Evening Ebola Update, Wed, 11/12: Travel leads to Mali cases/NEJM on tx at Emory/?new factors producing epidemic   Leave a comment

11/12/14

Dear Colleagues:

l.  WHO and NY Times both report today on the death of an iman from Guinea who traveled in a private auto to Mali for treatment of EBOV-like symptoms.  At the Mali clinic he was treated for renal failure.  He subsequently died, had ceremonial washing at a mosque in Mali, then was transported back to Guinea for burial.  Only when a nurse who cared for the iman in Mali fell ill with EBOV and died was it realized that the iman had died of EBOV also.  He was not tested for EBOV during his hospitalization in Mali.  A total of 108 contacts to date have been identified for the iman and nurse.  Several of the iman’s family have fallen ill and died of EBOV.

2.  The WHO and NY Times reports once again show that human mobility in West Africa is associated with transmission of EBOV.  An article in PLoS Current Outbreaks today (see below) states that human mobility in West Africa is 7X the mobility in the rest of the world.  The author recommends monitoring of human mobility when EBOV strikes any country in West Africa.  See: http://who.int/mediacentre/news/ebola/12-november-2014-mali/en/ for an initial WHO report of the iman case and http://www.nytimes.com/2014/11/13/health/mali-reports-a-second-larger-ebola-outbreak.html?ref=health&_r=0 for a later NY Times report with additional details.

3.  NY Times reports that tomorrow (Thursday) Mr. Banbury and Dr. Nabarro, the Secretary General’s leaders in the EBOV fight, will report to the General Assembly on the state of the EBOV fight in West Africa.  They will tell the Assembly that the U.N. is short $500 Million to fight the epidemic through March, 2015.

4.  PLoS Currents Outbreaks published today an article by Alexander, et. al. from Virginia Tech on the factors leading to the EBOV epidemic in West Africa.  Those factors include: poor health care systems, tribal customs, bushmeat for food, and all the other factors we are familiar with.  But the authors note additional factors to consider: human mobility in West Africa (see 2. above), seasonal weather, fruit bitten by hammer-headed bats and then eaten by humans, and duikers-a variety of antelope as an intermediate host.  The article is really a review of EBOV, not just a discussion of factors leading to the current epidemic.  Read the article at: http://blogs.plos.org/speakingofmedicine/2014/11/11/factors-might-led-emergence-ebola-west-Africa/

5.  Washington Post reports that 6,000 Guineans have fled the quarantined Wome village in Guinea because of the troops stationed there for months.  This village was a high incidence location of EBOV infection; several educators were killed there by villagers when the educators taught about EBOV.  HCW and educators have been killed in previous outbreaks as well in other locales when, out of fear, villagers considered them ‘witches’ who had brought the disease.

6.  NEJM on-line issue for November 13th includes an article by Lyon, et. al. from Emory University reporting on the clinical course of the two EBOV patients treated successfully at Emory recently.  Patient #1 was a physician directly caring for EBOV patients; Patient #2 was a nurse instructing HCW and helping with donning and doffing of PPEs.  The clinical course and treatment of both patients was in many ways similar to previous reports, but there were some differences and important take-home lessons: caregivers elected not to take X-rays in the ‘hot zone’; caregivers could not do alkaline phosphatase fractionation with the lab set up in the ‘hot zone’; both patients received whole blood after bloody vomitus or melena when hemoglobin above the usual value for transfusion; fluid replacement was 2-5L/day + oral fluids (not 10-15L) but third spacing was still marked; potassium, calcium, and manganese had to be given orally because standard amounts added to IVs were insufficient; ZMapp turned the course around in 8 hours in both cases (authors add disclaimer in their article, but facts are facts); development of rash indicated peak of viremia (Day #6), as in other viral infections.  See the entire article at: http://www.nejm.org/doi/full/10.1056/NEJMoa1409838?query=featured_ebola#t=article

7.  A non-mainstream news website reports today that Dr. Spencer, released yesterday from Bellevue Hospital, and his previously quarantined (in hospital, then at his home) wife-to-be were seen traveling in his automobile today in Harlem.  So both are free of disease.  She did not develop EBOV because she was in contact with Dr. Spencer only before he developed symptoms. 

RGL, MD

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Posted November 13, 2014 by levittrg in Ebola

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