Liberia - Health Authorities confirm 3 new Ebola Cases, 1 Death - All contacts completed 21-day follow-up - dec 16, 2015

[Pathfinder]

Ebola Mystery: Did A Mom Who Tested Negative Infect Her Family?

December 22, 20154:52 PM ET
CARIELLE DOE

...
That's what Dr. Mosoka Fallah, a Harvard-trained epidemiologist in Liberia who specializes in tracing the origins of Ebola cases, is trying to determine.

The first member of the family to be diagnosed was the 15-year-old son...
...
Then, the father and another son, who was actually 10 years old, were both diagnosed with Ebola. The 15-year-old died of the disease.

The mother, meanwhile, had her own complicated medical history. She had taken care of her brother, who had Ebola, in the summer of 2014. She could have contracted Ebola from him at the time ? she fell ill with symptoms that looked suspiciously like Ebola, but she was never tested. She recovered on her own.

She subsequently had a baby in September, became ill again in October, and then recovered once more. At that time she was tested for Ebola ? twice ? and the results were negative. Yet her system contained antibodies that develop when the body fights off an Ebola infection. She had what Fallah calls "the footprint of Ebola."
...
Did the mother, who might have been carrying Ebola she contracted from her brother, infect her husband and sons?

All the information that we've gathered points to the mom. If that is true, we've got to answer the fundamental question: Is there a potential for people to become carriers [yet] they themselves don't get sick? Is it possible that the mother [somehow fought off] the virus [in her system] because she had antibodies but infected others?

Might the mom's pregnancy have somehow figured in?

If she got sick with Ebola last year, is it possible that [the virus] got reactivated because of her lowered immune system [due to her pregnancy]. But she did not develop Ebola [this year] because she already had antibodies.

So is sexual transmission from the mother to her husband a possibility?

We do know that there can be sexual transmission from male to female. We have never had a documented incident of a female to male. That's a key question we have to answer.

My gut feeling tells me there are some rare cases where it can be a female to male [transmission]. Some people don't agree with me; some tend to agree with me now.
...
What's an important lesson from your investigation so far?

The mistake is to assume we know everything about Ebola. I think it would be the worst mistake any of us in the Ebola field would make.

http://www.npr.org/sections/goatsandsoda/2015/12/22/460700289/ebola-mystery-did-a-mom-who-tested-negative-infect-her-family

[Pathfinder]

Ebola Situation Report - 16 December 2015

No confirmed cases of Ebola virus disease (EVD) were reported in the week to 13 December. All contacts associated with the cluster of 3 confirmed cases of EVD reported from Liberia in the week to 22 November have now completed 21-day follow-up. The first-reported case in the cluster, a 15-year-old boy, died on 23 November. Two subsequent cases, the boy’s father and younger brother, tested negative twice for Ebola virus on 3 December and were discharged. As of 11 December, 210 eligible recipients associated with the cluster had received the rVSV-ZEBOV Ebola vaccine as part of the Partnership for Research on Ebola Vaccines in Liberia (PREVAIL study), which is administered by the Government of Liberia and the US National Institutes of Health.

Human-to-human transmission linked to the recent cluster of cases in Liberia will end on 14 January 2016, 42 days after the 2 most-recent cases received a second consecutive negative test for Ebola virus, if no further cases are reported. Human-to-human transmission linked to the primary outbreak in Guinea will end on 28 December 2015, 42 days after the country’s most recent case, reported on 29 October, received a second consecutive negative test for Ebola virus. In Sierra Leone, human-to-human transmission linked to the primary outbreak was declared to have ended on 7 November 2015. The country has now entered a 90-day period of enhanced surveillance scheduled to conclude on 5 February 2016.

The recent cluster of cases in Liberia is now understood to have been a result of the re-emergence of Ebola virus that had persisted in a previously infected individual. Although the probability of such re-emergence events is low, the risk of further transmission following a re-emergence underscores the importance of implementing a comprehensive package of services for survivors that includes the testing of appropriate bodily fluids for the presence of Ebola virus RNA. The governments of Liberia and Sierra Leone, with support from partners including WHO and US CDC, have implemented voluntary semen screening and counselling programmes for male survivors in order to help affected individuals understand their risk and take necessary precautions to protect close contacts. A network of clinical services for survivors is also being expanded in Liberia and Sierra Leone, with plans for comprehensive national policies for the care of EVD survivors due to be completed in January 2016.
...

http://apps.who.int/ebola/current-si...-december-2015

[Pathfinder]

Fresh Ebola Cases Damp Liberia Hopes of Eliminating Deadly Disease

New cases serve notice that the fight against the disease will take months, even years

By DREW HINSHAW in Monrovia, Liberia, and BETSY MCKAY in Atlanta
Dec. 9, 2015 7:31 p.m. ET

Nurses at a downtown Monrovia hospital were about to punch out from work late one November afternoon when a feverish teenager, convulsing and bleeding from his mouth, stumbled into the waiting room.

For Mosoka Fallah, the boy?s symptoms pointed in a grimly familiar direction. He drove off?speeding in the wrong lane and dodging head-on traffic?to a meeting of government officials in the center of the capital, where he burst into the room with the news: Ebola is back.
...
Dr. Fallah, the physician who drove off to deliver the news, said the boy?s mother had survived Ebola last year, then gave birth to a child in September.

About two weeks after the birth, her husband fell ill with fever. He later tested positive for Ebola, raising the question whether childbirth presents a window when survivors of the disease can infect people close to them, Dr. Fallah said.

?It is exhausting,? he said. ?Nobody knew these recurrences would happen.?

On a recent morning, Dr. Fallah was in the government?s Ebola command center, surrounded by bone-weary health workers trying to monitor the condition and whereabouts of 139 potentially infected people.

Some patients had slipped out of quarantine because nobody remembered to bring them breakfast. ?Contacts not getting food!? screamed an angry worker.

A whiteboard listed 20 people still unaccounted for, several of whom seemed to have turned off their phones.

Holding up a map of Monrovia, a city of one million people stretching across 100 square miles, Dr. Fallah pleaded to his staff, ?I need you to find those people!?

http://www.wsj.com/articles/fresh-ebola-cases-damp-liberia-hopes-of-eliminating-deadly-disease-1449707467

[Pathfinder]

Health | Thu Dec 3, 2015 2:31pm EST

Liberia's last two Ebola patients recover, leave hospital

MONROVIA

Liberia released its last two known Ebola cases from hospital on Thursday as it starts a new countdown to declaring itself free of the virus for a third time, health officials said.
...
The two patients released from the Paynesville ETU are the father and younger brother of the presumed index case, a 15-year-old boy named Nathan Gbotoe from a suburb of the capital Monrovia who died from the disease last week.

However, new cases could still emerge in Liberia since there are 165 contacts still under quarantine, of whom more than 30 are deemed high risk, health officials told Reuters.

Nyenswah say the contacts under surveillance have completed 14 of their obligatory 21-day monitoring - a period that corresponds with the typical incubation period of the virus.
...

http://www.reuters.com/article/us-health-ebola-liberia-idUSKBN0TM2KY20151203

[tetano]

Liberia: 'Blood Transfusion' - Responsible For New Ebola Out Break


Investigation conducted by this paper has established that unsafe blood transfusion is probably responsible for the new Ebola outbreak in Liberia.
A 15-year-old-boy was last weekend tested positive for Ebola and later pronounced dead on Tuesday. Dr. Francis Kateh, Chief Medical Officer of Liberia, said the boy's parents have also been tested positive for the virus and were undergoing observation.
The Ministry of Health and its partners are yet to disclose the source of the new outbreak, but a weeklong investigation conducted by this paper has established that blood recently transfused into the boy's mother at the Benson Hospital in Paynesville is the probable cause of the new Ebola infection.

During a visit to the family's residence on Duport Road, Paynesville, family members disclosed that the boy's mother was admitted at Benson Hospital in Paynesville, after giving birth at home. They disclosed that the woman was given several pounds of blood at the facility.

http://allafrica.com/stories/201511271009.html

[Pathfinder]

Puzzling Ebola Death Shows How Little We Know About The Virus

Updated November 24, 20157:36 PM ET

"The reality is this outbreak's not over," says Dr. William Fischer, speaking about Ebola. "It's just changed."
...
WHO officials say the latest cases hadn't been in contact with any known Ebola survivors or done anything else that would have put them at obvious risk of getting the disease.
...
The news from Liberia makes the work of doctors like William Fischer even more critical.

There are thousands of Ebola survivors in West Africa right now. Many of them are facing various health problems. And they may also be the reservoir that sparks the next major outbreak. Rather than handwringing over what went wrong in the international response to this outbreak, Fischer says, we need to understand how the disease continues to affect the survivors.

"We have to pivot. We can't stop and say, 'Oh what should we have done differently in the beginning of the epidemic,' " Fischer says. "We have to say, 'What do we need to do right now.' "

One of the obvious things is to get a clear understanding of how survivors can or can't pass the virus to others.

http://www.npr.org/sections/goatsandsoda/2015/11/24/457277942/puzzling-ebola-death-shows-how-little-we-know-about-the-virus

[alert]

Here's the explanation for the discrepancy:

http://reliefweb.int/report/liberia/...-november-2015

On 20 November 2015, the Government of Liberia confirmed three new cases of Ebola Virus Disease (EVD) in Liberia from a family of six members from a suburb in the capital Monrovia. There are no new cases.

• A fourteen year old boy was confirmed as having Ebola on 19 November 2015 and was taken to an Ebola Treatment Unit (ETU) in Monrovia. He died on 23 November 2015. Two other family members were also confirmed as having Ebola the subsequent day and continue to receive treatment at the ETU.
• Three others, also from the same family, are under observation at the ETU. The mother’s blood test has shown a high level of Ebola anti-bodies indicating a recent Ebola recovery. The two month old baby is showing anti-bodies which has been tentatively explained as coming from the mother and not from a recent infection. One child has tested negative.

--------

(Might the mother be the actual index case for this cluster? - alert)

[Gert van der Hoek]

Tue Nov 24, 2015 8:49am GMT

Boy dies of Ebola in Liberia, first such fatality for months

MONROVIA

A 15-year-old boy has died of Ebola in Liberia, the first such fatality for months in a country declared free of the disease in September, chief medical officer Francis Kateh said on Tuesday.

Liberia has placed under surveillance 153 people who may have come into contact with Gbotoe. An additional 25 healthcare workers are being monitored, of which 10 are identified as high-risk, Kateh said.

Read more at Reutershttp://www.reuters.com/article/2015/11/24/health-ebola-liberia-idUSL8N13J1V820151124#DyuztgB03hrHg1uS.99

[Gert van der Hoek]

Epidemiological update: Outbreak of Ebola virus disease in West Africa


23 Nov 2015

Background

An epidemic of Ebola virus disease (EVD) has been ongoing in West Africa since December 2013, mainly affecting Guinea, Liberia and Sierra Leone. On 8 August 2014, WHO declared the Ebola epidemic in West Africa a Public Health Emergency of International Concern (PHEIC). As of 18 November 2015, WHO has reported 28 598 cases of Ebola virus disease related to the outbreak in West Africa, including 11 299 deaths [1]. The number of cases in the most affected countries peaked in autumn 2014 and has been slowly decreasing since. Liberia was declared Ebola-free by WHO on 3 September 2015 and Sierra Leone on 7 November. Guinea has not reported new cases since 29 October 2015.

Current situation in Liberia

On 20 November 2015, the Liberian Ministry of Health and Social Welfare reported three confirmed cases of Ebola virus disease [2]. On 19 November 2015, a reference laboratory in Liberia reported an Ebola positive result in a sample from a patient who presented symptoms such as fever, weakness and bleeding at a hospital in Monrovia on 17 November 2015. The patient was placed in isolation. The Liberian Ministry of Health and Social Welfare stated in a press release that four patients and high risk contacts are cared for at an Ebola Treatment Unit in Monrovia. The hospital where the patient was detected is undergoing decontamination and all health care workers who were in contact with the patient are being monitored.

According to media, the first case is a boy with onset of symptoms on 14 November [3,4], who attended school on Monday 16 November, was admitted to a hospital on 17 November and confirmed positive on two samples on the 19 November 2015. Two additional cases have been identified among family members. As of 20 November 2015, four patients (corresponding to at least three confirmed cases) and high risk contacts are hospitalised in an Ebola Treatment Unit in Monrovia. According to media, 153 contacts presenting with high, medium and low-risk exposure are followed-up [5]. Further response activities and contact tracing are on-going.

Assessment

Liberia was declared free of Ebola virus transmission in the human population on 3 September 2015. Following which, Liberia entered a 90-day period of EVD heightened surveillance [6]. The confirmation of new EVD cases during heightened surveillance periods after the tail end of outbreaks is not unexpected as stated in the most recent ECDC risk assessments [7,8].

The identification of new cases in Liberia highlights the importance of maintaining enhanced surveillance and immediate response capacity for control in the aftermath of the Ebola epidemic in the affected countries.

[Gert van der Hoek]

Liberia monitors over 150 Ebola contacts as virus re-emerges

Source: Reuters - Sun, 22 Nov 2015

* Cause of three new Ebola cases unknown

* Liberia has been declared Ebola-free twice before

* Neighbours Guinea, Sierra Leone have no cases

MONROVIA, Nov 22 (Reuters) - Liberia has placed 153 people under surveillance as it seeks to control a new Ebola outbreak in the capital more than two months after the country was declared free of the virus, health officials said.

[Gert van der Hoek]

Liberia confirms three new Ebola cases

Liberia’s Minister of Health, Dr. Bernice Dahn, has announced that the confirmed cases of Ebola have risen to three.

Dahn told a news conference on Friday at the health ministry in the Monrovia suburb of Paynesville, that it all started on Thursday with a 10-year-old boy whose blood sample tested positive of Ebola.


She noted that the other two cases are relatives of the boy, who were his close high risk contacts.

Dahn explained that the boy is from a family of six who are high risk contacts and that they are undergoing treatment at an Ebola Treatment Unit in Monrovia.

She said all hospital workers, who came in contact with them, are also being monitored and have been notified.


Meanwhile, Dahn has said her ministry is working with the Montserrado County health team and partners to conduct an investigation to isolate and mitigate the effects of these cases and to quickly respond to any additional cases that may be identified.


"At this time, we are still gathering information to identify possible contacts to ensure all individuals are notified and if necessary, receive care," Dahn said in a statement.

[Gert van der Hoek]

Ebola mystery: It?s back in Liberia, and officials are stumped about how boy got infected

November 20

World Health Organization officials said Friday that they had identified a new case of Ebola in Liberia in a 10-year-old boy and two of his siblings who live close to the country's capital of Monrovia.

The boy became sick Nov. 14 and sought medical help. His infection with the deadly virus was confirmed over the past 24 hours, but health investigators have not been able to determine how he was exposed. He has no known history of contact with a survivor, travel to an affected area or other factors they typically look for to explain a case.

[Gert van der Hoek]

Liberia Ebola update: 3 new cases now confirmed

Nov 20 2015


Liberia’s Health Ministry on Friday confirmed three Ebola cases months after the country was declared by the World Health Organization as free of Ebola.

“It all started on Thursday, Nov. 19, when we received a report from one of our reference laboratories that a blood sample from a live patient tested positive for Ebola,” Health Minister Bernice Dahn told a news conference.

She said the patients and high risk contacts are in care at an Ebola Treatment Unit in Monrovia.

The News

[Gert van der Hoek]

20 NOVEMBER 2015

Liberia: Ebola Resurfaces in Liberia - 2 New Cases Confirmed

The Daily Observer has gathered that the nation now has at least two confirmed cases of the deadly Ebola virus disease (EVD).

The first of the new cases, which is a 10-year-old boy, Nathan Gbotee, was reported late Thursday evening. It was again reported today by Dr. Francis Kateh, Deputy Health Minister and Chief Medical Officer of Liberia.

The second case, little Nathan's father, is yet to be announced by health authorities in the country. But a very reliable health source on this new outbreak, confided in our Health Correspondent.

Our source, who asked not be named, said it is likely that within the next 48 hours, there would be no less than five new cases among the Gbotee family as the little boy's mother and other members are showing "very clear signs and symptoms" of the EVD.

[sharon sanders]

Ebola Cases in 3 Family Members Confirmed in Liberia

By HELENE COOPER and NICK CUMMING-BRUCENOV. 20, 2015

http://www.nytimes.com/2015/11/21/world/africa/ebola-case-in-10-year-old-confirmed-in-liberia.html?&_r=0

hat tip @crof for the link