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[stem-ebola] PRO/AH/EDR> Ebola virus disease - Africa, Europe cases, USA quarantine stations

ProMED-Mail Update on Ebola Outbreak.  Tues. Sep 8th 10:30AM.

*Includes what went wrong in Spain; how a Spanish nurse was infected

-------- Original Message --------
Subject: PRO/AH/EDR> Ebola virus disease - ex Africa (07): Europe cases, USA quarantine stations
Date: 2014-10-07 21:44
From: promed@xxxxxxxxxxxxxx
To: promed-post@xxxxxxxxxxxxxx, promed-edr-post@xxxxxxxxxxxxxx, promed-ahead-post@xxxxxxxxxxxxxx
Reply-To: promedNOREPLY@xxxxxxxxxxxxxx

A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases

In this update:
[1] Spain: nurse's Ebola infection blamed on substandard equipment
[2] Norway case
[3] USA: quarantine stations
[4] Where to find non-sensational Ebola coverage

[1] Spain: nurse's Ebola infection blamed on substandard equipment
Date: 7 Oct 2014
Source: The Guardian [edited]

Health professionals in Madrid have blamed substandard equipment and a
failure to follow protocol for the 1st case of Ebola to be contracted
outside West Africa. Health authorities announced on Mon [6 Oct 2014]
that a Spanish nurse at Madrid's Carlos III hospital who treated a
patient repatriated from Sierra Leone had twice tested positive for

Her husband had also been admitted to hospital and was in isolation,
and a 2nd nurse from the same team that treated both repatriated Ebola
victims was also being tested. In this case, the nurse contacted the
authorities on Mon [6 Oct 2014] complaining of a fever. She was in
isolation in the Carlos III Hospital while authorities waited for the
test results, a spokesperson for the Madrid regional government said.

Staff at the hospital told El Pais that the protective suits they were
given did not meet World Health Organization (WHO) standards, which
specify that suits must be impermeable and include breathing
apparatus. Staff also pointed to latex gloves secured with adhesive
tape as an example of how the suits were not impermeable and noted
that they did not have their own breathing equipment.

The nurse was part of a team attending to missionary MGV, 69, who died
4 days after being brought to Carlos III hospital on 20 Sep 2014. The
same team, including the nurse, also treated missionary MP, 75, who
was repatriated from Liberia in August 2014 and died 5 days later.
Staff at the hospital said waste from the rooms of both patients was
carried out in the same elevator used by all personnel and, in the
case of the 2nd patient, the hospital was not evacuated.

The European commission said on Tue [7 Oct 2014] it had written to the
Spanish health minister "to obtain some clarification" on how the
nurse had become infected when all EU member states were supposed to
have taken measures to prevent transmission. There is obviously a
problem somewhere," the commission spokesman Frederic Vincent said.

Spanish health authorities have said that professionals treating Ebola
patients in Spain always follow WHO protocols. The nurse would have
entered GV's room just twice, said Antonio Alemany, from the regional
government of Madrid, both times wearing protective equipment. "We
don't know yet what failed," Alemany said. "We are investigating the
mechanism of infection."

The nurse was in a stable condition. She had alerted the ministry of a
slight fever on 30 Sep 2014 and been checked into a hospital in
Alcorcon, on the outskirts of Madrid, with a high fever on Mon [6 Oct
2014]. The nurse, who is married with no children, was transferred to
Carlos III hospital early on Tuesday morning [7 Oct 2014]. El Mundo
reported that it was the nurse who asked to be tested for Ebola,
having to insist repeatedly on being tested before it was done on
Monday [6 Oct 2014].

While staff at the Alcorcon hospital were waiting for the test
results, the nurse remained in a bed in the emergency room, separated
only by curtains from other patients, hospital staff told El Mundo.
Their version of events clashes with that of health authorities, who
have said the patient was isolated from the 1st moment.

The woman was on holiday at an unknown location when she began showing
symptoms. "We are drawing up a list of all the people she may have
been in contact with, including with health professionals at the
Alcorcon hospital," said Alemany, estimating that more than 30 people
were being monitored for any sign of symptoms.

In August 2014, Spain became the 1st European country in the current,
fast-spreading outbreak to evacuate patients for treatment. The
decision prompted concern among health professionals, who said Spanish
hospitals were not adequately equipped to handle Ebola.

[Byline: Ashifa Kassam]

Communicated by:
ProMED-mail Rapporteur Kunihiko Iizuka

Spain: contacts quarantined
7 Oct 2014: (BBC) Three other people, including the nurse's husband,
have been quarantined. The nurse had twice gone into the room where
Mr. GV had been treated to be directly involved in his care and to
disinfect the room after his death. Both times, she was wearing
protective clothing. Madrid healthcare director Antonia Alemany told
reporters that according to the information available: "The nurse went
into the room wearing the individual protection gear, and there's no
knowledge of an accidental exposure to risk."... The hospital was
reported to have had extreme protective measures in place including 2
sets of overalls, gloves and goggles.

However, health workers told El Pais newspaper that the clothing did
not have level-4 biological security, which is fully waterproof and
with independent breathing apparatus. Instead, it was level 2, the
paper says, as photographs provided by staff indicated that the
overalls did not allow for ventilation, and the gloves were made of
latex and bound with adhesive tape.

Doctors are also monitoring 22 people with whom the nurse had contact
at Alcorcon hospital and 30 people working at Carlos III, according to
health sources quoted by Spanish newspaper El Pais. They include an
ambulance crew and doctors and nurses, and all have been contacted by
the health authorities.

[The] case highlighted the dangers that health care workers face
caring for Ebola patients; officials said she had changed a diaper for
the priest and collected material from his room after he died. Dead
Ebola victims are highly infectious, and in West Africa, their bodies
are collected by workers in hazmat outfits.

[This posting from the Washington Post originally cited an AP report
that said a Nigerian has been hospitalized in Spain. The AP has
updated its reporting to say that the man is Spanish and had recently
traveled to Nigeria. This post has been updated as well. - Mod.JW]

News of the quarantines hit Spain's stock market Tuesday [7 Oct 2014].
Spain is one of Europe's biggest tourist destinations, and stocks in
tourism-related companies such as airlines and hotel chains fell on
the Madrid stock exchange as investors feared the consequences of the
Ebola case. Shares in International Airlines Group, formed in early
2011 by the merger of British Airways and Iberia, dropped more than 6
percent, while those of NH Hotel Group and Melia Hotels were down 4
percent. The Ibex 35 stock market index was 1.7 percent lower.

The nurse, who did not leave Madrid during her vacation, was currently
being treated with drip using antibodies from previous infected
patients... [presumably plasma from the 2 missionaries who died in the
hospital. - Mod.JW]

[Byline: Inmaculada Sanz]

Ryan McGinnis

[2] Norway case
Date: 7 Oct 2014
Source: The Local, Norway [edited]

The Norwegian woman infected by Ebola [ebolavirus] in Sierra Leone and
currently receiving treatment in Oslo, will get the last dose of the
virus treatment medicine ZMapp available in the world. The news was
released by the Norwegian Medicines Agency on Tue [7 Oct 2014],
according to NTB. Steinar Madsen, medical director of the Norwegian
Medicines Agency, said to Dagens Medisin: "It looks like we could get
the last available dose of ZMapp to Norway. The medicine is now in

According to the professional medic's magazine, the agency has given
Oslo University hospital the authorisation to import Ebola medicines
not approved of in Norway. Madsen said: "When there are patients with
an acute need for medicine, we allow import of medicines that are not

While the medicine Avigan came to Norway already on Tue [7 Oct 2014],
TKM-Ebola will arrive on Wed [8 Oct 2014]. Madsen reported that ZMapp
has been the most difficult to get. "It must be said it is lucky that
Norway will get the last dose of ZMapp. There are no more doses in the
world, and it takes a long time to produce. It is the hospital
pharmacy that gets the medicine through contact networks all over the
world, while the Norwegian Medicines Agency gives the necessary
approval," said Madsen.

Madsen explained further the medicine will be imported to the Ebola
patient only. It has been tried on only a small number of patients,
and the effect of the medicine is, therefore, not fully known. Madsen
said: "Of those who have taken ZMapp, the majority have survived.
Another person has survived with TKM-Ebola, but the medicines are used
on a small number of patients."

It has been revealed that at least 27 Norwegians are still currently
working in Ebola-ridden areas and include:
- Medecins Sans Frontiers: Around 20 Norwegians take part in the Ebola
effort in Liberia, Sierra Leone and Guinea.
- Red Cross: 7 Norwegian employees in areas struck by Ebola.
- NORCAP: A Norwegian health logistics worker will travel to Liberia
on Fri [10 Oct 2014]. Other Norwegians are also on NORCAP's
preparedness lists.

Ryan McGinnis

[3] USA: quarantine stations
Date: 6 Oct 2014
Source: Washington Post [edited]

Public health officials say Ebola is extremely unlikely to spread in
the United States, but the Centers for Disease Control and Prevention
is on the lookout for international travelers who might be carrying
the deadly virus. The agency operates a network of 20 quarantine
stations where health officers can "decide whether ill persons can
enter the United States and what measures should be taken to prevent
the spread of contagious diseases."

The locations of all 20 U.S. quarantine stations (Courtesy of CDC):

On Sun [5 Oct 2014], one of those stations sprang to action after a
passenger began vomiting on board an international flight headed from
Brussels to New Jersey's Newark Liberty International Airport,
according to a CNN report. Most of the 255 passengers on the flight
were released to go through customs after about an hour and 35
minutes. The sick traveler was allowed to leave after the New Jersey
Department of Health, in coordination with federal officials,
determined that his condition was "consistent with another, minor
treatable condition unrelated to Ebola."

The CDC has the authority to deny entry to the United States for ill
people if they have one of 9 types of "quarantinable diseases," as
defined by executive order. The agency can also admit patients to
specialized hospitals for treatment. The list of quarantinable
diseases, which was last updated by President Obama in July [2014],
includes cholera, diphtheria, infectious tuberculosis, plague,
smallpox, yellow fever, viral hemorrhagic fevers, severe acute
respiratory syndromes, and new types of flu that could cause a
pandemic. Ebola counts as a viral hemorrhagic fever.

CDC quarantine centers are staffed by personnel who assess the health
of travelers on board landed aircraft when passengers become ill. Sick
individuals can be moved to isolation rooms at the quarantine
facilities, or the agency can send them for care at hospitals. To be
clear, the CDC considers "quarantine" to be different from
"isolation." Quarantines apply to individuals who have been exposed to
diseases but feel well and need monitoring, while isolation applies to
those who are actually ill...

[Byline: Josh Hicks]

Communicated by:

[4] Where to find non-sensational Ebola coverage
Date: 4 Oct 2014
Source: US4 [edited]

We talked to medical reporter Helen Branswell of The Canadian Press
about where she goes to find reliable news about Ebola.

Your Sanity Guide To Ebola
"A case of #Ebola in Dallas shows the risk this virus poses the world.
But the fight needs to go to the source, West Africa. #containment,"
tweeted Helen Branswell, the longtime medical reporter for The
Canadian Press, this week. She keeps us from going completely nutso
with fear every day, so we asked her where she goes for her most
reliable and up-to-date info.
- The World Health Organization is crucial for up-to-date information.
"I don't think anybody trusts the Ebola numbers, but the best ones
that are available are the ones WHO is generating."

- "It's hard to say that one thing is more important than the other,
but ProMED-mail is critical for trying to keep on top of things." It's
a push service and aggregator that sends out tailored email updates
several times a day with context added in by infectious disease

- The Journal of Science has "some of the best English language
science writers on the planet, and they are particularly strong on
infectious diseases." The full stories appear weekly in the journal,
but they put things up quickly on Science Insider.

- Dr. Richard Besser was an acting director of the CDC at one time and
is now Chief Health and Medical Editor at ABC News. He's currently in
Monrovia, and he's a good source of informative, non-hyped Ebola

- Follow Kai Kupferschmidt, a science writer, on Twitter; he's
phenomenal. It's hard to follow Ebola on Twitter right now because
it's moving so fast, but this is a good place to start.

Communicated by:

[ProMED thanks Helen, a good friend and contributor to our list, for
her kind mention. - Mod.JW

A HealthMap/ProMED-mail map can be accessed at:

[See Also:
Ebola virus disease - ex Africa (06): Spain case, USA case, US case
medevaced 20141006.2837374
Ebola virus disease - ex Africa (05): USA ex Liberia, prevention
Ebola virus disease - ex Africa (04): USA ex Liberia, prevention
Ebola virus disease - ex Africa (03): USA ex Liberia, Germany case ex
S. Leone 20141003.2830392
Ebola virus disease - ex Africa (02): USA ex Liberia, prevention,
false alarms 20141002.2827166
Ebola virus disease - ex Africa: USA ex Liberia, WHO 20141001.2823539
Ebola virus disease - West Africa (184): USA (TX) first case ex
Liberia 20140930.2819341]
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