Ebola deaths top 8,000; exposures trigger health worker evacuations

As deaths in West Africa's Ebola outbreak officially topped 8,000 over the weekend, leadership of the United Nations Mission for Ebola Emergency Response (UNMEER) changed hands, and Guinea launched a new effort to battle the disease amid continuing reports of community resistance.

The World Health Organization (WHO) said today that 20,656 people have been infected in the three hardest-hit countries and that the number of deaths has climbed to 8,153. The data include infections reported from Guinea and Sierra Leone as of Jan 3 and Liberia as of Dec 31.

Sierra Leone has the most cases, with 9,772, followed by Liberia with 8,115 and Guinea with 2,769, the WHO said. However, Liberia has the highest fatality count of the three countries, with 3,471.

African response updates

Over the New Year holiday, Anthony Banbury, who has led UNMEER since it was established in September, traveled to each of the countries for farewell visits, according to a Jan 2 UNMEER update. On Jan 3 Banbury handed off his duties to Ismail Ould Cheikh Ahmed, and in a joint town hall meeting Ahmed praised the achievements so far, but said the challenge remains to get to zero cases. "This is within our reach, but we should not be complacent," he said, according to UNMEER's update today.

Ould Cheikh Ahmed and David Nabarro, MD, the UN special envoy on Ebola, will visit Liberia and Sierra Leone this week and Guinea shortly afterward, according to UNMEER. In announcing Ould Cheikh Ahmed's appointment in the middle of December, UNMEER said Banbury would return to New York in early January and that Ould Cheikh Ahmed, who most recently was deputy head of the UN Support Mission to Libya, would succeed him.

In other developments, Guinea's government has announced the launch of a campaign called "zero Ebola in 60 days", UNMEER said today. Guinea's Ebola case counts have been oscillating over the past several months, and in its most recent update, the WHO said it's not clear what the trend is. The first part of Guinea's campaign will start tomorrow, with expert teams traveling to six regions to assess local response efforts and form an action plan for each prefecture that dovetails with Guinea's national action plan.

UNMEER said the campaign's working groups are targeting surveillance, case management, infection control, community engagement and social mobilization, and safe burials.

Response workers are still encountering resistance in some areas, including 25 subprefectures in Guinea, UNMEER said, citing WHO data. For example, on Jan 1 local people in the Guinea community of Kindia assaulted a Red Cross team and vandalized a vehicle. The Red Cross team had traveled to the area to conduct a safe burial and transport suspected Ebola patients. In its Jan 2 report, UNMEER said leaders held a community meeting in Sinoe County, Liberia, to dispel rumors that community health workers were being paid for every patient they refer to the county hospital.

Elsewhere, government and health officials in Sierra Leone are reviewing airport screening procedures as they investigate two Ebola cases that have connections to Lungi International Airport, according to a government press release flagged and posted by FluTrackers, an infectious-disease news message board.

The health ministry said it learned of a case confirmed on Jan 2 in an airport worker who had last been at the airport in mid-December and that one of the patient's contacts is an airport employee who has not worked since Dec 25. It said that though there is no transmission risk with the patient and contact, steps to prevent future events are being taken.

Health workers airlifted after potential Ebola exposure

Three foreign health workers have been airlifted out West Africa over the past few days for observation after potential Ebola exposure. One is an American healthcare provider who experienced a high-risk exposure and has been admitted to Nebraska Medical Center's biocontainment unit, according to a statement today.

Phil Smith, MD, the unit's medical director, said that the patient is not ill and not contagious, but is in the same room used to treat three Ebola patients and will be monitored for infection during the 21-day incubation period. The hospital said no other information will be released about the patient, unless he or she consents.

In addition, a South Korean health worker exposed to Ebola in West Africa has been evacuated to Germany for evaluation, the Associated Press (AP) reported on Jan 3, citing Berlin authorities. It said South Korea's government had asked Europe to assist after the medic suffered a needlestick injury while treating a patient who died the next day from the disease.

Meanwhile, a nurse who was potentially exposed to Ebola while working in Sierra Leone was admitted to Skane University Hospital in Lund, Sweden, yesterday. The Local, an English-language newspaper based in Sweden, said today, citing a hospital spokeswoman, that a specialist team evaluated the nurse overnight and found that she is healthy, with no signs of Ebola infection. The report said the woman has been cleared to leave the hospital, but a medical team will follow up.

In Italy, a doctor who contracted Ebola while working in Sierra Leone and was hospitalized in Rome has recovered from his illness and been discharged, according to a Jan 2 AP report. The doctor, Fabrizio Pulvirenti, MD, worked for the Italian aid group Emergency and was Italy's first Ebola case-patient. He was airlifted to Italy in late November, according to earlier reports.

Other developments

  • A clinical trial of an Ebola vaccine developed by Canadian researchers and licensed by NewLink Genetics and Merck resumed in Geneva today at a lower dose, after a pause prompted by reports of joint pain in some of the participants, Reuters reported today, citing a statement from the University of Geneva. The vaccine uses an Ebola virus protein spliced into a vesicular stomatitis virus (VSV-EBOV). The Swiss trial launched on Nov 10, but officials temporarily suspended it in early December after some volunteers reported mild joint pain the second week after they were vaccinated. The hospital said Swiss regulators have cleared the trial to resume at a lower dose and that the second part of the trial will use a dose of 300,000 vaccine particles, which should be better tolerated and hopefully produce enough antibodies. It said the initial phase of the study used 10 million to 50 million vaccine particles. The last 56 volunteers will receive either a low dose of vaccine or a placebo by groups of 15 each week through January. The hospital said Swiss researchers are in close contact with colleagues conducting similar studies in Canada, Gabon, Germany, and the United States. Final results are expected in March.

  • The US Centers for Disease Control and Prevention (CDC) tomorrow will remove Mali from the list of Ebola-hit countries subject to enhanced entry screening. The agency said the change is prompted by the passage of two 21-day incubation cycles since the last Ebola patient in Mali had contact with a person not wearing personal protective equipment (PPE). Mali's last patient tested negative for the virus on Dec 5, and no other cases have been detected since then. The CDC said tomorrow's change will mean travelers from Mali will no longer be required to go through enhanced screening and monitoring when entering the United States, and they won't be funneled through five airports that are handling all of the screening on travelers from the outbreak region. The CDC also said it would remove the level 2 travel notice for Mali, which urged travelers to take enhanced precautions when visiting the nation.

  • Aethlon Medical Inc., a medical device company based in San Diego, announced on Jan 2 that the Food and Drug Administration (FDA) has approved a clinical protocol to assess its Hemopurifier for treating people infected with Ebola in the United States. The device is designed to filter viruses and "shed glycoproteins" from the blood of infected individuals. The protocol cleared by the FDA would allow the company to conduct the study at up to 10 clinical sites and involve up to 20 US subjects. Patients who meet the criteria will receive a daily 6- to 8-hour session of Hemopurifier therapy until their Ebola viral load drops below 1,000 copies per milliliter. Aethlon said its device was used to treat a critically ill Ebola patient at Frankfurt Hospital in Germany, with the results presented at a scientific meeting in mid-November.

See also:

Jan 5 UNMEER report

Jan 5 WHO situation update

Jan 2 UNMEER report

FluTrackers thread

Jan 5 Nebraska Medical Center statement

Jan 3 AP story

Jan 2 AP story

Jan 5 Reuters story

Jan 5 CDC press release

Jan 2 Aethlon press release

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