Double-gloving, better face protection added in new guidance on Ebola gear

The UN health agency is updating its guidelines for health workers dealing with the deadly Ebola virus, recommending
tougher measures such as doubling up on gloves and making sure the mouth, nose and eyes are better protected from contaminated droplets and fluids.

But the World Health Agency says the choice of equipment is much less important than the way it's used.

Dr. Edward Kelley, director of service delivery and safety for WHO, told reporters Friday the updated guidelines call for wearing one of two materials for gowns or coveralls and "an absolute recommendation for double-gloving that didn't exist before."

Doctors Without Borders already recommends some of its staff in high-risk jobs, like cleaning Ebola treatment centres or handling bodies of Ebola victims, wear two or three pairs of gloves.

Meanwhile, two people are suspected of having Ebola after coming into contact with a two-year-old girl who died of the disease in Mali last week, according to data from the World Health Organization and the U.S. Centers for Disease Control.
 
An epidemiological presentation by both agencies, given on Thursday and seen by Reuters on Friday, breaks down the girl's journey from Guinea to Mali with her grandmother, five-year-old sister and her uncle, and shows she may have had contact with 141 people in all, 57 of them yet to be identified.

One of the 84 contacts who have so far been traced is suspected of having Ebola but has not been tested, the presentation shows. Another four suspected cases have been tested. Three showed negative results, with one result yet to come in.

Elsewhere, Liberia has opened one of its largest Ebola treatment centres yet in Monrovia, bracing for a new wave of infections even as officials express hope the disease is on the decline.

The World Health Organization said this week that the rate of infection in Liberia appears to be falling but warned that the response effort must be kept up or the trend could be reversed.

 Despite the signs of hope, President Ellen Johnson Sirleaf said Friday that the memory of the sick and dying lying at home or in the streets with no place to go is still fresh.

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Microbicides an 'empowering tool' to prevent HIV infection in women

Microbicides, products specifically aimed at protecting women from HIV without the need to negotiate condom use, are missing in the scientific response to the AIDS pandemic, say researchers working to bridge the gap.

In North America and Europe, HIV is most prevalent in the gay population. But in sub-Saharan Africa, where the virus has taken the greatest toll, the face of the epidemic is a young African woman, said Elizabeth Bukusi, deputy director of research and training at the Kenya Medical Research Centre.

South Africa has the highest prevalence of HIV/AIDS compared to any other country in the world, according to UNAIDS. (Themba Hadebe/Associated Press)

"We need an option that women have the choice about using," Bukusi said. "If she can't protect herself because her partner will not put [a condom] on, we need her to have something she can use to protect herself."

At Crossroads, a poor township with one of the highest rates of HIV in South Africa, residents are recruited for various HIV prevention studies. In return, participants are offered health care and the community receives educational and recreational programs.

For two years, Ntanda Kiwana has attended a clinic for monthly checks as part of a trial to see whether a vaginal ring with a long-acting microbicide embedded in it can prevent women from becoming infected.

"I don't even feel it," she said.

Prof. Sharon Hillier of the University of Pittsburgh is principal investigator for the Microbicide Trials Network, directing  research projects in seven countries.

"I think microbicides are just the kind of empowering tool that give women the chance to control their own health," Hillier said.

There are several microbicide designs that work to provide a physical barrier to keep out HIV and other sexually transmitted viruses from attaching to the vaginal walls or boost natural vaginal defences, such as by manipulating acidity levels.

So far, one study has shown a microbicide gel is partially effective against HIV. Researchers say two large studies reporting results in 2015 will likely confirm and possibly surpass that finding.

Two trials with microbicidal rings will release results shortly after. If the trials are successful, the products could be available to use commercially in a few years.

The HIV Research for Prevention Conference in Cape Town ends tomorrow.

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2 rounds of chemo fail to shrink Rob Ford's tumour

Two rounds of chemotherapy have failed to shrink the tumour in Toronto Mayor Rob Ford's abdomen, CBC News has confirmed.

Last month the Toronto mayor was diagnosed with a rare but aggressive type of malignant tumour.

His tumour has not shrunk, it has also not grown in size.

Ford is also battling pneumonia and is due to begin a third round of chemotherapy at Mount Sinai hospital on Monday.

The cancer diagnosis forced Ford to withdraw from the mayor's race last month. Instead, he won a council seat in the northwest Toronto ward currently held by his brother, who ran for mayor but finished second to John Tory.

Tory will be officially sworn in in December.

There are reports that Ford's doctor will provide an update about his treatment on Monday.

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Maine gets court order to isolate Ebola nurse who defied quarantine

Maine health officials obtained a 24-hour court order restricting Kaci Hickox's movement after the nurse repeatedly defied the state's quarantine for medical workers who have treated Ebola patients.

A judge granted the order Thursday limiting Hickox's travel, requiring a buffer of about a metre if she encounters people, and banning her from public places until there's a further decision Friday.

The state went to court Thursday, following through with a threat to try to impose restrictions on her until the 21-day incubation period for Ebola ends on Nov. 10. In court documents, the judge indicated further action was anticipated Friday.

Police were under orders to monitor the movements of the nurse who twice left home, once to talk to reporters Wednesday and again for a bike ride with her boyfriend on Thursday.

A state police cruiser remained outside her home Friday. Fort Kent Police Chief Tom Pelletier went inside the home briefly Friday morning and said afterward, "We just had a good conversation." He said he was not there to arrest or detain her.

Fort Kent Police Chief Thomas Pelletier leaves the home of nurse Kaci Hickox after a brief visit Friday. Main has obtained a 24-hour court order restricting Hickox's movements. (Robert F. Bukaty/Associated Press)

The legal action is shaping up as the nation's biggest test case yet in the struggle to balance public health and fear of Ebola against personal freedom.

In a court filing, the director of the Maine Center for Disease Control and Prevention backed away from the state's original request for an in-home quarantine and called for restrictions that fall in line with federal guidelines.

Hickox remains at risk of being infected with Ebola until the end of a 21-day incubation period, Dr. Sheila Pinette.

"It is my opinion that the respondent should be subjected to an appropriate public health order for mandatory direct active monitoring and restrictions on movement as soon as possible and until the end of the incubation period ... to protect the public health and safety," she wrote.

Hickox, who treated Ebola patients in Sierra Leone, says confinement violates her rights. She says that she has no symptoms and poses no risk to the public.

Hickox, 33, stepped into the media glare when she returned from treating Ebola patients in Sierra Leone to become subject to a mandatory quarantine in New Jersey. After being released from a hospital there, she returned to this small town, where she was placed under what Maine authorities called a voluntary quarantine.

She said she is following the federal Centers for Disease Control and Prevention recommendation of daily monitoring for fever and other signs of the disease.

"I'm not willing to stand here and let my civil rights be violated when it's not science-based," she said Wednesday evening.

Some states like Maine are going above and beyond the CDC guidelines to require quarantines. So is the U.S military.

President Barack Obama, the nation's top infectious-disease expert and humanitarian groups have warned that overly restrictive measures could cripple the fight against the disease at its source by discouraging volunteers like Hickox from going to West Africa, where the outbreak has sickened more than 13,000 people and killed nearly 5,000 of them.

"These kinds of restrictions could dissuade hundreds, if not thousands, of skilled volunteers from helping stop Ebola's spread, which is in the national interest of every one of our countries," Samantha Power, U.S. ambassador to the United Nations, said Thursday in Brussels.

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Final arguments in dispute over chemotherapy for First Nations girl

McMaster Children's Hospital is challenging a First Nations mother's decision to withdraw her daughter from chemotherapy. (McMaster)

An Ontario court on Wednesday heard final arguments in the precedent-setting case of whether a child can be forced into protective care without the say-so of the Children's Aid Service. 

The Ontario Court of Justice in Brampton, Ont. is considering the case of a young First Nations girl with acute lymphoblastic leukemia, whose mother in August called off her chemotherapy in favour of a U.S. clinic that she says is more in line with their traditional indigenous culture.

When Brant Children's Aid Society did not to intervene, McMaster Children's Hospital in nearby Hamilton, Ont., where the girl had been receiving chemotherapy, took the unusual step of going to court, to force the agency to intervene and return her to treatment. 

The McMaster medical team has stated the girl has an 90 to 95 per cent chance of survival on chemotherapy but, without it, the cancer could kill her.

A lawyer for the Six Nations band said in court last week that forcing the child back into chemo treatment would be the same as sending the child to a residential school to face abuse.

'This mother is doing everything possible to protect her child. She's just doing things that doctors disagree with.'- Mark Handelman, Brant Children's Services lawyer

Mark Handelman, the lawyer for Brantford Children's Aid Services, also argued the case is "a treatment dispute, in our view, not a child in need of protection."   

"My god — this mother is doing everything possible to protect her child. She's just doing things that doctors disagree with," Handelman said in court.

The mother, who, along with her daughter, cannot be identified because of a publication ban, told CBC News the family had a comprehensive health-care plan.

"We would not make a choice that would compromise her health or life. There is enough case evidence behind Onkwehonwe medicine and the practices at [the Hippocrates Health Institute​] that we know we have made the right choice," she said. Her daughter has since been treated at and returned from the U.S. clinic 

"My daughter feels great. I truly believe that there will be a positive outcome and this will be ended soon," her mother said. 

Judge Gethin Edward, presiding in this case, expressed concern about the legal precedent he could be setting, about who gets the final say over children in the future — and one very sick child, right now.

Edward will read his decision Nov. 14.

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Nurse Kaci Hickox defies Ebola quarantine again in Maine

A nurse who vowed to defy Maine's voluntary quarantine for health-care workers who treated Ebola patients followed through on her promise Thursday, leaving her home for a bike ride.

Kaci Hickox and her boyfriend stepped out of their Fort Kent, Me., home Thursday morning and rode away on mountain bikes, followed by state police cruiser.

Police were monitoring her movements and public interactions but couldn't detain her without a court order signed by a judge.

Hickox contends there's no need for quarantine because she's showing no symptoms. She's also tested negative for the deadly disease.

"I really hope that we can work things out amicably and continue to negotiate," she said Thursday morning while riding on a dirt trail.

Nurse Kaci Hickox rides away from the home she is staying in on a rural road in Fort Kent, Me., to take an hour-long bike ride on Thursday with her boyfriend Ted Wilbur. They were followed by state police who are monitoring her movements and public interactions. (Robert F. Bukaty Associated Press)

There was no immediate comment from state health officials, who were going to court in an effort to detain Hickox for the remainder of the 21-day incubation period for Ebola that ends on Nov. 10

It was the second time Hickox broke quarantine. She left her home Wednesday evening briefly to speak to reporters, even shaking a hand that was offered to her.

"There's a lot of misinformation about how Ebola is transmitted, and I can understand why people are frightened. But their fear is not based on medical facts," Norman Siegel, one of her attorneys, said Wednesday.

Hickox, who volunteered in Sierra Leone with Doctors Without Borders, was the first person forced into New Jersey's mandatory quarantine for people arriving at the Newark airport from three West African countries. Hickox spent the weekend in a tent in New Jersey before travelling to the home she shares with her boyfriend, a nursing student at the University of Maine at Fort Kent.

"I'm not willing to stand here and let my civil rights be violated when it's not science-based," she told reporters Wednesday evening.

State may have tough case to make

Generally, states have broad authority when it comes to such matters. But Maine health officials could have a tough time convincing a judge that Hickox poses a threat, said attorney Jackie L. Caynon III, who specializes in health law in Worcester, Massachusetts.

"If somebody isn't showing signs of the infection, then it's kind of hard to say someone should be under mandatory quarantine," he said.

Ebola, which is spread through direct contact with the bodily fluids of an infected person, has killed thousands of people in Africa, but only four people have been diagnosed with it in the United States. People can't be infected just by being near someone who's sick, and people aren't contagious unless they're sick, health officials say.

Guidelines from the federal Centers for Disease Control and Prevention recommend daily monitoring for health-care workers like Hickox who have come into contact with Ebola patients. But some states like Maine are going above and beyond those guidelines.

The defence department is going even further. On Wednesday, Defense Secretary Chuck Hagel ordered military men and women helping fight Ebola to undergo 21-day quarantines that start upon their return — instead of their last exposure to an Ebola patient.

President Barack Obama warned that overly restrictive measures imposed upon returning health care workers could discourage them from volunteering in Africa.

Filing expected today

But Maine Gov. Paul LePage, who cancelled campaign events to keep tabs on the situation, maintained that the state must be "vigilant" to protect others.

State law allows a judge to grant temporary custody of someone if health officials demonstrate "a clear and immediate public health threat."

The state's court filing was expected Thursday, officials said.

If a judge grants the state request, then Hickox will appeal the decision on constitutional grounds, necessitating a hearing, Siegel said.

Siegel said the nurse hopes her fight against the quarantine will help bring an end to misinformation about how the Ebola virus is transmitted.

"She wants to have her voice in the debate about how America handles the Ebola crisis. She has an important voice and perspective," he said.

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Refugee health cuts: Tories prep contingency plan as deadline looms

Immigration officials are working furiously to finalize contingency plans for refugee health care coverage in the event the government loses a court battle this week on how much coverage refugee claimants ought to receive.

The long-running fight over the existing program is before the Federal Appeal Court on Thursday with the government arguing it needs more time to comply with last summer's Federal Court decision that the current program is unconstitutional.

In her ruling, Justice Anne McTavish savaged the coverage system imposed by the Conservatives in 2012, saying it amounted to cruel and unusual treatment.

"The 2012 modifications to the interim federal health program potentially jeopardize the health, the safety and indeed the very lives, of these innocent and vulnerable children in a manner that shocks the conscience and outrages our standards of decency," she wrote.

She gave the government four months to create a charter-proof plan — that deadline is Nov. 4.

The government has appealed the decision, but in the meantime is asking for a stay, so that it doesn't have to impose a new system before the court finishes deliberating on the old one.

Judge sped up process

Officials would not reveal details of the contingency plans, saying they're not finished.

"The government is working on various contingency plans but intends to vigorously appeal this ruling," a government source said on the condition of anonymity as the matter remains before the court.

Justices often will suspend their decisions in charter cases for a year to give government enough time to create new policy.

But in this case, McTavish decided to speed up the process, ruling that while a certain amount of bureaucratic disruption is inevitable, lives were at risk.

In the court documents, the government outlines all the steps it would need to take to implement a new system, including getting it approved by cabinet and making sure border officers and immigration officials are up to speed on the changes.

The four months it was given weren't enough, the government argues.

"Should changes be implemented Nov. 4, 2014, the training process will likely be incomplete, potentially resulting in eligible clients being without IFHP certificates or being given incorrect IFHP coverage," one argument for more time suggests.

But the lead lawyer for the refugees said four months is plenty of time.

"The government has various alternatives and one of them would be to just return to the situation before 2012," Lorne Waldman said in an interview.

Changes made in 2012

The interim federal health program was developed in the wake of the Second World War to meet the needs of refugees coming to Canada, which at the time had a private health-care system.

Over the years, the program was expanded and prior to the 2012 changes, the federal government covered all manner of health-care expenses for those awaiting refugee claims until they were eligible to apply for provincial health-care coverage.

But citing a need to cut costs and bring health care for refugee claimants in line with what ordinary Canadians get, the government instituted sweeping changes in 2012.

They essentially reduced what taxpayers pay for to the bare minimum, depending on the nature of the refugee claim and the care being sought.

The cases of one of the men who filed the lawsuit against the government illustrates the differences.

Hanif Ayubi is a failed refugee claimant from Afghanistan who could not be deported because there is a moratorium on removals to that country.

Prior to the changes, he had full coverage of all his medical needs to manage his diabetes.

After, he received no coverage of medical supplies as he is a failed claimant, though the minister did intervene to make sure his doctor's appointments are paid for.

He now receives free samples of his required drugs through a community health-care centre.

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Wheelchair-bound students get level playing field in Grand-Digue, N.B.

Physical education teacher Rhéal Hébert of Grande-Digue, N.B., has gone an extra step to see that all students get moving in his classes.

When Hebert had two students with muscular dystrophy in his École Grande-Digue class — Renelle Belliveau and her older sister — he realized they weren't getting as much physical activity as the other students.

Rheal Hébert was honoured by Ability New Brunswick for exposing all students to para sports and recreation activities. (CBC)

"They still had their everyday wheelchair," said Hebert.

"They were being pushed around by the teacher's assistant, and that's when it really hit me that we have to do something about that, because everybody's moving and they're not. And that's not OK."

Hébert applied for a grant last year to purchase two wheelchairs designed for use in sports. They have a wide wheelbase and can turn on a dime.

"From one day to the other, it was such a huge difference," said Hébert.

"I knew from that point we had to go further, and we had to explore para sports at school."

Hébert wanted to do more than just have Renelle play with the other Grade 8 students.

He wanted the other students to be able to play with her. So Hébert borrowed about half a dozen sports wheelchairs from a club in Moncton that could be used by able-bodied students.

Now, Renelle and her friends have a level playing field: everyone's on wheels.

"It's really fun, because they feel what I felt when I was in a wheelchair and I played sports, and they like it very much," said Renelle, who was voted class president this year.

"They're very good at it."

Along with badminton, Renelle Belliveau and other students in Grand-Digue have been exposed to sledge hockey, basketball and track and field. (CBC)

​The class is currently doing court sports like badminton. They've also played sledge hockey, basketball and track and field.

Janie Cormier participates in para sports regularly at the school now that the sports chairs are available.

"She used to do things by herself with only her in a wheelchair, but now we get to do it with her, so we can see like how she got used to it and all that stuff," said Janie.

"So it's really nice."

Hébert's Sports Plus program is exposing students to para sports and recreation activities. It has grown from a pilot project involving two schools three years ago and now operates in eight schools.

Ability New Brunswick honoured Hébert this year with its Para Sport and Recreation Award.

"Rhéal strongly believes that all students deserve the same opportunities at school," states Ability NB's award citation for Hébert.

Lynn Belliveau, Renelle's mother, says she appreciates what the physical education teacher has done for the family.

Lynn Belliveau appeciates the effort of her daughter's physical education teacher to include her in sports activities. (CBC)

"It's getting them to be able to do stuff that I didn't imagine they'd be able to do and obviously as a mom, I'm really happy that they get that opportunity," said Belliveau.

Belliveau has installed a basketball hoop at the home where her daughters and their friends can play.

"It's important to them," said Belliveau. "Even though you have a disability, it's not going to stop you from doing what you want, and that's what I want them to learn from that. I mean, you thought you weren't able to participate in sports, but now you can."

Renelle also knows she has a teacher who has gone above and beyond what's expected. But she's never told him so.

"I never really thanked him because like, I get nervous and I just, like — I don't want to start crying because it really means so much to me."

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Texas nurse leaves Emory University Hospital free of Ebola virus

A nurse who fuelled Ebola fears by flying to Cleveland after being infected by her dying patient in Dallas was released Tuesday from a hospital isolation unit, where doctors defended her as a courageous and passionate front-line caregiver.

Another nurse, held for days against her will in a medical tent in New Jersey after volunteering in West Africa, was in an undisclosed location in Maine, objecting to quarantine rules as overly restrictive.

While world leaders appeal for more doctors and nurses on the front lines of the Ebola epidemic, health care workers in the United States are finding themselves on the defensive.

Lawyers now represent both Amber Vinson, who contracted the virus while caring for a Liberian visitor to Texas, and Kaci Hickox, who is challenging the mandatory quarantines that some states have imposed on anyone who came into contact with Ebola victims.

Getting more volunteers to the front lines is the only way to keep the virus from infecting people around the world, experts say. It's still spreading faster than the response, killing nearly half of the more than 10,000 people it has infected in West Africa.

World Bank President Jim Yong Kim said Tuesday that at least 5,000 more health workers are needed in Liberia, Sierra Leone and Guinea to fight the epidemic. Kim was in Ethiopia with United Nations Secretary-General Ban Ki-moon, who has spoken out against mandatory quarantines for health care workers, and said Ebola-related travel restrictions and border closings are not the answer.

Vinson was cleared to fly

Dr. Bruce Ribner, an infectious disease expert who oversaw Vinson's recovery at Emory University Hospital, said fellow medical workers "deeply admire Ms. Vinson's care and courage in caring for patients with serious communicable diseases."

But Vinson's trip home to join her bridesmaids for wedding preparations was one of several moves by doctors and nurses that may have exposed others in the United States. In Ohio alone, 163 people were still being monitored Tuesday because of contact or potential contact with Vinson in a bridal shop and on the airplanes she travelled in.

This undated image provided by University of Texas at Arlington shows Kaci Hickox. The nurse is back in her native Maine, where it appears she will remain quarantined at home for a period of time. (University of Texas at Arlington/Associated Press)

N.J. Gov. Chris Christie said voluntary stay-at-home measures were obviously insufficient, since even doctors and nurses had moved around in public before getting sick. He was among the first to announce mandatory 21-day quarantines for anyone who had contact with possibly infected people.

Vinson, 29, was infected while caring for Thomas Eric Duncan, who died at Texas Health Presbyterian Hospital Dallas on Oct. 8. She inserted catheters, drew blood, and dealt with Duncan's body fluids, all while wearing protective gear.

Ribner said her doctors in Atlanta don't have any knowledge of how she got infected in Dallas. Neither would he release any details about her treatment, or whether certain drugs are proving more effective. "The honest answer is we're not exactly sure," he said.

But Emory University Hospital spokeswoman Holly Korschun later confirmed that Vinson received blood plasma from Ebola survivor Kent Brantley, and said Ebola survivor Nancy Writebol also donated her plasma, but it wasn't ultimately needed.

Ebola is only contagious when people who carry the virus get sick, and Vinson didn't show symptoms before flying to Ohio on Oct. 10. She reported her temperature to the Centers for Disease Control and Prevention, as required, on Oct. 13, and was cleared to fly back to Dallas. The next day, she developed a temperature, and on Oct. 15, she tested positive for Ebola.

Hickox will be quarantined at home

Another nurse, Nina Pham, also was infected by Duncan, and was released Oct. 24 from the National Institutes of Health.

Vinson didn't take any questions at the Emory news conference. Instead, she read a statement thanking God, her relatives and her doctors, and asked "that we not lose focus on the thousands of families who labour under the burden of this disease in West Africa."

Hickox, the Doctors Without Borders volunteer, was staying meanwhile in an "undisclosed location," said Steve Hyman, one of her lawyers. Maine health officials announced that she will be quarantined at home for 21 days after the last possible exposure to the disease, following the state's health protocols.

But Hyman said he expected her to remain in seclusion for the "next day or so" while he discusses her situation with Maine health officials. Hyman said the state should follow the Centers for Disease Control and Prevention guidelines, which require only monitoring, not quarantine, for health care workers who show no symptoms after treating Ebola patients.

"She's a very good person who did very good work and deserves to be honoured, not detained, for it," he said.

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South Africa aiming to be 'leading player' in HIV research

South African doctors and researchers seem to be gaining confidence in their decades-long battle against HIV, international delegates at a conference in Cape Town say.  

The HIV Research for Prevention Conference is dedicated to biomedical HIV prevention research.

A nurse, left, speaks with a patient at an AIDS centre in South Africa, which strives to be a leading player in HIV science. (Schalk van Zuydam/Associated Press)

Sub-Saharan Africa remains the epicentre, with nearly 1 in every 20 adults living with HIV and accounting for 71 per cent of the people living with the illness worldwide, according to the World Health Organization.

South Africa's minister of science and technology, Naledi Pandor, told the conference today it's time the country assumed more responsibility "to be a leading player in science and not a client of others."

The country's government provides anti-retroviral medications to nearly 40 per cent of HIV-infected South Africans. On the research front, new labs, scientists, technicians and funding commitments are on the rise.

"They're very competitive for research funding elsewhere," said Canadian HIV researcher Cate Hankins, currently deputy director of science for the Amsterdam Institute for Global Health and Development.

Conference co-chair Anatoli Kamali, of Uganda's Medical Research Council, pointed out that a third of the research papers being presented this week are from African researchers.

Professor Robin Shattock of Imperial College London is another co-chair of the conference. Shattock said it makes sense to have people work across fields of prevention rather than working in a bubble.

The conference aims to build linkages between investigators in developing and developed countries to open the door to collaboration.

Before the conference closes on Oct. 31, scientists plan to present 550 research papers, such as new results on microbicidal gels and vaginal rings, to try to prevent HIV infections.

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WHO says 82 being monitored for Ebola in Mali

Health workers are monitoring 82 people who had contact with a toddler who died of Ebola in Mali last week, but no new cases of the disease have yet been reported, World Health Organization spokesman Tarik Jasarevic said on Tuesday.

Three WHO officials are already in the country, having travelled to Mali a week ago to test its Ebola preparedness, and five more are arriving, Jasarevic said.

Mali became the sixth West African country to report a case of the disease, and health officials want to try to contain the virus before it can spread out of control.

It has already killed some 5,000 people in Sierra Leone, Liberia and Guinea, but Senegal and Nigeria both stopped the virus in its tracks by tracking down hundreds of people who had contact with the person who first brought it into their country and monitoring them constantly for symptoms.

The girl had travelled with her grandmother hundreds of kilometres by bus from Guinea via Mali's capital and was hospitalized in the western Malian town of Kayes on Oct. 20, but died four days later.

WHO has said the girl already started showing symptoms including fever, vomiting and blood in her stools — and was therefore contagious — before being taken to Kayes.

Jasarevic said the 2-year-old girl's grandmother was "doing OK so far", but the deadly disease can take up to 21 days to show up in a patient, so all the 82 contacts who have been traced, including 11 health workers, will continue to be monitored.

Diplomatic sources have expressed concern about the preparedness of Mali, one of the world's poorest countries, to contain an outbreak. Home to a large UN peacekeeping mission, the mostly Muslim country is still battling northern Islamist militants after a brief French-led war last year.

The possibility of setting up a treatment centre in Kayes was being discussed, Jasarevic said, and 40 volunteers had been trained in contact tracing, which is considered one of the key defences against the fast-spreading disease.

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Ebola death count likely exceeds 5,000, as rate of new cases in Liberia slows, WHO says

The Ebola death toll is likely over 5,000 out of 13,703 cases worldwide, the World Health Organization says.

Dr. Bruce Aylward, WHO assistant director-general in charge of the operational response, gave the update to reporters on Wednesday.

In Liberia, there are signs of progress, such as decline in burial numbers and lab-confirmed cases that appear to have plateaued, Alyward said. That could be thanks to the right information getting to people to change their behaviour and protect themselves as well as safe burials.

Ibrahim Sorie Kamara looks after his child as they await transport to the holding centre in the Port Loko Government Hospital in Sierra Leone for those suspected of having Ebola. (Christopher Black/WHO/Reuters)

"Do we feel confident that the response is now getting an upper hand on the virus? Yes, we are seeing slowing rate of new cases, very definitely," he told a news conference.

While he's confident that they're seeing a slowing in the rate of new cases, the danger is that instead of cases going down steadily, they start to oscillate up and down, for example, if burials go wrong and start new chains of transmission, he warned.

The number of cases in the worst affected countries of Guinea, Liberia and Sierra Leone is 13,676.  WHO attributes what looks like a jump in the number of cases to updated data on old cases that were piling up and took time to reconcile.

In contrast, the seven-day rolling average has been steady at around 9,000 or 10,000 in recent weeks, he said.

Aylward said this isn't the time to let up, and the response needs to continue.

"I'm terrified the information will be misinterpreted," he said, and the international response will slow.

The downward trend in Liberia is based on information on burials, admission and occupancy rates at Ebola treatment centres and reports of cases from all sources.

But the outbreak is "burning quite hot" in parts of Sierra Leone, he said.

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No coverage for Saskatoon woman's $30K dental procedure so she can chew

Judy Perrin-Royer's dental surgeon described her as an oral cripple in need of dental implants, but the provincial government won't pay for the $30,000 procedure.

The 59-year-old Saskatoon woman cried when she heard herself described as an "oral cripple," but she said it's true.

Her upper jaw has deteriorated to the point that it no longer holds her dentures. They even move around while she talks.

The family support worker said she's approaching retirement and can't really afford to fix her teeth on her current income.

"We just had to set up financing in order to do it. And it's a necessity. I had no choice."

'I won't be able to eat'

When she was in her 20s, Perrin-Royer had a bone graft and dental implants on her lower jaw. She said she's never been sure exactly what's wrong with her.

"Just really unhealthy teeth. I am not certain whether it was lack of calcium during my mother's… pregnancy."

Regardless of the reason, she had to pay the $10,000 bill back then to fix her bottom teeth.

Now it's three times that amount for her upper teeth.

For months before the surgery, Perrin-Royer was in discussions with the ministry, asking the provincial government to cover the procedure.

However, her surgeon was told she didn't qualify for government funding.

So in September she decided to go ahead and get it done on her own because the situation was urgent.

Her surgeon grafted bone from her hip to her upper jaw and then drilled titanium posts into the bone, which will enable her new teeth to stay in place.

"If I don't have it done, then at some point, I won't be able to eat," she explained.

In a letter she delivered to the Ministry of Health, her surgeon, Dr. Myles MacLennan, explained Perrin-Royer's jaw had deteriorated to the point where it was "impossible… to even place a traditional denture."

And so he recommended dental implants "so that she can have teeth to chew food and speak."

Perrin-Royer said her doctor saw this surgery as a health-care necessity, not cosmetic.

"This is not an instance of 'I need pearly whites'. I need them to eat."

New program covers some dental implants

Dr. Frank Hohn is an oral surgeon in Saskatoon who says Saskatchewan's funding program for dental implants is flawed because applications are adjudicated by bureaucrats, not dental experts. He also says it is underfunded. (CBC)

Prior to 2010, the government of Saskatchewan wouldn't pay for dental implants under any circumstance.

Saskatoon-based oral surgeon Frank Hohn thought that was unacceptable and pushed the government for change.

"At the time, the Ministry of Health stopped all funding once it became a dental issue and that didn't satisfy the needs of the patient," Hohn said.

Hohn worked with the government to set up a new program that would pay for dental implants in cases where no other method of treatment is appropriate.

The ministry says that since the program began, it has received about 130 applications and approximately 60 per cent of them have been approved.

The government explains the implants will only be covered in the case of "tumours and congenital defects" (cleft palate and metabolic disorders).

Perrin-Royer denied coverage

Executive director of Saskatchewan Medical Services Branch Shaylene Salazar said Perrin-Royer's claim was not technically denied because she never submitted a formal application. But she says the ministry is taking another look at her case. (CBC)

Perrin-Royer said her dental surgeon had conversations with Ministry of Health officials and he was told she didn't fit that criteria and wouldn't be covered.

So he didn't formally apply for funding.

Because there was no formal application, executive director of Saskatchewan Medical Services Branch Shaylene Salazar said the claim was not technically denied.

However, she did confirm that, in effect, the claim was denied and she said the ministry is now having another look at Perrin-Royer's case.

"Every case that we get that we deny we evaluate it against the policy and see if the policy needs to change. We do that with all coverage decisions," Salazar said.

Program needs review

Hohn said he's happy the government has a program for dental implants, but he thinks it's in need of change.

For starters, he said the fact that government officials decide who gets covered, not oral surgeons, is problematic.  

"If individual cases were brought forward and adjudicated by the proper people, not bureaucrats, I think the program would be better," Hohn said.

He said independent dental experts should be evaluating applications "on their individual merits as opposed to just a cookie cutter 'it covers this that and the other thing and no more.'"

Hohn said there's another problem with the system.

As the former president of the Canadian Association of Oral and Maxillofacial Surgeons, where he worked closely with colleagues from across the country, it became clear to him that Saskatchewan's program "is underfunded" when compared with other provinces.

"This program has really become a cost containment program as opposed to a patient-centred program," Hohn said.

Salazar defended the province's program saying "our coverage in Saskatchewan is fairly comparable to other provinces across Canada."

And she said it is being constantly evaluated with an eye to improving it.

Dental care underfunded across Canada

The dean of the College of Dentistry at the University of Saskatchewan argued it's not just Saskatchewan that underfunds dental care.

Gerry Uswak said it's a national problem that becomes evident when you compare what Canada spends on a per capita basis to other G8 nations, including the United States.

"We are basically at the bottom of the barrel in terms of our public funding of oral health and dental care," Uswak said. 

As for Perrin-Royer, she had the titanium pins installed in September. The new teeth haven't been installed yet and likely won't be for a few months yet.

She said soon she'll be getting a temporary denture.

Perrin-Royer said she's looking forward to that as she says she's tired of drinking protein shakes.

An X-ray of Judy Perrin-Royer's mouth in February 2013 before she had bone grafting done. (Judy Perrin-Royer)

An X-ray of Judy Perrin-Royer's mouth in June 2014 after she had bone grafting done to increase the depth of her upper jawbone. (CBC)

---

Replay the live chat below, or if you'd like to weigh in, leave your thoughts in the comment section.

Join online host Matt Kruchak from Monday to Friday between 6-8:45 a.m. on cbc.ca/saskatoon for a lively and engaging live chat. While chatting, tune into Saskatoon Morning on 94.1 FM with host Leisha Grebinski.

Live Blog Live chat: Oct. 28

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Nun awake while heart valve replaced, procedure livestreamed

Less than an hour after having heart surgery on Monday, Sister Theresa Stickley was alert and in high spirits, and was looking forward to going home the next day.

"I'm feeling pretty good. I had a little pressure in the chest, that's all," the 83-year-old woman told reporters from her hospital bed, with the lead surgeon by her side.

Sister Theresa Stickley, left, was in good spirits just an hour after having a heart valve replaced on Monday, Oct. 27, 2014. Her doctors said she may be well enough to go home to Squamish the next day. (CBC)

"When he told me there'd be cameras, I thought 'oh my goodness sake, just keep me covered,'" she said.

Sister Theresa's aortic valve replacement operation, which went beautifully, was fairly unique in that it was broadcast in real time and observed by hundreds of cardiologists at the 2014 Canadian Cardiovascular Congress in Vancouver.

It was even more unique due to the fact that the Squamish-based Sister was awake during the entire procedure.

The surgery marks a stark departure from the standard valve replacement operation of a decade ago, in which doctors would have had to break open her sternum, or breastbone, and she would have been recovering in hospital for more than two weeks afterward. A full recovery could have taken up to six months.

Sister Theresa Stickley's heart valve replacement surgery was livestreamed to viewers at the 2014 Canadian Cardiovascular Congress in Vancouver, B.C. (CBC)

But in 2005, B.C. doctors pioneered a new procedure that threaded a replacement valve up to a patient's heart using a catheter inserted into the artery just above the leg.

The technique revolutionized the surgery, and now a team of B.C. cardiologists, including Dr. David Wood, is taking what they believe is the next step forward.

"The innovation done here at the Centre for Heart Valve Innovation is stripping that procedure down to its bare essentials," he said.

Using only a local anaesthetic, patients are wide awake during the surgery. Post-surgery recovery time is usually less than a day.

Cardiologist Dr. David Wood, centre, and two members of his team spoke with reporters following Monday's successful operation on Sister Theresa Stickley. (CBC)

"As you saw the case took about half an hour, and she'll be mobilized about four hours later and, if she's like the other patients, about over three-quarters will go home the next day—and why that's critical is that you don't pick up infections, you don't have any complications," he said.

In a pilot study, the one-year survival rate went from a 75 to 93 per cent. A clinical trial is about to get underway in 10 centres across North America and by the spring of 2016 the procedure, which also cuts health system costs, could be used in hospitals around the world.

"The economic, potential implications are just staggering," Wood said.

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PSA test should be abandoned as screen for prostate cancer, task force says

The blood test mostly commonly used to screen men for prostate cancer should be dropped, because it can result in  more harm than good, says a Canadian task force.

The prostate-specific antigen, or PSA, test measures inflammation that can be elevated for many reasons other than cancer, such as normal enlargement of the prostate with age or an infection.

Researchers said over-diagnosis occurs when cancer is detected correctly but would not cause symptoms or death.

The main problems are false-positive results and over-diagnosis, the review indicated. A positive PSA test result often leads to more tests such as a biopsy, which carries risks of bleeding, infection, and urinary incontinence.

In most men with prostate cancer, the tumour grows slowly, and they're likely to die of another cause before the prostate tumour causes any symptoms.  

Prostate cancer is the most commonly diagnosed non-skin cancer in men. The prognosis for most prostate cancers is good, with a 10-year survival rate of 95 per cent.

Screening aims to find cancer before symptoms appear and reduce the chance of dying from cancer with early treatment.

In Monday's issue of the Canadian Medical Association Journal, the Canadian Task Force on Preventive Health Care reviewed the latest evidence and international best practice to weigh the benefits and harms of PSA screening with or without digital rectal exams.

"Available evidence does not conclusively show that PSA screening will reduce prostate cancer mortality, but it clearly shows an elevated risk of harm. The task force recommends that the PSA test should not be used to screen for prostate cancer," Dr. Neil Bell, chair of the prostate cancer guideline working group member, and his team concluded.

The guideline is aimed at physicians and other health-care professionals and policymakers. It updates the task force's recommendation from 1994 on screening with the PSA test.

The new recommendations include:

• For men under age 55 and over age 70, the task force recommends not using the PSA test to screen for prostate cancer. This strong recommendation is based on the lack of clear evidence that screening with the PSA test reduces mortality and on the evidence of increased risk of harm.
• For men aged 55–69 years, the task force also recommends not screening, although it recognizes that some men may place high value on the small potential reduction in the risk of death and suggests that physicians should discuss the benefits and harms with these patients.
• These recommendations apply to men considered high risk — black men and those with a family history of prostate cancer — because the evidence does not indicate that the benefits and harms of screening are different for this group.

The key evidence was from a well-done European study. It showed inconsistent results, with a small potential positive effect over a long period of time, which the reviewers balanced against the clear evidence of harm, said Dr. James Dickinson, a member of the prostate cancer guideline working group and a professor of family medicine at the University of Calgary.

"Fundamentally this is not a good enough test to be worth using," Dickinson said in an interview. "Let's hope that better things come in the future, but right now it's not worth using. It's more likely to cause harm than benefit."

A Canadian specialist, however, takes issue with the recommendation.

The task force's guidelines are flawed for Canada, said Dr. Neil Fleshner, who studies and treats prostate cancer at Princess Margaret Cancer Centre in Toronto.

"By using the PSA test, we can absolutely find lethal cancers early and by intervening in those men, we can save their lives. Therefore, these recommendations undoubtedly will lead to more prostate cancer deaths," Fleshner said.

The task force's Bell said almost one in five men aged 55 to 69 have at least one false-positive PSA test, and about 17 per cent end up with unnecessary biopsies.

"If you screen men [aged 55 to 69] based on the protocol in those trials, every two to four years for 13 years, five out of 1,000 will die from prostate cancer. If you don't screen, six out of 1,000 men will die from prostate cancer," Bell said. "So the reduction in prostate cancer mortality is one in 1,000 or about 0.1 per cent."

"To get the benefit, you're diagnosing about 27 or 28 men with prostate cancer who would never benefit from the treatment related to prostate cancer because they would never suffer any difficulty from it."

Bell added that more than half of detected prostate cancers are over-diagnosed.

The task force said that separating screening from treatment through watchful waiting or active surveillance, could change the ratio of risks to benefits of PSA screening, but the hypothesis needs to be tested.

Dr. Murray Krahn of Toronto's University Health Network wrote a journal commentary on prostate cancer screening. 

Krahn said the task force guideline provides a good summary, but he would like to see more emphasis on patient preference, such as whether the harms are important, and shared decision-making.

On the sidelines of a recreational hockey game in Toronto, Rakesh Patel, 53, said he had a PSA test at his doctor's suggestion.

"She goes through the whole series of things that I should be aware of, especially at my age," Patel said.

The task force said it did not consider the costs of screening or treatment of prostate cancer.

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Amber Vinson, 2nd Texas nurse to contract Ebola, to be released today

A nurse being treated for Ebola will leave hospital Tuesday after tests showed she's virus-free, while another nurse quarantined against her will after treating patients in West Africa has returned to her home state.

Atlanta's Emory University Hospital spokeswoman Holly Korschun said Amber Vinson, who cared for the Liberian man who died of Ebola in the U.S. on Oct. 8, would be discharged following a 1 p.m. ET news conference.

Vinson, 29, was one of two nurses who became infected while caring for Thomas Eric Duncan at Texas Health Presbyterian Hospital Dallas.

The other infected nurse, Nina Pham, was released Oct. 24 from a hospital attached to the National Institutes of Health near Washington.

Meanwhile, Doctors Without Borders volunteer Kaci Hickox, has travelled to an "undisclosed location," in her home state of Maine, according to Steve Hyman, one of her lawyers.

Hickox spent the weekend in a quarantine tent in New Jersey upon returning from West Africa despite testing negative for Ebola and having no symptoms other than a slightly elevated temperature she blamed on "inhumane" treatment at Newark Liberty International Airport.

Maine health officials announced that Hickox will be quarantined at home for 21 days after the last possible exposure to the disease under the state's health protocols.

But Hyman, said he expected her to remain in seclusion for the "next day or so" while he works with Maine health officials.

Hyman said the state should follow the Centers for Disease Control and Prevention guidelines that require only monitoring, not quarantine, for health care workers who show no symptoms after treating Ebola patients.

"She's a very good person who did very good work and deserves to be honoured, not detained, for it," he said.

Hickox was the first person forced into New Jersey's mandatory quarantine for people arriving at Newark Liberty from three West African countries.

New Jersey Gov. Chris Christie and New York Gov. Andrew Cuomo were sharply criticized for ordering mandatory quarantines. But Christie said Monday that his priority is protecting the health of people in his state.

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Enterovirus D68 confirmed in Fredericton child

New Brunswick has its first confirmed case of Enterovirus D68, which is the strain that has hospitalized children across North America and been linked to at least three deaths.

A Fredericton child, who tested positive for Enterovirus D68, was hospitalized for four days, but is now doing well, public health officials say. (CBC)

The patient, a Fredericton school-aged child without underlying medical conditions, was hospitalized for four days, released in early October and is now doing well, said acting chief medical officer of health Dr. Jennifer Russell.

There are no other suspected cases in the province, she said in a statement on Monday.

Public health announced the confirmed case after receiving test results from the national microbiology lab in Winnipeg. Confirmation of test results takes several weeks, Russell said.

The results do not impact the treatment, which is the same for all strains of the disease, but they can be beneficial for researchers, she said.

Earlier this month, test results confirmed two other children in Fredericton, who tested positive for Enterovirus, did not have the D68 strain.

EV-D68 is one of more than 100 non-polio enteroviruses, which are common at this time of year.

Symptoms are similar to that of a cold, such as a runny nose and fever, but can cause serious respiratory problems.

Much like the common cold, the virus is transmitted through close contact, from nose or throat secretions.

New Brunswickers are encouraged to take proper measures to protect themselves through frequent washing of hands, coughing into one's sleeve and staying home when sick.

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U.S. Ebola quarantines sign of growing rift between politicians, health workers

New York Gov. Andrew Cuomo on Sunday night revised guidelines for the mandatory, 21-day quarantining of medical workers returning from West Africa that he and New Jersey Gov. Chris Christie ordered two days earlier, bringing the state closer in line with federal protocols.

He outlined the state's policy at a nighttime news conference with New York City's mayor after the Obama administration said it expressed concerns to Cuomo and Christie about their states' mandatory Ebola quarantines. The revision also comes amid criticism of the treatment of a nurse returning from Sierrra Leone who was forcibly quarantined is a New Jersey hospital isolation unit even though she said had no symptoms and tested negative for Ebola.

Under the revised New York guidelines, medical professors who have had contact with Ebola patients will be quarantined at home and receive twice-daily monitoring if they have no symptoms. The state will also pay for any lost compensation, if they are not paid by a volunteer organization.

Cuomo had criticized Dr. Craig Spencer, who tested positive for Ebola on Thursday, for not obeying a 21-day voluntary quarantine. But on Sunday, he called the health care workers "heroes" and said his administration would encourage more medical workers to volunteer to fight Ebola.

Kaci Hickox, the nurse quarantined at a New Jersey hospital because she had contact with Ebola patients in West Africa, said the process of keeping her isolated is "inhumane." (University of Texas at Arlington/Associated Press)

Meanwhile, Kaci Hickox, the first nurse forcibly quarantined in New Jersey under the state's new policy, said in a telephone interview with CNN that her isolation at a hospital was "inhumane," adding: "We have to be very careful about letting politicians make health decisions."

Saying the federal health guidelines are inadequate, Cuomo and Christie announced a mandatory quarantine program Friday for medical workers and other arriving airline passengers who have had contact with Ebola victims in West Africa, and Illinois soon followed suit. Twenty-one days is the incubation period for Ebola.

Christie on Sunday defended quarantining as necessary to protect the public and predicted it "will become a national policy sooner rather than later."

"I don't believe when you're dealing with something as serious as this that we can count on a voluntary system," said Christie, who is expected to run for the Republican nomination for president in 2016. He added: "I absolutely have no second thoughts about it."

State edicts 'not grounded in science': White House

The Obama administration considers the policy in New York and New Jersey "not grounded in science" and conveyed its concerns to Christie and Cuomo, a senior administration official told The Associated Press. The official wasn't authorized to comment by name and insisted on anonymity.

"The best way to protect us is to stop the epidemic in Africa, and we need those health care workers, so we do not want to put them in a position where it makes it very, very uncomfortable for them to even volunteer to go," said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.

Fauci made the rounds on five major Sunday morning talk shows to argue that policy should be driven by science — and that science says people with the virus are not contagious until symptoms appear. And even then, infection requires direct contact with bodily fluids.

He said that close monitoring of medical workers for symptoms is sufficient, and warned that forcibly separating them from others, or quarantining them, for three weeks could cripple the fight against the outbreak in West Africa — an argument that humanitarian medical organizations have also made.

"If we don't have our people volunteering to go over there, then you're going to have other countries that are not going to do it and then the epidemic will continue to roar," Fauci said.

Christie, traveling the country as head of the Republican Governors Association, said he was not worried that quarantining might discourage volunteers.

Earlier this month, four members of a family in Texas that Ebola victim Thomas Eric Duncan stayed with before he died were confined to their home under armed guard after failing to comply with a request not to leave their apartment. Also, 75 Dallas hospital workers were asked to sign legally binding documents in which they agreed not go to public places or use mass transit.

The New York-area quarantine measures were announced after Spencer returned to New York City from treating Ebola victims in Guinea for Doctors Without Borders and was admitted to Bellevue Hospital Center last Thursday to be treated for Ebola. In the week after his return, he rode the subway, went bowling and ate at a restaurant.

Hospital officials said Sunday that Spencer was in serious but stable condition, was looking better than he did the day before, and tolerated a plasma treatment well.

Hickox says she's asymptomatic

Hickox, the quarantined nurse who just returned from Sierra Leone, said she had no symptoms at all and tested negative for Ebola in a preliminary evaluation.

"It's just a slippery slope, not a sound public health decision," she said of the quarantine policy. "I want to be treated with compassion and humanity, and don't feel I've been treated that way."

Hickox has access to a computer, her cellphone, magazines and newspapers and has been allowed to have takeout food, New Jersey Health Department officials said.

New York City Mayor Bill de Blasio called Hickox a "returning hero" and charged that she was "treated with disrespect," as if she done something wrong, when she was put into quarantine. He said that she was interrogated repeatedly and things were not explained well to her.

Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, called the quarantine restrictions 'draconian.'

Samantha Power, the U.S. ambassador to the United Nations who is on a trip to West Africa, said returning U.S. health care workers should be "treated like conquering heroes and not stigmatized for the tremendous work that they have done."

In other developments, President Barack Obama met Sunday with his Ebola response team, including "Ebola czar" Ron Klain and other public health and national security officials. According to a statement released by the White House, Obama said any measures concerning returning health care workers "should be crafted so as not to unnecessarily discourage those workers from serving."

Florida Gov. Rick Scott ordered twice-daily monitoring for 21 days of anyone returning from the Ebola-stricken areas.

The World Health Organization said more than 10,000 people have been infected with Ebola in the outbreak that came to light last March, and nearly half of them have died, mostly in Guinea, Sierra Leone and Liberia.

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'No shortage of volunteers' for clinical trial of Canadian-made Ebola vaccine

The risk of contracting Ebola virus in suburban Washington, D.C., is vanishingly low. In fact, with the recovery and Friday's release from hospital there of Dallas nurse Nina Pham, it is actually nil.

But that fact isn't deterring people from stepping forward to volunteer for one of 78 spots in two clinical trials of an experimental Ebola vaccine designed by scientists at the National Microbiology Laboratory in Winnipeg.

The clinical trials are being conducted in Bethesda, Md., a science hub that is home to the U.S. National Institutes of Health and the Walter Reed Army Institute of Research, the two facilities doing the research.

Ninety minutes drive away, straight up highway 270, is the U.S. Army Medical Research Institute on Infectious Diseases, where one of the strains of Ebola — Ebola Reston — was first identified in monkeys imported from the Philippines. Scientists at USAMRIID, as it is known, collaborated with the Winnipeg lab in the making of the Canadian vaccine.

In other words, this is a nexus of the high calibre research, with many laboratories devoted to work on very bad bugs. And scientists in the labs who study Ebola and its cousin, the Marburg virus, have waited a long time for a chance to be vaccinated against the deadly viruses they research.

Healthy adults over 18

"We're not short of volunteers," says Col. Shon Remich, director of translational medicine at Walter Reed and an associate investigator on one of the trials.

'We're not short of volunteers. A lot of people want to be part of the solution.'- Col. Shon Remich, Walter Reed Army Institute of Research

"A lot of people want to be part of the solution," says Remich, who acknowledges he wishes he could volunteer to take the vaccine.

That's not to say researchers are the only volunteers for the trials, or that volunteers are only being drawn from the research community. Organizers of the trials are looking for healthy adults — 18 to 65 for the NIH trial, 18 to 50 at Walter Reed.

They want a mix of men and women, but are excluding pregnant women and medical professionals currently caring for patients. People who work with animals, take care of children under five or live with anyone who has a suppressed immune system are not eligible for the NIH trial.

Those exclusions are because the vaccine contains live virus — though not, of course, Ebola virus. This vaccine cannot give a recipient Ebola disease.

Still, there is some possibility recipients will emit or "shed" the viruses the vaccine does contain. The researchers are being cautious. This is, after all, the first time this vaccine has been tested in people.

The Canadian-made experimental Ebola vaccine rVSV-EBOV is one of two frontrunners that has started early clinical trial safety tests in humans. (Col. Shon Remich/Walter Reed Army Institute of Research/Canadian Press)

The vaccine, which the Canadian government licensed to NewLink Genetics of Ames, Iowa, is called VSV-ZEBOV. The VSV part of the name is short for vesicular stomatitis virus, a live animal virus that is harmless to humans.

It has been genetically modified so that it produces a protein made by Ebola viruses, in this case the Zaire strain of Ebola which is the one responsible for the West African outbreak. That's the Z (Zaire) EBOV (Ebola virus) part of the name.

Introducing that protein to recipients' immune systems should trigger the production of antibodies which would then mount up to fight off Ebola Zaire, if the recipient ever encounters it. Encountering it, though, is not part of these studies. While challenge studies are used for some mild pathogens — vaccinated volunteers are exposed to a pathogen to see if the vaccine works — that would never be done with something as dangerous as Ebola.

Antibodies

In these studies, the researchers will look for antibodies to the Ebola protein in blood drawn from the volunteers and will watch to see if antibody levels rise over time.

Volunteers will get either the vaccine or an injection of a placebo, probably saline. The primary goal is to see if people can safely take this vaccine. So far, some of the people who have received injections have experienced low grade fevers and muscle aches — the type of reaction one often sees in people who get vaccinated for anything. They are actually signs the vaccine is working.

VSV-ZEBOV has been genetically modified so that it produces a protein made by Ebola viruses, in this case the Zaire strain of Ebola which is the one responsible for the West African outbreak (Stephen Gire/ Associated Press)

Both trials are starting with low doses and are working their way up to higher doses only after it is determined if low doses are tolerable. That approach is called a "safety stagger," says Remich. A safety review committee will assess the first dose results before the trial organizers can move up to the next dose.

"The protocol is written to be cautious, so there is a step-wise enrolment," explains Dr. John Beigel, an associate investigator on the NIH trial.

"The last thing you want to do is vaccinate 50 people all in one day and then find that it's really toxic."

One of the challenges with a new vaccine or drug is determining what constitutes a dose. How much is needed to get the desired effect? How little can you give, so you can minimize the risk of side-effects while still getting a protective effect?

"We're trying to find that sweet spot in the middle where we generate antibodies but the side-effects are tolerable," Beigel explains.

The Walter Reed study is testing what happens when recipients receive only one dose of the vaccine, which many — including the scientist who led the development program — hope will be sufficient for this vaccine. A one-dose vaccine is much easier to administer, especially in emergency circumstances, than a two-dose vaccine, especially if the doses have to be given several weeks apart.

Two doses

The NIH study is looking at a two-dose regimen, trying to see if two low doses — given 28 days apart — would be as effective as a single dose that contains more vaccine than the two combined. It would be a way to stretch scarce vaccine, Beigel says.

Each study has three arms, which will receive a low, intermediate or high dose (or two) of vaccine. In the NIH trial, the intermediate dose is seven times larger than the low dose, and the high dose is five times higher than the intermediate. In the Walter Reed study, the intermediate and high doses involve 10 times more vaccine than the dose below.

In both trials, 10 people each will receive the low, intermediate and high doses, and nine people will receive placebo. Neither the researchers nor the recipients will know until after the results have been calculated who got which.

Both hope to have some data on the safety of the vaccine and information that can be used to make a decision about the size of a dose in December, though the results of the analysis of the impact of the second dose in the NIH study aren't expected until January, Beigel says.

The Walter Reed trial will follow volunteers for 180 days, drawing blood at sporadic intervals over that time. The NIH trial will follow its volunteers for a year to try to get a picture of how long the Ebola antibodies stick around.

Additional safety trials of the VSV-ZEBOV vaccine will soon start in Germany, Switzerland, Gabon and Kenya. The World Health Organization said Friday that much larger trials aimed at seeing if the vaccine is protective could start in December or shortly thereafter, depending on the safety trials results.

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Nova Scotia doctor to charge employers for sick notes

Nova Scotia physician Ethel Cooper-Rosen is going to start charging employers $30 for sick notes, saying they put unnecessary pressure on the health-care system and expose other patients in her waiting room to viruses.

Many employers and some universities require notes from doctors to verify that sick day policies aren't being abused.

The Dartmouth physician objects to patients coming into her office for the sole purpose of getting sick notes.

"We feel that this is inappropriate. Doctors Nova Scotia feels that this is inappropriate. Patients who have mild viral illnesses and have no reason to see the doctor, because really, the treatment for these illnesses is stay home and rest," she said.

"We are taking the position that it's an unnecessary medical visit taking up our time, exposing patients in the waiting room to illnesses, and it shouldn't be part of the system."

Cooper-Rosen said she gets three to five requests for a doctor's note a week when she's working in an urgent duty clinic. Doctors' notes are not covered by Medical Services Insurance.

She said it's standard procedure to charge third-party organizations for non-medical services.

"I have every right to charge for it.… We're trying to clear up space for patients who are sick. Our duty clinics are very busy. We also don't want patients with these mild viral illnesses sitting in our offices with patients who are sick and they have compromised immune systems and can pick up these illnesses. We have babies in there who can pick up the illnesses. So we would like them to stay home," Cooper-Rosen said.  

In a note to employers explaining the $30 invoice, Cooper-Rosen asks them to revisit their absentee policy. She said many patients with viral illnesses wouldn't even come to her office if their employer didn't require a note.

She said there might be resistance from employers, but there needs to be trust in the workplace.

"If an employee said they are sick, their employer should probably trust that they are telling the truth if they have a good relationship with them," she said. "The patient doesn't want to pay for the note and the employer generally doesn't want to pay for the note."

Last year, Doctors Nova Scotia — the professional association representing physicians in the province — made a public plea to employers to stop requiring doctors' notes for sick employees.

Cooper-Rosen said things haven't changed.

"I don't think the message is getting out there," she said.

In 2013, the average Nova Scotian took 8½ sick days, more than the national average of 7.4 days.

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2nd Dallas nurse to contract Ebola cleared of virus, hospital says

A second Dallas nurse who contracted Ebola is now free of the virus, Emory University Hospital in Atlanta said on Friday.

Amber Vinson, one of two nurses from a Dallas hospital infected with Ebola after treating the first patient diagnosed with the disease in the U.S., is still receiving supportive care at Emory and no release date has been set.

But tests no longer detect the virus in her blood, the hospital said in a statement.

Earlier on Friday, U.S. President Barack Obama met with Nina Pham, the other nurse who contracted the virus in Dallas, and gave her a big hug in the Oval Office after her release from a nearby hospital. 

Pham, 26, and Vinson became infected with Ebola while treating Thomas Eric Duncan, who died of the virus Oct. 8.

White House spokesman Josh Earnest said Obama brought Pham in for a meeting to recognize her work treating Duncan. 

"She was doing the work that many nurses do on a daily basis and she did so even though it did put her at some risk," Earnest told reporters.

U.S. President Barack Obama hugs Dallas nurse Nina Pham at the Oval Office. Pham was released from the NIH's hospital in Bethesda, Md., earlier in the day. (Larry Downing/Reuters)

Photographs of the meeting showed Obama hugging Pham. Reporters and television cameras were not allowed in for the meeting.

Earnest noted that Pham had been tested five times to ensure she was clear of Ebola before being released.

Obama, he said, was "not at all concerned" that he might come under risk of contracting Ebola by hugging Pham.

Pham was released from the National Institutes of Health's hospital outside of Washington earlier on Friday, where she said she felt "fortunate and blessed to be standing here today," as she walked out on to the front steps to address reporters. 

She thanked her health care team in Dallas and at the NIH and singled out fellow Ebola survivor Dr. Kent Brantly, who recovered after becoming infected in Liberia, for donating plasma containing Ebola-fighting antibodies as part of her care.

"Although I no longer have Ebola, I know it may be a while before I have my strength back," Pham said at the news conference. Doctors have cleared her to return home to Texas.

Nurse Nina Pham contracted Ebola while caring for Thomas Eric Duncan, who died in a Dallas hospital on Oct. 8. (Pablo Martinez Monsivais/Associated Press)

Dr. Anthony Fauci, infectious disease chief at the NIH, told reporters that the five consecutive tests showed no virus left in her blood. Five tests is way beyond the norm, he stressed, but his team did extra testing because the NIH is a research hospital.

"She is cured of Ebola, let's get that clear," Fauci said.

Pham arrived last week at the NIH Clinical Center in Bethesda, Maryland. She had been flown there from Texas Presbyterian Hospital in Dallas.

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Ebola outbreak: 2 U.S. states order mandatory quarantine for returning health workers

New York and New Jersey will automatically quarantine medical workers returning from Ebola-hit West African countries and the U.S. government is considering the same step after a doctor who treated patients in Guinea came back infected, officials said on Friday.

The steps announced by the two states, which go beyond the current restrictions being imposed by U.S. President Barack Obama's administration on travellers from Liberia, Sierra Leone or Guinea, came as medical detectives tried to retrace the steps in New York City of Craig Spencer, who tested positive for Ebola on Thursday.

Spencer, who returned from Guinea on Oct. 17, rode the subway, ate out, took a cab and went bowling in the Brooklyn borough since he got back

Dr. Craig Spencer, New York City's first Ebola patient, is a member of Doctors Without Borders. He is being treated in an isolation ward in Manhattan's Bellevue Hospital, a designated Ebola centre. (Craig Spencer/LinkedIn)

The new policy applies to medical workers returning from the region through John F. Kennedy International Airport in New York and Newark Liberty International Airport in New Jersey. In the first instance of the new move, a female health-care worker who had treated patients in West Africa and arrived at the Newark, New Jersey, airport was ordered into quarantine.

"Voluntary quarantine is almost an oxymoron," New York Gov. Andrew Cuomo said. "We've seen what happens ... You ride a subway. You ride a bus. You could infect hundreds and hundreds of people."

"It's too serious a situation to leave it to the honour system of compliance," Cuomo said.

Possible nation-wide policy

Cuomo, who appeared at a news conference with the governor of neighbouring New Jersey, Chris Christie, had earlier in the day sought to reassure New Yorkers that Ebola's threat was limited the day after Spencer tested positive for the virus.

Cuomo said the U.S. Centers for Disease Control and Prevention had agreed that individual states have the right to exceed federal requirements.

A federal quarantine of health-care workers returning to the U.S. from the three West African countries was one of a number of options being discussed by administration officials, Tom Skinner, a CDC spokesman, told Reuters.

Spencer, 33, who spent a month with the humanitarian group Doctors Without Borders in Guinea, was the fourth person diagnosed with the virus in the U.S. and the first in its largest city.

Dr. Mary Travis Bassett, New York's health commissioner, said Spencer was awake and talking to family and friends by cellphone and was listed in stable condition in Bellevue Hospital's isolation unit. Meanwhile, workers in biohazard gear began cleansing Spencer's apartment in upper Manhattan.

The virus is not airborne but is spread through direct contact with bodily fluids from an infected person who is showing symptoms.

No travel ban

The Obama administration has implemented a series of steps aimed at preventing the further spread of Ebola in the U.S. but has stopped short of a travel ban on people from Liberia, Sierra Leone or Guinea called for by some politicians.

The U.S. is funnelling travellers from those countries through five airports conducting special screening for signs of infection and is requiring them to report to health authorities for the 21-day Ebola virus incubation period.

Governors of N.J. Chris Christie (R) and of N.Y. Andrew Cuomo announced Friday that those states will implement a mandatory 21-day quarantine for all people who had contact with Ebola victims in West Africa. (Carlo Allegri/Reuters)

"We want to strike the right balance of doing what is best to protect the public's health while not impeding whatsoever our ability to combat the epidemic in West Africa. Our risk here will not be zero until we stop the epidemic there," Skinner said.

White House spokesman Josh Earnest declined to discuss the possibility of a nation-wide quarantine policy but said "these kinds of policy decisions are going to be driven by science" and the advice of medical experts.

Spencer finished his work in Guinea on Oct. 12 and arrived at John F. Kennedy International Airport in New York five days later. Six days later, he was quarantined with Ebola.

Three people who had close contact with Spencer were quarantined for observation. The doctor's fiancée was among them and was isolated at the same hospital, and all three were still healthy, officials said.

The worst Ebola outbreak since the disease was identified in 1976 has killed at least 4,877 people and perhaps as many as 15,000, predominantly in Liberia, Sierra Leone and Guinea, according to the World Health Organization. On Friday, health officials in Mali revealed that the first person to be diagnosed with the virus in that country, a 2-year-old girl, had died of the disease. 

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Ebola patient who died in Mali had contact with at least 300 others

Officials in Mali are working to identify everyone who came into contact with a two-year-old girl who has died from Ebola.

She had travelled with her grandmother for hundreds of kilometres by bus through Mali from Guinea. The bus travelled through Mali's capital, Bamako, to the western town of Kayes, where she was diagnosed on Thursday.

The girl, Mali's first case of Ebola, died on Friday, shortly after the World Health Organization warned that many people had potentially been exposed to the virus because she was taken across the country while ill.

WHO said it was "especially concerning" that the child showed symptoms during her bus journey, "as it presented multiple opportunities for exposures — including high-risk exposures — involving many people."

Health workers are now scrambling to trace hundreds of potential contacts in a bid to prevent Ebola from taking hold in Mali.

The worst Ebola outbreak on record has killed 4,900 people, mainly in nearby Liberia, Sierra Leone and Guinea. A global response to the epidemic is being rolled out but experts warn that tens of thousands more people are at risk.

In a statement on Friday night, Mali's government confirmed the death of the girl, who has not been identified.

"In this moment of sadness, the government would like to express its condolences to her family and reminds the population that maintain very strict hygiene rules remains the best way to contain this disease," it said.

Mali is the sixth West African nation to record a case of Ebola. Senegal and Nigeria have successfully contained outbreaks and has been declared free of the disease. Spain and the United States have had a few cases.

Diplomatic sources have expressed concern about the preparedness of Mali, one of the world's poorest countries, to contain an outbreak. Home to a large U.N. peacekeeping mission, the mostly Muslim country is still battling northern Islamist militants after a brief French-led war last year.

WHO said that an investigation into the girl's case revealed that she had already started showing symptoms - and was therefore contagious - before being taken to Kayes.

"WHO is treating the situation in Mali as an emergency," the U.N. health agency said in a statement.

"The child's symptomatic state during the bus journey is especially concerning, as it presented multiple opportunities for exposures — including high-risk exposures — involving many people," it added.

Girl went to 2nd hospital

The girl was seen by health workers on Oct. 20 in Kayes but was referred to another hospital the next day where she tested positive for typhoid but was also bleeding from her nose. It was not until Oct. 23 that she tested positive for Ebola, WHO said.

WHO said that 43 contacts had been identified and isolated but a second Malian health official, who asked not to be identified, told Reuters that authorities estimated that at least 300 people had been in contact with the infected child.

Hours before Mali confirmed the case on Thursday, WHO Assistant Director-General Keiji Fukuda said the agency had "reasonable confidence" that there was not widespread transmission of the Ebola virus into neighbouring countries.

WHO and Medical charity Medecins Sans Frontieres, which has helped run much of the response to Ebola, were both scrambling teams to Mali on Friday. A UN plane flew one tonne of medical supplies — including personnel protection equipment kits, gloves, face shields and buckets — to the country.

Kayes near Senegalese border

On the dusty streets of the capital Bamako, residents voiced alarm at the girl having spent time in the city's Bagadadji district before travelling on Sunday to Kayes, some 600 kilometres to the northwest near the Senegalese border.

"I am afraid because, with my job, I am in permanent contact with people but I can't afford to just stop," said taxi driver Hamidou Bamba, 46, in Bamako. "Today is Friday so let us pray to Allah that this disease will not spread in Mali."

Mali, together with cocoa producer Ivory Coast, has put in place border controls to stop Ebola at its frontiers. However, a visit to Mali's border with Guinea by Reuters this month showed vehicles avoiding a health checkpoint set up by Malian authorities by simply driving through the bush.

Ivory Coast was on alert after Guinean authorities informed them that a Guinean health worker had slipped surveillance and headed for the border after a patient had contracted Ebola.

Raymonde Goudou Coffie, Ivory Coast's health minister, said the authorities did not know if the medic had Ebola but had to be traced as he had been in contact with someone who had.

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'No shortage of volunteers' for clinical trial of Canadian-made Ebola vaccine

The risk of contracting Ebola virus in suburban Washington, D.C., is vanishingly low. In fact, with the recovery and Friday's release from hospital there of Dallas nurse Nina Pham, it is actually nil.

But that fact isn't deterring people from stepping forward to volunteer for one of 78 spots in two clinical trials of an experimental Ebola vaccine designed by scientists at the National Microbiology Laboratory in Winnipeg.

The clinical trials are being conducted in Bethesda, Md., a science hub that is home to the U.S. National Institutes of Health and the Walter Reed Army Institute of Research, the two facilities doing the research.

Ninety minutes drive away, straight up highway 270, is the U.S. Army Medical Research Institute on Infectious Diseases, where one of the strains of Ebola — Ebola Reston — was first identified in monkeys imported from the Philippines. Scientists at USAMRIID, as it is known, collaborated with the Winnipeg lab in the making of the Canadian vaccine.

In other words, this is a nexus of the high calibre research, with many laboratories devoted to work on very bad bugs. And scientists in the labs who study Ebola and its cousin, the Marburg virus, have waited a long time for a chance to be vaccinated against the deadly viruses they research.

Healthy adults over 18

"We're not short of volunteers," says Col. Shon Remich, director of translational medicine at Walter Reed and an associate investigator on one of the trials.

'We're not short of volunteers. A lot of people want to be part of the solution.'- Col. Shon Remich, Walter Reed Army Institute of Research

"A lot of people want to be part of the solution," says Remich, who acknowledges he wishes he could volunteer to take the vaccine.

That's not to say researchers are the only volunteers for the trials, or that volunteers are only being drawn from the research community. Organizers of the trials are looking for healthy adults — 18 to 65 for the NIH trial, 18 to 50 at Walter Reed.

They want a mix of men and women, but are excluding pregnant women and medical professionals currently caring for patients. People who work with animals, take care of children under five or live with anyone who has a suppressed immune system are not eligible for the NIH trial.

Those exclusions are because the vaccine contains live virus — though not, of course, Ebola virus. This vaccine cannot give a recipient Ebola disease.

Still, there is some possibility recipients will emit or "shed" the viruses the vaccine does contain. The researchers are being cautious. This is, after all, the first time this vaccine has been tested in people.

The Canadian-made experimental Ebola vaccine rVSV-EBOV is one of two frontrunners that has started early clinical trial safety tests in humans. (Col. Shon Remich/Walter Reed Army Institute of Research/Canadian Press)

The vaccine, which the Canadian government licensed to NewLink Genetics of Ames, Iowa, is called VSV-ZEBOV. The VSV part of the name is short for vesicular stomatitis virus, a live animal virus that is harmless to humans.

It has been genetically modified so that it produces a protein made by Ebola viruses, in this case the Zaire strain of Ebola which is the one responsible for the West African outbreak. That's the Z (Zaire) EBOV (Ebola virus) part of the name.

Introducing that protein to recipients' immune systems should trigger the production of antibodies which would then mount up to fight off Ebola Zaire, if the recipient ever encounters it. Encountering it, though, is not part of these studies. While challenge studies are used for some mild pathogens — vaccinated volunteers are exposed to a pathogen to see if the vaccine works — that would never be done with something as dangerous as Ebola.

Antibodies

In these studies, the researchers will look for antibodies to the Ebola protein in blood drawn from the volunteers and will watch to see if antibody levels rise over time.

Volunteers will get either the vaccine or an injection of a placebo, probably saline. The primary goal is to see if people can safely take this vaccine. So far, some of the people who have received injections have experienced low grade fevers and muscle aches — the type of reaction one often sees in people who get vaccinated for anything. They are actually signs the vaccine is working.

VSV-ZEBOV has been genetically modified so that it produces a protein made by Ebola viruses, in this case the Zaire strain of Ebola which is the one responsible for the West African outbreak (Stephen Gire/ Associated Press)

Both trials are starting with low doses and are working their way up to higher doses only after it is determined if low doses are tolerable. That approach is called a "safety stagger," says Remich. A safety review committee will assess the first dose results before the trial organizers can move up to the next dose.

"The protocol is written to be cautious, so there is a step-wise enrolment," explains Dr. John Beigel, an associate investigator on the NIH trial.

"The last thing you want to do is vaccinate 50 people all in one day and then find that it's really toxic."

One of the challenges with a new vaccine or drug is determining what constitutes a dose. How much is needed to get the desired effect? How little can you give, so you can minimize the risk of side-effects while still getting a protective effect?

"We're trying to find that sweet spot in the middle where we generate antibodies but the side-effects are tolerable," Beigel explains.

The Walter Reed study is testing what happens when recipients receive only one dose of the vaccine, which many — including the scientist who led the development program — hope will be sufficient for this vaccine. A one-dose vaccine is much easier to administer, especially in emergency circumstances, than a two-dose vaccine, especially if the doses have to be given several weeks apart.

Two doses

The NIH study is looking at a two-dose regimen, trying to see if two low doses — given 28 days apart — would be as effective as a single dose that contains more vaccine than the two combined. It would be a way to stretch scarce vaccine, Beigel says.

Each study has three arms, which will receive a low, intermediate or high dose (or two) of vaccine. In the NIH trial, the intermediate dose is seven times larger than the low dose, and the high dose is five times higher than the intermediate. In the Walter Reed study, the intermediate and high doses involve 10 times more vaccine than the dose below.

In both trials, 10 people each will receive the low, intermediate and high doses, and nine people will receive placebo. Neither the researchers nor the recipients will know until after the results have been calculated who got which.

Both hope to have some data on the safety of the vaccine and information that can be used to make a decision about the size of a dose in December, though the results of the analysis of the impact of the second dose in the NIH study aren't expected until January, Beigel says.

The Walter Reed trial will follow volunteers for 180 days, drawing blood at sporadic intervals over that time. The NIH trial will follow its volunteers for a year to try to get a picture of how long the Ebola antibodies stick around.

Additional safety trials of the VSV-ZEBOV vaccine will soon start in Germany, Switzerland, Gabon and Kenya. The World Health Organization said Friday that much larger trials aimed at seeing if the vaccine is protective could start in December or shortly thereafter, depending on the safety trials results.

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