Aug. 04--The best way to keep Ebola from reaching America through travelers is to get it under control in Liberia, Sierra Leone, and Guinea, where it has killed more than 700, CDC director Tom Frieden said last week. He added that the CDC has "quarantine stations" at all major U.S. airports. About 10,000 travelers from the three African countries typically visit the U.S. in a three- to four-month period.
The CDC declined to answer questions about its office at Philadelphia International Airport.
Area doctors said they were on the alert in case an infected person appears in Philadelphia.
But Edward Jasper, an emergency services doctor at Thomas Jefferson University Hospital, said they are always on alert. They have been on the lookout for MERS (Middle East Respiratory Syndrome), chikungunya, dengue fever, and various flus. Adding Ebola, he said, is no big deal.
"Travel history is just part of our ER history" for patients with fevers, Jasper said.
Ebola does not spread as efficiently as some diseases, he said, and public health officials would quickly act to stop any Ebola threat. Philadelphia hospitals have plans for regional cooperation during a health crisis. "I can't imagine we wouldn't be able to put a lid on this," he said.
Nonetheless, he said, "probably nobody is perfectly equipped to deal with an infectious disease with no cure and no vaccine."
"The disease spreads easily in underdeveloped areas of Africa because they have few health-care facilities and the ones they do have are under-resourced," said Neil Fishman, an infectious-disease doctor at the University of Pennsylvania Health System.
Stopping Ebola requires early identification and isolation of victims, along with meticulous infection control among health workers. Those steps are daunting in poor countries with populations that mistrust health workers. Containing the disease should be much easier in a country rich with sophisticated hospitals and public health agencies.
"I think of this as something very similar to meningococcal meningitis," Fishman added. "It is a disease that is very serious and can be fatal, but it's very difficult to transmit, and if you take appropriate precautions, you can prevent transmissions."
Eileen Farnon, an infectious-disease doctor at Temple University Hospital who worked with the U.S. Centers for Disease Control and Infection on Ebola outbreaks in Africa in 2007, said even community hospitals in the U.S. are equipped to contain the deadly virus.
It is, she said, "eminently controllable if the correct personal protective equipment is used."
Kent Brantly, an American doctor who became infected with Ebola while helping patients in Liberia, was airlifted Saturday to a special isolation unit at Emory University Hospital in Atlanta. Another infected aid worker, Nancy Writebol, was expected to arrive in several days. Public health officials say intense anti-infection measures at the hospital should prevent any spread of the virus from those two patients.
Mattias Schnell, a Jefferson microbiologist, is working on the "no vaccine" problem, but says his solution, a new vaccine, will not come fast enough for this outbreak. It might be ready for the next one. He is working on a combined rabies/Ebola vaccine with the National Institutes of Health. The rabies vaccine -- rabies is a big problem in Africa -- is already in use. He hopes to begin a Phase I clinical trial within eight to 12 months.
Frieden called Ebola a "dreadful and merciless" virus. He estimated that it would take three to six months to get the current outbreak under control "even in the best of circumstances."
A type of hemorrhagic, or bleeding, fever, Ebola has in the past killed up to 90 percent of those infected. The death rate in the most recent outbreak is 60 percent. It is not spread through air, water, or food, but through close, personal contact such as kissing or exposure to bodily fluids.
The disease is infectious only once symptoms have begun, two to 21 days after the victim gets the virus. It then can spread through sweat, breast milk, saliva, blood, fecal material, vomitus, and semen, Farnon said.
Early symptoms would not be unusual for travelers: fever, chills, and muscle aches. At that point, it can easily be confused with typhoid fever, malaria, or dengue, she said.
Later symptoms include diarrhea with abdominal pain, vomiting, and a rash on the trunk or chest. While Ebola has a reputation for causing bleeding out of every orifice, Farnon said bleeding is more commonly internal.
The only treatments are to give people fluids and blood transfusions along with antibiotics for related infections.
The key to containment is to quickly isolate people with infections and find everyone who has had contact with them while contagious. Those people then must be monitored and isolated if they develop symptoms.
In American hospitals, Ebola patients would be put in individual rooms with closed doors. Health workers who care for them would be covered head-to-toe in protective garments, including masks and eye protection. Jasper said he probably would put patients in rooms with negative air pressure, which is meant to prevent germs from spreading through air ducts, as an extra precaution, even though Ebola is not considered an airborne virus.
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