Zika link to birth defects could be proven within weeks


The suspected link between the Zika virus and two neurological disorders, the birth defect microcephaly and Guillain-Barre syndrome, could be confirmed within weeks, the World Health Organization (WHO) said on Friday.

A sharp increase in microcephaly cases in Brazil has triggered a global health emergency over the mosquito-borne virus, which had previously been viewed as causing only a relatively mild illness, and spurred a race to develop a vaccine, medicines and better diagnostic tests.

The WHO said U.S. government scientists and an Indian biotechnology firm were the front-runners in the vaccine effort but said it would take at least 18 months to start large-scale clinical trials of potential preventative shots. The U.N. health agency also for the first time advised pregnant women to consider delaying travel to Zika-affected areas.

Brazil is at the center of the Zika outbreak that has spread to more than 30 countries. Researchers there are working to determine whether Zika has caused a big rise in cases of microcephaly, a birth defect in which babies are born with abnormally small heads and may have developmental problems.

Brazil's health ministry issued fresh figures on Friday, reporting 4,314 suspected and confirmed cases of microcephaly, up from 4,074 cases on Feb. 2. The ministry said it had confirmed 462 of those cases as microcephaly or other alterations to the central nervous system. Researchers have identified evidence of Zika infection in 41 of these cases, either in the baby or in the mother. But scientists have not confirmed that Zika can cause microcephaly.

“It seems indeed that the link with Zika (and microcephaly) is becoming more and more probable, so I think that we need a few more weeks and a few more studies to have this straight,” Marie-Paule Kieny, WHO assistant director-general for health systems and innovation, told a news briefing in Geneva.

Studies of Zika-infected pregnant Latin American women who were due to deliver their babies soon should yield evidence, Kieny said, adding that data also was coming from studies in French Polynesia and Cape Verde.

Kieny said Zika-hit areas also have experienced increased cases of the neurological disease Guillain-Barre, adding: “The direct causality has still to be demonstrated but the association in time and in location seems to be clear.”

Guillain-Barre syndrome, in which the body's immune system attacks part of the nervous system, causes gradual weakness in the legs, arms and upper body and sometimes total paralysis.

In a statement, the WHO reiterated it was not recommending any general travel or trade restrictions related to the virus. But it added, “Women who are pregnant should discuss their travel plans with their healthcare provider and consider delaying travel to any area where locally acquired Zika infection is occurring.”

Brazil is set to host the Olympics in August in Rio de Janeiro, an event expected to draw hundreds of thousands of athletes, officials and spectators.

Many scientists are convinced the link between Zika and birth defects is real. New evidence of Zika in the brain of an aborted foetus, reported on Wednesday, added to the case.

Speaking at an American Association for the Advancement of Science news conference in Washington, another WHO official, Christopher Dye, reiterated the agency's strong suspicion.

“If we take all the information we have at the moment, the case for a causal link is quite strong,” Dye said. “We should now say that Zika is guilty until proven innocent.”

VACCINE RACE

The WHO's Kieny said two vaccine candidates seem to be more advanced: one from the U.S. National Institutes of Health (NIH) and one from the Indian company Bharat Biotech.

The NIH is working on a DNA-based vaccine that uses the same approach as one being developed for West Nile virus. India's Bharat said last week its experimental vaccine would start pre-clinical trials imminently in animals.

Overall, about 15 groups are working on Zika vaccines.

Kieny said new diagnostic test kits also were being rapidly developed and could be available within weeks.

Zika is predominantly spread by mosquito bites, but scientists are studying transmission by blood transfusions and sexual contact.

British health officials reported Zika was found in a British man's semen two months after being infected, suggesting the virus may linger in semen long after infection symptoms fade.

They said the 68-year-old man, infected in 2014 in French Polynesia, had low levels of the virus in initial blood tests. Subsequent tests of semen showed positive results at 27 days and 62 days after the start of Zika symptoms, with higher levels of the virus in the semen than the initial blood tests.

“Our data may indicate prolonged presence of virus in semen, which in turn could indicate a prolonged potential for sexual transmission” of this virus, the researchers from Public Health England and the National Institute for Health Research in Liverpool wrote in Emerging Infectious Diseases, a journal of the U.S. Centers for Disease Control and Prevention.

The WHO has advised women, particularly pregnant women, to protect themselves from mosquito bites in Zika-affected areas and to practice safe sex through the use of condoms.

Why the Zika virus is causing alarm


Global health officials have said that the Zika virus, which has been linked to severe birth defects in thousands of babies in Brazil, is rapidly spreading in the Americas and could infect 3 million to 4 million people. The race is on to develop a Zika vaccine. 

Here are some questions and answers about the virus and the current outbreak.

How do people become infected?

The virus is transmitted to people through the bite of infected female Aedes mosquitoes, the same type of mosquito that spreads dengue, chikungunya and yellow fever. The Pan American Health Organization (PAHO) said Aedes mosquitoes are found in all countries in the Americas except Canada and continental Chile, and the virus will likely reach all countries and territories of the region where Aedes mosquitoes are found.

How do you treat Zika infection?

There is no treatment or vaccine available for Zika infection. Companies and scientists are racing to develop a safe and effective vaccine for Zika, but one is not expected to be ready for months or years. 

How dangerous is it?

The PAHO said there is no evidence that Zika can cause death, but some cases have been reported with more serious complications in patients with pre-existing medical conditions.

The virus has been linked to microcephaly, a condition in newborns marked by abnormally small heads and brains that have not developed properly. It also has been associated with Guillain-Barre syndrome, a rare disorder in which the body's immune system attacks part of the nervous system. Scientists are studying whether there is a causal link between Zika and these two disorders.

How is Zika related to microcephaly?

Health officials have yet to establish a direct causal relationship between Zika virus infection and birth defects, but it is strongly suspected. Brazil has reported 3,700 cases of suspected microcephaly that may be linked to Zika. It is unclear whether in pregnant women the virus crosses the placenta and causes microcephaly. Research in Brazil indicates the greatest microcephaly risk appears to be associated with infection during the first trimester of pregnancy.

What are the symptoms of Zika infection? 

People who get Zika virus disease typically have a mild fever, skin rash, conjunctivitis, muscle and joint pain and fatigue that can last for two to seven days. But as many as 80 percent of people infected never develop symptoms. The symptoms are similar to those of dengue or chikungunya, which are transmitted by the same type of mosquito.

How can Zika be contained?

Efforts to control the spread of the virus focus on eliminating mosquito breeding sites and taking precautions against mosquito bites such as using insect repellent and mosquito nets. U.S. health officials have advised pregnant women to avoid travel to Latin American and Caribbean countries where they may be exposed to Zika.

How widespread is the outbreak in the Americas?

Health officials said Zika cases have been reported in more than 30 countries ranging from the Americas to Ireland to Australia in the current outbreak. Brazil has been the nation most affected. Other nations and territories include Barbados, Bolivia, Colombia, Costa Rica, Curacao, Dominican Republic, Ecuador, El Salvador, French Guiana, Guadeloupe, Guatemala, Guyana, Haiti, Honduras, Jamaica, Martinique, Mexico, Nicaragua, Panama, Paraguay, Puerto Rico, Saint Martin, Suriname, Venezuela and the U.S. Virgin Islands, according to the PAHO. (http://tinyurl.com/hoq6qqo)

What is the history of the Zika virus?

The Zika virus is found in tropical locales with large mosquito populations. Outbreaks of Zika virus disease have been recorded in Africa, the Americas, Southern Asia and the Western Pacific. The virus was first identified in Uganda in 1947 in rhesus monkeys and was first identified in people in 1952 in Uganda and Tanzania, according to the World Health Organization.

Can Zika be transmitted through sexual contact?

Two cases of possible person-to-person sexual transmission has been described, but the PAHO said more evidence is needed to confirm whether sexual contact is a means of Zika transmission. 

The PAHO also said Zika can be transmitted through blood, but this is an infrequent transmission mechanism. There is no evidence the virus can be transmitted to babies through breast milk.

What other complications are associated with Zika?

The WHO says because no big Zika outbreaks were recorded before 2007, little is known about complications caused by infection. During an outbreak of Zika from 2013-2014 in French Polynesia, national health authorities reported an unusual increase in Guillain-Barre syndrome. Health authorities in Brazil have also reported an increase in Guillain-Barre syndrome.

Long-term health consequences of Zika infection remain unclear. Other uncertainties surround the incubation period of the virus and how Zika interacts with other viruses that are transmitted by mosquitoes such as dengue.

Zika virus set to spread across Americas, spurring vaccine hunt


The mosquito-borne Zika virus, which has been linked to brain damage in thousands of babies in Brazil, is likely to spread to all countries in the Americas except for Canada and Chile, the World Health Organization said on Monday.

Zika transmission has not yet been reported in the continental United States, although a woman who fell ill with the virus in Brazil later gave birth to a brain-damaged baby in Hawaii.

Brazil's Health Ministry said in November that Zika was linked to a foetal deformation known as microcephaly, in which infants are born with smaller-than-usual brains.

Brazil has reported 3,893 suspected cases of microcephaly, the WHO said last Friday, over 30 times more than in any year since 2010 and equivalent to 1-2 percent of all newborns in the state of Pernambuco, one of the worst-hit areas.

The Zika outbreak comes hard on the heels of the Ebola epidemic in West Africa, demonstrating once again how little-understood diseases can rapidly emerge as global threats.

“We've got no drugs and we've got no vaccines. It's a case of deja vu because that's exactly what we were saying with Ebola,” said Trudie Lang, a professor of global health at the University of Oxford. “It's really important to develop a vaccine as quickly as possible.”

Large drugmakers' investment in tropical disease vaccines with uncertain commercial prospects has so far been patchy, prompting health experts to call for a new system of incentives following the Ebola experience.

“We need to have some kind of a plan that makes (companies) feel there is a sustainable solution and not just a one-shot deal over and over again,” Francis Collins, director of the U.S. National Institutes of Health, said last week.

The Sao Paulo-based Butantan Institute is currently leading the research charge on Zika and said last week it planned to develop a vaccine “in record time”, although its director warned this was still likely to take three to five years.

British drugmaker GlaxoSmithKline said on Monday it was studying the feasibility of using its vaccine technology on Zika, while France's Sanofi said it was reviewing possibilities.

RIO CONCERNS

The virus was first found in a monkey in the Zika forest near Lake Victoria, Uganda, in 1947, and has historically occurred in parts of Africa, Southeast Asia and the Pacific Islands. But there is little scientific data on it and it is unclear why it might be causing microcephaly in Brazil.

Laura Rodrigues of the London School of Hygiene and Tropical Medicine said it was possible the disease could be evolving.

If the epidemic was still going on in August, when Brazil is due to host the Olympic Games in Rio de Janeiro, then pregnant women should either stay away or be obsessive about covering up against mosquito bites, she said.

The WHO advised pregnant women planning to travel to areas where Zika is circulating to consult a healthcare provider before travelling and on return.

The clinical symptoms of Zika are usually mild and often similar to dengue, a fever which is transmitted by the same Aedes aegypti mosquito, leading to fears that Zika will spread into all parts of the world where dengue is commonplace.

More than one-third of the world's population lives in areas at risk of dengue infection, in a band stretching through Africa, India, Southeast Asia and Latin America.

Zika's rapid spread, to 21 countries and territories in the Americas since May 2015, is due to the prevalence of Aedes aegypti and a lack of immunity among the population, the WHO said in a statement.

RISK TO GIRLS

Like rubella, which also causes mild symptoms but can lead to birth defects, health experts believe a vaccine is needed to protect girls before they reach child-bearing age.

Evidence about other transmission routes, apart from mosquito bites, is limited.

“Zika has been isolated in human semen, and one case of possible person-to-person sexual transmission has been described. However, more evidence is needed to confirm whether sexual contact is a means of Zika transmission,” the WHO said.

While a causal link between Zika and microcephaly has not yet been definitively proven, WHO Director-General Margaret Chan said the circumstantial evidence was “suggestive and extremely worrisome”.

In addition to finding a vaccine and potential drugs to fight Zika, some scientists are also planning to take the fight to the mosquitoes that carry the disease.

Oxitec, the UK subsidiary of U.S. synthetic biology company Intrexon, hopes to deploy a self-limiting genetically modified strain of insects to compete with normal Aedes aegypti.

Oxitec says its proprietary OX513A mosquito succeeded in reducing wild larvae of the Aedes mosquito by 82 percent in an area of Brazil where 25 million of the transgenic insects were released between April and November. Authorities reported a big drop in dengue cases in the area.

Testing the waters


I took my 7-year-old, Micha-el, swimming at a neighbor’s last Shabbat. After an unseasonably cool June, July began with the full brunt of summer, and he was thrilled with the invitation. A growing number of Israelis have blow-up pools, thanks to the country’s enormous desalination plants that have enabled us to ignore the perennial water crisis (water and environmental experts say the jury is very much out on the ultimate viability of large-scale desalination, and they insist that Israel still needs to conserve water, but that is a topic for another column).

The afternoon was terrific — our adult hosts had gone upstairs for an afternoon rest so I sat inside with the weekend newspaper and a cool drink while the kids splashed and squealed. Pretty hard to think of a more relaxing way to spend a Shabbat afternoon.

But as I listened to the kids play, I couldn’t get my mind off the afternoon I’d spent in Hebron earlier in the week, getting to know a Palestinian family I’d been introduced to some months ago. We’d agreed to meet at 3 p.m., so I took the opportunity beforehand to visit the Cave of the Patriarchs to study a little and to pray the Mincha service, and then made my way to their home, adjacent to the Tel Rumeida neighborhood and archaeological dig. It being Ramadan, there was no food or drink on offer, but that hardly put a dent in the afternoon. Sitting under a lush canopy of grapevines and olive trees, we talked about my host’s teaching career and her adult daughter’s life growing up in 1980s and ’90s Hebron (I’m leaving the family anonymous because its members do not know I’m a settler, and I fear for their safety if it got out that they’d hosted one). Of course, the conversation also focused on Israeli violations real and imagined, and eventually the topic turned briefly to water.

The topic is one I’ve known about tangentially for years: According to the Btselem human rights organization, there is no limit to water consumption for Israeli citizens, whereas average water consumption for Palestinians in Judea and Samaria for domestic, urban and industrial purposes is approximately 73 liters per person per day, far below the World Health Organization recommendation of 100 liters per person per day.

But although I knew about the discrepancy, I had never paid any attention to it, certainly not in any real terms. Now I heard about the impact of the shortage.

“We usually have water to drink, but in every other area of life we have to take extreme caution not to waste,” my host said. “Everyone relies on water tanks on their roof. They get filled up about every 10 days by the baladiya (Hebron municipality). In the summer when there is a water shortage, we have to wait longer for them to get filled, so people run out and have to fill bottles at their neighbors’. I lived in one apartment that did not have enough water tanks, so we ran out every two weeks and we had to develop creative ways to save water. We kept a big tub under the shower so we could save the water and wash our clothes in it while it was still warm. Then it stayed in the bath to flush the toilet. We only flushed after solids, not for every pee.”

The conversation left me with an unfamiliar feeling of guilt — I routinely have to force my teenagers to cut their showers “down” to five minutes or so. But while driving home, I remembered an article I’d translated a year ago by Haim Gvirtzman, a professor of hydrology at the Institute of Earth Sciences at the Hebrew University and a member of the Israel Water Authority Council. Gvirtzman asserts that rather than a result of Israeli discrimination, the Palestinian water shortage stems mainly from a calculated Palestinian Authority policy not to develop PA water resources, despite the fact that the Oslo Accords provide for it.

“The Palestinians refuse to develop their own significant underground water resources, build a seawater desalination plant, fix massive leakage from their municipal water pipes, build sewage treatment plants, irrigate land with treated sewage effluents or modern water-saving devices, or bill their own citizens for consumer water usage, leading to enormous waste. At the same time, they drill illegally into Israel’s water resources, and send their sewage flowing into the valleys and streams of central Israel. … (The Palestinian Authority is) not interested in practical solutions to solve the Palestinian people’s water shortages, but rather perpetuation of the shortages and the besmirching of Israel,” Gvirtzman wrote.

All of which is probably correct, and would have been wholly relevant had we been onstage for a Lincoln-Douglas-style debate. But my visit was about caring and identifying with a family that cannot take for granted the privileges that I live with, not about pointing fingers or assigning blame. In Efrat, our kids don’t hesitate to fill a blow-up pool. In Hebron, they think twice about flushing the toilet.

For me, that’s a lot to think about.


Andrew Friedman is a member of Shorashim/Judur, a grass-roots movement of local Israelis and Palestinians creating relationships and friendships in Judea and Samaria, as well as of the Interfaith Encounter Forum.

Fear and indifference leave West Africa desperate for Ebola staff


When Australia offered more than $2 million last month to the medical charity leading the fight against Ebola in West Africa, Medecins Sans Frontieres bluntly rejected it.

What was urgently needed from rich Western countries, MSF said, was not more money but doctors and nurses.

Despite warnings that hundreds of thousands may die, foreign governments and organisations are still hesitating to dispatch highly trained civilian and military personnel to fight the worst ever outbreak of the deadly virus.

Even in the highly controlled environments in the West, two U.S. nurses and one Spaniard have contracted the disease, putting its dangers in sharp focus for Western governments and news media.

On Thursday, a New York City doctor who worked for MSF in Guinea became the organisation's third foreign medic to contract the disease while treating people in West Africa.

The contrast with other humanitarian disasters, from the Haitian earthquake to the 2004 Asian Tsunami is stark. Aid workers say it can partly be explained by unease over Ebola's deadly nature, uncertainty over how to look after infected staff, and competing demands from other crises around the world.

With nearly 5,000 recorded deaths, and estimates the real toll is likely to be three times higher, governments and health organisations have pledged hundreds of millions of dollars.

But the World Health Organization said this week that just 25 percent of the isolation beds needed to halt the disease's march through Sierra Leone, Guinea and Liberia are in place.

The WHO estimates that 1,000 foreign medical workers and 20,000 locals are needed to man the 50 Ebola treatment units due to be rolled out across the three worst effected nations.

So far, the WHO says there are firm commitments from foreign teams for just 30 of these Ebola units.

“The big gap is still in human resources,” said Manuel Fontaine, head of U.N. child agency UNICEF in West Africa. “Money is necessary. It is an expensive operation. But we need people.”

In order to get Ebola under control, U.N. organisations estimate they must get 70 percent of all cases into treatment centres and ensure 70 percent of those who die of Ebola are buried safely. They hope to achieve that within two months.

“It seems like it should be feasible but there is a lot of concern about bringing back infections,” he said.

THOUSANDS OF DETAILS

Without doubt, treating Ebola is dangerous. At least 443 health workers are known to have contracted Ebola, of whom 244 have died.

Donors are stumping up millions of dollars to pay local healthcare workers risk bonuses following a rash of strikes.

“Building ETUs (Ebola treatments units) is the easy part, the more challenging and more dangerous part is making them run safely. To stay safe you have to think through thousands of details,” said Sean Casey, who runs one such unit for the International Medical Corps in Bong County in northern Liberia.

After the Haiti earthquake, Casey said “hundreds if not thousands” volunteered. This was party due to geography but also as they were able to work for two weeks at a time.

A stint fighting Ebola in West Africa involves six weeks in the region and another three away from work to avoid potentially infecting hospitals back home, he said.

Casey said organisations were often reluctant to tackle the disease. “In Haiti, everyone was there on the ground. Here all the usual actors have not responded to the call for help and some have even pulled out their staff,” he said.

U.S. charity Samaritans Purse withdrew non-essential staff treating patients in July after two of its members caught Ebola. It has since returned but is not providing frontline care.

Trevor Hughes, director of security and risk management at U.S.-based International Relief and Development, which has staff on the ground, said Ebola was testing the limits of people who are used to volunteering for crises.

“There is an issue of the obvious, which is certainly fear,” he said, adding that while organisations offered training, equipment and support, volunteers still worried about issues like insurance, logistics and whether sufficient standards were being maintained in a chaotic crisis zone.

AFRO-CUBAN SOLUTION

One major issue had been the lack of guarantees that volunteers would be evacuated to Western hospitals if they fell ill. U.S. and EU officials have since guaranteed this.

“There will be a mark when the logistics and other things will be in place, when there is a little bit more trust being built, and people will start heading out,” Hughes said.

“It might be too little too late,” he added.

Some aid workers suggest that the strategic importance of Liberia, Sierra Leone and Guinea was not high enough to mobilise major resources until people in the United States and Europe fell ill and it became an issue in the West.

Citing the case of an Ebola treatment centre in Macenta, Guinea, one aid worker said France was putting up financing but then “sub-contracting” the construction and operation of these units to non-governmental groups.

“France says it is building it but in fact it is being built by MSF and it will be run by the Red Cross,” she said.

The United States has pledged more cash and manpower than any other nation – up to $1 billion and as many as 4,000 troops. But U.S. personnel will build treatment units and train local staff, not provide care. Britain is adopting a similar strategy.

“When the risk is very high, the West is not going to send a lot of its own people,” Dakar-based independent West African political analyst Gilles Yabi told Reuters.

Cuba, however, has bucked the trend, with Havana training up 461 doctors and nurses so they can help fight Ebola. So far, 256 have been dispatched to West Africa.

Having been criticised for not doing enough to help while also imposing border closures and travel restrictions that have hurt Ebola-hit nations, African nations are now starting to pledge medics.

Doctors from Uganda, with years of experience fighting Ebola, are helping run a clinic in Monrovia. Congo, which has faced six outbreaks back home, is training 1,000 volunteers.

East African Nations have promised over 600 health workers and Nigeria, which has successfully contained its Ebola cases this year, has pledged 500 medics.

Ian Quick, director at Rethink Fragility, an organisation that focuses on fragile states, said the Ebola response was echoing current trends international peacekeeping, where rich states provide funds but poor nations send personnel.

“It makes sense in terms of comparative advantage … but does tend to stick in everyone's craw ethically.”

Additional reporting by Daniel Flynn in Dakar, Pascal Fletcher in Johannesburg, and Tom Miles in Geneva; Editing by Daniel Flynn and Giles Elgood

Ebola among top U.S. worries but well behind economy, jobs


A new poll on Tuesday showed Ebola has moved into the top 10 issues of concern to Americans but ranks behind the economy, dissatisfaction with government and other worries.

The Gallup poll was conducted before Monday's announcement that 51 people had been removed from watch lists in Texas after showing no signs of Ebola symptoms for 21 days. Scores of others are still being monitored.

The removal of dozens of people from monitoring may have eased anxiety about the potential spread of the disease in the United States, where three people have been diagnosed with the virus that has killed more than 4,500 people, mostly in Liberia, Guinea and Sierra Leone.

The World Health Organization's emergency committee planned to meet on Wednesday to review the growing epidemic in West Africa, which the agency has declared an international public health emergency. The committee can recommend travel and trade restrictions.

While the United States has seen only three infections and one death from Ebola, the issue has moved to the forefront in the U.S. election campaign as Republicans ramp up criticism of the government's response.

Ebola made its debut in the top 10 concerns of Americans but remained well behind five other issues: the economy, dissatisfaction with government, jobs, healthcare and immigration, the Gallup polling organization said after the survey conducted Oct. 12-15.

Ebola was tied with the federal budget deficit, education, the battle against Islamic State militants and the decline of morality as a top concern of 5 percent of the public, Gallup said. The economy ranked No. 1 at 17 percent.

'SHAMEFULLY' EXPLOITING CONCERN

Concerns that Americans might fall victim to scams because of fear about Ebola prompted a warning on Tuesday from New York state Attorney General Eric Schneiderman about bogus Ebola preparedness kits and preventative medications.

“Scammers are shamefully exploiting this moment of heightened concern about public health to defraud good people,” Schneiderman said in a statement.

There are no U.S. government-approved vaccines, medications or dietary supplements to prevent or treat Ebola.

Such schemes aim to prey on Americans' worries over the virus after the first patient diagnosed in the United States, Thomas Eric Duncan, died in Dallas on Oct. 8 and another infected patient, nurse Amber Vinson, flew from Texas to Ohio and back.

Vinson's mother, Debra Berry, told ABC News on Tuesday that her daughter is weak but recovering.

“She's doing OK, just trying to get stronger,” Berry told ABC's “Good Morning America” program. She said Vinson's family is “very confident” she was getting good care at Emory University Hospital in Atlanta, where she was taken last week for treatment.

U.S. hospitals are on high alert for possible cases, and some U.S. airports have begun screening passengers arriving from West Africa.

A study published in The Lancet medical journal on Tuesday said three Ebola-infected travelers a month would be expected to board international flights from West African countries suffering epidemics of the virus if no effective exit screening existed.

Researchers used modeling based on this year's global flight schedules and last year's passenger itineraries, along with current epidemic conditions, to conclude that 2.8 people with Ebola, on average, would board international flights every month. They said exit screening was far more effective than screening at the point of arrival.

Some U.S. lawmakers have called for a travel ban from West Africa to help stop the spread of the virus.

U.S. Senator Marco Rubio, a Florida Republican, said on Monday he planned to introduce legislation when the Senate returns next month that would impose travel restrictions by creating a temporary ban on new visas for people from Liberia, Guinea and Sierra Leone, the hardest-hit countries.

Writing by Jim Loney; Editing by Meredith Mazzilli and Jonathan Oatis

Israel prepares to fight Ebola in West Africa


Even as Israeli Prime Minister Benjamin Netanyahu announced new measures on Oct. 12 to screen for Ebola cases at Israel’s points of entry, officials from the Foreign Ministry and the Ministry of Health had worked over the weekend to put in place an emergency response program to help combat the epidemic on the ground in West Africa. 

“After the meeting at the prime minister’s office we reached a decision to change the mode of our expected operation, and instead of sending three clinics to peripheral countries, which was our original program, we will deploy mobile field hospitals to Liberia and Sierra Leone,” Gil Haskel, director of MASHAV, Israel’s Agency for International Development Cooperation, said on Oct. 10.

The virus has hit Liberia and Sierra Leone the hardest, with the World Health Organization counting more 3,000 Ebola fatalities since the start of the outbreak in March 2014. 

“We don’t have the finalized numbers, but we are planning the configuration of the hospitals and staff,” Haskel told the Journal. “This will be a joint effort between MASHAV, Israel’s agency for development and global cooperation, and IsraAID,” a nongovernmental organization known globally for its crisis support, as well as its sustained work with earthquake survivors in Haiti and Japan.

The Ebola effort is aimed at helping medical professionals quarantine and care for their patients. 

Multiple reports from the outbreak zone indicate panic-filled health care workers are entering communities, issuing directives and then fleeing the areas without following through with the required prevention and quarantine measures. 

“We are putting the main emphasis on isolation units and protection gear for the medical staff,” Haskel said. “It doesn’t help if the virus will affect the nurse treating the first patient, because, of course, from there it is downhill.” 

IsraAID already has sent an advance team to Sierra Leone, and two of its staff members were the only representatives from international health groups at an Oct. 11 emergency Ebola meeting convened by Sierra Leone’s first lady, Sia Nyama Koroma. 

Yotam Polizer and Irina Polak, IsraAID staff specializing in social welfare and trauma programs, outlined training programs aimed at trauma prevention for health care workers and the affected communities.

“This is not going to be a hit-and-run. We’re looking at doing this Ebola work for a substantial time period, and we’re likely to be there for the next two years,” said IsraAID founding director Shachar Zahavi, who has issued a call for volunteer doctors, nurses and paramedics to set up the field clinics with supplies provided by Israel’s Foreign Ministry. 

“We will start with service providers to help reduce their stress, and then we will go with them into the communities and help them engage the community with a consistent message around Ebola prevention and treatment,” Zahavi said.

Health professionals serving in front-line medical teams are required to be in peak physical condition, as the conditions in which they work are extreme; while wearing their protective suits, they can lose up to a liter and a half of water per hour.  

The Israeli medical volunteers in the front lines of Ebola treatment will be integrated into teams already on the ground that were deployed earlier this month by the World Health Organization.  

“Ebola is a threat to global security, and we need to be in the front lines and demonstrate that Israelis and Jews care about the world. We can have a real impact on this situation,” said Zahavi, who added that he’s been in extensive consultations with North American Jewish leaders on ways to make the fight against this epidemic a genuine Israel-Diaspora partnership. 

IsraAID has been selected to lead the psychosocial aspect of the operation in this multinational effort, with the World Health Organization, Doctors Without Borders and the International Red Cross allocating the tasks in coordination with the governments in West Africa. 

“A colleague in Cameroon told me that Israel is a magical country, that we can do anything,” said Dr. Roee Singer, deputy director of the Division of Epidemiology at the Ministry of Health in Jerusalem. 

Singer was part of a team invited last month by the Cameroon government to train hospital and emergency service workers in Yaoundé who are anxious to prevent the incursion of Ebola into their country. 

“Of course we can’t solve all of their problems, but Israelis are treated with great esteem in places like Cameroon, where we’ve been involved for many years in health, agricultural development and security assistance,” Singer said.

“We ran seminars with doctors from the leading hospitals in the capital city, the army, police, firefighters and paramedics and airport workers. Our mission was to explain how personal protection works and how to then organize a protected space to treat Ebola patients,” said Singer, who when interviewed late in the day on Oct. 11 was working on crafting the Israeli border disease control measures. 

“I have to tell you that you can see the results of the training at the airport,” Nadav Cohen, Israeli Ambassador in Yaoundé, said in an interview Oct. 11. “They are checking the temperatures of arriving passengers and educating people with a visible public information campaign.”

West Africa Ebola outbreak could infect 20,000 people, WHO says


The Ebola epidemic in West Africa could infect over 20,000 people and spread to more countries, the U.N. health agency said on Thursday, warning that an international effort costing almost half a billion dollars is needed to overcome the outbreak.

The World Health Organisation (WHO) announced a $490 million strategic plan to contain the epidemic over the next nine months, saying it was based on a projection that the virus could spread to 10 further countries beyond the four now affected – Guinea, Liberia, Sierra Leone and Nigeria.

With the IMF warning of economic damage from the outbreak, Nigeria reported that a doctor indirectly linked to the Liberian-American who brought the disease to the country had died of Ebola in Port Harcourt, Africa's largest energy hub.

In Britain, drugmaker GlaxoSmithKline said an experimental Ebola vaccine is being fast-tracked into human studies and it plans to produce up to 10,000 doses for emergency deployment if the results are good.

So far 3,069 cases have been reported in the outbreak but the WHO said the actual number could already be two to four times higher. “This is not a West African issue or an African issue. This is a global health security issue,” WHO's Assistant Director-General Dr Bruce Aylward told reporters in Geneva.

With a fatality rate of 52 percent, the death toll stood at 1,552 as of Aug. 26. That is nearly as high as the total from all recorded outbreaks since Ebola was discovered in what is now Democratic Republic of Congo in 1976.

The figures do not include 13 deaths from a separate Ebola outbreak announced at the weekend in Congo, which has been identified as a different strain of the virus.

Aylward said tackling the epidemic would need thousands of local staff and 750 international experts. “It is a big operation. We are talking (about) well over 12,000 people operating over multiple geographies and high-risk circumstances. It is an expensive operation,” he said.

The operation marks a major raising of the response by the WHO, which had been accused by some aid agencies of reacting too slowly to the outbreak.

Medical charity Medecins sans Frontieres (MSF) welcomed the WHO plan but said the important thing was now to act upon it.

“Huge questions remain about who will implement the elements in the plan,” said MSF operations director Brice de le Vingne. “None of the organizations in the most-affected countries … currently have the right set-up to respond on the scale necessary to make a serious impact.”

EXPERIMENTAL DRUGS

Early this month, the WHO classified the Ebola outbreak as an international health emergency. Concerns that the disease could spread beyond West Africa have led to the use of drugs still under development for the treatment of a handful of cases.

Two American health workers, who contracted Ebola while treating patients in Liberia, received an experimental therapy called ZMapp, a cocktail of antibodies made by tiny California biotech Mapp Biopharmaceutical. They recovered and were released from hospital last week.

The virus has already killed an unprecedented number of health workers and is still being spread in a many places, the WHO said. About 40 percent of the cases have occurred within the past 21 days, its statistics showed.

Previous Ebola outbreaks have mainly occurred in isolated areas of Central Africa. However the current epidemic has spread to three West African capitals and Lagos, Africa's biggest city. The WHO said special attention would need to be given to stopping transmission in capital cities and major ports.

“This epidemic is a challenge. Challenging to Liberia and challenging to all of those who are friends and partners of Liberia,” President Ellen Johnson Sirleaf said on Wednesday, receiving a donation of ambulances from the Indian community.

“We can only return to our normal business … if together we beat this demon that is amongst us.” 

Authorities in Nigeria announced the doctor's death in Port Harcourt, the main oil industry terminal of Africa's largest crude exporter. The doctor had treated a patient who evaded quarantine after coming into contact with Patrick Sawyer – a U.S. citizen who died in Lagos after flying in from Liberia last month.

Health Ministry spokesman Dan Nwomeh wrote in his Twitter feed that 70 people were now under surveillance in Port Harcourt, which is home to foreigners working for international oil companies.

A spokesman for leading operator Royal Dutch Shell said in London that the firm was “liaising with health authorities on the steps being taken to contain the disease”.

Oil traders in Europe said insurance premiums for Nigerian cargoes had gone up slightly, but otherwise business was continuing as normal.

Analysts urged caution. “While major disruption to oil production appears unlikely, any further spread of Ebola … is likely to cause serious operational challenges,” said Roddy Barclay of the Control Risks consultancy.

According to new figures released on Thursday, Nigeria has recorded 17 cases, including six deaths, from Ebola, since Sawyer collapsed upon arrival at Lagos airport in late July.

While Nigeria has yet to suffer any major economic disruption, the International Monetary Fund said the smaller, poorer nations at the heart of the epidemic were being badly hurt. “The Ebola outbreak is having an acute macroeconomic and social impact on three already fragile countries in West Africa,” IMF spokesman Gerry Rice told reporters in Washington.

Rice said the IMF was assessing the impact and any extra financing needs with Guinea, Liberia and Sierra Leone.

The Lagos case contributed to the decision by a number of airlines to halt services to Ebola-affected countries. Air France said on Wednesday it had suspended flights to Sierra Leone on the advice of the French government.

Aylward said it was vital to restore commercial airline routes to the region to help transport aid workers and supplies, but in the meantime the WHO plan includes an “air bridge” to be operated by the U.N.'s World Food Programme.

“We assume current airline limitations will stop within the next couple of weeks. This is absolutely vital,” he said. “Right now the aid effort risks being choked off.”

West African health ministers meeting in Ghana on Thursday echoed the WHO's concerns and called for the reopening of borders and an end to flight bans.

Pakistan’s failings to fight polio spark global emergency response


Pakistan's failure to stem the spread of polio triggered global emergency health measures on Monday, with the World Health Organisation (WHO) recommending all residents must show proof of vaccination before they can leave the country.

The emergency measures also apply to Syria and Cameroon, which along with Pakistan are seen as posing the greatest risk of exporting the crippling virus and undermining a U.N. plan to eradicate it by 2018.

Pakistan is in the spotlight as the only country with endemic polio that saw cases rise last year. Its caseload rose to 93 from 58 in 2012, accounting for more than a fifth of the 417 cases globally in 2013.

The virus has recently spread to AfghanistanIraqIsrael and Syria, and has been found in sewage in the West Bank, Gaza Strip and greater Cairo, said WHO assistant director general Bruce Aylward. It also appeared in China two years ago.

“In the majority of these reinfected areas, the viruses circulating actually trace back to Pakistan within the last 12-18 months,” Aylward told reporters on a conference call.

Pakistan has called an emergency meeting of senior provincial and federal health officials for Wednesday to finalise how to implement the new requirements.

“The best option would be vaccinating the passengers at the airport departure where polio vaccination cards would be issued to the passengers. Human resource and vaccines would have to be worked out for the purpose,” State Minister for Health Services Saira Afzal Tarar said in a televised broadcast.

“It would be most practical as people often have to fly in emergencies.”

2018 TARGET

Aylward said Pakistan had done “tremendous” work to restore security in Peshawar after deadly attacks on health workers had impeded the fight against polio. The race to meet a target to eradicate polio by 2018 was still feasible, he said.

“In terms of the 2014 working target to try and stop transmission, from the data presented, clearly Pakistan would be the only country that would be considered 'off track' in terms of its ability to meet that deadline,” he added.

WHO chief Margaret Chan declared the resurgence of the disease to be a public health emergency of international concern, the first such designation since a 2009 flu pandemic.

The travel restrictions should stay in place until there is a whole year with no new exports of the disease, or six months if the countries can show they have carried out high quality eradication activities in infected and high risk areas.

The WHO's emergency committee, an independent group of experts that drew up the recommendations, will meet in three months to assess the countries' actions, or sooner if needed.

The steps published on Monday were the minimum actions that could be taken without unnecessarily disrupting travel or trade, but much stronger measures could have been recommended, Aylward said. Those include full vaccination programmes, restrictions on more countries and recommendations on countries of arrival.

The WHO says 10 million people are walking today thanks to efforts to wipe out the disease, which mainly affects children under five years old. It says economic models show eradicating polio would save at least $40-50 billion over the next 20 years.

Polio passes easily from person to person and can spread rapidly among children, especially in the kind of unsanitary conditions endured by displaced people in war-torn regions, refugee camps and areas where health care is limited.

The virus invades the nervous system and can cause irreversible paralysis within hours. The WHO has repeatedly warned that as long as any single child remains infected with polio, children everywhere are at risk.

There is no cure for the disease but it can be prevented by immunization. The polio vaccine, administered multiple times, can protect a child for life. 

Polio virus strain in Syria confirmed as being from Pakistan, WHO says


Polio that has crippled at least 13 children in Syria has been confirmed as being caused by a strain of the virus that originated in Pakistan and is spreading across the Middle East, the World Health Organisation said.

Genetic sequencing shows the strain found in Syrian children in Deir al-Zor, where an outbreak was detected last month, is linked to the strain of Pakistani origin found in sewage in Egypt, Israel and Palestinian territories in the past year.

“Genetic sequencing indicates that the isolated viruses are most closely linked to virus detected in environmental samples in Egypt in December 2012 (which in turn had been linked to wild poliovirus circulating in Pakistan),” the United Nations agency said in a statement on Monday.

Closely-related strains of the wild poliovirus of Pakistani origin have also been detected in sewage samples in Israel, the West Bank and Gaza Strip since February 2013, it said.

Polio virus has been confirmed in 13 of 22 children who became paralysed in the northern Syrian province of Deir al-Zor. Investigations continue into the other 9 cases. It is Syria's first polio outbreak since 1999.

No children in Egypt, Israel or the Palestinian territories have been hit by polio thanks to high immunisation rates and a strong response to the alert, WHO spokeswoman Sona Bari said.

Polio virus is endemic in Pakistan, Afghanistan and Nigeria despite a 25-year-old campaign to eradicate the disease, which can paralyse a child in hours.

IMMUNISATION RATES

Islamist fighters from countries including Pakistan are among groups battling to oust President Bashar al-Assad, leading to speculation that they brought the virus into the country.

The WHO says it is unlikely that adults, who generally have higher immunity, carried the virus into Syria and that its mode of transmission will probably never be known.

Syria's immunisation rates have plummeted from more than 90 percent before the conflict to around 68 percent. Polio mainly affects children under five and cannot be cured, only prevented.

“All the children (paralysed) are under two years old, so they were all born after immunisation services fell apart,” Bari told Reuters. “No doubt the outbreak will be large.”

Children living in unsanitary conditions are especially vulnerable to the virus, which spreads via faecal-oral transmission and contaminated food and water.

More than 20 million children, including 1.6 million in Syria, are to be vaccinated in Syria and neighbouring countries over the next six months, U.N. agencies said last week.

Reporting by Stephanie Nebehay; editing by Andrew Roche

CON PROP 37: Should genetically engineered foods be labeled?


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