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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Ebola outbreak: NYC mayor addresses case of doctor with Ebola

Officials tried to tamp down New Yorkers' fears Friday after a doctor was diagnosed with Ebola in a city where millions of people squeeze into crowded subways, buses and elevators every day.

Heath officials have repeatedly given assurances that the disease is spread only by direct contact with bodily fluids such as saliva, blood, vomit and feces, and that the virus survives on dry surfaces for only a matter of hours.

"We want to state at the outset that New Yorkers have no reason to be alarmed" by the doctor's diagnosis Thursday, said Mayor Bill de Blasio, even as officials described Dr. Craig Spencer riding the subway, taking a cab and bowling since returning to New York from Guinea a week ago. "New Yorkers who have not been exposed are not at all at risk."

Health officials said Spencer, a member of Doctors Without Borders, sought treatment with diarrhea and a 100.3-degree (38 C) fever — not 103 (39.5-Celsius) as officials initially reported Thursday night. The health department blamed a transcription error for the incorrect information. He was being treated in an isolation ward at Manhattan's Bellevue Hospital, a designated Ebola centre.

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))

Gov. Andrew Cuomo said Friday that the doctor "obviously felt he wasn't symptomatic" when he went out "in a limited way."

The governor, in an appearance on CNN's New Day, said there was no reason to fear riding the subway, and he would do so Friday.

The epidemic in West Africa has killed about 4,800 people and more than 440 health workers have contracted Ebola — about half have died.

Four American aid workers, including three doctors, were infected with Ebola while working in Africa and were transferred to the U.S. for treatment in recent months. All recovered. Health care workers are vulnerable because of close contact with patients when they are their sickest and most contagious.

In the United States, the first person diagnosed with the disease was a Liberian man, who fell ill days after arriving in Dallas and later died, becoming the only fatality. None of his relatives who had contact with him got sick. Two nurses who treated him were infected and are hospitalized. The family of one nurse said doctors no longer could detect Ebola in her as of Tuesday evening.

Health officials say the chances of the average New Yorker contracting Ebola are slim. Someone can't be infected just by being near someone who is sick with Ebola. Someone isn't contagious unless he is sick.

But some New Yorkers were not taking any chances.

Friday morning, a group of teenage girls in Catholic school uniforms riding the L subway train passed around a bottle of hand sanitizer. They said they were taking extra precautions because of the Ebola case. It was one of the subway lines the doctor rode after returning home.

Health officials have been tracing Spencer's contacts to identify anyone who may be at risk. The city's health commissioner, Mary Bassett, said Spencer's fiancee and two friends had been quarantined but showed no symptoms.

The Gutter bowling alley in the Williamsburg neighborhood of Brooklyn was closed, an establishment reportedly visited by Craig Spencer, a Doctors Without Borders physician who tested positive for the Ebola virus. (John Minchillo/The Associated Press)

According to a rough timeline provided by city officials, in the days before Spencer fell ill, he went on a five-kilometre jog, went to the High Line park, rode the subway and, on Wednesday night, got a taxi to a Brooklyn bowling alley. He felt tired starting Tuesday, and felt worse on Thursday when he and his fiancee made a joint call to authorities to detail his symptoms and his travels. EMTs in full Ebola gear arrived and took him to Bellevue in an ambulance surrounded by police squad cars.

Bassett said the probability was "close to nil" that Spencer's subway rides would pose a risk. Still, the bowling alley was closed as a precaution, and Spencer's Harlem apartment was cordoned off. The Department of Health was on site across the street from the apartment building Thursday night, giving out information to area residents.

The Centers for Disease Control and Prevention, which will do a further test to confirm the initial results, has dispatched an Ebola response team to New York. President Barack Obama spoke to Cuomo and de Blasio on Thursday night and offered the federal government's support. He asked them to stay in close touch with Ron Klain, his "Ebola czar," and public health officials in Washington.

Spencer, 33, works at NewYork-Presbyterian/Columbia University Medical Center. He had not seen any patients or been to the hospital since his return, the hospital said in a statement, calling him a "dedicated humanitarian" who "went to an area of medical crisis to help a desperately underserved population."

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Gluten-free market booming, but researchers aren't sold

Going gluten-free? You're not the only one. Celebrities including Gwyneth Paltrow and Miley Cyrus are aglow about the benefits of a gluten-free diet, and millions of Canadians are eating it up. But researchers say there isn't much science to support it.

The perception that gluten is unhealthy is pervasive, causing the market for gluten-free products to balloon to almost $500 million a year in Canada, and more than $4 billion in the U.S. annually.

And it's a fast growing trend: the market has grown an estimated 26 per cent a year since 2008.

"Gluten has become a proxy for evil," health researcher Timothy Caulfield told Marketplace co-host Tom Harrington. Caulfield is the Canada Research Chair in Health Law and Policy and a professor at the University of Alberta.

"If you have gluten-free label on a food product, you know, it's viewed as being healthier regardless of what the food product actually is," says Caulfield.

But a CBC Marketplace investigation reveals that many products with gluten-free labels break Health Canada rules, and add to consumer confusion about the issue. (The full investigation, The Truth Behind the Trend, airs Friday Oct. 24 at 8 p.m / 8:30 p.m. in NT on CBC Television. Follow the conversation on Twitter with #glutenfree.)

Misconceptions rampant

Gluten is a protein found in wheat, barley and rye that gives bread elasticity.

"If you have gluten-free label on a food product, you know, it's viewed as being healthier regardless of what the food product actually is," says Timothy Caulfield, the Canada Research Chair in Health Law and Policy and a professor at the University of Alberta. (CBC)

About 35,000 Canadians have celiac disease, an autoimmune disorder triggered by the protein. Yet many more — between four and seven million Canadians — are "gluten avoiders," choosing gluten-free products because they believe that it's a healthier choice.

Celiac disease is a serious illness, and people who have been diagnosed need to avoid gluten in their diets. But gluten-sensitivity and gluten-intolerance are not medical diagnoses, and have no agreed medical definition or diagnostic test.

Regardless, gluten-free products have become a big business. Many food makers are trying to capitalize on the trend, making gluten-free versions of foods, including bread and pasta, that normally contain gluten.

The market for gluten-free products has ballooned to almost $500 million a year in Canada, growing 26 per cent a year since 2008. (CBC)

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"[People] want a particular component, right? Whether it's sugar, whether it's fat, whether it's salt, something that's going to fix their health issues," Caulfield says. "And I think marketers can play on that ... it's almost like simplifying the story around nutrition to this component of going gluten-free." 

Gluten avoiders believe the protein is linked to a variety of ailments including bloating, weight gain, and fatigue, and even more serious health issues such as ADHD and autism. Caulfield says the evidence does not support the idea that a gluten-free diet is healthier for most people.

Marketplace discovered that gluten-free products often have more fat, calories and carbohydrates, and less fibre, vitamins and minerals than regular products. They can also be more expensive.

Gluten-free: What's in a label?

Canada is one of the only countries in the world with rules around use of the term "gluten-free." The rules are "intended to protect the health and safety of individuals who require foods for special dietary use," Health Canada told Marketplace in a statement.

"In the U.S., unlike in Canada, products that are inherently gluten free (e.g. bottled water, carrots) can be labelled 'gluten free,' whereas in Canada, only products that are specially processed or formulated can be labelled 'gluten-free.'"

Manufacturers defended the labels, telling Marketplace that consumers often contacted them to find out if the products contained gluten or might have been cross-contaminated during processing.

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