WHO Ebola Situation Report – January 21st

# 9611

 

The number of new cases continues to drop in all three hard hit West African nations, with Sierra Leone still seeing the worst of it, according to the latest update from the World Health Organization.   While a couple of months ago we were seeing nearly a thousand new cases a week, this past week only produced 145.

Despite these welcome downward trends, the horrendous toll of this epidemic continues to grow, with more than 21,000 cases reported – 8,600 deaths – and more than 800 HCW infections.

 

Follow the link below to either read, or download, the full report.

 

Ebola Situation report

21 January 2015

Now available in an interactive map journal that shows the evolution of the outbreak and the global response.

Download PDF

 

summary

Case incidence continues to fall in Guinea, Liberia, and Sierra Leone, with a halving time of 1.4 weeks in Guinea, 2.0 weeks Liberia, and 2.7 weeks in Sierra Leone. A combined total of 145 confirmed cases were reported from the 3 countries in the week to 18 January: 20 in Guinea, 8 in Liberia, and 117 in Sierra Leone. 

Mali has been declared free of Ebola virus disease (EVD) after completing 42 days since the last case tested negative for EVD.

Surveillance and information sharing will be increased in the border districts of Guinea-Bissau, Côte d’Ivoire, Mali and Senegal adjacent to the 3 intense-transmission countries.

Each of the intense-transmission countries has sufficient capacity to isolate and treat patients, with more than 2 treatment beds per reported confirmed, probable and suspected case. The planned numbers of beds in each country has now been reduced in accordance with falling case incidence.

Similarly, each country has sufficient capacity to bury all people known to have died from EVD.

Guinea, Liberia and Sierra Leone report that between 89% and 99% of registered contacts are monitored each day, though the number of contacts traced per EVD case remains lower than expected in many districts. In the week to 11 January, 53% of new confirmed cases in Guinea arose from known contacts; in the period between 1 January and 15 January, 53% of new confirmed cases in Liberia arose from known contacts. Equivalent data are not yet available for Sierra Leone.

There are currently 27 laboratories providing case-confirmation services in the 3 intense-transmission countries. Five more laboratories are planned in order to meet demand. The mean time between sample collection to sample testing in the 21 days to 18 January was 1.37 days in Guinea, 2.03 days in Liberia, and 2.32 days in Sierra Leone, although several districts in Guinea have yet to report data.

Case fatality among hospitalized patients (calculated from all hospitalized patients with a reported definitive outcome) is between 57% and 59% in the 3 intense-transmission countries, with no detectable improvement since the onset of the epidemic.

A total of 828 health worker infections have been reported in the 3 intense-transmission countries; there have been 499 reported deaths. The incidence of health worker infections has fallen in Liberia and Sierra Leone, but rose in Guinea throughout December.

As an indication of community engagement, 71% of districts in Guinea and 100% of districts in Sierra Leone have a list of key religious leaders who promote safe and dignified burials. No data are available for Liberia. Incidents of community resistance to safe burials and contact tracing continue to be reported in all 3 countries, although they are most common in Guinea.

(Continue . . . )

 

The WHO Weighs In On The Modes Of Ebola Transmission

 

Credit Dr. Ian Mackay’s  VDU Blog 

 

# 9151

A topic we’ve revisited often over the past couple of months are the ways that Ebola might be transmitted among humans.   While clearly not an airborne virus in the classic sense – else we’d have seen this virus already spread to every continent – there are potential routes of infection that do not involve actual direct physical contact with an infected, symptomatic individual.

 

Dr. Ian Mackay, in his blogs What words would you use to separate influenza spread from Ebola virus disease spread?, It's what falls out of the aerosol that matters.... & The wind beneath my Ebola virus.... ) has explored the potential role of large droplets – which could be coughed, sneezed, expressed or otherwise propelled a short distance onto another person by an infected individual.

 

What I’ve dubbed being within `spittle range’  (see Ebola Risk Communications & Ebola: Parsing The CDC’s Low Risk vs High Risk Exposures) – a risk that is more theoretical than documented - but one that cannot be ignored. 

 

Hence the call for PPEs (including facemasks and eye protection) when in close proximity to an infected, symptomatic case.

 

Today the World Health Organization  - who appears to have been listening and watching this online debate – has come out with an Ebola situation assessment that addresses these concerns.  


While their answer won’t fit neatly into a 10 second sound bite, it does acknowledge the potential for transmission to occur through `. . . virus-laden heavy droplets are directly propelled, by coughing or sneezing (which does not mean airborne transmission) onto the mucus membranes or skin with cuts or abrasions of another person.’

 

The WHO also addresses speculation that the Ebola virus might mutate into a more transmissible pathogen over time.

 

 

What we know about transmission of the Ebola virus among humans

Ebola situation assessment - 6 October 2014

The Ebola virus is transmitted among humans through close and direct physical contact with infected bodily fluids, the most infectious being blood, faeces and vomit.

The Ebola virus has also been detected in breast milk, urine and semen. In a convalescent male, the virus can persist in semen for at least 70 days; one study suggests persistence for more than 90 days.

Saliva and tears may also carry some risk. However, the studies implicating these additional bodily fluids were extremely limited in sample size and the science is inconclusive. In studies of saliva, the virus was found most frequently in patients at a severe stage of illness. The whole live virus has never been isolated from sweat.

The Ebola virus can also be transmitted indirectly, by contact with previously contaminated surfaces and objects. The risk of transmission from these surfaces is low and can be reduced even further by appropriate cleaning and disinfection procedures.

Not an airborne virus

Ebola virus disease is not an airborne infection. Airborne spread among humans implies inhalation of an infectious dose of virus from a suspended cloud of small dried droplets.

This mode of transmission has not been observed during extensive studies of the Ebola virus over several decades.

Common sense and observation tell us that spread of the virus via coughing or sneezing is rare, if it happens at all. Epidemiological data emerging from the outbreak are not consistent with the pattern of spread seen with airborne viruses, like those that cause measles and chickenpox, or the airborne bacterium that causes tuberculosis.

Theoretically, wet and bigger droplets from a heavily infected individual, who has respiratory symptoms caused by other conditions or who vomits violently, could transmit the virus – over a short distance – to another nearby person.

This could happen when virus-laden heavy droplets are directly propelled, by coughing or sneezing (which does not mean airborne transmission) onto the mucus membranes or skin with cuts or abrasions of another person.

WHO is not aware of any studies that actually document this mode of transmission. On the contrary, good quality studies from previous Ebola outbreaks show that all cases were infected by direct close contact with symptomatic patients.

No evidence that viral diseases change their mode of transmission

Moreover, scientists are unaware of any virus that has dramatically changed its mode of transmission. For example, the H5N1 avian influenza virus, which has caused sporadic human cases since 1997, is now endemic in chickens and ducks in large parts of Asia.

That virus has probably circulated through many billions of birds for at least two decades. Its mode of transmission remains basically unchanged.

Speculation that Ebola virus disease might mutate into a form that could easily spread among humans through the air is just that: speculation, unsubstantiated by any evidence.

This kind of speculation is unfounded but understandable as health officials race to catch up with this fast-moving and rapidly evolving outbreak.

To stop this outbreak, more needs to be done to implement – on a much larger scale – well-known protective and preventive measures. Abundant evidence has documented their effectiveness.

 

WHO WPRO H7N9 Situation Update – January 22nd

 

# 8204

 

The World Health Organization’s Western Pacific Region Office (WPRO), has released a lengthy situation update on the H7N9 virus this morning, which I’ve reproduced in part below. Follow the link for additional resources.

 

Human Infection with Avian Influenza A(H7N9)

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Situation update as of 22 January 2014

• The World Health Organization (WHO) has been officially notified by the China health authorities of more than forty additional laboratory-confirmed cases of human infection with avian influenza A (H7N9) virus, since 1 January 2014.
• WHO expects to continue to see sporadic cases of H7N9 in people.
• At this stage, there is no evidence of sustained human-to-human transmission.
• Given the population movement prior to Lunar New Year and potentially unpredictable behaviour of influenza viruses, continued vigilance and close monitoring are needed.
• WHO’s advice to the public is to continue to practice good hygiene and handle food properly.
• WHO does not advise special screening at points of entry with regard to this event, nor does it recommend that any travel or trade restrictions be applied.

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Situation update as of 17 January 2014

During the reporting period 10 to 17 January 2014, 31 cases (3 deaths) of human infection with avian influenza A (H7N9) virus were reported from China in the Western Pacific Region. Among the 31 cases, the median age was 48 years, ranging from 20-79 years, with a male to female ratio of 2.1:1.

Other relevant findings
In addition, during the reporting period 10 to 17 January 2014, China’s Ministry of Agriculture reported the presence of A(H7N9) in birds and in the environment from Guangdong and Zhejiang Provinces in December 2013.

• Zhejiang Province (4 sampling sites); 7 serological specimens out of 85 sampled tested positive (8.24%) and 18 pathological specimens out of 200 sampled tested positive (9.00%). The pathological specimens were from Sanliting Agriculture Products Market (6 oral/cloacal swabs, 2 environmental faecal swabs); Central Agriculture Products Market (2 oral/cloacal swabs, 1 environmental faecal swab); Fenghuangshan Agriculture Products Market (1 oral/cloacal swab); and Guoqing Poultry Wholesale Market (3 oral/cloacal swabs, 3 environmental faecal swabs).
• Guangdong Province (151 sampling sites); 0 serological specimens out of 2 192 sampled tested positive (0.00%) and 2 pathological specimens out of 2 521 sampled tested positive (0.08%). The pathological specimens were from: Muai Agriculture Products Market (1 oral/cloacal swab); and Yuhuan Agriculture Products Market (1 oral/cloacal swab).

Meanwhile Jiangxi Province (pathological specimens); Tianjin City, Hebei and Henan Provinces (serological specimens); Liaoning, Jilin, Heilongjiang, Jiangsu, Fujian, Shandong, Hubei, Hunan, Guangxi, Yunnan, Qinghai, Xinjiang Provinces and Chongqing and Shanghai Cities (both specimens) tested negative.
http://www.syj.moa.gov.cn/dwyqdt/jczt/201401/t20140114_3738212.htm
http://www.syj.moa.gov.cn/dwyqdt/jczt/201401/t20140114_3738521.htm
http://www.oie.int/wahis_2/public/wahid.php/Reviewreport/Review?page_refer=Ma pFullEventReport&reportid=14649
http://www.gzwst.gov.cn/front/web/showDetail/5767

There was another report of confirmed presence of A(H7N9) in environmental samples from Guangdong Province. Guangzhou City CDC detected A(H7N9) virus nucleic acid on 7 January 2013, in 3 out of 17 samples collected from the kitchen of a restaurant in Haizhu District, Guangzhou City, from the chopping board and sewage water. A human A(H7N9) case reported on 6 January (male, 47 years old) had delivered live poultry to the restaurant. Meanwhile, Guangdong Provincial CDC detected A(H7N9) virus nucleic acid in 8 out of 34 environmental monitoring samples collected from the Longbei Market, Jinping District, Shantou City.
http://www.gzcdc.org.cn/news/monitor/201401/content_1470.htm

Ningbo City in Zhejiang Province has temporarily suspended the transfer of commercial live birds from outside into the city and Shanghai City will suspend live bird trade all over the City from 31 January 2014 to 30 April 2014. During the suspension period, all live poultry from other provinces are not allowed to come in to the City and trade, except for the transport to the City's live poultry slaughterhouse for centralized slaughter.
http://www.fjphb.gov.cn/xlist.aspx?ctlgid=246246
http://www.gdwst.gov.cn/a/zwxw/

To date, there has been no evidence of sustained human-to-human transmission. It is expected that there may be further sporadic cases of human infection with the virus. Affected provinces and municipalities continue to maintain surveillance and response activities.

WHO does not advise special screening at points of entry with regard to this event, nor does it recommend any travel restrictions be applied. WHO continues to work closely with national authorities and technical partners to gain a better understanding of this disease in humans and will continue to provide updated information as the situation evolves.

For more information on human infection with avian influenza A(H7N9) virus, visit: