Could Ebola now be airborne?

A doctor works in a laboratory on collected samples of the Ebola virus at the Centre for Disease Control in Entebbe.

London - Fears are growing that the most lethal form of the Ebola virus can mutate into an airborne pathogen, making the spread of the terrifying disease more difficult to check.

It was previously thought that the untreatable virus, which causes massive internal bleeding and multiple organ failure, could be transmitted only through contact with infected blood.

But now Canadian researchers have carried out experiments showing how monkeys can catch the deadly disease from infected pigs without coming into direct contact.

“Our findings support the hypothesis that airborne transmission may contribute to spread, specifically from pigs to primates, and may need to be considered in assessing transmission from animals to humans in general,” they said.

The findings come as scores of people in Uganda were isolated last week to prevent the spread of a new Ebola outbreak that has already killed three in the country.

Ebola causes fatal haemorrhagic fevers in humans and many other species of non-human primates. It was first reported in 1976 in Congo and is named for the river where it was recognised. There is no cure or vaccine.

The illness is characterised by fever, headache, joint and muscle aches, sore throat and weakness, followed by diarrhoea, vomiting, and stomach pain, according to the US-based Centres for Disease Control and Prevention.

“A rash, red eyes, hiccups and internal and external bleeding may be seen in some patients.”

The virus is known to be transmitted through direct contact with the blood or secretions of an infected person, or objects that have been contaminated with infected secretions.

It is often spread during funerals where there has been an outbreak when the bereaved come into contact with an Ebola victim.

In some cases, it can trigger organ failure and unstoppable bleeding, killing a previously healthy adult within days.

One of the deadliest diseases known, it has killed two-thirds of the roughly 1 850 people who have been diagnosed with it.

Experts say this extreme virulence is its weak spot.

The virus can be contained because it kills its victims faster than it can spread to new ones.

However, if the disease is now airborne it could make containment more difficult.

Researchers at the University of Manitoba in Winnipeg deliberately infected six piglets with the Ebola virus and put them in pens where macaque monkeys were housed in wire cages.

Within eight days all four monkeys had caught the virus through indirect contact, according to the study published in the journal Scientific Reports.

Dr Gary Kobinger from the National Microbiology Laboratory at the Public Health Agency of Canada took part in the study.

He told BBC News that they suspect that large droplets of moisture containing the virus were being exhaled with the piglets’ breath.

“They can stay in the air, but not long, they don’t go far,” he said. “But they can be absorbed in the airway and this is how the infection starts, and this is what we think, because we saw a lot of evidence in the lungs of the non-human primates that the virus got in that way.”

Further work is needed, but the findings are worrying as macaques are close genetic relatives to humans, said the researchers.

Fruit bats are a known “reservoir” for the Ebola virus, and people have also contracted the disease after handling infected chimps, gorillas, monkeys, forest antelope and porcupines.

But this research suggests that wild or domestic pigs could also be a natural host.

The latest outbreak of the disease in Uganda – in a district just 65km from the capital Kampala – comes roughly a month after the country declared itself Ebola-free following an earlier outbreak in a remote district of western Uganda.

The latest Ebola outbreak, officials say, is of the Sudan strain of Ebola and not linked to the previous one, of the Congo variety, which killed at least 16 villagers in July and August in the western district of Kibaale.

In addition to the three dead in the latest outbreak, up to 15 are being monitored for signs of the disease, officials said.

Ebola is especially feared in Uganda, where multiple outbreaks have occurred over the years, and news of it can cause patients to flee hospitals to avoid infection.

In 2000, in one of the world’s worst Ebola outbreaks, the disease infected 425 Ugandans and killed more than half of them in the country’s north. Another outbreak in 2007 killed 37 people in Bundibugyo, a remote district near the Congolese border.

– Daily Mail

Growing concerns over 'in the air' transmission of Ebola

Workers prepare to disinfect during a recent Ebola outbreak in Uganda.

Canadian scientists have shown that the deadliest form of the ebola virus could be transmitted by air between species.

In experiments, they demonstrated that the virus was transmitted from pigs to monkeys without any direct contact between them.

The researchers say they believe that limited airborne transmission might be contributing to the spread of the disease in some parts of Africa.

They are concerned that pigs might be a natural host for the lethal infection.

Ebola viruses cause fatal haemorrhagic fevers in humans and many other species of non human primates.

Details of the research were published in the journal Scientific Reports.

According to the World Health Organization (WHO), the infection gets into humans through close contact with the blood, secretions, organs and other bodily fluids from a number of species including chimpanzees, gorillas and forest antelope.

The fruit bat has long been considered the natural reservoir of the infection. But a growing body of experimental evidence suggests that pigs, both wild and domestic, could be a hidden source of Ebola Zaire - the most deadly form of the virus.

Now, researchers from the Canadian Food Inspection Agency and the country's Public Health Agency have shown that pigs infected with this form of Ebola can pass the disease on to macaques without any direct contact between the species.

In their experiments, the pigs carrying the virus were housed in pens with the monkeys in close proximity but separated by a wire barrier. After eight days, some of the macaques were showing clinical signs typical of ebola and were euthanised.

One possibility is that the monkeys became infected by inhaling large aerosol droplets produced from the respiratory tracts of the pigs.

One of the scientists involved is Dr Gary Kobinger from the National Microbiology Laboratory at the Public Health Agency of Canada. He told BBC News this was the most likely route of the infection.
"What we suspect is happening is large droplets - they can stay in the air, but not long, they don't go far," he explained.

"But they can be absorbed in the airway and this is how the infection starts, and this is what we think, because we saw a lot of evidence in the lungs of the non-human primates that the virus got in that way."
The scientists say that their findings could explain why some pig farmers in the Philippines had antibodies in their system for the presence of a different version of the infection called Ebola Reston. The farmers had not been involved in slaughtering the pigs and had no known contact with contaminated tissues.

Dr Kobinger stresses that the transmission in the air is not similar to influenza or other infections. He points to the experience of most human outbreaks in Africa.

"The reality is that they are contained and they remain local, if it was really an airborne virus like influenza is it would spread all over the place, and that's not happening."

Hidden host
 
The authors believe that more work needs to be done to clarify the role of wild and domestic pigs in spreading the virus. There have been anecdotal accounts of pigs dying at the start of human outbreaks. Dr Kobinger believes that if pigs do play a part, it could help contain the virus.
"If they do play a role in human outbreaks it would be a very easy point to intervene" he said. "It would be easier to vaccinate pigs against Ebola than humans."

Other experts in the field were concerned about the idea that Ebola was susceptible to being transmitted by air even if the distance the virus could travel was limited. Dr Larry Zeitlin is the president of Mapp Biopharmaceuticals.

"It's an impressive study that not only raises questions about the reservoir of Ebola in the wild, but more importantly elevates concerns about ebola as a public health threat," he told BBC News. "The thought of airborne transmission is pretty frightening."

At present, an outbreak of ebola in Uganda has killed at least two people near the capital Kampala. Last month, Uganda declared itself Ebola-free after an earlier outbreak of the disease killed at least sixteen people in the west of the country.

- BBC

Eastern Cape Sewage water a health risk after severe flooding

Doctors have warned of a possible disease outbreak in waterlogged parts of the Eastern Cape after severe flooding caused widespread damage to sewerage infrastructure.

Port Alfred National Sea Rescue Institute (NSRI) volunteer Darryl Olivier yesterday said he feared for his life when he vomited blood after he spent days helping to rescue people from sewage-contaminated water in a caravan park.

Although Olivier was hardest-hit, his girlfriend Jade Fraser and at least four other NSRI volunteers also suffered from diarrhoea and nausea after working in the water.

Olivier said he was warned by a doctor that there was a strong possibility he had an e coli bacteria infection that could have been fatal had it not been treated properly.

Local government and traditional affairs MEC Mlibo Qoboshiyane and other officials raised fears earlier this week of possible health risks to the public from the large pools of contaminated water.

Qoboshiyane said the overflow of sewage into a water treatment plant in Grahamstown was life-threatening.

- Times Live

Epidemic Hazard in Uganda on Friday, 19 October, 2012 at 10:56 (10:56 AM) UTC.

Health experts have confirmed an outbreak of the deadly Marburg virus in the western district of Kabale after samples from two relatives taken to the Uganda Virus Institute tested positive. Police Thursday stopped the burial of Boaz Turyahikayo a lecturer at Uganda Christian University and his sister Mildrid Asasira after it emerged that their family had lost four people from a mysterious disease in just a month. The other two are Lillian Banegura their mother and an elder brother Bernard Rutaro who passed away early this month. Dr. Patrick Tusiime the Kabale district health officer said a team from the Ministry of Health and World Health Organization is on its way to oversee the burial of the two victims. The Marburg virus was last reported in Uganda in 2008. It carries symptoms similar to those of Ebola that include fever, vomiting and internal bleeding.

- RSOE EDIS

Meningitis outbreak expands to 15 states with Pennsylvania case

A fungal meningitis outbreak linked to contaminated steroid injections expanded to 15 states on Monday as Pennsylvania reported its first case of the disease that has killed 15 people nationwide.

The Pennsylvania patient, who received an epidural steroid injection in July from medications supplied by New England Compounding Center (NECC) of Framingham, Massachusetts, is being treated in a hospital, the Pennsylvania Department of Health said.

The new case means that all but eight of the 23 states that received suspect medications from the Massachusetts specialist pharmacy have reported at least one case of fungal meningitis, a rare and deadly disease that has proven difficult to treat.

Over the weekend the Centers for Disease Control and Prevention said its tally of cases, which sometimes lags reports from state health departments, showed 205 people stricken with the disease after receiving injections. Illinois and New Hampshire reported their first cases.

The suspect lots of steroid were shipped to 76 facilities in 23 states, including two locations in Pennsylvania.

"We have been working directly with the clinics to ensure that patients who received these injections are monitored and receive any necessary follow-up," said Acting Pennsylvania Secretary of Health Michael Wolf.

Health authorities believe that nearly 14,000 people nationwide received injections from the potentially contaminated medication.

The state worst affected by the outbreak, Tennessee with 53 cases and six deaths, was holding an administrative hearing on Monday to determine whether to suspend the license of NECC.

At one hospital in Tennessee, St. Thomas in Nashville, more than 275 patients have undergone spinal tap tests, a painful procedure to determine if they have meningitis, and 33 people infected with meningitis have been treated.

The company faces an array of federal and state investigations. It has recalled the suspect medicines, surrendered its license to operate in Massachusetts and suspended operations. A sister company, Ameridose, also has suspended operations.

Meningitis is an infection of the membranes covering the brain and spinal cord. Symptoms include headache, fever and nausea. Fungal meningitis is not contagious.

The outbreak raised questions about how the pharmaceuticals industry operates. NECC engaged in a little-known practice called drug compounding that is not regulated by the Food and Drug Administration, which generally oversees drug makers.

In compounding, pharmacies prepare specific doses of approved medications, based on guidance from a doctor, to meet an individual patient's need.

A Reuters investigation found that one NECC customer received solicitations from the company for bulk orders and failed to require proof of individual patient prescriptions as required by state regulations.

The emails support assertions made last week by state pharmacy regulators that the compounding firm, which was authorized to deliver products only in response to patient-specific prescriptions, had violated its license in Massachusetts.

Several states, including Michigan, Massachusetts, Indiana, Minnesota and Ohio, are investigating the company.

The 15 states reporting cases of meningitis are Tennessee, Michigan, Pennsylvania, New Hampshire, Illinois, Indiana, Minnesota, New Jersey, Texas, Idaho, Maryland, North Carolina, Virginia, Ohio and Florida.

- Times Live

Epidemic Hazard in Zambia on Friday, 12 October, 2012 at 15:30 (03:30 PM) UTC.

The diarrhoeal disease which broke-out last week and has since claimed over 14 lives of fishermen in Lukanga Swamps in Kapiri Mposhi district has been confirmed to be cholera. Kapiri Mposhi District Medical Officer, Charles Mwinuna confirmed to ZANIS today that according to the second-round of tests conducted on the samples obtained from the patients admitted at Waya clinic in the area, the diarrheal disease was confirmed cholera. Over 20 patients are admitted to Waya clinic after experiencing severe diarrhoea and vomiting. Dr Mwinuna said officers from the District Health Management Team have since been dispatched to Lukanga Swamps and were treating people with cholera symptoms. He also said precautionary measures were being taken to ensure that the disease does not spread to other areas in the district. Dr Mwinuna said the health personnel dispatched to Lukanga Swamps are also conducting further tests and contact tracing of the origin of patients admitted to the clinic and were sensitizing the community on hygiene and providing chlorine to households to reduce the chances of spreading the diarrheal disease. Fourteen people have so far died of the disease which was earlier mistaken to be severe diarrhoea. The diarrhoea and vomiting disease broke out at Kaswende, Waya, Kabosha and Ngwenya fishing camps on Lukanga Swamps. The bodies of the deceased are being buried at a cholera designated graveyard in the area Meanwhile, a traditional leader has appealed to the Ministry of Health to open-up cholera Centres in all fishing camps to treat patients and reduce chances of further spreading the diarrheal disease. Headwoman Agnes Chimbuleni noted that the disease has claimed many lives in the area because of the distances patients had to cover to Waya clinic from the fishing camps for treatment.

- RSOE EDIS

US fungal meningitis infections rise to 47

An outbreak of rare fungal meningitis in the US has now affected 47 people in seven states, health officials say.

Doctors at about 75 medical clinics are being warned to alert patients who received suspect steroid injections.

Five people have died from the illness, which the Centers for Disease Control (CDC) has linked to products from a Massachusetts-based pharmacy firm.

Officials say they found contamination in a sealed steroid vial at the New England Compounding Center.

The firm recalled the steroid doses and has since shut down operations, but the vials have already been shipped to 23 states.

Meningitis is an inflammation of the lining of the brain and spinal cord. Symptoms include severe headache, nausea, and fever as well as slurred speech and difficulty walking.

The fungal meningitis causing concern in the US is not infectious, the CDC says.
'Abundance of caution'

Confirming that 47 people were now affected - an increase of 12 in the space of 24 hours, the CDC said new cases were reported for the first time in Michigan.

In Tennessee, which has the majority of the cases, a total of 29 people have now fallen ill. There were six cases in Virginia, three in Indiana Indiana, two each in Maryland and Florida and one in North Carolina, the CDC said.

It is not yet clear how many patients may have been exposed to any contamination, and fungal meningitis can have a lengthy incubation period.

A briefing by the CDC and the Federal Drug Administration (FDA) on Thursday said a fungus linked to the steroid medication had been identified in tests of five patients.

"Out of an abundance of caution, we advise all health care practitioners not to use any product" from the company, said Ilisa Bernstein, director of compliance for the FDA's Center for Drug Evaluation and Research.

New England Compounding Center is a type of pharmacy that mixes ingredients for customised medicines. The steroid in question was three lots of methylprednisolone acetate from the firm.

On Friday, the CDC listed about 75 clinics and medical centres that received the suspected lots, and told doctors to immediately contact patients who have had an injection.

Tests are under way to confirm if the contamination is the same fungus blamed in the outbreak. The disease cannot be passed from person to person.

Three people have died in Tennessee, with one death in Virginia and one in Maryland, reports say.

- BBC

US fungal meningitis infections rise to 47

An outbreak of rare fungal meningitis in the US has now affected 47 people in seven states, health officials say.

Doctors at about 75 medical clinics are being warned to alert patients who received suspect steroid injections.

Five people have died from the illness, which the Centers for Disease Control (CDC) has linked to products from a Massachusetts-based pharmacy firm.

Officials say they found contamination in a sealed steroid vial at the New England Compounding Center.

The firm recalled the steroid doses and has since shut down operations, but the vials have already been shipped to 23 states.

Meningitis is an inflammation of the lining of the brain and spinal cord. Symptoms include severe headache, nausea, and fever as well as slurred speech and difficulty walking.

The fungal meningitis causing concern in the US is not infectious, the CDC says.
'Abundance of caution'

Confirming that 47 people were now affected - an increase of 12 in the space of 24 hours, the CDC said new cases were reported for the first time in Michigan.

In Tennessee, which has the majority of the cases, a total of 29 people have now fallen ill. There were six cases in Virginia, three in Indiana Indiana, two each in Maryland and Florida and one in North Carolina, the CDC said.

It is not yet clear how many patients may have been exposed to any contamination, and fungal meningitis can have a lengthy incubation period.

A briefing by the CDC and the Federal Drug Administration (FDA) on Thursday said a fungus linked to the steroid medication had been identified in tests of five patients.

"Out of an abundance of caution, we advise all health care practitioners not to use any product" from the company, said Ilisa Bernstein, director of compliance for the FDA's Center for Drug Evaluation and Research.

New England Compounding Center is a type of pharmacy that mixes ingredients for customised medicines. The steroid in question was three lots of methylprednisolone acetate from the firm.

On Friday, the CDC listed about 75 clinics and medical centres that received the suspected lots, and told doctors to immediately contact patients who have had an injection.

Tests are under way to confirm if the contamination is the same fungus blamed in the outbreak. The disease cannot be passed from person to person.

Three people have died in Tennessee, with one death in Virginia and one in Maryland, reports say.

- BBC

HAZMAT in Zimbabwe on Wednesday, 03 October, 2012 at 11:13 (11:13 AM) UTC.

Four people died from suspected food poisoning in Kadoma last week, while six others are battling for life at Harare Central Hospital. The poison also claimed birds, goats and dogs. The dogs died after eating goats that died after consuming the food in a chain reaction that has left people at Hezelmare 19 Mine and surrounding areas shocked. On the fateful Friday afternoon last week, Gift Watungwa (37) allegedly took a 20kg bucket of maize to the mill and on arrival he requested for an empty sack to transfer his maize, but the mill operator Mr Norbert Mhazi said he did not have any. Instead, he was shown a pile of maize and mealie-meal bags on the other side of the room. Watungwa allegedly took a bag that used to contain mealie- meal and put his maize inside. He headed home where another mineworker Douglas Pepukai (22) prepared sadza using mealie-meal from the bag.

The sadza was served with chicken bought at Hezelmare Shopping Centre. After eating the food, the 10 men started complaining of stomach pains and their condition continued to deteriorate before they fell unconscious. Another worker, who did not eat the food, made a report to the police and they were taken to Kadoma General Hospital. The 10 were subsequently transferred to Harare Central Hospital after their condition got serious. Acting Mashonaland West police spokesperson Assistant Inspector Ian Kohwera confirmed the incident. He said the bodies of the dead were awaiting post-mortem at Harare Central Hospital mortuary. The other six victims are still admitted at Harare Hospital where their condition was reported to be stable. "We are investigating a case in which four people have so far died after eating food suspected to have been contaminated with poison," said Asst Insp Kohwera. "Investigations are still at their infancy and we are following on a number of leads." The mill operator is assisting police with investigations.

- RSOE EDIS

Kwazulu Natal declares war on mushrooms

The KwaZulu-Natal government and eThekwini municipality have declared war on wild mushrooms following the deaths of six people poisoned by mushrooms picked in a nearby field.

The Department of Agriculture and Environmental Affairs yesterday confirmed that a sixth person, Sifiso Bhekuyise Ntuli, died this week after eating mushrooms that were picked from the same field where Bheki Mkhize had found the deadly mushrooms that wiped his family out last week.

Mkhize, 29, had taken the mushrooms to his Dassenhoek home on Tuesday last week for his girlfriend, Xoli Buthelezi, to make a curry for his two sisters, Nozipho and Nombulelo, and his 17-month-old child, Emenhle Mkhize.

The family started hallucinating, vomiting and losing physical energy.

Within five days, everyone save Nozipho's eight-month-old baby, Asanda, had died.

However, Asanda is being medically tested for poison as she was breast-fed after her mother had consumed the meal.

Yesterday, Durban mayor James Nxumalo and municipal officials publicly destroyed mushrooms growing in the wild.

"Following such tragedy in the city we took a decision to launch an offensive campaign to destroy wild mushrooms.

"Our officials will continue to educate people not to eat any mushrooms from the wild if they are not sure," Nxumalo said.

The city will send officials to the fields in Mariannhill to clear mushrooms as they spring up.

Ian MacDonald, from the provincial department of agriculture and environmental affairs, said that, with more than 14000 mushroom species, it was difficult to differentiate between poisonous and edible ones.

Agriculture and environmental MEC Meshack Radebe said the government would pay for the family's funerals.

The department has bought cattle for relatives while five funeral parlours have donated coffins.

- Times Live

World Health Organisation warns doctors of new SARS-like virus

Global health officials have alerted doctors to be on the lookout for a virus related to SARS but said there were no signs the disease was behaving like the respiratory syndrome that killed hundreds in 2003.

The World Health Organisation announced this week that a new coronavirus had been found in a critically ill Qatari man who was being treated in London as well as in a Saudi Arabian man who died several months earlier. Genetic sequencing found the viruses in the two men to be nearly identical.

The two men might have been infected directly by animals, however, and there was no proof of human-to-human spread of the virus, WHO spokesman Gregory Hartl said Thursday.

"This is not SARS, it is a new virus and very distinct from SARS," he said. "There are still a lot of unanswered questions, so we cannot predict what might happen."

Hartl said WHO could not elaborate on the men's cases until investigations by national authorities were finished.

The new coronavirus is from a family of viruses that cause the common cold as well as SARS, the severe acute respiratory syndrome that killed about 800 people, mostly in Asia in a 2003 epidemic.

SARS jumped to people from civet cats and then mutated into a form easily spread among humans.

Unlike SARS, the new virus also causes rapid kidney failure, a complication not usually seen in respiratory viruses. In London, the Qatari patient is in critical but stable condition and is being treated with an artificial lung machine.

Hartl said WHO is monitoring reports of suspect cases but none have so far been confirmed. Britain's Health Protection Agency said a small number of potential cases were being evaluated. On Wednesday, Danish authorities ruled out a handful of cases.

WHO also issued a case definition for the new virus to help doctors spot cases early. The agency advised them to investigate any patients hospitalized with acute respiratory syndrome not explained by other causes who had close contact with probable cases or had recently traveled to Saudi Arabia or Qatar.

Saudi officials said they were concerned that the next month's annual Muslim Hajj pilgrimage - which brings millions to Saudi Arabia from all around the world - could allow the virus to spread. As a precautionary measure, they advised pilgrims to keep their hands clean and wear masks in crowded places.

- Times Live

Epidemic Hazard in Ghana on Monday, 17 September, 2012 at 12:24 (12:24 PM) UTC.

Six people have died from the cholera outbreak in parts of the Volta Region. Five of the deaths were recorded in Akatsi South while the sixth death was recorded in Adidome in the Central Tongu District. Four Electoral Areas in the Akatsi District are all battling with the disease.The Assemblyman for the Wute Electoral Area, Sammy Wuadi, said the cholera outbreak did not come as a surprise and that the people are being conscientised to keep their surroundings clean. According to Mr Wuadi, the situation is gradually abating following the strategies put in place by the Environmental Health Directorate to forestall the spread. A Senior Environmental Health Assistant in the Akatsi South District, Ms Akua Dzaka also stated that residents are being advised to desist from drinking from the Tordji River which is believed to have been contaminated. “We suspect that that is the source of the cholera outbreak and we are also educating them to take good care of the food that they eat,” she said.

- RSOE EDIS

Rabies in Gauteng under control: MEC

Rabies is under control in Gauteng, agriculture and rural development MEC Nandi Mayathula-Khoza said on Monday.

"The presence of rabies in an area must always be considered as extremely serious," she told reporters in Johannesburg.

"So far so good; since the Fourways scare but also since the death of the little girl, Gauteng had really been able to control rabies."

Mayathula-Khosa said it was compulsory for all cats and dogs to be vaccinated against rabies, and failure to do so was illegal under the Animal Diseases Act of 1984.

"We have a law that is very clear as to what we should do to enforce it," she said.

If people failed to vaccinate their pets and someone got bitten, that household would be charged.

Gauteng director for animal health Dr Dietana Nemundzivhadi, said it seemed there was no rabies in Protea.

She said rabies accounted for 55 000 deaths in Africa each year despite being preventable.

"From 2006 to 2012 there have been 106 deaths from rabies in South Africa."

Children were the most vulnerable group, especially those under the age of 15 years, Mayathula-Khosa said.

September 28 is world rabies day and there will be free vaccinations across the province.

- Times Live

Superbug kills 7th victim at US hospital

Bethesda - A deadly germ untreatable by most antibiotics has killed a seventh person at the National Institutes of Health Clinical Centre in Maryland.

The Washington Post reported the death on Friday. NIH officials told the paper that the boy from Minnesota died on 7 September. NIH says the boy arrived at the research hospital in Bethesda in April and was being treated for complications from a bone marrow transplant when he contracted the bug.

He was the 19th patient at the hospital to contract an antibiotic-resistant strain of KPC, or Klebsiella pneumoniae. The outbreak stemmed from a single patient carrying the superbug who arrived at the hospital last summer.

The paper reported the Minnesota boy's case marked the first new infection of this superbug at NIH since January.

- SAPA/News24

Doctors did not need cellphone light - dept

Johannesburg - Doctors would not have needed their cellphone lights during an operation at Chris Hani Baragwanath Hospital last week, the Gauteng health department said on Tuesday.

"According to the hospital, they have battery-operated lights which they use in cases where there is a disruption of the electricity supply," spokesperson Simon Zwane said.

The hospital had 20 generators, two of which experienced problems during the blackout, he said.

The SA Registrars' Association has insisted that doctors were forced to continue a caesarean section by the lights of their cellphone screens during a power outage on Friday.

Asked whether a report to this effect in The Star was misleading, Zwane said: "Yes. It is."

Corroboration

The newspaper's editor, Makhudu Sefara, said this was patently false, as the photograph accompanying the story and the doctors' testimony showed.

"We not only relied on the people who alerted us to the story, but we went out of our way to find corroboration, and in fact did find it," he said.

The story was accompanied by a picture of doctors carrying out an operation in the dark.

Zwane was trying to deflect attention from the serious problems affecting healthcare in the province, Sefara said.

In its report, The Star quoted the association's chairperson Dr Langanani Mbodi saying the electricity went out while doctors were about to deliver a baby.

Mbodi had received this information from doctors at the hospital.

"The mother was opened and doctors had to take the baby out," The Star quoted him as saying.

"They couldn't stop, because the mother would have bled to death and the baby would have died."

A battery-operated torch and a cellphone light were used to complete the operation.

Manually pump oxygen

Another patient on a ventilator was kept alive by a staff member who had to manually pump the oxygen sack for about 30 minutes, after a back-up battery gave in, Mbodi said. He applauded the doctors on duty.

On Monday, the Gauteng health department denied that the outages affected operations.

"The power outage happened at 02:00 and the power was restored about two hours later, and in that period there were no operations taking place," Zwane said.

Asked if the hospital had in the past used cellphone lighting during operations, Zwane said: "I don't know where they got the picture from."

"The power outages cannot be blamed on the hospital. They occur in the electricity supply network that affects the entire area where the hospital is situated."

Democratic Alliance spokesperson Jack Bloom said he was encouraged by the honesty of Gauteng Health MEC Hope Papo, who had earlier admitted hospitals were in crisis.

Bloom hoped more money would be made available for Gauteng hospitals.

"It has been estimated that the Gauteng health department needs about R4bn extra every year to provide a proper service," he said.

But the existing budget had not been spent effectively. Corruption and mismanagement had resulted in huge wastage.

- SAPA/NEWS24

Cholera spreads in Sierra Leone

Freetown - A cholera epidemic in Sierra Leone which was declared a national emergency in mid-August has claimed 244 lives and affected 14 521 people, said a statement from a special cholera task force on Monday.

“We are continuing to map out strategies in support of initiatives to eradicate the outbreak,” read the statement from a presidential task force which was set up shortly after the outbreak was declared an emergency.

Sierra Leone has been hit by its worst outbreak of the water-borne disease in nearly 15 years and cases are expected to peak at around 32 000 in September, the West African nation's rainiest month, according to the World Health Organisation.

The capital Freetown remains the worst affected, accounting for 63 percent of cases, according to government statistics.

Neighbouring Guinea has also been hard hit with 104 deaths and 5 000 cases.

Whereas the disease usually appears at the start of the rainy season in June or July, this year cases were reported at the beginning of the year and have spread rapidly in the densely-populated capital.

Poor hygiene and living conditions have contributed to the spread leaving thousands stricken with vomiting, diarrhoea and stomach cramps and overwhelming Sierra Leone's health system.

“It is expected to get a lot worse before it gets better,” Claire Seaward of Oxfam in Sierra Leone told AFP recently.

The Chinese embassy in Freetown said on Monday it will provide urgent assistance to the country to express “the goodwill and support of the Chinese government”.

“The Chinese government is providing life-saving anti-cholera drugs worth one million yuan to help contain the spread of the epidemic,” the head of the embassy's political section Xu Zhou told reporters.

- Sapa-AFP-IOL

Epidemic Hazard in Kenya on Sunday, 12 August, 2012 at 17:20 (05:20 PM) UTC.

A truck driver was yesterday quarantined at Mombasa's Aga Khan Hospital on suspicion he was infected with the deadly Ebola virus. The man only identified as Moses, 61, is said to have been in Kampala as from August 3, and arrived yesterday in Mombasa with symptoms resembling those of Ebola. According to Coast provincial director of Public Health and Sanitation Anisa Omar, the man had symptoms of fatigue, sore throat and fever, prompting doctors to seclude him from the rest of the patients at the hospital. "It's true the man was in Kampala from August 3 and when he arrived, he developed the symptoms. He decided to seek medical attention at the hospital where he was isolated from the other patients after being examined by the doctors,' Omar said. Anisa said the patient's blood samples have been taken to the Kenya Medical Research Institute in Nairobi. She however allayed fears of the virus spreading to other parts of the region saying the situation is under control. This comes a week after Public Health Minister Beth Mugo assured the country that the government was doing all it can to shield Kenyans from the deadly virus. Ebola kiled 14 people in Western Uganda two weeks ago.

- RSOE EDIS

Epidemic Hazard in Democratic Republic of the Congo on Monday, 06 August, 2012 at 03:45 (03:45 AM) UTC.

Health workers in the east of the Democratic Republic of Congo say an outbreak of cholera has claimed at least nine lives in a refugee camp. The first case of cholera - a contagious disease caused by filth and lack of hygiene - emerged three days ago among thousands of people in a makeshift refugee camp, Doctors Without Borders said. Thousands of people have fled fighting between M23 rebels and government forces backed by UN peacekeepers. Patrick Wieland, from Doctors Without Borders, said his organisation had set up an isolation clinic tent at Kanyaruchinya on the outskirts of Goma, the capital of North Kivu province. Wieland said humanitarian agencies were delivering water to the camp but people probably were collecting the water with dirty containers. He said there were not enough toilets for the people who fled fighting last week in Rutshuru and neighbouring Kiwanja, about 80km north of Goma. "We're treating people with arms and legs blown-off by grenades and other heavy arms," said Wieland. He also said that for the first time they treated many more civilians than combatants. In Goma, locals had told that 13,500 families had arrived in the past month, displaced by the fighting. "People have been forced to build their own makeshift shelters - shelters made of twigs, grass and so on and a few leaves," he said.

"Few people have been able to get hold of plastic sheeting from the United Nations refugee agency, but for the most part people are being forced to live out in the open. "They're saying they have had no food for a month and have [had only] high-energy biscuits a week ago, but since then nothing." M23 rebels, who take their name from a March 23 2009 agreement they signed with the Congolese government, last week attacked government troops and UN peacekeepers, firing mortars at the peacekeepers' base at Kiwanja which was surrounded by more than 2,000 displaced people at the time. Wieland said the fighting was much heavier than any his team has seen in the three-month-old rebellion. He said that since April, Doctors Without Borders has treated more than 500 people hurt in the conflict. Congo's army now controls only the city of Goma and the village of Kibumba, 10km outside Goma. Now the rebels hold all towns going north as far as Rutshuru and are threatening to besiege Goma. The UN Security Council demanded on Thursday that the M23 halt any advances towards Goma. In a statement delivered by council president Gerard Araud of France, the Security Council expressed deep concern at the worsening humanitarian situation, especially a surge in the number of refugees. Araud called on the international community to provide appropriate humanitarian support.

- RSOE EDIS

Ebola haemorrhagic fever

Key facts

 

• The Ebola virus causes severe viral haemorrhagic fever (VHF) outbreaks in humans.
• Viral haemorrhagic fever outbreaks have a case fatality rate of up to 90%.
• Ebola haemorrhagic fever outbreaks occur primarily in remote villages in Central and West Africa, near tropical rainforests.
• The virus is transmitted to people from wild animals and spreads in the human population through human-to-human transmission.
• Fruit bats of the Pteropodidae family are considered to be the natural host of the Ebola virus.
• There is no treatment or vaccine available for either people or animals.

The Ebola virus can cause severe viral haemorrhagic fever (VHF) outbreaks in humans with a case fatality rate of up to 90%. Ebola first appeared in 1976 in two simultaneous outbreaks, in Nzara, Sudan, and in Yambuku, Democratic Republic of Congo (DRC). The latter was in a village situated near the Ebola River, from which the disease takes its name.

The Ebola virus is comprised of five distinct species: Bundibugyo, Ivory Coast, Reston, Sudan and Zaïre.
Bundibugyo, Sudan and Zaïre species have been associated with large Ebola haemorrhagic fever (EHF) outbreaks in Africa, while the Ivory Coast and Reston species have not. EHF is a febrile haemorrhagic illness which causes death in 25-90% of all cases. The Ebola Reston species, found in the Philippines, can infect humans, but no illness or death in humans has been reported to date.

Transmission

 

Ebola is introduced into the human population through close contact with the blood, secretions, organs or other bodily fluids of infected animals. In Africa, infection has been documented through the handling of infected chimpanzees, gorillas, fruit bats, monkeys, forest antelope and porcupines found dead or ill in the rainforest.

Later Ebola spreads in the community through human-to-human transmission, resulting from close contact with the blood, secretions, organs or other bodily fluids of infected people. Burial ceremonies where mourners have direct contact with the body of the deceased person can also play a role in the transmission of Ebola. Transmission via infected semen can occur up to seven weeks after clinical recovery.

Health-care workers have frequently been infected while treating Ebola patients. This has occurred through close contact without the use of correct infection control precautions and adequate barrier nursing procedures. For example, health-care workers not wearing gloves and/or masks and/or goggles may be exposed to direct contact with infected patients' blood and are at risk.

Among workers in contact with monkeys or pigs infected with Ebola Reston, several human infections have been documented and were clinically asymptomatic. Thus, the Ebola Reston virus appears to be less capable of causing disease in humans than the other Ebola species. However, the evidence available relates only to healthy adult males. It would be premature to conclude the health effects of the virus on all population groups, such as immuno-compromised persons, persons with underlying medical conditions, pregnant women and children. More studies of Ebola Reston virus are needed before definitive conclusions can be made about the pathogenicity and virulence of this virus in humans.

Signs and symptoms

 

EHF is a severe acute viral illness often characterized by the sudden onset of fever, intense weakness, muscle pain, headache and sore throat. This is followed by vomiting, diarrhoea, rash, impaired kidney and liver function, and in some cases, both internal and external bleeding. Laboratory findings show low counts of white blood cells and platelets as well as elevated liver enzymes.

People are infectious as long as their blood and secretions contain the virus. Ebola virus was isolated from seminal fluid up to the 61st day after the onset of illness in a laboratory acquired case.

The incubation period (interval from infection to onset of symptoms) varies between 2 to 21 days.

During EHF outbreaks, the case-fatality rate has varied from outbreak to outbreak between 25% and 90%.

Diagnosis

 

Differential diagnoses include, malaria, typhoid fever, shigellosis, cholera, leptospirosis, plague, rickettsiosis, relapsing fever, meningitis, hepatitis and other VHFs.

Ebola virus infections can only be diagnosed definitively in the laboratory by a number of different tests:

• enzyme-linked immunosorbent assay (ELISA)
• antigen detection tests
• serum neutralization test
• reverse transcriptase polymerase chain reaction (RT-PCR) assay
• virus isolation by cell culture.

Tests on samples from patients are an extreme biohazard risk and should only be conducted under maximum biological containment conditions.

Treatment and vaccine

 

Severe cases require intensive supportive care. Patients are frequently dehydrated and in need of intravenous fluids or oral rehydration with solutions containing electrolytes.

No specific treatment or vaccine is yet available for EHF. New drug therapies have shown promising results in laboratory studies and are currently being evaluated. Several vaccines are being tested but it could be several years before any are available.

Natural host of Ebola virus

 

In Africa, fruit bats, particularly species of the genera Hypsignathus monstrosus, Epomops franqueti and Myonycteris torquata, are considered possible natural hosts for Ebola virus. As a result, the geographic distribution of Ebolaviruses may overlap with the range of the fruit bats.

Ebola virus in animals

 

Although non-human primates have been a source of infection for humans, they are not thought to be the reservoir but rather an accidental host like human beings. Since 1994, Ebola outbreaks from the Zaire and Ivory Coast species have been found in chimpanzees and gorillas.

Ebola Reston has caused severe VHF outbreaks in macaque monkeys (Macaca fascicularis) farmed in the Philippines and in imported monkeys in 1989, 1990 and 1996 to the USA and in 1992 in monkeys imported to Italy from the Philippines.

Since 2008, Ebola Reston viruses were detected during several outbreaks of a deadly disease in pigs. Asymptomatic infection in pigs has been reported and experimental inoculations tend to demonstrate that Ebola Reston cannot cause a disease in pigs.

Prevention

 

Controlling Ebola Reston in domestic animals

There is no animal vaccine available against Ebola Reston. Routine cleaning and disinfection of pig or monkey farms (with sodium hypochlorite or other detergents) is expected to be effective in inactivating the virus. If an outbreak is suspected, the premises should be quarantined immediately. Culling of infected animals, with close supervision of burial or incineration of carcasses, may be necessary to reduce the risk of animal-to-human transmission. Restricting or banning the movement of animals from infected farms to other areas can reduce the spread of the disease.

As Ebola Reston outbreaks in pigs and monkeys have preceded human infections, the establishment of an active animal health surveillance system to detect new cases is essential in providing early warning for veterinary and human public health authorities.

Reducing the risk of Ebola infection in people

In the absence of effective treatment and a human vaccine, raising awareness of the risk factors of Ebola infection and the protective measures individuals can take is the only way to reduce human infection and death.

In Africa, during EHF outbreaks, educational public health messages for risk reduction should focus on several factors.

• Reducing the risk of wildlife-to-human transmission from contact with infected fruit bats or monkeys/apes and the consumption of their raw meat. Animals should be handled with gloves and other appropriate protective clothing. Their products (blood and meat) should be thoroughly cooked before consumption.
• Reducing the risk of human-to-human transmission in the community arising from direct or close contact with infected patients, particularly with their bodily fluids. Close physical contact with Ebola patients should be avoided. Gloves and appropriate personal protective equipment should be worn when taking care of ill patients at home. Regular hand washing is required after visiting sick relatives in hospital, as well as after taking care of ill patients at home.
• Communities affected by Ebola should inform the population about the nature of the disease and about outbreak containment measures, including burial of the deceased. People who have died from Ebola should be promptly and safely buried.
• Precautionary measures are needed in Africa to avoid that pig farms infected through contact with fruit bats amplify the virus and cause EHF outbreaks.

For Ebola Reston, educational public health messages should focus on reducing the risk of pig-to-human transmission as a result of unsafe animal husbandry and slaughtering practices, and unsafe consumption of fresh blood, raw milk or animal tissue. Gloves and other appropriate protective clothing should be worn when handling sick animals or their tissues or when slaughtering animals. In the regions where Ebola Reston has been reported/detected in pigs, all animal products (blood, meat and milk) should be thoroughly cooked before eating.

Controlling infection in health-care settings

Human-to-human transmission of the Ebola virus is primarily associated with direct contact with blood and body fluids. Transmission to healthcare workers has been reported when appropriate infection control measures have not been observed.

Health-care workers caring for patients with suspected or confirmed Ebola virus should apply infection control precautions to avoid any exposure to the patient’s blood and body fluids and/or direct unprotected contact with the possibly contaminated environment. Therefore the provision of health care for suspected or confirmed Ebola patients requires specific control measures and the reinforcement of standard precautions, particularly basic hand hygiene, the use of personal protective equipment, safe injections practices and safe burial practices.

Laboratory workers are also at risk. Samples taken from suspected human and animal Ebola cases for diagnosis should be handled by trained staff and processed in suitably-equipped laboratories.

WHO response

 

WHO has been involved in all past Ebola outbreaks by providing expertise and documentation to support disease investigation and control.

Recommendations for infection control while providing care to patients with suspected or confirmed Ebola haemorrhagic fever is provided in the: Interim infection control recommendations for care of patients with suspected or confirmed Filovirus (Ebola, Marburg) haemorrhagic fever, March 2008.

WHO has created an aide–memoire on standard precautions in health care. Standard precautions are meant to reduce the risk of transmission of bloodborne and other pathogens. If universally applied the precautions would help prevent most transmission through exposure to blood and body fluids.

Standard precautions are recommended in the care and treatment of all patients regardless of their perceived or confirmed infectious status. They include the basic level of infection control and include hand hygiene, use of personal protective equipment to avoid direct contact with blood and body fluids, prevention of needle stick and injuries from other sharp instruments, and a set of environmental controls.

Table: Chronology of major Ebola haemorrhagic fever outbreaks (as of May 2012)

 

Year	Country	Virus subtype	Cases	Deaths	Case fatality
2011	Uganda	Ebola Sudan	1	1	100%
2008	Democratic Republic of Congo	Ebola Zaire	32	14	44%
2007	Uganda	Ebola Bundibugyo	149	37	25%
2007	Democratic Republic of Congo	Ebola Zaire	264	187	71%
2005	Congo	Ebola Zaire	12	10	83%
2004	Sudan	Ebola Sudan	17	7	41%
2003	Congo	Ebola Zaire	35	29	83%
(Nov-Dec)
2003	Congo	Ebola Zaire	143	128	90%
(Jan-Apr)
2001-2002	Congo	Ebola Zaire	59	44	75%
2001-2002	Gabon	Ebola Zaire	65	53	82%
2000	Uganda	Ebola Sudan	425	224	53%
1996	South Africa (ex-Gabon)	Ebola Zaire	1	1	100%
1996	Gabon	Ebola Zaire	60	45	75%
(Jul-Dec)
1996	Gabon	Ebola Zaire	31	21	68%
(Jan-Apr)
1995	Democratic Republic of Congo	Ebola Zaire	315	254	81%
1994	Cote d'Ivoire	Ebola Ivory Coast	1	0	0%
1994	Gabon	Ebola Zaire	52	31	60%
1979	Sudan	Ebola Sudan	34	22	65%
1977	Democratic Republic of Congo	Ebola Zaire	1	1	100%
1976	Sudan	Ebola Sudan	284	151	53%
1976	Democratic Republic of Congo	Ebola Zaire	318	280	88%

- WHO

Ebola in Uganda – update

The Ministry of Health in Uganda has reported a cumulative number of 53 suspected cases of Ebola haemorrhagic fever including 16 deaths. Of these, five cases have been laboratory confirmed by the Uganda Virus Research Institute (UVRI) in Entebbe (this includes three fatal cases and two cases currently being treated in the isolation facility).

Currently 32 cases are admitted to an isolation facility in Kagadi hospital, Kibaale district, and a total of 312 contacts were identified, of whom 253 are being closely followed-up. So far all samples from other districts have tested negative for Ebola, indicating that there has been no expansion of the outbreak beyond Kibaale District. However a clinical officer who attended to a case in Kibaale district was transferred to Mulago Hospital in Kampala for treatment but later died.

Among the contacts being monitored daily are the seven health workers who attended to the fatal case transferred to Mulago Hospital, none of them has so far developed symptoms of the disease.

Response

The Government of Uganda is continuing to work with a number of partners to control the outbreak.

At the central level the Prime Minister convened a Ministerial Task Force, chaired by the Minister of Health, to facilitate and coordinate the outbreak response.

In Kibaale district, the local health authorities are working through its task force with several partners to mobilize resources and supplies. These partners include WHO, US Centers for Disease Control and Prevention (US CDC), the Uganda Red Cross Society (URCS) and Médecins Sans Frontières (MSF). WHO has deployed logisticians and supplies, including personal protective equipment (PPE) to Uganda.

Required funds for local operations are being mobilized. Additional support is being received from the EMESCO Foundation (a local NGO), Members of Parliament from Kibaale district, the Infectious Diseases Institute (IDI) and the Uganda Red Cross Society (URCS).

Epidemiologists from WHO and US CDC have arrived in Kibaale district and are supporting the response by screening and triaging suspected cases of Ebola haemorrhagic fever. WHO is coordinating with Global Outbreak Alert and Response Network partners.

With the support of MSF, the construction of a new isolation facility in Kagadi, Kibaale district, is expected to be completed today and additional wards will open to address the increasing number of suspected cases. MSF, IDI and EMESCO are providing food to patients in the isolation facility and have committed to continue to do so for the next two weeks.

For active surveillance and contact tracing in the communities, arrangements with local authorities are being made to increase the number of mobile teams and ambulances.

With regard to social mobilization, the Uganda Red Cross Society has trained 62 teams of Red Cross volunteers and village health teams to conduct social mobilization and public awareness activities. Additionally, public announcements are being disseminated in 11 local languages on 20 radio stations. WHO is facilitating the deployment of a medical anthropologist to assist in these activities.

Neighbouring countries

A number of countries neighbouring Uganda have taken proactive steps to enhance their surveillance to detect and respond to cases of Ebola haemorrhagic fever.

In Kenya, two rumoured suspected cases have since been reported and investigated. Both cases have tested negative for Ebola.

The South Sudan Ministry of Health, in collaboration with WHO, has issued guidance to the general public and has activated a national task force to undertake enhanced surveillance as population movement and trade between South Sudan and Uganda are high.

WHO does not recommend that any travel or trade restrictions are applied to Uganda.

- WHO