[hlth] Gabon Sealed Off to Contain Ebola

[Loon]

Gabon Sealed Off to Contain Ebola

--------------------------------------------------------------------------------

Story Filed: Saturday, January 05, 2002 3:21 PM EST


LIBREVILLE, Gabon (AP) -- Gabon's government was stepping up efforts to contain an outbreak of the deadly Ebola virus, restricting access to an entire province affected by the disease.

Security and defense forces were helping local officials control movement in and out of the northeastern frontier province of Ogooue Ivindo, where the virus has already killed 17 people, government spokesman Andre Mba Obame said late Friday on state TV.

Authorities had previously controlled access to several affected villages in Ogooue Ivindo -- a remote, thinly populated region inhabited by pygmies and other tribes who hunt in the vast rain forests of the Western Africa country.

There were no reports, however, that the disease was spreading.

Medical officials confirmed 20 Ebola cases in Gabon, of whom 17 have died since the outbreak began in October. Twelve other cases, including six fatalities, were identified in the neighboring Republic of Congo.

Gabon had already sealed off its border with the Republic of Congo, allowing only medical specialists dealing with the crisis to cross. Authorities in the Republic of Congo had also cordoned off a 125-mile region on their side of the border.

The World Health Organization said medical experts were monitoring 147 people in Gabon and 95 in the Republic of Congo who may have had contact with those infected with the disease.

Obame announced the creation of a special committee to deal with the crisis. He said it would be under the supervision of the prime minister and would include the ministers of health, defense, transport and the interior. He gave no other details.

Ebola is one of the most deadly viral diseases known, killing 50 to 90 percent of those who become infected. But the disease usually kills its victims faster than it can spread, burning out before it can reach too far.

The virus is passed through contact with bodily fluids, causing fever, diarrhea, vomiting and heavy bleeding.

http://library.northernlight.com/EC20020105280000035.html?cb=0&dx=2006&sc=0#doc

 

[timbo]

Loon,a question for you or for anyone here.

Your posted article stated, "But the disease usually kills its victims faster than it can spread,burning out before it can reach too far".

In my mind,the present site that Ebola is ravaging, the population is quite thin making that statement true. What about an area of close population,as a large city?
Would this still be true? Or is part of the reason that Ebola doesnt spread as far is because transportation of the people who are ill?
In the USA,with travel facilities being as they are,couldnt Ebola be spread quite quickly across the whole USA?

 

[Loon]

I think you are right. It isn't spreading fast because of the low population and because the victims die so quickly and probably feel so ill they don't travel. It could be a totally different scenario if Ebola hit a highly populated metropolitan area. Look for the government to step in quickly, close off al transportation into and out of the immediate and surrounding areas and quarantines to be invoked. Most of this is outlined in a plan already discussed here at Timebomb. It is a long document but worth the read.

 

[Loon]

Here is the link to the discussion.

http://www.timebomb2000.com/vb/showthread.php?s=&threadid=14519&highlight=quarantine

 

[Deb Mc]

Hoping you all don't mind my "ditching" into the conversation:

Ebola is supposed to be transferred by blood, not by breathing the air. Burial practices in Africa have the family and community bathing the deceased in the river - a perfect place for the blood to spread and contaminate many people.

 

[timbo]

Thanks Loon,I'll pop it in tomorrow. Appreciate it.

 

[Loon]

Ebola is supposed to be transferred by blood, not by breathing the air.

Of course AIDS is spread only by exchange of body fluids also and we all know how fast that spread here in the US.

 

[SnowMom]

I do not worry about these people exporting their sickness so much. My step-father had an aircraft part export business for 30 years. He did business almost exclusively in the third-world countries. He used to visit Gabon 1/2 times a year. He's had Malaria more times than he can count, and is happily retired now. Now someone like him, or several people like him, traveling to the same countries, with the same regularity, could be enough to ruin our whole day. Think about it.

 

[TBonz]

Hoping you all don't mind my "ditching" into the conversation:

Ebola is supposed to be transferred by blood, not by breathing the air. Burial practices in Africa have the family and community bathing the deceased in the river - a perfect place for the blood to spread and contaminate many people.

Quite true. However, Reston Ebola (which affected primates, but not humans) WAS found to be spread through the air.

God help us if someone figures out how to cross Reston Ebola with say Zaire Ebola, giving the nastiness of Ebola for humans with the ease of airborne transmission.

Stuff like that gives me the willies.

 

[CanadaSue]

Ebola & transmissibility

Yes, this outbreak has been ongoing since October & as noted, 17 of 20 cases have died. The neighbouring Republic of Congo also has cases dating back to roughly the same time period.

The Ebola virus is a fragile puppy. Ordinary bleach kills it, as does ultraviolet light. It likes hot, humid weather & would do poorly in North America... it's thought. Impossible to be more precide because we don't know where it lives between human outbreaks.

Most cases in the early outbreaks were spread in hospitals. Needles were reused without disinfection & anyone infected by needle stick dies... pure & simple. In other cases, infected medical/nursing staff treated other patients with no gloves or masks.

Most secondary cases occur due to the way bodies are handled in the countries which so far, have seen Ebola outbreaks. Bodies are washed & prepared for burial by family members. When I say prepared, I mean bowels emptied, mouths cleaned out, etc. All this without benefit of gloves.

By the time a patient dies with Ebola, he/she is a chunk of virus ridden meat... or rather soup, on the inside. Families mourn in part by touching the body, kissing it, etc. That explains why so many family members die.

So... what are the chances of a widespread outbreak in Canada or the US? None, frankly. There is a newly heightened awareness about hemmorhagic fevers. Anyone suspected of one is immediately isolated & everything used in their care double bagged, bleached & burned.

Having said that, we had a suspected case in Hamilton last year. Talk about a messed up situation. The patient recovered & what caused her illness was never determined, even after exhaustive lab testing by your CDC & ours. But then again, many mysterious fevers are still never diagnosed. What was scary in this case was what WASN'T done.

Lab techs drew blood WITHOUT gloves or masks... sheer idiocy. 2 ambulances used to transport her stayed in service through 7-8 more patients before being pulled for decontamination. She was transferred to another hospital for testing of some sort. The appropriate public health notifications were late & not complete. I consider we were darned lucky not to get secondary cases, although I'm asuming whatever she had might have been contagious... no proof of that in the absence of a definite diagnosis.

So if such an occurance were to repeat itself with similar screw ups, we might see some secondary cases among medical staff & relatives. Not many though, once the cause was determined. We would see a high level of panic. Too many nasty movies & books which tend to exaggerate what happens with hemmorhagic fevers. Ebolas which strike humans are, as yet, NOT airborne. Should that change or Ebola change enough to make people seriously ill, all bets are off.

In Gabon, the fea is that patients or relatives of patients who may already be infected may flee, hoping to avoid becoming ill. Inadvertantly, such behaviour spreads the disease in these cultures.

Last thing, after the Ebola Reston episode in Reston, 4 animal handlers DID test positive for Ebola Reston entibodies. Scary thought.

 

[Deb Mc]

C.S.,

Here's an article from Pro-Med that bothers me, about animals dying over there from hemorrhagic fever (possibly Ebola) too.

What's even more worriesome is that Pro-Med hasn't followed up with any more articles on the subject of these animals, and usually Pro-Med is VERY good about follow-ups.

Would you be able to read this article, please, and see what you think?

Thanks!

http://www.timebomb2000.com/vb/showthread.php?s=&threadid=16668&highlight=ebola

 

[CanadaSue]

Same observation Deb...

I remember the post & it also appeared in several news agencies. One thing about ProMed; they really do try to limit speculative articles or specualting on causes. Now that's not to say they don't invite speculation in the form of 'expert guesses'. I've found some marvellous material that way.

They may simply be waiting for corroboration of findsings via lab results. I know the filovirsues do whip through primate populations, chimps & gorillas I remember off hand, green monkeys & a few others. They're almost instant death to guniea pigs & rabbits.

Killing antelopes & tortoises is new to me. I'll see what the latest research shows.

 

[Deb Mc]

Pro-Med updates:

1. It's Ebola Zaire, the most deadly form, that is spreading through Gabon right now - 72% fatality rate.

2. Apes, chimpanzees found dead.


1. EBOLA HEMORRHAGIC FEVER - GABON/CONGO REP (08)
*********************************************


Date: Fri 11 Jan 2002
From: ProMED-mail <promed@promedmail.org>
Source: BioMedNet, Top Stories, Thu 10 Sep 2002 [edited]
<http://news.bmn.com/news/story?day=020110&story=2>


Ebola Zaire Virus May Be the Virus Responsible for Ebola Outbreak

-----------------------------------------------------------------

Chris Lane, who is involved in investigating the Ebola hemorrhagic
fever outbreak in Gabon & Congo Republic for the World Health
Organization (WHO), appeared unannounced this morning before a meeting in London of European virologists and microbiologists to update delegates on what is happening in central Africa. Lane, from the Environmental Surveillance Unit of Britain's Public Health
Laboratory Service, was also on the WHO team involved in the largest ever outbreak of Ebola Hemorrhagic Fever, which started in October 2000 in Uganda and infected more than 400 people by February last year [2001] when it was officially declared over.

There is a significant difference this time, Lane told delegates on
the first day of a joint meeting of the European Societies of Clinical
and Veterinary Virology and the Society for General Microbiology.
Latest figures from Gabon reveal there have been 33 cases of the
disease, which have led to 24 deaths; a fatality rate of 72%. This is much higher than in Uganda, where over 400 cases resulted in 224 deaths; a rate of 56%. There are 213 contacts currently being followed up in Gabon.

The figures lead Lane to suspect that the infection is being spread by the most virulent Ebola virus species, Ebola Zaire virus. The Uganda outbreak was spread by the less virulent species, Ebola Sudan virus. Lane's suspicions were supported today by fellow delegate Barbara Bannister, consultant for infectious and tropical diseases at the Royal Free Hospital in London. Her team has analyzed clinical samples from the first 3 victims of the Gabon outbreak, and discovered that Ebola Zaire virus was the agent responsible in each case. Lane was quick to stress that this has not been confirmed by the WHO, and that the release of any data relating to the outbreak is covered by extremely tight restrictions designed to minimize panic.

The source of the infection remains unknown, but several possibilities have been or are being investigated. "There has been an awful lot of speculation about chimpanzees, because there's been a lot of deaths among chimpanzees," said Lane. But investigations have failed to come up with any signs of infection among the animals. "I seriously doubt that is the source," he said. Similarly, although "bat in a basket is quite a [culinary] delicacy," extensive analysis of material collected from local bats has found no evidence of Ebola, Lane noted. December
is a particularly unfortunate month for the disease to have struck.
Many of the local tribes have converted to Christianity, said Lane,
and the tradition of visiting all your relations over the festive
period could well have increased the risk of infection.

[Byline: Bea Perks]

--
ProMED-mail
<promed@promedmail.org>

******
[2]
Date: Fri 11 Jan 2002
From: John Kwon <jtk81@hotmail.com>


Comment on Routes of Transmission of Ebola Virus

------------------------------------------------

The article that I previously posted mentioned the fear of contracting Ebola from a handshake, and while it is currently not clearly established that a handshake can be a reliable means of contracting the disease, experience seems to show that it is not worth taking the chance, particularly if the hands in question are not clean, or one of the persons is actually infected. This is probably one reason that the disease is classified as a Level 4 agent.

In a paper by Roels, E.H. et al., 1999 [see ref. below], the authors
report that in 1995, 316 people became ill with Ebola hemorrhagic
fever (EHF) in Kikwit, Democratic Republic of the Congo. The exposure source was not reported for 55 patients (17 percent) at the start of this investigation, and it remained unknown for 12 patients after extensive epidemiologic evaluation. Both admission to a hospital and visiting a person with fever and bleeding were risk factors associated with infection. 19 patients appeared to have been exposed while visiting someone with suspected EHF, although they did not provide care. Of the 19, 14 reported touching the patient with suspected EHF; 5 reported that they had no physical contact.

Although close contact while caring for an infected person was
probably the major route of transmission in this and previous EHF
outbreaks, the virus may have been transmitted by touch, droplet,
airborne particle, or fomite; thus, expansion of the use of barrier
techniques to include casual contacts might prevent or mitigate future epidemics.

--
John Kwon
<jtk81@hotmail.com>

[The full reference for the above paper is the following:

Ebola hemorrhagic fever, Kikwit, Democratic Republic of the Congo, 1995: risk factors for patients without a reported exposure. Roels TH, Bloom AS, Buffington J, Muhungu GL, Mac Kenzie WR, Khan AS, Ndambi R, Noah DL, Rolka HR, Peters CJ, Ksiazek TG. Epidemic Intelligence Service, Division of Applied Public Health Training, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. J Infect Dis 1999 Feb;179 Suppl 1:S92-7. - Mod.CP]
.................cp/pg/jw

 

[Deb Mc]

Now, more about the Chimpanzees and Apes:



EBOLA HEMORRHAGIC FEVER - GABON, CONGO: DEAD WILDLIFE
**************************************************


Date: Thu 10 Jan 2002
From: William Karesh <wkaresh@wcs.org>


Report from the Field Veterinary Wildlife Program in Gabon & Congo Republic

----------------------------------------------------------------------

As of Fri 4 Jan 2002, our field team in conjunction with local
collaborators (Centre International de Recherches Medicales de
Franceville (CIRMF) [Gabon], Ecosystemes Forestiers d'Afrique Centrale (ECOFAC), and the forestry and wildlife ministries of both Gabon and the Republic of Congo) have collected reports of animal mortalities from local people living in the current Ebola outbreak area of Gabon and the Republic of Congo and have investigated sites where carcasses were reported to be found. These are only descriptions of animal mortalities, *not* confirmed Ebola cases.

Findings include: 30 western lowland gorillas, 8 common chimpanzees, & 4 cercopithecus monkeys. For species not generally associated with susceptibility to Ebola, we have found or have reports of carcasses of 12 duikers [small antelope], 2 genets [spotted cat-like animals of the family Viverridae], 1 domestic goat, 2 porcupines, 1 pangolin [scaly anteater], 1 elephant, 2 forest pigs, 2 reptiles, & 1 bird. Due to rapid deterioration of carcasses, diagnostic samples (biopsies fixed
in formalin) have been collected only from 1 gorilla, 2 genets, and 1 goat.

No laboratory confirmation (positive or negative) has been made from any animal due to a lack of diagnostic reagents in Gabon or the Republic of Congo at this time. We are continuing to collect information from villagers and look for animal carcasses or remains in the forests.

--
William B. Karesh, D.V.M.
Annelisa Kilbourn, D.V.M.
Field Veterinary Program
Wildlife Conservation Society
2300 Southern Blvd.
Bronx, NY 10460 U.S.A.
<wkaresh@wcs.org>

[For more information on the Wildlife Conservation Society Field
Veterinary Program, go to: <www.fieldvet.org> - Mod.CP]
............................................cp/pg/jw

 

[Brock]

Deb,

This is really interesting. If this virus has gone cross-species in infection ability, there's no way to control it. A transmittion "vector" could be any critter and there will be no way to isolate an area.

If this outbreak doesn't "burn out" soon, and the virus has mutated to infect so many species, we're (the world) looking at a great deal of hurt.

Also, it doesn't sound good when researchers put a lid on information so as to prevent panic. Why should there be panic when this disease has been dealt with before? What's new that they know about but don't want the public to know?

Brock

 

[Bearded Weirdo]

Of course AIDS is spread only by exchange of body fluids also and we all know how fast that spread here in the US.

That is true Brenda, but you can be infected with HIV for years and feel fine or not even know you have the disease. The same is not true for Ebola. This would definately slow down the infection rate.

 

[CanadaSue]

Millie, answers...

From the beginning, Ebla has been known for its ability to infect other species; especially other primates. It's also deadl to guinea pigs & certain other mammalian species.

The CDC & other organizations have gone to Africa several times & done exhasutive surveys of local species looking for the nost. Bear in mind that to be a 'successful' host species, you must be able to carry the virus without dying from it or at least, taking a very long time to die. If not, the virus itself eventually dies out. To date, the search has been fruitless. However, there's a huge backlog of blood samples to be checked back at the CDC.

As to putting a 'lid on it'. The local populations dealing with Ebla right now are not educated in the way we understand. There is a lot of myth & superstition surrounding Ebola & many feel if they can get away from the affected area, they'll be safe. Unfortunately, that can spread the disease. That has happened here with a woman from Gabon being responsible for spreading the illness into Congo.

The panic is not among the aid agencies there; as you've stated they HAVE dealt with ths many times before. It's among the local population. It's very emotionally upsetting to them to be told they cannot handle the bodies of their loved ones in order to prepare them for burial in the amnner to which they'e accustomed. Also, many feel that bringing their sick loved ones to the attention of medical authorities is a death sentence. In the 2 original Kikwit outbreaks, this was unfortunately true as the hospitals were the sources of the disease spreading.

Add to that the current civil unrest in Gabon, with aid agencies having to withdraw... not a good scene.

Note this outbreak has been in progress since October. It's been identified as Ebola Zaire, which is the most letghal & we still only have 34 or so cases. This is NOT the Andromeda strai, at least not in its current form.

Current nfo about Ebola research is available through a great many medical journals, the best probably being JAMA & publications from the National Center for Infectious Diseasaes. I have those URLs if you;re interested.

 

[Brock]

CanadaSue,

Thanks for the info. I didn't know this disease(s) was carried by so many different animals. I knew about the primates, but it seems that many (most/all?) warm-blooded aminals may be suseptable.

It does make it more dangerous as far as spreading is concerned. Your point is well taken about the "locals" being panicked. The point I was making is that these doctors/scientists aren't sharing info at these meetings outside of Africa.

I don't believe that technical info shared in London or New York about possible means of spreading should affect local behaviour with the out-of-contact souls in the jungle.

It just doesn't ring right to me. With these types of diseases the folks working with them usually give the information as soon as possible so that as many knowledgable people as possible can give feedback or ideas. If there's new information, why aren't they sharing it within the scientific community? That's what these scientific meetings are for.

Again, thanks for the info and insights.

Brock