UK | SCAS to showcase Simbulance for first time at CarFest

South Central Ambulance Service NHS Foundation Trust (SCAS) will be showcasing its mobile simulation vehicle, the Simbulance, for the first time ever, at next week’s CarFest.

During CarFest, SCAS staff will be on hand to show members of the public inside the Simbulance. This is an innovative and award winning virtual classroom facility which normally enables ambulance staff to undergo and experience realistic medical situations inside an ambulance cabin thanks to educational elements including ambulance equipment, manikins and audio-visual recording capabilities on board.

Helen Pocock, Education Manager (Research and Development) for SCAS, said: “We’re really looking forward to showing people of all ages a variety of medical scenarios being simulated in a mobile setting. In the past, simulation has been restricted to labs or classrooms, but the Simbulance allows us to show types of medical situations that typically happen in an ambulance.  We are keen to show the wider public how we are using this technology to develop not only technical abilities, but also some of the other skills essential to our role.

“We are inviting children to bring along their teddies to be assessed in the Simbulance so that they can engage with us in an interactive way and familiarise themselves with basic equipment and the overall ambulance environment. This helps to reduce the fear factor should a child ever require our services in the future.  There will also be a chance for children to enter our ‘Name the Manikin’ competition in aid of Children in Need, so please come along and have a look.”

UK | EEAST crews assist with emergency childbirth at home

Picture is courtesy of Chris Rushton at Essex Chronicle. From left to right it shows: Lee Cutter, Jo Rogers, Lindsay with baby Theo, Ian Jones and Karen Frost.
Picture is courtesy of Chris Rushton at Essex Chronicle. From left to right it shows: Lee Cutter, Jo Rogers, Lindsay with baby Theo, Ian Jones and Karen Frost.

A paramedic’s sister has been able to thank the ambulance team that helped her after a surprise home birth in Chelmsford.

Lee Cutter is used to rushing to emergencies but on this occasion he had to spring into action to get to his own sister, Lindsay Masvaleix, 37 of Helson Road.

She called upon her brother who lives just around the corner when her waters broke back on 26th May.

Lindsay said: “We were watching a film at the time and I screamed at my husband [Fabien] ‘I think I’m having a baby, stop watching the film’. “

“As soon as I arrived I knew that Lindsay wasn’t going to get to hospital in time so I asked Fabien to call 999 as I didn’t have any equipment on me to actually deliver a baby”, said Lee.

Fabien spoke to call handler Jo Rogers and Paramedic Karen Frost and Emergency Care Assistant Ian Jones arrived within five minutes.

Ian said: “This was the first time I’d ever delivered a baby and it’s so lovely to see them again – they’re getting on so well.”

Lindsay and 13-week-old baby Théo met the ambulance crews at their home last week.

“The paramedics did brilliantly and I just wanted to thank everyone who helped me. You don’t think about what they do until you need them.”

UK | EEAST medics praised for actions after 35 people found in shipping container

At 6.37am yesterday morning (16th August), the East of England Ambulance Service NHS Trust was called to Tilbury Docks in Essex to treat 35 people who had been found in a shipping container.

The first crew on scene were there in 11 minutes and found the patients, including adults and 14 children of both genders, to be suffering from severe dehydration and hypothermia, with one male very sadly being declared deceased.

Daniel Gore, a Duty Assistant Chief Ambulance Officer at the scene, said: “The first crew on scene did a fantastic job in recognising the scale of this incident which meant we were able to get resources there very quickly and start delivering care to those involved.

“Our initial priority was to assess the level and nature of any injuries, and ensure that those people in most need were treated first and taken to hospital.”

Following first reports from crews the Trust quickly declared a major incident and sent seven ambulances, two rapid response cars, a patient transport services vehicle, two duty operational managers, two BASICS doctors and its hazardous area response team (HART) to the scene to help deliver care to those in need.

After initial treatment by our staff all patients were conveyed to surrounding hospitals for further care; seven were taken to Southend Hospital, nine to London Whitechapel Hospital and 18 to Basildon Hospital.

Daniel added: “Thanks to some excellent joint working between ourselves, our emergency services colleagues, the UK Border Agency and Tilbury Dock staff we were able to respond to this incident quickly and efficiently and provide an excellent level of care to the 34 patients.

“We do extensive planning and preparation for major incidents like this one, which means when they do happen we are able to provide the best possible response.

“On behalf of the Trust I’d like to thank every member of staff who helped at Tilbury today – from our call handlers and vehicle dispatchers to those treating people at the scene itself. Their work was excellent and I am immensely proud of the service we provided today.”

Kenya | All suspected Ebola cases test negative for the disease

Following the outbreak of Ebola Virus Disease in West Africa, the Ministry of Health through health facilities and all ports of entry has been carrying out active Ebola surveillance through screening.

The aim of this strategy is to avert the possibility of importation of a case of Ebola into Kenya.

In this regard, in the last 48 hours, the Ministry of Health has received four alerts of suspicious Ebola cases from various hospitals and the airport.

The first one was a Liberian national transiting through Jomo Kenyatta airport to India. The second was a Nigerian who had visited Kenya on 8th August but became ill while in Nairobi. The third one was a Zimbabwean who works in South Africa but was travelling to Sierra Leone. The fourth was Nigerian who reported to AAR clinic with symptoms suggestive of Ebola.

After clinical assessment, laboratory samples were taken from the four suspected cases. All the 4 samples tested negative for Ebola.

Kenya | Temporary travel suspension for all passengers travelling/transiting to Kenya from Ebola hot zone

World Health Organization (WHO) has declared the Ebola outbreak in four countries in West Africa as a Public Health emergency of international concern.

Currently 2127 people have been infected and 1145 have succumbed to the disease. Further WHO has described this outbreak as an ‘Extraordinary Event’ and a Public Health risk to other states.

WHO has also indicated that there are possible consequences of further international spread, particularly in view of the virulence of the virus, the extensive community and health facility transmission in the affected countries.

In view of the above, WHO has admitted that the magnitude of Ebola outbreak in West Africa was vastly underestimated and that the current outbreak is expected to continue for some time.

In the interest of Public Health, the Government of Kenya has therefore decided to temporarily suspend entry into Kenya of passengers travelling from and through the three West African countries affected by Ebola namely Sierra Leone, Guinea and Liberia, effective midnight, Tuesday 19th August 2014.

This suspension applies to all Kenyan ports of entry. The suspension will exclude Health Professionals supporting efforts to contain the outbreak and Kenyan citizens returning home from those three countries. However, such passengers will undergo extensive screening and thereafter close monitoring and where necessary shall be quarantined.

This step is in line with the recognition of the extraordinary measures urgently required to contain the Ebola outbreak in West Africa. Further, this decision has been arrived at after extensive consultations with various key stakeholders and Government Ministries including the Attorney General, Kenya Airways, Ministry of Foreign Affairs & International Trade and Ministry of Transport.

New South Wales | LODD – One firefighter killed another injured battling hotel blaze in Cobar

Fire & Rescue NSW is today mourning the death of one of their own, after a firefighter from Cobar died, and another was injured while fighting a fire at the Occidental Hotel this morning.

“It is with a heavy heart I confirm the death of a Fire and Rescue NSW officer in the state’s west today,” said Minister for Emergency Services Stuart Ayres.

“The officer was attending a fire at a hotel in Cobar when a wall collapsed and he suffered what is believed to be cardiac arrest.

“The officer was taken by ambulance to Dubbo Base Hospital where he was pronounced deceased.

“As a member of Fire & Rescue NSW, this man selflessly dedicated his life to the safety of his community.

“On behalf of the people of NSW, our thoughts and prayers are today with the officer’s family, friends and fellow firefighters” Mr Ayres concluded.

Fire & Rescue NSW Commissioner Greg Mullins said the whole firefighting community was devastated by the death and expressed condolences to the family and community of Cobar.

“Today we have lost a dedicated firefighter, committed to protecting his community.

“He lost his life protecting other people in his community and on behalf of all members of Fire & Rescue NSW I extend our deepest sympathies to firefighters, family and friends.”

The second firefighter is being treated in hospital for non life-threatening injuries.

Commissioner Mullins is currently travelling to Cobar, along with other senior officers and staff from Fire & Rescue NSW’s Critical Incident Support Team to be on hand to offer support and assistance to the family, firefighters and the community.

UK | National public health warning issued on nitrous oxide

A national public health warning is being issued by councils about ‘laughing gas’ as they launch a crackdown on the potentially lethal drug.

The Local Government Association (LGA), which represents almost 400 councils in England and Wales – who took over responsibility for public health last year, says local authorities up and down the country are seizing hauls of canisters and highlighting the dangers of the gas.

Warning postcards have been distributed to pupils at some schools and youth clubs. The drug – a favourite among some celebrities – has been linked with a number of deaths and is used by almost half a million young people across the country – equivalent to a city the size of Liverpool.

The LGA is particularly concerned that internet clips, self-filmed by children abusing the drug and uploaded onto YouTube, are glamourising it and wants the web giants to introduce health warnings and links to drug awareness charities. Online chat rooms discuss the best websites for users to buy laughing gas – which is regularly taken at nightspots, festivals and parties – and Facebook and Twitter users openly advertise delivery ‘to your door’.

The warning come after more than 20 music festivals chiefs announced that traders at their events selling so-called ‘legal highs’, including laughing gas, would be banned.

Laughing gas – real name nitrous oxide – is legally and safely used to numb pain during medical procedures such as dental work. However, it is also a hugely popular ‘party’ drug, with users inhaling it from balloons. This can lead to hypoxia (oxygen deprivation), resulting in loss of blood pressure, fainting and even heart attacks. Prolonged exposure can cause anaemia, bone marrow suppression and poisoning of the central nervous system. These risks are heightened if it is combined with drink or other drugs.

Abusing nitrous oxide can be fatal. In the last few weeks, a 25-year-old south Londoner drowned at a festival in the south of France after reportedly taking it. Earlier this year, it claimed the life of a 21-year-old chef, from Worcestershire, soon after finding out he was to become a father for the first time. A promising art student, 17, from north London, also suffered a cardiac arrest and died after reportedly inhaling it.

Cllr Katie Hall, Chair of the LGA’s Community Wellbeing Board, said:

“It is deeply disturbing that this drug, which can be highly dangerous, is still widely viewed as safe.

“It is imperative that users understand just how harmful it can be. This gas can kill – and much more needs to be done to get this message across.

“We are particularly concerned about internet pages and uploaded clips which are effectively ‘promoting’ this as a harmless drug. The web giants must do more to crack down on this – they cannot simply sit on their hands and ignore what is happening on their own sites.

“We are calling on the big internet corporations to step up to the plate and show responsibility by providing health warnings and links to drug awareness charities. It is wholly unacceptable that this craze is being glamourised and encouraged in this way.”

Council case studies

LB Hackney
More than 1,200 canisters of the chemical were seized in just one night outside the pubs and clubs of Shoreditch, east London, in the last few weeks.

Windsor and Maidenhead
A ‘concerning’ number of calls have been made by worried parents, who have found nitrous oxide cartridges in their children’s clothing or bedrooms, to the Royal Borough’s Young People’s Drug and Alcohol Team (YPDAAT). A nitrous oxide information postcard aimed at young people was produced by the YPDAAT and widely distributed to pupils at some schools and youth clubs when discarded cartridges were discovered.

Patrols by police and checks to tackle nitrous oxide and other ‘legal highs’ are being stepped up by police and Trading Standards officers at two popular music festivals, Brownstock and V, following a fatality last year at Brownstock. This was linked with a ‘legal high’ called 5-EAPB – a derivative of the designer drug ‘Benzo Fury’. The man-made drug was legal at the time but is now banned. The warning comes from Essex County Council, Chelmsford City Council and Essex Police.

Norfolk County Council is warning of the dangers of nitrous oxide following the discovery of a number of cartridges of the gas in the Prince of Wales Road area of Norwich.


Social media




Yahoo (an example of how the dangers could be highlighted)

Festival organisers warn about legal highs

500,000 users

For young adults, aged 16 to 24:
7.6 per cent had taken nitrous oxide in the last year (which equates to about 470,000 people in that age group). See page 11 of the link below:



Global | Public health and animal health experts review knowledge on MERS-CoV

The OIE convened a high level scientific expert Ad hoc Group meeting on Middle East Respiratory Syndrome coronavirus (MERS-CoV) infection in animals from 15 to 17 July in its Headquarters in Paris, in order to summarise the latest scientific data available and to provide guidance and recommendations to prevent and control the disease at the human-animal interface. The meeting welcomed public health and animal health experts from different countries.

MERS-CoV was first identified in humans in April 2012, causing a severe respiratory disease. Current outbreak investigations suggest that camels could be a source of human infections. Nevertheless, the exact route of transmission from camels to humans remains unclear. Dr Bernard Vallat, Director General of the OIE, highlighted the importance of MERS-CoV due to its public health impact. He explained that since the apparition of the disease, the OIE had been in permanent consultation with the World Health Organization (WHO) and the Food and Agriculture Organization of the United Nations on this topic.

The Group exchanged their views on the current state of knowledge about MERS-CoV infection in humans and animals, and scientific data on the performance of diagnostic tests. To date, accurate serology and Polymerase chain reaction (PCR) tests exist.

The criteria of surveillance of the disease in camels and other animal species were discussed, based on the current epidemiologic findings. The experts insisted on the fact that further evidence from epidemiologic studies is needed to better understand the behaviour of MERS-CoV infections in animals. They identified areas of priority for research studies in animals and collection of scientific data which will assist the development of appropriate animal health management measures and, when relevant, limit potential for further human infections.

The establishment of an OIE Reference Centre with expertise in MERS-CoV has been recommended in supporting further disease surveillance and research, as well as providing technical advice to the OIE Member Countries.

After proceeding to a science-based evaluation, the Group concluded that MERS-CoV in camels did not meet the criteria to figure in the OIE listed diseases. However, MERS-CoV is a serious public health concern with zoonotic potential and infection in animals must be reported to the OIE as an emerging disease.

The OIE will continue to work in close collaboration with the WHO and the public health sector and regularly update guidance to its Members and the public on this emerging disease.

Update August 2014 – Questions & Answers on Middle East Respiratory Syndrome Coronavirus (MERS‐CoV)

What is MERS-CoV?

MERS-CoV is a coronavirus (CoV) which causes Middle East Respiratory Syndrome (MERS), a severe respiratory disease, in humans. It was identified in humans in April 2012.

Sporadic human cases of MERS have occurred and continue to occur over a wide geographical distribution with the majority of cases reported from the Arabian Peninsula. Infections in dromedary camels also have been detected in a wide geographic distribution and appear to be widespread in some countries. Some human MERS cases are thought to be related to zoonotic transmission (transmission from animals to humans). In other cases human infections are either linked to health care settings or are unexplained. There is no evidence of sustained human to human transmission in the community but the clusters that have occurred in health care settings and households demonstrate that human to human transmission is possible.

So far, three patterns of infection have been reported by the World Health:

  1. community acquired cases (the exposure sources remain unknown and are believed to include direct or indirect contact with animals, especially camels, or environmental source)
  2. hospital acquired infections
  3. infections acquired through close human to human contact (household).

MERS-CoV and antibodies to MERS-CoV have been detected in samples taken from camels. To date, MERS-CoV has only been isolated from dromedary camels* and humans, but the exact relationship between MERS-CoV infections in humans and animals remains unclear.

What are coronaviruses?

Coronaviruses are a family of RNA (ribonucleic acid) viruses. They are called coronaviruses because under an electron microscope the virus particle exhibits a characteristic ‘corona’(crown) of spike proteins around its lipid envelope. Coronavirus infections are common in animals and humans, and there is a history of coronaviruses crossing species and adapting to new hosts. There are many species and strains of coronavirus which have different characteristics, causing a range of clinical signs– from mild to severe disease – in humans and in different animal species.

MERS-CoV is genetically and biologically distinct from other known coronaviruses, e.g. the coronavirus causing Severe Acute Respiratory Syndrome (SARS) in humans.

Why the concern?

MERS-CoV is considered by the WHO to be a serious public health threat to humans, because:

  1. the infection can cause severe disease in humans
  2. infection appears to be widespread in dromedary camels
  3. coronaviruses may adapt to new hosts, and then become more easily transmittable between humans

For these reasons, it is important to prevent introduction of these viruses into the human population.

What is the source of MERS-CoV?

MERS-CoV is thought to have an origin in animals. Evidence suggests that MERS-CoV has adapted to camels and that camels are a host for the virus. However, not all community acquired cases of MERS-CoV had reported prior animal contact and it is unclear how these persons were infected. Therefore, investigations of human cases of MERS-CoV infection should continue to include gathering of information about potential sources of exposure, including other humans, camels (including certain raw products, such as raw milk and meat and secretions/excretions), other domestic and wild animals, as well as the environment, food and water.

The OIE together with its partner organisations, the WHO, the Food and Agriculture Organization of the United Nations (FAO) and national animal health authorities of affected countries is closely following investigations which aim to better understand the epidemiological aspects of the disease, including its transmission and the potential relationship between human and animal infections with MERS-CoV.

Are animals responsible for MERS-CoV infections in people?

MERS-CoV has been isolated from humans and camels and recent studies suggest that camels are a source of human infections. Nevertheless, the exact relationship between MERS-CoV infections in camels and humans remains unclear. Joint human health and animal health investigations are needed to establish the source for human infections with MERS-CoV when not acquired from another human.

There remains the possibility that other animal species may be involved in the maintenance and transmission of MERS-CoV.

What is known about MERS-CoV in camels?

Between November 2013 and July 2014, Qatar and Kuwait have met their obligations to OIE by reporting that MERS-CoV has been identified in camels.

Other published studies have indicated that MERS-CoV and genetic material from MERS-CoV have been identified in camels in countries in the Middle East and North Africa; antibodies to MERS-CoV or a very similar virus have been identified in samples taken from camels in the Middle East and Africa. Similar strains of MERS-CoV have been identified in samples taken from camels and humans in the same locality and in some cases there has been an association between infections in humans and camels.

Serological studies suggest that antibodies to MERS-CoV have been detected with a prevalence range of 0-100% (varying within countries and between countries) in populations of camels in Middle East and African countries. This range of prevalence indicates the need to assess risk factors for infection between and within herds.

Infections with MERS-CoV have sometimes been associated with mild respiratory signs in camels, but this needs further investigation. Significant morbidity or mortality of unknown etiology should be investigated.

Evidence from MERS-CoV infections in camels suggests that infection has resulted in virus shedding for a limited period. The possibility for reinfection of camels cannot at this stage be excluded since immunity to infection is poorly understood. MERS-CoV has been identified in camels which have antibodies against the virus. The implications of these findings for management and control recommendations need further investigation.

To develop a more complete understanding of the potential role of camels (and other animals) in the epidemiology of MERS several types of investigation are needed:

  • Comparative epidemiological studies, in all countries with significant camel populations, to determine the prevalence, distribution, and demographics of MERS-CoV infections in camels
  • Studies to characterise the clinical and pathological effects and kinetics of virus shedding and immune response to MERS-CoV in experimentally and naturally infected camels
  • Studies to assess risk factors and potential sources for camel infection and the relationship between camel infections and human cases of MERS
  • Studies to assess the potential effectiveness of intervention measures aimed at reducing public health risk
  • To conduct genetic analyses of both MERS-CoV and infected hosts from different geographical areas to gain better understanding of the properties of MERS-CoV and to monitor evolution of the virus
  • To further assess diagnostic tests used for MERS-CoV surveillance in camels (and other animals) for the reliability of their results in these species.

OIE together with WHO and FAO reiterate the importance of the public health sector and the animal health sector working together to share data and design studies to develop a better understanding of the overall epidemiology of MERS.

Are other animal species involved?

Although genetically related viruses have already been detected in bat species around the world, and a fragment of viral genetic material matching the MERS-CoV was found in one bat from Saudi Arabia, current evidence does not indicate a direct link between bats and MERS-CoV in humans. More evidence is needed to directly link the MERS-CoV to bats or other animal species.

According to published literature other species of animals (including sheep, goats, cattle, water buffalo and wild birds) have tested negative for the presence of antibodies to MERS-CoV. However owing to the relatively small sample sizes the results of these studies cannot exclude infection in other animal species. Based on receptor studies other animal species have been identified as potential hosts.

In countries where MERS-CoV is present, studies to assess the presence of MERS-CoV in wild and other domestic species should be conducted to detect possible infection in other hosts.

It is important to remain open minded about all potential sources of exposure for humans and camels until more information is available.

How can camels and other animals be tested for MERS-CoV infection or previous exposure?

Serological tests detect antibodies produced by the host against the virus but do not detect the virus itself. Depending on the test that is used, the presence of antibodies may indicate previous exposure to MERS-CoV or a similar virus. Virus neutralisation is the most specific assay.

PCR (molecular) tests detect genetic material of the virus. Genome sequencing of the virus (parts of, or full genome) is the best way to confirm that the genetic material belongs to a MERS-CoV. Genetic data also provide important information about the evolution of the virus and how closely related MERS-CoV isolates are.

It is important that diagnostic tests used to detect MERS-CoV in animals are assessed for reliability of results when used in different animal species and when reported to the OIE.

Specific confirmatory molecular and serology diagnostic tests are now available for MERS-CoV. Positive results from screening tests should be confirmed using a confirmatory test. Processing of samples and laboratory testing should be conducted under appropriate biorisk management conditions.

What action should be taken when an animal is confirmed to be positive for MERS-CoV?

Infection by MERS-CoV in animals is confirmed by a positive detection of the virus or genetic material belonging to the virus in a sample taken from an animal.

OIE Member Countries are obliged to report a confirmed case of MERS-CoV in animals to the OIE, as an “emerging disease” with zoonotic potential in accordance with article 1.1.3 of the OIE Terrestrial Animal Health Code. If MERS-CoV is identified in an animal this would not necessarily mean that the animal is a source of human infection. Detailed investigations are needed to understand the relationship between any animal cases and human cases, and whether a finding in animals would be significant for human infection.

Given the current situation there is no evidence to support the implementation of specific animal health measures following the detection of MERS-CoV in animals or herds. When MERS-CoV is identified in an animal or herd, precautionary public health measures should be implemented to reduce the risk of human infection in accordance with WHO’s guidance on the WHO website. OIE will regularly review its guidance based on the latest scientific information.

Is a vaccine or treatment currently available for MERS-CoV in animals?

There are no vaccines or treatments available for MERS-CoV in animals. Further research is needed to assess the likely effectiveness of intervention measures.

What is OIE doing?

OIE is working closely with its partner organisations FAO and WHO to collate and share data to gain a better understanding about the disease situation in animals and to assess implications for animal and human health.

OIE has consulted its Ad Hoc Group on MERS-CoV Infections in Animals and the Ad Hoc Group on Camelid diseases to provide advice on the latest scientific information and to provide recommendations and guidance, including on priority research activities for the animal health sector.

The OIE is also working closely with its Member Countries to provide technical support and to encourage reporting of MERS-CoV detections in animals.

OIE develops and publishes international standards and guidelines on the prevention, control and surveillance of animal diseases including zoonoses (animal diseases transmissible to humans). These science-based standards provide guidance on the best control measures which should be applied, where appropriate, to allow control of infection in the identified animal source.

The OIE is the reference organisation for international standards relating to animal health and zoonoses under the World Trade Organization Sanitary and Phytosanitary Agreement (SPS Agreement). Decisions related to safe trade in terrestrial animals and animal products must respect the standards, recommendations and guidelines found in the OIE Terrestrial Animal Health Code.

For further information about public health implications visit the WHO website.

*In this text ‘camel(s)’ refers to ‘dromedary camel(s)’.

Global | WHO: Air travel is low-risk for Ebola transmission

The World Health Organization (WHO) today reiterated its position that the risk of transmission of Ebola virus disease during air travel remains low.

“Unlike infections such as influenza or tuberculosis, Ebola is not airborne,” says Dr Isabelle Nuttall, Director of WHO Global Capacity Alert and Response. “It can only be transmitted by direct contact with the body fluids of a person who is sick with the disease.”

On the small chance that someone on the plane is sick with Ebola, the likelihood of other passengers and crew having contact with their body fluids is even smaller. Usually when someone is sick with Ebola, they are so unwell that they cannot travel. WHO is therefore advising against travel bans to and from affected countries.

“Because the risk of Ebola transmission on airplanes is so low, WHO does not consider air transport hubs at high risk for further spread of Ebola,” says Dr Nuttall.

In early August, after the meeting of the Ebola Emergency Committee under the International Health Regulations, WHO provided advice to countries to help contain the current Ebola outbreak and prevent it from spreading further. The guidance recommended:

  • no ban on international travel or trade;
  • that countries be prepared to detect, investigate, and manage Ebola cases; including access to a qualified diagnostic laboratory for Ebola virus and, where appropriate, the capacity to identify and care for travellers originating from known Ebola-infected areas who arrive at international airports or major land crossing points with unexplained fever and other symptoms.

Worldwide, countries should provide their citizens traveling to Ebola-affected countries with accurate and relevant information on the Ebola outbreak and measures to reduce the risk of exposure.

West Africa | WHO: Scope of Ebola outbreak “vastly underestimated”

The outbreak of Ebola virus disease in West Africa continues to escalate, with 1975 cases and 1069 deaths reported from Guinea, Liberia, Nigeria, and Sierra Leone.

No new cases have been detected in Nigeria following the importation of a case in an air traveller last month. Extensive contact tracing and monitoring, implemented with support from the US Centers for Disease Control and Prevention (CDC), has kept the number of additional cases small.

Elsewhere, the outbreak is expected to continue for some time. WHO’s operational response plan extends over the next several months. Staff at the outbreak sites see evidence that the numbers of reported cases and deaths vastly underestimate the magnitude of the outbreak.

WHO is coordinating a massive scaling up of the international response, marshalling support from individual countries, disease control agencies, agencies within the United Nations system, and others.

The World Food Programme is using its well-developed logistics to deliver food to the more than one million people locked down in the quarantine zones, where the borders of Guinea, Liberia, and Sierra Leone intersect. Several countries have agreed to support the provision of priority food staples for this population.

Practical on-the-ground intelligence is the backbone of a coordinated response. WHO is mapping the outbreak, in great detail, to pinpoint areas of ongoing transmission and locate treatment facilities and supplies. Good logistical support depends on knowing which facilities need disinfectants or personal protective equipment, where new isolation facilities need to be built, and where the need for more health-care workers is most intense.

CDC is equipping the hardest-hit countries with computer hardware and software that will soon allow real-time reporting of cases and analysis of trends. This also strengthens the framework for a scaled-up response.

Today, WHO Director-General Dr Margaret Chan held discussions with a group of ambassadors from Geneva’s United Nations missions. The meeting aimed to identify the most urgent needs within countries and match them with rapid international support.

These steps align with recognition of the extraordinary measures needed, on a massive scale, to contain the outbreak in settings characterized by extreme poverty, dysfunctional health systems, a severe shortage of doctors, and rampant fear.

Be well. Practice big medicine.