[stem-ebola] PRO/AH/EDR> Ebola virus disease - ex Africa (11): Europe, t

[alex@xxxxxxxxxxxxxx]

EBOLA VIRUS DISEASE - ex AFRICA (11): EUROPE, THREAT TO NORTH AMERICA,
RECURRENCE
*********************************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

In this update:
[1] Ebola: 14 cases have been treated outside West Africa
[2] Spain: nurses quit
[3] Prevention & false alarms
[4] Threat to North America
[5] USA: Dallas case had high fever at 1st visit
[6] Recurrent cases

******
[1] Ebola: 14 cases have been treated outside West Africa
Date: Updated 8 Oct 2014
Source: New York Times [edited]
<http://www.nytimes.com/interactive/2014/07/31/world/africa/ebola-virus-outbreak-qa.html>


Ebola Facts: How many patients are being treated outside West Africa?
---------------------------------------------------------------------
At least 14 Ebola cases have been treated outside of West Africa in
the current outbreak. Most of these involve health and aid workers who
contracted Ebola in West Africa and were transported back to their
home country for treatment; 2 cases were diagnosed outside of West
Africa: A Liberian man began showing symptoms 4 days after arriving in
Dallas [Texas], and a Spanish nurse became ill after treating a
missionary in a Madrid hospital. These cases are compiled from reports
by the federal Centers for Disease Control and Prevention [CDC], the
World Health Organization, Doctors Without Borders [MSF] and other
official agencies.... -- more, with graphic

--
Communicated by:
ProMED-mail
<promed@xxxxxxxxxxxxxx>

******
[2] Spain: nurses quit
Date: Fri 10 Oct 2014
Source: Guardian UK [edited]
<http://www.theguardian.com/world/2014/oct/10/madrid-hospital-staff-quit-ebola>


Carlos III hospital treating virus-hit nurse suffers staff shortage
amid concerns over training and safety
--------------------------------------------------------------------------------
Concerns about a lack of training and safety standards have left some
staff refusing to attend to possible Ebola cases at Madrid's Carlos
III hospital, where the 1st known person to contract the disease
outside west Africa is being treated. 14 people are in quarantine at
the hospital, including 4 health workers who treated the Spanish nurse
who contracted the virus after treating an Ebola patient repatriated
from Sierra Leone. 7 people, including 2 hairdressers who had given
Romero a beauty treatment before she was diagnosed, entered the
isolation unit on Thursday [9 Oct 2014]. None has tested positive for
the disease except [the nurse], whose condition was described by the
hospital as serious but stable. Her treatment has included injections
with antibodies extracted from the blood of Ebola survivors....

While no official numbers were available, Elvira Gonzalez of the SAE
nurses' union said fear of Ebola had caused some staff to refuse to
treat certain patients, while others had resigned. One health worker
told the newspaper El Pais that many staff members were making excuses
to avoid work.... Others worry about being stigmatised. "Their
children aren't being invited to birthday parties and their friends
are cancelling joint holiday plans," Juan Jose Cano, a member of the
Satse nursing union, told El Pais. "They've become known as the Ebola
nurses. And it's not fair." ... -- more

[Byline: Ashifa Kassam in Madrid]

--
Communicated by:
Ryan McGinnis
<http://bigstormpicture.com>

******
[3] Prevention & false alarms

USA: Ebola victim's belongings burned in Port Arthur
----------------------------------------------------
10 Oct 2014: (AP) A Texas incinerator has destroyed drums loaded with
items believed to have been contaminated by a man with Ebola. Veolia
North America says the drums taken from a Dallas apartment where D
became ill were destroyed Friday [10 Oct 2014] at the company's
incinerator in Port Arthur [Texas]. Veolia says its incineration
process destroyed viruses and pathogens with temperatures ranging from
1500 to 2100 degrees F [816-1129 C]. A crew of 15 people spent 4 days
at the apartment where [he] had been staying when he developed
Ebola-related symptoms such as vomiting and diarrhea. They wore
protective suits with gas masks while filling about 140 barrels with
mattresses [Reportedly, he slept in all the beds. - Mod.JW], [his]
sheets and carpet from the entire apartment.... -- more
<http://www.macon.com/2014/10/10/3356426_ebola-victims-belongings-burned.html?rh=1>

--
How not to catch Ebola
----------------------
7 Oct 2014: (BBC) "If an infected droplet does get on to your skin, it
can be washed away immediately with soap and water or an alcohol-based
hand sanitiser. The eyes are a different matter. A spray of droplets
from a sneeze directly into the eye, for example, could let the virus
in. Similarly, the mucous membranes of the mouth and inside of the
nose are vulnerable areas, as is broken skin.... The virus can't
breach protective gear, such as gloves, a mask, goggles, a full body
suit and tough rubber wellington boots, but too few have access to
state-of-the-art kit.... Those who do get to wear it should keep
changing it every 40 minutes to be safe. Inside the suit it can get up
to about 40C [104F -- fever temperature]. Getting into the kit takes
about 5 minutes. Taking it off again takes the wearer and a designated
helper "buddy" about 15 minutes. This is one of the most dangerous
times for contamination and people are sprayed with chlorine as this
happens." ...
[Byline: Michelle Roberts]
<http://www.bbc.com/news/health-29518703>

--
Protective Ebola Suit -- Interactive Graphic
--------------------------------------------
10 Oct 2014: (BBC) [Look way down page; start at Gloves, then
counterclockwise] ... -- more
<http://www.bbc.com/news/world-europe-29531671>

--
Canada advises citizens to leave Ebola-hit countries
----------------------------------------------------
10 Oct 2014: (NDTV) The Canadian government advised its citizens on
Friday [10 Oct 2014] to leave the West African countries hardest hit
by Ebola, while taking measures at its own borders to screen for
potentially exposed travelers. "We are asking Canadians living in
Sierra Leone, Guinea and Liberia to consider leaving by commercial
means while they are still available," Health Minister Rona Ambrose
said. The minister also said that anyone traveling to Canada from the
countries affected by the epidemic will be screened at airports.... --
more
<http://ndtv.com/article/world/canada-advises-citizens-to-leave-ebola-hit-countries-605121>

--
USA: CDC could quarantine U.S. citizens for weeks if they refuse Ebola
screenings
--------------------------------------------------------------------------------
10 Oct 2014: (Yahoo) U.S. citizens who refuse to undergo the new
screenings for Ebola at 5 major American airports could find
themselves held in quarantine for up to 3 weeks, officials told Yahoo
News on Thursday [9 Oct 2014]. Non-citizens who refuse the screenings
could be quarantined or turned away from U.S. soil by U.S. Customs and
Border Protection. The Obama Administration announced on Wednesday [8
Oct 2014] that it would soon require passengers from Guinea, Liberia,
and Sierra Leone -- the countries at the epicenter of the deadly
outbreak in West Africa -- to answer questions about their potential
exposure to the illness and to have their temperature taken upon
arrival.
[Byline: Oliver Knox]
<https://www.yahoo.com/travel/cdc-could-quarantine-u-s-citizens-for-weeks-if-they-99662350657.html>
[Screening starts today, Sat 11 Oct 2014 at JFK airport, and on Mon 13
Oct 2014 at the other 4 airports. - Mod.JW]

--
USA: Some facilities run elaborate drills as others merely hand out
flyers
--------------------------------------------------------------------------
10 Oct 2014: (Yahoo) A few days before the Ebola-infected D arrived in
Dallas-Fort Worth Airport to reunite with his fiancee, the Centers for
Disease Control and Prevention released a sternly worded alert to the
nation's hospitals. "Now is the time to prepare," the memo said in
bolded letters at the beginning of a detailed 6-page checklist of
steps that hospitals should take to ready themselves for a patient
like D. "Every hospital should ensure that it can detect a patient
with Ebola." As is clear now, Texas Health Presbyterian Hospital in
Dallas was not ready to detect Ebola -- they sent D home with
antibiotics after he showed up with a fever and abdominal pain, and
acknowledged he had recently been in Liberia. He came into contact
with dozens of people after that -- including schoolchildren -- before
his disease worsened and he returned to the hospital in an ambulance.
On Wednesday [8 Oct 2014], he died.... But in the decentralized U.S.
health care system, hospitals don't necessarily have to take the CDC's
advice -- and federal funding streams to help them do so have been
slashed in recent years. The result is a health care system where some
hospitals are running intense, life-like drills featuring hypothetical
Ebola patients and others are just now beginning to send around memos
on the topic.... -- more
<http://news.yahoo.com/ebola-outbreak-reveals-massive-disparities-in-u-s--hospital-preparedness-214729813.html>
[Even if you don't live in the USA, why not check what your local
hospital is doing? - Mod.JW]

--
Number of Ebola false alarms mounts as panic grows
--------------------------------------------------
10 Oct 2014: (Mail Online) From American airliners to British buses,
number of Ebola false alarms mounts as panic grows over spread of
deadly disease:
- Australia: a plane made emergency landing when passenger vomited
blood.
- Czech Republic: Tests show man with symptoms of Ebola does not in
fact have virus.
- Taiwan: woman tested negative for Ebola after showing symptoms of
virus.
- UK: Scare at Liverpool coach station after passenger collapsed and
vomited, medical staff boarded coach in protective gear and removed
the woman. Doctors at Royal Liverpool Hospital confirmed she did not
have Ebola.
- USA: Another scare when man yelled 'I have Ebola!' on flight from
Philadelphia; 4 Hazmat officers rushed onto US Airways plane to
Dominican Republic (joke!).
- USA: CDC is handling more than 800 false alarms a day from worried
Americans. Dallas County sheriff tested negative after being in D.'s
flat.... -- more
[Byline: Annabel Grossman]
<http://www.dailymail.co.uk/news/article-2787973/from-american-airliners-british-buses-number-ebola-false-alarms-mounts-panic-grows-spread-deadly-disease.html>


--
Brazil: probable false alarm
----------------------------
10 Oct 2014: (Independent UK) Ebola crisis: Man in Brazil hospitalised
with symptoms of deadly virus. Brazil is treating a 47-year-old man
who has become the country's 1st suspected case of the deadly Ebola
virus. The man, originally from Guinea in West Africa, has been placed
into isolation at a hospital in the city of Cascavel, where Brazil's
ministry of health have sent specialists to provide additional help
and care. He arrived in Brazil on 19 Sep 2014 and is believed to have
travelled from Guinea. On Thursday [9 Oct 2014] afternoon the man went
to the emergency department at the hospital with a fever. His case is
being treated by medics as suspicious as his symptoms have developed
within the maximum incubation period for Ebola, which is 21 days.

Brazil's health officials said the man ... will be transferred to the
National Institute of Infectious Diseases at the Evandro Chagas
hospital in Rio de Janeiro, in accordance with security protocols in
place for suspected cases of Ebola. Health officials are now
attempting to identify people who may have come into contact with the
patient while displaying any symptoms, Brazilian newspaper O Globo
reported....

Brazil's health surveillance agency, Anvisa, said that any ships known
to have docked in Ebola-affected countries within the last 21 days
will need to provide thorough medical records and logs of medicines
used before receiving clearance to dock at Brazilian ports.
[Byline: Loulla-Mae Eleftheriou-Smith]
<http://www.independent.co.uk/news/world/americas/ebola-crisis-man-in-brazil-hospitalised-with-symptoms-of-deadly-virus-9786559.html>

[Cascavel is a city and municipality in western Parana state, Brazil
-- see map:
<http://cac-php.unioeste.br/eventos/sympass/img/toledogoogle.jpg>. The
Brazil health ministry reported the 1st test was negative Sat 11 Oct
2014, the 2nd test would be out in 48 hrs. - Mod.JW]

--
United Nations USD 1 billion Ebola appeal severely underfunded: UN
officials
----------------------------------------------------------------------------
11 Oct 2014: (Reuters) A USD 1 billion United Nations appeal to fight
Ebola has only been 25 percent funded and senior U.N. officials warned
on Friday [10 Oct 2014] that no country was safe as the world faced a
crisis with staggering potential. "It is the most extraordinary
challenge that the world could possibly face..." said Dr. David
Nabarro, who is heading the U.N. response to the Ebola epidemic.
Nabarro has said a "20-fold increase" in the global response is needed
compared to efforts at the end of August [2014]. The United Nations
has established a special mission, known as UNMEER, to coordinate
efforts to stop the spread of Ebola.... -- more
[Byline: Michelle Nichols]
<http://in.reuters.com/article/2014/10/10/health-ebola-un-idINL2N0S51HS20141010>

--
Communicated by:
Ryan McGinnis
<http://bigstormpicture.com>
& ProMED-mail Rapporteur Kunihiko Iizuka

******
[4] Threat to North America
Date: Wed 8 Oct 2014
Source: US Department of Defense, DoD News [edited]
<http://www.defense.gov/news/newsarticle.aspx?cid=social_20141008_33122226&id=123359>


US Marine Corps Gen. John F. Kelly on Ebola
-------------------------------------------
The potential spread of Ebola into Central and Southern America is a
real possibility, the commander of U.S. Southern Command told an
audience at the National Defense University here yesterday [7 Oct
2014]. "By the end of the year, there's supposed to be 1.4 million
people infected with Ebola and 62 percent of them dying, according to
the [CDC -- Centers for Disease Control and Prevention]," Marine Corps
Gen. John F. Kelly said. "That's horrific. And there is no way we can
keep Ebola [contained] in West Africa."

If it comes to the Western Hemisphere, many countries have little
ability to deal with an outbreak of the disease, the general said.
"So, much like West Africa, it will rage for a period of time," Kelly
said. This is a particularly possible scenario if the disease gets to
Haiti or Central America, he said. If the disease gets to countries
like Guatemala, Honduras or El Salvador, it will cause a panic and
people will flee the region, the general said. "If it breaks out, ...
there will be mass migration into the United States," Kelly said.
"They will run away from Ebola, or if they suspect they are infected,
they will try to get to the United States for treatment." Also,
transnational criminal networks smuggle people and those people can be
carrying Ebola, the general said. Kelly spoke of visiting the border
of Costa Rica and Nicaragua with U.S. embassy personnel. At that time,
a group of men "were waiting in line to pass into Nicaragua and then
on their way north," he recalled. "The embassy person walked over and
asked who they were and they told him they were from Liberia and they
had been on the road about a week," Kelly continued. "They met up with
the network in Trinidad and now they were on their way to the United
States -- illegally, of course." Those men, he said, "could have made
it to New York City and still be within the incubation period for
Ebola." ... -- more

[Byline: Jim Garamone]

--
Communicated by:
Jonathan Ezekiel
<jezekiel@xxxxxxx>

******
[5] USA: Dallas case had high fever at 1st visit
Date: Fri 10 Oct 2014
Source: New York Times [edited]
<http://www.nytimes.com/2014/10/11/us/thomas-duncan-had-a-fever-of-103-er-records-show.html>


Dallas Ebola patient was initially sent home despite high fever,
records show
-----------------------------------------------------------------------------
Medical records unveiled Friday [10 Oct 2014] of the Liberian man who
died of the Ebola virus have raised new questions about the treatment
he received when he 1st came to at a Dallas emergency room. The
patient, Duncan, had a high fever -- his temperature was 103 degrees F
[39.4 C] -- during his initial visit to the emergency room of Texas
Health Presbyterian Hospital on 25 Sep 2014, according to 1400 pages
of medical records that Duncan's family provided to AP. Despite the
fever, the hospital sent Duncan home, even after learning that he had
recently arrived from West Africa. Duncan returned to the emergency
room on 28 Sep 2014, and was immediately hospitalized. He died of
Ebola on Wednesday [8 Oct 2014] -- the only person to die from the
disease in the United States.

Previously, the hospital said that Mr. Duncan had a temperature of
100.1 degrees F [37.8 C] when he 1st arrived and that his symptoms
were not severe. The hospital said Duncan had told them that he had
been having abdominal pain for 2 days, a headache and decreased
urination. According to the medical records provided to AP, Duncan
reported severe pain -- rating it an 8 on a scale of 10. Doctors gave
him CT scans to rule out appendicitis, stroke and numerous other
serious ailments. Ultimately, he was prescribed antibiotics and told
to take Tylenol, then he returned to the apartment where he was
staying with a Dallas woman and 3 other people. A physician's note
dated 26 Sep 2014 said Mr. Duncan was "negative for fever and chills,"
according to the medical records. "I have given patient instructions
regarding their diagnosis, expectations for the next couple of days,
and specific return precautions," according to the emergency room
physician's note. "The condition of the patient at this time is
stable." ... -- more

[Byline: Manny Fernandez & Kevin Sack]

--
Communicated by:
ProMED-mail
<promed@xxxxxxxxxxxxxx>

******
[6] Recurrent cases
Date: Thu 9 Oct 2014
Source: Eurosurveillance, Volume 19, Issue 40 [edited]
<http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20924>


Rapid communications
Describing Readmissions to an Ebola Case Management Centre (CMC),
Sierra Leone, 2014
--------------------------------------------------------------------------------
[Authors: G Fitzpatrick, F Vogt, O B Moi Gbabai, B Black, M
Santantonio, E Folkesson, T Decroo, M Van Herp]

Case management centres (CMCs) are part of the outbreak control plan
for Ebola virus disease (EVD). A CMC in Sierra Leone had 33 percent
(138/419) of primary admissions discharged as EVD negative (not a
case). 15 of these were readmitted within 21 days, 9 of which were EVD
positive. All readmissions had contact with an Ebola case in the
community in the previous 21 days indicating that the infection was
likely acquired outside the CMC.

Between 26 Jun and 1 Sep 2014, 138 patients were discharged from the
Kailahun Ebola case management centre (CMC) in Sierra Leone, as
non-Ebola virus disease (EVD) cases, because they tested negative for
the virus by polymerase chain reaction (PCR). Of these, 15 returned to
the CMC within 21 days of their 1st admission and subsequently 9
tested positive for Ebola virus. This raised the question as to
whether CMCs could be acting as potential amplifiers of infection even
though appropriate infection control measures are being followed. Such
a question is of public health importance to the overall future
control of the EVD outbreak, which is ongoing in West Africa. To our
knowledge, there is no literature available which describes the
evolution of readmissions to Ebola CMCs during an outbreak and this
paper addresses that deficit.... -- more

--
Communicated by:
ProMED-mail
<promed@xxxxxxxxxxxxxx>

[I would not have called the 9 cases recurrent. They had compatible
symptoms on 1st admission, which may have been due to malaria or
something else -- the labs don't have time to try other tests. They
subsequently came down with ebolavirus infection within the incubation
period and returned far enough into their infection to have converted
to PCR-positive. Of course they could have caught EVD while waiting to
be admitted along with actual positives in the CMC -- but they were
not confirmed cases that had been discharged after they went negative
and returned positive once more, which would have been recurrence.
(Unless they were lab labeling errors, which are not unknown in
stressful lab conditions). - Mod.JW]

[See Also:
Ebola virus disease - ex Africa (10): WHO, UN, Liberia, medevac, S.
Leone, USA 20141010.2851248
Ebola virus disease - ex Africa (09): WHO, Spain, Australia, Canada,
USA 20141009.2848352
Ebola virus disease - ex Africa (08): US death, concern re. spread,
travel ban 20141008.2843902
Ebola virus disease - ex Africa (07): Europe cases, USA quarantine
stations 20141007.2840925
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
20141005.2834301
Ebola virus disease - ex Africa (04): USA ex Liberia, prevention
20141004.2832236
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]
.................................................sb/jw/je/mpp
*##########################################################*
************************************************************
ProMED-mail makes every effort to  verify  the reports  that
are  posted,  but  the  accuracy  and  completeness  of  the
information,   and  of  any  statements  or  opinions  based
thereon, are not guaranteed. The reader assumes all risks in
using information posted or archived by  ProMED-mail.   ISID
and  its  associated  service  providers  shall not be  held
responsible for errors or omissions or  held liable for  any
damages incurred as a result of use or reliance upon  posted
or archived material.
************************************************************
Donate to ProMED-mail. Details available at:
<http://www.isid.org/donate/>
************************************************************
Visit ProMED-mail's web site at <http://www.promedmail.org>.
Send all items for posting to: promed@xxxxxxxxxxxxxx (NOT to
an individual moderator).  If you do not give your full name
name and affiliation,  it may not be posted.  You may unsub-
scribe at  <http://ww4.isid.org/promedmail/subscribe.php>.
For  assistance  from   a   human   being, send mail to:
<postmaster@xxxxxxxxxxxxxx>.
############################################################
############################################################

List-Unsubscribe: http://ww4.isid.org/promedmail/subscribe.php