Mali reports its first Ebola case

Mali's health minister announced on state television today the detection of the country's first Ebola infection, signaling the spread of the virus to a third African nation outside the three main outbreak countries.

Health Minister Ousmane Kone said the patient is a 2-year-old girl who had recently arrived from neighboring Guinea, according to a Reuters report. The illness was detected in the Kayes region in western Mali.

The Kayes region borders Mauritania to the north, Senegal to the west, and Guinea to the south.

A machine-translated report from the Mali media on the H5N1 blog yesterday said Mali had a suspected Ebola case, in a 3-year-old girl whose aunt brought her from Guinea after the girl's father died in Conakry, Guinea's capital. The two passed through Bamako, Mali's capital, on their way to the Kayes region, where the girl and her contacts were admitted to a hospital for quarantine and testing. The report didn't say how the two traveled from Guinea to Mali.

Possible Ebola case in health worker in NYC

In another breaking development, New York City health officials today announced that a special emergency medicine service (EMS) unit has transferred a healthcare worker who recently returned from West Africa's outbreak region to Bellevue Hospital for a possible Ebola infection.

A law enforcement official told CNN that the worker is Craig Spencer, a 33-year-old physician who returned from West Africa 10 days ago. He works at Columbia Presbyterian Hospital, and his girlfriend has been isolated, CNN said.

New York City's health department (NYC Health) said today in a statement that the patient had returned to the United States within the past 21 days and presented with fever and gastrointestinal symptoms. The patient will be tested for Ebola, with results expected within the next 12 hours. It added that the patient will be evaluated for other conditions that have similar symptoms.

In a related development, Doctors without Borders (MSF) announced today that a New York City resident who recently worked with the group in one of the outbreak countries reporting having a fever this morning, based on the group's guidelines for workers who have returned from their Ebola assignments.

The group said that although Ebola has not been confirmed, it immediately notified New York City health officials, who are managing the patient's care.

Bellevue Hospital is one of the facilities designated by city and state health officials for the isolation, identification, and treatment of suspected Ebola cases. The ambulance crew was specially trained and wearing personal protective equipment (PPE).

As a precaution, epidemiologists from NYC Health started tracing the patient's contacts to identify those who might be at increased risk.

WHO committee weighs in on travel, mass gatherings

The World Health Organization (WHO) emergency committee on Ebola met for the third time yesterday and said the events still amount to a public health emergency of international concern and weighed in on recent travel screening announcements from different countries.

Since the group's last meeting on Sep 22, Ebola cases in Guinea, Liberia, and Sierra Leone have continued to rise rapidly, with cases exported to Spain and the United States resulting in limited transmission. As of yesterday, the epidemic total was at 9,936 cases and 4,877 deaths, the WHO said. The true burden of the disease in the three countries is thought to be dramatically higher than official totals.

In reviewing the outbreak's current status, the WHO said the continued rise in cases is still deeply concerning and that the crisis is yielding important lessons about controlling the epidemic, such as the importance of leadership, community engagement, bringing in more partners, paying staff on time, and accountability.

The panel recommended that the WHO keep all of the temporary recommendations in place, but it emphasized the importance of exist screening in the three hardest-hit countries and said the WHO and its partners should provide more support to strengthen the procedures.

They asked the countries to collect data from exit screening, monitor the results, and share them regularly with the WHO to increase public confidence and to provide key information to other countries.

Repeating its advice against travel restrictions, the committee said a general travel ban is likely to trigger economic hardships, which could increase uncontrolled migration from the outbreak countries, increasing the risk of international spread.

Countries that have introduced entry-screening measures should share their experiences and lessons learned, the committee said. However, it said the extra measures have a limited ability to reduce international spread of the virus when added to exit screening, and countries should carefully weigh the benefits and costs. Though the process can increase awareness about Ebola, the resources needed for screening can be significant, even when targeted.

Several countries have canceled or are considering canceling international meetings and mass gatherings, and though the committee doesn't recommend calling off events, it acknowledged that the decisions are complex and must be made on a case-by-case basis. Likewise, the WHO committee said it doesn't support bans on sports competitors or delegations from outbreak countries, saying participation decisions must be made case by case.

The committee will meet again in 3 months, or earlier as events warrant, the WHO said.

More US Ebola updates

The family of the second Dallas nurse infected with Ebola said yesterday that Amber Joy Vinson no longer has the virus in her blood, NBC News reported today. They said she will be transferred to a different part of Emory University Hospital's serious communicable disease unit.

Before being released from the hospital, tests over several consecutive days must show that the patient's blood shows no sign of the virus. Vinson's illness was diagnosed on Oct 15, a day after she reported a low-grade fever. She had returned from a trip to Ohio just a few hours before her fever developed, which triggered air-passenger tracing.

Health officials said Vinson—one of two nurses who got sick after caring for a Liberian man who died from Ebola—may have had atypical symptoms earlier, which spurred the quarantine of three of her close contacts in the Akron area. According to an update today from the Ohio Department of Health (ODH), health officials are monitoring a total of 163 contacts.

All Ohio hospitals have completed Ebola preparedness drills, which included how to manage suspected patients and proper use of PPE. It said so far there are no Ebola cases in Ohio and none of the contacts have shown any Ebola symptoms.

In Dallas, city officials said tests for Ebola on a dog owned by Nina Pham, the first nurse infected with the virus, are negative. The Cavalier King Charles spaniel named Bentley has been quarantined, and specimens will be collected again at the end of 21days.

Of 176 Ebola contacts identified in the Dallas area, 67 have completed their 21-day surveillance period, and monitoring is still under way for 109, according to an update today from the US Centers for Disease Control and Prevention (CDC). Only one of the people under monitoring is considered a close contact; the rest are possible contacts.

Vaccine announcements

The European Medicines Agency (EMA) said yesterday that it is ready to start reviewing Ebola vaccines and treatments as soon as data are available. In a statement, the group said it has assembled a system to give the best possible scientific advice to companies developing countermeasures against the virus.

The group also said it has developed a rolling review process that allows experts to continuously review new data as it comes in.

Tomas Salmonson, who chairs the EMA's Committee for Medicinal Products for Human Use (CHMP), said in the statement that companies are expected to show that the vaccines and drugs work and have acceptable safety and quality, to ensure that the benefits outweigh the risks. "However, in the current emergency situation we accept that the benefit-risk balance is determined largely by the public health need," he added.

In other developments, a European collaboration is expected this week to announce $250 million to develop vaccines and drugs to battle Ebola, according to a report yesterday from Reuters that cited two people with direct knowledge.

The funding would come from the Innovative Medicines Initiative (IMI), a public-private program funded by pharmaceutical companies and the European Commission, Reuters reported. The sources said the group will put the bulk of the funding toward large clinical trials of three experimental Ebola vaccines.

Meanwhile, Vaxart, a pharmaceutical company based in South San Francisco, Calif., said today that it is accelerating the development of its Ebola tablet vaccine, with human trials expected to start in the first quarter of 2015.

The vaccine showed promise in preclinical challenge studies in nonhuman primates conducted at the US Army Medical Research Institute of Infectious Diseases (USAMRIID). Vaxart's vaccine contains a disabled adenovirus that delivers an Ebola virus gene and a gene for a molecule that serves as an adjuvant.

The company said the tablet vaccine can be held at room temperature for more than a year, reducing or eliminating the need for cold storage, an advantage for settings like West Africa that have limited infrastructure.

Other developments

  • Guinea's government said yesterday that it will compensate families of health workers who died from Ebola with $10,000 each, Agence France-Presse (AFP) reported yesterday. A ministry official said 42 families so far are eligible for the payments. The total includes the families of eight members of an Ebola education team who were killed in an attack by residents in the town of Womey in the southern part of the country.

  • Some US hospitals are considering whether certain medical interventions should be withheld from Ebola patients, because they may pose a high risk to health providers with little benefit to patients, Reuters reported today. Officials from three health systems told Reuters that they were weighing the treatment issues. Federal health officials have said interventions available in hospitals in developed nations, such as intubation and kidney dialysis, may pose additional risks of Ebola virus transmission to healthcare workers, and concerns recently prompted tighter PPE recommendations, which now allow for no exposed skin and the addition of coveralls and single-use disposable hoods. Medical ethicists said they are fielding questions from doctors and hospitals about the benefits and risks of more advanced treatments for Ebola patients. Also, Reuters said groups including the CDC are working on guidelines for delivering dialysis to Ebola patients.

  • France's Atomic Energy Commission has developed a test that could allow doctors to diagnose a patient with Ebola in 15 minutes, compared with almost 3 hours presently, Radio France Internationale (RFI) reported yesterday. The test is expected to be available for clinical trials in Ebola outbreak countries by the end of October. It uses monoclonal antibodies to detect the virus in a small sample of blood, plasma, or urine. Results show up in the window of a handheld device, similar to an over-the-counter pregnancy test. RFI said two other companies are also working on rapid diagnostic tests for Ebola: Primerdesign, based in Britain, and Corgenix Medical Corp. in the United States.

See also:

Oct 23 Reuters story

Oct 22 H5N1 blog post

Oct 23 CNN story

Oct 23 NYC Health statement

Oct 23 MSF statement

Oct 23 WHO statement

Oct 22 EMA statement

Oct 22 Reuters story on European funding pledge

Oct 23 Vaxart press release

Oct 23 NBC News story

Oct 23 ODH contact report

Oct 23 ODH statement on hospital drills

Oct 22 City of Dallas press release

Oct 23 CDC Dallas contact monitoring update

Oct 22 AFP story

Oct 23 Reuters story

Oct 22 RFI report

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