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PostPosted: Sat Aug 09, 2014 2:54 pm 

Joined: Wed Aug 19, 2009 10:42 am
Posts: 56044
Location: Pittsburgh, PA USA
morning wrote:
niman wrote:
morning wrote:
Asymptomatic transmission? Game changer.

I am not sure that this is asymptomatic transmission. The HCWs did become symptomatic and were Ebola confirmed, but they may have been working with mild symptoms prior to the realization that Patrick Sawyer was infected. Details are just coming out on the transmission chains. Patrick Sawyer was symptomatic prior to leaving Liberia, so he was likely very contagious when he arrived and those in contact may have had a short incubation period.

Leroy, E. M., Kumulungui, B., Pourrut, X., Rouquet, P., Hassanin, A., Yaba, P., Délicat, A., Paweska, J. T., Gonzalez, J. -., & Swanepoel, R. (2005). Fruit bats as reservoirs of Ebola virus. Nature, 438(7068), 575-576.

I know it's a huge longshot from asymptomatic infection, to jump-species asymptomatic infection. Still, if as few as 1 to 10 organisms are reportedly enough to infect each new host, then the arithmetical likelihood of aerosol transmission crossing that barrier seems, layman that I am (degree in physics, not life sciences) very possible.

All of the sequences (representing cases in Guinea, Sierra Leone, Liberia, Nigeria are the same = 1 introduction in late 2013.


PostPosted: Tue Aug 12, 2014 9:13 am 

Joined: Wed Aug 19, 2009 10:42 am
Posts: 56044
Location: Pittsburgh, PA USA
Tuesday, 12 August 2014
Heartbreaking! Nursing Mother Contracts Deadly Ebola virus from Sawyer In Lagos

A medical doctor has revealed how a nursing mother contracted the deadly Ebola virus at a Lagos hospital. It was learnt that the woman was the patient who visited the Nigerian National Petroleum Corporation staff clinic on Muri Okunola Street in the Victoria Island area of Lagos.

The doctor, who had a first-hand information of the incident, said the nursing mother had first visited the First Consultant Medical Centre, Obalende.

He said, “The lady attended ante-natal at First Consultant prior to the arrival of the Liberian, Mr. Patrick Sawyer. She was delivered of her baby at the hospital after which she was discharged.

“A few weeks later, Mr. Sawyer came around and was attended to by health workers. He was first treated for malaria, then typhoid, before there was high index of suspicion. He tested positive for Ebola and died.

“Then the woman, who gave birth at the hospital came back to the hospital for her baby’s immunisation. The nurses who attended to Sawyer also attended to her.

“When she visited the place again last week, she discovered the place had been shut down for proper fumigation as a means of control against Ebola.”

He told Punch that the nursing mother decided to visit a neighbouring clinic which was the NNPC clinic. He said it was there she began her treatment after she fell ill.

“She was first treated for Malaria. However, after some medical tests, there was a high suspicion of Ebola haemorrhagic fever. On Friday, the Lagos State’s emergency response team on Ebola virus came around and took her to the Infectious Diseases Hospital,” he added.

The mother and her baby, who were taken away from the hospital on Friday, have been quarantined.

Confirming the report, the Medical Officer of Health, Iru-Victoria Island LCDA, Dr. Wale Akeredolu, said the patient tested positive to the Ebola virus after a second test was conducted on her.

He confirmed the incident at a sensitisation programme organised for residents of the Eti-Osa on Monday.

He said “The baby has also been quarantined to see if after the incubation period of two to 21 days, she would manifest the symptoms of Ebola.”

The council boss, Abayomi Daramola, appealed to residents not to shirk their responsibilities on the pretext of running away from the virus.

He said, “This is a trying time in Nigeria. But the presence of Ebola does not mean people should run away from their responsibilities. The public apprehension is what can even spread the disease faster. So, people should just follow personal hygiene, use sanitisers and wash their hands regularly.”

http://www.pakurumo.com/2014/08/heartbr ... racts.html


PostPosted: Thu Aug 14, 2014 7:36 pm 

Joined: Wed Aug 19, 2009 10:42 am
Posts: 56044
Location: Pittsburgh, PA USA
WHO pushes back against Ebola-related flight bans
Filed Under: Ebola
Lisa Schnirring | Staff Writer | CIDRAP News | Aug 14, 2014

With some airlines suspending flights to West Africa's Ebola outbreak region, the World Health Organization (WHO) today restated its position that the risk of disease transmission during air travel remains low, as a few doses of an investigational drug reached Africa.

Korean Air Lines (KAL) announced today that it would suspend flights to Nairobi, Kenya, starting Aug 20 to prevent the spread of Ebola virus disease (EVD), according to a report today from Reuters. KAL operates three return flights from Nairobi each week. Kenya has not reported any Ebola cases and does not border the affected area, though the WHO has urged it to take extra precautions, given the volume of travel between it and the outbreak countries.

Earlier this month, British Airways said it was suspending service to Liberia and Sierra Leone because of the EVD outbreak. Emirates Airlines, based in Dubai, has also suspended flights to Guinea.

So far, only one travel-related illness has been detected, in an airline passenger from Liberia who was sick upon his arrival in Nigeria, an event that sparked a transmission chain in the capital, Lagos. However, some airlines are concerned about the safety of passengers and staff who might need to seek care in a medical facility in outbreak countries.

WHO repeats advice against flight suspensions
Isabelle Nuttall, MD, director of the WHO Global Capacity Alert and Response, said in a WHO statement today that unlike flu and tuberculosis, Ebola doesn't spread through the air. "It can only be transmitted by direct contact with the body fluids of a person who is sick with the disease."

The WHO added that on the small chance that someone on a plane is sick with Ebola, the likelihood of other passengers and crew having contact with their body fluids is even smaller. Typically, when a person is sick with Ebola, they are so unwell that they can't travel. Health experts also say people who are infected with Ebola can't shed the virus until they have symptoms.

Last week the WHO's emergency committee on Ebola said the outbreak developments in West Africa qualify as a public health emergency of international concern (PHEIC), and it recommended a set of measures to curb the spread of the disease. The panel urged no bans on international travel or trade and that countries make sure they have the capacity to identify and care for travelers from Ebola-affected areas who arrive at travel hubs or destinations with unexplained fevers or other symptoms.

On its Twitter account today, the WHO said international airlines in affected countries are putting systems in place to screen passengers for possible infections. Global health officials have said exit screening in outbreak countries is likely to be more effective for flagging illnesses than entry screening in destination countries, because nonstop flights from African countries aren't the most common route, and it's more difficult to track passengers when they take multi-leg flights.

The WHO also tweeted that it is disappointed when airlines stop flying to West Africa: "Hard to save lives if we and other health workers cannot get in." (??)

Treatment, vaccine developments
In treatment developments, the first three doses of the experimental drug Zmapp arrived in Liberia last night, with two of them earmarked for two of the country's doctors who are in an isolation center at a hospital in Monrovia, the capital, AllAfrica reported today.

A Liberian health official said the government negotiated with the company, with the approval of the US Food and Drug Administration (FDA), to explore how the drugs could be given to the patients in Liberia. He also said negations are underway with other firms developing experimental Ebola drugs, including the Canadian company Tekmira, which makes the only Ebola treatment that has entered clinical trials.

Meanwhile, the president of NewLink Genetics Corp., which is developing an experimental Ebola vaccine based on technology developed by Canadian government researchers , said at least two contract manufacturers have been found to produce "tens of thousands" of doses in the next month or two, according to Reuters.

Charles Link, MD, told Reuters that the company's subsidiary has received funding from the US Department of Defense to speed up clinical trials and manufacturing. Canada's government recently announced that it will donate 800 to 1,000 doses of the vaccine that it has on hand to the WHO for use in battling the outbreak.

In another move that could speed development of an experimental treatment, BioCryst Pharmaceuticals, based in Research Triangle Park, N.C., announced yesterday that it has received an additional $4.1 million from the National Institute of Allergy and Infectious Diseases (NIAID) to conduct a phase 1 clinical trial of an intramuscular treatment for Ebola and other viral hemorrhagic fever diseases.

The additional funding for the treatment, called BXC4430, will also cover studies in nonhuman primates to gauge effective dose ranges and schedules.

The NIAID made its initial grant to BioCryst , valued at up to $22 million over 5 years, in September 2013.

In other developments, the FDA today warned consumers about online companies that are selling products to prevent or treat Ebola. In a statement it said it has received consumer complaints about a variety of products.

Though Ebola vaccines and treatments are under development, in early stages with very limited supply, there are no approved products that have been tested for safety or effectiveness, the FDA noted. The agency added that by law, dietary supplements can't claim to prevent or cure disease.

The FDA also mentioned that the CDC doesn't view the outbreak as a significant threat to the US public and noted that during outbreaks, fraudulent products that purport to prevent or treat the disease often appear on the market.

Latest African developments
Guinea's government has declared a national health emergency to tamp down the spread of Ebola, BBC News reported today, based on information from Guinea's state radio. The action is meant to trigger tighter border controls, order the immediate isolation of people with suspected infections, and prevent the movement of dead bodies from one town to another.

When the WHO declared a PHEIC on Aug 8, it urged the outbreak countries to declare national emergencies. Sierra Leone, Liberia, Nigeria had already declared national emergencies.

Sierra Leone has lost its second top doctor to EVD, Dr Modupeh Cole, who died yesterday at a Doctors Without Borders treatment center in Kailahun, the New York Times reported.

The health ministry said he was exposed to the virus while working in a hospital in Freetown, the capital, according to the Times report.

Nigerian health officials also today reported another death of a health worker, a nurse who had helped care for the country's first EVD case, a man whose illness was detected in Lagos after he had flown in from Liberia, the Associated Press (AP) reported today.

See also:

Aug 14 Reuters story

Aug 14 WHO statement

WHO Twitter feed

Aug 14 AllAfrica story

Aug 13 Reuters story

Aug 14 FDA statement

Aug 14 BBC News story

Aug 13 Times story

Aug 14 AP story
http://www.cidrap.umn.edu/news-perspect ... light-bans


PostPosted: Fri Aug 15, 2014 2:46 pm 
User avatar

Joined: Thu Aug 20, 2009 12:28 pm
Posts: 770
Hospital equipment is routinely rolled from room to room here. BP machines , Saturation monitors etc. that fit on the tip of a finger are often carried by a nurse and used on all patients on the same floor. If he wasn't in isolation the virus could easily hitch a ride all over the place. These are common tools used in taking vital signs. Same with a stethoscope. All ate potential fomites.

"Old Mother Goose, when she wanted to wander, would ride through the air on a very fine gander."
"Mother Goose had a house,
'Twas built in a wood,
Where an owl at the door
For sentinel stood."

PostPosted: Sat Aug 16, 2014 10:15 am 

Joined: Wed Aug 19, 2009 10:42 am
Posts: 56044
Location: Pittsburgh, PA USA
With Ebola Cases Still Few, Populous Nigeria Has Chance to Halt Its Outbreak
AUG. 15, 2014

Health workers have fought the Ebola outbreak to a tentative standstill in Nigeria, Africa’s most populous nation, offering at least a chance to eradicate the disease there before it spins out of control, as it has in Guinea, Liberia and Sierra Leone, where a sluggish response failed to halt it early.

Nigeria’s small number of cases — 11 confirmed and one suspected — provides a brief window in which to wipe out Ebola. If these efforts fail, the death toll could be horrific. The cases have occurred in Lagos, a city with 20 million people, many of them jammed into teeming slums where the virus could become unstoppable.

Dr. Thomas R. Frieden, the director of the Centers for Disease Control and Prevention, said health officials were watching Nigeria with intense interest, because of its huge population and because it is much more of a crossroads than the other three countries, in much closer touch with the rest of Africa.

“We’re waiting for the other shoe to drop,” he said.

The World Health Organization said on Thursday that staff members on the front lines of the outbreak across the region had warned that the nearly 2,000 reported cases and the more than 1,000 reported deaths “vastly underestimate the magnitude of the outbreak.” And Doctors Without Borders said on Friday that the disease was still spreading faster than the efforts of governments and health workers to keep up with it, calling ground conditions “like a war.”

About 200 people who had contact with the infected patients in Lagos are receiving daily visits from health workers for 21 days, the incubation period of the disease, to check for fever or other symptoms, said David Daigle, a spokesman for the team in Nigeria from the Centers for Disease Control and Prevention. So far, 61 have finished the follow-up and are in the clear, he said. About 60 Nigerian health workers have been trained to trace contacts, and more are being taught, to bring the total to 200, Mr. Daigle said.

Ebola arrived in Nigeria on July 20, carried by Patrick Sawyer, a native Liberian and naturalized American citizen. He contracted the disease in Liberia, flew to Lagos while he was ill and died on July 25. Health officials say he was vomiting during the flight.

Every case in Nigeria has been traced to him. Some victims had helped him when he arrived at the airport, and others were health workers who had treated him without gloves or other protection because they did not realize he had Ebola. President Goodluck Jonathan has been widely quoted in Nigerian newspapers as calling Mr. Sawyer “a madman.”

Four Nigerian patients have died, and the mood among the rest is somber, said Dr. Maurizio Barbeschi, a scientist from the World Health Organization who is working on the outbreak.

“They think it is a death sentence,” he said. But he said they were getting good care, and he doubted that their death rate would reach that of the other countries, where about 60 percent of the cases have been fatal in some locations.

Patients who are health workers are caring for others, helping with tasks like changing bags of intravenous medicines.

Last Saturday, Dr. Barbeschi said, he stepped outside the ward where patients are being treated and asked if anyone had a book so he could read to the patients. Mr. Daigle pulled a beat-up copy of Shakespeare’s “Henry IV” from his backpack.

Back inside, speaking through a surgical mask, Dr. Barbeschi acted out scenes from the play for a patient fighting for his life.

Nigeria has some advantages over other West African countries in dealing with the disease: It has a better health system, and it was on alert for Ebola because the illness had struck the other nations first. Doctors detected it there before a large number of people fell ill. Dr. Frieden said that it took too long to isolate the first person infected from contact, but that the ability to respond had improved tremendously.

But Lagos is a huge city. The outbreaks in the other countries have mostly struck villages and towns.

“An Ebola outbreak in a dense urban setting is very different from what we know already,” said Dr. Benjamin J. Park, an infection control specialist from the C.D.C. who is working on the outbreak in Lagos.

Health officials are using social media, among other channels, to get information to health workers in Lagos — a difficult task because the city has thousands of health facilities, including clinics and small hospitals, Dr. Park said.

Dr. Park has been training health workers in how to protect themselves around potentially infected patients. Everyone wants the white Tyvek suits that have been widely photographed, he said, but he tries to convince them that because the disease is spread only by bodily fluids, the suits are needed only when patients are very ill with symptoms like vomiting and diarrhea.

If used, they must be removed carefully to avoid contact with secretions that may have splashed on the outside. “I say: ‘Imagine that you’re covered with paint or mud. How are you going to take this off without getting any on your skin?’ ” Dr. Park said.

Recruiting health professionals to fight Ebola there has proved challenging. On Wednesday in Lagos, a Nigerian doctor who answered a government call said he was not very worried about the risks. But he declined to give his name because he feared reprisals from the state authorities for talking to the news media, and he said he worried that he would be stigmatized if others learned that he was involved with Ebola. Though the government was offering the equivalent of $185 a day, a substantial sum in Nigeria, only a dozen or so people answered the call that day.

A nurse who did respond said he hoped to work on the outbreak by day and continue his regular job at a private hospital by night. He also requested anonymity, for the same reasons as the doctor. Working at the private hospital was riskier than working on the outbreak , he said.

“Here, you already know the risk you are facing, but back at the hospital, it’s dangerous because you can’t treat every patient as an Ebola risk,” the nurse said. While working on the outbreak, he would at least be given training and kits with protective gear.

But he added, holding a Bible, “It’s God that protects, not the kits.”

Ben Ezeamalu contributed reporting from Lagos, Nigeria, and Nick Cumming-Bruce from Geneva.

http://www.nytimes.com/2014/08/16/scien ... .html?_r=0


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