Thursday, November 27, 2014

Bird Flu Reports From India, Japan, Korea & Taiwan


Credit UK Defra


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Between 2004 and 2007 the H5N1 avian flu virus expanded its range, going from basically being a problem for a handful of Southeast Asian countries, to being a problem for much of Europe, Asia, and the Middle East.  We saw huge wild bird die offs in China, Indonesia, and Eastern Europe, along with thousands of poultry infestations and culling operations.  


Along the way, several hundred humans were infected as well.


In 2008, H5N1’s expansion seemed to halt, and in many places the virus actually receded, leaving behind about a dozen places around the world where the virus remained entrenched.  Among them were Indonesia, Vietnam, Egypt, Cambodia, India,  Pakistan, Bangladesh, and China.


Even in these countries, the number of outbreaks reported – and the number of human infections – dropped markedly, with the peak reached in 2006 (n=115) and steadily dropping since then (2013= 39 cases).   The foci of infections also shifted away from Vietnam and Indonesia towards Egypt and Cambodia.

While never quite going away, it seemed as if the avian flu threat was simply fading away.


That is, until a new avian flu virus – H7N9 – appeared abruptly in China in the spring of 2013 sparking two consecutive winter epidemics, and is expected to return again this winter as well.  In quick succession, several more avian flu viruses appeared – including H5N8 in Korea (now spread to Europe & Japan), H5N6 in China and Vietnam, H5N3 in China, and H10N8 in China.


Now, instead of one avian flu threat, we have anywhere from three to six to keep track of (H5N1, H7N9, H5N8, H5N6, H5N3, H10N8), and no one should be terribly surprised if several more novel reassortants emerge over the next couple of years. 


Reassortant viruses emerge when two different flu viruses share a common host and swap genetic components. Most reassortant viruses are evolutionary failures, but every once in awhile a more `fit’ virus emerges.

Not only are there more `building blocks’ in play, for flu viruses to swap and play with, the poultry vaccines in use in China and elsewhere are losing their effectiveness, and that may be promoting the creation of new flu strains (see EID Journal: Subclinical HPAI In Vaccinated Poultry – China).


In recent weeks we’ve seen more bird flu stories, from more diverse locations, than we have in a number of years.  While this may be a flash in the pan, for now bird flu concerns are once more on the ascendant – albeit, for now, mostly for poultry operations


With so much going on in India, Korea, Japan, the Netherlands, Germany, the UK, and Egypt – instead of blogging separately about these news stories – I’ve put together a morning round up.

Our first stop: India, where over the past few days we’ve seen reports of massive duck die offs in Kerala, and government plans to cull 200,000 birds.  While initially only identified as an HPAI H5 virus, today multiple media sources are reporting the virus is the H5N1 subtype.


Kerala Confirms Bird Flu is Deadly and Highly Contagious Strain

Updated: November 27, 2014 15:56 IST

Kottayam: Kerala has confirmed that the outbreak of bird flu in the state is of the feared H5N1 strain, which is highly contagious and can be fatal to humans.

Government officials said that massive culling of birds is being done to prevent the spread of the disease.

The virus itself killed about 15,000 infected ducks in Kottayam and another 500 in nearby Alappuzha, the first cases of the disease in the country since February this year.

(Continue . . . )


Meanwhile, in Korea, there are fresh reports the the H5N8 virus – which emerged there last January and proceeded to devastate the poultry industry -  has been detected again on a poultry farm in the coastal city of Gyeongju in Gyeongsang Province.


Bird Flu Spreads in S. Korea

Pyongyang, November 26 (KCNA) -- A bird flu occurred at a chicken farm in Kyongju City, North Kyongsang Province, south Korea on Nov. 24, according to KBS of south Korea.

Hundreds of chickens were culled and buried.

It was also reported that bird flu caused by migratory birds is spreading.

(Continue . . .)


In Japan, another report of migratory bird feces testing positive for the H5N8 virus, this time in Tottori.

This season highly pathogenic avian influenza detected in Tottori third example

November 27, 2014

Ministry of the Environment is the 27th, highly pathogenic avian influenza virus from droppings of ducks found in Tottori (H5N8 subtype) was detected, was announced. Domestic wild birds in the highly pathogenic avian influenza has been confirmed Shimane Prefecture Yasugi, season three cases eyes continued to Chiba Prefecture Nagara.

(Continue . . .)


And from Taiwan this morning, reports (h/t Ronan Kelly of FluTrackers) of both H7N9 and H7N5 in migratory bird feces samples collected this month from Tainan City, in the southwest of Taiwan.  Further testing will be required to determine the pathogenicity of these subtypes.


Four grass wetlands and migratory birds excrement detection of H7N9 subtype avian influenza virus vaccination started around the poultry farms safe and secure

Published date: 2014/11/27 morning 10:55:20| last modification date: 2014/11/27 10:55:20

Four wetland today in this city (103) on November 15, feces sampling inspection in routine monitoring of migratory birds on 25th H7N5 and subtype H7N9 avian influenza viruses isolated, identified highly pathogenic virus does not at present, but homologous strains is a city, pending final confirmation.

Protection of animal epidemic prevention Department said in this city, as a safeguard against four grass migratory birds carrying the virus, around the 25th started 6 games within a 3 km radius of poultry farms quarantine measures, including 1 feeding chickens, health situation is good, same day sampling inspection. Animal Health Department has stepped up poultry farms in and around the public road disinfection and epidemic prevention work, and to strengthen the poultry farm visits and monitoring of the epidemic, and take precautions against the epidemic. According to the sampling frequency of the disposal process 1 times per month on poultry farms within 3 kilometers to strengthen monitoring for 3 months after confirming that the avian influenza virus activity was not detected, you can unlock the wetlands regional monitoring measures.

(Continue . . .)


Meanwhile we continue to see scattered media reports of bird flu `alarm’ in Egypt, amid numerous poultry outbreaks and three recent human infections (see Meanwhile, Back In Egypt . . . .), and Europe continues to ratchet up their biosecurity measures against any further introductions of the H5N8 virus (see Defra updated bird flu guidance).

While the public health threat fairly remains low from these viruses, the one constant with influenza viruses is their capacity for change.  So we watch these outbreaks carefully, for any signs that these viruses may be evolving into a greater human health threat.

Wednesday, November 26, 2014

WHO Ebola Response Roadmap - Situation Report 26 Nov




# 9379


The World Health Organization has released their latest weekly Ebola situation report, and while case counts and death tallies are still believed to be under-counted, they report that the number of new cases appears to be stable or declining in Liberia and Guinea, but may be rising again in Sierra Leone.

The toll on healthcare workers continues to run high, with nearly 600 infected, and 330 deaths.   Follow the link below ro read the full update online, or Download the PDF


Ebola response roadmap - Situation report

26 November 2014


A total of 15 935 confirmed, probable, and suspected cases of Ebola virus disease (EVD) have been reported in six affected countries (Guinea, Liberia, Mali, Sierra Leone, Spain and the United States of America) and two previously affected countries (Nigeria and Senegal) up to the end of 23 November. There have been 5689 reported deaths. Cases and deaths continue to be under-reported in this outbreak. Reported case incidence is stable in Guinea (148 confirmed cases reported in the week to 23 November), stable or declining in Liberia (67 new confirmed cases in the week to 23 November), and may still be rising in Sierra Leone (385 new confirmed cases in the week to 23 November). The total number of cases reported in Sierra Leone since the outbreak began will soon eclipse the number reported from Liberia. The case fatality rate across the three most-affected countries in patients with a recorded definitive outcome is approximately 60%. Three health-care workers were reported infected with EVD in Guinea in the week to 23 November. 

Response activities continue to intensify in line with the UNMEER aim to isolate 70% of EVD cases and safely bury 70% of EVD-related deaths by 1 December. Guinea isolates over 70% of all reported cases of EVD, and has more than 80% of required safe burial teams. Progress on isolation and safe burials has apparently been slower in parts of Liberia and Sierra Leone, although uncertainties in data preclude firm conclusions. At a national level, both countries are apparently unable to isolate 70% of patients, although data on isolation is up to 3 weeks out of date. Every EVD-affected district in the three intense-transmission countries has access to a laboratory for case confirmation within 24 hours of sample collection. All three countries report that more than 80% of registered contacts associated with known cases of EVD are traced, though the low mean number of contacts registered per case suggests that contact tracing is still a challenge in areas of intense transmission.  


Health-care workers

A total of 592 health-care workers (HCWs) are known to have been infected with EVD up to the end of 23 November, 340 of whom have died (table 5). The total case count includes 2 HCWs in Mali, 11 HCWs infected in Nigeria, 1 HCW infected in Spain while treating an EVD-positive patient, and 3 HCWs in the US (including a HCW infected in Guinea, and 2 HCWs infected during the care of a patient in Texas).


(Continue . . . )


Saudi MOH Reports Another MERS Case In Al-Kharj


# 9378


The Saudi MOH is reporting the fifth MERS case from the Al-Kharj region over the past two weeks. While exposure routes have undetermined for many of the other cases, this time nosocomial exposure is listed as a likely source of infection.



This is the 22nd MERS case announced thus far by KSA for the month of November, and comes on the heels of 34 cases reported in October, and 12 cases in September.

Thanksgiving Roll Call 2014


@FLA_MEDIC on Twitter

It is hard  for me to believe this makes my ninth Thanksgiving blogging at Avian Flu Diary.  Somehow, even after more than 9,300 blog posts, I still find there are new and interesting things to write about nearly every day. 

In November of 2006 I began what has turned out to be a joyous yearly tradition for me - taking the time to publicly acknowledge and thank many of the friends I've made along the way on this remarkable journey through Flublogia.

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When I began AFD almost 9 years ago, I did so with no expectations that anyone other than myself and maybe some family members would ever read it.  I thought of it as more of an online diary (hence the name) than a public blog, and no one was more surprised than I when it turned out people were actually reading it.

Looking back at the quality of many of my posts in that first year, I have to wonder why they bothered.  

But I suppose if you don’t cringe at least a little when you go back and read your old stuff, you aren’t making any progress as a blogger.  The credit for any progress I may have made, however, more properly belongs to the many people who have – over the years – lent their knowledge, assistance, support and friendship to this humble blogger.


Where I’ve done well, I’ve them to thank.  Where I’ve fallen short, I have only myself to fault.

Today, if you will indulge me, I’d like to publicly thank a few of those who have, in one way or another, contributed to the success and longevity of this blog.   In no particular order, my thanks go out to . . .

Revere at Effect Measure, who not only showed Flublogia how a `flu blog’ should be curated (science-based, but written in a way that non-scientists could understand) – but who extended to this fledgling blogger words of encouragement and support long before it was probably due.


Four years after he closed up shop, I still go back and re-read the archives, as do many others.  Gone, but far from forgotten, Revere left an indelible mark on flublogia - and hopefully a faint imprint on my ramblings as well. 


Readers of this blog no doubt have noticed that I’ve referenced the work of CIDRAP often over the years. The reason is simple: The reporting from CIDRAP News  is always first rate, with most of the heavy lifting done by Editor Robert Roos , and Lisa Schnirring.


Dr. Michael Osterholm, Director of CIDRAP, is arguably the best spokesperson on pandemic influenza in the country, and I was delighted to finally get to meet him in 2009. Before devoting his attentions to CIDRAP, Mike served for 24 years (1975-1999) in various roles at the Minnesota Department of Health (MDH), the last 15 as state epidemiologist and chief of the Acute Disease Epidemiology Section.

The gang at CIDRAP have been tremendously supportive over the years, and I hope they know how much it is appreciated.


Crof, at Crofsblog, has been on the `flu beat’ longer than anyone else, has a great `nose for news’, and has also been a stout supporter of AFD, and an amazing example of blogging tenacity and endurance. 


Blog long and prosper, my friend.


Last year I was extraordinarily pleased to help welcome Virologist Dr. Ian Mackay, curator of the Virology Down Under Blog, and associate professor of clinical virology at the University of Queensland to Flublogia.


Not only does Ian lend a much appreciated level of scientific expertise to the flu blogging scene, he’s fun to read, and a genuinely nice fellow. If you aren’t already reading his blog, you need to add him to your list.


Last year I added a new friend, Dr. John Sinnott, MD FACP FIDSA and Director of the Florida Infectious Disease Institute, and Chairman of Internal Medicine at USF, who has also been extraordinarily kind to this blogger.


Among members of the fourth estate, there are some truly remarkable science and health writers and reporters, several of whom I’ve been lucky enough to get to know over the years.


Helen Branswell, health reporter for the Canadian Press, has produced some of the finest reportage on the emergence of the H5N1 virus (and now H1N1) as exists anywhere in the world, and she started back when few had heard of the threat.


Her writing is clear, concise, and absent of the breathless prose that many lesser journalists rely upon.  Whenever I find a Branswell article, I know in advance it is going to be well worth reading.


Likewise, Maggie Fox  with NBC news  is another standout in the world of health reporting. Maggie understands the science, having completed fellowships at the National Institutes of Health on Genomics, at Harvard Medical School on infectious disease, and at the University of Maryland on child and family health policy.


Author, and science writer Maryn McKenna lends considerable talent and expertise to Flublogia, particularly on the antimicrobial resistance front.


In 2010 her second book, SUPERBUG: The Fatal Menace of MRSA was published to sterling reviews (you can read my review here). Her Superbug Blog continues to be one the best resources on antibiotic resistance issues available online. Maryn is also the author of Beating Back The Devil, the inside story of the CDC’s Epidemic Intelligence Service.

Although the infectious disease blogosphere has contracted a bit in recent years, new additions include the graphic and analysis rich Mens et Manus blog by  Maimuna Majumder, and  Microbiologist Robert Herriman’s Outbreak News Today. 


Robert has been kind enough to invite me on his weekly radio show on several occasions, and occasionally syndicates some of my blog posts.


Ian York, who now works at the CDC, also pens the  wonderful Mystery Rays blog (although his work schedule has severely limited his blogging). His eclectic meanderings through the world (and history) of infectious diseases are a delight for disease geeks and highly recommended.


In 2009, after several years of email correspondence, I finally got to meet the irrepressible (and now zombified!Scott McPherson. We were both part of the CIDRAP H1N1 summit in September 2009, and I got to spend two glorious days hanging out with him and Indigo Girl (of the AllNurses forum), forming what we called The Flu Amigos.


A fellow Floridian, Scott is the CIO of the Florida House of Representatives, and rubs elbows with State and Federal officials every day.  His insights, often sprinkled with a dash of healthy whimsy, are always a pleasure to read.  I remain hopeful that Scott will resume blogging on a regular basis again in the future.


While not necessarily flu-centric, some other bloggers of note that I follow, learn from, and recommend include:

Vincent Racaniello’s always excellent Virology Blog, which devotes a good deal of time to influenza.   His TWiV and TWiP  podcasts are also highly recommended.

Assistant Professor of Epidemiology, Tara Smith’s blog Aetiology and Celeste Monforton and Liz Borkowski of The Pump Handle are highly recommended as well.

And last, but hardly least, there’s Dr. Peter Sandman  who, along with his wife and colleague Dr. Jody Lanard , produce a wealth of invaluable risk management and pandemic communications advice on their Risk Communication Website.   Both have been great friends of this blog, and blogger.


And every day outside of the limelight dozens of hardworking flubies scour foreign language news reports, using search engines, text-finding software, and translating programs to bring us the latest tidbits of news from around the world.


While there are many who contribute, some of the names that pop up most often on the sites I visit include: Gert van der Hoek , Shiloh, Pathfinder, Emily, Sally, Carol@SC, mojo, bgw in MT, Readymom, Vibrant62, Sharon Sanders, Tetano, Diane Morin, Ronan Kelly . . . .

There are many others, of course.  My sincere apologies to those I failed to name.


I’ve written numerous times about the work they do, but if you want to know how they do it, check out Newshounds: They Cover The Pandemic Front. The work they do is remarkable. And I couldn't do much of what I do without them.  Thank you all.


The owners and moderators of the flu forums deserve mention, too. 


Labors of love, and devourer's of both time and money, flu forums provide a place for laymen and professionals to gather to discuss the various aspects of pandemic planning, and quite often, the science behind influenza and epidemiology. The founders and moderators do a terrific job keeping things on track, and do so without compensation. 

Most of the time, the costs (which can run into the hundreds of dollars each month) are borne by the owners.


There are a number of flu forums out there, but the two where I hang my hat are the Flu Wiki and  Flutrackers. Each has their own style and personality, and in many cases, members of one forum belong to several other forums as well.


The Flu Wiki, the first of the dedicated flu forums, was founded by DemFromCt, Pogge, and Melanie Matson.  In 2008, we lost Melanie after a long illness.  She was a pioneer, and an activist, and is greatly missed. This year,I’m sad to report, we lost Pogge.


FluTrackers, founded by Sharon Sanders (but is run with the aid of dozens of tireless volunteer moderators), boasts nearly 2,000 members and prides themselves on maintaining an impressive library of scientific literature on pandemic influenza and other emerging infectious diseases.


Sharon is also a dear friend, fellow Floridian, confidant, and unindicted co-conspirator.  And if it weren’t for Skype, we’d both be impoverished by long-distance phone charges by now.


And then there are the flubies, which number in the thousands. Some are active posters on the flu forums, while others take a more passive role.  Many have become activists in their communities.


Readymom, whom I've highlighted before in these pages, runs her own website Emergency Home Preparation.


Starting in mid-2007, more than a dozen volunteers worked to put together the GetPandemicReady.Org website.   There you will find more than 3 dozen easy-to-follow preparedness guides, written by some pretty familiar names from the Flu Forums.


Now is a good time to remind my readers that agencies like the Red Cross, Red Crescent, CARE, Save The Children, UNICEF, Médecins Sans Frontières and others are working around the world every day to combat poverty and disease, including pandemic flu.

They could use your support. These NGO’s do a great deal with very little, and even small donations can help make a difference.


Often forgotten, I also send out thanks to all who wear the uniform of our country, and who will are often called upon to be on the front lines during any crisis, including a pandemic.


This includes our military and national guard troops, both at home and abroad. You guys and gals do a tough, often thankless job, 365 days a year; and are deserving of both our respect and our nation's gratitude.


Please know, you have mine.


There are hundreds of thousands of doctors, nurses, technicians, EMT's, paramedics, firefighters, and law enforcement officers out there who put it on the line each and every day. I'm proud to have been able to be a part of that universe. And my thanks, and fervent best wishes go out to each of you.


And of course, thanks go to the readers of these forums and blogs. There are far more of you out there than you imagine.


Those that post on flu forums, or comment on blog sites are just the tip of the iceberg. Ninety percent of our visitors read and absorb the information here, and say nothing. We know you are out there because our web counter software logs every visit.


No, I’m not going to `out' anyone. Your secret is safe with me.


But even this humble blog gets visits every day from hundreds of corporations, government agencies, financial institutions, and even medical research facilities. Names that you would readily recognize. And that is both extremely gratifying and humbling at the same time.


It has been an amazing journey, these past nine years blogging on influenza and emerging infectious diseases, and I've been fortunate enough to meet scores of people, either in person, or via email or chat, from around the world due to this blog.


Some of those who deserve particular mention – for reasons they already know – include:


To Camille, Sharon & Lance, Cheryl, Scott and Crof, Maryn, Maggie and Helen, MTO & Lisa & Nick & Robert at CIDRAP, Chacal & Family, John Sinnott, Ian Mackay, Jody Lanard & Peter Sandman, Peter C. Hall, Anne, Eric Starbuck, Rolf, Dr. Michael Greger, Jim in Thailand, Anne, Seazar, Paul, Joel, AnnieRn, Caroldn,and Bonnie  (and many more I've no doubt  left out) a special holiday thanks to you and your families.  


You guys, whether you know it or not, have extended kindnesses that can never be repaid, but that will never be forgotten.


And to my best friend of 46 years, Cliff Travis, who left this mortal coil last August.  You are missed, buddy.  Every day.


And to everyone else, a safe, happy, and healthy Holiday.

Thanksgiving Is National Family History Day


Note: This is an updated (including new links) version of my yearly post on National Family History Day.


# 9375


Every year since 2004 the Surgeon General of the United States has declared Thanksgiving – a day when families traditionally gather together - as National Family History Day.


As a former paramedic, I am keenly aware of how important it is for everyone to know their personal and family medical history.  Every day emergency room doctors are faced with patients unable to remember or relay their health history during a medical crisis. And that can delay both diagnosis and treatment.


Which is why I keep a medical history form – filled out and frequently updated – in my wallet, and have urged (and have helped) my family members to do the same.


The CDC and the HHS have a couple of web pages devoted to collecting your family history, including a web-based tool to help you collect, display, and print out your family’s health history.

Family History: Collect Information for Your Child's Health

Surgeon General's Family Health History Initiative

Using this online tool, in a matter of only a few minutes, you can create a basic family medical history.  But before you can do this, you’ll need to discuss each family member’s medial history. The HHS has some advice on how to prepare for that talk:

Before You Start Your Family Health History

Americans know that family history is important to health. A recent survey found that 96 percent of Americans believe that knowing their family history is important. Yet, the same survey found that only one-third of Americans have ever tried to gather and write down their family's health history.

Here are some tips to help you being to gather information:

    I’ve highlighted several other methods of creating histories in the past, some of which you may prefer.  A few excerpts (and links) from these essays. First, I’ll show you how I create and maintain histories for my Dad (who passed away several years ago) and myself.  This was featured in an essay called A History Lesson.

    Today I’m going to impart a little secret that will ingratiate yourself with your doctor and not only improve the care you receive, but also reduce the amount of time you spend in the exam room. When you go to your doctor, have a brief written history printed out for him or her.

    I’ve created a sample based on the one I used for my Dad (the details have been changed).   It gets updated, and goes with him, for every doctor’s visit.

    And his doctors love it.


    While every history will be different, there are a few `rules’.

    • First, keep it to 1 page.     Even if the patient has an `extensive history’.   If your doctor can’t scan this history, and glean the highlights, in 60 seconds or less . . . it isn’t of much use.
    • Second, paint with broad strokes.   Don’t get bogged down in details.  Lab tests and such should already be in your chart.
    • Third, always fill in a reason for your visit.   Keep it short, your doctor will probably have 10 to 15 minutes to spend with you.   Have your questions and concerns down in writing before you get there.
    • Fourth, list all Meds  (Rx and otherwise) and indicate which ones you need a refill on.   If you have a question about a med, put a `?’ next to it.   And if you have any drug allergies, Highlight them.
    • Fifth,  Make two copies!   One for your doctor to keep, and one for you.  As you talk to your doctor, make notes on the bottom (bring a pen) of your copy.  

    Once you create the basic template (using any word processor), it becomes a 5 minute job to update and print two copies out for a doctor’s visit.

    The history above is great for scheduled doctor’s visits, but you also should have a readily available (preferably carried in your wallet or purse), EMERGENCY Medical History Card.

    I addressed that issue in a blog called Those Who Forget Their History . . . .   A few excerpts (but follow the link to read the whole thing):

    Since you can’t always know, in advance, when you might need medical care it is important to carry with you some kind of medical history at all times.  It can tell doctors important information about your history, medications, and allergies when you can’t.

    Many hospitals and pharmacies provide – either free, or for a very nominal sum – folding wallet medical history forms with a plastic sleeve to protect them. Alternatively, there are templates available online.

    I’ve scanned the one offered by one of our local hospitals below. It is rudimentary, but covers the basics.



    And a couple of other items, while not exactly a medical history, may merit discussion in your family as it has recently in mine.

    • First, all adults should consider having a Living Will that specifies what types of medical treatment you desire should you become incapacitated.
    • You may also wish to consider assigning someone as your Health Care Proxy, who can make decisions regarding your treatment should you be unable to do so for yourself.
    • Elderly family members with chronic health problems, or those with terminal illnesses, may even desire a home DNR (Do Not Resuscitate) Order.

    Verbal instructions by family members – even if the patient is in the last stages of an incurable illness – are likely to be ignored by emergency personnel.

    In Florida, the form must be printed on yellow paper. Different states have different requirements.  You should check with your doctor, or the local department of health to determine what the law is in your location.


    My father, who’s health declined greatly in his 86th year, requested a DNR in early 2011. That – along with securing home hospice care (see His Bags Are Packed, He’s Ready To Go) – allowed him to die peacefully at home in his own bed. 

    Admittedly, not the cheeriest topic of conversation in the world, but for a lot of people, this is an important issue to address.

    A few minutes spent this holiday weekend putting together medical histories could spare you and your family a great deal of anguish down the road.

    Tuesday, November 25, 2014

    WHO Update : 2 More Ebola Cases In Mali


    Mali – Credit Wikipedia


    # 9373


    On Thursday of last week, in WHO Update On Ebola In Mali – Nov 20th, the number of Ebola cases in Mali stood at six; the original 2 year-old who died in  October, and 5 unrelated cases stemming from the treatment of an Imam from Guinea at a local clinic.  

    Since then, there have been sporadic media accounts suggesting two more cases had emerged, but today we get the details from the following World Health Organization update.



    Mali confirms 2 new cases of Ebola virus disease

    Ebola situation assessment
    25 November 2014

    Mali’s Ministry of Health has confirmed an additional 2 new cases of Ebola virus disease. The first, confirmed on 22 November, occurred in the 23-year-old fiancée of the 25-year-old nurse who attended the Grand Imam from Guinea (the index case in this outbreak) and died of Ebola on 11 November.

    The young woman developed symptoms on 19 November and, on 20 November, was hospitalized in isolation at Bamako’s Ebola treatment centre, a new facility which opened last week.

    Because of her association with the nurse, most of her close contacts were already under surveillance. Her case was detected early in the disease course. Her quick isolation has further reduced opportunities for community exposures.

    The second new case is part of a family of previously confirmed and deceased patients. The 27-year-old man lost his mother and half-brother to Ebola.

    He developed symptoms on 19 November and was admitted for treatment at the new facility on 24 November. Laboratory confirmation was received the same day.

    The identification of patient contacts for daily monitoring has reportedly reached 99%. Based on experiences in Senegal and Nigeria, this achievement could augur well for rapid containment of Mali’s outbreak.

    Collaboration with health officials in Guinea

    To date, all 7 cases in this second wave of infections can be linked to contact with an Imam who developed symptoms on 17 October in his native village of Kourémalé, Guinea, and arrived in Bamako on 25 October for treatment at the Pasteur Clinic.

    His case has been classified as a Guinea case as he developed symptoms there. After his death on 27 October, his body was returned to Kourémalé for a funeral the following day that attracted a large number of mourners.

    These events ignited additional chains of transmission in Guinea, including several deaths, which are currently under investigation by WHO epidemiologists. Most of these patients had symptom onset in early to mid-November, indicating ongoing chains of transmission.

    With WHO support, staff from Mali’s Ministry of Health will be meeting with health officials from Guinea to discuss cross-border measures for coordinating control efforts and reducing the likelihood that additional cases will be imported from Guinea into Mali.