Ebola developments trigger CDC's highest response level

Editor's note: This story was revised on Aug 7, 2014, to correct the total number of Ebola cases and deaths reported by the WHO.

With the Ebola virus disease (EVD) situation in Nigeria worsening, the US Centers for Disease Control and Prevention (CDC) said today that it has moved its emergency operations center (EOC) to its highest activation level, an action it last took during the 2009 H1N1 influenza pandemic.

Meanwhile, countries including the United States and Saudi Arabia are following up on possible infections in travelers, with Spain announcing that it will bring a sick missionary priest in Liberia to Madrid for treatment, according to media reports.

Amid the other developments, the numbers of infections in West African countries hit by the outbreak grew steadily between Aug 2 and 4, with 108 new cases, along with 45 deaths, the World Health Organization (WHO) said today. The overall totals reached 1,711 cases and 932 deaths.

In addition, a WHO emergency committee today began discussing whether the unfolding disease threat amounts to an international public helath emergency.

CDC invokes top EOC level

The CDC EOC has moved to level 1 activation, reserved for the largest-scale responses that require substantial agency-wide efforts, CDC spokesman Tom Skinner told CIDRAP News.

"Our movement to level 1 activation is appropriate, given the significance of this outbreak, the extension to Nigeria, and the potential to affect many lives," he said.

The CDC uses the EOC to monitor and coordinate its response to public health threats that occur in the United States and other countries. Its EOC coordinates CDC staff deployment and manages equipment and supply needs of responders, and can move medications, samples, and personnel within 2 hours for domestic needs and 6 hours for international missions.

The EOC has responded to more than 50 public health threats since it was established in 2001 in the wake of the terrorist and anthrax attacks. Recent examples include activations at lower levels for the 2011 earthquake and tsunami in Japan and the 2010 earthquake and cholera outbreak in Haiti.

Quickly evolving Nigeria developments

Of the latest cases reported to the WHO, five were in Nigeria, which now has 9 cases and 1 death, with most of the cases related to a Liberian man who started having symptoms during an airline flight and died a few days later on Jul 25 in Lagos, a port that is the country's most populous city. His EVD case was the first detected in Nigeria.

At the end of July when the travel-linked case was detected, US Centers for Disease Control and Prevention (CDC) Director Tom Frieden, MD, called the event a significant development in the outbreak.

The WHO said Nigeria's government is following up on contacts of the index case, and that the country urgently needs clinical support as a treatment center is being established. WHO Director-General Margaret Chan, MD, MPH, said that as a result of her recent meetings in Guinea with officials from the outbreak region, Nigeria is among the four countries in line for intensified response efforts, along with Guinea, Liberia, and Sierra Leone.

Nigeria's health minister today confirmed five new Ebola cases in Lagos, one of which was in a nurse who took care of the country's first patient and has now died from the disease, AllAfrica news reported. Health Minister Onyebuchi Chukwu said all of the Nigerians diagnosed so far with EVD were primary contacts of the first victim. Earlier reports said the man had helped care for his sick sister in Liberia, who was first thought to have malaria but was later found to have EVD. En route to Nigeria, the man's flight took him to Togo and Ghana, which has prompted tracking of airline passengers and workers who may have been exposed to the virus.

In a related development, the CDC yesterday issued a level 2 (yellow) travel alert for Nigeria because opf Ebola activity there. At that level, the CDC recommends that visitors take enhanced precautions, such as avoiding contact with blood and body fluids of people who are sick with the virus.

A day earlier the CDC raised the travel health alerts for Guinea, Liberia, and Sierra Leone to the highest warning (red), which recommends no nonessential travel to the area.

Officials on alert for travel-linked cases

Elsewhere, suspicious illnesses in air travelers prompted a scare yesterday at New York City's John F. Kennedy International Airport, and health officials in Saudi Arabia are waiting on test results on a man who had viral hemorrhagic fever symptoms after traveling to Sierra Leone.

At JFK Airport, authorities held an Etihad Airlines flight that arrived from Abu Dhabi in the United Arab Emirates (UAE) yesterday after a report that a sick passenger was on board, the Wall Street Journal (WSJ) reported yesterday. CDC officials quickly determined that the passenger had a seizure, and no other measures were needed, a CDC spokeswoman told the WSJ. No EVD cases have been detected in the UAE.

The sick traveler was a 2-year-old girl who had vomiting and diarrhea, the New York Daily News reported today. Paramedics transported the child to Jamaica Hospital for observation, and passengers were allowed to leave the plane, which had landed in the late afternoon.

Meanwhile, a man in Saudi Arabia whose suspicious symptoms were reported yesterday by that country's health ministry has died, the Saudi Ministry of Health (MOH) said today. The 40-year-old man got sick after a trip to Sierra Leone, sought care at Jeddah hospital on Aug 4, and was isolated at a tertiary care center.

The MOH said the man died this morning and that the cause of his infection is still under investigation. Officials submitted samples to a reference lab in the United States as recommended by the WHO, and additional samples were sent to an accredited lab in Germany.

A later BBC report, which appears to be based on an Arabic version of an MOH statement, said the man  died of cardiac arrest, but it didn't say if tests concluded whether he had EVD.

The man's body will be prepared for burial at the hospital, observing both Islamic practices and international guidelines for patients with infectious disease such as EVD, the MOH said.

In another recent development, Morocco's health ministry has ruled out EVD in a Liberian traveler—a 44-year-old man--who died at the Casablanca airport on Jul 29, according to a Jul 31 machine-translated statement on the ministry Web site. It said the man died from a heart attack and was tested because he was from one of the EVD outbreak countries.

In an earlier media report, an official with Morocco's interior ministry said the man had an EVD infection.

Spain to fly sick missionary home

Spain's defense ministry said yesterday that a military plane will fly to Liberia to pick up an elderly Spanish missionary who is sick with EVD , Agence France-Presse (AFP) reported. The ministry did not say when the man would return to Spain.

The man is a 75-year-old Catholic priest who has worked at a hospital in Monrovia, Liberia's capital. He works for an aid organization called Juan Ciudad ONGD. Five other missionaries are also quarantined at the hospital, two of whom, a woman from Congo and another from Guinea, have EVD infections.

The announcement follows the recent medical evacuation of two American medical missionaries from Liberia's capital. They are Kent Brantly, MD, and Nancy Writebol, both of whom had been working at an EVD treatment center when they got sick. Both are being treated at Emory University Hospital in Atlanta.

Brantly, who arrived on Aug 2, is improving, and his wife has been able to see him and reports that he is in good spirits, Samaritan's Purse, a Christian relief group based in North Carolina, said yesterday in a statement. It said efforts are underway to evacuate all but the most essential personnel, with timelines and destinations kept private to respect their privacy. The group said none are sick, that its precautions exceed those recommended by the CDC, and that it will continue to monitor their health.

Writebol, who arrived at Emory yesterday, is still very weak but shows slow improvement, Bruce Johnson, president of SIM USA, a Christian aid group that also staffed the Liberian EVD treatment center, said yesterday in a statement. He said she was taken to the plane on a stretcher in Monrovia, but was able to stand up and walk with assistance onto the plane. News footage of her arrival at Emory yesterday showed Writebol being moved on a stretcher.

WHO updates outbreak numbers

The WHO said today that between Aug 2 and Aug 4 it received reports of 108 new EVD infections, along with 45 more deaths, from the four West African countries battling the outbreak.

Liberia reported 48 cases and 27 deaths, boosting its totals to 516 infections and 282 fatalities. The country's case count now surpasses that of Guinea, where the outbreak began in March. However, of all of the affected countries, Guinea still has the most deaths.

Sierra Leone reported 45 new cases and 13 deaths, and with 691 illnesses reported so far, it has the most EVD cases of the four outbreak countries. The latest fatalities nudge Sierra Leone's total to 286.

Guinea health officials reported 10 new cases and 5 deaths, boosting its overall numbers to 495 infections, of which 363 were fatal.

Nigeria reported 5 new cases during the time span, increasing its outbreak tally to 9 infections and one death, which does not include the nurse just reported by the country's health ministry.

The WHO's emergency committee will wrap up its discussions tomorrow, and soon afterward will announce if the developments in West Africa constitute a public health emergency of international concern (PHEIC). Declaring a PHEIC would trigger a set of measures to curb the international spread of the disease. The 13-member group is headed by Sam Zaramba, MD, a surgeon and former director general of health services for Uganda's health ministry. The group also has seven advisers.

Ebola has also gotten the attention of US lawmakers, who tomorrow will explore current international efforts to battle the world's worst EVD outbreak. A subcommittee of the House Committee on Foreign Affairs will hold the hearing at 2 pm, which will be Webcast.

CDC Director Frieden and other US government officials are on one witness panel, and two officials from Samaritan's Purse and SIM USA will testify during a second panel.

See also:

Aug 6 WHO update

Aug 6 AllAfrica story

Aug 5 CDC travel notice for Nigeria

Aug 5 WSJ story

Aug 6 Daily News story

Aug 6 Saudi Arabia MOH statement

Aug 6 BBC story

Jul 31 Morocco health ministry statement

Aug 5 AFP story

Aug 5 Samaritan's Purse statement

Aug 5 SIM statement

WHO Ebola emergency committee list

US House Committee on Foreign Affairs subcommittee hearing information

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