【エボラ出血熱】「乗るべきでなかった」2人目の感染者が飛行機に 混乱する医療現場

アメリカ国内で感染した2人目の医療従事者は、症状が出た前日の10月13日に、国内便の飛行機オハイオ州クリーブランド発、テキサス州ダラス行きの便に搭乗していた。
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ATLANTA, GA - OCTOBER 05: Director of Centers for Disease Control and Prevention Tom Frieden addresses the media on the Ebola case in the U.S. at the Tom Harkin Global Communications Center on October 5, 2014 in Atlanta, Georgia. The first confirmed Ebola virus patient in the United States was staying with family members at The Ivy Apartment complex before being treated at Texas Health Presbyterian Hospital Dallas. State and local officials are working with federal officials to monitor other individuals that had contact with the confirmed patient. (Photo by Kevin C. Cox/Getty Images)
Kevin C. Cox via Getty Images

アメリカ疾病管理予防センター(CDC)は10月15日、アメリカで初めてエボラ出血熱により死亡したトーマス・エリック・ダンカン氏の治療に携わっていたまた別の女性看護師が、エボラ出血熱に感染したことを確認したと発表した

アメリカ国内で感染した医療従事者は、これで2人目となる。しかもこの看護師は、症状が出た前日の10月13日に、国内便の飛行機に搭乗していたという。オハイオ州クリーブランド発、テキサス州ダラス行きの便だ。

CDCのトム・フリーデン長官は電話会見で、報道陣に対して次のように述べた。「この看護師は、民間航空機で旅行すべきではなかった。こういった場合のCDCガイドラインでは、いわゆる『制限された移動』が必要であることを規定している。これにはチャーター機や自動車が含まれるが、公共交通機関は含まれない」

この看護師は、ダンカン氏の治療にあたった76人の看護師のうちの1人だったため、飛行機に乗るべきではなかった、とフリーデン長官は述べた。76人は現在、全員が監視下に置かれている。

同長官はさらに、この看護師と同じ飛行機に搭乗していた人がエボラ出血熱に感染するリスクはほとんどないだろうとも付け加えた。エボラ出血熱は体液に触れることで感染するからだ。ただし、CDCは念のため、他の乗客たちに連絡を取っているという。

フリーデン長官は次のように述べた。「2人目の感染者が、搭乗の翌日まで発熱せず、機内で吐き気を催したり嘔吐することもなかったという事実は、この個人の周囲にいた乗客へのリスクが極めて低いことを示すものだ。ただしわれわれは、常により一層の安全対策を講じていく」

フリーデン長官ら衛生当局者は当初、1人目の感染者となった、ダラスにあるテキサス長老派教会病院の看護師ニーナ・ファムさんについて、「規定違反」があったに違いないということ以外、発病した状況や、エボラ出血熱に感染した経緯はわからないと述べていた。フリーデン長官は15日、何が問題だったのかが明らかになってきたことを示唆した。

「2人目の感染者は、1人目と同様、患者(ダンカン氏)による大量の嘔吐と下痢を処理していた際にかなりの接触があった」と、フリーデン長官は説明している。

病院の状態を査察したCDCチームによると、(ダンカン氏が)入院していた最初の数日間に、「さまざまな形態の個人用防護具」が使われたという。これに関して、登録看護師を代表するアメリカ最大の労働組合「全米看護師連合」(NNU)は10月14日、テキサス長老派教会病院の職員たちが、ダンカン氏の入院後、訓練や設備が不十分だと批判していたことを明らかにした。

NNUのデボラ・バーガー共同議長は次のように述べている。「看護師たちは、ダンカン氏がおびただしい量の下痢と嘔吐を繰り返し、感染源となる液体を大量に吐き出す間も、何であれその時点で利用できる限りの防護具を身に付けてダンカン氏と接触しなければならなかった」

NNUの根本的な主張は、ダラスの病院だけでなく他のどの病院であっても、エボラ出血熱に対応する訓練も設備も足りておらず(日本語版記事)、CDCの規定に従うことができない、というものだ。こうした主張についてハフポストUS版がフリーデン長官に尋ねたところ、長官は、CDCは当該病院と緊密に連携していると述べた。

フリーデン長官はさらに、アメリカ政府の対応として、看護師たちが個人用防護具を着脱する様子をチェックする現場監督者を置いた、と付け加えた(個人用防護具の安全な着脱手順は非常に複雑で、プロセスをチェックする専門スタッフが必要とされている)。

さらに、保健福祉省のシルビア・バーウェル長官は、オバマ政権が、どの病院でエボラ出血熱が発生してもすぐに駆け付けられる対策チームを設置したと述べた。

3月以降、4000人以上がエボラ出血熱に感染して死亡しており、そのほとんどは西アフリカで発生している。ダラスの病院で感染した2人の看護師は、アメリカで初めてエボラウイルスに感染した例となる。

[Arthur Delaney(English) 日本語版:湯本牧子/ガリレオ]

Ebola virus myth-busting
Ebola is highly infectious and even being in the same room as someone with the disease can put you at risk(01 of09)
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Not as far as we know. Ebola isn\'t contagious until symptoms begin, and it spreads through direct contact with the bodily fluids of patients. It is not, from what we know of the science so far, an airborne virus. So contact with the patient\'s sweat, blood, vomit, feces or semen could cause infection, and the body remains infectious after death. Much of the spread in west Africa has been attributed to the initial distrust of medical staff, leaving many to be treated at home by loved ones, poorly equipped medics catching the disease from patients, and the traditional burial rites involving manually washing of the dead body. From what we know already, you can\'t catch it from the air, you can\'t catch it from food, you can\'t catch it from water. (credit:ASSOCIATED PRESS)
You need to be worried if someone is sneezing or coughing hard (02 of09)
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Apart from the fact that sneezing and coughing aren\'t generally thought to be symptoms of Ebola, the disease is not airborne, so unless someone coughed their phlegm directly into your mouth, you wouldn\'t catch the disease. Though medical staff will take every precaution to avoid coming into contact with the body of an infected person at all costs, with stringent hygiene there should be a way to contain the virus if it reaches the UK. (credit:ASSOCIATED PRESS)
Cancelling all flights from west Africa would stop the spread of Ebola(03 of09)
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This actually has pretty serious implications. British Airways suspended its four-times-weekly flights to Liberia and Sierra Leone until the end of March, the only direct flight to the region from the UK. In practice, anyone can just change planes somewhere else and get to Britain from Europe, north Africa, or the Middle East. And aid agencies say that flight cancellations are hampering efforts to get the disease under control, they rely on commercial flights to get to the infected regions. Liberia\'s information minister, Lewis Brown, told the Telegraph this week that BA was putting more people in danger. \"We need as many airlines coming in to this region as possible, because the cost of bringing in supplies and aid workers is becoming prohibitive,\" he told the Telegraph. \"There just aren\'t enough seats on the planes. I can understand BA\'s initial reaction back in August, but they must remember this is a global fight now, not just a west African one, and we can\'t just be shut out.\" Christopher Stokes, director of MSF in Brussels, agreed: “Airlines have shut down many flights and the unintended consequence has been to slow and hamper the relief effort, paradoxically increasing the risk of this epidemic spreading across countries in west Africa first, then potentially elsewhere. We have to stop Ebola at source and this means we have to be able to go there.” (credit:ASSOCIATED PRESS)
Temperature screening at airports is an effective way to stop those who have the disease from travelling(04 of09)
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The screening process is pretty porous, especially when individuals want to subvert it. Wake up on the morning of your flight, feel a bit hot, and you definitely don\'t want to be sent to an isolation booth for days and have to miss your flight. Take an ibuprofen and you can lower your temperature enough to get past the scanners. And if you suspect you have Ebola, you might be desperate to leave, seeing how much better the treatment success has been in western nations. And experts have warned that you cannot expect people to be honest about who they have had contact with. Thomas Eric Duncan, the Ebola victim who died in Texas, told officials he had not been in contact with anyone with the disease, but had in fact visited someone in the late stages of the virus, though he said he believed it was malaria. The extra screening that the US implemented since his death probably wouldn\'t have singled out Duncan when he arrived from hard-hit Liberia last month, because he had no symptoms while travelling. (credit:ASSOCIATED PRESS)
Border staff should stop people coming in to the country who are at risk(05 of09)
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They\'re not doctors, and it\'s a monumental task to train 23,500 people who work for the UK Border Agency how to correctly diagnose a complex disease, and spot it in the millions of people who come through British transport hubs. Public Health England has provided UK Border Force with advice on the assessment of an unwell patient on entry to UK, but they can\'t be expected to check everyone. (credit:LEON NEAL via Getty Images)
Screening at British airports should be implemented to stop unwell people coming in from affected areas(06 of09)
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As mentioned before, the UK, especially London, is a major transport hub. Unlike the US, most of those coming from west Africa will have crossed through Europe, so infected people could be coming from practically anywhere, not just flights directly from those countries. This would require the UK to screen every returning traveller, as people could return to the UK from an affected country through any port of entry. This would be huge numbers of low risk people, at vast, vast expense. (credit:ASSOCIATED PRESS)
Ebola doesn't have a cure(07 of09)
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There are several cures currently being tested for Ebola. They include the ZMapp vaccine which was administered to British sufferer William Pooley and two other Americans who caught the disease in west Africa and they all recovered. Supplies of the drug have now run dry, and it has not been through clinical trials to prove its effectiveness. Mapp Biopharmaceutical, the company that makes ZMapp, says the drug\'s supplies are exhausted and that it takes months to make even a small batch. But an Ebola cure is very much on the horizon, and would have come sooner had it been seen as any kind of priority for drug companies before it started reaching the western world. (credit:John Moore via Getty Images)
Ebola is a death sentence(08 of09)
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It is true that certain strains of Ebola have had a death rate of 90%. However, with this particular epidemic the stats are more positive, a death rate of around 60%. Those who have decent, strong immune systems, are able to access intravenous fluids and scrupulous health care are far more likely to survive, which is why the survival rate of westerners who contract the disease is far better. Experts have suggested that, rather than waste money on pointless airport screenings, funds could be used to improve infrastructure in the affected nations to help halt the spread of the disease at source. (credit:ASSOCIATED PRESS)
Ebola turns you into a zombie(09 of09)
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Just, no. (credit:Renee Keith via Getty Images)

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