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CDC: First Ebola case diagnosed in United States
The CDC confirmed on Sept. 30 that a man in Texas who recently traveled from West Africa was diagnosed in the United States with Ebola virus.
The unidentified patient left Liberia on Sept. 19 and arrived in the United States the next day. He developed symptoms 4 to 5 days later and presented to a Dallas hospital on Sept. 28. Texas health officials sent samples from the patient to the CDC in Atlanta, where it was confirmed through PCR analysis that the patient was infected with the disease.
The exact source of the first US case is unknown, and the Texas health officials said there are no other suspected cases in the state.
The patient has been placed in isolation, and health authorities have identified and will monitor everyone who might have come into contact with the patient while he was infectious, according to CDC Director Thomas Frieden, MD, MPH.
"I have no doubt that we will control this importation of Ebola so that it does not spread widely in this country," Frieden said during a media briefing. "It is possible that someone who had contact with this individual — a family member or other individual — could develop Ebola in the coming weeks, but there is no doubt in my mind that we will stop it here."
U.N. mission
The U.N. General Assembly and the U.N. Security Council have approved resolutions to create the U.N. Mission for Ebola Emergency Response to contain the Ebola outbreak in West Africa.
According to WHO, this is the first time that the U.N. has created a mission for a public health emergency.
As of Sept. 26, there have been 6,553 cases and 3,083 deaths from Ebola throughout Guinea, Liberia and Sierra Leone, according to WHO. The International Health Regulations Emergency Committee determined that the outbreak continues to be a public health emergency of international concern.
Many countries, including the United States, the United Kingdom, China and Cuba, have pledged significant support to battle the outbreak, including health care workers, supplies, materials to build hospitals and military personnel.
"This is not just a public health crisis," WHO Director-General Margaret Chan, MD, said in an address to the U.N. Security Council. "This is a social crisis, a humanitarian crisis, an economic crisis and a threat to national security well beyond the outbreak zones. Everything now is 'unprecedented.' Everything now is happening faster than ever before. The needs are immense and we know it."
National security priority
The mission will join the resources of all of the U.N. agencies, funds and programs to support WHO's expertise and experience in disease outbreaks. WHO is leading the public health efforts for the response, but the support of other U.N. agencies is necessary to deal with social, economic, development and security challenges throughout the region.
"The unprecedented outbreak requires an unprecedented response," David Nabarro, MD, the U.N. secretary-general's senior coordinator for the Ebola response, said in a press release. "The number of cases have doubled in these countries in the last 3 weeks. To get in front of this, the response must be increased 20-fold from where it is today."
President Barack Obama, addressing the U.N., said the Ebola outbreak in West Africa is a top national security priority and he called for a global effort to combat the disease.
"If ever there were a public health emergency deserving an urgent, strong and coordinated international response, this is it," Obama said.
Obama called on international organizations to move faster and contribute important assets and capabilities. He also called for support from foundations and from businesses, especially those with a presence in the region, to provide expertise and resources. In addition, he has directed the military to establish a command in Liberia to help move supplies and personnel. In addition, the United States is working with Sierra Leone to create an air bridge to move supplies to the region faster.
"This is all progress, and it is encouraging," Obama said. "But I want us to be clear: We are not moving fast enough."
Future predictions
The WHO Ebola Response Team predicts the number of Ebola cases throughout Guinea, Liberia and Sierra Leone to exceed 20,000 by Nov. 2 if there are no changes in control measures for the outbreak, according to a report in The New England Journal of Medicine.
"Notwithstanding the geographic variation in case incidence within and among Guinea, Liberia and Sierra Leone, the current epidemiologic outlook is bleak," the investigators wrote. "Forward projections suggest that unless control measures — including improvements in contact tracing, adequate case isolation, increased capacity for clinical management, safe burials, greater community engagement and support from international partners — improve quickly, these three countries will soon be reporting thousands of cases and death each week, projections that are similar to those of the CDC."
In a similar analysis, a CDC Ebola Response model that corrected for underreporting suggested that if these trends continue, the case count could reach 1.4 million by Jan. 20 in Liberia and Sierra Leone, according to a report in MMWR. But if 70% of the patients are placed in Ebola treatment centers (ETUs) or other settings with reduced risk for disease transmission by late December, the epidemic would instead almost end by Jan. 20.
"If conditions continue without scale-up of interventions, cases will continue to double approximately every 20 days," the CDC investigators wrote. "However, the findings also indicate that the epidemic can be controlled. Ensuring that approximately 70% of the patients are in ETUs is necessary, or, when ETUs are at capacity, that they are at home or in a community setting such that there is a reduced risk for disease transmission (including safe burial when needed)."
Global humanitarian crisis
In an editorial accompanying the NEJM paper by the WHO Ebola Response Team, Jeremy J. Farrar, MD, PhD, professor of tropical medicine and global health at the University of Oxford, and Peter Piot, MD, PhD, director of the London School of Hygiene and Tropical Medicine, wrote that this epidemic "has evolved into a major humanitarian crisis that has finally mobilized the world."
They said the outbreak highlights three transformations needed when approaching rapidly emerging public health emergencies: certain conditions can cause a limited outbreak to become an uncontrollable epidemic; the current control efforts are not sufficient for epidemics of this size; and the development of diagnostic tools, therapies and vaccines need to be prioritized and have an approved, ethical mechanism for accelerating development when epidemics arise.
"There will be more epidemics and outbreaks of Ebola and other new or re-emerging infections," Farrar and Piot wrote. "Yet, our response to such events remains slow, cumbersome, poorly funded, conservative and ill prepared. We have been very lucky with [severe acute respiratory syndrome], H5N1 and H1N1 influenza, and possibly [Middle East respiratory syndrome] coronavirus, but this Ebola epidemic shows what can happen when luck escapes us. With a different pathogen and a different transmission route, a similar crisis could strike in New York, Geneva and Beijing as easily as this one has in West Africa."
WHO Ebola Response Team. N Engl J Med. 2014;doi:10.1056/NEJMoa1411100.