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Tighter border control over Ebola virus threat

Monday, August 11, 2014
In this photo taken on Saturday health worker wearing protective clothing and equipment, out of fear for the deadly Ebola virus, sit at a desk at the Kenema Government Hospital situated in the Eastern Province in Kenema, 300 kilometres, from the capital city of Freetown, Sierra Leone. Over the decades, Ebola cases have been confirmed in ten African countries, including Congo where the disease was first reported in 1976. But until this year, Ebola had never come to West Africa. AP Photo

The Caribbean is “partially” prepared to deal with the deadly Ebola virus and countries in the region need to do more to be fully prepared, says Dr C James Hospedales, executive director of the Caribbean Public Health Agency (Carpha). In a telephone interview on Friday, Hospedales said although the risk of an Ebola outbreak in the region was low, Caribbean countries could not afford to be complacent and had to prepare for the worst.

Last week, the World Health Organisation (WHO) said the current Ebola outbreak in West Africa met the conditions of a Public Health Emergency of International Concern, advising all countries to implement measures to prevent the spread of Ebola (see sidebar). 

“I would say we are partially prepared for something like this. The Chikungunya experience in the last six months has helped everyone to be much more attentive to the issue of imported infectious diseases. We are reasonably prepared, but can we be more prepared?Yes,” Hospedales said.

A qualified epidemiologist, Hospedales added: “Ports of entry need to be strengthened. The arrangements there need to be looked at and made sure they’re up to date and meet the requirements of the international health regulations. “In the event that someone who is infected arrives, he/she may have to receive a card with a number to call if symptoms develop in a few weeks. These are additional things that can get preparedness at a higher level,” he said.

He said while many Caribbean countries had protective personal equipment for health workers— gowns, gloves, and masks—having the discipline to consistently use them was the problem. He urged authorities to take steps to establish a culture of discipline in using protective equipment and practising proper infection control. He added some countries in the Caribbean were resource-constrained and were genuinely limited in what they could do.

In the coming weeks, many foreign students from Africa were expected to return to offshore medical schools in the region and this had gained the attention of Carpha, he said. “Altogether several hundreds of students come from Africa, several hundreds from India…so we will be providing advice to these academic institutions.”

However, Hospedales warned against unwarranted hostility toward African nationals, saying, “Part of being prepared is not to have irrational behaviour or panic-driven behaviour not based on fact.” He said although the risk was low, it was important at this stage for authorities to raise public awareness about the deadly virus through public education campaigns.

Asked if the region had a laboratory to test for Ebola, he said no, saying that type of laboratory had a biosafety level of four, the highest. “The Carpha laboratory is biosafety level three. For a biosafety level four pathogen like Ebola, the facilities used would be in the US and Canada. So we will work with those countries.”

He added: “During the cricket world cup there was a temporary biosafety level four because thousands of people came and it was necessary. Right now the assessment of the risk of Ebola arriving here is low, so the rationale for establishing a biosafety level four diagnostic facility is not so strong.” However, he said Carpha was in ongoing discussions with health authorities in Canada on the feasibility of establishing a biosafety level four laboratory in the region.

Hospedales said Carpha, whose mission was to provide strategic direction, in analysing, defining and responding to public health priorities of Caricom, held meetings with all the chief medical officers in the region, as well as epidemiology and laboratory directors, aimed at strengthening the region’s preparedness for Ebola.


Track record proven during cholera threat

Although the region is not yet fully prepared, Hospedales is confident, based on the Caribbean’s track record for controlling the spread of infectious diseases, that the Caribbean is capable of containing Ebola if it enters the region. “If heaven forbid a case of Ebola arrives here, I think we will do quite well in detecting, investigating, and managing it. It may be that a few people will get it but after, it would be shut down and we’ll be able to isolate it.

“We are fairly confident, knowing our member states, that widespread Ebola in our community is not going to happen.” Saying the Caribbean had a proud track record in controlling infectious diseases, he recalled when cholera—a disease caused by the water-borne bacterium Vibrio cholerae—emerged in South America in the early 1990s. “The region was on high alert, very similar to what we are seeing now. Cholera had spread from Ecuador, to Colombia then to Venezuela and reached north-west Guyana.

“I was part of the investigative team at the time. We were able to rapidly do a study to determine what the local risks and sources of transmission were. There was intensive education of the population on the importance of hand washing and boiling water and chlorinating water with bleach. “There were emergency meetings, sharing of information among all the chief medical officers and epidemiologists. As a result, it never spread into the islands and it disappeared because we were able to control it.”

He added the Caribbean was among the world leaders in controlling vaccine-preventable infectious diseases like polio, measles, smallpox, and German measles. “In 1991, we became the first region in the world to eliminate measles. We had the Americans, the British, and the French coming and saying ‘How did you do that?’ So we have punched above our weight in that regard.”

In the first half of the 20th century, he said, poliomyelitis, a deadly and crippling virus, was a major health concern in the region, claiming the lives of many children. “It (polio) came, we studied it, figured out how it spread, educated people…along came the vaccine and I think the last case of polio in the Caribbean might have been in 1982 in Jamaica.”

He said the region was accustomed to responding to high public health alerts, citing the 2009 H1N1 influenza (swine flu) pandemic and the 2007 cricket world cup as the most recent events that caused a high level of awareness and preparedness in the region.  “I would say that we are accustomed. The region has a high level of travel from different parts of the world, and I would say the public health officials are used to being faced with threats and there are systems in place to deal with that.”

However, Hospedales admitted the Caribbean was struggling to deal with the Chikungunya virus, saying Carpha planned to go back to the drawing board on this issue. He said: “Our record is not so proud with Chikungunya. We predicted that we would not do too well because of the abundance of the mosquito vector. “Over the years the vector, the aedes aegypti, has become much more adapted. It is everywhere and solid waste has gone up everywhere.”

He added: “Many years ago people had screens on their houses, but nobody does that anymore. “ChikV has revealed to us that where vector-borne diseases involving the aedes aegypti are concerned, we are not well prepared. We need some new innovative ideas.” He said Carpha planned to have an expert meeting in October to devise new strategies to tackle ChikV. At the moment, according to the Ministry of Health, there are 14 confirmed cases and 27 suspected cases of ChikV in T&T.

Ministry Ebola plans:
The Ministry of Health says it is currently reviewing and updating its public health emergency plans in light of the of the Ebola outbreak in West Africa. In an e-mail to T&T Guardian, the ministry said: “Over the years there have been many threats from diseases such as cholera, H1N1 and Sars and contingency plans have been developed for our health institutions.

“Should a case of Ebola be suspected in T&T, we would execute these plans and procedures to ensure that patients are appropriately cared for in a way that minimises the potential for spread to other persons. These plans include provisions for personal protective equipment for health care workers, designated facilities for isolation of patients and other logistics. “Our public health emergency plans are being reviewed and updated in light of this new public health concern.”

The ministry said it continued to work with all stakeholders to ensure international best practices were followed at ports of entry, adding that there was heightened vigilance for travellers arriving from countries where Ebola was endemic. The Ministry advised citizens to avoid non-essential travel to Sierra Leone, Guinea, and Liberia.

The term Public Health Emergency of International Concern (PHEIC) is defined in the International Health Regulations (2005) as “an extraordinary event” that is serious, unusual or unexpected; carries implications for public health beyond the affected State’s national border; and requires immediate international action.

According to the WHO, under the PHEIC, all states should:

• Be prepared to detect, investigate, and manage Ebola cases. This should include assured access to a qualified diagnostic laboratory for Ebola.
• Provide travellers to Ebola-affected and at-risk areas with relevant information on risks.
• Have the capacity to manage travellers from known Ebola-infected areas, arriving at international airports. 


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