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Online Discussion: Tracking new emerging diseases and the next pandemic; Now tracking the Aussie Flu.

Ebola is back - Epidemic Coming?

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Medclinician2013 View Drop Down
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Post Options Post Options   Thanks (2) Thanks(2)   Quote Medclinician2013 Quote  Post ReplyReply Direct Link To This Post Topic: Ebola is back - Epidemic Coming?
    Posted: June 15 2015 at 5:43am
http://www.foxnews.com/health/2015/06/15/ebola-could-hit-again-and-would-hardly-do-better-msf-head-says/

While the virus is spreading more slowly than at the peak last year and Liberia has defeated the outbreak, cases have risen sharply in the past two weeks in Guinea and Sierra Leone.

"We've been disappointed by the World Health Assembly and again by the G7 in terms of their recommendations," Liu, the international president of MSF, told Reuters. She was referring also to a World Health Organization (WHO) meeting last month.

The WHO did not declare an international public health emergency until August last year, eight months after the first Ebola case, delaying resources to the sick.

Jerome Mouton, MSF country head for Guinea, described a state of "semi-denial" about the virus similar to a year ago, adding that another major flare-up of the disease was possible.

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Jerome Mouton, MSF country head for Guinea, described a state of "semi-denial" about the virus similar to a year ago, adding that another major flare-up of the disease was possible.

"We are in the same situation where we are overly optimistic, saying that it is almost finished and there's no problem but in fact it's a big problem as there is potential for this to again set off a big epidemic," he said.



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Post Options Post Options   Thanks (0) Thanks(0)   Quote CRS, DrPH Quote  Post ReplyReply Direct Link To This Post Posted: June 15 2015 at 9:55pm
^Thanks, that is important news to report!
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Dutch Josh Quote  Post ReplyReply Direct Link To This Post Posted: June 16 2015 at 1:19am
Ebola might become like cholera in Haïti http://www.paho.org/hq/index.php?option=com_docman&task=doc_view&gid=29715+&Itemid=999999&lang=en that has been around since 2010 (and is worse in 2015 than 2014 !).
Que sera, sera, Whatever will be, will be, The future is not ours to see, Que sera, sera !
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Medclinician Quote  Post ReplyReply Direct Link To This Post Posted: June 16 2015 at 5:02pm
Originally posted by Dutch Josh Dutch Josh wrote:

Ebola might become like cholera in Haïti http://www.paho.org/hq/index.php?option=com_docman&task=doc_view&gid=29715+&Itemid=999999&lang=en that has been around since 2010 (and is worse in 2015 than 2014 !).


Cutting to the bottom line as far as America goes, we seem to have this overall spin that it can't happen here because West Africa is less sanitary. Given enough infected people the virus will mutate. However if it is airborne, then the difference vanishes. It could spread in the U.S. as much as it has in West Africa.

There was quite a debate on here when I first posted it was airborne. This got into a heavy discussion drawing a fine line between weaponized and spread by droplets. At one time the CDC were taking extensive precautions to protect for something passed by a cough or sneeze and some sources stated it could be for up to 12 feet.

http://nationalreport.net/ebola-mutation-confirmed-airborne/

National Report>A preliminary emergency investigation by the Center for Disease Control has determined that a new virulent mutation of the Ebola virus may have come into the U.S. on several international flights from the African continent.

Concern over an outbreak of Ebola in the United States had previously been low due to vastly better hygienic practices and the quality of medical facilities and treatments. But information coming out of Africa, which is currently experiencing the worst case of Ebola outbreak in modern history, suggests that the severity of the pandemic has been caused by a new mutation in the Ebola virus; one that has allowed it to live and transit infection in airborne particles of mucus and saliva.


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Post Options Post Options   Thanks (0) Thanks(0)   Quote jacksdad Quote  Post ReplyReply Direct Link To This Post Posted: June 16 2015 at 6:19pm
Med - that article is almost a year old and the site's credibility is questionable, to say the least.
Ebola is an RNA virus so we should most definitely expect mutations, but surely it would be hard to miss a more virulent airborne strain that was showing up at US airports last year because it would, by it's very nature, spread much faster and further. Other than a resurgence in West Africa that seems likely to be more attributable to a return to unsafe behaviors and complacency, I'm seeing no indication that Ebola has changed significantly.


"Stories from the National Report have been taken seriously by third parties such as Fox News Channel and the site drew criticism in October 2014 for running a series of fake stories about Ebola outbreaks in the United States, including the false report that the town of Purdon, Texas has been quarantined after an outbreak. The story led to a traffic spike of two million unique visitors, and although the story was debunked by other websites, the original National Report story received six times as many "shares" on social media sites as the debunking stories did."

https://en.wikipedia.org/wiki/National_Report


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Post Options Post Options   Thanks (1) Thanks(1)   Quote Technophobe Quote  Post ReplyReply Direct Link To This Post Posted: June 17 2015 at 3:37am
I'm back as JD's yesman.
Absolutely.
Absence of proof is not proof of absence.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Medclinician Quote  Post ReplyReply Direct Link To This Post Posted: June 17 2015 at 6:04am
http://wchildblog.com/2014/08/08/airborne-ebola-virus-confirmed-by-canadas-public-health-agency/

MODE OF TRANSMISSION:Humans may be infected by handling sick or dead non-human primates and are also at risk when handling the bodies of deceased humans in preparation for funerals, suggesting possible transmission through ‘Aerosol Droplets’ (2, 6, 28). In the laboratory, infection through small-particle ‘Aerosols’ has been demonstrated in primates, and AIRBORNE spread among humans is ‘Strongly Suspected’!

comment: I did publish quite an extensive lab report from this and it had nothing to do with the tabloids.

http://www.bbc.com/news/science-environment-20341423

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.

(Here we show ZEBOV transmission from pigs to cynomolgus macaques without direct contact. Interestingly, transmission between macaques in similar housing conditions was never observed. Piglets inoculated oro-nasally with ZEBOV were transferred to the room housing macaques in an open inaccessible cage system. All macaques became infected. Infectious virus was detected in oro-nasal swabs of piglets, and in blood, swabs, and tissues of macaques. This is the first report of experimental interspecies virus transmission, with the macaques also used as a human surrogate. Our finding may influence prevention and control measures during EBOV outbreaks.)

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 euthanized.

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

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Post Options Post Options   Thanks (0) Thanks(0)   Quote Medclinician Quote  Post ReplyReply Direct Link To This Post Posted: June 17 2015 at 8:16am
http://wqad.com/2015/06/12/dozens-of-new-ebola-cases-reported-in-west-africa/

(CNN) — It seemed like the number of people contracting Ebola in West Africa was on the decline. But now, officials say that trend has stalled, with dozens of new cases of the deadly virus reported so far this month.

Last week, there were 31 new cases of Ebola reported in a growing geographic area in Guinea and Sierra Leone, the World Health Organization said. At the beginning of this week, 14 additional cases were reported.

The latest figures mark the second straight week that the number of Ebola cases in West Africa has increased, officials said.

Investigators are working to trace how the latest cases of the disease were contracted, the WHO said.



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Post Options Post Options   Thanks (1) Thanks(1)   Quote Technophobe Quote  Post ReplyReply Direct Link To This Post Posted: June 17 2015 at 9:18am
The pig monkey viral contagion was over a year old too, Med.  The same researchers realised later that they had made several mistakes and re-ran the experiments with stricter controls.  The virus did not jump that time.  Hazlepad posted the details earlier in this very forum.

It is true that it can pass without direct contact, by  accidentally generated aerosol or splash, but not by the true airborne route, or the ancient idea of miasma.  

Though you are correct in everything you have said, Med, it would be a good idea to clarify that point.  Then we can save up the panic for the MERS virus!
Absence of proof is not proof of absence.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote DebraKay Quote  Post ReplyReply Direct Link To This Post Posted: June 18 2015 at 2:26pm
I actually paid a visit to my pulmonologist yesterday, and discussed MERS etc. I told him my theory on hospital spread due to the use of nebulizers to administer medications to open lungs, how when one who is having a nebulizer treatment breathes out the medication along with virus now aerosolized goes into HVAC vents lands on door knobs, faucets, sinks, lungs, etc. He said, "we are looking at discontinuing use of nebulizers in the USA. Hmm. wonder why, he says because it is because the people get so much medicine that it causes tachycardia rapid heart beat. So, a neb treatment so effectively delivers medication that it causes medication side effects. Who believes this that would cause them to not use the nebulizer, simply reduce the amount of medication given because it delivers so effectively it is not needed in prior thought doses. Trust me, when I say the military are all very well aware of the danger of nebulizers. I believe that more then tachycardia is why the treatment is discontinued. It does spread it in a hospital environment.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote CRS, DrPH Quote  Post ReplyReply Direct Link To This Post Posted: June 18 2015 at 7:49pm
There is absolutely nothing about the spread of MERS that we haven't seen with SARS.  We need to remember the lessons that we once learned. 


I feel that MERS is still "winding up" in a genetic sense, and is nowhere near optimized for human-to-human spread.  This may happen rather quickly, if the South Koreans don't stop playing games with it. 

Apparently, like the Chinese, they are primarily concerned about the impact of this MERS outbreak upon their economy.  

Oh, regarding Ebola....it is here, to stay, in Africa.  It will smolder in the bush at a low level, and every so often, MSF or other group will go in when it becomes obvious enough.  Eventually, a case will break out into a more populated area, and we'll go through the fire drill again.  

We humans seem to have very short memories. 
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Post Options Post Options   Thanks (0) Thanks(0)   Quote jacksdad Quote  Post ReplyReply Direct Link To This Post Posted: June 18 2015 at 9:57pm
Originally posted by CRS, DrPH CRS, DrPH wrote:

We humans seem to have very short memories. 


Isn't that the truth... Disapprove
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Post Options Post Options   Thanks (0) Thanks(0)   Quote onefluover Quote  Post ReplyReply Direct Link To This Post Posted: June 19 2015 at 8:56am
Huh?
"And then there were none."
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Post Options Post Options   Thanks (0) Thanks(0)   Quote jacksdad Quote  Post ReplyReply Direct Link To This Post Posted: June 19 2015 at 12:43pm
I forget.

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"Any community that fails to prepare, with the expectation that the federal government will come to the rescue, will be tragically wrong." Michael Leavitt, HHS Secretary.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Medclinician Quote  Post ReplyReply Direct Link To This Post Posted: June 20 2015 at 4:40pm
Meanwhile - back to the Ebola Outbreak -
http://reliefweb.int/report/sierra-leone/ebola-outbreak-updates-june-19-2015

CUMULATIVE CASES

  • Cumulative confirmed cases = 8,656 as follows:
    Kailahun = 565, Kenema = 503, Kono = 253 Bombali = 1,049, Kambia = 244, Koinadugu = 109, Port Loko = 1,477, Tonkolili = 454 Bo = 314, Bonthe = 5, Moyamba = 209, Pujehun = 31 Western Area Urban = 2,262, Western Area Rural = 1,164, Missing = 14  CUMULATIVE DEATHS

  • Total cumulative confirmed death is 3,560

  • Probable cases = 287

  • Probable deaths = 208

  • Suspected cases = 4,079

  • Suspected deaths = 158

Ebola Virus Disease Situation Report
PROVIDED BY: The Ministry of Health and Sanitation

comment: So that is a 4!% CFR (case fatality ratio)


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Post Options Post Options   Thanks (0) Thanks(0)   Quote Medclinician Quote  Post ReplyReply Direct Link To This Post Posted: June 22 2015 at 7:34am
http://www.opb.org/news/article/npr-why-ebola-wont-go-away-in-west-africa/

Ebola has dug in its heels.

Despite dramatic drops in the overall numbers of reported cases, Sierra Leone and Guinea are still struggling to stop the deadly disease.

Case tallies in both countries have dipped towards zero in the past few months, only to bounce back up. Sierra Leone reported 14 new cases this week and Guinea counted 10.

To try to finally wipe out Ebola once and for all, Sierra Leone President Ernest Bai Koroma ordered the military last week to enforce new community-wide quarantines around the most recent cases.

“The curfew restrictions and the soldier activities will last for a 21-day period,” President Koroma declared on TV last week. Anyone caught violating the quarantine will be arrested, he ordered.

People aren’t allowed to leave the quarantined communities, and the government has imposed a curfew from 6 p.m. to 6 a.m. The new restrictions are aimed at “ending the secret movement of cases, contacts, and dead bodies that has propagated transmission over the past 2 months,” the World Health Organization said.

Guinea arguably is in a worse position than Sierra Leone. The outbreak has been going on longer in Guinea. Cases are more geographically widespread, and some rural communities in Guinea have blocked health workers from entering.

“I think it’s going to be very difficult to actually get to zero cases and stay at zero cases in Sierra Leone and Guinea,” says Dr. Daniel Lucey, a professor of immunology at Georgetown University, who just returned from Guinea last week.

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Post Options Post Options   Thanks (0) Thanks(0)   Quote jacksdad Quote  Post ReplyReply Direct Link To This Post Posted: June 22 2015 at 12:22pm
It's moved geographically, but it's probably going to behave as it did in the Congo - hiding out in animal hosts and causing outbreaks in humans for the foreseeable future. West Africa is unfortunately going to have to learn how to deal with inevitable outbreaks as it does with other endemic diseases like Lassa Fever. It's not going away anytime soon, if ever, but I think it's shown that it doesn't have pandemic potential even as bad as the recent outbreak was.

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Post Options Post Options   Thanks (0) Thanks(0)   Quote Medclinician Quote  Post ReplyReply Direct Link To This Post Posted: June 23 2015 at 9:33am
Originally posted by jacksdad jacksdad wrote:

It's moved geographically, but it's probably going to behave as it did in the Congo - hiding out in animal hosts and causing outbreaks in humans for the foreseeable future. West Africa is unfortunately going to have to learn how to deal with inevitable outbreaks as it does with other endemic diseases like Lassa Fever. It's not going away anytime soon, if ever, but I think it's shown that it doesn't have pandemic potential even as bad as the recent outbreak was.



One of the considerations here is whether their health system or nations help them have improved as far as being to handle the outbreaks. This is a nasty disease that can get through even heavily protected workers with anything less than air isolation and contact gear. Many of the outfits used during the last serious outbreak last year were made by the workers and some just did not protect them enough to prevent infection. The bottom line is whether this is a sanitation issue and whether Europe and the U.S. simply handle their burials with no physical contact.

courtesy of Tara at Stanford University and for non-profit and educational use -
http://web.stanford.edu/group/virus/filo/transmission.html

We still don't know how primates contract filoviruses in nature. The secondary cases of filovirus infection have been the result of contact with contaminated blood, organs, semen or other bodily secretions. Marburg, a filovirus closely related to Ebola, can be transmitted via semen up to 12 weeks after clinical recovery (1). Ebola can also be transmitted through the handling of ill or dead chimpanzees. Amongst humans, Ebola is transmitted by contact with infected bodily fluids and/or tissues (2, 3). There is evidence of a possible respiratory route of transmission of Ebola in nonhuman primates (3). Even if Ebola is transmitted via the respiratory route to nonhuman primates, humans may be resistant to the airborne/aerosol transmission of Ebola (may not have the right receptors).
References:
  1. Martini, GA, Siegert R, eds. Marburg Virus Disease. Berlin: Springer-Verlag: 1971.
  2. "Ebola Haemorrhagic Fever in Gabon." WHO Press Release 19 February 1996.
  3. Jaax, N. et al. "Transmission of Ebola virus (Zaire strain) to uninfected control monkeys in a biocontainment laboratory." The Lancet. Vol. 346. December 23/30, 1995. 1669-1671.
  4. Peters, C.J. "An Introduction to Ebola: The Virus and the Disease." Journal of Infectious Disease. 1999;179(Suppl 1):ix-xvi

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Post Options Post Options   Thanks (0) Thanks(0)   Quote jacksdad Quote  Post ReplyReply Direct Link To This Post Posted: June 23 2015 at 9:40am
I agree, Med. Superstition, burial traditions and lack of education fueled the spread in West Africa. When it arrived, the residents of Liberia, Guinea and Sierra Leone were taken completely by surprise and often chose to seek traditional medicine, hide from the authorities or refuse to comply with quarantines.
By contrast, Lassa Fever has been entrenched in that part of the world for a long time and is well understood, even by the locals. I remember being amazed that countries like Sierra Leone, who are world leaders in dealing with outbreaks of Lassa, were being beaten by a different hemorrhagic disease that was similar in more ways than it was different.


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Post Options Post Options   Thanks (0) Thanks(0)   Quote Technophobe Quote  Post ReplyReply Direct Link To This Post Posted: June 23 2015 at 3:11pm
I agree too, Med..  I can't see the dangerous practices changing in sufficient degree anytime soon.
Absence of proof is not proof of absence.
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