Ebola Outbreak update from ALC Health

The Ebola disease outbreak which has been affecting Western Africa for the past 5 months is still not under control. It appears that local medical responses are organizing to face the crisis on the long term while neighbouring countries struggle to avoid importation of the disease into their territory.

Scepticism by some of the local population and lack of confidence in the healthcare provided to patients are complicating the crisis and creating additional challenges for medical teams (attack on a healthcare centre in Monrovia on August 18th).

On August 14th 2014, the W.H.O. “reiterated its position that the risk of transmission of Ebola virus disease during air travel remains low”(…) “WHO is therefore advising against air travel bans” (…) Nonetheless, consistent with airline guidelines, travellers should use prudent judgment in avoiding contact with any passengers who have obvious symptoms of illness.

Locally, the risk of coming into close contact with the disease or being contaminated remains low for expatriates or travellers following strict hygiene rules (cf. Ebola Outbreak Memo).

However, there is a real risk of facing the indirect consequences of the epidemic: compromised healthcare facilities and limited access to medical care, increasing restriction on air transportation options after the annulment of regular flights to the affected countries, by a number of air operators, restrictions on movements, airport screenings, and strict guidelines for the transfer of inbound patients from impacted countries.

Such measures are expected to affect all patients, including those suffering from conditions other than Ebola and will likely delay and complicate attempts at evacuation.

For all the above reasons, our emergency evacuation assistance partner recommendation remains to avoid or interrupt any travel to the affected countries for nonessential personnel. You will find in the attached memo the most recent updates and additional useful information.

Dr Cai Glushak International Medical Chief Medical Officer

Ebola – Scheduled Airlines suspended flights

A number of Scheduled Airlines have announced that they have suspended their flights to countries affected by the Ebola outbreak.
– Ai
– Arik Air [W3 / Lagos + Abuja]
– Asky [KP / Lomé]
– British Airways [BA / Londres]
– Camair
– Eagle
– Emirates [EK / Dubaï]
– Gam
– Kenya Airways [KQ / Nairobi]
Flight operations to other areas may also be affected by the Ebola Outbreak could be suspended at anytime with little or very short notice given by governments or air carriers.

Nigeria declares Ebola emergency

Nigerian President Goodluck Jonathan has declared the outbreak of Ebola “a national emergency”.

The move comes after the World Health Organization (WHO) said the spread of the virus in West Africa was an international health emergency.

WHO says 961 people have died from Ebola in West Africa this year, two of them in Nigeria.

The total number of cases stands at 1,779, the UN health agency said.

In a statement, President Jonathan called on Nigerians to report any suspected Ebola cases to the nearest medical authorities.

He also urged the public not to spread “false information about Ebola which can lead to mass hysteria”.

Nigeria became the fourth West African country involved in the outbreak when a dual US-Liberian citizen infected with Ebola arrived in Lagos after flying from Liberia via Togo on 20 July.

He died five days later and eight people who came into contact with him were also later diagnosed with Ebola. One of them, a nurse, died on Tuesday.

Source BBC World News

Liberia erects Ebola blockades

Liberian soldiers have set up a blockade stopping people from western regions affected by the Ebola outbreak from entering the capital, Monrovia.

It follows the president’s declaration of a state of emergency to tackle the outbreak that has killed more than 930 people in West Africa this year.

In Sierra Leone the security forces have now imposed a complete blockade of eastern areas hit by Ebola.

Health experts in Switzerland are discussing a response to the outbreak.

It is the world’s deadliest outbreak and the two-day World Health Organization (WHO) meeting will decide whether to declare a global health emergency.

Ebola, a viral haemorrhagic fever, is one of the deadliest diseases known to humans, with a fatality rate in this outbreak of between 50% and 60%. It is spread through contact with the bodily fluids of Ebola patients showing symptoms.

Source : BBC World News

Lessons in Ebola

EbolaIn 2 years time the Ebola virus will celebrate the 40th year of its discovery. It really is a twin birthday because it was 1st reported in 1976 in humans in both Zaire (now the Democratic Republic of the Congo) and Sudan writes Dr. Charlie Easmon, Medical Director at ALC Health and Your Excellent Health

I am privileged to know two of the original investigators/discovers of the virus who both work at the London School of Hygiene and Tropical Medicine, Professor Peter Piot and Dr David Heymann.

We know now that this virus has 5 subtypes, 4 of which can cause severe illness in man. The 5th affects monkeys and can infect man but does not cause any significant illness.

How long this virus has been on the earth is unknown but we do know that it has animal reservoirs such as bats. How it first gets into a human is not definitely known but it probably starts with eating infected animals (so called ‘bushmeat’)

Interestingly the virus is known to survive several weeks in semen but we do not know if that is a definite mode of transmission.

We know that once a human is infected the mortality without treatment will be between 50-90% depending on the strain. We know that it spreads by contact with infected blood or mucus. To date we do not know if the virus can be air-borne but fortunately we think it is not.

The symptoms start as sudden but non-specific with headache, muscle pains malaise, diarrhoea and fever. These are quickly followed by a bleeding tendency which is often fatal. Bleeding occurs from every orifice or any inflicted wound or medical access point. The incubation period is 2-21 days, which means that if you are exposed and not ill after 21 days you are safe.

Health care workers are infected by contact with blood or mucus and hence the need for basic precautions such as gloves, masks, goggles and where available bio-suits.

Relatives get infected by caring for the living and direct exposure to blood or mucus or as in many traditional African practices washing and cleaning the dead body. In the 1st outbreak it is now clear that non-medically trained nuns spread the infection by using unsterilised needles on a few hundred patients.  Controlling this virus in a country with good public health, trust in medical services, non-traditional practices and rule of law is relatively straightforward.

The spread within Africa is an indictment of lack of early political will, public health and lack of trust (understandably) in poorly functioning health systems.

With WHO and the African Development Bank offering millions to help control this infection let us hope that the money is used wisely.

What can you and your staff do to reduce the risk?

One option is not to go until the whole thing is declared over and recently borders have closed and airlines have stopped flying to affected countries.

However, business still needs to go on and you may have existing staff there.

Your staff should know the symptoms of Ebola, they should know who to send home when ill. They should know where to seek appropriate medical help.

A suspected contact case should be monitored for 21 days with daily temperatures.

If a local clinic does not have the basics such as gloves, masks, goggles and is suspected of reusing unsterilised medical equipment such as needles do not go there. You may need to supply your staff with their own kits including thermometers..

Local staff need to be educated about the disease and the public health measures required to control it. Traditional burial practices that involve washing or handling dead bodies need to cease.

Is there treatment for Ebola?

There is currently no vaccine and given the huge cost of vaccine development this may never happen. There are experimental drugs which use serum antibodies such as that used on the doctor flown to the USA.

The bleeding tendency and fluid loss need well-managed fluid regulation which is difficult and increase the risk to medical staff.

Conclusion

The spread of Ebola could have been stopped in the earlier stages for a few thousand of pounds but is now going to cost the UN agencies and African governments million in lost revenues and costs of control.  As long as the virus does not become airborne with the correct draconian public health measures it will be controlled within the next few months and business will return to normal.

This infection reminds every company to review its disaster recovery/business continuity plans since Ebola is just one bio-threat. There are things out there that we do not yet know about. We still have the possibility of another pandemic flu, extremely drug-resistant Tuberculosis and Middle East Respiratory Virus to contend with. So all companies should be bio-vigilant!

Dr Charlie Easmon
MBBS MRCP MSC Public Health DTM&H

Medical Director, ALC Health
Medical Director, Your Excellent Health

Ebola outbreak hits Guinea

The Guinea Ministry of Health announced a total of 485 suspect and confirmed cases of Ebola virus disease (EVD), including 358 fatal cases.

Affected districts include Conakry, Guéckédou, Macenta, Kissidougou, Dabola, Djingaraye, Télimélé, Boffa, Kouroussa, Dubreka, Fria, Siguiri, Pita; several are no longer active areas of EVD transmission.

340 cases across Guinea have been confirmed by laboratory testing to be positive for Ebola virus infection.

In Guinea’s capital city, Conakry, 95 suspect cases have been reported to meet the clinical definition for EVD, including 41 fatal cases.

British Airways suspends flights to Sierra Leone and Liberia in response to Ebola Outbreak concerns

British Airways has suspended flights to and from Liberia and Sierra Leone until the end of August amid concerns over the Ebola outbreak in west Africa.

The airline normally has four flights a week from London Heathrow to Freetown in Sierra Leone, with a connection to Monrovia in Liberia.

BA said it had temporarily suspended flights due to the “deteriorating public health situation”.

Source : BBC world News

Update on Ebola outbreak in West Africa – 31 July

Health Alert Update / Ebola outbreak

EBOLA

The Ebola outbreak in West Africa continues to evolve.  Case counts and deaths in Guinea, Sierra Leone and Liberia have continued to rise .

While still generally confined to specific groups in high risk situations (ex. those participating in traditional burial practices; eating bush meat), and of little risk to travellers who maintain previously outlined prudent hygiene practices,  the regional response to the outbreak threatens to pose significant impediments to foreigners’ movements, especially if they are seeking treatment or evacuation for illness.

 Confirmed, probable, and suspect cases and deaths from Ebola virus disease in Guinea, Liberia, and Sierra Leone, as of 27 July 2014

 

New (1) Confirmed Probable Suspect Totals by    country
Guinea
Cases 33 336 109 15 460
Deaths 20 218 109 12 339
Liberia
Cases 80 100 128 101 329
Deaths 27 72 62 22 156
Nigeria
Cases 1 0 1 0 1
Deaths 1 0 1 0 1
Sierra Leone
Cases 8 473 38 22 533
Deaths 9 195 33 5 233
Totals
Cases 122 909 276 138 1323
Deaths 57 485 205 39 729
1. New cases   were reported between 24 and 27 July 2014.

Several key developments have occurred in recent days that should be noted:

1)     Today, the United States Center for Disease Control issued a travel warning that any non-essential travel to Guinea, Sierra Leone or Liberia be deferred

2)     An air ambulance from a major assistance company attempting to evacuate a prominent physician from Sierra Leone who was infected with Ebola was prevented from doing so by the local authorities. He expired while awaiting evacuation and unconfirmed reports indicate the aircraft was grounded until it can be secured as “clean.”

3)     A Liberian national flew by commercial airline to Lagos, Nigeria.  After arrival in Nigeria he was admitted to hospital where he died of Ebola.  He was reportedly symptomatic during his travels. Health authorities are tracing his contacts during travel.  He passed through Ghana and Togo to transfer planes. No new Ebola cases are reported in these countries so far.

4)     Two African airlines (ASKY and Arik) have suspended flights and from the Ebola –affected countries and Nigeria.

5)     Liberia has closed its ground borders entirely, though the airport in Monrovia remains open.

6)     Sierra Leone has declared a state of emergency and will take more proactive measures perform contact tracing and enforce home isolation for suspected contacts.

7)     Airport screening of travelers is not yet common, even in the affected nations.  Monrovia airport is screening passengers who intend to travel. Ethiopia and Nigeria announced they will conduct airport screening of all passengers arriving from the affected countries.

8)     Monrovia:   Unconfirmed reports are that JFK Medical Center, the top level hospital facility in Monrovia is closed to new patients and under quarantine because of Ebola cases within the hospital. ELWA medical center in Monrovia is the regional treatment center for Ebola.  We advise travelers to avoid these two facilities when seeking medical care.

As the outbreak evolves, it is anticipated that affected and surrounding nations will impose increasing restrictions on crossing borders and at airports.  International health and immigration authorities will likely place tighter restrictions on travelers attempting to enter other countries from the affected countries.   For this reason, the general advise is that all non-essential travel or stays in these 3 countries be curtailed.   Please be prepared for the following realities in case of urgent travel requirements or illness:

1)     Travelers with any form of febrile illness are likely to be subject to close screening and evaluation for the possibility of Ebola and may even be quarantined in their locality until authorities are satisfied they are not infected with Ebola virus.  Since the early symptoms of many other infectious illnesses (such as flu, malaria/paludisme, gastroenteritis, a common cold) may be indistinguishable from early Ebola, patients who turn out to have these maladies may find themselves subject to such handling.

2)     Airports and airlines at both departure and reception points will likely screen for symptoms or exposure history for possible Ebola and deny passage, boarding or entry into the destination country.

3)     Similar restrictions may be set up at land border crossings with neighboring countries.

4)     If hospitalized with an illness of any sort, especially of a febrile or infectious nature, authorities may restrict evacuation from these countries and regular transportation providers may be reluctant to transport the patient until  Ebola has been definitively ruled out. We expect there will be an increasingly limited supply of air ambulance providers willing to service requests in the affected countries.

5)     If suspected of or diagnosed with Ebola, please anticipate the patient will not be allowed to exit the country.  Rather, they will likely be obliged to be admitted to a local Ebola treatment center.

For obvious reasons, request to evacuate travelers or expatriates with suspected/confirmed Ebola will receive even greater scrutiny with uncertainty as to whether they will be allowed to leave the affected country or enter another. This will be case-by-case dependent. No privately organized evacuation of an Ebola patient has yet taken place.

 

Ebola – the signs and symptoms

EVD is a severe acute viral illness often characterized by the sudden onset of fever, intense weakness, muscle pain, headache and sore throat. This is followed by vomiting, diarrhoea, rash, impaired kidney and liver function, and in some cases, both internal and external bleeding. Laboratory findings include low white blood cell and platelet counts and elevated liver enzymes.

People are infectious as long as their blood and secretions contain the virus. Ebola virus was isolated from semen 61 days after onset of illness in a man who was infected in a laboratory.

The incubation period, that is, the time interval from infection with the virus to onset of symptoms, is 2 to 21 days.

Diagnosis

Other diseases that should be ruled out before a diagnosis of EVD can be made include:  malaria, typhoid fever, shigellosis, cholera, leptospirosis, plague, rickettsiosis, relapsing fever, meningitis, hepatitis and other  viral haemorrhagic fevers.

Ebola virus infections can be diagnosed definitively in a laboratory through several  types of tests:

  • antibody-capture enzyme-linked immunosorbent assay (ELISA)
  • antigen detection tests
  • serum neutralization test
  • reverse transcriptase polymerase chain reaction (RT-PCR) assay
  • electron microscopy
  • virus isolation by cell culture.

Samples from patients are an extreme biohazard risk; testing should be conducted under maximum biological containment conditions.

SOURCE : World Health Organisation

Ebola outbreak: Royal Air Force ‘on standby’

The Royal Air Force’s Infection Prevention Control Team is likely to be placed on standby to collect UK citizens and return them to Britain in quarantine conditions if they are infected with Ebola reports the Telegraph Online

The Royal Air Force could be called in to bring back UK citizens infected with the deadly Ebola disease from West Africa.

David Cameron has said that Ebola outbreak is a ‘very serious threat’ to the UK and the foreign secretary, Philip Hammond, is preparing to chair an emergency meeting today on how to tighten Britain’s defences against the virus.

Major Thomas Fletcher, of the Royal Army Medical Corps said it was likely the meeting would discuss putting the military on alert to ‘repatriate’ Britons infected with the disease.

The Royal Air Force’s Infection Prevention Control Team is likely to be placed on standby to collect UK citizens and return them to Britain in quarantine conditions.

The ‘Deployable Air Transportable Isolator Team’ is made up of military doctors and specialists from the London Royal Free Hospital.

The team was last deployed in 2012 and has been used five times over-all for the repatriation of 3 suspected cases of Lassa fever, 1 suspected case of multi-drug resistant tuberculosis, and 1 case of Crimean-Congo Hemorrhagic Fever.

Speaking to The Telegraph, Major Fletcher, a consultant on infectious diseases who has been seconded to the World Health Organisation to help with the outbreak, said: “The UK has a close relationship with West Africa and there will be British citizens in those countries.

“The COBRA meeting is probably discussing the possibility of the Royal Air Force offering assistance to UK nationals aboard who may become infected and who need to be repatriated.

“There is no doubt about it that this outbreak is going to last for many months so it is a big deal. It is the largest and most complicated outbreak we have ever seen and it is clearly not under control yet.

“With the advent of global travel there is increasing risk of importing Ebola into the UK.

“The main risk is of contact with an Ebola sufferer who has the disease but hasn’t begun to show symptoms. There is also a risk from healthcare workers coming back.

“That is why the passenger who died in Nigeria is clearly a concern as it is highly likely he was infectious during the flights he took and potentially there are people out there who are also now infected. “

The disease, which can be fatal for up to 90 per cent of infected victims, has now killed more than 670 people across Guinea, Liberia and Sierra Leone.

Public Health England has issued an urgent warning to British doctors to watch for signs of the lethal disease after an infected man was allowed to travel through an international hub. They said the virus was ‘clearly not under control.’

The government’s Chief Scientific Advisor Sir Mark Walport has said that the increasingly ‘interconnected’ world was placing Britons at risk.

Another health expert has warned could spread to Britain in the same way that AIDS did in the 1980s, a health expert has warned.

Dr Derek Gatherer, a specialist in the evolution of viruses from Lancaster University, warned that the virus was as easy to catch as flu and passengers on flights from infected areas risked catching the deadly disease.

American Patrick Sawyer died in Lagos, Nigeria, after being allowed on several flights despite showing symptoms of the disease.

The airline he flew with his attempting to contact dozens of passengers who came into contact with Mr Sawyer over fears they may also be infected.

Dr Gatherer said that those passengers could be ‘anywhere else in the world now.’

“Aids spread from Central Africa to the western world in the 1980s – Ebola could do the same,” he said.

“Anyone on the same plane could have become infected because Ebola is easy to catch. It can be passed on through vomiting, diarrhoea or even from simply saliva or sweat – as well as being sexually transmitted.

“That is why there is such alarm over Mr Sawyer because he became ill on the flight so anyone else sharing the plane could have been infected by his vomit or other bodily fluids.

“Only about 10 per cent recover. The outlook is pretty bleak. They will need to trace everyone on the passenger list and isolate them as a precaution.

“I believe they have contacted about half so far but the others could be anywhere else in the world now.”

Two Britons have already been tested for the disease in London and Birmingham after reporting symptoms, but neither had the disease.

Mr Hammond said no British national so far had been affected by the outbreak, and there had been no cases in the UK but he would be chairing the Government’s Cobra emergencies committee later today to assess the situation.

“As far as we are aware, there are no British nationals so far affected by this outbreak and certainly no cases in the UK. However the Prime Minister does regard it as a very serious threat and I will be chairing a Cobra meeting later today to assess the situation and look at any measures that we need to take either in the UK, or in our diplomatic posts abroad in order to manage the threat,” he told Sky News.

“We are very much focused on it as a new and emerging threat which we need to deal with.”

Ebola first appeared in 1976 in two simultaneous outbreaks – in Nzara, Sudan; and in Yambuku, in the Democratic Republic of Congo. The latter was in a village situated near the Ebola River, from which the disease takes its name.

It is introduced into the human population through close contact with the sweat, blood, secretions, organs or other bodily fluids of infected animals such as chimpanzees, gorillas, fruit bats, monkeys, forest antelope and porcupines.

The virus then spreads in the community through human-to-human transmission.

Symptoms begin with fever, muscle pain and a sore throat, then rapidly escalate to vomiting, diarrhoea and internal and external bleeding. The incubation period can be up to 21 days.

SOURCE : The Telegraph Online