Sierra Leone doctor dies of Ebola at Nebraska hospital

A doctor from Sierra Leone sickened by Ebola in his home country and airlifted to the United States on Nov 15 in critical condition died today at Nebraska Medical Center's high containment unit, the second death from the virus to occur on US soil.

Martin Salia, MD, had advanced symptoms of the disease when he arrived at the hospital, including kidney and respiratory failure, according to a statement today from the hospital. It said his treatments included dialysis, mechanical ventilation, and multiple medications to support his organ systems. He also received two experimental treatments on the day he was admitted: convalescent serum and the drug ZMapp.

Salia, age 44, was a Sierra Leone native and a legal US resident who had a wife and two children who live in New Carrolltown, Md., a suburb of Washington, D.C., the Washington Post reported today. He had been working as a medical officer and surgeon at a hospital in Freetown and was the sixth doctor to be infected with Ebola in Sierra Leone. He initially tested negative for the disease, but follow-up tests were positive on Nov 10.

The man died at 4:00 this morning after cardiac arrest, the hospital said today in a Twitter feed from a press conference with doctors.

Phil Smith, MD, medical director of the containment unit, said during a media briefing today that Salia arrived at the center on day 13 of his illness and that other Ebola patients the facility treated arrived on day 6 and day 8 of their infections.

"The earlier you start supportive care, the better," he said. His doctors said it isn't unusual for people in the early stages of Ebola infection to test negative for the disease, because there isn't enough virus in their blood.

Developers of ZMapp who had some of the drug available reached out the hospital, and it was shipped and made available by the time Salia arrived. His doctors didn't say which Ebola survivor donated convalescent serum, which was already on site, because the hospital knew of Salia's arrival 2 to 3 days ahead of time.

The medical team collected blood samples, some of which will be evaluated by the US Centers for Disease Control and Prevention (CDC) to assess viral load. Salia's doctors said public health mandates cremation, and performing an autopsy is too hazardous.

US enhanced screening to include Mali travelers

The CDC and the Department of Homeland Security (DHS) yesterday added Mali to the list of Ebola-affected nations for which enhanced screening and monitoring measures will be taken. There are no direct flights from Mali, but each day a small number of travelers—about 15 to 20—travel from Mali through other countries on their way to the United States, the CDC said in a statement. Most are US citizens or lawful permanent residents returning home.

Federal officials took the precautionary step because a number of Ebola cases have been confirmed in Mali in recent days and a large number of people may have been exposed to the patients. The enhanced screening starts today and is the same as for those arriving from Guinea, Liberia, and Sierra Leone: 21-day monitoring and movement protocols with twice-a-day temperature and symptom checks, coordinated with state or local health officials or both.

The CDC said federal officials would work with airlines to make sure that the travelers are rerouted to land at one of five airports that are funneling and doing enhanced screening for all people arriving from the outbreak countries.

Mali's health ministry said yesterday that no new Ebola cases have been confirmed in a cluster of illnesses and deaths linked to a private clinic in Bamako, according to a machine translation of a statement in French. Three suspected case-patients have tested negative and no new deaths have been reported.

The ministry said the number of Ebola cases linked to the clinic remains at three fatal cases and one patient who is receiving specialized care. Health services workers are following 442 contacts.

Other developments

  • Safety data from human trials under way for an experimental Ebola vaccine developed by the National Institutes of Health and GSK are satisfactory so far, according to a scientist leading a trial at Oxford University. The 60th and last health volunteer in a phase 1 trial at Oxford will receive the vaccine tomorrow. The school said in a press release today that over the last 2 months nearly 200 people have received the vaccine in safety trials that are also under way in the United States, Mali, and Switzerland. If safety and immunogenicity data from phase 1 trials are promising, the vaccine will be assessed for safety and effectiveness in African countries. The vaccine, called ChAd3, uses a chimpanzee adenovirus as a carrier of pieces of Ebola virus genetic material.

  • China's embassy said yesterday that 160 Chinese health workers have arrived in Liberia to staff and manage a $41 million Ebola treatment unit, Agence France-Presse (AFP) reported today. They include doctors, epidemiologists, and nurses who helped respond to the SARS epidemic in Asia. The unit is slated to be built and operating within 10 days and will be made of concrete so that it can be used after the outbreak response.

  • Guinea-Bissau's government announced on Nov 15 that the country would reopen its borders with Guinea to ease the flow of trade between the two countries, the African Press Agency (APA) reported. Nicholas Almeida, the country's general director of prevention and health promotion, said Guinea-Bissau would continue to reinforce prevention measures against Ebola, with emergency plans in place, though it lacked funds to fully institute the measures. A radio sensitization campaign, health worker training, and some screening sites have been launched, but about 40 entry points require attention.

  • The CDC recently posted two new Ebola resources, guidance for talking to children about Ebola and a fact sheet for West Africans who live in the United States. The guidance for talking to children advises four steps: asking them what they've heard, correcting inaccuracies, answering questions in reassuring ways, and allowing children to express their feelings. The fact sheet for West African people covers what the disease is, how it spreads, and what to do if someone encounters stigma. Though the CDC encourages US residents to avoid travel to the area, it addresses points to consider if considering a trip, health issues to keep in mind after returning, and what to do if someone has Ebola symptoms after possible exposure.

See also:

Nov 17 Nebraska Medical Center statement

Nov 17 Washington Post story

Nebraska Medical Center Twitter feed

Nov 16 CDC press release

Nov 16 Mali health ministry statement

Nov 17 Oxford University statement

Nov 16 AFP story

Nov 15 APA story

Nov 14 CDC resource on talking to children about Ebola

Nov 14 CDC Ebola fact sheet for West African US residents

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