Evening Ebola Update, Fri, 10/31: New WHO PPE guidel./No EBOV to contacts in Kikwit 1995 incubat.   Leave a comment

10/31/14

Dear Colleagues:

l.  District Court in Maine released Nurse Hickox from her state ordered quarantine.  The judge stated that she had no symptoms of EBOV infection so she was not infectious.  She will continue to have daily monitoring for fever and other symptoms.

2.  NBC News reports that Canada will not issue visas to persons from Liberia, Sierra Leone, or Guinea to visit Canada.

3.  WHO has issued new guidelines for PPEs.  The emphasis now is on preventing mucosae of the eyes, nose, mouth from droplet contamination with EBOV.  The following recommendations are included in the new WHO guidelines: facemasks should not be a collapsible variety (which can touch the mouth); rubber aprons should cover gowns; if N95 respirators are used, they must be labelled as surgical N95 respirators for droplet protection; double gloving with nitrile not latex gloves- inner pair has cuffs under gown, outer pair has cuffs over gown; no tape used to seal any part of PPE.  See the complete new guidelines at: http://apps.who.int/iris/bitstream/10665/137410/1/WHO_EVD_Guidance_PPE_14.1_eng.pdf?ua=1&ua=1 or technical specifications and photographs at: http://apps.who.int/iris/bitstream/10665/137411/1/WHO_EVD_Guidance_SpecPPE_14.1_eng.pdf?ua=1&ua=1

4.  Correspondence to The Lancet this week states that Liberia had only 50 physicians for 4.3 million Liberians before this EBOV epidemic, and Sierra Leone had only 95 physicians for its 6 million population before this EBOV epidemic.  There are fewer physicians now in both countries due to EBOV physician deaths.

5. One of our EBOV Contact Group members, a infectious disease expert and chief medical officer at a university hospital in the U.S., has ‘set me straight’ about when persons exposed to EBOV patients may become ‘contagious’ to other persons. Previous research performed by Dowell, et. al. (JID 1999 179 Suppl 1) for risk factors to family members  during the 1995 Kikwit EBOV outbreak in DRC showed that the early phase of the disease (when EBOV patient at home) had less risk of contagion than the late phase of the disease (when EBOV patient hospitalized).  Viral particle number increases greatly as the EBOVpatient becomes sicker.  The closer the contact with the patient, the greater the risk of contagion to a person due to greater contact with patient’s fluids.  Most importantly, no person who touched, shared a bed with, or conversed with an EBOV patient during the incubation period (time from exposure to fever) became ill with EBOV.

So until fever develops in an EBOV exposed person, the number of viral particles circulating in the person is small, and chances of contagion w/o contact of bodily fluid is very small.  Once fever develops, the chance of contagion increases with the severity of the symptoms.  Dowell, et. al. notes that a few contacts did become EBOV patients even in the early phase of disease, so there is no ‘Get Home Free’ card.  See: https://col128.mail.live.com/mail/ViewOfficePreview.aspx?messageid=mgUpbqhTth5BGVrBBgS7PEFA2&folderid=flsent&attindex=0&cp=-1&attdepth=0&n=69807565
for Dowell’s article.  (Table 2 in the article gives the take-home message).
RGL, MD
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Posted November 1, 2014 by levittrg in Ebola

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