Saturday, 2 August 2014

Ebola Virus Disease









Ebola: WHO declares global health emergency
The Straits Times, 9 Aug 2014

LONDON - The World Health Organisation (WHO) has declared the Ebola outbreak in West Africa to be an international public health emergency, only the third declaration of its kind since regulations permitting it to do so were adopted in 2007.

It said the epidemic was an "extraordinary event" yesterday, but stopped short of calling for global travel restrictions, urging airlines to take strict precautions but to continue flying to the area.

"The likelihood is that things will get worse before they get better," said Mr Keiji Fukuda, the WHO's head of health security. "We are fully prepared for the outbreak to be at a high level for a number of months."

The decision came after a rare two-day closed-door session of the United Nations health body's emergency committee.

The WHO also said yesterday that the death toll from the outbreak stood at 961 people as of Wednesday, with 29 deaths reported on Tuesday and Wednesday. There were 68 new cases, bringing the total to 1,779. All the cases are in Guinea, Liberia, Sierra Leone and Nigeria.

Meanwhile, Asian nations are using thermal imaging cameras and posting doctors at airports to screen travellers as officials scramble to avert any outbreak.

There have been no confirmed cases of the virus in Asia, but the health authorities who have battled deadly viruses such as bird flu and severe acute respiratory syndrome in recent years were dusting off the drills used for those outbreaks. Most nations have advised the postponing of travel to affected areas.

Asia's efforts to screen visitors were adequate, said WHO spokesman Tarik Jasarevic. "As long as a person is not visibly sick, we think it's fine for them to be in public," he said by telephone. "We consider the risk for international spread quite low."

 Health officials in Thailand are monitoring 21 visitors from Sierra Leone, Liberia and Guinea, while the Philippine Department of Health said it would continue to monitor two of seven workers repatriated from Sierra Leone.

 In China, hospitals have been told to report any suspected cases, while India said it would screen travellers passing through affected countries.

NEW YORK TIMES, REUTERS, AGENCE FRANCE-PRESSE, XINHUA





Steps in place in Singapore
The Straits Times, 9 Aug 2014

SINGAPORE yesterday spelt out detailed measures to deal with a case of Ebola should one occur here.

Passengers at Changi Airport who show signs of Ebola - such as sudden high fever, diarrhoea, vomiting, rash or bleeding - will be isolated and transferred to Tan Tock Seng Hospital.

Suspect cases of patients who are seriously ill will be moved in specially configured ambulances.

All suspect cases will be managed in negative pressure isolation control rooms with strict infection control procedures.

The Ministry of Health will trace the people whom patients were in contact with. It will quarantine and monitor close contacts for up to 21 days in their homes or at the government quarantine facility in Pasir Ris.

It has also told hospitals and clinics to be alert for suspect cases, and how they should notify the ministry.









Singapore ramps up safeguards against Ebola
By Kash Cheong, The Straits Times, 8 Aug 2014

SINGAPORE is taking more measures to guard against Ebola, amid the world's worst outbreak of the deadly disease.

Nationals of Guinea, Liberia, Sierra Leone and Nigeria - where most cases have occurred - will be issued individual health advisories when they come through Singapore's immigration checkpoints, said the Ministry of Health (MOH) yesterday.

The advisory says that if travellers become unwell with Ebola symptoms, such as sudden high fever, stomach pains, diarrhoea, vomiting, rash or bleeding within three weeks of being in Ebola-hit areas of West Africa, they should see a doctor early at any clinic in Singapore.

They are also reminded to inform the doctor of where they have been.

The ministry will also put up similar health advisory posters at Changi Airport's arrival halls.

MOH maintained, however, that the disease still poses a low public health risk to Singapore.

This is because it can transmit from an infected person only if there is direct contact of bodily fluids. The current outbreak is also still contained within West Africa, and Singapore has no direct flights to and from affected areas.

Singapore's additional measures come after the United States issued its highest-level alert for Ebola yesterday.

The death toll for Ebola has topped 900, with 45 deaths between last Saturday and Monday.


So hospitals, clinics and doctors here have been told to stay vigilant. Suspected cases will be evaluated at hospitals' emergency departments for medical treatment and, as a precaution, isolated.

Measures are also in place to carry out contact tracing and to quarantine all close contacts, should there be a case here.

 Meanwhile, travel agencies such as Chan Brothers and Dynasty Travel have advised those on their South African tours to buy travel insurance and register with Singapore's Ministry of Foreign Affairs.

Both agencies said they have had calls from concerned travellers but no cancellations.



Singapore companies with business dealings in Africa also remain vigilant.

Commodities company Olam, which has operations in Nigeria, has issued health advisories to all its employees in Africa.

Water solutions company Hyflux, which has staff in Algeria in North Africa, is stressing the importance of good personal hygiene, among other things.

Singaporeans are advised to postpone non-essential travel to West Africa and check MOH's online Ebola advisory beforehand.

No travel curbs from WHO despite Ebola
The Straits Times, 1 Aug 2014

GENEVA - The World Health Organisation (WHO) is not recommending travel restrictions despite the Ebola outbreak, as it says that there is a low risk to airline passengers if an infected person is aboard.

The WHO advisory came as Sierra Leone declared a state of emergency yesterday in its struggle to control the epidemic, which has taken 729 lives.

Singapore's Ministry of Health (MOH) said yesterday that residents should not be alarmed by the spate of Ebola cases overseas either, but assured them that local hospitals would remain "vigilant" against the disease.

In the United States, Mr Stephen Monroe, deputy director of the Centre for Disease Control's National Centre for Emerging Zoonotic and Infectious Diseases, told CNN that it was very unlikely that Ebola victims would be able to spread the disease to fellow airline passengers.

"The Ebola virus spreads through direct contact with the blood, secretions, or other body fluids of ill people, and indirect contact - for example, with needles and other things that may be contaminated with these fluids," he said.

He said most people who were infected with Ebola had lived with or cared for an ill patient.



The statement on travel safety came from the International Air Transport Association (IATA) after several days of consultation with the WHO and the United Nations' International Civil Aviation Organisation (ICAO). Iata said Ebola is transmitted only when patients are displaying very severe symptoms in which case they are unlikely to feel well enough to travel.

However, the ICAO said it was considering passenger screenings for Ebola, now that the deadly virus has crossed international borders aboard an aircraft for the first time.

Concerns were raised after reports emerged that a man who died from Ebola had taken an international flight from Liberia to Nigeria with a stopover at Lomé in Togo.

The West Africa outbreak, which began in Guinea in February, has spread to Liberia and Sierra Leone. Another 57 deaths were recorded between Thursday last week and Sunday in Guinea, Liberia, Nigeria and Sierra Leone, the UN health agency said.

 It said 122 new cases were detected over those four days, taking the total number of confirmed and likely infected cases from the outbreak so far to 1,323.

Sierra Leone President Ernest Bai Koroma said he would meet the leaders of Liberia and Guinea in Conakry today to discuss the epidemic.

"Sierra Leone is in a great fight... Failure is not an option," he said in a speech late on Wednesday, adding that the state of emergency would initially last between 60 and 90 days.

Singapore's MOH noted that the country has "low travel connectivity" to West Africa. Changi Airport said there are no direct flights to or from that region.

Ebola also poses a "low public health risk", said the MOH, as it is transmitted only through direct contact with bodily fluids of those infected.

But hospitals will test for the disease in patients with symptoms and who have travelled to places where Ebola has been detected. If the disease is detected here, the MOH said it will isolate all suspected and confirmed cases.

Contact tracing will be conducted to find out who the patient had been in recent contact with, and all close contacts will be quarantined, it said.

Hong Kong has put quarantine measures in place, while Britain is considering emergency measures.

Fears that the outbreak could spread to other continents grew after leading medical charity Doctors Without Borders warned that the epidemic was out of control.

 REUTERS
Additional reporting by Kash Cheong








How Ebola travelled: By plane, bike and taxi
But so far, no action has been taken to curb travel in West Africa
The Straits Times, 1 Aug 2014

LONDON - For scientists tracking the deadly Ebola virus in West Africa, it is not about complex virology or genotyping, but about how contagious microbes can spread via planes, bikes and taxis.

So far, the authorities have taken no action to limit international travel in the region. The airlines association Iata said yesterday that the World Health Organisation (WHO) had not recommended any such restrictions or frontier closures.

The risk of the virus moving to other continents is low, disease specialists say. But tracing every person who may have had contact with an infected case is vital to getting on top of the outbreak in West Africa, and doing so often means teasing out seemingly routine information about victims' lives.

In Nigeria, which had an imported case of the virus in a Liberian-American man who flew to the capital Lagos this week and died, the authorities will have to trace all the passengers on his flight and anyone else he may have crossed paths with to avoid the kind of spread that other countries in the region have suffered.

The West Africa outbreak, which began in Guinea in February, has already spread to Liberia and Sierra Leone. With more than 1,323 cases and 729 deaths, it is the largest outbreak of the virus since it was discovered almost 40 years ago.

Sierra Leone has declared a state of public emergency to tackle the outbreak, while Liberia is closing schools and considering quarantining some communities.

"The most important thing is good surveillance of everyone who has been in contact or could have been exposed," said Dr David Heymann, a professor of infectious disease epidemiology and head of global health security at Britain's Royal Institute of International Affairs.

The spread of this outbreak from Guinea to Liberia in March shows how tracing even the most routine aspects of people's lives, relationships and reactions will be vital to containing Ebola's spread.

The original case in the cross-border spread is believed by epidemiologists and virus experts to have been a woman who went to a market in Guinea before returning, feeling unwell, to her village in neighbouring northern Liberia.

The woman's sister cared for her, and in doing so contracted the virus herself before her sibling died of the haemorrhagic fever it causes.

Feeling unwell and fearing a similar fate, the sister wanted to see her husband - an internal migrant worker then employed on the other side of Liberia at the Firestone rubber plantation.

She took a communal taxi via Liberia's capital Monrovia, exposing five other people to the virus who later contracted it and died.

In Monrovia, she switched to a motorcycle, riding pillion with a young man who agreed to take her to the plantation and whom the health authorities are desperate to trace.

 "It is an analogous situation to the man in the airplane (who flew to Lagos and died)," said Dr Derek Gatherer of Britain's Lancaster University, an expert in viruses who has been tracking the West Africa outbreak closely.

Liberia's Ebola case count is now 329, including 156 deaths, according to the latest information from the WHO, although not all are linked to the Guinea market case.

Dr Gatherer noted that while Ebola does not spread through the air and is not considered "super infectious", cross-border human travel can easily help it on its way.

The only known instance of Ebola reaching Europe from Africa via air travel occurred in 1994 when a Swiss zoologist became infected after dissecting a chimpanzee in Ivory Coast.

The woman was isolated in a Swiss hospital and discharged after two weeks without infecting anyone.

REUTERS







Sierra Leone buries 'hero' doctor
The Straits Times, 1 Aug 2014

KENEMA (Sierra Leone) - Sierra Leone has buried a doctor it hailed as a "national hero" for saving the lives of more than 100 Ebola patients before succumbing himself to the killer tropical disease.

Dr Umar Khan, 43, the West African nation's sole virologist, was at the forefront of his country's fight against the epidemic, which has seen more than 729 deaths in Sierra Leone and its West African neighbours.

He was buried yesterday in the eastern town of Kenema, where he had spent much of his working life, in a Muslim ceremony attended by family, friends, local dignitaries, aid workers and health officials.

"He was committed and dedicated in the quest to save the lives of his compatriots," said Health Minister Miatta Kargbo.

"For the short time we interacted, he constantly described Ebola as a war that all Sierra Leoneans should join to fight against, or otherwise it would be devastating," she added.

Local media described a "grief-laden" atmosphere weighing heavily on the town, with offices closed and markets empty.

President Ernest Koroma declared Dr Khan a "national hero" following the medic's death on Tuesday, and named a research centre in Kenema in his memory.

"The late doctor saved the lives of more than 100 patients before succumbing to the deadly Ebola disease himself," Mr Koroma said in a statement ahead of the funeral, which he did not attend.

Medical aid agency Doctors Without Borders described Dr Khan as "an extremely determined and courageous doctor who cared deeply for his patients".

"His work and dedication have been greatly appreciated by the medical community in Sierra Leone for many years," it said.

AGENCE FRANCE-PRESSE

















S'pore 'well prepared to deal with Ebola'
Ng Eng Hen cites professionalism of testing lab's staff
By Jermyn Chow Defence Correspondent, The Straits Times, 6 Dec 2014

SINGAPORE is well prepared to spot and deal with Ebola if it reaches the Republic's shores, Defence Minister Ng Eng Hen said yesterday after a visit to DSO's Clinical Diagnostic Services Laboratory.

The DSO lab has been designated by the Health Ministry as the national testing facility for the Ebola virus since Aug 1.

The research outfit has so far tested two suspected Ebola virus samples, both of which turned out to be negative, he said.

Post by cyberpioneer.
Noting that the lab's researchers and scientists were the same people who screened for the severe acute respiratory syndrome (Sars) and H1N1 and H7N9 influenza viruses, Dr Ng said: "They dealt with hundreds of specimens and, thankfully, as a testimony of their professionalism, there were no breaks of protocol... There was no outbreak from the lab. It was kept to very high standards."

The world's worst outbreak of Ebola has killed some 6,000 people in West Africa, and doctors and scientists are racing to develop an effective vaccine against it.

Dr Tan Boon Huan, who heads the DSO National Laboratories' biological defence programme, said Singapore has the know-how to raise its capabilities in this area.

Beefing up laboratory capabilities will boost Singapore's defences against an outbreak of new infectious diseases, he added."We cannot rely only on labs in other parts of the world," Dr Tan said. "We must have our own indigenous capabilities to stay ahead."

Dr Tan said this would benefit neighbouring countries without advanced virus-testing outfits.

Labs dealing with biological hazards are generally classified into four safety levels, Biosafety Level (BSL) one to four, with BSL-4 demanding the highest levels of protection. Singapore has labs with BSL-2 and BSL-3 capabilities that can spot bioterrorism agents or highly contagious and dangerous viruses. More contagious or deadly virus samples must be sent to BSL-4 labs in Japan or Australia.

Dr Tan, among only three scientists here who are trained to work in a BSL-4 lab, said such a lab will allow researchers to better spot pathogens and come up with effective countermeasures.

This was a point also made by Dr Ng: "You build up expertise, you get early warning for pathogens even before others and, therefore, you can build up your systems.

"But at the same time, you should only do it when you are fully confident because... if there is a break in protocol and if there is a breach in procedure and the virus leaks from the lab, you can have consequences."



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