End of 21-day Quarantine for Family of Ebola Patient

USA Today News (20:10:2014)

People who had contact with Ebola patient Thomas Eric Duncan before he was hospitalized are breathing a sigh of relief today.

Those 48 contacts, including four family members who shared a small Dallas apartment with him, have completed the 21-day observation period without falling ill and are no longer at risk of the disease. About 10 of the 48 contacts were considered to be a higher risk because of their closer contact with Duncan.

Ebola has an incubation period of up to 21 days, according to the World Health Organization. People who are exposed to an Ebola patient who don't become sick during that time are considered to be out of the woods.

That's welcome news to Dallas and U.S. public health officials, who have struggled to contain Ebola since Duncan's diagnosis at Texas Health Presbyterian on Sept. 28. Duncan died Oct. 8.

Last week, two of Duncan's nurses were diagnosed with Ebola and have been moved to specialized hospitals. Other health workers who treated Duncan during his hospital stay continue to monitor themselves for fever and other symptoms.

In Spain, a nursing assistant appears to have recovered from the Ebola virus, the Associated Press reported Sunday.

The good news for Duncan's family should also reassure Americans about a fact that public health officials have been emphasizing for weeks -- that Ebola is not spread through casual contact -- said Robert Murphy, director of the Center for Global Health at Northwestern University Feinberg School of Medicine.

Dallas Health officials quarantined 4 members of Duncan's family after he was diagnose, ordering them not to leave the small apartment they shared with Duncan. Officials worried that the family was at risk

not just because they spent time with Duncan while he was sick but also because they stayed in an apartment with his soiled bed linens after he was hospitalized.

The fact that Duncan's family remained healthy even as two of his nurses became infected illustrates the peculiar nature of Ebola, said Peter Hotez, dean of the National School of Tropical Medicine and professor at Baylor College of Medicine in Houston.

Although the West Africa outbreak of Ebola has a 70% mortality rate, the virus is actually not very contagious in the early stages of disease when people are most likely to circulate in the community, Hotez said. Ebola doesn't spread through coughs and sneezes, only through direct contact with bodily fluids.

Even then, people aren't contagious at all until they begin showing symptoms such as a fever. Before symptoms appear, levels of the virus in their blood are too low to be measured, Hotez said.

Yet Ebola is frighteningly infectious at advanced stages of the disease, when the virus begins multiplying out of control and patients begin producing large amounts of diarrhea, vomit and blood. At that point, even a tiny amount of blood is teeming with Ebola, which puts nurses and caregivers at high risk, Hotez said.

Few people in the general community are exposed to Ebola patients who are that contagious, because patients at that stage are usually too sick to move around. Most are hospitalized if a bed is available. In West Africa, patients who can't get to a hospital are bedridden and typically attended by relatives.

Those aspects of Ebola help explain why, on average, people in West Africa spread the disease to only one or two other people, said Paul Offit, chief of infectious diseases at Children's Hospital of Philadelphia. In contrast, people with an airborne virus such as measles can spread the disease to 14 susceptible people.

Ebola has spread in West Africa because of burial rites that aren't practiced in the USA, in which relatives of the deceased touch the body and prepare it for the grave.

Only about 15% of Ebola cases in West Africa involve children, reflecting the fact that children are rarely home caregivers, Offit said.

U.S Ebola Patient: Family Quarantined

Courtesy Medpage Today by Michael Smith

The family of the Dallas Ebola patient has been quarantined so they can be monitored twice a day for symptoms of the virus, according to a Texas health official.

The so-called "control order" was issued in order to ensure the family members would be available for the monitoring, according to David Lakey, MD, the commissioner of the Texas Department of State Health Services.

They're among about 100 people being assessed for possible exposure to the patient, identified as Thomas Eric Duncan, while he was symptomatic, Lakey told reporters in a joint telebriefing between the CDC and Texas officials.

But Lakey and other Texas officials didn't explain why the quarantine order was needed, except to say they were concerned that the family might not be properly monitored -- with temperatures taken twice daily -- without it.

In a later news conference, Dallas County Judge Clay Lewis Jenkins, the country's chief executive, said he and other officials had information that suggested the order was "appropriate ... for the safety of the family and the safety of the public."

But he said he would not be disclosing the information.

Earlier, Lakey said food and groceries were being delivered to the family and a cleaning organization would be brought in to decontaminate the apartment and safely to remove soiled sheets, laundry, and other potentially contaminated items.

At the moment, he said, the family members have no symptoms and pose no risk to others.

Lakey also said the man was sent home with antibiotics after his first appearance at Texas Health Presbyterian Hospital even though he had told a nurse that he had been in Liberia. "Unfortunately, connections weren't made between the travel history and symptoms," he said.

He said the case is a "lesson for all of us ... across the U.S., people don't take the travel history as seriously as they need to."

CDC Director Tom Frieden, MD, said the lapse is "a teachable moment."

The officials gave no details of Duncan's condition, except to say that it is serious. Frieden added that the use of experimental therapies is "being discussed" and decisions will rest with the treating physician and the patient.

Several of the American Ebola patients airlifted from West Africa for treatment in the U.S. were given investigational therapies, but it remains unclear what effect they had.

The "bottom line," Frieden said, is that "we remain confident that we can contain any spread of Ebola within the United States."

He said some of the people in Dallas who were in close contact with Duncan might have been infected, but systems are being put in place so that those infections won't spread.

That requires "meticulous and rigorous" work to assess possible contacts and identify those who are at risk and need to be monitored for 21 days, Frieden said. CDC experts, as well as state and local officials, are doing that work now, he said.

Indeed, "the risk of an ongoing or uncontained outbreak in the U.S. is highly unlikely within our public health and medical infrastructure," commented Steven Lawrence, MD, of Washington University School of Medicine in St. Louis.

And the infection is unlikely to spread within the hospital where Duncan is being cared for, he told MedPage Today in an email: "We know how to contain it ... the infection prevention methods are effective when used properly."

Ebola: Sierra Leone Quarantines A Million People

The Guardian (25:09:2014)

Sierra Leone’s government has quarantined more than a million people in an attempt to bring an end to the spread of the deadlyEbola virus.

Areas in the east of the country on the border of Guinea have been under quarantine for months but travel is now restricted in three more areas where an estimated 1.5 million people live. Nearly a third of the country’s population across 14 districts is now under curfew.

The move comes as world leaders meet to discuss the crisis at the United Nations, and days after a three-day nationwide lockdown ended.

Healthworker being disinfectted after helping out with a suspected case of Ebola on Freetown, Sierra Leone

In an address to the nation, Sierra Leone’s president, Ernest Bai Koroma, said the weekend’s lockdown had “met its objectives” but had also exposed the challenges posed by the Ebola crisis.

In addition to announcing the new isolation districts, the government is establishing corridors for travel between non-quarantined districts, with a curfew on all travel outside the hours of 9am and 5pm. Koroma said the isolation would “definitely pose great difficulties for our people in these districts”.

The British charity Street Child said there had been no warning given of the latest lockdown and said it was concerned that this would lead to mass starvation. “We were not prepare for the quarantine overnight. The areas being quarantined are really poor communities, most people live on 50p a day,” its country director, Kelfa Kargbo, told the Guardian.

“We need more help from the World Food Programme, but more than that we need a distribution network to be built to make sure the food gets in and gets in regularly to the starving people. I am expecting starvation to show in three or four weeks unless this is addressed.”

The northern districts of Port Loko and Bombali have been closed off indefinitely along with the southern district of Moyamba, effectively sealing in around 1.2 million people.

The deadliest Ebola epidemic on record has infected more than 6,200 people in westAfrica and killed nearly half of them, according to the World Health Organisation’s latest figures.

The virus is spread through bodily fluids and once symptomatic can kill within four or five days. Symptoms include rampant fever, severe muscle pain, vomiting, diarrhoea and, in some cases, internal and external bleeding through the eyes and mouth.

World leaders are due to attend a meeting on Ebola convened by the UN secretary general, Ban Ki-moon, in New York later on Thursday, with Koroma and Liberia’s President Ellen Johnson Sirleaf connected by video link.

The meeting, part of the UN general assembly, will hear from Barack Obama, and world leaders are expected to pledge help for attempts to contain the spread of the virus.

Obama, who is sending 3,000 troops to west Africa to help health workers, urged other countries to get behind a broader international effort.

In a speech to the general assembly, Obama grouped Ebola with the crisis in Ukraine and the threat posed by Islamic State in Iraq and Syria as new dangers to global security.

“As we speak, America is deploying our doctors and scientists – supported by our military – to help contain the outbreak of Ebola and pursue new treatments,” Obama told the assembly. “But we need a broader effort to stop a disease that could kill hundreds of thousands, inflict horrific suffering, destabilise economies and move rapidly across borders.”

Door-to-door searches during the three-day curfew in Sierra Leone identified more than 350 suspected new cases of Ebola, according by the top US diplomat in the country. Charge d’affairs Kathleen Fitzgibbon said teams of volunteers had also discovered 265 corpses, of which 216 had since been buried.

In an email to emergency workers, she said one of the priorities was to ensure all bodies were buried correctly, as funerals have been identified as one of the ways the disease has spread, with relatives touching the bodies of the deceased.

The US Centres for Disease Control estimated that the number of cases in Liberia and Sierra Leone could rise to 1.4 million by January, in a worst-case scenario based on data obtained before the world ramped up its response.

Quarantine or Death Scare?

Medic-ALL (11:08:2014)

As the Ebola epidemic continues to ravage the African continent, turning the entire globe into a high dependency emergency unit and placing everyone on an unforced but compulsory Ebola Alert, many more people continue to find themselves subjected to the necessary precautionary measure of quarantining.

Quarantine is simply a public health measure used to protect the public, which. requires healthy people who were exposed to a disease to be prevented from contact with others until it is certain that they are not infected. As concerns over the deadly virus becoming a pandemic fill the air, quarantining seems to be the most useful measure to prevent this as researches and experiments continue to go on towards finding some form of remedy.

The quarantine period for the Ebola virus is set at 21 days , based on the longest duration of Ebola incubation – the delay between exposure and onset of illness, the average incubation period however has been found to be between eight to 10 days. While it can be an effective way to contain the disease, the challenge lies in the fact that contact tracing in some of the affected countries in West Africa has not being absolute.

There are rumours that some known contacts of infected persons in certain parts of Africa have been on the run in a bid to escape been isolated. This is not so surprising , as many realise that confirmation of having contracted the virus is more or less a death sentence in the absence of no known cure. It is worrisome though as most of the affected countries have weak health systems and we are dealing with areas in which practices like good infection prevention and control practices are not the norm in some of the hospitals and in families and communities.

In certain cases, quarantine has been known to be expanded to include management and intervention in addition to the routine inspections. As the number of exposed persons who are being isolated across West Africa continue to rise we can only hope that interventions will eventually have a role in the quarantining process depending on the success of experimental work going in the direction of developing a vaccine or a cure to combat the 5-strain virus. 

Medic-ALL Inc. 2014

Ebola Latest: New Patient discovered

Dailypost 08:08:14

Following a suspected case of Ebola virus, the Nigerian National Petroleum Corporation, NNPC, clinic in Victoria Island in Lagos State has been shut down indefinitely.

In a statement issued on Friday, by the Group General Manager, Group Public Affairs Division, Mr. Ohi Alegbe, he stated that the a suspected Ebola virus victim was on admission at the clinic.

He said, “The management of the NNPC has announced the indefinite shutdown of its clinic in the Muri Okunola area of Victoria Island, Lagos, following a suspected case of Ebola virus victim on admission at the clinic.

“It was discovered that the patient visited the First Consultant Medical Centre during the period the first Ebola case was reported at that clinic”.

The corporation, in the statement, explained that the pre-emptive step was taken after the case was duly reported to the Federal Ministry of Health as well as officials of the Lagos State Ministry of Health.

It said, “In the meantime, all contacts with this case are being traced and adequate precautionary measures instituted to contain the possible spread of the disease.

“The medical team has assured that the patient is in stable condition.”