THE scientist leading Britain’s fight against ebola has claimed the plight of the stricken Scots nurse Pauline Cafferkey shows that there is inadequate testing for volunteers who have worked in countries hit by the virus.
Professor Tom Solomon, director of the Institute of Infection and Global health at Liverpoool University, said that health workers returning from ebola-affected countries should always be tested for the virus if they ever became unwell.
This weekend Cafferkey, who for several weeks has shown symptoms common to people with ebola, is fighting for her life after suffering an apparent relapse following her return from Sierra Leone at the end of last year and being declared ebola-free in January.
Last Monday evening Cafferkey, the first ebola victim diagnosed on British soil, reported to an out-of-hours clinic at Glasgow’s Victoria Hospital feeling unwell but a doctor who assessed her told her she had a virus and she was sent home.
Relatives have complained that this meant a day was wasted with her feeling poorly the following day before being admitted to Glasgow’s Queen Elizabeth University Hospital, from where she was transported by military aircraft to an isolation unit at the Royal Free hospital in London on Friday morning. However, health authorities say the clinical decisions taken were appropriate for the symptoms she displayed.
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Since then 65 people close to the 39-year-old, including health care workers, friends and community contacts, have been contacted, with 26 vaccinations issued as a p
recaution.
In a television interview last month, Cafferkey, from Cambuslang near Glasgow, said that after leaving hospital in January her hair had fallen out and in the past two or three months she had been getting “a lot of joint pain”.
Ebola experts including Dr Ben Neuman, a virologist at Reading University, say these appear to be signs not of the after-effects of ebola but of small amounts of ebola still residing in the body.
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Solomon said Cafferkey’s case suggests that all doctors and nurses who have worked in epidemic-hit nations ought to undergo testing for ebola if they fall ill, even if it is months afterwards and they show no symptoms of the virus.
He said her sudden deterioration raised the case for extending his previous request for automatic ebola tests for any health professionals who reported being sick soon after coming home — even if they displayed no fever — as a precautionary measure.
Solomon, director of the institute which has played a lead role in work to develop a vaccine, said: “If someone has been back [from an ebola affected area] for months and is apparently well, when they become unwell again your first thought would not be ‘let’s check for ebola’ but clearly now that will have to be on the agenda.
“What’s happening with Pauline has shown us that we have to remain vigilant and we will have to be more careful if someone has been previously infected and they appear to be unwell with something else.
“We have a small number of people now in the UK who have had ebola and recovered. I guess if they have any other illness our approach will have to be a bit different. We have to think, ‘Could this be ebola again?’ ”
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But Solomon also warned against “over-reactions” and stressed that it was currently still unclear whether Cafferkey — who collected a Pride of Britain award in London last month — was suffering from an ebola relapse or something else, such as meningitis, which has also been suggested.
Neuman agreed there should be a presumption in favour of testing again for ebola when a patient who has had it in the past presents as unwell. “If someone has had ebola then for at least the first year afterwards it has to be at least considered when they have a health problem.
“That has got to be the new way we deal with this because otherwise the risk is that the ebola is back and spreads in the UK. It means more tests and more work for these guys but I would rather that than the alternative,” said Neuman.
A spokesman for Health Protection Scotland, a division of the NHS, said: “Pauline Cafferkey is the only confirmed case of ebola in Scotland.
“Since her diagnosis last year and subsequent discharge from hospital, she has been intensively followed up by the infectious diseases specialists in Glasgow, in close collaboration with their counterparts in the Royal Free hospital.
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“As part of the follow-up, she would have been advised by the specialist on what to do should she develop any further health problems.”
He added: “The recurrence of Pauline’s ebola infection into a severe life-threatening illness is something new and literally a world first.
“Little is known about the long-term complications of the disease, because earlier outbreaks occurred on a much smaller scale with only a few cases to guide clinicians.
“With more than 17,000 survivors in the recent west African outbreak, researchers are gathering further information and intelligence from affected cases.
“As we find out and learn more about the long-term complications of these cases and how to manage them, NHS Scotland, in liaison with other countries, will be developing appropriate protocol and care plans on how to manage these complications.”
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He said that anyone presenting as unwell would be assessed according to the information they gave.