So will we unless there's an International ban on flying!Originally Posted by Terpe
So will we unless there's an International ban on flying!
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!
Ebola patients are very messy patients constantly vomiting and defecating so I can see it spreading like wildfire in South East Asia
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.
Keith - Administrator
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
Thank you to all members who have read and responded to my posts
This summary may be helpful for those of us in the UK :-
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.
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
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.
Australia stops processing visas from Ebola-hit countries
http://uk.reuters.com/article/2014/1...0SM5X920141027
Well done the Australian Govt - a sensible precautionary measure
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
I can’t control a viral outbreak of ebola threads on the Forum, but only intend to update here – no repetition!
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
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!
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. 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
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 )
We are now one step closer to an Ebola virus vaccine, better late than never
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
The search for an effective Ebola virus vaccine goes on
• 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. People living in Glasgow are infinitely more at risk from Hogmanay celebrations than contracting Ebola
http://www.thelancet.com/journals/la...385-0/abstract
http://www.economist.com/blogs/graph...ebola-graphics
http://www.nejm.org/doi/full/10.1056/NEJMe1413139
Excellent post Doc Alan .......... and most definitely agree about the volunteer healthcare workers!
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 :-
• The inadequacies of health-care systems in the three most-affected countries help to explain how the Ebola outbreak was so bad :-
• 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-v...ola-virus.aspx
• See also :-
http://www.economist.com/blogs/graph...ebola-graphics
• … and for the Philippines :-
http://www.mb.com.ph/doctors-from-eb...eport-on-ofws/
http://www.reuters.com/article/2014/...0IU0EW20141110
There is good news about Ebola virus disease ( EVD )
• 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. Luckily Nigeria does have the capacity to tackle such outbreaks, and there were just 20 infections ( 8 deaths ).
• More good news
• We don’t know what / when the next disease will be, and the risks need to be kept in perspective
• 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
http://www.nature.com/news/how-to-be...-ebola-1.18114
Interesting read doc Alan.
Thanks
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....003#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.
I'm pleased to hear that there are signs of improvement!
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 in June last year.
The Scottish nurse, 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 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 " 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 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.
There are currently 1 users browsing this thread. (0 members and 1 guests)
Posting Permissions
Quote Reply
