There are conflicting reports over the fate of 17 suspected Ebola patients who vanished after a quarantine centre in the Liberian capital was looted.
An angry mob attacked the centre in Monrovia’s densely populated West Point township on Saturday evening.
A senior health official said all of the patients had been moved to another medical facility.
But a reporter told the BBC that 17 had escaped while 10 others were taken away by their families.
More than 400 people are known to have died from the virus in Liberia, out of a total of 1,145 deaths recorded in West Africa by the World Health Organization since March.
Assistant Health Minister Tolbert Nyenswah said protesters had been unhappy that patients were being brought in from other parts of the capital.
Other reports suggested the protesters had believed Ebola was a hoax and wanted to force the quarantine centre to close.
The attack at the Monrovia centre is seen as a major setback in the struggle to halt the outbreak, says the BBC’s Will Ross, reporting from Lagos.
Health experts say that the key to ending the Ebola outbreak is to stop it spreading in Liberia, where ignorance about the virus is high and many people are reluctant to cooperate with medical staff.
Mr Nyenswah said after the attack that 29 patients at the centre were being relocated and readmitted to an Ebola treatment centre located in the facility of the country’s John F Kennedy Memorial Medical Center.
However, Jina Moore, a journalist for Buzzfeed who is in Monrovia, told the BBC that 10 people had been freed by their relatives on Friday night and 17 had escaped during the looting the next day.
Rebecca Wesseh, who witnessed the attack, told the AFP news agency: “They broke down the door and looted the place. The patients have all gone.”
The attackers, mostly young men armed with clubs, shouted insults about President Ellen Johnson Sirleaf and yelled “there’s no Ebola”, she said, adding that nurses had also fled the centre.
The head of the Health Workers Association of Liberia, George Williams, said the unit had housed 29 patients who “had all tested positive for Ebola” and were receiving preliminary treatment.
Confirming that 17 had escaped, he said that only three had been taken by their relatives, the other nine having died four days earlier.
However, Mr Nyenswah said it was not confirmed that the patients had Ebola.
Fallah Boima’s son was admitted to the ward four days ago, and seemed to be doing well, but when the distraught father arrived for his daily visit on Sunday his son was nowhere to be seen, AFP adds.
“I don’t know where he is and I am very confused,” he said. “He has not called me since he left the camp. Now that the nurses have all left, how will I know where my son is?”
Ebola is spread by contact with an infected person’s bodily fluids, such as sweat and blood, and no cure or vaccine is currently available.
Blood-stained mattresses, bedding and medical equipment were taken from the centre, a senior police officer told BBC News, on condition of anonymity.
“This is one of the stupidest things I have ever seen in my life,” he said. “All between the houses you could see people fleeing with items looted from the patients.”
The looting spree, he added, could spread the virus to the whole of the West Point area.
Described as a slum, there are an estimated 50,000 people in the West Point neighbourhood.
The Ebola epidemic began in Guinea in February and has since spread to Liberia, Sierra Leone and Nigeria.
One Nigerian doctor has survived the disease and was sent home on Saturday night, said Health Minister Onyebuchi Chukwu in a statement.
Mr Chukwu said five other people infected with Ebola had almost fully recovered.
On Friday, the death toll rose to 1,145 after the WHO said 76 new deaths had been reported in the two days to 13 August. There have been 2,127 cases reported in total.
H7N9 avian flu, which emerged in humans in China in the spring of 2013 and has since caused more than 450 cases, was found to replicate well in both the upper and lower respiratory tracts of cynomolgus macaques, a model for humans, and to show extended replication in the upper tract, indicating the possibility of prolonged shedding and transmissibility, say findings of a study today in mBio.
Macaques were used because they reflect human physiology and attachment patterns of H7N9, even better than ferrets do, the authors explain.
The researchers inoculated eight 5-year-old cynomolgus macaques via the ocular, oral, intranasal, and intratracheal routes with infectious doses of H7N9. The animals were checked twice daily for clinical signs. Signs of disease began 1 day postinoculation (dpi), and clinical disease peaked at 3 to 4 dpi.
Six of the eight animals had obvious respiratory signs, including increased respirations, abdominal breathing, and coughing; only one had nasal discharge and cough. The induced clinical disease was judged to be moderate.
Chest films showed interstitial infiltration, first in the lower right lung lobe and then spreading. Oropharyngeal swabs were positive by 1 dpi and remained so through 6 dpi. Not all nasal swabs were positive, nor were conjunctival swabs. Bronchoalveolar lavage showed H7N9 virus in the fluid of all animals at 1 dpi that continued through 6 pdi. The authors surmised that virus shedding occurred primarily through the throat.
Lung changes were similar but less severe histopathologically to those in infected humans and included diffuse alveolar damage, infiltration of polymorphonuclear cells, and other changes.
Viral titers in nasal turbinates, oronasopharynges, tracheas, bronchi, and lung tissue samples showed the H7N9 replicated well in both the upper and lower respiratory tracts. However, the titers in samples from tissue other than the lung were higher than those in the lungs, and they did not decrease from 3 dpi to 6 dpi, as did those of the lung samples. The authors say this indicates not only widespread but also sustained viral replication throughout the upper respiratory tract.
Although H7N9 caused mild to moderate disease in the macaques, the authors say it was more pathogenic than seasonal influenza A virus and most 2009 H1N1 isolates but not as pathogenic as the 1918 flu virus or H5N1 avian flu.
H7N9 in humans has tended to be more severe than that induced in macaques in this study. The authors say this may be due to underlying medical complications in infected patients.
Aug 12 mBio study
A World Health Organization (WHO) ethics panel said today that it’s ethical to use unlicensed experimental drugs and vaccines to fight West Africa’s Ebola epidemic, as media reports said the last available doses of one such drug are being sent to Liberia to treat two doctors stricken by the disease.
At a press conference, Marie-Paule Kieny, PhD, the WHO’s assistant director-general for health systems and innovation, said a committee of a dozen experts who conferred by phone yesterday agreed that it’s appropriate to use the interventions now in development, provided patients are fully informed of the risks and that health workers gather maximal data about the results.
The panel didn’t suggest criteria for deciding who should have priority for use of the products, but the group will consider that at a later meeting, Kieny said. She speculated that November or December may be the earliest that any additional doses of any of the drugs could be available.
Deaths top 1,000
Meanwhile the epidemic continued to grow. Late yesterday the WHO said 69 more confirmed, probable, and suspected cases of Ebola virus disease (EVD) were reported by the four affected countries from Aug 7 through 9. The total count reached 1,848 cases and 1,013 deaths.
Liberia reported 45 of the new cases and 29 deaths, the WHO said. Sierra Leone had 13 cases and 17 deaths, while Guinea reported 11 cases and 6 deaths. Nigeria had no new cases or deaths.
Those hit by EVD include nearly 170 healthcare workers (HCWs), more than 80 of whom have died, WHO Director-General Margaret Chan, MD, MPH, said today in an Ebola briefing to United Nations member state representatives. She said those casualties weaken the healthcare response, can prompt closure of hospitals, and drive public fear “to new extremes.”
Ethics panel consensus
In a statement, the WHO said Ebola outbreaks can be contained through the standard methods of early case detection and isolation, contact tracing, and strict infection control, but added that a specific treatment or vaccine would be a “potent asset to counter the virus.”
“In the particular circumstances of this outbreak, and provided certain conditions are met, the panel reached consensus that it is ethical to offer unproven interventions with as yet unknown efficacy and adverse effects, as potential treatment or prevention,” the agency said.
“Ethical criteria must guide the provision of such interventions. These include transparency about all aspects of care, informed consent, freedom of choice, confidentiality, respect for the person, preservation of dignity, and involvement of the community.”
The committee also advised that when any unlicensed products are used, “there is a moral obligation to collect and share all data generated,” including that resulting from “compassionate use,” meaning use apart from a clinical trial.
Kieny told reporters, “This is an opportunity to right a wrong of history—it’s only relatively recently that researchers began investigating treatments for Ebola,” a disease that was first recognized in 1976.
The ethics panel also agreed unanimously that there is a moral duty to conduct the best possible clinical trials in the context of the epidemic to gather the best evidence on their worth, the WHO said.
Three subjects that need more detailed analysis and discussion, the panel decided, are:
- Ethical ways to gather data while providing optimal care
- Criteria to prioritize the use of drugs and vaccines
- Criteria for fair distribution of products in communities and among countries, given that all of them are likely to remain scarce in the near term
Though the group didn’t suggest prioritization guidelines, said Kieny, there was some support for the view that HCWs should have priority, since they put their lives in danger. But others observed that the families of patients also face life-threatening risks and should have priority along with HCWs, she said.
How many products?
Responding to questions, Kieny said the untried products in question include ZMapp, the antibody mixture that has been given to two Americans and is being sent to Liberia to treat two doctors, along with several antivirals and two vaccines.
Mapp Biopharmaceutical, the maker of ZMapp, has used up all the doses it had but is working to make more, according to a Bloomberg Business Week report today. The antibodies are produced in genetically engineered tobacco plants.
Kieny said the number of EVD antivirals that have shown promise in monkey trials is more than three but fewer than 10. There are two vaccines, clinical trials of which could begin as soon as the end of September, she added.
When she was pressed about how soon any drugs might be available, she said that there is so much effort to advance development right now that the likely date keeps getting closer. “It’s in flux right now,” she said, but went on to suggest that some supplies might be available by November, December, or January.
“The fact that there is not a treatment for Ebola is a market failure,” Kieny said. “It’s a disease of poor people in countries where there is no market. . . . If it hadn’t been for the investment of a few governments in the development of these drugs and vaccines, we’d be nowhere.”
The US government has financed most of the research on Ebola interventions, along with the Canadian government and private companies, she added later.
In response to a question about whether the WHO would “broker” supplies of any Ebola drugs or vaccines, Keiny said, “We don’t get involved in decisions as to who should get which drug at which moment. Discussion can occur between someone who has a drug or vaccine and someone who would like to obtain it.”
Safety risks for HCWs?
Kieny acknowledged that the safety of HCWs could be at risk if an EVD treatment is made available but only to some, or if a vaccine becomes available but some people mistake it for a treatment. “It will be of utmost importance to have the right communication and also to engage with the community and healthcare workers to explain what these are and their scope,” she said.
She also acknowledged that legal liability for adverse effects of an untried drug would be a concern for the manufacturing and others involved in providing it. “But I see a lot of good will by many stakeholders who want to do their utmost best to help patients in this terrible outbreak,” she added.
Kieny also stressed that standard public health interventions like patient isolation, contact tracing, and infection control are the main tools for fighting EVD: “It’s very important not to give false hope to anybody that Ebola can be treated. This is absolutely not the case now.”
Doses for Liberian doctors
In other developments, the Liberian government said today it would treat two infected doctors with ZMapp, which would make them the first Africans to receive the treatment, according to a Chicago Tribune report. Lester Brown, Liberia’s information minister, said the two physicians gave their consent to be treated, and the US Food and Drug Administration also approved the step.
Brown said the drug was expected to reach Liberia within 2 days.
Also today, a Spanish missionary priest who was flown home from Liberia after contracting EVD died in a Madrid hospital, the Associated Press (AP) reported. Media reports yesterday said Spain had obtained ZMapp for the 75-year-old man, but the hospital would not confirm that he had been treated with it, according to the AP.
At the WHO press conference, Kieny said she didn’t know if the priest was given the drug.
A US House committee heard grim testimony today on West Africa’s Ebola epidemic, with an official of a leading aid group asserting that inaction by the rest of the world has let the disease get out of control.
“It’s clear to say that this disease is uncontained and out of control in West Africa,” said Ken Isaacs, vice president of program and government relations for the relief group Samaritan’s Purse (SP). “The international response has been a failure, and it’s important to understand that.”
He said SP’s experts believe the official epidemic case numbers from the World Health Organization (WHO) represent only 25% to 50% of the true numbers. Yesterday the WHO put the Ebola total for Guinea, Liberia, Sierra Leone, and Nigeria at 1,711 cases and 932 deaths.
“The governments simply do not have the capacity to handle the crisis in their countries,” Isaacs added. “If a mechanism isn’t found to create a paradigm for the international community to get involved, the world will effectively relegate the containment of this disease to three of the poorest nations in world.”
Isaacs spoke at a hearing convened by the House Foreign Affairs Subcommittee on Africa, Global Human Rights, and International Organizations. The session was streamed over the Web.
The subcommittee also heard from several other witnesses, including Tom Frieden, MD, director of the US Centers for Disease Control and Prevention (CDC), who called the epidemic unprecedented in multiple ways but asserted that it can be stopped by using tried-and-true public health interventions.
A daunting challenge
But Isaacs made the challenge sound daunting. His organization employs Keith Brantly, MD, one of two American health workers who contracted Ebola while working in Liberia and were recently flown back to the United States for treatment. He and Nancy Writebol of SIM (Service in Mission), the other patient, have been treated with an experimental drug and are said to be improving.
“There are bodies lying in the street in Liberia,” a nation that’s still trying to recover from a long civil war that left lingering tensions, Isaacs said. “There are gangs threatening to burn down hospitals.”
“It’s clear to me that Liberia is in a severe crisis that I believe threatens the stability of the society as it exists today,” he told the panel.
SP’s office in Liberia remains open, but “we’ve in fact suspended all other program activity,” he said. “We’re in the process now of backing up and reloading. We intend to come back.”
The committee also heard sobering observations from Frank Glover, MD, a urologist and medical missionary with SIM, who described the weakness of Liberia’s medical system.
Glover said 95% of expatriate doctors in Liberia have left, leaving only 50 doctors in the country. After the second of two doctors died of the disease, all the government hospitals shut down.
The country has only two Ebola treatment centers, one in Monrovia and one in Lofa, Glover reported. Many patients are dying of Ebola in community settings because of the lack of treatment facilities.
Unprecedented in five ways
The epidemic has previously been described as unprecedented, but Frieden expanded on the theme, saying that’s true on five counts.
“First it’s the largest outbreak ever. In a few weeks there’ll be more cases than in all previous outbreaks put together,” he said. “Second, it’s multi country. One of the epicenters is on the confluence of three different countries” (Liberia, Guinea, and Sierra Leone).
“Third, this is the first outbreak in west Africa. And because of this it’s been a particular challenge. Fourth, many of the cases have been in urban areas, and there’s been spread in urban areas, and this is something we’ve not seen before.”
Fifth, Frieden said, “it’s the first time we’ve had to deal with it in the US.” Besides the presence of the two sick American medical workers, the nation has to worry about testing travelers who are sick after returning to the states from the affected countries, he explained.
He noted that the CDC has an Ebola test that’s relatively fast, and the agency is working to make it available to the Laboratory Response Network (LRN) within a few weeks. The network consists of state public health labs and other labs that can test for a wide range of diseases.
Frieden laid out what he called three basic facts about Ebola: “First, we can stop Ebola, we know how to do it. It will be a long and hard fight, the situation in Lagos [Nigeria] is particularly concerning. Second, we have to stop it at the source in Africa, that’s the only way to get control. Third, we have to stop it at the source through tried and true means, the core publih health interventions that work.”
He re-emphasized the CDC message that only people who have symptoms can spread Ebola to others and that transmission occurs only through close contact with body fluids.
To arrest an outbreak requires “meticulous isolation” of those infected, followed by equally carefully tracing and management of their contacts, Frieden said. If a contact gets a fever, the process must be started all over. “It’s laborious, it’s hard, it requires local knowledge, but it’s how Ebola is stopped.”
Isaacs, however, told the committee that that type of follow-up isn’t happening in Liberia. “I don’t think the ministry of health can fight this. There’s no contacts being run down in Liberia,” he said.
Frieden, who voiced confidence that the United States will not face a big Ebola outbreak, was asked if the virus can spread through sneezing or coughing.
“In medicine we often say, ‘Never say never,'” he replied. He noted that a Liberian official who died in Nigeria was sick on an airliner. So far no illnesses have been identified in his fellow passengers, but “we do have concerns that there could be transmission from someone who is very ill.”
“If someone is ill on an airplane, having a fever or bleeding, that might present a risk to someone who came in contact and didn’t take appropriate precautions,” he said.
Education helps fight the virus and overcome panic.
Friday, August 08, 2014 • Ebun James-DeKam
Let me preface my comments by saying responding efficiently and effectively to an Ebola outbreak would in all probability be a challenge for any country in the world. When the Ebola outbreak occurred in Guinea, our neighboring country early in 2014, we as a country seem to have missed the opportunity to ensure our preparedness should we have an outbreak in Sierra Leone. When the outbreak did occur, we were not prepared for it; the necessary PPEs (personal prevention equipment i.e. masks, goggles, gloves etc. were in short supply, testing centers and laboratories were not set up to handle testing for Ebola).
Medical staff not trained at first
Medical staff were not trained in proper use of the PPEs, Medical expertise with genuine knowledge and experience in dealing with Ebola were in extremely short supply. Tracing units had to be organized and trained, burial teams had to be organized and trained. Ambulances had to be procured and or refitted to accommodate only Ebola victims. The general population began to protest vigorously that regular patients and Ebola patients had to go to the same facility for medical attention. This put the uninfected population at higher risk.
Only after the outbreak occurred was there mass training of medical staff in government and private hospitals, treatment centers and isolation units/wards established. The rural population in Kailahun District, the first “hot spot” had not been sensitized and the Government and other first responders did not take into account traditional customs and rites related to caring for the sick and burying the dead.
Little sensitivity in dealing with customs
Added to that was the fact that the behavior of the Ministry of Health, accompanied by Military and Police, showed little sensitivity in dealing with the population directly affected. Rumors were plentiful as to the cause and role of the government in addressing the issue. In some cases, the outbreak and response was attributed to political dynamics (the outbreak occurred in the opposition party’s stronghold or heartland). There was a genuine lack of trust between those who desperately wanted to assist and those who desperately needed the assistance; this lack of trust developed into opposition and resistance dynamics that fed on and grew due to misinformation and rumors.
Ebola virus and response has reached crisis point
All the above has led to this point; the Ebola virus and response has reached crisis point. The government, as evidenced by the recent announcement of the National Public Health Emergency by the President (60 to 90 days in length), is attempting to launch a more effective and efficient response aimed at limiting the transfer of the Ebola Virus to other uninfected persons. A national response plan has been developed that clearly presents the resources available and needed and the gap between them. Under the national Public Health Emergency, movement of whole communities is been restricted and some may be quarantined. To ensure this and to enforce the new rules and regulations, the Military and Police have been empowered to assist and protect medical responders (government and NGOs) as they engage in response initiatives at the community level. There continues to be a steady increase in the number of confirmed cases and deaths, thankfully the number of survivors has also increased.
Role of CCSL and its parishes: prevention strategies
CCSL, with Funding from the ACT Alliance, launched and intensive sensitization and awareness building campaign in villages and communities within the Border Chiefdoms (bordering Guinea and Liberia). This campaign included training and collaborating health workers, sensitizing traditional authorities (Christian and Muslim leaders, Market Women’s associations, school teachers and students, transportation unions etc. We have purchased radio time for panel discussions conducted in local languages for community people with a “call in” segment where the radio audience can call in for clarification of issues. We have provided megaphones and given megaphones to town criers and village level Ebola Task Forces to continue spread Ebola messages, Posters and fliers were printed and distributed that illustrates (to a largely illiterate target group) origin of Ebola, signs and symptoms, containment and prevention strategies for persons and communities. CCSL is also a member of the National Ebola Task force that meets 3x a week, we are a member of the Communication Working Group and thereby have the opportunity to influence the Ebola Messages used to sensitise the general population. We receive almost daily Ebola updates on the progression of the disease and these are disseminated to our local and international partners.
Recently we have invited other religious bodies (Catholic mission, Pentecostal fellowship and different Muslim bodies) to address the Ebola crisis from a united perspective. This has now developed into the Religious Leaders Task Force on Ebola (RLTFE) which in turn has conducted more anti Ebola trainings in more communities, the have printed Stickers for vehicles and T-shirts announcing that Ebola can be prevented; Heads of churches and mosques speak to their congregation not only from the pulpit but on radio and television. Buckets of chlorinated water are now found at the entrance of many churches and mosques.
On the 31st of July the president had a meeting with the religious leaders in his office acknowledging our role as moral grantors, informed us of steps on the fight against Ebola, calling on us to work together
CCSL staff faces challenges in its engagement against further dissemination
One challenge for CCSL staff is the weather. It is the rainy season now and transport to rural communities is time consuming and hazardous due to the condition of the roads.Our vehicles (4 wheel drive and motorcycles) take a regular pounding. The other are the expenses. Accessing resources to cover the expenses for more training and sensitization at the Community level, training and sensitization of religious leaders, collaborating with Ministry or Health workers (assisting them with logistical issues)
Ebola affects all day life in Sierra Leone: lack of income
In those areas that are the epicenter, movement will now restricted this will affect trade and livelihood of the people, people live here on a day to day economy, that is they go to the market to sell and then get money to purchase what they need that day, or they go fishing, cut fire wood or charcoal, sell and buy basic household necessities. When movement is restricted, incomes and livelihoods will be affected.
The wellbeing of persons and access to medical services and health is disrupted. The Ebola unit is in the Government General Hospital in Kenema. I hear from staff that patients are apprehensive about going there for treatment when Ebola patients are being coming to the same facility when they are sick (vomiting and diarrhea).
Back to school in September?
Currently schools are on holidays, but the there is fear that in September they will not be open. This will retard or set back the educational process for our children. The attending danger of teenagers when they are left unsupervised with lots of time on their hands is the nightmares of mothers. Public exams have been postponed due to the Ebola outbreak and this this will affect the performance of pupils taking the exams in as much as schools have been dismissed since mid-June. The percentage of those passing the exams will decrease and this may affect students’ opportunity for future educational opportunities or employment. In all probability gains made related in decreasing the school “drop out” rate among students, especially female students, may be lost while teenage pregnancy may increase.
Grief for the children
Personally, I am emotional affected; though our war was considered the most brutal during its time, my fear now of the situation is worse than it was during the war. Simply because you cannot see the enemy, you cannot adequately protect yourself from it, just a handshake from a friend/ relative and you may be contacting an infected person and your likelihood of survival is quite low. Also as a Mother, I think about the number of children who would have lost their parents and because of that, possibly their link to good education at home and at school
It will take time to slow progression of disease
During the next couple of weeks, I expect a continued increase in the number of newly confirmed cases of Ebola and an increase in the number of deaths. I do expect increased resources being applied to the crisis but it will take time to slow the progression of the disease. As a nation we need to increase in the sensitization and awareness messages that result in empowering individuals and communities to rigorously implement the full range of Ebola prevention strategies leading to a decrease in the number of newly infected persons. We need to rebuild the trust between the Government medical professional and staff and the populace in rural and urban communities. We also need to ensure that the quantity and quality of the PPEs used by the Health professional is readily available for those who need them.
God bless all of you and thank you for your support. Continue to pray for the front line medical staff who are protecting us to the best of their ability and for all persons engaged in attempting to prevent the spread of this virus.
The World Health Organization (WHO) has declared the spread of Ebola in West Africa an international health emergency.
WHO officials said a coordinated international response was essential to stop and reverse the spread of the virus.
The announcement came after experts convened a two-day emergency meeting in Switzerland.
So far more than 960 people have died from Ebola in West Africa this year.
The United Nations health agency said the outbreak was an “extraordinary event”.
“The possible consequences of further international spread are particularly serious in view of the virulence of the virus,” it said in a statement.
More than 1,700 cases of Ebola have been reported in Guinea, Liberia, Nigeria and Sierra Leone.
WHO director-general Dr Margaret Chan appealed for help for the countries hit by the “most complex outbreak in the four decades of this disease”.
She said there would be no general ban on international travel or trade.
Guinean Ebola survivor
A fifth year medical student in Guinea tells the BBC French Service about how she is being shunned since recovering from Ebola which she caught whilst working as an intern at a clinic in March:
We are stigmatised – you know when they look at us like that, even in my own family people are rejecting me. I live with my uncle – my parents are in the village. In the house I eat alone. I feel lonely.
When I felt better, I started going back to medical school. Many distanced themselves from me. Four of us used to sit together, but I ended up sitting by myself.
The treatment centre gave me a certificate showing I had been healed. I showed it to my teachers as I’d missed some assessments while sick. But I haven’t done the two exams. The head of department told me to stay at home and get treated. I can’t even get an internship.
However, states should be prepared to detect, investigate and manage Ebola cases, including at airports, she said.
Other recommendations include:
- Good surveillance to pick up potential cases
- Giving people in affected countries up-to-date information on risks
- Effective measures to manage risks to healthcare workers.
There were a number of challenges in affected countries, said the WHO. These include “very weak health system capacity” and lack of medical staff, laboratory technicians and protective clothing.
States of emergency are in effect in Liberia, Guinea and Sierra Leone.
An H5N1 avian flu virus that killed a Canadian woman in January had two uncommon mutations that may have helped increase its ability to bind to human cells, researchers from Singapore and Canada reported yesterday in a letter in Emerging Infectious Diseases.
The woman, who had visited China before her illness in December, had neurologic symptoms and no known contact with poultry. She remains Canada’s only H5N1 patient.
The investigators note two previously reported mutations, R189K and G221R, in the hemagglutinin protein in the virus isolated from the patient. They write that both mutations are found in the immediate receptor-binding pocket, and G225R has been known to change specificity of an H3N2 virus toward human erythrocytes. The authors note that the two receptor-binding pocket mutations were not seen in the most closely related Asian H5N1 sequences.
They write, “Our results suggest that G225R could incur a relative predicted increase in binding to the human-like receptors. . . . The role of R193K is less clear with a slight predicted tendency of favoring avian-like receptors.”
Editor’s note: This story was revised on Aug 7, 2014, to correct the total number of Ebola cases and deaths reported by the WHO.
With the Ebola virus disease (EVD) situation in Nigeria worsening, the US Centers for Disease Control and Prevention (CDC) said today that it has moved its emergency operations center (EOC) to its highest activation level, an action it last took during the 2009 H1N1 influenza pandemic.
Meanwhile, countries including the United States and Saudi Arabia are following up on possible infections in travelers, with Spain announcing that it will bring a sick missionary priest in Liberia to Madrid for treatment, according to media reports.
Amid the other developments, the numbers of infections in West African countries hit by the outbreak grew steadily between Aug 2 and 4, with 108 new cases, along with 45 deaths, the World Health Organization (WHO) said today. The overall totals reached 1,711 cases and 932 deaths.
In addition, a WHO emergency committee today began discussing whether the unfolding disease threat amounts to an international public helath emergency.
CDC invokes top EOC level
The CDC EOC has moved to level 1 activation, reserved for the largest-scale responses that require substantial agency-wide efforts, CDC spokesman Tom Skinner told CIDRAP News.
“Our movement to level 1 activation is appropriate, given the significance of this outbreak, the extension to Nigeria, and the potential to affect many lives,” he said.
The CDC uses the EOC to monitor and coordinate its response to public health threats that occur in the United States and other countries. Its EOC coordinates CDC staff deployment and manages equipment and supply needs of responders, and can move medications, samples, and personnel within 2 hours for domestic needs and 6 hours for international missions.
The EOC has responded to more than 50 public health threats since it was established in 2001 in the wake of the terrorist and anthrax attacks. Recent examples include activations at lower levels for the 2011 earthquake and tsunami in Japan and the 2010 earthquake and cholera outbreak in Haiti.
Quickly evolving Nigeria developments
Of the latest cases reported to the WHO, five were in Nigeria, which now has 9 cases and 1 death, with most of the cases related to a Liberian man who started having symptoms during an airline flight and died a few days later on Jul 25 in Lagos, a port that is the country’s most populous city. His EVD case was the first detected in Nigeria.
At the end of July when the travel-linked case was detected, US Centers for Disease Control and Prevention (CDC) Director Tom Frieden, MD, called the event a significant development in the outbreak.
The WHO said Nigeria’s government is following up on contacts of the index case, and that the country urgently needs clinical support as a treatment center is being established. WHO Director-General Margaret Chan, MD, MPH, said that as a result of her recent meetings in Guinea with officials from the outbreak region, Nigeria is among the four countries in line for intensified response efforts, along with Guinea, Liberia, and Sierra Leone.
Nigeria’s health minister today confirmed five new Ebola cases in Lagos, one of which was in a nurse who took care of the country’s first patient and has now died from the disease, AllAfrica news reported. Health Minister Onyebuchi Chukwu said all of the Nigerians diagnosed so far with EVD were primary contacts of the first victim. Earlier reports said the man had helped care for his sick sister in Liberia, who was first thought to have malaria but was later found to have EVD. En route to Nigeria, the man’s flight took him to Togo and Ghana, which has prompted tracking of airline passengers and workers who may have been exposed to the virus.
In a related development, the CDC yesterday issued a level 2 (yellow) travel alert for Nigeria because opf Ebola activity there. At that level, the CDC recommends that visitors take enhanced precautions, such as avoiding contact with blood and body fluids of people who are sick with the virus.
A day earlier the CDC raised the travel health alerts for Guinea, Liberia, and Sierra Leone to the highest warning (red), which recommends no nonessential travel to the area.
Officials on alert for travel-linked cases
Elsewhere, suspicious illnesses in air travelers prompted a scare yesterday at New York City’s John F. Kennedy International Airport, and health officials in Saudi Arabia are waiting on test results on a man who had viral hemorrhagic fever symptoms after traveling to Sierra Leone.
At JFK Airport, authorities held an Etihad Airlines flight that arrived from Abu Dhabi in the United Arab Emirates (UAE) yesterday after a report that a sick passenger was on board, the Wall Street Journal (WSJ) reported yesterday. CDC officials quickly determined that the passenger had a seizure, and no other measures were needed, a CDC spokeswoman told the WSJ. No EVD cases have been detected in the UAE.
The sick traveler was a 2-year-old girl who had vomiting and diarrhea, the New York Daily News reported today. Paramedics transported the child to Jamaica Hospital for observation, and passengers were allowed to leave the plane, which had landed in the late afternoon.
Meanwhile, a man in Saudi Arabia whose suspicious symptoms were reported yesterday by that country’s health ministry has died, the Saudi Ministry of Health (MOH) said today. The 40-year-old man got sick after a trip to Sierra Leone, sought care at Jeddah hospital on Aug 4, and was isolated at a tertiary care center.
The MOH said the man died this morning and that the cause of his infection is still under investigation. Officials submitted samples to a reference lab in the United States as recommended by the WHO, and additional samples were sent to an accredited lab in Germany.
A later BBC report, which appears to be based on an Arabic version of an MOH statement, said the man died of cardiac arrest, but it didn’t say if tests concluded whether he had EVD.
The man’s body will be prepared for burial at the hospital, observing both Islamic practices and international guidelines for patients with infectious disease such as EVD, the MOH said.
In another recent development, Morocco’s health ministry has ruled out EVD in a Liberian traveler—a 44-year-old man–who died at the Casablanca airport on Jul 29, according to a Jul 31 machine-translated statement on the ministry Web site. It said the man died from a heart attack and was tested because he was from one of the EVD outbreak countries.
In an earlier media report, an official with Morocco’s interior ministry said the man had an EVD infection.
Spain to fly sick missionary home
Spain’s defense ministry said yesterday that a military plane will fly to Liberia to pick up an elderly Spanish missionary who is sick with EVD , Agence France-Presse (AFP) reported. The ministry did not say when the man would return to Spain.
The man is a 75-year-old Catholic priest who has worked at a hospital in Monrovia, Liberia’s capital. He works for an aid organization called Juan Ciudad ONGD. Five other missionaries are also quarantined at the hospital, two of whom, a woman from Congo and another from Guinea, have EVD infections.
The announcement follows the recent medical evacuation of two American medical missionaries from Liberia’s capital. They are Kent Brantly, MD, and Nancy Writebol, both of whom had been working at an EVD treatment center when they got sick. Both are being treated at Emory University Hospital in Atlanta.
Brantly, who arrived on Aug 2, is improving, and his wife has been able to see him and reports that he is in good spirits, Samaritan’s Purse, a Christian relief group based in North Carolina, said yesterday in a statement. It said efforts are underway to evacuate all but the most essential personnel, with timelines and destinations kept private to respect their privacy. The group said none are sick, that its precautions exceed those recommended by the CDC, and that it will continue to monitor their health.
Writebol, who arrived at Emory yesterday, is still very weak but shows slow improvement, Bruce Johnson, president of SIM USA, a Christian aid group that also staffed the Liberian EVD treatment center, said yesterday in a statement. He said she was taken to the plane on a stretcher in Monrovia, but was able to stand up and walk with assistance onto the plane. News footage of her arrival at Emory yesterday showed Writebol being moved on a stretcher.
WHO updates outbreak numbers
The WHO said today that between Aug 2 and Aug 4 it received reports of 108 new EVD infections, along with 45 more deaths, from the four West African countries battling the outbreak.
Liberia reported 48 cases and 27 deaths, boosting its totals to 516 infections and 282 fatalities. The country’s case count now surpasses that of Guinea, where the outbreak began in March. However, of all of the affected countries, Guinea still has the most deaths.
Sierra Leone reported 45 new cases and 13 deaths, and with 691 illnesses reported so far, it has the most EVD cases of the four outbreak countries. The latest fatalities nudge Sierra Leone’s total to 286.
Guinea health officials reported 10 new cases and 5 deaths, boosting its overall numbers to 495 infections, of which 363 were fatal.
Nigeria reported 5 new cases during the time span, increasing its outbreak tally to 9 infections and one death, which does not include the nurse just reported by the country’s health ministry.
The WHO’s emergency committee will wrap up its discussions tomorrow, and soon afterward will announce if the developments in West Africa constitute a public health emergency of international concern (PHEIC). Declaring a PHEIC would trigger a set of measures to curb the international spread of the disease. The 13-member group is headed by Sam Zaramba, MD, a surgeon and former director general of health services for Uganda’s health ministry. The group also has seven advisers.
Ebola has also gotten the attention of US lawmakers, who tomorrow will explore current international efforts to battle the world’s worst EVD outbreak. A subcommittee of the House Committee on Foreign Affairs will hold the hearing at 2 pm, which will be Webcast.
CDC Director Frieden and other US government officials are on one witness panel, and two officials from Samaritan’s Purse and SIM USA will testify during a second panel.
Two US aid workers that contracted the Ebola virus in Liberia are said to be improving after receiving an experimental treatment, ZMapp, which had never been tested in humans before. While we cannot be certain that ZMapp is attributable to this improvement, the treatment yielded promising results in nonhuman primate studies. Rather than being a synthetic drug, ZMapp is actually an antibody therapy consisting of a cocktail of three different antibodies to the Ebola virus. And it’s made in a rather intriguing way- within plants.
Inside massive greenhouses in Owensboro, Kentucky, thousands of tobacco plants are being grown by a company called Kentucky BioProcessing (KBP). These plants, called bioreactor plants, are being used to produce a variety of proteins for pharmaceutical products, for example vaccines and antibodies against certain disease causing organisms. KBP has actually been selected to produce therapeutic proteins for a variety of health threats, for example flu, rabies, HIV and HPV.
How does it work? Researchers start by inserting a desirable gene, for example a gene encoding a particular antibody, into a plant virus. The tobacco plant is then infected with the virus and consequently infected cells start to produce the proteins which are eventually extracted and purified into a serum. This is similar to how we use bacteria as protein making factories, for example by inserting the human insulin gene into E.coli in order to produce synthetic insulin for individuals with diabetes.
Bioreactor plants are proving to be extremely useful in the production of various therapeutic proteins. They’re faster, more efficient and cheaper to use than traditional methods that require complex bioreactors. Tobacco plants also grow quickly which makes scaling-up production easy.
Although ZMapp has not yet been approved for use as human trials have not been conducted, according to Kentucky.com KBP has started increasing production in anticipation of further trials this year.
Florida health officials yesterday announced two more locally acquired chikungunya cases, lifting the total to four.
One of the cases is the first to be reported in St Lucie County, in an adult who lives in a residential area north of Dan McCarty School in Fort Pierce, the Florida Department of Health (FDH) said in a statement. The patient did not need to be hospitalized and is recovering. The county’s mosquito control department launched aggressive efforts on Jul 27 in response to the new case.
The other case is Palm Beach County’s second, according to a separate FDH statement. No details were available about the patient. The confirmation of the second infection prompted the county to raise the mosquito warning level from “advisory” to “alert,” signifying that the virus is likely in the mosquito population.
On Jul 17 the FDH announced its first locally acquired chikungunya cases, the first such infections on the US mainland. One was in Dade County, in addition to Palm Beach County’s first case.
Florida also has reported 115 travel-related cases, most of them linked to destinations in the Caribbean region, which is experiencing a large epidemic. At the national level, 398 travel-linked cases have been reported to the US Centers for Disease Control and Prevention.