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Sierra Leone: Ebola update, August 23
« on: August 23, 2014, 11:42:35 PM »

This is a very interesting blog. It is one of several.

This posting here is an attractor. Please go to the linked page and read there. Only there you will get the URLs of the sources.


"Medicine is a social science, and politics is nothing else but medicine on a large scale"—Rudolf Virchow
August 23, 2014

Sierra Leone: Ebola update, August 23

Via the Facebook page of the Ministry of Health and Sanitation, Sierra Leone:

Ebola outbreak update: As of today, 23 August 2014, we have a total of 236 patients who have survived Ebola Virus Disease and subsequently discharged.
The total number of new confirmed cases for today is 56: Kailahun 6, Kenema 13; Bombali 6; Tonkolili 2; Port Loko 14; Pujehun 1; Bo 6; Moyamba 1 and Western Area 10 The total number of cumulative confirmed deaths is 333 and cumulative number of confirmed cases is 881 with Kailahun 417, Kenema 303; Kono 1; Kambia 1; Bombali 17; Tonkolili 10; Port Loko 47; Pujehun 5; Bo 33; Moyamba 9; Bonthe 1; Western Area Urban 26; Western Area Rural 11. Koinadugu district still remains the only district that has not registered confirmed cases of Ebola in Sierra Leone. 
The cumulative number of probable cases is 36 and probable deaths 34 while the total cumulative number of suspected cases is 49 and suspected deaths is 8. 
The United Nations high level delegation headed by the Special Representative of the UN Secretary General for Food and Nutrition, David Nabarro is currently in Freetown to assess the current Ebola Response in the country. The team visited the Emergency Operations Center (EOC) where they met with the Minister of Health and Sanitation and cross-section of members of the EOC to discuss the progress the country has made so far in the fight against the Ebola Virus Disease (EVD) and the challenges.
The Minister of Health and Sanitation, Miatta Kargbo in her welcome address informed the delegation that though the country still faces challenges, much progress has been made especially in the epicenter districts of Kenema and Kailahun with the measures government has put in place such as declaring the state of emergency and isolating those two epicenter districts and the quarantining of homes with confirmed cases across the country. She highlighted the shortage of clinical expertise, logistics ranging from transportation to protective gears and food supplies for quarantined homes and epicenter districts as the major challenges facing the fight against the Ebola outbreak in Sierra Leone.
The delegation discussed several issues such as health workers incentives and donor support to Sierra Leone. The head of delegation, David Nabarro while addressing the meeting said that the Secretary General is concerned about the growing frustration from Sierra Leone of the slow financial support coming from the Donors to support the fight against the outbreak and went further that they have been sent by the UN Secretary General to find out why donors have been slow to release funds that they have committed to the countries affected.
He further disclosed that the World Bank has committed six million dollars to Sierra Leone that could be used to support contact tracing activities and health worker incentives and suggested some innovative ways these incentives could be paid to the health workers, such as using telephone banking system or mobile phone system available in the country.
The Minister of Health and Sanitation was however, quick to inform the delegation that the country has yet to receive the six million dollars committed by the World Bank.
The delegation is scheduled to meet with the donor community and the Non- Governmental Organizations operating in Sierra Leone later tonight and with His Excellency the President Dr. Ernest Bai Koroma tomorrow to discuss the Ebola response in Sierra Leone.
Other members of the delegation include the Regional Director for the World Food Programme, the Regional Director of the Office of Coordination of Humanitarian Affairs (OCHA); the Deputy Regional Director for UNICEF and the WHO Assistant Director General for Health Safety
August 23, 2014 at 07:29 PM in Ebola, Politics and health | Permalink | Comments (0)
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Ebola: Research team says migrating fruit bats responsible for outbreak

Via The Observer: Ebola: research team says migrating fruit bats responsible for outbreak. Excerpt:

The largest-ever outbreak of Ebola was triggered by a toddler's chance contact with a single infected bat, a team of international researchers will reveal, after a major investigation of the origins of the deadly disease now ravaging Guinea, Liberia, Ivory Coast and Nigeria.
A group of 17 European and African tropical disease researchers, ecologists and anthropologists spent three weeks talking to people and capturing bats and other animals near the village of Meliandoua in remote eastern Guinea, where the present epidemic appeared in December 2013. They have concluded that the disease was spread by colonies of migratory fruit bats. Their research is expected to be published in a major journal in the next few weeks.
News of the research came as the first confirmed case of a Briton contracting the disease emerged on Saturday night. Professor John Watson, deputy chief medical officer, said the overall risk to the UK public remains "very low".
Early studies suggested that a new strain of Ebola had emerged in west Africa but, according to epidemiologist Fabian Leendertz, a disease ecologist at the Robert Koch Institute in Berlin, who led the large team of scientists to Guinea, it is likely the virus in Guinea is closely related to the one known as Zaire ebolavirus, identified more than 10 years ago in the Democratic Republic of the Congo.
Leendertz said the virus had probably arrived in west Africa via an infected straw-coloured fruit bat. These bats migrate across long distances and are commonly found in giant colonies near cities and in forests.
The outbreak has killed more than 1,300 people in west Africa so far, many of the deaths occurring in Liberia. Within a week of the two-year-old boy catching the disease in Meliandoua, both he and his mother had died and it was spread to nearby communities and urban areas by mourners at a funeral.
Scientists have suspected for several years that bats are the wild "reservoirs" of Ebola, but direct transmission to humans is extremely rare, despite communities regularlyhunting the bats for food. Nearly all previous epidemics had been linked to the bushmeat trade, with hunters picking up dead infected animals in the forestand selling them on.
Previous outbreaks saw catastrophic death rates in gorilla and chimpanzee populations, which led some scientists to think they may be responsible for the disease spreading.
August 23, 2014 at 07:23 PM in Animal to human diseases, Ebola | Permalink | Comments (0)
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Ebola in Liberia: Bullet removed from West Point boy's stomach

Credit: FrontPageAfrica

Via FrontPageAfrica: West Point Riot: Bullet Removed From Another Boy Stomach. In the photo above, the boy is presumably the one on the right, with an obvious bullet wound; Shaki Kamara is at left in the green shirt, his shattered leg bandaged. Excerpt:

A second boy from the quarantined community of West Point had a bullet removed from his stomach at the S.D Cooper Clinic in Monrovia on Friday after his family with the help of the commissioner and health workers rushed him to hospital. The boy identified as Benny-Boy sustained a bullet hole in the stomach during the riot in West Point on Wednesday according to family sources.
The boy’s family confirmed that a bullet was removed from his belly. His uncle Mr. Arthur Gurley said the boy sustained the injuries during Wednesday’s riots and that the boy’s condition is not yet stable.
“Well, according to reports from the hospital, he is in critical condition. They did the operation and took a bullet from inside his stomach,” said Gurley via a mobile phone interview with FrontPageAfrica. He said the wounded boy was earlier taken to the Redemption hospital and discharged, but he continued to bleed from his wound, which led them to take him back to a health facility.
“When the incident occurred, they took him to the checkpoint, but the officers could not permit him to be taken to hospital. But later they took him to the Redemption hospital and after treatment at the Redemption hospital, they brought him back home,” said Gurley.
“But they never knew that the bullet was inside him. But when they brought him home his condition began to worsen and the commissioner took him to the S. D. Cooper clinic; that’s where the operation was done. He’s under critical condition at the S.D. Cooper clinic on 12th street.”
Riots broke out in West Point on Wednesday after the police backed by the army had gone in to evacuate the commissioner and her family. Miatta Flowers called for help after angry residents had surrounded her house in anger when they noticed she was trying to flee the area. The residents threw stones at the security forces as they escorted Flowers and her family out of the densely populated area.
The stoning intensified and the army fired live shots. One 15-year-old boy died on Wednesday evening from apparent gunshot wound. But authorities in Monrovia say there was no shot fired at rioting West Pointers.
Defense minister Brownie Samukai said the wound was a superficial one caused by a barbed wire that has been placed in the buffer zone and that the boy had tripped and fell over it with a wheel he was pushing.
I have seen at least one photograph showing Shaki Kamara's wound, and it is far from a superficial laceration; his right shin has been exploded.

If the Liberian government has started out lying about events like this, it will end in much worse than tears before bedtime.
August 23, 2014 at 04:58 PM in Ebola, Physical trauma, Politics and health, Social disruption, Violence | Permalink | Comments (0)
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UN intensifies Ebola response in Liberia

Via ReliefWeb, an August 22 WHO report: UN intensifies Ebola response in Liberia.

As Liberia continues to struggle with the largest and most complex outbreak of Ebola in history, the World Health Organization (WHO) is working with the UN, the government and other partners to intensify the Ebola response by injecting new assets into Liberia’s health sector and beyond.
The announcement comes following the UN high level delegation’s meetings with government officials, NGOs and other partners to review and fill the gaps in the ongoing Ebola response. “Ebola in Liberia must be addressed to ensure a stable economy, future and society,” says Karin Landgren, the Special Representative to the UN Secretary-General.
“The magnitude of this outbreak requires a higher level of coordination than previous responses and the UN Mission in Liberia will play a strong role in this effort.” The outbreak in Liberia continues to expand.
As of 22 August, there have been 1,082 cases and 624 deaths reported. Ebola virus disease is putting strains on society and areas outside the disease itself. Systems for common and sometimes serious health conditions are not functioning as they should. Increasingly, mothers and children cannot access the care they need.
“This extraordinary outbreak requires an unprecedented response in all dimensions,” says Dr David Nabarro, the UN Secretary-General’s Coordinator for the Ebola response working in close collaboration with WHO. “The new coordinating platform that engages government, partners and the UN will bring a new level of accountability, and integrate effective action so we can ensure the right resources get to the areas they are needed most.”
Stepping up the health aspects of the outbreak are the key to stopping it. First, identifying those who are sick early, caring for them in health facilities and protecting others so this disease does not spread to any more people. But the number of patient beds available in care centres in Monrovia are insufficient for the numbers of patients expected.
“We have seen some of the available current care centres in Monrovia that have been set up by the Ministry of Health and Social Welfare, Medecins Sans Frontier and other partners, and we recognize containing this outbreak will require many more areas like this,” says Dr Keiji Fukuda, Assistant Director-General for WHO and one of the leaders of the UN high-level delegation in Monrovia this week.
“Therefore, today, WHO is committing to step up its work with partners to build additional care facilities around Monrovia to expand the number of Ebola care beds by as many as 500 in the next 6 weeks.”
Although Ebola has a high fatality rate, experience has shown that even without new medicines, proper treatment of persons increases chance of survival. In addition, if it continues unabated, the Ebola outbreak could pose an additional risk to other health issues. Some health clinics have closed and resources have been shifted to the Ebola response.
August 23, 2014 at 04:43 PM in Ebola, NGOs, Public health | Permalink | Comments (0)
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Sierra Leone: If they survive in Ebola ward, they work on

A great find by Lucie Lecomte in The New York Times: If They Survive in Ebola Ward, They Work on. Click through for a video about the "burial boys." Excerpt from a report datelined Kenema:

The best defense against despair was to keep working. Many times, that choice was far from obvious: Josephine Finda Sellu lost 15 of her nurses to Ebola in rapid succession and thought about quitting herself.
She did not. Ms. Sellu, the deputy nurse matron, is a rare survivor who never stopped toiling at the government hospital here, Sierra Leone’s biggest death trap for the virus during the dark months of June and July. Hers is a select club, consisting of perhaps three women on the original Ebola nursing staff who did not become infected, who watched their colleagues die, and who are still carrying on.
“There is a need for me to be around,” said Ms. Sellu, 42, who oversees the Ebola nurses. “I am a senior. All the junior nurses look up to me.” If she left, she said, “the whole thing would collapse.”
The other nurses call her Mummy, and she resembles a field marshal in light brown medical scrubs, charging forward, exhorting nurses to return to duty, inspecting food for patients, doing a dance for once-infected co-workers who live — “nurse survivors,” she called them enthusiastically — and barking orders from the head-to-toe suit that protects her from her patients.
In the campaign against the Ebola virus, which is sweeping across parts of West Africa in an epidemic worse than all previous outbreaks of the disease combined, the front line is stitched together by people like Ms. Sellu: doctors and nurses who give their lives to treat patients who will probably die; janitors who clean up lethal pools of vomit and waste so that beleaguered health centers can stay open; drivers who venture into villages overcome by illness to retrieve patients; body handlers charged with the dangerous task of keeping highly infectious corpses from sickening others.
Their sacrifices are evident from the statistics alone. At least 129 health workers have died fighting the disease, according to the World Health Organization. But while many workers have fled, leaving already shaky health systems in shambles, many new recruits have signed up willingly — often for little or no pay, and sometimes giving up their homes, communities and even families in the process.
“If I don’t volunteer, who can do this work?” asked Kandeh Kamara, one of about 20 young men doing one of the dirtiest jobs in the campaign: finding and burying corpses across eastern Sierra Leone.
When the outbreak started months ago, Mr. Kamara, 21, went to the health center in Kailahun and offered to help. When officials there said they could not pay him, he accepted anyway.
“There are no other people to do it, so we decided to do it just to help save our country,” he said of himself and the other young men. They call themselves “the burial boys.”
August 23, 2014 at 04:07 PM in Ebola, Healthcare-associated infections, Occupational health & safety | Permalink | Comments (0)
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Canada: Quarantine case at Maisonneuve-Rosemont Hospital not Ebola

Thanks to Viki Hansen for sending the link to this CBC News report: Quarantine case at Maisonneuve-Rosemont Hospital not Ebola. As Viki says, "That's some fast testing!" Excerpt:

A patient who was quarantined at Maisonneuve-Rosemont Hospital in Montreal on Saturday after exhibiting some signs of Ebola has tested negative for the deadly virus.
The patient had a fever after recently returning from a trip to West Africa.
The hospital issued a statement on Saturday morning saying that it had quarantined the patient as a precaution even though the chances of the person actually having Ebola were quite slim.
Dr. Karl Weiss, chief of the hospital’s infectious diseases department, said the patient’s tests were run through a specialized lab in Winnipeg. 
"You can't take any chance, so this is what happened with someone who just returned from Guinea within the last 21 days, came to the hospital with fever and other general symptoms — non-specific symptoms —  and because of that we have no choice but to put in place a certain protocol and make sure," Weiss said.
August 23, 2014 at 03:56 PM in Ebola, Surveillance, Travel & health | Permalink | Comments (0)
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Ebola in Liberia: UNICEF SitRep #48, August 22

Via ReliefWeb, a UNICEF report: UNICEF- Liberia Ebola Virus Disease: SitRep #48, 22 August 2014. Click through to download the PDF. The summary:

• According to the MoHSW, in the past week,1 297 new suspected, probable and confirmed cases of Ebola were reported in Liberia – the largest number of cases reported in one week since the epidemic began in late March.
• With the additional cases, as of 20 August, the cumulative number of suspected, probable and confirmed Ebola cases reported during Outbreak #22 stood at 1,074; the total number of suspected, probable and confirmed Ebola deaths reported during Outbreak #2 stood at 613; and the total number of suspected, probable and confirmed Ebola cases reported among health care workers (HCWs) during both outbreaks stood at 115.
• Confirmed Ebola cases have now been reported in 12 of Liberia’s 15 counties, and a suspected Ebola case has been reported in one additional county in the southeast.
• In an effort to prevent the further spread of the disease, the Government of Liberia has commenced quarantining some communities, including West Point in Monterrado County, where several security incidents have occurred in the past week. The Government has also instituted a nationwide curfew from 2100 to 0600, until further notice; and has deployed additional security forces to border points and some quarantined communities. Travel to the south east counties has been restricted. For more details, refer to Special Sitrep on 20 August 2014.
• UNICEF’s Deputy Regional Director, Christine Muhigana, arrived in Liberia this week for discussions with Government, UN and other partners to discuss scaling up UNICEF’s support to the national Ebola response.
• In the past week, UNICEF worked closely with the Health Promotion Division of the MoHSW and key partners to revise Ebola awareness and prevention messages; to develop new information, education and communication (IEC) materials to carry these messages; and to develop a standardized training module for potential use by all national Social Mobilization partners. The agency also provided an additional five 45-kg drums of chlorine to the MoHSW and, with support from USAID, has scheduled a major airlift to Liberia of 68 metric tons of urgent material, including chlorine, medical and water, sanitation and hygiene (WASH) supplies from UNICEF’s supplies division in Denmark.
• The total budget for UNICEF’s six-month Ebola response plan, which covers the period from July to December, is US$ 6 million. The current funding gap is US$ 5 million. Support is urgently needed to implement and sustain the plan in the medium- to long-term.
August 23, 2014 at 03:28 PM in Ebola | Permalink | Comments (0)
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Ebola's enduring legacy of trauma

Thanks to Lucie Lecomte for sending the link to this report in The Sydney Morning Herald: Ebola's enduring legacy of trauma. Excerpt:

Before he enters the makeshift hospital wards at Sierra Leone's Ebola treatment centre - the largest of its kind in the world - Malcolm Hugo spends several minutes dressing for the job.
The psychologist layers up in a plastic bodysuit, chlorine-rinsed white gumboots, hood, mask, rubber apron, plastic gloves and goggles. As the Australian approaches bedridden patients carrying Ebola, not a millimetre of skin is exposed to the potential harm of the deadly virus.
He says it is too hot to wear the protective outfit for more than half an hour. But it is more impractical in another, more important way: if a patient is too sick to walk, they are normally too sick to talk.
"They come outside the tent and I can sit there and talk to them without protective gear," the Medecins Sans Frontieres volunteer, who has been living in the world's Ebola epicentre since June, told The Sun-Herald.
"The first thing I do (when a new patient is admitted) is get contact numbers of family, so I can ring family to let them know how they're doing. I give them a phone in each tent so they can make calls. I do anything that makes them feel more comfortable."
It is his remit, too, to notify families when patients die.
"The lousy part of the job is telling relatives that their children are dead, telling patients that they they have Ebola - how to deliver that in a sensitive way. The most difficult part is telling people their relatives have died. Particularly children."
The needs of a growing Ebola-affected population have never been greater. Nearly half a million people live in the remote region, their villages spread across an area that is as logistically challenging as it is economically disadvantaged. It is the rainy season, and, as temperatures hover around 30C, downpours hamper movement of both people and supplies on mud roads that are all but impassable. 
Hugo, a grandfather and retired clinical psychologist from Adelaide, is the only Australian in a group of around 30 expat medical staff working in the eye of West Africa's Ebola outbreak. An additional 150 to 200 national staff manage nursing, cleaning and burying bodies.
The 80-patient facility has treated approximately 360 suspected cases of Ebola since opening in June. Of the approximately 260 confirmed cases, just 62 have survived. With many deaths beyond the fences of the centre, death figures are much higher.
The disease is passed on by contact with bodily fluids. A single touch of skin against skin is enough to spread the virus. Symptoms can be flu-like and include bleeding and nervous system damage. The latest outbreak has so far killed 1350 people.
In a remote region in a country as poorly resourced as Sierra Leone, Hugo says the virus affects everybody in some way or other.
"A lot of my time is with children, finding places for them to go when their parents die," he says. He has watched as doctors have been forced to remove babies from the breasts of breastfeeding mothers.
With entire families and communities living in fear and grief, the virus brings with it a raft of psychological effects, many of which remain uninvestigated, given the disease's rarity.
"My own observations are that it's extremely traumatic and I don't use that word loosely ... Children are often in a state of shock and not sure what's going on. With adults, some people are a little bit angry, and there's grief.
"I've just come from speaking with a man and woman whose three children have died here in the last three days; it's difficult for them to process that given that they are ill, too." Hugo pauses. "He won't survive, she will."
August 23, 2014 at 03:23 PM in Ebola, Psychosocial issues and health, Social disruption | Permalink | Comments (0)
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Ebola in Sierra Leone: More on the British case

Via, Lucie Lecomte has found this CNN report: British national in Sierra Leone tests positive for Ebola virus. Excerpt:

A British citizen who lives in the West African nation of Sierra Leone has tested positive for the Ebola virus, according to Britain’s Department of Health.
The man, simply identified as “William,” was living in a home established by an American university for researchers in Sierra Leone.
“William” was a volunteer nurse in Kenema Government Hospital and was working with Ebola patients in the hospital, according to Dr. Robert Garry of Tulane University. Garry is manager of the university’s program that researches Ebola. The hospital is run by the government of Sierra Leone, but receives support from Tulane researchers.
Garry said that no one else living in the house was “significantly exposed” and “William” is still in Sierra Leone.
According to the Tulane doctor, “William” got sick on Friday and had a low viral load, meaning he wasn’t infected for a long time.
Garry added that the British national has a fever but none of the other symptoms of the Ebola virus. 
In a statement, posted on the United Kingdom’s government website Saturday, British Chief Deputy Medical Officer John Watson said the overall risk to the public in the UK is very low.
Watson also said that medical experts are “assessing the situation in Sierra Leone to ensure that appropriate care is provided.”
August 23, 2014 at 03:16 PM in Ebola, Healthcare-associated infections | Permalink | Comments (0)
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Canadian hospital isolates possible Ebola patient

Via Yahoo!News, an AFP report: Canadian hospital isolates possible Ebola patient. Excerpt:

A Canadian hospital said Saturday it has placed a patient who recently returned from West Africa in isolation as it awaits whether the individual tests positive for Ebola.
The patient was quarantined after experiencing a high fever, a symptom of the often fatal virus, according to Montreal's Maisonneuve-Rosemont Hospital.
The person had recently returned from Guinea, one of the West African countries affected by the worst Ebola epidemic since its discovery four decades ago.
On Friday, the World Health Organization said the outbreak sweeping the region has claimed 1,427 lives.
Blood samples taken Friday are currently being tested at a laboratory in Winnipeg, according to Karl Weiss, who heads the hospital's infectious disease department.
Public health authorities said it was highly unlikely the patient has Ebola but that it wanted to eliminate any doubts.
August 23, 2014 at 01:28 PM in Ebola, Travel & health | Permalink | Comments (0)
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UNICEF airlifts 68 tonnes of supplies to Liberia, ramping up Ebola response

Via ReliefWeb, a news release: UNICEF airlifts 68 tonnes of supplies to Liberia, ramping up Ebola response. Excerpt:

A cargo plane carrying 68 metric tonnes of health and hygiene supplies from UNICEF landed in Monrovia early Saturday morning, bringing urgently needed supplies to combat the worst Ebola outbreak in global history.
Today’s shipment, from UNICEF’s global supply hub in Copenhagen, contained basic emergency items for front-line health workers to protect themselves and prevent the spread of infection. They included 27 metric tonnes of concentrated chlorine for disinfection and water purification and 450,000 pairs of latex gloves. Also on board were supplies of intravenous fluids, oral rehydration salts and ready-to-use therapeutic food to feed patients undergoing treatment.
The flight was met in Monrovia by representatives of UNICEF and Liberia’s Ministry of Health and Social Welfare. Supplies will be distributed to health facilities nationwide, many of which are critically short of basic health care materials. Coupled with a shortage of manpower, this has left thousands of Liberians without access to treatment and essential health care.
“UNICEF has been a friend and partner to Liberia for decades and has seen us through some of our darkest days,” said Tolbert Nyenswah, Assistant Minister of Health and Social Welfare and national incidence manager for the Ebola response in Liberia. “We are extremely grateful for these supplies, which will help us to begin disinfecting, resupplying and reopening clinics and hospitals so that they can resume providing essential health services to Liberians.”
As of Friday, 20 August, there have been over 1,000 confirmed or suspected cases of Ebola in Liberia, with 613 deaths linked to the outbreak. In part the rapid spread of the disease is due to the country’s weakened health care system, which had been seriously damaged by years of civil war.
“Basic health care cannot be Ebola’s next casualty,” said Sheldon Yett, UNICEF’s Liberia Country Representative. “UNICEF has been working on multiple fronts since the beginning of the outbreak to provide critically needed supplies as well arming communities with the information they need to stop the spread of the disease. This shipment will complement those efforts with a new surge of supplies to equip health facilities, support infection control, and protect health workers on the front lines.”
The supplies delivered this morning, were procured and delivered with support from USAID’s Ebola Disaster Assistance Response Team, which is coordinating US government efforts to stop the spread of Ebola.
August 23, 2014 at 12:22 PM in Ebola | Permalink | Comments (0)
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Ebola outbreak: British national living in Sierra Leone tests positive for virus

Via The Guardian: Ebola outbreak: British national living in Sierra Leone tests positive for virus. Excerpt:

A British national living in Sierra Leone has tested positive for the Ebola virus – the first Briton confirmed to have contracted the disease.
The Department of Health said medical experts were assessing the situation "to ensure that appropriate care is delivered". Consular assistance is being provided.
Professor John Watson, deputy chief medical officer, said: "The overall risk to the public in the UK continues to be very low. Medical experts are currently assessing the situation in Sierra Leone to ensure that appropriate care is provided.
"We have robust, well-developed and well-tested NHS systems for managing unusual infectious diseases when they arise, supported by a wide range of experts."
Meanwhile, west African nations have imposed stringent new measures to stop the spread of Ebola as two new cases emerged in Nigeria that appear to indicate a widening of the circle of those affected.
The Ivory Coast has closed its borders with its Ebola-hit neighbours and Sierra Leone has said it will jail people who hide patients with the virus. The World Health Organisation (WHO) believes the practice has contributed to a major underestimation of the current outbreak.
It was announced on Saturday that the borders between Ivory Coast and both Guinea and Liberia had been closed the previous day as the death toll of the epidemic reached 1,427 across west Africa.
Agence France-Presse reported that the measure was put in place "to protect all people, including foreigners, living on Ivorian territory," Ivorian prime minister Daniel Kaban Duncan said.
August 23, 2014 at 12:16 PM in Ebola | Permalink | Comments (0)
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Ebola: Canada advises citizens against non-essential travel to Liberia

Via the Government of Canada: Travel Advice and Advisories for Liberia.

Foreign Affairs, Trade and Development Canada advises against non-essential travel to Liberia, due to the Ebola outbreak and its impacts on mobility and access to quality health care. There is no Government of Canada office in Liberia. As such, our ability to provide consular assistance is extremely limited.
If you are in Liberia and your presence is not essential, you should consider leaving by commercial means, as it is becoming increasingly difficult to do so.
August 23, 2014 at 10:01 AM in Ebola, Travel & health | Permalink | Comments (0)
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Losing sight of Ebola victims' humanity

Thanks to Laura Seay for tweeting the link to this excellent long article in The Atlantic: The Danger in Losing Sight of Ebola Victims' Humanity. Strongly recommended. Excerpt:

When a crisis like Ebola strikes in this context it is not surprising that aggressive, opaque public health measures are met with suspicion, resistance, and anger. The Ebola task force meetings I continued to attend increasingly focused on these community level challenges. The hour long task force meetings turned into four hours, circling around and around one issue: “the lack of understanding.”
Funding began pouring in from the large NGOs for door-to-door sensitization. Pickup trucks with large speakers drove slowly through the market each day, blasting: “It feels like malaria, but it’s not! If you want to survive, go quickly to a facility!” One day, my motorbike taxi was halted as a several-thousand-person “Ebola protest” marched through town, families vehemently chanting as if to scare the disease away.
As public health authorities in Freetown and Kono—as well as the international media—increasingly complained of how people in Kailahun “did not understand,” the situation was spiraling out of control. Several times, patients were forcibly removed by their relatives from isolation wards and disappeared into the rural provinces.
This, too, was interpreted as a result of ignorance, and inspired a new round of educational initiatives arguing against the use of local healers and traditional medicine in Kono and elsewhere.
“Many people in Sierra Leone, where an Ebola epidemic has gripped the country for the first time, refuse to accept that the disease can be tackled by Western medicine,” a writer for The Economist’s Baobab Blog explained. As the outbreak continued to spread, so too did a shallow discourse of socio-cultural explanations. Health authorities, experts, and the media increasingly blamed communities for the continued spread of the disease.
In public health, the emphasis on “harmful behaviors” arising from ignorance fails to acknowledge the complex socioeconomic factors and structural conditions that can lead to poor health. In the wake of the first Ebola cases in Guinea, the Guinean government and later the Sierra Leonean government launched a massive campaign to persuade people not to hunt and consume bushmeat, which is thought to carry Ebola.
Though well-intentioned, these campaigns did not adequately consider that malnutrition is widespread in rural West Africa, and villages in which the population heavily relies on bushmeat are often healthier—in our experience, they even have significantly lower rates of malnourishment.
It wasn’t just an issue of people “not knowing” not to eat fruit bats and gorillas—bushmeat was their only source of protein. Continuing to eat it can be understood as a rational decision based on a risk assessment—malnutrition will likely always lead to more deaths in West Africa than an Ebola outbreak. 
But I’ve also observed through four years of fieldwork in Sierra Leone that public health interventions that rely on the passive reception of “medical facts” by target communities and that hinge on getting "them" to think like "us," are simply ineffective.
To health workers, taking patients home to die in surrounded by their families, to be collectively buried and remembered in their villages might be considered “irrational” or “contributing to the spread of the disease.” But these practices also allow for a kind of solidarity and resilience in the face of capricious, cruel disease.
August 23, 2014 at 09:09 AM in Culture and health, Ebola, Public health | Permalink | Comments (0)
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Vietnam officials give green light to feverish Nigerian

Via Thanh Nien Daily: Vietnam officials give green light to feverish Nigerian. Excerpt:

Following a string of sensationalist stories, health officials assured the Vietnamese public that an Ebola-stricken patient cannot dodge Vietnam's thermal imaging cameras by taking a Tylenol.
Phan Trong Lan, director of the Pasteur Institute in Ho Chi Minh City, made the announcement after reports got out that a Nigerian passenger had entered Vietnam on Tuesday with fever and went undetected by thermal imaging cameras set up at Tan Son Nhat International Airport.
The passenger took fever relief medicine six hours before arriving at the airport, Lan said.
Although the man was not detected by the cameras, he was quarantined by Vietnamese health officers for a medical checkup.
He was among 20 Nigerian passengers who were required to undergo medical screening as soon as they arrived at the airport.
The man wrote on a health declaration form that he had sore throat, and had taken a fever relief pill.
He was then kept at the airport for 10 hours and discharged after his fever failed to return.
Vietnamese health officers made a list of all the 20 passengers with their contact addresses and phone numbers so they could monitor them for 21 days.
Two other feverish Nigerian men sent to the HCMC-based Hospital for Tropical Diseases on Tuesday evening for isolation were discharged from hospital Wednesday evening as they are not having fever and have no Ebola-like symptoms, said a health ministry spokesman.
Nguyen Van Vinh Chau, the hospital director, said many passengers took fever relief medicine to avoid being detected by cameras at airports as they didn't want to be bothered.
Fever relief medicine is effective for around 8-12 hours against normal fevers and flu, he said. But such medicine would only prove effective against fever caused by the Ebola virus for an hour or less.
A person infected with Ebola virus suffers high and continuous fever that grows progressively worse by the hour, according to Chau.
August 23, 2014 at 08:56 AM in Ebola, Travel & health | Permalink | Comments (0)
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Ebola fears, precautions pose new risks in US hospitals: Researchers

Via The Globe and Mail, a Reuters report: Ebola fears, precautions pose new risks in U.S. hospitals: researchers.

Fear of Ebola is causing U.S. hospitals to take precautions that, paradoxically, might backfire, increasing the risk to those caring for a patient with the deadly disease, researchers warned this week.
The only confirmed Ebola cases on U.S. soil so far have been two American aid workers flown from Liberia for treatment at Emory University Hospital. They were discharged this week after recovering from the disease that has killed more than 1,400 people in Africa.
While calling the extra steps “understandable given the horrific mortality of this disease,” Dr. Michael Klompas of Harvard Medical School and lead author of the paper in Annals of Internal Medicine, said they are unnecessary and could backfire.
For instance, if nurses and doctors wear unfamiliar gear such as head-to-toe hazmat suits, “there is absolutely a risk of making mistakes and contaminating yourself” with a patient’s bodily fluids, said Dr. David Kuhar of the Centers for Disease Control and Prevention.
Going overboard could also hurt patients, Klompas said. If workers need to don hazmat suits before entering a patient’s room, they will likely examine, test and care for patients less frequently.
Hospitals in 29 states have contacted CDC about 68 suspected cases: 66 were not Ebola and two test results are pending. Ebola is spread only by direct contact with patients’ bodily fluids. A 2007 study of an African outbreak found no traces of virus on a bed frame, chair, bowl, floor, or even a stethoscope used to examine a patient - only on a blood-stained glove. CDC advises hospitals to place suspected Ebola cases in a one-patient room and have doctors and others wear a fluid-impermeable gown, gloves, surgical mask, and goggles or a face shield.
If the patient has “copious” secretions, CDC guidelines call for shoe and leg coverings plus a second pair of gloves. During procedures that might allow viruses to become airborne, such as inserting a breathing tube, workers should wear respirators.
The American Hospital Association has urged its members “to follow CDC’s guidance for this and all infectious diseases,” said Vice President Nancy Foster.
There is nevertheless a “temptation to maximize precautions that exceed CDC recommendations,” Klompas said. Many of the 60 or so hospitals he has been in contact with plan to go beyond CDC’s guidelines, usually at the request of worried doctors, nurses, and other front-line workers.
August 23, 2014 at 08:42 AM in Ebola, Healthcare-associated infections, Infection control | Permalink | Comments (0)
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Nigeria: Kano approves N33.4m for Ebola isolation centre

Via Punch: Kano approves N33.4m for Ebola isolation centre. Excerpt:

The Kano State Government has approved N33.4m for the immediate renovation of Yar’Gaya Health Centre recently designated as an Isolation Centre for the treatment of Ebola disease.
The Commissioner for Information, Dr. Danburan Abubakar, made the disclosure at a news conference in Kano on Friday.
He said the approval was part of the decisions taken at the weekly meeting of the State Executive Council held on Wednesday.
Abubakar said the council had also approved the release of N2.2m for the purchase of personal protective equipment for the prevention of the deadly disease.
“Some decisions were taken and approvals granted in line with government’s stated policies towards human and infrastructure development,” he said.
The commissioner said the council had during the meeting, also given approval for the release of N12.5m for the control of cholera outbreak in some parts of the state.
Similarly, he said the council approved another request for the sum of N9.2m for the recruitment of medical doctors from Egypt.
August 23, 2014 at 07:40 AM in Cholera, Ebola | Permalink | Comments (0)
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How Canada developed pioneer drugs to fight Ebola

Via The Globe and Mail: How Canada developed pioneer drugs to fight Ebola. Excerpt:

A significant portion of the funding for Canada’s path-breaking research into an experimental therapy and a vaccine for Ebola came from the research arm of the Department of National Defence, which has spent nearly $7-million since 2002 developing the drugs as part of a program designed to shield this country from security threats. 
Defence Research and Development Canada (DRDC) has funded five Ebola-related projects at the National Microbiology Labratory (NML) in Winnipeg, three of which contributed to developing ZMapp, the experimental serum that received worldwide attention after it was given to a pair of Ebola-infected American aid workers who have since recovered.
The other two DND-funded projects were instrumental in developing an experimental vaccine, known as VSV-EBOV, that Ottawa has offered to donate to the World Health Organization for distribution in West Africa, where the worst Ebola outbreak on record has killed at least 1,427 people.
The Winnipeg lab’s contribution to the pharmacological battle against Ebola has come as a surprise to most Canadians, who may wonder why and how the Public Health Agency of Canada’s Prairie facility became involved in developing experimental drugs for a viral hemorrhagic fever that has never turned up in Canada.
The work has its roots in Canada’s decision to open its first – and only – biosafety level-4 containment lab in the late 1990s.
The NML’s bosses set out to hire staff experienced in handling the world’s deadliest pathogens, and one of their recruits was Heinz Feldmann, a German-born scientist with an interest in Ebola and its close relative, the Marburg virus.
“It [the Winnipeg research] started off as a counterterrorism measure, but it became obvious that it would be useful in a possible outbreak scenario in Canada or perhaps elsewhere,” said Frank Plummer, the recently retired former director of the NML. “Not so much for the general population as for health-care workers who might have been exposed.”
After the Sept. 11 attacks and the anthrax scare that followed, both the Canadian and U.S. governments became more willing to fund Ebola-related research as a check against a possible terror attack, according to experts in bioterrorism. The challenge has been in persuading drug makers to pick up where that basic science funding leaves off and pay for expensive clinical trials.
“When you have a disease like Ebola that only sporadically affects the poorest populations in the world, essentially, there’s not a lot of economic incentive for a company to get in and do that,” said Daniel Bausch, an associate professor in the Department of Tropical Medicine at Tulane University in New Orleans who recently returned from stints fighting Ebola in Guinea and Sierra Leone.
Dr. Bausch pointed out that Ebola would not make a very efficient weapon. The disease is only transmitted through bodily fluids, meaning it is much less likely to spread than an airborne virus. Still, Ebola could spread panic.
“When you’re talking about bioterror, there’s the bio and there’s the terror,” said Peter Singer, the chief executive officer of Grand Challenges Canada, which funds projects to improve global health. “A disease with mortality of up to 90 per cent with blood coming out of your orifices is a disease that certainly can spread terror, regardless of the extent to which it can spread person to person.”
August 23, 2014 at 07:34 AM in Biological warfare, Biosecurity, Ebola, Pharmaceuticals, Politics and health | Permalink | Comments (0)
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Togo: Filipino seaman negative for Ebola

Via ABS-CBN News: Filipino seaman negative for Ebola. Excerpt:

A Filipino seafarer in Togo, West Africa who showed Ebola-like symptoms, has tested negative of the virus, the Department of Foreign Affairs (DFA) said Saturday.
Based on information gathered by the DFA from its embassy in Nigeria, the Filipino tested negative for Ebola. He was diagnosed to have the flu.
A senior health official in Togo said last Thursday that 2 suspected Ebola cases, including a seafarer from the Philippines, were being tested for the virus.
August 23, 2014 at 07:22 AM in Ebola, Travel & health | Permalink | Comments (0)
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US: IDSA guidance on Ebola

Thanks to Greg Folkers for sending the link to this guidance: IDSA Ebola Guidance. Excerpt:

In early 2014, investigation of cases of fever, vomiting and severe diarrhea led to the identification of Ebola virus disease in Guinea1. Previously only a single case of human infection with Tai Forest Ebola virus in Ivory Coast in 1994 had been reported2, and Ebola virus disease (EVD) was viewed as endemic in Central, but not West, Africa.
The Ebola virus identified in Guinea appears to have had a common ancestor with Zaire Ebola virus strains circulating in Central Africa, with subsequent parallel evolution with them1.
As of August 21 2014, EVD in West Africa is now the largest and most complex epidemic of Ebola ever. More than 2,000 cases with a fatality rate of approximately 60% have occurred in Guinea, Sierra Leone, Liberia and Lagos, Nigeria. The World Health Organization now registers it as a Public Health Emergency of International Concern (PHEIC)3.
Clinical Aspects
Fever, myalgia, vomiting, diarrhea and/or abdominal pain are among the most consistently observed signs early in the course of EVD4-5.  These symptoms are nonspecific and can be seen in other illnesses (such as malaria, typhoid fever and Lassa fever) common in the areas where EVD is presently occurring. Clinically evident bleeding is noted in only about one-third6.
It is critical to take a travel history from patients presenting with these symptoms7. This includes dates and location of travel to and within affected areas not just of the patient but of others with whom the patient has been in close contact.
For those who have travelled to areas with ongoing Ebola transmission, questions should focus on close contact with or care of ill persons, clinical or laboratory work in medical facilities, preparation of the dead for burial or participation in funeral rites and handling of bats, rodents or primates8.
Use of personal protective equipment (PPE) with any of these activities should be assessed as well. The average incubation period is 8-10 days (range 2-21 days)4. 
Approach to the Patient
At the present time in the US, ill persons who have been in one of the outbreak countries should have both symptoms of and risk factors for EVD to be a suspected case8 including:
1. Fever of >38.6o Celsius (101.5o F) and
2. Severe headache, muscle pain, vomiting, diarrhea, abdominal pain or hemorrhage     
If the ill patient has the following exposures in their history, EVD should be suspected:
1. High risk exposures: percutaneous or mucous membrane exposure to body fluids of EVD patients, direct care of EVD patients without PPE, laboratory exposure to body fluids of confirmed EVD patients without standard PPE or biosafety precautions, direct exposure to deceased persons, including at funeral rites, in areas with EVD transmission.
2. Low risk exposures: household or casual contact with an EVD patient, provision of care or casual contact in medical facilities in affected areas.
Mike Coston at Avian Flu Diary has meanwhile posted CDC's new Ebola interim guidance.

August 23, 2014 at 07:14 AM in Ebola | Permalink | Comments (0)
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