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Portugal starts to take Ebola threat seriously

EBOLAVIRUSPortugal’s National Public Health Council met yesterday and set in motion a series of key actions and information alerts for health professionals and airport staff to identify, isolate and treat any victims of the Ebola virus that end up on Portuguese soil.

Emergency drills and an information campaign will run alongside more training and information for health professionals, airport workers and  the general public.

Emergency exercises in cases of suspected Ebola virus carriers will be prepare for front line staff at airports and docks who may be dealing with anyone coming from affected countries.

Staff will receive current information about the disease, but for now there will be no screening for passengers on arrival in Portugal with the country's safety dependent on pre-embarcation checks at foreign ariports.

The Health Minister, Paulo Macedo, finally decided to set up an Ebola Response Unit to prevent infected persons entering the country but this is reliant on airport staff who are not medically trained and is unlikely to be water-tight as screening checks are not to be carried out on arrival due to difficult logistical considerations.

In a statement, the Health Ministry said it had approved the Response Unit which has "a clearly defined line of command and hierarchy and which can be adapted to the changing epidemiological situation, adjusting and strengthening measures as and when necessary."

Some of the measures have been welcomed by Portugal’s Medical Association which has been requesting a strengthening of the existing measures.

The responsibility for the Response Unit will be shared between the Director General of Health and the presidents of the INEM, the Medicines Authority, the National Institute of Health and the various regional health authority chiefs.

The Response Unit will include, as observers, representatives of Portugal's autonomous regions,of the Armed Forces and from the Director-General for Consular Affairs of Portuguese Communities.



How can you catch Ebola?

It can only be caught by direct contact with bodily fluids and by handling soiled clothing or unsterilised medical equipment that was in contact with an infected person. It is not possible to get infected through social contact or using the same transport or room as a carrier.

How can it be prevented?

By not handling dead animals or their raw meat, not eating ‘bushmeat’ (wild animals not fit for human consumption), avoiding contact with infected people, avoiding sexual contact with people in areas with cases of Ebola and regularly cleaning hands with soap and water, or with alcohol gel.

How is it diagnosed?

A specialist infection clinician will make judgements on what the most likely diagnosis may be based on the patient’s history. If Ebola is considered a cause, blood samples can be sent for laboratory testing and a diagnosis can be made quickly.

How is it treated?

Patients need to be placed in isolated intensive care and the body will need to be kept hydrated, and sometimes an intravenous drip will need to be administered. Blood pressure and oxygen levels need to be maintained with the body organs supported while the body fights the disease.


Ebola background from the World Health Organisation

The Ebola virus causes an acute, serious illness which is often fatal if untreated. Ebola virus disease (EVD) first appeared in 1976 in 2 simultaneous outbreaks, one in Nzara, Sudan, and the other in Yambuku, Democratic Republic of Congo. The latter occurred in a village near the Ebola River, from which the disease takes its name.

The current outbreak in west Africa, (first cases notified in March 2014), is the largest and most complex Ebola outbreak since the Ebola virus was first discovered in 1976. There have been more cases and deaths in this outbreak than all others combined. It has also spread between countries starting in Guinea then spreading across land borders to Sierra Leone and Liberia, by air (1 traveller only) to Nigeria, and by land (1 traveller) to Senegal.

The most severely affected countries, Guinea, Sierra Leone and Liberia have very weak health systems, lacking human and infrastructural resources, having only recently emerged from long periods of conflict and instability. On August 8, the WHO Director-General declared this outbreak a Public Health Emergency of International Concern.

A separate, unrelated Ebola outbreak began in Boende, Equateur, an isolated part of the Democratic Republic of Congo.

The virus family Filoviridae includes 3 genera: Cuevavirus, Marburgvirus, and Ebolavirus. There are 5 species that have been identified: Zaire, Bundibugyo, Sudan, Reston and Taï Forest. The first 3, Bundibugyo ebolavirus, Zaire ebolavirus, and Sudan ebolavirus have been associated with large outbreaks in Africa. The virus causing the 2014 west African outbreak belongs to the Zaire species.


It is thought that fruit bats of the Pteropodidae family are natural Ebola virus hosts. Ebola is introduced into the human population through close contact with the blood, secretions, organs or other bodily fluids of infected animals such as chimpanzees, gorillas, fruit bats, monkeys, forest antelope and porcupines found ill or dead or in the rainforest.

Ebola then spreads through human-to-human transmission via direct contact (through broken skin or mucous membranes) with the blood, secretions, organs or other bodily fluids of infected people, and with surfaces and materials (e.g. bedding, clothing) contaminated with these fluids.

Health-care workers have frequently been infected while treating patients with suspected or confirmed EVD. This has occurred through close contact with patients when infection control precautions are not strictly practiced.

Burial ceremonies in which mourners have direct contact with the body of the deceased person can also play a role in the transmission of Ebola.

People remain infectious as long as their blood and body fluids, including semen and breast milk, contain the virus. Men who have recovered from the disease can still transmit the virus through their semen for up to 7 weeks after recovery from illness.

Symptoms of Ebola virus disease

The incubation period, that is, the time interval from infection with the virus to onset of symptoms is 2 to 21 days. Humans are not infectious until they develop symptoms. First symptoms are the sudden onset of fever fatigue, muscle pain, headache and sore throat. This is followed by vomiting, diarrhoea, rash, symptoms of impaired kidney and liver function, and in some cases, both internal and external bleeding (e.g. oozing from the gums, blood in the stools). Laboratory findings include low white blood cell and platelet counts and elevated liver enzymes.

It can be difficult to distinguish EVD from other infectious diseases such as malaria, typhoid fever and meningitis. Confirmation that symptoms are caused by Ebola virus infection are made using the following investigations:

    antibody-capture enzyme-linked immunosorbent assay (ELISA)
    antigen-capture detection tests
    serum neutralization test
    reverse transcriptase polymerase chain reaction (RT-PCR) assay
    electron microscopy
    virus isolation by cell culture.

Samples from patients are an extreme biohazard risk; laboratory testing on non-inactivated samples should be conducted under maximum biological containment conditions.
Treatment and vaccines

Supportive care-rehydration with oral or intravenous fluids- and treatment of specific symptoms, improves survival. There is as yet no proven treatment available for EVD. However, a range of potential treatments including blood products, immune therapies and drug therapies are currently being evaluated. No licensed vaccines are available yet, but 2 potential vaccines are undergoing human safety testing.
Prevention and control

Good outbreak control relies on applying a package of interventions, namely case management, surveillance and contact tracing, a good laboratory service, safe burials and social mobilisation. Community engagement is key to successfully controlling outbreaks. Raising awareness of risk factors for Ebola infection and protective measures that individuals can take is an effective way to reduce human transmission. Risk reduction messaging should focus on several factors:

Reducing the risk of wildlife-to-human transmission from contact with infected fruit bats or monkeys/apes and the consumption of their raw meat. Animals should be handled with gloves and other appropriate protective clothing. Animal products (blood and meat) should be thoroughly cooked before consumption.

Reducing the risk of human-to-human transmission from direct or close contact with people with Ebola symptoms, particularly with their bodily fluids. Gloves and appropriate personal protective equipment should be worn when taking care of ill patients at home. Regular hand washing is required after visiting patients in hospital, as well as after taking care of patients at home.

Outbreak containment measures including prompt and safe burial of the dead, identifying people who may have been in contact with someone infected with Ebola, monitoring the health of contacts for 21 days, the importance of separating the healthy from the sick to prevent further spread, the importance of good hygiene and maintaining a clean environment.

Controlling infection in health-care settings:

Health-care workers should always take standard precautions when caring for patients, regardless of their presumed diagnosis. These include basic hand hygiene, respiratory hygiene, use of personal protective equipment (to block splashes or other contact with infected materials), safe injection practices and safe burial practices.

Health-care workers caring for patients with suspected or confirmed Ebola virus should apply extra infection control measures to prevent contact with the patient’s blood and body fluids and contaminated surfaces or materials such as clothing and bedding. When in close contact (within 1 metre) of patients with EBV, health-care workers should wear face protection (a face shield or a medical mask and goggles), a clean, non-sterile long-sleeved gown, and gloves (sterile gloves for some procedures).

Laboratory workers are also at risk. Samples taken from humans and animals for investigation of Ebola infection should be handled by trained staff and processed in suitably equipped laboratories.

© World Health Organisation 2014

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0 #1 Geofrey Thompson 2014-10-17 17:37
Excelent work here, Ed. Clear facts.

Often ask myself, having been here a few years - what shape would the EU be in, if at all - if entirely run by south europeans ?

Instead of the hard factual laws, regulations and procedures there would constantly be 'special' soft instances to allow 'wriggle room'.

Time and again we read of airports that never opened, motorways to no-where, buildings built but no staff in them. Also endemic fraud and corruption etc etc

Constant over-spending on things that do not matter to the general public but grease the lucky few and not much or at all on things that do matter.

Italys flooding is just a recent example - 35 million euros already set aside years ago in Tuscany, following detailed planning, to minimise the threat. yet, years later, still nothing done.

What wriggle room is there with Ebola ? How about the private jets flying in or the luxury yachts mooring? Who is checking them in Southern Europe?

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