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Ebola virus disease in Spain

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In 2014, two patients with cases of Ebola virus disease contracted in the Ebola virus epidemic in West Africa were medically evacuated to Spain. A failure in infection control in the treatment of the second patient led to an isolated infection of Ebola virus disease in a health worker in Spain itself. The health worker survived her Ebola infection, and has since been declared infection-free.

Initial medevac cases

On 5 August 2014, the Brothers Hospitallers of St. John of God confirmed that Brother Miguel Pajares, who had been volunteering in Liberia, had become infected. He was evacuated to Spain on 6 August 2014, and subsequently died on 12 August.[1]

On 21 September it was announced that Brother Manuel García Viejo, another Spanish citizen who was medical director at the San Juan de Dios Hospital in Lunsar, had been evacuated to Spain from Sierra Leone after being infected with the virus. His death was announced on 25 September.[2] Both of these cases were treated at the Hospital Carlos III in Madrid.[3]

Medical personnel infection

In October 2014, María Teresa Romero Ramos, an auxiliary nurse who had cared for Manuel García Viejo[4] at the Hospital Carlos III had become unwell and on 6 October tested positive for Ebola at her local hospital in Alcorcón, the Hospital Universitario Fundación Alcorcón.[5][6][7] A second test confirmed the diagnosis,[8] making this the first confirmed case of Ebola transmission outside Africa. Following testing, she was transferred to the Hospital Carlos III in Madrid for treatment.[9]

As of October 7, 50 contacts were being monitored, with 7 kept in isolation at the Hospital Carlos III, and an investigation was under way.[10][11]

Protest against euthanasia of Romero Ramos' pet dog

On 7 October, Madrid's regional government got a court order to euthanize Romero's pet dog, Excalibur, concerned that it posed a risk as a reservoir host.[12] By the afternoon there were over 30 animal rights activists who had barricaded the apartment to prevent officials from removing the dog. A number of online petitions were started rallying to save the dog, garnering hundreds of thousands of indications of support. Ramos' quarantined husband, Javier, called on a veterinarian radio show host, and recorded a video appeal, for help to save his dog. On 8 October, Spanish authorities removed, sedated and euthanized the dog and arranged for the safe disposal of its remains.[13]

On 9 October the Spanish health ministry quarantined three more people.[7] The health authorities announced that Maria Teresa Romero Ramos' condition had worsened significantly.[14] On October 12, she began to show some improvement. According to one report, the improvement may be attributed to Romero's having received the experimental drug ZMab which is similar to ZMapp, which has been used to treat several Ebola patients. However, according to information released by Spain's Centre for Health and Emergency Alerts, the nurse did not receive ZMab due to concerns over possible side-effects.[15][16] Romero, however, was given the experimental antiviral drug Favipiravir, and it was reported that the dosages used were much higher than those used in the treatment of other patients.[17]

Medical staff in Madrid protested about the lack of effective protective equipment and safety precautions.[14]

It was reported on October 17 that all the other people suspected of being infected in Spain had tested negative for the Ebola virus.[18]

On October 20 it was announced that Teresa Romero had tested negative for the Ebola virus,[19] suggesting she may have cleared the virus from her system. On November 1, it was announced that she was Ebola-free, and had been moved out of the isolation ward into a normal hospital bed to finish the process of recuperation from her illness.[20]

The WHO declared Spain Ebola-free on 2 December, 42 days after Teresa Romero was shown to be free of Ebola on 21 October.[21]

References

  1. ^ "Muere el religioso español Miguel Pajares a causa del ébola". RTVE. 12 August 2014. Retrieved 12 August 2014.
  2. ^ "Ebola Outbreak: Spanish Missionary Manuel Garcia Viejo Dies of Deadly Virus in Madrid". International Business Times. 25 September 2014. Retrieved 25 September 2014.
  3. ^ "Una auxiliar de enfermería que atendió al misionero fallecido García Viejo, contagiada de ébola" (in Spanish). El Mundo. Retrieved 6 October 2014.
  4. ^ "Spanish nurse tests positive for Ebola". RTE. 7 October 2014.
  5. ^ Greg Botelho, Laura Smith-Spark and Laura Perez Maestro (8 October 2014). "Hospital worker: Spaniard exposed in ER for 8 hours after positive Ebola test". CNN.
  6. ^ "Nurse 'infected with Ebola' in Spain". BBC. Retrieved 6 October 2014.
  7. ^ a b Raphael Minder (9 October 2014). "Spain Quarantines 3 More Over Ebola". New York Times.
  8. ^ "La enfermera ingresada en Alcorcón da positivo por ébola -- La segunda prueba ha dado positivo y confirma el diagnóstico". Cadena Ser. 6 October 2014.
  9. ^ "La segunda enfermera ingresada da negativo en la prueba del virus" (in Spanish). El Confidencial. 2014-10-07.
  10. ^ Raphael Minder (2014-10-07). "Demands for an Explanation Grow After a Nurse in Spain Contracts Ebola". New York Times.
  11. ^ "More health workers hospitalised in Spain Ebola scare". News24.
  12. ^ http://www.nytimes.com/2014/10/09/science/ebola-dog-excalibur-nurse-spain.html
  13. ^ "Spanish Ebola nurse's pet dog put down". News24. Retrieved 11 October 2014.
  14. ^ a b Raphael Minder (9 October 2014). "Condition of Spanish Nurse With Ebola Worsens, Officials Say". New York Times.
  15. ^ "Ebola-infected Spanish nurse improving after dose of experimental drug ZMapp: health source". NEW YORK DAILY NEWS. October 11, 2014. Retrieved October 16, 2014.
  16. ^ "Public Health Agency gives Spain, Norway ZMapp-like drug to treat Ebola cases". The Local Europe. 16 October 2014. Retrieved 16 October 2014.
  17. ^ http://www.abc.es/sociedad/20141024/abci-ebola-dosis-antiviral-teresa-201410241656.html
  18. ^ Ashifa Kassam (17 October 2014). "All four suspected Ebola cases in Spain test negative for the disease". The Guardian.
  19. ^ "Ebola crisis: Tests show Spanish nurse Teresa Romero no longer has the virus". ABC News. 20 October 2014.
  20. ^ Harold Heckle (1 November 2014). "Spanish Woman Cured of Ebola Moves to Normal Room". ABC News.
  21. ^ "WHO Says Spain Ebola-Free Following Nurse Recovery". ABC News. 2 December 2014. Retrieved 2 December 2014.
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