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Mali - First confirmed case of Ebola in Kayes - a 2 year old girl from Kissidougou, Guinea - deceased

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  • #46
    Re: Mali - First confirmed case of Ebola in Kayes - a 2 year old girl from Kissidougou, Guinea - deceased

    WHO says currently no Ebola cases in Mali, 39 contacts sought

    Tue Nov 4, 2014 6:53am GMT
    By Tom Miles

    GENEVA (Reuters) - Thirty-nine people who travelled on buses with a toddler who died from Ebola in Mali are still being sought for checks, although the country is believed to be free of the disease, the World Health Organization said on Monday.

    A WHO spokeswoman said 108 contacts were being followed up, including 33 health workers, but epidemiologists believe those who have not been traced are at low risk, as they are unlikely to have had physical contact with the sick two-year-old.

    The girl's five-year-old sister had a fever but was suffering from malaria, not Ebola, tests showed. Other family members are under observation in the same hospital and doing well, with no fever or other symptoms, the WHO said.
    ...
    The toddler's family - including her grandmother, uncle, great aunt and sister, will remain in quarantine for one more week before reaching the 21 days which is the maximum incubation period of the virus. If they do not develop Ebola, they will be allowed to leave the hospital.
    ...

    http://af.reuters.com/article/topNew...0IO0G820141104
    "Safety and security don't just happen, they are the result of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of violence and fear."
    -Nelson Mandela

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    • #47
      Re: Mali - First confirmed case of Ebola in Kayes - a 2 year old girl from Kissidougou, Guinea - deceased

      Mali case, Ebola imported from Guinea

      <!-- Default DIV wrapper for all story meta data -->Ebola situation assessment - 10 November 2014

      <!-- close of the meta div -->Investigations undertaken by Ministries of Health in Mali and Guinea, assisted by WHO, have clarified the early exposure history of Mali’s first Ebola case.

      The index case in Mali, a 2-year-old girl who resided with her family in the urban commune of Beyla, Guinea, was diagnosed with Ebola, in Kayes, Mali, on 23 October and died on the following day.

      In Guinea: a family devastated by an undiagnosed disease

      The child’s history while still residing in Guinea strongly suggests that several members of her family died from Ebola virus disease. Most of the patients described below were buried safely by Red Cross volunteers, but not tested until late in the transmission chains.

      The Guinea history reveals many difficult challenges faced by ministries of health, local health officials, WHO and other partners in the Ebola response.

      The child’s history begins with the death of her father, of unidentified causes, on 3 October.

      The father was a Red Cross worker who also provided care at a private medical clinic owned by his father (the paternal grandfather of the index case). The paternal grandfather was a retired health care worker.

      While working at the private medical clinic, the child’s father had contact with a farmer from another village who died, of undiagnosed causes, on 12 September. The farmer sought treatment accompanied by his two daughters. Both daughters died, of undiagnosed causes, in Beyla on 23 September, one at dawn and the other in the evening.

      WHO data from Sierra Leone strongly suggest that Ebola care in private health facilities, as opposed to care in publicly-funded or MSF-run Ebola treatment centres, carries a higher risk of infection. In Kenema, for example, 87% of new infections among health care workers have been acquired in privately-run non-Ebola clinics.

      Going home to die

      The child’s father fell ill sometime during the third week of September. Fellow residents and neighbours in Beyla believed he was the victim of a bad-luck “curse” following an argument with the village chief. Witchcraft, and not Ebola, was suspected.

      Shunned by the community, and on the advice of his own father (the paternal grandfather of the index case and the head of the family), the father returned to his native village of Sokodougou, in the sub-prefecture of Moussadou – a trip of more than 70 kilometres. He died there on 3 October.

      This pattern of returning to a native village to grow old or die is commonly seen in Guinea, Liberia, Sierra Leone and many other countries around the world.

      Such frequent travels by symptomatic Ebola patients, often via public transportation and over long distances, unquestionably create multiple opportunities for high-risk exposures – en route and also when the patient reaches his home and is greeted by family and friends.

      Diagnosis: Ebola

      Meanwhile in Beyla, the paternal grandfather and family head lost his wife to an unknown disease on 8 October. He then allowed health officials to undertake contact tracing of 16 family members who had been in close contact with his deceased son (the father of the index case in Mali).

      On the following day (9 October), two of his other sons were admitted to hospital. The hospital referred them to a MSF-run Ebola transit centre in Macenta.

      The first son died the same day en route to Macenta. On 10 October, samples from both sons tested positive for Ebola, strongly suggesting that other family members had also died from Ebola virus disease.

      On 16 October, the paternal grandfather travelled to Macenta, seeking treatment for what he told medical staff was “rheumatoid arthritis”. As part of a thorough medical examination, he was tested for Ebola. Positive results were received from the laboratory on 17 October. The paternal grandfather died at an Ebola treatment centre in Gueckedou on 20 October.

      Mali’s index case leaves Guinea

      Following news of the death of relatives in Guinea, the child’s grand aunt or “Grandma” (the second wife of the maternal grandfather) travelled to Beyla, Guinea, to offer her condolences to her relatives. The “Grandma” resides in Kayes, Mali.

      She left Guinea to return to Mali on 19 October, taking the 2-year-old index case and her 5-year-old sister with her. A maternal uncle, the mother’s brother, also accompanied them. The index case was showing haemorrhagic symptoms in Guinea when the three began their extensive travels.

      The mother is alive and is in regular telephone contact with the Mali team. She has to remain in the village where her husband was buried for 40 days for the official mourning, before she can leave. Her three-month-old baby is with her in Guinea. Both are under observation and, to date, neither has shown any symptoms.

      The family group travelled via public transportation, taking at least one bus and 3 taxi rides as they journeyed more than 1200 kilometres through Mali. The buses made frequent stops for fuel or to let passengers on. The four spent 2 hours in the capital, Bamako, visiting relatives in a household with 25 people.

      On 19–20 October, they travelled overnight in one bus from Bamako to Kayes. Between Bamako and Kayes, only two persons left the bus at Niamiga village. Persistent tracking eventually located both at their final destinations, in Dakar, Senegal and Paris, France.

      Once in Kayes, the Grandma and index case consulted two traditional healers. The second healer took them to a retired nurse, who was alarmed by the child’s high temperature, which was above 40oC. When he learned they had recently travelled in Guinea, he suspected Ebola and advised them to seek treatment at a hospital.

      The child was admitted to the hospital in Kayes on 21 October and diagnosed with Ebola following receipt of positive laboratory results on 23 October. She was hospitalized and treated in isolation, with infection prevention and control equipment and procedures in place. She died on 24 October.

      The emergency response in Mali continues

      In collaboration with WHO, the Ministry of Health has established an incident command structure to mount a coordinated response that includes surveillance and contact tracing, case management, safe burials, social mobilization and logistics.

      To date, Malian health officials, aided by WHO, the US Centers for Disease Control and Prevention (CDC), Mèdecins sans Frontières (MSF), the International Federation of Red Cross and Red Crescent Societies, and several other partners have identified 108 contacts of the symptomatic patient, including 33 health care workers who were exposed. Of the 108 contacts, 25 have been followed for 21 days and have been released from the surveillance system.

      Seventy-nine contacts were at the hospital where the child was treated and in the Kayes community. All have been monitored. To date, no one has shown signs of Ebola or tested positive for the disease.

      The government has accelerated the completion of an isolation facility at the Center for Vaccine Development in Bamako. Isolation facilities were part of the strategies put in place in Senegal and Nigeria to successfully contain Ebola.

      Bamako has a well-functioning biosafety level 3 laboratory, previously established with support from the US National Institutes of Health to carry out diagnostic work with tuberculosis bacteria and HIV. The laboratory has now been repurposed to safely test Ebola samples.

      With persistent and thorough contact tracing, isolation and monitoring in place, confidence is growing that no further spread within Mali followed exposure to the index case, who had haemorrhagic symptoms but no diarrhoea or vomiting during her travels.

      http://www.who.int/mediacentre/news/...-2014-mali/en/
      "Safety and security don't just happen, they are the result of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of violence and fear."
      -Nelson Mandela

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      • #48
        Re: Mali - First confirmed case of Ebola in Kayes - a 2 year old girl from Kissidougou, Guinea - deceased

        It appears, if this is correct, that Mali's first case of ebola was likely not the 2 year old, but her father, who died on Oct 3 of unidentified causes in Sokodougou, Mali.


        How Ebola spread to Mali: The lessons learned

        When the father of Mali’s first confirmed Ebola victim, a 2-year-old girl, fell ill while working at a private clinic in neighboring Guinea, fellow townspeople suspected witchcraft.

        The man's father advised him to return to their native village of Sokodougou, more than 40 miles away in Mali, where he died of unidentified causes Oct. 3. The elder man would later die as well, one of several family members diagnosed with Ebola.

        The family’s story illustrates some of the reasons why the Ebola virus spread so rapidly in parts of West Africa, infecting more than 13,200 people and killing 4,960, according to estimates reported to the World Health Organization.

        The virus struck in a region that had never seen Ebola cases before, where traditional beliefs about the source of disease are widespread, and where healthcare workers operating outside specialized treatment facilities often lack the equipment and training to protect themselves from infection.

        It is also a region where people commonly return to their native villages to grow old or die.

        "Such frequent travels by symptomatic Ebola patients, often via public transportation and over long distances, unquestionably create multiple opportunities for high-risk exposures – en route and also when the patient reaches his home and is greeted by family and friends," the World Health Organization said in an assessment released Monday.

        WHO officials helped the ministries of health in Mali and Guinea trace what happened to the family of the 2-year-old girl, who was diagnosed in the western city of Kayes on Oct. 23 and died the following day.

        The girl lived with her family in the southeastern Guinea town of Beyla, where her father worked with the Red Cross and also provided care at a clinic owned by his father. There the girl’s father came into contact with a farmer who died of undiagnosed causes on Sept. 12, the WHO said.

        The farmer’s two daughters, who had accompanied him to the clinic, died 11 days later, within hours of each other.

        The 2-year-old’s father fell ill in the third week of September. Beyla residents believed he was the victim of a bad-luck curse following an argument with a traditional chief.

        The man’s father was later diagnosed with Ebola and died at a treatment unit in Gueckedou, Guinea, the WHO said. Two of his other sons also tested positive for the virus, and one of them died.

        ....

        http://www.latimes.com/world/africa/...110-story.html
        "We are in this breathing space before it happens. We do not know how long that breathing space is going to be. But, if we are not all organizing ourselves to get ready and to take action to prepare for a pandemic, then we are squandering an opportunity for our human security"- Dr. David Nabarro

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        • #49
          Re: Mali - First confirmed case of Ebola in Kayes - a 2 year old girl from Kissidougou, Guinea - deceased

          Looking at google maps, I cannot find a village called Sokodougou in Mali, but there is one in Guinea. Reporter error?
          "We are in this breathing space before it happens. We do not know how long that breathing space is going to be. But, if we are not all organizing ourselves to get ready and to take action to prepare for a pandemic, then we are squandering an opportunity for our human security"- Dr. David Nabarro

          Comment


          • #50
            Re: Mali - First confirmed case of Ebola in Kayes - a 2 year old girl from Kissidougou, Guinea - deceased

            Originally posted by MHSC View Post
            Looking at google maps, I cannot find a village called Sokodougou in Mali, but there is one in Guinea. Reporter error?
            Report from WHO, post #47:

            "The child’s father fell ill sometime during the third week of September. Fellow residents and neighbours in Beyla believed he was the victim of a bad-luck “curse” following an argument with the village chief. Witchcraft, and not Ebola, was suspected.

            Shunned by the community, and on the advice of his own father (the paternal grandfather of the index case and the head of the family), the father returned to his native village of Sokodougou, in the sub-prefecture of Moussadou – a trip of more than 70 kilometres. He died there on 3 October."

            The father of the 2 year old little girl died in Guinea.

            The village of Sokodougou is located in the sub-prefecture of Moussadou, in Beyla Prefecture.


            http://en.wikipedia.org/wiki/Moussadou
            "Safety and security don't just happen, they are the result of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of violence and fear."
            -Nelson Mandela

            Comment

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