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Tuesday, October 7, 2014

CDC: Doctors, nurses fleeing Ebola hospitals, virus not contained


CDC: Doctors, nurses fleeing Ebola hospitals, virus not contained

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A new and remarkably candid on-the-ground audit from the Centers for Disease Control and Prevention of the Ebola crisis in Liberia said that doctors and nurses have fled hospitals in the infection zone and that obstacles to killing the virus remain.
The analysis of four remote Liberian counties conducted by local and CDC officials that were Ebola-free in August revealed that massive amounts of aid are still needed in the areas to fight the spread of the virus, which can be as simple as burying a dead victim.
While the CDC said locals are getting a handle on the crisis, it warned, “obstacles to preventing spread of Ebola remain, and personal protective equipment, sufficient personnel for effective contact tracing and case management, efficient patient transport and regional diagnostic laboratory capabilities are urgently needed.”
RELATED: House panel will hold Ebola hearing in Dallas
The review of the southeastern Liberian counties in August found utter chaos and a full breakdown in the medical system, which has contributed to the spread of Ebola. It also found that locals didn’t know how to identify Ebola, even though the virus was dominating other areas of the country.“No Ebola surveillance systems were in place,” the doctors found in the report issued Tuesday.
And the lack of medical staff seemed to surprise the report authors. “Before the epidemic, six physicians served all four counties. At the time of the evaluation, only three physicians remained; the others had left Liberia because of the epidemic. In two of four hospitals assessed, nursing staff members were not coming to work or had abandoned facilities; in another hospital, health care providers had not been paid for three months but were still providing basic care,” said the analysis.
RELATED: Obama calls for more Ebola screening at airports
Once locals were explained about the symptoms of Ebola, they realized that the virus had already hit.
“After basic training on case definitions and surveillance was provided to local officials, River Gee County health officials reviewed recent deaths and identified a patient with suspected Ebola. On Aug. 3, a pregnant woman (patient 1) died during a spontaneous abortion after leaving Monrovia where she had contact with an infected person at a funeral; she was buried by the community in the week after her death.
RELATED: Superbugs spread across U.S.
“On Aug. 24, 2014, Maryland County authorities identified a man hiding in a rice truck who had signs and symptoms of Ebola (patient 2). The truck had departed from Fish Town, River Gee County, and was destined for Pleebo, Maryland County. The man, who was reported to have participated in the burial of patient 1, was sent back to Fish Town, where he later was reported to have died of laboratory-confirmed Ebola. This was the first evidence of secondary transmission of Ebola in southeast Liberia.”

Staff attended Alcorcón Hospital Auxiliary Ebola infected unprotected



Some Ebola experts worry virus may spread more easily than assumed



Ebola researcher says he would not rule out possibility that the virus spreads through air in tight quarters
'There are too many unknowns here,' a virologist says of how Ebola may spread
Ebola researcher says he thinks there is a chance asymptomatic people could spread the virus
 
U.S. officials leading the fight against history's worst outbreak of Ebola have said they know the ways the virus is spread and how to stop it. They say that unless an air traveler from disease-ravaged West Africa has a fever of at least 101.5 degrees or other symptoms, co-passengers are not at risk.
"At this point there is zero risk of transmission on the flight," Dr. Thomas Frieden, director of the federal Centers for Disease Control and Prevention, said after a Liberian man who flew through airports in Brussels and Washington was diagnosed with the disease last week in Dallas.
Other public health officials have voiced similar assurances, saying Ebola is spread only through physical contact with a symptomatic individual or their bodily fluids. "Ebola is not transmitted by the air. It is not an airborne infection," said Dr. Edward Goodman of Texas Health Presbyterian Hospital in Dallas, where the Liberian patient remains in critical condition.
Yet some scientists who have long studied Ebola say such assurances are premature — and they are concerned about what is not known about the strain now on the loose. It is an Ebola outbreak like none seen before, jumping from the bush to urban areas, giving the virus more opportunities to evolve as it passes through multiple human hosts.
Dr. C.J. Peters, who battled a 1989 outbreak of the virus among research monkeys housed in Virginia and who later led the CDC's most far-reaching study of Ebola's transmissibility in humans, said he would not rule out the possibility that it spreads through the air in tight quarters.
"We just don't have the data to exclude it," said Peters, who continues to research viral diseases at the University of Texas in Galveston.
Dr. Philip K. Russell, a virologist who oversaw Ebola research while heading the U.S. Army's Medical Research and Development Command, and who later led the government's massive stockpiling of smallpox vaccine after the Sept. 11 terrorist attacks, also said much was still to be learned. "Being dogmatic is, I think, ill-advised, because there are too many unknowns here."
If Ebola were to mutate on its path from human to human, said Russell and other scientists, its virulence might wane — or it might spread in ways not observed during past outbreaks, which were stopped after transmission among just two to three people, before the virus had a greater chance to evolve. The present outbreak in West Africa has killed approximately 3,400 people, and there is no medical cure for Ebola.
"I see the reasons to dampen down public fears," Russell said. "But scientifically, we're in the middle of the first experiment of multiple, serial passages of Ebola virus in man.... God knows what this virus is going to look like. I don't."
Tom Skinner, a spokesman for the CDC in Atlanta, said health officials were basing their response to Ebola on what has been learned from battling the virus since its discovery in central Africa in 1976. The CDC remains confident, he said, that Ebola is transmitted principally by direct physical contact with an ill person or their bodily fluids.
Skinner also said the CDC is conducting ongoing lab analyses to assess whether the present strain of Ebola is mutating in ways that would require the government to change its policies on responding to it. The results so far have not provided cause for concern, he said.

The researchers reached in recent days for this article cited grounds to question U.S. officials' assumptions in three categories.
One issue is whether airport screenings of prospective travelers to the U.S. from West Africa can reliably detect those who might have Ebola. Frieden has said the CDC protocols used at West African airports can be relied on to prevent more infected passengers from coming to the U.S.
"One hundred percent of the individuals getting on planes are screened for fever before they get on the plane," Frieden said Sept. 30. "And if they have a fever, they are pulled out of the line, assessed for Ebola, and don't fly unless Ebola is ruled out."
Individuals who have flown recently from one or more of the affected countries suggested that travelers could easily subvert the screening procedures — and might have incentive to do so: Compared with the depleted medical resources in the West African countries of Liberia, Sierra Leone and Guinea, the prospect of hospital care in the U.S. may offer an Ebola-exposed person the only chance to survive.
A person could pass body temperature checks performed at the airports by taking ibuprofen or any common analgesic. And prospective passengers have much to fear from identifying themselves as sick, said Kim Beer, a resident of Freetown, the capital of Sierra Leone, who is working to get medical supplies into the country to cope with Ebola.
"It is highly unlikely that someone would acknowledge having a fever, or simply feeling unwell," Beer said via email. "Not only will they probably not get on the flight — they may even be taken to/required to go to a 'holding facility' where they would have to stay for days until it is confirmed that it is not caused by Ebola. That is just about the last place one would want to go."
Liberian officials said last week that the patient hospitalized in Dallas, Thomas Eric Duncan, did not report to airport screeners that he had had previous contact with an Ebola-stricken woman. It is not known whether Duncan knew she suffered from Ebola; her family told neighbors it was malaria.
The potential disincentive for passengers to reveal their own symptoms was echoed by Sheka Forna, a dual citizen of Sierra Leone and Britain who manages a communications firm in Freetown. Forna said he considered it "very possible" that people with fever would medicate themselves to appear asymptomatic.
It would be perilous to admit even nonspecific symptoms at the airport, Forna said in a telephone interview. "You'd be confined to wards with people with full-blown disease."
On Monday, the White House announced that a review was underway of existing airport procedures. Frieden and President Obama's assistant for homeland security and counter-terrorism, Lisa Monaco, said Friday that closing the U.S. to passengers from the Ebola-affected countries would risk obstructing relief efforts.
CDC officials also say that asymptomatic patients cannot spread Ebola. This assumption is crucial for assessing how many people are at risk of getting the disease. Yet diagnosing a symptom can depend on subjective understandings of what constitutes a symptom, and some may not be easily recognizable. Is a person mildly fatigued because of short sleep the night before a flight — or because of the early onset of disease?
Moreover, said some public health specialists, there is no proof that a person infected — but who lacks symptoms — could not spread the virus to others.
"It's really unclear," said Michael Osterholm, a public health scientist at the University of Minnesota who recently served on the U.S. government's National Science Advisory Board for Biosecurity. "None of us know."
Russell, who oversaw the Army's research on Ebola, said he found the epidemiological data unconvincing.
"The definition of 'symptomatic' is a little difficult to deal with," he said. "It may be generally true that patients aren't excreting very much virus until they become ill, but to say that we know the course of [the virus' entry into the bloodstream] and the course of when a virus appears in the various secretions, I think, is premature."
The CDC's Skinner said that while officials remained confident that Ebola can be spread only by the overtly sick, the ongoing studies would assess whether mutations that might occur could increase the potential for asymptomatic patients to spread it.
Finally, some also question the official assertion that Ebola cannot be transmitted through the air. In late 1989, virus researcher Charles L. Bailey supervised the government's response to an outbreak of Ebola among several dozen rhesus monkeys housed for research in Reston, Va., a suburb of Washington.
What Bailey learned from the episode informs his suspicion that the current strain of Ebola afflicting humans might be spread through tiny liquid droplets propelled into the air by coughing or sneezing.
"We know for a fact that the virus occurs in sputum and no one has ever done a study [disproving that] coughing or sneezing is a viable means of transmitting," he said. Unqualified assurances that Ebola is not spread through the air, Bailey said, are "misleading."
Peters, whose CDC team studied cases from 27 households that emerged during a 1995 Ebola outbreak in Democratic Republic of Congo, said that while most could be attributed to contact with infected late-stage patients or their bodily fluids, "some" infections may have occurred via "aerosol transmission."
Skinner of the CDC, who cited the Peters-led study as the most extensive of Ebola's transmissibility, said that while the evidence "is really overwhelming" that people are most at risk when they touch either those who are sick or such a person's vomit, blood or diarrhea, "we can never say never" about spread through close-range coughing or sneezing.
"I'm not going to sit here and say that if a person who is highly viremic … were to sneeze or cough right in the face of somebody who wasn't protected, that we wouldn't have a transmission," Skinner said.
Peters, Russell and Bailey, who in 1989 was deputy commander for research of the Army's Medical Research Institute of Infectious Diseases, in Frederick, Md., said the primates in Reston had appeared to spread Ebola to other monkeys through their breath.
The Ebola strain found in the monkeys did not infect their human handlers. Bailey, who now directs a biocontainment lab at George Mason University in Virginia, said he was seeking to research the genetic differences between the Ebola found in the Reston monkeys and the strain currently circulating in West Africa.
Though he acknowledged that the means of disease transmission among the animals would not guarantee the same result among humans, Bailey said the outcome may hold lessons for the present Ebola epidemic.
"Those monkeys were dying in a pattern that was certainly suggestive of coughing and sneezing — some sort of aerosol movement," Bailey said. "They were dying and spreading it so quickly from cage to cage. We finally came to the conclusion that the best action was to euthanize them all." http://www.latimes.com/nation/la-na-ebola-questions-20141007-story.html#page=1

Suspected Ebola case causes panic in Manipur

October 6, 2014 12:05 IST
Panic gripped Manipur when a Japanese woman who had made a stop-over at Imphal was suspected of having infected with Ebola virus. The tourist, identified as Kawakubo Yuko (27), had already visited five countries. She was coming to Nagaland and had checked in at a hotel in Imphal as she was planning to visit some places in the state. She came to Manipur from Myanmar by road.
Doctors said that she had started showing symptoms of a patient suffering from Ebola. She was shifted to a private hospital in Imphal. Local tests for some common ailments proved negative.
Accordingly the doctors here collected her blood samples for testing at the National Institute of Virology, Pune.
Later she was admitted in J.N. Institute of Medical Sciences in Imphal since there are better medical facilities. Hospital sources said that she is kept in an isolation room. If she is found to be Ebola positive many other persons of the hotel, the doctors and paramedics in the government and the private hospitals are susceptible to this deadly disease. Hospital sources said that since there is no proper isolation ward in JNIMS the patient may be shifted to Regional Institute of Medical Sciences, Imphal if she is found to be Ebola positive. Sources also said that all tourists coming by road or flight to Manipur may be screened for this disease.  http://www.thehindu.com/sci-tech/health/policy-and-issues/suspected-ebola-case-causes-panic-in-manipur/article6475140.ece

Epidemiologist: Stop the flights now

Epidemiologist: Stop the flights now

Infected men and women may not be contagious on the plane, but they could wreak havoc when they arrive.

October 6 at 12:24 PM
David Dausey, a Yale-trained epidemiologist who works on controlling pandemics, is dean of the School of Health Professions and Public Health at Mercyhurst University in Erie, Pennsylvania.
The United States got its first scare from Ebola last week when Thomas Eric Duncan, a man sick with the virus, traveled from Liberia to Dallas. This man was feared to have been in contact with up to 100 people after he became contagious, all of whom had to be individually evaluated by public health professionals for their exposure risk. Half of these individuals are currently under observation. Nine of them considered to be at highest risk are being checked twice daily for symptoms.
Bodily fluids including vomit spread Ebola, and Duncan — who presented himself to a Dallas hospital only to be misdiagnosed and sent home — vomited on the sidewalk outside of his home. It took days before a properly trained Hazmat crew was sent to the apartment to clean it. The human errors in this single case highlight why it is urgent that we ban all commercial flights from the impacted countries to all non-affected countries until the outbreak is contained. *
Individuals who suspect they have been exposed to Ebola and have the means to travel to the United States have every reason to get on a plane to the United States as soon as possible. There are no direct flights from the three most-affected nations, but passengers can transfer elsewhere, as Duncan did. If they stay in Africa, the probability that they will survive the illness if they have it is quite low. If they make it to the United States, they can expect to receive the best medical care the world can provide, and they will have a much higher probability of survival. So they are motivated to lie about their exposure status (wouldn’t you, in their shoes?) to airlines and public health officials and travel to the United States. *
The incubation period for Ebola is up to 21 days, so a person could get on a plane the day he or she is exposed and spend three weeks in the United States or elsewhere before exhibiting symptoms. Then he or she could potentially infect any number of people here before the disease is properly diagnosed, and they are isolated or quarantined. *
Top U.S. government health officials have spoken strongly against creating a travel ban (though members of Congress increasingly disagree). They say restricting flights will also restrict aid to affected countries and will increase the amount of ongoing unrest. But commercial airlines are not the only ways for the United States to send aid and aid workers. The United States has the most advanced military in the entire world; we can transport people and supplies without commercial carriers.
The Ebola outbreak in West Africa has been compared to a war zone. The disease is now being viewed as a national security threat on par with nuclear weapons. The United States has committed nearly 4,000 troops to impacted countries. It’s time to take security precautions that align with the gravity of the threat. That means doing whatever it takes to keep infected people from coming here.
Correction: Language was added to the paragraphs marked by an asterisk (*) to clarify that there are no direct flights to the United States, though flights stop in other non-affected nations.  http://www.washingtonpost.com/posteverything/wp/2014/10/06/epidemiologist-stop-the-flights-now/

Redemption Hospital: A ‘Slaughter House?’ - An Insider’s Horrifying Eyewitness Account of What Women and Children Have To Contend With Inside This Ebola Holding Center


1:45 PM
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#ebola #ebolaoutbreak
Fanta Jabateh picture with children at their homes in Garnerville
Over six months after the first few deaths were reported in Liberia as a result of the deadly Ebola virus disease, the country’s problems in the fight continue to shift in sharp dimensions. The earliest challenge had been huge citizens’ denial that culminated in evident recalcitrance towards government’s regulation on prevention, hence more deaths.
One another hand, especially when the death toll began to increase, the healthcare system collapsed in its totality – of course confirmed by government. When few hospitals reassured themselves to open, there came the problem of lack of willing health workers and drugs to treat even ordinary illnesses, lack of sufficient ambulances and citizens’ opposition to government’s involvement of the military.
Now that some of these challenges are beginning to subside due to the glaring deadly realities of the disease and the intervention of the international community, Liberia’s worries are far from over as expert predictions project an exponential increase in the number of cases.
In between, the best place for a sick person is a holding center, if not a treatment center. Not only does it give hope to the sick, it prevents others from contracting the virus of he or she remains in the community.
Redemption is the biggest holding center in Montserrado, a county of over one million people. But the stories from within this facility portray the hospital in a different way. One person has described it as, for lack of a moderate name, a modern day concentration camp.
Fanta Jabateh, 48, escaped from this holding center over two weeks ago on Sunday, September 21, 2014. Her story sums up generally what patients undergo at Redemption Hospital and in particular what women and children have to contend with before either their death or recuperation.
Fanta is sitting in the comfort of a partially scary family at their Gardnersville residence in Monrovia. Fanta explains the horrors she underwent before her escape. "I spent five days in the hospital. My stomach ran for these five days and no one attended to me," she told me in her native Mandingo language.
She continued: "I called my children several times outside to inform the world about my condition. They tried their best but no one helped. I became helpless and thought that death was even better than my present condition. I called nurses' attention but no one cared. I saw death in that hospital but it refused to take my life. I wished it had taken my life then. All the time I was at the hospital, they never fed me nor allowed my family to bring me food."
Fanta's family has suffered more than nine deaths to the Ebola virus. Her crutch-carrying husband sits in frustration as Fanta narrates her ordeal at Redemption. "I am happy that we are able to see her alive. We heard rumors that she was already dead. Even though she was not supposed to escape, we are glad to see her," he said, struggling to hold back his tears in the midst of his family. But his body language no doubt explained exactly what was going on inside this old man.
Fanta says she escaped along with more than twenty people who suffered similar neglect. "I am not alone. There were more than 20 people that ran away from that hospital because of no care. I don't know where they went." Finding their whereabouts appears to be more difficult than even testing their Ebola status.
For all time Fanta spent at the hospital, she was never tested, never treated. Unaware of her Ebola status, Fanta is at home. When she escaped, she went at the Duala Market to board a taxi cab. She couldn't get one. Then her eighteen years old son, Sekou Jabateh, aided her get a motorbike that conveyed them home; risking all three onboard and people in the market.
Before she escaped, there were rumors that people who are not nurses and health workers were forcing their way into the hospital to cater to their 'detained' family members. The rumors were true and Sekou took advantage of it. He found his way through the nonchalant health workers, wore protective equipment (PPE) and went to his mother; already suspected of Ebola.

"Yes it's true. I saw men moving in and get their people out. I saw some of them wearing PPEs. When I asked them to help me get my mother, one of them said 'ain't you man?' Go and get your mother. I know I am a man; so I went in, I wear (wore) PPE and went to see my mother," Sekou told me as his siblings looked on.
How could people who don't work at the hospital have access to it and even wear PPE? I asked him. His response was no different from what disappointed people in Liberia would say. "Those who work there are not motivated. They are afraid of their own lives. They are afraid to come closer to sick people. So, they just sat there and we do (did) our thing."
I needed to confirm Sekou's story of infiltrating an already risky territory. A nurse on one of the few ambulances that conveyed sick people at the hospital that very day confirmed the story.
"When we carried people in the hospital, one of them was too weak. So, we used the stretcher to take her inside. When we got in, someone recognized me and called my name. I turned around and it was Sekou. He said, 'big brother, it's me, Sekou. Am doing my thing here!' And I asked, but how come you got in here. Why (are) you in PPE? He explained his story to me. It's scary how things are going on around here," the nurse, preferring anonymity, told me.
Not capacitated to care for patients is one thing, but allowing people who are not health workers infiltrate the system is even more worrisome as these people, without the proper knowledge of prevention, could infect themselves and spread the virus in the communities they come from. Officials at the hospital would not make any official comment. Health Ministry official Tolbert Nyensuah who is also topflight head on the National Taskforce on Ebola could not be reached over the weekend.
To test the possibility of infiltrating the hospital even when you are not a nurse, I went to the hospital and approached people assigned at the warehouse. Two ambulances had just arrived with sick people; so I guessed my timing was perfect. I would just go in there pretending to be one of the ambulance attendants. I crossed the first few doors but realized how panicking I was. Why? A pick-up filled with dead bodies was leaving the hospital to give way to newly brought-in sick people. Sources say the dead bodies were more than 48. This cannot be independently verified. So, I rescinded my brave-heart decision and drove back home in despair.
Several family members of other patients taken to the Redemption hospital have corroborated Fanta's story.
A daughter of one of the escapees who later passed away narrated even horrifying accounts. “My mother was kept there for more than ten days. They wanted her to spend 21 days there under observation. All during these days, the hospital never gave her food or drugs. I had to buy biscuits and bread for my mother.
“Can you imagine my mother was undergoing women’s monthly cycle? If you don’t care for women, how do you know their special needs? My mother told me she received (menstruation) for more than a week but had nothing to protect herself with. No cortex, nothing. The rapper she wore was already messy. Don’t they know that some of the people they are holding in there are women? We all know what that means. How could they do this to our people? They wanted us to bring our sick people to the hospital, we have brought them. Yet, they are not able to take care of them. I don’t see the reason they taking our sick people to that killing ground. I don’t see the difference,” Marie Cyphus, a sociology student at the University of Liberia said in tears.
Standing just outside the Redemption Hospital, Marie has just successfully helped her mother escape the holding facility but she would not say where her mother was at. She also explained how she saw a child, about a year old, die in the eyes of nurses.
“They said she and her mother were brought together. She was still suckling breast. Since her mother was suspected of Ebola and the baby was suckling, they suspected her too. They say Ebola is spread through fluids like breast milk. I heard the mother die few days ago. The child remained there and no one could take care of her. I saw the baby’s life going out of her.  I could not help. My worry was my mother,” Marie said in a rush as she boarded a taxi cab heading for Broad Street, central Monrovia.


StoryBy:
Samuka V. Konneh (+231) 886422711 / 777464028)

DID TEXAS EBOLA VICTIM CONTRACT THE VIRUS THROUGH HIS PREGNANT GIRLFRIEND?


4:13 PM
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#Liberia #texasebola
Thomas Eric Duncan
New details are now emerging about Thomas Eric Duncan activities prior to departing Liberia for the United States. Sources in Liberia told Tmz Liberia Magazine that the 19 year Ebola victim Mr. Duncan helped transport to the hospital was caring his baby. 

Thomas Eric Duncan who is in his mid 40's was a tenant at the Williams' home and was allegedly having an affair with their 19 year old daughter Marthelene Williams, sources told us. After her death, he wouldboard a flight four days later to his family in Texas.

In an exclusive video interview obtained from Frontpage Africa online, residents explained that Thomas was actively involved in the handling of the Marthelene Williams during her ailment. 

"He helped take her to the hospital for fear that she might lose their baby," one resident said. 

Mr. Duncan
What is still unclear is whether he knew that she was infected with the Ebola virus disease (EVD).

Resident informed Tmz Liberia Magazine that after her death neighbors were told that she had died from a car accident. As words start to spread in the community, residents would discover that Marthelene Williams had died of Ebola; leaving seven infections and one fatality. They were all People that had direct contact with Miss Williams.

The hysterical residents of 72nd SKD Boulevard neighborhood stories confirmed earlier New York Times reports that Mr. Duncan was in contact with the tenant’s daughter, Marthelene Williams before her death on September 15.

After his exposure to the virus, Thomas would leave Liberia for the US four days later. We also know that he lied on airport questionnaire given to him by the Liberian Airport authority. CNN has now confirmed that the government of Liberia is planning on prosecuting Mr. Duncan for lying on his departure form.

Weeks after his departure, the virus is already manifesting itself in the community and those he left behind; infecting about ten people already.

“It is good to be realistic. When this girl got sick and died other people when to help them and we have been interacting with each other ever since. Why didn’t they tell us that she had died from Ebola” said another angry neighbor. 
Thomas Eric Duncan resident in Liberia
This is a pattern seen around Liberia as residents are in denial of the virus and also fear stigmatization, despite public awareness.
In another development, Texas authority has quarantine four members of the family at the home where the U.S. Ebola patient was staying. Armed guard was place at the home on Thursday as the circle of people possibly exposed to the virus widened.
THOMAS RESIDENT IN LIBERIA
AFP reported that 100 people are being monitored for possible Ebola exposure. The unusual confinement order was made after the family was "noncompliant" with a request not to leave their apartment, according to Dallas County Judge Clay Jenkins.

Texas State Health Commissioner David Lakey said the confinement would help ensure the relatives can be closely watched, including checking them for fevers over the next three weeks.

Ebola in Spain: 4 people including nurse hospitalized in Madrid


Edited time: October 07, 2014 11:22

Health officials in Madrid say three more people are in the hospital on suspicion of contracting Ebola. The news comes a day after a nurse who treated two Ebola patients at a city hospital became infected with the disease.
The nurse is now being treated with a drip using antibodies from those previously infected with the virus, Reuters reports. Approximately 22 contacts of the woman, often referred to as the 'Spanish Ebola nurse,' have been identified and are being monitored, Madrid health officials told a press conference on Tuesday.
The officials added that the hospitalized include the nurse's husband, another health worker and a traveler who had spent time in one of he affected West African countries.http://rt.com/news/193820-ebola-spain-hospitalized-nurse/

Health maintains three other cases in study

husband and the passenger side, two possible cases of suspected Ebola

Health maintains three other cases in study

The Madrid remains on alert for the possible three other suspected cases of Ebola. The Ministry of Health has said that being watched four cases: the case confirmed the nurse's aide infected two other suspects and another fourth person who has not yet entered a fever.
The two suspected cases are the husband of the infected nursing assistant and an engineer who returned to the airport of Barajas international travel and is in isolation. This man has been subject to analysis, which was negative, and is waiting to be done a second test tomorrow. This man may have malaria.
As reported in a press conference the manager of the Hospital La Paz and the physicians who care for patients at the Carlos III, the husband of the health infected is being studied by the "high-risk exposure without protection" that has been subject. So far, no symptoms of having contracted the disease, as reported by medical sources.
The fourth case is being studied is a nurse who was part of the medical team who treated the two Spanish victims of the virus, the religious Miguel Pajares and missionary Viejo Manuel Garcia in Hospital Carlos III of Madrid, as confirmed by a spokesman the Ministry of Health in the region. The nurse has diarrhea and no fever, but has proceeded cautiously to enable protocols.
The woman contacted Monday with the medical services of the Community after feeling unwell and had noted that symptoms of fever. A team from SUMMA 112 moved to their home and moved to the premises of the Hospital de La Paz-Carlos III, where he was admitted and remains isolated since.
The center is responsible for coordinating the testing to confirm or rule out the existence of contagion, carried out at the Institute of Health Carlos III, whose results will be announced around noon on Tuesday. These four people are hospitalized in rooms with high security.
The nursing assistant has evolved favorably infected and being treated with the serum of missionary Paciencia Melgar. The assistant does not want to tell the media their health status. She maintained contact with 22 people outside the hospital, which is being monitored.
Alerts jumped on Monday, when a nursing assistant who also participated in the operation care Viejo Garcia came to Alcorcón Hospital with fever and other symptoms suspicious. The center activated the isolation protocol and hours later, tests confirmed that the patient was infected with the Ebola virus; It thus became the first spread out of Africa.
The health worker was moved to midnight at Hospital Carlos III, where it is isolated and remains stable and "not life threatening" , as reported by the center coordinator Alerts and Emergencies of the Ministry of Health, Fernando Simón.
On September 26, a day after the death of García Viejo, the assistant went on vacation, but not out of Madrid, 30 September contacted the occupational health services of the hospital because I had a few tenths Alcorcón fever and asthenia.
However, it was not until six days later at the medical center when they attended your request for proof of Ebola done at the insistence of the patient. His worst suspicions were confirmed a few hours later and since then has launched a special protocol to locate and evaluate people in recent days have been in contact with women. For now, her husband remains under surveillance in an isolation unit Hospital Alcorcón and authorities are investigating their surroundings.  https://translate.google.com/translate?sl=auto&tl=en&js=y&prev=_t&hl=en&ie=UTF-8&u=http%3A%2F%2Fwww.elmundo.es%2Fespana%2F2014%2F10%2F07%2F5433a9a7268e3e94268b4575.html&edit-text=

Monday, October 6, 2014

POLIO-LIKE ILLNESS - NORTH AMERICA (05): USA, REQUEST FOR INFORMATION

Published Date: 2014-10-06 21:55:55
Subject: PRO/EDR> Polio-like illness - North America (05): USA, RFI
Archive Number: 20141006.2837556
POLIO-LIKE ILLNESS - NORTH AMERICA (05): USA, REQUEST FOR INFORMATION
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International Society for Infectious Diseases
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In this update:
[1] Colorado, 1 new case - media report
[2] USA, overview - media report

******
[1] Colorado, 1 new case - media report
Date: 6 Oct 2014
Source: Denver Post [edited]
http://www.denverpost.com/news/ci_26673730/colorado-health-dept-says-12-children-stricken-partial?source=infinite


A 12th case of partial paralysis in a child treated in Colorado for viral respiratory illness was confirmed Monday [6 Oct 2014] by the Colorado Department of Public Health and Environment.

The latest case was reported by Denver Health Medical Center. The 1st 11 cases were treated at Children's Hospital Colorado, where 3 children remain hospitalized.


The U.S. Centers for Disease Control and Prevention is investigating a possible link between the cases and enterovirus D-68, which is suspected in a nationwide outbreak of cold-like symptoms and severe respiratory illness among children and adults.

Denver Health officials said their patient was treated and discharged last week, and no further information was available.

The cases included in the CDC and health department investigation are those in which children have experienced severe polio-like muscle weakness in one or more limbs after a fever, and who have lesions on their spinal cord.

"We don't have any new information from the CDC," said CDPHE director Larry Wolk. "We are expecting one or 2 more additional cases. We think the outbreak of enteroviruses and rhinoviruses peaked a couple of weeks ago and will continue to decline."

Enterovirus and rhinovirus cases are not reported to the state, and the health department doesn't track statewide numbers. The information on paralysis cases is based on surveillance data from 5 hospitals in 4 regions of the state, including the Denver-metro area, Montrose/Delta, El Paso and Mesa counties, as well as from outpatient visits to a large Denver-area system.

"We're doing the best possible surveillance we can under the circumstances," Wolk said.

[Byline: Electa Draper]

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Communicated by:
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******
[2] USA, overview - media report
Date: 7 Oct 2014
Source: NZ Stuff.co.nz [edited]
http://www.stuff.co.nz/world/americas/61731966/poliolike-virus-infects-hundreds-in-us


Amid fears of the Ebola virus, a more enigmatic virus is suspected of causing paralysis in dozens of children in the United States as doctors race to solve one of the most perplexing mysteries of their careers.

Enterovirus D68, which has hospitalised hundreds of children in almost every state and been linked to at least 4 deaths, may also have caused unexplained paralysis cases from Boston to San Diego, doctors said. Researchers said they fear the virus known as EV-D68 could be this generation's version of polio, said Ben Greenberg, a neurologist at the University of Texas Southwest Medical Center.

Non-polio enterovirus is related to the common cold, and this rare strain has hit children hardest. There have been 538 confirmed cases of EV-D68 in 43 states, beginning in the Midwest in August 2014, according to the Centers for Disease Control and Prevention, though doctors said the number is probably far greater since not all those infected are tested. Most only experience symptoms such as a runny nose, though a small percentage develop serious breathing difficulties, especially those with a history of such issues including asthma.

In rare cases, some children develop a fever, then headaches, neck pain, and within a few days or weeks, a swift and sudden paralysis that in the most severe cases left children bound to a wheelchair, unable to speak or breathe on their own, said Keith Van Haren, a Stanford School of Medicine neurologist who has been studying a link between the virus and paralysis since 2012.

The CDC so far hasn't determined whether the virus is causing the paralysis cases. EV-D68 hasn't been detected in all of the paralysed patients, and, given its widespread circulation, its presence could be coincidental, the agency said last week.

As the CDC investigates a possible connection between the virus and paralysis, more than 50 doctors at the country's top hospitals are holding regular calls, pooling research and studying those infected in hopes they can find a link that will lead to a drug or vaccine. They are racing against time as EV-D68 shows no signs of waning in many parts of the country.

Greenberg and his colleagues said they didn't realise the full scope of the outbreak until early last week. After reports of a cluster of 10 paralysis cases in Colorado, he and 30 other neurologists, infectious disease experts and public health officials hastily organised a conference call on 29 Sep 2014. To his surprise, almost every doctor on the phone had seen at least one case of unexplained paralysis in the past several months, some as many as 10.


While there were some variations, most images from medical scans looked strikingly similar, with the connection between the spinal cord and the muscles killed off with little chance of rebuilding the bridge, just like seen in those infected with polio, Greenberg said.
"There were remarkable similarities," said Van Haren, who was also on the doctors' conference call. "They sounded like interchangeable cases."

While the CDC continues to study the paralysis cases, "as a member of the clinical community, I think it is just a matter of time before we establish a definitive link between EV-D68 and this polio-like illness that follows," Van Haren said.

The virus has also been documented in at least 4 deaths. Elie Waller, a 4-year-old New Jersey boy, was kept home from school by his mother one day last month [September 2014] because he was developing a little bit of pinkeye, said Jeff Plunkett, the health officer for Hamilton Township where the boy lived. That night, he died in his sleep. The Mercer County medical examiner's office listed EV-D68 as the cause of death.

There are currently no vaccines in development for the virus, which was rarely seen until this year [2014], and before work on one can begin, researchers need more data to prove the virus is the cause of the paralysis, Greenberg said. Too often, samples aren't taken in time to detect the virus, and it's possible multiple viruses may be to blame.

As of last week, the CDC has begun a national surveillance and testing program, and Greenberg and other neurologists have formed a group to study patients more in depth.

The cases have doctors brushing up on their knowledge of polio, which hasn't naturally occurred in the US since 1979, after a vaccine was introduced in the 1950s. When Greenberg started seeing the polio-like cases, he called an older colleague at the National Institutes of Health who had trained in India to get a crash course on the disease and compare notes.

In contrast to enterovirus, there has been just one case so far of Ebola that was brought into the US from a patient infected in Liberia. Though Ebola can be lethal, with a mortality rate in Africa as high as 60 per cent, it is much less easily transmitted from person to person. Enterovirus is spread through casual contact, such as when an infected person sneezes or coughs, while Ebola is only transmitted through the sharing of bodily fluids, like blood, vomit or saliva.

Carrie Baker-Bailey fears her son William, 8, is one of those who may have lost the use of his arm from the virus. At the end of August 2014, she took him to the hospital near their San Diego home with neck pain, headache and a fever. An X-ray showed some inflammation in his chest, and his doctor sent him home with antibiotics, Baker-Bailey said in a telephone interview.

Two days later, he was feeling worse and had a stomachache, was constipated and was complaining of pain all over his body. They went back to the hospital, where doctors did a spinal tap, diagnosed him with spinal meningitis, and sent him home again.

That night, Baker-Bailey said she remembers him screaming in pain as he lay with her at 3:00 am trying to fall back asleep. The next morning, she knew something wasn't right and took him back to the hospital again. By then, he said he couldn't move his arm.

An MRI showed inflammation of his spinal cord, and he was admitted to the hospital where he spent 13 days in the intensive care unit. He tested positive for enterovirus, though doctors never did further testing to determine which of the more than 100 types of enterovirus he had.

Now, back at home, he still can't lift or move his arm and has weakness in his back. The once-active little boy who played baseball year-round and swam competitively now has difficulty sitting up on his own in a chair, can't dress himself, and hasn't been able to start the 3rd grade.

Baker-Bailey thinks the virus had something to do with her son's paralysis, but doctors haven't been able to give her a clear answer for what caused it or whether he will ever regain use.

"How did he get it; what did he even have, and is it ever going to get better? We don't have any answers," she said. "Sitting in the ICU for 13 days asking why? why? why? and not having any answers, that has been the hardest part."

[Byline: Shannon Pettypiece]

--
Communicated by:
ProMED-mail


[According to the above media report in [1], there have now been 12 cases of polio-like paralysis reported by Colorado. One of the cases reported earlier was mentioned to have been from another state in the catchment area for the Children's Hospital Colorado, but the state was not identified at that time (see prior ProMED-mail posts referenced below for more details).

Acute onset of weakness or paralysis not caused by infection with poliovirus has not been an officially reportable disease in the USA. On 26 Sep 2014, CDC issued an alert following the report of a cluster of 9 such cases in Colorado and requested that cases meeting the following case definition be reported to their state and local health departments: Patients less than 21 years of age with an acute onset of focal limb weakness occurring on or after 1 Aug 2014, and, an MRI showing a spinal cord lesion largely restricted to grey matter.


In response to a ProMED RFI on 27 Sep 2014 (see Polio-like illness - USA (02): (CO) enterovirus 68 susp, alert, RFI 20140927.2809908), we received a 1st hand report from the British Columbia Provincial Centre for Disease Control (BCCDC) on 2 cases that met the case definition (see Polio-like illness - North America: Canada (BC) 20140930.2819618). There was a CDC MMWR report providing more details on the original 9 cases reported by Colorado, and a detailed report on earlier reports of similar such cases identified in California during the period December 2012 and February 2014 (and previously reported on ProMED -- see Polio-like illness - USA: (CA) enterovirus 68 susp, RFI 20140224.2296126) published on 3 Oct 2014. Other than the CDC and and BCCDC reports as described above, all other case reports have come from media reports and not official sources.

In many of the cases, either infection with EV-D68 has been identified or a history of an antecedent respiratory illness compatible with that seen with EV-D68 infection was observed, so that current thinking is leaning towards a possible association with EV-D68. But caution has been raised that this may well be a coincidental finding, as it is coinciding with reports of major EV-D68 activity in North America at this time. A causal relationship has not as yet been established/confirmed.

That being said, according to the media reports, there have been a total of 30 cases identified in the USA from 9 (or possibly 10 states if the one case in Colorado was from a state not previously mentioned: Alabama, California, Colorado, Massachusetts, Michigan, Missouri, Pennsylvania, Texas and Virginia) and 13 cases identified in Canada from 3 provinces (Alberta, British Columbia and Ontario).


More information on the current status of reporting of cases meeting the CDC case definition would be greatly appreciated.

For the HealthMap/ProMED map of the USA see http://healthmap.org/promed/p/106. - Mod.MPP]


Ebola Outbreak: India Monitoring Possible New Ebola Victim From Japan


on October 06 2014 1:39 PM
Treatment for Ebola in Monrovia, Liberia
Liberia health workers wearing protective clothing prepare to carry an abandoned dead body presenting with Ebola symptoms at Duwala market in Monrovia on Aug. 17, 2014. Reuters/2Tango
A Japanese tourist visiting India is reportedly suspected to have contracted the Ebola virus that is wreaking havoc across West Africa and causing scares from Dallas to France. Kawakubo Yuko, 27, was visiting Imphal, the capital of the Indian state of Manipur, after touring five other countries and arriving from Myanmar, The Hindu, an English-language daily Indian newspaper, reported Monday.
Yuko was planning to tour Manipur, but her trip was cut short when she began to exhibit symptoms of a potential Ebola infection. After tests for more common illnesses came up negative at Imphal’s hospital, doctors sent blood samples to India’s National Institute of Virology to be tested for Ebola, The Hindu reported.
If she's found to be positive for Ebola, Indian health officials may decide to have her moved to the Regional Institute of Medical Sciences, Imphal, because it has an isolation ward, which Imphal’s J.N. Institute of Medical Sciences, where she's currently being held, does not, according to India’s Z News service. Z News added that Indian officials may decide to screen visitors to Manipur for the Ebola virus infection.
Yuko’s case isn't the first to raise alarms about Ebola potentially spreading to India. A 26-year-old Indian man named Alip Das was reportedly suspected earlier this month of having contracted Ebola during a trip to Nigeria, which has had a number of Ebola cases. But tests showed that he didn't have Ebola, according to the Echo of India newspaper.
But fears and anxiety about the deadly virus have been -- and remain -- high across India, as the country works to keep Ebola from reaching its people. Health Minister Dr. Harsh Vardhan spoke out in late August to quash rumors that a person who had traveled to Liberia had brought the hemorrhagic fever back from the Ebola-ravaged country, India’s NDTV reported.
"We are carefully screening all passengers coming from Ebola infected countries at the airport itself. As of today there is no suspected case of Ebola in India," the health minister said in Indore.

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Marburg: Five more suspects reported, 97 being monitored

 
An Ebola isolation unit at Mulago Hospital which is being rehabilitated to accommodate Marburg patients. PHOTO BY RACHEL MABALA 
By Agatha Ayebazibwe

Posted  Tuesday, October 7  2014 at  01:00
In Summary
On alert. Marburg samples picked Mpingi District to be examined by the virus institute. P.45 Marburg suspects reported
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Kampala. The Ministry of Health yesterday sent five more samples of the suspected Marburg fever to the Uganda Virus Research Institute (UVRI) for more tests after they presented signs of the disease.
On Sunday, the ministry confirmed a health worker had succumbed to the disease following laboratory tests done on September 30.
The ministry is also awaiting results of a sample from the deceased’s brother, who has so far been listed as having developed signs of the deadly disease. He has since been quarantined and isolated for further monitoring.
According to the World Health Organisation country representative, Dr Alemu Wondimagegnehu, the five samples were drawn from people who were in contact with the deceased while at Mpingi Health Centre IV.
“The information we got from the team on the ground is that the five presented with signs of the disease. The samples have been delivered at UVRI and results are expected soon,” Dr Wondimagegnehu told Daily Monitor in an interview.
A temporary isolation centre has been set up at Mpigi Health Centre IV where the suspected cases are being quarantined.
The permanent secretary in the Ministry of Health, Dr Asuman Lukwago, also said another 17 contacts have been identified in Kampala, bringing the total of those who were in contact with the deceased to 97.

“Our teams are still on the ground tracing all the possible contacts. Those who have been identified will be isolated in their homes for at least 21 days. If they show any signs such as fever and headache, then we take their samples for further tests,” Dr Lukwago told Daily Monitor.
He added that results of the six samples are expected in a few hours.
However, some officials have expressed concern over the ministry’s preparedness to handle the crisis, should it become a fully-fledged Marburg outbreak.
“The confirmatory test results were received at the Ministry of Health on September 30, but to date, the ministry has not released any money to facilitate the teams to respond appropriately,” said a source within the ministry who preferred to remain anonymous.
But Dr Lukwago said they are still treating the matter as an emergency, saying those involved can use their money which will be refunded once the ministry gets the money.
“We are aiding them with things such as fuel, cars to enable them move from one place to another. We also expect to have a costed plan for the response in the next 36 hours,” he added.  http://www.ugandan-news.com/
Eight under surveillance over Marburg
Publish Date: Oct 06, 2014

By Vision Reporter

The Ministry of Health has said a total of eight people who earlier got into contact with the Marburg confirmed case have developed signs of the disease.

This follows the death of a 30-year old health worker that was announced Sunday.
The victim had been a radiographer, or X-ray technician, at the Mpigi Health Centre IV, but was recruited two months ago for a similar position at Mengo Hospital.

When he felt ill on September 17, he traveled back to Mpigi for treatment since “he felt more confortable with a facility that he had worked with for a long time.”

Below is the full statement from the Ministry of Health:

A total of eight people who earlier got into contact with the Marburg confirmed case have developed signs of the disease.

The Ministry has taken samples from the eight suspects and are being investigated at the Uganda Virus Research Institute.

Among the suspects are four from Mpigi, two from Kasese and two from Kampala district. Preparations are underway to quarantine the suspects as a preventive measure for the spread of the disease.

To date there is only one laboratory confirmed case that has been reported in the country. This is the first case that was reported at Mengo Hospital and
has since died.

The National Taskforce continues to closely monitor all people who got into contact with this confirmed case.

The surveillance team on Monday was able to list an additional 17 people who got into contact with this confirmed case.

These include 16 people from Kampala and one from Kasese. This therefore brings the total number of contacts under surveillance to 97.

The Ministry of Health with support from Medicens San Frontiers (MSF) and the US Center for Disease Control and Prevention, has today trained a total of 103 health workers from Mengo Hospital.

The team was trained in Marburg prevention, treatment and control. Others were trained in sample picking and infection control. A team of experts will tomorrow be dispatched to Kagando Hospital in Kasese district to guide health workers in infection control measures.

With support from MSF, rehabilitation of the Isolation Facility at Mulago National Referral Hospital will commence tomorrow 7th October 2014 and will be ready and operational by Wednesday October 8th 2014.

The facility will in addition to the National Isolation Center in Entebbe attend to all suspect and confirmed cases in Kampala and neighboring districts. The Ministry of Health has today dispatched a total of 300 Personal Protective Equipment (PPEs) to Mpigi Health Center IV and Mengo Hospital.

The Government reassures the general public that the situation is under control as everything is being done to control the spread of this highly infectious disease.


Dr. Alex Opio
FOR: Director General of Health Serviceshttp://www.newvision.co.ug/news/660469-eight-under-surveillance-over-marburg.html