Feds unveil Ebola screening steps; Texas patient dies

With the death today of a patient hospitalized in Texas from Ebola serving as a reminder about how serious the disease can be, federal officials announced new steps to screen the roughly 150 people who come into the United States each day from West Africa's three hardest-hit outbreak countries.

At a media briefing today, Centers for Disease Control and Prevention (CDC) Director Tom Frieden, MD, MPH, said the stepped-up measures will be instituted at five of the nation's major airports, which handle about 95% of the people coming into the country from Guinea, Liberia, and Sierra Leone.

Also today, the World Health Organization (WHO) said official Ebola cases in West Africa topped 8,000, but it warned that the total doesn't reflect the dire conditions responders in the region are seeing.

Five airports to do enhanced screening

The new procedures will be rolled out on Saturday at JFK International Airport outside of New York City and will take effect at four more international airports next week: Newark, Washington-Dulles, Chicago-O'Hare, and Atlanta.

Frieden called the move a layered approach designed to enhance protection for the American public and for the travelers from the three outbreak nations.

Customs and Border Patrol (CBP) staff at the five airports will escort travelers from the countries to a screening area, ask them detailed questions to identify if they had contact with Ebola, assess if they have fevers with a reliable no-touch thermometer, and get contact information about how officials can reach them, if needed, while they are in the United States.

Travelers who have had possible Ebola exposure or have a fever will be evaluated by an officer at the airports' CDC quarantine station and referred to appropriate health authorities, as needed.

The steps announced today won't disrupt the travel of large numbers of people and will take only a small number of federal staff to make sure quarantine stations at the five airports are staffed around the clock.

Frieden warned that although the steps should afford some extra protection, federal officials can't reduce the risk of more Ebola cases being detected in the United States to zero until the disease is stamped out in West Africa. He added that the enhanced measures are likely to identify people with fevers who don't have Ebola, because fever is also a symptom of malaria, an extremely common disease in Africa.

Alejandro Mayorkas, deputy secretary of the Department of Homeland Security (DHS), said systems at the airport can identify passengers' full journey, even if the last leg of their flight wasn't from one of the outbreak countries. He said the DHS, other federal agencies, and the Obama administration will continually assess the situation to see if other travel-related measures are necessary.

Texas patient dies from Ebola

A few hours before federal officials announced the enhanced airports screening, Texas Health Presbyterian Hospital in Dallas said the Liberian man hospitalized with Ebola died from his infection at 7:51 this morning local time, according to a statement from the hospital's parent company.

"He fought courageously in this battle," Texas Health Resources said, extending its condolences to the man's family, as well as to the medical team who treated him.

As of yesterday, the man, Thomas Eric Duncan, was listed in critical condition, on a ventilator, and receiving kidney dialysis. The hospital had said his liver function declined over the weekend but had then improved. According to earlier reports, he had been receiving the investigational antiviral drug brincidofovir.

David Lakey, MD, commissioner of the Texas Department of State Health Services (TDSHS), said today in a statement, "The past week has been an enormous test of our health system, but for one family it has been far more personal. Today they lost a dear member of their family."

He said the hospital staff provided excellent and compassionate care, "but Ebola is a disease that attacks the body in many ways. We'll continue every effort to contain the spread of the virus and protect people from this threat."

In a separate statement today, Lakey said state health officials realize it's a difficult time for the family and said they will continue to treat Duncan's body with respect, while ensuring that there is no added threat to the public. He said the CDC has guidelines for handing the bodies of people who die from Ebola, which includes double bagging them and disinfecting the bag before transport.

The body will be cremated, and Lakey said he explained to the family about why state health officials recommend cremation, and they have agreed. He said the process kills any remaining virus and allows the family to receive the remains without needing protective gear.

Texas hospital evaluates man for possible Ebola symptoms

In other Texas Ebola developments today, Texas Health Presbyterian Hospital in Dallas said a patient has been admitted to its emergency department after reporting possible exposure to the Ebola virus. "Right now there are more questions than answers about this case," the hospital said in a statement.

Frieden, during today's media briefing, said he had been informed about the new development and the patient had no definite contact with Duncan and no definitive Ebola symptoms.

According to a Dallas Morning News report, the patient undergoing evaluation at the hospital isn't one of the 48 contacts of Duncan's who are being monitored. The man is a Dallas County sheriff's deputy who went to an urgent care clinic in the suburb of Frisco reporting Ebola-like symptoms.

According to media reports, the man was part of a group that had entered Duncan's apartment without wearing protective gear. WFAA, the ABC television affiliate in Dallas, said the officer was part of a group that went to the apartment to serve quarantine papers, which was before the facility was decontaminated. Health experts have said the risk of Ebola transmission is limited to direct contact with a sick patient's body fluids.

Spanish nurse's initial concerns went unheard

In Spain, a nursing assistant who contracted Ebola after caring for an infected priest (who later died) said she told health authorities about her fever at least three times before she was hospitalized and isolated, according to a report today in the British newspaper The Guardian.

The woman, Teresa Romero Ramos, is the first person in the current epidemic who has contracted Ebola outside West Africa. She initially reported a fever to an occupational health service at the Carlos III Hospital, where she works, on Sep 30, according to The Guardian, which based its story on Spanish newspaper reports. Because her fever was mild, she was advised to visit her local clinic.

A few days later she called the hospital again, but no action was taken. Then on Oct 6 she told the hospital she was feeling "terrible." Rather than send her to the hospital in which Spain's two previous Ebola case-patients had been treated, officials told her to seek treatment at the hospital nearest her home, the newspaper reported. There, doctors didn't immediately isolate her despite her expressed fear of having Ebola virus disease.

A doctor attending to Romero Ramos said she might have contracted the virus when she was taking off her protective equipment, the story said. But in an interview with El Mundo, she said she had followed protocols while caring for the priest and had no idea how she became infected.

Another nursing assistant on the team that cared for the two Spanish missionaries who were evacuated to Spain after contracting Ebola in West Africa was admitted to Carlos III Hospital last night for monitoring, according to the newspaper El Pais. A translation of the story was provided by the H5N1 blog. The story said she had a very slight fever and that she is a friend of Romero Ramos.

West Africa cases top 8,000

The World Health Organization (WHO) said today that the Ebola situation in Guinea, Liberia, and Sierra Leone continues to deteriorate, and it said the continuing surge of new cases in Liberia has overwhelmed responders, who are having problems gathering epidemiologic data there.

In releasing its new case numbers today, it warned that the charts and patterns don't reflect the dire conditions responders are seeing in the field.

As of Oct 5, the region reported 8,033 suspected or confirmed infections, along with 3,879 deaths. Since the WHO's last update on Oct 3, the countries have reported 563 more infections and 448 more fatalities. Global health groups have said the official numbers dramatically underestimate the true burden of the disease in West Africa.

The WHO said there is no evidence that the region's epidemic is being brought under control, though responders are evaluating possible declines in disease incidence in Liberia's Lofa district and Sierra Leone's Kailahun and Kenema districts.

The agency called the data-gathering problems in Liberia "profound" and said responders and lab staff have said there is widespread under-reporting and that the situation in Liberia, especially in the capital Monrovia, is deteriorating from week to week.

Vaccine developments

  • NewLink Genetics, the small Iowa company that holds the license for a Canadian candidate Ebola vaccine, said at least five clinical trials of the vaccine will soon be under way in the United States, Germany, Switzerland, and an unnamed African country not now battling Ebola, according to a Canadian Press story today. Canada had offered part of its supply of the vaccine to the WHO for use in the outbreak and said the rest would be used for trials. But it now appears that all the doses will be made available for the trials. It was initially thought that some of the donated vaccine might be used to protect healthcare workers involved in the Ebola response, but the current thinking is that this and other Ebola vaccines need to be tested for both safety and immunogenicity before they can be used in the field, the story said.
  • The question whether to use a placebo group in trials of the NewLink vaccine and a candidate Ebola vaccine developed by GSK is sparking "furious debate" among infectious disease experts, Bloomberg News reported yesterday. It said plans call for trials of the vaccines in West African medical workers starting in January, if safety data expected next month are satisfactory. If all the workers get the vaccines, it may not be clear how well they work, since the outcomes could be affected by other factors that might not be detected without a placebo group. But giving some medical workers a placebo means they would continue to run the risk of Ebola infection with no additional protection. A consortium involving WHO officials, GSK, and others will make the call whether to use placebo groups, the story said.

Illness and symptom observation reports

  • A US health worker who was admitted to the National Institutes of Health (NIH) Clinical Center on Sep 28 for observation after he was exposed to the Ebola virus while working in Sierra Leone has been discharged to his home, the NIH said today in a statement. His exposure was a needlestick injury, which is considered high risk. When he was first hospitalized he had a brief fever that was determined not to be related to an Ebola infection. He was monitored in isolation because of his high-risk exposure and the fever. The patient will remain in his home for the rest of the 21-day fever-monitoring period. In its Sep 28 statement, the NIH had said the patient is a doctor who had been volunteering in an Ebola treatment unit and that he would also enroll in a clinical protocol during his stay at the NIH Clinical Center.
  • The United Nations (UN) mission in Liberia (UNMIL) today announced that a second employee has been infected with Ebola, Agence France-Presse (AFP) reported today. Karin Landgren, who heads UNMIL, said in a statement that an international staff member working in its medical department tested positive for the virus after reporting symptoms of the disease. Last week Landgren said one of UNMIL's Liberian employees died of a probable Ebola infection.
  • A freelance photojournalist hospitalized in Nebraska after he was infected with Ebola in Liberia will receive convalescent serum today from survivor Kent Brantly, MD, a missionary physician who recently recovered from Ebola after he was infected in Liberia, according to a statement today from Nebraska Medical Center (NMC). Brantly had also donated convalescent serum to Rick Sacra, MD, another infected missionary doctor who was the first patient hospitalized for Ebola at NMC. The hospital said in a statement yesterday that its latest patient, Ashoka Mukpo, is also being treated with the experimental antiviral drug brincidofovir.

News editor Robert Roos contributed to this report.

See also:

Oct 8 Texas Health Resources statement on patient's death

Oct 8 TDSHS statement on the death

Oct 8 TDSHS statement on federal Ebola death guidance

Oct 8 Texas Health Resources statement on possible Ebola exposure case

Oct 8 Dallas Morning News story

Oct 8 WFAA story

Oct 8 Guardian story

Oct 7 H5N1 blog post with translated story

Oct 8 WHO Ebola roadmap situation update

Oct 8 Canadian Press story

Oct 7 Bloomberg News story

Oct 7 NIH statement

Oct 8 AFP story

Oct 8 NMC statement

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