Ebola 8/23

[Buster's Uncle]

How doctors know an Ebola patient is no longer contagious
CBS News
By Guest Author  August 21, 2014 9:17 PM



Dr. Kent Brantly, right, an Ebola patient at Emory Hospital, stands with his wife, Amber Brantly, during a press conference announcing his release from the hospital in Atlanta, Georgia, Aug. 21, 2014. Dr. Brantly and another patient, Nancy Writebol, were released from Emory Hospital after receiving treatment for Ebola that they both contracted while working as medical missionaries in Liberia.



As Dr. Kent Brantly and Nancy Writebol make their way back into the world after a three week quarantined battle with the Ebola virus, the public may be wondering how exactly their doctors determined the two patients are no longer contagious.

On Thursday, at a press conference at Emory University Hospital, where Brantly and Writebol received their care, Dr. Bruce Ribner, medical director of the infectious disease unit at the hospital, assured the public that he and his team had taken all the appropriate safety precautions to be sure both patients were safe for discharge.


"After a rigorous and successful course of treatment and testing, the Emory health care team has determined that both patients have recovered from the Ebola virus and can return to their families and community without concern for spreading this infection to others," said Ribner.

He said patients who do not show clinical symptoms of the virus for two days are believed to no longer be contagious, though he wasn't specific about which types of lab tests were conducted to make the final call, perhaps out of respect for his patients' privacy.

However, a statement released by the Centers for Disease Control and Prevention provided somewhat more detail and said blood tests indicated both patients are now free of the virus. "CDC provided consultation to the healthcare team at Emory University Hospital and conducted the laboratory testing of patients to confirm that they no longer had Ebola virus circulating in their blood," the statement said.

The CDC also made clear that contact with the recovered patients, either by their families or members of the public, does not pose a risk.

"Individuals who recover from Ebola are not contagious as far as transmitting the virus through close personal contact with blood or body fluids such as urine, feces, sweat, or vomit," the CDC statement said. The agency added that case studies of patients who have survived the disease in West Africa provide further evidence that Ebola survivors don't pose a threat to others once the virus is no longer detectable in their blood.


Dr. Amar Safdar, associate professor of infectious diseases and immunology at NYU Langone Medical Center, told CBS News that blood, or serologic, tests are typically done to assess if a patient with an infectious disease is still sick. Blood test results of someone recovering from the Ebola virus will indicate a decreased viral load compared to someone with an acute infection. Doctors will also look to see if the patient has developed certain antibodies that indicate the body is fighting off the infection.

In addition to lab work, doctors also rely on less high-tech approaches such as basic physical exams. "The standard is if the symptoms have resolved and the patient has clinically improved that means the patient has recovered from the acute infection," said Safdar.

There is some indication that a patient may continue to shed the virus even after a doctor determines the acute infection has subsided. Most likely, the rate at which the virus clears the body varies just as much as the incubation period, which is between 2 and 21 days. According to the World Health Organization, in one instance, a lab worker who contracted Ebola on the job and survived was found to have traces of the virus in his semen 61 days after the initial infection. This could theoretically mean a man could infect his partner during sexual intercourse weeks after he's declared disease-free, although no such cases have been documented.

Ribner said he doesn't think Brantly, 33, and Writebol, 59, would suffer any long-term health problems as a result of contracting the virus. "There may be some recovery time because this is fairly devastating disease," he said. "We would anticipate that any patients who have had not any significant organ damage will make a full recovery."

And they probably don't need to worry about going through this ordeal ever again. Safdar said when a person contracts the Ebola virus their immune system creates antibodies that will protect them from that strain of the virus in the future.

However, there are at least three deadly strains of Ebola. The strain of the virus that has so far killed more than 1,200 people in West Africa is believed to be Ebola Zaire, which has the highest mortality rate; as many as 96 percent of people infected with this strain of Ebola will die. Safdar said the two other strains found in Sudan and Uganda kill about a quarter of those who contract it.

"There are certain types of antibodies that have been shown to protect against certain types of Ebola infections -- neutralizing antibodies," explained Sadfar. "These are desirable to protect from further exposure."

He added that researchers are especially interested in examining blood samples of patients who have made a full recovery from the virus since a closer look at those antibodies could provide crucial information for developing an effective vaccine.


http://news.yahoo.com/doctors-know-ebola-patient-no-011736617.html

[Buster's Uncle]

Sierra Leone makes harboring Ebola victims a crime
Reuters
By Umaru Fofana and Joe Bavier  59 minutes ago



Medicins Sans Frontieres (MSF) health workers prepare at ELWA's isolation camp during the visit of Senior United Nations (U.N.) System Coordinator for Ebola David Nabarro, at the camp in Monrovia August 23, 2014. REUTERS/2Tango



FREETOWN/ABIDJAN (Reuters) - Sierra Leone's parliament has made the harboring of Ebola victims a crime punishable by two years' jail in an attempt to stop the spread of the deadly virus, the justice minister said on Saturday.

The decision came as the World Health Organization (WHO) warned that the hiding of victims and the existence of "shadow zones" where medics cannot go has concealed the true scale of the epidemic.

Some 1,427 people have died among 2,615 cases documented since the current outbreak - the worst since the disease's discovery - was first identified in Guinea in March, according to figures released by the WHO on Friday.

Lawmakers in Sierra Leone's capital Freetown voted overwhelmingly in favor of the 2014 Public Health Amendment Act, which amends a 54-year-old public health ordinance.

"The new regulation will provide for summary trial, meaning trial by a magistrate court alone," Justice Minister Frank Kargbo told Reuters.

Under-reporting of Ebola cases has been a problem particularly in Liberia and Sierra Leone, currently the two countries hardest hit by the virus. Nigeria, the fourth country affected, has reported 14 cases of the disease.



Medicins Sans Frontieres (MSF) health workers prepare at ELWA's hospital isolation camp during the visit of Senior United Nations (U.N.) System Coordinator for Ebola, David Nabarro, in Monrovia August 23, 2014. REUTERS/2Tango


Fear, stigma and denial have led many families to hide their infected loved ones from health officials. In other instances, patients have been forcibly removed from treatment facilities and isolation centers, creating the risk of the disease's further spread.

"The amendment is needed at this time taking into account the fact that when the 1960 ordinance was drafted and passed into law, a disease such as Ebola did not exist," said Kargbo, who also serves as Sierra Leone's attorney general.


REGIONAL PANIC

Despite initial assertions by regional health officials that the virus had been contained in its early stages, Ebola case numbers and deaths have increased dramatically in recent months.

As the outbreak has spread across borders from its initial epicenter in Guinea, governments in the region have introduced increasingly strict travel restrictions.

Ivory Coast has closed its land borders Guinea and Liberia to try to prevent the virus from crossing onto its territory, the government announced late on Friday.



Senior United Nations (U.N.) System Coordinator for Ebola, David Nabarro (L), talks with a Medicins Sans Frontieres (MSF) health worker during his visit, outside the ELWA's hospital isolation unit in Monrovia August 23, 2014. REUTERS/2Tango


Ivory Coast, French-speaking West Africa's largest economy and the world's top cocoa producer, had previously imposed a ban on flights to and from Sierra Leone, Liberia and Guinea.

Liberia's Nimba County, which shares a border with Ivory Coast, has seen the number of Ebola cases balloon in recent weeks. According to Moses Massaquoi, the head of Ebola case management at Liberia's health ministry, 65 cases including 25 confirmed patients have now been reported there.

"The number of cases in Nimba has spiked recently and it is now an area of concern," Massaquoi told Reuters.

The WHO does not recommend travel or trade restrictions for countries affected by Ebola, saying such measures could heighten food and supply shortages. But residents of Ivory Coast's commercial capital Abidjan voiced support for the decision.

"I don't think simply closing the border is enough. We need to go even further," said Romaric Kouadio, a laboratory technician.

The Philippines on Saturday ordered 115 soldiers to return home from peacekeeping operations in Liberia due to the outbreak there.

Brussels Airlines, Belgium's largest carrier, said on Saturday it was cancelling flights to the capitals of Guinea, Liberia and Sierra Leone for Sunday and Monday due to new restrictions put in place by Senegal's aviation authority.

The company's flight to Freetown on Friday was denied permission to land for a crew change at the airport in Senegal's capital Dakar, and the plane was forced to continue on to Casablanca for an unscheduled landing.

Senegal, West Africa's humanitarian hub, had announced earlier in the day that it was banning all flights to and from countries affected by Ebola. It also blocked a U.N. aid plane from landing in Dakar.

"We cannot fly like that. It is pretty dangerous," Paul Delafaille, Brussels Airlines' country manager in Sierra Leone, told Reuters.

A spokesman for the airline, in which Germany's Lufthansa owns a 45 percent stake, said it was exploring options that would allow it to resume service to the three countries.

(Writing by Joe Bavier; Additional reporting by Clair MacDougall in Monrovia and Alain Amontchi in Abidjan; Editing by Stephen Powell)


http://news.yahoo.com/sierra-leone-makes-harboring-ebola-victims-crime-161037243.html

[Buster's Uncle]

Nigerian who died in UAE tests negative for Ebola
Reuters
August 22, 2014 3:45 AM



DUBAI (Reuters) - A Nigerian woman with cancer who died in the Emirati capital this week has tested negative for Ebola, the Health Authority of Abu Dhabi said.

The 35-year-old woman with advanced cancer had been traveling via Abu Dhabi airport when her health deteriorated. When medics tried to resuscitate her, the patient had shown signs that may have been consistent with the Ebola virus.

"Some of her signs during resuscitation, although explainable by her medical condition, could also have been caused by Ebola virus, and hence this diagnosis needed to be excluded," the authority said in a statement according to the state WAM news agency on Thursday.

At the time, the patient's husband and the five medics who tried to resuscitate her were put in isolation. The Health Authority said none of them had shown any symptoms.

"Given the negative result, all these are individuals are scheduled to be released from isolation today (Thursday)," the statement added.

(Writing by Yara Bayoumy; Editing by Alison Williams)


http://news.yahoo.com/nigerian-died-uae-tests-negative-ebola-074515913.html

[Buster's Uncle]

Senegal closes border as UN warns on Ebola flare-up
AFP
By Selim Saheb Ettaba with Zoom Dosso in Monrovia  August 22, 2014 6:21 AM



A Senegalese hygienist demonstrates how to protect oneself against the Ebola virus on April 8, 2014 at Dakar airport (AFP Photo/Seyllou)



Dakar (AFP) - Senegal has become the latest country to seal its border with a west African neighbour to ward off the deadly Ebola virus, as the new UN pointman on the epidemic said preparations must be made for a possible flare-up of the disease.

Senegal's decision to close its land border with Guinea, announced by the interior ministry on Thursday, is part of intensifying efforts to contain the outbreak that has killed 1,350 people since March in Guinea, Liberia, Nigeria and Sierra Leone.

David Nabarro, a British physician who the United Nations appointed last week to coordinate the global response to the crisis, was in the Liberian capital Monrovia on Friday for the second day of a tour of the region.

"We're either close to a plateau, but then we'll drop, or we're in a phase -- an inflexion point -- where it is going to increase, and I absolutely cannot tell," Nabarro told AFP during a stopover at Conakry airport en route to Monrovia.

He said he was determined to "ensure that every piece of our apparatus is at its optimum so it could deal possibly with a flare-up if that's necessary".

Nabarro is also due to visit Freetown, Conakry and Abuja in Nigeria during the trip, where he is tasked with revitalising the health sectors of Ebola-hit countries.



Recovered Ebola patient Dr Kent Brantly (R) stands with his wife, Amber Brantly, during a press conference at Emory Hospital on August 21, 2014 in Atlanta, USA (AFP Photo/Jessica Mcgowan)


Authorities have been hampered in their fight against Ebola by the deaths of several top health officials and numerous frontline doctors to the virus.

However, two American missionaries who contracted Ebola while treating patients in Liberia and were taken to the US for treatment, have left hospital after making a full recovery.

Kent Brantly, 33, and Nancy Writebol, 60, were given experimental drugs before being airlifted to a hospital in Atlanta where they were treated for the last three weeks.

"The discharge from the hospital of both these patients poses no public health threat," said Bruce Ribner, director of Emory Hospital's Infectious Disease Unit.



A Liberian soldier observes as police deploy in Monrovia's West Point slum as part of quarantine measures to contain the spread of Ebola on August 20, 2014 (AFP Photo/Zoom Dosso)


- Liberia crematorium overflows -

Liberia, which has seen the biggest toll in this epidemic with 576 deaths, has witnessed chaotic scenes in recent days following a surge in cases.

The Red Cross said the crematorium in Monrovia was struggling to deal with the dozens of bodies being brought in each day.

Workers were having to return corpses to a hospital in the city because they "did not have the capacity to cremate all the bodies", Fayah Tamba, the head of the charity's Liberian office, told a local radio station.

Her comments came a day after troops used tear gas to disperse protesting crowds after President Ellen Johnson Sirleaf ordered a nightime curfew and quarantine zone in Monrovia's West Point slum and Dolo Town, to the east of the capital.

Fear of the virus spreading to other continents has seen flights to the region cancelled, and authorities around the world have adopted measures to screen travellers arriving from affected nations.



A group of Guinean sanitation control agents prepare to leave on August 20, 2014 in Conakry, to act as reinforcements in the provinces infected by Ebola (AFP Photo/Cellou Binani)


Air France is one of the few airlines running daily routes to and from Sierra Leone. On a flight this week from Freetown to Paris, via the Guinean capital Conakry, fear of the virus was ubiquitous.

"I had to close my textile shop and return to China," said Wu Guo Gang, 60, on the flight with his wife.

"Many Chinese are leaving. If they stay, they may die," he added.

The couple is leaving behind a business in Freetown as well as their family home. They said they would stay with their son in southern China until the crisis was over.

Other passengers spoke of having to pay for costly diversions due to the many airlines not travelling to the region.


- DR Congo fever -

UN Secretary-General Ban Ki-moon's special representative for Liberia, Karin Landgren, said West Africa was in urgent need of international medical personnel as well as basic supplies including chlorine, gloves and body bags.

"Health-care systems in the most affected countries were weak before the outbreak. Now they are overwhelmed," she said.

Meanwhile, as fears grow that the outbreak will spread across Africa and beyond, DR Congo's Health Minister Felix Kabange Numbi said a haemorrhagic fever of unknown origin had killed 13 people in the country's northwest in the past two weeks.

"All 13 people who have died suffered from a fever, diarrhoea, vomiting and, in a terminal stage, of vomiting a black matter," he said.

The first victim was a pregnant woman and the 12 others -- including five medics -- died after coming into contact with her. About 80 people who had contact with the deceased are also under observation.

Samples taken from the victims are to be tested to find the exact strain of the pathogen and results are expected in a week.


http://news.yahoo.com/us-missionaries-beat-ebola-liberia-crisis-worsens-173138997.html

[Buster's Uncle]

Experimental Ebola Drug’s Role in Americans’ Recoveries Remains Unclear
ABC News Nightline
By KATIE MOISSE via World News  August 22, 2014 11:06 AM



American Ebola survivor Dr. Kent Brantly credited doctors, God and an experimental drug for his recovery today. But experts say it’s unclear whether the drug, known as ZMapp, helped or hindered his recovery.

Brantly and fellow American aid worker Nancy Writebol contracted the virus while working inLiberia with the missionary groups Samaritan’s Purse and SIM. They received ZMapp -- a cocktail of three antibodies that attack the virus -- and were evacuated from the growing outbreak zone to Emory University Hospital in Atlanta, where they were isolated for at least two weeks.

"Today is a miraculous day," Brantly said today as he was released from the hospital. "Through the care of the Samaritan’s Purse and SIM missionary team in Liberia, the use of an experimental drug, and the expertise and resources of the health care team at Emory University Hospital, God saved my life -- a direct answer to thousands and thousands of prayers."

Writebol was released Tuesday, hospital officials said.

Brantly was first human to receive ZMapp, which until recently had only been tested in monkeys. His condition improved within an hour, according to the aid group Samaritan’s Purse. But Dr. Bruce Ribner, director of Emory’s infectious disease unit, said drug’s role in his and Writebol’s survival is unclear.

"Frankly we do not know if it helped them, made any difference, or even delayed their recovery," he said.

Out of six people known to have received ZMapp, two have recovered, three have shown improvement and one has died, according to the World Health Organization. Even the drug's manufacturer, California-based Mapp Pharmaceuticals, acknowledges the lack of evidence that the drug actually works against the Ebola virus.

"We don’t know," the company's website reads, stressing that larger trials are needed to determine the drug's safety and effectiveness.

But those studies might have to wait. Mapp Pharmaceuticals said it has run out of ZMapp after complying with "every request for ZMapp that had the necessary legal/regulatory authorization," adding that the drug was "provided at no cost in all cases." The company is currently working with the U.S. government to accelerate scaled up production, it said in a statement.

"The work to date has been funded by grants and contracts that were only sufficient to produce doses for animal safety and efficacy testing," the company's website reads. "The present epidemic has changed the picture dramatically, and additional resources are being brought to bear on scaling up."

Ebola continues to spread through West Africa, where nearly 2,500 people have contracted the virus. Roughly 47 percent those infected have survived, according to WHO, making it difficult to understand the role of any experimental treatments.

In addition to ZMapp, Samaritan's Purse said Brantly also received a blood transfusion from a 14-year-old Ebola survivor -- another unproven treatment with unknown results.

"We have no idea how that might have affected his outcome," Ribner said, adding that "there is a crying need for research" into experimental Ebola treatments.

A group of 100 doctors, researchers, ethicists and drug developers is scheduled to meet in early September to discuss "the most promising experimental therapies and vaccines and their role in containing the Ebola outbreak in West Africa," WHO announced today, adding that "ways to ramp up production of the most promising products" will be explored.

More than 20 experts from West Africa are expected to attend, the agency said.


http://news.yahoo.com/blogs/nightline-fix-abc-news/experimental-ebola-drug-role-americans-recoveries-remains-unclear-150613227.html