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Ebola Virus Disease Home Page
Fatu Kekula, student nurse, Kakata, Liberia saved her family from Ebola virus disease All the world is proud of having Fatu Kekula among us. ebola-virus-disease.com

ebola-virus-disease.com

Ebola virus disease (EVD) aka Ebola hemorrhagic fever (EHF) [ICD-10 A98.4] by dr Z Halat, Medical Epidemiology Consultant


The 1567 plague epidemic killed a third of the inhabitants of Wroclaw. Are we globally helpless again?
 
The 1567 plague epidemic killed a third of the inhabitants of Wroclaw. Are we globally helpless again? Epitaph paintings by Tobias Fendt, 1567: Christ pronounces the Final Judgement and Family of the deceased on the background panorama of Wroclaw
Epitaph paintings by Tobias Fendt, 1567: Christ pronounces the Final Judgement and Family of the deceased on the background panorama of  Wroclaw
National Museum in Wroclaw, Poland



 
Five co-authors of this study died of Ebola virus disease before their research was published. "Genomic surveillance elucidates Ebola virus origin and transmission during the 2014 outbreak" Originally published in Science Express on August 28 2014
Five co-authors of this study died of Ebola virus disease before their research was published.
 "Genomic surveillance elucidates Ebola virus origin and transmission during the 2014 outbreak"
Originally published in Science Express on August 28 2014

'In its largest outbreak, Ebola virus disease is spreading through Guinea, Liberia, Sierra Leone, and Nigeria. We sequenced 99 Ebola virus genomes from 78 patients in Sierra Leone to ~2,000x coverage. We observed a rapid accumulation of interhost and intrahost genetic variation, allowing us to characterize patterns of viral transmission over the initial weeks of the epidemic. This West African variant likely diverged from Middle African lineages ~2004, crossed from Guinea to Sierra Leone in May 2014, and has exhibited sustained human-to-human transmission subsequently, with no evidence of additional zoonotic sources. Since many of the mutations alter protein sequences and other biologically meaningful targets, they should be monitored for impact on diagnostics, vaccines, and therapies critical to outbreak response.'
(...)

'In memoriam: Tragically, five co-authors, who contributed greatly to public health and research efforts in Sierra Leone, contracted EVD in the course of their work and lost their battle with the disease before this manuscript could be published. We wish to honor their memory.'




 
Dr Ameyo Stella Adadevoh, OBM (of blessed memory) Consultant Physician and Endocrinologist, the Lead Consultant at First Consultants Medical Centre Lagos. was heroically instrumental to preventing a massive outbreak of Ebola virus diseasein Nigeria, an effort she paid for with her life. Eternal rest, grant unto her, O Lord, and let perpetual light shine upon her. May she rest in peace. Amen
Dr Ameyo Stella Adadevoh, OBM (of blessed memory)
 Consultant Physician and Endocrinologist
the Lead Consultant at First Consultants Medical Centre Lagos
was heroically instrumental to preventing a massive outbreak of Ebola virus disease in Nigeria,
an effort she paid for with her life.
Eternal rest, grant unto her, O Lord, and let perpetual light shine upon her.
May she rest in peace. Amen


The statement by First Consultants Medical Center Ltd

In the interest of our patients, staff, the general public the nation at large we state the following:

A 40-years old gentlemen came into the hospital with symptoms suggestive of Malaria (fever, headache, extreme weakness) on Sunday night (20th July 2014). He was fully conscious and gave us his clinical history and told us he is a Senior Diplomat from Liberia. Laboratory investigations confirmed malaria whilst other test for HIV, Hepatitis B&C were negative. He was admitted and treatment commenced.

However, due to the fact that he was not responding to treatment but rather was developing haemorrhagic symptoms we further questioned him. He denied having been in contact with any persons with EVD (Ebola Virus Disease) at home, in any hospital or at any burial.

In spite of this denial we immediately decided to do the following:

1. To conduct further tests for possible Infectious Haemorrhagic Disease, especially EBOLA VIRUS DISEASE, based on the fact that he was a Liberian citizen and the recent outbreak of EBOLA VIRUS DISEASE in that country.

2. We immediately isolated/quarantined the patient, commenced barrier nursing and simultaneously contacted the Lagos State Ministry of Health and the Federal Ministry of Health to enquire where further laboratory tests could be performed as we had a high index of suspicion of possible EBOLA VIRUS DISEASE

3. WE REFUSED FOR HIM TO BE LET OUT OF THE HOSPITAL IN SPITE OF INTENSE PRESSURE, AS WE WERE TOLD THAT HE WAS A SENIOR ECOWAS OFFICIAL AND HAD AN IMPORTANT ROLE TO PLAY AT THE ECOWAS CONVENTION IN CALABAR, CROSS RIVER STATE.

4. The initial test results from LUTH laboratory indicated a signal of possible EBOLA VIRUS DISEASE, but required confirmation.

5. We then took the further step of reaching out to Senior Officials in the office of the Secretary of Health of the United States of America who promptly assisted us with contacts at the centres for Disease Control (CDC) and World Health Organisation Regional Laboratory Centre in Senegal.

6. Working jointly with the State, Federal Agencies and International Agencies, we were able to obtain confirmation of EBOLA VIRUS DISEASE (ZAIRE STRAIN), (W.H.O. Regional Center Lab-Senegal/Redeemes lab/LUTH Laboratory)

7. The gentleman subsequently died on Friday at a 6.50 (25th July, 2014)

8. All agencies were promptly notified and in consultation with W.H.O, Regional EBOLA VIRUS DISEASE Centre in Conakry, Guinea and Best Practices, the following was commenced:

a. Orderly temporarily shut down of the hospital with immediate evacuation of in house patients

b. The appropriate professional removal of the body and its incineration under W.H.O. guidelines, witnessed by all appropriate agencies.

9. Having concluded the above, it is now appropriate to give this press release in the interest of our patient, staff, the general public and the nation at large.

10. In keeping with W.H.O, guidelines, hospital is shut down briefly as full decontamination exercise is currently in progress W.H.O. Guidelines

In conclusion, working with the STATE, FEDERAL AND INTERNATIONAL AGENCIES, we were able to identify and confirm the diagnosis of the EBOLA VIRUS DISEASE. We hope that by our action of preventing this gentleman from being extracted from our hospital and traveling to Calabar we have been able to prevent the spread of EBOLA VIRUS DISEASE in Nigeria.

The Board and Management of the Hospital wish to thank all our staff members for their diligence and professionalism.

Thank You.

Signed
Dr. B.N. OHIAERI
DR. A.S. ADADEVEOH
First Consultants Medical Centre Limited
16/24 Ikoyi Road,
Obalende,
Lagos






Lady Nurse Justina Echelonu, OBM (of blessed memory) died following the contact she had in Lagos with the Liberian American, Mr. Patrick Sawyer, in the course of discharging her duty at First Consultants Medical Centre. Before she died, she posted the Facebook message: "I never contacted his fluids. I checked his vitals, helped him with his food (he was too weak)... . I basically touched where his hands touched and that's the only contact, not directly with his fluid." Eternal rest, grant unto her, O Lord, and let perpetual light shine upon her. May she rest in peace. Amen
Lady Nurse Justina Echelonu,  OBM (of blessed memory)
died following the contact she had in Lagos with the
Liberian American, Mr. Patrick Sawyer, in the course of
discharging her duty at First Consultants Medical Centre.
Before she died, she posted the Facebook message:
"I never contacted his fluids. I checked his vitals,
helped him with his food (he was too weak)... .
I basically touched where his hands touched and
that's the only contact, not directly with his fluid."
Eternal rest, grant unto her, O Lord, and let perpetual light shine upon her.
May she rest in peace. Amen


Before Lady Nurse Justina Echelonu died, she posted the message below 
on a Facebook group page that organises free medical services:

"I never contacted his fluids. I checked his vitals, helped him with his food (he was too weak)... .I basically touched where his hands touched and that's the only contact, not directly with his fluids. At a stage, he yanked off his infusion and we had blood everywhere on his bed... but the ward maids took care of that and changed his linen with great precaution.

"Every patient is treated as high risk... if it were airborne, by now wahala for dey. I still thank God.

Friends, up to our uniforms and all linen were burnt off. We are on surveillance and off work till 11th.

"Our samples have long been taken by WHO and so far we have been fine. For me, kudos to my hospital management because we work professionally with every patient considered risk, because that's the training.

"Had it been it's a hospital where they manage ordinary gloves like government hospitals and some janjaweed private hospital, ... wahala for dey o. I must also thank Lagos Govt... in fact! Even Federal Government sef (sic)... all have been supportive. I'm good and so are the others in the hospital...





 
Mr Dessie Quinn, OBM (of blessed memory) treated for malaria, died from malaria ebola or both? Eternal rest, grant unto him, O Lord, and let perpetual light shine upon him. May he rest in peace. Amen.

Mr Dessie Quinn, OBM (of blessed memory) treated for malaria, died from malaria ebola or both?
Eternal rest, grant unto him, O Lord, and let perpetual light shine upon him. May he rest in peace. Amen




Republic of Ireland Health Service Executive

HSE Statement, 22nd August 2014, 13.00 hours

The HSE has confirmed that laboratory test samples for an individual, who had recently returned from Africa, has proved negative for Ebola Virus.

Infection control procedures, which had been put in place as a precautionary measure, will now be stepped down.

The HSE expressed its condolences to the individual’s family and friends for their loss.

Further information on Ebola virus disease can be found on the HPSC’s website at http://www.hpsc.ie/ and  http://www.hpsc.ie/A-Z/Vectorborne/ViralHaemorrhagicFever/Ebola/.




MALARIA OR /AND? EBOLA VIRUS DISEASE
The first symptoms
of malaria (WHO): fever, headache, chills and vomiting
of Ebola Virus Disease (CDC) fever, headache, diarrhea, vomiting, weakness, stomach pain, lack of  appetite, unexplained bleeding, joint & muscle aches
Case fatality rate (CFR) for malaria in sub-Saharan Africa in 2012 was ca 0.3%.
CFR for Ebola Virus Disease in West Africa 2013/2014 outbreak is 53% (mid September 2014)
[CFR - number of deaths divided by number of cases expressed as a percentage]
ESTIMATED NUMBER OF DEATHS FROM MALARIA IN SUB-SAHARAN AFRICA IN 2012
AMONG CHILDREN UNDER FIVE YEARS OF AGE WAS 1 282 (1 087 - 1 463) DAILY.
MALARIA OR /AND? EBOLA VIRUS DISEASE It took 260 days for Ebola Viral Disease to reach the estimated number of deaths equal to estimated DAILY number of deaths among children under five years of age in sub-Saharan Africa. If the current Ebola Virus Disease outbreak is not the final lesson, we are being given possibly the last choice to improve or perish.dr Z Halat, Medical Epidemiology ConsultantThe first symptoms of malaria (WHO): fever, headache, chills and vomiting of Ebola Virus Disease (CDC) fever, headache, diarrhea, vomiting, weakness, stomach pain, lack of  appetite, unexplained bleeding, joint & muscle aches Case fatality rate (CFR) for malaria in sub-Saharan Africa in 2012 was ca 0.3%.CFR for Ebola Virus Disease in West Africa 2013/2014 outbreak is 53% (mid September 2014) [CFR - number of deaths divided by number of cases expressed as a percentage] ESTIMATED NUMBER OF DEATHS FROM MALARIA IN SUB-SAHARAN AFRICA IN 2012 AMONG CHILDREN UNDER FIVE YEARS OF AGE WAS 1 282 (1 087 - 1 463) DAILY. There were 333 320 deaths from malaria among children under five years of age and 1 244 deaths from Ebola Viral Disease among cases of all ages from 2 December 2013 to 18 August 2014.
There were 333 320 deaths from malaria among children under five years of age
and 1 244 deaths from Ebola Viral Disease among cases of all ages from 2 December 2013 to 18 August 2014.
It took 260 days for Ebola Viral Disease to reach the estimated number of deaths equal to estimated DAILY number
of deaths among children under five years of age in sub-Saharan Africa.
If the current Ebola Virus Disease outbreak is not the final lesson,
we are being given possibly the last choice to improve or perish.
dr Z Halat, Medical Epidemiology Consultant
Malaria is an enemy to children in Africa. Save People from Dying from Malaria in  South Sudan  www.globalgiving.org project 
Malaria is an enemy to children in Africa. Save People from Dying from Malaria in  South Sudan  
www.globalgiving.org


The Wall Street Journal

How the 2014 Ebola Crisis Unfolded
 Last updated Sept. 8, 2014 5:05 p.m. ET Published Sept. 8, 2014 11:15 a.m. ET
Christopher Kaeser, Betsy McKay, Taylor Umlauf and Colleen McEnaney

The early stages of the disease’s transmission

The Path of Transmission

The early stages of the Ebola outbreak began in the village of Meliandou, Guinea, where it spread to immediate family members and caretakers. In mid-February, a hospital worker contracted the disease and spread it to other villages. By April, the outbreak threatened a much larger population. Shown is the initial transmission chain of the current Ebola virus outbreak. Family members of those infected and health-care workers in the region are most at risk
The Wall Street Journal How the 2014 Ebola Crisis Unfolded Christopher Kaeseret al.The early stages of the disease’s transmission The Path of Transmission The early stages of the Ebola outbreak began in the village of Meliandou, Guinea, where it spread to immediate family members and caretakers. In mid-February, a hospital worker contracted the disease and spread it to other villages. By April, the outbreak threatened a much larger population. Shown is the initial transmission chain of the current Ebola virus outbreak. Family members of those infected and health-care workers in the region are most at risk. The New England Journal of Medicine  5, April 2014 Emergence of Zaire Ebola virus disease in Guinea — Preliminary report. Sylvain Baize et al.

The New England Journal of Medicine
N. Engl. J. Med. 10.1056/NEJMoa1404505 (2014).doi:10.1056/NEJMoa1404505, April 2014
Emergence of Zaire Ebola virus disease in Guinea — Preliminary report.
Sylvain Baize et al.




JGV Papers in Press. Published May 2, 2014 as doi:10.1099/vir.0.067199-0
The 2014 Ebola virus disease outbreak  in west Africa
Derek Gatherer

On the 23rd of March 2014, the WHO issued its first communiqué on a new outbreak of Ebola virus disease (EVD) which began in December 2013 in Guinée Forestière (Forested Guinea), the eastern sector of the Republic of Guinea.




Africaguinee.com, March 14, 2014

Africaguinee.com, March 14, 2014 Santé : Une étrange fièvre se déclare à Macenta, plusieurs cas de morts signalés…MACENTA- Une nouvelle maladie dont-on ignore  le nom a été signalé dans  la préfecture de Macenta située à 800 KM de Conakry, faisant  8 morts  et plusieurs autres personnes contaminées, a appris Africaguinee.com. Cette maladie jugée contagieuse se manifeste par une hémorragie nasale et anale. A new disease that we do not know the name was reported in the prefecture of Macenta located 800 KM from Conakry, killing 8 people dead and several others contaminated learned Africaguinee.com. This disease found to be contagious  is manifested by anal and nasal bleeding.Santé : Une étrange fièvre se déclare à Macenta, plusieurs cas de morts signalés…MACENTA- Une nouvelle maladie dont-on ignore  le nom a été signalé dans  la préfecture de Macenta située à 800 KM de Conakry, faisant  8 morts  et plusieurs autres personnes contaminées, a appris Africaguinee.com. Cette maladie jugée contagieuse se manifeste par une hémorragie nasale et anale.


A new disease that we do not know the name was reported in the prefecture of Macenta located 800 KM from Conakry, killing 8 people dead and several others contaminated learned Africaguinee.com. This disease found to be contagious  is manifested by anal and nasal bleeding.

TEN DAYS LATER THE WORLD HEALTH ORGANIZATION
ISSUED ITS FIRST INFORMATION ABOUT THE EBOLA VIRUS EPIDEMIC OUTBREAK
WHICH HAS STARTED DECEMBER 2, 2013 WITH INFECTION OF A TODDLER
WHO CONTRACTED  EBOLA VIRUS DISEASE FROM A MIGRATING BAT


World Health Organization
Disease outbreak news: Ebola virus disease

(...)
24 March 2014
Ebola virus disease in Guinea – update
23 March 2014
Ebola virus disease in Guinea
30 November 2012
Ebola in Uganda - update
(...)

Ebola virus disease in Guinea ( Situation as of 24 March 2014)

A total of 86 cases including  59 deaths (CFR: 68.5%) reported from 4 districts ( Guekedou, Macenta, Nzerekore and Kissidougou)

Event description

The Ministry of Health (MoH) of Guinea has notified WHO of a rapidly evolving outbreak of Ebola virus disease in forested areas south eastern Guinea. As of 24 March 2014, a total of 86 cases including 59 deaths (case fatality ratio: 68.5%) had been reported. The cases have been reported in Guekedou, Macenta, Nzerekore and Kissidougou districts. In addition, three suspect cases including two deaths in Conakry are under investigation. Four health care workers are among the victims. Reports of suspected cases in border areas of Liberia and Sierra Leone are being investigated.

Six of seven blood samples from suspect cases tested at Institut Pasteur in Lyon, France were positive for Ebola virus by PCR, confirming the first Ebola haemorrhagic fever outbreak in Guinea. Preliminary results from sequencing of a part of the L gene has showed strong homology with Zaire Ebola virus, Additional laboratory studies are ongoing to confirm these findings.

Actions taken

The Ministry of Health (MoH) together with WHO and other partners have initiated measures to control the outbreak and prevent further spread. The MoH has activated the national and district emergency management committees to coordinate response. The MoH has also advised the public to take measures to avert the spread of the disease and to report any suspected cases.

Multidisciplinary teams have been deployed to the field to actively search and manage cases; trace and follow-up contacts; and to sensitize communities on the outbreak prevention and control. Médecins Sans Frontières, Switzerland (MSF-CH) is working in the affected areas and is assisting with establishment of isolation facilities, and also supported transport of the biological samples from suspect cases and contacts to international reference laboratories for urgent testing.

The Emerging and Dangerous Pathogens Laboratory Network (EDPLN) is working with the Guinean VHF Laboratory in Donka, the Institut Pasteur in Lyon, the Institut Pasteur in Dakar, and the Kenema Lassa fever laboratory in Sierra Leone to make available appropriate Filovirus diagnostic capacity in Guinea and Sierra Leone.

WHO and other partners are mobilizing and deploying additional experts to provide support to the Ministry. The necessary supplies and logistics required supporting the management of patients and all aspects of outbreak control are also being mobilized.

The situation is rapidly evolving and reported figures are likely to change.



 
Security Council Meeting on the 13th Report of the Secretary-General
on the activities of the United Nations Office for West Africa (UNOWA)
Statement of Mr. Said Djinnit, 
8 July 2014
Said Djinnit July 8, 2014 alarmed Security Council on Ebola virus disease com “It  is_important that the international community pays due attention and support to this epidemic“ He was the Special Representative of the United Nations Secretary-General for West Africa
(...) THE EBOLA EPIDEMIC
Mr. President,
14. I would like to draw the Council’s attention to the fact that West Africa is currently struggling to respond to a deadly pandemic caused by the Ebola virus. The outbreak identified in February in the south-eastern region of Guinea has rapidly spread to Liberia and Sierra Leone. While significant progress in efforts to contain the outbreak of the disease has been recorded, a relapse has been noted in the last few weeks, with the risk of further spread within the region. The World Health Organization (WHO) reports that since February there have been at least 759 infections and 467 deaths related to the disease. It is important that the international community pays due attention and support to this epidemic which is adding to many other challenges to stability in the region.

full text


Security Council Press Statement
on United Nations Office for West Africa
8 July 2014

The following Security Council press statement was issued today by Council President Eugène-Richard Gasana (Rwanda):

On 8 July 2014, the members of the Security Council were briefed by the Special Representative of the Secretary-General for West Africa, Said Djinnit.

(...)

The members of the Security Council also expressed their deep concern over the current outbreak of the Ebola virus in some countries in West Africa and conveyed to the international community the need to provide prompt assistance in order to prevent the spread of the virus.

(...)
full text


World Health Organization Self-Accusation of Gross Negligence

World Health Organization Self-Accusation of Gross Negligence People responsible for for controlling the spread of infection failed epically. dr Z Halat , Medical Epidemiology Consultant: ebola-virus-disease.com

 
Statement of Dr Joanne Liu, International President, Médecins Sans Frontières/Doctors Without Borders (MSF)
in a special briefing at the United Nations, September 2, 2014

Ms Under Secretary General, Mr Special Coordinator, Mr Assistant Director General, distinguished delegates, ladies and gentlemen.
Two weeks ago, I made an urgent appeal to member states of the United Nations in New York for your help in stemming the Ebola epidemic in West Africa.
(...)
Today, the response to Ebola continues to fall dangerously behind, and I am forced to reiterate the appeal I made two weeks ago:
We need you on the ground. The window of opportunity to contain this outbreak is closing. We need more countries to stand up, we need greater deployment, and we need it NOW.  This robust response must be coordinated, organised and executed under clear chain of command.
Today, in Monrovia, sick people are banging on the doors of MSF Ebola care centres, because they do not want to infect their families and they are desperate for a safe place in which to be isolated.
Tragically, our teams must turn them away. We simply do not have enough capacity for them. Highly infectious people are forced to return home, only to infect others and continue the spread of this deadly virus. All for a lack of international response.
As of today, MSF has sent more than 420 tonnes of supplies to the affected countries. We have 2,000 staff on the ground. We manage more than 530 beds in five different Ebola care centres. Yet we are overwhelmed. We are honestly at a loss as to how a single, private NGO is providing the bulk of isolation units and beds.
We are unable to predict how the epidemic will spread. We are dealing largely with the unknown. But we do know that the number of recorded Ebola cases represents only a fraction of the real number of people infected.
We do know that transmission rates are at unprecedented levels. We do know that communities are being decimated. And, with CERTAINTY, we know that the ground response remains totally, and lethally, inadequate.
With every passing week, the epidemic grows exponentially. With every passing week, the response becomes all the more complicated.
(...)
The fight against this outbreak is more than just about controlling the virus. While thousands have died of Ebola, many more are dying from easily treatable conditions and diseases because health centres no longer function. Health structures need support to start working again and reduce death rates and suffering caused by other untreated ailments.
(...)
How the world deals with this unprecedented epidemic will be recorded in history books. This is a regional crisis with economic, social and security implications that reach far beyond the borders of the affected countries.

States have a political and humanitarian responsibility to halt this mounting disaster.
It can only be done by massively deploying assets to the field, and battling the epidemic at its roots.
The first pledges have been made, now more countries must urgently also mobilise. The clock is ticking.



People responsible for for controlling the spread of infection failed epically. God will not fail us.
We are just pilgrims passing through this world on our way to God.



Ignorance is excusable, but arrogance is a deadly sin.


What Secretary-General of the United Nations, Ban Ki-moon was preoccupied with?
Instead of fighting the Ebola virus disease global threat?

The United Nations arrogance is a deadly sin. They sin, others die.
The United Nations arrogance is a deadly sin. They sin, others die. The health and social consequences of premature sexual initiation and promiscuity. A lecture by dr Z Halat, Medical Epidemiology Consultant (2013)
The health and social consequences of premature sexual initiation and promiscuity.
A lecture by dr Z Halat, Medical Epidemiology Consultant (2013)

The United Nations arrogance is a deadly sin. They sin, others die.
The United Nations arrogance is a deadly sin. They sin, others die. The health and social consequences of premature sexual initiation and promiscuity. A lecture by dr Z Halat, Medical Epidemiology Consultant (2013)
The health and social consequences of premature sexual initiation and promiscuity.
A lecture by dr Z Halat, Medical Epidemiology Consultant (2013)

The United Nations arrogance is a deadly sin. They sin, others die.
The United Nations arrogance is a deadly sin. They sin, others die. The health and social consequences of premature sexual initiation and promiscuity. A lecture by dr Z Halat, Medical Epidemiology Consultant (2013)
The health and social consequences of premature sexual initiation and promiscuity.
A lecture by dr Z Halat, Medical Epidemiology Consultant (2013)

The United Nations arrogance is a deadly sin. They sin, others die.
The United Nations arrogance is a deadly sin. They sin, others die. The health and social consequences of premature sexual initiation and promiscuity. A lecture by dr Z Halat, Medical Epidemiology Consultant (2013)
The health and social consequences of premature sexual initiation and promiscuity.
A lecture by dr Z Halat, Medical Epidemiology Consultant (2013)

The United Nations arrogance is a deadly sin. They sin, others die.
The United Nations arrogance is a deadly sin. They sin, others die. The health and social consequences of premature sexual initiation and promiscuity. A lecture by dr Z Halat, Medical Epidemiology Consultant (2013)
The health and social consequences of premature sexual initiation and promiscuity.
A lecture by dr Z Halat, Medical Epidemiology Consultant (2013)

The United Nations arrogance is a deadly sin. They sin, others die.
The United Nations arrogance is a deadly sin. They sin, others die. The health and social consequences of premature sexual initiation and promiscuity. A lecture by dr Z Halat, Medical Epidemiology Consultant (2013)
The health and social consequences of premature sexual initiation and promiscuity.
A lecture by dr Z Halat, Medical Epidemiology Consultant (2013)

The United Nations arrogance is a deadly sin. They sin, others die.
The United Nations arrogance is a deadly sin. They sin, others die. The health and social consequences of premature sexual initiation and promiscuity. A lecture by dr Z Halat, Medical Epidemiology Consultant (2013)

All European campaign against promoting
incest, pedophilia,
and
teaching infants, toddlers, and preschoolers how to  masturbate.




 

Woman wearing trash bags saves family from Ebola
Morning Express with Robin Meade staff, September 25, 2014

Fatu Kekula created protective clothing from plastic bags, boots, simple mask
Turned away from hospital, Kekula took care of family at home

Fatu Kekula, student nurse, Kakata, Liberia saved her family from Ebola virus disease
All the world is proud of having Fatu Kekula among us.
Fatu Kekula, student nurse, Kakata, Liberia saved her family from Ebola virus disease

Fatu Kekula, student nurse, Kakata, Liberia saved her family from Ebola virus disease
All the world is proud of having Fatu Kekula among us.
Fatu Kekula, student nurse, Kakata, Liberia saved her family from Ebola virus disease

Fatu Kekula, student nurse, Kakata, Liberia saved her family from Ebola virus disease
All the world is proud of having Fatu Kekula among us.
Fatu Kekula, student nurse, Kakata, Liberia saved her family from Ebola virus disease

Fatu Kekula, student nurse, Kakata, Liberia saved her family from Ebola virus disease
All the world is proud of having Fatu Kekula among us.
Fatu Kekula, student nurse, Kakata, Liberia saved her family from Ebola virus disease

Fatu Kekula, student nurse, Kakata, Liberia saved her family from Ebola virus disease
All the world is proud of having Fatu Kekula among us.
Fatu Kekula, student nurse, Kakata, Liberia saved her family from Ebola virus disease


Fatu Kekula, student nurse, Kakata, Liberia saved her family from Ebola virus disease
All the world is proud of having Fatu Kekula among us.

And what about you? You mindless individual? No? Speak your mind.
Wah sa halat. If you aren't. Wolof is a language spoken in West Africa.

SPEAK YOUR MIND! WAH SA HALAT! FOLLOW YOUR SPIRITUAL LEADERS! ebola-virus-disease.com
SPEAK YOUR MIND! WAH SA HALAT! FOLLOW YOUR SPIRITUAL LEADERS!


Africa Stop Ebola
Tiken Jah Fakoly, Amadou & Mariam, Salif Keita, Oumou Sangare and others.
youtube
Ebola : «Aie confiance aux docteurs»
Paroles
LIBERATION 29 OCTOBRE 2014

Dans l’ordre d’apparition :
Kandia Kora (Guinée, en français) : «L’Afrique est pleine de tristesse de voir nos familles mourir, ne touchons pas nos malades, ne touchons pas les mourants. Tout le monde est en danger, les jeunes et les anciens, il faut agir pour nos familles.»

Tiken Jah Fakoly (Côte-d’Ivoire, en français) : «Ebola tu es notre ennemi. Si vous vous sentez malade les docteurs vont vous aider. Je vous rassure, les docteurs vont vous aider, il y a de l’espoir d’arrêter Ebola. Aie confiance aux docteurs».

Amadou et Mariam (Mali, en français) : «Ebola ce n’est pas bon, allez voir le médecin. Ebola fait du mal, il faut voir le docteur, Ebola ce n’est pas bon, allez voir le médecin.»

Salif Keita (Mali, en malinké) : «Prenez Ebola au sérieux. C’est une maladie très grave. Quand elle vous atteint, la mort s’ensuit. Des que vous avez les symptômes, envoyez chercher les médecins. Ils pourront vous aider. Lavez-vous régulièrement les mains et éviter de serrer la main d’autrui.»

Sia Tolno (Guinée, en kissi) : «Je vous prie chers parents, suivons les conseils des autorités médicales. Ebola est venu nous faire du mal, respectons leurs conseils.»

Barbara Kanam (RDC, en lingala) : «Ebola, tu tues nos populations, tu rajoutes de la douleur à la RDC, mais nous te vaincrons. Restons debout!»

Mory Kante (Guinée, en malinké et en soussou) : «Levez-vous, levez-vous, Ebola est un problème pour nous. On ne peut pas saluer quelqu’un, on ne peut pas embrasser quelqu’un. Ca ne veut pas dire que cette personne te fait honte, cest juste une réalité.»

Oumou Sangaré (Mali, en bambara): «Ebola est devenu un problè̀me pour nous aujourd’hui.Je demande à̀ tous les docteurs d’Afrique de se lever, Ebola est vraiment devenu un problème pour nous.»

Didier Awadi (Sénégal, en français): «Encore une fois on parle de tragé́die, comme une fausse note qui vient dans la mélodie, Ebola on te pensait depuis lors aboli, tu te balades en déboulant, semant la maladie On va pas fuir devant toi, on va pas s’enterrer. Car on le sait, on a les moyens de s’en tirer. On va te ferrer, on n’est pas pestiférés. On va se mettre ensemble, on va te virer.»

Marcus (Guinée, en soussou) : «Parmi eux, il y en a beaucoup qui ont pu accéder aux hôpitaux, ceux qui sont gué́ris ne sont plus contagieux. Il y en a qui restent chez eux jusqu’à ce que le mal prenne de l’ampleur. Oh mon Dieu, Mama Africa, lève-toi et restons unis comme nous avons l’habitude de le faire pour nos autres batailles: Ebola tu seras aussi vaincu.»

Mokobé (Mali, en français): «Encore un drame qui frappe le continent. L’Afrique a besoin de vaccin, de médicaments. Est-ce que l’espoir pour eux est permis? Faut-il fermer les yeux et les laisser dans l’oubli? Alors on s’unit pour la bonne cause. On se mobilise, on brise les portes closes. Ebola, je jure de te poursuivre jusqu’à̀ t’évincer. L’Afrique a besoin du vaccin pour se soigner. Ebola, Ebola, invisible enemy, Ebola Ebola, aie confiance aux docteurs.»
Ebola: "Trust the doctors'
lyrics
Google translated

In order of appearance:
Kandia Kora (Guinea, French): "Africa is full of sad to see our families die, do not touch our patients, do not touch the dying. Everyone is at risk, young and old, we must act for our families. "

Tiken Jah Fakoly (Ivory Coast, French): "Ebola you are our enemy. If you feel sick the doctors will help you. I assure you, the doctors will help you, there is hope to stop Ebola. Have confidence to the doctors. "

Amadou & Mariam (Mali, in French): "Ebola is not good, go see the doctor. Ebola hurt, you have to see the doctor, Ebola is not good, go see the doctor. "

Salif Keita (Mali, Malinke) "Take Ebola seriously. This is a very serious disease. When it reaches you, death follows. Once you have the symptoms, send for the doctors. They can help you. Wash your hands frequently and avoid shaking hands with others. "

Sia Tolno (Guinea, Kissi): "I beg you dear parents, following the advice of medical authorities. Ebola came to do us harm, respect their advice. "

Barbara Kanam (DRC, Lingala): "Ebola, you kill our people, you want to add some pain to the DRC, but we will defeat you. Remain standing! "

Mory Kante (Guinea in Malinke and Sousou): "Get up, get up, Ebola is a problem for us. We can not greet someone, you can not kiss someone. That does not mean that that person makes you ashamed, it's just a reality. "

Oumou Sangare (Mali, Bambara): "Ebola has become a problem for us today.I'll ask all doctors from Africa to stand up, Ebola has really become a problem for us."

Awadi (Senegal, French): "Once again we speak of tragedy, as a false note in the melody that comes, Ebola thought you since abolished thou rides tumbling, spreading the disease is going to flee you, we will not be buried. As we know, we have the means to get away. We will strike you, you are not the plague. We will come together, we will fire you. "

Marcus (Guinea, Susu): "Among them, there are many who have gained access to hospitals, those who are cured are no longer contagious. There are those who remain at home until the evil from worsening. Oh my God, Mama Africa, rise up and stand together as we used to do for our other battles. Ebola thou also shalt be defeated "

Mokobé (Mali, French): "Another tragedy strikes the continent. Africa needs vaccines, medicines. Do hope for them is allowed? Should we close our eyes and let them into oblivion? So we united for a good cause. It mobilizes the closed doors is broken. Ebola, I swear to pursue you until evict you. Africa needs the vaccine for treatment. Ebola Ebola invisible enemy, Ebola Ebola, trust the doctors. "


Frequently asked questions on Ebola virus disease
Updated 8 August 2014

WHO does not advise families or communities to care for individuals who may present with symptoms of Ebola virus disease in their homes. Rather, seek treatment in a hospital or treatment centre staffed by doctors and nurses qualified and equipped to treat Ebola virus victims. If you do choose to care for your loved one at home, WHO strongly advises you to notify your local public health authority and receive appropriate training, equipment (gloves and personal protective equipment [PPE]) for treatment, instructions on proper removal and disposal of PPE, and information on how to prevent further infection and transmission of the disease to yourself, other family members, or the community.

 

Ebola: Massive Distribution of Home Disinfection Kits Underway in Monrovia
October 2, 2014 

Teams from Doctors Without Borders/Médecins Sans Frontières (MSF) have begun distributing more than 50,000 family protection and home disinfection kits in Monrovia, Liberia, as part of the organization’s Ebola response. The kits are designed to give people some protection should a family member become ill and also allow them to disinfect their homes, reducing the chance that others in the household could become infected.

“We know these kits are not the solution to the Ebola crisis in Monrovia,” said Anna Halford, coordinator for the distribution. “But the scale of the epidemic, and the inadequacy of the response so far, means that we are forced to take unprecedented and imperfect measures.

"In order to get the epidemic under control, all infected people must be able to have a bed in a treatment center, but until the facilities that have been promised materialize, this will be impossible. In the meantime, these kits offer people some protection from an infected family member until they can get the medical care they need in an Ebola management center.”

The kits, which are distributed in two buckets, contain chlorine, soap, gloves, a gown, plastic bags, a spray bottle, and masks. The kits also contain health promotion messages and instructions for their safe use. MSF started the distribution by giving the kits to people who were turned away from MSF’s treatment center when it was full, to contacts of patients at the center, to those working at the center, and to those living nearby.
(...)

full text



Deuteronomy 31:8  "The Lord will lead you. He himself is with you. He will not fail you or leave you. Don’t worry. Don’t be afraid!”
Easy-to-Read Version (ERV)
Gospel of John 6:51 : "I am the living bread that came down from heaven. Whoever eats this bread will live forever. This bread is my body. I will give my body so that the people in the world can have life.”
Easy-to-Read Version (ERV).
. Saint Charles Borromeo, the patron saint of plague victims, pray for us.
Caspar Franz Sambach:  'St. Charles Borromeo ministering Holy Communion to the dying during the 1576 plague epidemic in Milan', 1751 (detail) National Museum in Wroclaw, Poland  Saint Charles Borromeo, the patron saint of plague victims, pray for us.
Caspar Franz Sambach: 'St. Charles Borromeo ministering Holy Communion to the dying during the 1576 plague epidemic in Milan', 1751 (detail),
entire painting

 National Museum in Wroclaw, Poland  


In 1576 there was famine at Milan due to crop failures, and later came an outbreak of the bubonic plague (Peste di San Carlo 1576-1577) with 17,000 deaths. The city's trade fell off, and along with it the people's source of income. The governor and many members of the nobility fled the city, but Charles cardinal Borromeo archbishop of Milan remained, to organize the care of those who were stricken and to minister to the dying. Borromeo's emblem is the Latin word humilitas (humility),  Borromeo is one of only four people mentioned at the beginning of the Catechism of the Catholic Church: "The Council of Trent initiated a remarkable organization of the Church’s catechesis. Thanks to the work of holy bishops and theologians such as St. Peter Canisius, St. Charles Borromeo, St. Turibius of Mongrovejo, or St. Robert Bellarmine, it occasioned the publication of numerous catechisms", The Roman Catechism
Catechism of the Council of Trent  of 1566 was edited under St. Charles of Borromeo

"We are passing through a very difficult time for our Hospitaller Family, having lost three Brothers, one Sister and several Co-workers as a result of this Ebola epidemic. I therefore urge everyone to unite in prayer, hospitality and fraternity. Although the news fills us with sadness and grief, we have to accept the life of our Brothers, given up like Christ’s to the point of dying after contracting this virus, in the light of faith, with hope and a healthy sense of pride in their faithfulness and radical testimony to hospitality."
Bro. Jesús Etayo, Superior General, New Circular Letter of the Prior General to the Provincial Superiors, All the Members of the Hospitaller Family of St John of  God, August 12, 2014
full text here

Information concerning our Centres in Liberia and Sierra Leone
To the whole Hospitaller Family of St John of God
We should like to give you some information about the present situation in the Order’s Centres in these two countries where, during the months of July and August, a number of Brothers and co-workers died after contracting the Ebola virus. At the Hospital of Saint Joseph in Monrovia (Liberia) Brothers Patrick Nshamdze, George Combey and  Miguel Pajares lost their lives (Pajares who fell ill in Liberia, was repatriated to Spain, where he died). Also killed were Sister Chantal Mutwameme and five Co-Workers – three women and two men.  At the Hospital of St John of God in Lunsar (Sierra Leone) Ebola killed eight Co-Workers – three men and five women – including  a student nurse in her last year of training. All died of Ebola in the performance of their duty of assisting the sick.
Let us recall and honour their memories once again, and thank the Lord for their testimony of hospitality on behalf of our Hospitaller Family and of the whole Church. At the same time we ask them to let their living testimony yield abundant fruits for the Church and the Order, just as a kernel of wheat dies to produce new life.
General Curia, Missions and International Cooperation Office, Rome, 10 September 2014
full text here
El Hermano Manuel García Viejo es médico especialista en medicina interna y diplomado en medicina tropical, y pertenece a la Orden Hospitalaria de San Juan de Dios (OHSJD) desde hace 52 años. Asimismo, ha dedicado los últimos 30 años a trabajar en Africa, y desde hace 12 años es el director médico del Hospital San Juan de Dios en Lunsar. El enfermo habría dado positivo en la prueba de ébola a primeras horas de sábado 20 de septiembre de 2014.
full text here

Orden Hospitalaria de San Juan de Dios - Brothers Hospitallers of St. John of God - Ordine ospedaliero di San Giovanni di Dio, Fatebenefratelli

Brother Patrick Nshamdze, Medical Doctor born in Cameroon died from Ebola Virus Disease August 2, 2014 Sister Chantal Pascaline Motwameme born in the Congo died from Ebola Virus Disease August 9, 2014 Brother George Combey born in Ghana died from Ebola Virus Disease August 12, 2014 Brother Miguel Pajares born in Spain died from Ebola Virus Disease August 12, 2014
Brother Patrick Nshamdze,
Medical Doctor
born in Cameroon
died from Ebola Virus Disease
August 2, 2014
Sister Chantal Pascaline Motwameme
born  in the Congo
died from Ebola Virus Disease
August 9, 2014
Brother George Combey
born in Ghana
died from Ebola Virus Disease
August 12, 2014
Brother Miguel Pajares
born in Spain
died from Ebola Virus Disease
 August 12, 2014


Brother Manuel García Viejo Medical Doctor born in Spain died from Ebola Virus Disease September 25, 2014
Brother Manuel García Viejo
Medical Doctor
born in Spain
died from Ebola Virus Disease
September 25, 2014

Why do Christians risk their lives? ¿Por qué los cristianos arriesgan su vida? Dlaczego chrześcijanie ryzykują życiem?
For the love of God, Christians devote themselves to the poor, the sick and all the disadvantaged of the world.
Por el amor de Dios los cristianos se entregan a los pobres, enfermos y a todos los desfavorecidos del mundo.
Z miłości do Boga chrześcijanie poświęcają się biednym, chorymi i wszystkim pokrzywdzonym na świecie.

Statue of St. John of God, the patron saint of the sick and the dying (L to R) at the Church of the Holy Trinity of Brothers Hospitallers of St. John of God in Wroclaw, Brothers Hospitallers Province of Poland, dedicated to the Annunciation of the Most Holy Virgin Mary. Church of Saint Lazarus built in the 14th century at a leper colony by The Military and Hospitaller Order of Saint Lazarus of Jerusalem
Statue of St. John of God, the patron saint of the sick and the dying
(L to R) at the Church of the Holy Trinity of Brothers Hospitallers
of St. John of God in Wroclaw, Brothers Hospitallers Province of Poland, dedicated to the Annunciation of the Most Holy Virgin Mary.
Church of Saint Lazarus built in the 14th century at a leper colony by The Military and Hospitaller Order of Saint Lazarus of Jerusalem



By Bro. Tagoy Jakosalem, OAR

THEY have chosen the path to serve the people of Sierra Leone in the face of the harrowing outbreak of Ebola virus. The four (4) Filipino missionaries are: Br. Jonathan Jamero, OAR; Fr. Roy Baluarte, OAR; Fr. Russell Lapidez, OAR and Fr. Dennis Castillo, OAR; they are accompanied by two other Spanish missionaries: Fr. Jose Luis Garayoa, OAR & Fr. Rene Gonzales.

Mission beginnings

The Order of Augustinian Recollects or Recoletos started their missionary activity in Sierra Leone, West Africa in the year 1997; administering the Our Lady of Sierra Leone Parish in Kamabai, Biriwa Chiefdom. Due to the civil war, the missionaries suffered the effects of the conflict; after defending and accompanying the flock they were compelled to leave Sierra Leone. After peace has been restored in the country, the second batch of Recoletos missionaries returned in the year 2004.

There are about sixty small Christian communities under the community’s mission. The Diocese of Makeni entrusted to the missionaries the administration of the thirty-three (33) primary schools. Besides the work of evangelization, the missionaries are also engaged in charitable works such as, medical help, installation of water-wells in remote villages, and other humanitarian services to the people who are in need.

“I’m proud of the brothers who are brave enough on deciding to stay amidst the danger, let us support them with our prayers,” said Fr. Edgar Tubio, OAR, prior of the mission, who got back to the Philippines for vacation few months before the Ebola outbreak. “Let us continue to intensify our support to the Recoletos missionaries who are working with the Sierra Leonean people.”

Lately, the missionaries created preventive measures to contain the outbreak, devising practical strategies to quarantine affected areas, and providing water-cleanser in the chapels and convent compound.

Decision to stay

“Few days ago, after conferring to each other we, the Augustinian Recollect missionaries have decided to remain steadfast to the mission entrusted to us. We are all afraid but we choose to be with our people to continue to give hope to them especially during this time of difficulties. Preaching the Gospel and at the same time sensitizing the people about the Ebola virus gives new meaning to our work of evangelization. May God protect us from Ebola virus” said Fr. Russel Lapidez, OAR.

The work of the Recoletos missionaries in the Diocese of Makeni mostly involved in education and community organizing, fomenting a holistic development of faith-experience. Actively engaging the people and being part of the local community.

Fr. Lauro V. Larlar, OAR, the Prior Provincial of the Province of St. Ezekiel Moreno, in whose jurisdiction the Sierra Leone mission belongs, reiterated “May we ask the Augustinian Recollect family and our people to please offer prayers and sacrifices for the people in West Africa, especially to our missionaries stationed in Sierra Leone, who are now in a frightening situation due to the deadliest Ebola virus outbreak. Together we humbly beg the help of God’s grace and mercy to protect them from all harm and allowing them to see His beam of light in the midst of this darkness. For this and in solidarity with our suffering brothers and sisters, may we ask you dear people of God to pray with us that the good Lord be their comfort and strength in this time of uncertainty.”

First hand experience, evaluating realities

Fr. Lapidez provided this reality-check experience in his communication to fellow Recoletos: “It was early April when I heard the Ebola outbreak for the first time, and from that time on I tried to follow the issue, since we are not really far from Guinea, and my fear at that time that the EVD will enter Sierra Leone is now a reality. Based on the testimonies of those who were directly involved in handling the cases and other sources of information, these are the contributing factors that led to the rapid wide spread of the Ebola Virus disease in Sierra Leone in the span of six months. First is the delayed imposition of the government for stricter movement of the people in the borders of Sierra Leone after the first case of Ebola contagion in neighboring countries (Guinea and Liberia) erupted.

“Second is the ignorance and incredulity of some people regarding the reality and dangers of Ebola virus. There are those in the villages whom we have tried to sensitize about the existence of EVD and warned not to eat monkeys or bush meat that could possibly be infected by the EVD but they just shrug us off for a simple reason that, from the time of their ancestors up to this moment they have been eating monkeys and bush meats, and so far they have not yet been infected by the Ebola virus. It was only when Doctor Sheik Umar Khan, the only virologist in Sierra Leone and the head of the task force fighting EVD outbreak, got infected of the virus and later on died, that the people begun to realize that Ebola virus is really real and deadly.

“Third is the traditional washing or ritual cleansing of the dead bodies which is usually done in the house. The immediate family members are the most susceptible in contracting the EVD. Just like the sixteen year old boy who took care of his sick mother and afterward died with Ebola virus. Consequently, the boy got infected also and later on died as well.

“Fourth is the poor health facilities and shortage of trained personnel that are capable of handling Ebola infected patients. In fact, three medical doctors and over 20 nurses who took care of the patients also got infected and died. This terrible situation stimulated some of the medical staffs to abandon their work as a protest to the government for neglecting them in spite of their sacrifices and putting their lives in danger.

“Fifth, the contributing factor is the stigma of being infected by the virus or just being suspected which compelled the victims not to go to the hospital or to seek any medical help. As an alternative, the Ebola virus carriers look for traditional healers and consequently transmit the disease to them. The stigma also affects the family members, like what happened to a woman who was admitted to a hospital in Freetown and been confirmed positive of Ebola virus. The family members tried to use force to remove the woman out of the hospital. The condition got worse after another frightful situation happened in the Ebola treatment Centre at Kenema, when a group of people staged riot outside the facility which was instigated by a woman who broadcasted that Ebola does not exist at all, and the center is just a front of the medical practitioners to make money by harvesting organs and extracting blood from the patients. Reflecting on the flow of events I surmised that the utmost contributors to the outbreak are the people themselves.”

Continuing heroism

The Filipino Recoletos missionaries’ dedication to mission is a continuing heroic legacy especially in Sierra Leone, in Africa. During the civil war in the 1990′s, three Missionaries opted to stay with the people; heroically defending women & children at gunpoint. Fr. Raul Buhay, OAR, Fr. Manny Lipardo, OAR & Fr. Jose Luis Garayoa, OAR together with the people walked across miles and months evading armed rebels and the danger of execution, and being able to survive and being freed.

The mark of the Recoletos mission is: bringing the experience of Christ’s love in the community. In the name of the Recoletos missionaries, Fr. Lapidez said “I reiterated the stand of the Augustinian Recollects that we are staying and we will continue the mission entrusted to us by the Church. And since we decided to stay with the people whom we are serving, we are then bound to take part in the government effort of informing the people of the reality and the threat of Ebola virus, as well as, how to protect themselves from contracting it.”

Augustinian Recollect Province of Saint Ezequiél Moreno
Orden de Agustinos Recoletos
Los agustinos recoletos asumen el riesgo de contraer el ébola y se quedan en sus misiones
Agosto 2014, SIERRA LEONA

“Tengo miedo, mucho miedo. Pero sé que todos los que me conocéis os sorprenderíais si huyese por temor al contagio”, escribe desde la misión de Kamabai, en Sierra Leona, el agustino recoleto José Luis Garayoa. Este religioso navarro está íntimamente ligado a la historia del país africano. En 1998 fue secuestrado por los rebeldes durante la guerra civil que asoló el país. En 2005 pidió a sus superiores volver a alguna de las dos misiones que la Orden tiene en Sierra Leona. Son cuatro filipinos y dos españoles los agustinos recoletos que trabajan en el país africano.2014-08-06 El misionero agustino recoleto José Luis Garayoa, rodeado de niños de Sierra LeonaHace cuatro meses que el misionero alertaba sobre la situación del ébola en la zona a través de su blog. “Es cierto que el problema es más serio de cómo nos lo presentan, porque tampoco es bueno provocar el pánico. Han muerto bastantes en la frontera con Sierra Leona y el virus ya lo tenemos aquí, en Kambia. También lo tienen en Liberia. Y parece ser que de los 5 tipos posibles, nos ha tocado el premio gordo, la cepa Zaire, la más mortal. Es la lotería de los pobres”. Las autoridades españolas, conocedoras de la situación y de su presencia en el oeste africano, se han puesto en contacto con él: “Me llamaron de parte de la Embajada Española para asegurarse de que estaba bien y pidiéndome tener cuidado. Lo que pasa es que no me veo embutido en un traje tipo espacial de la NASA para convivir con mi gente. Han venido de la OMS (Organización Mundial de la Salud) y de MF (Médicos sin Fronteras) para intentar cercar y aislar el virus, porque otra cosa no se puede hacer. Solo dan tratamiento paliativo a los contagiados y la mortalidad es del 90%. También se nos ha hablado del protocolo que se sigue en estos casos: si en una aldea se multiplican los infectados, aíslan la aldea, dejan morir a todos, y luego incineran el lugar. Parece que eso era algo que sólo se daba en las películas, pero a pesar de lo duro que suena, sabemos que es así. Quizás ésa es una de las razones por las que no se puede hablar con detalle de todo lo que conlleva la aparición de un nuevo brote de ébola”. Mono, murciélago y puercoespín Los gobiernos de la región también se dirigieron al misionero agustino recoleto para que tomara medidas: “Acabo de recibir una carta del Ministerio de Educación y del Ministerio de Salud para que informemos a nuestras escuelas de que deben de extremar los cuidados. Y sobre todo, no comer carne de mono, ni de murciélagos, ni de pMr Dessie Quinn, OBM (of blessed memory)
treated for malaria, died from malaria, ebola or both?
Eternal rest, grant unto him, O Lord,
and let perpetual light shine upon him.
May he rest in peace. Amen.uerco espines, ni de animales muertos. Tampoco tocar a los enfermos sospechosos, y simplificar los ritos funerarios porque el cadáver podría estar también contaminado. Ni me quiero acordar de todos los monos y puerco espines que me he comido celebrando San Francisco Javier, el santo Patrono de Kamayeh. Los Ministros de Sanidad de los países vecinos comienzan a pensar en la posibilidad de cerrar fronteras para evitar la propagación. Parece que la OMS todavía no ha prohibido los vuelos al West África”. Con ébola o sin él “No lo he hecho nunca, y ya no tengo edad para huir. Mis noches se llenarían de pesadillas al sentirme traidor a mi pueblo. Así que, con ébola o sin él, no pienso alterar en lo más mínimo mi salida del país que, si Dios quiere, será la primera semana de septiembre”, aclara Garayoa en su blog. Al mismo tiempo que se lamenta de que la enfermedad haya paralizado el programa previsto con los voluntarios: “Lo cierto es que voluntarios que pensaban venir a Sierra Leona, con visado y billete de avión ya listos, han sido convencidos por el Instituto Pasteur, que es el encargado de analizar las muestras de sangre que les envían desde la zona del brote, sobre la no conveniencia de venir por el momento. En fin, nos duele, pero entendemos perfectamente la decisión de anular el viaje, a pesar de la tristeza que da el tener que renunciar a los planes soñados. Al final, los que lo pagan, como siempre, son los más pequeños”. Y concluye certeramente: “Los misioneros no solemos ser nunca los primeros en abandonar el barco. Tampoco ahora. Si, como dice el Papa Francisco, el pastor debe de oler a oveja, conviviendo cerquita de ellas, con mucha más razón deberá estar presente si el lobo las ataca. Solo el asalariado huye cuando ve llegar el peligro. El buen pastor es el que da la vida por las ovejas. Y eso es amor que de Jesús de Nazareth aprendí”. Misionero infatigable José Luis Garayoa Alonso nació en Falces (Navarra, España). Vivió en Pamplona con su familia hasta que ingresó en el seminario menor de Lodosa (Navarra), hizo la profesión en Monteagudo (Navarra) el 13 de agosto de 1972, estudió en Marcilla (Navarra) donde hizo la profesión solemne en 1975 y fue ordenado sacerdote el 11 de julio de 1976. Comenzó a ejercer su ministerio en México: Chihuahua y México DF. Ha trabajado en la Ciudad de los Niños de Costa Rica durante diez años, en el colegio San Agustín de Valladolid nueve, y después de pasar un breve tiempo en Madrid fue voluntario para la misión agustino recoleta en África, en Sierra Leona. A las pocas semanas de estar en la misión, fue secuestrado por las RUF (guerrilla rebelde) de Sierra Leona el 14 de febrero de 1998 en Lunsar. Fue liberado, junto a sus compañeros (tres hermanos de San Juan de Dios y un voluntario), 15 días más tarde. Después estuvo siete años en El Paso (USA) y desde 2005 desarrolla su labor en la misión de Kamabai, de nuevo en Sierra Leona.



Medical workers cope with fear and deadly Ebola virus
Maria Cheng, Associated Press, August 18, 2014

Doctors and nurses fighting Ebola in West Africa are working 14-hour days, seven days a week, wearing head-to-toe gear in the heat of muddy clinics. Agonizing death is the norm.
(...)
Cokie van der Velde, a sanitation specialist for Doctors Without Borders in Guinea and Liberia, cleaned Ebola wards — washing floors, emptying buckets and collecting bodies.

One day, she came across a harrowing sight.

"I walked into a room with four bodies and they'd all died in the most grotesque positions, with a lot of blood and feces everywhere," she said. "During the night, one man had crawled to the door and the other people who died, they seemed to have fallen off their beds and were bent backwards."

Normally, the Briton spends her days in Yorkshire, England, tending to her garden and looking after her grandchildren. Van der Velde has worked on two previous Ebola outbreaks and says she does it because she believes in justice and equality.

She said the need for medical care is overwhelming in this outbreak because of the heavy toll Ebola has taken on health workers. Many of those sickened and killed have been doctors and nurses. That has sparked fear among local staffers and led to strikes and resignations.

"I can't blame them," van Der Velde said. "They're scared."




 Leipzig, Deutschland / Leipzig, Germany
14.10.2014 15:35

Ebola-Patient am Klinikum St. Georg verstorben

Die Isolierstation des Klinikums St. Georg/The Secure Isolation Ward of St. Georg Hospital

Leipzig. Der seit vergangenen Donnerstag im Klinikum St. Georg behandelte Patient mit Ebola ist in der Nacht zum Dienstag an den Folgen seiner Erkrankung verstorben. Der 56-jährige UN-Mitarbeiter war in der vergangenen Woche mit einem Spezialflugzeug nach Leipzig gebracht worden. Zu den näheren Umständen des Todes können aufgrund der ärztlichen Schweigepflicht und der Personenschutzrechte keine Angaben gemacht werden.
„Wir bedauern den Tod des an Ebola erkrankten Patienten sehr und sprechen der Familie und den Freunden des Patienten unser tiefes Mitgefühl aus. Trotz der intensiven medizinischen Betreuung und den höchsten Anstrengungen der Ärzte und Pfleger konnte der Tod nicht verhindert werden“, erklärte Dr. Iris Minde, Geschäftsführerin des Klinikums St. Georg.

Hintergrund
Der Patient befand sich bereits bei seiner Ankunft in einem sehr kritischen Zustand und erhielt am Klinikum eine lebensstabilisierende Behandlung. Auf der Sonderisolierstation für hochinfektiöse Krankheiten war er in einem Unterdruckzimmer untergebracht. Hohe Sicherheitsvorkehrungen gewährleisten dort, dass keine Krankheitserreger nach außen gelangen. Dazu gehören unter anderem ein spezielles Lüftungssystem, das die Zu- und Abluft filtert, sowie die Dekontamination des Abwassers.

In den letzten Tagen wurden bei der Behandlung des Patienten pro Stunde mindestens 20 bis 30 Einweg-Handschuhe gewechselt. Zusätzlich wurden pro Tag bis zu 100 spezielle Schutzanzüge verbraucht. Alle verwendeten Materialien gelten als Sondermüll der Sicherheitsstufe 4 und werden entsprechend der Richtlinien des Robert Koch Institutes sicher entsorgt. Für die Dekontaminierung des Sondermülls kommt direkt im Klinikum St. Georg der Autoklav zum Einsatz. Das ist ein gasdicht verschließbarer Druckbehälter zur Dampfdrucksterilisation.

Der Erkrankte wurde rund um die Uhr von Mitarbeitern im Schichtsystem versorgt. Pro Schicht sind mindestens sechs Mitarbeiter im Dienst. Das Personal wurde in der medizinischen Versorgung von Infektionskrankheiten speziell ausgebildet. In der Einhaltung der hygienischen Standards wurde größte Sorgfalt angewandt. Das Klinikpersonal war stets mit flüssigkeitsdichten Anzügen und speziellen Respiratoren ausgestattet. Das Ausziehen der Schutzkleidung wurde durch eine zweite und dritte Person übernommen und niemals selbst durchgeführt. Jeder dekontaminierte den anderen – dabei erfolgt eine wechselseitige Kontrolle. Das Personal wird kontinuierlich gesundheitlich überwacht.
October 14, 2014   15:35

Ebola patient died at the St. George Hospital

The isolation ward of the hospital St. George / The Secure Isolation Ward of St. Georg Hospital

Leipzig. The treated since last Thursday in St. Georg Hospital patient with Ebola died in the early hours of Tuesday from the effects of his illness. The 56-year-old UN staff had been brought in the past week with a special plane to Leipzig. The detailed circumstances of death, no details can be made due to medical confidentiality and the protection of persons rights.
"We regret the death of the patient suffering from Ebola much and talk to family and friends of patients, our deepest sympathy. In spite of intensive medical care and the highest efforts of the doctors and nurses of death could not be prevented, "said Dr. Iris Minde, director of the Hospital of St. George.

Background
The patient was already on his arrival in a very critical condition at the hospital and received a life-stabilizing treatment. On the special isolation forinfectious diseases he was housed in a vacuum room.High safety precautions ensure there that nopathogens escape. These include a special ventilation system, which filters the air supply and exhaust, as well as decontamination of the waste water.

In recent days, at least 20 to 30 disposable gloves were changed in the treatment of patients per hour. In addition, up to 100 special protective suits were consumed per day. All materials used are classified as hazardous to the safety level 4 and be disposed of safely in accordance with the guidelines of the Robert Koch Institute. For the decontamination of hazardous waste comes directly in Hospital St. Georg, the autoclave is used. Which is a gas-tight sealable pressure vessel for steam-pressure sterilization.

The ill was provided around the clock by employees in the shift system. At least six employees are on duty per shift. The staff has been in the medical treatment of infectious diseases specially trained. In compliance with the hygiene standards with utmost care. The hospital staff was always equipped with liquid-tight suits and special respirators. The removing overalls was taken over by a second and third person and never performed himself. Each decontaminated the other - while there is a mutual control. The staff is continuously monitored health.






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Petitioning World Health Organization 2
Help Prevent the Ebola Pandemic in West Africa
Elexie Munyeneh
Petition by
Elexie Munyeneh 
Charlotte, United States

The Ebola virus is a rare and annihilative disease which has a 90% fatality rate. In 1976, the first occurrence of Ebola was recorded in the Democratic Republic of Congo. 318 people tested positive for the disease, and 280 died. Between 1976 and 2013, the virus has sporadically reoccurred in remote parts of the world and has claimed the lives of more than 1,548 people. Due to the virus’ sporadic occurrences, medical researchers have been unable to find a cure. Little is known of the virus but that it can be contracted through bodily fluids (sweat, blood, saliva, semen, urine) and close contact to areas of infection. Symptoms observed in Ebola patients include reddening of the eyes, diarrhea, swelling of the genitals, profuse internal and external bleeding, etc. The most recent and also deadliest case of Ebola is currently occurring in West Africa. The first case of Ebola in West Africa was reported from a small Guinean district in the February of this year. Three days later, a bordering country, Liberia, identified its first Ebola victim. On March 31, only a day later, Sierra Leone marked the third West African country to have succumbed to the disease. And on July 22, a Liberian-American who stopped in Nigeria, died of the disease there. Between these four African countries, 1,200 cases of Ebola have been reported, while more than 672 people have been pronounced dead. 672 may seem too little a number for a so-called fatal disease, but other unmentioned details of the outbreak may cause more alarm. The first detail to note is that the virus has been spreading in very remote regions, and has been contained in these remote regions of West Africa because of the doctors who have been stridently working to halt the outbreak. Dr. Sheik Umar, a Sierre Leonean doctor who had treated more than 100 Ebola victims died of the disease on July 23. Dr. Samuel Brisbane, a Liberian doctor who had also been working against the outbreak died on July 27. Dr. Kent Brantly, an American doctor from Texas who had been in Liberia for more than 3 months, and who also played a major role in eradicating the virus, is in grave condition and needs serious medical attention. Nancy Writebol, an American missionary and Health Care worker also helping to eradicate the virus has fallen ill to it. The sudden illness of major Doctors has caused local nurses to flee Ebola treatment centers, leaving many patients unattended and thus spread the disease.

These countries, on their own, cannot contain the Ebola. In Liberia for an example, the ratio of doctors to citizens is 1 to 100,000. But by signing and sharing this petition, more awareness will be created about the outbreak, thus increasing medical doctors and supplies sent to West Africa. Thank you.

Samiritan Purse Has Pulled More of it's Workers Out of Liberia.

***Tell Who To Send More Doctors to West Africa***

Sign this petition
300,000 supporters needed


WEST AFRICA Ebola Outbreak How do you get the Ebola virus? Direct contact with: 1. Bodily fluids of a person who is sick with or has died from Ebola. (blood, vomit, pee, poop, sweat, semen, spit, other fluids) 2. Object contaminated with the virus (needles, medical equipment) 3. Infected animals (by contact with blood or fluids or infected meat) August 16, 2014: U. S. Department of Health and Human Services Centers for Disease Control and Prevention (CDC) Infographics WEST AFRICA
Ebola Outbreak


How do you get the Ebola virus?


Direct contact with:

1. Bodily fluids of a person who is sick with or has died from Ebola.
(blood, vomit, pee, poop, sweat, semen, spit, other fluids)

2. Object contaminated with the virus (needles, medical equipment)

3. Infected animals (by contact with blood or fluids or infected meat)


August 16, 2014: U. S. Department of Health and Human Services
Centers for Disease Control and Prevention (CDC) Infographics


Centers for Disease Control and Prevention
Q&As on Transmission; updated: September 22, 2014

What are body fluids?

Ebola has been detected in blood and many body fluids. Body fluids include saliva, mucus, vomit, feces, sweat, tears, breast milk, urine, and semen.

Can Ebola spread by coughing? By sneezing?

Unlike respiratory illnesses like measles or chickenpox, which can be transmitted by virus particles that remain suspended in the air after an infected person coughs or sneezes, Ebola is transmitted by direct contact with body fluids of a person who has symptoms of Ebola disease. Although coughing and sneezing are not common symptoms of Ebola, if a symptomatic patient with Ebola coughs or sneezes on someone, and saliva or mucus come into contact with that person’s eyes, nose or mouth, these fluids may transmit the disease.

What does “direct contact” mean?

Direct contact means that body fluids (blood, saliva, mucus, vomit, urine, or feces) from an infected person (alive or dead) have touched someone’s eyes, nose, or mouth or an open cut, wound, or abrasion.

How long does Ebola live outside the body?

Ebola is killed with hospital-grade disinfectants (such as household bleach). Ebola on dried on surfaces such as doorknobs and countertops can survive for several hours; however, virus in body fluids (such as blood) can survive up to several days at room temperature.

Are patients who recover from Ebola immune for life? Can they get it again - the same or a different strain?

Recovery from Ebola depends on good supportive clinical care and a patient’s immune response. Available evidence shows that people who recover from Ebola infection develop antibodies that last for at least 10 years, possibly longer.
We don’t know if people who recover are immune for life or if they can become infected with a different species of Ebola.

If someone survives Ebola, can he or she still spread the virus?

Once someone recovers from Ebola, they can no longer spread the virus. However, Ebola virus has been found in semen for up to 3 months. People who recover from Ebola are advised to abstain from sex or use condoms for 3 months.

Can Ebola be spread through mosquitos?

There is no evidence that mosquitos or other insects can transmit Ebola virus. Only mammals (for example, humans, bats, monkeys and apes) have shown the ability to spread and become infected with Ebola virus.

Page last reviewed: September 22, 2014
Page last updated: September 22, 2014


CDC Removed Info On Coughing And Sneezing From Ebola Q&A (UPDATE)

Q&As on Transmission

What are body fluids?

Ebola has been detected in blood and many body fluids. Body fluids include saliva, mucus, vomit, feces, sweat, tears, breast milk, urine, and semen.

What does “direct contact” mean?

Direct contact means that body fluids (blood, saliva, mucus, vomit, urine, or feces) from an infected person (alive or dead) have touched someone’s eyes, nose, or mouth or an open cut, wound, or abrasion.

Can Ebola be spread by coughing or sneezing?

There is no evidence indicating that Ebola virus is spread by coughing or sneezing.  Ebola virus is transmitted through direct contact with the blood or body fluids of a person who is sick with Ebola; the virus is not transmitted through the air (like measles virus). However, droplets (e.g., splashes or sprays) of respiratory or other secretions from a person who is sick with Ebola could be infectious, and therefore certain precautions (called standard, contact, and droplet precautions) are recommended for use in healthcare settings to prevent the transmission of Ebola virus from patients sick with Ebola to healthcare personnel and other patients or family members.

How long does Ebola live outside the body?

Ebola is killed with hospital-grade disinfectants (such as household bleach). Ebola on dry surfaces, such as doorknobs and countertops, can survive for several hours; however, virus in body fluids (such as blood) can survive up to several days at room temperature.

Are patients who recover from Ebola immune for life? Can they get it again - the same or a different strain?

Recovery from Ebola depends on good supportive clinical care and a patient’s immune response. Available evidence shows that people who recover from Ebola infection develop antibodies that last for at least 10 years, possibly longer.

We don’t know if people who recover are immune for life or if they can become infected with a different species of Ebola.

If someone survives Ebola, can he or she still spread the virus?

Once someone recovers from Ebola, they can no longer spread the virus. However, Ebola virus has been found in semen for up to 3 months. Abstinence from sex (including oral sex) is recommended for at least 3 months. If abstinence is not possible, condoms may help prevent the spread of disease.

Can Ebola be spread through mosquitos?

There is no evidence that mosquitos or other insects can transmit Ebola virus. Only mammals (for example, humans, bats, monkeys and apes) have shown the ability to spread and become infected with Ebola virus.

Page last reviewed: October 30, 2014
Page last updated: October 30, 2014
 full text





World Health Organization
What we know about transmission of the Ebola virus among humans
Ebola situation assessment - 6 October 2014
 
The Ebola virus is transmitted among humans through close and direct physical contact with infected bodily fluids, the most infectious being blood, faeces and vomit.

The Ebola virus has also been detected in breast milk, urine and semen. In a convalescent male, the virus can persist in semen for at least 70 days; one study suggests persistence for more than 90 days.

Saliva and tears may also carry some risk. However, the studies implicating these additional bodily fluids were extremely limited in sample size and the science is inconclusive. In studies of saliva, the virus was found most frequently in patients at a severe stage of illness. The whole live virus has never been isolated from sweat.

The Ebola virus can also be transmitted indirectly, by contact with previously contaminated surfaces and objects.
The risk of transmission from these surfaces is low and can be reduced even further by appropriate cleaning and disinfection procedures.

Not an airborne virus

Ebola virus disease is not an airborne infection. Airborne spread among humans implies inhalation of an infectious dose of virus from a suspended cloud of small dried droplets.

This mode of transmission has not been observed during extensive studies of the Ebola virus over several decades.

Common sense and observation tell us that spread of the virus via coughing or sneezing is rare, if it happens at all. Epidemiological data emerging from the outbreak are not consistent with the pattern of spread seen with airborne viruses, like those that cause measles and chickenpox, or the airborne bacterium that causes tuberculosis.

Theoretically, wet and bigger droplets from a heavily infected individual, who has respiratory symptoms caused by other conditions or who vomits violently, could transmit the virus – over a short distance – to another nearby person.

This could happen when virus-laden heavy droplets are directly propelled, by coughing or sneezing (which does not mean airborne transmission) onto the mucus membranes or skin with cuts or abrasions of another person.

WHO is not aware of any studies that actually document this mode of transmission. On the contrary, good quality studies from previous Ebola outbreaks show that all cases were infected by direct close contact with symptomatic patients.

No evidence that viral diseases change their mode of transmission

Moreover, scientists are unaware of any virus that has dramatically changed its mode of transmission. For example, the H5N1 avian influenza virus, which has caused sporadic human cases since 1997, is now endemic in chickens and ducks in large parts of Asia.

That virus has probably circulated through many billions of birds for at least two decades. Its mode of transmission remains basically unchanged.

Speculation that Ebola virus disease might mutate into a form that could easily spread among humans through the air is just that: speculation, unsubstantiated by any evidence.

This kind of speculation is unfounded but understandable as health officials race to catch up with this fast-moving and rapidly evolving outbreak.

To stop this outbreak, more needs to be done to implement – on a much larger scale – well-known protective and preventive measures. Abundant evidence has documented their effectiveness.





WEST AFRICA Ebola Outbreak Early Symptoms: Ebola can only be spread to others after symptoms begin. Symptoms can appear from 2 to 21 days after exposure. Fever Headache Diarrhea Vomiting Weakness Stomach pain Lack of appetite Unexplained bleeding Joint & muscle aches August 16, 2014: U. S. Department of Health and Human Services Centers for Disease Control and Prevention (CDC) Infographics WEST AFRICA
Ebola Outbreak


Early Symptoms:


Ebola can only be spread to others after symptoms begin. Symptoms can appear from 2 to 21 days after exposure.
- Fever
- Headache
- Diarrhea
- Vomiting
- Weakness
- Stomach pain
- Lack of  appetite
- Unexplained bleeding
- Joint & muscle aches


August 16, 2014: U. S. Department of Health and Human Services
Centers for Disease Control and Prevention (CDC) Infographics
s


What is the diagnostic value
of self-reported fever and history
of people knowingly exposed to the Ebola virus,
 even if they are health workers?

Teresa Romero: así ha sido paso a paso su contagio y convalecencia del ébola
20minutos, October 13, 2014
(...)
Esto es lo que se conoce hasta el momento:
7 de agosto: El misionero Miguel Pajares es trasladado a España desde Liberia.
12 de agosto: El religioso español de 75 años infectado con ébola muere, convirtiéndose en el primer fallecido por el virus en Europa. La auxiliar de enfermería Teresa Pajares le atendió sin ningún problema.
21 de septiembre: Otro misionero, Manuel García Viejo, es repatriado desde Sierra Leona hasta España.
22 de septiembre: García Viejo es ingresado en el hospital Carlos III. La auxiliar Teresa Romero entró en una ocasión a la habitación en la que se encontrada.
25 de septiembre: Fallece García Viejo a los 70 años. De nuevo, Teresa entra en la habitación y maneja material peligroso. En esta ocasión, según ha reconocido ella misma, se toca la cara con un guante al retirarse el traje de seguridad. Supuestamente se contagia en ese momento, pero todavía no lo sabe.
27 de septiembre: Teresa Romero termina su trabajo y coge vacaciones. El protocolo indica que debe tomarse la temperatura dos veces al día. En este mismo día se presenta a las oposiciones a Auxiliar de Enfermería en la Universidad Complutense de Madrid.
30 de septiembre: La enferma empieza a sentir síntomas del virus, pero todavía muy leves y no lo identifica con el ébola. Llama al Servicio de Prevención de Riesgos Laborales del hospital Carlos III, pero al no llegar a superar los 38,6 grados de fiebre no la internan y le dicen que tome precauciones y que siga observándose. Más tarde la auxiliar acudió al centro de salud Alcorcón, pero supuestamente no se identifica como una de las personas que atendió a los misioneros. Le diagnostican gripe y le receta paracetamol. Antes de volver a su casa fue a una peluquería a depilarse.
2 de octubre: Vuelve a llamar por teléfono al hospital Carlos III siguiendo las instrucciones que fueron facilitadas por teléfono por el facultativo especialista de riesgos laborales, e informa de que tenía fiebre de 38 grados. A partir de ese momento, la sanidad madrileña se pone en contacto con ella dos veces al día para que informara de la fiebre que tenía, según ha señalado el consejero de Sanidad de la Comunidad de Madrid, Javier Rodríguez.
3 de octubre: Tiene 36 grados, sin haber consumido ninguna medicación, y niega cualquier incidencia con la protección personal y contacto con fluidos del paciente.
6 de octubre: A las 4 de la mañana, la trabajadora llamó al sistema de alerta de salud pública con fiebre de 37,3 grados y tos, además de astenia (cansancio) y mialgias (dolores musculares), y desde Salud Pública adoptaron la decisión de trasladar un equipo del SUMMA 112 al domicilio de la paciente, desde donde fue trasladada a Urgencias del Hospital Fundación de Alcorcón. Allí le realizan una primera prueba del ébola y da positivo. Una segunda prueba confirma el primer positivo por ébola fuera de África en el mundo.  
This is what is known so far:
August 7: The missionary Miguel Pajares is transferred to Spain from Liberia.
August 12: The Spanish religious 75 years infected with Ebola died, becoming the first died from the virus in Europe. The nursing assistant Teresa Pajares served him without any problems.
September 21: Another missionary, Manuel García Viejo, is repatriated from Sierra Leone to Spain.
September 22: García Viejo is hospitalized Carlos III. The auxiliary Teresa Romero once entered the room in which it is found.
September 25: Garcia dies at 70 years old. Again, Teresa entered the room and manages hazardous material. This time, as she has acknowledged she touched her e face with a glove to take off her safety-suit. Supposedly she got infected at the time, but does not know yet.
September 27: Teresa Romero finishes his work and take vacations. The protocol indicates that the temperature should be taken twice daily. On the same day it is presented to the Nursing Assistant oppositions from the Complutense University of Madrid.
September 30: The patient begins to experience symptoms of the virus, but still very mild and does not identify with Ebola. Call Service Occupational Risk Prevention Hospital Carlos III, but does not reach more than 38.6 degree fever and is not hospitalised, told to take precautions and to continue self-observing. Later the assistant went to the health center Alcorcón, but supposedly not identified herself as one of the people who attended the missionaries. Was diagnosed wih flu and prescribed paracetamol. Before returning home she went to a hairdresser to get depilated.
October 2: Again calls by phone the hospital Carlos III following the instructions that were provided by telephone by the specialist doctor of occupational hazards, and reports that she had a fever of 38 degrees. From that moment, the Madrid Health contacted her twice a day to know her fever, as noted by the Minister of Health of the Community of Madrid, Javier Rodriguez.
October 3: has 36 degrees, without consuming any medication and denied any incident to personal protection and patient contact with fluids.
October 6: At 4 am, the health worker called public health emergemcy system with fever of 37.3 degrees and a cough, plus asthenia (fatigue) and myalgia (muscle pain), and from Public Health adopted decision to move a team from SUMMA 112  to the address of the patient, from which she was taken to Emergency Hospital Alcorcón Foundation. There she got her first test which was positive for Ebola. A second test confirmed the first positive for Ebola outside of Africa in the world.  

full text




When is someone able to spread the disease to others? Ebola only spreads when people are sick. A patient must have symptoms ro spread the disease to others. After 21 days, if an exposed person does not develop symptoms, they will not become sick with Ebola. WEST AFRICA
Ebola Outbreak


When is someone able
to spread the disease to others?


Ebola only spreads when people are sick.

A patient must have symptoms to spread the disease to others.

After 21 days, if an exposed person does not develop symptoms, they will not become sick with Ebola.






August 16, 2014: U. S. Department of Health and Human Services
Centers for Disease Control and Prevention (CDC) Infographics



World Health Organization
Are the Ebola outbreaks in Nigeria and Senegal over?
Ebola situation assessment - 14 October 2014

(...)

For WHO to declare an Ebola outbreak over, a country must pass through 42 days, with active surveillance demonstrably in place, supported by good diagnostic capacity, and with no new cases detected. Active surveillance is essential to detect chains of transmission that might otherwise remain hidden.

Incubation period

The period of 42 days, with active case-finding in place, is twice the maximum incubation period for Ebola virus disease and is considered by WHO as sufficient to generate confidence in a declaration that an Ebola outbreak has ended.

Recent studies conducted in West Africa have demonstrated that 95% of confirmed cases have an incubation period in the range of 1 to 21 days; 98% have an incubation period that falls within the 1 to 42 day interval. WHO is therefore confident that detection of no new cases, with active surveillance in place, throughout this 42-day period means that an Ebola outbreak is indeed over.

(...)
full text



Supplementary Appendix 1. Supplement to: WHO Ebola Response Team.
 Ebola virus disease in West Africa — the first 9 months of the epidemic
and forward projections. N Engl J Med. DOI: 10.1056/NEJMoa1411100
Gamma parametric fits to the distributions of incubation periods
among confirmed and probable EVD cases reporting
(A) single day and (B) multiday exposures.


95% of confirmed cases have an incubation period in the range of 1 to 21 days 98% have an incubation period that falls within the 1 to 42 day interval. WHO Ebola Response Team. Ebola virus disease in West Africa — the first 9 months of the epidemic and forward projections. This article was published on September 23, 2014  at NEJM.org. N Engl J Med 2014;371:1481-95
95% of confirmed cases have an incubation period in the range of 1 to 21 days 98% have an incubation period that falls within the 1 to 42 day interval
This article was published on September 23, 2014
 at NEJM.org. N Engl J Med 2014;371:1481-95


full text





Centers for Disease Control and Prevention (CDC)
Interim Guidance for Monitoring and Movement 

of Persons with Ebola Virus Disease Exposure

Updated: August 22, 2014

The world is facing the biggest and most complex Ebola virus disease (EVD) outbreak in history. On August 8, 2014, the EVD outbreak in West Africa was declared by the World Health Organization (WHO) to be a Public Health Emergency of International Concern (PHEIC) because it was determined to be an ‘extraordinary event’ with public health risks to other States. The possible consequences of further international spread are particularly serious considering the following factors:

  1. the virulence of the virus,

  2. the intensive community and health facility transmission patterns, and

  3. the strained health systems in the currently affected and most at-risk countries.

Coordinated public health actions are essential to stop and reverse the spread of Ebola virus. Due to the complex nature and seriousness of the outbreak, CDC has created guidance for monitoring people exposed to Ebola virus and for evaluating their travel, including the application of movement restrictions when indicated.

Definitions used in this document

For case and exposure level definitions, see: Case Definition for Ebola Virus Disease (EVD).

Close contact

Close contact is defined as

  1. being within approximately 3 feet (1 meter) of an EVD patient or within the patient’s room or care area for a prolonged period of time (e.g., health care personnel, household members) while not wearing recommended personal protective equipment (i.e., standard, droplet, and contact precautions; see Infection Prevention and Control Recommendations); or

  2. having direct brief contact (e.g., shaking hands) with an EVD patient while not wearing recommended personal protective equipment.

Brief interactions, such as walking by a person or moving through a hospital, do not constitute close contact.

Conditional release

Conditional release means that people are monitored by a public health authority for 21 days after the last known potential Ebola virus exposure to ensure that immediate actions are taken if they develop symptoms consistent with EVD during this period. People conditionally released should self-monitor for fever twice daily and notify the public health authority if they develop fever or other symptoms.

Controlled movement

Controlled movement requires people to notify the public health authority about their intended travel for 21 days after their last known potential Ebola virus exposure. These individuals should not travel by commercial conveyances (e.g. airplane, ship, long-distance bus, or train). Local use of public transportation (e.g. taxi, bus) by asymptomatic individuals should be discussed with the public health authority. If travel is approved, the exposed person must have timely access to appropriate medical care if symptoms develop during travel. Approved long-distance travel should be by chartered flight or private vehicle; if local public transportation is used, the individual must be able to exit quickly.

Quarantine

Quarantine is used to separate and restrict the movement of persons exposed to a communicable disease who don’t have symptoms of the disease for the purpose of monitoring.

Self-monitoring

Self-monitoring means that people check their own temperature twice daily and monitor themselves for other symptoms.

Early Recognition and Reporting of Suspected Ebola Virus Exposures

Early recognition is critical to controlling the spread of Ebola virus. Health care providers should be alert for and evaluate any patients with symptoms consistent with EVD and potential exposure history. Standard, contact, and droplet precautions should be immediately implemented if EVD is suspected. Guidance for clinicians evaluating patients from EVD outbreak-affected countries is available at Ebola virus disease Information for Clinicians in U.S. Healthcare Settings .

Health care professionals in the United States should immediately report to their state or local health department any person being evaluated for EVD if the medical evaluation suggests that diagnostic testing may be indicated. If there is a high index of suspicion, US health departments should immediately report any probable cases or persons under investigation (PUI) to CDC’s Emergency Operations Center at 770-488-7100.

Important Evaluation Factors

Both clinical presentation and level of exposure should be taken into account when determining appropriate public health actions, including the need for medical evaluation or monitoring and the application of movement restrictions when indicated.

Recommendations for Evaluating Exposure Risk 
to Determine Appropriate Public Health Actions

This guidance provides public health authorities and other partners a framework for determining the appropriate public health actions based on risk factors and clinical presentation. It also includes criteria for monitoring exposed people and for when movement restrictions may be needed.
At this time, CDC is NOT recommending that asymptomatic contacts of EVD patients be quarantined, either in facilities or at home.

Exposure Level

Clinical Criteria

Public Health Actions

High Risk

Percutaneous (e.g., needle stick) or mucous membrane exposure to blood or body fluids of EVD patient

Direct skin contact with, or exposure to blood or body fluids of, an EVD patient without appropriate personal protective equipment (PPE)

Processing blood or body fluids of a confirmed EVD patient without appropriate PPE or standard biosafety precautions

Direct contact with a dead body without appropriate PPE in a country where an EVD outbreak is occurring

Fever OR other symptoms consistent with EVD without fever

Consideration as · a probable case

Medical evaluation using · infection control precautions for suspected Ebola, consultation with public health authorities, and testing if indicated

If air transport is clinically appropriate and indicated, only · air medical transport (no travel on commercial conveyances permitted)

If · infection control precautions are determined not to be indicated: · conditional release and · controlled movement until 21 days after last known potential exposure


Asymptomatic

 · Conditional release and · controlled movement until 21 days after last known potential exposure

Some Risk of Exposure

Household contact with an EVD patient

Other · close contact with an EVD patient in health care facilities or community settings

Fever WITH OR WITHOUT other symptoms consistent with EVD

Consideration as · a probable case

Medical evaluation using initial · infection control precautions for suspected Ebola, consultation with public health authorities, and testing if indicated

If air transport is clinically appropriate and indicated, · air medical transport only (no travel on commercial conveyances permitted)

If · infection control precautions are determined not to be indicated: · conditional release and · controlled movement until 21 days after last known potential exposure


Asymptomatic or clinical criteria not met

 · Conditional release and · controlled movement until 21 days after last known potential exposure

No Known Exposure

Having been in a country in which an EVD outbreak occurred within the past 21 days and having had no exposures

Fever WITH other symptoms consistent with EVD

Consideration as a · person under investigation (PUI)

Medical evaluation and optional consultation with public health authorities to determine if movement restrictions and · infection control precautions are indicated

If movement restrictions and · infection control precautions are determined not to be indicated: travel by commercial conveyance is allowed;  · self-monitor  until 21 days after leaving country


Asymptomatic or clinical criteria not met

No movement restrictions

Travel by commercial conveyance allowed

· Self-monitor until 21 days after leaving country

Page last reviewed: August 29, 2014
Page last updated: August 29, 2014
Content source:
Centers for Disease Control and Prevention
National Center for Emerging and Zoonotic Infectious Diseases (NCEZID)
Division of High-Consequence Pathogens and Pathology (DHCPP)
Viral Special Pathogens Branch (VSPB)




Ebola Viral Carrier: the 35 countries one flight away from Ebola-affected countries by Quarz, July 30, 2014Ebola Viral Carrier: the 35 countries one flight away from Ebola-affected countries by Quarz, July 30, 2014



CDC Quarantine and Isolation Airline GuidanceManaging Ill Passengers/Crew

Ebola Guidance for Airlines
Updated: August 11, 2014

 Interim Guidance about Ebola Infection
for Airline Crews, Cleaning Personnel, and Cargo Personnel
Overview of Ebola

Ebola (also known as Ebola hemorrhagic fever) is a Statement on travel and transport in relation to 
Ebola virus disease (EVD) outbreaksevere, often-fatal disease caused by infection with a species of Ebola virus. Although the disease is rare, it can spread from person to person, especially among health care staff and other people who have close contact* with an infected person. Ebola is spread through direct contact with blood or body fluids (such as saliva or urine) of an infected person or animal or through contact with objects that have been contaminated with the blood or other body fluids of an infected person.

The likelihood of contracting Ebola is extremely low unless a person has direct contact with the body fluids of a person or animal that is infected and showing symptoms. A fever in a person who has traveled to or lived in an area where Ebola is present is likely to be caused by a more common infectious disease, but the person would need to be evaluated by a health care provider to be sure.

The incubation period, from exposure to when signs or symptoms appear, for Ebola ranges from 2 to 21 days (most commonly 8-10 days). Early symptoms include sudden fever, severe headaches, and muscle aches. Around the fifth day, a skin rash can occur. Nausea, vomiting, chest or abdominal pain, and diarrhea may follow. Symptoms can become increasingly severe and may include difficulty breathing or swallowing, bleeding inside and outside the body, and multi-organ failure.

The prevention of Ebola infection includes measures to avoid contact with blood and body fluids of infected individuals and with objects contaminated with these fluids (e.g., syringes).

Stopping ill travelers from boarding aircraft

People who have been exposed to Ebola should not travel on commercial airplanes until there is a period of monitoring for symptoms of illness lasting 21 days after exposure. Sick travelers should delay travel until cleared to travel by a doctor or public health authority.

Airlines should consider using their own authority (for U.S. airlines, and foreign airlines serving the United States Federal Register[PDF - 74 pages], Department of Transportation 14 CFR Part 382) to deny boarding of sick travelers if Ebola is suspected.

Management of ill people on aircraft if Ebola is suspected

It is difficult to know what illness a sick person has on an airplane without further evaluation and laboratory testing. Therefore, cabin crew should follow routine infection control precautions for ill travelers identified during flight. Although Ebola does not spread through the air, these routine precautions include management of travelers with respiratory illness to reduce the number of droplets expelled into the air.

  • Keep the sick person separated from others as much as possible.
  • If the sick person is coughing or sneezing, provide a surgical mask (if the sick person can tolerate wearing one).
  • If a mask cannot be tolerated, provide tissues and ask the person to cover mouth and nose when coughing or sneezing.
  • Provide a plastic bag for disposing used tissues.
  • Provide an air sickness bag if traveler is vomiting or reports feeling nauseous.
  • Wear impermeable disposable gloves for direct contact with blood or other body fluids.

Universal Precaution Kits: Airplanes traveling to countries affected with Ebola should carry Universal Precaution Kits, as recommended by the International Civil Aviation Organization[PDF - 30 pages] (ICAO), for managing ill onboard passengers.

Visit CDC's Infection Control Guidelines for Cabin Crew Members on Commercial Aircraft for more information on practical measures cabin crew members can take to protect themselves, passengers and other crew members.

Reporting Ill Travelers

The captain of an aircraft bound for the United States is required by law to report to the Centers for Disease Control and Prevention (CDC) before arrival any deaths onboard or ill travelers who meet specified criteria. This is consistent with mandatory reporting requirements of ICAO (ICAO document 4444 and Annex 9, Ch. 8, of the Chicago Convention).

CDC staff can be consulted to assist in evaluating an ill traveler, provide recommendations, and answer questions about reporting requirements; however, reporting to CDC does not replace usual company procedures for in-flight medical consultation or obtaining medical assistance.

CDC routinely conducts contact investigations to alert other passengers and crew of their exposure to ill travelers with certain diseases who were possibly contagious on their flight.

General Infection Control Precautions

Personnel should always follow basic infection control precautions to protect against any type of infectious disease.

What to do if you think you have been exposed

Any airline crew, cleaning or cargo personnel who think they were exposed to Ebola either through travel, assisting an ill traveler, handling a contaminated object, or cleaning a contaminated aircraft should take the following precautions:

  • Notify your employer immediately.
  • Monitor your health for 21 days. Watch for fever (temperature of 101.5°F/38.6°C or higher), severe headaches, muscle aches, diarrhea, vomiting, rash, and other symptoms consistent with Ebola.

When to see a health care provider

  • If you develop sudden fever, chills, muscle aches, severe diarrhea, vomiting, rash, or other symptoms consistent with Ebola, you should seek immediate medical attention.
    • Before visiting a health care provider, alert the clinic or emergency room in advance about your possible exposure to Ebola virus so that arrangements can be made to prevent spreading it to others.
    • When traveling to a health care provider, limit contact with other people. Avoid all other travel.
  • If you are located abroad, contact your employer for help with locating a health care provider. The U.S. embassy or consulate in the country where you are located can also provide names and addresses of local physicians.

Guidance for Airline Cleaning Personnel

Ebola virus is transmitted by close contact* with a person who has symptoms of Ebola. Treat any body fluid as though it is infectious. Blood or body fluids on interior surfaces can spread Ebola if they get into your eyes, nose, or mouth. Therefore, hand hygiene is the most important infection control measure. Wear disposable impermeable gloves when cleaning visibly contaminated surfaces.

For any ill traveler on board an aircraft, even if Ebola is not considered, the airline's ground and cleaning crews should be notified so that preparations can be made to clean the aircraft after passengers have disembarked. When cleaning aircraft after a flight with a patient who may have had Ebola, personnel should follow these precautions:

  • Wear impermeable disposable gloves while cleaning the passenger cabin and lavatories.
  • Wipe down lavatory surfaces and frequently touched surfaces in the passenger cabin, such as armrests, seat backs, tray tables, light and air controls, and adjacent walls and windows with an Environmental Protection Agency (EPA) registered cleaner/disinfectant that has been tested and approved for use by the airplane manufacturers.
  • Special cleaning of upholstery, carpets, or storage compartments is not indicated unless they are obviously soiled with blood or body fluids.
  • Special vacuuming equipment or procedures are not necessary.
  • Do not use compressed air, which might spread infectious material through the air.
  • If a seat cover or carpet is obviously soiled with blood or body fluids, it should be removed and discarded by the methods used for biohazardous material.
  • Throw used gloves away according to the company's recommended infection control precautions when cleaning is done or if they become soiled or damaged during cleaning.
  • Clean hands with soap and water (or waterless alcohol-based hand sanitizer when soap is not available) immediately after gloves are removed.

Guidance for Air Cargo Personnel

Packages should not pose a risk. Ebola virus is spread through direct contact with blood or body fluids (such as urine or saliva) from an infected person.

  • Packages visibly soiled with blood or body fluids should not be handled.
  • Cargo handlers should wash their hands often to prevent other infectious diseases.

* Close contact is defined as having cared for or lived with a person with Ebola or having a high likelihood of direct contact with blood or body fluids of an Ebola patient. Close contact does not include walking by a person or briefly sitting across a room from a person.




World Health Organization
WHO statement

Statement on travel and transport in relation to 
Ebola virus disease (EVD) outbreak
18 August 2014

The current Ebola virus disease (EVD) outbreak is believed to have begun in Guinea in December 2013. This outbreak now involves community transmission in Guinea, Liberia and Sierra Leone and recently an ill traveller from Liberia infected a small number of people in Nigeria with whom he had direct contact.

On 8 August 2014, WHO declared the Ebola virus disease outbreak in West Africa a Public Health Emergency of International Concern (PHEIC) in accordance with the International Health Regulations (2005).

In order to support the global efforts to contain the spread of the disease and provide a coordinated international response for the travel and tourism sector, the heads of WHO, the International Civil Aviation Organization (ICAO), the World Tourism Organization (UNWTO), Airports Council International (ACI), International Air Transport Association (IATA) and the World Travel and Tourism Council (WTTC) decided to activate a Travel and Transport Task Force which will monitor the situation and provide timely information to the travel and tourism sector as well as to travellers.

The risk of transmission of Ebola virus disease during air travel is low. Unlike infections such as influenza or tuberculosis, Ebola is not spread by breathing air (and the airborne particles it contains) from an infected person. Transmission requires direct contact with blood, secretions, organs or other body fluids of infected living or dead persons or animals, all unlikely exposures for the average traveller. Travellers are, in any event, advised to avoid all such contacts and routinely practice careful hygiene, like hand washing.

The risk of getting infected on an aircraft is also small as sick persons usually feel so unwell that they cannot travel and infection requires direct contact with the body fluids of the infected person.

Most infections in Liberia, Guinea and Sierra Leone, are taking place in the community when family members or friends take care of someone who is ill or when funeral preparation and burial ceremonies do not follow strict infection prevention and control measures.

A second important place where transmission can occur is in clinics and other health care settings, when health care workers, patients, and other persons have unprotected contact with a person who is infected. In Nigeria, cases are related only to persons who had direct contact with a single traveller who was hospitalized upon arrival in Lagos.

It is important to note that a person who is infected is only able to spread the virus to others after the infected person has started to have symptoms. A person usually has no symptoms for two to 21 days (the “incubation period”). Symptoms include fever, weakness, muscle pain, headache and sore throat. This is followed by vomiting, diarrhoea, rash, and in some cases, bleeding.

The risk of a traveller becoming infected with the Ebola virus during a visit to the affected countries and developing disease after returning is very low, even if the visit includes travel to areas in which cases have been reported.

If a person, including a traveller, stayed in the areas where Ebola cases have been recently reported, he/she should seek medical attention at the first sign of illness (fever, headache, achiness, sore throat, diarrhoea, vomiting, stomach pain, rash, red eyes, and in some cases, bleeding). Early treatment can improve prognosis.

Strengthened international cooperation is needed, and should support action to contain the virus, stop transmission to other countries and mitigate the effects in those affected.

Affected countries are requested to conduct exit screening of all persons at international airports, seaports and major land crossings, for unexplained febrile illness consistent with potential Ebola infection. Any person with an illness consistent with EVD should not be allowed to travel unless the travel is part of an appropriate medical evacuation. There should be no international travel of Ebola contacts or cases, unless the travel is part of an appropriate medical evacuation

Non-affected countries need to strengthen the capacity to detect and immediately contain new cases, while avoiding measures that will create unnecessary interference with international travel or trade.

WHO does not recommend any ban on international travel or trade, in accordance with advice from the WHO Ebola Emergency Committee.

Travel restrictions and active screening of passengers on arrival at sea ports, airports or ground crossings in non-affected countries that do not share borders with affected countries are not currently recommended by WHO.

Worldwide, countries should provide their citizens traveling to Ebola-affected countries with accurate and relevant 




U. S. Department of Health and Human Services
Centers for Disease Control and Prevention (CDC)
August 16, 2014 


Ebola Radio Health Messages in Local Languages

(Fullar,  Kissi, Kono, Krio, Limba, Loko, Madingo, Mende, Susu, Themne)

Spot 1. "It's probably malaria, not Ebola!"

One difficult thing about Ebola is that the signs – sudden fever, diarrhea, vomitting – these are shared by other diseases. So, perhaps it's not Ebola. It could be malaria. Or perhaps typhoid fever. So, it's quite difficult for anyone, except a health care worker, to say definitively 'Yes, it is Ebola,' or 'No, it is not Ebola.'

So, if you have sudden fever, diarrhoea or vomiting, you should go to the health centre, because, no matter the cause, you can receive help there.

And remember: with the right information, and together with our health care workers, we can protect ourselves from Ebola.

Spot 2. Where does Ebola live?

The Ebola virus lives in the bats and does not make them sick. The Ebola virus is released from the bats from time to time and can infect monkeys, chimpanzees, and humans, and other wild animals.

So, can Ebola be caused by witchcraft or a curse, or any other cause? No. Remember: the Ebola virus lives in bats.

And remember: with the right information, and together with our health care workers, we can protect ourselves from Ebola.

Spot 3. If there is no fever, there is no Ebola.

If a person has no fever, he or she can move about, touch others, ride the bus, take a taxi. And they cannot pass Ebola to other people. A person who develops a fever, however, can pass Ebola to others. Once they have recovered and been discharged, they are free from Ebola, and should be welcomed back into the family and the community.

And remember: with the right information, and together with our health care workers, we can protect ourselves from Ebola.

Spot 4. Who is at risk for Ebola?

Outbreak Update

Who is at risk of getting Ebola? It’s the people who are in contact with those who are sick from Ebola, including family members and health care workers. And also people who are in contact with wild animals, including bats and monkeys, or fruit partially eaten by bats (bat mot).

Do people have any risk of getting Ebola by riding the bus? No.
Do people have any risk of getting Ebola by wearing a helmet? No.

And remember: with the right information, and together with our health care workers, we can protect ourselves from Ebola.

Spot 5. Ebola transmission within the family

Outbreak Update

Many times, when a man becomes sick with Ebola, it is the woman who cares for him. And then what happens? Then, the woman becomes sick. And then who cares for the woman? The grand-mother or a family member

Then, the children can become infected, as well as others having direct contact with the sick person

This is how Ebola can pass from one person to another in the community.

And remember: with the right information, and together with our health care workers, we can protect ourselves from Ebola.

Spot 6. Ebola virus is very fragile and easily destroyed

Here is some good news about Ebola: although it is dangerous, Ebola virus is easily destroyed/(fragile).

Heat will destroy Ebola virus. Sunlight will destroy it. Light will destroy it. Bleach and laundry detergent will destroy it.

All these will kill Ebola virus.

And remember: with the right information, and together with our health care workers, we can protect ourselves from Ebola

Spot 7. Stigmatisation

Many Ebola patients who are treated in hospital will survive and recover. Ebola is a serious disease, but when people have recovered, the doctors test them, and when the disease is all gone, they are discharged.

The discharged patients can not transmit Ebola. The virus has left their bodies, and they can not pass Ebola to anyone: not their children, their other family members, people sitting next to them in the taxi or bus. Partners, however, must abstain or always use a condom for sex for 3 months after discharge from the health centre.

And remember: with the right information, and together with our health care workers, we can protect ourselves from Ebola.





Public Health Agency of Canada

EBOLA VIRUS
PATHOGEN SAFETY DATA SHEET - INFECTIOUS SUBSTANCES

SECTION I
INFECTIOUS AGENT

NAME: Ebola virus

SYNONYM OR CROSS REFERENCE: African haemorrhagic fever, Ebola haemorrhagic fever (EHF, Ebola HF), filovirus, EBO virus (EBOV), Zaire ebolavirus (ZEBOV), Sudan ebolavirus (SEBOV), Ivory Coast ebolavirus (ICEBOV), Ebola-Reston (REBOV), Bundibugyo ebolavirus (BEBOV), and Ebola virus disease (1, 2).

CHARACTERISTICS: Ebola was discovered in 1976 and is a member of the Filoviridae family (previously part of Rhabdoviridae family, which were later given a family of their own based on their genetic structure). It is an elongated filamentous molecule, which can vary between 800 – 1000 nm in length, and can reach up to14000 nm long (due to concatamerization) with a uniform diameter of 80 nm (2-5). It contains a helical nucleocapsid, (with a central axis) 20 – 30 nm in diameter, and is enveloped by a helical capsid, 40 – 50 nm in diameter, with 5 nm cross-striations (2-6). The pleomorphic viral fragment may occupy several distinct shapes (e.g., in the shape of a “6”, a “U”, or a circle), and are contained within a lipid membrane (2, 3). Each virion contains one molecule of single-stranded, non-segmented, negative-sense viral genomic RNA (3, 7).
Five Ebola subtypes have been identified: Zaire ebolavirus (ZEBOV), which was first identified in 1976 and is the most virulent; Sudan ebolavirus, (SEBOV; Ivory Coast ebolavirus (ICEBOV); Ebola-Reston (REBOV), and Bundibugyo ebolavirus (BEBOV) (1, 3, 8, 9). Reston was isolated from cynomolgus monkeys from the Philippines in 1989 and is less pathogenic in non-human primates. It was thought to be the only subtype that does not cause infection in humans until 2009, when it was strongly speculated to have been transferred from pigs to humans. Bundibugyo was discovered in 2008, and has been found to be most closely related to the ICEBOV strain (9).

SECTION II
HAZARD IDENTIFICATION

PATHOGENICITY/TOXICITY: The Ebola virions enter the host cells through endocytosis and replication occurs in the cytoplasm. Upon infection, the virus targets the host blood coagulative and immune defence system and leads to severe immunosuppression (6, 10). Early signs of infection are non-specific and flu-like, and may include sudden onset of fever, asthenia, diarrhea, headache, myalgia, arthralgia, vomiting, and abdominal pains (11). Less common early symptoms such as conjunctival injection, sore throat, rashes, and bleeding may also appear. Shock, cerebral oedema, coagulation disorders, and secondary bacterial infection may co-occur with onset of infection (4). Haemorrhaging symptoms begin 4 – 5 days after onset, which includes hemorrhagic conjunctivitis, pharyngitis, bleeding gums, oral/lip ulceration, hematemesis, melena, hematuria, epistaxis, and vaginal bleeding (12). Hepatocellular damage, marrow depression (such as thrombocytopenia and leucopenia), serum transaminase elevation, and proteinuria may also occur. Persons that are terminally ill typically present with obtundation, anuria, shock, tachypnea, normothermia, arthralgia, and ocular diseases (13). Haemorrhagic diathesis is often accompanied by hepatic damage and renal failure, central nervous system involvement, and terminal shock with multi-organ failure (1, 2). Contact with the virus may also result in symptoms such as severe acute viral illness, malaise, and maculopapular rash. Pregnant women will usually abort their foetuses and experience copious bleeding (2). Fatality rates range between 50 – 100%, with most dying of dehydration caused by gastric problems (14). Subtype Ebola-Reston manifests lower levels of pathogenicity in non-human primates and has not been recorded to be infectious in humans; however, sub-clinical symptoms were observed in some people with suspected contact after they developed antibodies against the virus (8).
Pathogenicity between different subtypes of Ebola does not differ greatly in that they have all been associated with hemorrhagic fever outbreaks in humans and non-human primates. The Ebola-Zaire and Sudan strains are especially known for their virulence with 53 – 90% fatality rate. Less virulent strains include the Côte d’Ivoire ebolavirus and the Reston strain, and the latter has only been observed to cause sub-clinical infections to humans, with transmission from pigs (9). The major difference between the strains lies in the genome, which can vary by 30 – 40% from each other. This difference might be the cause of the varying ecologic niches of each strain and their evolutionary history. The newly discovered Bundibugyo strain, which caused
a single outbreak in Uganda, has a genome with 30% variance from the other strains. It is most closely related to the Côte d’Ivoire ebolavirus strain; however, it has been found to be more virulent as 37 fatal infections were recorded.

EPIDEMIOLOGY: Occurs mainly in areas surrounding rain forests in central Africa (6) with the exception of Reston which occurs in the Phillipines (9). No predispositions to infection have been identified among infected victims; however, the 20 – 30-year-old age group seems to be particularly susceptible.

Outbreaks:
Democratic Republic of the Congo (formerly Zaire): The first outbreak was recorded in 1976 with 318 cases (88% fatality); in 1995 with 315 cases (81% fatality); in 2001 with 59 cases (75% fatality); in 2003 as two separate outbreaks with 143 cases (90% fatality) and 35 cases (83% fatality), respectively; and recently in 2007 with reports of 372 cases involving 166 deaths (1, 2, 15, 16).
Sudan: The first outbreak was recorded in 1976 with 284 cases (53% fatality); and a second was recorded in 1979 with 34 cases (65% fatality) (1, 2, 15).
Gabon: The first outbreaks were recorded in 1994 with 52 cases (60% fatality); in 1996 as two separate outbreaks with 37 cases (57% fatality) and 60 cases (74% fatality), respectively; and in 2001-2 with 65 cases (82% fatality) (1, 2, 15).
Côte-d’Ivoire: Single non-fatal case of a scientist infected during a necropsy of an infected chimpanzee in the Tai Forest (17).
Uganda: Outbreaks were recorded in 2000 with 425 cases (53% fatality); and recently in 2007 with reports of 93 cases involving 22 deaths (2, 15, 18).
Philippine: In 2009, local authorities and international agencies confirmed for the first time that the Ebola Reston virus was strongly likely to have been transmitted from pigs to humans, when it was discovered that 5 out of 77 people who had come in contact with the pigs had developed antibodies to the EBOV virus, no other clinical signs were observed (19).
United States: An outbreak of REBOV in monkeys in 1989 in a shipment of animals from the Philippines, and a second outbreak occurred in 1996 in Texas among animals from the same Phillipine supplier (20).
Western Uganda: The outbreak in 2007 in the townships of Bundibugyo and Kikyo in the Bundibugyo district marked the discovery of the fifth strain of the virus, the Bundibugyo ebolavirus (9). The outbreak lasted for 2 months, with 149 suspected cases and 37 deaths.

HOST RANGE: Humans, various monkey species, chimpanzees, gorillas, baboons, and duikers (1-3, 15, 16, 18, 21-23). The Ebola virus genome was recently discovered in two species of rodents and one species of shrew living in forest border areas, raising the possibility that these animals may be intermediary hosts (24). Other studies of the virus have been done using guinea pig models (25). A survey of small vertebrates captured during the 2001 and 2003 outbreaks in Gabon found evidence of asymptomatic infection in three species of fruit bat (Hypsignathus monstrosus, Epomops franqueti, and Myonycteris torquata) (26).

INFECTIOUS DOSE: 1 – 10 aerosolized organisms are sufficient to cause infection in humans (21).

MODE OF TRANSMISSION: In an outbreak, it is hypothesized that the first patient becomes infected as a result of contact with an infected animal (15). Person-to-person transmission occurs via close personal contact with an infected individual or their body fluids during the late stages of infection or after death (1, 2, 15, 27). Nosocomial infections can occur through contact with infected body fluids due to the reuse of unsterilized syringes, needles, or other medical equipment contaminated with these fluids (1, 2). Humans may be infected by handling sick or dead non-human primates and are also at risk when handling the bodies of deceased humans in preparation for funerals, suggesting possible transmission through aerosol droplets (2, 6, 28). In the laboratory, infection through small-particle aerosols has been demonstrated in primates, and airborne spread among humans is strongly suspected, although it has not yet been conclusively demonstrated (1, 6, 13). The importance of this route of transmission is not clear. Poor hygienic conditions can aid the spread of the virus (6).

INCUBATION PERIOD: Two to 21 days, more often 4 – 9 days (1, 13, 14).

COMMUNICABILITY: Communicable as long as blood, secretions, organs, or semen contain the virus. Ebola virus has been isolated from semen 61 days after the onset of illness, and transmission through semen has occurred 7 weeks after clinical recovery (1, 2).

SECTION III
DISSEMINATION

RESERVOIR: The natural reservoir of Ebola is unknown (1, 2). Antibodies to the virus have been found in the serum of domestic guinea pigs, with no relation to human transmission (29). The virus can be replicated in some bat species native to the area where the virus is found, thus certain bat species may prove to be the natural hosts (26).

ZOONOSIS: Probably transmitted from animals (non-human primates and/or bats) (2, 15, 26).

VECTORS: Unknown.

SECTION IV
STABILITY AND VIABILITY

DRUG SUSCEPTIBILITY: Unknown. S-adenosylhomocysteine hydrolase inhibitors have been found to have complete mortality protection in mice infected with a lethal dose of Ebola virus (30).

DRUG RESISTANCE: There are no known antiviral treatments available for human infections.

SUSCEPTIBILITY TO DISINFECTANTS: Ebola virus is susceptible to sodium hypochlorite, lipid solvents, phenolic disinfectants, peracetic acid, methyl alcohol, ether, sodium deoxycholate, 2% glutaraldehyde, 0.25% Triton X-100, β-propiolactone, 3% acetic acid (pH 2.5), formaldehyde and paraformaldehyde, and detergents such as SDS (20, 21, 31-34).

PHYSICAL INACTIVATION: Ebola are moderately thermolabile and can be inactivated by heating for 30 minutes to 60 minutes at 60ºC, boiling for 5 minutes, gamma irradiation (1.2 x106 rads to 1.27 x106 rads), and/or UV radiation (3, 6, 20, 32, 33).

SURVIVAL OUTSIDE HOST: The virus can survive in liquid or dried material for a number of days (23). Infectivity is found to be stable at room temperature or at 4°C for several days, and indefinitely stable at -70°C (6, 20). Infectivity can be preserved by lyophilisation.

SECTION V
FIRST AID / MEDICAL

SURVEILLANCE: Monitor anyone suffering from an acute febrile illness that has recently travelled to rural sub-Saharan Africa, especially if haemorrhagic manifestations occur (3). Diagnosis can be quickly done in an appropriately equipped laboratory using a multitude of approaches including ELISA based techniques to detect anti-Ebola antibodies or viral antigens (12), RT-PCR to detect viral RNA, immunoelectron microscopy to detect Ebola virus particles in tissues and cells, and indirect immunofluorescence to detect antiviral antibodies (1, 2, 12, 21). It is useful to note that the Marburg virus is morphologically indistinguishable from the Ebola virus, and laboratory surveillance of Ebola is extremely hazardous and should be performed in a Containment Level 4 facility (1, 2, 12, 35).
Note: All diagnostic methods are not necessarily available in all countries.

FIRST AID/TREATMENT: There is no effective antiviral treatment (23, 26). Instead, treatment is supportive, and is directed at maintaining renal function and electrolyte balance and combating haemorrhage and shock (15). Transfusion of convalescent serum may be beneficial (3). Post-exposure treatment with a nematode-derived anticoagulation protein and a recombinant vesicular stomatitis virus vaccine expressing the Zaire Ebola virus glycoprotein have been shown to have 33% and 50% efficacy, respectively, in humans (4). Recent studies have shown that small interfering RNAs (siRNAs) can be potentially effective in silencing Zaire Ebola virus RNA polymerase L, and treatments in rhesus macaque monkeys have resulted in 100% efficacy when administered everyday for 6 days; however, delivery of the nucleic acid still remains an obstacle.

IMMUNIZATION: None (23).

PROPHYLAXIS: None. Management of the Ebola virus is solely based on isolation and barrier-nursing with symptomatic and supportive treatments (4).

SECTION VI
LABORATORY HAZARDS

LABORATORY-ACQUIRED INFECTIONS: One reported near-fatal case following a minute finger prick in an English laboratory (1976) (36). A Swiss zoologist contracted Ebola virus after performing an autopsy on a chimpanzee in 1994 (2, 37). An incident in Germany in 2009 when a laboratory scientist pricked herself with a needle that had just been used to infect a mouse with Ebola, however infection has not be confirmed. Additional incidents were recorded in the US in 2004, and a fatal case in Russia in 2004 (4).

SOURCES/SPECIMENS: Blood, serum, urine, respiratory and throat secretions, semen, and organs or their homogenates from human or animal hosts (1, 2, 35). Human or animal hosts, including non-human primates, may represent a further source of infection (35).

PRIMARY HAZARDS: Accidental parenteral inoculation, respiratory exposure to infectious aerosols and droplets, and/or direct contact with broken skin or mucous membranes (35).

SPECIAL HAZARDS: Work with, or exposure to, infected non-human primates, rodents, or their carcasses represents a risk of human infection (35).

SECTION VII
EXPOSURE CONTROLS / PERSONAL PROTECTION

RISK GROUP CLASSIFICATION: Risk Group 4 (38).

CONTAINMENT REQUIREMENTS: Containment Level 4 facilities, equipment, and operational practices for work involving infectious or potentially infectious materials, animals, and cultures.

PROTECTIVE CLOTHING: Personnel entering the laboratory must remove street clothing, including undergarments, and jewellery, and change into dedicated laboratory clothing and shoes, or don full coverage protective clothing (i.e., completely covering all street clothing). Additional protection may be worn over laboratory clothing when infectious materials are directly handled, such as solid-front gowns with tight fitting wrists, gloves, and respiratory protection. Eye protection must be used where there is a known or potential risk of exposure to splashes (39).

OTHER PRECAUTIONS: All activities with infectious material should be conducted in a biological safety cabinet (BSC) in combination with a positive pressure suit, or within a class III BSC line. Centrifugation of infected materials must be carried out in closed containers placed in sealed safety cups, or in rotors that are unloaded in a biological safety cabinet. The integrity of positive pressure suits must be routinely checked for leaks. The use of needles, syringes, and other sharp objects should be strictly limited. Open wounds, cuts, scratches, and grazes should be covered with waterproof dressings. Additional precautions should be considered with work involving animal activities (39).

SECTION VIII
HANDLING AND STORAGE

SPILLS: Allow aerosols to settle and, wearing protective clothing, gently cover spill with paper towels and apply suitable disinfectant, starting at the perimeter and working towards the centre. Allow sufficient contact time before clean up (39).

DISPOSAL: Decontaminate all materials for disposal from the containment laboratory by steam sterilisation, chemical disinfection, incineration or by gaseous methods. Contaminated materials include both liquid and solid wastes (39).

STORAGE: In sealed, leak-proof containers that are appropriately labelled and locked in a Containment Level 4 laboratory (39).

SECTION IX
REGULATORY AND OTHER INFORMATION

REGULATORY INFORMATION: The import, transport, and use of pathogens in Canada is regulated under many regulatory bodies, including the Public Health Agency of Canada, Health Canada, Canadian Food Inspection Agency, Environment Canada, and Transport Canada. Users are responsible for ensuring they are compliant with all relevant acts, regulations, guidelines, and standards.

UPDATED: August 2010.

PREPARED BY: Pathogen Regulation Directorate, Public Health Agency of Canada.

Although the information, opinions and recommendations contained in this Pathogen Safety Data Sheet are compiled from sources believed to be reliable, we accept no responsibility for the accuracy, sufficiency, or reliability or for any loss or injury resulting from the use of the information. Newly discovered hazards are frequent and this information may not be completely up to date.

Copyright © Public Health Agency of Canada, 2010,Canada

REFERENCES:
1. Plague. (2004). In R. G. Darling, & J. B. Woods (Eds.), USAMRIID's Medical Management of Biological Casualties Handbook (5th ed., pp. 40-44). Fort Detrick M.D.: USAMRIID.
2. Acha, P. N., & Szyfres, B. (2003). In Pan american Health Organization (Ed.), Zoonoses and Communicable Diseases Common to Man and Animals (3rd ed., pp. 142-145). Washington D.C.: Pan American Health Organization.
3. Sanchez, A. (2001). Filoviridae: Marburg and Ebola Viruses. In D. M. Knipe, & P. M. Howley (Eds.), Fields virology (4th ed., pp. 1279-1304). Philadelphia, PA.: Lippencott-Ravenpp.
4. Feldmann, H. (2010). Are we any closer to combating Ebola infections? Lancet, 375(9729), 1850-1852. doi:10.1016/S0140-6736(10)60597-1.
5. Beran, G. W. (Ed.). (1994). Handbook of Zoonosis, Section B: Viral (2nd ed.). Boca Raton, Florida: CRC Press, LLC.
6. Mwanatambwe, M., Yamada, N., Arai, S., Shimizu-Suganuma, M., Shichinohe, K., & Asano, G. (2001). Ebola hemorrhagic fever (EHF): mechanism of transmission and pathogenicity. Journal of Nippon Medical School = Nihon Ika Daigaku Zasshi, 68(5), 370-375.
7. Sanchez, A., Kiley, M. P., Klenk, H. D., & Feldmann, H. (1992). Sequence analysis of the Marburg virus nucleoprotein gene: comparison to Ebola virus and other non-segmented negative-strand RNA viruses. The Journal of General Virology, 73 ( Pt 2)(Pt 2), 347-357.
8. Takada, A., & Kawaoka, Y. (2001). The pathogenesis of Ebola hemorrhagic fever. Trends in Microbiology, 9(10), 506-511.
9. Towner, J. S., Sealy, T. K., Khristova, M. L., Albarino, C. G., Conlan, S., Reeder, S. A., Quan, P. L., Lipkin, W. I., Downing, R., Tappero, J. W., Okware, S., Lutwama, J., Bakamutumaho, B., Kayiwa, J., Comer, J. A., Rollin, P. E., Ksiazek, T. G., & Nichol, S. T. (2008). Newly discovered ebola virus associated with hemorrhagic fever outbreak in Uganda. PLoS Pathogens, 4(11), e1000212. doi:10.1371/journal.ppat.1000212 .
10. Harcourt, B. H., Sanchez, A., & Offermann, M. K. (1999). Ebola virus selectively inhibits responses to interferons, but not to interleukin-1beta, in endothelial cells. Journal of Virology, 73(4), 3491-3496.
11. Bwaka, M. A., Bonnet, M. J., Calain, P., Colebunders, R., De Roo, A., Guimard, Y., Katwiki, K. R., Kibadi, K., Kipasa, M. A., Kuvula, K. J., Mapanda, B. B., Massamba, M., Mupapa, K. D., Muyembe-Tamfum, J. J., Ndaberey, E., Peters, C. J., Rollin, P. E., Van den Enden, E., & Van den Enden, E. (1999). Ebola hemorrhagic fever in Kikwit, Democratic Republic of the Congo: clinical observations in 103 patients. The Journal of Infectious Diseases, 179 Suppl 1, S1-7. doi:10.1086/514308.
12. Zilinskas, R. A. (Ed.). (2000). Biololgical Warfare - Modern Offense and Defense. Boulder, Colorado, USA: Lynne Rienner Publishers, Inc.
13. Feigin, R. D. (Ed.). (2004). Textbook of Pediatric Infectious Diseases (5th ed.). Philadelphia, USA: Elsevier, Inc.
14. Casillas, A. M., Nyamathi, A. M., Sosa, A., Wilder, C. L., & Sands, H. (2003). A current review of Ebola virus: pathogenesis, clinical presentation, and diagnostic assessment. Biological Research for Nursing, 4(4), 268-275.
15. Bausch, D. G., Jeffs B.S.A.G, & Boumandouki, P. (2008). Treatment of Marburg and Ebola haemorrhagic fevers: a strategy for testing new drugs and vaccines under outbreak conditions. Antiviral Res., 78(1), 150-161.
16. WHO Disease Outbreak News - Ebola Haemorrhagic Fever in the Democratic Republic of Congo. (2007). , 2008.
17. Formenty, P., Boesch, C., Wyers, M., Steiner, C., Donati, F., Dind, F., Walker, F., & Le Guenno, B. (1999). Ebola virus outbreak among wild chimpanzees living in a rain forest of Cote d'Ivoire. The Journal of Infectious Diseases, 179 Suppl 1, S120-6. doi:10.1086/514296.
18. WHO Disease Outbreak News - Ebola Haemorrhagic Fever in Uganda - Update. (2007). , 2008 .
19. Morris, K. (2009). First pig-to-human transmission of Ebola Reston virus.9(3), 148.
20. Evans, A. S., & Kaslow, R. A. (Eds.). (1997). Viral Infections of Humans - Epidemiology and Control (4th ed.). New York, NY: Plenum Publishing Corporation.
21. Franz, D. R., Jahrling, P. B., McClain, D. J., Hoover, D. L., Byrne, W. R., Pavlin, J. A., Christopher, G. W., Cieslak, T. J., Friedlander, A. M., & Eitzen E.M., J. (2001). Clinical recognition and management of patients exposed to biological warfare agents. Clinics in Laboratory Medicine, 21(3), 435-473.
22. Bray, M. (2003). Defense against filoviruses used as biological weapons. Antiviral Research, 57(1-2), 53-60.
23. Leroy, E. M., Rouquet, P., Formenty, P., Souquière, S., Kilbourne, A., Froment, J. -., Bermejo, M., Smit, S., Karesh, W., Swanepoel, R., Zaki, S. R., & Rollin, P. E. (2004). Multiple Ebola Virus Transmission Events and Rapid Decline of Central African Wildlife. Science, 303(5656), 387-390.
24. Morvan, J. M., Nakouné, E., Deubel, V., & Colyn, M. (2000). Ebola virus and forest ecosystem. [Écosystèmes forestiers et virus Ebola] Bulletin De La Societe De Pathologie Exotique, 93(3), 172-175.
25. Connolly, B. M., Steele, K. E., Davis, K. J., Geisbert, T. W., Kell, W. M., Jaax, N. K., & Jahrling, P. B. (1999). Pathogenesis of experimental Ebola virus infection in guinea pigs. The Journal of Infectious Diseases, 179 Suppl 1, S203-17. doi:10.1086/514305.
26. Leroy, E. M., Kumulungui, B., Pourrut, X., Rouquet, P., Hassanin, A., Yaba, P., Délicat, A., Paweska, J. T., Gonzalez, J. -., & Swanepoel, R. (2005). Fruit bats as reservoirs of Ebola virus. Nature, 438(7068), 575-576.
27. Arthur, R. R. (2002). Ebola in Africa--discoveries in the past decade. Euro Surveillance : Bulletin Europeen Sur Les Maladies Transmissibles = European Communicable Disease Bulletin, 7(3), 33-36.
28. Hewlett, B. S., & Amolat, R. P. (2003). Cultural contexts of Ebola in Northern Uganda. Emerging Infectious Diseases, 9(10), 1242-1248.
29. Stansfield, S. K., Scribner, C. L., Kaminski, R. M., Cairns, T., McCormick, J. B., & Johnson, K. M. (1982). Antibody to Ebola virus in guinea pigs: Tandala, Zaire. The Journal of Infectious Diseases, 146(4), 483-486.
30. Huggins, J., Zhang, Z. X., & Bray, M. (1999). Antiviral drug therapy of filovirus infections: S-adenosylhomocysteine hydrolase inhibitors inhibit Ebola virus in vitro and in a lethal mouse model. The Journal of Infectious Diseases, 179 Suppl 1, S240-7. doi:10.1086/514316.
31. Loutfy, M. R., Assmar, M., Burgess, D. C. H., & Kain, K. C. (1998). Effects of viral hemorrhagic fever inactivation methods on the performance of rapid diagnostic tests for Plasmodium falciparum. Journal of Infectious Diseases, 178(6), 1852-1855.
32. Elliott, L. H., McCormick, J. B., & Johnson, K. M. (1982). Inactivation of Lassa, Marburg, and Ebola viruses by gamma irradiation. Journal of Clinical Microbiology, 16(4), 704-708.
33. Mitchell, S. W., & McCormick, J. B. (1984). Physicochemical inactivation of Lassa, Ebola, and Marburg viruses and effect on clinical laboratory analyses. Journal of Clinical Microbiology, 20(3), 486-489.
34. Mahanty, S., Kalwar, R., & Rollin, P. E. (1999). Cytokine measurement in biological samples after physicochemical treatment for inactivation of biosafety level 4 viral agents. Journal of Medical Virology, 59(3), 341-345.
35. Biosafety in Microbiological and Biomedical Laboratories (BMBL) (2007). In Richmond J. Y., McKinney R. W. (Eds.), . Washington, D.C.: Centers for Disease Control and Prevention.
36. Emond, R. T. D., Evans, B., Bowen, E. T. W., & Lloyd, G. (1977). A case of Ebola virus infection. British Medical Journal, 2(6086), 541-544.
37. Formenty, P., Hatz, C., Le Guenno, B., Stoll, A., Rogenmoser, P., & Widmer, A. (1999). Human infection due to Ebola virus, subtype Cote d'Ivoire: Clinical and biologic presentation. Journal of Infectious Diseases, 179(SUPPL. 1), S48-S53.
38. Human pathogens and toxins act. S.C. 2009, c. 24, Second Session, Fortieth Parliament, 57-58 Elizabeth II, 2009. (2009).
39. Public Health Agency of Canada. (2004). In Best M., Graham M. L., Leitner R., Ouellette M. and Ugwu K. (Eds.), Laboratory Biosafety Guidelines (3rd ed.). Canada: Public Health Agency of Canada.
Date Modified: 2012-03-26, Date Modified: 2014-08-01  [unchanged]





WHO Director-General assesses the Ebola outbreak with three West African presidents

Dr Margaret Chan
 Director-General of the World Health Organization
 
Overview of the Ebola situation delivered to the Presidents of Guinea, Liberia, and Sierra Leone
Conakry, Guinea, 1 August 2014

full text
(...)

West Africa is facing its first outbreak of Ebola virus disease. This is an unprecedented outbreak accompanied by unprecedented challenges. And these challenges are extraordinary.

West Africa’s outbreak is caused by the most lethal strain in the family of Ebola viruses.

The outbreak is by far the largest ever in the nearly four-decade history of this disease. It is the largest in terms of numbers of cases and deaths, with 1,323 cases and 729 deaths reported to date in four countries.

It is the largest in terms of geographical areas already affected and others at immediate risk of further spread.

It is taking place in areas with fluid population movements over porous borders, and it has demonstrated its ability to spread via air travel, contrary to what has been seen in past outbreaks. Cases are occurring in rural areas which are difficult to access, but also in densely populated capital cities.

(...)

First, this outbreak is moving faster than our efforts to control it. If the situation continues to deteriorate, the consequences can be catastrophic in terms of lost lives but also severe socioeconomic disruption and a high risk of spread to other countries. As I said before, this meeting must mark a turning point in the outbreak response.

In addition, the outbreak is affecting a large number of doctors, nurses, and other health care workers, one of the most essential resources for containing an outbreak. To date, more than 60 health care workers have lost their lives in helping others. Some international staff are infected. These tragic infections and deaths significantly erode response capacity.

Second, the situation in West Africa is of international concern and must receive urgent priority for decisive action at national and international levels. Experiences in Africa over nearly four decades tell us clearly that, when well managed, an Ebola outbreak can be stopped.

This is not an airborne virus. Transmission requires close contact with the bodily fluids of an infected person, also after death. Apart from this specific situation, the general public is not at high risk of infection by the Ebola virus.

At the same time, it would be extremely unwise for national authorities and the international community to allow an Ebola virus to circulate widely and over a long period of time in human populations.

Constant mutation and adaptation are the survival mechanisms of viruses and other microbes. We must not give this virus opportunities to deliver more surprises.


Third, this is not just a medical or public health problem. It is a social problem. Deep-seated beliefs and cultural practices are a significant cause of further spread and a significant barrier to rapid and effective containment. This social dimension must also be addressed as an integral part of the overall response.

Fourth, in some areas, chains of transmission have moved underground. They are invisible. They are not being reported. Because of the high fatality rate, many people in affected areas associate isolation wards with a sure death sentence, and prefer to care for loved ones in homes or seek assistance from traditional healers.

Such hiding of cases defeats strategies for rapid containment. Moreover, public attitudes can create a security threat to response teams when fear and misunderstanding turn to anger, hostility, or violence.

Finally, despite the absence of a vaccine or curative therapy, Ebola outbreaks can most certainly be contained. Bedrocks of outbreak containment include early detection and isolation of cases, contact tracing and monitoring of contacts, and rigorous procedures for infection control.

(...)

Accurate and detailed mapping of the outbreak is urgently needed. All affected and at-risk countries need a national response plan, and these plans need to be regionally coordinated.

Facilities for isolation and supportive therapy need to be properly equipped and adequately staffed. Some facilities lack such essentials as electricity and a safe supply of running water.

Current numbers of national and international response staff are woefully inadequate. Personal protective equipment is absolutely essential, but it is hot and cumbersome, limiting the time that doctors and nurses can work on an isolation ward.

Work is also emotionally very stressful. For national staff, salaries need to be paid.

Dignified burial makes an essential contribution to public trust and eases family grieving, but this must be done safely. Traditional funeral practices are a well-documented spark that ignites further chains of transmission.

Contact tracing is a formidable challenge, for reasons I have mentioned. Again, more staff are needed.

Public awareness of the facts about this disease needs to increase dramatically. Messages from presidents and community and religious leaders are important, but this outbreak needs professionally designed and implemented campaigns, again with help from external experts.

Depending on the epidemiological situation, your governments may need to impose some restrictions, for example, on population movements and public gatherings.

Governments may need to use their police and military forces to guarantee the safety and security of response teams. Some are already doing so.

Under the provisions of the International Health Regulations, I have convened an Emergency Committee that will meet on 6 August to assess the international implications of West Africa’s outbreak.

I am relying on the experts in this Committee, including those from West African nations, to heighten international awareness of the magnitude of this outbreak and the many challenges that need urgent support from the international community.

I am also here to learn first-hand your specific concerns and needs for support.

As I said, Ebola outbreaks can be contained. Chains of transmission can be broken. Together, we must do so.

Thank you.




The Washington Post
CDC director: Ebola is ‘out of control’ in West Africa but can be stopped 
By Katie Zezima August 3 , 2014
full text

Tom Frieden, the director of the Centers for Disease Control and Prevention, said Sunday that the Ebola virus is "out of control" in parts of West Africa but it can be contained with certain "tried and true" public health measures.

"The plain truth is that we can stop Ebola," he said on ABC's "This Week." "We know how to control it."

Frieden said the CDC will put 50 staff members on the ground to help contain the outbreak. Ebola, he said, is contracted only when people come into contact with the bodily fluids of infected people or handle the body of someone who died from the disease. Burial practices in the affected countries often involve family members touching the body of an Ebola victim.

An American doctor suffering from Ebola arrived Saturday in Atlanta, where he will be treated in a special isolation unit at Emory University Hospital. Kent Brantly is the first person to be treated for Ebola in the United States.

(...)

The virus can be transmitted only by people who are showing symptoms; those who may have it but have not gotten sick cannot pass it to others, Frieden said.

"Ebola is such a scary disease because it's so deadly," he said. "The plain fact is we can stop it."

Frieden said it is impossible to say that no one in the United States will contract the disease but again noted that one must come into intimate contact with someone who is sick and infected.

"I don't think it's in the cards that we would have widespread Ebola in this country," he said.

"We're not going to hermetically seal the borders of the U.S.," Frieden said. "But really the single most important thing we can do to protect Americans is to stop this disease at the source in Africa."

President Obama and White House officials have said that the outbreak will not affect a summit of African leaders slated to take place in Washington this week. Presidents of two of the affected countries, Liberia and Sierra Leone, have indicated that they may not travel to Washington.
(...)




How reliable are the CDC's Predictions
 About The Ebola Virus Disease Epidemic Outbreak?


ABC NEWS
CDC Director Says U.S. 'Surging' Efforts to Stop Ebola Outbreak
August 3, 2014
full text, video

The Centers for Disease Control and Prevention is escalating its response to the deadly Ebola outbreak, sending 50 staff members to West Africa to stop the disease at the source, CDC Director Dr. Tom Frieden said today.

"We are surging our response," Frieden told ABC News' George Stephanopoulos. "We're going to put 50 staff on the ground in these three countries to help stop the outbreak in the next 30 days."
(...)

Twenty days later

NBC NEWS
Every Second Counts: New Ebola Report Predicts Huge Spike Without Action
by Maggie Fox, August 23, 2014
full text
(...)

CDC researchers made several different calculations about what the Ebola epidemic in West Africa will do. It’s already by far the worst outbreak ever seen, and the first to rise to the level of an epidemic.

Their worst-case scenario? More than 1.4 million cases by the end of January if governments stop what little they are doing now and if much, much more is not done to stop the spread. That’s assuming cases are being underreported by a factor of 2.5.

But those numbers are based on what was happening in August, Frieden said. "Events on the ground have changed quite a bit since," he told reporters. "We are seeing a rapid scale-up of the response."

The CDC scenarios differ from the WHO projections. WHO projects 20,000 cases in West Africa, but not until six weeks from now. It's hard to tell how many people really are being infected and what’s happening to them. Only a portion are even seeking help — many are hiding or quietly dying at home. And many more are being turned away from overwhelmed treatment centers.
(...)


We're going to put 50 staff on the ground in these three countries to help stop the outbreak in the next 30 days: CDC Director Dr. Tom Frieden, August 3, 2014 Estimated number of Ebola cases with and without correction for underreporting Ebola Response modeling tool, Liberia and Sierra Leone combined, 2014–2015 Centers for Disease Control, MMWR / September 26, 2014 / Vol. 63 / No. 3
Estimated number of Ebola cases with and without correction for underreporting
Ebola Response modeling tool, Liberia and Sierra Leone combined, 2014–2015
Centers for Disease Control, MMWR / September 26, 2014 / Vol. 63 / No. 3





SOURCE: ALFRED GEZAYE

Information Minister Lewis G. Brown has announced that government is now set to cremate all bodies of dead Ebola victims – a practice he said will continue until Ebola is eradicated from Liberia.
Min. Brown disclosed that there is currently a team of experts in the country to carry out the cremation of bodies.
President Ellen Johnson Sirleaf in her last nationwide address on the state of Ebola urged the Ministry of Health and Social Welfare and relevant agencies to consider cremation as a means of avoiding tampering with Ebola infected bodies and avoiding the contamination of water sources.

The Liberia Government: Burn all bodies, cremate all bodies of dead Ebola victims. MOH contradicts the order
The Liberia Government: Burn all bodies, cremate all bodies of dead Ebola victims. MOH contradicts the order.

A Liberia Ministry of Health team unloaded the bodies of Ebola victims for a funeral pyre in Marshall, Liberia, on Friday Source: Two New Cases of Ebola Stem From Secondhand Contact, August 22, 2014
A Liberia Ministry of Health team unloaded the bodies of Ebola victims for a funeral pyre in Marshall, Liberia, on Friday Source: Two New Cases of Ebola Stem From Secondhand Contact, August 22, 2014

Burial teams from the Liberian Ministry of Health disinfect themselves before burning the bodies of Ebola victims in Marshall, Liberia. Source: Two new cases of Ebola reported in Democratic Republic of Congo, August 24, 2014
Burial teams from the Liberian Ministry of Health disinfect themselves before burning the bodies of Ebola victims in Marshall, Liberia. Source: Two new cases of Ebola reported in Democratic Republic of Congo, August 24, 2014


However, Assistant Minister of Health for Preventive Services, Mr. Tolbert Nyenswah, told a media gathering at the Ministry of Information that there was no need for cremation, especially so that it is not a part of Liberian culture.
He said it is not scientific proven that burying in the soil cause the contamination of water source and noted that it is the best way to inter bodies.
Ebola infected corpses were buried by the Ministry of Health in isolated areas which are not made known to the bereaved families. The burial of Ebola victims by the ministry had often met strong resistance by members of the bereaved families. This prompted the assigning of police to various health facilities in order to enable health workers carryout their jobs smoothly.
However, the Government of Liberia in its quest to eradicate the viral disease from Liberia has resolved to cremate all dead Ebola victims so as to avoid reoccurrence of the epidemic.
Many Liberians have through the media called on the government to consider designating a protected site for the burying of all dead Ebola victims instead of burying them in ‘secret areas’ or cremating the bodies.




Ministry of Health Portal, Kingdom of Saudi Arabia

Death of Ebola Suspected Patient Wednesday Morning in Jeddah, August 6, 2014

 A Saudi man suspected of being infected with the Ebola virus passed away at 8:45 a.m. Wednesday at a specialized hospital in Jeddah. May Allah have mercy upon him. The patient had been admitted to the intensive care unit late Monday after exhibiting symptoms of viral hemorrhagic fever following a business trip to Sierra Leone. The cause of the infection is still under investigation.
 
The Ministry of Health has submitted samples to an international reference lab in the United States as recommended by the World Health Organization. Additional samples are being sent to an accredited laboratory in Germany.
 
Preparations for burial will be performed at the hospital in keeping with Islamic religious practices and international guidelines for patients suspected of having an infectious disease like Ebola.
 
MOH officials have been in direct and continuous contact with the family of the patient. Public health experts began retracing the patient’s travels upon notification of his symptoms and travel history. They are currently monitoring the people he came into contact with for any symptoms associated with viral hemorrhagic fever.

UPDATE: LAB TESTS NEGATIVE FOR EBOLA VIRUS
09 August 2014

Samples submitted to an international reference laboratory were negative for Ebola virus, the Ministry of Health announced Saturday August 9th,2014  in Jeddah. Tests conducted at the U.S. Centers for Disease Control and Prevention (CDC), which has a special laboratory for testing the most dangerous microbes, indicate Ebola virus was not the cause of this patient’s illness.
 
CDC is conducting additional tests to confirm the negative Ebola finding and to determine if the patient was infected with another virus causing hemorrhagic fevers found in Sierra Leone 
 
Additional Ebola tests will be conducted on samples that have been sent to another international reference laboratory in Hamburg, Germany.
 
The results of these tests will be released to the public once they are complete.
 
The man became symptomatic after traveling to one of the countries that has been hardest hit by the Ebola outbreak in West Africa. Because of his symptoms and travel history, the man was identified as a suspected Ebola case, transferred to a specialized hospital in Jeddah, and the World Health Organization and general public were notified. He passed away last Wednesday while being treated in isolation.
 
As a precaution, MOH continues to monitor individuals who came into contact with the patient while he was exhibiting symptoms of viral hemorrhagic fever. 
 
This was the only suspected Ebola case identified in the Kingdom of Saudi Arabia.
 
As previously announced, MOH is advising Saudi citizens and residents to avoid all travel to Sierra Leone, Guinea and Liberia until further notice. People from those three countries have been prohibited from participating in this year’s umrah and hajj pilgrimages due to the outbreak in West Africa. 
 
MOH is taking a number of steps to ensure that highly contagious diseases are detected, diagnosed and tracked by public health professionals. 

UPDATE: GERMAN LAB CONFIRMS NEGATIVE EBOLA TEST RESULTS
12 August 2014

A German laboratory reported Tuesday that samples taken from a Saudi man were negative for Ebola virus, the Ministry of Health announced.
The laboratory at Bernhard Nocht Institute for Tropical Medicine, which is accredited by the World Health Organization, confirmed earlier test results from the U.S. Centers for Disease Control and Prevention (CDC) that indicated the man was not infected with Ebola virus.
At the request of MOH, both laboratories are conducting additional tests to determine the source of this patient’s infection.




WHO Statement on the Meeting of the International Health Regulations Emergency Committee
Regarding the 2014 Ebola Outbreak in West Africa
WHO statement
8 August 2014
 
The first meeting of the Emergency Committee convened by the Director-General under the International Health Regulations (2005) [IHR (2005)] regarding the 2014 Ebola Virus Disease (EVD, or “Ebola”) outbreak in West Africa was held by teleconference on Wednesday, 6 August 2014 from 13:00 to 17:30 and on Thursday, 7 August 2014 from 13:00 to 18:30 Geneva time (CET).

Members and advisors of the Emergency Committee met by teleconference on both days of the meeting1. The following IHR (2005) States Parties participated in the informational session of the meeting on Wednesday, 6 August 2014: Guinea, Liberia, Sierra Leone, and Nigeria.

During the informational session, the WHO Secretariat provided an update on and assessment of the Ebola outbreak in West Africa. The above-referenced States Parties presented on recent developments in their countries, including measures taken to implement rapid control strategies, and existing gaps and challenges in the outbreak response.

After discussion and deliberation on the information provided, the Committee advised that:
the Ebola outbreak in West Africa constitutes an ‘extraordinary event’ and a public health risk to other States;
the possible consequences of further international spread are particularly serious in view of the virulence of the virus, the intensive community and health facility transmission patterns, and the weak health systems in the currently affected and most at-risk countries.
a coordinated international response is deemed essential to stop and reverse the international spread of Ebola.

It was the unanimous view of the Committee that the conditions for a Public Health Emergency of International Concern (PHEIC) have been met.

The current EVD outbreak began in Guinea in December 2013. This outbreak now involves transmission in Guinea, Liberia, Nigeria, and Sierra Leone. As of 4 August 2014, countries have reported 1 711 cases (1 070 confirmed, 436 probable, 205 suspect), including 932 deaths. This is currently the largest EVD outbreak ever recorded. In response to the outbreak, a number of unaffected countries have made a range of travel related advice or recommendations.

In light of States Parties’ presentations and subsequent Committee discussions, several challenges were noted for the affected countries:
their health systems are fragile with significant deficits in human, financial and material resources, resulting in compromised ability to mount an adequate Ebola outbreak control response;
inexperience in dealing with Ebola outbreaks; misperceptions of the disease, including how the disease is transmitted, are common and continue to be a major challenge in some communities;
high mobility of populations and several instances of cross-border movement of travellers with infection;
several generations of transmission have occurred in the three capital cities of Conakry (Guinea); Monrovia (Liberia); and Freetown (Sierra Leone); and
a high number of infections have been identified among health-care workers, highlighting inadequate infection control practices in many facilities.

The Committee provided the following advice to the Director-General for her consideration to address the Ebola outbreak in accordance with IHR (2005).

States with Ebola transmission

The Head of State should declare a national emergency; personally address the nation to provide information on the situation, the steps being taken to address the outbreak and the critical role of the community in ensuring its rapid control; provide immediate access to emergency financing to initiate and sustain response operations; and ensure all necessary measures are taken to mobilize and remunerate the necessary health care workforce.
Health Ministers and other health leaders should assume a prominent leadership role in coordinating and implementing emergency Ebola response measures, a fundamental aspect of which should be to meet regularly with affected communities and to make site visits to treatment centres.

States should activate their national disaster/emergency management mechanisms and establish an emergency operation centre, under the authority of the Head of State, to coordinate support across all partners, and across the information, security, finance and other relevant sectors, to ensure efficient and effective implementation and monitoring of comprehensive Ebola control measures. These measures must include infection prevention and control (IPC), community awareness, surveillance, accurate laboratory diagnostic testing, contact tracing and monitoring, case management, and communication of timely and accurate information among countries. For all infected and high risks areas, similar mechanisms should be established at the state/province and local levels to ensure close coordination across all levels.

States should ensure that there is a large-scale and sustained effort to fully engage the community – through local, religious and traditional leaders and healers – so communities play a central role in case identification, contact tracing and risk education; the population should be made fully aware of the benefits of early treatment.
It is essential that a strong supply pipeline be established to ensure that sufficient medical commodities, especially personal protective equipment (PPE), are available to those who appropriately need them, including health care workers, laboratory technicians, cleaning staff, burial personnel and others that may come in contact with infected persons or contaminated materials.

In areas of intense transmission (e.g. the cross border area of Sierra Leone, Guinea, Liberia), the provision of quality clinical care, and material and psychosocial support for the affected populations should be used as the primary basis for reducing the movement of people, but extraordinary supplemental measures such as quarantine should be used as considered necessary.

States should ensure health care workers receive: adequate security measures for their safety and protection; timely payment of salaries and, as appropriate, hazard pay; and appropriate education and training on IPC, including the proper use of PPEs.

States should ensure that: treatment centres and reliable diagnostic laboratories are situated as closely as possible to areas of transmission; that these facilities have adequate numbers of trained staff, and sufficient equipment and supplies relative to the caseload; that sufficient security is provided to ensure both the safety of staff and to minimize the risk of premature removal of patients from treatment centres; and that staff are regularly reminded and monitored to ensure compliance with IPC.

States should conduct exit screening of all persons at international airports, seaports and major land crossings, for unexplained febrile illness consistent with potential Ebola infection. The exit screening should consist of, at a minimum, a questionnaire, a temperature measurement and, if there is a fever, an assessment of the risk that the fever is caused by EVD. Any person with an illness consistent with EVD should not be allowed to travel unless the travel is part of an appropriate medical evacuation.

There should be no international travel of Ebola contacts or cases, unless the travel is part of an appropriate medical evacuation. To minimize the risk of international spread of EVD:
  • Confirmed cases should immediately be isolated and treated in an Ebola Treatment Centre with no national or international travel until 2 Ebola-specific diagnostic tests conducted at least 48 hours apart are negative;
  • Contacts (which do not include properly protected health workers and laboratory staff who have had no unprotected exposure) should be monitored daily, with restricted national travel and no international travel until 21 days after exposure;
  • Probable and suspect cases should immediately be isolated and their travel should be restricted in accordance with their classification as either a confirmed case or contact.
  • States should ensure funerals and burials are conducted by well-trained personnel, with provision made for the presence of the family and cultural practices, and in accordance with national health regulations, to reduce the risk of Ebola infection. The cross-border movement of the human remains of deceased suspect, probable or confirmed EVD cases should be prohibited unless authorized in accordance with recognized international biosafety provisions.
  • States should ensure that appropriate medical care is available for the crews and staff of airlines operating in the country, and work with the airlines to facilitate and harmonize communications and management regarding symptomatic passengers under the IHR (2005), mechanisms for contact tracing if required and the use of passenger locator records where appropriate.
  • States with EVD transmission should consider postponing mass gatherings until EVD transmission is interrupted.
  • States with a potential or confirmed Ebola Case, and unaffected States with land borders with affected States
  • Unaffected States with land borders adjoining States with Ebola transmission should urgently establish surveillance for clusters of unexplained fever or deaths due to febrile illness; establish access to a qualified diagnostic laboratory for EVD; ensure that health workers are aware of and trained in appropriate IPC procedures; and establish rapid response teams with the capacity to investigate and manage EVD cases and their contacts.
  • Any State newly detecting a suspect or confirmed Ebola case or contact, or clusters of unexplained deaths due to febrile illness, should treat this as a health emergency, take immediate steps in the first 24 hours to investigate and stop a potential Ebola outbreak by instituting case management, establishing a definitive diagnosis, and undertaking contact tracing and monitoring.
  • If Ebola transmission is confirmed to be occurring in the State, the full recommendations for States with Ebola Transmission should be implemented, on either a national or subnational level, depending on the epidemiologic and risk context.

All States

There should be no general ban on international travel or trade; restrictions outlined in these recommendations regarding the travel of EVD cases and contacts should be implemented.

States should provide travelers to Ebola affected and at-risk areas with relevant information on risks, measures to minimize those risks, and advice for managing a potential exposure.

States should be prepared to detect, investigate, and manage Ebola cases; this should include assured access to a qualified diagnostic laboratory for EVD and, where appropriate, the capacity to manage travelers originating from known Ebola-infected areas who arrive at international airports or major land crossing points with unexplained febrile illness.

The general public should be provided with accurate and relevant information on the Ebola outbreak and measures to reduce the risk of exposure.

States should be prepared to facilitate the evacuation and repatriation of nationals (e.g. health workers) who have been exposed to Ebola.

The Committee emphasized the importance of continued support by WHO and other national and international partners towards the effective implementation and monitoring of these recommendations.

Based on this advice, the reports made by affected States Parties and the currently available information, the Director-General accepted the Committee’s assessment and on 8 August 2014 declared the Ebola outbreak in West Africa a Public Health Emergency of International Concern (PHEIC). The Director-General endorsed the Committee’s advice and issued them as Temporary Recommendations under IHR (2005) to reduce the international spread of Ebola, effective 8 August 2014. The Director-General thanked the Committee Members and Advisors for their advice and requested their reassessment of this situation within 3 months.

--------------------------------------------------------------------------------
1 IHR Emergency Committee Members and Advisers

List of Members of, and Advisers to, the International Health Regulations
(2005) Emergency Committee regarding Ebola
6 and 7 August 2014

CHAIR

Dr Sam Zaramba

Senior Consultant Surgeon, Former Director General of Health Services, Ministry of Health, Kampala, Uganda

VICE-CHAIR

Professor Robert Steffen

Department of Epidemiology and Prevention of Infectious Diseases, WHO Collaborating Centre for Travellers’ Health, University of Zurich, Zurich, Switzerland

RAPPORTEUR

Professor Oyewale Tomori
Redeemer’s University, Redemption City, Lagos, Nigeria

MEMBERS

Dr Abdullah Al-Assiri
Assistant Deputy Minister of Health for Preventive Health, Riyadh, Kingdom of Saudi Arabia

Professor Chris Baggoley
Chief Medical Officer, Department of Health and Ageing, Canberra, Australia

Professor Lucille Blumberg
Deputy Director, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa

Dr Martin Cetron
Director, Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, United States of America

Dr Alain Epelboin
Researcher in Medical Anthropology, National Centre for Scientific Research and National Museum of Natural History, Paris, France

Dr Amara Jambai
Director, Disease Prevention and Control, Ministry of Health, Freetown, Sierra Leone

Professor James LeDuc
Director of Galveston National Laboratory, University of Texas Medical Branch, Galveston, United States of America

Dr Fernando Otaiza
Chief, National Infection Prevention and Control Programme, Ministry of Health, Santiago, Chile

Dr Mark Salter
Global Health Consultant, Public Health England, London, United Kingdom of Great Britain and Northern Ireland

Dr Theresa Tam
Branch Head, Health Security Infrastructure Branch, Public Health Agency of Canada, Ottawa, Canada

ADVISERS

Professor William Ampofo
Head of Virology Department, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana

Colonel (retired) Vincent Anami
Continent Representative (Africa), Center for Disaster and Humanitarian Assistance Medicine, Uniformed Services University of the Health and Sciences, Friends International Centre, Nairobi, Kenya

Dr Vincent Covello
Director, Center for Risk Communication, New York, United States of America

Dr Anthony Evans
Chief, Aviation Medicine Section, International Civil Aviation Organization

Dr Maria João Martins
Advisor to the General Director of Health for International Health, Ministry of Health, Lisbon, Portugal

Professor Jean-Jacques Muyembe
Department of Microbiology, University of Kinshasa, and Director-General, National Institute of Biomedical Research, Kinshasa, Democratic Republic of Congo

Professor Michael Selgelid
Director, Centre for Human Bioethics, Monash University, Melbourne, Australia





FEDERAL REPUBLIC OF NIGERIA
STATE HOUSE PRESS RELEASE
August 8, 2014

President Goodluck Ebele Jonathan Friday in Abuja declared the control and containment of the Ebola virus in Nigeria, a National Emergency.

Accordingly, the President has directed the Federal Ministry of Health to work in collaboration with the State Ministries of Health, the National Centre for Disease Control (NCDC), the National Emergency Management Agency (NEMA) and other relevant agencies to ensure that all possible steps are taken to effectively contain the threat of the Ebola virus  in line with international protocols and best practices.

President Jonathan also approved a Special Intervention Plan and the immediate release of N1. 9 billion for its implementation, to further strengthen on-going steps to contain the virus such as the establishment of additional isolation centres, case management, contact tracing, deployment of additional personnel, screening at borders, and the procurement of required items and facilities.

The President commends the vigilance of  aviation and health authorities in Lagos who identified and isolated the index case in Nigeria, the late Patrick Sawyer, an American-Liberian who flew into the country.

He also applauds the good work of health authorities at both State and Federal levels who have traced persons who had contact with him, isolated  other identified cases and embarked on massive public enlightenment.

President Jonathan calls for even greater vigilance and co-operation at all levels to stop the Ebola virus from spreading further.

As the effective implementation of the Federal Government's Special Intervention Plan will require other stakeholders to take certain precautionary steps that are supportive of the government’s initiative, the President calls on members of the public to follow all directives by health authorities and report any suspected Ebola case to the nearest health facility for immediate medical attention. 

He also enjoins the public to desist from spreading false information about  Ebola which can lead to mass hysteria, panic and misdirection, including unverified suggestions about the prevention, treatment, cure and spread of the virus. 

President Jonathan urges that the movement of corpses from one community to the other, and from overseas into the country should be stopped forthwith. Every death should be reported to the relevant authorities, and special precautions should be taken in handling corpses.

Religious and political groups, spiritual healing centres, families, associations and other bodies should, in the meantime, discourage gatherings and activities that may unwittingly promote close contact with infected persons or place others at risk.

Public enlightenment agencies, including privately-owned media organs should support government’s efforts and disseminate correct information in all Nigerian languages, about preventive personal hygiene measures, the nature of the Ebola virus, modes of transmission and consequential steps to be taken in the event of infection. 

President Jonathan appeals to State governments and private daycare, nursery, primary and secondary schools owners to consider the option of extending the current school holiday until such a time when a national reassessment of the level of the Ebola threat is conducted. 

The President further directs the National Emergency Management Agency and similar agencies at the state level to strengthen their public enlightenment campaigns and to use their networks to distribute hand sanitisers and other protective items nationwide. He has also directed the aviation and health authorities to embark on immediate intensification of the screening of travelers at all the nation’s borders.

President Jonathan reassures everyone that the Government of Nigeria will continue to take every step, deploy all resources, and mobilize every support and assistance to check the spread of Ebola in the country.

Medical workers and other health professionals are expected to regard this declaration of a National Emergency as a patriotic call to duty and service.
 
Reuben Abati
Special Adviser to the President
(Media and Publicity)





Update On Patient Being Tested For Ebola Virus Disease in Ontario
Ontario Hospital Testing Patient as Precautionary Measure
August 9, 2014 5:45 P.M.
Ministry of Health and Long-Term Care
 
William Osler Health System's Brampton Civic Hospital is currently testing a patient who recently travelled to Canada from Nigeria and presented with symptoms including fever, headache and malaise.

This action was taken as a precautionary measure and results of the testing are expected within the next 24 hours. Samples have been sent to the National Microbiology Laboratory in Winnipeg.

The patient is currently in isolation and is being treated for a fever and other flu-like symptoms.

The Minister of Health is closely managing the situation and is in close contact with the Chief Medical Officer of Health, the local public health unit and the hospital.

Initial signs and symptoms of Ebola are similar to many more common diseases and health care providers have been advised to be on heightened alert for Ebola cases. Although the risk of transmission of the Ebola virus disease in Ontario remains very low, the ministry is taking measures to ensure the province's health care sector is prepared and the public is protected.

Given the current outbreak of Ebola in West Africa, it is expected that health care providers will consider Ebola as one of the diseases to rule out for persons who have recently travelled to one of the affected African countries, and who are presenting with symptoms seen in many more common diseases such as malaria or the flu. These symptoms could include fever, malaise, muscle pain and headache.  

Health professionals are responding to the alert appropriately, by identifying individuals who potentially may be affected, taking enhanced infection-prevention precautions, and testing. Our system is working as it should.

Ontario learned many lessons from SARS including the need to ensure health care providers have the information they need to respond appropriately and quickly.

The ministry, in collaboration with Public Health Ontario, has recently advised Ontario health care providers of the Ebola virus disease outbreak in West Africa, and the need to consider Ebola as one possible diagnosis for travellers who have visited Africa in the previous 21 days, and who show symptoms such as fever, malaise, muscle pain and headaches.  Guidelines have been provided regarding: disease diagnosis; specimen collection; infection, prevention and control measures and testing.

Quick Facts
•People in need of medical care returning from a West African country affected by the Ebola outbreak should seek care immediately.
•The current Ebola Virus Disease (EVD) outbreak began in Guinea in December 2013. This outbreak now involves transmission in Guinea, Liberia, Nigeria and Sierra Leone.
•The CMOH notified the health system to the risk posed by Ebola in West Africa in the Spring. Guidance for health care workers was posted on Public Health Ontario’s website on April 9, 2014.
•On August 1 and 8, 2014, CMOH memos were issued to the health system to alert health workers and health sector employers to the latest guidance on appropriate occupational health & safety, infection prevention & control measures and laboratory testing protocols.

Quotes


Dr. Eric Hoskins

“My number one priority is ensuring Ontarians are healthy and safe. I am closely monitoring this situation, I am in constant contact with the Chief Medical Officer of Health, and I remain thoroughly confident in our health system's ability to contain and treat any infectious illness. There are currently no confirmed cases of Ebola in North America, but we have taken strong action to prepare our system so that it is fully equipped to deal with any potential cases in Ontario. I want to thank all of the dedicated frontline health professionals and public health officials who have been working together to address the patient’s illness and ensure Ontarians are protected from infectious disease.”

Dr. Eric Hoskins

Minister of Health and Long-Term Care

“Ontario continues to take steps to ensure the health system is prepared should a returning traveller from a country where Ebola is circulating be suspected of having the disease. Our hospitals have sophisticated infection control systems and procedures in place that are designed to limit the spread of infection, protect health care workers, and provide the best care possible for the patient.”

Dr. Graham Pollett

Interim Chief Medical Officer of Health

“William Osler Health System is committed to the health and safety of patients, families and staff and we take the prevention of infectious diseases very seriously. Osler’s medical experts have been working with our public health partners to manage the current situation and confirm a patient diagnosis as quickly as possible. I want to thank all of our staff, physicians and volunteers for their dedication and commitment to delivery of patient-inspired care.”

Matthew Anderson

President and CEO, William Osler Health System



Viral Haemorrhagic Fever: Update for Clinicians
Updated July 22, 2014


Background: Fever in the returning traveller

• Fever in the international traveller post-travel is a common scenario.
• Fever may herald a serious, life-threatening illness; therefore, all returning travellers who are febrile or complaining of a fever should be promptly and thoroughly evaluated.
• The top infectious causes of fever in international travellers include malaria (20-30%), acute traveller’s diarrhea (10-20%), and respiratory tract infections (10-15%). Therefore, febrile patients who have travelled to malaria endemic areas should be considered to have malaria until proven otherwise.
• Accurate diagnosis and appropriate management of the febrile traveller requires a comprehensive travel history that should include:
  • pre-travel preparations (e.g., pre-travel immunizations, malaria prophylaxis)
  • itinerary (e.g., destination, arrival and departure dates)
  • style of travel (e.g., accommodation, camping, contact with local populations)
  • purpose of travel (e.g., tourism, business, visiting friends and relatives)
  • potential exposures (e.g., blood/body fluids, street foods, local water, uncooked meat, unpasteurized dairy products, fresh water activities, arthropod bites, animal exposures)
  • medical care or treatment received abroad
• The pattern (e.g., continuous, biphasic, relapsing) and duration of fever, as well as the apparent incubation period (i.e., time from potential exposure/infection to symptom onset) are also helpful in suggesting possible infectious etiologic agents.
• The patient also requires a complete physical examination with particular attention paid to localizing symptoms or signs.
• Although the risk is otherwise extremely low, viral hemorrhagic fever (VHF) should be considered in the differential diagnosis of febrile persons who have returned from endemic regions or specific local areas of a country where VHF cases have recently occurred. In addition to malaria, typhoid fever, shigellosis, cholera, leptospirosis, plague, rickettsiosis, relapsing fever, meningitis, and hepatitis may also be considered in these patients.

Clinical aspects of viral haemorrhagic fever (VHF)

• Initial symptoms are non-specific and include acute onset of fever, myalgia, headache, pharyngitis, diarrhea, and chest pain.
• Later signs are more specific to VHF: conjunctivitis, petechiae, morbilliform rash, and may progress to haemorrhagic shock.
• In severe and fatal forms, the haemorrhagic diathesis may be accompanied by hepatic damage, renal failure, CNS involvement and terminal shock with multi-organ dysfunction.

Diagnostic laboratory testing for suspect VHF patients

• Please refer to the PHO Laboratory Viral Haemorrhagic Fever Testing Information Sheet for detailed information on specimen collection and submission
Infection prevention and control practices
• Nosocomial transmission can occur directly (e.g., contact or droplets), indirectly (e.g., instruments and hard surfaces), and possibly by aerosols.
• VHF patients developing a prominent cough, vomiting, diarrhea, or haemorrhage may expose persons to airborne particles.
• Therefore suspect or confirmed VHF patients must be managed using contact, droplet and airborne precautions (including a fit-tested, seal checked N95 respirator and eye protection). These precautions apply to all persons including visitors in the same room as the patient, when transporting or caring for the patient or within two metres of a patient not in a room.
• Symptomatic patients should be isolated in a single room with negative air pressure; the door should be closed.
• The need for additional barriers (e.g., leg and shoe coverings) depends on the potential for fluid contact as determined by the procedure to be performed and the presence of clinical symptoms that increase the likelihood of contact with body fluids from the patient (viral shedding and associated risks appear to increase from the incubation period through the last stages of infection).
• Avoid the use of sharp objects. Use and properly dispose of all safely engineered medical devices.
• Standard hospital disinfectants may be used to clean the environment of suspect or confirmed VHF patients.

• Standard hospital disinfectants may be used to clean the environment of suspect or confirmed VHF patients.



Nurses wearing protective clothing are sprayed with disinfectant Friday, August 1, in Monrovia after they prepared the bodies of Ebola victims for burial
Nurses wearing protective clothing are sprayed with disinfectant Friday, August 1, in Monrovia
after they prepared the bodies of Ebola victims for burial.
Source: CNN
UNICEF has supplied its partners in Guinea with materials for disinfecting hospitals including sprayers and cleansers to prevent further spread of Ebola. Photo: UNICEF
UNICEF has supplied its partners in Guinea with materials for disinfecting hospitals including sprayers and cleansers to prevent further spread of Ebola. Photo: UNICEFSource: UN News Centre

 Environmental Service personnel must use the same PPE as all individuals entering the room.

• Do not spray disinfectants or use fogging as part of the cleaning process.
• Only essential medical, nursing and other hospital personnel, and immediate family members, should enter the patient's room.
• Caregivers and visitors should perform hand hygiene (soap/water or alcohol-based hand rub) before and after patient care and after leaving the patient’s room; and ensure appropriate removal of personal protective equipment following patient contact.
• Deceased patients should be prepared for prompt burial using similar precautions.

 Source: Heymann, David L., ed. Control of Communicable Diseases Manual, 19th edition. American Public Health Association


CDC, October 1, 2014: Avoid aerosol-generating procedures if possible

Checklist for Patients Being Evaluated for Ebola Virus Disease (EVD) in the United States

CDC, October 1, 2014: Avoid aerosol-generating procedures if possible. Checklist for Patients Being Evaluated for Ebola Virus Disease (EVD) in the United States. Mist and foam spraying generates aerosol. Fogging presents a particular risk to the respiratory system as it produces smaller droplets than spraying. These can remain suspended in air for 45-60 minutes or longer. 1 – 10 aerosolized Ebola viruses are sufficient to cause infection in humans.
Mist and foam spraying generates aerosol. Fogging presents a particular risk to the respiratory system as it produces smaller droplets than spraying. These can remain suspended in air for 45-60 minutes or longer.
1 – 10 aerosolized Ebola viruses are sufficient to cause infection in humans.

Red Cross volunteers disinfect each other with chlorine after removing the body of an Ebola victim
 from a house in Pendembu on July 18., 2014 (originally AP)
Red Cross volunteers disinfect each other with chlorine after removing the body of an Ebola victim from a house in Pendembu on July 18., 2014 (originally AP).  Avoid aerosol-generating procedures. Do not spray disinfectants or use fogging as part of the cleaning process. ebola-virus-disease.com
Avoid aerosol-generating procedures. Do not spray disinfectants or use fogging as part of the cleaning process.
ebola-virus-disease.com


Viral Haemorrhagic Fevers (VHFs) –
Sample Collection and Submission Guide


This document provides:
1. Background information on VHFs
2. Sample collection guidelines
3. Shipping instructions
4. Links for further information

1. Background

Viral haemorrhagic fevers (VHFs) are characterized by initial non-specific symptoms, including acute onset of fever, myalgia, headache, pharyngitis, diarrhoea, and chest pain. Later signs are more specific to VHF including conjunctivitis, petechiae and morbilliform rash with possible progression to haemorrhagic shock. In severe and fatal forms, the haemorrhagic diathesis may be accompanied by hepatic damage, renal failure, CNS involvement and terminal shock with multi-organ dysfunction.

VHFs are associated with a number of geographically restricted viruses including Lassa fever, Marburg virus haemorrhagic fever, Ebola Virus Disease (formerly Ebola haemorrhagic fever), Crimean-Congo haemorrhagic fever, Bolivian haemorrhagic fever (Machupo) and Venezuelan haemorrhagic fever (Guanarito).

VHFs are not indigenous to Canada, but there have been both suspected and confirmed convalescent cases, and the potential for importation of an acute case is of concern. Circumstances under which the diagnosis of acute VHF should be considered are individuals who, within 3 weeks before onset of fever, have either:
• travelled in the specific local area of a country where VHF has recently occurred
(If exact travel history is unknown, risk assessment should be done through consultation with an Infectious Disease Specialist).
• had direct contact with blood, other body fluids, secretions, or excretions of a person or animal with VHF, or
• worked in a laboratory or animal facility that handles haemorrhagic fever viruses.

VHFs are known to have caused outbreaks of disease with person-to-person spread. Transmission of VHF from person to person is primarily due to contact with virus-infected blood and body fluids, such as urine, vomitus or faeces, or by the use of contaminated needles or syringes in the health care setting. Ebola, Marburg and Lassa viruses can be transmitted by semen for up to 3 months after clinical recovery. Epidemiological studies of VHF in humans indicate that infection is not transmitted readily from person to person by the airborne route. Airborne transmission involving humans is considered a possibility only in rare instances from persons with advanced stages of disease and pulmonary involvement. The risk for person-to-person transmission of a haemorrhagic fever virus is highest during the later stages of illness, which are characterized by vomiting, diarrhoea, shock and often haemorrhage.

It is important that in all suspected cases, other more common and potentially treatable diseases such as malaria are eliminated from the differential diagnosis.

When a possible case of VHF is suspected, the following tests must be done immediately:
• Blood film examination for malaria (thick and thin blood films); a smear from a second specimen must be examined 12 to 24 hours later if the first does not reveal parasites.
• Two sets of blood cultures with a total volume per set (two bottles) of 16 to 20 ml in adults. Recommended volume collection for blood cultures in children is based on body weight.
• White blood cell and differential counts, and either haemoglobin or haematocrit, urine culture if symptoms or manual dipstick suggests infection. Other critical tests can be considered if they can be performed on closed systems, i.e. arterial blood gases, electrolytes, liver function tests, creatinine, clotting function.

2. Specimen Collection Guidelines

Before the collection of specimens to be submitted to PHO Laboratory (PHOL), contact PHOL Customer Service Centre at 416-235-6556 or 1-877-604-4567. The following five principles should be observed in the collection of all patient specimens:
• Only specimens essential for diagnosis or monitoring should be obtained.
• Specimens should be obtained by staff experienced in the required techniques. The same protective clothing as described for other hospital staff should be worn by those obtaining and testing laboratory specimens.
• Glass containers should not be used. Disposable sharp objects, such as scalpel blades, should be placed in approved sharps containers immediately after use and later autoclaved or incinerated before disposal.
• Blood samples must be collected with extreme care to avoid self-inoculation. Needles should not be removed from disposable syringes, or otherwise handled. After use, blood-taking equipment should be immediately placed in approved sharps disposal containers and autoclaved or incinerated before disposal.
• The entire outside surface of each specimen container should be wiped with disinfectant, and a label should be attached bearing the patient's name, hospital identification code, source of the specimen, date of collection, and the nature of the suspected infection. Clinical laboratory specimens should each be placed into a separate sealable plastic biohazard bags that are sealed, then transported in a durable, leak-proof secondary container directly to the specimen handling area of the laboratory. A fully completed laboratory requisition form for each sample should be placed in a separate pocket of the biohazard bag, not inside the sealed compartment with the sample. The outside of these biohazard bags should be wiped with a disinfectant solution such as a 1:10 dilution of household bleach (5,000 ppm available chlorine) before leaving the patient's room. Automated delivery (pneumatic tube) systems should not be used as they may disseminate aerosols in the event of a spill or breakage. Laboratory staff should be alerted to the nature of the specimens, which should remain in the custody of a designated person until testing is done.

Table 1: Recommended specimen collection guidelines for diagnosis/detection of specific viral aetiology of VHF.

Specimen Test How to submit
Blood Serology Two (2) serum separator tubes (SST)
(Ideally 10ml each; minimum 2ml each)
Blood Viral culture
PCR
Two (2) tubes containing EDTA
(Ideally 10ml each, minimum 2ml each)
Throat swab Viral culture
PCR
Place swab in plastic screw cap container with Viral Transport Media (VTM)
Tissue μ Viral culture
PCR
Place in sterile screw cap container.

μ Tissue should not be tested as a first line specimen due to biosafety concerns related to specimen collection.

• Each sample for VHF-specific testing must be submitted with its own separate requisition form requesting VHF testing only – specify which particular VHFs are suspected. Other tests requested on same requisition will be cancelled.
• If additional tests are requested submit separate samples, each with its own laboratory requisition, clearly stating patient’s suspected diagnosis and risk factors. Other tests may be delayed pending VHF testing results.

3. Shipping Instructions

• Shipping of samples must be done in accordance with the Transportation of Dangerous Goods Regulations (TDGR) by a TDG certified individual. These regulations require handling and shipping patient’s samples according to the international procedures for transport of category A infectious substances (UN2814). See link provided below for further information.  
• Store samples in refrigerator or frozen until being shipped for testing.
• Frozen specimens should be shipped on dry ice and refrigerated samples with ice-packs. Blood and throat swabs should be shipped immediately with cool packs. If shipment is expected to take longer than 24 hours it should be shipped on dry ice. Tissue should be preferentially shipped on dry ice.
• Ship specimens in separate sealable leak-proof biohazard bags placed in an approved shipping container.

4. Specimen Handling/Processing in the Laboratory

• Process clinical specimens for microbiology testing, including malaria smears, in a class II biological safety cabinet following biosafety level 3 practices.
• Heating at 60◦C for one hour renders specimens non-infectious and enables measurement of heat-stable substances such as electrolytes, blood urea nitrogen, and creatinine.
• Non-inactivated specimens can be processed in automated analysers that do not require removal of the top of the blood collection tube, provided there is proper disposal of waste fluids and the machine can be decontaminated after use.
• Haematologic specimens can be processed in a Coulter counter provided it does not require manual removal of the top of the blood collection tube and there is proper disposal of waste fluids.
• Blood smears (for malaria, blood films) are not infectious for VHF viruses after fixation in solvents.
• Specimens for nucleic acid amplification can be inactivated by heat treatment at 60◦C for one hour. Inactivation also occurs once material is exposed to the lysis reagent used for nucleic acid extraction e.g. guanidinium thiocyanate.
• Note: Cross-matching of blood cannot be performed safely. If transfusion is required, O Rh negative blood (universal donor) should be used.
See section 5 (second bullet) for links to relevant documents with further information on methods for viral inactivation and how to conduct non-microbiological essential laboratory testing.

5. Further Information

• Contact the PHOL Customer Service Centre at 416‐235‐6556 or 1‐877‐604‐4567 (toll-free).
• For further information about the processing of specimens of suspect or confirmed case with Viral Haemorrhagic Fever (VHF) in hospital laboratories:
  •  CDC: Interim Guidance for Managing Patients with Suspected Viral Haemorrhagic Fever in U.S. Hospitals
  •  Australian Public Health Laboratory Network: Laboratory Precautions for Samples Collected from Patients with
Suspected Viral Haemorrhagic Fevers
• PHOL: Laboratory services and testing information
• PHOL: Viral Haemorrhagic Fever Testing Information Sheet
• The current version of the PHOL laboratory requisition form is available here.
• PHO: Viral Haemorrhagic Fever homepage (includes PHO Update for Physicians)
• PHAC: Viral Haemorrhagic Fever homepage
• Biosafety information relevant to viral haemorrhagic fevers (PHAC)
  • PHAC: Pathogen Safety Data Sheets and Risk Assessment (index)
  • PHAC: Canadian Biosafety Standards and Guidelines –First Edition
• Transport Canada : Transportation of Dangerous Goods Regulations





Ebola reaches U.S.: A tragedy of errors
By Ford Vox, October 2, 2014
Health workers in Monrovia place a corpse into a body bag on September 4 (originally AP)
Health workers in Monrovia place a corpse into a body bag on September 4 (originally AP) still this is not your corpse? ebola-virus-disease.com
still this is not your corpse?
Prof. Peter Piot, co-discoverer of the Ebola virus in 1976, Director of the London School of Hygiene & Tropical Medicine, interviewed by the BBC October 3, 2014, contrasted the US, the UK, Cuba and China with Angela Merkel ruled Europe which does almost nothing to prevent global catastrophe of the Ebola virus disease pandemic.




Ebola reaches Europa.: A tragedy of errors
Spanish Ebola virus disease case the first acquired outside Africa
 
Javier Limón, marido de la auxiliar contagiada por ébola, ha explicado en 'Más Vale Tarde' que su mujer siguió en todo momento el protocolo de seguridad para controlar la enfermedad y que cuando acudió al centro de salud, con 37 grados de fiebre, le dijeron que se fuera a casa porque podía ser "un simple constipado".
Spanish Ebola virus disease case the first acquired outside Africa, Teresa Romero Ramos, 44, nursing assistant
Spanish Ebola virus disease case the first acquired outside Africa, Teresa Romero Ramos, 44, nursing assistant

Javier Limón, husband of the assisstant nurse  infected by Ebola, explained in 'Mas Vale Tarde' his wife followed at all times the security protocol to control the disease and that when he went to the health center with 37 degrees of fever, she was told to go home because she could be "simply constipated". on youtube

“Teresa se medía la temperatura varias veces al día y luego le llamaban para preguntarle”. Javier Limón, marido de la auxiliar de enfermería contagiada por ébola, relató ayer a La Sexta y a otros medios digitales cómo fue el protocolo que llevó su mujer desde el 26 de septiembre, fecha en la que inició sus vacaciones tras la muerte el día anterior del misionero Manuel García Viejo. Limón, que permanece aislado en el mismo hospital Carlos III que su mujer, aseguró que “ella hizo todo lo que le dijeron, nunca me comentó nada, volvió a casa tan normal y en ningún momento ha tenido ninguna preocupación de nada”.

El marido de la auxiliar infectada, que asegura encontrarse bien, dice que todo era normal hasta el 30 de septiembre: “Ella empezó con fiebre, pero nunca alta. No llegaba a los 38,6 grados centígrados”, aseguró. Según el relato del marido de la auxiliar de enfermería, llamó varias veces al hospital indicando lo que pasaba, pero le dijeron que “no se preocupara”. “Teresa observó que tenía fiebre y acudió a su médico de cabecera. Allí le contó lo que le ocurría y que había estado en contacto con el operativo que atendía a enfermos de ébola en el Carlos III. Este profesional, siempre según el relato de Javier Limón, descartó que fuera algo grave y le recetó paracetamol a la mujer. En su opinión se trataba de un resfriado común. La fiebre de Teresa no superaba los 38 grados: “Si lo hubiera hecho es probable que las alarmas habrían saltado antes”.

Javier Limón asegura desde su aislamiento en el hospital Carlos III que “contacto con ella no he tenido ninguno, lo que me van contando los médicos que entran en mi habitación. Me cuentan que le han puesto unas plaquetas de una paciente que tuvo ébola y se recuperó, ahí andamos”. Limón reconoció que “nos íbamos a ir de vacaciones porque estuvo haciendo el examen para la plaza fija. Lleva quince años trabajando aquí [en el Carlos III] y no nos pudimos ir por un accidente que tuve yo, y ella dijo: ‘Pues bueno, me voy yo a pasar unos días con mi madre’. Pero luego empezó con la fiebre y...”.

“Ya está mejor”, dice su madre

Por su parte, Jesusa Ramos, madre de la enfermera infectada, aseguró que su hija no ha vuelto a su localidad de origen, Becerreá, en Lugo, desde finales de agosto. No obstante, ayer por la mañana pudo hablar con ella y le trasladó que “se encuentra mejor”. Así lo explicó Jesusa Ramos a La Voz de Galicia, según se recoge en su web en un vídeo de menos de un minuto en el que la madre de la auxiliar afectada realiza unas breves declaraciones desde la ventana de su casa. “Hablé con ella y me dijo que parece que se encontraba mejor, que una compañera le estaba dando el medicamento y ya no quise molestarla más, porque me dijo su marido que hablara con él, que a ella no la molestara”, explicó.

Preguntada sobre cuándo fue la última vez que estuvo con su hija, respondió que “en agosto”. “Últimos de agosto, ya nos despedimos, y hasta ahora”, señaló. Así, cuestionada sobre si su hija había estado desde entonces en Becerreá dijo que “no”. De este modo, requerida sobre si quería mandar un mensaje de tranquilidad a los vecinos y a la sociedad, la madre de la auxiliar pidió “que se tranquilicen, que se encuentra mejor”.

DEIA, October 7, 2014
"Teresa temperature was measured several times a day and then called him to ask him." Javier Limón, the husband of the nurse's aide infected by Ebola, reported yesterday at The Sixth and other digital media what was the protocol that took his wife since 26 September, the date on which he began his vacation after the death the previous day of  missionary Manuel García Viejo. Lemon, who remains isolated in the same hospital Carlos III that his wife, said that "she did everything she was told, never told me anything, again as normal home and has never had any concern at all."

The husband of the infected person, ensuring unwell, said that everything was normal until 30 September: "She started with fever, but never high. It didn't reach 38.6 degrees Celsius, "he said. According to the story of the husband of the nurse's aide, she called several times to the hospital stating what happened, but was told "not to worry". "Teresa noted that he had a fever and went to their GP. There she told him what was wrong and had been in contact with a person in charge attending Ebola patients in the Carlos III. This professional, always according to the story of Javier Limón, denied that it was something serious and prescribed paracetamol for the  women. It was a common cold in his opinion. Teresa fever did not exceed 38 degrees: "If he had probably jumped the alarms have before."

Javier Limón said from his isolation in the hospital Carlos III that "contact with her have not had any, which doctors are telling me to enter my room. They tell me that they have put some platelets of a patient who had recovered Ebola, walk there. "Lemon admitted that "we were going on vacation because he was doing the test for permanent position. Spent fifteen years working here [at the Carlos III] and we could not go for an accident that I had, and he said, 'Well then, I'll spend a few days with my mother. But then he started with fever and ... ".

"That's better," says his mother

Meanwhile, Jesusa Ramos, mother of the infected nurse, said her daughter has not returned to its place of origin, Becerreá in Lugo, from late August. However, yesterday morning he could talk to her and moved that "feeling better". This was explained by Jesusa Ramos La Voz de Galicia, as stated on its website a video in less than a minute in which the mother of the auxiliary involved makes brief remarks from the window of her house. "I talked to her and she told me that it seems that it was better than a mate was giving him the medication and no longer wanted to bother her more because her husband told me to talk to him, that she did not bother her," he said.

He asked about when was the last time she was with her daughter, he replied that "in August." "Last August, as we parted, and so far," she said. So, questioned whether her daughter had since been in Becerreá said "no". Thus, required if he wanted to send a message of reassurance to neighbors and society, the mother asked the assistant "to calm down, which is better."

Google translated

La Voz de Galicia


Sra / Mrs Teresa Romero Ramos "Doy gracias a Dios y a Santiago Apóstol por devolverme la vida"."I thank God and St. James for giving me back my life. " Curada, 5 de noviembre de 2014 / Cured, November 5, 2014  Ebola Virus Disease Home Page
Sra / Mrs Teresa Romero Ramos
"Doy gracias a Dios y a Santiago Apóstol por devolverme la vida".
"I thank God and St. James for giving me back my life.
"
Curada, 5 de noviembre de 2014 / Cured, November 5, 2014

Dan de alta a Teresa Romero, la primera infectada con Ébola fuera del continente africano
youtube




WHO Ebola news 
14 August 2014
 
The outbreak of Ebola virus disease in West Africa continues to escalate, with 1975 cases and 1069 deaths reported from Guinea, Liberia, Nigeria, and Sierra Leone.

No new cases have been detected in Nigeria following the importation of a case in an air traveller last month. Extensive contact tracing and monitoring, implemented with support from the US Centers for Disease Control and Prevention (CDC), has kept the number of additional cases small.

Elsewhere, the outbreak is expected to continue for some time. WHO’s operational response plan extends over the next several months. Staff at the outbreak sites see evidence that the numbers of reported cases and deaths vastly underestimate the magnitude of the outbreak.

WHO is coordinating a massive scaling up of the international response, marshalling support from individual countries, disease control agencies, agencies within the United Nations system, and others.

The World Food Programme is using its well-developed logistics to deliver food to the more than one million people locked down in the quarantine zones, where the borders of Guinea, Liberia, and Sierra Leone intersect. Several countries have agreed to support the provision of priority food staples for this population.

Historically unprecedented number of more than one million people locked down in the Ebola Virus Disease quarantine zones raises more questions than answers. dr Halat, Epidemiologist
Historically unprecedented number of more than one million people locked down in the
Ebola Virus Disease quarantine zones raises more questions than answers. dr Halat, Epidemiologist

Practical on-the-ground intelligence is the backbone of a coordinated response. WHO is mapping the outbreak, in great detail, to pinpoint areas of ongoing transmission and locate treatment facilities and supplies. Good logistical support depends on knowing which facilities need disinfectants or personal protective equipment, where new isolation facilities need to be built, and where the need for more health-care workers is most intense.

CDC is equipping the hardest-hit countries with computer hardware and software that will soon allow real-time reporting of cases and analysis of trends. This also strengthens the framework for a scaled-up response.

Today, WHO Director-General Dr Margaret Chan held discussions with a group of ambassadors from Geneva’s United Nations missions. The meeting aimed to identify the most urgent needs within countries and match them with rapid international support.

These steps align with recognition of the extraordinary measures needed, on a massive scale, to contain the outbreak in settings characterized by extreme poverty, dysfunctional health systems, a severe shortage of doctors, and rampant fear.


eLife
 eLife 2014;10.7554/eLife.04395. Published September 8, 2014  

Mapping the zoonotic niche of Ebola virus disease in Africa

David M Pigott, Nick Golding, Adrian Mylne, Zhi Huang, Andrew J Henry, Daniel J Weiss, Oliver J Brady, Moritz U G Kraemer, David L Smith, Catherine L Moyes, Samir Bhatt, Peter W Gething, Peter W Horby, Isaac I Bogoch, John S Brownstein, Sumiko R Mekaru, Andrew J Tatem, Kamran Khan, Simon I HayCorresponding Author

Areas where Ebola virus infection in animals is likely (colour scale ranging from red for most likely, through yellow to blue for least likely). David M Pigott et al: Mapping the zoonotic niche of Ebola virus disease in Africa.  eLife 2014;10.7554/eLife.04395. Published September 8, 2014
Areas where Ebola virus infection in animals is likely (colour scale ranging from red for most likely, through yellow to blue for least likely).


Areas where Ebola virus infection in animals is likely (colour scale ranging from red for most likely, through yellow to blue for least likely). The borders of all African countries are outlined in grey. David M Pigott et al: Mapping the zoonotic niche of Ebola virus disease in Africa.  eLife 2014;10.7554/eLife.04395. Published September 8, 2014
Areas where Ebola virus infection in animals is likely (colour scale ranging from red for most likely, through yellow to blue for least likely). The borders of all African countries are outlined in grey.

Areas where Ebola virus infection in animals is likely (colour scale ranging from red for most likely, through yellow to blue for least likely). The borders of African countries containing areas likely to be at risk are outlined. David M Pigott et al: Mapping the zoonotic niche of Ebola virus disease in Africa.  eLife 2014;10.7554/eLife.04395. Published September 8, 2014
Areas where Ebola virus infection in animals is likely (colour scale ranging from red for most likely, through yellow to blue for least likely). The borders of African countries containing areas likely to be at risk are outlined.

Areas where Ebola virus infection in animals is likely (colour scale ranging from red for most likely, through yellow to blue for least likely). The borders of African countries where Ebola virus outbreaks have started are outlined. David M Pigott et al: Mapping the zoonotic niche of Ebola virus disease in Africa.  eLife 2014;10.7554/eLife.04395. Published September 8, 2014
Areas where Ebola virus infection in animals is likely (colour scale ranging from red for most likely, through yellow to blue for least likely). The borders of African countries where Ebola virus outbreaks have started are outlined.

full text
 
 

Priv.-Doz. Dr. med. Dr. med. habil. Jonas Schmidt-Chanasit, MD
 of the Bernhard Nocht Institute for Tropical Medicine in Hamburg told Germany’s Deutsche Welle
that hope is all but lost for the inhabitants of Sierra Leone and Liberia and that the virus will only “burn itself out”
when it has infected the entire population and killed five million people.

“The right time to get this epidemic under control in these countries has been missed,” said Schmidt-Chanasit. “That time was May and June. “Now it is too late.”

Deutsche Welle, 11.09.2014

Autorin: Brigitte Osterath

Sierra Leone und Liberia drohen an Ebola zu zerbrechen


Das Virus verbreitet sich wie ein Lauffeuer. Nun stellt ein Virologe eine schockierende These auf: Liberia und Sierra Leone seien mit den bisher ergriffenen Maßnahmen kaum noch zu retten.

Seine Behauptung wird viele Menschen schockieren. Aber Jonas Schmidt-Chanasit vom Bernhard-Nocht-Institut für Tropenmedizin in Hamburg sagt im DW-Interview, dass er und seine Kollegen "so langsam die Hoffnung für Sierra Leone und Liberia verlieren". Diese beiden Länder sind besonders hart von der Ebola-Epidemie getroffen.

Die richtige Zeit einzuschreiten wäre im Mai/Juni gewesen, sagt der Virologe. "Der Zeitpunkt wurde verpasst."

Schmidt-Chansit erwartet, dass sich das Virus in den westafrikanischen Ländern stark ausbreiten könnte. Mit anderen Worten: Fast jeder könnte sich infizieren.

Helfen, wo es noch möglich ist

Schmidt-Chanasit weiß, dass das eine radikale Aussage ist. Er betont, dass er keinesfalls dafür plädieren möchte, Hilfe für die westafrikanischen Staaten zu stoppen. Im Gegenteil: Er fordert "massive Hilfe". Er glaubt allerdings, dass es im Falle von Sierra Leone und Liberia schwierig , so viel Hilfe zu besorgen wie nötig wäre, um die Epidemie in den Griff zu bekommen.

Nach Aussage des Virologen ist es jetzt das Wichtigste, ein Übergreifen auf andere Länder zu verhindern und da zu helfen, "wo es noch möglich ist, in Nigeria und Senegal etwa."  

(...)

Katastrophal, aber nicht hoffnungslos

Die Weltgesundheitsorganisation mit Sitz in Genf möchte nach einer Anfrage der Deutschen Welle Schmidt-Chanasits Aussage nicht kommentieren. Pressereferentin Fadéla Chaib sagt aber, dass es "natürlich" noch Hoffnung für beide Länder gebe. "Wir können die Situation in sechs bis neun Monaten unter Kontrolle bringen", sagt sie der Deutschen Welle.

(...)

full text

Deutsche Welle, September 11, 2014

by Brigitte Osterath

Ebola threatens to destroy Sierra Leone and Liberia

The virus is spreading like wildfire. A German Ebola expert tells Deutsche Welle, that it will not be possible to contain the virus with the measures that have been taken so far. 

His statement might alarm many people.

But Jonas Schmidt-Chanasit of the Bernhard Nocht Institute for Tropical Medicine in Hamburg told DW that he and his colleagues are losing hope for Sierra Leone and Liberia, two of the countries worst hit by the recent Ebola epidemic.

"The right time to get this epidemic under control in these countries has been missed," he said. That time was May and June. "Now it is too late."

Schmidt-Chanasit expects the virus will "burn out itself" in this part of the world.

With other words: It will more or less infect everybody and half of the population - in total about five million people - could die.

Stop the virus from spilling over to other countries

Schmidt-Chanasit knows that it is a hard thing to say.

He stresses that he doesn't want international help to stop. Quite the contrary: He demands "massive help".

For Sierra Leone and Liberia, though, he thinks "it is far from reality to bring enough help there to get a grip on the epidemic."

According to the virologist, the most important thing to do now is to prevent the virus from spreading to other countries, "and to help where it is still possible, in Nigeria and Senegal for example."

(...)

Disastrous, but not without hope

The WHO in Geneva refuses to comment on Schmidt-Chanasit's statement.

WHO spokeswoman Fadéla Chaib, though, says that there is "of course" still hope for both countries.

"We can bring the situation under control in 6 to 9 months," she told DW.

(...)

full text




United Nations Secretary General Ban Ki-moon
Secretary-General's Remarks to the Security Council on Ebola
New York, 18 September 2014 
I would like to thank Ambassador Power and the United States for convening this Security Council session on the Ebola Virus Disease.

Only twice before has the Security Council met to discuss the security implications of a public health issue -- both times on the AIDS epidemic.  Like those meetings, today’s session on the outbreak of Ebola in West Africa is timely and clearly warranted.

The Ebola crisis has evolved into a complex emergency, with significant political, social, economic, humanitarian and security dimensions.  The suffering and spillover effects in the region and beyond demand the attention of the entire world.  Ebola matters to us all.

The outbreak is the largest the world has ever seen.  The number of cases is doubling every three weeks.  There will soon be more cases in Liberia alone than in the four-decade history of the disease.

In the three most affected countries – Guinea, Liberia and Sierra Leone – the disease is destroying health systems.  More people are now dying in Liberia from treatable ailments and common medical conditions than from Ebola.

The virus is also taking an economic toll.  Inflation and food prices are rising. Transport and social services are being disrupted.  The situation is especially tragic given the remarkable strides that Liberia and Sierra Leone have made in putting conflict behind them.

National governments are doing everything they can.  I applaud the courageous actions of the governments, communities and individuals on the frontlines, including local health workers, Médecins Sans Frontières, the International Federation for the Red Cross and Red Crescent and UN entities.

The gravity and scale of the situation now require a level of international action unprecedented for a health emergency.

Excellencies,

The leaders of the affected countries have asked the United Nations to coordinate the global response.  We are committed to do what is needed, with the speed and scale required.

Under the leadership of Dr. Margaret Chan, the World Health Organization is working to identify the best epidemiological ways to address the outbreak.

I have activated, for the first time, the system-wide organizational crisis response mechanism.  Under the leadership of Anthony Banbury, an Ebola Response Centre is operational. 

With the support of the Government of Ghana and UNMIL, the UN peacekeeping mission in Liberia, an air-bridge has been established in Accra to facilitate the influx of key health responders and equipment.  The UN Humanitarian Air Service is operating between the countries.

UNMIL is adapting its tasks to the current context, and the Under-Secretary-General for Peacekeeping Operations, Hervé Ladsous, visited Monrovia last week to assure Liberia’s leaders of the mission’s support.

In addition to the many local and international workers already on the ground, WHO, UNDP, UNICEF, WFP and others are actively delivering emergency assistance.  The UN Volunteers programme has identified more than 200 healthcare professionals and other experts willing to be trained and deployed.

Despite these wide-ranging efforts, the spread of the disease is outpacing the response.  No single government can manage the crisis on its own.  The United Nations cannot do it alone.

This unprecedented situation requires unprecedented steps to save lives and safeguard peace security.  Therefore, I have decided to establish a UN emergency health mission, combining the World Health Organization’s strategic perspective with a very strong logistics and operational capability.

This international mission, to be known as the United Nations Mission for Ebola Emergency Response, or UNMEER, will have five priorities: stopping the outbreak, treating the infected, ensuring essential services, preserving stability and preventing further outbreaks.

(...)

Dr. David Nabarro will continue in his vital role as my Special Envoy for Ebola, providing strategic direction and galvanizing international support.

Excellencies,

My colleagues and I will do everything we can to ensure the success of the new mission.  But its effectiveness will depend crucially on support from the international community.  Our best estimate is that we need a twenty-fold increase in assistance.

Earlier this week, the United Nations outlined a set of critical needs totalling almost $1 billion over the next six months.

One key enabler is medevac capacity.  This is essential if we are to give the assurances to the heroic international health and aid workers who place themselves at personal risk while serving others.

I applaud the leadership of United States President Barack Obama, and warmly welcome his announcement that the United States will deploy 3,000 troops to provide expertise in logistics, training and engineering. 

I also thank the many Governments that have made contributions – including Canada, China, Cuba, the Democratic Republic of the Congo, Ethiopia, France, Germany, Ghana, Ireland, Italy, Japan, Kenya, Norway, Qatar, the Russian Federation, Rwanda, South Africa, Switzerland, Uganda and the United Kingdom.  I hope other countries will follow suit.

Airports in Senegal and Spain are serving as logistical hubs.  The AU, ECOWAS, European Union, World Bank, African Development Bank, Gates Foundation and Global Fund are also engaged.

(...)

We cannot afford delays.  The penalty for inaction is high. We need to race ahead of the outbreak -- and then turn and face it with all our energy and strength.

I count on the Security Council’s support and that of the General Assembly and all Member States in meeting this test.

Thank you.


Statements on 18 September 2014

full text

 

 

The full text of resolution 2177 (2014) reads as follows:

The Security Council,

Recalling its resolution 2176 (2014) adopted on 15 September 2014 concerning the situation in Liberia and its press statement of 9 July 2014,

Recalling its primary responsibility for the maintenance of international peace and security,

Expressing grave concern about the outbreak of the Ebola virus in, and its impact on, West Africa, in particular Liberia, Guinea and Sierra Leone, as well as Nigeria and beyond,

Recognizing that the peacebuilding and development gains of the most affected countries concerned could be reversed in light of the Ebola outbreak and underlining that the outbreak is undermining the stability of the most affected countries concerned and, unless contained, may lead to further instances of civil unrest, social tensions and a deterioration of the political and security climate,

Determining that the unprecedented extent of the Ebola outbreak in Africa constitutes a threat to international peace and security,

Expressing concern about the particular impact of the Ebola outbreak on women,

Welcoming the convening of the Mano River Union Extraordinary Summit, held in Guinea on 1 August 2014, and the commitments expressed by the Heads of State of Côte d’Ivoire, Guinea, Liberia and Sierra Leone to combat the Ebola outbreak in the region, including by strengthening treatment services and measures to isolate the outbreak across borders,

Taking note of the measures taken by the Member States of the region, especially Liberia, Guinea and Sierra Leone, as well as Nigeria, Côte d’Ivoire and Senegal, in response to the Ebola outbreak and recognizing that the outbreak may exceed the capacity of the governments concerned to respond,

Taking note of the letter (S/2014/669) dated 29 August 2014 to the Secretary-General from the Presidents of Liberia, Sierra Leone and Guinea, requesting a comprehensive response to the Ebola outbreak, including a coordinated international response to end the outbreak and to support the societies and economies affected by restrictions on trade and transportation during the outbreak,

Recognizing the measures taken by the Member States of the region, in particular Côte d’Ivoire, Cabo Verde, Ghana, Mali and Senegal, to facilitate the delivery of humanitarian assistance to the most affected countries,

Emphasizing the key role of Member States, including through the Global Health Security Agenda where applicable, to provide adequate public health services to detect, prevent, respond to and mitigate outbreaks of major infectious diseases through sustainable, well-functioning and responsive public health mechanisms,

Recalling the International Health Regulations (2005), which are contributing to global public health security by providing a framework for the coordination of the management of events that may constitute a public health emergency of international concern, and aim to improve the capacity of all countries to detect, assess, notify and respond to public health threats and underscoring the importance of WHO Member States abiding by these commitments,

Underscoring that the control of outbreaks of major infectious diseases requires urgent action and greater national, regional and international collaboration and, in this regard, stressing the crucial and immediate need for a coordinated international response to the Ebola outbreak,

Commending Member States, bilateral partners and multilateral organizations for the crucial assistance, including financial commitments and in-kind donations, provided to and identified for the affected people and governments of the region to support the scaling up of emergency efforts to contain the Ebola outbreak in West Africa and interrupt transmission of the virus, including by providing flexible funds to relevant United Nations agencies and international organizations involved in the response to enable them and national governments to purchase supplies and enhance emergency operations in the affected countries, as well as by collaborating with public and private sector partners to accelerate development of therapies, vaccines and diagnostics to treat patients and limit or prevent further infection or transmission of the Ebola virus disease,

Expressing deep appreciation to the first-line responders to the Ebola outbreak in West Africa, including national and international health and humanitarian relief workers contributed by the Member States of diverse regions and non-governmental organizations such as Médecins Sans Frontières (MSF) and the International Federation of Red Cross and Red Crescent Societies (IFRC) and also expressing appreciation to the United Nations Humanitarian Air Service (UNHAS) for transporting humanitarian personnel and medical supplies and equipment, especially to remote locations in Guinea, Liberia and Sierra Leone, during the outbreak,

Welcoming the efforts of the African Union (AU), in coordination with bilateral partners and multilateral organizations, to craft a united, comprehensive and collective African response to the outbreak, including through the deployment of healthcare workers to the region, and also the efforts of the Economic Community of West African States (ECOWAS) to support steps to contain the spread of the Ebola virus, including through the support of the defense forces of its Member States,

Expressing concern about the impact, including on food security, of general travel and trade restrictions in the region and taking note of the AU call on its Member States to lift travel restrictions to enable the free movement of people and trade to the affected countries,

Emphasizing the role of all relevant United Nations System entities, in particular the United Nations General Assembly, Economic and Social Council, and Peacebuilding Commission, in supporting the national, regional and international efforts to respond to the Ebola outbreak and recognizing, in this regard, the central role of the World Health Organization (WHO), which designated the Ebola outbreak a public health emergency of international concern,

Stressing the need for coordinated efforts of all relevant United Nations System entities to address the Ebola outbreak in line with their respective mandates and to assist, wherever possible, national, regional and international efforts in this regard,

Taking note of the WHO Ebola Response Roadmap of 28 August 2014 that aims to stop transmission of the Ebola virus disease worldwide, while managing the consequences of any further international spread and also taking note of the 12 Mission Critical Actions, including infection control, community mobilization and recovery, to resolve the Ebola outbreak,

Taking note of the WHO protocols to prevent the transmission of the Ebola virus disease between individuals, organizations and populations, underlining that the Ebola outbreak can be contained, including through the implementation of established safety and health protocols and other preventive measures that have proven effective and commending the efforts of the United Nations Mission in Liberia (UNMIL) to communicate, including through UNMIL Radio, such protocols and preventive measures to the Liberian public,

Reiterating its appreciation for the appointments by the Secretary-General of David Nabarro as the United Nations System Senior Coordinator for Ebola Virus Disease and of Anthony Banbury as the Deputy Ebola Coordinator and Operation Crisis Manager operating from the Crisis Response Mechanism of the United Nations, activated on 5 September 2014 and which aims to consolidate the operational work of the United Nations System, Member States, non-governmental organizations and other partners focused on providing assistance to the affected countries in response to the Ebola outbreak, as well as to ensure United Nations System assistance to developing, leading and implementing an effective response to the broader dimensions of the outbreak that include food security and access to basic health services,

Welcoming the intention of the Secretary-General to convene a high-level meeting on the margins of the sixty-ninth United Nations General Assembly to urge an exceptional and vigorous response to the Ebola outbreak,

1. Encourages the governments of Liberia, Sierra Leone and Guinea to accelerate the establishment of national mechanisms to provide for the rapid diagnosis and isolation of suspected cases of infection, treatment measures, effective medical services for responders, credible and transparent public education campaigns, and strengthened preventive and preparedness measures to detect, mitigate and respond to Ebola exposure, as well as to coordinate the rapid delivery and utilization of international assistance, including health workers and humanitarian relief supplies, as well as to coordinate their efforts to address the transnational dimension of the Ebola outbreak, including the management of their shared borders, and with the support of bilateral partners, multilateral organizations and the private sector;

2. Encourages the governments of Liberia, Sierra Leone and Guinea to continue efforts to resolve and mitigate the wider political, security, socio-economic and humanitarian dimensions of the Ebola outbreak, as well as to provide sustainable, well-functioning and responsive public health mechanisms, emphasizes that responses to the Ebola outbreak should address the specific needs of women and stresses the importance of their full and effective engagement in the development of such responses;

3. Expresses concern about the detrimental effect of the isolation of the affected countries as a result of trade and travel restrictions imposed on and to the affected countries;

4. Calls on Member States, including of the region, to lift general travel and border restrictions, imposed as a result of the Ebola outbreak, and that contribute to the further isolation of the affected countries and undermine their efforts to respond to the Ebola outbreak and also calls on airlines and shipping companies to maintain trade and transport links with the affected countries and the wider region;

5. Calls on Member States, especially of the region, to facilitate the delivery of assistance, including qualified, specialized and trained personnel and supplies, in response to the Ebola outbreak to the affected countries and, in this regard, expresses deep appreciation to the government of Ghana for allowing the resumption of the air shuttle of UNMIL from Monrovia to Accra, which will transport international health workers and other responders to areas affected by the Ebola outbreak in Liberia;

6. Calls on Member States, especially of the region, and all relevant actors providing assistance in response to the Ebola outbreak, to enhance efforts to communicate to the public, as well as to implement, the established safety and health protocols and preventive measures to mitigate against misinformation and undue alarm about the transmission and extent of the outbreak among and between individuals and communities and, in this regard, requests the Secretary-General to develop a strategic communication platform using existing United Nations System resources and facilities in the affected countries, as necessary and available, including to assist governments and other relevant partners;

7. Calls on Member States to provide urgent resources and assistance, including deployable medical capabilities such as field hospitals with qualified and sufficient expertise, staff and supplies, laboratory services, logistical, transport and construction support capabilities, airlift and other aviation support and aeromedical services and dedicated clinical services in Ebola Treatment Units and isolation units, to support the affected countries in intensifying preventive and response activities and strengthening national capacities in response to the Ebola outbreak and to allot adequate capacity to prevent future outbreaks;

8. Urges Member States, as well as bilateral partners and multilateral organizations, including the AU, ECOWAS, and European Union, to mobilize and provide immediately technical expertise and additional medical capacity, including for rapid diagnosis and training of health workers at the national and international level, to the affected countries, and those providing assistance to the affected countries, and to continue to exchange expertise, lessons learned and best practices, as well as to maximize synergies to respond effectively and immediately to the Ebola outbreak, to provide essential resources, supplies and coordinated assistance to the affected countries and implementing partners and calls on all relevant actors to cooperate closely with the Secretary-General on response assistance efforts;

9. Urges Member States to implement relevant Temporary Recommendations issued under the International Health Regulations (2005) regarding the 2014 Ebola Outbreak in West Africa, and lead the organization, coordination and implementation of national preparedness and response activities, including, where and when relevant, in collaboration with international development and humanitarian partners;

10. Commends the continued contribution and commitment of international health and humanitarian relief workers to respond urgently to the Ebola outbreak and calls on all relevant actors to put in place the necessary repatriation and financial arrangements, including medical evacuation capacities and treatment and transport provisions, to facilitate their immediate and unhindered deployment to the affected countries;

11. Requests the Secretary-General to help to ensure that all relevant United Nations System entities, including the WHO and UNHAS, in accordance with their respective mandates, accelerate their response to the Ebola outbreak, including by supporting the development and implementation of preparedness and operational plans and liaison and collaboration with governments of the region and those providing assistance;

12. Encourages the WHO to continue to strengthen its technical leadership and operational support to governments and partners, monitor Ebola transmission, assist in identifying existing response needs and partners to meet those needs to facilitate the availability of essential data and hasten the development and implementation of therapies and vaccines according to best clinical and ethical practices and also encourages Member States to provide all necessary support in this regard, including the sharing of data in accordance with applicable law;

13. Decides to remain seized of the matter.”


Briefings

JACKSON K.P. NIAMAH, a physician’s assistant and representative of Médecins Sans Frontières, speaking via video link from Monrovia, welcomed United States President Barack Obama’s Ebola response plan and expressed hope it would be implemented immediately.  He called on all Member States to mobilize their capacities as well.  With every passing day, the epidemic spread and destroyed more lives.  Because there was no cure for Ebola, his organization’s treatment centre in Monrovia, which he headed, provided food, hydration and basic treatment of symptoms.  Early treatment greatly improved a patient’s chance of survival, he added.

“We are trying to treat as many people as we can, but there are not enough treatment centres and patient beds.  We have to turn people away.  And they are dying at our front door,” he said.  “Right now, as I speak, people are sitting at the gates of our centres, literally begging for their lives.  They rightly feel alone, neglected, denied — left to die a horrible, undignified death.”

The health-care community was failing the sick and not properly preventing the spread of the virus due to a lack of help on the ground, he said, stressing, “we urgently need to get the disease under control, and we urgently need your help.”  Contact tracing, or following up every person who had contact with an infected person or one who had died from the virus, was vital, as was raising awareness about the disease in the face of much denial. 
More care centres were needed for sick people to prevent them from staying at home and risking infecting their families.  It was also vital to train medical staff in proper procedures in order to keep the centres and other health services running, and make sure it was safe for health-care staff to return to work.  Too many health workers and ambulance drivers arrived at the centres as patients.

“Please send your helicopters, your centres, your beds, and your expert personnel.  But know that we also need the basics,” he said, adding that many homes in Monrovia still lacked soap, water and buckets — simple things that could help curb the virus’ spread.  Ebola had affected every aspect of life; schools and universities had shut down, as had civil services, he noted. 

“I feel the future of my country is hanging in the balance,” he went on, calling on Member States to set an example to their peers — nations with the resources, assets and skills required to stop the Ebola catastrophe.  “We do not have the capacity to respond to this crisis on our own.  If the international community does not stand up, we will be wiped out.  We need your help.  We need it now,” he said.

Statements

SAMANTHA POWER (United States) said the Security Council’s resolution represented a call for action to face this unprecedented threat.  “Looking away will not make this threat go away.”  Besides, as the world was not prepared for the scope of the outbreak, the first reaction to seal off the effected countries had been counter-productive.  Instead of isolating the affected countries, they should flood them with assistance, she said, noting her country’s announcement of the deployment of 3,000 troops, the establishment of training centres and the provision of logistics.  Hopefully, many other countries would announce additional aid today, she said, stressing that help from all sectors was required. 

She noted that today’s resolution had 130 co-sponsors, the most in history, but said that if it did not result in adequate action, it would not stem the projected “steep, terrifying curve”.  With that, she said, “We must bend the curve”, as she appealed for contributions of everything, from health centres to buckets.

USMAN SARKI (Nigeria) said that today’s debate and Council resolution underscored the seriousness with which the international community viewed the threat to his region and the world.  He concurred with the Secretary-General on the gravity of the crisis.  Personnel, clean water, generators, ambulances and fuel, and a range of other needs were great.  His country’s experience showed that the epidemic could be stemmed.
(...)

DMITRY I. MAKSIMYCHEV (Russian Federation) underlined his concern at the rapid spread and consequences of Ebola.  Guinea, Liberia and Sierra Leone urgently needed international support.  He singled out the early contributions made by Cuba and Médecins Sans Frontières.  The Russian Federation had also contributed bilaterally and multilaterally, financing medical modules through WHO to treat 60,000 people.  A specialist Russian anti-epidemic brigade had been deployed to Guinea, which was assisting the Health Ministry in organizing activities to stem the epidemic and diagnose the virus.  Personal protection equipment would be dispatched for health-care volunteers and food assistance would be given to the three most affected countries.  The virus was being studied in the Russian Federation, with trials for treatment, and he was ready to supply laboratories in the area of the outbreak.  However, helping the sick was vital, but it was only part of the problem.  The disease would continue to spread without proper prophylactics and awareness-raising efforts in affected countries. 

WANG MIN (China) said that given the severity of the outbreak, the international community should provide rapid assistance to the affected countries.  He supported the United Nations leading role in coordinating assistance through the proposed Mission and relevant agencies.  Long-term health needs should be addressed along with the response to the Ebola virus, since the gaps in care helped foment such epidemics.  China was sharing its experience in epidemic control and sending resources and expertise to the affected countries, as well as to WHO and the African Union.  He hoped that a ramped-up global effort would stop the threat and allow the affected countries to return to development.

MARK LYALL GRANT (United Kingdom) said that Ebola was preventable and containable, but only if the international community acted with urgency and provided assistance not only to those countries already affected but also to those at risk.  He described his country’s announced package of support for Sierra Leone, funding hundreds of beds along with the personnel to staff the endeavour, as well as its assistance through multilateral institutions.  He called for particular attention to women during the epidemic and on all countries to join the global coalition against Ebola before the crisis became a catastrophe.

SYLVIE LUCAS (Luxembourg), associating herself with the statement of the European Union, concurred with the gravity of the threat and the need for a commensurate response as well as for the United Nations to play a coordinating role.  She said that the new Mission should assist countries not yet affected to prevent the spread.  Luxembourg had already provided much assistance and was considering further contributions.  Along with fighting Ebola, it was critical to address the structural weaknesses of the countries involved, she said, pledging to work with other countries active in the country specific configurations of the Peacebuilding Commission for that purpose.

MARIA CRISTINA PERCEVAL (Argentina) said the Council had met before on a public health issue, dealing with the implications for public security of the spread of HIV/AIDS.  Without an urgent response to Ebola, the living conditions of people around the world could be impacted.  Urgency and commitment were needed as was an ethical institutional response.  It was not just a health problem, it was a “multidimensional reality” that had the potential to “kill the present and wound the future”.  The epicentre of the epidemic was in an area recently blighted by conflict and the outbreak hit just as people there were looking to the future.  It was essential to work with the United Nations to address the outbreak’s causes and consequences.  The General Assembly should take responsibility for the response to the Secretary-General’s proposal to create a mission in the region.  The outbreak could have been better handled with better health-care systems.  The epidemic showed the role of inequality and economic injustice in spreading the disease.

AUGUSTINE KPEHE NGAFUAN, Minister for Foreign Affairs of Liberia, said that even before the Ebola outbreak, his country was grappling with herculean challenges in such areas as productive employment, especially among youth, some of whom are former combatants, as well as in rule of law and security sector reform.  The country had been making valiant efforts to comply with regional protocols aimed at curbing the spread of small arms and light weapons and transnational crime, but the disease had distracted national attention from those priorities and gravely undermined its ability to address them.

The impact of the Ebola outbreak, he continued, had been multidimensional, negatively affecting all sectors of Liberia’s economy and effectively arresting the nation’s progress.  A preliminary assessment indicated a 3.4 per cent decline in real gross domestic product (GDP) growth, from the previously projected 5.9 per cent to a low of 2.5 per cent.  The mining, agriculture and services sectors were expected to bear the greatest brunt of the crisis.  The global community could not remain passive.  “We cannot sit idly and watch, as we would do watching a movie on our TV screen,” he said, adding that the reality did not have a pre-determined climax.


FRANÇOIS LOUNCÉNY FALL, Minister for Foreign Affairs, Guinea, said the unanimous adoption of the Council resolution showed the clear need for a global solution to a scourge that was a genuine threat to peace and security in West Africa and therefore to collective security.  The disease had a severe economic impact and it could affect all sectors.  It had the potential to slice 2.5 per cent from gross domestic product (GDP) in the affected countries, which would seriously undermine their development efforts.  A humanitarian crisis loomed unless measures were taken, which was particularly bad news for the three countries most affected, all of whom were on the agenda of the Peacebuilding Commission.  It was vital not to isolate affected countries, even while trying hard to isolate and eradicate the disease itself. 

Multilateral and bilateral partners were caring for victims and working to eradicate the virus from Guinea, he said, noting that his Government had also been deeply involved in the response.  The outbreak appeared to have been controlled in May but new cases emerged in June, with a spread to other countries and the onset of a subregional crisis.  Women were most affected.  The National Epidemic Management Committee carried out accelerated responses for two to six months focused on security, prevention and screening at borders.  Other action on the ground was ongoing, including the strengthening, monitoring and tracking of the disease, the establishment of management committees and efforts to ensure proper burial of the dead.  Outreach efforts sought to alter the perception of the disease on the ground, especially in rural areas.  Despite ongoing efforts, challenges to meeting people’s needs and to stem the outbreak remained.  A variety of medical equipment was needed, including ambulances.  He thanked doctors who had travelled to the region to assist.

SAMURA KAMARA, Minister for Foreign Affairs and International Cooperation of Sierra Leone, said that the cumulative figure of confirmed Ebola cases in his country stood at 1,571 with 483 people dead.  The nature of the virus was such that it even had claimed the lives of people trained medically to deliver health care.  To date, more than 34 courageous medical personnel, including four doctors, had lost their lives while saving the lives of their compatriots.  That had contributed to the culture of fear, which had created further difficulties for responding to non-Ebola diseases as most private clinics and hospitals had scaled back operations.

The outbreak, he noted, came at a time when Sierra Leone had achieved tremendous progress in rebuilding its State institutions and strengthening democratic governance.  The withdrawal of the United Nations Integrated Peacebuilding Mission in March, after an internationally acclaimed success story, was a testament to the progress made.  With Ebola, economic disruptions had already been felt, and inflation, which had declined from 12 per cent in December 2012 to 6.5 per cent in April 2014 — the first single digit rate in five years — was now on an upward trend, approaching 8 per cent due to concerns about the food supply.  The International Monetary Fund (IMF) had estimated gross domestic product (GDP) would drop by 3.3 points from 11 to 8 per cent.


OMAR HILALE (Morocco) pointed to an unprecedented outbreak of the virus, intensified by weak public health centres that were pushed beyond capacity.  The situation was worsening daily due to a lack of vaccines and specific treatments and to contagion.  The number affected could rapidly double or triple with severe consequences for the region and the globe.  The international community must use the Council meeting to push its response forward and tackle the outbreak’s short and longer term consequences.  Concerned by the negative impact of isolating countries, Morocco had maintained the air services of Royal Air Maroc, providing several fights per week to each of the most-affected countries.  Solidarity was needed not just to respond to conflict and human rights violations, but also to prevent a public health emergency.

THOMAS MAYR-HARTING, Head of the European Union Delegation, expressing deep concern over the Ebola crisis, said the best way to do justice to those who had lost their lives was to act and prevent future victims.  The Union would continue its help in the most affected areas, in partnership with WHO, the Office of the Coordination of Humanitarian Affairs and other international partners.  He welcomed WHO’s leadership in developing the Ebola Response Roadmap, and the United Nations system-wide response.  The Union had pledged 150 million euros for treatment, training and steps to contain the epidemic, medical laboratories, health services and budget support.  That figure also included 5 million euros to the African Union to support affected nations.  Several Union members had given bilateral support totalling 23 million euros and were contributing with in-kind aid, including the secondment of health-care specialists.  The European Emergency Response Coordination Centre supported the Union’s efforts.

Furthermore, the Union was working actively to find ways to reduce the growing isolation of affected areas, he said.  It would address the urgent need to retain and re-establish transport links and medical evacuation.  Additionally, it was preparing a comprehensive framework for its response, aligned with WHO’s road map, which took into account the food and health system crises caused by the crisis and its damaging economic impact.  On Monday, the Union held a high-level meeting on Ebola in Brussels; health ministers would meet next week in Milan. 

GUILLERMO RISHCHYNSKI (Canada) said that his Government had early on recognized the risks the Ebola outbreak represented and it had been a leader in making significant contributions to help contain its spread.  It had provided expert deployments, vaccines, and financial support.  Canada’s contributions to WHO, Médecins Sans Frontières, and local Red Cross and Red Crescent organizations had helped establish the base for their respective response activities.  Canada also had deployed a mobile laboratory to Sierra Leone and committed more than $2.5 million in personnel protective equipment to WHO for distribution, donating as many as 1,000 doses of experimental vaccine to that health agency.

TETE ANTONIO, Permanent Observer of the African Union, said citizens in affected countries were living in great trepidation since the onset of the epidemic.  Farmers and health workers could not go about their business without fear and the situation was exacerbated by the fact that it was taking place in post-conflict countries in transition.  Neighbouring countries remained on constant alert, with mistrust growing regionally and locally because of the disease’s deadliness.  That was affecting cross-border trade and impacting food security, with prices rising.  The need to stem the epidemic was clear and continuing agricultural production was essential.  The crisis highlighted the weaknesses of public health systems and showed the importance of the African Health Strategy.  Weak health systems were major impediments to fighting the disease and that was particularly true for countries emerging from conflict. 

“Desperate times called for desperate measures,” he said, urging an end to procrastination.  “The time to act is now.”  There were two priorities — tackling the immediate emergency and preparing a long-term approach.  An Emergency Public Health Fund had been established by the African Union Commission, and the African Union had made a monetary pledge from its Humanitarian Assistance Fund and Department of Political Affairs.  The long-run approach included creation of an African Centre for Disease Control and Prevention.  The focus was on operationalizing the Centre for Disease Control to speed up information-sharing, tracking the disease and implementing a coordinated response.  The Peace and Security Council had authorized the deployment of a humanitarian mission aimed at containing the outbreak; it was expected to run for six months with monthly rotations of volunteers.  Describing the work of the African Union, he stressed the importance of being guided by the reality on the ground.

JUAN MANUEL GONZÁLEZ DE LINARES PALOU (Spain) stressed the need to care for the sick, while looking after those giving the care.  It was vital to ensure that affected States’ medical facilities, as well as their social, economic and security structures, did not collapse.  Additionally, it was counterproductive to isolate affected countries.  The disease was not quarantined, and so that only hindered response efforts.  Spain was actively tackling all the challenges, treating the ill by sending tons of medical and emergency supplies as well as experts in several fields.  Spanish staff in affected countries was caring for the sick, but they, too, needed protection.  The death of Fr. Miguel Pajares underlined the need for their protection.  He noted also that pressure on health systems caused by Ebola was increasing the number dying from other basic diseases and the rate of maternal mortality.  Spain continued providing food and nutritional support and was aware of the need to prevent the problem in neighbouring countries.

ALBERT SHINGIRO (Burundi) expressed great concern about Ebola’s rapid spread, with the current degree of international mobilization not yet at the level needed to meet the current rate of spread.  A more structured, coordinated approach was needed; waiting until tomorrow would be too late.  The scope of the outbreak demanded a more robust response and greater regional and international preparations.  Local communities should participate, as grass-roots groups took ownership of fights when they established their own responses and could really slow the spread if people were educated properly.  Gains made through peacebuilding were being eroded daily and the affected countries’ abilities to deal with the scourge were limited.  He warned against isolating countries suffering outbreaks, suggesting it amounted to a denial of basic humanitarian assistance.  Neighbouring countries should open humanitarian corridors to ensure supplies got through.  Widespread panic hampered economies and slowed agricultural production, potentially leading to a food crisis in affected States.


JIM MCLAY (New Zealand), in the context of what he agreed was an unprecedented crisis, recalled the warning about Ebola by Said Djinnit, head of the United Nations Office in West Africa, in a July briefing to the Council.  It showed the importance of briefings from regional offices to flag emerging threats.  He welcomed support already pledged for the response to the epidemic, including to regional organizations.  His country was on the eve of a general election, but one of the first tasks of the new Government would be the urgent consideration of a range of options so that it could play its part in the international response.

SITI HAJJAR ADNIN (Malaysia) said her Government earlier this week had answered the call for international support, particularly in response to the testimonies by medical authorities which identified the shortage of medical rubber gloves as a problem in combating the outbreak.  The consignment of 20.9 million medical rubber gloves had been prepared for distribution in the affected countries.  Of the 11 containers, three each would go to Liberia, Sierra Leone and Guinea, with one each for the Democratic Republic of the Congo and Nigeria.

MIGUEL CAMILO RUIZ (Colombia) said all support must be given to the Ebola-effected countries.  They had made enormous efforts to stem the disease and they should not be marginalized.  His country would provide funding as well as medicines.  Clear lines of responsibility in support of the national priorities should be drawn, and support provided for long-term structural improvement.  As the crisis was not strictly a security matter, he stressed that the General Assembly should decide on the competence over the matter, he stressed.

SÉKOU KASSÉ (Mali) said the United States’ reputation for being a pioneer was reflected in its organization of this important meeting.  The delegation had organized a similar meeting in January 2000 on HIV/AIDS.  Ebola was not new to the African region, but the epidemic affecting the west of the continent was unprecedented in terms of its spread and the number affected.  Mali was working bilaterally, sub-regionally and regionally to implement measures recommended by various bodies.  He was pleased to join the response and commended the United States’ initiative and strong international mobilization coalescing around it.  It was urgent to coordinate efforts to tackle the disease because it would wait for no one in moving from person to person, country to country and around the world.  He supported the Secretary-General’s proposed mission.

IBRAHIMA SORY SYLLA (Senegal) stressed his appreciation to the Council for trying to help countries affected by the Ebola epidemic.  Ebola was not just an African issue, but a global one which affected all.  He was grateful to international partners, including States and civil society organizations, which had helped the affected countries, and he underlined his full support to brother countries, noting efforts made to establish humanitarian corridors.  Senegal, since it had raised its head, had implemented a strategy to prevent the disease’s spread.  There was no record of any patient dying from Ebola on Senegal’s national territory, he said, adding that one person had contracted it but had been treated and survived.  Unified action must be strengthened given the solid links between the countries in the subregion.

ANATOLIO NDONG MBA (Equatorial Guinea) welcomed the international solidarity on Ebola that had been shown in the Security Council chamber today.  It was now time to “walk the talk”.  All relevant United Nations agencies must be engaged in the response because of the efforts required in many sectors.  His country planned to open up transport to the countries of the region and to make millions of dollars available to the international response.  The pandemic could spread throughout the world, and therefore as much support as possible should be provided.


Taking the floor to make additional comments, Ms. CHAN thanked the Security Council membership for the very valuable and various types of support given to the three affected countries.  The unanimous support for the resolution and the level of co-sponsorship was unprecedented and she said her heart was warmed by support for the Secretary-General’s initiative to establish a mission to tackle the outbreak.  She promised to act quickly and efficiently and to work to kick the Ebola outbreak out of the African continent.


Also speaking for a second time, Dr. NABARRO gave feedback on the remarks made, saying that speakers appreciated the seriousness of the challenges of this major public health crisis that could have many other extensive impacts.  He also welcomed the solidarity shown to affected countries and saw increased signs of willingness to open or maintain air and other trading links, as well as strong indications of solidarity among African nations and around the world.  He was also pleased to see recognition of the other parts of the United Nations, particularly the WHO, along with other agencies.  Several Governments, some of which were in Africa, had offered generous commitments, as had the more traditional donors.  It was indeed “a global coalition” and Governments were keen to coordinate and to trust the United Nations in acting as the coordinating body.  Virtually all speakers noted support for the exceptional public health mission proposed by the Secretary-General.

 
 

 


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