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Europe to see more Ebola cases after first transmission outside Africa

[MADRID] The World Health Organization said on Tuesday that Europe would almost certainly see more cases of Ebola after a nurse in Spain became the first person known to have caught the virus outside Africa.

With concerns growing globally that Ebola could spread beyond West Africa, where it has already killed more than 3,400 people in the worst outbreak in history, Spanish officials tried to reassure the public that they were tackling the threat. But health experts said the risk of a full-blown outbreak outside Africa was slim.

Rafael Perez-Santamaria, head of the Carlos III Hospital in Madrid, where the infected nurse had treated two Spanish missionaries who had contracted the disease in West Africa, said medical staff were "revising our protocols". Four people including the nurse's husband were admitted to hospital for observation.

Even though west European hospitals, unlike most of those in the affected parts of Africa, have the facilities to isolate an infected patient thoroughly, WHO European director Zsuzsanna Jakab said it was "quite unavoidable ... that such incidents will happen in the future because of the extensive travel from Europe to the affected countries and the other way around".

Nevertheless, she said that "the most important thing in our view is that Europe is still at low risk, and that the western part of the European region particularly is the best prepared in the world to respond to viral haemorrhagic fevers including Ebola".

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Still, health authorities in the developed world are being forced to re-examine their alertness to a disease that has been raging through Guinea, Sierra Leone and Liberia since March, killing more than half of those it infects.

The Spanish nurse, Teresa Romero, had gone on holiday in Madrid after the second of her Ebola patients died on Sept 25, but did not start feeling ill until Sept 30. Her trade union said she had then asked three times to be tested for Ebola before the infection was finally confirmed on Oct 6.

Dozens of doctors and nurses demonstrated outside La Paz Hospital in Madrid demanding more information about how Romero had caught Ebola, which is not airborne but transmitted through direct contact with the body fluids of a person who, experts say, must already be showing symptoms. "Given that both the transmission methods and the methods of prevention are well known, it is clear that some mistake was made," the Madrid College of Doctors said in a statement.

The story of slow response was echoed in Dallas, Texas, where the first Ebola patient diagnosed on US soil, Thomas Eric Duncan, was in critical condition.

Even though Duncan told a nurse he had recently come from West Africa, the hospital initially sent him back to his apartment with antibiotics, only to have him return two days later in an ambulance.

Peter Piot, a professor at the London School of Tropical Medicine who was one of the discoverers of Ebola, said caring for its victims demanded draconian discipline, as the slightest mistake could be fatal. "It should be a lesson for everybody that you can't overreact. You can't overprotect," he told a WHO science group teleconference.

But he also said such cases would remain rare, with carers most at risk: "There is a difference with what is going on in West Africa. It won't really give rise to outbreaks." The European Centre for Disease Prevention and Control (ECDC), which monitors disease in the EU, said that, while there was a small risk of travellers bringing Ebola in without knowing it, the region's public health authorities "can efficiently detect and confirm cases of Ebola virus disease and thus prevent its onward spread".

U.S. President Barack Obama said on Monday that his government would develop expanded screening of airline passengers for Ebola, both in the United States and in affected parts of West Africa. But the White House said there were no plans for a travel ban, which would only impede assistance to the region.

In contrast to the vast majority of African patients, some of those in Europe and the United States have been given experimental treatments for Ebola, which has no proven cure.

In Madrid, Romero has received antibodies from patients who survived Ebola. And Texas Health Presbyterian Hospital in Dallas said Duncan had been given the experimental drug brincidofovir, developed by Chimerix Inc for use against a respiratory virus but untested on Ebola patients.

Spanish authorities said Romero's husband had so far shown no symptoms of Ebola. The others admitted were a health worker who had diarrhoea but no fever, and a Spaniard who had travelled from Nigeria.

Twenty-two other people who had come into contact with the nurse were not isolated, but were having their temperature taken twice a day.

The Ebola epidemic has overwhelmed the health systems and battered the economies of Guinea, Sierra Leone and Liberia, which were showing signs of recovering from a decade of civil wars in the 1990s.

UN Assistant Secretary-General Magdy Martinez-Soliman said the crisis was "wiping out livelihoods and basic services, and could undo years of efforts to stabilise West Africa".

The UN Development Program noted that the price of rice was up 30 per cent in Sierra Leone, while production had fallen by 10 per cent in Guinea as fewer people were tending to crops. With health systems buckling, vaccine coverage in Liberia was down 50 per cent.

The World Bank said that, if the response to the epidemic was not stepped up, transport, cross-border trade, supply chains and tourism across West Africa could be severely disrupted, costing the region as a whole tens of billions of dollars.

Fears of economic consequences were felt in Europe too, where travel and leisure shares fell an average 2.4 per cent on the London exchange on news of the Spanish Ebola case. - Reuters

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