Investigations yield insights into Ebola outbreak’s early months

nordepcom — Mon, 05 Jan 2015 02:00:10 +0000

Lisa Schnirring, Staff Writer CIDRAP News December 30, 2014 With West Africa’s Ebola epidemic passing the 1-year mark, two new reports yielded details about factors that fueled the event, including bats in a hollow tree that may have infected the index patient, a young Guinean child, and a silent chain of transmission that caused the disease to flare again in May after cases had sharply dropped off. Also today, the World Health Organization (WHO) updated its Ebola numbers, saying there have been 20,129 cases, along with 7,879 deaths, in the three hardest-hit countries. The data include cases reported through Dec 28 in Guinea and Sierra Leone and through Dec 24 in Liberia. The totals reflect an increase of 48 cases and 37 deaths since the WHO’s update yesterday. In addition, the WHO today posted a new timeline of the event, starting with its African regional office’s first report on the outbreak on Mar 23. Bat colony suspected as virus source The bat study, by a multidisciplinary group of German-led researchers, was conducted in April in the area around Meliandou, a village in a plantation region of Guinea where a 2-year-old boy thought to have been the index patient lived. The team published its findings today in an online edition of EMBO Molecular Medicine. The 4-week investigation of the roots of zoonotic transmission where the outbreak began involved a field team that included anthropologists who looked at human exposure to bush meat and bats, ecologists who surveyed local wildlife, and veterinarians who analyzed samples from bats and other animals. In other Ebola outbreaks, the virus was known to take a toll on larger animals, such as wild apes. However, the team found no evidence of population declines in the region’s wildlife populations. Also, children and women were among the first victims in the outbreak, rather than hunters, also suggesting that the virus probably didn’t jump from a larger animal. Hunting and butchering fruit bats—a suspected Ebola reservoir—were common activities in southern Guinea, providing a link to humans. Also, the team found that children often hunt and grill insect-eating bats in and around villages, providing more exposure to the animals. Though the group didn’t find any large colonies of bats in or near Meliandou, villagers showed them a large tree stump from a hollow tree near which the village children, including the index case, frequently played, catching and playing with bats. They said the tree burned on Mar 24, triggering a “rain of bats” that were collected to eat. However, the local people disposed of them after authorities the next day imposed a ban on consuming bush meat. Genetic sequencing of the environment near the tree confirmed that small free-tail bats had been in the area, the same type the villagers described. The team said the circumstances may have led to a massive exposure to bats, similar to events in bat-inhabited caves that have been implicated in the zoonotic transmission of Marburg virus. They added that their findings confirm the index case but suggest a slightly different transmission timeline, with the virus spreading to other parts of Guinea, then to Sierra Leone and other countries. Local people told the researchers that the boy died on Dec 28, several weeks later than the Dec 6 date reported in the medical literature. Times piece describes missed opportunities An undetected transmission chain was one of several missteps that led to the Ebola outbreak’s unprecedented size, according to an in-depth look at the events by a team of reporters from the New York Times. The report, based on a 2-month investigation, was first published yesterday. The report describes how experts thought the outbreak was close to burning itself out, with sharply declining at the beginning of May, along with clues they may have missed that an unusual event was about to unfold, and missteps in the response. Focusing on the time frame of the lull and the spike that followed, the team found that WHO and Guinean officials documented a handful of suspected cases across the border in Sierra Leone in March, but that information about two of the cases never got to senior health officials and investigators. This circumstance appears to have led to a chain of transmission that went unchecked for 2 months and didn’t surface until late May, when Sierra Leone confirmed its first Ebola case. The report also says the same two cases that fell through the cracks sparked a second wave of illnesses in Liberia that began in late May. Experts involved in the early response told the reporters that they didn’t deploy enough staff to the region and pulled them too soon. They also described management glitches by the WHO, which was stretched thin by budget cuts and other health and humanitarian crises. Other factors that hobbled the response included some officials’ downplaying of the Ebola threat and public education campaigns that did more harm than good, such as early efforts that highlighted the lethality of the disease. In tracing the first illnesses, including the boy who had the index case, investigators made faulty assumptions, and it took 12 weeks to determine that the illnesses and deaths were caused by Ebola, according to the report. The WHO’s African regional office, initially appointed to lead the response, was suffering from sharp cuts in preparedness money and staff and was overmatched in its ability to handle the task, and it posed bureaucratic roadblocks in getting help from global experts, the article says. In the first few months of the outbreak, lack of cross-border coordination hampered the response, and officials arriving from outside West Africa lacked a full understanding of the political and cultural challenges they would face, including deep distrust of government. The Times team pointed out that Doctors without Borders declared the outbreak out of control on Jun 21, but the WHO didn’t declare a public health emergency of international concern until Aug 8. Health officials who spoke with the Times said they wish they had devoted more staff and resources to the outbreak early on and had recognized how weak contact tracing was and the distinct culture of West Africa. Pierre Rollin, MD, a top Ebola expert at the US Centers for Disease Control and Prevention, who was quoted extensively in the Times report, said some of the events couldn’t have been predicted, especially in the midst of an unfolding crisis. “There were a lot of things we didn’t know at that time. No one could have imagined that it would be what we have now,” he said.

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Hospital patients rarely wash their hands, may spread disease

nordepcom — Thu, 23 Oct 2014 08:59:40 +0000

Although healthcare workers are urged to wash their hands often and hand sanitizer dispensers are everywhere in hospitals, patients are less scrupulous and may be contributing to the spread of hospital-acquired infections, say Canadian researchers. After tracking hundreds of patients in a transplant ward for nearly a year, the study team found that hand washing followed less than a third of bathroom visits, and washing or hand-sanitizer use happened only rarely after patients entered or left a room. “We know that certain infections can be spread on people’s hands, and hand washing is an important way to prevent those infections,” said the study’s lead author, Dr. Jocelyn Srigley, associate medical director of infection prevention and control at Hamilton Health Sciences in Hamilton, Ontario. One in 25 hospital patients has at least one infection contracted at the hospital at any given time, according to the U.S. Centers for Disease Control and Prevention. The CDC estimates there were 722,000 cases of hospital-acquired infection in 2011, many of them serious or even life-threatening. The role of healthcare workers in transferring infectious microbes from place to place and person to person in hospitals has been well-studied, and staff are trained to take measures to avoid spreading infections. But just two previous studies have looked at the potential for patients to spread infections in hospitals, to others and themselves, Srigley and her colleagues write in the journal Infection Control and Hospital Epidemiology. The Canadian study team tracked 279 adult patients in a multiorgan transplant ward using tags attached to hospital ID bracelets that sent out ultrasound signals. Wireless receivers were installed throughout the ward to pick up the signals and track each patient’s location. The system also detected every time a soap or hand sanitizer dispenser was used. They found that patients washed their hands about 30 percent of the time during bathroom visits, 40 percent of the time during mealtimes, 3 percent of the time while using kitchens on the wards, 3 percent of the time when entering their own rooms and 7 percent when exiting their room. Women washed their hands more often than men, and were more likely than men to use soap when they did. All patients were more likely to wash their hands later in the day than in the morning. Among 1,122 visits by 97 patients to the ward’s two kitchens, only 3 percent involved hand hygiene and less than one percent involved soap. The researchers point to a previous study that found requiring patients to disinfect their hands four times a day significantly reduced the number of respiratory and gastrointestinal disease outbreaks in a psychiatric ward. Srigley noted that the ultrasound observation system was not perfect and one limitation was that it, “didn’t know exactly what a patient was doing in the bathroom or when they were eating, so we don’t know for sure that a patient should have washed their hands at that time.” In addition, “not all patients agreed to wear the system tags so we don’t know if the ones who wore the tags are reflective of all patients,“ Srigley said. Despite these limitations, the new technology used in the study eliminated the problem of people changing their behavior when they know they’re being watched, said Dr. Yuen Kwok-yung, chair of Microbiology at the University of Hong Kong. Kwok-yung told Reuters Health by email, “The findings will provide important data for the formulation of hand hygiene policy.” Srigley feels that hospitals should encourage patients to wash their hands at certain times, but she is not yet sure what would be the most effective method. Possibilities include “putting up posters, having someone talk to patients about hand washing, providing hand sanitizer or alcohol wipes at the bedside, etc.,” she said, adding that more research is necessary to determine the most effective method. “The key message is that hand washing is an important way for people to protect themselves and prevent infections, whether they’re in the hospital, at home, at work, or anywhere else,” she said. “Especially with influenza season coming up soon, hand washing can help to keep us all healthy.” Source: (http://www.foxnews.com/health/2014/10/23/hospital-patients-rarely-wash-their-hands-may-spread-disease/)

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Investigations yield insights into Ebola outbreak’s early months

Hospital patients rarely wash their hands, may spread disease