1. WHO has issued guidelines for convalescent whole blood and serum transfusions to EBOV patients. The infected NBC cameraman hospitalized in Nebraska is to receive a donation from Dr. Brantley. Donors are to wait 28 days after discharge before donation and have two negative EBOV tests two days apart before donation. Recipients should have same ABO grouping and Rh factor. If not possible, whole blood donation should be Group 0; serum donation should be Group AB.
2. Given Mr. Duncan’s death from EBOV in Dallas, CDC has reminded everyone of how remains should be handled: everyone involved should wear PPE; CDC should be contacted in advance; body to be placed in two leak-proof bags without removal of any tubes, etc.; body should be cremated or placed in hermetically sealed casket. NO autopsy. Morticians should do nothing to the body; body stays in double bag; everyone wears PPE.
3. NPR interview this morning on the CDC training camps for EBOV caregivers going to West Africa was not reassuring. CDC uses the buddy system which is not used in Spain for gowning and degowning. The nurse interviewed touched her face, let her face guard expose skin; her buddy slipped in the chlorine solution on the floor.
4. NY Times reports on the status of EBOV patients today: 6 patients are recovering in Omaha, Atlanta, London, Paris, and Hamburg; 3 patients are dead in Dallas and Madrid (2); 5 patients are under treatment in Omaha, Atlanta, Frankfurt, Oslo, and Madrid.
5. The White House via the Press Secretary announced that temperatures and questionnaires will be taken on passengers arriving in the U.S. who started their flights in West Africa. This will happen at JKF, Washington Dulles, O’Hare, Hartsfield-Jackson (Atlanta) and Newark (New Jersey) airports. These terminals receive 94% of international travelers. Miami, Dallas-Fort Worth, and Los Angeles airports will not have these entry checks.
6. Time reports that Liberia has all but banned burials, and is insisting on cremation of deceased.
7. NEJM October 9th issue contains a Brief Report by Baize, et. al. on EBOV in Guinea, beginning last December. This Report appeared on line last April as a preliminary Report, and then again in September on line as a finished Report. The Guinea EBOV is a new strain of EBOV. Remember that EBOV is the Zaire ebolavirus. I have asked the senior author by email some questions about his article because I am not a virologist, but radiologist. I wonder why the first victim in Guinea was a very young child (2 y.o.); if the spread of EBOV to neighboring villages was due to infected patients traveling on the main road; if spread to Liberia and Sierra Leone was also by travelers on the main road to Kenema and Monrovia. See: DOI:10.1056/NEJMoa1404505. Hope to hear back from him for tomorrow’s blog.
8. NEJM on line has a Perspective by the Journal’s editorial fellow, Dr. Kanapathipillai, on the two vaccines undergoing Phase 1 testing on volunteers for safety and humoral and cellular immunity response. Then Phase 2a testing begins in West Africa in non-EBOV regions. Simultaneously Phase 2b testing will begin in EBOV affected areas in caregivers, family members of EBOV patients, burial details, basically anyone with exposure to EBOV patients. If everything goes well, a vaccine will become available in quantity for EBOV regions in first quarter of 2015. See: DOI: 10.1056/NEJMp1412166.
Regarding entry point screening, I’m glad it’s being done, but this screening does not significantly reduce the risk of importing EBOV. When Australia entry screened 1.84 arrivals into Australia in 2003 to check for SARS symptoms or fever, they found only 4 people who met the WHO criteria for SARS and none of the 4 people had SARS. See: Medical Journal of Australia; 180: 220-223.