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  • Discussion: Laboratory Treatment of Ebola Samples

    WHO pulls staff from Sierra Leone Ebola lab after doctor infected

    The WHO said it had withdrawn staff from the laboratory testing for Ebola at Kailahun – one of only two in Sierra Leone – after a Senegalese epidemiologist was infected with Ebola.

    “It’s a temporary measure to take care of the welfare of our remaining workers,” WHO spokeswoman Christy Feig said, without specifying how long the measure would last. “After our assessment, they will return.”

    Feig said she could not assess what impact the withdrawal of WHO staff would have on the fight against Ebola in the Kailahun, the area hardest hit by the disease.

    The infected Senegalese medic – the first worker deployed by the WHO to be infected – will be moved out of Sierra Leone in the coming days, Feig said. He is currently being treated at a government hospital in the eastern town of Kenema.




    Just as a comment, here in the UK the NHS seem happy to treat any samples from possible, probably and even CONFIRMED Ebola cases in Cat 2 containment, not even CL3 never mind CL4. Strange.

    Below is a quote taken from NHS UK Viral haemorrhagic fever algorithm and guidance on management of patients. ( link at bottom of post.to full guidelines which.gives every step of dealing with patient, from containment, to treatment, to transporting etc etc...every bit is dealt as a Cat 4 biohazard. Full protective gear double pairs of gloves for the medics and nurses collecting the samples etc.... However when it comes to the poor lab staff it is Cat 2, I.e. on the bench with single pair of gloves, doing blood films to exclude malaria while waiting on confirmation of Ebola etc.....even in confirmed cases basic bloods etc done while waiting for transfer. To be processed as Cat 2...very very strange.

    Quote:
    Specimens *from *a *patient *categorised *as *‘high *possibility *of *VHF.

    The overall risk to laboratory workers from specimens from this category of patient is also considered to be low, and specimens may continue to be processed (for the restricted list of investigations – see algorithm) at containment level 2 in routine autoanalysers. Waste from these machines is not considered to pose a significant risk because of the small sample size and dilution step and will therefore require no special waste disposal precautions.

    Procedures must be in place for the effective management of spillages (see Appendix 10). A sealed centrifuge bucket or rotor should be used for centrifugation procedures that are being undertaken manually i.e. not within an autoanalyser.

    6. For *specimens *categorised *as *‘high *possibility *of *VHF’ *laboratory *staff *should be informed so that original patient specimens can be retained and provision made for disposal as category A waste in the event that VHF is subsequently confirmed.

    7. Blood film slides for malaria testing should be disposed of in a dedicated sharps bin, which should be retained and processed as category A waste in the event that VHF is subsequently confirmed in any of the samples. After use, the work surfaces should be treated with 1,000 ppm available chlorine (see Appendix 10).

    Specimens from a patient with confirmed VHF 8. The number of patients with a positive VHF screen in the UK is very low (~1-2 cases every two years). In most cases, patients with a positive VHFviral-haemorrhagic-fever-algorithm-and-guidance-on-management-of-patients screen will be transferred to an HLIU and specimens will be analysed at the dedicated HLIU laboratory. However, where transfer is delayed or considered inadvisable, the specimens may be processed in a containment level 2 laboratory using routine autoanalysers



  • #2
    Re: WHO pulls out their lab staff.

    The worker is reportedly an epidemiologist from Senegal who is with the Global Outbreak Alert and Response Network (GOARN) and was in Kailahun district tracing EVD cases, according to earlier reports


    So it's possible his work tracing contacts took him into the community where he could have been exposed, rather than in a lab?

    Comment


    • #3
      Re: WHO pulls out their lab staff.

      I notice in Reuters they have now dropped the word epidemiologist. Perhaps he was a microbiologist or a virologist or an epidemiologist virologist , sometimes in the press all the ..,....ologists get lumped together. Guess they suspect the lab or they wouldn't have closed it so readily. Perhaps other technician has contracted it but we only hearing about the doctor.

      FREETOWN/KINSHASA, Aug 26 (Reuters) - The World Health Organization (WHO) said on Tuesday it had shut a laboratory in Sierra Leone after a health worker there was infected with Ebola, a move that may hamper efforts to boost the global response to the worst ever outbreak of the disease.

      The Senegalese medic -- the first worker deployed by WHO to be infected -- will be evacuated from Sierra Leone in the coming days, Feig said. He is currently being treated at a government hospital in the eastern town of Kenema.



      Still miffed about the UK cat2 for samples, anyone any idea why. I mean even HIV and Mycobacterium work done in Class 3. ( see refs in my post at start of thread)

      Comment


      • #4
        Re: WHO pulls out their lab staff.

        It all seems a bit mixed up on this story. Like seriously mixed up.

        First they say they are closing a lab because an epidemiologist got infected.
        Next they say it was a lab worker that was infected.
        The article quoted below now says 3 Canadian microbiologists workers are coming home after 3 other people in the hotel they were staying at got Ebola.
        These 3 microbiologists work with 3 others at the lab in question.
        Lastly WHO says they are checking all the lab equipment and procedures.

        Sorry I was never any good at jigsaws. Maybe someone can explain it to me.


        The Public Health Agency of Canada said in a statement late Tuesday it is finalizing plans to bring its three-person mobile laboratory team home from Sierra Leone.


        Quote from above ref : The Public Health Agency of Canada said in a statement late Tuesday it is finalizing plans to bring the three-person mobile team from Winnipeg's National Microbiology Laboratory home from Sierra Leone.

        The team is being recalled after three people staying at their hotel were diagnosed with the Ebola virus. None of the team members had direct contact with those diagnosed, and they are not displaying any signs of illness, officials said.

        The three Canadians were among six workers at the lab.

        There will be an investigation to see whether it was a routine infection, or something to do with the lab's processes or equipment, WHO said
        The three Canadians were among six workers at the lab.

        Eh...confusing ...

        Following on from my last post on this thread with references showing how NHS lab workers are to be expected to perform routine patient sample work on Ebola under category 2 conditions. ( note these guidelines will be following WHO risk assessment. Which will be used globally, perhaps even at a lab near you).. Is it just me or would you like to make a blood film to check malaria status on a suspected Ebola sample, wearing only one pair of gloves and on an open bench. ( I.e. cat 2 containment level).

        Here's what making a blood film involves

        Blood films are made by placing a drop of blood on one end of a slide, and using a spreader slide to disperse the blood over the slide's length. The aim is to get a region, called a monolayer, where the cells are spaced far enough apart to be counted and differentiated. The monolayer is found in the "feathered edge" created by the spreader slide as it draws the blood forward. "

        If lab workers are doing this type of work on a Cat4 biohazard no matter what country the lab is in, then it may be one source of the problems which has closed the WHO lab, rather than a dogy centrifuge or something.

        Just my thoughts.

        Comment


        • #5
          Re: Discussion: Laboratory Treatment of Ebola Samples

          Foxp3 - I completely agree with you. This flies in the face of everything we know about ebola, and if we got an outbreak, we could expect infections in lab workers if this is followed.

          In my experience of H5N1 planning there was very much a train of thought within the NHS which was - 'the NHS couldnt cope with a pandemic with a CFR of more than 2.5% so lets not plan for it'. I found that quite astonishing at the time.

          I wonder if there is a similar mentality here. Aka - we dont have the capabilities for widespread BL3 or 4 testing, so lets be pragmatic and use what we have aka BL2 level testing.

          Either way, its a disgrace. I am sure it will be revised shortly, or at least I hope it will. Even if testing has to be done in BL2 labs they could still get lab workers to upgrade their protection and protocols to keep them safe, and prevent novel transmission chains being created amongst healthcare workers... after all, lab workers have close contacts with all NHS staff including doctors and nurses, never mind cleaning staff etc.

          Comment


          • #6
            Re: Discussion: Laboratory Treatment of Ebola Samples

            Seems the US have addressed this as labs have been told to stand down until procedures are checked.




            Quote:
            Nearly every day, the American public is reminded of the critical role that life-sciences researchers and public health workers play in mitigating the threat of infectious diseases. Whether these diseases arise naturally in the United States or in other parts of the world, as is the case with the current unprecedented outbreak of Ebola in West Africa, or are deliberately released to cause harm here at home, as occurred with the anthrax attacks in 2001, U.S. government scientists are charged with confronting threats to the health and well-being of the citizens, economy, and security of the United States.

            Working with pathogens in the laboratory is vital to ensuring that the United States and the global community possess a robust set of tools?such as drugs, diagnostics, and vaccines?to counter the ever evolving threat of infectious diseases.




            That?s why, when we learned earlier this summer of several incidents within the Nation?s premier laboratories of the Centers for Disease Control and Prevention and on the campus of the National Institutes of Health, we immediately sought meaningful measures to address the underlying causes and reduce the risk that such incidents woulurging them to take immediate and longer-term steps aimed at addressing the underlying causes of the recent laboratory incidents and strengthening overall biosafety and biosecurity at federal facilities.

            We urged all relevant federal facilities?including extramural facilities that receive federal funding?to conduct a ?Safety Stand-Down? in the near-term, during which senior leaders would review laboratory biosafety and biosecurity best practices and protocols, and would develop and implement plans for sustained inventory monitoring.


            In contrast the NHS still instruct samples from possible, probable and if it happens ...CONFIRMED patients as Cat 2. Theses guidelines were issued originally back in may and were based on probabilities that the UK would see no patients. So samples would most likely never be Ebola. Nothing has been updated now that the risk of sample being positive has grown. It is an accident waiting to happen.

            Fp

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