22 Oct 2014

#Ebola, #CDC Announces #Active Post-Arrival #Monitoring for #Travelers from Impacted Countries (@CDCgov, October 22 2014)

[Source: US Centers for Disease Control and Prevention (CDC), full page: (LINK). Edited.]

CDC Announces Active Post-Arrival Monitoring for Travelers from Impacted Countries [      ]

The Centers for Disease Control and Prevention (CDC) announced that public health authorities will begin active post-arrival monitoring of travelers whose travel originates in Liberia, Sierra Leone, or Guinea

These travelers are now arriving to the United States at one of five airports where entry screening is being conducted by Customs and Border Protection and CDC. 

Active post-arrival monitoring means that travelers without febrile illness or symptoms consistent with Ebola will be followed up daily by state and local health departments for 21 days from the date of their departure from West Africa. 

Six states (New York, Pennsylvania, Maryland, Virginia, New Jersey, and Georgia), where approximately 70% of incoming travelers are headed, have already taken steps to plan and implement active post-arrival monitoring which will begin on Monday, October 27. 

Active post-arrival monitoring will begin in the remaining states in the days following.  

CDC is providing assistance with active post-arrival monitoring to state and local health departments, including information on travelers arriving in their states, and upon request, technical support, consultation and funding.

Active post-arrival monitoring is an approach in which state and local health officials maintain daily contact with all travelers from the three affected countries for the entire 21 days following their last possible date of exposure to Ebola virus. Twenty-one days is the longest time it can take from the time a person is infected with Ebola until that person has symptoms of Ebola. 

Specifically, state and local authorities will require travelers to report the following information daily: 

  • their temperature and
  • the presence or absence of other Ebola symptoms such as headache, joint and muscle aches, weakness, diarrhea, vomiting, stomach pain, lack of appetite, or abnormal bleeding; and
  • their intent to travel in-state or out-of-state.

In the event a traveler does not report in, state or local public health officials will take immediate steps to locate the individual to ensure that active monitoring continues on a daily basis.

In addition, travelers will receive a CARE (Check And Report Ebola) kit at the airport that contains a tracking log and pictorial description of symptoms, a thermometer, guidance for how to monitor with thermometer, a wallet card on who to contact if they have symptoms and that they can present to a health care provider, and a health advisory infographic on monitoring health for three weeks.

Active monitoring establishes daily contact between public health officials and travelers from the affected region.

In the event a traveler begins to show symptoms, public health officials will implement an isolation and evaluation plan following appropriate protocols to limit exposure, and direct the individual to a local hospital that has been trained to receive potential Ebola patients.

Post arrival monitoring is an added safeguard that complements the existing exit screening protocols, which require all outbound passengers from the affected West African countries to be screened for fever, Ebola symptoms, and contact with Ebola and enhanced screening protocols at the five U.S. airports that will now receive all travelers from the affected countries. All three of these nations have asked for, and continue to receive, CDC assistance implementing exit screening. 

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#EBOLA #RESPONSE ROADMAP #SITUATION #REPORT, 22 OCTOBER 2014 (@WHO, edited)

[Source: World Health Organization, full PDF document: (LINK). Edited.]

EBOLA RESPONSE ROADMAP SITUATION REPORT, 22 OCTOBER 2014 [      ]

 

SUMMARY

A total of 9936 confirmed, probable, and suspected cases of Ebola virus disease (EVD) have been reported in five affected countries (Guinea, Liberia, Sierra Leone, Spain, and the United States of America) and two previously affected countries (Nigeria and Senegal) up to the end of 19 October. A total of 4877 deaths have been reported.

The outbreaks of EVD in Senegal and Nigeria were declared over on 17 October and 19 October 2014, respectively.

EVD transmission remains persistent and widespread in Guinea, Liberia, and Sierra Leone.

All but one administrative district in Liberia and all administrative districts in Sierra Leone have now reported at least one confirmed or probable case of EVD since the outbreak began.

Cases of EVD transmission remain lowest in Guinea, but case numbers are still very high in absolute terms.

Transmission remains intense in the capital cities of the three most affected countries.

Case numbers continue to be under-reported, especially from the Liberian capital Monrovia.

Of the countries with localized transmission, both Spain and the United States continue to monitor potential contacts.

On 21 October the single patient with EVD in Spain tested negative for the disease for a second time. Spain will be declared free of EVD 42 days after the date of the second negative test unless a new case arises during that period.

On 22 October 2014, WHO convened the third Emergency Committee on Ebola under the International Health Regulations (2005).

 

OUTLINE

This is the ninth in a series of regular situation reports on the Ebola Response Roadmap.

The report contains a review of the epidemiological situation based on official information reported by ministries of health, and an assessment of the response measured against the core Roadmap indicators where available.

The data contained in this report are the best available.

Because of widespread under-reporting of confirmed cases in Liberia, suspected cases are now also shown in country histograms.

Substantial efforts are ongoing to improve the availability and accuracy of information about both the epidemiological situation and the implementation of response measures.

Following the roadmap structure, country reports fall into three categories:

  • (1) those with widespread and intense transmission (Guinea, Liberia, and Sierra Leone);
  • (2) those with or that have had an initial case or cases, or with localized transmission (Nigeria, Senegal, Spain, and the United States of America); and
  • (3), those countries that neighbour or have strong trade ties with areas of active transmission.

An overview of the situation in the Democratic Republic of the Congo, where there is a separate, unrelated outbreak of EVD, is also provided (see Annex 2).

 

1. COUNTRIES WITH WIDESPREAD AND INTENSE TRANSMISSION

A total of 9911 confirmed, probable, and suspected cases of EVD and 4868 deaths have been reported up to the end of 19 October 2014 by the Ministries of Health of Guinea, and Sierra Leone, and 18 October for Liberia (table 1).

All but one district in Liberia and all Sierra Leone have now reported at least one case of EVD since the start of the outbreak (figure 4).

Of the eight Guinean and Liberian districts that share a border with Cote d Ivoire, only the Guinean district of Mandiana is yet to report a confirmed or probable case of EVD.

 

Table 1: Confirmed, probable, and suspected cases in Guinea, Liberia, and Sierra Leone

[Country - Case definition - Cumulative Cases - Cases in past 7 days - Cases in past 7 days/total cases (%) – Deaths]

  • Guinea
    • Confirmed – 1289 – 106 - 8% – 710
    • Probable – 193 – 3 - 2% – 193
    • Suspected – 58 – 0 - 0% – 1
      • All – 1540 – 109 - 7% – 904
  • Liberia*
    • Confirmed – 965 – 17 - 2% – 1241
    • Probable – 2106 – 185 - 9% – 803
    • Suspected – 1594 – 211 - 13% – 661
      • All – 4665 – 413 - 9% – 2705
  • Sierra Leone**
    • Confirmed – 3223 – 374 - 12% – 986
    • Probable – 37 – 0 - 0% – 164
    • Suspected – 446 – 80 - 18% – 109
      • All – 3706 – 454 - 12% – 1259
  • Total – 9911 – 976 - 10% – 4868

____

*For Liberia, 276 more confirmed deaths have been reported than have confirmed cases.

**For Sierra Leone, 127 more probable deaths have been reported than have probable cases.

Data are based on official information reported by Ministries of Health. These numbers are subject to change due to ongoing reclassification, retrospective investigation and availability of laboratory results.

 

GUINEA

EVD transmission in Guinea remains intense.

By contrast with Liberia and Sierra Leone, however, several areas of Guinea are still to report a single case of EVD, whilst seven have now been free of cases for over 21 days after an initial case or cases of EVD (figure 4).

The outbreak in Guinea is being driven by transmission in four key areas.

The 18 confirmed cases newly reported this week from the capital, Conakry, is the second highest weekly total since the outbreak began (figure 1).

N Zerekore (19 confirmed cases) and erouane (18 confirmed cases) have shown a sustained increase in new cases over the past two weeks.

Both areas are near the border with Cote d Ivoire to the east; to the west they border the district of Macenta, where transmission has been intense for the past 10 weeks (38 new confirmed cases reported during the past week).

The district of Coyah reported 5 new confirmed cases this week compared with 25 the previous week, but it is too early to tell whether this decline will be sustained.

Gueckedou, where the outbreak originated, has reported few new cases for the past 6 weeks (2 confirmed cases this week), but transmission is persistent.

Two districts in Guinea reported a case or cases of EVD for the first time during the past week.

In the east of the country, on the border with Cote d Ivoire and on a ma or trade route with Mali, the previously unaffected district of Kankan reported 1 new confirmed case (figure 4), again emphasizing the need for active surveillance at local border crossings.

The district of erouane, which is currently reporting intense transmission, lies on ankan s southern border. In the centre of the country, the previously unaffected district of Faranah has reported 1 new confirmed cases.

Faranah is bordered by the newly affected Sierra Leonean district of Koinadugu to the southwest.

The adjacent central district of Mamou, which was classified last week as having reported its first confirmed case, is now classed as unaffected after the single confirmed case was discarded.

(...)

 

LIBERIA

The 444 confirmed, probable, and suspected cases reported from Liberia this week is the highest number in the past four weeks and the fourth highest since the outbreak began (figure 2).

Liberia remains the country worst affected by the outbreak.

All but one of Liberia s 15 administrative districts has now reported at least one confirmed or probable case of EVD (figure 4) since the outbreak began, but transmission is most intense in the capital, Monrovia, with 305 new probable and suspected cases reported this week.

Only 15 of the 444 new cases reported nationwide from Liberia this week are confirmed cases. This is due to a continuing failure to integrate laboratory results into clinical epidemiology reports. Many probable and suspected cases are likely to be genuine cases of EVD.

Outside Monrovia, most newly reported cases have come from the districts of Bong (40 cases), Margibi (22 cases), and Nimba (29 cases), which borders both Cote d Ivoire to the east and Guinea to the north.

The recent fall in the number of new cases reported from Lofa, which borders the district of Gueckedou in Guinea, has continued for a third week (two confirmed cases). Reports from observers suggest this is a genuine decline as a result of control measures.

(...)

Data are based on official information reported by the Ministry of Health of Liberia up to the end of 18 October. These numbers are subject to change due to ongoing reclassification, retrospective investigation and availability of laboratory results.

 

SIERRA LEONE

EVD transmission remains intense in Sierra Leone, with 325 new confirmed cases reported during the past week (figure 3). The capital, Freetown, reported 138 new confirmed cases, and remains the area of most intense transmission, followed by the neighbouring western districts of Bombali (53 confirmed cases) and Port Loko (39 confirmed cases).

(...)

The central districts of Bo (23 new confirmed cases), and Tonkolili (23 new confirmed cases) are the next most badly affected areas, along with neighbouring enema (23 new confirmed cases) to the east. enema has now reported an increase in the number of new cases for the past two weeks, after a prolonged period during which transmission appeared to be slowing.

Transmission also appeared to have been slowing in ailahun, but the district has now reported an increase in new cases (10 confirmed cases) for the third consecutive week.

In the north of the country, the previously unaffected area of oinadugu, which borders the newly affected Guinean district of Faranah, has reported 2 confirmed cases of EVD during the past week (figure 4). All districts of Sierra Leone have now reported at least one probable or confirmed case of EVD since the start of the outbreak.

(...)

 

HEALTH-CARE WORKERS

A total of 443 health-care workers (HCWs) are known to have been infected with EVD up to the end of 19 October. 244 HCWs have died (table 2).

WHO is undertaking extensive investigations to determine the cause of infection in each case.

Early indications are that a substantial proportion of infections occurred outside the context of Ebola treatment and care.

Infection prevention and control quality assurance checks are now underway at every Ebola treatment unit in the three intense-transmission countries.

At the same time, exhaustive efforts are ongoing to ensure an ample supply of optimal personal protective equipment to all Ebola treatment facilities, along with the provision of training and relevant guidelines to ensure that all HCWs are exposed to the minimum possible level of risk.

 

Table 2: Ebola virus disease infections in health-care workers

[Country - Case definition – Cases – Deaths]

  • Guinea*
    • Confirmed – 70 – 33
    • Probable – 8 – 8
    • Suspected – 0 – 0
      • All – 78 – 41
  • Liberia*
    • Confirmed – 78 – 64
    • Probable – 109 – 34
    • Suspected – 35 – 5
      • All – 222 – 103
  • Nigeria**
    • Confirmed – 11 – 5
    • Probable – 0 – 0
    • Suspected – 0 – 0
      • All -  11 – 5
  • Sierra Leone*
    • Confirmed – 125 – 91
    • Probable – 2 – 2
    • Suspected – 2 – 2
      • All – 129 – 95
  • Spain
    • Confirmed – 1 – 0
    • Probable – *** – ***
    • Suspected – *** – ***
      • All – 1 – 0
  • United States of America
    • Confirmed – 2 – 0
    • Probable – *** – ***
    • Suspected – *** – ***
      • All – 2 – 0
  • Total – 443 – 244

_____

*Countries with widespread and intense transmission.

**Now declared free of EVD transmission.

***No available data.

Data are based on official information reported by Ministries of Health. These numbers are subject to change due to ongoing reclassification, retrospective investigation and availability of laboratory results.

 

RESPONSE IN COUNTRIES WITH WIDESPREAD AND INTENSE TRANSMISSION

The first-ever UN emergency health mission, the UN Mission for Ebola Emergency Response (UNMEER) has been set up to address the unprecedented EVD epidemic. The strategic priorities of the Mission are to stop the spread of the disease, treat infected patients, ensure essential services, preserve stability, and prevent the spread of EVD to countries currently unaffected by EVD. WHO will continue to be responsible for overall health strategy and advice within the Mission, and has now moved its base of operations from Conakry, Guinea, to the UNMEER Mission headquarters in Accra, Ghana.

Following the creation of UNMEER, a comprehensive 90-day plan to control and reverse the epidemic of EVD in West Africa has been put into action. To rapidly reverse the current crisis, capacity will be put in place to isolate at least 70% of EVD cases and safely bury at least 70% of patients who die from EVD by 1 December 2014 (the 60-day target).

The ultimate goal is to have capacity in place for the isolation of 100% of EVD cases and the safe burial of 100% of patients who die from EVD by 1 January 2015 (the 90-day target), which is projected to result in a declining rate of transmission. In accordance with the WHO Ebola Response Roadmap, the 90-day Ebola Response plan requires that at least 50% of major inputs in five crucial domains be put in place by 1 November, with 100% of inputs in place by 1 December. Progress towards putting these inputs in place and the attainment of each target will be assessed through a comprehensive response-monitoring system, and will be reported in due course. The latest key developments in each domain are detailed below.
Case management

Capacity for case management has been increased substantially in all three intense-transmission countries, but remains far short of requirements (figure 5). Recent operational planning pro ections hold that 4388 beds are required in 50 Ebola treatment units (ETUs) across the three intense-transmission countries (table 3) to achieve the target of isolating 70% of EVD cases by 1 December. At present, 1126 (25%) are already in place. In addition, there remains a gap in the availability of foreign medical teams to manage and staff ETUs. At present, there are firm commitments from teams for 30 of the 50 ETUs. WHO continues to work with Member States and partners to close these gaps.

A lack of available beds in ETUs often forces families to care for sick relatives at home. In the home setting, care givers are unable to adequately protect themselves from EVD exposure, and thus the risk of transmission within the family and throughout the community is greatly increased. As a remedial measure, Ebola Community Care Units (ECUs)/Community Care Centres (CCCs) are now being trialled by governments and partners in both Sierra Leone and Liberia. These facilities will be closely linked to other essential activities such as case finding, community engagement, and safe burials.

Promotion of strict adherence to infection prevention and control (IPC) guidance is ongoing. WHO continues to seek consensus for refinements to existing guidance on the use of personal protective equipment in EVD outbreaks. A formal WHO Guidelines Development Group, which includes experts from a wide range of partners, has been convened on numerous occasions over recent weeks, and updated guidelines are expected before the end of this week.

 

Table 3: Available and planned EVD bed capacity

[Existing ETU beds - Required ETU beds - Existing ETU beds/required ETU beds (%)]

  • Guinea – 160 – 260 - 61%
  • Liberia – 620 – 2690 - 23%
  • Sierra Leone – 346 – 1198 - 29%

 

 

Case confirmation

Based on the most recent operational planning projections, an estimated 28 laboratories are required across the three intense-transmission countries. At present, 12 laboratories are operational (three in Guinea, five in Liberia, and four in Sierra Leone; figure 5). In Sierra Leone, the US Centres for Disease Control and Prevention laboratory that was previously located in Kenema has now relocated to the district of Bo.

 

Surveillance

As has been recently demonstrated by the success of Nigeria and Senegal, surveillance and contact tracing are essential components of an effective response to EVD. With support from WHO and other partners, the governments of Guinea, Liberia and Sierra Leone are rapidly expanding their capacity for contact tracing and case finding. Large volumes of cases mean that over-stretched contact-tracing teams are often unable to identify and trace all contacts in some urban and sub-urban settings, whilst the remote locations of some rural cases also present challenges. Based on the latest operational planning projections, up to 20 000 contact tracing staff may be needed to meet the UNMEER target of isolating 70% of EVD cases by 1 December, and 100% of cases by 1 January.

(...)

 

Safe and dignified burialsAt present there are approximately 140 teams trained in the management of dead bodies operating in the three intense-

transmission countries: 34 in Guinea, 56 in Liberia, and 50 in Sierra Leone. To meet the UNMEER target that 70% of burials should be carried out safely by properly trained and equipped teams by 1 December, an estimated 230 additional dead-body-management teams will be required across the three intense-transmission countries. Governments, with support from WHO and other partners, are increasing their capacity to train, equip, and deploy new teams.

 

Social mobilization

Social mobilization, including outreach to community, religious, and traditional leaders, and women and youth groups, is being intensified. Key messaging is focused on the need to isolate suspected cases early, promote safe and dignified burials for those who die, and address misperceptions, resistance, and stigma associated with EVD.

With support from UNICEF support, radio broadcasts about EVD prevention and protection reached an estimated 1.5 million listeners tuning into over 50 radio stations covering all 15 counties in Liberia last week. Two of the broadcasts featured testimonials from survivors and their families, with the aim of fostering acceptance of survivors within communities.

 

2. COUNTRIES WITH AN INITIAL CASE OR CASES, OR WITH LOCALIZED TRANSMISSION

Four countries, Nigeria, Senegal, Spain, and the United States of America have now reported a case or cases imported from a country with widespread and intense transmission.

In Nigeria, there were 20 cases and eight deaths. In Senegal, there was one case and no deaths. However, following a successful response in both countries, the outbreaks of EVD in Senegal and Nigeria were declared over on 17 October and 19 October 2014, respectively.

A national EVD outbreak is considered to be over when 42 days (double the 21-day incubation period of the Ebola virus) has elapsed since the last patient in isolation became laboratory negative for EVD.

 

Table 4: Ebola virus disease cases and deaths in Spain and the United States of America

[Country - Case definition – Cases – Deaths]

  • Spain
    • Confirmed – 1 – 0
    • Probable – * – *
    • Suspected – * – *
      • All – 1 – 0
  • United States of America
    • Confirmed – 3 – 1
    • Probable – * – *
    • Suspected – * – *
      • All – 3 – 1
  • Total – 4 – 1

_____

*No available data.

Data are based on official information reported by Ministries of Health. These numbers are subject to change due to ongoing reclassification, retrospective investigation and availability of laboratory results.

 

In Spain the single case (table 4) tested negative for EVD on 19 October. A second negative was obtained on 21 October. Spain will therefore be declared free of EVD 42 days after the date of the second negative test if no new cases are reported. A total of 83 contacts are being monitored.

In the United States of America there have been three cases and one death (table 4).

Of 172 possible contacts, 60 have completed 21-day follow-up.

A total of 112 contacts are currently being monitored in Texas.

In Ohio, 153 crew and passengers who shared a flight with the third confirmed case (prior to the case developing symptoms) are being followed-up, though they are considered low-risk.

 

3. PREPAREDNESS OF COUNTRIES TO RAPIDLY DETECT AND RESPOND TO AN EBOLA EXPOSURE

The success of Nigeria and Senegal in halting the transmission of EVD highlights the critical importance of preparedness in countries at high risk of an outbreak of EVD. Important factors in preventing the spread of EVD in both countries included strong political leadership, early detection and response, public awareness campaigns, and strong support from partner organizations.

In accordance with the UNMEER 90-day plan, strengthening the ability of all countries to respond effectively to an initial case of EVD is a mission-critical priority. Accordingly, all countries should have a protocol for suspect cases, an equipped isolation unit, a minimum stock of personal protective equipment, a case-management team trained in infection prevention and control, and a public communications strategy.

All countries bordering affected areas should have active surveillance in, and weekly reporting from, areas assessed as at the highest risk of an initial exposure. Countries will be supported with appropriate technical guidance, simulation and protocol testing, and, in case of the importation of an EVD case, a rapid response capacity. A meeting between WHO and partner organizations in Brazzaville on 10 October agreed on a range of tools to support countries unaffected by Ebola in strengthening their preparedness in the event of an outbreak. One of these tools is a comprehensive consolidated checklist of 10 core components and tasks for countries and the international community.

The checklist defines minimal required resources, and highlights key reference documents such as guidelines, training manuals and guidance notes that will help countries to implement each key component. The components are: overall coordination; rapid response teams; public awareness and community engagement; infection prevention and control; case management (divided into two components: Ebola treatment centre and safe burials); epidemiological surveillance; contact tracing; laboratory; and capacities at points of entry.

Fifteen countries that neighbour countries with widespread and intense transmission, or that otherwise have strong trade and travel ties with countries with widespread and intense transmission, will be prioritized for technical assistance on preparedness from specialist WHO teams. These countries are: Benin, Burkina Faso, Cameroon, Central African Republic, Cote D Ivoire, Democratic Republic of Congo, Gambia, Ghana, Guinea Bissau, Mali, Mauritania, Nigeria, Senegal, South Sudan, and Togo.

Beginning with missions to Cote D Ivoire and Mali, WHO teams will build on previous work with each country to help identify any gaps in their capacity to identify and respond to an initial EVD case. The programme of work will include a simulation exercise to test the performance of detection and response systems to a suspected case of EVD.

On 22 October 2014, WHO convened the third Emergency Committee on Ebola under the International Health Regulations (2005). The Committee will review the latest developments in the epidemic and advise on whether adjustments should be made to current recommendations on how to halt the spread of EVD.

(...)

 

ANNEX 2: EBOLA OUTBREAK IN DEMOCRATIC REPUBLIC OF THE CONGO

As at 20 October 2014 there have been 66 cases (38 confirmed, 28 probable) of Ebola virus disease (EVD) reported in the Democratic Republic of the Congo, including eight among health-care workers (HCWs). All suspected cases have now been laboratory confirmed or discarded. In total, 49 deaths have been reported, including eight among HCWs.

Of 1121 total contacts, 1116 have now completed 21-day follow-up. Of five contacts currently being monitored, all were seen on 20 October, the last date for which data has been reported. This outbreak is unrelated to that affecting Guinea, Liberia, Nigeria, Senegal and Sierra Leone.

(...)

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#OHIO DAILY #EBOLA #CONTACT #REPORT, 10-22-14, 11 a.m. (DoH, edited)

[Source: Ohio Department of Health, full PDF document: (LINK). Edited.]

FOR IMMEDIATE RELEASE / October 22, 2014 / Contact: State Joint Information Center, (614) 799-6480

OHIO DAILY EBOLA CONTACT REPORT, 10-22-14, 11 a.m. [      ]

COLUMBUS – The Ohio Department of Health reported this morning in its Daily Ebola Contact Report that there are currently:

  • 0 confirmed cases of Ebola in Ohio;
  • 3 people under quarantine;
  • 164 contacts statewide;

ODH’s Daily Ebola Contact Report is issued at approximately 11 a.m. and is compiled from the local health districts, ODH officials and Centers for Disease Control and Prevention (CDC) Ohio team members who are working together to identify anyone who may have had contact of some type with the Dallas nurse who was in Northeast Ohio, Oct. 10-13.

Symptoms may appear anywhere from 2-21 days after exposure to Ebola, but the average is 8-10 days.

It is anticipated that contacts will be removed from the contact list between October 31, and November 4, 2014.

The figures may change daily based on the information officials learn from contacts and the type of exposure they may have had.

The report is below and also found on ODH’s website here: http://www.odh.ohio.gov/odhprograms/dis/orbitdis/ebola/Ebola.aspx

 

OHIO EBOLA DAILY CONTACT REPORT 10/22/14 (as of 11 AM, EST of date of issuance)

SUMMARY

  • CONFIRMED EBOLA CASES – 0
  • QUARANTINED OHIOANS – 3
  • TOTAL OHIO CONTACTS – 16

_____

 

CONTACTS BY COUNTY AND TYPE

[QUARANTINE, TIER 1  - ACTIVE MONITORING, TIER 2A  - VERIFIED SELF (PHONE) MONITORING, TIER 2B  - SELF-MONITORING, TIER 3 – PENDING – TOTAL]

  • Cuyahoga – 1 – 3 – 34 – 16 – 1 – 55
  • Medina  - 0 – 1 – 4 – 5 – 0 – 10
  • Portage – 0 – 0 – 4 – 5 – 1 – 10
  • Summit – 2 – 8 – 15 – 16 – 0 – 41
  • All Other Counties * – 0 – 5 – 36 – 7 – 0 – 48
  • TOTAL – 3 – 17 – 93 – 49 – 2 – 164

_____

* 15 counties have seven or less contacts and those figures are not being broken out by county in order to protect the privacy of individual contacts. (Belmont, Erie, Franklin, Geauga, Hamilton, Hardin, Lake, Lorain, Mahoning, Putnam, Seneca, Stark, Trumbull, Tuscarawas, Wayne)

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#USA, #CDC: #Monitoring for all [#passengers] coming from #Ebola #nations (Yahoo!, October 22 2014)

[Source Yahoo!, full page: (LINK).]

CDC: Monitoring for all coming from Ebola nations [      ]

WASHINGTON (AP) — Federal health officials are significantly expanding the breath of vigilance for Ebola, saying that all travelers who come into the U.S. from Ebola-stricken West African nations will now be monitored for symptoms of illness for 21 days.

(…)

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#Saudi Arabia reported a new #MERS-CoV case; an earlier case died (@SaudiMOH, October 22 2014, edited)

[Source: Saudi Arabia Ministry of Health, full page: (LINK). Edited.]

#Saudi Arabia reported a new #MERS-CoV case; an earlier case died [      ][      ]

10/22/2014

_______

New Cases:

  1. man, 46 years old, Saudi national, resident in Medina, currently hospitalized.

Earlier reported cases discharged from hospital:

  • No reports

Deaths in previously announced cases:

  1. man, 56 years old, Saudi national, resident in Taif, with pre-existing medical condition.

_______

22-10-2014-003.jpg

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22-10-2014-004.jpg

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#Epidemiological #update: #MERS-CoV case imported to #Turkey (@ECDC_EU, October 22 2014)

[Source: European Centre for Disease Prevention and Control (ECDC), full page: (LINK).]

Epidemiological update: MERS-CoV case imported to Turkey [      ]

22 Oct 2014

On 18 October 2014, the Ministry of Health Turkey reported that a Turkish citizen working in Saudi Arabia died on 11 October 2014, ten days after onset of a confirmed MERS-CoV infection.

The case returned to Turkey on 10 October 2014. It is assumed that the case was symptomatic during the flight. The local health authorities are conducting contact tracing.

 

Worldwide situation

Overall, 906 laboratory-confirmed cases of MERS-CoV have been reported to the public health authorities worldwide, including 361 deaths as of 21 October 2014 (Figure 1).

 

Figure 1. Distribution of confirmed cases of MERS-CoV reported as of 21 October 2014, by date and place of probable infection (n=906)

______

Most of the cases have occurred in the Middle East (Saudi Arabia, United Arab Emirates, Qatar, Jordan, Oman, Kuwait, Egypt, Yemen, Lebanon and Iran) (Table 1).

Between 1 September and 21 October 2014, the health authorities in Saudi Arabia reported 29 cases, 15 of which were in Taif.

Twenty-four of them (83%) are male, of which 20 (83%) above 40 years of age.

Comorbidities were reported in 20 of the 29 cases. Four cases were reported among healthcare workers. Several cases had contact with animals, including camels, and some reported having drunk camel milk.

On 20 October, the Ministry of Health of Saudi Arabia issued a press release about the implementation of measures to control the cluster of cases in Taif, in particular addressing the dialysis units

 

Table 1. Number of confirmed cases and deaths, by country of reporting as of 21 October 2014

[Reporting country – Cases – Deaths - Date of onset/reporting for most recent cases]

  • Middle East
    • Saudi Arabia – 771 – 328 - 21/10/2014
    • United Arab Emirates – 73 – 9 - 11/06/2014
    • Qatar – 8 – 4 - 12/10/2014
    • Jordan – 18 – 5 - 23/05/2014
    • Oman – 2 – 2 - 20/12/2013
    • Kuwait – 3 – 1 - 07/11/2013
    • Egypt – 1 – 0 - 22/04/2014
    • Yemen – 1 – 1 - 17/03/2014
    • Lebanon – 1 – 0 - 22/04/2012
    • Iran – 5 – 2 - 25/06/2014
  • Europe
    • Turkey – 1 – 1 - 06/10/2014
    • Austria – 1 – 0 - 29/09/2014
    • United Kingdom – 4 – 3 - 06/02/2013
    • Germany – 2 – 1 - 08/03/2013
    • France – 2 – 1 - 08/05/2013
    • Italy – 1 – 0 - 31/05/2013
    • Greece – 1 – 1 - 08/04/2014
    • Netherlands – 2 – 0 - 05/05/2014
  • Rest of the world
    • Tunisia – 3 – 1 - 01/05/2013
    • Algeria – 2 – 1 - 24/05/2014
    • Malaysia – 1 – 1 - 08/04/2014
    • Philippines – 1 – 0 - 11/04/2014
    • United States of America – 2 – 0 - 01/05/2014
  • Total – 906 – 361

_____

 

Geographical distribution

All cases reported outside of the Middle East have had a recent travel history to the Middle East or contact with a case who had travelled from the Middle East (Figure 2).

 

Figure 2. Geographical distribution of confirmed MERS-CoV cases and place of probable infection, worldwide, as of 21 October 2014 (n=906)

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Conclusions

  • The incidence of cases in September and October 2014 is slightly higher than in July and August 2014.
    • This pattern was also observed in 2012 and 2013.
    • The majority of MERS-CoV cases are still being reported from the Arabian Peninsula, specifically from Saudi Arabia, and all cases have epidemiological links to the outbreak epicentre.
  • According to the pattern observed in 2012 and 2013, more cases could be observed in the coming weeks.
  • The latest importation to the EU (Austria) and to Turkey are not unexpected and do not indicate a significant change in the epidemiology of the disease.
    • Importation of MERS-CoV cases to the EU remains possible.
    • However, the risk of sustained human-to-human transmission remains very low in Europe.

 

Further Reading

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#Ebola, La #vigilance reste en vigueur en #Algérie (Le Temps d'Algérie, October 22 2014)

[Source: Le Temps d’Algérie, full page: (LINK).]

La vigilance reste en vigueur en Algérie [      ]

Virus Ebola / La vigilance reste en vigueur en Algérie. «Aucun cas d'affection par le virus Ebola n'a été enregistré, mais la vigilance reste en vigueur en Algérie. Notre dispositif anti-Ebola et coronavirus est réévalué régulièrement par un comité d'experts pour éviter tout risque de contamination», a indiqué hier un responsable du ministère de la Santé.

(…)

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#Ebola: #Newark, #Plane #passenger hospitalized after screening (CBS News, October 22 2014)

[Source: CBS, full page: (LINK).]

Plane passenger hospitalized after Ebola screening [      ]

NEWARK, N.J. -- An airline passenger was being evaluated at a hospital in Newark Tuesday due to Ebola concerns, reports CBS New York. Centers for Disease Control and Prevention spokesperson Carol Crawford said the passenger was "identified as reporting symptoms or having a potential exposure to Ebola" during the enhanced screening process for those arriving in the U.S. from the West African nations of Liberia, Sierra Leone and Guinea.

(…)

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Mosquito-borne #chikungunya virus has infected more than 200 #Canadians (CTVNews.ca, October 22 2014)

[Source: CTV, full page: (LINK).]

Mosquito-borne chikungunya virus has infected more than 200 Canadians [      ]

Health Canada says more than 200 Canadians have been infected by a virus that has sickened hundreds of thousands of people in the Caribbean and spurred a state of emergency

(…)

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Two #Passengers From #Liberia To #Chicago Quarantined (CBS Chicago, October 22 2014)

[Source: CBS, full page: (LINK).]

Two Passengers From Liberia To Chicago Quarantined [      ]

(CBS) – Two passengers who were reportedly sick while traveling to Chicago from Libera are being quarantined at Chicago hospitals, according to the Mayor’s Office.

(…)

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