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expert reaction to reports of a healthcare worker infected with Ebola in Glasgow

A healthcare worker recently returned to Glasgow from Sierra Leone has been diagnosed with Ebola, and is being treated in isolation at Gartnavel Hospital.

 

Prof. David Mabey, Professor of Communicable Diseases, London School of Hygiene & Tropical Medicine, said:

“Some of us expressed doubts about the value of airport screening for Ebola when it was introduced in the UK. The events of the past few days have done nothing to allay those doubts. On the one hand many people at low risk have been inconvenienced and delayed by having to fill in a form and talk to an official. On the other hand when a person at high risk arrives at Heathrow, tells them she is concerned and is found to have a raised temperature, she is given paracetamol and, after a long delay, allowed to board a flight to Glasgow.”

 

Prof. David Evans, Professor of Virology, University of Warwick, said:

“The ‘normal’ body temperature fluctuates in an individual during the day and varies slightly between individuals. Therefore it is not possible to be certain that an individual has an elevated temperature until it is outside this range of normal temperatures. Assuming the thermometers used were calibrated properly it’s certainly possible that the returning nurse could have felt feverish without presenting with an obviously elevated temperature. This might explain why she was permitted to fly on to Glasgow. Whether she should have been permitted to fly since she felt unwell is a separate issue and should necessitate review of the screening procedures. If feeling unwell precludes flying what then happens to these individuals? Are they housed at Heathrow/Gatwick and monitored? If so, for how long? Are alternative travel arrangements made for them?

“The introduction of screening inbound passengers was largely a means of raising Ebola awareness in travellers. When introduced it was acknowledged that it would likely miss individuals who were infected but asymptomatic. It is accepted that Ebola-infected asymptomatic individuals are not infectious via any sort of routine contact. The virus is not transmitted by aerosol and so risk to other passengers on the inbound Heathrow flight or internal flight to Glasgow was likely to be very low.”

 

Dr Alain Kohl, MRC Programme Leader, MRC Centre for Virus Research, University of Glasgow, said:

“Self monitoring over the incubation period is the most important factor upon return. Given the nature of the disease, airport checks will never pick up every potentially infected person. We are talking about a gradual process, and a virus which can only be transmitted by body fluids. It needs to kept in mind that in this case the infection was diagnosed and patient is being treated.”

 

Prof. Jonathan Ball, Professor of Molecular Virology, University of Nottingham, said:

“Whether or not an individual returning from an Ebola-affected country, especially one who has had contact with infected individuals, should be tested for the virus when they don’t present with a fever, but who state that they are feeling unwell, is a contentious issue. There is no evidence that a test would be able to detect the virus before a fever has started to develop, and there are lots of reasons why a person who has been stationed in Africa and has just endured a fairly lengthy journey might be feeling unwell.

“Perhaps the key issue here is that the returning nurse did not have overt signs of infection, in particular she was not experiencing diarrhoea, vomiting or haemorrhaging – and it’s these body fluids that transmit the virus. Therefore she posed little, if any, risk to her fellow passengers or subsequent contacts.

“Returning healthcare workers are given guidance on what to do on their return and these seem to have worked, as the patient was diagnosed before severe symptoms had developed; minimising the risk to others and ensuring that the nurse could be treated properly.”

 

Prof. Andrew Easton, Professor of Virology, University of Warwick, said:

“The diagnosis of Ebola virus in a nurse returning from a period of deployment to Sierra Leone marks the first case identified within the UK and inevitably raises concerns about the risk to fellow passengers who shared flights on her return to the UK and then on an internal flight to Glasgow.  If it is the case as current reports suggest that Ms Cafferkey did not present with symptoms until shortly after her arrival in Glasgow the risk to fellow passengers and others who had contact with her is extremely low.  The spread of Ebola virus between people is not efficient and requires direct contact with body fluids containing infectious virus; a situation that only occurs when patients are showing severe signs of infection which does not appear to be the case here.  Nonetheless this is a distressing situation for Ms Cafferkey herself and her friends and family.  The decision to move her to the Royal Free Hospital ensures that she will receive the necessary treatment to provide the best opportunity for a successful recovery as was seen with William Pooley.

“An important question that arises is what is the current state of the Ebola virus outbreak, which is the most extensive seen since the identification of the virus in 1976.  The recent update from the World Health Organisation indicates that almost 20,000 people have been infected with almost 8000 deaths.  While there are signs that the situation in Liberia has improved over recent months, the spread of infection in Sierra Leone has shown less of a decline.  This serves to emphasise that the international community must continue to increase its efforts to provide aid and expertise to eliminate the infection in West Africa.”

 

Prof. Jonathan Ball, Professor of Molecular Virology, University of Nottingham, said:

“Given the scale of the problem in Sierra Leone there was always a risk that UK volunteers could become infected.  This is tragic news for the brave volunteer, but hopefully they will make a full recovery – there is no better place to be cared for than in the fantastic facilities that we are blessed with in the UK.

“Ebolavirus isn’t very contagious and its transmission is associated with development of advanced signs of disease – vomiting, diarrhoea, bleeding and death.

“Apparently, this case was picked up very quickly – before serious symptoms have developed – so the risk to the wider public is very very small. I would be incredibly surprised if this case caused other infections. Even so, contacts will be traced and monitored, just to be on the safe side.”

 

Dr Alain Kohl, MRC Programme Leader, MRC Centre for Virus Research, University of Glasgow, said:

“This shows the risk associated with some of the work carried out by volunteers. Sadly there was always a chance this would happen but the patient will receive the highest standard of care. The outbreak is far from over and we need to continue our support”

 

Prof. Ian Jones, Professor of Virology, University of Reading, said:

“This is an unfortunate development amid the news generally that the Ebola situation may be coming under control. However, with the experience of treating previous cases there is every chance of a speedy recovery and as the patient has been isolated there is essentially no risk to the general population at large.

 

Prof. Nigel Brown, President of the Society for General Microbiology, said:

“Ebola is a very difficult virus to transmit. If a person is symptomless they are unable to infect anyone else. Public health officials have fully prepared for an Ebola case being imported into the UK and are ready to respond quickly and efficiently. We should be proud of the British healthcare workers and microbiologists who have volunteered to fight this disease in West Africa.”

 

Prof. Tom Solomon, Director of Liverpool’s Institute of Infection and Global Health, said:

“From as early as July, we predicted that the UK was it risk of importing a case of Ebola. Despite restrictions in airline routes, and screening at airports, we thought we were likely to see a case before the end of the year. This has now happened. Because this was a health care worker, who knew what to look out for, and what to do once they felt unwell, the risks to the general public are minimal. It is important to remember that the only people who get Ebola are those who have been caring for someone who had Ebola, because the virus is passed on infected bodily fluids.

“We would hope that because this patient appears to have come to medical attention relatively early, the risks to others are very small; also because they have been hospitalised early, they have a better chances of getting through this terrible illness. Although there is no established antivirus treatment, we do know that supportive treatment, to maintain hydration and stop patients becoming acidic, is vital.”

 

Declared interests

None declared

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