A Spanish nurse who helped care for a sick priest who was brought back from West Africa has tested positive for Ebola, based on initial lab findings, which if confirmed would mark the first local transmission of the disease outside of West Africa.

The impact of West Africa's Ebola outbreak continued to reach across the globe to other locations, as Nebraska hospital officials announced that an American photojournalist sickened in Liberia has been airlifted to their facility, and Norway prepared to receive its first Ebola patient, a Norwegian woman who was infected with Ebola while working for Doctors without Borders (MSF) in Sierra Leone.

Meanwhile, recent events surrounding the Ebola illness of a Liberian man in Dallas have fueled calls from the public and some politicians officials for the US government to do more to screen travelers arriving in the United States from the outbreak countries.

Spain, MSF report infected health workers

The Spanish nurse helped care for a Spanish missionary who was flown to Madrid 2 weeks ago after he was sickened with Ebola while working in Sierra Leone, The Guardian, a newspaper based in London, reported today. The man died on Sep 25, 4 days after he arrived back in Spain. The nurse sought treatment at a hospital today, where initial tests were positive for Ebola, according to The Guardian. Spanish officials are waiting for the results of the second test to confirm the case.

The woman works as a "sanitary technician" and entered the sick priest's room twice: once to treat him and once after he died to retrieve his belongings, NBC News reported today. She started having symptoms on Sep 30 and sought care. She had also been part of the medical team that in early August treated another Spanish priest who was infected in West Africa and was brought back to Spain.

The case is sure to raise questions across the globe about protecting healthcare workers, even those in developed nations, and the preparedness of hospitals outside the outbreak region to handle Ebola cases.

In another development, MSF confirmed today that one of its staff members in Sierra Leone has been infected with Ebola. The worker from Norway was isolated yesterday after coming down with a fever, and tests confirmed Ebola infection. MSF said the patient will be evacuated to a treatment center in Europe and that an investigation is underway to determine how the contamination occurred. According to media reports, the worker is a woman and will be airlifted for treatment at an Oslo hospital.

MSF is known to have strict infection control protocols, and the Norwegian is the second from MSF to be infected with Ebola. The first is a French woman who recovered from her infection and was recently discharged after being treated at a Paris hospital, Agence France-Presse (AFP) reported on Oct 4, citing the French health ministry. She had received the experimental antiviral drug favipiravir (Avigan), developed by a subsidiary of Japan-based Fujifilm.

Meanwhile, Nebraska Medical Center's first Ebola patient, Rick Sacra, MD, is hospitalized with a respiratory infection at a Massachusetts hospital. Sacra recovered after contracting Ebola in Liberia and was discharged from the Omaha hospital on Sep 25.

SIM USA, the missionary group Sacra serves with, announced yesterday that Sacra went to a Boston-area emergency room on Oct 4 because of a persistent cough and low-grade fever, with concerns that he might be getting pneumonia. He was transferred to UMass Memorial Medical Center in Worcester for observation as a precaution according to Centers for Disease Control and Prevention (CDC) guidelines, according to SIM.

Sacra's doctors from Nebraska Medical Center said in the SIM statement that his immune system is compromised because of his recent battle with Ebola and that his symptoms point to a respiratory illness and not Ebola. It added that three CDC-confirmed blood tests showed that Sacra was virus-free when he left Nebraska, and that while the likelihood of an Ebola relapse is low, the medical team orders diagnostic testing to be certain.

UMass Memorial said in a statement late last night that the CDC confirmed that Sacra's lab tests were negative for Ebola and that they were removing him from isolation. It added that physicians are continuing routine care for his upper respiratory tract infection.

Sick journalist hospitalized in Nebraska

In related developments, Nebraska Medical Center in Omaha said today that it admitted a second patient infected with Ebola in West Africa, Ashoka Mukpo, a freelance photojournalist who got sick while working for an ABC News crew in Liberia.

The hospital made the announcement in its Twitter feed during a live media briefing today. Mitchell Levy, MD, the patient's father, said his son's illness is still in the early stages, and that he has fever and nausea but no diarrhea. Hospital officials said Mukpo was alert and already on intravenous fluids as he was being admitted.

Bradley Britigan, MD, dean of the College of Medicine at the University of Nebraska Medical Center, said hydration, symptom control, and blood chemistry monitoring are the main components of Mukpo's medical care and that the medical team is assessing all treatment options, including experimental ones.

Mukpo's mother, Diana Mukpo, and his father appeared at the press briefing today and said their son is in good spirits and that discussions about treatment are underway. His father said it's not clear how his son was infected, but that he had apparently helped spray-wash a car that someone had died in.

Texas contact tracing, patient developments

In media briefings over the weekend, Texas health officials and CDC Director Tom Frieden, MD, said so far no symptoms have been reported in 48 contacts of a man from Liberia who is hospitalized in critical condition with an Ebola infection at a Dallas hospital.

David Lakey, MD, commissioner of the Texas Department of State Health Services (TDSHS), said 10 of the people are considered close contacts, including 3 thought to have had direct contact with the man, along with 7 healthcare workers. An additional 38 are considered possible contacts, and will also undergo health monitoring for 21 days.

Clay Jenkins, Dallas County judge, said four members of a family who had stayed in an apartment with the patient have been relocated to a private four-bedroom home made available by a member of the Dallas faith community. He said he personally drove the family to the location to ensure that it meets their needs and that they feel safe and comfortable.

He also revealed that over the weekend health officials lost track of one of the low-risk contacts, a homeless man, and that law enforcement officials were trying to locate him. However, the authorities found him and he is now being monitored at Parkland Memorial Hospital, the Dallas Morning News reported today.

The Liberian man's condition has been downgraded to critical, and Texas Health Presbyterian Hospital in Dallas said he is receiving the experimental antiviral drug brincidofovir, made by Chimerix Inc., a pharmaceutical company based in Durham, N.C.

The company in a statement today confirmed that the drug had been provided for use in patients and that the US Food and Drug Administration (FDA) has approved an emergency investigational new drug application for it. It said in vitro studies conducted by the CDC and the National Institutes of Health (NIH) suggest that the drug may offer a potential treatment for Ebola. Phase 3 studies of the drug as a treatment for cytomegalovirus and adenovirus infections have provided safety and dosing information that has allowed the drug to be considered as a possible treatment for Ebola, Chimerix said.

In another development, Texas Health Presbyterian Hospital's parent company on Oct 3 retracted its key investigation finding regarding a communication breakdown during the Liberian patient's first visit to the emergency department on Sep 25, his recent travel to Africa was overlooked. In an earlier statement the company said the travel history was taken and appeared in the nursing workflow portion of the electronic health record (EHR), but that it wasn't visible in the physician workflow.

However, the hospital said on Oct 3 that the patient's travel history was documented and available to the full care team in the EHR. "There was no flaw in the EHR in the way the physician and nursing portions interacted related to this event," according to the clarification from Texas Health Resources.

Texas Gov Rick Perry today announced that the state has created a special task force to assist with the Ebola response and build the capacity to respond to similar threats in the future. Perry named Brett Giroir, MD, executive vice president and chief executive officer of the College of Medicine at Texas A&M Health Science Center, as director of the 16-member task force, which includes epidemiologists, public health experts, scientists, academics, and state government officials. Its first report is due Dec 1.

"Over the past several days we have learned a lot about the unique challenges of situations like this, and it's important that we continue to adapt our response to those realities," Perry said in a statement, adding that the task force will develop a long-term plan to help the state handle future outbreaks, based on an existing plan.

At a media briefing to announce the task force, aired by NBC News today, Perry urged the federal government to help Texas and other states by tightening screening procedures at entry points, such as obtaining extra information from passengers, taking their temperatures, and boosting staffing at quarantine stations.

Federal officials consider added screening steps

President Barack Obama said his administration is working on additional steps for screening airline passengers to identify people with possible Ebola infections and to make sure medical teams know what to do when they flag a suspected illness, Reuters reported today. The President's remarks came after a briefing today with CDC Director Tom Frieden, MD, MPH, and other government officials involved in the outbreak response.

Obama said that for now the administration is not considering a travel ban from West Africa, but he said other measures could be considered to help keep infected travelers from entering the United States.

At a media briefing over the weekend, Frieden said the CDC is open to suggestions on ways to step up screening, but he added that flight bans have been shown to impede the outbreak response in West Africa, and that stopping Ebola transmission in West Africa would be the best way to protect Americans.

So far, outbound traveler screening in the outbreak countries has stopped 77 people from boarding flights, including 17 in September. Though he said the CDC doesn't have follow-up information on all of the travelers, many had malaria, a common condition in the countries.

While other steps could be discussed, he told reporters it would be a mistake to take any step that would make it harder to battle the virus in West Africa.

"We're looking at all possibilities. There have been suggestions from people in Congress, from the public, from the media—we'll look at those and see what works to protect Americans and to make sure that whatever we do doesn't unintentionally actually increase our risk," Frieden said.

He also noted that the nature of Ebola infection makes it difficult to flag infected travelers, because fever and other symptoms can begin as long as 21 days after exposure to the virus.

See also:

Oct 6 Guardian story

Oct 6 Reuters story on Norwegian Ebola patient

Oct 6 MSF press release

Oct 4 AFP story

Nebraska Medical Center Twitter feed

Oct 5 SIM press release

Oct 5 UMass Memorial statement

Oct 6 Dallas Morning News story

Oct 6 Chimerix statement

Oct 3 Texas Health Resources press release

Oct 6 Texas Governor's Office press release

Oct 6 Reuters story