/ 23 October 2014

Don’t screen, follow Nigeria’s lead

Don't Screen, Follow Nigeria's Lead

Screening for passengers arriving at airports in the United Kingdom and United States will have little chance of detecting someone infected with the virus and will cost money that could be better spent, a paper in the Lancet medical journal warned this week.

The findings come as Gatwick airport announced it will begin screening passengers arriving from countries at risk of Ebola. Heathrow airport began screening last week.

The authors say that restricting air travel from Guinea, Sierra Leone and Liberia, where the epidemic is at its worst, is damaging to those countries’ economies and may potentially handicap efforts to end the Ebola outbreak.

The paper is written by Dr Kamran Khan of St Michael’s Hospital in Toronto, and colleagues. The team, which calculated that fewer than three people a month infected with Ebola are likely to try to board planes out of West Africa, argue that exit screening in the capital cities of Conakry, Freetown and Monrovia “would offer greater efficiency, and might be simpler to operationalise, than entry screening all flights arriving directly from affected countries”.

But such a move needs support from the international community. A lot of attention has been focused on ways in which affluent countries can protect their populations, said Khan. But, he said, “the most proactive way is to decrease the many new infections in the source region itself”.

His argument was reinforced this week when Nigeria was declared Ebola-free in what the World Health Organisation’s director for Nigeria, Rui Gama Vaz, described as a “spectacular success story”. The way they beat the virus could serve as a model for the rest of the world.

See Rednecks have no space and Ebola flight risk fears ungrounded

The outbreak began in Nigeria when a Liberian man, Patrick Sawyer, flew to Lagos on July 20 against medical advice. He was visibly ill when he boarded the plane and collapsed at the airport, but was treated for malaria because he denied he had been in contact with Ebola. It took three days, during which time nine medical staff nursing him became infected, four of whom later died, before Ebola was diagnosed and he was placed in isolation. He died two days later.

As soon as the virus was confirmed, a massive public health effort began. Every person who may have been exposed to the virus had to be found and isolated if they developed symptoms. Even though that involved hunting through crowded buildings in streets without door numbers, Nigerian teams managed to trace everyone who had been in contact with Sawyer and everyone who had contact with those who later developed the disease.

In total, 19 people became ill in Nigeria, seven of whom died. It could have been much worse in Nigeria’s densely populated cities – there are 21-million people in Lagos. But Nigeria set up an emergency operations centre, staffed with many experts who work on polio eradication.

According to a paper written by some of those involved, in the journal Eurosurveillance, the list of contacts reached 898, and they were not all in Lagos. A nurse who became infected travelled about 500km to Enugu, finding at least 21 contacts. But the biggest crisis was caused by one of Sawyer’s contacts, who had been infected, fleeing to Port Harcourt, where he infected a doctor. That doctor, who died, was linked to 526 contacts, including many members of his church who carried out a healing ceremony for him involving the laying on of hands. In total, the contact tracers made 18 500 face-to-face visits. Their persistence paid off.

Meanwhile in the US, the first wave of people who may have had contact with Thomas Eric Duncan have been declared Ebola-free after 21 days of twice-daily temperature checks, bringing welcome news to a Dallas hospital that was sent into a tailspin by the discovery of the virus.

No longer at risk
At least 43 of the 48 people who may have come into contact with Duncan, the first person to be diagnosed with Ebola in the US, are no longer at risk of developing the virus, the Texas department of health announced in a statement on Monday. Duncan died from Ebola on October 8.

Teresa Romero, the Spanish nursing auxiliary who earlier this month became the first person to contract Ebola in Europe, was this week judged to have been cured. Doctors said earlier that her appetite had improved to the point that she was demanding “jamon and chorizo”.

Madrid health authorities have claimed that Romero contracted the disease after touching the face of the Spanish missionary she was treating.

However, she said that she had no memory of this. “If something like that had happened I would have told you,” she is reported to have told her husband.

Romero was treated with a combination of serum made up of antibodies extracted from Ebola survivors and anti-viral drugs.

However, experts warn that the antiviral is experimental and has only been tested on mice. The possible side-effects on humans are not known. – © Guardian News & Media 2014, additional reporting by Stephen Burgen and Lauren Gambino