got off to a slow start, waiting several hours to receive kits containing soap, stickers and flyers. "This morning many families are calling on the radio crying because of lack of food in their homes," said Ahmed Nanoh, executive secretary of Sierra Leone's chamber of agriculture. "Food prices have gone up 30 percent. Many homes that cannot afford (food) are starving.

Medical charity Medecins Sans Frontieres (MSF/Doctors Without Borders), which has been at the forefront of the effort to contain the epidemic, warned last week that the lock-down could lead to the concealment of cases, potentially causing the disease to spread further. [Another unintended consequence. - Mod.JW] An official for the United Nations children's agency UNICEF, Roeland Monasch, said, however, that the "Ose to Ose" campaign, which means "house to house" in local Krio, would be helpful. "If people don't have access to the right information, we need to bring life-saving messages to them, where they live, at their doorsteps," he said.
http://www.interaksyon.com/article/9578 ... own-starts

[The country had 2 weeks notice of the lockdown; food prices probably started going up immediately. But many families probably live hand to mouth. Woman goes out to the market, sells a few things, and with that money buys a bit of food for the family. Husband may be on daily labor, and as he is confined to the house, has no income. - Mod.JW/Corr.SB]

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

******
[3] Liberia: declaration by front line health worker
Date: Sat 20 Sep 2014
Source: Quartz [edited]
http://qz.com/268824/liberia-needs-more ... feat-ebola


Liberia needs more than just a serum to defeat EVD
--------------------------------------------------
Liberia is fighting a war, which has already killed hundreds and is showing no signs of relenting. We health workers are in the front line of this war, and count for over 8 percent of the victims of EVD in West Africa. We're called "front liners," "national heroes," "true patriots," and yet we are not paid proportionally to the risk we are taking, nor are we provided with the necessary gear to minimize the chance of contagion, or given the vital psychological support as we watch our colleagues die. The families of those who die aren't given support, even though they may have lost their sole breadwinner.

Every EVD victim is 1st of all a human who deserves to be treated with dignity and accorded all the inalienable rights, including the provision of holistic medical service of which quality social and mental health support are fundamental components. EVD victims particularly need to have access to professional counseling because they are not just victims of physical illness but of gross discrimination and abject neglect. In most cases, EVD's victims are prey to minor depression, which speedily degenerates into acute depression, which can be a staunch barrier to physical healing.

But this isn't true only of the victims -- health workers experience vicarious trauma and we need to feel that the Ministry of Health and Social Welfare and the Ebola National Task Force consider it their priority to guarantee support and care for us, as well as for the victims.

When doctor Kent Brantly and his colleague Nancy Writebol chose to serve in the EVD treatment center, they fearlessly did so for many reasons, knowing very well (as all Americans do) that in the worst-case scenario their government would watch their backs. Sure enough, when the worst situation occurred, the US didn't default on its promises and eventually airlifted and treated the ill in their best facilities. Dare Liberia not raise the argument that we lack the capacity to follow suit: when the same happened before our eyes, our heroes and heroines were not given the best treatment.

I have not lost hope in Liberia. On the contrary, despite the unfavorable figures and data, I still believe that we have a chance in fierce fight against EVD. But to make it, we have to change a few things now:

- Redefine the role of psychological and social support in our national strategy against EVD and get mental health clinicians, social workers and counselors trained and on board speedily.
- Assign at least 4 social workers or counselors to every EVD treatment unit.
- Let victims in the units, survivors of the disease and their families have access to psychological support as soon as possible.
- Hire and train data entry clerks and 4 data analysts to track and analyze data related to survivors, patients' death, their families' locations and contacts, and the frequency of counseling sessions provided to them.
- Pay health workers their overdue salary and add some incentive to motivate us.
- Enforce the rewarding practice of debriefing, self-care and vicarious trauma counseling session for all staffers at the EVD treatment units.

This isn't done by simply waving a magic wand; there are hurdles and constraints of all sorts. Yet I am of the staunch conviction that if the right people are empowered, monitored and listened to, we as a nation can prevail overall against EVD and other foes -- as we have, with sweat, blood and diligence, overcome in the past.

[Byline: Ernest G. Smith Jr.]

[Bravo to this Liberian front line health worker for laying it on the line. He is still hopeful his country can overcome this terrible plague. - Mod.JW]

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

******
[4] Volunteering: British front line health worker speaks
Date: Fri 19 Sep 2014
Source: BBC News [edited]
http://www.bbc.com/news/magazine-29245149


Why I'll risk my life for EVD patients
--------------------------------------
Hundreds of foreign aid workers are in West Africa treating people with EVD. One of them is Cokie van der Velde who has just flown from the UK to Liberia. She explains why she has left the safety of her home to face the deadly virus.... [clip]

I do enjoy my job, I don't think you could do what I do if you didn't enjoy your work. I can't say I particularly enjoy working with dead bodies but there's a lot of camaraderie -- there's a satisfaction when you do get it right, and eventually we will get this epidemic under control. When that happens there will be great elation and the satisfaction of knowing I did a job that maybe not everyone could have done and that I played a small part in helping to overcome this.

[A moving account of working in an EVD treatment center run by MSF. Like her Liberian counterpart above, she also has hope. - Mod.JW]

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

******
[5] Region: critical hospital staff shortage
Date: Sat 20 Sep 2014
Source: Reuters [edited]
http://uk.reuters.com/article/idUKKBN0H ... 0?irpc=932


The USA this week announced it will send in its military to build 17 EVD treatment centers in Liberia. Army engineers from Britain are building a 200-bed hospital in Sierra Leone, while the United Nations has formed a special mission to lead efforts. Experts at a poverty conference run by the US development agency USAID in Washington on Friday [19 Sep 2014] said recruiting staff must be a top priority.

Each 100-bed Ebola treatment center under construction needs 230 trained staff, including 12 medical experts, to function, US officials said. That would mean nearly 4000 personnel for the Liberian facilities due to start opening in October [2014], and it is unclear where they will come from. "Building hospitals and equipping them is great. But unless you have trained personnel to work in them, that is not going to help," said Rabih Torbay, senior vice president at the global healthcare nonprofit International Medical Corps (IMC). "17 [hundred] beds, but who is going to staff them?" asked Torbay, who leads IMC's EVD response.

The epidemic has overwhelmed Liberia, Sierra Leone and Guinea, which had a critical shortage of doctors and nurses even before the EVD outbreak, which began earlier this year [2014]. Infections are estimated at 5000, though the actual rate may be 2 or3 times larger since many people are hiding in their homes. The World Health Organization says the infection rate is doubling every 10-21 days, which means hospitals and clinics may not be built and staffed fast enough to meet demand.

US officials are recruiting healthcare personnel from universities and hospitals, said Torbay. China has pledged doctors and nurses, and the African Union is sending a team of 30 health workers and specialists to the region. But the task of training them is huge, said Christie. They require 7-10 days of classroom and practical work before they can enter hospitals and clinics. Relief staff must replace them every 4-6 weeks because workers get exhausted -- emotionally from the high death toll and physically from wearing 5 layers of protective gear in extreme heat ... [more]

(Byline: Stella Dawson; editing by Megan Rowling)

[For volunteers from the USA, the CDC training courses in the USA will help: http://www.cdc.gov/vhf/ebola/hcp/safety ... id=cs_1344. Perhaps other countries that have already sent volunteers, like the UK, France, Spain and the Netherlands, could set up pre-departure training. - Mod.JW]

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

******
[6] Senegal now EVD-free
Date: Sat 20 Sep 2014
Source: Reuters [edited]
http://www.reuters.com/article/2014/09/ ... DU20140919


Senegal says no risk of EVD spreading from imported case
--------------------------------------------------------
Senegal's health minister said on Friday [19 Sep 2014] there was no further risk of EVD spreading in the West African country, following the end of a quarantine period for those who came into contact with an infected Guinean man. "The risk of the ebolavirus spreading from the imported case is non-existent for our country," Awa Marie Coll Seck told a news conference.

[Byline: Diadie Ba; writing by Emma Farge; editing by Daniel Flynn]

[The Guinean student was reported to be a confirmed EVD case and quarantined in Senegal on Friday, 29 Aug 2014, so the maximum incubation period of 21 days for any contact ended on Friday, 19 Sep 2014. I hate to put a damper on this good news, but
(a) he may have still been infectious in to health workers in hospital for a few days, and
(b) to be absolutely sure, it is usual for a country to wait twice the maximum incubation period, in this case 42 days, before being declared disease-free.

All of Guinea was free of EVD after 42 days without a case (except for Gueckedou), and it looked as though the epidemic was close to an end, when new cases suddenly appeared. - Mod.JW]

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

[A HealthMap/ProMED-mail map can be accessed at http://healthmap.org/ebola. - Mod.JW]

[Birgitt]

EBOLA VIRUS DISEASE - WEST AFRICA (173): WHO, SIERRA LEONE, RESPIRATORS, 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] WHO update 22 Sep 2014
[2] Sierra Leone: lockdown
[3] Aerosol transmission?
[4] Respirators: correction
[5] USA: aid shipment
[6] USA: military aid
[7] Prevention, false alarms

******
[1] WHO update 22 Sep 2014
Date: Mon 22 Sep 2014
Source: WHO Global Alert and Response (GAR), Pandemic and Epidemic Diseases, Ebola virus disease, Ebola response roadmap [summ., edited]
http://apps.who.int/iris/bitstream/1066 ... 14_eng.pdf


WHO: EVD Response Roadmap Update 22 Sep 2014
---------------------------------------------------
An overview of the situation in the Democratic Republic of the Congo, where a separate, unrelated outbreak of Ebola virus disease (EVD) is occurring, is also provided (see Annex 1).

1. Countries with widespread and intense transmission
5843 (probable, confirmed and suspected; see Annex 2) cases and 2803 deaths have been reported in the current outbreak of EVD as of 20 Sep 2014 by the Ministry of Health of Guinea, as of 17 Sep 2014 by the Ministry of Health of Liberia, and as of 19 Sep 2014 by the Ministry of Health of Sierra Leone (table 1).

Table 1: Cases of Ebola virus disease in Guinea, Liberia, and Sierra Leone
Country
Case definition / Cases / Deaths

Guinea
Confirmed 818 / 465
Probable 162 / 162
Suspected 28 / 5
All 1008 / 632

Liberia
Confirmed 863 / 670
Probable 1342 / 544
Suspected 817 / 364
All 3022 / 1578

Sierra Leone
Confirmed 1640 / 545
Probable 37 / 37
Suspected 136 / 11
All 1813 / 593

Total 5843 / 2803

These numbers are subject to change due to on-going reclassification, retrospective investigation and availability of laboratory results.

Figure 1 shows the location of cases throughout the 3 countries with widespread and intense transmission. The cumulative numbers of cases of EVD in each area are shown (grey circles).

In Guinea, one confirmed case of EVD was reported in Kindia district; the 1st time an EVD case has been reported from the area.

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

[There have been 3321 lab confirmed EVD cases (57 percent of the total, not all of which had specimens submitted), which is a very good effort by the few hot labs in the region. It is anyone's guess how many of the remaining 2522 suspected and probable cases would have tested positive; the number of deaths in each category may give a clue.

These totals show 508 new cases (including unconfirmed) and 181 deaths in West Africa in the 3 days to a week (depending on the country's report date) since WHO Sitrep No. 4 with figures as of 14 Sep 2014. Note that the figures for Liberia are from before the lockdown, which has turned up 92 more cases at 1st count [see [2] below].

WHO released on 22 Sep 2014 a statement on the 2nd [virtual] meeting of the International Health Regulations Emergency Committee regarding the 2014 EVD outbreak in west Africa http://www.who.int/mediacentre/news/sta ... meeting/en. - Mod.JW]

*******
[2] Sierra Leone: lockdown
Date: Sun 21 Sep 2014
Source: Sky News [edited]
http://news.sky.com/story/1339751/ebola ... erra-leone


During a nationwide EVD lockdown 92 bodies and at least 56 new infections have been discovered in Sierra Leone. The 3-day lockdown came into effect on Fri [19 Sep 2014] and is aimed at stemming the worst EVD epidemic on record. The country's 6 million residents have been ordered to stay indoors as volunteers circulate to educate people about the outbreak and isolate the sick.

Stephen Gaojia, head of the Emergency Operations Centre which leads the EVD response, said "There is a very strong possibility it will be extended. "Even though the exercise has been a huge success so far, it has not been concluded in some metropolitan cities like Freetown and Kenema."

Some 123 people have contacted authorities during the lockdown so far, believing they might be infected. Of these, 56 have tested positive for EVD, 31 tested negative, and 36 were still awaiting their results, he said. Residents have largely complied with the plan, and the streets have remained mostly deserted, except for ambulances and police vehicles.

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

[This is encouraging news, contrary to dire predictions of failure and contra-productivity. It must have turned up hundreds of contacts. ProMED-mail would be interested to hear what is going to be done about them. - Mod.JW]

*******
[3] Aerosol transmission?
Date: Sun 21 Sep 2014
From: Shaheen Mehtar <smehtar@sun.ac.za> [edited]


I am rather concerned that we have lost perspective of the mode of transmission in this EVD outbreak. To my knowledge it is not aerosol borne so I am at a loss to understand why there is so much emphasis on this route of transmission when clearly the need is to reduce splash and droplets in the 40-50 percent of cases where respiratory bleeding is found.

--
Prof Shaheen Mehtar
Extraordinary Professor
Unit for Infection Prevention and Control
Faculty of Medicine and Health Sciences
Stellenbosch University
PO Box 19063; Francie van Zijl Drive
Tygerberg 7505
South Africa
<smehtar@sun.ac.za>
http://www.sun.ac.za/uipc

[We agree with Professor Mehtar. The reason for the emphasis is because some have raised the issue of the possibility of aerosol transmission, and this would be a serious event. However, the prepoderance of evidence and expert opinion is that it is not aerosol transmitted, nor is the virus likely to mutate to one that is aerosol transmitted. If it were already being aerosol transmitted face-to-face in crowded places such as markets and public transport, there would be massively greater numbers of cases in Monrovia. We have never heard of sneezing blood as a symptom in either Ebola or influenza, and there are no reports of a concurrent epidemic of influenza in Liberia. - Mods.JW/DK]

******
[4] Respirators: correction
Date: Sun 21 Sep 2014
From: Mark Liao <markliaohk@gmail.com> [edited]


I refer to the editor's comments in the ProMED-mail post, Ebola virus disease - West Africa (171): lockdown, serum, aerosol, team killed 20140920.2789476; "[3] Commentary: Health workers need optimal respiratory protection for Ebola."

Please note that the 2 pictures attached to the post are not images of N95 respirators. These are pictures of surgical masks (procedure facemasks), and can be identified due to the use of ear-loops or ties -- as noted in the posting, these facemasks do not provide sufficient protection for aerosols. N95 respirators can generally be identified by the presence of 2 elastic bands that go over the head rather than around the ears -- there are no NIOSH certified N95 respirators that use ear-loops or ties to my knowledge. Additionally I am unaware of any NIOSH [National Institute for Occupational Safety and Health] certified N95 respirators that have an integrated eye shield -- additional safety goggles, glasses or visors must be donned for eye protection. The 3rd image posted is a correct image of a PAPR [http://www.ojmedical.com/img/prods/larg ... h_a_sp.jpg.

Correct example of N95 respirators with goggles
http://www.ojmedical.com/img/prods/larg ... h_a_sp.jpg

--
Mark Liao
UC Davis School of Medicine, Class of 2015
USA

[ProMED-mail thanks Mark for this important correction. Moral: never post an online image without checking the associated text. - Mod.JW]

*******
[5] USA: aid shipment
Date: Sat 20 Sep 2014
Source: Bloomberg News [edited]
http://www.bloomberg.com/news/2014-09-2 ... -much.html


Aid organization Direct Relief had 100 tons of gloves, masks, medicines, and gowns stockpiled in a California warehouse. Doctors fighting EVD were calling from West Africa desperate for supplies. Getting it there was the challenge. With airlines halting flights and borders closing to stop the disease from spreading, the nonprofit took matters into its own hands, chartering a Boeing 747 that's leaving New York today [20 Sep 2014] for Sierra Leone and Liberia. It'll figure out how to pay the USD 500 000 bill later. "Sometimes we need to do the work, then hope the financial support follows," Chief Executive Officer Thomas Tighe said.

The shipment of gloves, masks, medicines, and gowns, the 11th one Direct Relief has sent to West African nations, is part of newly urgent efforts by agencies and governments to accelerate aid as estimates of the potential spread of the Ebola epidemic grow exponentially...

"Our health workers have been on the front lines and they've been dropping dead because of the lack of equipment," Augustine Kpehe Ngafuan, Liberia's minister of foreign affairs, said today at John F Kennedy Airport as the plane was being loaded. "The more the health workers have confidence, the more patients will have confidence to go to the hospital."

Direct Relief is sending 2.8 million gloves donated by Australian manufacturer Ansell Ltd; generic drugs donated from Israel drugmaker Teva Pharmaceuticals Industries Ltd., (TEVA) including azithromycin for bacterial infections. The supplies also include enough rehydration solution to supply 2 EVD wards for a year. The 370 pallets packing USD 6 million worth of supplies crossed the US in 7 53-foot trailers, then were loaded onto the 747 at Kennedy Airport. Other companies donating supplies include Merck & Co., Covidien Plc (COV), and Baxter International Inc. It is a "significant contribution" given the scope of the outbreak, said Darius Mans, president of aid organization Africare, whose 100-person staff in Liberia will help unload the supplies. "This will not be the last one. It can't be." -- more

[Byline: Caroline Chen; edited by Reg Gale, Bernard Kohn, Stephen West]

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

[To paraphrase a famous quote attributed to US Senator Everett Dirksen (RIP), "100 tons here, 100 tons there, and pretty soon it will add up to real relief." - Mod.JW]

******
[6] USA: military aid
Date: Fri 19 Sep 2014
Source: The Washington Times, Associated Press (AP) report [edited]
http://www.washingtontimes.com/news/201 ... in-liberia


The US Embassy says Maj. Gen. Darryl Williams arrived in the country on Tue 16 Sep 2014, and has been meeting with Liberian officials, and a C-17 US military aircraft brought a team of 7 military personnel along with some equipment on Thu 18 Sep 2014.

--
Date: Sun 21 Sep 2014
Source: Agence France-Press (AFP) [edited]
http://news.yahoo.com/more-us-troops-eb ... 02446.html

A 2nd deployment of US troops arrived on Sunday [21 Sep 2014] at Liberia's international airport, as part of an eventual 3000-strong mission to help battle the outbreak.

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

[I do not want to play down the importance of the US contribution, but must point out that Laurie Garrett told National Public Radio (NPR) on 20 Sep 2014: "Even the US military, which is the fastest mobilizing operation I know of, tells me directly in my meeting with the Joint Chiefs of Staff that it's going to take 50 to 100 days to mobilize the different elements that they've promised to commit."


With cases estimated to double every 21 days -- Sierra Leone had 650 in the 21 days ending 14 Sep 2014 (WHO) http://apps.who.int/iris/bitstream/1066 ... p4_eng.pdf -- 1700 new beds may be inadequate in 50 days, even allowing for deaths and discharges, and it may be difficult to find the 4000 new health workers US officials have said are needed for the 17 new hospitals to function http://uk.reuters.com/article/idUKKBN0H ... 0?irpc=932. - Mod.JW]

******
[7] Prevention, false alarms

Australia: false alarm
----------------------
21 Sep 2014 (The Age): Last [Fri 19 Sep 2014] a young child was suspected of having [Ebola virus] disease which activated the state's response plan for EVD. Tests at the Royal Children's Hospital [Melbourne] proved negative. A one-year-old child from West Africa, who had returned to Australia early last week, was tested for EVD at the Children's hospital after being initially treated at Frankston Hospital with diarrhoea-like symptoms on Friday night [19 Sep 2014]. The hospital's chief medical officer Dr Peter McDougall said the system, including placing the child into isolation and ensuring staff were well protected, worked well... -- more
http://www.theage.com.au/victoria/ebola ... 0jy9l.html

Ghana: false alarms
-------------------
20 Sep 2104: (CitiFM Online): Tests conducted on blood samples of a suspected EVD patient who visited the Achimota Hospital [Ghana] have proved negative. The suspected EVD patient, who is a Nigerian, sought medical attention at the health facility on 14 Sep 2014 with symptoms of hemorrhagic fever. The situation compelled hospital authorities to isolate the patient for further examination of any EVD infection. The patient's blood samples were subsequently taken to the Noguchi Memorial Institute for Medical Research for testing.

Confirming the status of the patient to Citi News, the Administrator of the Achimota Hospital, Atindaana Nsobilla said the patient has been treated and discharged. He said the hospital received the results "before 2 pm on [Mon 15 Sep 2014] and the results were negative for the ebolavirus." According to him, before the results were in, the patient had improved tremendously. "Just after we received the results and it was negative, we discharged him to continue treatment so we believe that he should be doing very well wherever he is by now." Ghana has so far, investigated 38 suspected EVD cases which have all tested negative.
http://www.citifmonline.com/2014/09/20/ ... s-negative

Lebanon: what the Lebanese government is doing about the EVD outbreak
---------------------------------------------------------------------
21 Sep 2014 (Gino's Blog): No EVD infections in Lebanese in West Africa, 6 suspected cases turned out to be malaria and were treated accordingly. Nationals of infected countries are not allowed entry into Lebanon (6 countries in total) -- more
http://ginosblog.com/2014/09/21/what-th ... a-outbreak


Netherlands: evacuated Dutch doctor actually has malaria
--------------------------------------------------------
21 Sep 2014 (Dutch News): One of the 2 doctors brought back to the Netherlands after coming into [unprotected] contact with EVD patients in Sierra Leone actually has malaria, a spokesman for the public health institute RIVM [National Institute for Public Health and the Environment] said on [Sun 21 Sep 2014]. "The doctor was admitted to hospital with a temperature on Saturday evening [20 Sep 2014] -- which is a sign of both EVD and malaria," the spokesman said. "Tests have shown he has malaria." The 2 doctors worked for the Lion Heart Foundation at a hospital in Sierra Leone. They arrived back in the Netherlands a week ago. However, the incubation period for EVD is 3 weeks, so the doctors cannot yet be given the all clear.
http://www.dutchnews.nl/news/archives/2 ... lly_ha.php

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

[An up-to-date HealthMap/ProMED-mail map can be accessed at http://healthmap.org/ebola. - Mod.JW]

[Birgitt]

EBOLA VIRUS DISEASE - WEST AFRICA (174): WHO, UNMEER, AFRICAN UNION, 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] WHO forecast
[2] Ghana, Liberia: UNMEER advance teams arrive
[3] Liberia: African Union team arrives
[4] Sierra Leone: British military & humanitarian staff arrive
[5] Sierra Leone: more cases found during lockdown
[6] Sierra Leone: nurse evacuated
[7] Liberia: 120-bed EVD hospital opens
[8] Liberia, Sierra Leone: community care centres planned

*******
[1] WHO forecast
Date: Tue 23 Sep 2014
Source: NBC News [edited]
http://www.nbcnews.com/storyline/ebola- ... st-n209226


World Health Organization researchers issued a dire new forecast for the EVD epidemic Tue [22 Sep 2014, one that sees 20 000 cases by 2 November [2014]. And 70 percent of patients are dying. That's a big increase over the previous estimates of a 50 percent fatality rate. Caregivers and health care workers have a high risk. More than 300 health care workers have been infected, and half of them have died.

"These data indicate that without drastic improvements in control measures, the numbers of cases of and deaths from Ebola virus disease [EVD] are expected to continue increasing from hundreds to thousands per week in the coming months," the WHO Ebola Response Team, led by Dr Christopher Dye, wrote in a report rushed into print by the New England Journal of Medicine.

This projection includes nearly 10 000 people in Liberia alone. WHO said earlier Mon [22 Sep 2014] that more than 5800 people had been infected with EVD and more than 2800 had died of it since the virus first broke out in Guinea in December [2013]. "The true case load, including suspected cases and undetected cases, will be higher still."

It's looking so bad that EVD could take permanent hold in West Africa, they said -- something that's never happened before. "For the medium term, at least, we must therefore face the possibility that Ebola virus disease will become endemic among the human population of West Africa," they said.

What could change that?
-----------------------
Quick action by the world, the experts said. That means sending more people to track down potential EVD cases so they can be isolated and treated, providing better hospital treatment and safer burials, and getting better buy-in from the community. In some places, residents still don't believe EVD is [caused by] a virus, and they have attacked and even killed health workers trying to spread the word about the danger. Patients are also running away and spreading the disease that way. To stop the epidemic, transmission must be cut in half, they said. "Considering the prospects for a novel EVD vaccine, an immunization coverage exceeding 50 percent would have the same effect," they wrote.

The United States is leading a new response, sending troops and supplies and offering to help coordinate help. WHO and the UN are urging other countries to help. Germany, France, Cuba, and China are among countries also sending teams and equipment.

Not as easily transmitted as influenza or measles
-------------------------------------------------
To make the forecast, the team looked at all the available data on the epidemic, which has spread more widely than any previous outbreak of EVD, in part because it broke out in an area where people travel widely across borders. It remains clear that close contact with an infected person or their bodily fluids is needed for infection to happen. There's nothing mysterious about how EVD spreads, and it's not as easily transmitted as influenza or measles.

Hemorrhage in less than 20 percent
-------------------------------
The most common 1st symptoms are fever and fatigue. Hemorrhage -- the most feared symptom -- is seen in fewer than 5 percent of patients, although about 18 percent had unexplained bleeding, the WHO team said. Forget about the tales of horrific bleeding from the eyes, nose, and mouth. Bleeding is one of the most unusual symptoms, the team of experts from around the world said. [There is no mention of hiccups, a characteristic symptom in the Kikwit epidemic & also in Uganda; see ProMED-mail posting Ebola virus disease - West Africa (86): WHO, UNSC, ECOWAS, Guinea, Liberia 20140711.2603448 & CDC MMWR archives. - Mod.JW]

EVD has an [average] incubation period of 11 days, and people cannot infect others before they begin to show symptoms -- unlike flu, which people can pass along before they even feel ill. One important number is how many other people each patient infects. It's different for each country, Dye says -- an average of 1.7 in Guinea and 1.8 in Liberia. In Sierra Leone, an infected person sickens 2 other people on average. Some patients infect many more people than that -- [more] than a dozen mourners were infected at the funeral of a single traditional healer who died in Sierra Leone, for instance. And some die or recover without infecting anybody else.

Another important number is what's called doubling time -- how long it takes for the number of cases to double. This varies greatly from country to country; in Guinea it's just under 16 days, in Liberia it's nearly 23 days, and in Sierra Leone it's 30 days. That's what leads to the projection of 20 000 cases by [2 Nov 2014].

Most of those infected are ages 15 to 44, although people those ages only account for 44 percent of the population in those countries. Older patients are more likely to die, and those who have diarrhea, hemorrhage, difficulty breathing, or confusion also seem more likely to die. Most of those who died succumbed on average 4 days after they were admitted to a hospital or clinic, and if someone survived, it was usually 11 days before they were better enough to go home, on average. It's possible that patients who get hospital care live longer, the researchers said, but there's not enough information to say that for sure.

Patients get vastly different care, depending on where they are treated; 3 out of 4 patients treated in the USA have recovered or nearly recovered and the 4th has released little information about his condition. They all got the best possible care, including carefully measured and balanced rehydration, 24-hour nursing care, immaculate conditions, and experimental treatments, including drugs and transfusions of blood from patients who have recovered. In West Africa, some lucky patients get good hospital care that includes saline [solution] to replace fluids lost to vomiting and diarrhea, antibiotics to prevent other infections, and pain control. But many are given little more than a bed or a space on the floor, and many are also turned away to die at home or in the streets. So it's hard to say what will save someone's life.

The report strongly suggests what doctors are saying is true -- there's nothing unusual about the virus itself, say Dr Peter Piot of the London School of Hygiene and Tropical Medicine, who helped discover EVD, and Dr Jeremy Farrar of Britain's Wellcome Trust. It's spreading because of dysfunctional health systems, a lack of action by local and international governments, and a population that hasn't caught on immediately to the dangers and what to do about EVD, they wrote in a commentary in the journal.

Stopping the epidemic
---------------------
"Classic 'outbreak control' efforts are no longer sufficient for an epidemic of this size," they added. "Rather, what's required is a large-scale, coordinated humanitarian, social, public health, and medical response, combining classic public health measures with safe and effective interventions including behavioral changes, therapies, and, when possible, vaccination." It will take both a "massive" response and, probably, the use of new treatments and vaccines to control the epidemic, Farrar and Piot wrote.

[Byline: Maggie Fox]

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

******
[2] Ghana, Liberia: UNMEER advance teams arrive
Date: Mon 22 Sep 2014
Source: United Nations News Centre [edited]
http://www.un.org/apps/news/story.asp?N ... CC36Pm3OPM


Laying the groundwork for the effective and coherent action necessary to stop the EVD outbreak in West Africa that has sickened more than 5800 people and killed some 2800, an advance team of the United Nations Mission for Ebola Emergency Response [UNMEER] arrived today in Accra, Ghana to set up the operation's headquarters.

Another advance team of the Organization's 1st ever mission dealing with a public health crisis, to be known as UNMEER, also arrived in Liberia, one of the countries, along with Guinea and Sierra Leone, which has been hardest hit by the unprecedented outbreak.

UN spokesman Stephane Dujarric also announced today [22 Sep 2014] that the world body has established the Ebola Response Multi-Partner Trust Fund to ensure a coherent UN system contribution to the overall response. The Fund seeks contributions from Member States, regional legislative bodies, inter-governmental or nongovernmental organizations, businesses, and individuals. Donors can also choose to channel their contributions directly to UN agencies... -- more

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

******
[3] Liberia: African Union team arrives
Date: 22 Sep 2014
Source: GlobalPost, Xinhua News Agency report [edited]
http://www.globalpost.com/dispatch/news ... es-liberia


1st African Union (AU) EVD team arrives in Liberia
--------------------------------------------------
The African Union (AU) said on Mon [22 Sep 2014] in a statement that its 1st team combating the EVD outbreak in West Africa has arrived in Monrovia, Liberia. The team comprising of both medical and non-medical support personnel is expected to swing into action providing support to the Liberian government in curbing the menace of the deadly Ebola virus disease (EVD).

Deputy chief of protocol at the Liberian ministry of foreign affairs appreciated the willingness of the team and encouraged them in the mission to win what he called "the Ebola war". Re-deployments to different counties in Liberia are expected to commence soon, said the statement.

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

******
[4] Sierra Leone: British military & humanitarian staff arrive
Date: Tue 23 Sep 2014
Source: UK Government press release [edited]
https://www.gov.uk/government/news/the- ... erra-leone


The UK is leading the international drive against EVD in Sierra Leone
---------------------------------------------------------------------
British military and humanitarian staff have arrived in Freetown to spearhead the UK's GBL 100 million [about USD 164 million] mission to contain and control the outbreak. Construction begins on the UK medical facility in Sierra Leone [see photo at source URL above]. More than 40 military personnel and humanitarian staff have arrived to oversee the construction of the UK's medical facility and assist with the UK's response.

The latest update follows a meeting of the UK's emergency committee COBR [Cabinet Office Briefing Room] this afternoon [23 Sep 2014]. Chaired by the Foreign Secretary Philip Hammond from New York, the meeting reviewed progress on the UK's commitment to boost significantly public health provision across Sierra Leone, including support for 700 EVD treatment beds. The UK has published an action plan setting out how it will work alongside the United Nations and Sierra Leone, to mobilise international medical teams and support further treatment centres.

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

******
[5] Sierra Leone: more cases found during lockdown
Date: Mon 22 Sep 2014
Source: Reuters Africa [edited]
http://af.reuters.com/article/topNews/i ... me=topNews


Sierra Leone recorded 130 new cases of EVD during a 4-day lockdown and is waiting for test results on a further 39 suspected cases, Stephen Gaojia, head of the Ebola Emergency Operations Centre, said on Mon [22 Sep 2014]. The country had ordered its 6 million citizens to stay indoors until Sunday night [21 Sep 2014] in the most extreme strategy employed by a West African nation since the start of an epidemic that has infected [more than 5800] people since March [2014] and killed [more than 2800] of them. "The exercise has been largely successful ...

The outreach was just overwhelming. There was massive awareness of the disease," Gaojia said, noting that authorities reached more than 80 percent of the households they had intended to target. Sierra Leone now needs to focus on treatment and case management and it urgently needs treatment centres in all its 14 districts as well as "foot soldiers" in clinics and hospitals, he said. "We need clinicians, epidemiologists, lab technicians, infection-control practitioners, and nurses," he said... -- more

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

******
[6] Sierra Leone: nurse evacuated
Date: Mon 22 Sep 2014
Source: WLTX, Associated Press (AP) report [edited]
http://www.wltx.com/story/news/health/2 ... /16053011/


Child with EVD bites nurse
--------------------------
Swiss authorities say a male nurse who was bitten by an EVD patient while working in West Africa has been flown to Switzerland as a precaution. The health ministry says the unidentified man was working for an international organization in Sierra Leone when he was bitten by a child infected with EVD on Sat [20 Sep 2014]. The ministry says the nurse was wearing protective gear and is unlikely to have contracted the disease. It said the man, who was flown to Switzerland by a private transport company Mon [22 Sep 2014], will be kept under observation at Geneva's University Hospital for the incubation period of 3 weeks. The ministry said it was the 1st medical transport to Switzerland from the EVD-affected region.

[Unless teeth penetrated the protective gear, this sounds like an expensive overabundance of caution. It should have been safe for him and any co-passengers to take a regular commercial flight -- but perhaps none is available any more in Sierra Leone, only charter? - Mod.JW]

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

******
[7] Liberia: 120-bed EVD hospital opens
Date: Mon 22 Sep 2014
Source: AllAfrica, FrontPageAfrica (Monrovia) report [edited]
http://allafrica.com/stories/201409221723.html


120-bed EVD treatment center opens in Liberia
---------------------------------------------
As the opening ceremony for a 120-bed EVD treatment facility constructed by the government of Liberia with technical support from the World Health Organization was going on, 6 ambulances packed with 24 suspected EVD patients were already on standby. At the side entrance of the building were some patients who managed to walk with the help of their relatives to the center at the Old Island Clinic on Bushrod Island [Monrovia]. Some groaned in pain as others lay on the ground under the hot Sunday afternoon sun, waiting and praying for the formalities to be over so the staff could let them in to the facility to begin to receive care... -- more

[Byline: Wade CL Williams]

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

******
[8] Liberia, Sierra Leone: community care centres planned
Date: 22 Sept 2014
Source: The Washington Post [edited]
http://www.washingtonpost.com/national/ ... story.html


New effort to fight EVD in Liberia would move infected patients out of their homes
----------------------------------------------------------------------
Looking for a new approach to blunt the EVD epidemic sweeping West Africa, the Liberian government, the World Health Organization, and their nonprofit partners are launching an ambitious but controversial program to move infected people out of their homes and into ad hoc centers that will provide rudimentary care, officials said [Mon 22 Sep 2014].

The effort, which is expected to begin in the next few weeks, is an intermediate step, officials said. The goal is to reduce the chances that EVD patients will infect their own families and others while ensuring that they receive basic care -- such as food, water, and pain medicine -- at a time when many hospitals and treatment centers are closed.

The initiative also is a tacit acknowledgment that it could be weeks, even months, before new treatment facilities promised by the USA and others are operational. Continued reliance on home-based care doesn't do much good, officials said, in taming a devastating epidemic in a country where large groups of people live in crowded, urban settings.

The proposed community care centers, as they are dubbed by officials, would have between 15-30 beds. Ultimately, as many 70 centers could be set up across Liberia, if the strategy proves successful. Such a program has never been tried on such a large scale. A similar effort is being discussed for Sierra Leone... -- more

[Byline: Lenny Bernstein and Lena H Sun]

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

[There is an explanatory graphic of the layout of such a center. I understand that cholera cots are under consideration for beds -- cheap, light, folding, practical camp beds with a hole in the middle for a bucket underneath, easy to disinfect by one person compared to metal frame beds with mattresses which need to be handled and disinfected by 2 people. - Mod.JW

[ProMED thanks ProMED-mail Rapporteur Kunihiko Iizuka for his submissions to today's update.

An up-to-date HealthMap/ProMED-mail map can be accessed at http://healthmap.org/ebola. - Mod.JW]

[Birgitt]

EBOLA VIRUS DISEASE - WEST AFRICA (175): SIERRA LEONE, DRUGS, SURVIVORS REQUEST FOR INFORMATION
***********************************************************************************************
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] CDC telebriefing transcript
[2] CDC Ebola Safety Training Courses travel grants
[3] Sierra Leone: deaths undercounted?
[4] New drug field trials
[5] Prevention & false alarms
[6] Survivors: availability as health workers?

******
[1] CDC telebriefing transcript
Date: Tue 23 Sep 2014
Source: CDC [excerpts, edited]
http://www.cdc.gov/media/releases/2014/ ... -tool.html


CDC Telebriefing: Update on Ebola Response Tool
-----------------------------------------------
Dr. Tom Frieden, Director of the Centers for Disease Control and Prevention (CDC):

"What we're releasing today is a useful tool. It comes with an online spreadsheet so that planners in countries as well as in international organizations can model what might happen in different circumstances. The tool was created several weeks ago with data that was available several weeks ago and a lot has happened since then ...

"[The] bottom line here is, and I think what's really important in this tool, is that the model shows -- and I don't think this has been shown by other modeling tools out there -- that a surge now can break the back of the epidemic. It also shows that there are severe costs of delay. And that the importance of implementing effective programs rapidly can't be overemphasized. It's definitely still possible to reverse the epidemic ..."

Ms. Gayle Smith, special assistant to the President of the United States and Senior Director of the National Security Council:

"[Some] of the projections that you will be seeing don't take into account something that Tom just referred to, which is the tremendous surge in resources and response, even in the last few weeks. As you know, President Obama announced that we would be sending in a joint force command, which has been stood up in Monrovia to support the regional civilian effort. They have provided more personnel on the ground since the force commander deployed last week. They are calling in assets and capabilities to rapidly get to scale a response that will provide more treatment units, training at scale and logistics to support what is a complex region wide operation ...

"We are also continuing to build out our civilian response ... The 3rd line of effort is work very aggressively with countries all over the world to urge and urge them to ramp up their responses ... [We] think it's imperative that we keep the pressure on the international community to respond as quickly as possible. So we can get ahead of this and get ahead of it quickly."
... [more; Q&A from media]

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

[The EVD tool is described in Estimating the Future Number of Cases in the Ebola Epidemic -- Liberia and Sierra Leone, 2014-2015, 23 Sep 2014 / 63(Early Release);1-14. http://www.cdc.gov/mmwr/preview/mmwrhtm ... 3e0923a1_w. - Mod.JW]

******
[2] CDC Ebola Safety Training Courses: travel grants
Date: Wed 24 Sep 2014
Source: International Society for Infectious Diseases (ISID) [edited]
http://www.isid.org/grants/grant_ebola_ ... avel.shtml


In response to the 2014 EVD outbreak in West Africa, ISID has searched for ways to assist the people most affected. We are pleased to announce that we are sponsoring a limited number of travel grants to individuals who are attending one of the Centers for Disease Control and Prevention (CDC) Ebola Safety Training Courses. The courses will help prepare healthcare personnel to provide medical care to Ebola patients in an established Ebola Treatment Unit (ETU).

The 1st CDC Ebola Safety Training Course starts on 6 Oct 2014 and the schedule currently extends through the end of this year [2014]. The courses are open to healthcare workers from all over the world and are being offered free of charge, but participants are responsible for paying for their own travel to the course in Alabama. Full information on the CDC course: http://www.cdc.gov/vhf/ebola/hcp/safety ... index.html

Only individuals who have been accepted to the CDC Ebola Safety Training Course and who will deploy to West Africa after completion of the course will be eligible for ISID funding. Travel grants of USD 500 each will be awarded to US residents and USD 1000 to residents of other countries.

For more information on the ISID CDC Ebola Safety Training travel grant, please go to: http://www.isid.org/grants/grant_ebola_ ... ravel.shtm.

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

******
[3] Sierra Leone: deaths undercounted?
Date: Tue 23 Sep 2014
Source: New York Times [excerpts, edited]
http://www.nytimes.com/2014/09/23/world ... ebola.html


Fresh graves point to undercount of EVD toll
--------------------------------------------
The gravedigger hacked at the cemetery's dense undergrowth, clearing space for the day's EVD victims. A burial team, in protective suits torn with gaping holes, arrived with fresh bodies. The backs of the battered secondhand vans carrying the dead were closed with twisted, rusting wire. Bodies were dumped in new graves, and a worker in a short-sleeve shirt carried away the stretcher, wearing only plastic bags over his hands as protection. The outlook for the day at King Tom Cemetery was busy. "We will need much more space," said James C. O. Hamilton, the chief gravedigger, as a colleague cleared the bush with his machete ...

Since the beginning of the outbreak more than 6 months ago, the Sierra Leone Health Ministry reported only 10 confirmed EVD deaths here in Freetown, the capital of more than one million people, and its suburbs as of Sunday [21 Sep 2014] -- a hopeful sign that this city, unlike the capital of neighboring Liberia, had been relatively spared the ravages of the outbreak. But the bodies pouring in to the graveyard tell a different story. In the last 8 days alone, 110 EVD victims have been buried at King Tom Cemetery, according to the supervisor, Abdul Rahman Parker, suggesting an outbreak that is much more deadly than either the government or international health officials have announced. "I'm working with the burial team, and the 1st question I ask them is, 'Are they Ebola-positive?'" said Mr. Parker, adding that the figures were based on medical certificates that he had seen himself. The deaths are carefully recorded by name and date in a notebook headed "Ebola Burials." ...

The majority of the recent deaths recorded at the cemetery were young people -- young adults, people in early middle age, or children -- with very few elderly people on the list. Several of the deaths also occurred in a concentrated area, sometimes in the same house, suggesting that a virulent infection had struck ...

Other houses in Wilberforce Barracks, the village-like compound surrounding the hospital, were on the list of the dead and placed under quarantine, marked off from the surrounding jumble of shacks and cinder-block houses by a thin line of red or blue string. In one of them, ... the residents said that a total of 5 people who lived there had died of EVD -- yet 4 of them did not even appear on the cemetery list ...
At another 6 households on the cemetery supervisor's list of the dead, residents gave similar accounts. One family said the victim had definitely died of EVD, while 5 others described EVD-like symptoms -- vomiting, diarrhea, fever -- though none had been given an official cause of death.

International health experts here had no explanation for the striking discrepancy between the government's tally of the dead in the capital and the cemetery crew's statistics. Several of them noted the general confusion surrounding official statistics here from the beginning, with one leading international health official saying: "We don't know exactly what is going on." But nobody disputed that things appear to be getting worse. The WHO has shown a sharp increase in new cases in Freetown in recent weeks, rising from almost none early in the summer to more than 50 during the week of 14 Sep 2014 ... But the exhaustion of the EVD gravediggers at King Tom Cemetery, who dig as many as 16 graves a day, indicated that the disease was far from being contained ... [more]

[Byline: Samuel Aranda]

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

******
[4] New drug field trials
Date: Tue 23 Sep 2014
Source: Washington Post [edited]
http://www.washingtonpost.com/news/to-y ... est-africa


Health officials will begin 1st EVD treatment trials in West Africa
-------------------------------------------------------------------
Although experimental treatments for ebolavirus have already been administered to westerners who contracted the disease, scientists in London, with the help of international aid groups, plan on bringing clinical trials for those treatments to West Africa for the 1st time. The trials could begin in a matter of months.

Wellcome Trust's USD 5 million initiative will include drugs from Mapp Biopharmaceutical, Sarepta and Tekmira, according to Reuters. Mapp makes zMapp, the experimental cocktail administered to 2 Americans who contracted the disease in Liberia. And Tekmira recently gained the approval of the US Food and Drug Administration to use its TKM-Ebola treatment on confirmed or suspected cases of the disease ... [more]

[Byline: Abby Ohlheiser]

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

[I can't find anything in the Reuters source to say the trials could [only] begin in a matter of months -- every week counts now. There is a standard protocol for clinical trials; surely a trial can begin in a dedicated West African hospital on rapid authorization by a national government without waiting for UK government or US FDA clearance, provided the African government agrees in advance not to claim damages from the pharmaceutical companies if serious side effects are found? ProMED would welcome clarification of the reasons for delay. - Mod.JW]

******
[5] Prevention & false alarms


Australia: EVD scares at Perth hospital
---------------------------------------
23 Sep 2014 (News Limited): A woman in Western Australia has been cleared of the deadly ebolavirus, it has emerged. The woman had recently arrived in the country from West Africa and was currently being treated at Sir Charles Gairdner Hospital in Perth. She was transported to the facility, the state's quarantine hospital, after suffering EVD-like symptoms, which include fever. The woman instead could be suffering from malaria, which was the diagnosis for a man who presented at the hospital last week with flu-like symptoms after working in west Africa.
http://www.news.com.au/national/ebola-s ... 7067424834

Canada: Edmonton (Alberta) false alarm
--------------------------------------
22 Sep 2014 (Edmonton Sun): The threat of Ebola led to the temporary closure of the Royal Alexandra Hospital emergency department on Monday [22 Sep 2014]. Alberta Health Services (AHS) took extraordinary precautions due to the threat of the deadly ebolavirus. "We did have a patient there who gave a travel history and had a clinical condition that was suggestive that he might have EVD but on further assessment we've ruled [it] out," said AHS senior medical officer of health, Dr. Gerry Predy ... [more]
http://www.edmontonsun.com/2014/09/22/e ... al-closure

CDC guidelines for aircrew
--------------------------
22 Sep 2014 (Daily Mail): [On Fri 19 Sep 2014] the [US CDC] stressed that airlines may 'deny boarding to air travelers with serious contagious diseases that could spread during flight'
- The rule applies to all US airlines and to foreign airlines flying directly in or out of the USA
- Ebola has infected at least [5800] people in West Africa and has killed [over 2800] of them
- Thousands of US soldiers are slated to enter Africa to help stem the out-of-control outbreak over the next 30 days
The new guidance stresses that flight crews should 'treat any body fluid as though it is infectious' ... [more]
http://www.dailymail.co.uk/news/article ... lines.html

Ghana: suspect cases
--------------------
23 Sep 2014 (Modern Ghana): [A] man who was on board a Kumasi-Bolga bound mini bus ... allegedly complained of some ailment and started having a running stomach [diarrhea] and vomiting blood when the vehicle got to Kintampo Sunday [21 Sep 2014] morning. He died some few minutes later. Eyewitnesses told Daily Guide that the development created panic among both the passengers and the residents around the lorry park where he passed on, as medical personnel, dressed in their full EVD apparel, stormed the scene to convey the body to prevent people from contacting it ... the body had since been buried, whilst the blood sample had been taken to the Noguchi Medical Research Centre in Accra for testing ... the deceased was among a group of students from the Upper East Region who went to the Wassa area in the Western Region to embark on galamsey (illegal mining) during the holidays to earn some money to pay their fees ... the cause of death could be mercury poisoning ... a similar incident happened recently at the Goaso area where a galamseyer died vomiting blood as a result of mercury poisoning [mercury is used during gold mining].
http://www.modernghana.com/news/570653/ ... tampo.html

Ebola scare hits Dominase, Ghana; 1 dead, 2 hospital staff quarantined
----------------------------------------------------------------------
24 Sep 2014 (Modern Ghana): An EVD scare at the Dominase SDA Hospital in the Ashanti Regional has created panic in the area. A man believed to be in his late twenties died in the hospital with the symptoms of EVD Tuesday [23 Sep 2014]. He was left unattended to by frightened hospital staff who did not have basic protective equipment with which to handle the patient. According to the Medical Superintendent of the hospital, Prince Kwakye Afriyie, the deceased reported to the hospital 3 days ago with fever. He was treated and discharged. But the Pusiga native returned to the hospital, this time with blood oozing out of his orifices, Dr Afriyie said. Frightened hospital, suspecting the victim to be suffering from the deadly Ebola which has killed over 2000 across West Africa, called the District health authorities for Personal Protective Equipment. There was none there.
http://www.modernghana.com/news/570792/ ... taff-.html

Guinea-Bissau: Community radios and televisions join to prevent epidemic
------------------------------------------------------------------------
22 Sep 2014 (Observador): 32 radio stations and 4 community television of Guinea-Bissau will broadcast from Monday [22 Sep 2014] a campaign to prevent Ebola epidemic, which the country remains free, said the association Action for Development (AD). The nongovernmental organization (NGO) aims to put the issue on the agenda "with communities" with which it works across the country, announced today in a statement. The messages to send over the National Network of Radios and Televisions Guinea-Bissau Community (RENARC), coordinated by AD, will be complemented with a newsletter distributed in the neighborhood of Quelele in Bissau, plays and music broadcast in public spaces. At the same time, the NGO has involved nearly 200 associations and organizations receiving shares of AD in rural and urban areas and regions of Bissau and Cacheu Cubucare such as schools, health facilities and communities. The campaign also provides for intervention in community spokespersons information, responsible for making it reach the most isolated households ... [more]
http://observador.pt/2014/09/22/radios- ... r-epidemia [in Portuguese, machine transl.]

[Guinea-Bissau shares a long border with Guinea. - Mod.JW]

India: suspected case
---------------------
23 Sep 2014 (Times of India): A 22-year-old man who returned from Nigeria on Monday [22 Sep 2014] with a high fever was being closely monitored at an isolated ward in the Government General Hospital [GH in Chennai) for symptoms of EVD. The patient ... has been working at a private hospital in Nigeria. [He] was on vacation, arrived at Chennai airport via Abu Dhabi on Monday night with a high fever. He was immediately screened at the airport and sent to the GH where he was quarantined ... after starting the 1st course of treatment, the patient's fever had subsided considerably but nothing was certain as yet and they would continue to monitor him at an isolated ward ... [more]
http://timesofindia.indiatimes.com/City ... 259251.cms

[He was infectious on board. Nothing is said about tracing the aircrew and other passengers, or about any protection worn by the Chennai airport personnel. Let's hope it was malaria, not transmissible by contact. - Mod.JW]

Madagascar: 10 false alarms
---------------------------
20 Sep 2014 (L'Express de Madagascar): Since August [2014], we have analyzed 10 cases of people suspected of being infected with EVD. All tests were negative. "It is in these terms that Professor Christophe Rogier, director of the Pasteur Institute of Madagascar (IPM), wanted to reassure the public in face of the threat of this deadly virus ... They were suspected of being infected following the detection of a rise in their temperature after traveling abroad, according to Herlyne Ramihantaniarivo, Director General of the Ministry of Public Health.
http://www.lexpressmada.com/blog/actual ... fies-17881 [in French, machine transl.]

[Madagascar is one of the countries labeled at risk for EBV, because of its forest fauna, by an Oxford University [UK] study: http://www.washingtonpost.com/news/to-y ... a-exposure. - Mod.JW]

Sierra Leone: seals borders
---------------------------
23 Sep 2014 (Reuters): Sierra Leone's army has "sealed off" the borders with Liberia and Guinea in a bid to halt the spread of EVD, the army spokesman said on Tuesday [23 Sep 2014]. The spokesman told Reuters that troops had been sent to all border crossing points.
http://www.reuters.com/article/2014/09/ ... 23?rpc=401

[They mean sealing all road traffic crossings. But when the border guard is the same tribe as you -- or even if he is not -- the seal can be unstuck. Also, it is impossible to seal off all footpaths through the forest. - Mod.JW]

Switzerland: Guinean refugee an EVD contact
-------------------------------------------
23 Sep 2014 (AFP): A Guinean asylum seeker has been hospitalized in Switzerland with suspected EVD, health authorities announced in Bern on Tuesday [23 Sep 2014]. "The individual fulfils the criteria for a suspected case of EVD," the Federal Office of Public Health said in a statement. He was being monitored under tightly controlled conditions at the university hospital (CHUV) in Lausanne in the canton of Vaud, the office said. "He is undergoing medical examinations in order to determine whether he is indeed suffering from the disease," it added. The office said that the man had arrived at an asylum centre in the western town of Vallorbe on 17 Sep 2014, and had told officials that he had left Guinea for France 2 days earlier. Officials at the centre acted fast because the man said he had lost a family member to EVD, placing him in quarantine under watch from physicians. After he began showing feverish symptoms on Tuesday [23 Sep 2014], the authorities decided to transfer him immediately to Lausanne amid tight security. The office stressed that the disease does not spread until the symptoms appear, and that there was no risk to the local population, saying the swift handling of the case showed the effectiveness of EVD monitoring in the country.
http://www.thelocal.ch/20140923/guinean ... n-lausanne

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

******
[6] Survivors: availability as health workers?
Date: Wed 24 Sep 2014
From: Michael Barza, MD <Michael.Barza@steward.org> [edited]


Apart from buying the blood of EVD survivors, I wonder why I have heard no discussion of having the more able-bodied of these survivors work in the effort to contain EVD. Presumably they would be immune -- at least to the strain in their own geographic area.

--
Michael Barza, MD, Chief of Medicine
Steward Carney Hospital
2100 Dorchester Avenue
Boston, Massachusetts 02124
USA
Sara Jordan Professor of Medicine
Tufts University School of Medicine

[ProMED would be interested to hear the reasons. I think it's probably because of stigma -- nobody wants contact with survivors; husbands are reportedly even rejecting recovered wives. But survivors could work with cleanup in treatment centers, and on burial crews -- saving PPE (personal protective equipment). They would unfortunately probably not be welcomed into households as contact tracers. I'm amazed to see CDC personnel going out into the bush tracing contacts -- see one in a sleeveless top trekking into the jungle in the CDC photo gallery at: http://www.cdc.gov/24-7/protectingpeopl ... index.html. Maybe she has PPE in her backpack?

An up-to-date HealthMap/ProMED-mail map can be accessed at http://healthmap.org/ebola. - Mod.JW]

[Birgitt]

EBOLA VIRUS DISEASE - WEST AFRICA (176): SIERRA LEONE, USA, NIGERIA, 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

In this update:
[1] Sierra Leone: increased quarantine restrictions
[2] USA EVD patient released; says he feels great
[3] USA: Obama speaks to UN
[4] Nigeria EVD-free?
[5] Germany: 2000 army volunteers to fight EVD in West Africa
[6] UK: NHS pharmacists & other volunteers
[7] Symptoms: hiccups: correction
[8] Prevention & suspected cases

******
[1] Sierra Leone: increased quarantine restrictions
Date: 25 Sep 2014
Source: NY Times [edited]
http://www.nytimes.com/2014/09/26/world ... .html?_r=0


Acknowledging that the EVD epidemic sweeping Sierra Leone was worsening, officials here put hundreds of thousands of more citizens under quarantine on Thu [25 Sep 2014], sealing off more than a quarter of the country and warning travelers not to get out of their vehicles in [when passing through] the districts under isolation.

Nearly all of the country's 14 districts are now under either total or partial quarantine, with over one million people affected, as the disease advances into areas that have previously not been affected. Infection rates have been rising in the capital, Freetown, a dangerous development because of the city's density.

In an address to citizens late Wednesday night [24 Sep 2014], President Ernest Bai Koroma acknowledged that the new quarantine orders would "definitely pose great difficulties for our people," but he suggested that officials had little choice. Makeni, the largest city in the country's Northern Province, is in one of the newly quarantined districts, and foreign health care workers are particularly worried about a surge in infections there.

[Travelers by road from Guinea through Sierra Leone to Liberia have many alternative routes, most of them now quarantined; see map at: http://wikitravel.org/upload/shared//th ... ns-map.png. - Mod.JW]

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

******
[2] USA EVD patient released; says he feels great
Date: 25 Sep 2014
Source: ABC News [edited]
http://abcnews.go.com/US/wireStory/nebr ... t-25751592


[See link for further information.]

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

******
[3] USA: Obama speaks to UN
Date: 25 Sep 2014
Source: Washington Post [edited]
http://www.washingtonpost.com/politics/ ... story.html


Obama: Ebola is a "growing threat to regional and global security." [See link for further information.]

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

******
[4] Nigeria EVD-free?
Date: 25 Sep 2014
Source: IB Times [edited]
http://www.ibtimes.co.uk/nigeria-ebola- ... un-1467150


Nigeria is "Ebola-free," President Goodluck Jonathan tells the UN. The president made the comment during a UN General Assembly in New York.

"We can confidently say that today [25 Sep 2014], Nigeria is Ebola-free," said Jonathan.

However, an email from the head of the Emergency Operation Centre for Ebola in Lagos, Faisal Shuaib, said: "The outbreak in Nigeria can be declared officially over only if there are no more cases after 42 days, or 2 incubation periods from the last confirmed case."

Eight people have died out of 20 confirmed Ebola cases in Nigeria since July 2014, and Nigeria has not reported any new cases since 8 Sept 2014.

[I hope the president is proved right in early October 2014. - Mod.JW]

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

******
[5] Germany: 2000 army volunteers to fight EVD in West Africa

More than 2000 Germans have volunteered to travel to West Africa to help fight the Ebola outbreak. The country's 1st shipment of roughly 10 tons of supplies leaves Thu [25 Sep 2014].

On Wed [24 Sep 2014], Defense Minister Ursula von der Leyen announced that 2000 German soldiers had volunteered for duty in Africa to aid in the battle against EVD...

Ursula von der Leyen says she didn't expect such a large and sudden response. The answer to a call for help the defense minister made on Monday [22 Sep 2014] "moved and overwhelmed" her, she said. However, she added that the Bundeswehr [army] still needed to check the experience and vaccination histories of the active-duty soldiers, reservists and civilians who signed up.

[It's not clear whether the civilians who signed up are included in the 2000 total, but this is hopeful news. Perhaps, to avoid potential problems, the USA should also consider deploying only volunteers from the military? - Mod.JW]

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

******
[6] UK: NHS pharmacists & other volunteers
Date: 25 Sep 2014
Source: Pharmaceutical Journal UK [edited]
http://www.pharmaceutical-journal.com/n ... 30.article


UK pharmacists have been urged to volunteer in the fight against EVD in West Africa in an open letter from 4 of the most senior figures in UK healthcare. The letter, signed by Dame Sally Davies, chief medical officer at the Department of Health, says that staff wishing to help should register with the UK International Emergency Medical Register. It said that NHS-funded organisations will have individual "leave policies" in place but cautioned that "safe staffing levels and services are maintained in the NHS in England."

A range of healthcare professionals may be required, including doctors, nurses, paramedics, pharmacists, psychologists, health information managers, logisticians and outreach managers, says the letter. At last count, about 200 NHS staff had volunteered to work in West Africa.

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

******
[7] Symptoms: hiccups: correction
Date: 24 Sep 2014
From: Shamsudeen Fagbo <oloungbo@yahoo.com> [edited]


Re: the comment in Ebola virus disease - West Africa (173): WHO, Sierra Leone, respirators, aid, Archive No. 20140922.2792415:

["There is no mention of hiccups, a characteristic symptom in the Kikwit epidemic and also in Uganda; see ProMED-mail posting Ebola virus disease - West Africa (86): WHO, UNSC, ECOWAS, Guinea, Liberia 20140711.2603448 and CDC MMWR archives. - Mod.JW"]

You may wish to make this correction: The paper does mention hiccups in more than one place, e.g. in Table 1.

--
Shamsudeen Fagbo
<oloungbo@yahoo.com>

[He is right. I should have referred to the original article at http://www.nejm.org/doi/full/10.1056/NE ... articleTop and written: "There is no mention of hiccups in this news report." - Mod.JW]

******
[8] Prevention & suspected cases

FDA: fake drug alert
--------------------------
24 Sep 2014: (WaPo) The US Food and Drug Administration [FDA] sent letters to 3 companies this week warning them against marketing their products as possible treatments or cures for EVD. The letters, posted online on Wed [24 Sep 2014], document multiple claims from the companies or their paid representatives that essential oils and other natural remedies can "help prevent your contracting the ebolavirus," and in at least one instance, "effectively kill the ebolavirus." There are currently no approved treatments, cures or vaccines for EVD. Natural Solutions Foundation, Young Living, and doTERRA International LLC all produce products that were promoted on the Web as cures for a variety of ailments, all without FDA approval. The products in question, the letters note, are not FDA-approved drugs, yet their marketing makes the sort of claims that only approved drugs may make, that they can be used to treat, mitigate, prevent and cure diseases. According to the 3 letters, those promotions -- either on Web sites ... Pinterest messages, Facebook postings and blog posts -- claim that products such as "CBD Organic Dark Chocolate Bars," "Clary Sage" essential oils and the "Family Protection Pack" can do what has not yet been done: Treat, cure or prevent the deadly ebolavirus.
http://www.washingtonpost.com/news/to-y ... s-or-cures

[What does "warning" actually mean? I somehow doubt it will stop their internet marketing. - Mod.JW]


--
Ghana: Dominase, suspected EVD case proves negative
Click to view:
http://www.modernghana.com/news/571015/ ... ative.html


--
Guinea-Bissau: World Bank USD 750 000 loan for EVD preparedness
-----------------------------------------------------
25 Sep 2014: (World Bank)
Click to view:
http://www.worldbank.org/en/news/press- ... nea-bissau.


--
Liberia: call for convalescent blood donors
---------------------------------------
24 Sep 2014: (Reuters) The head of an EVD treatment center in Liberia, the country worst-hit by West Africa's deadly Ebola outbreak, has urged survivors of the disease to donate their blood for use in treating infected patients. "We need survivors to come and help us with blood donations," said Attai Omoruto, the Ugandan doctor in charge of the newly opened, 150-bed Island Clinic in Liberia's capital Monrovia.
http://www.reuters.com/article/2014/09/ ... healthNews


--
Netherlands: repatriated patients do not have EVD
-----------------------------------------------
24 Sep 2014: (Dutch News) A Dutch doctor and a man from Eindhoven [Netherlands] who have been under observation in hospitals in Leiden and Nijmegen do not have EVD, the public health institute RIVM said on Wednesday [24 Sep 2014]. Both had reported having a raised temperature and had been in countries where EVD is present. Tests have now shown they do not have the virus but do both have malaria, the RIVM said.
http://www..nl/news/archives/2014/09/dutch_patients_do_not_have_ebo.php

[I wonder whether malaria prophylaxis is not working in the EVD countries if there is multiple drug resistance. - Mod.JW]


--
Nigeria: schools reopen (laser thermometer misuse)
----------------------------------
24 Sep 2014: (Independent, Ireland) A school official takes a young pupil's temperature using an infrared digital laser thermometer in front of the premises as private schools resume services in Lagos, Nigeria yesterday [23 Sep 2014]. (Reuters)
http://www.independent.ie/irish-news/ir ... 11141.html

[The photo shows a dangerous misuse of a laser; it should be aimed at the side of the head, not where it could blind the eyes. - Mod.JW]


--
Russia: quarantines Africa students
---------------------------------------
24 Sep 2014: (Xinhua) Russian consumer safety watchdog Rospotrebnadzor places all newly arrived residents from the high-risk countries under a 3-week quarantine. Some 335 students from high-risk regions in Africa remain in quarantine in Russia for Ebola, a Russian health official said Wed [24 Sep 2014]. About 1000 residents from African countries were put in quarantine for the virus, and the majority have been cleared, the Interfax news agency quoted Chief Sanitary Inspector Anna Popova as saying. No case of EBV has been detected in Russia, she said, adding that, due to high migration flows, the country is not 100 percent guaranteed [safe] from the risk. Russian authorities are prepared not to let the virus spread into the country, with strict medical control imposed at the ports of entry, she said. At Moscow's airports, [arriving passengers] must walk through detectors that sound an alarm if the person's body temperature is above normal. Russian scientists have been working on a cure for EVD for over 10 years, Popova said. http://www.shanghaidaily.com/article/ar ... ?id=243062

[Re: "high migration flows," it did not say whether they are quarantining immigrants from certain African countries. - Mod.JW]


--
Zimbabwe: quarantines Nigerians, others
-----------------------------
25 Sep 2014: (News Day) At least 98 people have reportedly been placed under EVD quarantine in Harare, the capital city of Zimbabwe. The country has taken strict measures in monitoring visitors who wish to enter the country. This comes as fears continue to grow that the deadly ebolavirus might spread beyond West Africa where the epidemic has killed 2800 people. According to News Day, out of the 98 people who have been quarantined, 84 were coming from Nigeria.
http://malawi24.com/zimbabweans-under-ebola-quarantine

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

[A ProMED HealthMap is available at http://healthmap.org/ebola.]

[Birgitt]

EBOLA VIRUS DISEASE - WEST AFRICA (177): WHO, QUARANTINE, VACCINE, LIBERIA, SURVIVORS
*************************************************************************************
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 situation report
[2] Spain: repatriated missionary dies
[3] Quarantine
[4] Vaccine delivery dilemma
[5] China: mobile lab arrives in Sierra Leone
[6] Liberia: collateral deaths
[7] Survivors help out
[8] Mapping the EVD zone

******
[1] WHO Situation Report 24 Sep 2014
Date: Wed 24 Sep 2014
Source: WHO [edited]
http://apps.who.int/iris/bitstream/1066 ... 14_eng.pdf


WHO: Ebola Response Roadmap Situation Report 24 Sep 2014 [data as at the end of 21 Sep 2014]
--------------------------------------------------------------------------------
Overview
--------
The total number of probable, confirmed and suspected cases (see Annex 1) in the current outbreak of Ebola virus disease (EVD) in West Africa was 6263, with 2917 deaths, as at the end of 21 Sep 2014. Countries affected are Guinea, Liberia, Nigeria, Senegal and Sierra Leone.

Figure 1 shows the total number of confirmed and probable cases by country that have been reported in each epidemiological week between the start of 30 Dec 2013 (start of epidemiological week 1) and the end of 21 Sep 2014 (epidemiological week 38: 15-21 Sep 2014), and indicates a fall in the number of reported new cases compared with the previous 2 weeks. However, for reasons given below, this is unlikely to be an accurate reflection of the reality.

The epidemic of EVD in West Africa is still increasing.

Outline
-------
This is the 5th in a series of regular situation reports on the Ebola Response Roadmap. The report contains a review of the epidemiological situation based on official information reported by ministries of health, and an assessment of the response measured against the core Roadmap indicators where available.

The data contained in this report are based on the best information available. Substantial efforts are ongoing to improve the availability and accuracy of information about both the epidemiological situation and the implementation of the response.

Following the roadmap structure, country reports fall into 3 categories:

(1) those with widespread and intense transmission (Guinea, Liberia, and Sierra Leone);
(2) those with an initial case or cases, or with localized transmission (Nigeria, Senegal); and
(3), those countries that neighbour areas of active transmission (Benin, Burkina Faso, Cote d'Ivoire, Guinea-Bissau, Mali, Senegal).

An overview of the situation in the Democratic Republic of the Congo, where there is a separate, unrelated outbreak of EVD, is also provided (see Annex 2)... -- more

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

******
[2] Spain: repatriated missionary dies
Date: Thu 25 Sep 2014
Source: International Business Times [edited]
http://www.ibtimes.co.uk/ebola-outbreak ... id-1467233


Spanish Missionary Manuel Garcia Viejo Dies of Deadly Virus in Madrid
---------------------------------------------------------------------
The Spanish missionary who was flown home to Madrid from Sierra Leone after contracting the ebolavirus has died, according to hospital sources. According to the Spanish news agency Efe, Manuel Garcia Viejo died from the disease at the Carlos III hospital in Madrid. Viejo was a medical director of the Hospital Order of San Juan de Dios and was working in the western Sierra Leonean city of Lunsar when he caught the disease. He was flown to Madrid in an isolation chamber by military plane and received by doctors in fully protective biohazard suits. Viejo is the 2nd Spanish priest to die of the ebolavirus in the space of a month, after Miguel Pajares died after being flown back to Spain from Liberia.

[Byline: Jack Moore]

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

******
[3] Quarantine

Liberia: medical chief quarantined; aide dies
---------------------------------------------
26 Sep 2014: (Front Page Africa Online) Liberia's Ministry of Health and Social Welfare has recorded an EVD death with the Special Assistant to the Chief Medical Officer falling prey to the deadly virus. Rev. Napoleon Braithwaite, a Special Assistant to the Chief Medical Officer, Dr. Bernice Dahn, has become the latest to fall to the deadly ebolavirus. News of Rev. Braithwaite's demise broke on Thursday morning [25 Sep 2014] as the government of Liberia was preparing for a news conference at the Health Ministry to announce the outsourcing of Liberia's Ebola Fight to United Nations Agencies in Liberia. The venue was quickly changed and the entire Ministry ordered by Health Minister, Dr Walter Gwenigale to [be sprayed]. A Health Ministry spokesperson confirmed Thu [25 Sep 2014] that the deceased died from the deadly ebolavirus and family members who helped to put him in a car to take him to the hospital, said he had not been going to work for a week now. The relative said it was difficult not to hold and touch him because they had a special bond and they could not see him suffer and not help. According to one relative, they place themselves under quarantine for 21 days.
http://frontpageafricaonline.com/index. ... -aide-dies

--
Ebola epidemic: house-to-house search in Sierra Leone reveals 358 new cases
-------------------------------------------------------------------------
Teams of volunteers also find hundreds of unburied corpses.
[See link for further information.]
http://www.theguardian.com/world/2014/s ... one-curfew

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

******
[4] Vaccine delivery dilemma
Date: Wed 24 Sep 2014
Source: CBC (Canadian Broadcasting Corporation) News [edited]
http://www.cbc.ca/news/health/ebola-vac ... -1.2776627


WHO still figuring out where [and to whom] it will go and how it will get there
----------------------------------------------------------------------
The experimental EVD vaccine that Canada promised to ship to West Africa to help fight the epidemic 6 weeks ago has yet to be shipped to West Africa a, says Dr Gregory Taylor, the country's new chief public health officer. The 800-1000 doses of the vaccine, which was developed at the National Microbiology Laboratory in Winnipeg, are ready to be shipped at any time, Taylor said, but the WHO is still trying to figure out where exactly the vaccine should be shipped, how it will get there, including how to keep it refrigerated for the entire trip to West Africa, and who will be responsible for it when it arrives.

"We have such a small amount. Even with 1000 doses, the number of people with this disease is huge compared to that," Taylor said. "Where should you ship it? How should you ship it? It is a live, attenuated virus, so that means it has to be kept at a certain temperature throughout or it kills the virus and it's inactive. "You have to have a receiving facility that will receive the vaccine, and then you have to have confirmed consent [from the vaccinees] because this is experimental. So, all of those issues are challenging, and I think it does seem like a long time, I know that, but there's huge issues with this."

Vaccine must go to all health workers
-------------------------------------
Taylor said one of the conditions of Canada providing the vaccine is that it be made available to local as well as international health workers fighting the epidemic. [But see comment] "When we put this on the front lines, we're insisting that this be available to all health care workers," Taylor said. "There are other health care workers than just those flying in from developed countries, all the African countries have their own health care workers."

On Thursday [25 Sep 2014], Minister of International Development Christian Paradis announced that Canada would be providing CAD 30 million [USD 27 million] more to the global effort to fight EVD... -- more

[Byline: Kelly Crowe & AP]

[800 vials of the NewLink candidate vaccine are expected to yield at least 1500 doses, and the US-based firm is "working very hard to produce a few more thousand doses in the coming months," Dr Marie-Paule Kieny, WHO assistant director-general said (http://www.trust.org/item/2014092613351 ... OtherNews2).

MSF alone has 280 internationals on the ground in West Africa; adding to that all the other internationals would make over 1000, but even supposing half the vaccine can be used for them, how would they be selected among those? Those at highest risk -- determined how? Furthermore, the vaccine is a live one, and reversion and breakthroughs have been known to happen with other live vaccines. - Mod.JW]

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

******
[5] China: mobile lab arrives in Sierra Leone
Date: Fri 26 Sep 2014
Source: Sierra Express Media [edited]
http://www.sierraexpressmedia.com/?p=70661


China-aided Mobile Bio-Safety Level III laboratory arrived in Sierra Leone
---------------------------------------------------------------------
On 25 Sep 2014, a China-chartered airplane carrying a China-aided mobile bio-safety level III laboratory arrived at Lungi International Airport of Sierra Leone. Chinese Ambassador Zhao Yanbo, Acting Minister of Foreign Affairs and International Cooperation Dr Ebun Strasser-King, Deputy Minister of Health and Sanitation Mr Foday Sawi, Deputy Minister of Transport and Aviation Mr Ibrahim Mansaray and other senior Sierra Leonean officials attended the arrival ceremony held at the airport. Sierra Leone Broadcasting Corporation (SLBC), and other media organizations covered the event.

Ambassador Zhao stated that Chinese President Xi Jinping is very much concerned about the EVD situation and cares for the friends in EVD-stricken countries. President Xi announced on 18 Sep 2014 during his visit to India that China will provide a further 200 million Yuan (USD 32.54 million) package of cash, food, and material aid to Sierra Leone, Liberia, Guinea, and neighbouring countries to help contain EVFD. Ambassador Zhao indicated that taking into consideration the Ebola situation in Sierra Leone and in response to the urgent need for labs in the country, China decided to provide a mobile bio-safety level III laboratory to Sierra Leone. China's laboratory will scale up the testing of EVD cases and help Sierra Leone control EVD at an earlier date.

Acting Foreign Minister Strasser-King ... said that the 3-day national lockdown from 19-21 Sep 2014 resulted in a large number of survivors waiting to be tested, and indicated that China's mobile laboratory will speed up the detection process to help Sierra Leone cut off the transmission chain of EVD... -- more

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

******
[6] Liberia: collateral deaths
24 Sep 2014 (CNN) [This is the harrowing story of a woman with convulsions due to high blood pressure being turned away from the hospital where she used to be treated because it was closed for fear of EVD, then turned away from another because they are now taking only suspected EVD cases. At the 3rd she was bleeding, having bitten her tongue, and was turned away as a suspected EVD case. She had to be taken back home, untreated for her convulsions, to die. This is a very sad situation. Deaths in homes do not all get medically certified, but in any case, evidently not all deaths are due to EVD. - Mod.JW]
http://www.cnn.com/2014/09/23/health/eb ... uninfected

--
26 Sep 2014 (Reuters): Deaths from infectious diseases like malaria, diarrhea and pneumonia are likely to soar in West African countries where a vast outbreak of Ebola has crushed health systems and killed nurses and doctors.

Specialists on deadly diseases say deaths from malaria alone, which even before the EVD crisis killed around 100 000 a year in the West Africa region as a whole, could increase 4-fold in EVD-hit countries as people miss out on life-saving treatments. Even at this point, said Professor Chris Whitty of the London School of Hygiene and Tropical Medicine in London [UK], in countries facing the worst of the EVD outbreak, "many more people are dying of other things that are not EVD". As the epidemic continues, these so-called "collateral" deaths -- including from complications in childbirth and chronic conditions such as heart disease -- will rise as the clinics and health workers that would normally treat them are overwhelmed... -- more
http://www.interaksyon.com/article/9620 ... ola-crisis

[So probably many of the unconfirmed deaths attributed to EVD had other causes. - Mod.JW]

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

******
[7] Survivors help out
Date: Thu 25 Sep 2014
Source: KTEP (NPR) [edited]
http://ktep.org/post/grieving-grateful- ... -give-back


[A 21-year-old] EVD survivor is caring for an infant whose mother died of the disease. [A] 39-year-old former teacher can't stop smiling. "I have to smile," he says. "I'm the 1st survivor from Ebola for the case management center here." Former patients like him, who've recovered from the virus, lift the collective spirit at the Doctors Without Borders [MSF] EVD center in Liberia's northern town of Foya. He was admitted to the high-risk isolation unit, which is part of a cluster of large tents that make up the bulk of the center.

While health workers busy themselves caring for patients on one side -- with all the stress, hard work, death and sorrow that entails -- there's an oasis of joy and relief on the other side, where a few brick buildings stand to the right. That's where EVD survivors congregate. But their smiles may mask deep sorrow. "I'm very fine, even though I've lost 7 [family members]," says [the 39-year-old man]. He and other survivors gather together in their own little center, beyond the pop-up tents. Several are helping Doctors Without Borders [MSF], looking after orphaned children and performing other tasks.

That's the case of the 21-year-old woman. With a sleeping infant tied to her back, she tells NPR that the person she loved most -- her big sister who raised her as a child after their mother died -- has died of EVD.... Now she doesn't have anybody else to look up to as a mother. But she's finding a way to give back for her own survival, watching over the 15-month-old baby girl strapped to her back. She never met the infant's mother, who died of the virus. The baby's grandmother, she adds, was being cared for in the isolation unit. "That's the reason I'm still at the EVD treatment center, volunteering to take care of this baby," she tells NPR. "The grandmother tested positive, but the baby tested negative, so Doctors Without Borders was looking for somebody to volunteer to take care of the baby." ... -- more

[Byline: Ofeibea Quist-Arcton]

[A heart-warming story amidst the doom and gloom reports, and an effective response to calls for survivors of EVD to help out, as in ProMED Ebola virus disease - West Africa (175): CDC, Sierra Leone, drugs, survivors RFI 20140924.2802601. - Mod.JW]

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

******
[8] Mapping the EVD zone
Date: Thu 18 Sep 2014
Source: Thomson Reuters Foundation [edited]
http://www.trust.org/item/2014091805091 ... =spotlight


Online volunteers map uncharted EVD zones to help save lives
------------------------------------------------------------
Citizens from all over the world are donating their time by going online to build maps for relief workers. Call it crowd-sourced cartography that can save lives. Roads or paths to remote villages through deep forest in West Africa, bridges, and river crossings, school buildings that can be used as temporary clinics, an open field for a helicopter landing -- all these are visible from satellite imagery and provide critical information for delivering aid. However, these details never made it onto official maps in Liberia, Guinea, and Sierra Leone -- countries too poor to worry about whether there are accurate Google Maps loaded onto smartphones.

So when the EVD epidemic erupted earlier this year [2014], Doctors Without Borders [MSF], the American Red Cross, and other groups on the ground found that unreliable maps made fighting the spread of the deadly virus much more difficult. They could not trace the likely vectors of transmission because they did not know the patterns of peoples' daily lives, and they could not plan effective aid delivery.

Enter the collaborative Ebola project by the Humanitarian OpenStreetMap Team (HOT). OpenStreetMap is a project to create a free, open map of the world, built by volunteers through GPS surveying, aerial imagery, and public sources of geographic data. Taking that concept a step further, HOT connects the OpenStreetMap community with humanitarian players on the ground to fill in the gaps on maps for disaster and crisis zones. Around 1200 volunteers so far have logged onto HOT's website, clicked on a map quadrant and traced in the rich geographic details visible from satellites. A quick tutorial guides volunteers through the work, which is similar to using a software programme like Adobe Photoshop.

[Byline: Stella Dawson]

--
Communicated by:
ProMED-mail Rapporteur Mary Marshall

[A HealthMap interactive map for the whole EVD-affected region plus current statistics is available at http://healthmap.org/ebola. - Mod.JW

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

[Birgitt]

EBOLA VIRUS DISEASE - WEST AFRICA (178): WHO ROADMAP UPDATE 26 SEP 2014
***********************************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

Date: 26 Sep 2014
Source: WHO Roadmap Update 26 Sep 2014 [edited]
http://apps.who.int/iris/bitstream/1066 ... g.pdf?ua=1

WHO: Ebola Response Roadmap Update 26 Sep 2014 [data as of 23 Sep 2014]
---------------------------------------------------
Following the roadmap structure, country reports fall into 2 categories: those with widespread and intense transmission (Guinea, Liberia, and Sierra Leone); and those with an initial case or cases, or with localized transmission (Nigeria, Senegal).

An overview of the situation in the Democratic Republic of the Congo, where a separate, unrelated outbreak of Ebola virus disease (EVD) is occurring, is also provided (see Annex 1).

In addition to the midweek Ebola Response Roadmap situation report, Ebola Response Roadmap updates will now be issued on Friday evening, and will replace the updates usually issued on Monday evening until further notice.

1. Countries with widespread and intense transmission
6553 (probable, confirmed and suspected; see Annex 2) cases and 3083 deaths have been reported in the current outbreak of EVD as at 23 September 2014 by the Ministries of Health of Guinea, Liberia, and Sierra Leone (table 1)
... more
--
Communicated by
Ryan McGinnis http://bigstormpicture.com

*******

[This is 290 new cases and 166 deaths in 2 days since the previous update - see ProMED Ebola virus disease - West Africa (177): WHO, quarantine, vaccine, Liberia, surv. Archive No. 20140926.2808526.

A HealthMap interactive map of all current EVD outbreaks plus current statistics is available at http://healthmap.org/ebola. - Mod.JW]