Ebola outbreak: Safe burial manual released as death toll rises

Incidence declines in some districts in Guinea, Liberia and Sierra Leone while ‘steep rises persist’ in others

team of funeral agents who specialize in the burial of victims of the Ebola virus carry a body in Freetown last month. The World Health Organization has released a new manual on safe Ebola burial practices. (Florian Plaucheur/AFP/Getty)

At least 20 per cent of new Ebola infections occur during burials, the World Health Organization said in issuing a new funeral manual developed by an interfaith panel.

Ebola infections can spread when family and community members perform religious rites that involve directly touching or washing a corpse that continues to contain high levels of the infectious virus.

• Ebola outbreak: What you need to know
• Ebola facts: The truth about the virus

The guidelines released Friday are part of the UN health agency’s efforts to reduce the likelihood of Ebola transmission. It includes advice to health workers for “dignified burials” in the Christian and Muslim context.

“It is clear from Islamic juristic ruling that the necessity of religious washing of the body before burial of patients who die from Ebola is overruled,” Rehanah Sadiq, a Muslim chaplain with University Hospitals Birmingham NHS Foundation Trust who served as consultant to WHO, said in a release.

Sadiq suggested that health-care workers offer safer alternatives, such as give relatives the opportunity to view the body and to be involved in digging the grave.

The new guidelines also recommend that mattresses and other items handled by the Ebola patient be burned.

Separately on Friday, the WHO said 13,268 cases of Ebola have been reported in the eight currently and previously affected countries, including 4,960 reported deaths, up to the end of Nov. 4.

“Case incidence is declining in some districts in Guinea, Liberia and Sierra Leone, while steep rises persist in other districts,” the report’s authors said.

“Intense transmission in the three most affected countries demands widespread rigorous control measures. Preparedness in unaffected neighbouring countries is also critical.”

More Ebola treatment beds needed

The WHO report noted a total of 549 health-care workers are known to have been infected, including 311 deaths.

The agency said early indications are that many of those infections occurred outside of Ebola treatment and care in the three countries with the most intense transmission, Guinea, Liberia and Sierra Leone.

• Ebola outbreak: cases surge in Sierra Leone amid lack of treatment centres, UN finds

It added that exhaustive efforts continue to increase the supply of personal protective equipment as well as training on how to don and doff the gear to minimize possible risk.

Of the 4,707 Ebola treatment centre beds that WHO estimates are needed in the three heavily affected West African countries, only 22 per cent are currently up and running. The WHO said one of the biggest obstacles to opening more beds is lack of skilled staff trained in infection prevention and control.

In the U.S., where there have been four cases, including one death, public health officials announced they’re increasing a national stockpile of Ebola protective gear for U.S. hospitals.

The U.S. Centers for Disease Control and Prevention (CDC) said it has ordered $2.7 million US in personal protective equipment (PPE) that will be distributed into 50 kits that can be rapidly delivered to hospitals.

“We are making certain to not disrupt the orders submitted by states and hospitals, but we are building our stocks so that we can assist when needed. Some of these products are not normally used by hospitals for regular patient care,” Greg Burel, director of CDC’s Division of Strategic National Stockpile, said in a release.

Elsewhere, the WHO reiterated that quarantining travellers arriving from Ebola-affected nations can create “false impression of control” and may have a detrimental impact on how many health-care workers volunteer to help contain the outbreak.

Exclusive: Scientists tell U.S. – find recipe for Ebola cure in survivors’ blood

NEW YORK (Reuters) – A group of scientists including three Nobel laureates in medicine has proposed that U.S. health officials chart a new path to developing Ebola drugs and vaccines by harnessing antibodies produced by survivors of the deadly outbreak.

The proposal builds on the use of “convalescent serum,” or survivors’ blood, which has been given to at least four U.S. Ebola patients who then recovered from the virus. It is based on an approach called passive immunization, which has been used since the 19th century to treat diseases such as diphtheria but has been largely surpassed by vaccination.

The scientists propose using new genetic and other technologies to find hundreds or thousands of different Ebola antibodies, determine their genetic recipe, grow them in commercial quantities and combine them into a single treatment analogous to the multi-drug cocktails that treat HIV-AIDS.

That contrasts with current drug development, which focuses on finding one molecule, or a small number, to defeat the Ebola virus that has killed nearly 5,000 people in West Africa and infected thousands more since March.

Nobel laureates David Baltimore, an expert in the molecular biology of the immune system, James Watson, co-discoverer of the double helix that is DNA, and Jim Simons, who founded hedge-fund Renaissance Technologies and was a pioneer in the quant revolution on Wall Street, are among the advocates of the idea. It was outlined in a letter that was reviewed by Reuters.

The proposal was sent to officials at the Department of Health and Human Services, including the Food and Drug Administration, to lawmakers and to biotech companies. They have not responded, said geneticist Michael Wigler of Cold Spring Harbor Lab, who wrote and gathered signatures for the position paper. The recipients did not respond to Reuters’ requests for comment or said they had no comment.

The scientists urged government leadership without offering a specific development or production plan, and it is not clear whether the idea would offer a faster track to success than current efforts.

“Government agencies, commercial manufacturers and perhaps philanthropy” must work together to form a research and development infrastructure capable of producing therapeutic antibodies, Wigler said in an interview.

Although there is no proof that blood from survivors helps Ebola patients survive, it is known that patients recover when their own blood produces enough antibodies to stop the virus.

OLD PROCESS

Antibodies are proteins produced by the immune system to fight bacteria, viruses, and other invaders, from colds to measles. Giving antibodies to infected people would offer their immune systems a head start in fighting Ebola, the theory goes.

If the antibodies in survivors’ blood is genetically sequenced, they would provide a recipe for treatments, which could be produced with technologies already used to manufacture antibodies that target cancer or rheumatoid arthritis, the scientists said.

“It would cost less than $1 million to get the genetic sequences of the antibodies from people who have recovered, and then we would have an armamentarium of hundreds or even thousands of antibodies,” Wigler said.

He speculated that the idea has not gained traction before because “academics are trained to overlook the obvious.” The approach would be difficult, and “many people in this day and age are afraid to risk failure,” he said.

Ebola experts were cautious about the possibility that hundreds of anti-Ebola antibodies would prevent or cure infections.

Studies have shown that some antibodies that neutralize Ebola virus in test tubes don’t protect infected lab animals, said Dr. Thomas Geisbert of the University of Texas Medical Branch, who is working on Ebola vaccines. He also questioned whether the proposal would save time, given the need to test any antibody cocktail in both lab animals and human volunteers.

One of the most promising experimental treatments, Mapp Biopharmaceutical’s ZMapp, consists of three different antibodies produced by mice infected with Ebola. Initial research was published in 2000, but it took until this summer for a study to show that ZMapp cured Ebola-infected lab monkeys.

GlaxoSmithKline Plc and Johnson & Johnson are among the drugmakers working on an Ebola vaccine. Both declined to comment on whether the antibodies proposal might be effective against Ebola.

Wigler acknowledges that none of those who have signed on to the proposal are experts on Ebola. Nor do they know how long it might take to develop a production line, get regulatory approval, and test the antibodies.

LESSON FROM DIPHTHERIA

European researchers separately are planning to test whether Ebola survivors’ serum can cure patients, starting this month. But relying on transfusions of survivors’ blood for those antibodies is a daunting task in West Africa, given the need to screen it for other diseases and ensure health workers aren’t exposed during the collection or infusion process.

By contrast, “it takes a very short time” to produce countless copies of antibody genes, said molecular biologist Michel Nussenzweig of the Rockefeller University, an expert on the immune system who was not involved in the Ebola proposal. “Hundreds are not a problem; this has been automated,” he said. However, he questioned whether hundreds would be necessary to fight Ebola.

Wigler’s answer: the Ebola virus is mutating. That might thwart an three-antibody cocktail like ZMapp, he said, but it is highly unlikely that the targets of hundreds of antibodies would all mutate. A diversity of antibodies “mimics the body’s own defenses and could overcome mutations in the virus that may develop,” he said.

Multiple antibodies is what finally worked against HIV, which causes AIDS and, like the Ebola virus, mutates rapidly.

“We should make sure we learn from HIV to take our best shot at Ebola,” Nobelist Baltimore said in an interview.

To stop Ebola’s spread in West Africa, target funerals: study

Volunteers lower a corpse, which is prepared with safe burial practices to ensure it does not pose a health risk to others and stop the chain of person-to-person transmission of Ebola, into a grave in Kailahun August 2, 2014. REUTERS/WHO/Tarik Jasarevic/Handout via Reuters 

NEW YORK (Reuters) – As the global health community ramps up its efforts to treat Ebola patients and curb its spread in West Africa, a new analysis finds that the greatest impact would come from insuring safe burials for victims, scientists reported on Thursday.

The need for safe burials has been known from the beginning of the epidemic last spring, when people who attended the funeral of a faith healer in Guinea became infected.

U.S. guidelines call for workers wearing full protective gear to wrap the remains of Ebola victims, which have an extremely high concentration of the virus, in a plastic shroud and then place them in two body bags. The body should not be washed or handled in any way, something that has been a common practice in much of West Africa.

The new findings, published in the journal Science, are based on a mathematical model being developed by Ebola researchers at Yale School of Public Health.

It takes into account data from the current outbreak and previous ones, including how long people harbor the virus before becoming ill, how long they are infectious, and what percentage are isolated at home or in a treatment center.

Similar models have already informed public policy. A U.S. projection that there could be 1.4 million cases in Liberia and Sierra Leone by late January spurred some Western countries to commit more funds and personnel to curb the worst Ebola outbreak since the disease was identified in 1976.

The Yale model calculates the spread of Ebola in the community, in hospitals and at funerals, including how many secondary cases are caused by the average case in each setting.

If transmission in the community or in hospitals could be eliminated through better isolation practices, Yale’s Alison Galvani and her colleagues found, each Ebola case would still cause 1.4 or 1.5 additional infections.

But if transmission via burial practices were eliminated, the secondary infection rate would drop below one per Ebola case, the sole way epidemics peter out.

“Reducing transmission in hospitals and the community is insufficient to stop the exponentially growing epidemic,” the scientists wrote. The most effective intervention is halting burial practices in which mourners handle bodies, which “are effectively serving as superspreader events.”

Because making all Ebola burials sanitary might not be feasible, said Yale’s Martial Ndeffo-Mbah, the Ebola response must also continue to isolate cases.

Other modelers predicted the study’s emphasis on funerals would be “quite controversial,” according to biostatistician Ira Longini of the University of Florida.

Longini and colleagues at Northeastern University created a mathematical model that shows that most Ebola transmission occurs in the community and within households, so isolating patients would have the most effect on the epidemic.

Still, “Liberia has concentrated hard on the funeral problems,” Longini said, and is now seeing fewer new cases than in recent weeks.

Busting the Top 5 Ebola myths that are causing fear and hysteria around the world

Nearly nine months since the start of the current Ebola outbreak in West Africa, the news keeps changing day to day, and even hour by hour.

At this point, however, fear and myths surrounding Ebola appears to have spread faster than the virus itself. Between the continued rising number of new cases in Africa and the botched official responses, it is a lot to take in for the general public and has caused unnecessary hysteria.

But let’s all take a deep breath and remember that while there are now 9,000 cases of Ebola confirmed by the World Health Organization, only a handful of cases have been reported outside of Africa, most of which have been health care workers who are battling the virus on the front lines. Accurate and timely information helps fight not only the disease itself but also side-effects like paranoia, and help us take a more rational approach towards the disease.

Here now we separate the fact from the fiction and dispel some of the most common myths associated with Ebola.

Myth #1: Ebola is highly contagious

Ebola cannot be spread through the air or by water, and can only be transmitted through direct contact with bodily fluids.

This has been the key problem in the hot zone of West Africa where the disease has become embedded. Care for the infected usually rests on family members who are not wearing proper protection and are in contact with highly-infected bodily fluids like vomit and diarrhea.

Health care workers in hospitals and treatment centres are also at risk working in close contact with Ebola patients who may produce projectile droplets that may contain the virus.

However, the general public should not be worried about catching the disease during normal, daily, community activities like walking through a shopping mall or going to school.

Rachael Jones, an infectious disease specialist from University of Illinois told NPR Radio in an interview this week that “particles are not going to travel hundreds of feet or hundreds of meters to cause an infection.”

So this means that travellers returning from other regions of Africa should not be shunned like inHazlehurst, Mississippi, where parents pulled their children out of school over concerns their principal had taken a trip to southern Africa, or the Texas college that rejected student applicantscoming from Nigeria.

Myth #2: Chances are that Ebola will spread and create a pandemic

According to a recent ABC News – Washington Post poll, 65 per cent of Americans are worried about a possible widespread epidemic in that country.

The WHO said this week that the number of new cases per week could rise tenfold by December, andworst-case scenarios project those numbers may add up to 1.4 million cases by early 2015.

But does this mean the virus will take off like wildfire and spread around the world? Highly unlikely, say virologists. It is much more likely that individual cases, and even small, isolated clusters would pop up outside of Africa – just as we have seen happening already.

However, the reality is that while West African countries are ill-equipped to deal with the spread of viruses like Ebola, developed nations around the world have functioning health systems and associated resources at their disposal that can effectively stop its spread to the general population.

Myth #3: Closing our borders to those traveling from infected areas of West Africa is the best way to prevent further spread of the disease.

Experts believe that if we ban travellers from the affected countries from entering it could potentially send infected travellers underground and make it near impossible to track their movements.

Stopping flights altogether would only further devastate the impoverished African countries that rely on help from the West to stamp out the current outbreak. It would also make it difficult to get relief workers and supplies into the region.

Myth #4: Survivors of Ebola are still contagious

According to the CDC, once someone makes a recovery, they are no longer able to transmit the virus. With that said, however, the Ebola virus has been found in the semen of patients who have regained their health up to three months later.

Those who do recover from Ebola also appear to get immunity for about 10 years, as their body makes the antibodies against the virus. But it’s not yet known if this immunity translates to other species of Ebola.

Myth #5: Ebola is likely to become an airborne disease

All the epidemiological studies show no evidence that Ebola is airborne-transmitted between humans.

While it can’t be ruled out completely, scientists have never found a virus that has completely changed their mode of transmission and do not believe that Ebola will undergo such a drastic mutation to become a respiratory transmissible virus.

A case in point, the highly successful H5N1 avian influenza that has spread among billions of birds around the world has not changed its DNA to transmit differently than it has for thousands, if not hundreds of thousands of years.

While it is important to be vigilant to avoid contracting any disease, there’s little reason for Canadians to panic about the spread of Ebola at this point, and understanding the facts is a key first step.

Can Health Workers Refuse to Treat Ebola Patients? Maybe.

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Boehner says U.S. should consider travel ban from countries with Ebola

WASHINGTON (Reuters) – U.S. House Speaker John Boehner said on Wednesday that President Barack Obama should “absolutely consider” a temporary ban on travel to the United States from countries suffering an outbreak of the Ebola virus.

“Today we learned that one individual who has contracted the virus flew to Ohio through the Cleveland airport in the last few days,” Boehner, an Ohio Republican, said in a statement.

“A temporary ban on travel to the United States from countries afflicted with the virus is something that the president should absolutely consider along with any other appropriate actions as doubts about the security of our air travel systems grow,” he said.

‘Biggest Risk’ in Ebola Protection Is Gear Removal

A “breach in protocol” is what led a nurse in Dallas to become the first person infected with Ebola in the United States, according to the Centers for Disease Control and Prevention. The nurse was involved in treating Ebola patient Thomas Eric Duncan, and her case has researchers trying to figure out exactly what went wrong with the safety protocols.

Ebola spreads through contact with an infected person’s bodily fluids. Guidelines for health care workers recommend using personal protective equipment, including gloves, a fluid-resistant gown, goggles or a face shield and a face mask. They also recommend certain techniques — such as turning gloves inside out when removing them — that allow workers to safely remove the equipment after contact with an Ebola patient.

How contamination can happen

“The greatest risk overall is probably taking off or ‘doffing’ the equipment,” said Dr. Sandro Cinti, an infectious-disease specialist at the University of Michigan Health System/VA Ann Arbor Healthcare System. [Infographic:Protective
Gear For Ebola Patient Care]

In removing the equipment, health care workers should take care not to contaminate themselves or their clothing, Cinti said. Ebola can’t get into the body through the skin itself, but having the virus on the skin means it could be transferred to the eyes or other mucous membranes, where it can enter the body, Cinti said. “Even a small breach can lead to an infection,” he said.

In some situations, such as when there’s a lot of blood or bodily fluids present, additional gear — such as double gloves, disposable shoe covers and leg coverings — may be needed, according to the CDC. Many hospitals are now looking at whether to expand the gear their workers wear to include disposable protective coveralls known as Tyvek suits, Cinti said.

When donning the equipment, “it’s important to ensure the hands and wrists are covered completely, and the best way to do that is to have workers watch each other don the equipment,” Cinti told Live Science.

Equipment should be discarded after use or, if it’s reusable, cleaned and disinfected, according to the CDC. Frequent hand washing is also critical for preventing infection. “This virus is easily killed by soap and the hand washes we use,” Cinti said.

How did the Dallas nurse get Ebola?

It’s not yet clear exactly how the Dallas nurse — who has been identified as Nina Pham, according toDallas news station WFAA— acquired the virus. The woman had extensive contact with the infected patient after he was admitted to TexasHealthPresbyterianHospital on Sept. 28, CDC officials said.

She had been monitoring herself for symptoms, and had not been at work for two days before being admitted to the hospital and put into isolation. Officials are now monitoring other health care workers who also treated Duncan, according to the CDC.

The nurse’s infection is worrisome, but should not be cause for panic, Cinti said.

People do not need to be concerned about going to a hospital if there’s an Ebola patient there, and health care workers can avoid infection if proper precautions are taken, he said.

“Many health care workers have been exposed [to Ebola] in taking care of patients,” Cinti said. Although some of them have become infected, it’s “quite uncommon,” even in Liberia, he said.

A nurse in Spain who recently became infected with Ebola after caring for two Spanish missionaries is showing signs of improvement, NBC News reported today.

The current Ebola outbreak in West Africa is the worst in history, and is responsible for the deaths of more than 4,000 people so far, according to the CDC.

Ebola article

http://www.lfpress.com/2014/09/26/simpson-the-devastation-caused-by-the-ebola-virus-cries-out-for-people-worldwide-to-get-past-their-indifference-to-impoverished-africans

Patient isolated at St. Catharines hospital as Ebola precaution

A patient is in isolation at a St. Catharines hospital after arriving from the Ebola hot zone of West Africa with “flu-like symptoms.”

The patient is in stable condition and is considered “low risk,” said Niagara Health System (NHS) spokesperson Brady Wood, adding that test results confirming whether the patient has Ebola, a deadly virus, are expected by Thursday.

“Our analysis indicates this situation is very low-risk,” said Dr. Tom Stewart, chief of staff and executive vice-president medical at the NHS.

“We are taking every precaution and isolating the patient per the best practice protocols, with advice from infectious disease experts and public health.”

The NHS won’t confirm where the patient is from or disclose the West African country where the person was travelling.

More on thestar.com

World is ‘losing the battle’ against Ebola, warns aid group

The region is beset by the largest-ever Ebola outbreak, with reported cases in Sierra Leone, Guinea, Senegal and Nigeria. A second outbreak of the disease has occurred further south in the Democratic Republic of the Congo.

More than 1,500 people have died, while more than 3,000 have contracted the disease during this year’s epidemic, according to the World Health Organization.

Though no cases of Ebola have been reported in Canada, people in Brampton andMontreal have been quarantined as a precaution after returning from Africa with symptoms of the flu. Both patients were ultimately shown not to have the disease.

This latest isolation case in St. Catharines is part of a “heightened vigilance” to prevent to the spread of the disease.

Stewart said Ontario hospitals have been prepping in recent weeks to handle any cases of Ebola. He added that the St. Catharines hospital has new negative pressure rooms and isolation capabilities.

“Our goal in this case is to ensure this individual receives great care while protecting our staff and the public,” he said.

“We will keep the public updated in an orderly fashion, and in the meantime we are asking staff and the public to remain calm and to be extremely vigilant in terms of hand hygiene at our sites.”

Ebola is transmitted through direct contact with an infected person’s body fluid. It has a 90-per-cent fatality rate, making it one of the world’s most virulent diseases, according to the World Health Organization.

How a Canadian Prairie city made an Ebola vaccine

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