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Ebola Virus Disease (EVD) in the United States


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Myself . By T.V. Antony Raj

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Great Seal of the United States

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Today, Ebola virus disease (EVD) represents a major public health issue, not only in sub-Saharan Africa, where it originated, but also to the whole world.

Researchers believe that the index case of the current EVD epidemic was the death of a 2-year-old boy in the village of Meliandou, Guéckédou Prefecture, in the West African nation of Guinea.

Guinea’s local health officials reported the first cases of fever in February 2014. They diagnosed the early cases as other diseases more common to the area and not as Ebola.

On March 19, 2014, Reuters reported an outbreak of an undetermined haemorrhagic fever in Guinea.

On March 22, 2014, Guinea confirmed that the viral hemorrhagic fever that killed more than 50 people is Ebola. On the same day, Liberia reported two EVD cases.

On March 30, 2014, Sierra Leone reported suspected cases.

On April 4, 2014, a mob attacked the Ebola treatment center in Guinea. In Sierra Leone and Liberia healthcare workers faced hostility from fearful, suspicious people.

On June 17, 2014, Liberia’s capital Monrovia reported the first case of Ebola.

On July 27, 2014, Liberia closed its borders with neighbouring countries. Three days later, Liberia shut down all schools. It quarantined worse-affected communities using troops.

On August 2, 2014, a U.S. missionary physician infected with Ebola in Liberia was flown to Atlanta in the United States for treatment.

On August 5, 2014, a second U.S. missionary infected with Ebola was flown from Liberia to Atlanta for treatment.

On August 8, 2014, World Health Organization (WHO) declared Ebola as “international public health emergency.”

On August 15, 2014, Médecins Sans Frontières (MSF) or Doctors Without Borders said it would take about six months to control the epidemic.

On August 19, 2014, one of the two U.S. missionaries treated in Atlanta declared free of the virus was released from the hospital.

On August 21, 2014, the second U.S. missionary treated in Atlanta declared free of the virus was released from the hospital.

By September the epidemic accelerated in sub-Saharan Africa.

On September 3, 2014, a third U.S. missionary doctor infected with Ebola was flown from Liberia for treatment in Omaha, Nebraska.

On September 7, 2014, President Barack Obama said the United States needs to do more to help prevent Ebola from becoming a global crisis.

On September 8, 2014, a fourth Ebola patient was flown to Atlanta.

On September 9, 2014, WHO said at least 2,296 died out of 4,293 cases recorded in five countries.

On September 13, 2014, Liberia appealed to Obama for help fight Ebola.

On September 16, 2014, President Obama promised to send 3,000 military engineers and medical personnel to West Africa to build clinics and train healthcare workers.

Thomas Eric Duncan (Source: abcnews.go.com)
Thomas Eric Duncan (Source: abcnews.go.com)

On September 20, 2014, Thomas Eric Duncan, a Liberian, flew to the United States after trying to help a woman with Ebola in his home county. He flew from Liberia to Dallas in the United States via Brussels and Washington.

On September 25, 2014, Duncan went to the Texas Health Presbyterian Hospital Dallas with fever and abdominal pain. Despite telling a nurse that he travelled from West Africa, the hospital sent him back to the apartment where he was staying with antibiotics.

On September 28, 2014, Duncan returned to Dallas hospital by ambulance.

On September 30, 2014, U.S. Centers for Disease Control and Prevention (CDC) confirmed Duncan afflicted with Ebola. This was the first case diagnosed in the United States.

On October 2, 2014, NBC News said that Ashoka Mukpo, the American freelance cameraman in its employ, afflicted with Ebola will be flown to the United States for treatment.

On October 8, 2014, Duncan, the first person diagnosed with Ebola in the United States, died in Texas Health Presbyterian Hospital Dallas.

The United States government ordered five major airports to screen passengers from West Africa for fever.

On October 9, 2014, WHO said there is no evidence of the epidemic being brought under control in West Africa. Some lawmakers in the United States called for the ban of travelers from the West African countries hit hardest by Ebola.

On October 10, 2014, WHO raised the death toll to 4,033 out of 8,399 cases in seven countries. Most fatalities were in Liberia, Sierra Leone and Guinea.

On October 11, 2014, Medical teams at New York’s John F. Kennedy International airport began screening travelers for Ebola symptoms from three West African countries.

Ebola survivor Nina Pham appears at a press conference after she was discharged from the hospital on ct. 24, 2014. (Source: abcnews.go.com)
Ebola survivor Nina Pham appears at a press conference after she was discharged from the hospital on October 24, 2014. (Source: abcnews.go.com)

On October 12, 2014, Nina Pham the nurse who took care of Liberian, Thomas Eric Duncan, at Texas Health Presbyterian Hospital Dallas tested positive for Ebola. She became the first person to contract the virus in the United States. U.S. National Institutes of Health said nurse Pham will be moved from Dallas to a National Institutes of Health (NIH) isolation unit in Bethesda, Maryland.

Nurse Amber Vinson (Source: nbcnews.com)
Nurse Amber Vinson (Source: nbcnews.com)

On October 15, 2014, officials said that Amber Vinson, a second Texas nurse who treated Duncan had contracted Ebola. She was treated at Emory University Hospital in Atlanta. Authorities said Vinson took a flight from Cleveland to Dallas/Fort Worth International Airport while running a slight fever.

On October 16, 2014, a U.S. congressional subcommittee sharply questioned health officials about the response to Ebola in the United States.

Dr. Craig Spencer (Source - nbcnews.com)
Dr. Craig Spencer (Source – nbcnews.com)

On October 17, 2014, The 33-year-old Dr. Craig Spencer, a New York doctor returned from Ebola-hit Guinea. Spencer, treated Ebola patients while working for MSF. After completing his work on October 12, 2014, he left Guinea two days later via Brussels, Belgium. He arrived at John F. Kennedy International Airport in New York City, on October 17, 2014. On his arrival, he did not exhibit any symptoms of the virus. The physician, who worked at Columbia Presbyterian Hospital, was checking his temperature twice a day. He had not seen any patients since his return.

On October 20, 2014, Emory University Hospital in Atlanta released an unidentified American who had contracted Ebola in Sierra Leone.

In Texas, 43 people were taken off Ebola watch lists. About 260 people were still being monitored in Texas and Ohio. United States issued stricter guidelines for health workers treating Ebola victims. Not to expose skin or hair.

On Tuesday, October 21, 2014, Dr. Spencer started feeling fatigued and sluggish though without a fever. That day, he visited a coffee stand and a meatball restaurant in Manhattan. The next day, he ran for three miles in his neighborhood, and took the subway to a bowling alley in Brooklyn. He was not symptomatic then.

On October 23, 2014, Spencer developed a fever, nausea, pain and fatigue in the morning. His fever spiked to 100.3 degrees Fahrenheit (about 38 Celsius). He tested positive for Ebola. He is the first case of the deadly virus in New York City and the fourth diagnosed in the United States.

Health officials cleared both the coffee stand and the bowling alley after assessing them. After closing the bowling alley on Thursday, they had the bar cleaned and sanitized as a precaution.

Spencer’s Manhattan apartment has been isolated and locked.

Spencer was in contact with a few people after he started exhibiting symptoms. Ebola is not contagious until someone has symptoms. Health officials said that three people – his fiancée and two friends – are on quarantine and monitored,

“They are all well at this time; none of them is sick,” said Dr. Mary Travis Bassett, New York City’s health commissioner.

Spencer also travelled on three subway lines. “At the time that the doctor was on the subway, he did not have fever… He was not symptomatic,” Bassett said. The chances of anyone contracting the virus from contact him are “close to nil,” she said.

Ebola spreads by direct contact with the body fluids of an infected person. The time between exposure to the virus and the development of symptoms of the disease is usually two to 21 days. Estimates based on mathematical models predict around 5% of cases might take greater than 21 days to develop the symptoms.

Dr. Craig Spencer is now lodged at New York’s Bellevue Hospital Center. He has been in isolation since emergency personnel took him there. It is one of the eight hospitals statewide designated by New York Governor Andrew Cuomo as part of an Ebola preparedness plan.

“We are as ready as one could be,” Cuomo said. New York state will be different from Texas he said.

“We had the advantage of learning from the Dallas experience,” he said, recalling the death of Liberian Thomas Eric Duncan on October 8, 2014, diagnosed with Ebola.

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Ebola Virus Disease (EVD) in Liberia


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Myself . By T.V. Antony Raj

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Coat of arms of Liberia

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On December 6, 2013, a 2-year-old boy died in the village of Meliandou, Guéckédou Prefecture, Guinea. Researchers believe the boy’s death was the index case of the current Ebola virus disease epidemic.

Hammer-headed bat (Hypsignathus monstrosus), also known as the big-lipped bat, is a megabat widely distributed in equatorial Africa. (Credit - Shyamal - Wikipedia)
Hammer-headed bat (Hypsignathus monstrosus), also known as the big-lipped bat, is a megabat widely distributed in equatorial Africa. (Credit – Shyamal – Wikipedia)

Bushmeat refers to meat from non-domesticated mammals, reptiles, amphibians, and birds hunted for food in tropical forests. The dead boy’s family were hunters of bats for bushmeat. They hunted the Ebola-harbouring species Hypsignathus monstrous and Epomops franqueti. This may have been the original source of the infection. The dead boy’s mother, sister, and grandmother fell ill with similar symptoms and died. People infected by those victims spread the disease to other villages.

Now, Ebola represents a major public health issue in sub-Saharan Africa. But in early 2014, West Africa did not report any no cases of Ebola. The early cases of Ebola were diagnosed as other diseases more common to the area. Thus, the disease had several months to spread before it was recognized as Ebola.

On Wednesday, March 19, 2014,  Reuters reported an outbreak of an undetermined viral haemorrhagic fever in the West African nation of Guinea. According to Guinea’s local health officials, the first case of the fever was reported in February 2014 that sickened at least 35 people and killed 23.

Dr. Sakoba Keita, the doctor in charge of the prevention of epidemics in Guinea’s Health Ministry said:

“Symptoms appear as diarrhoea and vomiting, with a very high fever. Some cases showed relatively heavy bleeding… We thought it was Lassa fever or another form of cholera, but this disease seems to strike like lightning. We are looking at all possibilities, including Ebola, because bushmeat is consumed in that region and Guinea is in the Ebola belt.”

Keita also said that most of the victims had been in contact with the deceased or had handled the dead bodies. He said those infected had been isolated, and they had sent samples to Senegal and France for further tests.

By March 24, 2014, Médecins Sans Frontières (MSF) or Doctors Without Borders had set up an isolation facility in Guéckédou.

By late May 2014, the outbreak had spread to Guinea’s capital, Conakry, a city of about two million inhabitants. On May 28, 2014, the total number of cases reported had reached 281 with 186 deaths.

In late March 2014, Liberia, reported the spread of Ebola in Lofa and Nimba counties. In mid-April 2014, the Liberia’s Ministry of Health and Social Welfare recorded possible cases of Ebola in Margibi and Montserrado counties. In mid-June 2014, Liberia’s capital Monrovia reported the first cases of Ebola. On July 27, 2014, Ellen Johnson Sirleaf, the Liberian president, announced that Liberia would close its borders with neighbouring countries. In August, he declared a national state of emergency, with the “suspensions of certain rights and privileges”.

Liberia faced a health crisis even before the outbreak of the Ebola virus. It had only 50 physicians in the entire country — one for every 70,000 Liberians. In September 2014, the US Centers for Disease Control and Prevention (CDC) reported that some hospitals in Liberia had been abandoned. The report also said the hospitals which were still functioning lacked basic facilities such as running water, rubber gloves, and sanitizing supplies.

At the end of August, the World Health Organization (WHO) stated that Liberia’s capacity to treat Ebola Virus Disease (EVD) cases fell short of 1,550 beds. In September, a new 150-bed treatment clinic was opened in Monrovia. At the time of the opening ceremony six ambulances were already waiting with potential Ebola patients. More patients were waiting by the clinic after making their way on foot with the help of relatives.

2014 ebola virus epidemic in West Africa (Author: Mikael Häggström)
2014 Ebola virus epidemic in West Africa (Author: Mikael Häggström)

As on October 19, 2014, out of the 4,665 patients diagnosed for Ebola in Liberia, 2,705 had died. In the past week alone Monrovia reported 305 new EVD cases. Out of the 15 counties in Liberia 14 have reported cases of Ebola. Only Grand Gedeh has yet to report an EVD case.

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Report Says EU Nuclear Reactors Need Repair


October 3, 2012

A leaked report on Europe’s nuclear reactors found that up to $32bn needs to be invested to prevent disaster.

Almost all of Europe’s nuclear reactors are in need of an urgent overhaul that could cost as much as $32bn, according to a leaked draft-report by the European Commission.

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The Commission is expected on Thursday to finalise its stress test report, which was designed to ensure that a disaster similar to the one at Japan’s Fukushima could not happen again.

The report will be debated by EU ministers later this month..

After that, the Commission intends in 2013 to propose new laws, including on insurance and liability to “improve the situation of potential victims in the event of a nuclear accident”, the draft obtained by Reuters news agency said.

Of the 134 EU nuclear reactors grouped across 68 sites, 111 have more than 100,000 inhabitants living within 30 km.

Safety regimes vary greatly and the amount that needs to be spent to improve them is estimated at $13-32bn across all the reactors, the draft says.

France’s nuclear watchdog has already said the country, which relies on nuclear power for about 75 per cent of its electricity, needs to invest billions of Euros.

The lesson of Fukushima was that two natural disasters could strike at the same time and knock out the electrical supply system of a plant completely, so it could not be cooled down.

The stress tests found that four reactors, in two different countries, had less than one hour available to restore safety functions if electrical power was lost.

By contrast, four countries operate additional safety systems fully independent from the normal safety measures and located in areas well-protected against external events. A fifth country is considering that option.

The main finding, the draft says, is that there are “continuing differences” between member states’ safety regimes.

It also says provisions to ensure the independence of national regulators are “minimal”.

Imad Khadduri, a nuclear analyst, told Al Jazeera that this report reflects “what is now an issue in Japan, which is the complacency of the nuclear industry, and the following up with modifications and updates on safety issues.”

“European power reactors should take much more strident efforts in fixing and implementing the safety issues.

Khadduri went on to say that if the public “is going to be alarmed by the $30bn cost of it all, they should be more worried about how much it could cost to decommission reactors, which is incredibly costly.”

Voluntary exercises

The stress tests are a voluntary exercise to establish whether nuclear plants can withstand natural disasters, aircraft crashes and management failures, as well as whether adequate systems are in place to deal with power disruptions.

All 14 member states that operate nuclear plants took part, however, as did Lithuania, which is decommissioning its nuclear units.

From outside the 27-member bloc, Switzerland and Ukraine joined in the exercise.

The tests were meant to have been completed around the middle of the year, but countries were given extra time to assess more reactors.

Non-governmental organisations are among those who have criticised the process as not going far enough and having no powers to force the shutdown of a nuclear plant.

“The stress tests only give a limited view,” said Roger Spautz, energy campaigner at Greenpeace, which believes nuclear power should be phased out.

He cited independent research earlier this year which said some European reactors needed to be shut down immediately, as well as the example of Belgium, where the Doel 3 and Tihange 2 reactors have been halted because of suspected cracks.

The draft report says the stress tests are not a one-off exercise and will be followed up. Existing legislation also needs to be enforced, it said.

The deadline for passing the existing nuclear safety directive into national law was July 2011. The Commission started infringement proceedings against 12 member states that missed it.

To date, two have still not complied but the report did not specify which ones.

The Commission does not comment on leaked drafts.

But on Monday, the EU energy spokeswoman said the recommendations were being finalised and would not be “very, very detailed”.

In France, the nuclear watchdog and operator EDF said they would not comment before seeing the official report.

Source: Al Jazeera and agencies
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Disfigured victim’s plea to die exposes India’s acid violence


Source: Trustlaw // Nita Bhalla

Sonali Mukherjee, 27, sits in a room temporarily offered by a Sikh temple during an interview in New Delhi July 22, 2012. REUTERS/Ahmad Masood

* Acid attack victim says can no longer endure suffering

* India needs strong laws on acid attacks, says U.N.

* Concentrated acids cheaply and easily available in India

By Nita Bhalla

NEW DELHI, July 27 (TrustLaw) – They came in the dead of night, broke into her home as she slept and poured a cocktail of acids over her face — burning her skin, melting her eyelids, nose, mouth and ears, and leaving her partially deaf and almost blind.

Her crime? She had spurned their sexual advances.

Nine years on, Sonali Mukherjee, 27, is appealing to the Indian government for medical support for skin reconstructive surgery as well as tougher penalties on her three assailants, who were released on bail after only three years in prison.

Either that, she says, or authorities should give her the right to kill herself. Euthanasia is illegal in India.

“For the last nine years, I am suffering … living without hope, without future. If I don’t have justice or my health, my only way out is to die,” she says, sitting on a bed in a sparsely furnished room above a Sikh temple in south Delhi.

“I don’t want to live half a life, with half a face.”

Sonali’s desperate plea highlights the heinous crime of throwing acid on women in India, the lack of support for victims, and lax laws which have allowed attackers to get away with what activists say is the equivalent of murder.

Acid violence – where acid is intentionally thrown to maim, disfigure or blind – occurs in many countries across the world, and is most common in Cambodia, as well as Bangladesh, Pakistan, Afghanistan and India where deep-rooted patriarchy persists.

Around 1,500 acid attacks are reported globally each year, with 80 percent of them on women, says London-based charity, Acid Survivors Trust International, adding this is a gross under-estimate as most victims are scared to speak out.

There is no official statistics for India, but a study conducted by Cornell University in January 2011 said there were 153 attacks reported in the media from 1999 to 2010.

Many of these attacks, said the study, are acts of revenge because a woman spurns sexual advances or rejects a marriage proposal.

“These men feel so insulted that a woman could turn them down and have an attitude of ‘If I can’t have you, no one can’,” says Sushma Kapoor, deputy director for UN Women in South Asia.

ISOLATED AND DISFIGURED

With a bright future ahead of her, Sonali was a 17-year-old sociology student in the city of Dhanbad in India’s central state of Jharkhand when the attack happened back in April 2003.

The three men were her neighbours and harass ed her as she left for college every morning. When she threatened to call the police, they took revenge, leaving her with 70 percent burns to her face, neck and arms.

An Indian court handed down nine-year jail terms to each of her attackers. But within three years, the men were out on bail. Her appeal against their release has yielded little results, says Sonali, and she continues to worry about her safety.

Unlike countries like Pakistan and Bangladesh, where acid violence has in recent years been listed as a specific offence, India still categorises it as grievous hurt, dolling out penalties which are lenient and jail-terms which are bailable.

“The actual attack is just the start of a life of suffering. Most are disfigured and blind. They face years of physical and mental pain and need rehabilitation,” says Sushma Varma, founder of the Campaign and Struggle Against Acid Attacks on Women (CSAAAW), a Bangalore-based voluntary group.

“In most cases there is no help, no support, no money.”

With a rising number of reports of such attacks, the cabinet this month approved a proposal to make acid attacks a separate offence, making it punishable by 10 years imprisonment and a fine of up to 10 lakh rupees ($180,000). This will now have to be approved by parliament.

But victims and activists say the government must also look at regulating the sale of locally produced household cleaners, which contain highly concentrated acids, that are easily and cheaply available in local markets across the country.

Acids are increasingly being used as weapons, like guns, they say, but there are no licensing laws for those who sell and purchase these deadly chemicals which also include neat hydrochloric and sulphuric acids.

“You can buy highly concentrated chemicals like those used on me in most markets for less than 50 rupees a bottle,” says Sonali. “This is enough to ruin a woman’s life. They may not have killed me, but I might as well be dead.” (TrustLaw is a global hub for news and information on good governance and women’s rights run by the Thomson Reuters Foundation. For more, visit http://www.trust.org/trustlaw) (Editing by Sanjeev Miglani)