Emory Varsity Expert Provides Perspectives on Ebola Management

31 Aug 2014

health workers attending to ebola patient

By Anayo Okolie

Useful hints on how to contain the rampaging Ebola Virus Disease has been offered by an Emory University Hospital expert, under whose watch two American aid workers who had contracted Ebola while working in West Africa were recently released and pronounced “recovered”.

The hospital’s Infectious Disease Unit’s medical director, Bruce Ribner, had in a recent interview with a US journal, Scientific American, disclosed how the two US aid workers – Kent Brantly, a physician with the humanitarian group Samaritan’s Purse, and missionary Nancy Writebol, of SIM USA – were able to survive the strain of the disease that kills 52 per cent of its victims.

According to the medical expert, who led a team of 25 nurses and five physicians, lessons learnt from the care of the aid workers could be useful in the management of the disease across Africa.

He identified “a terrible lack of infrastructure and the sort of testing that everyone in our society takes for granted” as among the challenges facing health workers in West Africa. He said countries in the region lack “the ability to do a complete blood count—measuring your red blood cells, your white blood cells and your platelets—which is done as part of any standard check-up here. The facility in Liberia where our two patients were didn’t even have this simple thing, which everyone assumes is done as part of your annual physical.”

“What we found in general is that among our Ebola patients, because of the amount of fluid they lost through diarrhoea and vomiting, they had a lot of electrolyte abnormalities.” Continuing he said “And so replacing that with standard fluids [used in hospital settings] without monitoring will not do a very good job of replacing things like sodium and potassium. In both of our patients we found those levels to be very low. One of the messages we will be sending back to our colleagues is even if you don’t have the equipment to measure these levels, do be aware this is occurring when patients are having a lot of body fluid loss. Our two patients also gained an enormous amount of fluid in their tissues, what we call oedema. In Ebola virus disease there is damage to the liver and the liver no longer makes sufficient amount of protein; the proteins in the blood are very low and there is an enormous amount of fluid leakage out into the tissues. So one of the takeaway messages is to pay closer attention to that and perhaps early on try to replace some of these proteins that patients’ livers lack.”

Explaining the dramatic recovery of the two American patients, he attributed it to their development of immunity to the Zaire strain of the virus, which they had contracted. “They develop antibodies against the virus and they also developed cell-mediated immunity—the lymphocytes important to form viral control of pathogens,” he explained.
“In general, the finding is basically like being immunised—it would be unusual to get infection with the same strain.”
But uncertainty hovers over whether or not that immunity protects them from the other four known strains of the virus. While stating that the possibility is still being evaluated in the two patients, he acknowledged that “cross-protection” among the five strains of the Ebola virus “is not quite as robust”, adding, “Even though that data is not great, the feeling is there is potential for being infected if you go to a different part of Africa and get exposed to a different strain.”

An implication of “still evaluating” the two discharged patients is their being monitored as outpatients, part of which involves their undergoing additional testing to help the experts throw more light on the immunity to the virus.

As part of new Ebola care guidelines, he cites the several articles on the disease submitted to major medical journals, working with several government agencies, including the U.S. State Department, to help them come up with lessons which could be shared with other countries.

A caveat by WHO, however, upholds the assertion to the effect that patients could still remain vectors of the disease via their sexual fluids for several months after recovery. “There are data that go back several decades—over several outbreaks—that suggest when you have individuals that have recovered from Ebola virus infection they may still be shedding nuclear material [genetic material from the virus which could potentially help spread it] in semen in males and vaginal secretions in females and also, potentially in urine.”

Dr Ribner, however, added that the “epidemiological investigations” had not shown people shedding these nuclear materials as a source of infection after their being discharged.

“Looking at Ebola survivors who were discharged and successfully resolved the infection, following up several months later and evaluating their family members, there has never been any evidence that family members became infected. A lot of the thinking now is this probably was not live and is not important in terms of control of infection. We did give both of our patients the standard recommendations, which are contained on the CDC [U.S. Centres for Disease Control] Web site—not having unprotected sex for three months.”

On the experimental drug ZMapp, which could not save the lives of some of the few patients that received it, he said that it being an experimental drug implies that it cannot be guaranteed to cure the virus.

“We are a long way from being able to say that someone that received one of these agents benefited, it had no impact or it may be that their outcome may be impeded. Until we have good studies looking at outcomes of patients who received these medications, compared to patients who didn’t receive them, we should be very cautious,” he said.
Source: THISDAY:-

Ebola: FG to Seek Amendment of Quarantine Law

31 Aug 2014

Minister of Health, Prof. Onyebuchi Chukwu

*Sawyer came to spread Ebola in connivance with Liberian officials, says Obasanjo

By Paul Obi and Sheriff Balogun

Following two cases of escape from quarantine and surveillance by two Ebola virus patients from Lagos to Enugu and Port Harcourt, the Ministry of Health has said it would approach the National Assembly in order to enact a binding on patients under surveillance during outbreak of epidemics such as Ebola Virus Disease (EVD).

Also Saturday, former President Olusegun Obasanjo described Patrick Sawyer, the Liberian American, who brought the Ebola virus into Nigeria as devilish, adding that he came to the country with the connivance of some Liberian officials.

Minister of Health, Prof. Onyebuchi Chukwu, told THISDAY Saturday that the review of the quarantine law became necessary given the current Ebola outbreak.
According to him, “we are strengthening surveillance and we will work with the National Assembly to review the country’s quarantine law.”

“Apart from the two known cases (of escape) to Enugu and Port Harcourt respectively, no other cases have been identified” adding: “nonetheless” there is need to strengthen or set in motion an enabling law to prevent patients from escaping surveillance,” he added.

Nigeria has an existing Quarantine Act, which was enacted in 1926. This Act has however become grossly inadequate.

In view of this, Senator Clever Marcus Ikisikpo recently sponsored a bill that seeks to repeal and re-enact the Quarantine Act.

The bill if passed, seeks to make provisions for preventing the introduction into Nigeria and from Nigeria, dangerous infectious and communicable diseases, organisms and agents and to repeal the Quarantine Act, 1926.

In a bid to prevent the further escape of Ebola patients in isolation centres as well as those placed under surveillance, there are indications that the Federal Government may be considering assigning security agencies to monitor the movement of Ebola patients under surveillance.

Already, there were reports last Wednesday that the Federal Executive Council (FEC) was looking at several legal instruments that might be used to charge Ebola patients who intentionally spread the virus to the general public.

A source within the ministry of health told THISDAY that though it is not yet certain, if it becomes necessary, government will not hesitate to take such steps.

This came as a medical expert and member of the Nigerian Medical Association (NMA), Dr. Henry Ewunonu, said the time had come for government to bring in security personnel to track down and checkmate the movement of Ebola patients to prevent them from spreading the virus.

Ewunonu, who spoke with THISDAY, said: “Security should be brought in to track down any Ebola patient escaping quarantine or surveillance. Ebola patients intentionally spreading the disease are death agents to the public. It is not a human right issue”
He told THISDAY that “government can do anything for the overriding national and public interest to keep Nigerians protected. Ebola patient transmitting the virus is worse than a bomber.”

“Anyone, including medical officers, hiding Ebola patients is like hiding a bomber. And as such, the person can be charged as associate in crime,” he submitted.

However, the Director of Public Health, Federal Ministry of Health, Dr. Bridget Okoeguela, informed THISDAY that calling in security agencies to monitor the movement and behaviours of Ebola patients is difficult.

“It is difficult to bring in Police and other security agencies to monitor Ebola patients. When they are on surveillance, they are restricted, that does not mean they cannot move but they cannot leave where they are staying,” she said.

She added: “When they are on surveillance, we check them every day to see their health, whether they are having fever or other symptoms of Ebola Virus Disease (EVD).”

Also, the National Centre for Disease Control (NCDC) said the Nigerian diplomat attached to Economic Community of West African States (ECOWAS), Olubukun Koye, who sneaked into Port Harcourt, the Rivers State capital and transmitted the virus lied to avoid thorough medical screening.

Project Director of NCDC, Prof. Abdulrahman Nasidi, told THISDAY that he deliberately left Lagos to avoid surveillance.

“We are all human; not that we are not in charge or in control, he never said the truth, he was telling us lies,” Nasidi explained.

“He avoided us, switched off his phones and he wickedly went to Port Harcourt to infect some people else. The disease is very dangerous, so even some medical officers are hiding, they don’t want to come out and show themselves.”

NCDC Project Director further stated that “we are lucky that we were able to pick up this case, it is not easy. He didn’t tell us the truth. He just escaped, which is like going to harm and kill people.”

Meanwhile, the Minister of State for Health, Dr. Khaliru Alhassan, said yesterday that the Federal Government was committed to containing the Ebola virus disease in the country.

Alhassan made this known during a chat with newsmen in Sokoto. He stated that the scourge had already been contained in Lagos State, while a special team was mobilised to Rivers state to contain the scourge.

“Presently, a specialised team comprising staff of World Health Organisation, Centre for Disease Control, Atlanta United States and Geneva and Medecin Sans Frontiers are already in Port Harcourt to address the situation.

“We are confident we have won the war in Lagos, though we still have one patient receiving attention there but we are still not out of the woods yet. So, Nigerians should remain calm, as we are adequately prepared to contain the spread of the scourge,” he said.

Alhassan disclosed that over 400 people were currently under strict surveillance in the country. The minister stated that adequate preparations had been made in collaboration with the Ministry of Interior to ensure proper checks of travellers at the border posts in the country.
He pointed out that vehicles and motorcycles had been mobilised to the borders. He acknowledged that the greatest challenge was getting the understanding of the public, especially those under quarantine.

“As of now, we want those under quarantine that were asked to remain indoors to cooperate and should remain calm because we are determined to contain the disease,” he added

According to former president Obasanjo, “it is devilish enough that Patrick Sawyer had to spread this, and indeed spread it to Nigeria in connivance with some authorities in his country, because they knew he had it before he came to Nigeria.

He added: “The EVD has started to take its toll on the country and the West African sub region. The toll is not only on the number of those that are ill or dead but on the economies of communities, countries, region and sub-region.”

Obasanjo spoke in an event organised by the publisher of Inside Watch Africa magazine, Mr. Oluwaseyi Adegoke-Adeyemo, at the Olusegun Obasanjo Presidential Library, Abeokuta yesterday.

He, however, chided Liberian officials who connived with the late Sawyer, who brought the deadly EVD to Nigeria, saying the singular misadventure has started to take its toll on the manpower and the economy of not only Nigeria but the West Africa sub-region.
Obasanjo said he had spoken with some other African leaders and discussed how to contain the spread of the deadly virus within the sub-region.

He said he had spoken with the presidents of Liberia and Sierra Leone to “give them words of encouragement and support” on the scourge of Ebola in their countries.
Speaking further, he noted that EVD was not only a regional or sub-regional threat but a global one, and called for a summit where a national policy on the disease would be formulated.

Obasanjo also advocated the need to encourage the world pharmaceutical companies to carry on research on the virus and come up with the needed vaccine to eliminate it.
He said, “Pharmaceutical companies in the country should be encouraged to carry out research on the EVD and come up with vaccines to treat the deadly disease.

“Also, we have to be aggressive in taking precautionary measures. When you see your neighbour or someone who has unique symptoms not just of ordinary cold or fever, take him to the doctor, whether it is symptomatic of Ebola or ordinary malaria.

“We should not wait till someone has got it incubated, just like Patrick Sawyer, who knew he had it and he deliberately spread it.”

Source: THISDAY:- 22007A84


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