E.Coli infection linked to romaine lettuce claims one life

Sadly, on Wednesday May 2nd , the CDC reported that one person has died in California from the E. coli outbreak linked to romaine lettuce from the Yuma, Arizona, growing region in the United States.This is the first known fatality from the outbreak.

The CDC also reported 23 additional cases of illness from 10 states, bringing the total number of cases 121 since March. Kentucky, Massachussets and Utah are the new states with reported cases.

There are concerns that the strain of E.Coli identified is particularly virulent and and associated with more complications and hospitalizations.

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Outbreak: Eat your Greens, Beware of Lettuce

When you plant lettuce, if it does not grow well, you never blame the lettuce- Thich Nhat Hanh

Fifty-Three cases of Escherichia coli infections across 16 states in the United States, linked to romaine lettuce consumption led to the Center of Disease Control and Prevention (CDC) issuing warnings to consumers last week.

All the  lettuce contaminated with the E.coli O157:H7 strain has so far been traced to Yuma, Arizona and the public are advised not to buy or consume any lettuce except it has been confirmed that it was not grown there. The warning includes whole heads and hearts of romaine lettuce, in addition to chopped romaine and salads and salad mixes containing romaine.

Although no deaths have been reported, 31 of the 53 cases of E.coli infections required hospitalization.  The infected states include Connecticut, New York, New Jersey, Pennsylvania, Ohio, Michigan, Illinois, Virginia, Missouri, Louisiana, Arizona, California, Idaho, Montana, Washington and Alaska.

Escherichia coli O157:H7 is a Shiga-toxin producing strain which causes hemolytic uremic syndrome with symptoms of bloody diarrhea, decreased frequency of urination, paleness and lethargy.

Meanwhile, the CDC continues to investigate and monitor the outbreak and more information on the warning and latest updates are available on the CDC website.

https://www.cdc.gov/ecoli/2018/o157h7-04-18/

Medic-ALL 2018


Ref: CDC Website

What About the Zika Virus?

Medic-ALL (01-30-2016) DISEASES
by Kayode Kuku

I am probably not the only one to have noticed that the "short-named" viruses seem to be making all the headlines over the cancers and "mouthful-named" diseases. From the Ebola virus to Lassa, the last couple of years have witnessed deadly outbreaks of these viral hemorrhagic fevers in different parts of the world...meaning we should be taking them seriously. 

Humans are infected through the bite of an infected Aedes Mosquito

What about the Zika virus?

Over the last couple of weeks, the Zika virus has been spreading aggressively throughout Latin America and with global infection rates rising, the world is very much at alert to learn more about the emerging disease.

Zika virus is a mosquito-borne viral disease that was first identified in rhesus monkeys in Uganda, East Africa in 1947 through a monitoring network set up for yellow fever at the time (Zika belongs to the same viral family-Flavivirus as the yellow fever and dengue virus). It was subsequently found in humans in Uganda and Tanzania 5 years later. Since then outbreaks have been recorded in the Americas, Africa, Asia and the Pacific.

It is spread primarily through the bite of an infected Aedes mosquito (which usually bites during the morning and late afternoon/evening hours.

Playing odds... you probably would not know if you were bitten and got infected, because only 1 out of 5 people develop symptoms...How Nice! The incubation period is thought to be about a few days and those who develop symptoms get fever, red eyes, rash, headache  joint pain,  and malaise which resolve within a week.Oh then, Whats all the noise about right??

Not as friendly in Pregnant women

Micocephaly is a  devastating condition

The Zika virus has been associated with miscarriages and birth defects, specifically microcephaly which is characterized by severe mental and physical disability in the newborn. That to me would mean, that ladies who are pregnant or intend to get pregnant should not be heading towards countries like  Brazil, Colombia, El Salvador, French Guiana, Guatemala, Haiti, Honduras, Martinique, Mexico, Panama, Paraguay, Suriname, Venezuela, and Puerto Rico at this time. 

Precautions however

First is to do all you can not to get bitten by a mosquito. Application of insect repellents as well as wearing of protective clothing, (since Aedes bites in daylight as well) will definitely be beneficial if travelling to the tropics or any of the affected nations. Your Doctor may also consider prophylactic medications. 

Those infected are advised to get plenty of rest , drink adequate amount of fluids and treat pain and fever with  common medications. No vaccines are available presently.

More to learn

Even though Zika is not some new virus, there is still a lot to learn regarding our understanding of the virus, its association with other medical conditions and other dangers to pregnancy especially with its continuing spread to new areas and rising worldwide concerns.

Medic-ALL Inc. 2016

Refs: KevinMD, WHO

Lassa Outbreak in Nigeria..Months and counting

Medic-ALL (01-25-2016) DISEASE

by Kayode Kuku

Just less than 2 years after the Ebola virus hit the Nigeria and other countries in the West African region, Lassa fever, another viral hemorrhagic fever, with similar symptoms as Ebola broke out in the country.

Lassa fever is an acute viral illness first discovered in Nigeria in 1969 when 2 missionary nurses died from the disease. The virus was subsequently named after the town in Borno State, Nigeria where the first cases occurred. The virus belongs to the virus family, Arenaviridae, a single stranded RNA virus which is animal borne and usually associated with rodent transmitted diseases in humans.

It is endemic in parts of West Africa including Sierra Leone, Gambia, Liberia and Nigeria notably but the risk is spread throughout the region where the disease vector, the multimammate rat (Mastomys Natalensis) is distributed.

Lassa virus is transmitted to humans by contact with excreta or urine of infected rats.

Lassa virus is transmitted to humans by contact with food or household items which have been contaminated with excreta or urine of infected rats. Since the disease is endemic in rodent population, it tends to affect communities with poor sanitation and crowded living conditions the most. Hence it is sometimes referred to as a "disease of the poor".

The present outbreak of Lassa Fever broke out in Nigeria, August 2015 and reports show that it has claimed up to 63 lives as at the January, 24, 2016  out of over 200 suspected cases spread across 17 states in the country including the Federal Capital Territory, Abuja. Nigeria's Health Minister, Professor Isaac Adewole, stated that 212 suspected cases have been reported in the last 3 months.

While the world's most populous black nation was praised for its prompt containment of Ebola in 2014, things appear a little more complicated in the case of Lassa , as many stakeholders including specialists have raised concerns ranging from ignorance of the disease among the vulnerable communities, leading to under-reporting of the cases and under-mining the scale of the outbreak  , and even the capacity of the country's healthcare system to deal with the outbreak at this time.

These are valid concerns, considering the "skeletal" state of the country's primary health care system and the lack of access to adequate health care in the vulnerable regions. The country reported 112 deaths and over 1700 cases of Lassa fever in 2012, yet in a population of over 170 million people, there is only one research center in the country to cater for Lassa fever research.

As far as comparison with Ebola goes, Lassa fever is not necessarily as deadly, but it spreads faster.

Meanwhile, while Lassa fever has exposed the level of preparedness of the nation's health care system to cope with such outbreaks, the WHO and US CDC are working with Nigeria Health Ministry in containing the outbreak.

Medic-All Inc. 2016

Refs: CDC, Punch Nigeria

Is Sex Bringing Ebola Back?

Medic-ALL (03:29:2014) -DISEASE

Its been a year long outbreak of the deadly Ebola virus and whilst the whole world looked back at the losses and lessons from the epidemic this past year, the virus appears to be making an unheralded comeback.

On Friday, in Liberia (one of the hardest hit countries alongside Sierra Leone and Guinea) , a 44 year old victim of the deadly virus was reported dead. There are indications that the new case may have occured via sexual transmission from a survivor she was said to be dating. Additional tests are being carried out to confirm this.

Research has shown traces of Ebolacan remain  in the  semen of some survivors for at least 82 days after the onset of symptoms. There is no conclusive scientific proof these traces are infectious. But anecdotal evidence in the latest case, and several others in West Africa, along with and confirmed transmission of Marburg, another viral hemorrhagic fever, have led experts to warn of the potential risk of sexually transmitted Ebola.

The World Health Organization, as a precautionary measure, advises Ebola survivors to abstain from sex during a 90-day period following recovery. At the very least, they should practice safe sex.

The case threatens to undermine the country's efforts to end a year long outbreak which has claimed over 10,300 lives across the African continent.

The country was on it's way to completing a 42-days period without a new case of the disease, which is necessary to declare the country free of the disease when it recorded the recent case.

Ebola continues to spread in Africa, though not as bad as it was some months ago. 79 new cases were reported last week. 

Though, it was known that Ebola was largely transmitted through body fluids of close contacts, no case of transmission via sex had been previously documented. 

Ref: World Health Organization, NBCNews

    

Record Drop in Ebola Cases since June

Medic-ALL (01:29:2015)

The health world continues to get the better of the deadly Ebola virus disease with latest reports showing a significant drop in the number of cases of the disease since June, 2014 when the disease began ravaging parts of the African continent  (where many of the countries initially affected have now been declared Ebola-free) and later spread to other parts of the world including the United States and parts of Europe. This Cable News Network (CNN) report puts in perspective the road to achieving this decline in the number of cases of the deadly virus particularly in the largely affected nations of Guinea, Sierra Leone and Liberia.
Read Here
http://www.cnn.com//2015/01/29/africa/ebola-virus/index.html

Ebola: West African Nation Declared Free

Medic-ALL (01:18:2015) Healthcare News-

Ebola virus stopped in yet another West African Country

The Government of the West African nation, Mali today declared the country free of the deadly Ebola virus following a 42-day period without a new case of the disease.

Mali's Health Minister Ousmane Koné declared this in a statement in which he thanked the country's health workers and international partners for their work which helped to see a halt to the outbreak.

Countries must report no new cases for 42 days - or two incubation periods of 21 days - to be declared Ebola-free.

Mali recorded a total of seven deaths caused by the Ebola outbreak that began just over a year ago

According to World Health Organization (WHO) data the worst epidemic of the viral haemorrhagic fever on record has killed more than 8,400 people, mostly in neighbouring Guinea, Sierra Leone and Liberia.

At least 21,296 people have so far been infected with the virus worldwide.

Mali's last infected patient recovered and left hospital early last month. At one point health officials had been monitoring more than 300 contact cases.

Mali became the sixth West African country to record a case of Ebola when a two-year-old girlfrom Guinea died in October. It was close to being declared Ebola free in November before a second wave of infections.

The country now joins other West African countries Nigeria and Senegal who had been declared Ebola-free in the last couple of months.

Medic-ALL.Inc 2015

Ref: BBC, WHO

Ebola Response On Track -WHO

Medic-ALL (19:12:2014) Via MedPage Today

The response to the Ebola epidemic is on track to meet U.N. targets, the World Health Organization said in a mildly optimistic midweek situation report.
By New Year's Day, the agency said, the three hardest-hit countries will likely have the capacity to isolate and treat all cases and to bury all Ebola victims "safely and with dignity."

Guinea, Liberia, and Sierra Leone all now have more available beds than reported patients, the WHO said, although they are not distributed evenly and some regions still have "serious shortfalls." By the same token, each country has enough safe burial teams to handle all people known to have died from Ebola; however, some regions might lack enough capacity.

The U.N. goals are to have 100% of new patients under treatment by Jan. 1 and all known Ebola victims buried safely. Isolating patients breaks the chain of transmission, while safe burials -- avoiding unprotected contact with the highly infectious body of an Ebola victim -- avoid an important risk factor for new cases.
The agency also had a brighter picture of the incidence of cases, suggesting there are signs that the epidemic in Sierra Leone might be starting to slow -- even though the country reported 327 new confirmed cases in the week ending Dec. 14.
Most of the cases are in the western part of the country, with the capital, Freetown, accounting for 125 of the new cases. Teams began house-to-house searches in Freetown yesterday, seeking hidden Ebola patients, according to the BBC.
The searches are part of the so-called Western Area Surge, which aims to get Ebola patients into treatment and also to raise the number of available beds in the capital, the WHO said.

In Guinea, there has been no evident pattern in recent weeks, with the number of new confirmed cases each week fluctuating between 75 and 148. For the week ending Dec. 14, there were 76.
In Liberia, on the other hand, incidence is falling, with only six districts reporting new confirmed or probable cases in the week ending Dec. 14, although data are missing for much of the week.
The cumulative Ebola toll worldwide, to Dec. 14, is 18,603 confirmed, probable, and suspected cases in five affected countries (Guinea, Liberia, Mali, Sierra Leone, and the U.S.) and three previously affected countries (Nigeria, Senegal, and Spain), the agency said.

The U.S. has not had a new Ebola case since Craig Spencer, MD, was reported to be be cured Nov. 9; the country can be declared free of the disease Sunday, which will be 42 days after Spencer tested negative.
Mali also appears to have controlled the disease; all of the contacts of the country's eight confirmed and probable Ebola patients (six of whom died) have now passed the 21-day incubation period without developing the disease.


The last patient tested negative for the disease Dec. 6.

The WHO also reported, for the first time, population-based Ebola rates for Guinea, Liberia, and Sierra Leone:

In Guinea, there have been 22 reported cases and 14 deaths per 100,000 people, with a cumulative total of 2,416 cases and 1,525 fatalities.

Liberia has had 197 reported cases and 83 deaths per 100,000 population, with a total of 7,790 cases and 3,290 deaths.

And Sierra Leone has had 145 cases and 36 deaths per 100,000 people, for a total of 8,356 cases and 2085 deaths.

Meanwhile, researchers are reporting that laboratory tests show that 53 existing and approved drugs have the effect of blocking ebolavirus entry to target cells.

The list includes a wide range of drug classes: microtubule inhibitors, estrogen receptor modulators, antihistamines, antipsychotics, pump/channel antagonists, anticancer drugs, and antibiotics, according to Adolfo Garcia-Sastre, PhD, of the Icahn School of Medicine at Mount Sinai Hospital in New York City, and colleagues.
But more experiments will be needed to understand how useful any of the compounds might be, Garcia-Sastre and colleagues cautioned in Emerging Microbes and Infections.

The work is a positive step, commented Ben Neuman, PhD, of England's University of Reading, who was not part of the study.
The research "extends the list of drugs that are safe to use in people, and have been shown to interfere with Ebola in the lab," he said. But, he added, "it takes a lot to stop Ebola and none of the drugs identified in this study has been shown to protect an experimental animal yet."

"We now have a longer list of things that might work, but the list of things that definitely will work still unfortunately stands at zero," Neuman said.
Indeed, there is little evidence of efficacy even for the drugs that have been used experimentally during this current outbreak, according to the European Medicines Agency, which is conducting a continuing review of them.

The agency is looking at such medicines as brincidofovir, favipiravir, TKM-100802, and ZMapp -- all used to treat one or more patients -- but there is nothing to be said so far about their efficacy, according to an interim report.
"Treatments for patients infected with the Ebola virus are still in early stages of development," an agency spokesman said in a statement. "We encourage developers to generate more information on the use of these medicines in the treatment of Ebola patients."

Ref: World Health Organization
Photo Credits
Medpage today
in.pharmatechnologists.com
seattletimes.com

Victory over Ebola-Like Virus in Uganda!

Medic-ALL (14:11:2014)

In what can be regarded as another "win" for humans over the recently "more popular" viral haemorragic diseases, authorities in the east African country of Uganda reported that the country was now free of Marburg, a virus similar to Ebola in many respects, after no new cases had been reported for more than a month after a hospital worker died of the disease in the capital, Kampala. The declaration by the United Nations Health Agency comes after a 42-day Surveillance period.

The virus is transmitted through bodily fluids or by handling infected wild animals, Marburg starts with a severe headache followed by hemorrhaging and kills in 80 percent or more cases within about a week. There is no vaccine or specific treatment for the virus.

A total of 197 people were in contact with the healthcare worker, but none of them were found to have been infected, Junior health minister Sarah Opendi told a news conference.

Opendi said 42 days was the minimum period of monitoring before an outbreak is declared contained, and there had been no new cases reported since the death in Kampala on Sept. 28.

"This implies that the Marburg outbreak in the country has been completely controlled," she said.

The worst outbreak of Ebola on record has killed nearly 5,000 people - all but a handful in West Africa's Guinea, Liberia and Sierra Leone - since March.

Marburg disease virus (MVD) (formerly known as Marburg haemorrahagic fever) was first identified in the 1967 epidemics in Marburg (hence the name) and Frankfurt in Germany and Belgrade in the former Yugoslavia following importation of infected monkeys from Uganda.

Uganda, according to the Health Minister of the country, in 2012, endured an outbreak of Marburg that killed 9 of the 18 people infected

Ref: WHO Global Alert and Response

Medic-ALL.Inc 2014

Chikungunya: Yet Another Virus!

Medic-ALL  (24:10:2014) by Kayode Kuku MB;BS

At a time when the world is agog with the now very popular but deadly "Ebola virus disease", its outbreak in parts of West Africa and recent spread to the United States and Spain, some other parts of the world are having to contend with "Yet Another Viral" disease without a known cure.

The Chikungunya (pronunciation:/ chi-ken-gun-ye: meaning, that which bends over in the "Makonde" language of Tanzania and Mozambique) disease is caused by a mosquito-borne virus (meaning it is transmitted to people by mosquitoes).

The chikungunya virus was documented for the first time, last December in the islands of St Martin in the Caribbeans, even though it is believed to have existed in parts of Africa, Europe and Asia-Pacific regions for decades. The major symptoms of the disease include fever (usually over 39°C) and severe joint pain (causing infected persons to bend over), others may include muscle pain, headache, joint swelling, nausea, fatigue or rash. Occasional cases of eye, neurological, heart and gastrointestinal complications have been reported.

According to Dr Lyle Petersen of the Centre for Disease Prevention and Control (CDC), the virus has an incubation period (time between exposure to manifestation of first symptom) of about 3-7 days, with a range of about 2-12 days. The acute symptoms could resolve within 7 to 10 days but some patients could develop complications in the coming months.

Nearly 800,000 people have been infected with the Chikungunya virus in the Caribbeans, majority in the Dominican Republic. Jamaica declared a state of emergency last weekend with estimated reports of about 60 percent of the country's population down with the virus and almost 200 persons are documented to be infected with the disease in Canada according to Canadian Health officials. The United States recently reported its first locally-acquired case of the disease in a man in Florida.

                                                Distribution map of Chikungunya in the Americas

As of October 17, 2014, local transmission have been identified in 36 countries or territories in the Caribbeans, Central America, North America and South America, with a total of 759,742 suspected and 14,035 laboratory-confirmed cases have been reported from these areas (Updated data from Pan-American Health Organization).

The fear is that the disease may likely continue to spread throughout the Americas through infected people and mosquitoes as the mosquito which carries the virus in found in many parts of the region including the United States. Moreso, the chikungunya virus is new to the continent and many are not immune to it.

Furthermore, as has been the case with the "traveling Ebola" there is definitely the risk of the virus been imported to new areas by infected travelers. There is presently no vaccine nor medicine to prevent or treat the chikungunya virus disease. Travelers are advised to protect themselves when traveling to countries with the virus by preventing mosquito bites with use of insect repellents, insecticide-treated nets, wearing of long sleeves and pant and stay in places with air-conditioning or that use window or door screens.

Though it is estimated that up to 72%-97% of persons infected with the Chikungunya virus will develop clinical symptoms, Mortality is rare, except in older patients with underlying conditions!....not necessarily "Good" news ,but "Better" news.

Refs:
1.Centre for Disease Control and Prevention
2.CBC News

Resource: Dr. Patience Akahara

New York Doctor with Ebola after return from Guinea

By Ellen Wulfhorst and Sebastian Malo

NEW YORK (Reuters) - A doctor who worked in West Africa with Ebola patients was in an isolation unit in New York on Friday after testing positive for the deadly virus, becoming the fourth person diagnosed with the disease in the United States and the first in its largest city.

The worst Ebola outbreak on record has killed at least 4,900 people and perhaps as many as 15,000, mostly in Liberia, Sierra Leone and Guinea, according to World Health Organization figures.

Only four Ebola cases have been diagnosed so far in the United States: Thomas Eric Duncan, who died on Oct. 8 at Texas Health Presbyterian Hospital in Dallas, two nurses who treated him there and the latest case, Dr. Craig Spencer.

Spencer, 33, who worked for Doctors Without Borders, was taken to Bellevue Hospital on Thursday, six days after returning from Guinea, renewing public jitters about transmission of the disease in the United States and rattling financial markets.

Three people who had close contact with Spencer were quarantined for observation - one of them, his fiancée, at the same hospital - but all were still healthy, officials said.

Mayor Bill de Blasio and Governor Andrew Cuomo sought to reassure New Yorkers they were safe, even though Spencer had ridden subways, taken a taxi and visited a bowling alley between his return from Guinea and the onset of his symptoms.

"There is no reason for New Yorkers to be alarmed," de Blasio said at a news conference at Bellevue. "Being on the same subway car or living near someone with Ebola does not in itself put someone at risk."

Health officials emphasized that the virus is not airborne but is spread only through direct contact with bodily fluids from an infected person who is showing symptoms.

After taking his own temperature twice daily since his return, Spencer reported running a fever and experiencing gastrointestinal symptoms for the first time early on Thursday. He was then taken from his Manhattan apartment to Bellevue by a special team wearing protective gear, city officials said.

He was not feeling sick and would not have been contagious before Thursday morning, city Health Commissioner Mary Travis Bassett said.

Owners of the bowling alley he visited said they had voluntarily closed the establishment for the day as a precaution. But the driver of the ride-sharing taxi Spencer took was not considered to be at risk, and officials insisted the three subway lines he rode before falling ill remained safe.

"We consider that it is extremely unlikely, the probability being close to nil, that there would be any problem related to his taking the subway system," Bassett said.

The U.S. Centers for Disease Control and Prevention (CDC) will confirm Spencer's test results within 24 hours, she said.

RESIDENTS, INVESTORS RATTLED

His case brings to nine the total number of people treated for the disease in U.S. hospitals since August, but just two - Duncan's nurses - contracted the virus in the United States.

The New York case surfaced days after dozens of people who were exposed to Duncan emerged from the 21-day incubation period with clean bills of health, easing a national sense of crisis that took hold when his nurses, Nina Pham and Amber Vinson, became infected.

"I'm really concerned," said Kiki Howard, 26, a student who lives on the block next to Spencer's home in Harlem. "There's a school at the end of the block. My main concern is for the safety of the children."

The health commissioner said Spencer's apartment was isolated and sealed off, noting, "I see no reason for the tenants in the apartment building to be concerned."

Still, there were signs that the latest Ebola case had unnerved investors. S&P futures fell 9 points or 0.45 percent. The dollar slipped against the euro and the U.S. 10-year Treasury rose, lowering its yield to about 2.24 percent.

The city health commissioner said Spencer completed work in Guinea on Oct. 12 and arrived at John F. Kennedy International Airport in New York on Oct. 17. His Facebook page, which included a photo of him clad in protective gear, said he stopped over in Brussels.

Spencer has specialized in international emergency medicine at Columbia University-New York Presbyterian Hospital in New York City since 2011.

Columbia, in a statement, said he has not been to work nor seen any patients since his return.

A woman named Morgan Dixon was identified on Spencer’s Facebook page as his fiancée. Her Linked-In profile said she worked in nonprofit management and international development with the Hope Program, a career development agency for homeless and welfare-dependent adults.

The CDC did not name Spencer but said he "participated in the enhanced screening" instituted for all travelers returning from Guinea, Liberia and Sierra Leone this month at five major U.S. airports - including Kennedy.

The doctor "went through multiple layers of screening and did not have a fever or other symptoms of illness", the CDC said in a statement.

End of 21-day Quarantine for Family of Ebola Patient

USA Today News (20:10:2014)

People who had contact with Ebola patient Thomas Eric Duncan before he was hospitalized are breathing a sigh of relief today.

Those 48 contacts, including four family members who shared a small Dallas apartment with him, have completed the 21-day observation period without falling ill and are no longer at risk of the disease. About 10 of the 48 contacts were considered to be a higher risk because of their closer contact with Duncan.

Ebola has an incubation period of up to 21 days, according to the World Health Organization. People who are exposed to an Ebola patient who don't become sick during that time are considered to be out of the woods.

That's welcome news to Dallas and U.S. public health officials, who have struggled to contain Ebola since Duncan's diagnosis at Texas Health Presbyterian on Sept. 28. Duncan died Oct. 8.

Last week, two of Duncan's nurses were diagnosed with Ebola and have been moved to specialized hospitals. Other health workers who treated Duncan during his hospital stay continue to monitor themselves for fever and other symptoms.

In Spain, a nursing assistant appears to have recovered from the Ebola virus, the Associated Press reported Sunday.

The good news for Duncan's family should also reassure Americans about a fact that public health officials have been emphasizing for weeks -- that Ebola is not spread through casual contact -- said Robert Murphy, director of the Center for Global Health at Northwestern University Feinberg School of Medicine.

Dallas Health officials quarantined 4 members of Duncan's family after he was diagnose, ordering them not to leave the small apartment they shared with Duncan. Officials worried that the family was at risk

not just because they spent time with Duncan while he was sick but also because they stayed in an apartment with his soiled bed linens after he was hospitalized.

The fact that Duncan's family remained healthy even as two of his nurses became infected illustrates the peculiar nature of Ebola, said Peter Hotez, dean of the National School of Tropical Medicine and professor at Baylor College of Medicine in Houston.

Although the West Africa outbreak of Ebola has a 70% mortality rate, the virus is actually not very contagious in the early stages of disease when people are most likely to circulate in the community, Hotez said. Ebola doesn't spread through coughs and sneezes, only through direct contact with bodily fluids.

Even then, people aren't contagious at all until they begin showing symptoms such as a fever. Before symptoms appear, levels of the virus in their blood are too low to be measured, Hotez said.

Yet Ebola is frighteningly infectious at advanced stages of the disease, when the virus begins multiplying out of control and patients begin producing large amounts of diarrhea, vomit and blood. At that point, even a tiny amount of blood is teeming with Ebola, which puts nurses and caregivers at high risk, Hotez said.

Few people in the general community are exposed to Ebola patients who are that contagious, because patients at that stage are usually too sick to move around. Most are hospitalized if a bed is available. In West Africa, patients who can't get to a hospital are bedridden and typically attended by relatives.

Those aspects of Ebola help explain why, on average, people in West Africa spread the disease to only one or two other people, said Paul Offit, chief of infectious diseases at Children's Hospital of Philadelphia. In contrast, people with an airborne virus such as measles can spread the disease to 14 susceptible people.

Ebola has spread in West Africa because of burial rites that aren't practiced in the USA, in which relatives of the deceased touch the body and prepare it for the grave.

Only about 15% of Ebola cases in West Africa involve children, reflecting the fact that children are rarely home caregivers, Offit said.

Ebola in Spain

Medic-ALL (07:10:2014)

In the first known case of Ebola transmission outside the shores of Africa, a Spanish Nurse has tested positive for the deadly Ebola virus in Madrid, Spain just days after the United States reported it's first case of the disease. The Spanish medical worker tested positive after treating an Africa-based missionary who had been infected with the virus and flown to Madrid, where he was been admitted at the Carlos Ill Hospital which had been specially prepared to treat the disease. Alarms are however being raised by Spanish medical-worker representatives over the adequacy of the country's medical procedures to manage the disease and prevent the spread in the country and beyond.

The infected medical worker was part of a team that treated Brother Manuel Garcia Viejo, a Spanish missionary who served as a medical director of a hospital in Sierra Leone and died of Ebola on September 25, three days after he was flown into Madrid. She worked as a sanitary technician and may have being in contact with the patient once while he was alive and with with clothes after he died. She subsequently presented with a fever on September 30th, admitted at a Suburban hospital in Madrid.

The infection was confirmed by two tests, the second one yesterday October 6th.

As the world continues to be gripped with news of spread of the virus, we continue to hope it is contained successfully world-wide. There have been over 7400 cases reported in Guinea, Sierra Leone and Liberia mainly and the death toll has surpassed 3400 deaths in the deadliest Ebola outbreak in world history.

CONTAINING EBOLA: Learning From Nigeria

Medic-ALL (05:10:2014) 

Ref: Washingtonpost

After several months of the Ebola outbreak and devastating reports streaming out of West Africa where the deadly virus has overwhelmed already weak public health systems and left thousands of people dead, anxiety has begun to grip in the United States over the first case of Ebola diagnosed in the country, one West African nation serves as an example of hope: Nigeria, which appears to have successfully contained  the Ebola virus, with no new case reported in the country since the 31st of August 2014.

As concerns spread over the readiness of U.S. hospitals , there are some lessons to be learned from Nigeria, where officials managed to get ahead of the fast-moving virus after it was brought into Africa's most populous country by an Ebola-infected Liberian-American man who had flown into Lagos from Liberia for an ECOWAS meeting.

As in the U.S. case, Ebola arrived in Nigeria by passenger plane. But unlike Thomas Eric Duncan — who arrived in Dallas before he became symptomatic and was therefore not contagious during his flights from Liberia to Texas through Brussels and Dulles International Airport — Patrick Sawyer was already symptomatic when he landed in Lagos on July 20. At that point, Sawyer, Nigeria's Patient Zero, was contagious and dying.

It was a nightmare scenario with the potential to spiral out of control, given the bustling city of Lagos, Africa's largest, is a major transportation hub. As Sawyer was placed in isolation, public health officials had to track down every single person who'd come into contact with him, from the flights he'd boarded to the Lagos airport and the private hospital where he went after landing. And they had to do so quickly, making the process known as contact tracing a priority.

"In the whole system approach in beating the war on Ebola, contact tracing is the key public health activity that needs to be done," said Gavin MacGregor-Skinner, who helped with the Ebola response in Nigeria with the Elizabeth R. Griffin Research Foundation. "The key is to find all the people that patient had direct close contact with."

From that single patient came a list of 281 people, MacGregor-Skinner said. Every one of those individuals had to provide health authorities twice-a-day updates about their well-being, often through methods like text-messaging. Anyone who didn't feel well or failed to respond was checked on, either through a neighborhood network or health workers.

Nigeria is said to have taken a "whole community approach," with everyone from military officials to church elders in the same room, discussing how to handle the response to the virus.

Such an approach, and contact tracing in general, requires people be open and forthright about their movements and their health, he said. Stigmatization of patients, their families and contacts could only discourage that, so Nigerian officials sent a message to "really make them look like heroes," MacGregor-Skinner said.

"This is the best thing people can do for Nigeria: They are going to protect and save Nigeria by being honest, by doing what they need to do, by reporting to the health commission," he said. This made people feel like they were a part of something extremely important, he said, and also took into account real community needs. "You got real engagement and compliance from the contacts. They're not running and hiding."

In Nigeria, Sawyer had come into contact with someone who ended up in Port Harcourt, Rivers State That person, a regional official, went to a doctor who ended up dying from Ebola in August. Within a week, 70 people were being monitored. It ballooned to an additional 400 people in that one city.

Success stories of people coming through strict Ebola surveillance alive and healthyhelped encourage more people to come forward, as they recognized that ending up in a contact tracer's sights didn't mean a death sentence.

In the end, contact tracers — trained professionals and volunteers — conducted 18,500 face-to-face visits to assess potential symptoms, according to the CDC, and the list of contacts throughout the country grew to 894. Two months later, Nigeria ended up with a total of 20 confirmed or probable cases and eight deaths.

The CDC also pointed to the robust public health response by Nigerian officials, who have had experience with massive public health crises in the past — namely polio in 2012 and large-scale lead poisoning in 2010.

When someone is on a contact list, thatdoesn't mean that person has to stay at home for the entire incubation period of 21 days from the last contact with someone who had Ebola. People on contact lists are not under quarantine or in isolation. They can still go to work and go on with their their lives. But they should take their temperature twice a day for 21 days and check in with health workers.

Officials in Texas began with a list of about 100 names; they have whittled the list down to 50 people who had some contact with Duncan. Of those, 10 are considered high-risk.

The CDC recommends that people without symptoms but who have had direct contact with the bodily fluids of a person sick with Ebola be put under either conditional release, meaning that they self-monitor their health and temperature and check in daily, or controlled movement. People under controlled movement have to notify officials about any intended travel and shouldn't use commercial planes or trains. Local public transportation use is approved on a case-by-case basis.

When symptoms do develop, that's when the response kicks into high gear. People with Ebola are contagious only once they begin exhibiting symptoms, which include fever, severe headaches and vomiting.

While four people in Dallas are under government-ordered quarantine, that is not the norm. Those individuals "were non-compliant with the request to stay home. I don’t want to go too far beyond that," Dallas County Judge Clay Lewis Jenkins said Thursday.On Friday, the four people were moved to a private residence from the apartment where Duncan had been staying when he became symptomatic.

A law enforcement officer will remain with them to enforce the order, and none of the people are allowed to leave until Oct. 19.

Duncan is the only person with an Ebola diagnosis in Dallas, and no one else is showing symptoms at the moment. But, as Nigeria knows, the work in Dallas has just begun.

Washingtonpost article by Elahe Izadi