Flynas fights MERS, ebola with Virus Guard

Flynas, a low-cost airline from Saudi Arabia, has added Virus Guard disinfectant wet wipes and sprays to its in-flight hygiene programme.

In a region where MERS cases are on the rapid rise, and with over 1,000 cases reported to date, Flynas says it is determined to protect passengers and crew from viruses.

Flynas spokesperson Mrs Eman Yusuf, In-flight Services and On-board Product Manager, said: "Flynas will use the special wet wipes and sprays to disinfect all surface areas on board the aircraft such as galleys, ovens, lavatories, lavatory door handles, passenger tray tables, overhead bins, window blinds, seat pockets, armrests and so on. We make passenger safety and comfort a top priority and using Virus Guard will reassure them we are doing all we can to combat cross contamination."

"Typically, aircraft surfaces used or touched by passengers are rarely or never disinfected, but because our product is simple to use and extremely effective for up to 10 days, we're confident it can help to eliminate the risk of cross contamination," said Alex Sahni, a spokesperson for Virus Guard. 

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GSK fast-tracks development of Ebola vaccine candidate

Update: On 22 October 2014, GSK announced its 3rd quarter results for fiscal 2014. At the accompanying analyst call, Sir Andrew Witty, CEO of GSK said: "Given the apparent health emergency we are leaving no stone unturned in this project and, if all goes well, I fully expect GSK to be the first company in a position to make a vaccine available to health agencies and governments, hopefully towards the end of 2014."

GSK has announced that it is working closely with the World Health Organization (WHO), regulators and other partners to respond to the Ebola outbreak, accelerating development of its investigational Ebola vaccine, and ramping up production as quickly as possible.

According to the company, development of the vaccine candidate is progressing "at an unprecedented rate", with first phase 1 safety trials with the vaccine candidate under way in the US, UK and Mali. Further trials are due to start in the coming weeks.
"We are actively exploring with relevant organisations and partners all opportunities to accelerate the development of manufacturing at an industrial scale so that if the trials are successful, we will be in a position to significantly ramp up production of the vaccine candidate to help combat this or future Ebola outbreaks," the company said in a statement on its website dated October 18. 

Initial data from the phase 1 trials are expected by the end of the year and if successful, the next phases of the clinical trial programme will begin in early 2015. This will involve the vaccination of frontline healthcare workers in Sierra Leone, Guinea and Liberia. "If the vaccine candidate is able to protect these healthcare workers as we hope it will, it could significantly contribute to efforts to bring this epidemic under control," the company added.

GSK is also working with the WHO, regulators and other stakeholders on logistics, to determine how and when near-term supplies of the Ebola vaccine could be made available for targeted vaccination of additional healthcare workers and other people at high risk of infection in the affected countries where the impact would be most likely to limit the further spread of the epidemic. Safety and the supply chain will come into play for mass vaccination campaigns. GSK said it will depend on whether the vaccine candidate provides protection against Ebola without causing significant side effects and how quickly large enough quantities can be made.

GSK acquired this Ebola vaccine candidate through the acquisition of a biotechnology company, Okairos, in May 2013 and has since been working with the US National Institutes of Health to develop this vaccine candidate in response to the threat of Ebola.

The WHO and partner organizations said tools are being developed to help any country to intensify and accelerate their readiness.

One of these tools is a comprehensive checklist of core principles, standards, capacities and practices, which all countries should have or meet. The checklist can be used by countries to assess their level of preparedness, guide their efforts to strengthen themselves and to request assistance. Items on the checklist include infection prevention control, contact tracing, case management, surveillance, laboratory capacity, safe burial, public awareness and community engagement and national legislation and regulation to support country readiness.

“While we rightly focus on stopping the outbreak in affected countries, we should not forget that all other countries are at risk, albeit at varying levels,” said WHO Regional Director for Africa, Dr Luis Sambo.

Also under development is a framework to measure the key milestones and mutual accountability for assessment by international partners and countries. The tools are being reviewed by experts and will be made public available shortly, stated the WHO on October 10.

Read the blog post on what we know about Ebola so far here. 

What we now know about ebola

Source: WHO.

Update: As of October 20, two nurses who had cared for the index patient have caught ebola. There are allegations that the hospital was not properly prepared for the case, and they did not have proper equipment while they looked after him.

Update: The news broke on October 11 and 12 that a nurse who had cared for the first (index) case of ebola in the US had caught ebola herself. It is worrying because she had worn the full hazmat gear in caring for the patient, and that she cannot remember committing any breach of security, unlike a nurse in Spain who said she had accidentally touched her face with a gloved hand. The US Centers for Disease Control and Prevention is firm that some breach of 'protocol' did occur; the question is where, or whether ebola is not well-understood enough.

The World Health Organization shared a list of ways in which the ebola virus may be transmitted on 6 October. While it's known that the virus is transmitted among humans through close and direct physical contact with infected bodily fluids, the most infectious are blood, faeces and vomit, the WHO said.

The virus has also been detected in breast milk, urine and semen. In a convalescent (recovering) male, the virus can persist in semen for at least 70 days; one study suggests persistence for more than 90 days. This implies that the virus can remain in semen for a longer period, but it remains unclear whether the virus can be transmitted through this method.

WHO also says that saliva and tears may also carry some risk of infection. However, the studies implicating these additional bodily fluids were extremely limited in sample size and the science is inconclusive. In studies of saliva, the virus was found most frequently in patients at a severe stage of illness. 

The whole live virus has never been isolated from sweat. This implies that sweat from a victim cannot transmit the virus.

The ebola virus can also be transmitted indirectly, by contact with previously contaminated surfaces and objects. The risk of transmission from these surfaces is low and can be reduced even further by appropriate cleaning and disinfection procedures.

Ebola virus disease is not an airborne infection. Airborne spread among humans implies that you can catch the virus from inhaling a suspended cloud of small dried droplets. This mode of transmission has not been observed during extensive studies of the ebola virus over several decades.

Theoretically, bigger droplets from a heavily infected individual, who has respiratory symptoms caused by other conditions or who vomits violently, could transmit the virus – over a short distance – to another nearby person. This could happen when virus-laden droplets are directly propelled, by coughing or sneezing (which does not mean airborne transmission) onto the mucus membranes or skin with cuts or abrasions of another person.

However, observation to date is that the spread of the virus via coughing or sneezing is rare, if it happens at all. Epidemiological data emerging from the outbreak are simply not consistent with the pattern of spread seen with airborne viruses, like those that cause measles and chickenpox, or the airborne bacterium that causes tuberculosis.

WHO is not aware of any studies that actually document this mode of transmission. On the contrary, good quality studies from previous ebola outbreaks show that all cases were infected by direct close contact with symptomatic patients.

There are also fears that the disease could change its mode of transmission. The WHO says scientists are unaware of any virus that has dramatically changed its mode of transmission. Speculation that ebola virus disease might mutate into a form that could easily spread among humans through the air is just that: speculation, unsubstantiated by any evidence.

For example, the H5N1 avian influenza virus, which has caused sporadic human cases since 1997, is now endemic in chickens and ducks in large parts of Asia. That virus has probably circulated through many billions of birds for at least two decades. Its mode of transmission remains basically unchanged.

The WHO is calling for more to be done to implement – on a much larger scale – well-known protective and preventive measures. Abundant evidence has documented their effectiveness, it says.

Over 10,000 screened for Ebola at Indian airports since 10 August

The Indian government has reported that 10,194 passengers from countries affected by Ebola virus disease (EVD) have been screened by the Immigration Department via airports at Delhi, Mumbai, Bengaluru, Chennai, Trivandrum, Kolkata and Kochi.

A number of individuals have tested negative for the disease as of 16 August, including two Nigerian nationals and an Indian national. Another Nigerian national is under observation at Dr RML Hospital. 

A quarantine cum isolation health facility at Delhi Airport is operational, and all suspect cases detected at Delhi Airport will now be admitted to this facility, the government said. Since 16 August, five citizens of Indian origin aged 38 (M), 38(F), 7(M), 2 (F) and 31(F) have been admitted to this facility. All of them have been found negative for EVD in tests done at NCDC.

The Integrated Disease Surveillance Programme (IDSP) is tracking such passengers, the details of whom are provided to them by the Airport Health Organization. Today, 90 passengers were enrolled for follow up in their respective states through State IDSP units. As of 17 August, a cumulative number of 267 passengers are being tracked. Most of them are in the States of Maharashtra, Kerala and Tamil Nadu.

The Control Room in the Ministry of Health & Family Welfare has received 557 calls since its inception on 9 August. Most of the callers have sought information on signs and symptoms of the disease and travel related risk of acquiring the infection.

WHO has reported a total of 2,127 cases and 1,145 deaths as of 13 August 2014 due to EVD from affected countries. 

WHO says Ebola unlikely to spread through air travel

The World Health Organization has stated that air travel to and from affected countries is not a high-risk activity for the spread of Ebola. Dr Isabelle Nuttall, speaking on behalf of WHO, said, “Air travel, even from Ebola-affected countries, is low-risk for Ebola transmission.”

Dr Nuttall emphasised that the disease is not spread by airborne particles, like influenza or tuberculosis. The infection is transmitted to others through direct contact with the bodily fluids of a sick person, such as blood, vomit, sweat, and diarrhoea. Even if an individual infected with Ebola virus disease (EVD) travels by plane, the likelihood of other passengers and crew coming into contact with the individual’s bodily fluids is very low.

The WHO does not recommend any travel or trade restrictions be applied except in cases where individuals have been confirmed or are suspected of being infected with EVD or where individuals have had contact with cases of EVD. The organisation stresses that contacts do not include properly-protected healthcare workers and laboratory staff.

As of August 13, the latest dates available as of August 15, there have been a total of 2,127 cases reported, including confirmed, probable and suspected cases, and 1,145 deaths, from the four West African countries dealing with the EVD outbreak. Between 12 and 13 August 2014, a total of 152 new cases of Ebola virus disease (laboratory-confirmed, probable, and suspect cases) as well as 76 deaths were reported from Guinea, Liberia, Nigeria and Sierra Leone.

According to Flightstats, airlines in the Niddle East that fly to the four countries include Royal Air Maroc, which flies to all four countries, and Etihad, which flies to Conakry, Guinea and Lagos, Nigeria. Emirates and Qatar Airways fly to Lagos, Nigeria. Emirates had flights to Conakry but these are now suspended until further notice because of Ebola.

The WHO downplayed the possibility of a global pandemic here.

WHO downplays possibility of global ebola epidemic

The World Health Organization (WHO) provided an overview of the spread of Ebola virus disease (EVD) in West Africa on 11 August and stressed that in countries with well-developed health systems, an epidemic is highly unlikely "given the epidemiology of the Ebola virus and experiences in past outbreaks".

The organisation noted that fear has led to a very high level of vigilance and clinical suspicion worldwide, stating that "such a high level of alert further increases the likelihood that any imported case will be quickly detected and properly managed, limiting onward transmission."

On the downside, the WHO observes that the same fear is compromising outbreak control when it causes airlines to refuse to transport personal protective equipment and courier services to refuse to transport properly and securely packaged patient samples to a WHO-approved laboratory.

Facts about Ebola

• The Ebola virus is highly contagious, but is not airborne. 
• Transmission requires close contact with the bodily fluids of an infected person, as can occur during health-care procedures, home care, or traditional burial practices. 
• The incubation period ranges from two to 21 days, but patients become contagious only after the onset of symptoms. As symptoms worsen, the ability to transmit the virus increases. As a result, patients are usually most likely to infect others at a severe stage of the disease, when they are visibly, and physically, too ill to travel. 
• There is no cure. 
• Early detection and supportive care greatly improve prospects for survival. 

Read about the WHO announcement of the gravity of the EVD situation here, and how India and Singapore have prepared for the disease.

Singapore is on standby to act on Ebola

Singapore's Ministry of Health (MOH) has gone beyond WHO recommendations for Ebola virus disease (EVD), which it says it has already put in place as part of its preparedness plan against EVD. It is also ready to calibrate its measures as the situation evolves.

As recommended, the ministry is raising the awareness and knowledge of travellers about the potential risk of EVD. "Information on EVD has been provided to the public and potential travellers on MOH’s website, and in its media release issued on 7 August. Singaporeans have been advised to avoid non-essential travel to affected areas. Instructions have also been provided on precautions to take if there is a need to travel to affected areas," the ministry stated in a release on 8 August.

At the same time, all medical practitioners and hospitals have been alerted, through professional circulars, to the EVD situation in West Africa. "They are advised to remain vigilant to pick up cases of EVD early amongst patients with compatible symptoms and a travel history to affected areas. MOH has also provided guidance on the criteria for defining suspect EVD cases, and on how to notify MOH of such cases," the ministry said.

Singapore is no stranger to preparedness procedures for infectious diseases since dealing with SARS in 2003. According to the Ministry of Health, all public hospitals have put in place infection control procedures in the event of an imported EVD case. Processes have also been put in place include:

• Sending samples for EVD testing at the National Public Health Laboratory’s designated testing facilities. 
• Centralising the management of suspect cases of EVD in Tan Tock Seng Hospital (TTSH). Suspect cases who are seriously ill will be transported in specially configured ambulances, and all suspect cases will be managed in negative pressure isolation rooms with strict infection control procedures.

Contingency plans are also in place at Singapore's Changi Airport to manage passengers with signs of EVD. In 2013, Changi saw 53.7 million passengers arriving and departing. Such passengers will be isolated and transferred using a portable medical isolation unit (PMIU) to TTSH for further management.

Precautionary measures in Singapore's preparedness against EVD over and above the WHO recommendations include border health measures as well as contact tracing and quarantine. MOH has worked with the Civil Aviation Authority of Singapore (CAAS), the Immigration & Checkpoints Authority (ICA) and the Changi Airport Group (CAG) on border health measures. Individual health advisory notices (HANs) have been distributed to nationals from the affected areas at air and land checkpoints since 2pm on 7 August 2014.

The HAN advises travellers to consult a doctor early, and inform the doctor of their travel history if they become unwell, with sudden onset of high fever, stomach pains, diarrhoea, vomiting, rash or bleeding, within three weeks of being in any of the affected areas in West Africa. Similar advice is provided in Health Advisory posters at land and air checkpoints, which have been progressively put up from 8 August.

The MOH says it has been ready to conduct contact tracing in the event of a confirmed case of EVD since the beginning of the outbreak in West Africa. All close contacts will be quarantined and monitored for up to 21 days, either in their homes or in the Government Quarantine Facility (GQF) in Pasir Ris.

Read about the WHO announcement here.

India's preparedness measures are here.

India institutes Ebola preparedness measures

The Indian government is performing "intensive surveillance" to prevent the spread of Ebola virus disease (EVD) in the country. There are three local helpline numbers: 2306 3205, 2306 1469 and 2306 1302 operational as of 9 August at the Health Ministry to field calls.

Dr Harsh Vardhan, Minister for Health, has clarified that India does not have any confirmed or suspected Ebola victims. However, WHO had informed the government that one Indian passenger had travelled on the same flight on which an Ebola virus patient had travelled on, from Monrovia in Liberia to Lagos in Nigeria. Both countries are dealing with EVD outbreaks.

Thirty calls have been fielded so far. “Most of the callers to the helpline reflected a mature understanding of the collective responsibility in times like this. They wanted to know details about the symptoms and preventive measures,” Dr Vardhan said.

According to the government, the Indian passenger is back in India and being monitored. The Health Minister said: “We are happy to share that the said person is healthy, fit and fine.”

The government has already implemented the following steps:

1. Tracking of passengers arriving from the affected countries by the Airport Health Organizations based on the information provided by Ministry of External Affairs

2. Tracking and monitoring health of passengers, who travelled from the affected countries, in their respective States, by the Integrated Disease Surveillance Programme.

3. Designation of Dr. RML Hospital, New Delhi for management of cases in Delhi. The hospital has earmarked treatment facilities and a Nodal Officer.

4. The Government has advised Indians against non-essential travel to the four West African countries – Guinea, Liberia, Sierra Leone and Nigeria – which form the epicentre of EVD.

Read about the WHO announcement and the response from airlines here.

World Health Organization calls Ebola outbreak a public health emergency of international concern

The World Health Organization (WHO) has warned 8 August that the Ebola outbreak in West Africa is a Public Health Emergency of International Concern (PHEIC).

As of 4 August 2014, there have been 1,711 cases (1,070 confirmed, 436 probable, 205 suspect) of Ebola virus disease (EVD), including 932 deaths. Between 5 and 6 August 2014, a total of 68 new cases of EVD (laboratory-confirmed, probable, and suspect cases) as well as 29 deaths were reported from Guinea, Liberia, Nigeria, and Sierra Leone.

On 6 August, a Saudi man suspected of being infected with the Ebola virus passed away at 8.45am at a specialised hospital in Jeddah, Saudi Arabia. The patient had been admitted to the intensive care unit late on 4 August after exhibiting symptoms of viral hemorrhagic fever following a business trip to Sierra Leone, Saudi's Ministry of Health said. The cause of the infection is still under investigation, and people who had been in contact with the man are being traced or monitored for symptoms of Ebola.

The WHO further provides the following recommendations for states which are currently not affected by EVD nor adjacent to a state which is affected:

• There should be no general ban on international travel or trade; restrictions outlined in recommendations regarding the travel of EVD cases and contacts should be implemented.
• States should provide travelers to Ebola affected and at-risk areas with relevant information on risks, measures to minimise those risks, and advice for managing a potential exposure. 
• States should be prepared to detect, investigate, and manage Ebola cases; this should include assured access to a qualified diagnostic laboratory for EVD and, where appropriate, the capacity to manage travelers originating from known Ebola-infected areas who arrive at international airports or major land crossing points with unexplained febrile illness (fever). 
• The general public should be provided with accurate and relevant information on the Ebola outbreak and measures to reduce the risk of exposure. 
• States should be prepared to facilitate the evacuation and repatriation of nationals (e.g. health workers) who have been exposed to Ebola. 

On 11 August, WHO will convene a panel of medical ethics experts to begin looking at the use of experimental treatments in the ongoing EVD outbreak in West Africa. At this time, there are no registered medicines or vaccines against this deadly virus, though several experimental options are currently under development.

Emirates has already suspended flights to Conakry in Guinea until further notice due to the Ebola outbreak, the company said on its website. "We apologise for any inconvenience caused to our customers, however the safety of our passengers and crew is of the highest priority and will not be compromised," the company stated, asking affected customers to contact their travel agent or Emirates Call Centres for rebooking options, and visit the website for further updates.

Airlines flying to Sierra Leone include British Airways and Air France. British Airways has cancelled flights to Sierra Leone and Liberia till August 31. Air France also flies to Guinea, while Lufthansa flies to Nigeria.

Gulf Business has also reported that hajj visas are not being issued to pilgrims of the affected countries.

View the latest FAQ on EVD here.
Read about Singapore's preparedness activities here. Read about what India is doing about tracking nationals exposed to Ebola here.