Nigeria to get Ebola drug from Japan

Nigeria was set to receive the antiviral drug Favipiravir from Japan as a possible Ebola treatment, the Health Ministry said on Monday.

Favipiravir, developed by the Japanese pharmaceutical company Fujifilm Holdings, was available for immediate delivery, Health Minister Onyebuchi Chukwu said during an emergency meeting in the capital, Abuja

The drug was approved to treat the flu by the Japanese health ministry in March. Fujifilm Holdings is in talks with the US Food and Drug Administration to begin clinical testing of Favipiravir as an Ebola treatment.

"It is shown to have strong antiviral property against the Ebola virus" in the lab and in patients, the minister said as the Ebola outbreak continues to accelerate in West Africa with the death toll now estimated at 1 552, according to the World Health Organization (WHO).

The Geneva-based WHO said 3 069 suspected or confirmed cases had been reported in Guinea, Liberia, Nigeria and Sierra Leone.

Enough dosages of Favipiravir to treat about 20 000 patients were available.

Nigeria also applied for the experimental Ebola drug TKM-Ebola, Chukwu said.

TKM-Ebola was tested for safety in a small number of humans, but the trial was halted in January when one volunteer developed moderate gastrointestinal side effects.

Nigeria also offered to participate in clinical trials for two Ebola vaccines, the health minister said.

Success rate

In Liberia, two Ebola-infected health workers who were treated with the experimental drug ZMapp have recovered, the health ministry said on Monday.

A third physician treated there with ZMapp, Abraham Dorbor, died last week.

The two doctors who recovered, a Nigerian and a Ugandan working in Liberia, had received ZMapp treatment since 10 August, ministry spokesperson John Sumo said. They were discharged from a treatment centre in the capital, Monrovia, at the weekend.

Two US health workers, Kent Brantly and Nancy Writebol, who had contracted Ebola in Liberia, were discharged in mid-August from a hospital in Atlanta, where they had been treated with ZMapp.

Spanish priest Miguel Pajares, however, died from Ebola in a Madrid hospital after his evacuation from Liberia despite also receiving ZMapp.

Ebola causes massive haemorrhaging and is transmitted through contact with blood and other bodily fluids. If left untreated, it has a fatality rate of up to 90%.

Read More

Woman tests positive to Ebola as Nigeria seeks drug from Japan

A medical doctor and a pharmacist who were quarantined at the Rivers State Ebola treatment centre have been discharged, having tested negative to the deadly disease.

They were among the personnel who managed the late Dr. Ikechukwu Sam. Enemuo at his SamSteel Hospital  in Port Harcourt when he became symptomatic of Ebola disease. He died penultimate Friday in another hospital.

The doctor and pharmacist were his workers. They had feverish conditions as high as could suggest the disease, and were quarantined on Saturday alongside Enemuo’s hospital room mate at Good Hart Hospital where he died. Their test results were negative and they have been released from the centre, but the ex-Good Hart patient was not that lucky. She tested positive to the virus and is receiving treatment at the centre.

Commissioner for Health Dr. Sampson Parker, in a situation report he released yesterday in Port Harcourt, the state capital, said the late Enemuo’s sister in-law, simply identified as Chinyere, who was with him during his illness,  had been admitted at the quarantine centre.  She ran off to Abia State after the death of her in-law, but has been brought back by the Ebola Emergency Operation Committee (EOC). She became feverish in Port Harcourt and was isolated. Her test result is being awaited.

The Commissioner said over 200 contacts of the late Enemuo had been traced and put under watch; 50 of them are classified high-risk and 60 are in hiding. He appealed to them to come out, so they could be monitored for their safety and that of the public. The disease, said Parker, could be treated if discovered on time .

Parker noted that the contacts that ran to Imo and Benue states had been  called back  to Port Harcourt, but that of Akwa-Ibom could not be reached. He said the assistance of the State Security Services (SSS) in Akwa-Ibom State had been employed to track and send her back to Port Harcourt.

The commissioner said four doctors, eight nurses and six expatriates, all volunteers, are working at the centre while another batch is under going training to join them.

Parker said the Federal and State governments were not relenting in their efforts to ensure that the virus does not claim more lives in the country. Three medical doctors, including Enemuo, have died of the virus.

The late Enemuo contracted the disease when he treated a Nigerian diplomat, Oluibukun Koye, who had contact with the index case,  Liberian-American Patrick Sawyer.

Koye sneaked into Port Harcourt from the Lagos Isolation centre where he was placed under watch. He is alive and well.

To forestall Ebola’s spread, the remains of Enemuo and several others at the University of Port Harcourt (UPTH) mortuary would be buried in Port Harcourt this week, under the supervision of the World Health Organisation (WHO).

Parker classified the bodies as high-risk, adding that they would not be allowed to leave Port Harcourt.

He said: “Dr. Enemuo’s sister in-law, who ran off to Abia State after the death of her in-law, has returned to Port Harcourt. She has become symptomatic and now at the treatment centre.

“Results of the three patients we earlier admitted at the centre are out; two of them tested negative, one tested positive. The two persons who tested negative have been discharged and have left. However, we will repeat the test after 21 days.

“The one tested positive person shared room with late Enemuo at the Good Hart Hospital.

“As we continue together in this fight, it is important that you be vigilant. In fact we screen ourselves in our Ebola Emergency Operation Committee (EOC) meetings now, in-case there was any error made in the field.

“Country Director of World Health Organisation(WHO) and Director of National Centre for Disease Control were with us in the meeting and we have decided that within this week, Enemuo’s body and other high-risk bodies in UPTH mortuary will be buried according to WHO protocol, meaning that they will not leave Port Harcourt.

“The government will not allow the movement of either Enemuos’ body or any of those considered high-risk to leave Port Harcourt. They will be buried under the supervision of WHO, officials of the Ministry of Health and other officials, so that we don’t expose the relatives to danger.

“We will take care of all the safety measures, families/relatives of the bodies will all be there to do whatever rite they want to do for their deceased, but we will not allow them to touch the body. Management of the bodies will be strictly under WHO protocols.

“And I can tell you here that none of the people involved in managing Ebola patients both here (Port Harcourt) and Lagos has had any issue; there is high mark of safety for Nigerians in this business.

“Let me assure you again that Ebola Virus Disease is not a death sentence, in as much as we get those that have contracted it early.

“We still want to encourage those persons that are listed that we have not seen, to come up. We have a lady that went to Akwa-Ibom State from the hotel; we are still to get to her, we’ve sent her trackmen through the SSS officials to Akwa Ibom, the one that went to Imo State returned yesterday, she is still ok, but we don’t want to take chances. We don’t want to fall into the same trick Oluibukun Koye played us here in Port Harcourt.”

At the treatment centre are four doctors, eight nurses and six expatriate officials (Doctors without Border) – all volunteers. The number is still counting, because we have sent in more volunteers for training before they could be allowed to go to the treatment centre.

Parker added: “We have earlier trained over 500 people on Ebola management in our on-going training for health officials in the state, but we considered it necessary to yet train those that have volunteered at the centre before we can allow them to operate.

“Like Enemuo wore protective gadgets, but the issue is not wearing it to do the job; the issue is on removing the gears; that is the point at which the infection is contracted.”

Reacting to a statement credited to the Minister of State for Education Nnyesom Wike, on the disease in Rivers State, Parker described him as “an apology”.

Wike reportedly said the spread of the disease into the state was as a result of the government’s insensitivity. The commissioner expressed regrets at Wike’s statement, saying that the state made a big mistake by nominating him to the Federal Government for ministerial appointment.

He said how the virus entered the state was common knowledge, adding: “The best thing is to ignore him, because if I don’t ignore him, it means that he does not even respect his boss the President of Nigeria. The only thing I will say is that maybe we will apologise to the President for nominating him for minister. This is because everybody is now aware of how we got into this challenge; so if a minster of state does not still know, I’m getting very worried that we have done disservice to the government.

“His colleague in the cabinet, the minister of health, has made a broadcast, where he explained how the whole thing happened, not commissioner for Health , but the minister.

“I don’t know what he means by insensitivity. This is a government that before the outbreak, we had spent so much money to go for personal protective equipment, sent officials to go and see how the thing is done, came back and been training members of staff, in case it happens. As at today we have trained more than 500 staff in preparation for Ebola, and someone is saying it is insensitivity.”

Parker went on: “We are not kind of mood and we should not mix politics with what we are doing. Other people are asking us what they can do to help; that is what he should do, he is a Rivers man and should be concerned about the challenge in the state now and rally round the government to face the problem, irrespective of our party affiliation.

“Nobody can fault the health system of Rivers State. Nobody can throw stone on it, because it is unbeatable.

“We are not talking of mass failure in WASC; we are faced with something else now, so we are not talking about that.” He said.

Read More

Health workers death toll mounts in W.Africa as Ebola spreads

Nigeria's health minister will hold an emergency meeting of state health commissioners on Monday as West Africa struggles to halt the deadly Ebola virus, amid growing concern at the toll among healthcare workers.

Nigeria on Sunday confirmed a fresh case of Ebola in a doctor whose husband died from the virus, adding to a growing list of those providing healthcare in West Africa to be hit by the epidemic.

The woman's husband was also a doctor who died in the city of Port Harcourt on August 22 after treating a patient who had contact with the Liberian man who brought the virus to Nigeria in late July.

She was in a stable condition at an isolation unit in the financial capital, Lagos, said Sampson Parker, the health commissioner of Rivers State, of which Port Harcourt is the capital.

Nigeria's medics have paid a heavy price in the outbreak: of the six people who have died from the disease in Africa's most populous nation, two have been doctors and two others nurses.

Another doctor and a pharmacist were put into isolation at a unit outside Port Harcourt, Parker said.

The Nigerian health officials meeting Monday are not the only ones in the region struggling with the problem of how to treat victims of the deadly virus while protecting those treating them.

The World Health Organization has voiced concern about the "unprecedented" number of healthcare workers hit by the Ebola outbreak. More than 120 health workers have died and over 240 others infected so far.

The disease has killed a total of 1,552 people and infected 3,062 as of August 26, according to WHO figures.

In Guinea, where 430 people have died, nurses told AFP they lacked basic medical equipment to treat patients and had even bought items such as gloves and protective clothing themselves.

- Travel restrictions -

In Senegal, doctors were treating a young Guinean man who became the country's first confirmed case of the disease. He was said to be in a "satisfactory" condition in hospital on Saturday.

The case lends credence to fears that the haemorrhagic fever, for which there is currently no vaccine, is spreading rapidly.

Stockholm authorities on Sunday said a suspected case of Ebola had been discovered in the Swedish capital. A local health specialist told AFP the patient was from an African country and had arrived in Sweden a few days ago.

At current infection rates, the WHO fears it could take six to nine months and at least $490 million (373 million euros) to bring under control, by which time over 20,000 people could be affected.

In Liberia, which has been hardest-hit by the outbreak with 694 deaths, the government has denied permission for any crew to disembark from ships docking at any of the country's four ports.

Medical screening of passengers was also causing long delays at Monrovia's international airport, but a 21-day quarantine thrown around the city's West Point neighbourhood was lifted on Saturday.

Air travel to west Africa has been badly hit by the disease. Eight of the 11 international airlines serving Monrovia have suspended flights, including British Airways and Air France.

The WHO and the west African regional bloc ECOWAS have both called for travel bans to be lifted, saying medical screening should identify at-risk passengers instead.

- Football qualifiers -

The Ebola crisis has also cast doubt over a number of international football fixtures involving the worst-hit countries, with qualifying beginning next week for the 2015 Africa Cup of Nations.

Sierra Leone, where 422 people have died so far, named a 20-man squad consisting entirely of foreign-based players for its matches against Ivory Coast and the DR Congo.

Ivory Coast's government has refused to allow the game to be played in Abidjan and not announced an alternative venue. The Ivorians risk forfeiting the match if they fail to show up.

Ebola-linked restrictions have led to sporadic violence in recent weeks. In Guinea, 55 people were injured in the second-largest city N'Zerekore after two days of protests this week over a government-imposed curfew.

The WHO has credited public health campaigns, especially in Guinea and Nigeria, for limiting the transmission of Ebola.

Guinea-Bissau, currently Ebola-free, on Saturday announced a national hygiene drive, with the cleaning and disinfection of public places on the last Saturday of every month.

Nigeria, however, has seen its hopes of containing the virus dashed with the outbreak in its oil-producing hub, 435 kilometres (270 miles) east of Lagos.

The city is home to a number of global oil and gas majors. Anglo-Dutch giant Shell and France's Total said this week that the arrival of Ebola has not affected operations.

Chevron said it, too, was closely monitoring developments and implementing "precautionary measures" for its work force.

Read More

Ebola is not a “zombie disease,” China’s state-owned media affirms

“Expert: There is no evidence that coffee and onions cure Ebola.”

That’s the headline of a public service article on Xinhua (link in Chinese), China’s official news agency, that aims to dispel “internet rumors” about the virus that has killed more than 1,000 people in West Africa. Having thusly dispatched the rumor that a coffee-onion blend can cure the disease, Xinhua took on rumor number two: “Ebola leads to the appearance of the ‘living dead.'”

Images and lore of Ebola’s spread, and of the fever’s horrific consequences, have been shared across the world, and the Chinese internet in particular seems to have incubated some outlandish theories. Addressing these, Xinhua first debunks the notion that Ebola has made its way into China. (There was some concern that a man who traveled from Nigeria to Shanghai had contracted the disease, and a woman in Hong Kong tested negative after returning from Africa.)

Xinhua promised readers that, contrary to chatter on the internet, Ebola is not a “zombie disease.” But the agency’s attempt to allay readers’ fears of reanimation actually isn’t particularly reassuring.

“An Ebola sufferer may lose consciousness or faint, making him or her appear dead,” Xinhua explains. “But a few hours or even days later the patient may suddenly come to and enter an extremely violent state, tearing at and biting anything that moves, including people and animals.”

This suggestion is itself highly suspect. Violent episodes could conceivably happen as the result of an extreme hallucinogenic fever brought on by Ebola, but Quartz hasn’t been able to find any reports of the phenomenon described in Xinhua. Most of the violence related to the Ebola outbreak so far has been the work of uninfected locals who have attacked international health organizations they think are responsible for bringing the disease to them.

Xinhua’s article finally comforts readers by assuring them that Ebola is in fact extremely deadly. “The scariest thing about Ebola is the high death rate,” Xinhua concludes. “There have never been cases of Ebola sufferers becoming zombies and attacking people. That can only happen in movies.”

Read More

Liberia's Ebola problem far worse than imagined, says WHO

The World Health Organization (WHO) has released a statement saying problems related to the Ebola outbreak in Liberia are increasingly dire.

Situation in Liberia: non-conventional interventions needed

8 September 2014

During the past weeks, a WHO team of emergency experts worked together with President Ellen Johnson Sirleaf and members of her government to assess the Ebola situation in Liberia.

Transmission of the Ebola virus in Liberia is already intense and the number of new cases is increasing exponentially.

The investigative team worked alongside staff from the Ministry of Health, local health officials, and other key partners working in the country.

All agreed that the demands of the Ebola outbreak have completely outstripped the government’s and partners’ capacity to respond. Fourteen of Liberia’s 15 counties have now reported confirmed cases.

Some 152 health care workers have been infected and 79 have died. When the outbreak began, Liberia had only one doctor to treat nearly 100,000 people in a total population of 4.4 million people. Every infection or death of a doctor or nurse depletes response capacity significantly.

Liberia, together with the other hard-hit countries, namely Guinea and Sierra Leone, is experiencing a phenomenon never before seen in any previous Ebola outbreak. As soon as a new Ebola treatment facility is opened, it immediately fills to overflowing with patients, pointing to a large but previously invisible caseload.

Of all Ebola-affected countries, Liberia has the highest cumulative number of reported cases and deaths, amounting, on 8 September, to nearly two thousand cases and more than one thousand deaths. The case-fatality rate, at 58%, is also among the highest.

Situation in Montserrado county

The WHO investigation concentrated on Montserrado county, which includes Liberia’s capital, Monrovia. The county is home to more than one million people. The teeming West Point slum, which has no sanitation, little running water, and virtually no electrical supplies, is also located in Monrovia, and is adjacent to the city’s major market district.

In Montserrado county, the team estimated that 1000 beds are urgently needed for the treatment of currently infected Ebola patients. At present only 240 beds are available, with an additional 260 beds either planned or in the process of being put in place. These estimates mean that only half of the urgent and immediate capacity needs could be met within the next few weeks and months.

The number of new cases is moving far faster than the capacity to manage them in Ebola-specific treatment centres.

For example, an Ebola treatment facility, hastily improvised by WHO for the Ministry of Health, was recently set up to manage 30 patients but had more than 70 patients as soon as it opened.

WHO estimates that 200 to 250 medical staff are needed to safely manage an Ebola treatment facility with 70 beds.

The investigation team viewed conditions in general-purpose health facilities as well as Ebola-specific transit and treatment facilities.

The John F Kennedy Medical Center in Monrovia, which was largely destroyed during Liberia’s civil war, remains the country’s only academic referral hospital. The hospital is plagued by electrical fires and floods, and several medical staff were infected there and died, depleting the hospital’s limited workforce further.

The fact that early symptoms of Ebola virus disease mimic those of many other common infectious diseases increases the likelihood that Ebola patients will be treated in the same ward as patients suffering from other infections, putting cases and medical staff alike at very high risk of exposure.

In Monrovia, taxis filled with entire families, of whom some members are thought to be infected with the Ebola virus, crisscross the city, searching for a treatment bed. There are none. As WHO staff in Liberia confirm, no free beds for Ebola treatment exist anywhere in the country.

According to a WHO staff member who has been in Liberia for the past several weeks, motorbike-taxis and regular taxis are a hot source of potential Ebola virus transmission, as these vehicles are not disinfected at all, much less before new passengers are taken on board.

When patients are turned away at Ebola treatment centres, they have no choice but to return to their communities and homes, where they inevitably infect others, perpetuating constantly higher flare-ups in the number of cases.

Other urgent needs include finding shelters for orphans and helping recovered patients who have been rejected by their families or neighbours.

Last week, WHO sent one of its most experienced emergency managers to head the WHO office in Monrovia. Coordination among key partners is rapidly improving, aiming for a better match between resources and rapidly escalating needs.

Implications of the investigation

The investigation in Liberia yields three important conclusions that need to shape the Ebola response in high-transmission countries.

First, conventional Ebola control interventions are not having an adequate impact in Liberia, though they appear to be working elsewhere in areas of limited transmission, most notably in Nigeria, Senegal, and the Democratic Republic of Congo.

Second, far greater community engagement is the cornerstone of a more effective response. Where communities take charge, especially in rural areas, and put in place their own solutions and protective measures, Ebola transmission has slowed considerably.

Third, key development partners who are supporting the response in Liberia and elsewhere need to prepare to scale up their current efforts by three- to four-fold.

As WHO Director-General Dr Margaret Chan told agencies and officials last week in New York City and Washington, DC, development partners need to prepare for an “exponential increase” in Ebola cases in countries currently experiencing intense virus transmission.

Many thousands of new cases are expected in Liberia over the coming three weeks.

WHO and its Director-General will continue to advocate for more Ebola treatment beds in Liberia and elsewhere, and will hold the world accountable for responding to this dire emergency with its unprecedented dimensions of human suffering.

Read More