Quarantine escapee sparked more Ebola in Nigeria


A contact of Nigeria's first Ebola patient fled quarantine in August and passed the disease to a doctor, who subsequently infected at least two other people, offering a textbook example of how not to deal with the disease, the World Health Organization (WHO) reported today.

The episode extended Ebola's reach in Nigeria from Lagos, the capital, to Port Harcourt, the country's oil hub on the southeastern coast. Because of the number of people exposed to the doctor, the outbreak in Port Harcourt could grow bigger than the original outbreak in Lagos, the WHO said.

Meanwhile, a trio of United Nations (UN) and WHO officials today again stressed the urgent need to expand the international response to West Africa's Ebola epidemic, but insisted that the governments of the affected countries must remain in charge of efforts within their borders. The officials estimated that the international effort will cost at least $600 million.

Port Harcourt cases

A sick airline passenger, Patrick Sawyer, spread Ebola virus to Nigeria when he flew from Liberia to Lagos on Jul 20; he died on Jul 25. One of Sawyer's close contacts in Lagos fled the city, where he was under quarantine, to seek treatment in Port Harcourt, the WHO said in today's statement.

The contact was treated from Aug 1 to 3 by a male physician at a Port Harcourt hotel. The physician fell ill on Aug 11, but for 2 days afterward he continued treating patients at his private clinic, operating on at least two of them, the WHO said.

On Aug 13 his symptoms worsened, and he then stayed home until he was hospitalized on Aug 16, the WHO said. He died on Aug 22, and his Ebola virus disease (EVD) was confirmed on Aug 27 by a lab at Lagos University Teaching Hospital.

After he got sick, the doctor had numerous contacts with others, both before and after his hospitalization, the WHO said. In the hospital, members of his church visited him and performed a healing ritual said to involve the laying on of hands, and he was attended by most of the hospital staff.

The two people who caught the virus from the physician are his wife, also a doctor, and another patient at the hospital where he was treated, according to the WHO, which did not describe their conditions. Other hospital staff members are being tested.

"Given these multiple high-risk exposure opportunities, the outbreak of Ebola virus disease in Port Harcourt has the potential to grow larger and spread faster than the one in Lagos," the agency said.

It said Nigerian health workers and WHO epidemiologists are monitoring more than 200 contacts, including about 60 believed to have had high-risk or very high-risk exposures.

The Port Harcourt cases apparently raise Nigeria's Ebola count to at least 20 cases and 7 deaths. The latest WHO general update on Ebola in West Africa, on Aug 28, put Nigeria's tally at 17 cases and 6 deaths.

Nigeria responds

The WHO said the Nigerian government has taken a number of emergency steps in response to the new cases, with support from the WHO, the UN Children's Fund, and Medecins Sans Frontieres (MSF).

The government has activated an Ebola emergency operations center, set up a 26-bed isolation facility, and put 21 teams to work on contact tracing. The emergency center is supported by the US Centers for Disease Control and Prevention (CDC).

In addition, the WHO and local officials are assessing public measures at airport gates and other ports of entry in Port Harcourt.

But the agency warned that security problems and public fear of Ebola "create serious problems that could hamper response operations," with military escorts needed when moving patients into the Ebola treatment center.

WHO, UN officials underline urgency

At a press briefing in Washington, DC, today, WHO and UN officials again stressed the need to accelerate the response to West Africa's Ebola crisis.

"We're not in a position where we can afford to lose a day, because the outbreak is currently moving ahead of efforts to control it," said David Nabarro, MD, senior UN system coordinator for Ebola disease.

Nabarro, who just returned from a needs assessment trip to West Africa with the WHO's Keiji Fukuda, MD, said, "We need on the order of three to four times what is currently in place" in the way of resources to battle the epidemic.

He estimated that it will cost "at least $600 million and maybe a lot more to get the necessary support to the countries to get this under control."

Today's briefing followed a meeting in New York yesterday at which UN and other officials addressed UN member states to emphasize the seriousness of the Ebola situation in West Africa and urged them to send aid to the region.

Fukuda, the WHO's assistant director-general for health security and environment, said he and Nabarro met with a wide range of officials and people at all levels during their visit to Monrovia, Liberia, and Freetown, Sierra Leone.

The main message they heard was about the lack of capacity to respond to the epidemic, including the lack of treatment centers, vehicles, protective equipment, and funds, he said.

"But of all things that are low in capacity, the most important is that we don't have enough people on the ground," including nurses, doctors, drivers, contact investigators, Fukuda said.

Aside from Nabarro's cost estimate, he, Fukuda, and WHO Director-General Margaret Chan, MD, MPH, declined to estimate just how many health workers or other types of resources are needed. They noted previously announced goals of reversing the trend in cases within 3 months and stopping transmission in 6 to 9 months.

They also stressed the obstacles caused by the Ebola-inspired cancellations of airline flights to Liberia, Sierra Leone, and Guinea. Chan said she has talked with experts from around the world who are willing to go to the region to provide infection control and clinical care, but because of flight cancellations, "We are unable to deploy them."

Reporters asked the three officials why, given the magnitude or the problem, they weren't calling for more of a military-style, "command and control" response, like the "massive mobilization" coordinated by the US Navy in response to the 2004 tsunami in Aceh, Indonesia.

Nabarro replied that he believes it is possible to cope with the situation "with the institutions and resources we have," but added that scaling up the response sufficiently and fast enough is very difficult. "Over the next few days we are changing the way the WHO and UN works on this issue, and talking to governments to get them fully invested," he said. "We are talking to all other groups that could provide support."

He commented further, "The governments of the affected countries are in charge; our role is to help them do the job they need to do." He added that the UN aims to do all it can to ensure that responders are protected from infection.

Chan echoed the point about national sovereignty saying, "I don't think any government in this world will accept a takeover by others. So whatever we are doing, we are supporting national authorities to take the leadership."

UK patient released

In other developments, Royal Free Hospital in London today announced the release of William Pooley, a British nurse who contracted EVD in Sierra Leone and was treated at the hospital for 10 days. His treatment included the experimental drug ZMapp, which has been given to several other patients, including two Americans.

In addition, Nancy Writebol, an American missionary and medical worker who was flown back to the United States after contracting EVD in Liberia, talked about her illness and recovery at a press conference today. She was hospitalized at Emory University in Atlanta and was released Aug 19.

Writebol, who worked for the SIM (Service in Mission), said she initially thought she had malaria and was tested and treated for that disease. She said there were many times when she thought she wouldn't survive.

She said she didn't know if the ZMapp she received was what cured her, but suggested it was more the overall combination of treatment, prayers, and support from others that saw her through the illness.

Meanwhile, Bruce Johnson, president of SIM, identified the SIM worker who was recently infected with Ebola in Liberia as Rick Sacra, MD, a Boston doctor, according to a WSOC-TV news report on Writebol's press conference. Johnson said Sacra is in good spirits and communicating with his family by phone and the Internet, the story said.

Also today, the WHO released a list of 197 experts and officials who will take part in a WHO meeting in Geneva the next 2 days to discuss how experimental treatments and vaccines should be used in the Ebola epidemic.

In addition, the biopharmaceutical company Chimerix announced today that its investigational antiviral drug brincidofovir has shown in vitro activity against Ebola virus. The findings came in testing by the CDC and the US National Institutes of Health, the company said in a press release.

Chimerix said phase 3 trials of brincidofovir as a treatment for cytomegalovirus and adenovirus are currently under way. The company noted it will have representatives at the WHO meeting on Ebola treatments this week.

See also:

Sep 3 WHO statement on situation in Nigeria

Audio recording of Sep 3 UN press briefing

Sep 3 press release on release of William Pooley from Royal Free Hospital, London

Sep 3 WSOC-TV story on Nancy Writebol comments (with video link)

WHO's list of participants in Sep 4-5 meeting on Ebola interventions

Sep 3 Chimerix press release

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