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PostPosted: Wed Aug 13, 2014 7:32 am 
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The recent WHO assessment if Ebola in western Africa and the declaration of a PHEIC (Public Health Emergency of International Concern) has increased surveillance throughout Africa,

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PostPosted: Wed Aug 13, 2014 7:36 am 
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Barriers to rapid containment of the Ebola outbreak

Overview - 11 August 2014

The outbreak of Ebola virus disease in west Africa continues to evolve in alarming ways, with no immediate end in sight. Many barriers stand in the way of rapid containment.

The most severely affected countries, Guinea, Liberia, and Sierra Leone, have only recently returned to political stability following years of civil war and conflict, which left health systems largely destroyed or severely disabled.

Lack of capacity makes infection control difficult

This lack of capacity makes standard containment measures, such as early detection and isolation of cases, contact tracing and monitoring, and rigorous procedures for infection control, difficult to implement. Though no vaccine and no proven curative treatment exist, implementation of these measures has successfully brought previous Ebola outbreaks under control.

The recent surge in the number of cases has stretched all capacities to the breaking point. Supplies of personal protective equipment and disinfectants are inadequate. The outbreak continues to outstrip diagnostic capacity, delaying the confirmation or exclusion of cases and impeding contact tracing.

Diagnostic capacity is especially important as the early symptoms of Ebola virus disease mimic those of many other diseases commonly seen in this region, including malaria, typhoid fever, and Lassa fever.

Some treatment facilities are overflowing; all beds are occupied and patients are being turned away. Many facilities lack reliable supplies of electricity and running water. Aid organizations, including Médecins Sans Frontières (Doctors without Borders), which has provided the mainstay of clinical care, are exhausted.

Managerial framework for Ebola

Last week, the WHO Director-General, Dr Margaret Chan, announced a new managerial framework designed to ensure that WHO’s emergency response is fully staffed, drawing on personnel in all WHO regional and country offices, for an around-the-clock response.

The Ebola virus is one of the world’s most virulent pathogens. Personal protective equipment is essential, but in short supply. It is also hot and cumbersome, severely limiting the number of hours that medical and nursing staff can work on an isolation ward. On present estimates, a facility treating 70 patients needs a minimum of 250 health-care staff.

Fear is hard to overcome

Six months into the outbreak, fear is proving to be the most difficult barrier to overcome. Fear causes contacts of cases to escape from the surveillance system, families to hide symptomatic loved ones or take them to traditional healers, and patients to flee treatment centres. Fear, and the hostility it can feed, have threatened the security of national and international response teams.

Health-care staff fear for their lives. To date, more than 170 health-care workers have been infected and at least 81 have died.

Outbreak control is further compromised when fear causes airlines to refuse to transport personal protective equipment and courier services to refuse to transport properly and securely packaged patient samples to a WHO-approved laboratory.

Fear has spread well beyond west Africa, leading some to suggest that imported cases, also in wealthy countries, could ignite widespread infections in the general population. In countries with well-developed health systems, such a scenario is highly unlikely, given the epidemiology of the Ebola virus and experiences in past outbreaks.

Transmission

The Ebola virus is highly contagious, but is not airborne. Transmission requires close contact with the bodily fluids of an infected person, as can occur during health-care procedures, home care, or traditional burial practices, which involve the close contact of family members and friends with bodies. In Guinea, around 60% of cases have been linked to these burial practices, with women, who are the principal care-givers, disproportionately affected.

The incubation period ranges from 2 to 21 days, but patients become contagious only after the onset of symptoms. As symptoms worsen, the ability to transmit the virus increases. As a result, patients are usually most likely to infect others at a severe stage of the disease, when they are visibly, and physically, too ill to travel.

Vigilance means better detection

On the positive side, fear has led to a very high level of vigilance and clinical suspicion worldwide, as seen in the number of false alarms at airports and in emergency rooms. Such a high level of alert further increases the likelihood that any imported case will be quickly detected and properly managed, limiting onward transmission.

This pattern was clearly seen during the 2003 SARS outbreak. Of the total number of cases during that outbreak, 98% occurred in the four countries affected prior to the WHO global alert issued on 15 March. The high level of vigilance and preparedness that followed that alert helped the additional 26 outbreak sites with imported cases to prevent onward transmission or hold it to just a handful of cases.

Also on the positive side, the presidents of the hardest-hit countries have made outbreak containment a top national priority. Several extraordinary measures have been introduced over just the past few days, though it is too early to assess their impact.

In some areas, the inclusion of social anthropologists on outbreak teams is helping to reduce fear and change behaviours. The fact that no effective medical treatment exists has enforced the desire of families to care for patients in their homes or turn to traditional healers. Many communities now understand the importance of managing symptoms through supportive care. Evidence that early detection and supportive care greatly improve prospects for survival is a powerful incentive to seek medical care.

Last week, an Emergency Committee, convened under the provisions of the International Health Regulations, met to consider all the evidence and unanimously agreed that this outbreak meets the criteria for declaring it a public health emergency of international concern (PHEIC). On Friday, 8 August 2014, Dr Margaret Chan accepted that advice and declared the outbreak a PHEIC. The committee also advised Dr Chan that:

the Ebola outbreak in west Africa constitutes an ‘extraordinary event’ and a public health risk to other States;
the possible consequences of further international spread are particularly serious in view of the virulence of the virus, the intensive community and health facility transmission patterns, and the weak health systems in the currently affected and most at-risk countries;
a coordinated international response is deemed essential to stop and reverse the international spread of Ebola.
Emergency meeting on the role of experimental therapies in outbreak response

On Monday 11 August, WHO is holding an emergency meeting with ethicists, scientific experts and lay people from affected countries to assess the role of experimental therapies in the Ebola outbreak response. Issues to be considered include the ethics surrounding use of therapies when safety is unproven, ethics governing priority setting for access to these therapies and principles for fair distribution.

http://who.int/csr/disease/ebola/overvi ... t-2014/en/

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PostPosted: Wed Aug 13, 2014 7:37 am 
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WHO Statement on the Meeting of the International Health Regulations Emergency Committee Regarding the 2014 Ebola Outbreak in West Africa

WHO statement
8 August 2014

The first meeting of the Emergency Committee convened by the Director-General under the International Health Regulations (2005) [IHR (2005)] regarding the 2014 Ebola Virus Disease (EVD, or “Ebola”) outbreak in West Africa was held by teleconference on Wednesday, 6 August 2014 from 13:00 to 17:30 and on Thursday, 7 August 2014 from 13:00 to 18:30 Geneva time (CET).

Members and advisors of the Emergency Committee met by teleconference on both days of the meeting1. The following IHR (2005) States Parties participated in the informational session of the meeting on Wednesday, 6 August 2014: Guinea, Liberia, Sierra Leone, and Nigeria.

During the informational session, the WHO Secretariat provided an update on and assessment of the Ebola outbreak in West Africa. The above-referenced States Parties presented on recent developments in their countries, including measures taken to implement rapid control strategies, and existing gaps and challenges in the outbreak response.

After discussion and deliberation on the information provided, the Committee advised that:

the Ebola outbreak in West Africa constitutes an ‘extraordinary event’ and a public health risk to other States;
the possible consequences of further international spread are particularly serious in view of the virulence of the virus, the intensive community and health facility transmission patterns, and the weak health systems in the currently affected and most at-risk countries.
a coordinated international response is deemed essential to stop and reverse the international spread of Ebola.
It was the unanimous view of the Committee that the conditions for a Public Health Emergency of International Concern (PHEIC) have been met.

The current EVD outbreak began in Guinea in December 2013. This outbreak now involves transmission in Guinea, Liberia, Nigeria, and Sierra Leone. As of 4 August 2014, countries have reported 1 711 cases (1 070 confirmed, 436 probable, 205 suspect), including 932 deaths. This is currently the largest EVD outbreak ever recorded. In response to the outbreak, a number of unaffected countries have made a range of travel related advice or recommendations.

In light of States Parties’ presentations and subsequent Committee discussions, several challenges were noted for the affected countries:

their health systems are fragile with significant deficits in human, financial and material resources, resulting in compromised ability to mount an adequate Ebola outbreak control response;
inexperience in dealing with Ebola outbreaks; misperceptions of the disease, including how the disease is transmitted, are common and continue to be a major challenge in some communities;
high mobility of populations and several instances of cross-border movement of travellers with infection;
several generations of transmission have occurred in the three capital cities of Conakry (Guinea); Monrovia (Liberia); and Freetown (Sierra Leone); and
a high number of infections have been identified among health-care workers, highlighting inadequate infection control practices in many facilities.
The Committee provided the following advice to the Director-General for her consideration to address the Ebola outbreak in accordance with IHR (2005).

States with Ebola transmission

The Head of State should declare a national emergency; personally address the nation to provide information on the situation, the steps being taken to address the outbreak and the critical role of the community in ensuring its rapid control; provide immediate access to emergency financing to initiate and sustain response operations; and ensure all necessary measures are taken to mobilize and remunerate the necessary health care workforce.
Health Ministers and other health leaders should assume a prominent leadership role in coordinating and implementing emergency Ebola response measures, a fundamental aspect of which should be to meet regularly with affected communities and to make site visits to treatment centres.
States should activate their national disaster/emergency management mechanisms and establish an emergency operation centre, under the authority of the Head of State, to coordinate support across all partners, and across the information, security, finance and other relevant sectors, to ensure efficient and effective implementation and monitoring of comprehensive Ebola control measures. These measures must include infection prevention and control (IPC), community awareness, surveillance, accurate laboratory diagnostic testing, contact tracing and monitoring, case management, and communication of timely and accurate information among countries. For all infected and high risks areas, similar mechanisms should be established at the state/province and local levels to ensure close coordination across all levels.
States should ensure that there is a large-scale and sustained effort to fully engage the community – through local, religious and traditional leaders and healers – so communities play a central role in case identification, contact tracing and risk education; the population should be made fully aware of the benefits of early treatment.
It is essential that a strong supply pipeline be established to ensure that sufficient medical commodities, especially personal protective equipment (PPE), are available to those who appropriately need them, including health care workers, laboratory technicians, cleaning staff, burial personnel and others that may come in contact with infected persons or contaminated materials.
In areas of intense transmission (e.g. the cross border area of Sierra Leone, Guinea, Liberia), the provision of quality clinical care, and material and psychosocial support for the affected populations should be used as the primary basis for reducing the movement of people, but extraordinary supplemental measures such as quarantine should be used as considered necessary.
States should ensure health care workers receive: adequate security measures for their safety and protection; timely payment of salaries and, as appropriate, hazard pay; and appropriate education and training on IPC, including the proper use of PPEs.
States should ensure that: treatment centres and reliable diagnostic laboratories are situated as closely as possible to areas of transmission; that these facilities have adequate numbers of trained staff, and sufficient equipment and supplies relative to the caseload; that sufficient security is provided to ensure both the safety of staff and to minimize the risk of premature removal of patients from treatment centres; and that staff are regularly reminded and monitored to ensure compliance with IPC.
States should conduct exit screening of all persons at international airports, seaports and major land crossings, for unexplained febrile illness consistent with potential Ebola infection. The exit screening should consist of, at a minimum, a questionnaire, a temperature measurement and, if there is a fever, an assessment of the risk that the fever is caused by EVD. Any person with an illness consistent with EVD should not be allowed to travel unless the travel is part of an appropriate medical evacuation.
There should be no international travel of Ebola contacts or cases, unless the travel is part of an appropriate medical evacuation. To minimize the risk of international spread of EVD:
Confirmed cases should immediately be isolated and treated in an Ebola Treatment Centre with no national or international travel until 2 Ebola-specific diagnostic tests conducted at least 48 hours apart are negative;
Contacts (which do not include properly protected health workers and laboratory staff who have had no unprotected exposure) should be monitored daily, with restricted national travel and no international travel until 21 days after exposure;
Probable and suspect cases should immediately be isolated and their travel should be restricted in accordance with their classification as either a confirmed case or contact.
States should ensure funerals and burials are conducted by well-trained personnel, with provision made for the presence of the family and cultural practices, and in accordance with national health regulations, to reduce the risk of Ebola infection. The cross-border movement of the human remains of deceased suspect, probable or confirmed EVD cases should be prohibited unless authorized in accordance with recognized international biosafety provisions.
States should ensure that appropriate medical care is available for the crews and staff of airlines operating in the country, and work with the airlines to facilitate and harmonize communications and management regarding symptomatic passengers under the IHR (2005), mechanisms for contact tracing if required and the use of passenger locator records where appropriate.
States with EVD transmission should consider postponing mass gatherings until EVD transmission is interrupted.
States with a potential or confirmed Ebola Case, and unaffected States with land borders with affected States

Unaffected States with land borders adjoining States with Ebola transmission should urgently establish surveillance for clusters of unexplained fever or deaths due to febrile illness; establish access to a qualified diagnostic laboratory for EVD; ensure that health workers are aware of and trained in appropriate IPC procedures; and establish rapid response teams with the capacity to investigate and manage EVD cases and their contacts.
Any State newly detecting a suspect or confirmed Ebola case or contact, or clusters of unexplained deaths due to febrile illness, should treat this as a health emergency, take immediate steps in the first 24 hours to investigate and stop a potential Ebola outbreak by instituting case management, establishing a definitive diagnosis, and undertaking contact tracing and monitoring.
If Ebola transmission is confirmed to be occurring in the State, the full recommendations for States with Ebola Transmission should be implemented, on either a national or subnational level, depending on the epidemiologic and risk context.
All States

There should be no general ban on international travel or trade; restrictions outlined in these recommendations regarding the travel of EVD cases and contacts should be implemented.
States should provide travelers to Ebola affected and at-risk areas with relevant information on risks, measures to minimize those risks, and advice for managing a potential exposure.
States should be prepared to detect, investigate, and manage Ebola cases; this should include assured access to a qualified diagnostic laboratory for EVD and, where appropriate, the capacity to manage travelers originating from known Ebola-infected areas who arrive at international airports or major land crossing points with unexplained febrile illness.
The general public should be provided with accurate and relevant information on the Ebola outbreak and measures to reduce the risk of exposure.
States should be prepared to facilitate the evacuation and repatriation of nationals (e.g. health workers) who have been exposed to Ebola.
The Committee emphasized the importance of continued support by WHO and other national and international partners towards the effective implementation and monitoring of these recommendations.

Based on this advice, the reports made by affected States Parties and the currently available information, the Director-General accepted the Committee’s assessment and on 8 August 2014 declared the Ebola outbreak in West Africa a Public Health Emergency of International Concern (PHEIC). The Director-General endorsed the Committee’s advice and issued them as Temporary Recommendations under IHR (2005) to reduce the international spread of Ebola, effective 8 August 2014. The Director-General thanked the Committee Members and Advisors for their advice and requested their reassessment of this situation within 3 months.

1 IHR Emergency Committee Members and Advisers

http://who.int/mediacentre/news/stateme ... 140808/en/

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PostPosted: Wed Aug 13, 2014 7:40 am 
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13 August 2014 Last updated at 06:40 ET Share this pagePrint

Ebola outbreak: Kenya at high risk, warns WHO

The World Health Organization (WHO) has classified Kenya as a "high-risk" country for the spread of the deadly Ebola virus.

Kenya was vulnerable because it was a major transport hub, with many flights from West Africa, a WHO official said.

This is the most serious warning to date by the WHO that Ebola could spread to East Africa.

Health experts are battling to contain the outbreak in West Africa, where it has killed more than 1,000 people.

Canada said it would donate up to 1,000 doses of an experimental Ebola vaccine to help fight the outbreak.

Airport health checks
Ebola was first reported in Guinea in February, before spreading to Sierra Leone and Liberia.

Nigeria, Africa's most populous state, is the latest to be affected, reporting a third Ebola-related death on Tuesday.

The WHO's country director for Kenya, Custodia Mandlhate, said the East African state was "classified in group two; at high risk of transmission".

Health checks at the main airport in the capital, Nairobi, have been stepped up in recent weeks.

The government said it would not ban flights from the four countries hit by Ebola.

"We do not recommend ban of flights because of porous borders," health cabinet secretary James Macharia said.

Kenya receives more than 70 flights a week from West Africa.

The West African regional body, Ecowas, said one of its officials, Jatto Asihu Abdulqudir, 36, had died of Ebola in Nigeria.

He had been in contact with Patrick Sawyer, the Liberian government employee who was the first to be killed by the virus in Nigeria on 25 July, Ecowas said in a statement.
Image
Graphic: Cumulative death toll for the 2014 outbreak
Mr Sawyer had flown in from Liberia, when he was diagnosed with Ebola after collapsing at the airport in Lagos, the biggest city in sub-Saharan Africa.

There is no cure for Ebola and the outbreak has been declared a global health emergency by the WHO.

On Tuesday, it approved the use of untested drugs on Ebola patients.

However, experts say supplies of both the vaccine and the experimental drug Zmapp are limited and it could take months to develop more supplies.

Dr Gregory Taylor, deputy head of Canada's Public Health Agency, said he saw the vaccines as a "global resource".

He said he had been advised that it would make sense for healthcare workers to be given the vaccine, given their increased risk of contracting the disease.

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What drugs exist currently ?

There are a handful of drugs that have been shown to work well in animals.

One is Zmapp - the drug requested by the Liberian government. This contains a cocktail of antibodies that attack proteins on the surface of the virus.

Only one drug has moved on to early safety testing in humans. Known as TKM-Ebola, this interrupts the genetic code of the virus and prevents it from making disease-causing proteins.

The drug was trialled in healthy volunteers at the beginning of 2014 but the American medicines regulator asked for further safety information. The manufacturer says human studies may soon resume.

Another option would be to use serum from individuals who have survived the virus - this is a part of the blood that may contain particles able to neutralise the virus.

Vaccines to protect against acquiring the disease have also been shown to work in primates. American authorities are considering fast-tracking their development and say they could be in use in 2016. Trials are likely to start soon, according to the WHO.

But experts warn that ultimately the only way to be sure a drug or vaccine is effective is to see if it works in countries affected by Ebola.

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Zmapp has been used on two US aid workers who have shown signs of improvement, although it is not certain what role the medication played in this.

A Roman Catholic priest, infected with Ebola in Liberia, who died after returning home to Spain is also thought to have been given the drug.

Ebola's initial flu-like symptoms can lead to external haemorrhaging from areas such as eyes and gums, and internal bleeding which can lead to organ failure. Patients have a better chance of survival if they receive early treatment.

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PostPosted: Wed Aug 13, 2014 7:47 am 
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Kissing the Corpses in Ebola Country
Image
Ebola victims are most infectious right after death—which means that West African burial practices, where families touch the bodies, are spreading the disease like wildfire.
From 8 a.m. to midnight, wearing three pairs of gloves, the young men of Sierra Leone bury their dead. An activity that’s earned the Red Cross recruits an unwelcome designation: The Dead Body Management Team.

Some days, just one call to collect a newly deceased Ebola victim comes in from the Kailahun district. Some days, the team receives nine. The calls from medical professionals at isolation centers are met with relief. These bodies have been quarantined. The infection can—with copious amounts of disinfectant and meticulous attention to detail—end there. Once cleaned and sealed in two body bags, the corpse will be driven to a fresh row of graves. In gowns, boots, goggles, and masks, the men will lower the body into a 6-foot grave below. These burials aren’t just compassionate—they’re safe.

The harder phone calls that the Dead Body Management Team receives, and the more dangerous burials they perform, take place in the communities themselves. Here, they must walk a delicate line between allowing the family to perform goodbye rituals and safeguarding the living from infecting themselves. The washing, touching, and kissing of these bodies—typical in many West African burials—can be deadly. But prohibiting communities from properly honoring their dead ones—and thereby worsening their distrust in medical professionals—can be deadly, too.

Insufficient medical care, shortage of supplies, and lack of money are undoubtedly contributing to an epidemic the World Health Organization has a deemed a “national disaster.” But with a death toll now topping 1,000 in four countries, it’s the battle over dead bodies that is fueling it.

***

In the remains of a deceased victim, Ebola lives on. Tears, saliva, urine, blood—all are inundated with a lethal viral load that threatens to steal any life it touches. Fluids outside the body (and in death, there are many) are highly contagious. According to the World Health Organization, they remain so for at least three days.

Dr. Terry O’Sullivan, director of the Center for Emergency Management and Homeland Security Policy Research, spent three years volunteering in Sierra Leone. He remembers vividly the sight of a hemorrhagic fever overtaking the body. “Those that have just died are teeming with virus, in all their fluids,” says O’Sullivan. “That is in fact the worst point because their immune systems are failed...they are leaking out of every orifice. They are extremely dangerous.” A passage in the 2004 paper Containing a Haemorrhagic Fever Epidemic published in the International Journal of Infectious Diseases paints an even bleaker picture. Citing two specific studies, the authors suggest that a “high concentration of the virus is secreted on the skin of the dead.”

With fluids seeping out of every body opening, and potentially every pore, it’s no mystery why the burial rituals of West Africa pose such a danger. In a pamphlet on safety methods for treating victims of Ebola, The World Health Organization outlines proper procedures to prevent infection from spreading outward from a deceased Ebola victim. “Be aware of the family’s cultural practices and religious beliefs,” the WHO document reads. “Help the family understand why some practices cannot be done because they place the family or others at risk for exposure...explain to the family that viewing the body is not possible.”

Villagers began running from the ambulances, trying to burn down hospitals, and attacking humanitarian workers.
Telling this to the families of deceased is one thing—making sure they understand is entirely another. In Sierra Leone, a country where the literacy rate is among the lowest in the world, it’s particularly challenging. In neighboring Guinea and Liberia, two places with similar levels of poverty and illiteracy, education alone isn’t a viable solution either.

It’s a phenomenon O’Sullivan witnessed firsthand in Sierra Leone. “People have no idea how infectious diseases work. They see people go into the hospital sick and come out dead—or never come out at all,” he says. “They think if they can avoid the hospital they can survive.” This mistrust of the medical world seems to be validated when a family is prohibited from honoring the dead, participating in the funeral, or even seeing the body.

Prior Ebola outbreaks in Africa, specifically in Uganda in 2000, have yielded similar reactions among afflicted communities. Dr. Barry Hewlett and Dr. Bonnie Hewlett, the first anthropologist to be invited by WHO to join a medical intervention team, studied the Ugandan Ebola outbreak. In a book cataloging their experience—Ebola, Culture, and Politics: The Anthropology of an Emerging Disease— they explore the dangers of African burial rituals, as well as the dangers of prohibiting them.

In the Ugandan ceremonies the Hewletts witnessed, the sister of the deceased’s father is responsible for bathing, cleaning, and dressing the body in a “favorite outfit.” This task, they write, is “too emotionally painful” for the immediate family. In the event that no aunt exists, a female elder in the community takes this role on. The next step, the mourning, is where the real ceremony takes place. “Funerals are major cultural events that can last for days, depending on the status of the deceased person,” they write. As the women “wail” and the men “dance,” the community takes time to “demonstrate care and respect for the dead.” The more important the person, the longer the mourning. When the ceremony is coming to a close, a common bowl is used for ritual hand-washing, and a final touch or kiss on the face of the corpse (which is known as a “a love touch”) is bestowed on the dead. When the ceremony has concluded, the body is buried on land that directly adjoins the deceased’s house because “the family wants the spirit to be happy and not feel forgotten.”


According to the Hewletts’ analysis, these burial rituals and funerals are a critical way for the community to safely transfer the deceased into the afterlife. Prohibiting families from performing such rites is not only viewed as an affront to the deceased, but as actually putting the family in danger. “In the event of an improper burial, the deceased person’s spirit (tibo) will cause harm and illness to the family,” the Hewletts write. In Sierra Leone, O’Sullivan experienced similar sentiments when proper burials were not performed. “It is tragic. In those countries they feel very strongly about being able to say goodbye to their ancestors. To not be able to have that ritual, or treat them with the respect they traditionally give for those who passed away is very difficult,” says O’Sullivan. “Especially in concert with the fear of the disease in general.”

Worse than stopping burial rites, found the Hewletts, is keeping the body (and the burial) hidden. Barring relatives from seeing the dead in Uganda fueled hostility and fear—leading some communities to believe that medical professionals were keeping the corpses for nefarious purposes. A mass graveyard near an airfield—an attempt to remedy the problem by allowing families to see, but not touch, the graves—didn’t help. Villagers began running from the ambulances, trying to burn down hospitals, and attacking humanitarian workers. They feared the disease—but they feared the medicine even more, as well as the people delivering it.

***

In a July 28 interview with ABC News, Dr. Hilde de Clerck of Doctors Without Borders described resistance from residents in Sierra Leone, who, he says, accused him and his colleagues of bringing the disease to the country. “To control the chain of disease transmission it seems we have to earn the trust of nearly every individual in an affected family,” de Clerck said. It is, in this case, a seemingly impossible feat.

There aren’t enough health-care workers in all of West Africa to ensure that community burials are performed safely. There aren’t enough in the world to convince every family that banning such a burial isn’t the work of the devil. “It’s gotten out of control,” says O’Sullivan of this new outbreak. “So many people involved who have responded to this in the past are completely overwhelmed. They can’t get the messages out.”

Until the medical community can win the trust of West Africans, the infected will miss their chance at potentially life-saving medicine. Until the dangers of the burial ceremonies are fully realized, their family members will likely face the same fate.

http://www.thedailybeast.com/articles/2 ... untry.html

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PostPosted: Wed Aug 13, 2014 8:05 am 
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WHO Director-General briefs Geneva UN missions on the Ebola outbreak

Dr Margaret Chan
Director-General of the World Health Organization

Briefing to United Nations Member States on the Ebola outbreak and response in Guinea, Liberia, Nigeria and Sierra Leone
Geneva, Switzerland
12 August 2014

Distinguished Member States of the United Nations, ambassadors, diplomats, ladies and gentlemen,

Thank you. I want to share WHO’s assessment of the Ebola outbreak and brief you on the response.

We are facing a public health emergency of international concern.

The outbreak of Ebola virus disease in west Africa is a crisis. It is a crisis for the affected countries and their neighbours, for the African continent, and for the international community.

The outbreak is unprecedented in its size, severity, and complexity. Cases are occurring in remote rural areas that are difficult to access, but also in capital cities.

Confirmation of the first case in Lagos, Nigeria, was a wake-up call. Ebola virus disease can be spread by international travel, placing every city with an international airport at risk of an imported case.

To date, nearly 2000 people have been infected and more than 1000 have died. No one is talking about an early end to the outbreak.

This is a severe health crisis, and it can rapidly become a humanitarian crisis if we do not do more to stop transmission.

Decisions to seal off the hot zone of disease transmission, that is, the area where the borders of Guinea, Liberia, and Sierra Leone intersect, are critical for stopping the reinfection of areas via the cross-border movement of people.

More than one million people are affected, and these people need daily material support, including food. The isolation of this zone has made it even more difficult for agencies, like MSF, to bring in staff and supplies.

I have discussed this situation with the presidents of the three countries. The international community must come together to give them the resources they need.

The number of health-care workers who have been infected is unprecedented. In past outbreaks, transmission of the virus in health-care settings ended after the Ebola virus was identified and measures for infection control were put in place.

Not in the current outbreak. To date, nearly 170 health-care workers have been infected, and more than 80 have died.

The infections and deaths of health-care workers have three major consequences. First, they diminish one of the most important assets for the response to any outbreak.

Second, they can lead to the closure of hospitals and isolation wards, especially when staff refuse to come to work. Third, they drive fear, already very high, to new extremes. The general public is asking this question: if well-trained and equipped doctors and nurses are getting infected, what hope is there for us?

This is what I heard yesterday, in a meeting with ambassadors from a core group of African countries. Many feel helpless and hopeless given the demands of this outbreak, which far outstrip their capacity to respond. Others on the panel will be sharing their assessments.

As just one example, a facility treating 70 Ebola patients needs at least 250 health-care workers. In this region, staff are scarce and hospitals with isolation facilities are virtually non-existent.

Many facilities lack reliable supplies of electricity and running water. Other severe infectious diseases, like malaria, typhoid fever, and Lassa fever, and many chronic diseases are being neglected, as people are too frightened to seek hospital care.

Guinea, Liberia, and Sierra Leone have only recently returned to political stability following years of civil war and conflict, which left health systems largely destroyed or severely disabled.

The outbreak, which is already having serious economic consequences, threatens to push these countries backwards. Airlines are cancelling flights. Companies are moving their staff out.

Let me be clear. Travel bans will not stop this outbreak. But preventive efforts will.

Standard measures, like early detection and isolation of cases, contact tracing and monitoring, and rigorous procedures for infection control, have stopped previous Ebola outbreaks and can do so again. We have learned much during past outbreaks, including in Uganda, Democratic Republic of the Congo, and Gabon.

But like the outbreak, the challenges to containment are unprecedented. The recent surge in the number of cases has stretched all capacities to the breaking point.

Supplies of personal protective equipment and disinfectants are inadequate. Rumours and myths abound. The outbreak continues to outstrip diagnostic capacity, delaying the confirmation or exclusion of cases and impeding contact tracing.

Some treatment facilities are overflowing. All beds are occupied and patients are being turned away.

Other facilities are empty. The fact that Ebola has no cure reinforces the desire of families to care for loved ones in their homes or seek help from traditional healers. Both practices fuel further transmission.

Deep-seated traditional burial practices, which involve close contact with highly infectious corpses, are another major impediment to control. In Guinea, for example, around 60% of cases have been associated with burial practices.

Data from the field show that risks of transmission are greatly diminished when burials are performed, with dignity, by properly trained teams with pay, mobile phones, and designated vehicles.

Six months into the outbreak, fear is proving to be the most difficult barrier to overcome. Fear causes contacts of cases to escape from the surveillance system, families to hide symptomatic loved ones, and patients to flee treatment centres. Fear, and the hostility it can provoke, have threatened the security of national and international response teams.

Ladies and gentlemen,

This is a fast-moving outbreak. It has come in three waves, with the current wave by far the most severe. WHO and its partners are rapidly catching up.

I have personally made myself responsible for coordinating the response under WHO leadership, and for mobilizing support from the international community.

Affected countries are being equipped with IT systems and programmes that allow real-time reporting of cases. The outbreak is being mapped so that all transmission zones are identified and priorities can be assigned.

More international aid is flowing in. WHO logisticians are coordinating this aid to ensure that it goes where most needed and assists countries instead of overburdening them.

The UN Secretary-General has asked Dr David Nabarro to coordinate the response throughout the UN system. He has agreed to do so and has been with us here in Geneva since the start of the week.

I speak frequently with Jim Kim, the President of the World Bank Group. We both want to ensure that financial support goes some way towards strengthening health systems. But the most important immediate priority is to stop the virus from spreading, both within affected countries and to others. This is critical to the outbreak response.

The level of vigilance and alert is high worldwide, as seen by the number of false alarms at airports and in emergency wards. High vigilance helps ensure that imported cases are identified and isolated before they have chance to spread infection to others. This was well-done in Nigeria.

I am optimistic that, with strong support from our partners, working together with the UN agencies and other partners here on this panel, we can get this outbreak under control. The US Centers for Disease Control and Prevention is not here today but has been providing robust support within countries.

But as I said, there is no early end in sight. This is an extraordinary outbreak that requires extraordinary measures for containment. Together we can do it. Everyone has a role to play.

Thank you.

http://www.who.int/dg/speeches/2014/ebola-briefing/en/

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PostPosted: Wed Aug 13, 2014 8:26 am 
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Ebola continues to gain ground, the international community promises to help Africa
- Published 08/13/2014 at 12:57

By Didier Raoult

The Africa West struggled Wednesday not to panic facing Ebola, despite the thousands of deaths caused by the epidemic and the lack of available resources, while the international community promised to provide help.

Permission certainly still experimental treatments is a glimmer of hope. But only will benefit a handful of people, a drop in the bucket compared to the hundreds or even to thousands of patients identified.

"We have to avoid panic and fear, it is possible to stop Ebola," assured the Secretary General of the UN Ban Ki-moon , who on Tuesday announced the appointment of a UN coordinator for Ebola, the British doctor David Nabarro, specialist epidemics.

"Ebola has been contained elsewhere and we can do it here too," said Mr Ban. "In the coming days, the United Nations will strengthen their efforts to combat the epidemic," he promised, citing sending medical personnel and equipment protection.

The Economic Community of the West African (ECOWAS) has announced the death in Lagos one of its officials, bringing to three the number of deaths in Nigeria, Africa's most populous country. The three victims are a Liberian patient arrived in late July, and two more people infected by it.

The Presidency of Liberia said the American experimental serum ZMapp, which gave positive results in two Americans infected in the country, but did not save a Spanish priest died Tuesday, will be administered to two Liberian doctors The Dr. Zukunis Ireland and Abraham Borbor.

"The approval of the American Drug Agency (FDA) allows the manufacturer to send the treatment to the Department of Health only to be used on the two doctors. Medicines will be in the country within 48 hours," the Presidency .

In neighboring Sierra Leone, the Ministry of Health told AFP he had written a letter to the American group for this serum.

The World Health Organization (WHO) "has approved our request for the drug ZMapp be made available in both Sierra Leone and Liberia," said Sidi Yahya Tunis, spokesman of the ministry, saying expect a response from the group within 48 hours.

- 'Disease poor' -

However, Guinea has not yet applied for this serum, told AFP a government source in Conakry.

The American pharmaceutical company that developed the ZMapp said Monday it shipped all doses available in West Africa, without specifying the country, ensuring that the treatment had been provided "for free in all cases."

Given the scale of the epidemic, an expert committee convened by WHO said Tuesday "ethics of offering unapproved treatments whose effectiveness is not yet known and the side effects, such as treatment potential or as a preventive measure. "

The deputy chief of the organization, Marie-Paule Kieny, nevertheless acknowledged the lack of availability, because Ebola is "a disease of the poor in poor countries where there is no market" for pharmaceutical companies.

Sierra Leone's President Ernest Bai Koroma, has appealed to the international community to find the $ 18 million (13.5 million) missing to fund the fight against the epidemic.

In the region, Guinea-Bissau has announced the closure of its borders with Guinea, another country hit, "until further notice," the Prime Minister Domingos Simoes Pereira.

The Confederation of African Football (CAF) has also called on the Guinean Federation (FGF) to relocate the matches of the Guinean national team until mid-September because of the epidemic.

The steps of the continent, in the Strait of Gibraltar and the Spanish enclave of Melilla, members of the Civil Guard have recovered in recent days over a thousand migrants from sub-Saharan Africa were equipped for some gloves and protective masks to protect themselves from the virus.

The most serious since the onset of the hemorrhagic fever Ebola outbreak in 1976, issued 1,013 deaths in West Africa, including 373 in Guinea, Liberia and 15 323 in Sierra Leone, according to the latest report WHO dated August 9.

http://www.lepoint.fr/monde/ebola-gagne ... 525_24.php

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