Ebola Virus

[Doc Alan]

Ebola ( named after a river in Democratic Republic of Congo ) is only ONE of the " viral haemorrhagic fevers " which include dengue and yellow fever. The present outbreak has caused huge publicity because of its high fatality rate. About a thousand have died so far – several thousand since its discovery in 1976.


It’s rightly being taken seriously. A multimillion dollar international strategy to bring the outbreak under control ( successful with previous outbreaks ) has been launched by WHO ( World Health Organization ) and affected countries. WHO declares Ebola an international emergency.


The problems, now well known, are :-

• Transmitted to humans from wild animals and then human-human transmission ( through close contact ) ;

• No licensed specific treatment or vaccine;

• Stigma – local resistance and hostility based on ignorance.

• Lack of facilities and health workers ( themselves at risk, over 60 have died helping others ).

• Incubation period ( time from infection to symptoms ) is between 2 – 21 days. Many other diseases causing fever need to be ruled out ( including malaria, typhoid, and other viral causes of fever like dengue ).



Every infection gives Ebola a chance to better adapt to humans, but a future global pandemic is UNLIKELY :-

1. It can ONLY be spread by close contact.

2. It kills a large proportion of its victims, LIMITING its ability to spread.

3. It’s thought that " urbanisation " is a contributory factor in this outbreak – previously village outbreaks remained small, and victims ( sadly ) died without ever going to hospital.



The diagnosis can be proved in the laboratory by a variety of blood tests and/or viral culture. There are five different virus types. The most lethal ( Zaire ebolavirus ) is causing this outbreak.


There is a PHILIPPINES connection. One subtype, the Reston Ebolavirus, has caused severe outbreaks in macaque monkeys farmed in the Philippines and imported to the USA ( including Reston, Virginia ) for research. It may also infect pigs without causing symptoms. NO illness or death in humans has been reported to date.


Ebola has raised questions about whether medicines / vaccines that have never been tested on people should be used in this outbreak. " ZMapp " – a drug produced in genetically engineered tobacco plants - has apparently been given to two US health workers. WHO this week has convened an " ethical review of experimental drugs " – knowing there will be far too few in the near future to treat the general population.


" Innovative " medicine is to be encouraged generally, whether for severe infections, cancer or dementia - but ideally it needs :-


• Informed consent from the patient ( difficult with no evidence of effectiveness );

• Explanation of risks and benefits ( also difficult because not known );

• Record of the outcome ( success or not, only known once large scale trials have been carried out ).


The Ebola epidemic is small in absolute numbers – compared to measles ( over 120,000 deaths in 2012 ) and the millions affected by malaria and tuberculosis. But it is a test for the future of public health interventions in Africa.


The world is now waking up to antibiotic resistance and fears of bioterrorism. We must hope that this particularly nasty viral haemorrhagic fever is contained in Africa, brought under control, and the pharmaceutical industry can be encouraged to come up as soon as possible with effective vaccines and treatment.


http://www.who.int/mediacentre/factsheets/fs103/en/


http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)61322-2/fulltext


http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)61319-2/fulltext


http://jid.oxfordjournals.org/content/204/suppl_3/S757.full


http://businessmirror.com.ph/index.php/en/news/opinion/36505-ebola-and-the-philippines


http://www.bbc.co.uk/news/health-28708632

[les_taxi]

Thanks for Info doc.

[Terpe]

Very interesting that :xxgrinning--00xx3:

[Doc Alan]

Thanks Les and Terpe :xxgrinning--00xx3:.

[Dedworth]

Another interesting and informative post Doc http://www.theblitz.org/uploads/users/365fe1b8c1well_done.gif . Obviously a nasty virus but not quite as easy to catch as I thought.

The WHO have just okayed the use of untested drugs http://www.bbc.co.uk/news/health-28751623

From the BBC link I learnt a new word "ethicist - I wonder who the present day ethicists are and how they qualify as such :Erm:

[raynaputi]

Thanks for this Doc. :xxgrinning--00xx3:

[Doc Alan]

Thank you Dedworth, Mari, Rayna, and everyone else who has read this post :smile:.


• W.H.O. and their " ethicists " probably didn’t have much choice but to " okey the use of untested drugs " in this situation. Hopefully the ethicists understand that obtaining informed consent is NOT easy in the local population of countries affected by Ebola. There is resistance and mistrust - based not only on culture, but also their past experience of untested drugs proving ineffective or even dangerous.


• Drug companies themselves are wary. Pfizer had to make a multimillion dollar settlement in Nigeria about 20 years ago, when a new antibiotic for meningitis caused brain damage and death. Hostility from the local population has resulted in polio vaccination workers in Pakistan being killed. Even in the UK and Western Europe measles outbreaks still occur because parents have misguided mistrust of MMR vaccine.


• In fact the UK NHS Litigation Authority says claims of negligence against doctors for " innovative treatment " of serious conditions are very rare.


• There’s also the question of cost. The UK medicine " watchdog " - National Institute for Health and Care Excellence – " NICE " recently rejected a breast cancer drug which costs £ 90,000 for a course of treatment which might extend a patient’s life by 6 months. Branded drugs are relatively expensive ( but generics not always reliable ) in the Philippines. It has been said while it’s impossible to put a price on life’s precious moments, it ‘s not impossible to put a fair price on drugs :smile: !


• Until recent weeks it was said there was no specific treatment and no vaccines were available for Ebola. Realistically there still aren’t, at least on the scale required :NoNo:.


• To be fair, I understand " ZMapp " ( a combination of antibodies ) would be made available at no charge by the makers ( Mapp Pharmaceutical ). A few other drugs and serum may also become available – NONE yet proven by human trials. Until now, progress has been painfully slow, in part because the financial rewards have not been great.


• Until there ARE effective vaccines and drugs, good public health ( rapid diagnosis, isolation, and barrier nursing by properly equipped staff ) are the best hope for controlling this outbreak, and limiting its spread beyond West Africa.


• The latest Ebola outbreak is evolving, with over 1000 deaths so far. However, it’s worth noting that while a high death rate among patients ( over 50% this time ) is very bad news, it’s ALSO bad news for survival of the virus. The most " successful " viruses are those which are easily spread between human / animal " hosts " , infecting but not killing them, so the viruses themselves survive. Ebola does not spread through the air like cold and flu viruses – and there is no genetic evidence so far to show it mutating into more dangerous types.


• An international emergency, yes, but also reasons to be cheerful that it will NOT become a pandemic :xxgrinning--00xx3:.

[Michael Parnham]

Cracking stuff again Alan! :xxgrinning--00xx3:

[Arthur Little]

Yet ANOTHER interesting and informative thread, Alan ... :68711_thanx:

[Steve.r]

Interesting reports Alan, thanks :xxgrinning--00xx3:

[Doc Alan]

Thank you Michael, Arthur, and Steve.r :smile: .

Without adding more links ( there are regular updates in news media ), in my opinion :-


• Unlikely to be a miracle cure or vaccine for Ebola any time soon.


• An infected person COULD board a plane and unknowingly carry Ebola virus to a country beyond West Africa, before symptoms appear. Usual incubation period up to a week.


• " High index of suspicion " essential to recognize the chance of Ebola virus infection if the travel history raises this possibility. Diagnosis on blood samples can be made a day before symptoms appear. Tight border controls, with early isolation, are vital. Contacts need to be traced, with safe handling of " biohazardous " materials and ( if required ) bodies.


• Virus not transmitted person-person through the air, or by " casual " contact.


• This all suggests the chance of an outbreak of Ebola virus infection is very low in high-resource countries, and low elsewhere.


• International assistance is already promised. What healthcare workers and the public already know hopefully should control this epidemic and avert panic through misinformation.

[Doc Alan]

Recent looting of a quarantine centre in Monrovia ( capital of Liberia ) – forcing it to close – highlights the problems in controlling this West African epidemic. There is ignorance about the virus, even disbelief that it exists, and reluctance to cooperate with health care workers ( who are feared to be carrying the virus ) :doh.


In ways Ebola is similar to AIDS – diseases starting in animals of African jungles and taking hold in countries without decent health infrastructure, but on a FAR smaller scale. Lessons have been learned from AIDS - prevention is better than cure ( or treatment if incurable ), and certainly much cheaper.


Panic, fear, and disbelief are – up to a point – understandable. Vaccines and antibiotics have surely made infectious diseases less threatening :NoNo:? But AIDS, SARS, MERS, bird flu and swine flu – plus antibiotic resistance - have made us think again.


Communicable ( infectious ) diseases now account for around a third of deaths, and non-communicable diseases ( cardiovascular; diabetes; cancers ) two thirds, worldwide. In the UK communicable diseases account for 10% ; the Philippines 40% ; but 60% or more in poor countries such as those affected by Ebola.


We don’t even know for sure how many people have been affected in this Ebola epidemic :NoNo:. But it’s thought more WILL, before control is achieved, hopefully in the next 6 months. We do know how few resources have – so far – been available in the countries involved.

According to World Health Organization, Guinea spends under £ 40 / person on health each year. Sierra Leone has 2 doctors/100,000. Compare this to UK ( over £ 2000 and 272 doctors ) or Philippines ( £ 85 and 115 doctors ). Unlike the UK, “ pay as you go “ / “ out of pocket “ healthcare is more often the rule than the exception.


At least the severity of this outbreak is recognised. There is international financial help. More health workers are available ( and sadly already around 150 infected / 80 deaths ). Long term investment is needed in providing more doctors, health infrastructure ( public health measures, clinics ) and education. Eventually new drugs / vaccines should become available.


Unfortunately the cost to the affected economies could exceed the medical bills :doh. Lethal diseases that have no cure tend to cause over-reactions and confusion. There are already travel restrictions, and a few firms have removed foreign workers. This is understandable, but while most firms are taking a “ wait and see “ approach, let’s hope this epidemic will be contained sooner than later.


http://www.bbc.co.uk/news/world-africa-28827091



http://www.economist.com/news/international/21612157-spread-ebola-west-africa-deeply-troubling-region-and-world-fever

[Doc Alan]

The Ebola virus epidemic in west Africa has now infected up to 12,000, and killed more ( at least 2,400 ), than all the others combined, with regular updates including last week’s edition of " Horizon " .


• This is uncharted territory - but the epidemic appears right now to be out of control :doh. Liberia’s existence as a country is claimed to be " seriously threatened ". World Health Organization thinks there may be 20,000 cases before this epidemic can be contained and controlled, perhaps within 6 – 9 months. Other diseases like malaria – with similar symptoms – of course continue to need treatment.


• Good news is that the Bill and Melinda Gates Foundation is to spend $50 million ( on top of $10 m already committed ) to support emergency responses :xxgrinning--00xx3:. Of course this is a tenth of what is claimed by UN to be needed, and a tiny proportion of the Foundation’s money – but every little helps !



• New treatments and vaccines are now urgently being sought. Until now it was confined to poor African countries and largely containable with strict infection control. The possibility of international spread is a factor in this burst of activity. However, countries with good health services SHOULD be able to identify and isolate cases, preventing further spread.



• Already across Africa there is " economic contagion " – the whole continent is suffering the stigma of the disease, even though it’s largely affecting only three countries in west Africa :doh. South Africa’s ailing economy, for example, can do without this, when it’s so far from the affected countries and has no known cases.



• The genetic code of the Ebola virus is RNA – like HIV and influenza. Increasing human-human transmission ( rather than its natural hosts, animals like fruit bats ) gives it the chance to become more " transmissible ". Every time it replicates, new mutations appear. If these reduced the human death rate, it could spread more easily – like common colds – but never be completely eliminated.



• The other good news is that there are several human trials of vaccines that have shown promise in animal tests :xxgrinning--00xx3:. Usually a more cautious approach requires " Phase I " trials ( testing if a drug / vaccine is safe in healthy individuals ), followed by another series of trials over time. But these will be offered to health workers, and then others, in infected areas, sooner rather than later.


• One vaccine uses a chimpanzee " cold " virus to deliver Ebola genetic material, which triggers an immune response. Other viruses which readily infect cells could similarly be used to deliver Ebola viral proteins into cells and cause an immune response.



• Blood may also be given from Ebola " survivors " ( containing antibodies ) to existing patients – hopefully resulting in " passive immunity " ( as with other infections ).


• " ZMapp " is a cocktail of antibodies made by genetic engineering which appears to protect against Ebola ( 2 out of 4 infected people who have received it recovered ) – but supplies have run out for now. Existing drugs used for other conditions may also be tried - not the usual cautious, " evidence-based " approach, but justifiable if health care workers and patients are willing to try them.


• Resources of ALL kinds, from hospital beds to protective gear, and health care workers ( either local, or working for agencies such as Medecins San Frontieres ) are in short supply. But almost 40 years since discovery, the fight back against Ebola virus disease has at last become serious :xxgrinning--00xx3:.




http://www.bbc.co.uk/iplayer/episode/b04hcthj/horizon-20142015-6-ebola-the-search-for-a-cure


http://www.bbc.co.uk/news/world-africa-28754546

[Dedworth]

I read the other day that Pooley the British nurse is OK and out of hospital :xxgrinning--00xx3:

http://www.independent.co.uk/life-style/health-and-families/health-news/ebola-british-nurse-who-caught-virus-plans-return-to-treat-people-with-deadly-disease-9722544.html

[Longweekend]

I read the other day that Pooley the British nurse is OK and out of hospital :xxgrinning--00xx3:

http://www.independent.co.uk/life-style/health-and-families/health-news/ebola-british-nurse-who-caught-virus-plans-return-to-treat-people-with-deadly-disease-9722544.html

Yes, and he wants to go back again after we sent an RAF plane out there to pick him up.....:mad:

[London_Manila]

It's only a matter of time until this virus hits the UK :cwm25:
Until then i would not want to use Airports like Dubai which has/have many connecting flights from Africa

The UK government seems to be doing nothing about the vast amount of flights arriving at Heathrow from Africa
Surely monitoring inbound passengers from this continent is a must :doh

How many of our poor troops who have been sent out to Sierra Leone will end up catching this virus?

[Arthur Little]

It's only a matter of time until this virus hits the UK :cwm25:


:omg: ... you are certainly one "cheery" chappie and no mistake!

[Michael Parnham]

:omg: ... you are certainly one "cheery" chappie and no mistake!

I must admit Arthur, he has a point! :Erm:

[Pete/London]

I think we must close off the countries at the source of the disease until it's under control.

At the moment it seems it's anyone's guess where it will spread to.

[Terpe]

I think we must close off the countries at the source of the disease until it's under control.

At the moment it seems it's anyone's guess where it will spread to.

Agree.

Much more effective than attempting to prevent the spread at arrival points. :xxgrinning--00xx3:

[Terpe]

http://www.youtube.com/watch?v=C_itlEamvBo&sns=em

[Michael Parnham]

I think we must close off the countries at the source of the disease until it's under control.

At the moment it seems it's anyone's guess where it will spread to.

I agree also! :xxgrinning--00xx3:

[andy222]

Agree.

Much more effective than attempting to prevent the spread at arrival points. :xxgrinning--00xx3:

I don't know whether it's just my thinking or what. But why are we sending people out there to help only to let them back here with the risk that they could contract the virus and cause an epidemic here?

By the way, great post Doc. :xxgrinning--00xx3:

[Doc Alan]

I have not recently added to this thread because of the regular developments and frequent updates available elsewhere ( http://www.bbc.co.uk/news/world-africa-28754546 ;

http://www.who.int/csr/disease/ebola/en/ ).



• The disease does highlight global disparities in healthcare resources. The chance that the virus will establish a foothold in high resource countries like the UK or United States remains very small. The UK has " tried and tested systems " in place for dealing with severe infectious diseases.


• The cost to the poor countries of West Africa affected by the epidemic is not only in terms of numbers affected and deaths ( 4000 of the latter, including 200 health workers, probably an underestimate ) but also economic ( see the BBC link ).



• It’s hard to keep vigilant, and mount an appropriate, measured, response without panic.


• Screening of airline passengers as they arrive from West Africa – directly or via some other country - is being implemented in the USA and seems likely to follow in the UK . This alone DOESN'T solve the problem :-


1. Immigration officers are not trained health professionals.


2. There are many causes of fever apart from ebola ( such as malaria, typhoid, cholera, hepatitis, dengue, and other viral haemorrhagic fevers ).



3. As the incubation period for ebola varies between 2 – 21 days, potential victims might not even have a fever on attempted entry - by whatever route - to a country such as the U K.


4. Definitive laboratory diagnosis takes time, apart from the expense ( a variety of blood tests for the virus, antibodies to it, looking for the virus by electron microscopy, or culture of the virus ).



• The Philippines has many ( possibly 3,500 ) OFWs, living and working in the areas of Guinea, Liberia, and Sierra Leone. There has been a travel ban to those affected areas in West Africa for over three months. The few OFWs who have returned are being " monitored " by the Department of Health ( DOH ). Rightly, the Philippines government has rejected WHO’s call to send health workers to West Africa. There is an “ Ebola summit “ today ( 9 September ) which intends to update and inform Filipinos and of course keep the country free of the virus
( http://www.philstar.com/headlines/2014/10/07/1377345/doh-hold-ebola-summit-thursday ).


• In addition to the huge amount of information available on ebola, it may be worthwhile reminding Forum members :-


1. It’s ONLY transmitted among humans by close and direct physical contact with infected bodily fluids – especially blood, faeces and vomit.


2. It can be transmitted " indirectly " – by contact with previously contaminated surfaces and objects. Appropriate cleaning and disinfection procedures reduce this already low chance.



3. It is NOT an airborne virus. ‘Flu, common colds, measles, and TB are more easily spread because they ARE airborne. We’ve known this by studying the virus over the four decades since its discovery. There is NO evidence that the ebola virus could mutate into a form that could be easily spread among humans through the air.


• This epidemic IS out of control in West Africa – but is still very unlikely to become a pandemic, even if isolated cases are almost inevitable in other continents.


• At last the international community has recognised ebola as a " public health emergency of international concern " . Sadly many more seem likely to be infected and die in West Africa before this epidemic is controlled. Effective vaccines and drugs are on the horizon to prevent and treat future outbreaks.


• There is – unsurprisingly - a good deal in the medical press on this topic. More recent ones include :-


http://download.thelancet.com/flatcontentassets/pdfs/S0140673614617918.pdf



http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)61697-4/fulltext

[KeithD]

Good to see the prepared western countries struggling to cope with one infection! :doh

[London_Manila]

:omg: ... you are certainly one "cheery" chappie and no mistake!

Preparing for the worst case scenario seems prudent at this stage

Travelers and relatives should be advised against any travel to the effected countries and neighbouring countries and Africa should be classed as off limits

I would think countries like Spain have proper procedures in place to deal with infectious diseases but that did not stop that poor nurse catching Ebola

Have doctors on standby at the immigration halls at all major airports in the UK
All persons returning from affected countries to be monitored daily until the incubation period has passed

I have seen a few African guys around Manila and if it hits the Philippines I for sure won't go there

[Doc Alan]

Updates continue to appear daily on BBC, World Health Organization / WHO and other websites.


The Philippines is in the Western Pacific Region of WHO, and there is a regional meeting in Manila to address various health issues including the Ebola outbreak.


While the points made at the meeting may seem obvious, they do summarize the current situation :-


• The world’s growing social and economic inequalities


• Rumours and panic spread faster than the virus


• The world is put at risk when a deadly virus hits the destitute


• Decades of neglected basic health systems and services can bring a fragile country to its knees


• There is a lack of research and development incentive as evidenced by the absence of an Ebola vaccine


• The world is ill-prepared to respond to a severe, sustained and threatening public health emergency.


I would not over-estimate my expertise in this topic :NoNo:. It seems that the Philippines government IS responding to the outbreak in order to prevent ( or at least control ) Ebola virus infection reaching the country. President Aquino recognises that the several million OFWs - with thousands of OFWs in West Africa – does “ make these kinds of outbreaks of paramount concern “.



Hopefully the West African epidemic will be controlled with the measures being implemented ; the infection rate will peak then decline ; the crisis will pass ; and cases in other countries including the UK and Philippines will be isolated. Effective vaccine(s) and drugs will become available :xxgrinning--00xx3:.

The alternative is that cases will increase, travel restrictions will multiply, and the economy in Africa ( and elsewhere ) will suffer, a vicious circle :omg:.


What I do know is that it’s unlikely this virus will become airborne. It may well mutate, but only to a milder, more easily transmissible form, more “ successful “ than killing half its victims. Viruses do mutate but are not known for changing their actual mode of transmission.



http://www.wpro.who.int/mediacentre/releases/2014/20141013/en/


http://globalnation.inquirer.net/112453/filipinos-to-be-screened-for-ebola-outside-ph


http://www.healthpromo.doh.gov.ph/doh-holds-national-summit-on-ebola-virus-disease/

[KeithD]

I wonder what happens if we get a wider outbreak in the west. We keep getting told that we have these amazing rooms for dealing with such viruses, but an outbreak would soon fill them up, and then what? :cwm3:

[Pete/London]

I wonder what happens if we get a wider outbreak in the west. We keep getting told that we have these amazing rooms for dealing with such viruses, but an outbreak would soon fill them up, and then what? :cwm3:

I London they would be treated at the Royal Free Hospital in Belsize Park/ Hampstead. They would be cared for by Nurses and Junior Doctors, none of whom are able to afford to live in that area so travel to work on the underground and buses. Any failure to contain the virus would enable it to be spread around London very quickly,
We are all doomed !

It would be far better to isolate the countries at the source of the outbreak, not been done yet,
or build an isolation area miles from major cities and towns and when necessary, have staff there on 3 month shifts. Cant see anything else working.

[malolos]

I wonder what happens if we get a wider outbreak in the west. We keep getting told that we have these amazing rooms for dealing with such viruses, but an outbreak would soon fill them up, and then what? :cwm3:

There are enough old RAF AND Army camps where isolation units could be set up.

[bigmarco]

According to LBC this morning the screening at Heathrow is not mandatory. Seems a bit pointless if you can opt out :Erm:

[London_Manila]

According to LBC this morning the screening at Heathrow is not mandatory. Seems a bit pointless if you can opt out :Erm:

Most will probably lie anyway if they have been in infected countries or have been in contact with Ebola

Thomas Duncan who died in the USA of Ebola said he had never been in contact with anyone who had Ebola when he filled out his pre flight questionnaire = untrue

[KeithD]

There are enough old RAF AND Army camps where isolation units could be set up.

With Spain and the US already having failures in isolation units, I very much doubt that would work.

[Dedworth]

No screening at Dover & 50 plus germs were pulled out of trucks there last month

http://www.dover-express.co.uk/EXCLUSIVE-Illegal-immigrants-screen-Ebola-Port/story-23154162-detail/story.html

[KeithD]

Another US health worker has Ebola. Good to see the CDC doing its job. :Help1:

[Dedworth]

'Who's the idiot with the clipboard?' Disbelief and panic as mystery man WITHOUT a hazmat suit helps second Ebola nurse board her plane to Atlanta, disposes waste and then climbs aboard


Man casually dressed in shirt and pants seen on TV walking with Ebola patient Amber Vinson
He carried a clipboard and walked alongside Ms Vinson and healthcare workers who were ALL dressed in hazmat suits
He has been identified as a supervisor for Phoenix Air, the company that flew Miss Vinson to Atlanta
Miss Vinson walked onto the plane in Dallas and the man without protection also boarded the plane, flying with her to Atlanta, Georgia
Social media has dubbed him the 'clipboard man' - expressing shock that he came so close to an infected patient and unprotected


http://i.dailymail.co.uk/i/pix/2014/10/16/1413418145946_wps_8_As_coverage_of_the_transp.jpg

Read more: http://www.dailymail.co.uk/news/article-2794854/what-thinking-mystery-man-without-hazmat-suit-seen-helping-2nd-ebola-nurse-board-plane-atlanta-joining-them.html#ixzz3GJcqPaIl

[Michael Parnham]

Air France have a suspected case of Ebola in Madrid at the moment. We are seriously having second thoughts on flying to Philippines in January as the Ebola outbreak is accelerating throughout the world quite rapidly now, we'll just have to monitor the danger until nearer the time. Hope it gets nipped in the bud sooner rather than later and the main reason we are concerned is going to Philippines is not a problem, it's getting home if there is an International decision regarding flying!:Erm:

[KeithD]

Airline shares are dropping.

[Michael Parnham]

Airline shares are dropping.

Not surprising Keith! :smile:

[andy222]

According to LBC this morning the screening at Heathrow is not mandatory. Seems a bit pointless if you can opt out :Erm:

Nice to hear you listen to LBC occasionally Marco. Good radio station. :xxgrinning--00xx3:

[Doc Alan]

• Screening travellers arriving at airports is not an effective way of identifying those with serious infections. That’s why pre-entry screening for TB was introduced. Canada introduced airport screening during the SARS ( severe acute respiratory syndrome ) epidemic – it cost £ 9m and not one case was identified.

The longer the incubation period in relation to the flight duration, the lower the chance of successful entrance screening.
WHO recommends passengers on international flights out of Sierra Leone, Guinea and Liberia should be screened BEFORE boarding their flights.


• Providing adequate testing facilities on site is a challenge:-

1. There’s a limit to how many doctors and nurses with the necessary expertise can be on " stand by " ;

2. would passengers answer questions voluntarily and honestly ( even if they might be expected to do so if there was a one in two chance of dying without care ) ;

3. isolation of all passengers waiting for test results is a problem ;

4. and illegal immigrants would neither be tested, nor would they necessarily seek early medical help if they had symptoms.


• The Philippines is not sending health workers to West Africa ; the government preferring to focus on efforts to prepare the country for possible entry and spread of Ebola virus. The DOH has identified one referral hospital for each of the country’s 17 regions. It’s preparing the Lung Center of the Philippines, San Lazaro Hospital, and the Research Institute for Tropical Medicine to accommodate possible cases. DOH claims to have enough protective gear, and will train health personnel in all government and private hospitals – better late than never !
Filipinos in West Africa have apparently not come forward to be repatriated, despite the government offering to pay their airfare.


• Apart from daily coverage in the media, articles in medical journals continue to proliferate. This is still an evolving situation.

Points from the articles :-

1. Critical care services in the countries at the centre of the epidemic are urgently needed ( and only now being addressed ) - such that the death rate could be reduced from the present 70% to below 40% and ultimately the epidemic controlled.


2. It’s ethical to try drugs and vaccines with potential benefits even before their effectiveness and safety are fully understood.



3. Many Ebola infections may not have symptoms. These are thought not to be infectious – such people have " naturally acquired immunity ". They need investigating as possibly the best people to care for acutely ill patients ; and their immune serum could be useful.





• As if there wasn’t enough information readily available, here are a few links which are perhaps less easily found :-

1. Philippines :-


• http://www.philstar.com/headlines/2014/10/16/1380632/phl-doctors-buck-ebola-deployment

• http://www.philstar.com/headlines/2014/10/17/1381099/phl-wont-send-ebola-workers



2. Medical journals :-


• http://www.bmj.com/content/349/bmj.g6202


• http://www.thelancet.com/journals/lanres/article/PIIS2213-2600(14)70242-5/fulltext?rss=yes

• http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)61839-0/fulltext

• http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)61734-7/fulltext

[Dedworth]

I wouldn't pussy foot about - complete ban on travellers from the affected African countries

[andy222]

Politicians and some medical staff are telling us what we want to hear. i.e. we expect a few cases here and our hospitals can cope. The truth is if there is a breakout here we will not cope. There will be too many infected to deal with.

[bigmarco]

Good old Cuba.

http://www.theguardian.com/world/2014/oct/12/cuba-leads-fights-against-ebola-africa

[Terpe]

'Who's the idiot with the clipboard?'


Phoenix Air responds (via ABC News)...


"Our medical professionals in the biohazard suits have limited vision and mobility and it is the protocol supervisor’s job to watch each person carefully and give them verbal directions to insure no close contact protocols are violated," a spokesperson from Phoenix Air told ABC News said.

"There is absolutely no problem with this and in fact insures an even higher level of safety for all involved," the spokesperson said.

Source (http://abcnews.go.com/Health/clipboard-man-hazmat-suit/story?id=26235850 )

And we're supposed to put trust in these folks :yikes:

[London_Manila]

Air France have a suspected case of Ebola in Madrid at the moment. We are seriously having second thoughts on flying to Philippines in January as the Ebola outbreak is accelerating throughout the world quite rapidly now, we'll just have to monitor the danger until nearer the time. Hope it gets nipped in the bud sooner rather than later and the main reason we are concerned is going to Philippines is not a problem, it's getting home if there is an International decision regarding flying!:Erm:

I agree and i am thinking along the same lines as you

I have little faith in the Uk dealing with any Ebola outbreak and zero faith in the Philippine government dealing with it :unitedkingdom::philippines:

There should be a travel ban on everybody from Africa until this outbreak is under control

Drastic measures are needed now before it spreads everywhere

[Doc Alan]

No one now doubts that the Ebola crisis is the most severe acute public health emergency in modern times. It is a matter of opinion, whether among Forum members or so-called experts, just how bad this epidemic will become, and how to respond – to bring it under control.


• A travel ban on everybody from the affected African countries – quarantine in other words – would be hard to enforce. Borders are " permeable " – people would " escape " and pay bribes to do so. If the virus conquered West Africa unchecked, more untraceable emigrants would carry it inside their bodies. When the epidemic spread, could Ivory Coast, Nigeria, and the entire African continent be quarantined ? What if the virus travelled on to India, with its slums and poor healthcare, or China, where infection control in hospitals may be substandard ?


• The brave volunteer health care workers from other countries including Cuba and Medecins Sans Frontieres - who are so desperately needed - deserve to be cared for and if necessary flown out if they get ill. More treatment centres, with the necessary resources to build them, and healthcare staff to run them, are urgently needed.


• Ebola is not just a public health emergency – it infects everything ! In West Africa, children are orphaned, people stay away from fields and market places, businesses close, and there’s a risk of hunger.


• Errors will continue to occur in this uncharted territory. An outbreak of litigation is being predicted. Care workers and hospitals have a duty of care, not only to infected patients but also to protect those treating and working with the patients and other members of the public.


• I’m optimistic that outbreaks CAN be contained in countries such as the UK, with robust medical systems and the ability to trace contacts, and that in future effective vaccine(s) and drugs will become available. I would have less optimism – but not " zero faith " - in the ability to cope in countries such as the Philippines.


However, as I have said already – I don’t claim expertise and can’t predict with certainty the eventual outcome of this war on Ebola.

[Michael Parnham]

A couple more very informative post's Alan, thank you!:xxgrinning--00xx3:

[KeithD]

I see the nurse Pham in the US has a video out. She is just in a normal hospital ward :cwm24:

[Pete/London]

I do think it is a good idea what the British Army Medical team are doing though, building a field hospital close to the outbreak and wish them every success.

What has surprised me in some of the pics I have seen is an amateur looking way of decontamination. I had to call in specialized companies for Asbestos removal on sites and they completely seal off an area and the removal workers have to go through showers in their working equipment before leaving the area. No one standing around with what looks like a garden spray.

[fred]

Phl won’t send Ebola workers


MANILA, Philippines - The Philippines is not sending health workers to Ebola-plagued countries in West Africa despite the World Health Organization (WHO)’s call for states to deploy health personnel.
Department of Health (DOH) spokesman Lyndon Lee Suy announced yesterday that the Philippine government has not made a commitment to WHO’s appeal to send health workers to Sierra Leone, Liberia and Guinea, but it is considering other assistance for these affected countries.
“We are not taking the call (to send health workers) but we are looking at other ways to help. We don’t have to be physically present there. Assistance is not only humanitarian, we can send money or in kind,” Lee Suy explained.
The government, he added, would rather focus on efforts to prepare the Philippines for the possible entry and spread of Ebola virus.
Lee Suy gave assurance that the Philippines is now in a better position to respond to the Ebola threat despite doubts on DOH’s capability to address the global health crisis.
“This is not the first time that we are receiving this kind of threat and because we have experienced preparing for MERS-COVs and SARS, we are now in a better position to address the threat of Ebola,” he said.
The DOH has sufficient supply of protective gear and other necessary equipment to prevent the spread of Ebola for the next three months.
The DOH has also identified one referral hospital for each of the country’s 17 regions and is readying the Lung Center of the Philippines, San Lazaro Hospital and the Research Institute for Tropical Medicine to accommodate possible Ebola cases.
Lee Suy said the DOH would train health personnel in all government and private hospitals on how to properly handle Ebola cases.
A number of Filipino workers have returned from West Africa, but Lee Suy said the country remains Ebola free.

http://www.philstar.com/headlines/2014/10/17/1381099/phl-wont-send-ebola-workers

[Michael Parnham]

A couple more very informative post's Alan, thank you!:xxgrinning--00xx3:

Thank you again Alan!:xxgrinning--00xx3:

[Michael Parnham]

I agree and i am thinking along the same lines as you

I have little faith in the Uk dealing with any Ebola outbreak and zero faith in the Philippine government dealing with it :unitedkingdom::philippines:

There should be a travel ban on everybody from Africa until this outbreak is under control

Drastic measures are needed now before it spreads everywhere

The problem with Philippines is that only the people with money would get treatment for Ebola, so it would escalate!:NoNo:

[Terpe]

The problem with Philippines is that only the people with money would get treatment for Ebola, so it would escalate!:NoNo:

I'll probably get shot down for suggesting this, but I don't think it's very easy to become infected with Ebola.

I'll be travelling to the Philippines as planned.

[Doc Alan]

Phl won’t send Ebola workers


MANILA, Philippines - The Philippines is not sending health workers to Ebola-plagued countries in West Africa despite the World Health Organization (WHO)’s call for states to deploy health personnel.
Department of Health (DOH) spokesman Lyndon Lee Suy announced yesterday that the Philippine government has not made a commitment to WHO’s appeal to send health workers to Sierra Leone, Liberia and Guinea, but it is considering other assistance for these affected countries.
“We are not taking the call (to send health workers) but we are looking at other ways to help. We don’t have to be physically present there. Assistance is not only humanitarian, we can send money or in kind,” Lee Suy explained.
The government, he added, would rather focus on efforts to prepare the Philippines for the possible entry and spread of Ebola virus.
Lee Suy gave assurance that the Philippines is now in a better position to respond to the Ebola threat despite doubts on DOH’s capability to address the global health crisis.
“This is not the first time that we are receiving this kind of threat and because we have experienced preparing for MERS-COVs and SARS, we are now in a better position to address the threat of Ebola,” he said.
The DOH has sufficient supply of protective gear and other necessary equipment to prevent the spread of Ebola for the next three months.
The DOH has also identified one referral hospital for each of the country’s 17 regions and is readying the Lung Center of the Philippines, San Lazaro Hospital and the Research Institute for Tropical Medicine to accommodate possible Ebola cases.
Lee Suy said the DOH would train health personnel in all government and private hospitals on how to properly handle Ebola cases.
A number of Filipino workers have returned from West Africa, but Lee Suy said the country remains Ebola free.

http://www.philstar.com/headlines/2014/10/17/1381099/phl-wont-send-ebola-workers

No harm in repeating the message in #41 :smile:

[Doc Alan]

I'll probably get shot down for suggesting this, but I don't think it's very easy to become infected with Ebola.

I'll be travelling to the Philippines as planned.

You won't, and it isn't :xxgrinning--00xx3:

I will also be travelling to Philippines as planned :smile:

#24 :

1. It’s ONLY transmitted among humans by close and direct physical contact with infected bodily fluids – especially blood, faeces and vomit.


2. It can be transmitted " indirectly " – by contact with previously contaminated surfaces and objects. Appropriate cleaning and disinfection procedures reduce this chance.



3. It is NOT an airborne virus. ‘Flu, common colds, measles, and TB are more easily spread because they ARE airborne. We’ve known this by studying the virus over the four decades since its discovery. There is NO evidence that the ebola virus could mutate into a form that could be easily spread among humans through the air.


• This epidemic IS out of control in West Africa – but is still very unlikely to become a pandemic, even if isolated cases are almost inevitable in other continents.

[Terpe]

You won't, and it isn't :xxgrinning--00xx3:

I will also be travelling to Philippines as planned :smile:

:icon_lol::icon_lol:

:xxgrinning--00xx3:

[cheekee]

I'm still going to Cebu in November.

I will take some alcohol gel so I can disinfect my hands if needed.

Here is some info that I found useful.

EPIDEMIOLOGY: Occurs mainly in areas surrounding rain forests in equatorial Africa with the exception of Reston, which has been documented to originate in the Philippines. The Reston virus (RESTV), is not thought to cause disease in humans, but has caused disease in non-human primates.

So the Reston Strain of the Ebola Virus in the Philippines hasn't so far infected humans.

*Edit*Doc alan Mentions in his first post about the Reston virus. Reassuring for us guys going to the Philippines. soon

SUSCEPTIBILITY TO DISINFECTANTS: Ebolavirus is susceptible to 3% acetic acid, 1% glutaraldehyde, alcohol-based products, and dilutions (1:10-1:100 for ≥10 minutes) of 5.25% household bleach (sodium hypochlorite), and calcium hypochlorite (bleach powder).

The WHO recommendations for cleaning up spills of blood or body fluids suggest flooding the area with a 1:10 dilutions of 5.25% household bleach for 10 minutes for surfaces that can tolerate stronger bleach solutions (e.g., cement, metal). For surfaces that may corrode or discolour, they recommend careful cleaning to remove visible stains followed by contact with a 1:100 dilution of 5.25% household bleach for more than 10 minutes.

PHYSICAL INACTIVATION: Ebola are moderately thermolabile and can be inactivated by heating for 30 minutes to 60 minutes at 60°C, boiling for 5 minutes, or gamma irradiation (1.2 x106 rads to 1.27 x106 rads) combined with 1% glutaraldehyde. Ebolavirus has also been determined to be moderately sensitive to UVC radiation.

[Michael Parnham]

I'm still going to Cebu in November.

I will take some alcohol gel so I can disinfect my hands if needed.

Here is some info that I found useful.

SUSCEPTIBILITY TO DISINFECTANTS: Ebolavirus is susceptible to 3% acetic acid, 1% glutaraldehyde, alcohol-based products, and dilutions (1:10-1:100 for ≥10 minutes) of 5.25% household bleach (sodium hypochlorite), and calcium hypochlorite (bleach powder).

The WHO recommendations for cleaning up spills of blood or body fluids suggest flooding the area with a 1:10 dilutions of 5.25% household bleach for 10 minutes for surfaces that can tolerate stronger bleach solutions (e.g., cement, metal) Footnote 62. For surfaces that may corrode or discolour, they recommend careful cleaning to remove visible stains followed by contact with a 1:100 dilution of 5.25% household bleach for more than 10 minutes.

PHYSICAL INACTIVATION: Ebola are moderately thermolabile and can be inactivated by heating for 30 minutes to 60 minutes at 60°C, boiling for 5 minutes, or gamma irradiation (1.2 x106 rads to 1.27 x106 rads) combined with 1% glutaraldehyde. Ebolavirus has also been determined to be moderately sensitive to UVC radiation.

Very useful info!:xxgrinning--00xx3:

[Dedworth]

You won't, and it isn't :xxgrinning--00xx3:

I will also be travelling to Philippines as planned :smile:

#24 :

1. It’s ONLY transmitted among humans by close and direct physical contact with infected bodily fluids – especially blood, faeces and vomit.


2. It can be transmitted " indirectly " – by contact with previously contaminated surfaces and objects. Appropriate cleaning and disinfection procedures reduce this chance.



3. It is NOT an airborne virus. ‘Flu, common colds, measles, and TB are more easily spread because they ARE airborne. We’ve known this by studying the virus over the four decades since its discovery. There is NO evidence that the ebola virus could mutate into a form that could be easily spread among humans through the air.


• This epidemic IS out of control in West Africa – but is still very unlikely to become a pandemic, even if isolated cases are almost inevitable in other continents.


Thanks Doc - common sense prevails. I still think we should have an incoming travel ban on people coming from the affected African countries, no point encouraging possible problems

[Michael Parnham]

I'll probably get shot down for suggesting this, but I don't think it's very easy to become infected with Ebola.

I'll be travelling to the Philippines as planned.

So will we unless there's an International ban on flying!:Erm:

[cheekee]

At the acute hospital where I work we have protocols and procedures in place for Ebola.

We have all been measured and fitted for PPM3 respirators. We have guidance on how to gown up and only a small specific number of staff will treat any suspected cases.

Any patients that do end up at the hospital with confirmed ebola will be transferred safely to an infectious diseases specialist unit as soon as feasibly possible.

[London_Manila]

At the acute hospital where I work we have protocols and procedures in place for Ebola.

We have all been measured and fitted for PPM3 respirators. We have guidance on how to gown up and only a small specific number of staff will treat any suspected cases.

Any patients that do end up at the hospital with confirmed ebola will be transferred safely to an infectious diseases specialist unit as soon as feasibly possible.

They seem to have protocol measures in place in other countries and still health workers are catching it

Thomas Duncan presented himself at the hospital and was then sent home with antibiotics!

[London_Manila]

I'll probably get shot down for suggesting this, but I don't think it's very easy to become infected with Ebola.

I'll be travelling to the Philippines as planned.

Ebola patients are very messy patients constantly vomiting and defecating so I can see it spreading like wildfire in South East Asia :cwm25:

[KeithD]

It doesn't matter what protocols are in place, humans act on instinct. The US cases seem to be people removing the gear and then scratching themselves without realising that they were doing it.

Surely the only suitable suits are those they use in the bio labs with? The all-in-one with a zip up the back.

[Rosie1958]

I think it's the sheer magnitude of how this deadly disease could affect the whole world if it's not controlled that's scary.

Thanks for the very informative medical posts Doc Alan :xxgrinning--00xx3:

[Doc Alan]

Thank you to all members who have read and responded to my posts :xxgrinning--00xx3:.

This summary may be helpful for those of us in the UK :-


http://i1265.photobucket.com/albums/jj517/DocAlan/Ebola_zps69d20b42.jpg (http://s1265.photobucket.com/user/DocAlan/media/Ebola_zps69d20b42.jpg.html)

[grahamw48]

I would like to see those wishing to travel from infected areas being subjected to quarantine in an internationally-approved facility for a suitable period (3 weeks ?) BEFORE leaving their country.

[Terpe]

I would like to see those wishing to travel from infected areas being subjected to quarantine in an internationally-approved facility for a suitable period (3 weeks ?) BEFORE leaving their country.

Totally agree BEFORE leaving their country. :xxgrinning--00xx3:

[Doc Alan]

The only pre-entry screening of which I’m aware, certainly for the UK, is for TB. " Entry " screening was not effective for " latent " ( hidden or symptomless TB ) - which can reactivate, to infect others.


Pre-entry screening is thought to work for migrants applying for a visa to enter the UK from countries where TB is relatively common, including the Philippines. It’s too early to say just how many cases have been so detected and treated.


• Such screening with quarantine for ANY infection might be desirable, but is untried.


The West African countries most affected by this Ebola epidemic have very limited health services. For Guinea and Liberia TB screening is required - but is actually performed in an approved centre in Accra, Ghana ; it’s also required for Sierra Leone ( in Freetown ).


• To set up such centres would be costly. Resources needed for this epidemic are still inadequate ! Last month around 1,000 people arrived from these countries to the UK.

There could be unintended consequences, if potential migrants knew they also faced quarantine for 3 weeks. Borders are already " permeable ". People could pay bribes and either obtain documents " confirming " their health, or simply escape into other countries. If they entered the UK - legally or otherwise - and developed Ebola disease, they would have free treatment here ( as for TB or malaria ).


Your opinions are welcome and I’ve responded to the best of my knowledge ! With international collaboration and more resources the war on Ebola can be won :xxgrinning--00xx3:.

[Terpe]

Personally I feel that international resources should be focused on containing the outbreak.
If it becomes a problem in too many other countries outside of west Africa then perhaps resources will be overstretched.

There are plenty of Asian and Eastern European countries without adequate health care.

I say containment is key.

[Dedworth]

Australia stops processing visas from Ebola-hit countries

http://uk.reuters.com/article/2014/10/27/health-ebola-australia-idUKL4N0SM5X920141027

Well done the Australian Govt - a sensible precautionary measure

[bigmarco]

I'm not a great lover of Australians but I do admire the way they protect their borders.

[Dedworth]

I'm not a great lover of Australians but I do admire the way they protect their borders.

Common sense and unlike our self servers the govt demonstrates their duty of care to its citizens

[Doc Alan]

I can’t control a viral outbreak of ebola threads on the Forum, but only intend to update here – no repetition :smile: !


So Australia has announced a travel ban – and shut down an aid program in West Africa. Now Canada has followed suit, although it doesn’t have direct flight connections with West Africa, and Canadians in West Africa - including healthcare workers - WILL be allowed back to Canada !



Over 30 countries have already imposed some form of travel restrictions, including other African nations. North Korea will quarantine every foreigner for 21 days :smile:.


Of course the idea seems logical, and understandable – if selfish and hard to enforce. Prevent sick people entering your country! Either pre-entry screening with treatment if needed ( as for TB ) - or a complete ban :doh !



Would travel bans be effective as a protective measure ? Apart from causing economic hardship, unintended consequences are uncontrolled migration from the affected countries by devious routes ( land and sea ) , almost impossible to track, with illegal immigration into other countries.


The United Nations could not enforce the international coordination needed for such a ban :NoNo:. Not every nation would agree to quarantine West Africa ; crippling their economy ; cutting off their humanitarian aid ; with the ebola epidemic spiralling out of control, instead of reaching a plateau and numbers of cases eventually declining.


U.N. is in fact encouraging the international community to send more healthcare teams and other resources to the three West African nations most affected. This is what they should be doing :xxgrinning--00xx3: ! World Health Organization ( WHO ) may be the global health leader, but the UN has legitimacy and authority to at least try to influence member states.


Let’s also keep matters in perspective – since the epidemic started seven months ago FAR more have died in this region from malaria ( treatable ) and basic hunger.



The countries now fighting ebola are among the poorest in the world with inadequate health infrastructure. At last - forty years after discovery of ebola - there’s a reasonable chance of containment through effective resources, vaccines, and treatments, thanks to international awareness ( if not panic ) :xxgrinning--00xx3:.

[Doc Alan]

We are now one step closer to an Ebola virus vaccine, better late than never :xxgrinning--00xx3: !


The two main promising vaccine " candidates " are " vectored " ( carried ) in other, harmless, viruses. Only part of the Ebola virus is thus carried - a surface protein which helps the virus enter " host " human ( or non-human primate ) cells. The hope is that this stimulates an immune response which stops the Ebola virus infection.


The vaccine in a small trial just completed in the USA is " bivalent " – acting against the current ( " Zaire " ) strain, and also the " Sudan " strain. It had already been shown to work in non-human primates. The trial only involved 20 healthy human volunteers. None of these suffered major side effects. There was an antibody response in all of them, and also other ( " T cell " ) responses.


Of course this was only a phase I trial, confirming an immune response. It needs a much larger trial involving healthcare workers, burial workers and others in close proximity to people with Ebola disease. This would hopefully confirm a lasting, protective, immune response - and no major side effects. Other similar trials are under way elsewhere, including Oxford, Switzerland and Mali.


There is little " good news " about the Ebola virus disease crisis. One is the stimulus to look for new treatments and vaccines. Things are moving faster than usual when evaluating such developments, because this is a humanitarian crisis. It doesn’t mean that trials of prevention or treatment of other illnesses could - or should - be as rapid. There are all sorts of considerations like cost, effectiveness, and side effects which would normally favour more caution and patience.


There are reasons to be cheerful that this battle for control within West Africa, and then protection, CAN be achieved next year. All the other problems - both health-related ( TB, malaria, malnutrition ) and economic, facing this part of Africa, may well not be solved so rapidly.


http://www.nejm.org/doi/full/10.1056/NEJMe1414305

[Doc Alan]

The search for an effective Ebola virus vaccine goes on :xxgrinning--00xx3: ! Now the first vaccine trial done in Africa has been reported, not only for Ebola but also for Marburg ( another viral haemorrhagic fever ). It was carried out in 108 healthy Ugandan adult volunteers, showing both vaccines were safe and produced immune responses.


• There have now been at least 7,800 deaths and over 20,000 cases of Ebola, the vast majority in Guinea, Sierra Leone, and Liberia. These West African countries have INADEQUATE healthcare systems - which help to explain how the Ebola outbreak is so bad. Sadly there have also been about 370 deaths among 670 cases in healthcare workers.


• This week’s headline news ( http://www.bbc.co.uk/news/uk-30637199 ) concerns a Scottish nurse diagnosed with Ebola after returning to Glasgow from Sierra Leone, now being treated at the Royal Free Hospital in London, probably including use of recovered patients’ plasma – containing antibodies. Inevitably this has prompted renewed concerns among the UK public, reassurances by medical experts – and another thread on this Forum.


• Probably everyone agrees that it’s essential to stop outbreak(s) of Ebola disease at their source. In time, specific treatments and vaccines will be available.


• However, unlike the aftermath of Typhoon Haiyan – when there weren’t enough seats on the planes for all the international volunteers – FAR more resources, including thousands of additional healthcare volunteers, are needed in West Africa. These are people who put their lives at risk to save those suffering Ebola infection, with the aim of source control, and bringing the world closer to stopping its spread.



• The health care volunteers are HEROES and HEROINES – and also responsible enough to identify themselves before they become a threat to their community. They know better than anyone that without symptoms ( fever, vomiting, diarrhoea ) they are NOT contagious. There are inadequate facilities for putting such workers in quarantine in the three West African countries. Even if there were, attempts to enforce it - before OR after return to their own countries - would add to the lack of enthusiasm for volunteers to go in the first place. A FAR greater risk is the untraceable number of locals emigrating from these countries by whatever means possible, who are not so motivated to control Ebola, and know less about it in any case.


• Three cheers for the health care workers trying to control this terrible disease :Hellooo::Hellooo::Hellooo:. People living in Glasgow are infinitely more at risk from Hogmanay celebrations than contracting Ebola :smile:.



http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2814%2962385-0/abstract


http://www.economist.com/blogs/graphicdetail/2014/12/ebola-graphics


http://www.nejm.org/doi/full/10.1056/NEJMe1413139

[Rosie1958]

Excellent post Doc Alan .......... and most definitely agree about the volunteer healthcare workers! :xxgrinning--00xx3::xxgrinning--00xx3::xxgrinning--00xx3: :appl: :appl: :appl:

[Doc Alan]

By late February there have been about 24,000 cases and nearly 10,000 deaths reported worldwide, almost all in Guinea, Sierra Leone, and Liberia. Left-click on images to enlarge :-


http://i1265.photobucket.com/albums/jj517/DocAlan/Ebola_zps6j24y8we.png (http://s1265.photobucket.com/user/DocAlan/media/Ebola_zps6j24y8we.png.html)


• The inadequacies of health-care systems in the three most-affected countries help to explain how the Ebola outbreak was so bad :-


http://i1265.photobucket.com/albums/jj517/DocAlan/Health%20care%20systems%20%20ebola%20_zps5t5req0g.png (http://s1265.photobucket.com/user/DocAlan/media/Health%20care%20systems%20%20ebola%20_zps5t5req0g.png.html)


• Despite that, the " experts " ( like World Health Organization ) were still confounded - they had feared much worse. The " worst case scenarios " grabbed the headlines. Fortunately communication with locals, isolation of cases and safe burials, proved effective ; numbers of new cases appear to have passed their peak ; Ebola has not gone airborne ; and its economic effects are also not so dire as thought – good news, but it will be harder to catch the world’s attention next time.


• The rapid roll-out of several vaccine trials has been impressive. They were not originally developed with African public health in mind ( but fear that the virus could be used as a bioweapon ). Fewer Ebola cases now runs the risk that the " business case " for such vaccines is weaker ( limited market size and recipient governments’ ability to pay ). With over 800 cases and nearly 500 deaths in medical staff so far, the need for vaccines is just as vital for the population and health workers alike. Hopefully there will be external financial support, such as from the Bill and Melinda Gates Foundation.


• It seems that returning Philippine peacekeepers have been quarantined for 21 days on Caballo Island ( a navy-run island at the mouth of Manila Bay ), in addition to thorough medical screening. A handful of Filipino doctors returned from the Ebola-stricken countries this month, having also finished a " 21-day quarantine abroad, outside the three affected countries ".


• A recent UK NHS update on Ebola virus is available here :-

http://www.nhs.uk/conditions/ebola-virus/pages/ebola-virus.aspx


• See also :-

http://www.economist.com/blogs/graphicdetail/2015/02/ebola-graphics


• … and for the Philippines :-


http://www.mb.com.ph/doctors-from-ebola-stricken-areas-back-report-on-ofws/


http://www.reuters.com/article/2014/11/10/us-health-ebola-philippines-idUSKCN0IU0EW20141110

[Doc Alan]

There is good news about Ebola virus disease ( EVD ) :xxgrinning--00xx3: !


• Only 2 confirmed cases were reported in the last week ( 1 in Guinea, 1 in Sierra Leone ) – the lowest since March 2014.


• The first large-scale trial of a vaccine, in Guinea, showed NO EVD cases in over 2,000 volunteers who were vaccinated immediately, but 16 cases in a similar number where vaccination was delayed for at least 21 days. A single injection produces a rapid immune response against a surface protein of EV. The vaccine is not yet licensed, but in future every contact at risk of infection will receive it immediately.


• The technique used in the trial was " ring vaccination " – a new design where contacts of each newly diagnosed EVD case were vaccinated and monitored. The vaccine is also being trialled against frontline health workers.


• If we needed reminding, EVD has infected about 28,000 and killed over 11,000 – almost all in Guinea, Liberia and Sierra Leone - including over 500 health workers. Apart from this, these countries’ healthcare systems were severely disrupted, with far more cases of malaria, and it took a terrible toll on their economies.


• There have only been a handful of EVD cases elsewhere in Africa, and worldwide. But it could have been much worse ! A year ago a Liberian man infected with EVD flew into Lagos, Nigeria. This megacity has 21 million inhabitants and the virus could have spread there – then ( Lagos being an international travel hub ) beyond :yikes:. Luckily Nigeria does have the capacity to tackle such outbreaks, and there were just 20 infections ( 8 deaths ).


• More good news :xxgrinning--00xx3:. The EVB outbreak in West Africa has alerted the world to the possibility of another epidemic or pandemic of a disease spreading much more easily than Ebola. It happened with influenza in 1918, killing up to 50 million people. Smallpox may have killed 300 million before eradication in 1980. The Ebola epidemic has spurred World Health Organization and others to recognise and react more quickly to an emerging outbreak, hopefully having – or developing – drugs and vaccines to deal with it.


• We don’t know what / when the next disease will be, and the risks need to be kept in perspective :doh! History has shown that new " bugs " posing a large epidemic threat are RARE. The last one was " SARS " ( severe acute respiratory syndrome ) over a decade ago ( over 8,000 infections, nearly 800 deaths ).


• Many " new " human diseases have come from animals, with a spectrum of types :-


1. Animals only ( possible future threats because of similar past behaviour ).
2. Limited spread from animals to humans ( H5N1 flu, rabies ).
3. Small outbreaks ( MERS / Middle East Respiratory Syndrome )
4. Large outbreaks ( Ebola ).
5. Humans only / originally animals ( HIV/AIDS ).


• Most infections, such as drug-resistant TB and malaria, evolve SLOWLY, but are ultimately more serious than the acute outbreaks attracting more attention ( 7 separate Forum threads on MERS ! ).


• Of course 2/3 diseases in the world are non-communicable, such as heart disease and cancers ( 90% in UK ; 60% in Philippines ). Together with improved outlooks for most " non-communicable diseases ", let’s hope the lessons learned from Ebola will better prepare the world for any future outbreaks, whatever the cause :xxgrinning--00xx3:




http://www.nature.com/news/how-to-beat-the-next-ebola-1.18114

[cheekee]

Interesting read doc Alan.

Thanks

[Doc Alan]

Thankfully the Scottish nurse who contracted Ebola while working in West Africa is improved ( " serious but stable " ) after developing meningitis as a late complication of the original infection. Full recovery is likely to take a long time. ( See http://filipinaroses.com/showthread.php/58301-Scots-Ebola-Nurse-In-Serious-Condition?p=553003#post553003 )


Of course she’s neither the only seriously ill patient to benefit from our NHS, nor the only healthcare worker to contract Ebola. 3% of all the West African cases and 5% ( over 500 ) of the deaths were such workers. Vaccination would be the best solution to prevent or control future outbreaks.


Now that West Africa seems close to being Ebola-free for the present, the focus is going to change towards prevention of future outbreaks, and also the chances of other survivors developing recurrences.


We know that the virus can persist in tissues such as the eyes, nervous system, placenta, prostate, and semen. There has been ( only ) one case of sexual transmission to a woman in Liberia, from a male survivor 5 months after his recovery.


We’re still learning about this virus and the complications of infection after apparent recovery. In the meantime, the known 17,000 ( + ) survivors need to be treated with caution in their recovery from a painful severe illness, with the apparently low risk of recurrence and risk to the public, so they don’t become social outcasts unwilling to be identified.

[Michael Parnham]

I'm pleased to hear that there are signs of improvement!

[Doc Alan]

The outbreak of Ebola virus disease ( Evd ) in 2014-2015 was the largest known, with around 28,000 cases and 11,000 deaths, mainly affecting West Africa ( Guinea, Liberia and Sierra Leone ). Evd was declared over (http://www.nhs.uk/Conditions/ebola-virus/Pages/Ebola-virus.aspx)in June last year.


The Scottish nurse, Pauline Cafferkey (http://filipinaroses.com/showthread.php/59694-Scots-Ebola-Nurse-Pauline-Cafferkey-Charged-Over-Concealing-Temperature?highlight=Pauline+Cafferkey), infected while working in Sierra Leone in 2014, has been cleared of misconduct charges by the Nursing and Midwifery Council. On her fourth admission to hospital ( Queen Elizabeth University Hospital, Glasgow ) since returning from West Africa, she tested negative for the virus ( October 2016 ).


There’s still a chance, hopefully small, that cases of Evd may occur in Africa.


We’ve known about Evd for over 40 years, but it took the last outbreak to stimulate overdue investments in vaccines and drug treatments.


Several " candidate " vaccines have been developed and tested in clinical trials. As there is no identifiable high-risk population that can be targeted without the presence of an Evd epidemic, and Evd outbreaks are unpredictable, it’s just as well that vaccine trials are now already established.


Treatments need to be based on good evidence, not anecdotes.


Clinical trials (http://www.nhs.uk/Conditions/Clinical-trials/Pages/Introduction.aspx) must be regulated and judged ethical. They are usually staged in four " phases " - involving progressively larger groups of people.


Trials of Ebv vaccines may involve " ring vaccination " of " clusters " (http://www.bmj.com/content/351/bmj.h3740) of individuals at high risk of infection, due to social /geographical connection to a known case. Ring vaccination helped smallpox eradication in the 1970s.


Towards the end of last year final trial results showed a highly effective vaccine (http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)32621-6/abstract) for preventing Evd, now being " fast tracked " for regulatory approval. This was an " open-label " trial ( both researchers and participants knew whether vaccination was immediate OR delayed by 21 days ). It wasn’t possible for the more common " blind " trial, where those taking part don’t know the treatment being given. The vaccine was also " recombinant " ( from more than one source, possible because DNA molecules from all organisms share similar chemical structure ), and " vector-based " ( " carried " by a harmless virus, to make more effective ).


The vaccine WAS effective in preventing Evd in all of almost 6,000 people receiving it.


It could be available by next year ( far less time than most new vaccines take ), and the manufacturer ( Merck ) has made 300,000 doses available, thanks to $5m from " GAVI " ( Global Vaccine Alliance).


Good news indeed, although more lives could be saved if countries invested in vaccines and treatments BEFORE outbreaks, rather than during them - unfortunately NOT always possible to predict, whether ‘flu, Zika, or other infection.