26 Jul 2014

Dublin: EBOLA EPIDEMIC IN NIGERIA IS OUT OF CONTROL: WHO: *LATEST UPDATES

The government of Africa’s most populous country confirmed this evening that the virus caused the death of a Liberian national who died in quarantine in Lagos.
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NEW UPDATE: * DAKAR, Senegal (AP) — No one knows for sure just how many people Patrick Sawyer came into contact with the day he boarded a flight in Liberia, had a stopover in Ghana, changed planes in Togo, and then arrived in Nigeria, where authorities say he died days later from Ebola, one of the deadliest diseases known to man.
Now health workers are scrambling to trace those who may have been exposed to Sawyer across West Africa, including flight attendants and fellow passengers.
Health experts say it is unlikely he could have infected others with the virus that can cause victims to bleed from the eyes, mouth and ears. Still, unsettling questions remain: How could a man whose sister recently died from Ebola manage to board a plane leaving the country? And worse: Could Ebola become the latest disease to be spread by international air travel?
Sawyer's death on Friday has led to tighter screening of airline passengers in West Africa, where an unprecedented outbreak that emerged in March has killed more than 670 people in Guinea, Sierra Leone and Liberia. But some health authorities expressed little confidence in such precautions.
"The best thing would be if people did not travel when they were sick, but the problem is people won't say when they're sick. They will lie in order to travel, so it is doubtful travel recommendations would have a big impact," said Dr. David Heymann, professor of infectious diseases at the London School of Hygiene and Tropical Medicine.
"The important thing is for countries to be prepared when they get patients infected with Ebola, that they are isolated, family members are told what to do and health workers take the right steps."
The World Health Organization is awaiting laboratory confirmation after Nigerian health authorities said Sawyer tested positive for Ebola, WHO spokesman Gregory Hartl said. The WHO has not recommended any travel restrictions since the outbreak came to light.
"We would have to consider any travel recommendations very carefully, but the best way to stop this outbreak is to put the necessary measures in place at the source of infection," Hartl said. Closing borders "might help, but it won't be exhaustive or foolproof."
The risk of travelers contracting Ebola is considered low because it requires direct contact with bodily fluids or secretions such as urine, blood, sweat or saliva, experts say. Ebola can't be spread like flu through casual contact or breathing in the same air.
Patients are contagious only once the disease has progressed to the point they show symptoms, according to the WHO. And the most vulnerable are health care workers and relatives who come in much closer contact with the sick.
Still, witnesses say Sawyer, a 40-year-old Liberian Finance Ministry employee en route to a conference in Nigeria, was vomiting and had diarrhea aboard at least one of his flights with some 50 other passengers aboard. Ebola can be contracted from traces of feces or vomit, experts say.
Sawyer was immediately quarantined upon arrival in Lagos — a city of 21 million people — and Nigerian authorities say his fellow travelers were advised of Ebola's symptoms and then were allowed to leave. The incubation period can be as long as 21 days, meaning anyone infected may not fall ill for several weeks.
Health officials rely on "contact tracing" — locating anyone who may have been exposed, and then anyone who may have come into contact with that person. That may prove impossible, given that other passengers journeyed on to dozens of other cities.
Patrick Sawyer had planned to visit his family in Minnesota next month to attend two of his three daughters' birthdays, his wife, Decontee Sawyer, told KSTP-TV in Minnesota.
"It's a global problem because Patrick could have easily come home with Ebola, easy," she said. The Associated Press left phone and email messages for her Monday.
International travel has made the spread of disease via airplanes almost routine. Outbreaks of measles, polio and cholera have been traced back to countries thousands of miles away. Even Ebola previously traveled the globe this way: During an outbreak in Ivory Coast in the 1990s, the virus infected a veterinarian who traveled to Switzerland, where the disease was snuffed out upon arrival and she ultimately survived, experts say.
Two American aid workers in Liberia have tested positive for the virus and are being treated there. U.S. health officials said Monday that the risk of the deadly germ spreading to the United States is remote.
The mere prospect of Ebola in Africa's most populous nation has Nigerians on edge.
In Nigeria's capital, Abuja, Alex Akinwale, a 35-year-old entrepreneur, said he is particularly concerned about taking the bus, which is the only affordable way to travel.
"It's actually making me very nervous. If I had my own car, I would be safer," he said. "The doctors are on strike, and that means they are not prepared for it. For now I'm trying to be very careful."
It's an unprecedented public health scenario: Since 1976, when the virus was first discovered, Ebola outbreaks were limited to remote corners of Congo and Uganda, far from urban centers, and stayed within the borders of a single country. This time, cases first emerged in Guinea, and before long hundreds of others were stricken in Liberia and Sierra Leone.
Those are some of the poorest countries in the world, with few doctors and nurses to treat sick patients let alone determine who is well enough to travel. In Sawyer's case, it appears nothing was done to question him until he fell sick on his second flight with Asky Airlines. An airline spokesman would not comment on what precautions were being taken in the aftermath of Sawyer's journey.
Liberian Assistant Health Minister Tolbert Nyenswah told The Associated Press last week that there had been no screening at Liberia's Monrovia airport. That changed quickly over the weekend, when President Ellen Johnson Sirleaf said a new policy on inspecting and testing all outgoing and incoming passengers will be strictly observed. She also announced that some borders were being closed and communities with large numbers of Ebola cases would be quarantined.
International travelers departing from the capitals of Sierra Leone and Guinea are also being checked for signs of fever, airport officials said. Buckets of chlorine are also on hand at Sierra Leone's airport in Freetown for disinfection, authorities said.
Still, detecting Ebola in departing passengers might be tricky, since its initial symptoms are similar to many other diseases, including malaria and typhoid fever.
"It will be very difficult now to contain this outbreak because it's spread," Heymann said. "The chance to stop it quickly was months ago before it crossed borders ... but this can still be stopped if there is good hospital infection control, contact tracing and collaboration between countries."
Nigerian authorities so far have identified 59 people who came into contact with Sawyer and have tested 20, said Lagos State Health Commissioner Jide Idris. Among them were officials from ECOWAS, a West African governing body, airline employees, health workers and the Nigerian ambassador to Liberia, he said. He said there have been no new cases of the disease.
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Associated Press Medical Writer Maria Cheng reported from London. Jonathan Paye-Layleh in Monrovia, Liberia; Clarence Roy-Macaulay in Freetown, Sierra Leone; Erick Kaglan in Lome, Togo; and Heather Murdock in Abuja, Nigeria, also contributed to this report.
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Nigeria’s Health Minister Onyebuchi Chukwu told journalists that “thorough medical tests” had confirmed “the virus of Ebola” as the cause of death.
Irish travelers are being advised to contact the embassy of Nigeria in advance of their journey, and to read the World Health Organisation factsheet on Ebola.
Outbreak
The 40-year-old Liberian man, who died overnight, worked for his country’s government and had travelled to Nigeria from Monrovia by air via Togo’s capital Lome.
His final destination was the southern city of Calabar where he was scheduled to attend a meeting organised by the west African bloc known as ECOWAS (Economic Community of West African States).
Lagos government officials have previously said that he arrived at the city’s international airport on Sunday.
He was suffering from severe vomiting and diarrhea upon arrival and was transported directly to hospital, according to the minister.
The patient “avoided contact with the general public” between the airport and the hospital and “there was no time for him to mingle in Lagos,” he added.
“All the passengers that the patient came in contact with have been traced and are being investigated,” in a bid to contain any spread of the virus across the city of more than 20 million people, Chukwu said.
The minister insisted that health officials had made direct contact with everyone on board the flight and were monitoring their conditions but offered no explanation as to how that was done.
The Liberian was flying on the Togo-based ASKY Airlines. African airlines typically do not require detailed contact information from passengers and it was not immediately clear how Nigeria had succeeded in tracing everyone on board.
‘Red alert’
As of July 20, the number of Ebola cases recorded in the months-long epidemic stood at 1,093, including more than 660 deaths, according to the World Health Organisation.
Liberia has seen 127 fatalities.
Lagos, the largest city in sub-Saharan Africa, poses challenges to health officials seeking to contain a spread of the virus.
The congested city has terrible sanitation and a poor health system, especially in public hospitals which are grossly under-funded, badly equipped and regularly do not have electricity.
Chukwu said ministry specialists had been deployed at all major ports — both sea and air — to screen anyone suffering from symptoms associated with Ebola.
Border officials have been put on “red alert,” he said.
Ebola is a form of haemorrhagic fever which can have a 90-percent fatality rate.
It can fell victims within days, causing severe fever and muscle pain, vomiting and diarrhoea — and in some cases, organ failure and unstoppable bleeding.
Ebola is believed to be carried by animals hunted for meat, notably bats.
It spreads among humans via bodily fluids including sweat, meaning you can get sick from simply touching an infected person.
With no vaccine, patients believed to have caught the virus must be isolated to prevent further contagion.
Ebola first emerged in 1976 in what is now the Democratic Republic of Congo, and is named after a river there.
Includes reporting from AFP.
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