Monday, October 6, 2014

Wikipedia:2014 Ebola virus cases in the United States

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2014 Ebola virus cases in the United States
 

2014 Ebola virus cases in the United States

From Wikipedia, the free encyclopedia
Cases in the United States
United States (US48), administrative divisions - XY.svg
Updated: Oct. 6, 2014
Deaths 0
Cases first diagnosed in U.S. 1
Cases evacuated to U.S. from other countries 6[1]
Suspected cases in medical isolation 0[2]
Quarantined people 4[3]
Under observation 10 (via primary contact)[note 1][5]
40 (via secondary contact)[note 2][5]
On September 30, 2014, the first case of Ebola virus disease diagnosed in the United States was confirmed in a 40-year-old Liberian national, Thomas Eric Duncan, who was visiting family living in Dallas, Texas.[6][7] Prior to Duncan's diagnosis, three Americans had been medically evacuated from Africa and treated in the US for Ebola virus disease during the current Ebola virus epidemic in West Africa. Two were treated at Emory University Hospital's isolation unit and one at Nebraska Medical Center.
Duncan is being treated at Texas Health Presbyterian Hospital in Dallas.[8] By October 4, his condition had deteriorated from "serious but stable" to "critical".[9]On October 4, Duncan started receiving the experimental drug brincidofovir, but he was still in critical condition as of October 6.[10][11]
On October 1, a second person who had close contact with Duncan was put under close observation.[12] On October 3, Howard University Hospital announced they had placed a patient in isolation after he displayed Ebola-like symptoms and had recently traveled to Nigeria,[13] but that patient was later "ruled out" of having Ebola.[14] On October 4, 2014, two people earlier suspected of having Ebola were declared not infected.[2]

History

In West Africa

Map showing countries affected with Ebola.
Map, showing African countries and U.S. states affected with Ebola in color. Texas is in lime green on the left side of the map.
For more details on this topic, see Ebola virus epidemic in West Africa § Initial outbreak.
Researchers believe that the 2014 Ebola virus epidemic began on December 2, 2013, when a 2-year-old boy in the village of Meliandou, Guéckédou, in Guinea, a country in West Africa, fell ill that day, and died four days later. It is believed the child may have contracted the virus through contact with a fruit bat. His sister fell ill next, followed by his mother and grandmother. It is believed the Ebola virus was then spread to the villages of Dandou Pombo and Dawa, both in Guéckédou, by the midwife who attended them. From Dawa village, the virus spread to Guéckédou Baladou District and Guéckédou Farako District, and on to Macenta and Kissidougou.[15][16]
The virus then spread to Sierra Leone when 14 mourners at a traditional healer's funeral became infected. It is believed the healer had been to Guinea, possibly to treat the family of the index case. The funeral was in Koindu, a diamond-mining town across the border from Guéckédou in Guinea. The virus then spread to Liberia, Nigeria, and Senegal. Of all the countries, Liberia has experienced the most cases and the highest death rate.[17][18]

Background of first U.S. case

On September 30, 2014, the Centers for Disease Control and Prevention (CDC) reported that Thomas Eric Duncan traveled from Monrovia, Liberia, on September 19, 2014, and arrived in Dallas, Texas, on September 20. On September 24, he developed symptoms, and sought medical care at 10:00 p.m. on September 25. He was admitted to the hospital on September 28. On September 30, the CDC laboratory confirmed that he was infected with Ebola virus.
The man, Thomas Eric Duncan, a Liberian national in his mid-40s, had lived in Monrovia, Liberia. On September 15, 2014, Duncan helped to transfer his housemate and landlord's daughter Marthalene Williams, 19, who had Ebola, to the hospital. The family of Williams took her by taxi to an Ebola Treatment Ward in Monrovia after failing to get an ambulance ride. Duncan rode in the taxi to the treatment ward with Williams, her father, and her brother Sonny Boy. Duncan rode in the front seat and the others rode in the back. The family was turned away due to lack of space and Duncan helped carry Williams from the taxi back into her home, where she died shortly thereafter.[19]
On September 19, Duncan left Monrovia for Brussels where he boarded United Airlines Flight 951 to Washington Dulles Airport. Before departing Liberia, he lied about his history of contact with the disease on an airport questionnaire, according to an airport official.[20] From Washington, he boarded United Airlines Flight 822 to Dallas/Fort Worth. He arrived in Dallas at 7:01 p.m. CDT [21] on September 20, 2014,[8][22] and stayed with his partner and her five children, who lived in the North East community of Dallas known as Fair Oaks.[23][24]
Duncan began experiencing symptoms on September 24, 2014, and went to the Texas Health Presbyterian Hospital emergency room late in the evening of September 25, 2014. During this visit, his reported symptoms were a 100.1 °F (37.8 °C) fever, abdominal pain for two days, a headache, and decreased urination. He reported to not have vomiting, diarrhea, or nausea at the time. The ER nurse had asked about his travel history and recorded he had come from Liberia. It was initially reported that this information was not relayed to the doctor by the hospital's electronic medical record (EMR) system,[25] but the hospital later retracted that statement. Hospital officials also said that Duncan had been asked if he had been around anyone who had been sick, and said Duncan told them he hadn't.[26] He was diagnosed with a "low-grade, common viral disease" and was sent home with a prescription for antibiotics.[27] Duncan began vomiting on September 28, 2014, and was transported the same day to the same emergency room by ambulance.[28][29] His Ebola diagnosis was confirmed during a CDC news conference on September 30, 2014.[30][31]
On October 1, 2014, Texas Governor Rick Perry announced at a news conference that Duncan had contact with up to 18 people in Dallas, including several school children,[32][33] who are being monitored at home.[34] Up to 80–100 people may have had contact with people who had contact with Duncan after he showed symptoms. Health officials later monitored 50 low-risk contacts, and 10 high-risk contacts. The 10 high-risk contacts are Duncan's close family members and three ambulance workers who took him to the hospital.[35] Everyone who came into contact with Duncan are currently being monitored daily to watch for symptoms of the virus.[36]
Duncan is being treated at Texas Health Presbyterian Hospital in Dallas.[8] As of October 4, his condition had deteriorated from "serious but stable" to "critical".[37] Duncan is not being given the experimental drug ZMapp, which was used to treat previous cases of Ebola in aid workers and medical staff, as stocks of the drug were depleted at the time of his infection.[38]
On October 4, Duncan started receiving the experimental drug brincidofovir, which only received a FDA emergency investigational new drug authorization for Ebola treatment on October 6. Duncan was still in critical condition as of October 6, while still receiving brincidofovir.[39][40]
On October 5, 2014, the CDC announced it had lost track of a homeless man who had been in the same ambulance as Duncan had. They announced efforts were under way to locate the man and place him in a comfortable and compassionate monitoring environment.[41] Later that day, the CDC announced that the man had been found and is being monitored.[4]

Reaction

Liberian authorities said they could prosecute Duncan if he returned because he had filled out a form before flying falsely stating he had not come into contact with an Ebola case.[42] Liberian President Ellen Johnson Sirleaf told Canadian Broadcasting Corporation that she was angry with Duncan for what he had done, especially given how much the United States was doing to help tackle the crisis:
One of our compatriots didn't take due care, and so, he's gone there and in a way put some Americans in a state of fear, and put them at some risk, and so I feel very saddened by that and very angry with him.…The fact that he knew (he might be a carrier) and he left the country is unpardonable, quite frankly.[43]
In the United States, the US government, in statements through social media, told American citizens not to worry about an epidemic of Ebola in the United States, stating that the risk of such an epidemic was very low.[44] On Twitter on September 30, over 50,000 tweets in response to the Ebola case were posted in one hour.[45] The U.S. government will improve screening of passengers, but there will be no travel ban.[46]

Medically evacuated to the United States

As of October 6, 2014, five Americans have been evacuated to the U.S. for treatment after contracting Ebola in West Africa.[47] Kent Brantly, a physician and medical director in Liberia for the aid group Samaritan’s Purse, and co-worker Nancy Writebol were infected while working in Monrovia.[48][49][50] Both were flown to the United States at the beginning of August for further treatment in Atlanta's Emory University Hospital.[51] On August 21, Brantly and Writebol recovered and were discharged.[52]
On September 4, a Boston physician, Rick Sacra, was airlifted from Liberia to be treated in Omaha at the Nebraska Medical Center. Working for Serving In Mission (SIM), he is the third US missionary to contract EVD.[53] He believes he probably contracted Ebola while performing a caesarean section on a patient who had not been diagnosed with the disease. While in hospital, Sacra received a blood transfusion from Kent Brantly, who had recently recovered from the disease. On September 25, Sacra was declared Ebola-free and released from hospital.[54]
On September 9, the fourth U.S. citizen who contracted the Ebola virus arrived at Emory University Hospital in Atlanta for treatment. The identity of the patient, a doctor working for the WHO in Sierra Leone, was not released.[55] He was scheduled to receive a blood or serum transfusion from a British man who had recently recovered from the disease.[56] In addition, on September 21, a CDC employee was flown back to the US after low risk exposure with a healthcare worker. Currently he shows no symptoms and is being monitored. The CDC announced he poses no risks to his family or the US.[57] On September 28, a fourth American doctor was admitted to National Institutes of Health hospital.[58]
On October 2, NBC News photojournalist, Ashoka Mukpo, covering the outbreak in Liberia, tested positive for Ebola after showing symptoms.[59] Four other members of the NBC team, including Dr. Nancy Snyderman, were being closely monitored for symptoms.[60] Mukpo was evacuated on October 6 to the University of Nebraska Medical Center for treatment in their isolation unit.[47]

Key disease facts

Description

Main article: Ebola virus disease
Ebola virus disease (EVD) is a lethal viral hemorrhagic disease. The disease occurs primarily in Africa, where sporadic outbreaks have been documented since 1976, with the most recent outbreak occurring in West Africa in 2014. It is considered a Level 4 biohazard disease by the CDC due to its high fatality rate. There is currently no cure or vaccine, with over 50% of infected persons eventually dying.

Causes and transmission

For more details on this topic, see Ebola virus disease § Causes.
Infection is caused by one of four strains of the Ebola virus from the viral family Filoviridae. Transmission is primarily by contact with blood, bodily fluids, or tissues of infected individuals or infected animals.[61]

Signs and symptoms

For more details on this topic, see Ebola virus disease § Signs and symptoms.
Early symptoms of Ebola can include the sudden onset of fatigue, fever, headache, sore throat, weakness, and muscle pain. Those symptoms are often followed by vomiting, diarrhea, loss of appetite, and stomach pain. Other symptoms include red eyes, rash, jaundice, and internal and external bleeding.[62] The average time between contracting the infection and the start of symptoms (incubation period) is 8 to 10 days, but can vary between 2 and 21 days.[63]

Diagnosis

For more details on this topic, see Ebola virus disease § Diagnosis.
Experienced medical personnel would perform blood tests to check for the virus or for antibodies. They will also document a travel and work history. If Ebola infection is suspected, medical isolation or quarantine is important pending a final diagnosis.

Treatment

For more details on this topic, see Ebola virus disease § Treatment.
As there is currently no cure or vaccine for ebola, current treatment is limited to giving supportive care, which includes administering intravenous fluids and electrolytes to maintain hydration and blood pressure. Medications for nausea, fever and muscle aches are also given. Oxygen is administered if necessary and any secondary infections are also treated. When possible, medical isolation of infected persons is required during treatment.

Prevention

For more details on this topic, see Ebola virus disease § Prevention.
The primary prevention methods include wearing personal protective equipment, such as masks, gloves, liquid-proof gowns, and goggles, when near persons suspected of being infected. Disposal of potentially contaminated medical equipment, especially needles and syringes, along with careful disposal of clothing, bedding and any potentially contaminated items, is also necessary. Medical isolation or quarantine is generally required for persons suspected of being infected to prevent them from transmitting the disease to others.[62]

Epidemiology

For more details on this topic, see Ebola virus disease § Epidemiology.
The first known outbreak of Ebola took place in Sudan in 1976, where over 280 people became infected with a 50% mortality rate. Prior to the 2014 outbreak in West Africa, there have been 1,850 documented infections, of which over 1,200 people have died. WHO estimates that the overall mortality rate is 50%. As of October 1, 2014, for the 2014 outbreak in West Africa, WHO and the CDC have reported a total of 7,492 suspected cases and 3,439 deaths. There is one confirmed case in the United States.

See also

Notes

  1. These people may have had direct contact with Duncan after he started showing symptoms. Includes one homeless man found on October 5, 2014.[4]
  2. These people may have had contact with people who may have had direct contact with Duncan.

References

  1. "Who are the American Ebola patients?", CNN, Oct. 6, 2014
  2. "Ebola ruled out for 2 patients in isolation at D.C.-area hospitals; 1 has malaria", ABC News, October 4, 2014
  3. "Dallas Ebola Family Joins Long History of Quarantines", NBC News, October 4, 2014
  4. "Found: Homeless Man Sought in Ebola Case Being Monitored". NBC News. October 5, 2014. Retrieved October 5, 2014.
  5. "CDC chief warns against restricting entry to the US over Ebola crisis", Fox News, October 4, 2014
  6. http://www.cdc.gov/media/releases/2014/s930-ebola-confirmed-case.htm
  7. "Did US Ebola victim change flights at Heathrow?". Mail Online. Retrieved October 1, 2014.
  8. http://www.nytimes.com/2014/10/02/us/after-ebola-case-in-dallas-health-officials-seek-those-who-had-contact-with-patient.html?_r=0
  9. "First US Ebola case Thomas Duncan 'critical'". BBC News. October 4, 2014. Retrieved October 4, 2014.
  10. http://www.huffingtonpost.com/2014/10/06/experimental-drug-dallas-ebola-thomas-eric-duncan_n_5941104.html
  11. http://money.cnn.com/news/newsfeeds/articles/globenewswire/10101305.htm
  12. Marjorie Owens, WFAA-TV, Dallas-Fort Worth (October 1, 2014). "Officials: Second person being monitored for Ebola". Retrieved October 1, 2014.
  13. Doug Stanglin (October 3, 2014). "D.C. hospital admits patient with Ebola-like symptoms". Retrieved October 3, 2014.
  14. "Texas Ebola patient worse, but still the only case among scores evaluated". Washington Post. Retrieved October 5, 2014.
  15. Baize, Sylvain; Pannetier, Delphine; Oestereich, Lisa; Rieger, Toni (April 16, 2014). "Emergence of Zaire Ebola Virus Disease in Guinea — Preliminary Report". New England Journal of Medicine. doi:10.1056/NEJMoa1404505.
  16. John Vidal. "Ebola: research team says migrating fruit bats responsible for outbreak". the Guardian. Retrieved September 30, 2014.
  17. http://www.nytimes.com/2014/08/29/health/ebola-outbreak-in-sierra-leone-is-tied-to-one-funeral.html?_r=0
  18. "WHO - Sierra Leone: a traditional healer and a funeral". Retrieved September 30, 2014.
  19. http://www.nytimes.com/2014/10/02/world/africa/ebola-victim-texas-thomas-eric-duncan.html?action=click&contentCollection=U.S.&module=RelatedCoverage&region=Marginalia&pgtype=article
  20. "Ebola Patient in Dallas Lied on Screening Form, Liberian Airport Official Says", New York Times, October 2, 2014
  21. "History ✈ United #822 ✈ FlightAware". FlightAware. Retrieved October 2, 2014.
  22. "Thomas Eric Duncan: From healthy to Ebola". WYFF4. Retrieved October 3, 2014.
  23. "Dallas Man Tells of U.S. Ebola Patient’s Decline". WSJ. October 2, 2014. Retrieved October 4, 2014.
  24. http://www.nytimes.com/interactive/2014/10/01/us/retracing-the-steps-of-the-dallas-ebola-patient.html?_r=0
  25. "Scarier Than Ebola: Human Error". BusinessWeek. Retrieved October 3, 2014.
  26. "Liberia, U.S. Hospital Both Say Ebola Patient Lied About Exposure". NPR.org. October 2, 2014. Retrieved October 4, 2014.
  27. "Texas Ebola patient told hospital of travel from West Africa but was released". Washington Post. Retrieved October 3, 2014.
  28. "Electronic-Record Gap Allowed Ebola Patient to Leave Hospital". Bloomberg. Retrieved October 3, 2014.
  29. "Dallas hospital says Ebola patient denied being around sick people". Los Angeles Times. Retrieved October 3, 2014.
  30. "Ebola in the US - Ebola in Dallas - 2014 Ebola Outbreak". 2014 Ebola Outbreak. Retrieved October 3, 2014.
  31. Maggie Fox. "How Did The Ebola Patient Escape for Two Days?". NBC News. Retrieved October 3, 2014.
  32. "Texas Ebola Patient Had Contact With School-Age Kids, Perry Says". NBC News. Retrieved October 1, 2014.
  33. "Administration resending Ebola guidance after TX case - CNN.com". CNN. October 1, 2014. Retrieved October 1, 2014.
  34. "Five Dallas ISD students in contact with Ebola patient now monitored". October 1, 2014. Retrieved October 2, 2014.
  35. "10 people at 'high risk' for Ebola as 50 people monitored daily after contact with Dallas Ebola patient". New York Daily News. Retrieved October 3, 2014.
  36. "Hospital: Dallas Ebola patient in critical condition - CNN.com". CNN. October 4, 2014. Retrieved October 5, 2014.
  37. "First US Ebola case Thomas Duncan 'critical'". BBC News. October 4, 2014. Retrieved October 4, 2014.
  38. Boseley, Sarah (October 1, 2014). "First Ebola patient diagnosed in US won’t be treated with ZMapp". The Guardian. Retrieved October 5, 2014.
  39. http://www.huffingtonpost.com/2014/10/06/experimental-drug-dallas-ebola-thomas-eric-duncan_n_5941104.html
  40. http://money.cnn.com/news/newsfeeds/articles/globenewswire/10101305.htm
  41. "'We can stop Ebola in the US': CDC and Texas health officials say disease is under control but admit they have LOST one of the people who rode in ambulance that carried infected patient". Mail Online. Retrieved October 5, 2014.
  42. "Liberia to Prosecute Man Who Brought Ebola to United States". NBC News. Retrieved October 3, 2014.
  43. "Liberian President criticizes Ebola patient in Dallas - CNN.com". CNN. 2 October 2014. Retrieved 3 October 2014.
  44. September 30, 2014. "White House Urges Calm After First Confirmed U.S. Ebola Case". Time (magazine). Retrieved October 3, 2014.
  45. Yan, Holly (October 1, 2014). "1st Ebola diagnosis in the United States: Should we worry?". CNN. Retrieved October 3, 2014.
  46. http://www.reuters.com/article/2014/10/06/us-health-ebola-usa-idUSKCN0HT0MZ20141006
  47. "Journalist With Ebola Being Evaluated at US Hospital", Voice of America, Oct. 6, 2014
  48. "Two Americans Stricken With Deadly Ebola Virus in Liberia". 28 July 2014. Retrieved 2 August 2014.
  49. "Ebola outbreak: U.S. missionary Nancy Writebol leaves Liberia Tuesday". August 4, 2014. Retrieved August 4, 2014.
  50. "Ebola drug likely saved American patients". CNN.com. August 8, 2014. Retrieved August 8, 2014.
  51. Steenhuysen, Julie. "Ebola patient coming to U.S. as aid workers' health worsens". MSN News. Retrieved August 1, 2014.
  52. "American Ebola doc: 'I am thrilled to be alive'". Retrieved August 21, 2014.
  53. "A Third US missionary with Ebola virus leaves Liberia". The Telegraph. September 5, 2014. Retrieved September 5, 2014.
  54. "American Doctor With Ebola Is 'Grateful' Following Release From Hospital". ABC News. September 25, 2014. Retrieved September 25, 2014.
  55. "Ebola patient arrives at Atlanta hospital". WCVB Boston. September 9, 2014. Retrieved September 10, 2014.
  56. "British Ebola survivor flies to United States for blood donation". Reuters. Retrieved September 25, 2014.
  57. "2014 Ebola Outbreak in West Africa-September 25, 2014". CDC. September 25, 2014. Retrieved September 28, 2014.
  58. Maggie Fox. "Possible Ebola Patient Arrives at U.S. NIH Lab". NBC News. Retrieved September 30, 2014.
  59. "US Journalist Believes He Got Ebola While Cleaning Infected Car", ABC News, Oct. 6, 2014
  60. "US cameraman tests positive for Ebola". News24. Retrieved October 3, 2014.
  61. "Transmission of Ebola", CDC
  62. Cavendish, Marshall. Diseases and Disorders, Volume 1, Marshall Cavendish Corp., (2008) pp. 302-303
  63. "Signs and Symptoms of Ebola", CDC

External links

This page was last modified on 6 October 2014 at 23:41.
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2014 Ebola virus cases in the United States
 

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