Wednesday, 1 October 2014

The United States of America is the 6th country to host a 2014 West African Ebola virus variant..

v4 08102014 07:00am AEST
First thing...
CALM DOWN!

This (announced 30-Sept) is the first case of Ebola virus infection to arrive in the United States that was not deliberately flown in. Its not the first viral haemorrhagic fever case though (1 case of Marburg virus disease and at least 4 Lassa virus infections and the Reston ebolavirus outbreak among imported animals[3,5]), and none of the earlier infections resulted in secondary transmission among humans; no-one else got infected from by the case.[4]
Countries that have hosted people infected
with the Ebola virus variant causing the
& 2014 West African Ebola virus
disease epidemic.
Click on image to enlarge.

The male is in critical condition.
When he flew from Liberia to the United States (finally arriving in Dallas,Texas). The man was not showing signs of disease when leaving Liberia or on the plane or immediately after arriving.[6]

This means that the man was not infectious - he could not spread it to fellow travellers or airport workers - because it is well known that disease in another does not develop due to virus being shed before disease is obvious in the infected person.

Briefly[1,2]:
  • 19th: Departed Liberia, checked and found to be symptom-free
  • 20th: Arrived in Dallas, US (Brussels to Washington on United Airlines 951, then to Dallas Fort Worth on 822 [7])
  • 24th: Started to develop symptoms
  • 26th: Initially sought care for fever and abdominal pain (not vomiting). Sent home with antibiotics.[8]
  • 28th: Admitted to Texas Health Presbyterian hospital in Dallas, Texas. Vomited as leaving home to get into ambulance.
  • 30th: Texas public health laboratory found Ebola virus this morning of 30th Sept. CDC received samples, tested and confirmed as Ebola virus disease
  • 1st Oct: WHO announced case
  • Patient is ill and is under intensive care

US family and community contacts (a "handful") are known or being traced and will be under observation/monitoring for 21-days (~21-Oct) for fever. Will any become positive for Ebola virus? Perhaps. I look to Port Harcourt (Nigeria) for some comfort. There were around 60 "high risk" contacts of there and they did not all become ill.

The man identified his country of recent origin, Liberia-the country carrying more cases of Ebola virus disease than any other in history, to a triage nurse on the 26th when he first reported to the Texas Health Presbyterian Hospital. That the information was not passed along sufficiently.[7] While the signs and symptoms were non-specific-all sorts of infectious agents could cause fever and gut issues-the travel history should have been a very important red flag. 

He was sent home with antibiotics. Many acute febrile illnesses are viral  in nature, and antibiotics do not treat viral infections, just bacterial ones but do a great job at helping out antibiotic resistance. Sigh.

So now we have evidence that supports all those talking heads (me included) who noted that it was possible for sporadic cases of EVD to be imported into countries outside of those in West Africa (Guinea, Liberia, Sierra Leone, Nigeria, Senegal). It also, sadly, shows how human infectious disease are - literally by infecting us and using us to cough, vomit and bleed the bug onto to another person, but also figuratively in the roles we play in helping that spread to happen.

Soon, I very much believe, we will also have evidence that in richer countries with functioning healthcare systems, a good knowledge of what is needed to contain virus infections spread by all possible routes, stocks of the necessary personal protective equipment needed to protect healthcare workers from nosocomial infections and the training to use those stocks...that even when unexpected Ebola virus disease cases arrive or incubate and emerge, they will not result in outbreaks.

References...
  1. https://www.youtube.com/watch?v=6Bxencye1cg&feature=youtu.be
  2. http://www.nytimes.com/2014/10/01/health/airline-passenger-with-ebola-is-under-treatment-in-dallas.html?partner=rss&emc=rss&smid=tw-nytimes
  3. http://scienceblogs.com/aetiology/2014/08/02/ebola-is-already-in-the-united-states/.
  4. http://blogs.scientificamerican.com/molecules-to-medicine/2014/09/30/ebola-in-usno-need-to-panic/?WT.mc_id=SA_sharetool_Twitter
  5. http://www.cdc.gov/media/releases/2014/s930-ebola-confirmed-case.html
  6. http://news.sciencemag.org/health/2014/09/one-more-ebola-question-dr-frieden-answers-journalists-would-have-first-u-s-case?rss=1
  7. http://www.usatoday.com/story/news/nation/2014/10/01/hospital-ebola-patient/16527143/
  8. http://www.usatoday.com/story/news/nation/2014/10/01/texas-ebola-patient/16525649/