Saturday, August 23, 2014

Bárðarbunga Volcano Aviation Alert Raised To Red


# 8991



Over the past week Iceland’s second tallest (and arguably, most powerful) volcano has begun to stir after roughly a century of somnolence.  The Icelandic Met Office  upgraded the volcano’s aviation alert status to Orange on Monday, and since that time we’ve seen almost non-stop tremors indicating magma movement.


After a slowdown in tremors yesterday, overnight we’ve seen another spike in activity.   In the past hour a small eruption has been detected under the Dyngjujökull glacier, and the Aviation Alert code has been raised to RED.


Although this volcano has produced some monumental eruptions in the past, there is no way to know how big - or how small - this current event is likely to be.   For now, only local air traffic is impacted.


Apparently, volcano watching in Iceland is an activity akin to Hurricane watching here in Florida, and so there’s plenty of twitter activity using the hashtag  #Bárðarbunga.  But as always, Caveat Lector.


Most of the webcams are either badly slammed by those eager to get a glimpse, or out of service right now, but if you are very patient you might get a look at Live From Iceland.



This from the Icelandic MET Office.


  • Warning

    It is believed that a small subglacial lava-eruption has begun under the Dyngjujökull glacier. The aviation color code for the Bárðarbunga volcano has been changed from orange to red.

  • Specialist remark

    It is believed that a small subglacial lava-eruption has begun under the Dyngjujökull glacier. The aviation color code for the Bárðarbunga volcano has been changed from orange to red. Just now (14:04), an earthquake, estimated at magnitude of 4.5 was detected.
    Written by a specialist at 23 Aug 14:34 GMT

Bárðarbunga - updated information


Overview of seismic events in August 2014

In this article, updated information on the Bárðarbunga seismic activity is given with daily status reports from the scientist of IMO and the University of Iceland. New material is added to the top of the article. The original information is at the end of the article. All in all, this article gives an overview of events. For additional material, check also the news list on our front page.

23rd August 2014 14:10 - a small eruption under Dyngjujökull

  • A small lava-eruption has been detected under the Dyngjujökull glacier.
  • The Icelandic Coast Guard airplane TF-SIF is flying over the area with representatives from the Civil Protection and experts from the Icelandic Met Office and the Institute of Earth Sciences. Data from the equipment on board is expected later today.
  • Data from radars and web-cameras is being received, showing no signs of changes at the surface.
  • The estimate is that 150-400 meters of ice is above the area.
  • The aviation color code for the Bárðarbunga volcano has been changed from orange to red.
  • Some minutes ago (14:04), an earthquake occurred, estimated 4.5 in magnitude.

23rd August 2014 12:20 - notes from the scientists' meeting

Intense earthquake activity continues at the Bárðarbunga volcano – a situation that has persisted since 16 August.

During the last 6 hours the dyke has propagated ~5 km to the north. The rate of earthquakes has increased such that they are happening so quickly that it is difficult for the seismologist to discern individual events. Observed high frequency tremor is interpreted to be caused by the propagation of the dyke.

Some larger earthquakes of magnitude 3 - 4 have been measured in the Bárðarbunga caldera in the last days. These events in the Bárðarbunga caldera are interpreted as adjustments related to decompression in the caldera since the beginning of the unrest.

Most recent GPS data shows that magma flow is continuing.

The Coast Guard TF SIF aircraft is taking off by 13:00 to make observations with scientists from Icelandic Met Office, the Institute of Earth Sciences, and people from the Civil Protection.

A tourist plane called in at noon to report no visible changes at the surface.

Current winds: weak winds at low levels. At higher levels winds are northerly (towards the south).
Hydrological measurements at Jökulsá á Fjöllum, Upptypingar, do not indicate a contribution of geothermal/volcanic gases to the hydrological system that is outside of the typical range observed in the last decade.

The activity continues and an eruption can therefore not be ruled out.

The aviation colour-code for the Bárðarbunga volcano remains unchanged at ‘orange', and we are continuously evaluating if this should be changed. The volcano is exhibiting heightened levels of unrest.

CDC Updated Interim Guidance On Ebola


Credit CDC


# 8990


Over time, as the CDC gathers new evidence, their guidance documents on the handling of various diseases evolves.  We saw rapid evolution of advice during the first couple of months of the 2009 H1N1 pandemic, and we are seeing it now with the Ebola virus outbreak in West Africa. 


Often these changes are minor adjustments or clarifications, designed to make earlier guidance clearer.


Just over two weeks ago we saw the CDC Issue New Ebola Case Definitions, along with Interim Guidance for Monitoring and Movement of Persons with Ebola Virus Disease Exposure.  We took a closer look at the CDC’s risk groups in Ebola: Parsing The CDC’s Low Risk vs High Risk Exposures.


Although they incorporate only relatively minor changes, last night the CDC posted updates to both documents. 

The first involves the risks of exposure and the case definition for EVD. A side-by-side comparison with the previous guidance shows relatively minor changes,  mostly to the format, and to some definitions (i.e.. `Low risk’ = `some risk’). 

Case Definition for Ebola Virus Disease (EVD)

Updated: August 22, 2014

Early recognition is critical for infection control. Health care providers should be alert for and evaluate any patients suspected of having Ebola Virus Disease (EVD).

Person Under Investigation (PUI)

A person who has both consistent symptoms and risk factors as follows:

  1. Clinical criteria, which includes fever of greater than 38.6 degrees Celsius or 101.5 degrees Fahrenheit, and additional symptoms such as severe headache, muscle pain, vomiting, diarrhea, abdominal pain, or unexplained hemorrhage; AND
  2. epidemiologic risk factors within the past 21 days before the onset of symptoms, such as contact with blood or other body fluids or human remains of a patient known to have or suspected to have EVD; residence in—or travel to—an area where EVD transmission is active*; or direct handling of bats or non-human primates from disease-endemic areas.

Probable Case

A PUI whose epidemiologic risk factors include high or low risk exposure(s) (see below)

Confirmed Case

A case with laboratory-confirmed diagnostic evidence of Ebola virus infection

Exposure Risk Levels

Levels of exposure risk are defined as follows:

High risk exposures

A high risk exposure includes any of the following:

  • Percutaneous (e.g., needle stick) or mucous membrane exposure to blood or body fluids of EVD patient
  • Direct skin contact with or exposure to blood or body fluids of an EVD patient without appropriate personal protective equipment (PPE)
  • Processing blood or body fluids of a confirmed EVD patient without appropriate PPE or standard biosafety precautions
  • Direct contact with a dead body without appropriate PPE in a country where an EVD outbreak is occurring*

Low1 risk exposures

A low risk exposure includes any of the following

  • Household contact with an EVD patient
  • Other close contact with EVD patients in health care facilities or community settings. Close contact is defined as
    1. being within approximately 3 feet (1 meter) of an EVD patient or within the patient’s room or care area for a prolonged period of time (e.g., health care personnel, household members) while not wearing recommended personal protective equipment (i.e., standard, droplet, and contact precautions; see Infection Prevention and Control Recommendations)
    2. having direct brief contact (e.g., shaking hands) with an EVD case while not wearing recommended personal protective equipment.
  • Brief interactions, such as walking by a person or moving through a hospital, do not constitute close contact

No known exposure

Having been in a country in which an EVD outbreak occurred within the past 21 days and having had no high or low risk exposures

* As of 22 August 2014, countries with EVD outbreaks are Guinea, Liberia, and Sierra Leone. There are also cases of EVD in Lagos, Nigeria. For more information about specific districts where the EVD outbreak is occurring, visit:

1 For purposes of monitoring and movement restrictions of persons with Ebola virus exposure, low risk is interpreted as some risk. See

The second update, fleshes out the public Health response for those who may have have had an Ebola exposure, but who are currently asymptomatic.  The bottom line is:


At this time, CDC is NOT recommending that asymptomatic contacts of EVD cases be quarantined, either in facilities or at home.


For the purposes of this document, the following definitions are used:


Conditional release

Conditional release means that people are monitored by a public health authority for 21 days after the last known potential Ebola virus exposure to ensure that immediate actions are taken if they develop symptoms consistent with EVD during this period. People conditionally released should self-monitor for fever twice daily and notify the public health authority if they develop fever or other symptoms.

Controlled movement

Controlled movement requires people to notify the public health authority about their intended travel for 21 days after their last known potential Ebola virus exposure. These individuals should not travel by commercial conveyances (e.g. airplane, ship, long-distance bus, or train). Local use of public transportation (e.g. taxi, bus) by asymptomatic individuals should be discussed with the public health authority. If travel is approved, the exposed person must have timely access to appropriate medical care if symptoms develop during travel. Approved long-distance travel should be by chartered flight or private vehicle; if local public transportation is used, the individual must be able to exit quickly.


Quarantine is used to separate and restrict the movement of persons exposed to a communicable disease who don’t have symptoms of the disease for the purpose of monitoring.


Far less draconian than many people might expect, for either High or Low (some) risk exposures – as long as the person remains asymptomatic - the guidance simply recommends:


Conditional release and controlled movement until 21 days after last known potential exposure


It is a lengthy document, and so you’ll want to read it in its entirety on the website.  The decision chart can be expanded using the Chart icon at the bottom of the page.


Interim Guidance for Monitoring and Movement of Persons with Ebola Virus Disease Exposure
Updated: August 22, 2014

The world is facing the biggest and most complex Ebola virus disease (EVD) outbreak in history. On August 8, 2014, the EVD outbreak in West Africa was declared by the World Health Organization (WHO) to be a Public Health Emergency of International Concern (PHEIC) because it was determined to be an ‘extraordinary event’ with public health risks to other States. The possible consequences of further international spread are particularly serious considering the following factors:

  1. the virulence of the virus,
  2. the intensive community and health facility transmission patterns, and
  3. the strained health systems in the currently affected and most at-risk countries.

Coordinated public health actions are essential to stop and reverse the spread of Ebola virus. Due to the complex nature and seriousness of the outbreak, CDC has created guidance for monitoring people exposed to Ebola virus and for evaluating their travel, including the application of movement restrictions when indicated.

(Continue . . .)

The CDC also released an info service (lowest level) HAN Notice with an updated list of Ebola Resources:


HAN 367: CDC Ebola Response Update #3



Friday, August 22, 2014

WHO Ebola Update – Aug 22nd


# 8989



Ebola virus disease update - west Africa

Disease outbreak news
22 August 2014

Epidemiology and surveillance

Between 19 and 20 August 2014, a total of 142 new cases of Ebola virus disease (laboratory-confirmed, probable, and suspect cases) as well as 77 deaths were reported from Guinea, Liberia, Nigeria, and Sierra Leone.

Health sector response

Questions have been received in WHO Headquarters about the original proposed budget for the response and the new draft budget, which is being reviewed by partners. The increase in needed resources is based on improved data and understanding of the situation on the ground in the affected countries. The new estimation of costs is derived using a unit-cost model, built for the most intense transmission areas and reflects the average operational costs based on the current situation in the affected countries. The major assumptions for the cost estimates will be announced towards the end of next week.

WHO continues to receive reports of rumoured or suspected cases from countries around the world and systematic verification of these cases is ongoing. Countries are encouraged to continue engaging in active surveillance and preparedness activities. As of today, no new cases have been confirmed outside of Guinea, Liberia, Nigeria, or Sierra Leone.

WHO does not recommend any travel or trade restrictions be applied except in cases where individuals have been confirmed or are suspected of being infected with EVD or where individuals have had contact with cases of EVD. (Contacts do not include properly-protected health-care workers and laboratory staff.) Temporary recommendations from the Emergency Committee with regard to actions to be taken by countries can be found at:

WHO Ebola Messaging – Shadow Zones & Uncounted Cases


Credit CDC


# 8988


In every serious disease outbreak – in every nation of the world – there are always uncounted cases.  Sometimes, as with the H1N1 pandemic of 2009 or with our yearly seasonal flu, there are simply too many cases to test or count, and so we rely on estimates based on mathematical models.  

Often, mild cases of some diseases simply don’t seek medical help, and fall through the cracks, as the pyramid chart below illustrates.



But more ominously, particularly in under-developed regions of the world dealing with deadly illnesses, undercounts can result from serious deficits in their public health infrastructure, and a reluctance of people to come forward.


It has become increasingly apparent over the past month that the numbers we have on the Ebola outbreak in West Africa badly underestimate the true scope of the outbreak. Today, the World Health Organization weighs in on some of the reasons why the impact of this outbreak remains so difficult to quantify.



Twitter messaging From @WHO this morning.


This from an email sent to journalists.  I would expect it to be posted HERE at some point.


Why the Ebola outbreak has been underestimated

Situation assessment - 22 August 2014

The magnitude of the Ebola outbreak, especially in Liberia and Sierra Leone, has been underestimated for a number of reasons.

Many families hide infected loved ones in their homes. As Ebola has no cure, some believe infected loved ones will be more comfortable dying at home.

Others deny that a patient has Ebola and believe that care in an isolation ward – viewed as an incubator of the disease – will lead to infection and certain death. Most fear the stigma and social rejection that come to patients and families when a diagnosis of Ebola is confirmed.

These are fast-moving outbreaks, creating challenges for the many international partners providing support. Quantities of staff, supplies, and equipment, including personal protective equipment, cannot keep up with the need. Hospital and diagnostic capacities have been overwhelmed.

Many treatment centres and general clinics have closed. Fear keeps patients out and causes medical staff to flee.

In rural villages, corpses are buried without notifying health officials and with no investigation of the cause of death. In some instances, epidemiologists have travelled to villages and counted the number of fresh graves as a crude indicator of suspected cases.

In parts of Liberia, a phenomenon is occurring that has never before been seen in an Ebola outbreak. As soon as a new treatment facility is opened, it is immediately filled with patients, many of whom were not previously identified. This phenomenon strongly suggests the existence of an invisible caseload of patients who are not being detected by the surveillance system.

For example in Monrovia, Liberia’s capital, an Ebola treatment centre with 20 beds, which opened last week, was immediately overwhelmed with more than 70 patients.

An additional problem is the existence of numerous “shadow-zones”. These are villages with rumours of cases and deaths, with a strong suspicion of Ebola as the cause, that cannot be investigated because of community resistance or lack of adequate staff and vehicles.

In some areas, most notably Monrovia, virtually all health services have shut down. This lack of access to any form of health care contributed to the mobbing incident on Saturday at an Ebola holding facility in the West Point township, Liberia’s most disease-prone slum.

Rumours spread that the holding facility, hastily set up by local authorities in an abandoned schoolhouse, was actually a clinic for general health care. People from other communities brought their ailing family members there, where they were housed together with suspected Ebola patients.

The presence of patients from these other communities was resented by the West Point community, and this resentment contributed to the riot and subsequent looting, in which potentially contaminated materials were carried into these communities.

WHO epidemiologists in Sierra Leone and Liberia are working with other agencies, including Médecins Sans Frontières (Doctors without Borders) and the US Centers for Disease Control and Prevention, to produce more realistic estimates and thus communicate the true magnitude of needs.

WHO media contacts:
Gregory Hartl
Telephone: +41 22 791 4458
Mobile: +41 79 203 6715
Fadéla Chaib
Telephone: + 41 22 791 3228
Mobile:+ 41 79 475 55 56
Tarik Jasarevic
Mobile: +41 793 676 214

Meanwhile, Back In Vietnam . . . .


Credit FAO



# 8987



The FAO is reporting a third outbreak of the newly emerging avian H5N6 virus – this time on a Pheasant farm in Lao Cai Province.  This latest outbreak is nearly 300km distant from the closest of the two outbreaks reported last week (see  Vietnam Gears Up To Detect, Fight Avian H5N6), suggesting the virus is already widely dispersed.




Like the H5N8 avian virus, which appeared in South Korean poultry last January, H5N6 is a relatively new avian threat.  While low pathogenic versions of this virus have been reported in the past, it wasn’t until last spring did we see a highly pathogenic (HPAI) strain emerge – this time in Southern China.

And in that case – unlike H5N8 – there was a (fatal) human infection involved (see Sichuan China: 1st Known Human Infection With H5N6 Avian Flu).


Up until last week, we’d not heard any more about this upstart virus, and there were hopes it was a flash in the pan.  But over the summer two widely separated outbreaks were reported in Vietnam, and now we have a this third, more recent report.  


Both of these emerging avian viruses are related to the highly pathogenic H5N1 virus, which has infected more than 600 people over the past decade, killing roughly 60% of known cases.   In the case of H5N8, we know it is continuing to evolve, and now consists of multiple clades (see EID Journal: Describing 3 Distinct H5N8 Reassortants In Korea).


While less is known about the evolution of the H5N6 virus, the longer it remains in circulation, the more opportunities it will have to mix and match genes with other avian viruses (notably H9N2), and the better chance it will have to become firmly entrenched in the environment.


While we watch the Ebola outbreak in Africa, and wait to see if MERS-CoV has any ambitions this fall, it is important to remember that historically, the most efficient pandemic viruses have been influenza viruses. 


While we may not see another pandemic for years to come, right now we have no lack of contenders in the wild - H5N1, H7N9, H10N8, H5N6, H9N2 . . . . – to keep our eyes on.

Ireland: HSE Statement – Suspected Ebola Case Tests Negative


Credit Wikipedia



# 8986


Yesterday (see HSE Statement: Ireland Testing Deceased Traveler From West Africa) we saw an investigation launched into the death of a recently arrived traveler from West Africa.  Today, the HSE has announced that tests have come back negative for Ebola.


22nd August 2014

HSE Statement

The HSE has confirmed that laboratory test samples for an individual, who had recently returned from Africa, has proved negative for Ebola Virus.

Infection control procedures, which had been put in place as a precautionary measure, will now be stepped down.

The HSE expressed its condolences to the individual’s family and friends for their loss.


It has been widely reported this week that more than 5 dozen people have been recently hospitalized, and either examined or tested for Ebola in the United States.  


Of those, none have tested positive for the disease.


Frankly, this is exactly what we want to see.  Aggressive testing, an abundance of caution, and lots of negative results.   


With the threat of a return of MERS this fall with the Hajj, an expected resurgence of avian flu this fall and winter in Asia, and the ongoing Ebola outbreak in Africa – we need to be prepared to see a lot of `suspect cases’ being tested both here in the United States, and around the world.