Wednesday, June 25, 2014

Spain Testing Traveler For Possible Ebola Infection



UPDATED 1350 HRS EDT:  Spanish Media: Negative Test Reported On Suspected Ebola Case


# 8779


While we don’t know yet if it will amount to anything, over the past 16 hours or so the Spanish press has been reverberating with reports of a suspected imported Ebola case, hospitalized and being tested, in Valencia (see FluTrackers thread). 


The patient, who apparently fell ill (shortness of breath, fever, nosebleed) on a flight from Morocco on Monday, is reportedly  `clinically stable’ in isolation at Hospital La Fe de Valencia, as test results are awaited.  


Given the ongoing Ebola outbreak in West Africa (see WHO Ebola Update – June 24th), and out of an abundance of caution, anyone with recent travel history to the region who displays signs of severe illness is likely to trigger a full scale public health response such as this. 


Typical of the media coverage of this event is the following from


The possible case of Ebola evolves favorably isolated on Faith

  EFE , Castellón

The patient is isolated in the hospital La Fe suspected of having Ebola, of Guinean origin and landed in Valencia from Morocco, is progressing well from a clinical point of view while trying to determine if you have this pathology.


The Minister of Health, Manuel Llombart, has provided this information on statements to the media in Castellón, where today signed a collaboration agreement with the University Jaume I.


According Llombart, the patient, who has not offered more data, presented a series of symptoms during a flight from Morocco, as oxygen requirement and nasal bleeding, they did suspect the crew that could be infected by the Ebola virus.

(Continue . . .)


The prodromal symptoms of Ebola infection are nonspecific enough that they could be easily confused with a number of other viral (or malarial) illnesses, and so we’ll have to wait for test results before we know the score.  But even if this patient tests positive, the rapid isolation of the patient by local public health authorities is likely to prevent further spread.


Movies like 1995’s Outbreak with Dustin Hoffman, and books like Tom Clancy’s Executive Orders and The Hot Zone by Richard Preston, have helped to turn Ebola into the ultimate nightmare disease in the eyes of the public.


But the reality is, the spread of African Viral Hemorrhagic Fevers (VHFs which includes Ebola, Marburg & Lassa) have traditionally been geographically limited. The illness strikes quickly, with profound and debilitating symptoms, and that helps to limit human-to-human spread.


That isn’t to say it is inconceivable for one of these viruses to be exported outside of Africa. After all, over the past decade we’ve seen three cases of Lassa fever imported in the United States (see Minnesota: Rare Imported Case Of Lassa Fever). 


But for now, the risks of seeing Ebola get a foothold outside of Western and Central Africa is considered low. 


In the most recent ECDC Rapid Risk Assessment on Ebola (June 9th), experts worked out several scenarios where the Ebola virus might travel to the European Union, including a scenario similar to the one that is currently under investigation. 


As you will see, the recommendations are quite specific, and not as draconian as many might suppose:


Scenario 3: Passenger with symptoms compatible with EVD on board an airplane

Cabin crew that identify a sick passenger on board and suspect an infectious disease, and ground staff receiving the passenger at the destination, should strictly follow the IATA guidelines for suspected communicable diseases.

These guidelines provide information on how to handle a sick passenger during the flight, how to reduce the risk of transmission on board the aircraft, how to communicate the event to the destination airport, and how to record  contact details on passenger locator cards for the passengers in the two rows around the case. Public health authorities and emergency medical services at the airport of destination should be informed in advance of arrival.

On arrival, the sick passenger should be put in a separate room awaiting medical assessment. The assessment of possible exposure to ebolavirus and of the compatibility of the symptoms with Ebola virus disease is outside the  scope of the airline crew’s actions and should be performed by medically trained ground staff.

The population incidence of Ebola virus infection is low, even during an outbreak, and it is considered highly
unlikely that a passenger infected with Ebola virus boards an airplane. In addition, the prodromal presentation of the disease is not characteristic enough to distinguish an Ebola virus infection from many other viral diseases. The public health response to a sick passenger on an aircraft should be based on a thorough assessment of the patient’s possible exposure to ebolavirus rather than on the clinical presentation. The evaluation of the exposure should check if, within the past three weeks, the passenger has:

•  visited a country where ebolavirus disease has been confirmed (for the current outbreak: Guinea, Sierra Leone and Liberia); AND
•  been in contact with a sick or dead wild animal (particularly bats) while there;


•  cared for and touched a severely ill or dead person.

A ‘yes’ to question 1 and to either question 2 or 3 would signify that the ill passenger has been potentially exposed to Ebola virus in an affected country in the past three weeks. If the investigation does not conclude a  significant  risk of exposure to ebolavirus (no specific exposure for the sick traveller, no symptoms during the flight), contact tracing is not indicated. If the passenger is at risk of having been exposed to Ebola virus, the following epidemiological measures based upon proximity to the index patient should be considered (ECDC RAGIDA guidelines):

•  Passengers and crew with reported direct contact

Co-travellers and crew members who had reported direct body contact with the index case should be tracedback. To gather this information, any records of significant events on the flight should be obtained from the airline.

•  Passengers seated one seat away from the index patient

As direct contact is the main route of transmission for Ebola virus, only passengers who were seated one seat
away from the index case in all directions should be included in the trace-back. If the index case occupied an
aisle seat, the three passengers seated directly across the aisle from the index case should also be traced-back.

•  Crew members of plane section

Crew members who provided in-flight service in the section of the aircraft where the index case was seated
should be included in the trace-back, as well as other crew members who had direct contact with the patient.

•  Cleaning staff of plane section

The staff that cleaned the section seat where the index case was seated and the toilet facilities (if used by the
index case) should be traced-back.

Traced-back passengers, crew members and cleaning staff who have been identified should be assessed for their specific level of exposure. The risk for transmission is considered low if no direct contact with the passenger or with material potentially contaminated by the passenger’s bodily fluids has occurred. Self-monitoring of temperature should be considered for 21 days for all contacts. The same measures should be considered when a patient reports symptoms during a flight but fails to alert the crew.

There is no reason to quarantine the airplane upon arrival when a passenger presents with symptoms during the flight.


It should be noted that we don’t know if the suspect case meets the criteria (had recent contact with sick or dead wild animals or cared for or touched a severely ill or dead person), only that he supposedly hails from Guinea and fell ill on the flight. 


Hopefully we’ll get test results later today to either confirm or rule out Ebola. 


But either way those tests come out the risks to his fellow airline passengers, the general public in Spain (and the rest of Europe), remain low.

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