Ebola virus disease in the United Kingdom

This article describes cases of Ebola virus disease in the United Kingdom.

1976 needlestick case

On 5 November 1976, Geoffrey Platt, a laboratory technician at the former Microbiological Research Establishment in Porton Down, Wiltshire, contracted Ebola in an accidental needlestick injury from a contaminated needle while handling samples from Africa.[1] He was treated with human interferon and convalescent serum. The course of his disease was mild and he fully recovered.[2][3]

Medically evacuated cases

Royal Free Hospital

The high-level isolation unit at the Royal Free Hospital, in the Hampstead area of London, received its first case on 24 August 2014. William Pooley, a British nurse who contracted the disease while working in Sierra Leone as part of the relief effort for the Ebola virus epidemic in West Africa, was medically evacuated by the Royal Air Force on a specially-equipped C-17 aircraft.[4]

He was released from hospital on 3 September 2014.[5] Pooley delivered the UK's Channel 4 television program Alternative Christmas message in 2014.[6] He was reported to be planning to return to Sierra Leone on October 19, 2014.[7] He also donated blood to support developing a cure for the disease.[7]

On 11 March 2015, a UK military worker tested positive for Ebola and was flown home for treatment at Royal Free Hospital in London.[8] On 17 March, it was reported that another U.K. worker had been sent back to the United Kingdom from Sierra Leone due to fear of having contracted the virus.[9] Cpl Anna Cross, the U.K. military worker tested positive for Ebola, was the first person in the world to be treated with the experimental Ebola drug MIL 77 and was released from hospital after making a full recovery. Cpl Anna Cross contracted the disease in Sierra Leone while volunteering as a nurse. The doctors treating her at London's Royal Free Hospital confirmed it is too soon to speculate if the drug helped in her recovery.[10]

2014 returning aid worker

Initial illness

Location of the United Kingdom (highlighted in green, centre)

On 29 December 2014, Pauline Cafferkey, a British aid worker who had just returned to Glasgow from Sierra Leone via Casablanca Airport and London Heathrow Airport, was diagnosed with Ebola at Glasgow's Gartnavel General Hospital.[11][12][13] She had been working at an Ebola treatment centre in Kerry Town in Sierra Leone,[12] and it is thought she contracted the virus as a result of wearing a visor, as recommended by the World Health Organization and the UK Ministry of Defence, instead of goggles.[14]

After initial treatment in Glasgow, she was transferred by air to RAF Northolt, then to the specialist high-level isolation unit at the Royal Free Hospital in London for longer-term treatment.[12][15] A Scottish government spokesman described the risk to the general public as "extremely low to the point of negligible" due to the very early stage of the infection at the time of detection.[12] Contact tracing was carried out on the other passengers who traveled on the flight from London to Glasgow with her.[15] Medical staff described her condition at the time as "as well as we can hope for at this stage."[16]

On 4 January 2015, the Royal Free Hospital announced that her condition had deteriorated to critical,[17] with her health later stabilising before she was declared no longer critically ill on 12 January.[18][19] Cafferkey received blood plasma from William Pooley and has been treated with experimental drugs as part of her treatment.[19] On 24 January, she was declared to be free of infection, and released from hospital.[20]

Criticism of entry precautions

Due to the fact that Pauline Cafferkey had passed through border controls and travelled on a domestic flight from Heathrow to Glasgow, criticism was levelled at current screening protocols at UK points of entry, which mainly consist of taking a person's temperature and asking a series of questions. When she boarded her flight, her symptoms had not yet developed, making a diagnosis hard to detect.[21] As of December 2014, Public Health England were planning a review of the screening procedures.[22]

2015 readmission to hospital

The prognosis after recovery from Ebola virus disease can include joint pains, muscular pain, skin peeling, or hair loss.[23][24][25] In a media interview in September 2015, Cafferkey said "I’ve had trouble with my thyroid, lost some of my hair and get really sore joints but I guess side effects are to be expected."[26]

It was found in 2015 that, after an apparent complete cure, with the bloodstream, saliva and organs such as the liver free of the Ebola virus, it can linger on in parts of the body not protected by the immune system, including fluid in the eye, the central nervous system and, in men, the testes and semen.[27]

Cafferkey went to a 24 hour GP clinic in New Victoria Hospital in Glasgow on the night of 5 October 2015 and was diagnosed with "a virus" (unspecified) and sent home.[28] 24 hours later she was admitted to Queen Elizabeth University Hospital where she was diagnosed with late complications caused by the Ebola virus hitherto considered unusual, and was flown by military jet to London, to the Royal Free Hospital. Her condition was initially described as serious and she was being treated in the high-level isolation unit. Doctors discovered that, after she had been deemed cured, the virus had remained in her cerebrospinal fluid and feared that it might be in her central nervous system.[27] Personnel in Scotland monitored those whom she had come into contact with, since the virus can be spread through exposure to the infected person's body fluids, though they said the risk was likely to be small.[29]

Her condition declined rapidly, and on 14 October 2015 she was reported to be critically ill.[30] Five days later, on 19 October 2015, the Royal Free Hospital announced that: "Pauline Cafferkey's condition has improved to serious but stable".[31]

On 21 October 2015 Dr Michael Jacobs, Cafferkey's doctor at the Royal Free Hospital, gave a televised press conference in which he explained that she has been suffering from meningitis caused by Ebola virus, and that she has not been re-infected with Ebola. He stated: "This is the original Ebola virus that she had many months ago, which has been lying inside the brain, replicating at a very low level probably, and has now re-emerged to cause this clinical illness of meningitis." He stated that this was unprecedented. Dr Jacobs went on to say that Cafferkey had "became critically ill due to neurological complications from the meningitis", and explained that she has been treated using a highly experimental anti-viral agent called GS5734, but he stressed that the crucial part of her treatment has been the exceptional nursing care which she is receiving. He said that "I'm really pleased to tell you that in the last few days she's made a significant improvement. She is much better now.", and that she has been talking to staff members, eating a little, and even using an iPad, although she remains in an isolation tent and is not well enough to get out of bed. He added that: "I think she has a long recovery ahead of her and will be with us for quite a while still." [32][33][34]

On 12 November the Royal Free Hospital said that Cafferkey had made a full recovery and was no longer infectious.[35] She has been transferred to Glasgow's Queen Elizabeth University Hospital.

Needlestick incidents

Healthcare workers who sustained needlestick injuries in January 2015 while caring for Ebola patients were put under medical observation, but not found to have contracted the Ebola virus.[36][37][37][38]

References

  1. ↑ Sam Rkaina (25 August 2014). "Ebola: Last British man to survive deadly virus says public must be warned of danger". Daily Mirror.
  2. ↑ Emond RT, Evans B, Bowen ET; et al. (1977). "A case of Ebola virus infection". British Medical Journal 2 (6086): 541–544. doi:10.1136/bmj.2.6086.541. PMC 1631428. PMID 890413.
  3. ↑ "Outbreaks Chronology: Ebola Virus Disease". CDC.
  4. ↑ "British Ebola patient arrives in UK for hospital treatment". BBC News. 24 August 2014. Retrieved 25 August 2014.
  5. ↑ "Ebola: British nurse makes full recovery and leaves hospital". The Week. 3 September 2014. Retrieved 5 September 2014.
  6. ↑ "UEA graduate to deliver Channel 4 Christmas message". 23 December 2014. Retrieved 23 December 2014.
  7. 1 2 Helen Lock (19 October 2014). "Ebola outbreak: British survivor William Pooley returns to Sierra Leone to fight the disease". The Independent.
  8. ↑ "BBC News - UK female military health worker has Ebola". BBC News. Retrieved 12 March 2015.
  9. ↑ "BBC News - Ebola: Seventh British health worker sent home". BBC News. Retrieved 19 March 2015.
  10. ↑ "British medic declared free of Ebola". BBC News. 27 March 2015. Retrieved 27 March 2015.
  11. ↑ "Ebola case confirmed in Glasgow hospital". BBC News. 29 December 2014.
  12. 1 2 3 4 Severin Carrell, Libby Brooks and Lisa O'Carroll (29 December 2014). "Ebola case confirmed in Glasgow". The Guardian.
  13. ↑ "Hero nurse Pauline Cafferkey could have contracted deadly Ebola at Christmas Day service". The Telegraph. 30 December 2014.
  14. ↑ Gallagher, James (4 February 2015). "Ebola nurse infection 'down to visor'". BBC News. Retrieved 8 February 2015.
  15. 1 2 "Ebola nurse Pauline Cafferkey transferred to London unit". BBC News. 30 December 2014.
  16. ↑ "Ebola: Nurse Pauline Cafferkey 'as well as hoped for'". BBC News. 1 January 2015. Retrieved 1 January 2015.
  17. ↑ "BBC News - UK Ebola nurse Pauline Cafferkey 'in critical condition'". BBC News. 4 January 2015. Retrieved 4 January 2015.
  18. ↑ Gallagher, James. "UK Ebola nurse Pauline Cafferkey has 'stabilised'". BBC News. Retrieved 5 January 2015.
  19. 1 2 "Ebola nurse no longer critically ill". BBC News. 12 January 2015. Retrieved 12 January 2015.
  20. ↑ "Ebola nurse: Pauline Cafferkey 'happy to be alive'". BBC News. 24 January 2015.
  21. ↑ "BBC News - Doctor travelling with Ebola nurse: Screening 'chaotic'". BBC News. 30 December 2014.
  22. ↑ Josh Halliday (30 December 2014). "Ebola screening to be reviewed after doctor attacks ‘inadequate’ measures". the Guardian.
  23. ↑ Qureshi, Adnan I.; Chughtai, Morad; Loua, Tokpagnan Oscar; Pe Kolie, Jean; Camara, Hadja Fatou Sikhe; Ishfaq, Muhammad Fawad; N'Dour, Cheikh Tidane; Beavogui, Kezely (2015). "Study of Ebola Virus Disease Survivors in Guinea: Table 1.". Clinical Infectious Diseases 61 (7): 1035–1042. doi:10.1093/cid/civ453. ISSN 1058-4838.
  24. ↑ Goeijenbier M, van Kampen JJ, Reusken CB, Koopmans MP, van Gorp EC (November 2014). "Ebola virus disease: a review on epidemiology, symptoms, treatment and pathogenesis". Neth J Med 72 (9): 442–8. PMID 25387613.
  25. ↑ Carod-Artal, Francisco Javier (2015). "Post-Ebolavirus disease syndrome: what do we know?". Expert Review of Anti-infective Therapy 13 (10): 1185–1187. doi:10.1586/14787210.2015.1079128. ISSN 1478-7210. PMID 26293407.
  26. ↑ http://www.dailyrecord.co.uk/news/health/ebola-survivor-pauline-cafferkey-ordeal-6434413
  27. 1 2 The Guardian newspaper:How Pauline Cafferkey's Ebola relapse tears up everything doctors thought they knew, 16 October 2015
  28. ↑ http://www.theguardian.com/world/2015/oct/11/pauline-cafferkey-family-accuses-doctors-of-major-failings
  29. ↑ "Ebola nurse Pauline Cafferkey 'in serious condition'". BBC News. Retrieved 2015-10-09.
  30. ↑ "Scottish Ebola nurse Pauline Cafferkey 'critically ill'". BBC News. 2015-10-14.
  31. ↑ "Ebola nurse Pauline Cafferkey's condition 'has improved'". BBC News. 2015-10-19.
  32. ↑ "Ebola caused meningitis in nurse Pauline Cafferkey". BBC News. 2015-10-21.
  33. ↑ Dr Michael Jacobs (2015-10-21). Royal Free Hospital Press Conference (Television).
  34. ↑ Dr Michael Jacobs (2015-10-21). Ebola-stricken nurse Pauline Cafferkey makes 'significant improvement' (Television production). Royal Free Hospital, London: Press Association. Retrieved 2015-10-21.
  35. ↑ "Ebola nurse Pauline Cafferkey 'has made full recovery'". BBC News. 12 November 2015. Retrieved 2015-11-14.
  36. ↑ "British health worker returned to UK for Ebola monitoring". Channel 4 News. 31 January 2015.
  37. 1 2 "Ebola: military healthcare worker returns to UK after needle injury". The Guardian. 31 January 2015.
  38. ↑ "Second UK military Ebola worker flies back home after needlestick injury". The Guardian. 2 February 2015.

See also

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