Monday, November 17, 2014

That UN peacekeeper with fever

The Department of Health (DOH) should be more cautious. Something may not be right.

According to a news report, the DOH announced on Friday that a Filipino soldier who served as a UN peacekeeper exhibited fever, chills and body malaise, which are also symptoms of hemorrhagic fever or Ebola. By Saturday DOH's Acting Health Secretary Janette Garin announced that the UN peacekeeper has Malaria not Ebola. Further:
The unnamed trooper was transferred from Carballo Island to the Research Institute for Tropical Medicine (RITM) in Alabang for further tests.
“The Philippines is still Ebola free. Our patient is negative for Ebola,” Garin declared Saturday, Nov. 15. Garin said the other peacekeepers were happy after they were informed that their colleague tested negative for Ebola.
RITM chief Socorro Lupisan said two tests were conducted on the patient.
Lupisan said one of these was polymerace chain reaction, a test to determine if the virus had the genetic makeup of Ebola. The other, an antigen test, was to see if the patient had developed antibodies.
Garin said they were able to rule out Ebola with these two tests, despite not having completed the 48-hour period. She explained the period was only needed if there were doubts on the test results, resulting in the need for a repeat of the tests.


A self-explanatory description on diagnosing Ebola appears on the website of Centers for Disease Control and Prevention (Atlanta, USA), thus:
Diagnosing Ebola in a person who has been infected for only a few days is difficult because the early symptoms, such as fever, are nonspecific to Ebola infection and often are seen in patients with more common diseases, such as malaria and typhoid fever.
However, if a person has the early symptoms of Ebola and has had contact with the blood or body fluids of a person sick with Ebola; contact with objects that have been contaminated with the blood or body fluids of a person sick with Ebola; or contact with infected animals, they should be isolated and public health professionals notified. Samples from the patient can then be collected and tested to confirm infection.
Ebola virus is detected in blood only after onset of symptoms, most notably fever, which accompany the rise in circulating virus within the patient's body. It may take up to three days after symptoms start for the virus to reach detectable levels. 

AND MORE:


WHO recommendations for testing for Ebola virus disease and confirming a case

WHO is alarmed by media reports of suspected Ebola cases imported into new countries that are said, by government officials or ministries of health, to be discarded as “negative” within hours after the suspected case enters the country.
Such rapid determination of infection status is impossible, casting grave doubts on some of the official information that is being communicated to the public and the media.
  • For early detection of Ebola virus in suspected or probable cases, detection of viral ribonucleic acid (RNA) or viral antigen are the recommended tests.
  • Laboratory-confirmed cases must test positive for the presence of the Ebola virus, either by detection of viral RNA by RT-PCR, and/or by detection of Ebola antigen by a specific Antigen detection test, and/or by detection of immunoglobulin M (IgM) antibodies directed against Ebola.
  • Two negative RT-PCR test results, at least 48 hours apart, are required for a clinically asymptomatic patient to be discharged from hospital, or for a suspected Ebola case to be discarded as testing negative for the virus.
  • Laboratory results should be communicated to WHO as quickly as possible, in addition to reporting under the requirements and within the timelines set out in the International Health Regulations, which are administered by WHO.

Note

WHO recommends that the first 25 positive cases and 50 negative specimens detected by a country without a recognized national reference viral haemorrhagic fever laboratory should be sent for secondary confirmatory testing to a WHO collaborating centre, designed as specialized in the safe detection (at biosafety level IV) of viral haemorrhagic fevers.
Similarly, for countries with a national reference laboratory for viral haemorrhagic fevers, the initial positive cases should also be sent to a WHO collaborating centre for confirmation.
If results are concordant, laboratory results reported from the national reference laboratory would be accepted by WHO.

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