Saturday, March 14, 2015

CDC Statement: Investigating Additional Potential Ebola Exposures To American Citizens In West Africa

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# 9828

 

Yesterday, in NIH Statement On Arrival Of American HCW With Ebola Virus For Treatment, we looked at the evacuation of an American HCW  - infected with Ebola – from Sierra Leone to the NIH hospital in Bethesda, Md.


Late yesterday the CDC announced they are investigating this HCWs exposure, with an eye cast towards others who may have been exposed at the same time.

 

A second HCW, who was exposed (but has not tested positive for the virus) is being flown to Emory University Medical Center in Georgia.   First the CDC’s statement, after which I’ll return with a bit more:

 

 

CDC investigating potential exposures of American citizens to Ebola in West Africa

 

For Immediate Release: Friday, March 13, 2015
Contact: CDC Media Relations
404-639-3286

On March 13, an American volunteer healthcare worker in Sierra Leone who tested positive for Ebola virus returned to the U.S. by medevac and was admitted to the NIH Clinical Center for care and treatment.  As a result of this case, CDC is conducting an investigation of individuals in Sierra Leone, including several other American citizens, who may have had potential exposure to this index patient or exposures similar to those that resulted in the infection of the index patient.  At this time, none of these individuals have tested positive for Ebola. These individuals are volunteers in the Ebola response and are currently being monitored in Sierra Leone.  Out of an abundance of caution, CDC and the State Department are developing contingency plans for returning those Americans with potential exposure to the U.S. by non-commercial air transport. Those individuals will voluntarily self-isolate and be under direct active monitoring for the 21-day incubation period.

One of these American citizens had potential exposure to the individual being treated at NIH and is currently being transported via charter to the Atlanta area to be close to Emory University Hospital. The individual has not shown symptoms of Ebola and has not been diagnosed with Ebola. Upon arrival in Atlanta, the individual will voluntarily self-isolate and be under direct active monitoring for the 21-day incubation period

 

 

Although the Ebola outbreak in Liberia in West Africa has significantly improved, Sierra Leone and Guinea continue to report dozens of cases each week.   Liberia, amazingly has gone two weeks with reporting a new case, and overall, the number of new cases in the latest reporting week is down about 80% over the peak we were seeing last fall.


Some excerpts from The World Health Organization’s latest Ebola Situation Report (11 March 2015) follow:

SUMMARY

  • A total of 116 new confirmed cases of Ebola virus disease (EVD) were reported in the week to 8 March, compared with 132 the previous week. Liberia reported no new confirmed cases for the second consecutive week. New cases in Guinea and Sierra Leone occurred in a geographically contiguous arc around the coastal capital cities of Conakry and Freetown, with a total of 11 districts reporting cases. Although there has been no significant decline in overall case incidence since late January, the recent contraction in the geographical distribution of cases is a positive development, enabling response efforts to be focused on a smaller area.
  • Guinea reported 58 new confirmed cases in the week to 8 March, compared with 51 cases the previous week. Cases were clustered in an area around and including the capital Conakry (13 cases), with the nearby prefectures of Boffa (2 cases), Coyah (8 cases), Dubreka (5 cases), Forecariah (28 cases), and Kindia (2 cases) the only other prefectures to report cases.
  • Sierra Leone reported 58 new confirmed cases in the week to 8 March; the first time since June 2014 that weekly incidence has not exceeded that of Guinea. Cases were reported from 5 north and western districts clustered around the capital Freetown, which reported 27 new confirmed cases. The neighbouring districts of Bombali (6 cases), Kambia (7 cases), Port Loko (12 cases) and Western Rural (6 cases) also reported cases.
  • In the 4 days to 5 March there were 90 reported suspected cases in Liberia, none of whom tested positive for EVD, indicating that vigilance is being maintained. A total of 102 contacts were being followed up.
  • The number of confirmed EVD deaths occurring in the community has risen for the past 3 weeks in Guinea, suggesting that there are still significant challenges in terms of contact tracing and community engagement. Of a total of 40 EVD-positive deaths reported in the week to 8 March, 24 occurred in the community. By contrast, a far smaller proportion of EVD-positive deaths occurred in the community in Sierra Leone: 11 of 83. A total of 13 unsafe burials were reported from Guinea and 2 from Sierra Leone over the same period.
  • In the week to 1 March, 7 of 51 (14%) confirmed cases of EVD reported from Guinea arose among known contacts of previous cases, indicating that there are a large number of untraced contacts associated with known chains of transmission, and that unknown chains of transmission persist. In Sierra Leone, by contrast, 52 of 81 (64%) of confirmed EVD cases arose among known contacts over the same period. The average daily number of contacts traced in the week to 8 March was 1433 in Guinea, compared with 7934 in Sierra Leone.
  • The relatively low proportion of cases arising among known contacts, the relatively high proportion of EVD-positive deaths that occur in the community, and the continued occurrence of unsafe burials in Guinea are all indicative of continued difficulties engaging effectively with affected communities. A total of 7 Guinean prefectures reported at least one security incident in the week to 8 March.
  • During the week to 1 March, five cross-border meetings took place, including a coordination meeting in Kambia and Forecariah to facilitate communication, share best practices, and align strategies.
  • In the week to 8 March, 1 new health worker infection was reported in Guinea, bringing the total number of health worker infections reported across the three most-affected countries since the start of the outbreak to 840, with 491 deaths.

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