H5N1

Ebola in Liberia: Bomi health administrator, family test positive

Via the Daily Observer: Bomi Health Admin, Family Test Positive for Ebola.

Credible reports reaching the Daily Observer from Tubmanburg, Bomi County, have revealed that the government-run hospital in Bomi County has been shut down. 

According to our sources, this is largely because Mr. Sando Sirleaf, the County Health Services Administrator (CHSA), and his family of 10 have been tested positive with the deadly Ebola virus, which is ravishing the nation. 

One of our sources, who is very close to the hospital, the county’s only referral hospital and major health facility, however, clarified that the hospital’s doors have not been totally closed, but that all of the patients, including admitted ones, have fled. 

Our source also said the Out-Patient Department (OPD) for routine treatments for malaria and other “common sicknesses,” is also empty, as out-patients have stopped coming to the hospital. 

According to our source, who has asked to remain anonymous, “Even most of the nurses have now left the hospital because they are afraid for their lives. This is why I said the hospital has now closed.” 

Our source further disclosed that on Sunday, July 27, the only two out-patients that went to the hospital were the last two remaining family members of the county’s Health Service Administrator, Mr. Sirleaf. 

The Daily Observer learned  that Mr. Sirleaf and nine members of his family were brought to Monrovia for screening after his son, Sando Sirleaf, Jr., head of the Gayah Hill Health Center, had tested positive with the Ebola virus, which is taking the lives of people every day. 

Following the screening, our Health Correspondent was reliably told that eight tested positive, are now isolated and are being given supported treatment by health workers. It was the last two, who were confirmed Sunday, as also having come down with the virus. 

Another source, who is also a Sirleaf, but no relation to Sando, said he is a very good friend of the Bomi Health Service Administrator’s entire family. This source disclosed to us that it was through the auspices of Mr. Sando Sirleaf that the Ghana-based Multi-TV came to Liberia and opened one of its overseas offices here in Monrovia. 

Also speaking to the Observer, however, Dr. Bernice Dahn, Liberia’s Chief Medical Officer and Deputy Health Minister for Health Services, said that the hospital has not been shut down. 

With what is happening in the country, she explained, people are just afraid to go to the health facility which, the CMO said, is the wrong decision to make.

Ebola in West Africa: Four misunderstandings

Via the Institute of Development Studies, a thoughtful, well-documented article: Strengthening knowledge to tackle Ebola. Click through for the full report and many links to sources. Excerpt: 

At IDS, researchers are investigating the complex forces (or ‘drivers’) behind the emergence and spread of diseases such as Ebola which are transmitted from animals to people and known as zoonoses. They are also investigating the social contexts  in which these diseases often emerge and the contending narratives surrounding disease control. 

Research – drawing together social and natural science, and engaged with local people, international agencies, and national and local governments and practitioners - can lead to better theory, improved mutual comprehension, and better-informed measures and practices to manage and control disease. 

Misunderstanding one: Chopping down trees causes Ebola 

While there is good evidence that bats are the natural reservoir for the Ebola virus, the complex interactions that cause the disease to spillover to humans are as yet unclear. 

A popular environmental narrative claims that rapid and unprecedented deforestation of primary forests is leading to increased human-bat contact in West Africa for the first time, making transmission of the disease to people from bats more likely. However, research by IDS's Melissa Leach and others has shown the upper Guinea forests have been a dynamic mosaic of forest, savannah, and farmland for centuries, with people in this region having long co-habited with bats. 

Over-simplified views of one-way deforestation feed popular ideas that stereotype and blame rapacious farmers and loggers for their current disease predicament. They do not help us understand Ebola's origins. 

Misunderstanding two: People in Africa are ignorant of effective ways to deal with diseases like Ebola 

The difficulties medical teams have sometimes had in establishing effective community relations during the current Ebola epidemic have led to some wild generalisations. People in West Africa are not living in archaic, unchanging tradition, refusing to engage with modern concepts of health. 

However, the dimensions of cultural context remain real and relevant as disease possibilities, and therefore as logical explanations of worrying events and circumstances, even to the educated. People can live with multiple framings of disease and outside intervention, and can switch between them according to context. Public behaviours and attitudes can and should be seen as part of cultural logics that make sense given regional history, social institutions and experience. 

For this reason, an anthropological perspective is important for disease control efforts, which should include building good community relations, working with traditional authorities and seeking to understand local ideas and practices.

Ebola in Liberia: Dr. Brantly's condition "deteriorates"

Thanks to ironorehopper for tweeting the link to this Sky News report vis Yahoo!News: Ebola: US Doctor's Condition 'Deteriorates'. Excerpt:

The condition of an American doctor who contracted the deadly Ebola virus in Liberia has deteriorated. 

Dr Kent Brantly was working in West Africa tackling the deadly outbreak when he recognised his own symptoms and placed himself in isolation. 

The 33-year-old father of two from Texas had been chatting to his doctors and working on his computer while receiving treatment. 

Melissa Strickland, spokesperson for the Samaritan's Purse charity that Dr Brantly was working for told Sky News: "Overnight, Dr Kent Brantly's condition deteriorated, but we are still classifying him as stable. 

"He continues to receive intensive medical care." 

Dr Brantly is a medical director for the organisation and had been involved in the treatment of many local patients during his time in Liberia. 

A second US citizen, health worker Nancy Writebol, has also tested positive for Ebola and is also receiving treatment. 

She was working in a support role with the medical teams. Her condition is serious but stable. 

Ms Strickland said: "There are currently no more identified cases of Ebola among our team."

Saudi Arabia: No new MERS cases, no deaths, as of noon July 28

Via the KSA MOH Command and Control Center: MOH: 'No New Corona Cases Recorded'. A 49-year-old Saudi male has recovered in Hafoof. The numbers are now 28 cases under care, 395 recovered, 721 total, and 298 deaths. We've now gone about three weeks without a Saudi MERS case.

Nigeria: Arik Air suspends flights to Liberia, Sierra Leone over Ebola

Via allAfrica.com, a report from Leadership: Nigeria: Arik Air Suspends Flights to Liberia, Sierra Leone Over Ebola Virus. Excerpt:

Arik Air on Sunday said it would suspend flight operations to Monrovia in Liberia and Freetown in Sierra-Leone on Monday following the first Ebola virus death officially confirmed in Lagos. 

This is disclosed in a statement issued and signed by the airline's Head of Corporate Communications, Mr Ola Adebanji, in Lagos. 

It said the suspension would be in force until further notice. 

The News Agency of Nigeria (NAN) reports that the first Ebola virus death officially confirmed in Lagos involved a Liberian national. 

He had flown into Lagos on a foreign airline from Monrovia via Lome in Togo last week. 

The statement said the flights suspension decision was a precautionary measure aimed at safeguarding the lives of Nigerians. 

"We are taking this important step as a concerned corporate citizen, bearing the interest of Nigerians at heart. 

"We acknowledge the steps the Federal Government of Nigeria is currently undertaking to prevent the spread of the deadly Ebola virus," it said. 

The statement said the airline felt compelled to take the business decision to immediately suspend flight services into the two Ebola virus-affected countries. 

It said this was due to its interest in the well-being of Nigerians. 

"At the early stages of the virus development across West Africa, the Gambian Government took the proactive decision to stop airlines, including Arik Air, from bringing in-bound passengers from Monrovia, Conakry in Guinea and Freetown into Banjul in Gambia. 

"Hence, in line with the actions taken by the Gambian Government, we trust and are confident that the FGN shall take all steps necessary to control and curtail the spread of the virus," the statement said. 

It advised that all in-bound flights into Nigeria, which originate from any of the Ebola-affected countries, be immediately suspended.

Ebola in Liberia: Brisbane laid to rest in Bomi as two US citizens test positive

Via the Daily Observer: Brisbane Laid to Rest in Bomi as 2 US Citizens Test Positive. Excerpt:

The remains of Dr. Samuel Brisbane were buried Saturday night at his home in Bomi County, less than 24 hours after he succumbed to the deadly Ebola virus, the Ministry of Health and Social Welfare (MOH/SW) has confirmed.   

Dr. Brisbane was a senior medical doctor working at Liberia’s leading referral hospital, the John F. Kennedy (JFK) Medical Center in Monrovia. 

The JFK’s Chief Medical Officer, Dr. Billy Johnson, confirmed Brisbane’s demise to the Daily Observer Saturday afternoon.  

Liberia’s Chief Medical Officer, Dr. Bernice Dahn, also confirmed Dr.  Brisbane’s death, which occurred at around one o’clock p.m. on Saturday at an Ebola treatment center at ELWA Hospital in Paynesville, near Monrovia.  

The BBC reports Dr. Brisbane succumbed to the deadly disease after a three-week battle. 

The late Dr. Brisbane, Liberia’s leading internist, headed the Emergency Unit at the JFK and saw most patients coming there for various treatments.  

According to reports, he is the first Liberian doctor to die since the outbreak of the deadly Ebola disease. 

The US-based aid group, Samaritan’s Purse, also said Saturday that an American doctor working in Liberia is sick. 

A spokeswoman for the group says Dr. Kent Brantly is undergoing intensive medical treatment. She added that patients have a better chance of survival if they receive treatment immediately after being infected, which Brantly did. Dr. Brantly, 33, is married and a father of two. 

A second U.S. citizen working in Liberia has tested positive for the Ebola virus, Samaritan’s Purse also announced. Nancy Writebol is employed by SIM (Sudan Interior Mission) in Liberia and was helping the joint SIM/Samaritan’s Purse team that is treating Ebola patients at the Case Management Center in Monrovia. SIM manages ELWA Hospital there, and the two organizations have been working closely to combat Ebola since the current outbreak began in Liberia in March. 

Nancy Writebol serves as a Personnel Coordinator by helping missionaries and short-term teams with their entry into Liberia. She is married to David Writebol who is the Technical Services Manager and SIM’s Eternal Love Winning Africa’s (ELWA’s) complex of 100 buildings. He helps staff provide electrical power, water and other technical services to the campus, which are utilized by the radio station, hospital, elementary and secondary schools on the campus. 

So far this morning I've found no updates on the condition of the American cases.

Canada: Will BC cover pricey Hep C 'miracle' treatment?

It's World Hepatitis Day, and The Tyee has a timely article by Pauline Holdsworth: Will BC Cover Pricey Hep C 'Miracle' Treatment? Excerpt:

Hepatitis C patients in B.C. are waiting to hear whether the province will cover new drugs doctors say represent society's first real chance to wipe out the disease, but which are impossible for most people to afford. 

In November, Health Canada approved a treatment called Sovaldi, manufactured by Gilead, and another similar drug called Galexos manufactured by Janssen Inc. In combination with another drug, they've been shown to cure hep C 90 per cent of the time. 

Dr. Mel Krajden, a hepatologist with the B.C. Centre for Disease Control, said the new treatments are a public health "miracle." 

He said they have the potential to "eliminate" hep C, which in public health speak means reducing it by 90 per cent. That includes those with cirrhosis, an advanced form of liver damage caused by the disease. 

Approximately 242,500 people in Canada have hep C, a serious, sometimes fatal infectious disease that can cause liver failure and is spread through contact with infected blood. 

Hep C disproportionally affects marginalized populations. In Vancouver's Downtown Eastside, approximately nine in 10 injection drug users have hep C, and a recent study from the B.C. Centre for Excellence in HIV/AIDS called the rate of infection among Vancouver street youth "alarmingly high." 

For years, the only option for hep C patients has been interferon therapy, a treatment that kickstarts the body's immune system to try to flush the disease out, but which has debilitating side effects. 

The new medications are the first interferon-free drugs available outside of a clinical trial. The catch? The 12-week treatment has a price tag of approximately $55,000, making it prohibitively expensive for most patients.

Hong Kong: CHP investigates three suspected cases of MERS

Via the Centre for Health Protection, a news release: Three suspected cases of MERS. One has already tested negative. Excerpt:

The Centre for Health Protection (CHP) of the Department of Health (DH) is today (July 28) investigating two suspected cases of Middle East Respiratory Syndrome (MERS) affecting a 34-year-old man and a 45-year-old woman, and called on the public to stay alert and maintain good personal, food and environmental hygiene during travel. In addition, the CHP provided an update on the suspected case of MERS notified yesterday (July 27). The 2-year-old boy's respiratory specimen tested negative for MERS Coronavirus (MERS-CoV).      

The first patient is a 34-year-old man with good past health. He travelled from Pakistan to Hong Kong via Dubai yesterday and arrived in Hong Kong today. He has presented with fever and vomiting and was screened to have fever at the Hong Kong International Airport today. He was subsequently transferred to Princess Margaret Hospital for isolation. He is currently in stable condition.      

The second patient is a 45-year-old woman with good past health. She returned to Hong Kong from Paris via Dubai on July 25 and arrived in Hong Kong on July 26. She has presented with fever and diarrhoea since yesterday and was admitted to Princess Margaret Hospital for isolation today. She is currently in stable condition.      

Both patients' respiratory specimens have been collected for laboratory testing by the CHP's Public Health Laboratory Services Branch (PHLSB). Their travel collaterals have remained asymptomatic.      

Regarding the suspected case of MERS notified yesterday, the 2-year-old boy's nasopharyngeal aspirate tested negative for MERS-CoV upon preliminary laboratory testing by the CHP's PHLSB. The patient travelled with his family from Dubai to Hong Kong on July 23. He has presented with fever since July 24 and cough since July 26. He was admitted to Princess Margaret Hospital on July 26 and has been in stable condition. His travel collaterals remain asymptomatic.

The CHP consistently reports suspected MERS cases, and just as consistently reports negative tests. If one or both of the two present suspects are positive for MERS, it will be a big event.

ECDC: CDTR for week 30, July 28

ECDC has published Monitoring current threats, week 30/2014: ECDC Communicable Disease Threats Report. Click through to download the full report and use the links. The summary:

​This issue covers the period from 20 to 26 July 2014 and includes updates on:    

Mass gathering monitoring: Commonwealth Games 2014 

In collaboration with Health Protection Scotland, ECDC enhanced its monitoring activities during the Commonwealth Games in Scotland (23 July to 3 August 2014). During the past week, ECDC has not detected any events of public health significance to the Games.     

West Nile virus 

During the past week, no new human cases have been reported in the EU or in neighbouring countries. West Nile fever in humans is a notifiable disease in the EU.   

Chikungunya, the Caribbean 

Most of the areas previously affected by the outbreak that has been on-going since December 2013 continue to report cases. The situation is particularly severe on the island of Hispaniola, i.e. Haiti and the Dominican Republic, and Guadeloupe. Costa Rica, Venezuela, the Cayman Islands and the Republic of Trinidad and Tobago have now also notified local transmission of chikungunya infection. Jamaica and Colombia have reported imported cases during week 29.   

ECDC published a risk assessment on 25 June and an epidemiological update on 30 June.    

Outbreak of Ebola Virus Disease (EVD), West Africa 

During the last week, the affected countries have reported 111 new cases and 47 new fatalities. The largest increase in cases since the previous update was reported in Sierra Leone, followed by Liberia and Guinea. As a follow-up action to the Emergency Ministerial meeting held in Ghana, the World Health Organization established a sub-regional outbreak coordination centre in Conakry (Guinea) on 16 July 2014 to meet the needs to control the outbreak.    

This outbreak has been affecting Guinea, Liberia and Sierra Leone since December 2013. While this is the largest EVD outbreak reported, the risk of infection for travellers is considered very low.     

ECDC published a risk assessment on 9 June and an epidemiological update on 17 July.    

Middle East Respiratory Syndrome Coronavirus (MERS-CoV) 

Since the last CDTR, one new fatal case has been reported by Iran. Saudi Arabia has reported additional deaths in previously reported cases. ECDC published its updated rapid risk assessment on MERS-CoV on 31 May 2014 and an epidemiological update on 5 June 2014.   

Pneumonic plague, China 

On 17 July 2014, Chinese health authorities reported a fatal case of pneumonic plague in a 38-year-old man from Yumen City (Gansu province). The patient was admitted to hospital on 15 July 2014 and died one day later. He was a farm worker and had a history of exposure to a dead marmot that he had fed his dog. In response, the Chinese authorities issued an emergency alert for the region and implemented control measures including isolation and prophylactic treatment of the patient’s close contacts. No further cases have been reported as of 23 July 2014, and the quarantine has been lifted as of 24 July.

Nigeria: How Sawyer's hospital dealt with his Ebola

Via Nigerian Bulletin: How we Prevented Spread of Ebola Virus- Lagos Hospital.

The Lagos hospital where 40 year old Patrick Sawyer, who tested positive to the #Ebola virus and died briefly afterwards, said it took special pains to prevent the virus from spreading to other parts of the country. 

According to This Day Live, a statement signed by the Chief Consultant and Medical Director, Dr. B.N. Ohiaeri and the Senior Consultant and Endocrinologist, Dr. A.S. Adadevoh and the hospital located at Ikoyi Road, Obalende, #Lagos, said its effort to keep the patient confined in the hospital, against intense pressure from his organisation to release him to attend an important assignment in Calabar, Cross River State, saved the nation from an imminent spread of the highly infectious disease. 

"We refused for him to be let out of the hospital in spite of the intense pressure, as we were told that he was a senior ECOWAS official and had an important role to play at the ECOWAS convention in Calabar," the hospital said. 

"We hope that by our action of preventing this gentleman from being extracted from our hospital and travelling to Calabar, we have been able to prevent the spread of the Ebola Virus Disease in Nigeria," the statement added. 

Recounting the whole incident, the hospital statement explained that "a 40-year-old gentleman came into the hospital with symptoms suggestive of malaria (fever, headache and extreme weakness) on Sunday night, July 20, 2014. 

"He was fully conscious and gave us his clinical history and told us he is a senior diplomat from Liberia. Laboratory investigation confirmed malaria, while other tests for HIV, Hepatitis B and C were negative. He was admitted and treatment commenced. 

"However, due to the fact that he was not responding to treatment but rather was developing haemorrhagic symptoms, we further questioned him. He denied having been in contact with any person with EVD at home, in any hospital or at any burial. In spite of this denial, we decided to conduct further tests for possible infectious haemorrhagic disease especially EVD, based on the fact that he was a Liberian citizen and the recent outbreak of the disease in that country," the hospital stated. 

The Consultants Medical Centre Limited said it immediately isolated and quarantined the patient, commenced barrier nursing and simultaneously contacted the Lagos State Ministry of Health and the Federal Ministry of Health to enquire where further laboratory tests could be performed. 

According to the hospital, initial test result from the Lagos University Teaching Hospital (LUTH), indicated a signal of possible EVD, but required confirmation. 

"We then took steps to reach out to senior officials in the office of the Secretary of Health of the United States of America, who promptly assisted us with the contacts of the Centre for Disease Control (CDC) and the World Health Organisation (WHO) Regional Laboratory Centre in Senegal. 

"Working jointly with the state, federal agencies and international agencies, we were able to obtain confirmation that the patient was infected with the EVD (Zaire Strain) and the gentleman subsequently died on Friday, July 25, at 6.50 am.” 

The hospital explained that orderly temporary shut down of the hospital with immediate evacuation of in-house patients followed as well as professional removal of the body and its incineration under WHO guidelines, witnessed by all appropriate agencies. 

It said that in keeping with the WHO guidelines, the hospital is shut down briefly as full decontamination exercise is currently in progress and the reopening of the hospital will also be in accordance with WHO guidelines.

See also this Reuters report: Nigeria isolates Lagos hospital where Ebola victim died.