Sunday, July 27, 2014

WHO, Govt Shut Down Hospital Over Ebola Virus
Guinea-Conakry hospital admitting Ebola virus patient.
Written by Chukwuma Muanya
Nigerian Guardian

Chukwu-ok-•  Begin testing of all passengers on board with Liberian victim

•  How we identified disease in patient, by doctors

•  Experts list measures to prevent infection

AS part of measures to prevent the spread of Ebola Virus Disease (EVD), the World Health Organisation (WHO) and the Federal Government have shut down the hospital, First Consultants Medical Centre Limited, Ikoyi Road, Obalende, Lagos, where the first victim died.

    They have also begun testing of all passengers on the same flight with the first Ebola virus victim in Nigeria who died on Friday in a Lagos hospital. Already, the WHO African Region has opened a sub-regional outbreak coordination centre in Conakry, Guinea.

    It is feared that all the over 200 passengers on board are exposed to the deadly virus and may continue to spread the disease if they are not quarantined.

   First Consultants Medical Centre Limited in a statement yesterday by the Chief Consultant/Medical Director, Dr. B. N. Ohiaeri, and the Senior Consultant Physician and Endocrinologist, Dr. A. S. Adadevoh, said: “In keeping with WHO guidelines, the hospital is shut down briefly as full decontamination exercise is currently in progress. The reopening of the hospital will also be in accordance with WHO guidelines.

    “In conclusion,  working with the state, federal and international agencies, we were able to identify and confirm the diagnosis of the Ebola Virus Disease.

   “We hope that by our action of preventing this gentleman from being extracted from our hospital and traveling to Calabar we have been able to prevent the spread of Ebola virus disease in Nigeria.

   “The board and management of the hospital wish to thank all our staff members for their diligence and professionalism.”  

    According to the statement, the victim, was a senior diplomat with the Economic Community of West African States (ECOWAS), from Liberia, who arrived in Nigeria to attend the ECOWAS Convention in Calabar, Cross River State.

    The hospital said working jointly with the state, federal agencies and international agencies, they were able to obtain the confirmation of Ebola virus disease (Zaire strain) from the WHO regional centre laboratory in Senegal, Redeemers University laboratory in Ogun State, and the Lagos University Teaching Hospital (LUTH), Idi Araba, and that the gentleman subsequently died on July 25, 2014, at 6:50 a.m.  

    The statement reads: “A 40-year-old gentleman came into the hospital with symptoms suggestive of malaria (fever, headache, extreme weakness) on Sunday night (20th July 2014).

    “He was fully conscious and gave us his clinical history and told us he was a senior diplomat from Liberia. Laboratory investigations confirmed malaria whilst 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 persons with Ebola virus disease at home, in any hospital or at any burial. In spite of this denial we immediately decided to do the following:

    “To conduct further tests for possible infectious haemorrhagic disease, especially Ebola virus diseases, based on the fact that he was a Liberian citizen and the recent outbreak of the disease in that country.

   “We immediately isolated/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 as we had a high index of suspicion of a possible Ebola virus disease.

    “We refused for him to be let out of the hospital in spite of intensive 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, Cross River State.

    “Initial test results from LUTH laboratory indicated a signal of possible Ebola virus disease, but required confirmation.

    “We then took the further step of reaching out to senior officials in the office of the Secretary of Health of the United States of America who promptly assisted us with contacts at the Centres for Disease Control (CDC) and WHO Regional Laboratory Centre in Senegal…”

    According to reports, the fact that the traveller from Liberia could board an international flight also raised new fears that other passengers could take the disease beyond Africa due to weak inspection of passengers and the fact Ebola’s symptoms are similar to other diseases.

    Officials in the country of Togo, where the sick man’s flight had a stopover, also went on high alert after learning Ebola could possibly have spread to a fifth country.

    Also, in response to the first Ebola virus disease (EVD) in Nigeria and to answer questions and have feedback from Nigerians, the Federal Ministry of Health (FMoH) has opened special email and twitter accounts, email address is being protected from spambots. You need JavaScript enabled to view it. and @EbolaInfoFmohNg, and is also working on a Facebook account.

    Minister of Health, Prof. Onyebuchi Chukwu, and Coordinator, Nigeria Centre for Disease Control (NCDC), Dr. Abdulsalami Nasidi, have reassured Nigerians that the country has the capacity to control the disease.

    Also, there is renewed promise for Human Immuno-deficiency Virus (HIV) vaccine as researchers have found a way to ‘neutralize’ the antibodies.

    Antibody is a protective protein produced by the immune system in response to the presence of a foreign substance, called an antigen.

     According to a study published yesterday in Cell, researchers from Duke University School of Medicine in Durham, North Carolina, United States, say they have discovered a way to “neutralize” antibodies in individuals who are infected with HIV-1 - the most predominant form of the virus - paving the way for such a vaccine.

   Could there be a HIV vaccine? Researchers say they have found a way to neutralize antibodies in people infected with HIV-1.

     The research team, led by Dr. Barton Haynes, director of the Duke Centre for HIV/AIDS Vaccine Immunology-Immunogen Discovery (CHAVI-ID) and the Duke Human Vaccine Institute, recently published their findings in the journal Cell.

    This latest study follows on from research conducted by the team last year. In that study, published in the journal Nature, Dr. Haynes and colleagues detailed the co-evolution of broadly neutralizing antibodies (bnAbs) and pinpointed the viruses that trigger the production of these antibodies in an HIV-infected individual.

    In this new study, the team discovered exactly how B cells - immune system cells that secrete antibodies into bodily fluids - are able to neutralize an array of HIV strains.

   The researchers say they were surprised to find that the B cells secreted both a “helper” set of neutralizing antibodies and cross-reactive neutralizing antibodies - found in around 20 per cent of HIV-1 infected individuals - which “teamed up” to guide a vigorous set of bnAbs to HIV strains.

   They explain that these antibodies worked by targeting an outer shell region of HIV strains - known as the “viral envelopes” - to which bnAbs also stick.

   According to a WHO Fact Sheet on EVD, formerly known as Ebola haemorrhagic fever, is a severe, often fatal illness in humans. EVD outbreaks have a case fatality rate of up to 90 per cent. EVD outbreaks occur primarily in remote villages in Central and West Africa, near tropical rainforests.

   According to WHO, Genus Ebolavirus is one of three members of the Filoviridae family (filovirus), along with genus Marburgvirus and genus Cuevavirus. Genus Ebolavirus comprises five distinct species: Bundibugyo ebolavirus (BDBV); Zaire ebolavirus (EBOV); Reston ebolavirus (RESTV); Sudan ebolavirus (SUDV); and Taï Forest ebolavirus (TAFV).

   BDBV, EBOV, and SUDV have been associated with large EVD outbreaks in Africa, whereas RESTV and TAFV have not. The RESTV species, found in Philippines and the People’s Republic of China, can infect humans, but no illness or death in humans from this species has been reported to date.

Signs and symptoms

   EVD is a severe acute viral illness often characterised by the sudden onset of fever, intense weakness, muscle pain, headache and sore throat. This is followed by vomiting, diarrhoea, rash, impaired kidney and liver function, and in some cases, both internal and external bleeding. Laboratory findings include low white blood cell and platelet counts and elevated liver enzymes.

   People are infectious as long as their blood and secretions contain the virus. Ebola virus was isolated from semen 61 days after onset of illness in a man who was infected in a laboratory.

   The incubation period, that is, the time interval from infection with the virus to onset of symptoms, is two to 21 days.

Vaccine and treatment

    No licensed vaccine for EVD is available. Several vaccines are being tested, but none are available for clinical use.

     Severely ill patients require intensive supportive care. Patients are frequently dehydrated and require oral rehydration with solutions containing electrolytes or intravenous fluids.

     No specific treatment is available. New drug therapies are being evaluated.

Prevention and control

     Controlling Reston ebolavirus in domestic animals. No animal vaccine against RESTV is available. Routine cleaning and disinfection of pig or monkey farms (with sodium hypochlorite or other detergents) should be effective in inactivating the virus.

    If an outbreak is suspected, the premises should be quarantined immediately. Culling of infected animals, with close supervision of burial or incineration of carcasses, may be necessary to reduce the risk of animal-to-human transmission. Restricting or banning the movement of animals from infected farms to other areas can reduce the spread of the disease.

    As RESTV outbreaks in pigs and monkeys have preceded human infections, the establishment of an active animal health surveillance system to detect new cases is essential in providing early warning for veterinary and human public health authorities.

Reducing the risk of Ebola infection in people

   In the absence of effective treatment and a human vaccine, raising awareness of the risk factors for Ebola infection and the protective measures individuals can take is the only way to reduce human infection and death.

   In Africa, during EVD outbreaks, educational public health messages for risk reduction should focus on several factors:

. Reducing the risk of wildlife-to-human transmission from contact with infected fruit bats or monkeys/apes and the consumption of their raw meat. Animals should be handled with gloves and other appropriate protective clothing. Animal products (blood and meat) should be thoroughly cooked before consumption.

. Reducing the risk of human-to-human transmission in the community arising from direct or close contact with infected patients, particularly with their bodily fluids. . Close physical contact with Ebola patients should be avoided. Gloves and appropriate personal protective equipment should be worn when taking care of ill patients at home. Regular hand washing is required after visiting patients in hospital, as well as after taking care of patients at home.

. Communities affected by Ebola should inform the population about the nature of the disease and about outbreak containment measures, including burial of the dead. . People who have died from Ebola should be promptly and safely buried.

. Pig farms in Africa can play a role in the amplification of infection because of the presence of fruit bats on these farms. Appropriate biosecurity measures should be in place to limit transmission. For RESTV, educational public health messages should focus on reducing the risk of pig-to-human transmission as a result of unsafe animal husbandry and slaughtering practices, and unsafe consumption of fresh blood, raw milk or animal tissue.

. Gloves and other appropriate protective clothing should be worn when handling sick animals or their tissues and when slaughtering animals. In regions where RESTV has been reported in pigs, all animal products (blood, meat and milk) should be thoroughly cooked before eating.

Controlling infection in health-care settings

    Human-to-human transmission of the Ebola virus is primarily associated with direct or indirect contact with blood and body fluids. Transmission to health-care workers has been reported when appropriate infection control measures have not been observed.

   It is not always possible to identify patients with EBV early because initial symptoms may be non-specific. For this reason, it is important that health-care workers apply standard precautions consistently with all patients – regardless of their diagnosis – in all work practices at all times. These include basic hand hygiene, respiratory hygiene, the use of personal protective equipment (according to the risk of splashes or other contact with infected materials), safe injection practices and safe burial practices.

   Health-care workers caring for patients with suspected or confirmed Ebola virus should apply, in addition to standard precautions, other infection control measures to avoid any exposure to the patient’s blood and body fluids and direct unprotected contact with the possibly contaminated environment. When in close contact (within one metre) of patients with EBV, health-care workers should wear face protection (a face shield or a medical mask and goggles), a clean, non-sterile long-sleeved gown, and gloves (sterile gloves for some procedures).

   Laboratory workers are also at risk. Samples taken from suspected human and animal Ebola cases for diagnosis should be handled by trained staff and processed in suitably equipped laboratories.

 Passengers screened for virus

   According to Yakubu Dati, the spokesman for Federal Aviation Authority of Nigeria, international airports in Nigeria are screening passengers arriving from foreign countries for symptoms of Ebola. Health officials are also working with ports and land borders, he said. “They are giving out information in terms of enlightenment, what to do, what to look out for.”

    Nigerian airports are setting up holding rooms to ready in case another potential Ebola victim arrives in Nigeria.

     Airports in Guinea, Liberia and Sierra Leone, the three other West African countries affected by the current Ebola outbreak, have implemented some preventive measures, according to officials in those countries. But none of the safeguards are foolproof, say health experts.

Variable incubation period

   Doctors say health screens could be effective, but Ebola has a variable incubation period of between two and 21 days and cannot be diagnosed on the spot.

   A consultant for the Liberian Ministry of Finance, Patrick Sawyer, arrived in Nigeria on Tuesday and was immediately detained by health authorities suspecting he might have Ebola, Plyler said.

   On his way to Lagos, Sawyer’s plane also stopped in Lome, Togo, according to the WHO.

   Authorities announced on Friday that blood tests from the LUTH confirmed Sawyer died of Ebola earlier that day.

    Sawyer reportedly did not show Ebola symptoms when he boarded the plane, Plyler said, but by the time he arrived in Nigeria he was vomiting and had diarrhea. There has not been another recently recorded case of Ebola spreading through air travel, he added.

    Nearly 50 other passengers on the flight are being monitored for signs of Ebola but are not being kept in isolation, said an employee at Nigeria’s Ministry of Health, who insisted on anonymity because he was not authorised to speak to the press.

    Sawyer’s sister also died of Ebola in Liberia, according to Liberian officials, but he claimed to have had no contact with her. Ebola is highly contagious and kills more than 70 per cent of people infected.

Traditional burials spread disease

   Ebola is passed by touching bodily fluids of patients even after they die, he said. Traditional burials that include rubbing the bodies of the dead contribute to the spread of the disease, Krishnan added.

    There is no “magic bullet” cure for Ebola, but early detection and treatment of fluids and nutrition can be effective, said Plyler in Liberia. Quickly isolating patients who show symptoms is also crucial in slowing the spread of the disease.

    West African hospital systems have weak and “often paralyzed” health care systems, he added, and are not usually equipped to handle Ebola outbreaks. International aid organizations like his and Doctors Without Borders have stepped in, but they also lack enough funding and manpower. “We need more humanitarian workers,” he said. “We need resources.”

     WHO Regional Director for Africa, Dr Luis Gomes Sambo, said: “The Centre will allow monitoring in real-time of the activities to fight the epidemic...

    “The Centre will allow monitoring in real-time of the activities to fight the epidemic, in collaboration with the national committees and the teams deployed on the ground.”

    Director for Disease Prevention and Control for the WHO African Region, Dr Francis Kasolo, said: “The Centre will act as a platform to consolidate and harmonize the technical support being provided to West African countries affected by the outbreak. It will also help to mobilize resources for the response.

   “Alongside national health authorities and WHO, other partner agencies involved in the Ebola response, such as Médecins Sans Frontières (MSF), the Red Cross, the US Centers for Disease Control and Prevention (CDC) and technical partners in the Global Outbreak Alert and Response Network (GOARN), will also work from the Centre.”

    The establishment of the Centre was requested by health ministers from 11 African countries at an emergency meeting convened by WHO in Accra, Ghana, 2-3 July.

    The Accra meeting identified critical challenges and gaps in the response: coordination, communications, cross-border collaboration, treatment of patients, contact tracing and community participation, human resources and financial support.

   The Sub-regional Centre will be responsible for ensuring effective use and deployment of limited, but highly critical resources based on prioritization and agreed objectives. The organization and coordination of key support functions and field operations will move closer to outbreak areas, or ‘hot spots’.

    In addition, the Sub-regional Centre will:

. ensure sufficient technical and operational support and resources to sustain response activities in the field, facilitate the coordination of GOARN partners and networks, prepare public communications materials and activities, engage in contingency planning, risk assessments, and scaling of operations as required, and secure an environment that enables effective and successful field operations;

. define operational periods to achieve agreed objectives and ensure the planning, coordination, and optimum use of limited resources, as well as continuity of action and management;

. direct human and material resources for: communications and social mobilization, investigation of alerts and new outbreaks, case finding and contact tracing, surveillance and data management, patient treatment and care, logistics, stockpiling, and movement of personal protective equipment to key locations; and

. provide technical guidance and resources, communications support, decision-making, and reporting for all field teams in the sub-region.


   Ebola is introduced into the human population through close contact with the blood, secretions, organs or other bodily fluids of infected animals. In Africa, infection has been documented through the handling of infected chimpanzees, gorillas, fruit bats, monkeys, forest antelope and porcupines found ill or dead or in the rainforest.

   Ebola then spreads in the community through human-to-human transmission, with infection resulting from direct contact (through broken skin or mucous membranes) with the blood, secretions, organs or other bodily fluids of infected people, and indirect contact with environments contaminated with such fluids. Burial ceremonies in which mourners have direct contact with the body of the deceased person can also play a role in the transmission of Ebola. Men who have recovered from the disease can still transmit the virus through their semen for up to seven weeks after recovery from illness.

    Health-care workers have frequently been infected while treating patients with suspected or confirmed EVD. This has occurred through close contact with patients when infection control precautions are not strictly practiced.

    Among workers in contact with monkeys or pigs infected with Reston ebolavirus, several infections have been documented in people who were clinically asymptomatic. Thus, RESTV appears less capable of causing disease in humans than other Ebola species.

     However, the only available evidence available comes from healthy adult males. It would be premature to extrapolate the health effects of the virus to all population groups, such as immuno-compromised persons, persons with underlying medical conditions, pregnant women and children. More studies of RESTV are needed before definitive conclusions can be drawn about the pathogenicity and virulence of this virus in humans.


   Other diseases that should be ruled out before a diagnosis of EVD can be made include: malaria, typhoid fever, shigellosis, cholera, leptospirosis, plague, rickettsiosis, relapsing fever, meningitis, hepatitis and other viral haemorrhagic fevers.

     Ebola virus infections can be diagnosed definitively in a laboratory through several types of tests:

. Antibody-capture enzyme-linked immunosorbent assay (ELISA);

. antigen detection tests;

. serum neutralization test;

. reverse transcriptase polymerase chain reaction (RT-PCR) assay;

. electron microscopy;

. virus isolation by cell culture.

    Samples from patients are an extreme biohazard risk; testing should be conducted under maximum biological containment conditions.

Natural host of Ebola virus

   In Africa, fruit bats, particularly species of the genera Hypsignathus monstrosus, Epomops franqueti and Myonycteris torquata, are considered possible natural hosts for Ebola virus. As a result, the geographic distribution of Ebolaviruses may overlap with the range of the fruit bats.

Ebola virus in animals

    Although non-human primates have been a source of infection for humans, they are not thought to be the reservoir but rather an accidental host like human beings. Since 1994, Ebola outbreaks from the EBOV and TAFV species have been observed in chimpanzees and gorillas.

    RESTV has caused severe EVD outbreaks in macaque monkeys (Macaca fascicularis) farmed in Philippines and detected in monkeys imported into the USA in 1989, 1990 and 1996, and in monkeys imported to Italy from Philippines in 1992.

   Since 2008, RESTV viruses have been detected during several outbreaks of a deadly disease in pigs in People’s Republic of China and Philippines. Asymptomatic infection in pigs has been reported and experimental inoculations have shown that RESTV cannot cause disease in pigs.

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