Showing posts with label Ebola. Show all posts

Thursday 9 October 2014

US military planes arrive at epicenter of Ebola

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(AP) — Six U.S. military planes arrived in the Ebola hot zone Thursday with more Marines, as West Africa's leaders pleaded for the world's help in dealing with "a tragedy unforeseen in modern times."

"Our people are dying," Sierra Leone President Ernest Bai Koroma lamented by videoconference at a World Bank meeting in Washington. He said other countries are not responding fast enough while children are orphaned and infected doctors and nurses are lost to the disease.

Alpha Conde of Guinea said the region's countries are in "a very fragile situation."

"This disease is today an international threat and deserves an international response," he said, speaking through a translator.

Tom Frieden, director of the U.S. Centers for Disease Control and Prevention, said he was reminded of the start of the AIDS epidemic.

"We have to work now so this is not the next AIDS," Frieden said.

The fleet that landed outside the Liberian capital of Monrovia consisted of four MV-22 Ospreys and two KC-130s. The 100 additional Marines bring to just over 300 the total number of American troops in the country, said Maj. Gen. Darryl A. Williams, the commander leading the U.S. response.

Williams joined U.S. Ambassador to Liberia Deborah Malac at the airport to greet the aircraft, which arrived in two groups of three.

As vehicles unloaded boxes of equipment wrapped in green-and-black cloth, the Marines formed a line on the tarmac and had their temperatures checked by Liberian health workers.

Meanwhile, British authorities said they would introduce "enhanced" screening of travelers for Ebola at Heathrow and Gatwick airports and Eurostar rail terminals.

Prime Minister David Cameron's office said passengers arriving from West Africa would be quizzed about their travels and contacts. Some people could be given a medical assessment and advice on what to do if they develop symptoms.

Also Thursday, Liberian police used batons and rattan whips to disperse 100 protesters outside the National Assembly, where lawmakers were debating granting President Ellen Johnson Sirleaf more powers beyond those contained in a state of emergency declared in August. Her handling of the crisis has been criticized as heavy handed and ineffective.

Liberian state radio announced that Senate elections scheduled for next week would be postponed. No new date was given.

The outbreak has killed more than 3,800 people, according to the latest World Health Organization figures. The vast majority of those deaths have been in Guinea, Liberia and Sierra Leone.

The U.S. military is working to build medical centers in Liberia and may send up to 4,000 soldiers to help with the Ebola crisis. Medical workers and beds for Ebola patients are sorely lacking.

British Defense Secretary Michael Fallon said his country would provide more than 750 troops to help build treatment centers and an Ebola "training academy" in Sierra Leone. Army medics and helicopters will provide direct support. Britain will also contribute an aviation support ship.

British troops are expected to arrive next week in Sierra Leone, where they will join military engineers and planners who have been there for nearly a month helping to construct medical centers.

The German military, which has already been flying material such as protective clothing from Senegal to the worst-hit countries, planned to start a wider deployment of aid in mid-November. The military is expected to set up a clinic for 50 patients.

Sierra Leone officials finally released a shipping container filled with medical gear and mattresses that had been held up at the port for more than a month.

Ibrahim Bangura, an official who handles medical supplies, said the container's contents were finally in his possession on Thursday. Bureaucracy and political infighting were blamed for delay in distributing the aid.

In Guinea, where the first Ebola cases were confirmed back in March, Doctors Without Borders warned on Thursday of a "massive" influx of cases in the capital.

The aid group's center in Conakry received 22 patients on Monday alone, including 18 from the same region 50 kilometers east of the city, the group said, adding that its facilities were reaching their limits.

A Uganda-born doctor, John Taban Dada, died Thursday of Ebola at a treatment center on the outskirts of Monrovia. His death brings to four the number of doctors who have died in Liberia since the outbreak. More than 90 health workers, including nurses and physician assistants, have also died.

There was continued concern about Ebola in Spain, where the first person known to have caught the disease outside the outbreak zone in West Africa became sick.

The condition of Spanish nursing assistant Teresa Romero deteriorated on Thursday, said Yolanda Fuentes, deputy director of Madrid's Carlos III hospital.

Four doctors have been admitted to the Madrid hospital for precautionary observation, bringing to eight the number of people being monitored at the center, health officials said Thursday.

In Germany, a man infected in Liberia arrived Thursday at a hospital for treatment — the third Ebola patient to be flown to the country. The St. Georg Hospital in Leipzig said the patient works for the United Nations in Liberia.

Wednesday 8 October 2014

3 win chemistry Nobel for super-zoom microscopes

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 (AP) — Three researchers won a Nobel Prize on Wednesday for giving microscopes much sharper vision than was thought possible, letting scientists peer into living cells with unprecedented detail to seek the roots of disease.

The chemistry prize was awarded to U.S. researchers Eric Betzig and William Moerner and German scientist Stefan Hell. They found ways to use molecules that glow on demand to overcome what was considered a fundamental limitation for optical microscopes.

Betzig, 54, works at the Howard Hughes Medical Institute in Ashburn, Virginia. Hell, 51, is director of the Max Planck Institute for Biophysical Chemistry in Goettingen, Germany, and also works at the German Cancer Research Center in Heidelberg. Moerner, 61, is a professor at Stanford University in California.

Their work, done independently and extending back to the 1980s, led to two techniques that were first demonstrated in 2000 and 2006.

Previously, a calculation published in 1873 was thought to define the limit of how tiny a detail could be revealed by optical microscopes.

"As recently as 15 years ago, it was believed to be theoretically impossible to break this barrier," said Nobel committee member Claes Gustafsson. He called the laureates' work "a revolution."

The result of their advance is "really a window into the cell which we didn't have before," said Catherine Lewis, director of the cell biology and biophysics division of the National Institute of General Medical Sciences in Bethesda, Maryland.

"You can observe the behavior of individual molecules in living cells in real time. You can see ... molecules moving around inside the cell. You can see them interacting with each other."

The research of the three men has let scientists study diseases such as Parkinson's, Alzheimer's and Huntington's at a molecular level, the Royal Swedish Academy of Sciences said.

"Due to their achievements, the optical microscope can now peer into the nanoworld," the academy said, giving the 8 million-kronor ($1.1 million) award jointly to the three for "the development of super-resolved fluorescence microscopy."

While scientists can get still finer resolution by using an electron microscope, that device can't be used to examine cells that are alive.

"You really need to be able to look at living cells because life is animate — it's what defines life," Betzig said.

Hell said that close look can shed light on disease.

"Any disease, in the end, can be boiled down to a malfunctioning of the cell," he said. "And in order to understand what a disease actually means, you have to understand the cell and you have to understand the malfunction."

Hell has used the technology to examine nerve cells, Moerner studied proteins related to Huntington's disease, and Betzig tracked cell division inside embryos, the academy said.

Betzig said his reaction to hearing about the prize was "kind of like 50 percent happiness and 50 percent fear. Because I don't want my life to change. I really like my life, and I'm busy enough already."

Moerner heard the news as he stepped out of a shower in Brazil, where he was attending a conference. The phone call came from his wife, who learned that he'd won from The Associated Press.

"I'm incredibly excited and happy to be included with Eric Betzig and Stefan Hell," Moerner told the AP.

Hell, who was born in Romania, said he was "totally surprised, I couldn't believe it."

This year's Nobel awards began Monday with U.S.-British scientist John O'Keefe splitting the medicine award with Norwegian couple May-Britt Moser and Edvard Moser for brain research that could pave the way for a better understanding of diseases like Alzheimer's.

On Tuesday, Isamu Akasaki and Hiroshi Amano of Japan and U.S. scientist Shuji Nakamura won physics award for the invention of blue light-emitting diodes — a breakthrough that spurred the development of LED technology, which can be used to light up homes, offices and the screens of mobile phones, computers and TVs.

The Nobel Prize in literature will be announced Thursday, followed by the Nobel Peace Prize on Friday and the economics prize Monday.

The prizes are always handed out on Dec. 10, the date that prize founder Alfred Nobel died in 1896.

Ebola training focuses on astronaut-like gear

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(AP) — The serious-faced physicians practice pulling on bulky white suits and helmets that make them look more like astronauts than doctors preparing to fight a deadly enemy. These training sessions at U.S. hospitals on Ebola alert and for health workers heading to Africa can make the reality sink in: Learning how to safely put on and take off the medical armor is crucial.

"When you're in the real deal, remember to take your time," biosafety expert John Bivona told doctors during a course this week at the University of Chicago's medical center. Suits splashed with patients' vomit or blood must be removed carefully, he explained.

"As much as possible, grab from the inside" to avoid touching contaminated parts of the suits, he said. "Be liberal with disinfectant."

Looking stoic after this week's training, Dr. Mark Nunnally said he's "not overly worried, but I think there's a legitimate concern" that someone with Ebola may arrive at the hospital's door.

An anesthesiologist, he's among about 35 doctors and nurses who've volunteered to treat any Ebola patients who may show up at the Chicago hospital. Nunnally said he volunteered because "somebody has to do it, and I think it's important to give care where there's a need."

The University of Chicago medical staffers get several hours of Ebola training, plus refresher courses and videos in donning and doffing protective gear.

Meanwhile, the Centers for Disease Control and Prevention this week started training volunteer health workers heading to Africa to help fight the epidemic.

Dr. David Sugerman, an Emory University emergency room doctor heading soon to Sierra Leone, was among students in a CDC training session Monday in Anniston, Alabama.

Sugerman, who also works for the CDC, said breaches in health workers' protective gear in West Africa have contributed to Ebola's spread.

"You realize going through these exercises how easy that is," he said.

"In Sierra Leone or Liberia or Guinea it's going to be quite hot and humid. And you start sweating. And some of the procedures, like placing an IV, you get pretty nervous with a patient that you know has a high viral load," he said. "Then you get fogged up and you get anxious and you could start pulling at your" equipment, which could be contaminated with virus. "So you have to mentally go through this a number of times and become well-versed. So it becomes a routine."

For U.S. hospitals, the CDC has issued guidance on how to spot suspicious cases and isolate them if necessary, with an emphasis on the importance of asking patients about recent travel to the outbreak region, where more than 3,400 people have died from the disease.

The only person diagnosed with Ebola in the U.S. had traveled from Liberia. When he first sought medical care for a fever and abdominal pain at a Dallas hospital, Ebola wasn't suspected. Hospital officials initially said they didn't know about his travel, but later said that information had been provided and was available to the medical staff caring for him at that time. He was diagnosed with Ebola when he went back to the hospital days later; he died there Wednesday.

"It's so easy to forget to ask about travel," said Dr. Emily Landon, director of a University of Chicago infection control program. "That's our one vulnerability."

Emergency room staffers are trained to focus on the most critical problem, like providing fast treatment for a heart attack or broken leg, she explained. If the same patient also has a fever and headache — common problems but also Ebola symptoms — "it's hard to break that autopilot and say, 'Oh, by the way, did you travel'" recently, Landon said. "We have to get them to break that autopilot every time."

Across town, at Rush University Medical Center, doctors got a frightening test run this past weekend when a man coughing up blood said he had been in contact with someone from Nigeria, one of the countries in West Africa where Ebola spread.

ER staffers donned protective gear and immediately escorted him to a nearby isolation room, but tests showed he had bronchitis, not Ebola, said Dr. Dino Rumoro, Rush's emergency medicine chief.

Rumoro said he's worked through similar scary disease threats — AIDS, SARS, swine flu and smallpox after 9/11 — that were in some ways more worrisome because many of them can spread invisibly through the air. Ebola is transmitted through direct contact with blood, vomit and other body fluids, or contact with needles, syringes or other objects contaminated by the virus.

"At least with Ebola we have a fighting chance," Rumoro said, "because I know that it is coming from body fluid and I know if I wear my (protective) suit I'm safe and I know if I don't stick myself with a needle or cut myself with a scalpel I'm safe."

"There's always going to be a little bit of fear in your head," Rumoro said. "But that's OK. That's what keeps us safe."

Spain Ebola nurse may have touched face with contaminated gloves

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(Reuters) - A Spanish nurse who is the first person to contract Ebola outside of Africa may have touched her face with the gloves of her protective suit while caring for a priest who died of the disease, a doctor treating her said on Wednesday.

The nurse, Teresa Romero, was being treated for the deadly infection at a Madrid hospital while Spanish officials launched an investigation into how she was able to contract Ebola despite strict protocols for handling contagious patients.

The virus, which the World Health Organization said had killed 3,879 people by Oct. 5 in West Africa since March in the largest outbreak of the disease on record, causes haemorrhagic fever and is spread through direct contact with body fluids from an infected person.

A Liberian man who was the first person diagnosed with Ebola in the United States died in a hospital isolation ward on Wednesday and the U.S. government ordered extra screenings at five major airports.

The WHO said it saw no evidence of the disease being brought under control in Liberia, Sierra Leone and Guinea, with neighbouring countries being told to prepare for the disease to spread across their borders.

Britain said it was sending extra troops, aircraft and a naval vessel to Sierra Leone to help stem the spread. The deployment will see 750 military personnel help set up treatment centres and a training facility. Three helicopters and a 100-bed naval hospital will also be sent to the region.

INTERNET DISCOVERY

While Romero is the only confirmed Ebola case in Spain aside from two priests who contracted the disease in Africa and died, more than 50 other people who may have had contact with the virus in the country are being monitored, including primary health care and hospital staff, European officials said.

"She has talked to me about the gloves, she touched her face with the gloves. That's what she remembers and what she has told me three times," German Ramirez, one of the doctors at Carlos III hospital where the nurse is being treated, told reporters.

The nurse took leave from work immediately after Spanish missionary Manuel Garcia died on Sept. 25. Wearing a full protective suit, she had entered the priest's room once while he was alive and once after his death to clean the room.

"I believe the error was made when taking off the suit," she told Spain's El Pais newspaper in a telephone interview published on Wednesday. "I see that as the most critical moment, when something could have happened. But I'm not sure."

Health worker union officials said Romero alerted hospital staff three times to say she had a fever and a rash, but because her temperature had not gone above 38.6 degrees Celsius the hospital did not see her as a risk.

Romero found out she had the disease by looking at the news on the Internet on her phone while she was waiting for the result of her test, she told Cuatro television station in a telephone interview.

"I asked the doctor for the result and he didn't answer in a very clear way and that's when I started to suspect," adding she then looked at her phone to find there was a positive case of Ebola in Spain.

Health authorities on Thursday put down the dog, a labrador-type breed called Excalibur, who lived with the nurse and her husband in a suburban Madrid flat, saying it posed a biological risk and there was evidence dogs could carry the virus.

The dog was taken out of the apartment block in a police-protected van with the windows blacked out and a driver in a protective suit while around 30 animal rights activists shouted "Murderers!".

The childless couple are two of six people under observation in the sealed-off sixth floor of the hospital in Madrid. The rest of the people, including other nurses who cared for the infected priests, have initially tested negative for Ebola, health authorities said.

Other people being monitored include two hairdressers who waxed the nurse as part of a beauty treatment, media reports said.

CALLS FOR CALM

Spanish Prime Minister Mariano Rajoy defended his country's health authorities and urged people not to panic.

"We have to keep calm. It is extremely unlikely that this will turn into an outbreak affecting many people," he said.

Rajoy said he had created a committee to oversee co-ordination between the regional Madrid government, the central government and European institutions. He said Spain was in constant contact with the European Union and the World Health Organization.

"Let the professionals do their work," he said. "The Spanish health system is one of the best in the world."

He said the investigation into how the infection had occurred was a priority and was still under way.

Two experts from the Stockholm-based European Centre for Disease Prevention and Control (ECDC), which monitors disease in the region, have gone to Spain to help with the investigation, a spokesman for the European Commission said.

The spokesman said Spanish authorities had told the EU it was not clear at this stage how the infection had occurred, but it may have been due to "possible relaxation" of protocols for handling the corpse or for the disposal of medical waste.

The Commission's health security committee gathered representatives from all EU states, the ECDC and from the World Health Organisation's European regional headquarters to discuss the situation on Wednesday.

The WHO's Europe director Zsuzsanna Jakab told Reuters in an interview on Tuesday it was "unavoidable" that Europe would see more cases of Ebola within its borders because of busy travel links with Guinea, Liberia and Sierra Leone.

She stressed, however, that the continent was well prepared for handling Ebola virus disease, and said she did not expect to see any widespread outbreaks in European countries.

A new World Bank assessment of the potential impact of the epidemic estimated that if it spread wider from the three states into neighbouring larger economies, the two-year regional financial impact could reach $32.6 billion by the end of 2015.

Ebola patient dies in Texas; U.S. orders airport screenings

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(Reuters) - The first person diagnosed with Ebola in the United States died on Wednesday and the government ordered five airports screen passengers from West Africa for fever, underscoring concerns about U.S. treatment and preparedness for the virus.

The administration of President Barack Obama has been under pressure from lawmakers to enhance screening and even ban flights after Liberian national Thomas Eric Duncan flew to Dallas, Texas in late September after having contact with a woman who later died of Ebola.

The White House said on Wednesday that extra screening for fever will be carried out for arriving aircraft passengers from West Africa, where the virus has killed nearly 4,000 people in three countries. The screening will start at New York's John F. Kennedy airport from the weekend, and later at Newark Liberty, Washington Dulles, Chicago O'Hare and Hartsfield-Jackson Atlanta.

Authorities will use a non-invasive device to take the temperature of passengers and have them fill out a questionnaire created by the U.S. Centers for Disease Control and Prevention (CDC) asking for detailed information about their activities

Duncan had been in critical condition and on a ventilator in an isolation ward at Texas Health Presbyterian Hospital in Dallas. He was also given an experimental medication to try to keep him alive before the hospital announced his death Wednesday morning.

A spokeswoman for a clinic in a suburb of Dallas said it was examining a man who said he had contact with Duncan and was exhibiting symptoms.

Questions have been raised on what impact a decision by the hospital to initially discharge Duncan had on his treatment. In animal tests of experimental Ebola drugs, the chance of survival drops the longer it takes to begin treatment.

"You can have the best drug in the world and there is a point where that drug just won’t work," said virologist Thomas Geisbert of the University of Texas Medical Branch, who has done pioneering work on Ebola treatments.

“There is a point where the virus has done so much damage you can’t recover from it," Geisbert said.

Duncan was able to fly to the United States from Liberia’s capital Monrovia because he did not have a fever when screened at the airport and filled out a questionnaire saying he had not been in contact with anyone infected with Ebola. Liberian officials have said Duncan lied on the questionnaire and had been in contact with a pregnant woman who later died.

"It is with profound sadness and heartfelt disappointment that we must inform you of the death of Thomas Eric Duncan this morning at 7:51 a.m.," hospital spokesman Wendell Watson said in an emailed statement. The hospital said he was 45.

About 48 people who had direct or indirect contact with Duncan since he arrived on Sept. 20 are being monitored, but none have yet shown any symptoms, according to health officials.

The CDC and other U.S. health officials say the chances of Ebola spreading in the United States are very slim.

Duncan's fiancée, Louise Troh, who is being quarantined, wrote in a statement: "His suffering is over. My family is in deep sadness and grief, but we leave him in the hands of God."

CDC RECOMMENDS CREMATION

The hospital has not released details on how it will handle Duncan's body but said it will follow protocols from the CDC.

The guidelines recommend careful preparation of the body before movement, including enclosing it in two bags and disinfecting the bags. The body can then be transported without the need for protective gear for a driver or others who are near the body but they are not to handle the remains before cremation.

The current Ebola outbreak, the worst on record, began in March. On Wednesday, the World Health Organization updated its toll of the disease. WHO said Ebola has killed 3,879 people out of 8,033 cases by the end of Oct. 5.

Ebola can take as long as three weeks before its victims show symptoms, at which point the disease becomes contagious. Ebola, which can cause fever, vomiting and diarrhea, spreads through contact with bodily fluids such as blood or saliva.

While several American patients have been flown to the United States from West Africa for treatment, Duncan was the first person to start showing symptoms on U.S. soil.

A nurse in Spain who treated a priest who worked in West Africa is also infected.

U.S. Secretary of State John Kerry on Wednesday appealed to other governments to do more to help contain the spread of Ebola, urged countries not to shut their borders and told airlines to keep flying to West Africa.

"All of these things are frankly urgent in order to be able to quickly move to contain the spread of Ebola," Kerry said.

Shares of biotech companies linked to the development of treatments against Ebola reacted sharply on Wednesday to Duncan's death. Shares in Chimerix, whose experimental Ebola drug was being administered to Duncan, tumbled 9.5 percent to $30.08. U.S.-traded shares of Tekmira Pharmaceuticals Corp, whose treatment has been used in other Ebola patients, sharply pared losses, briefly turning positive after having fallen as much as 8.8 percent earlier.

Monday 6 October 2014

Journalist with Ebola arrives at Nebraska hospital

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(AP) — An American video journalist who contracted Ebola while working in Liberia has arrived at a Nebraska hospital, where he will be treated for the deadly disease.

Ashoka Mukpo, 33, arrived by ambulance Monday at the Nebraska Medical Center, where he will be kept in a specialized containment unit built specifically to handle this type of illness.

Mukpo was working in Liberia as a freelance cameraman for NBC News when he became ill last week. He is the fifth American with Ebola to return to the U.S. for treatment during the latest outbreak, which the World Health Organization estimates has killed more than 3,400 people.

Meanwhile, a Liberian man with Ebola who started showing symptoms while visiting the U.S. is in critical condition at a Dallas hospital.

Mukpo was able to walk off the plane under his own power Monday before being loaded onto a stretcher for the ambulance ride to the hospital.

His parents traveled from Rhode Island to Nebraska to be with Mukpo, but during his treatment they will have to rely on a video chat system in his hospital room to communicate with him.

Doctors at the isolation unit — the largest of four in the U.S. — will evaluate Mukpo before determining how to treat him. They said they will apply the lessons learned while treating American aid worker Rick Sacra, who was allowed to return home to Massachusetts after three weeks, on Sept. 25.

Sacra received an experimental drug called TKM-Ebola, as well as two blood transfusions from another American aid worker who recovered from Ebola at an Atlanta hospital. The transfusions are believed to help a patient fight off the virus because the survivor's blood carries antibodies for the disease. Sacra also received supportive care, including IV fluids and aggressive electrolyte management.

But doctors have said they can't be sure what helped Sacra recover because he was receiving multiple treatments.

After Sacra was released, the Nebraska Medical Center set up a separate lab within the isolation unit, so test results would be available more quickly and samples wouldn't have to be sent across campus to the main lab.

Sacra was admitted Saturday to UMass Memorial Medical Center after he came in complaining about a cough and low-grade fever and was put in isolation as a precaution. The hospital said weekend test results came back negative for Ebola, and the Centers for Disease Control and Prevention confirmed that Sacra's symptoms were not caused by the virus.

In Dallas, another man who recently traveled to the U.S. from Liberia was listed in critical condition Sunday. Thomas Eric Duncan has been hospitalized at Texas Health Presbyterian Hospital since Sept. 28.

Dr. Tom Frieden, the CDC's director, said he was aware that Duncan's health had "taken a turn for the worse," but he declined to describe Duncan's condition further.

The virus that causes Ebola is not airborne and can only be spread through direct contact with the bodily fluids — blood, sweat, vomit, feces, urine, saliva or semen — of an infected person who is showing symptoms.

Duncan arrived in Dallas on Sept. 20 and fell ill a few days later. Officials say 10 people definitely had close contact with Duncan and a further 38 may have been around him when he was showing symptoms of the disease.

5th American with Ebola returning from Liberia

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(AP) — An American photojournalist who contracted Ebola while working in Liberia is expected to arrive Monday in Nebraska where he will be treated for the virus that has ravaged West Africa.

Ashoka Mukpo, 33, will be the second Ebola patient to be treated at the Nebraska Medical Center's specialized isolation unit. Mukpo was working in Liberia as a freelance cameraman for NBC News when he became ill last week.

NBC reported Sunday evening that Mukpo had started his journey to the U.S. for treatment and that he would arrive Monday morning. Mukpo's family said Friday he would be treated in Omaha. Hospital officials said they expected an Ebola patient to arrive Monday, but declined to provide a name.

Mukpo is the fifth American to return to the United States for treatment since the start of the latest Ebola outbreak, which the World Health Organization estimates has killed more than 3,400 people.

The hospital's biocontainment unit was created in 2005 specifically to handle this kind of illness, said Dr. Phil Smith, who oversees the unit.

"We are ready, willing and able to care for this patient," Smith said. "We consider it our duty to give these American citizens the best possible care we can."

Mukpo's father, Dr. Mitchell Levy, told NBC Sunday that his son was "counting the minutes" until he could leave Liberia but that he was not feeling that ill Sunday. Levy said the family was travelling from Rhode Island to Nebraska.

Doctors at the isolation unit — the largest of four nationwide — will evaluate Mukpo before determining how to treat him. They said they will apply the lessons learned while treating American aid worker Rick Sacra in September. Sacra was successfully treated in the Nebraska unit and was allowed to return to his home in Massachusetts after three weeks, on Sept. 25.

Sacra received an experimental Tekmira Pharmaceuticals drug called TKM-Ebola, as well as two blood transfusions from another American aid worker who recovered from Ebola at an Atlanta hospital. The transfusions are believed to help a patient fight off the virus because the survivor's blood carries antibodies for the disease. Sacra also received supportive care, including IV fluids and aggressive electrolyte management.

In Dallas, another man who recently traveled to the U.S. from Liberia was listed in critical condition Sunday. Thomas Eric Duncan has been hospitalized at Texas Health Presbyterian Hospital since Sept. 28. Dr. Tom Frieden, director of the federal Centers for Disease Control and Prevention, said he was aware that Duncan's health had "taken a turn for the worse," but he declined to describe Duncan's condition further.

The virus that causes Ebola is not airborne and can only be spread through direct contact with the bodily fluids — blood, sweat, vomit, feces, urine, saliva or semen — of an infected person who is showing symptoms.

Duncan arrived in Dallas on Sept. 20 and fell ill a few days later. Officials say 10 people definitely had close contact with Duncan and a further 38 may have been around him when he was showing symptoms of the disease.

Before he was admitted to the hospital, Duncan stayed with Louise Troh, her 13-year-old son and two nephews in their northeast Dallas apartment. The family has been kept in isolation in an undisclosed location since Friday and a hazardous materials crew has twice decontaminated their home. No one in the family has developed Ebola symptoms.

On Sunday, Troh told The Associated Press that she was afraid the crew might damage or destroy some irreplaceable keepsakes that she was forced to leave at the apartment, including photographs and recordings of her daughter, a singer, who died in childbirth.

"If they throw out her picture, her recordings, I'll be hurt. Her live CD's in there. That's all I have to show her children in the future. I don't want to miss it," she said in a phone interview.

Thursday 2 October 2014

Many sick in US Ebola patient's Liberia hometown

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(AP) — Thomas Eric Duncan rushed to help his 19-year-old neighbor when she began convulsing days after complaining of stomach pain. Everyone assumed her illness was related to her being seven months pregnant.

When no ambulance came, Duncan, Marthalene Williams' parents and several others lifted her into a taxi, and Duncan rode in the front seat as the cab took Williams to the hospital. She later died.

Within weeks, everyone who helped Williams that day was either sick or dead, too — victims of Ebola, the virus that is ravaging Liberia's capital and other parts of West Africa, with more than 3,300 deaths reported.

The disease is spread through direct contact with saliva, sweat, blood and other bodily fluids, and all those who fell ill after helping Williams had touched her. She turned out to have Ebola.

Duncan is now hospitalized in an isolation ward in Texas after falling sick with Ebola following his arrival last month on a family visit. He has become a symbol of how the lethal disease could spread within the U.S.

Here in Liberia, however, he is just another neighbor infected by a virus that is devastating the cluster of tin-roof homes along 72nd SKD Boulevard where Williams lived.

"My pa and four other people took her to the car. Duncan was in the front seat with the driver, and the others were in the back seat with her," recounted her 15-year-old cousin Angela Garway, standing in the courtyard between the homes where they all lived. "He was a good person."

Meanwhile, Liberian authorities Thursday announced plans to prosecute Duncan, saying the delivery driver lied about his Ebola status upon leaving the country.

On an airport screening questionnaire obtained by The Associated Press, Duncan said that he hadn't come into contact with an Ebola patient. However, it is not clear whether he had learned of Williams' diagnosis before traveling.

In the neighborhood where Williams lived, some people were no longer willing to take any risks Thursday, not after seeing what happened to those who showed compassion for the pregnant woman.

As 9-year-old Mercy Kennedy sobbed along with neighbors mourning news of her mother's death, not a person would touch the little girl to comfort her.

Mercy's mother had helped to wash the pregnant woman's clothes, and had touched her body after she died at home when no hospital could find space for her, neighbors said.

On Thursday, little Mercy walked around in a daze in a torn nightgown and flip-flops, pulling up the fabric to wipe her tears as a group of workers from the neighborhood task force followed the sound of wailing through the thick grove of banana trees and corn plants.

"We love you so dearly, yeah," one man wearing rubber gloves told her from a safe distance. "We want to take care of you. Have you been playing with your friends here?"

With Mercy's mother dead, neighbors fear it is only a matter of time before she, too, shows signs of the virus, and they want to know which other children may have come into contact with her while she was fetching water.

Pewu Wolobah, a member of the neighborhood anti-Ebola task force, lamented that even as Americans try to trace all of Duncan's contacts there, the virus is spreading through Duncan's old neighborhood faster than anyone can keep track.

The aunt of the pregnant victim died on Wednesday after collapsing in her house next door to the Williams home. Her 15-year-old daughter Angela is left behind, along with the pregnant woman's three younger siblings — Ezo Williams, 16, Tete Williams, 12, and Stanley Williams, 3 — and the family dog.

Their parents left Thursday morning for an Ebola treatment center. As word spread that they, too, took a taxi, the health workers expressed alarm.

"Does anybody know the taxi number or the license plate?" one man called into the crowd. "We need to find this vehicle!"

All the cases, including Duncan's, appear to have started with Williams, though some wondered how a pregnant woman who stayed at home could have contracted Ebola. Maybe it was her boyfriend, who hasn't been seen in weeks, they said. Or could it have been her close friend known as Baby D, who has since died herself?

The tragedy of Williams' death could grow larger still: Neighbors and relatives said more than 100 people came to a wake for her. No one could say for sure how many people may have touched the body.

"We had a lot of people come from a great distance to sympathize with her family," said Joseph Dolo from the anti-Ebola task force. "She had a lot of friends."

U.S. nears solution for safe disposal of Ebola waste

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(Reuters) - The United States is days away from settling the critical question of how hospitals should handle and dispose of medical waste from Ebola patients, a government official said on Wednesday.

Experts have warned that conflicting U.S. regulations over how such waste should be transported could make it very difficult for U.S. hospitals to safely care for patients with Ebola, a messy disease that causes diarrhea, vomiting and in some cases, bleeding from the eyes and ears.

Safely handling such waste presents a dual challenge for regulators, who want to both prevent the accidental spread of the deadly disease and avert any deliberate attempts to use it as a bioweapon.

Most U.S. hospitals are not equipped with incinerators or large sterilizers called autoclaves that could accommodate the large amounts of soiled linens, contaminated syringes and virus-spattered protective gear generated from the care of an Ebola patient, said Dr. Jeffrey Duchin, chair of the Infectious Diseases Society of America's Public Health Committee.

Sterilizing Ebola waste before it is transported is important not only to protect waste haulers but to guard against someone using the waste "for nefarious purposes," said Sean Kaufman, ‎president of Behavioral-Based Improvement Solutions, an Atlanta-based biosafety firm. "It's not just a safety issue," he said.

The matter, which was first reported by Reuters last month, may pose a significant challenge for Texas Health Presbyterian Hospital in Dallas, which is now treating the first Ebola patient to be diagnosed on U.S. soil.

Duchin said he is not aware of whether the hospital has its own incinerator or large autoclave, but if it does not, "they are going to have to find a temporary solution for managing infectious waste. That puts the hospital in a very difficult situation."

Cynthia Quarterman, administrator of the U.S. Department of Transportation's Pipeline and Hazardous Material Safety Administration, which oversees dangerous shipments, said her agency is "working on how we can clarify even further for hospitals, for the public, what the appropriate transportation should be."

Another official said that news could come within days.

The issue centers on guidance over handling Ebola-contaminated waste. The U.S. Centers for Disease Control and Prevention advises hospitals to treat items infected with the Ebola virus in leak-proof containers and discard them as they would other biohazards that fall into the category of "regulated medical waste."

But the DOT deems Ebola a Category A infectious agent, meaning it is capable of killing people and animals, and not "regulated medical waste," a category in which pathogens are not capable of causing harm.

Waste management contractors who normally handle hazardous hospital waste say they cannot legally haul the material, which leaves hospitals stuck without a way to dispose of the waste.

Already the issue has created problems. When Emory University Hospital in Atlanta was preparing to care for two U.S. missionaries infected with Ebola in West Africa in its high-security biocontainment unit, their waste hauler, Stericycle, initially refused to handle it.

Bags of Ebola waste quickly began piling up until the hospital worked out the issues with the help of the U.S. Centers for Disease Control and Prevention.

CDC spokesman Tom Skinner said the waste management problem has not been resolved yet, but he has said previously that the CDC is meeting with officials at the DOT to resolve the matter.

Duchin said he has heard that the discussion "has been elevated at the fed to decision makers who can solve the problem."

A DOT official said the CDC and DOT will likely issue joint guidance by next week.

Wednesday 24 September 2014

U.S. hospitals unprepared to handle Ebola waste

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(Reuters) - U.S. hospitals may be unprepared to safely dispose of the infectious waste generated by any Ebola virus disease patient to arrive unannounced in the country, potentially putting the wider community at risk, biosafety experts said.

Waste management companies are refusing to haul away the soiled sheets and virus-spattered protective gear associated with treating the disease, citing federal guidelines that require Ebola-related waste to be handled in special packaging by people with hazardous materials training, infectious disease and biosafety experts told Reuters.

Many U.S. hospitals are unaware of the regulatory snafu, which experts say could threaten their ability to treat any person who develops Ebola in the U.S. after coming from an infected region. It can take as long as 21 days to develop Ebola symptoms after exposure.

The issue created problems for Emory University Hospital in Atlanta, the first institution to care for Ebola patients here. As Emory was treating two U.S. missionaries who were evacuated from West Africa in August, their waste hauler, Stericycle, initially refused to handle it. Stericycle declined comment.

Ebola symptoms can include copious amounts of vomiting and diarrhoea, and nurses and doctors at Emory donned full hazmat suits to protect themselves. Bags of waste quickly began to pile up.

"At its peak, we were up to 40 bags a day of medical waste, which took a huge tax on our waste management system," Emory's Dr. Aneesh Mehta told colleagues at a medical meeting earlier this month.

Emory sent staff to Home Depot to buy as many 32-gallon rubber waste containers with lids that they could get their hands on. Emory kept the waste in a special containment area for six days until its Atlanta neighbor, the U.S. Centers for Disease Control and Prevention, helped broker an agreement with Stericycle.

While U.S. hospitals may be prepared clinically to care for a patient with Ebola, Emory's experience shows that logistically they are far from ready, biosafety experts said.

"Our waste management obstacles and the logistics we had to put in place were amazing," Patricia Olinger, director of environmental health and safety at Emory, said in an interview.

       

NOT IF, BUT WHEN

The worst Ebola outbreak on record is now projected to infect as many as 20,000 people in West Africa by November, while U.S. officials have said that number could rise above 550,000 by mid-January without an international intervention to contain its spread. Experts say it is only a matter of time before at least some infected patients are diagnosed in U.S. hospitals, most likely walking into the emergency department seeking treatment.

Already there have been several scares. As of Sept. 8, as many as 10 patients have been tested by U.S. hospitals for suspected Ebola cases, Dr. Barbara Knust, team leader for the CDC's Ebola response, said at a medical meeting this month. All tested negative.

The CDC has issued detailed guidelines on how hospitals can care for such patients, but their recommendations for handling Ebola waste differs from the U.S. Department of Transportation, which regulates the transportation of infectious waste.

CDC advises hospitals to place Ebola-infected items in leak-proof containers and discard them as they would other biohazards that fall into the category of "regulated medical waste." According to DOT guidelines, items in this category can't be in a form that can cause human harm. The DOT classifies Ebola as a Category A agent, or one that is potentially life-threatening.

DOT regulations say transporting Category A items requires special packaging and hazmat training.

CDC spokesman Tom Skinner said the agency isn't aware of any packaging that is approved for handling Ebola waste.

As a result, conventional waste management contractors believe they can't legally haul Ebola waste, said Thomas Metzger, communication director for the National Waste & Recycling Association trade group.

   

A TEMPORARY FIX

Part of Emory's solution was to bring in one of the university's large-capacity sterilizers called an autoclave, which uses pressurized steam to neutralize infectious agents, before handing the waste off to its disposal contractor for incineration.

Few hospitals have the ability to autoclave medical waste from Ebola patients on site.

"For this reason, it would be very difficult for a hospital to agree to care for Ebola cases - this desperately needs a fix," said Dr Jeffrey Duchin, chair of the Infectious Diseases Society of America's Public Health Committee.

Dr. Gavin Macgregor-Skinner, an expert on public health preparedness at Pennsylvania State University, said there's "no way in the world" that U.S. hospitals are ready to treat patients with highly infectious diseases like Ebola.

"Where they come undone every time is the management of their liquid and solid waste," said Macgregor-Skinner, who recently trained healthcare workers in Nigeria on behalf of the Elizabeth R. Griffin Research Foundation.

Skinner said the CDC is working with DOT to resolve the issue. He said the CDC views its disposal guidelines as appropriate, and that they have been proven to prevent infection in the handling of waste from HIV, hepatitis, and tuberculosis patients.

Joe Delcambre, a spokesman for DOT's Pipeline and Hazardous Materials Safety Administration, could not say whether requiring hospitals to first sterilize Ebola waste would resolve the issue for waste haulers. He did confirm that DOT is meeting with CDC.

Metzger said his members are also meeting with officials from the DOT, the CDC and the Environmental Protection Agency to sort out the issue.

Until the matter is resolved, however, "We're bound by those regulations," he said.

Monday 22 September 2014

WHO experts advise against travel or trade bans on Ebola-hit Africa

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(Reuters) - Independent health advisers to the World Health Organization (WHO) have assessed that there should be no general ban on travel or trade with countries reeling from an Ebola epidemic in West Africa, the U.N. agency said on Monday.

Some airlines have stopped flights to affected areas and WHO and other agencies have said this has hampered aid efforts and the ability of experts to reach victims of the world's worst ever outbreak of the hemorrhagic fever.

In a statement issued after the Emergency Committee held its second meeting last week, the WHO said Ebola had now killed at least 2,793 people in five countries and remains a "public health emergency of international concern".

"Flight cancellations and other travel restrictions continue to isolate affected countries, resulting in detrimental economic consequences, and hinder relief and response efforts risking further international spread," the statement said.

"The Committee strongly reiterated that there should be no general ban on international travel or trade..."

The experts urged authorities in the affected countries - Guinea, Liberia, Nigeria, Senegal and Sierra Leone - to work with the aviation and maritime sectors to resolve differences and "develop a coordinated response" to transport issues.

Quarantines may be deemed necessary in areas of intense and widespread transmission of the deadly Ebola virus, the committee statement went on.

"States should ensure that they are proportionate and evidence-based and that accurate information, essential services and commodities, including food and water, are provided to the affected populations."

WHO advisers earlier recommended the screening of travelers departing Ebola-affected countries from airports and ports.

The committee, composed of some 20 experts who advise WHO Director-General Margaret Chan, declared on Aug. 8 that the epidemic constituted a public health emergency of international concern. The medical charity Medecins Sans Frontieres has warned since late March that the outbreak, which began in the remote Gueckedou area of southeastern Guinea, is "unprecedented".

Sierra Leoneans on Sunday celebrated the end of a three-day lockdown meant to stem Ebola's reach, with authorities saying the move had identified dozens of new infections and located scores of bodies.

Separately on Monday, the WHO said two of the five affected countries - Nigeria and Senegal - were managing to halt the spread of the disease.