Posted on 05/25/2004 6:32:27 AM PDT by Caipirabob
NEW ORLEANS, May 24 - A Russian scientist at a former Soviet biological weapons laboratory in Siberia has died after accidentally sticking herself with a needle laced with ebola, the deadly virus for which there is no vaccine or treatment, the lab's parent Russian center announced over the weekend.
Scientists and officials said the accident had raised concerns about safety and secrecy at the State Research Center of Virology and Biotechnology, known as Vector, which in Soviet times specialized in turning deadly viruses into biological weapons. Vector has been a leading recipient of aid in an American program to help former Soviet scientists and labs convert to peaceful research.
Although the accident occurred May 5, Vector did not report it to the World Health Organization until last week. Scientists said that although Vector had isolated the scientist to contain any potential spread of the disease and there was no requirement that accidents involving ebola be reported, the delay meant that scientists at the health agency could not provide prompt advice on treatment that might have saved her life.
Bump
It looks like it is still doing something with biological agents.
Sorry; I dupe posted. I did a search on 'ebola' and nothing recent came up.
LOL! No biggie....
In 1988 a Soviet scientist named Ustinov accidently infected himself with the Marburg filovirus and died most hideously in a few short weeks. He was part of the operation that refined agents like anthrax, smallpox and other diseases so they could be transported by MIRV rockets to the United States and released.
http://www.mail-archive.com/ecofem@csf.colorado.edu">http://www.mail-archive.com/ecofem@csf.colorado.edu/msg04503.html
Bad links. This one should work.
http://www.meguiar.addr.com/russian_bioweapons_expert.htm
Ping.
3rd paragraph "the delay meant that scientists at the health agency could not provide prompt advice on treatment that might have saved her life."
The "paper of record" needs a science editor.
*ping
The "paper of record" needs a(n) science editor.
No knowledge of what science even is required to catch that one.
Only a complete fool would attempt to splice the virulence of the Ebola virus with the contagiousness of the influenza virus, right? Right?
Interesting link.
Good pickup.
Large doses of anti-viral medications and smaller doeses of clotting factor and saline help some survive.
I suggest that the ban on above ground nuclear testing be relaxed just once. The Russians should napalm the island, drop chlorine bombs, and then telst the Topol-M on it.
I looked at PubMed and couldn't find anything. Where did you come across that information? While ebola has a very high mortality rate, it isn't 100% fatal.
OUR CURRENT GUIDELINES
Hemorrhagic fever viruses as biological weapons: medical and public health management.
Exposure to or infection with viral hemorrhagic fever
(Filoviridae: Ebola and Marburg; Arenaviridae: Lassa fever and New World arenaviruses; Bunyaviridae: Rift Valley fever; Flaviviridae: Yellow fever, Omsk hemorrhagic fever, and Kyasanur Forest disease)
Interventions After Identification of Suspected Index Case of Viral Hemorrhagic Fever
Identification
Identify suspected index case using these clinical criteria:* temperature greater thna 101 degrees F (38.3 degrees C) of less than 3 weeks' duration; severe illness, and no predisposing factors for hemorrhagic manifestations; and at least 2 of the following hemorrhagic symptoms: hemorrhagic or purple rash, epistaxis, hematemesis, hemoptysis, blood in stools, other, and no established alternative diagnosis.
Reporting
Report immediately to local and/or state health department.
Report immediately to infection control professional and
laboratory personnel.
Treatment
Initiate supportive and ribavirin therapy immediately while diagnostic confirmation is pending.
If infection with arenavirus or bunyavirus is confirmed, continue 10-day course of ribavirin.
If infection with filovirus or flavivirus is confirmed, or if the diagnosis of viral hemorrhagic fever is excluded or an alternative diagnosis is established, discontinue ribavirin.
Infection Control Measures
Initiate viral hemorrhagic fever-specific barrier precautions.
Initiate airborne precautions, with negative-pressure rooms if resources are available.
Public Health Measures
Confirm or exclude diagnosis via Laboratory Response Network.
Designated public health authority begins epidemiologic investigation.
Identify close and high-risk contacts and place under medical surveillance for 21 days from day of suspected/known exposure.
If contact does not have temperature greater than 101 degrees F (38.3 degrees C) or signs or symptoms of viral hemorrhagic fever by the end of 21 days, discontinue medical surveillance.
If contact has temperature greater than 101 degrees F (38.3 degrees C) or signs or symptoms consistent with viral hemorrhagic fever, initiate diagnostic workup and treatment, infection control, and public health interventions described for index case.
Diagnosis
A high index of suspicion will be required to diagnose viral hemorrhagic fever (VHF) among persons exposed to a covert bioterrorist attack. In naturally occurring cases, patients are likely to have risk factors such as travel to Africa or Asia, handling of animal carcasses, contact with sick animals or people, or arthropod bites within 21 days of onset of symptoms. No such risk factors would be associated with a bioterrorist attack. The variable clinical presentation of these diseases presents a major diagnostic challenge. Clinical microbiology and public health laboratories are not currently equipped to make a rapid diagnosis of any of these viruses, and clinical specimens would need to be sent to the U.S. Centers for Disease Control and Prevention (CDC) or the U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID; Frederick, MD), the only 2 level D laboratories in the Laboratory Response Network.
All suspected cases of hemorrhagic fever virus disease should be immediately reported to local and/or state health departments, who would then notify the Centers for Disease Control and Prevention. The World Health Organization (WHO)has developed surveillance standards for acute viral hemorrhagic fever syndrome with the aim of early detection of naturally occurring outbreaks and notification of cases, even before identification of the causal agent. This includes prompt reporting to public health authorities of any patient with acute onset of fever of less than 3 weeks' duration who is severely ill, has no known predisposing host factors for hemorrhagic manifestations, and has any 2 of the following: hemorrhagic or purpuric rash, epistaxis, hematemesis, hemoptysis, blood in stool, or other hemorrhagic symptom. This broad definition may be useful in the early period following a confirmed bioterrorist-related case of viral hemorrhagic fever as well. Public health authorities may develop more specific case definitions after the etiologic agent is identified.
Public health authorities, in consultation with the Centers for Disease Control and Prevention, should provide assistance and detailed instructions to clinical laboratories and to clinicians for processing and transport of laboratory specimens required for diagnosis of these agents. (See the resource page titled "Packaging Protocols for Biological Agents/Diseases" at the Centers for Disease Control and Prevention Web site.)
Methods of diagnosis at specialized laboratories include antigen detection by antigen-capture enzyme-linked immunosorbent assay (ELISA), IgM antibody detection by antibody-capture enzyme-linked immunosorbent assay, reverse transcriptase polymerase chain reaction (RT-PCR), and viral isolation. Antigen detection (by enzyme-linked immunosorbent assay) and reverse transcriptase polymerase chain reaction are the most useful diagnostic techniques in the acute clinical setting.
Viral isolation is of limited value because it requires a biosafety level 4 (BSL-4) laboratory. (A full description of biosafety level-4 criteria is available at the Centers for Disease Control and Prevention Web site.) There are only 2 biosafety level-4 facilities in the United States, located at the Centers for Disease Control and Prevention and the U.S. Army Medical Research Institute of Infectious Diseases, with in-depth diagnostic capability. Either the presence of IgM or a 4-fold rise in titer of IgG antibody between acute- and convalescent-phase serum samples are diagnostic of these viral illnesses, but antibody-capture enzyme-linked immunosorbent assay is of limited value in early diagnosis because antibodies to these viruses usually do not appear until onset of recovery, approximately at the second week of illness. The Centers for Disease Control and Prevention requires approximately 1 working day (with prior notification of arrival) to offer a preliminary laboratory diagnosis following receipt of patient specimens.
The diagnosis of viral hemorrhagic fever should be based initially on clinical criteria and judgment, with laboratory testing used to confirm or exclude this clinical diagnosis. Laboratory testing will require time and, in the event of a large attack, may be delayed or perhaps not possible given current laboratory capacities.
Treatment
The mainstay of treatment of viral hemorrhagic fever is supportive, with careful maintenance of fluid and electrolyte balance, circulatory volume, and blood pressure. Because in some cases intravenous fluids have not reversed hypotension and may have contributed to pulmonary edema, consideration should be given to early vasopressor support with hemodynamic monitoring. Mechanical ventilation, renal dialysis, and antiseizure therapy may be required. Intramuscular injections, aspirin, nonsteroidal anti-inflammatory drugs, and anticoagulant therapies are contraindicated. Steroids are not indicated.
Therapy
There are no antiviral drugs approved by the U.S. Food and Drug Administration for treatment of hemorrhagic fever viruses. Ribavirin, a nucleoside analog, has some in vitro and in vivo activity against Arenaviridae and Bunyaviridae (including Crimean-Congo hemorrhagic fever) but no utility against Filoviridae or Flaviviridae. Oral ribavirin, in combination with interferon alfa, is Food and Drug Administration-approved for treatment of chronic hepatitis C virus infection. Intravenous ribavirin is of limited availability in the United States.
It is produced by ICN Pharmaceuticals Inc (Costa Mesa, CA) for compassionate use under an investigational new drug (IND) application.
Recommendations for drug therapy by the working group are not approved by the U.S. Food and Drug Administration for any of these indications and should always be administered under an investigational new drug protocol.
In a mass casualty situation, these requirements may need to be modified to permit timely administration of the drug. In addition, treatment of other suspected possible causes, such as bacterial sepsis, should not be withheld while awaiting confirmation or exclusion of the diagnosis of viral hemorrhagic fever.
In a contained casualty situation (in which a modest number of patients require therapy), the working group recommends that an intravenous regimen of ribavirin be given as described in Table 4 in the original guideline document, in accordance with Centers for Disease Control and Prevention's recommendations for treating patients with suspected viral hemorrhagic fever of unknown cause, pending identification of the agent. A similar dose has been used in the treatment of Lassa fever.
In a mass casualty situation (in which the number of persons requiring therapy is sufficiently high that delivery of intravenous therapy is no longer possible), an oral regimen of ribavirin as described in Table 4 in the original guideline document is recommended. This dose is currently licensed for treatment of chronic hepatitis C infection in the United States. Although it is substantially lower than that in the intravenous regimen, a similar dose has been used to treat a few patients with Lassa fever, and there are no available studies on tolerability or efficacy of higher doses of oral ribavirin.
Ribavirin is contraindicated in pregnancy. However, in the context of infection with viral hemorrhagic fever of unknown cause or secondary to an arenavirus or Rift Valley fever, the working group believes that the benefits appear likely to outweigh any fetal risk of ribavirin therapy, and ribavirin is therefore recommended. The associated mortality of viral hemorrhagic fever tends to be higher in pregnancy.
The use of oral or intravenous ribavirin is not approved by the Food and Drug Administration for children, and proper doses have not been established. Only aerosolized ribavirin has been approved by the Food and Drug Administration for children, to treat respiratory syncytial virus infection. However, in the context of infection with viral hemorrhagic fever of unknown cause or secondary to an arenavirus or Rift Valley fever, the working group believes that the benefits likely outweigh the risks of ribavirin therapy, and it is therefore recommended as described in Table 4 in the original guideline document. Similar doses have been used to treat children with adenovirus pneumonia and hepatitis C and were well tolerated. Ribavirin capsules may not be broken open and are only available in 200-mg doses. However, Schering-Plough Corp (Kenilworth, NJ) produces a pediatric syrup formulation (which is not commercially available) for use under an investigational new drug application.
For infections caused by filoviruses or flaviviruses, the working group recommends supportive medical care only.
Ribavirin has been shown to have no clinical utility against these groups of viruses.
Postexposure Prophylaxis
Effective prophylaxis following exposure to a hemorrhagic fever virus is hampered by the absence of effective vaccines and antiviral medications. The working group does not recommend preemptive administration of ribavirin in the absence of signs of infection to persons with known or suspected exposures to the hemorrhagic fever viruses.
Ribavirin has no utility against filoviruses or flaviviruses. For arenaviruses, there is limited experimental evidence that postexposure prophylaxis with ribavirin will delay onset of disease but not prevent it.
Furthermore, the effectiveness of ribavirin as postexposure prophylaxis for arenaviruses or Rift Valley fever virus has never been studied in humans. While 1995 Centers for Disease Control and Prevention guidelines (Update: management of patients with suspected viral hemorrhagic fever--United States. MMWR Morb Mortal Wkly Rep 1995 Jun 30;44:475-9) recommend ribavirin to high-risk contacts of patients with Lassa fever, a review and possible revision of these recommendations is to be shortly undertaken (James Hughes, MD, oral communication, January 10, 2002). However, public health professionals suggest that stratification of risk groups into high-risk and close contacts may facilitate counseling and outbreak investigation. High-risk contacts are those who have had mucous membrane contact with a patient (such as during kissing or sexual intercourse) or have had a percutaneous injury involving contact with the patient's secretions, excretions, or blood.
Close contacts are those who live with, shake hands with, hug, process laboratory specimens from, or care for a patient with clinical evidence of viral hemorrhagic fever prior to initiation of appropriate precautions.
Persons considered potentially exposed to hemorrhagic fever viruses in a bioterrorist attack and all known high-risk and close contacts of patients diagnosed with viral hemorrhagic fever should be placed under medical surveillance. All such individuals should be instructed to record their temperatures twice daily and report any temperature of 101 degrees F (38.3 degrees C) or higher (or any symptom noted in Table 3 in the original guideline document) to a clinician, hospital epidemiologist, or public health authority designated with surveillance. Surveillance should be continued for 21 days after the person's deemed potential exposure or last contact with the ill patient.
If a temperature of 101 degrees F (38.3 degrees C) or higher develops, ribavirin therapy should be initiated promptly as presumptive treatment of viral hemorrhagic fever unless an alternative diagnosis is established or the etiologic agent is known to be a filovirus or a flavivirus. In the case of close and high-risk contacts of patients diagnosed with Rift Valley fever or a flavivirus, only those who process laboratory specimens from a patient prior to initiation of appropriate precautions require medical surveillance, as these specific viruses are not transmitted from person to person but may be transmitted in the laboratory setting.
Infection Control
Recommendations for Protective Measures Against Nosocomial
Transmission of Hemorrhagic Fever Viruses
Strict adherence to hand hygiene: Health care workers should clean their hands prior to donning personal protective equipment for patient contact. After patient contact, health care workers should remove gown, leg and shoe coverings, and gloves and immediately clean their hands.
Hands should be clean prior to the removal of facial protective equipment (i.e., personal respirators, face shields, and goggles) to minimize exposure of mucous membranes with potentially contaminated hands, and once again after the removal of all personal protective equipment
Double gloves
Impermeable gowns
N-95 masks or powered air-purifying respirators, and a negative isolation room with 6 to 12 air changes per hour, as required by Healthcare Infection Control Practices Advisory Committee (Centers for Disease Control and Prevention) standards for airborne precautions*
Leg and shoe coverings
Face shields**
Goggles for eye protection**
Restricted access of nonessential staff and visitors to patient's room
Dedicated medical equipment, such as stethoscopes, glucose monitors, and, if available, point-of-care analyzers
Environmental disinfection with an Environmental Protection Agency-registered hospital disinfectant or a 1:100 dilution of household bleach
If there are multiple patients with viral hemorrhagic fever in one health care facility, they should be cared for in the same part of the hospital to minimize exposures to other patients and health care workers
* These resources may not be possible in many health care facilities or in a mass casualty situation. In this case, all other measures should be taken and would, in combination, be expected to substantially diminish the risk of nosocomial spread.
** Face shields and eye protection may be already incorporated in certain personal protective equipment, such as powered air-purifying respirators.
Given the lack of licensed or effective therapies and vaccines against the hemorrhagic fever viruses, efforts to prevent transmission of infection must rely on the meticulous implementation of and compliance with strict infection control measures. Filoviruses and arenaviruses are highly infectious after direct contact with infected blood and bodily secretions. A suspected case of viral hemorrhagic fever must be immediately reported to the hospital epidemiologist (or infection control professional) and to the local or state health department. The epidemiologist (or infection control professional) should, in turn, notify the clinical laboratory (so that additional precautions are put in place) as well as other clinicians and public health authorities.
Isolation Precautions
Direct contact with infected blood and bodily fluids has accounted for the majority of person-to-person transmission of filoviruses and arenaviruses.
Therefore, the guideline developers recommend that in the case of any patient with suspected or documented viral hemorrhagic fever, viral hemorrhagic fever-specific barrier precautions should be implemented immediately.
These precautions do not reflect Healthcare Infection Control Practices Advisory Committee (Centers for Disease Control and Prevention) isolation guidelines terminology and are defined here as strict hand hygiene plus use of double gloves, impermeable gowns, face shields, eye protection, and leg and shoe coverings (given the copious amounts of infected material, such as vomitus and liquid stool, that may be present in the environment).
Airborne transmission of hemorrhagic fever viruses appears to be a rare event but cannot be conclusively excluded. Given the inability to completely exclude this potential, the lack of preventive vaccines, and, in the case of filoviruses, the lack of effective drug therapy, we recommend that in addition to viral hemorrhagic fever-specific barrier precautions, airborne precautions also be instituted.
Airborne precautions entail the use of a high-efficiency particulate respirator for any person entering the room and, as required by Healthcare Infection Control Practices Advisory Committee (Centers for Disease Control and Prevention) standards, the patient should be placed in a room with negative air pressure, 6 to 12 air changes per hour, air exhausted directly to the outdoors or passage through a high-efficiency particulate air (HEPA) filter before recirculation, and doors kept closed. There are many circumstances in which the use of negative-pressure rooms may not be possible, including mass casualty situations. In such conditions, all other infection control measures should be taken (i.e., viral hemorrhagic fever-specific barrier precautions and a high-efficiency particulate air respirator for any person entering the room), which would, in combination, substantially reduce the risk of nosocomial transmission. Available evidence suggests that in the great preponderance of historical cases, these measures were sufficient to prevent transmission of disease to health care workers, family members, and other patients.
Nonessential staff and visitors should have restricted access to patients' rooms. If there are multiple patients with viral hemorrhagic fever in a health care facility, they should be cared for in the same part of the hospital to minimize exposure to other persons.
All persons, including health care workers and laboratory personnel who have had a close or high-risk contact with a patient infected with a filovirus or an arenavirus within 21 days of the patient's onset of symptoms, prior to the institution of appropriate infection control precautions, should be placed under medical surveillance and managed as described in the section on postexposure prophylaxis.
Laboratory personnel who have processed laboratory specimens from a patient with any hemorrhagic fever viruses (including Rift Valley fever and the flaviviruses) within 21 days of the patient's onset of symptoms, prior to the institution of appropriate infection control precautions, should also be placed under medical surveillance.
Because some of these viruses may remain present in bodily fluids for long periods following clinical recovery, convalescent patients continue to pose a risk of disease transmission.
Therefore, patients convalescing from a filoviral or an arenaviral infection should refrain from sexual activity for 3 months after clinical recovery.
Personal Protective Equipment
Powered air-purifying respirators (PAPRs) are theoretically more efficacious than N-95 disposable masks in providing respiratory protection from small-particle aerosols, mostly due to issues related to proper fitting of the masks. However, no data exist to support higher efficacy of powered air-purifying respirators over N-95 masks in preventing airborne transmission of infection in the health care setting. Powered air-purifying respirators are more expensive ($300-$600 vs less than $1 for disposable N-95 masks), are bulky, require maintenance, and impair voice communication to a higher degree than disposable N-95 masks. One study has shown that powered air-purifying respirators are associated with a higher incidence of needlestick injuries.
Disadvantages of the N-95 masks include the difficulty in ensuring a reliable face-mask seal with each use and impossibility of effective use by bearded individuals. The theoretical advantage of powered air-purifying respirators over N-95 masks may be offset by the danger of increased needlestick or sharp injuries to those using powered air-purifying respirators in these settings. The N-95 masks (in combination with face shields and goggles) are likely equivalent in protection to powered air-purifying respirators in the health care setting.
Therefore, the developers recommend that clinicians caring for patients with a viral hemorrhagic fever use either N-95 masks or powered air-purifying respirators, depending on their familiarity with one or the other, the suitability for the individual, and availability at a given institution. Some experts have advocated that powered air-purifying respirators be used during cough-inducing procedures (i.e., endotracheal intubations, bronchoscopies), autopsies, and centrifugation or pipetting of laboratory specimens. While there are no data to support this recommendation, the guideline developers would concur as long as the health care workers are familiar with the use of powered air-purifying respirators and are not subjecting themselves to the risk of inadvertent needlestick injury.
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