WHO prioritises world Epidemic Threats

A panel of experts met at WHO Geneva this week to prioritise the top five to ten emerging pathogens likely to cause severe outbreaks in the near future, and for which few or no medical countermeasures exist.

These diseases are a blueprint for R&D preparedness to help control potential future outbreaks.

The initial list, to be reviewed annually, comprises:

Three other diseases were designated as ‘serious’, requiring action by WHO to promote R&D as soon as possible; these were chikungunya, severe fever with thrombocytopaenia syndrome, and Zika.

Other diseases with epidemic potential – such as HIV/AIDS, Tuberculosis, Malaria,Avian influenza and Dengue – were not included in the list because there are major disease control and research networks for these infections, and an existing pipeline for improved interventions.

Sierra Leone is at ZERO – it’s official!

On Sat Nov 7th, WHO officially declared Sierra Leone free of Ebola – after 42 Ebola-free days.

I have watched and waited for each of the 42 days and on Sat Nov 7th, while in USA, I sat at my laptop watching the National Ebola Response Centre‘s Ebola Clock click the seconds down to ZERO .

Surprisingly the website did not erupt into digital fireworks as I expected, perhaps because they are now on a 90 days of enhanced surveillance as it is not quite “over” – neighbouring Guinea still has a few Ebola cases.

What I guarantee is the music- and fun-loving people of Sierra Leone will be celebrating for days, maybe weeks. God knows they deserve it!

It was a privilege to be a tiny part of the recovery.

Travel history is essential – not just for Ebola

There are many lethal, more frequently occurring diseases than Ebola, entering our countries.

Recently, on the chat room of USA Assoc. for Professionals in Infection Control & Epidem (APIC), members have asked how much longer hospitals should ask patients about overseas travel (to alert staff for Ebola).

Malaria is another reason why travel history must CONTINUE to be sought.

Several decades ago as a Malariologist in a developing country, I strove to remind colleagues in developed countries to ALWAYS ask a travel history when any patient presented with fever, chills or headache (FC&H). I have seen a patient walk in unassisted with FC&H at 5pm, and die from P. falciparum cerebral malaria at midnight.

The deaths of two tourists from cerebral malaria in a Springfield Missouri motel last month shows how rapidly and insidiously this disease can kill travelers. And underpins why travel history is essential if patients present with fever to an emergency dept.

In 2011 USA hit an all-time high with nearly 2,000 cases of malaria being diagnosed in travellers. In 2012 1,687 cases of Malaria were diagnosed in USA, with 1,683 (99.8%) occurring in travelers. Six of the cases died.

Ebola pales into the background in the face of other imported diseases for which a travel history is needed for diagnosis.

Sierra Leone Ebola surge – curfew needed

You probably noted my excitement, after I returned from Sierra Leone, when a week of “zero” days occurred in early May. However recently in Port Loko and Kambia cases have surged and the President has declared a 21 day dusk-to-dawn curfew in these districts .

The graph below (compiled from Ministry Reports) shows why the decree was issued – cases had fluctuated from 0 to 2 per day, but in the last two weeks, 5 cases were reported in one day, then 9 on another, all from the two districts. 15 cases in one week is the highest since March.

Of the recent cases some have occurred in individuals unlinked to known cases, and others in areas free of cases for over 40 days – two signs of loosening of behaviours. The good news is that the previous “hotspot”, Freetown Western Urban, had zero cases – the first time in 10 months.

WHO in their latest summary, said the decline had “stalled”. I feel sad for the people of the two curfew districts – and for the contact tracers – and all aid workers and national staff arduously trying to reach zero.

Hopefully in this Ebola warzone, the curfew is the last offence needed to win the battle.

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Handling New Zealand’s 1st Ebola suspect- excellent test of smooth planning

There is no substitute for repeated, detailed practice.

Ruth Barratt’s Open Access Case Report this week in Healthcare Infection is testimony to thorough planning and training, with the “real run” showing improvements can still be made.
The Report is a clear expose of the importance of Infection Prevention and Control and the availability, use, suitability and shortfalls of Personal Protective Equipment (PPE).
Having returned from Sierra Leone, I can confirm Barratt’s “real-life” is “real-life”. Her emphasis on the necessity of preparedness through practice drills, reflects that required in Ebola Red Zones.
Other mirrorings they found were:
• Staff preferring certain PPE over others (WHO state gown+hood vs coverall is personal choice – there is no evidence one is safer over other, and staff may find gown safer through familiarity, and, in certain cultures, more gender-acceptable);
• Fogging of eye-protection (CDC now recommends face-shields over goggles and many Red Zone staff leave face-shield bottoms outside their hood). Some Ebola Red Zones rub toothpaste on inside of lenses as a defogger (an old SCUBA-diving technique);
• Swapping thick outer gloves for long-cuff surgical outer gloves aids dexterity – others agree;
• Locating in-country sources for preferred PPE;
• Some PPE items being too small for taller/larger staff;
• Gowns not lasting (UNICEF recently published recommended product-specifications for PPE).

The author stressed the importance of having a trained observer in addition to a “buddy”. In Ebola Red Zones such observers are called “hygienists” and their calm, talking-through of each PPE-removal step is considered a God-send by near-exhausted staff.

The patient (who proved Ebola negative) was an Ebola-trained nurse – and assisted the staff with some of her own care and gave feedback on their procedures!

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Sierra Leone – helping rebuild the local school

Walking by the local village, angelic children’s voices singing “ABCDEFG” enticed me to a dilapidated hut.

Through the broken doors I saw a room with about 30 children – who immediately stood and chanted in perfect unison, “Good afternoon sir“. I don’t know who had the biggest grin, the children or me!

I’d passed the small hut many times and never knew it was a school. It is voluntary, and Bailor and assistant-teacher Mustapha, unpaid. Classes are conducted six days a week from 3-6pm and on Saturdays they ask a 1,000 Leones (20 cents) “fee” from those who can afford it. few attend on Saturday.

In an impromptu geography quiz (“Where do you think I come from”), I noticed they had no map so my wife Jenny and I bought books, pencils etc and a large wall atlas – the children recognized Africa, and pointed to Sierra Leone – but couldn’t quite fathom New Zealand’s distance. And couldn’t believe NZ had fewer people than their country.

The school, originally built by a UN peacekeeping contingent from Mongolia in 2008, was in a poor state and on one of my visits Bailor gently asked could we help fund the repair of the leaking school. I suggested he obtain a quote and Momoh Sesay the village Chairperson, upon hearing this, took the lead. Momoh is an engineer, (unemployed since Ebola – as were most in the village) and next day he had a detailed written quote for me – $900! Low, because he would use the unemployed builders, painter and artist in the village.

I mentioned the project to WHO colleagues and without exception, all donated and raised the $900. After giving Momoh Sesay and the teachers the go-ahead, the village was soon abuzz. Leaving the following Wednesday, I was sad not to be able see the project finished . No problem they said “We’ll start tomorrow and finish it before you go“.

They started that Friday 8am and worked 5 days straight including Sunday, (“God will forgive us for not attending church”). At one stage I counted 15 men, women and paint-covered children lending a hand – the village was proudly rebuilding their own school.

I suggested we preserve the Mongolian’s original painted animals (a panda, two lions and Pooh Bear) so I borrowed a hacksaw blade from my hotel and showed some helpers how to cut out the animals from the original plywood walls – by day’s end they had all four neatly cut out and edges sanded. The village artist bought paints and restored each animal to its former glory and attached them to the new walls – big smiles abounded! And he skillfully painted a sign acknowledging the WHO Ebola response team’s donation.

The finished school was fitted with mosquito netting all round and we had a grand opening Tuesday evening!

Momoh Sesay’s wife, Aisha, cooked all day and WHO staff and villagers reveled in the grand opening party. Aisha is Head of the nearby Dance Academy (they’ve performed nationally and internationally but had only had 2 engagements since Ebola) and she brought her dancers and drummers and “Rubberman”, the troupe’s contortionist – and the dusty street was transformed into a festive stage.

What a profound, humbling, once-in-a-lifetime experience.

Day 45: A single-digit week and schools opening!

Single digit. Last week was first with single digits – 9 cases – helped by 3 zero days. Now striving for first zero week. I’d love to see it before I leave – SL’s have had hell for 12 months – over 12,000 cases, nearly 4,000 deaths, many children. 221 healthcare workers died.
Tents galore with primary school in background	Schools in! After a year of closure, excitement is palpable – schools open Tues! There’s been intense decommissioning of temporary (now surplus) Ebola centres – many erected on school grounds. Teams in protective gear sweated to ensure schoolyards were handed back safe and clean – many with a new coat of paint. Many workers can sustain 45mins in the suits outdoors – I lasted 25mins indoors. Some schools had many tents erected, cement paths laid, latrines dug, etc., and at handback don’t want any evidence whatsoever – major logistics!Our task is to ensure the 2000 odd HCW (all trained well in “Ebola”) are upskilled in basic “Infection Prevention & Control” before resuming their former hospital roles. NB. IPC did not exist in SL before Ebola
Burying stigma.Try as we may, it is hard to neutralize the “Ebola” stigma attached to materials reclaimed from previous Ebola centres (some in unused boxes in store). As a greenie it is hard and staff aggressively cull materials so that receivers are absolutely assured of safety, The rest is burnt or buried. These beds didn’t pass cull.
What a treat to train this group of Port Loko drivers, sprayers & car washers from PLAN. Friday is “Mufti” – you wear “Afrikana” – they said I blended in well but for the hair!
The brave haircut. Talking of hair – some aid workers go without a haircut for their deployment – after all, scissors are a “sharp”. But I am now freshly shorn as I found a barber who changed his gloves between clients and disinfected all his clippers and scissors with alcohol-spray between uses – the cut was $8 – I gave him extra $2 for getting A+ in hygiene – and asked him did he want a job in Infection Prevention!
Stayed in Port Loko IHP-DEMA Tent City again – their drone takes excellent aerials!
Evidence-based decisions at the edge. In Infection Prevention and Control, we strive to ensure all our recommendations to colleagues and clients are evidence-based and guidance from CDC, WHO and our Professional Associations enables us to pretty well achieve this. This Ebola epidemic, in a poverty-stricken country, has raised questions that push us hard. I can’t thank enough our international IPC consultants here in WHO and CDC, whose combined knowledge is enabling us to make practical and safe decisions at the edge of evidence.
If you would like to receive a new post alert –sign up at bottom of page. I won’t hassle you, ever. Best regards, Terry. PS. Strange feeling – I have just 3 weeks before my deployment ends.

Sierra Leone Day 36: ZERO again! Lockdown, Tragic tryst & Hospital fear

Yesterday was 2nd ZERO day in 2 weeks! Last weekend was 3-day Lockdown		– everyone indoors save for aid staff and 7000 gov workers delivering soap, brochures, advice & support
What was daily a bustling road and marketplace that you weaved your vehicle through – was eerily empty! Not a soul – an Apocalypse. This is Lockdown
		Lockdown means travel to distant districts to assist local staff. Mine were Tonkolili, Port Loko and Kambia. IHP camp at Port Loko is “tent city” all for aid workers –I was the “1,000^th guest” (no prize tho) and 88 staying the night. The Danish disaster-response group DEMA were hosts –respond within 24hrs of a disaster; have tents up in a week; underground piping 2 weeks later. 8 to a tent, all with own “room”, 24/7 light, power, internet, reception and cafeteria. No one snored but the stretchers creaked with resolving minds.
Tragic tryst. The woman who contracted Ebola and broke the 3-week Zero in Liberia, may have contracted it via unprotected sex with her Survivor partner – prompting the Liberian Gov to extend the “protected sex period” from 90 days (semen safe time) – to “Indefinite pending further research”.
Hospital fear. This Health Unit wall chart reveals a troublesome issue – all patient visits and drug treatments suddenly stopped in Oct – when word spread that you, “contracted Ebola by going to hospital” To receive alerts when new posts are added, please add your email address at bottom of page. Regards, Terry

Day 13 – Sierra Leone

Hi all,

I haven’t “gone to ground” – just full-on training 75 nurses/docs in Infection Prevention & Control – 10 hrs teaching a day – v rewarding – group is amazing – intelligent, fun and passionate about IPC – all passed Week 1 exam – now in week 2 (practice, practice, practice).

Ebola has devastated SL economically, socially and educationally – schools and univ have been closed 8 months (teachers not paid), still no body contact, all shops must close at 6pm to avoid crowds (beaches are closed to SL’s – but strangely we were allowed to enter beach – ??expats can’t spread Ebola.

Signs everywhere remind us of Ebola threat. In developing countries Ebola’s “Reproductive Number” is 2 (i.e. 1 case leads to 2 others) but last week a single case in a remote village led to 57 cases! The reason – “women’s secret things” (incl bathing of children in dead body wash-water to pass on “power’ of female leader) and “exorcism” – emphasizing persistent need for health education in remote areas – hence intense training of 75 to “spread (the correct) word”.

PS. I have never seen so many humanitarian organizations in one place! Amazing inflow of compassion.

Good news is that beds in “Ebola Treatment Centres” are at 12% capacity – we’re meeting this weekend to discuss decommissioning and recovery of resources for distribution to “non-Ebola” resource-poor healthcare facilities (after disinfection of course).

Liberia discharged its last case of Ebola last week – we hope Sierra Leone can do same within 3 months?

Regards to you all, Terry

Sierra Leone – Rule #1 – no handshakes

After a 15 hr event-full trip from WHO Geneva I arrived in Freetown, Sierra Leone (SL) capital, yesterday at 8am to the sound of crowing roosters (they got up late).

Jet lag, hungry (I can never decide) – breakfast won and I was immediately “adopted” by Michael Cosby (USA) and Shoaib Hussan (India), two WHO volunteers.

An hour later I was sitting in the midst of their weekly “Epi” (Epidemiology) meeting – a boiler-room of amazing teamwork and activity coordinating all intelligence on cases as they are confirmed – I say amazing as they are all on 6-12 week deployments, all work 7 days a week – Johann Conzalez (Columbia) was up till 1am completing a survey map for a news release that day. Their dedication under the leadership of Eilish Cleary (Canada) was humbling.

Twice I forgot and extended my hand – only to be embarrassingly reminded “No handshakes here“.

Eilish took me to “IPC” (infection Prevention & Control) and had to reassure Mandy (Canada) she was not poaching me (newbies are grabbed by anyone – there is such a need). To my surprise the IPC Leader is Julie Storr (UK), former UK IPS President.

Talk again soon. My CDC-ICAN Train The Trainer (TTT) colleagues arrive tmrw – we start Monday.

Rooster is crowing again – poor thing needs a clock.

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Terry Grimmond

Microbiologist, speaker and researcher on sharps injury prevention

Post Category → Ebola