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Gates Foundation boosts aid to stamp out malaria

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NEW ORLEANS (AP) — Philanthropist Bill Gates says he wants to end malaria in his lifetime and will give more money toward that goal, part of his broader fight against tropical diseases that are getting unusual public attention because of the Ebola epidemic.

In an interview with The Associated Press and in a speech Sunday at a global health conference in New Orleans, the Microsoft co-founder said his Bill & Melinda Gates Foundation would increase its malaria program budget by 30 percent, to more than $200 million per year. That’s on top of the foundation’s other donations to the Global Fund to Fight AIDS, Tuberculosis and Malaria.

Small steps won’t get the job done, and scientists don’t have all the tools they need to eradicate malaria, Gates said.

His plan includes developing a drug or vaccine to purge the malaria parasite in people who carry it without showing symptoms — a “human reservoir” that helps spread the disease.

“I really do believe that malaria can be eradicated in my lifetime,” said Gates, who just turned 59.

Gates spoke at the annual meeting of the American Society of Tropical Medicine and Hygiene, a conference that usually gets little public notice, about diseases often referred to as “neglected.”

That is not the case this year. On Wednesday, Louisiana officials created a stir by asking the 3,500 people registered for the conference to stay away if they have been to certain West African countries or have had contact with an Ebola patient in the last 21 days, the maximum incubation period for Ebola.

Conference organizers called the stance an overreaction to Ebola fears, and said it would prevent some scientists from presenting studies on the outbreak, which has killed about 5,000 Africans this year.

In all, Gates said his foundation will commit more than $500 million this year to fight malaria, pneumonia, and diarrheal and parasitic diseases in poor countries. Here are some he discussed.

EBOLA

The conference comes “at a pivotal moment in the history of global health” because of the world’s largest outbreak of Ebola, Gates said. He and his wife have pledged $50 million to help contain it and for research on treatments, rapid tests and vaccines. Another Microsoft co-founder, Paul Allen, has pledged $100 million, and Facebook founder Mark Zuckerberg and his wife Priscilla Chan, $25 million.

The global response to Ebola initially stumbled and revealed flaws in our health systems, Gates said. Since then, some countries and groups have helped, but much more is needed, he said.

“We’re likely in the next several decades to have an epidemic that’s more transmissible than this Ebola epidemic,” so bolstering health systems in all countries and ensuring investment in drugs and vaccines is key, he said.

MALARIA

It kills more than 600,000 people each year, mostly children in Africa but also in Asia, Latin America and other areas.

It is caused by parasites spread through the bite of infected mosquitoes. In areas where the disease is common, people can develop partial immunity — they carry the parasite but don’t get sick, and mosquitoes who bite them become infected and then spread the disease when they bite others.

Efforts to control the disease, such as bed nets to prevent mosquito bites, must continue but “the only way to stop malaria is to end it forever,” Gates said.

His plan includes $156 million over five years to the PATH Malaria Vaccine Initiative to develop vaccines that prevent mosquitoes from infecting people and vice versa.

Dr. Chris Plowe, a malaria expert at the University of Maryland’s Center for Vaccine Development and incoming president of the tropical medicine group, said targeting silent infection is key because “if you want to eradicate or eliminate malaria, you have to get rid of all the parasites.”

The idea of ending malaria in 20 to 40 years “is faster than most people expect,” but a good goal, Plowe said.

POLIO

Gates called polio eradication “my top priority,” noting the viral disease remains endemic in three countries — Nigeria, Pakistan and Afghanistan. He cited progress: Polio was eliminated in India earlier this year, and as of early September, Nigeria had confirmed only six wild poliovirus cases this year. There is a good chance of getting the polio case count down to zero for the entire continent of Africa, he said.

DENGUE FEVER

The mosquito-borne disease, also known as breakbone fever for the pain it causes, has spread from a few countries a few decades ago to more than 100 today, including the southern United States. An experimental vaccine seems to prevent most severe disease and hospitalizations. Details of a major study on it will be presented at the conference on Monday, and Gates said his foundation would work to build on that work and make a vaccine available to all who need it.

CHIKUNGUNYA

Another mosquito-borne disease, chikungunya causes fever and extremely painful joints. It spread to the Caribbean last year after expanding in Africa and South Asia, and in July, the first locally acquired case in the U.S. was documented in Florida. It’s an important field for research and vaccine development, Gates said.

___

Online:

Gates Foundation/malaria: http://www.gatesfoundation.org/What-We-Do/Global-Health/Malaria

WHO on malaria: http://www.who.int/mediacentre/factsheets/fs094/en/

Malaria vaccine effort: http://www.malariavaccine.org/

Help for Ebola: www.TackleEbola.com

___

Marilynn Marchione can be followed at http://twitter.com/MMarchioneAP

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Duke University evaluating potential Ebola patient; risk downplayed

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A patient who entered the United States from Liberia on Friday was in isolation at Duke University Hospital in Durham after developing a fever and was being tested for Ebola, North Carolina state health authorities announced Sunday night.

The North Carolina Department of Health and Human Services emphasized that the patient, who was not identified, had no known exposure to Ebola and no other symptoms besides the fever. They said the patient’s blood sample would be tested Monday at a state-run health laboratory.

The patient also is being tested to determine other possible causes of the fever, health authorities said.

“The patient will remain in a contained, isolated and secured unit until the results of testing are known,” the department said in a statement. “These precautions are being taken based on the patient’s recent travel from Liberia.”

The risk to the public is extremely low, the health department said.

“Ebola is not spread through the air, water or food – or simply by being near an infected person,” the department’s statement said. “Ebola is only spread through unprotected contact with blood or body fluids from an infected person who has symptoms, or with objects like needles that have been contaminated with the virus.”

The World Health Organization estimates that nearly 5,000 people have died of Ebola in the latest outbreak, which has been traced back to December. Most cases have been in Liberia, Sierra Leone and Guinea.

The first person diagnosed on U.S. soil was a Liberian man, Thomas Eric Duncan, who arrived in Dallas Sept. 20 and became ill days later. He was hospitalized Sept. 28 and died Oct. 8. Two nurses who treated him contracted the virus, and both have been cured.

An American doctor with Ebola is being treated at Bellevue Hospital Center in New York after becoming ill Oct. 23. Dr. Craig Spencer, 33, had volunteered with Doctors Without Borders in Guinea. His doctors said Saturday that he was stable and responding well to treatment.

At least four other Americans, including two doctors, a missionary and a freelance journalist, have contracted the virus in West Africa and received treatment in the U.S. All have been cured. Duncan is the only Ebola victim to die in the U.S.

National nervousness about the disease has led to several false alarms across the U.S., with subsequent tests showing the patients did not have Ebola. Another scare occurred Friday in Oregon, where a woman was hospitalized. Officials said Saturday that she is at low-risk for Ebola.

Copyright © 2014, Los Angeles Times

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U.S. Liberia lab chief tells hip hop-dancing boys they’re Ebola-free

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Boys Solomon (C, rear) and Joe (R, rear) stand in the ''red zone'' where they are being treated for Ebola at the Bong County Ebola Treatment Unit about 200 km (120 miles) east of the capital, Monrovia, in this October 28, 2014 file photo. REUTERS/Michelle Nichols/Files

Boys Solomon (C, rear) and Joe (R, rear) stand in the ”red zone” where they are being treated for Ebola at the Bong County Ebola Treatment Unit about 200 km (120 miles) east of the capital, Monrovia, in this October 28, 2014 file photo.

Credit: Reuters/Michelle Nichols/Files

 

 

(Reuters) – For the past five weeks U.S. Navy Lieutenant Commander Benjamin Espinosa has been testing blood samples for the deadly Ebola virus at a mobile laboratory in Liberia.

 

Liberia, Sierra Leone and Guinea have been gripped by the worst outbreak of the hemorrhagic fever on record. The laboratory in Bong County, about 200 km (120 miles) east of the capital Monrovia, has cut testing time to five hours from five days.

 

Nearby patients are being treated in the Bong County Ebola Treatment Unit (ETU).

 

“When I first arrived and visited the ETU, seeing the actual people that were relying on our work … it changed me. Now when we work in the lab, we see the person behind the sample and know that their lives could depend on us. It drives us,” he told Reuters in an email on Sunday.

 

Espinosa, a father of four originally from Colorado, is due to leave Liberia shortly. On Friday he unexpectedly got to deliver the news to Solomon, 14, and Joe, 11, that they were now Ebola-free.

 

“Joe and Solomon were already at the barrier fence (when we arrived). I’m sure someone told them we had something to tell them,” Espinosa said. “When we walked up they were dancing to music that was playing from a radio inside the Confirmed Ward. They are actually very impressive hip hop dancers.”

 

“‘Today you are finally cured! You have no virus left inside of you. You can go home,’” Espinosa said he told them. “People started clapping for them, the boys started clapping and smiling and one asked if he could leave right then. They were obviously very excited and happy.”

 

Joe and Solomon had been treated in the Bong County Ebola Treatment Unit for several weeks and went home on Saturday.

 

Espinosa said he had a hard time controlling his emotions as he told the boys.

 

“When I see the ages of the children that we test it’s very hard not to visualize my own children sick, in pain, and isolated there with no one to comfort them. It kills me,” he said. “So, telling these boys, who are the same age as mine, was amazing.”

 

(Reporting by Michelle Nichols in New York; Editing by Eric Walsh)

 

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71% Back Mandatory Quarantines for Ebola Workers: Poll

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By Carrie Dann

More than seven in 10 Americans support mandatory quarantines for health professionals who have treated Ebola patients in West Africa, even if they have no symptoms, according to a new NBC News/Wall Street Journal poll.

The survey shows that 71 percent of those surveyed say the health workers should be subject to a 21-day quarantine, while 24 percent disagree.

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The question of mandatory quarantines exploded into the public debate after nurse Kaci Hickox battled with the governors of New Jersey and Maine over the mandated isolation, arguing that she has exhibited no symptoms and tested negative for the virus. Those who oppose the practice – including top health officials and White House administration officials — say that it is unnecessary and discourages health workers from fighting the Ebola outbreak at its source.

Support for the quarantines varies by political party, age and education level.

Eighty-five percent of self-described Republicans say they think the quarantines should be enforced, versus 65 percent of Democrats and 60 percent of independents. Ninety-one percent of Tea Party backers also believe the quarantines are necessary.

Older Americans are also more likely to back mandatory isolation for the health workers. A third of those 18-34 years old oppose the requirements, compared with just one in 10 seniors.

And those with lower levels of education are more likely to support quarantines (80 percent of those with a high school education or less are in favor) than those with college or post-graduate educations (63 percent are in favor.)

The poll was conducted October 30 through November 1, 2014. The margin of error for the poll question regarding Ebola quarantines was 5.73 percent.

First published November 2 2014, 3:29 PM

Carrie Dann

Carrie Dann is a national political writer for NBCNews.com. She has worked for NBC and NBCNews.com since 2006. Dann writes about politics and Congress. Dann rejoined the web team after 18 months as a campaign reporter for NBC News, covering presidential and vice presidential candidates during the 2012 election. She also covered the 2007-2008 presidential campaign for NBC, including extensive reporting on the Iowa caucuses.

Prior to her work at NBCNews.com, Dann was a staff reporter at CongressDaily, where she covered lobbying and government reform.

A Virginia native, she now lives in Washington, D.C.

… Expand Bio

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Maine nurse sees Ebola quarantines as ‘abundance of politics’

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Nurse Kaci Hickox (L) joined by her boyfriend Ted Wilbur speak with the media outside of their home in Fort Kent, Maine October 31, 2014. REUTERS/Joel Page

 

 

(Reuters) – A U.S. nurse who challenged quarantines of health care workers returning from treating West African Ebola patients said on Sunday she thought “an abundance of politics” lurked behind them.

 

Kaci Hickox has fought a heated public battle over what she considers draconian measures to isolate her for 21 days after her return from Sierra Leone, in a case that highlights the dilemma over how to balance public health needs and personal liberty.

 

In some U.S. states officials such as New Jersey Governor Chris Christie have imposed strict quarantines on health workers returning from three Ebola-ravaged West African countries, but the U.S. federal government opposes such measures.

 

“When Governor Christie stated that it was an abundance of caution, which is his reasoning for putting health care workers in a sort of quarantine for three weeks, it was really an abundance of politics,” Hickox said in an interview with NBC’s “Meet the Press”.

 

“And I think all of the scientific and medical and public health community agrees with me on that statement,” she said.

 

Christie has defended his decision to impose a mandatory three-week quarantine, saying that counting on a voluntary system may or may not work and that protecting health and safety is the government’s job.

 

The most deadly outbreak of Ebola on record has killed nearly 5,000 people, all but a handful of them in Liberia, Guinea and Sierra Leone.

 

ISOLATION TENT

 

Hickox tested negative for Ebola after returning recently from working for Doctors Without Borders in Sierra Leone. But she was placed in an isolation tent in New Jersey when she returned before being allowed to leave for Maine, which also sought to quarantine her at home.

 

A judge in Maine on Friday rejected that state’s bid to quarantine Hickox, instead imposing limited restrictions on her. The judge said that Hickox must continue direct monitoring of her health, coordinate travel plans with health officials and report any symptoms.

 

“We know a lot about Ebola,” Hickox told Meet the Press. “We know that it’s not transmitted from someone who is asymptomatic, as I am and many other aid workers will be when they return.”

 

Speaking to NBC from Fort Kent, Maine, Hickox indicated she would continue to stay away from crowds in her community, but that her partner, Ted Wilbur, should be allowed to go back to nursing school on Monday.

 

“I understand that the community has been through a lot in the past week and I do, you know, apologize to them for that,” she told NBC.

 

“I will not go into town, into crowded public places … But on the other hand, you know, my partner is currently in nursing school and there is definitely zero scientific evidence that says he shouldn’t be allowed to return to his campus on Monday.”

 

Only one person in the United States is currently being treated for Ebola, a New York doctor, Craig Spencer, who cared for patients in West Africa. His condition was upgraded by New York City health officials on Saturday to “stable” from “serious but stable” at Bellevue Hospital.

 

In Oregon, test results were awaited for a woman with a fever who was hospitalized in an isolation unit on Friday after returning from West Africa, Oregon health officials said.

 

She had not come into known contact with Ebola patients while in Africa, the officials added.

 

(Reporting by Susan Cornwall in Washington; Editing by Gareth Jones)

 

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Ebola-carrying bats may be heroes as well as villains

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Fruit bats are seen for sale at a food market in Brazzavile, Republic of Congo, in this file photograph dated December 15, 2005. REUTERS/Jiro Ose/Files

Fruit bats are seen for sale at a food market in Brazzavile, Republic of Congo, in this file photograph dated December 15, 2005.

Credit: Reuters/Jiro Ose/Files

 

 

(Reuters) – Bats are living up to their frightening reputation in the world’s worst Ebola outbreak as prime suspects for spreading the deadly virus to humans, but scientists believe they may also shed valuable light on fighting infection.

 

Bats can carry more than 100 different viruses, including Ebola, rabies and severe acute respiratory syndrome (SARS), without becoming sick themselves.

 

While that makes them a fearsome reservoir of disease, especially in the forests of Africa where they migrate vast distances, it also opens the intriguing possibility that scientists might learn their trick in keeping killers like Ebola at bay.

 

“If we can understand how they do it then that could lead to better ways to treat infections that are highly lethal in people and other mammals,” said Olivier Restif, a researcher at the University of Cambridge in Britain.

 

Clues are starting to emerge following gene analysis, which suggest bats’ capacity to evade Ebola could be linked with their other stand-out ability — the power of flight.

 

Flying requires the bat metabolism to run at a very high rate, causing stress and potential cell damage, and experts think bats may have developed a mechanism to limit this damage by having parts of their immune system permanently switched on.

 

The threat to humans from bats comes en route to the dinner plate. Bushmeat — from bats to antelopes, squirrels, porcupines and monkeys — has long held pride of place on menus in West and Central Africa. The danger of contracting Ebola lies in exposure to infected blood in the killing and preparation of animals.

 

NATURAL HOSTS

 

Scientists studying Ebola since its discovery in 1976 in Democratic Republic of Congo, then Zaire, have long suspected fruit bats as being the natural hosts, though the link to humans is sometimes indirect as fruit dropped by infected bats can easily be picked up by other species, spreading the virus to animals such as monkeys.

 

This nexus of infection in wildlife leads to sporadic Ebola outbreaks following human contact with blood or other infected animal fluids.

 

This no doubt happened in the current outbreak, although the scale of the crisis now gripping Liberia, Sierra Leone and Guinea, which has killed around 5,000 people, reflects subsequent public health failures.

 

“What is happening now is a public health disaster rather than a problem of wildlife management,” said Marcus Rowcliffe at the Zoological Society of London (ZSL), which runs London Zoo.

 

Bats’ role in spreading Ebola is probably a function both of their huge numbers, where they rank second only to rodents among mammals in the world, as well as their unusual immune system, according to Michelle Baker of the Commonwealth Scientific and Industrial Research Organisation, Australia’s national science agency.

 

Baker, who is intrigued by bats’ ability to live in “equilibrium” with viruses, published a paper with colleagues in the journal Nature last year looking at bat genomes. They found an unexpected concentration of genes for repairing DNA damage, hinting at a link between flying and immunity.

 

“(This) raises the interesting possibility that flight-induced adaptations have had inadvertent effects on bat immune function and possibly also life expectancy,” they wrote.

 

UNDERSTANDING BATS

 

As well as tolerating viruses, bats are also amazingly long-lived. The tiny Brandt’s bat, a resident of Europe and Asia, has been recorded living for more than 40 years, even though it is barely the size of a mouse. Bats also rarely get cancer.

 

“We are just at the beginning,” Baker said in a telephone interview. “But if we can understand how bats are dealing with these viruses and if we can redirect the immune system of other species to react in the same way, then that could be a potential therapeutic approach.”

 

It won’t be easy. Turning on components of the immune system can bring its own health problems, but the idea — which has yet to get beyond the basic research stage — is to turn up certain elements to achieve a better balance.

 

One reason why Ebola is so deadly to people is that the virus attacks the immune system and when the system finally comes back it goes into over-drive, causing extra damage.

 

Ebola works in part by blocking interferon, an anti-virus molecule, which Baker has found to be “up-regulated”, meaning it is found in higher levels, in bats.

 

VENISON, WITH WINGS

 

The bat immune system may or may not lead to new drugs one day. Still, experts argue there are plenty of other reasons to cherish bats, which also play a vital role in pollination and controlling insect pests.

 

They are also a traditional source of protein in West Africa, often served in a spicy stew, and restrictions on bushmeat consumption are now contributing to food shortages in parts of West Africa, according to the International Food Policy Research Institute.

 

Hunting and butchering bats may be risky but cooking is thought to make them safe. The World Health Organization advises animals should be handled with “gloves and other appropriate protective clothing” and meat should be “thoroughly cooked”.

 

“In the long run it would be sensible to see people moving away from hunting bats but in the short term they provide an important source of food,” said Rowcliffe of ZSL.

 

“Essentially, wild meat is a good, healthy product. People in Britain eat venison and rabbit, and in many ways it’s no different to that.”

 

(Editing by Peter Millership and Giles Elgood)

 

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U.N. health worker flown to France for Ebola treatment

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(Reuters) – A United Nations health worker suffering from Ebola has been flown to France from Sierra Leone for treatment, the French health ministry said in a statement overnight.

 

The UN worker, whose name and nationality have not been disclosed, was transported to France aboard a specially equipped jet and placed in isolation at the Begin military hospital in the eastern Paris suburb of Saint-Mandé, the statement said.

 

The UN worker is the second Ebola sufferer to have received treatment in France since the start of the epidemic ravaging West Africa. A French nurse repatriated in September has since made a full recovery from the virus, which has killed almost 5,000 people.

The worker is being treated at the request of the World Health Organization, the ministry said, adding that there were currently no other confirmed Ebola cases in France.

 

(Reporting by Laurence Frost; editing by Jane Baird)

 

11-1-2014 Updates

3 Monitored Cases in San Diego, California: http://www.nbcsandiego.com/news/health/3-Locals-Being-Monitored-for-Ebola-Exposure-Under-States-Guidelines-280927122.html

5 Monitored Cases in Montana: http://flatheadbeacon.com/2014/10/31/governor-announces-ebola-virus-protocols/+

100 Monitored Cases in Trenton, New Jersey: http://www.nj.com/healthfit/index.ssf/2014/10/ebola_100_nj_residents_with_no_symptoms_monitored_at_home_says_says.html#incart_river

100 Monitored Cases in New York, New York: http://www.myfoxny.com/story/27173162/nyc-tracking-117-people-for-ebola-symptoms

1 Self-Monitored Case in Austin, Texas : http://www.wfaa.com/story/news/health/2014/10/29/nurse-working-ebola-patients-abia/18122201/

Saint Monde (eastern suburb of
Paris), France (Nov. 2)
1 person who worked in Sierra Leone confirmed ebola diagnosis (UN
employee placed in isolation unit in France)
Source: http://www.leparisien.fr/laparisienne/sante/ebola-la-france-accueille-un-employe-a-l-onu-touche-par-le-virus-02-11-2014-4258581.php#xtref=http%3A%2F%2Fshtfdashboard.com%2Fpandemic%2Febola-alert%2Ffrance-le-parisien-reports-that-france-is-caring-for-a-un-employee-with-ebola%2F

Vietnam
1 person suspected of ebola symptoms after returning from Guinea where
he worked for 2 years.
Source: http://www.thesaigontimes.vn/122149/Da-Nang-Mot-truong-hop-bi-nghi-nhiem-Ebola.html

 

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Scientists try to predict number of US Ebola cases

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STANFORD, Calif. (AP) — Top medical experts studying the spread of Ebola say the public should expect more cases to emerge in the United States by year’s end as infected people arrive here from West Africa, including American doctors and nurses returning from the hot zone and people fleeing from the deadly disease.

But how many cases?

No one knows for sure how many infections will emerge in the U.S. or anywhere else, but scientists have made educated guesses based on data models that weigh hundreds of variables, including daily new infections in West Africa, airline traffic worldwide and transmission possibilities.

This week, several top infectious disease experts ran simulations for The Associated Press that predicted as few as one or two additional infections by the end of 2014 to a worst-case scenario of 130.

“I don’t think there’s going to be a huge outbreak here, no,” said Dr. David Relman, a professor of infectious disease, microbiology and immunology at Stanford University’s medical school. “However, as best we can tell right now, it is quite possible that every major city will see at least a handful of cases.”

Relman is a founding member of the U.S. Department of Health and Human Services advisory board for biosecurity and chairs the National Academy of Sciences forum on microbial threats.

Until now, projections published in top medical journals by the World Health Organization and the Centers for Disease Control have focused on worst-case scenarios for West Africa, concluding that cases in the U.S. will be episodic, but minimal. But they have declined to specify actual numbers.

The projections are complicated, but Ebola has been a fairly predictable virus — extremely infectious, contagious only through contact with body fluids, requiring no more than 21 days for symptoms to emerge. Human behavior is far less predictable — people get on airplanes, shake hands, misdiagnose, even lie.

Pandemic risk expert Dominic Smith, a senior manager for life risks at Newark, California-based RMS, a leading catastrophe-modeling firm, ran a U.S. simulation this week that projected 15 to 130 cases between now and the end of December. That’s less than one case per 2 million people.

Smith’s method assumes that most cases imported to the U.S. will be American medical professionals who worked in West Africa and returned home.

Smith said the high end may be a bit of an overestimate as it does not include the automatic quarantining measures that some areas in the U.S. are implementing.

Those quarantines “could both reduce the number of contacts for imported cases, as well as increase the travel burden on — and perhaps reduce the number of — U.S. volunteers planning to support the effort in West Africa,” he said.

In a second simulation, Northeastern University professor Alessandro Vespignani projected between one case — the most likely scenario — and a slim chance of as many as eight cases though the end of November.

“I’m always trying to tell people to keep calm and keep thinking rationally,” said Vespignani, who projects the spread of infectious diseases at the university’s Laboratory for the Modeling of Biological and Socio-Technical Systems.

In an article in the journal PLOS ONE, Vespignani and a team of colleagues said the probability of international spread outside the African region is small, but not negligible. Longer term, they say international dissemination will depend on what happens in West Africa in the next few months.

Their first analysis, published Sept. 2, proved to be accurate when it included the U.S. among 30 countries likely to see some Ebola cases. They projected one or two infections in the U.S., but there could be as many as 10.

So far, nine Ebola patients have been treated in the U.S., and one has died. Seven became infected in West Africa, including Thomas Eric Duncan, the first to arrive undiagnosed and the first to die. He was cared for at a Dallas hospital, where two of his nurses were also infected.

Duncan, who was initially misdiagnosed and sent home from the emergency room, is Vespignani’s worst-case scenario for the U.S.

A similar situation, if left unchecked, could lead to a local cluster that could infect, on the outside, as many as 20, he said.

The foreseeable future extends only for the next few months. After that, projections depend entirely on what happens in West Africa. One scenario is that the surge in assistance to the region brings the epidemic under control and cases peter out in the U.S. A second scenario involves Ebola spreading unchecked across international borders.

“My worry is that the epidemic might spill into other countries in Africa or the Middle East, and then India or China. That could be a totally different story for everybody,” Vespignani said.

Dr. Ashish Jha, a Harvard University professor and director of the Harvard Global Health Institute, said he’s not worried about a handful of new cases in the U.S. His greatest worry is if the disease goes from West Africa to India.

“If the infection starts spreading in Delhi or Mumbai, what are we going to do?”

Dr. Peter Hotez, founding dean of the National School of Tropical Medicine at Baylor College of Medicine and director of the Texas Children’s Hospital Center for Vaccine Development, pegs the range of cases in the U.S. between five and 100.

The Centers for Disease Control and Prevention prefers not to focus on a particular number. But spokeswoman Barbara Reynolds said Ebola will not be a widespread threat as some outside the agency have warned.

“We’re talking about clusters in some places but not outbreaks,” she said.

The CDC is using modeling tools to work on projections in West Africa, but “there isn’t enough data available in the U.S. to make it worthwhile to go through the exercise.”

University of Texas integrative biology professor Lauren Ancel Meyers said there are inherent inconsistencies in forecasting “because the course of action we’re taking today will impact what happens in the future.”

Her laboratory is running projections of Ebola’s spread in West Africa.

The U.S. simulations run for the AP had fairly consistent results with each other, she said. And they are “consistent with what we know about the disease.”

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Spanish woman cured of Ebola moves to normal room

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MADRID (AP) — A Spanish nursing assistant who recovered from an Ebola virus infection has left the isolation unit where she was being monitored and moved to a normal room, a hospital statement said Saturday.

Teresa Romero tested positive on Oct 6, but was declared cured of the virus 15 days later. She was the first known person to contract the disease outside of West Africa in the latest outbreak.

Madrid’s Carlos III hospital said that Romero, 44, was now being attended by hospital staff that no longer needed to wear protective outfits.

Romero was able to reunite with her husband, Javier Limon, and other staff members at the hospital.

The statement said tests confirmed Romero was free from all traces of the virus in her body fluids.

Romero had treated two Spanish missionaries who died of Ebola in August and September after they were flown back to Spain from West Africa.

She still needs to recover fully from the after-effects of the serious infection.