Mali Already Has An Ebola Cluster: Can The Virus Be Stopped?

"This is not just one case," says Tom Frieden, director of the Centers for Disease Control and Prevention. "It's a cluster." He's talking about the Ebola situation in Mali, where two people have likely died of the disease in Bamako, the capital, and two others have tested positive.

Hundreds more may have been exposed. Officials from the U.N., the World Health Organization, the government of Mali and the CDC are all calling for swift action to keep Mali from descending into the Ebola chaos that's hit neighboring Guinea, Liberia and Sierra Leone.

"This is very deeply concerning," says Frieden. The CDC is sending additional staff to help respond to the outbreak.

This cluster of new cases centers around a private hospital in Bamako. On Oct. 27, an imam from Guinea died at the clinic from what had been diagnosed as kidney failure.

This week a nurse who treated him died of Ebola. Two other people from the clinic — one of them a doctor — have tested positive for the virus. The body of the imam was sent to a mosque for ritual cleansing, then returned to Guinea for a large public funeral before authorities in Mali realized he probably died of Ebola.

Frieden says the risk of this cluster turning into a major outbreak is high.

"There will be hundreds of contacts who need to be traced. Every single one needs to be contacted every day. If anyone dies, they need to be safely buried."

Frieden says the CDC may introduce exit screening at the Bamako airport and the U.S. may consider new entry requirements for travelers arriving from the landlocked nation.

Prior to this cluster, Mali had had only one Ebola case: a 2-year-old girl from Guinea who died on Oct. 24. But there were worries about the virus, and the country had been preparing just in case.

Teresa Sancristoval, who's with the emergency desk of Doctors Without Borders, had helped the health ministry set up a 13-bed Ebola isolation hospital in Bamako. The two confirmed cases are being treated there.

"The challenge is that all the people working with us [are] new to the disease so there's a lot of training to be done," she says.

The staff need to be taught meticulous infection control. Contact tracers need to be trained. And when anyone now dies of an unexplained illness, the body needs to treated as if it's potentially infected.

Because West Africans often touch the body before burial, funerals have been a potential place for transmission during this outbreak. Sancristoval says getting people to change deeply-held cultural beliefs about how they say goodbye to a loved one is hard.

For the moment, traditional burials continue in Mali, she says. Up until now there hasn't been the need for campaigns warning people about the risks of touching dead bodies as there have been in the other Ebola-affected countries.

Sancristoval says it's very hard to predict whether this flare-up will be snuffed out quickly. The international community knows how to contain it, she says. The question is whether aid organizations and the government can mount an adequate response fast enough.

Meanwhile, she has her own perspective on the virus.

"People who take care of you while you are sick [are] the people who get affected," she says. "People who prepare your body for the burial are the people who get affected."

That's why she thinks of Ebola as the disease of love: The virus turns acts of compassion into chains of transmission.

A LOOK AT EBOLA TREATMENT IN THE USA BY NUMBERS

OMAHA, Neb. (AP) -- When Dr. Martin Salia arrives in Omaha from Sierra Leone, he'll be the 10th person with Ebola to receive treatment in the U.S.

The surgeon was heading Saturday to the Nebraska Medical Center. The 44-year-old Salia is a Sierra Leone citizen and a permanent resident of the U.S., where he lives in Maryland.

He had been working at Kissy United Methodist Hospital in the Sierra Leone capital of Freetown when he fell ill. Last Monday, Salia tested positive for Ebola, which has killed more than 5,000 people and infected more than 14,000 in West Africa.

His wife, Isatu Salia, said Friday afternoon that she had spoken with her husband by phone earlier in the day and that he sounded weak but lucid and understood what was going on.

A look at Ebola treatment in the US by the numbers:

NINE:

Nine people with Ebola have received medical treatment in the United States, many of them aid workers. The first, Dr. Kent Brantly, returned to the U.S. in early August. The latest, Dr. Craig Spencer, left a New York City hospital on Tuesday. He fell ill with Ebola after returning from West Africa.

FIVE:

Five of the nine people treated in the United States were - like Salia - diagnosed with Ebola in West Africa and flown to the United States. They include three doctors, a medical aid worker and man who worked as a video journalist. The other four were diagnosed in the United States.

FOUR:

Four U.S. hospitals have specialized treatment units for people with highly infectious diseases, including the largest one at the Nebraska Medical Center in Omaha. The others are at Emory University Hospital in Atlanta, the National Institutes of Health near Washington and St. Patrick Hospital in Missoula, Montana.

Salia will be the third at the Omaha hospital; the Montana unit is the only one that hasn't been used yet for an Ebola patient.

TWO:

Two cases of Ebola have originated in the United States. Two Dallas nurses - Nina Pham and Amber Vinson - were infected while caring for a Liberian man sick with the disease. Both of the nurses have recovered.

ONE:

There has been only one Ebola death in the United States. Thomas Eric Duncan became sick days after arriving in Dallas from Liberia. He went to the emergency room at Texas Health Presbyterian Hospital but was sent home, which the hospital has acknowledged was a mistake. He returned a few days later, was diagnosed with Ebola and died Oct. 8.

EBOLA: Doctor infected with Ebola in Sierre Leone being brought to US

told The Associated Press on Friday. The US Embassy in Freetown said Salia himself was paying for the expensive evacuation. He reportedly lives in Maryland.

The US State Department said Thursday that Salia’s wife, who also lives in Maryland, has asked the State Department to investigate whether he is well enough to be flown to Nebraska.

Salia is a general surgeon who had been working at Kissy United Methodist Hospital in the Sierra Leone capital of Freetown. Patients, including mothers who hours earlier had given birth, fled from the 60-bed hospital after news of the Ebola case emerged, United Methodist News reported.

The hospital was closed on Tuesday after Salia tested positive and he was taken to the Hastings Ebola Treatment Center near Freetown, the church news service said. Kissy hospital staffers will be quarantined for 21 days.

A citizen of Sierra Leone, the 44-year-old lives in Maryland and is a permanent US resident, according to a person in the United States with direct knowledge of the situation. The person was not authorized to release the information and spoke on condition of anonymity.

The doctor will be the third Ebola patient at the Omaha hospital and the 10th person with Ebola to be treated in the US. The last, Dr Craig Spencer, was released from a New York hospital on Tuesday.

The Nebraska Medical Center said Thursday it had no official confirmation that it would be treating another patient, but that an Ebola patient in Sierra Leone would be evaluated for possible transport to the hospital. The patient would arrive Saturday afternoon.

Salia came down with symptoms of Ebola on 6 November but test results were negative for the deadly virus. He was tested again on Monday, and he tested positive. Salia is in stable condition at an Ebola treatment center in Freetown. It wasn’t clear whether he had been involved in the care of Ebola patients.

Kissy is not an Ebola treatment unit but Salia worked at at least three other medical facilities, United Methodist News said, citing health ministry sources.

Sierra Leone is one of the three West Africa nations hit hard by an Ebola epidemic this year. Five other doctors in Sierra Leone have contracted Ebola — and all have died.

The disease has killed more than 5,000 people in West Africa, mostly in Sierra Leona, Guinea and Liberia.

The Nebraska Medical Centre is one of four US hospitals with specialized treatment units for people with highly dangerous infectious diseases.

It was chosen for the latest patient because workers at units at Atlanta’s Emory University hospital and the National Institutes of Health near Washington are still in a 21-day monitoring period.

Those hospitals treated two Dallas nurses who were infected while caring for Thomas Eric Duncan, a Liberian man who fell ill with Ebola shortly after arriving in the US.


Sourced from TheGuardian

Ebola outbreak: MSF to start West Africa clinical trials

THE charity Medecins Sans Frontieres has said it will host clinical trials of new treatments for Ebola at three centres in West Africa.

Medical staff will use two drugs from a World Health Organization shortlist, as well as blood and plasma therapy also endorsed by the WHO.

The aim of the trials is to keep the patients alive during the critical first 14 days of the illness.

The news comes as the number of people to die from Ebola rose to 5,160.

The outbreak is thought to have infected more than 14,000 people, almost all of them in West Africa.

The frequency of new cases no longer appears to be increasing in Guinea and Liberia but remains high in Sierra Leone, the World Health Organization says.

But transmission remains "intense" in the first two countries, the WHO added, and the deaths of three people in Mali were reported on Wednesday.

MSF spokeswoman Annick Antierens said the charity was taking part jointly with British, French and Belgian researchers to give Ebola sufferers a better chance of survival.

"This is an unprecedented international partnership which represents hope for patients to finally get a real treatment," she said.

Ebola: Fears amid Hope

Okechukwu Emeh, Jr

The fear from this worst-even Ebola outbreak is heightened by the fact that the virus is mentioned among the most deadly emerging and re-emerging diseases, which infectious-disease specialists tagged “the 12 apocalypes”. Others of the same genre, whose spread could get worse in the future and portend a public health threat if not checked, are Avian Flu, Babesiosis, cholera, parasites, Lyme disease, plague, red tides, Rift Valley Fever, sleeping sickness, tuberculosis (TB) and yellow fever. Recent disturbing statistics, for example, indicated that about 1.5 million people around the world died of TB in 2013.


Fears are also mounting about the potential of the Ebola virus as a weapon of mass destruction (WMD), just as the lethal pathogens of other highly contagious diseases like small pox, anthrax, plague, botulism and tularemia. In fact, there is growing concern in many quarters, including the UN and Western countries, that the virus could be cultured in a laboratory for the purpose of producing biological weapons by rogue states or fringe criminal elements like terrorists. It is instructive that modern unconventional arsenal contains viral or bacterial weapons, with microbes cultured and refined, or weaponised, to increase their ability to kill. Unlike a bacterial attack, antibiotics are not usually effective against pathogen with haemorrhagic fever agents (including Ebola, lassa and bubonic plague). Thus, the major trepidation about the arms race in this post-Cold War order, which has somehow declined since the East-West reconciliation in 1989, is no longer about the deployment of nuclear and chemical weapons in the event of conflict. Rather, it is about the possibility of the use of biological weapons, which are difficult to control but relatively easy to produce. This is small wonder President Barrack Obama of the US, whose country designated the Ebola virus as a category A bio-germ weapon, has described the current outbreak of the disease as a national security threat with potential to destabilise volatile part of the world.


Thankfully, the international community has mobilised both human and material resources on a massive scale to combat and arrest the spread of the EVD. Giving another cause for hope amid the fears about this deadly scourge of our age was the recent certification of Senegal and Nigeria by the WHO as being free from the virus after 42-day benchmark of no incidence of the case. However, this clean bill of health calls on the two countries not to be overwhelmed by euphoria over such feats but to remain fully alert by maintaining necessary precautionary and preventive measures against the disease, which could make a comeback through international travels and infected animals. Thus, in the words of the WHO while congratulating Nigeria for its spectacular success story in curbing the spread of the EVD, “such countries have won a battle against Ebola, the war will only truly end when West Africa, Africa and the world are declared free of Ebola”. For other countries, especially those in the throes of the Ebola epidemic like Liberia and Sierra Leone, they should rely on better and faster testing with a view to saving lives and bringing an end to the outbreak. This is imperative because based on the recent fearful projection by the US Centres for Disease Control and Prevention (CDC), if the international community fails to increase the existing efforts to stop the alarming spread of the epidemic significantly and immediately, it could infect about 1.4 million people at the heart of the outbreak in West Africa by January next year, as well as spill over into other parts of Africa with porous borders and weak health care infrastructure. Already, the Ebola virus was reported recently to have entered neighbouring Mali where it killed one infected victim.


Also holding the light at the end of the tunnel of the current Ebola crisis are the reports that substantial progress has been made by several top-flight universities and pharmaceutical companies in the US, Canada, the UK, Belgium, Switzerland and the rest to produce effective drugs – a kind of ZMapp and plasma – for the treatment of the victims of the disease. At the same time, the WHO has raised hopes that the trial vaccines that will trigger the production of necessary anti-bodies in humans against the EVD are being produced from the serum made from the blood of recovered patients and will be tested in West Africa in January next year.


However, if there is any important lesson from the ongoing Ebola crisis, it is the urgent necessity of injecting a new lease of life into the comatose public health sector in Africa, where about 24 outbreaks of the epidemic have been reported since 1976. Expectedly, this would require more funding of primary health care systems and centres for disease control and prevention, along with recruitment of additional health workers who will be well-trained, well-equipped, well-paid and well-motivated. On the part of the developed world of Europe, North America and Asia South Pacific, they should help African states to revive their ailing health sector, just as Cuba and China, which are actively involved in the Ebola emergency operations in West Africa, have exemplary done. This is crucial because any threat of deadly and contagious disease somewhere is a threat to human safety elsewhere, especially considering that we now live in a world where countries, regardless of their remoteness are all connected by the air we breathe, the food we eat and by international travels.


So, the developed world, in concert with the WHO, should be helpful in strengthening the health care systems of poor African countries by giving support in the vital areas of staff capacity building, development of new medicines, better sexual reproductive health services and subsidisation of medical bill for killer diseases like cancer, cardiac problem, kidney failure, diabetes, AIDS, tuberculosis and hepatitis. They should also assist in reversing the grim scenario in the health sector in many parts of Africa, as made egregious in inadequate coverage and access to basic health services like maternal, infant and child health, a predilection towards curative services and health policy framework that do not pay sufficient attention to primary health care, lack of requisite drugs and health care facilities. Advanced countries should equally help poor African states in ensuring that public health is prioritised with the overall national development plan and articulating health strategies that respond to the diverse and changing policy-making and accountability, as well as attracting the support of donor community in the areas of providing clean water supply and sanitisation, which are critical to healthy living.


It is impossible to conclude without stating that despite the global panic about the present Ebola outbreak, this re-emerging public health emergency cannot wipe out humans from the face of the earth. This is mindful that humankind never solves any of its nagging problems, whether deadly disease, violent conflict, terrorism, political oppression, social injustice, inequality, abject poverty, hunger or natural disaster, but rather outlives them. Accordingly, the human community will not merely survive with a sense of resilience but will overcome agonising challenges like the EVD with the ennobling spirit of cooperation and solidarity.


Emeh, a social researcher, sent this piece from Abuja. okemehjr@yahoo.com

NIGERIA: FG Launches Ebola Surveillance Scheme

The federal government has launched Ebola Virus Disease (EVD) surveillance and operational vehicles to stave off a reoccurrence of the deadly disease in the country.
The supervising Minister of Health, Dr KhaliruAlhassan who launched the scheme that includes operational vehicles in Abuja said all hands must be on deck to ensure Nigeria do not return to abyss of the deadly Ebola virus disease.

Alhassan said: "As you are aware, following successful collaboration among the Federal Ministry of Health and the Governments of Lagos, Rivers and Enugu States, Nigeria was able to halt the spread of EVD. With a case fatality of 36.8 per cent, and the time taken to contain Ebola, ours has been one of the most successful responses to EVD containment in history.
"However, while we are happy with our achievements, we are not oblivious of the fact that for as long as Ebola is still ravaging our brothers and sisters in Guinea, Sierra Leone and Liberia, it remains a threat to us. Coupled with the lesson we have learned so far, that you do not wait for emergencies/disease outbreaks to occur before you plan your response, we have agreed to continue to progressively invest in disease surveillance, preparedness and response. Above all to ensure that we secure our various ports of entry.”


He added: "At the federal level, we remain committed to support the states to establish isolation centres and pre-position some of the materials required to begin to respond to outbreaks like that of the EVD. Furthermore, we are going ahead with our efforts to strengthen a number of reference laboratories spread across the six geographical regions to facilitate diagnosis of diseases. The EVD outbreak has also reinforced the need to strengthen the infection prevention and control practices as well as research in the country.

"As such, through the advice of the Treatment Research Group, which was inaugurated to guide the Ministry on research into preventive and curative treatments for EVD, we are also preparing to begin clinical trials on some candidate EVD vaccines. In this regard and it is our commitment to work together with all stakeholders to ensure that these studies are conducted in ways that are ethical, ensuring maximum possible protection for the research participants and their communities accordingly.
"We are here today to launch these vehicles to support surveillance and emergency preparedness and response activities. The vehicles shall be stationed at some of our key ports of entry and also used to communicate between operations centres and surveillance offices within and across states.


"I wish to call on all our state governments to also take a leaf from our work at the federal level to continue to strengthen their surveillance and outbreak preparedness and responses to ensure that no room is given to Ebola to return to Nigeria and that in the event of any other emergency or disease outbreak, we would be prepared to respond and curtail its impact even better than we have done with the EVD.”

Ebola: Lagos to Upgrade Infectious Diseases Hospital

The Lagos State Government has revealed its plans to upgrade the Infectious Diseases Hospital (IDH) in a bid to meet the standard of handling Ebola Virus Disease (EVD) and other hemorrhagic fevers in the future.
This plan was unveiled in Lagos recently, where the Lagos State Governor, BabatundeRajiFashola also reiterated that “the state is now Ebola-free, hence safe for business, conducive to live in and work for local and international visitors, with readiness of the state to tackle any emergency as it did in the case of Ebola outbreak.”

Fashola who was represented by the Deputy Governor of the state, Mrs AdejokeOrelope- Adefulire, said, “although Ebola was a test case for this part of the world which was effectively tackled, we are prepared to contain any emergency.”
While reassuring partners in the hospitality industry that the state is ready for business after the brief lull caused by the Ebola outbreak, the Lagos State Governor said “we will do whatever we can do to further assist in moving the hotel industry forward.”


On plans by the state to upgrade the IDH to meet standards in tackling hemorrhagic fevers including Ebola, Lassa, dengue fevers, among others, the Lagos State Commissioner for Health, Dr.JideIdris who was also in attendance explained that the state will upgrade the existing facility as well as increase isolation facility, diagnostic to bio-safety level 4 laboratory, to enable it handle any virology laboratory investigations to tackle existing haemorrhagic fevers presently ravaging the nation’s population.
“Training facilities will also be established and because the state has a number of survivors, it is looking into using serum from these survivors to treat Ebola patients. There will be a plasma unit that will be collecting serum from survivors, freeze them and use them for research to tackle not just Ebola but any other condition it can work for,” Idris said.


The Commissioner revealed that the Lagos State Government has the support of Bill and Melinda Gates Foundation to bring a mobile laboratory that has facility to take the serum and this will be done temporarily until the upgrade of the IDH will be fully on ground.
“A research group from the United States (U.S), the ARM Research Group, is partnering Lagos State, because of the high number of survivors from the state. The future of medicine is going to genomics. Nigeria and Lagos State should not be left behind. At the end of the day, that is the future. So, we need to start now. What Lagos is trying to do now is research along that line,” he added.
Idris described the planned research facility as a Bio Bank, adding that it can take tissues, take serum, take plasma, can store them in a specific manner and determine whether to do genetic studies. “It is a way of solving medical and clinical problems along that line,” Idris explained.

In line with establishing research group, the commissioner said the upgraded IDH will be divided into various zones – highly infectious, incinerators, sewage treatment, among others.
According to him, it is necessary to sensitise Nigerians and the research community on this initiatives and further urged anyone including organisations that are interested in funding research to key into the projects in order to build the states capability to handle emergencies locally as well as create the expertise.