[Start of Page 3 of the discussion]


I think your point is very important. In Ebola containment, we need to think of toilets that may be in bad condition also (built too long ago or not constructed properly, etc.,) - cleaning / disinfecting would be all the more difficult in such cases. If it is not possible to use disinfectant chemicals (because the discharge might get mixed with the compost / fertilizer to be added to the fields), there could be a risk of infection.

Taking all these factors into consideration, it might be best to adopt the normal cleaning procedure for the toilet with the proviso that users wash their hands and feet thoroughly with soap and water outside the toilet (preferably with the water going into a small hole in the ground so that there is no unsightly pool of dirty water stagnating near the toilet) and, after drying, to dust their hands and feet with antiseptic / germicidal powder.

The small hole should probably be not more than 1-1.5 feet deep and 1-1.5 feet diameter as the hole should not be large enough to allow children or small animals to get hurt while running and preferably be kept closed with a lid that will not break into sharp shards if someone stamps on it accidentally - maybe a plastic / rubber ring (eg., a used pressure cooker gasket) with brightly-colored plastic cover on it. Or, can always use bamboo like the ones used for making baskets to make the ring. Probably better solutions are available but I am just thinking of the most resource scarce situation possible and without the possibility of quickly distributing required materials.

A germicidal solution, like Dettol or Savlon, could also be used instead of germicidal powder (I do not have scientific evidence but if other proven options are not available, this could probably be used). Further, for public toilets, a good solution could be the arrangements MSF had made for the hospital in Kitwit (please see article referred by Joe) to have a footbath. Individuals going from one area to the other had to wade through a tray filled with disinfectant (Pedi-Luve or foot bath). The material used had been developed, adapted and tested by MSF during previous emergency situations. 0.2% Calcium Hypochlorite solution 70% was used for the footbath. Something similar could also be used in households, if possible.

Warm regards,

Sowmya

Friends - I want to say this carefully because I do not want anyone to get the wrong idea.

We have been talking about the risks of stored faeces, should we also be thinking about the risks associated with 'fresh' faeces from ebola victims?

It seems that there is little information about the risks of infection from faeces, but it also seems that one does not need to be exposed much of the virus to get infected.

Should we, therefore, be also talking about the risks of the toilet (delivery) part of sanitation systems?


[End of Page 2 of the discussion]

John Oldfield from WASHadvocates just shared the following blog post which looks to have some other interesting links
bloggingonwater.blogspot.co.uk/2014/10/e...and-hygiene.html?m=1

Roslyn, congrats on a very well-written summary of the discussion thread. I really loved reading it.

Please find below some additional points:

1. Soiled linen (of infected patients) disposal in household / community setting.
2. (i) Disposal of feces of infants and very small children admitted in isolation wards; (ii) where infants have cloth diapers and not disposable diapers, what is the protocol for management of soiled linen? Low-income households may not have the financial resources to dispose cloth diapers after each use, so soaking the cloth diaper in Dettol or Savlon is good practice (because it is anyway recommended practice)? In case Dettol or Savlon is not available, would phenol or sodium bicarbonate be more easily available and effective? (Please see Wiki page for list of commonly used antiseptics .]
3. How to ensure sanitation workers are fully informed particularly (i) where sanitation workers are employed by projects which are managed only locally and not connected to a municipal or panchayat committee and (ii) where some people undertake sanitation as a tradition / indigenous occupation? Any other situation where sanitation workers may not be connected to a system that can transfer information?
4. Information to households that maintain the toilets by themselves (for instance, shift an Arborloo, etc.,), how to ensure the right information reaches them?
5. The 2014 WHO Interim Guidelines for Management of Ebola does not have a section on sanitation. It would be great to have sanitation guidelines during Ebola epidemic. The guidelines could also have a format of records that could be maintained so that field information gets aggregated (at least for post-epidemic research) with adequate harmonization of terms, etc.
6. (i) How to clean sanitation equipment after use? (ii) would there be any difference in cleaning protocol for a shovel compared to motorized equipment?
7. Any factors to be considered with respect to toilets in airplanes and airports? Most planes have chemical toilets. As per the Wiki page on chemical toilets , a chemical toilet deodorizes the waste. Does deodorizing include disinfection? Also, what factors should be considered with respect to faucets in airport toilets ? Though, I guess, even if the faucets are not hands-free, using soap & water and closing the tap after washing hands with a clean paper towel would solve any problems provided there is adequate supply of paper towels.
8. (i) What factors need to be considered for toilets in train & bus stations which do not have chemical toilets and can have significant usage? (ii) What factors need to be considered in case of gatherings of people (like village shanties, melas, etc.,)?
9. Not sure if windrows are used in countries currently facing Ebola outbreak but where excreta is taken from the site for community composting elsewhere, how to prevent humans or animals from going near it? This could potentially be a problem if the windrows presently do not have fencing.
10. Significance of pest control to ensure pests do not carry infected excreta on them?
11. Any factors to be considered with respect to menstrual hygiene during Ebola outbreak?
12. Given that sanitation workers may be illiterate or not highly educated (compared to health professionals), should the communication and training strategy for sanitation workers be modified? If so, how?
13. In some communities, houses may be constructed near trees where fruit bats reside. Stepping barefoot on excreta of fruitbats has been found to be one of the transmission modes. How to clear animal droppings in the area surrounding households? In areas affected by the outbreak, do sanitation workers clean the common areas around houses? Any special considerations relating to handling of domestic animals (to prevent the virus from breaking the species barrier)?

Question 3: What are some options for dealing with excreta and avoiding open defecation / exposed fecal matter?

Instead of incineration, collect feces (in bags and place them without closing the lid) in a container and pour adequate quantities of bleach (or other appropriate disinfectant) into the container to immediately disinfect the excreta. Useful in places with no toilets (ie., only OD) or even in hospital settings where use of common toilets may present additional risk of disease spread. The flip side is that the chemically disinfected excreta cannot be used as organic fertilizer but this solution is only for places with no sanitation or particularly resource-constrained hospital settings. It can also be incinerated later.

Warm regards,

Sowmya

Thank you very much for the latest very detailed contribution Sowmya, including the resourceful links to further information!

I am also a member of HIFA , and have been following their recent thematic discussion on Ebola entitled: “HIFA discussion on Ebola: How can we more effectively meet the information needs of frontline health workers and the general public?”

They are holding the upcoming four webinars which may be of interest:

• 21st October: "Introduction: Response to learning and information needs for frontline health workers"
• 23rd October: "The health system: supporting frontline health workers"
• 28th October: "Community sensitization, mobilization and support; interactions with clients"
• 30th October: "Data to support effective response and case management"

And are currently discussing the following thematic discussion questions on their d-group :

• Question 1: What more can be done to ensure FLHWs are fully informed? Is there a role for SMS or short voice messages (e.g. for information and training)?
• Question 2: FLHWs are part of the local system of care; how can their experience inform health officials so they can respond more effectively and quickly to specific patient and health worker needs?
• Question 3: Can healthcare organizations design public information campaigns and use FLHWs to provide reliable actionable information for the general public on how to prevent Ebola and what to do in case of symptoms?

I have put together a summary of this SuSanA Forum discussion on Ebola to forward to HIFA, to contribute to their thematic discussion, and bring awareness that SuSanA is currently discussing Ebola from a sanitation perspective, and hopefully bring awareness of the connection to sanitation, as well as potential involvement of HIFA members who may be able to contribute additional information.

I have attached the summary document (also with a section of links to sanitation and Ebola) which I summarized based on this discussion topic (as of 15.10.2014), and focused around 5 questions which I felt have emerged from the posts of this discussion, and which I hope we can continue to discuss on in the forum as they all have a lot of room for expansion and information:

Question 1: What does sanitation have to do with Ebola?
Question 2: What information is available around the persistence of the Ebola virus in human faeces?
Question 3: What are some options for dealing with excreta and avoiding open defecation/ exposed faecal matter?
Question 4: Which factors need to be considered regarding handling of excreta?
Question 5: Which factors should be considered in the discussion of whether municipal sanitation workers at pump stations and at sewage treatment are at risk?

Please let me know if you have additional suggestions with forwarding this summary document on to HIFA. I hope that there may be some continued involvement and input from the sanitation sector in their thematic discussions and webinars, and likewise contributions from some of their members to the ongoing discussions here on SuSanA.
Thank you again for the information that has already been posted, and for additional information, links, articles etc. to come which highlight the role of sanitation in connection to Ebola.

Thank you,

Roslyn

[To provide an updated one-stop list of all Ebola resources posted on HIFA2015 and SuSanA, I will keep editing this message. Please check the date of update to know which resources have been added since your last visit. Thanks.]

Thank you for all the lovely articles posted in this thread. Very insightful and relevant. Please find below a list of Ebola-related information resources posted on HIFA2015 Forum. As several of our SuSanA Forum members are actively looking for scientific information related to Ebola, I thought this might be useful.

I have largely focused on ‘basic science’ related information and included other initiatives which I thought might be of interest to SuSanA members. Further, I might have missed some information resources posted on HIFA2015. My sincere apologies for any omission and please let me know of the same so I can include it in this list. Additionally, much of the descriptive text is copy-pasted from the email messages on HIFA2015 but I have not placed them within quotes, as required under anti-plagiarism guidelines, to make the content more readable.

A special thanks. Access to scientific publications is a much-debated topic in the health sector with strong arguments present for both sides of the debate (subscription versus open access). We owe a special thanks to the several journals and organizations that have responded to the Ebola outbreak by giving open access to Ebola-related scientific information despite the ongoing debate. And, I am sure all of you will be happy to know that UpToDate gave open access to two important articles after Dr. Neil, Moderator, HIFA2015, wrote to them.

Warm regards,

Sowmya



Ebola-related information resources:

I. WHO’s Ebola-related information & information for the public:
1. Information from WHO: URL: www.who.int/csr/disease/ebola/en/ for WHO website on Ebola, www.who.int/csr/disease/ebola/faq-ebola/en/ for WHO FAQs on Ebola and www.who.int/mediacentre/factsheets/fs103/en/ for media FactSheet on Ebola.
2. Ebola topic pages for the general public are available from MedlinePlus in English (www.nlm.nih.gov/medlineplus/ebola.html) and in Spanish (www.nlm.nih.gov/medlineplus/spanish/ebola.html).

II. Open science participative programs:

1. OpenIDEO fighting Ebola in collaboration with the Grand Challenge for Development. URL: openideo.com/content/fighting-ebola

III. Ebola-related information from national public health agencies:

1. Public Health Agency of Canada (PHAC): www.phac-aspc.gc.ca/lab-bio/res/psds-ftss/ebola-eng.php
2. US Center for Disease Control (US CDC): www.cdc.gov/vhf/ebola/
3. European Center for Disease Control (EU ECDC): www.ecdc.europa.eu/en/healthtopics/ebola...eak-west-africa.aspx
4. Informative website from South Africa with maps & graphs: www.ebola.org.za/

IV. Ebola-related information repositories and other information access programs:

1. Medbox: www.medbox.org/ebola-toolbox/viral-haemo...ers/preview?q=manson
2. New platform for Ebola resources: ebolacommunicationnetwork.org/ The site is coordinated by the USAID-funded Health Communication Capacity Collaborative and includes information resources for the general public, health workers and 'leaders'. For example, you can see several infographics of Ebola here:
ebolacommunicationnetwork.org/latest-mat...#!/resource_types=76 The collection includes 113 items in English, 12 in French and 2 in Portuguese. Please see footnote for more detailed description.
3. Please see the guide "Ebola Outbreak 2014: Information Resources" at disasterinfo.nlm.nih.gov/dimrc/ebola_2014.html. The guide is frequently updated and now has a section on "Situation Reports" and has added links to "Free Resources from Publishers."
4. Disaster Lit continues to add guidelines from CDC, World Health Organization and others; reports; government documents; factsheets and more. disasterlit.nlm.nih.gov/search/?searchTe...h.y=11&search=Search
5. The National Library of Medicine (NLM) Emergency Access Initiative, eai.nlm.nih.gov/, is available through October 17 for free access to 650 journals, 4,000 reference books and online databases to healthcare professionals and libraries affected by disasters. It serves as a temporary collection replacement and/or supplement for libraries affected by disasters that need to continue to serve medical staff and affiliated users. It is also intended for medical personnel responding to the specified disaster. EAI is not an open access collection. It is only intended for those affected by the disaster or assisting the affected population. If you know of a library or organization involved in healthcare efforts in response to the Ebola outbreak, please let them know of this service. Virology, epidemiology, and infectious disease textbooks have been the most popular.
6. The "Virus Variation: Ebolavirus Resource" for genome and protein sequences is now available from the NLM National Center for Biotechnology Information. www.ncbi.nlm.nih.gov/genome/viruses/variation/ebola/
7. Documents collated by One World Medical Network. URL: www.case.io/Documents-about-Ebola-LJ15xk...jcFSMGnd1JeExrutghEC You can view and download the documents with any computer, laptop, tablet PC and smart phone which is connected to the internet. Case.io works in areas with slow internet connections. Share the documents by using "send case" and add as many email addresses you want. You can use the platform free of charge for distribution of any documents concerning Ebola. Please send email to This email address is being protected from spambots. You need JavaScript enabled to view it. if you have further questions or need any further help.
8. Bioline platform (http://www bioline.org br) – research publications from the global south. All articles from journals published in 16 developing countries are free to all users. In the first 6 days of October, 115,082 full text articles were downloaded, showing that research from Africa and the other partner developing countries is very well used and visible world wide. Bioline has been operating for over 20 years and is recognised as a valuable resource for the distribution of quality research information from the developing world. Such data is essential for the advancement of science, since without the unique information from such countries, the global picture is incomplete.
9. HINARI: HINARI ( extranet.who.int/hinari/en/journals.php ) continues to play a major role. HINARI Programme set up by WHO together with major publishers, enables low- and middle- income countries to gain access to one of the world's largest collections of biomedical and health literature. Up to 13,000 journals (in 30 different languages), up to 29,000 e-books, up to 70 other information resources are now available to health institutions in more than 100 countries, areas and territories benefiting many thousands of health workers and researchers, and in turn, contributing to improve world health.
10. Search PubMed.gov Publications on Ebola: www.ncbi.nlm.nih.gov/pubmed/?term=ebola
11. Search ClinicalTrials.gov for Ebola: clinicaltrials.gov/ct2/results?term=ebola&Search=Search
12. Resources from Disaster Lit (including info from CDC and WHO): 1.usa.gov/1oZpqGK

V. Scientific journals that have made their Ebola content open access:

1. Lancet’s Ebola Resource Centre URL: www.thelancet-ebola.com. You are also encouraged to share your front-line experiences at www.thelancet-ebola.com
2. The New England Journal of Medicine (NEJM) Ebola Resources: www.nejm.org/page/ebola-outbreak
3. Two articles from UpToDate: www.uptodate.com/contents/diagnosis-and-...?source=related_link and www.uptodate.com/contents/epidemiology-p...arburg-virus-disease.
4. Global Health Knowledge Base newsletter (September 2014, Issue 56) – Ebola is now FREE online at: dmtrk.net/VZZ-1Q40V-4AY19T-P7X5S-1/c.aspx including a week's free trial to the Global Health database.
5. Content from CellPress: ebola.thelancet.com/cpress
6. Elsevier Virology articles: ebola.thelancet.com/elsevier-articles
7. Journals from Oxford University Press Publications on Ebola: www.oxfordjournals.org/en/our-journals/m...nd-health/ebola.html

VI. Ebola-related textbook content that has been made open access:

1. Chapter on Ebola and Marburg viruses in 18th Edition of Harrison’s ‘Principles of internal medicine’ URL: accessmedicine.mhmedical.com/content.asp...1§ionid=40726956

VII. Universities and organizations that have specific webpages of Ebola related content:

1. Bioethics Research Library at Georgetown University: bioethics.georgetown.edu/ebola/ (Articles describing key health sector discussions on Ebola)
2. Center for Infectious Disease Research and Policy (CIDRAP), University of Minnesota: www.cidrap.umn.edu/infectious-disease-topics/ebola
3. Doctors Without Borders URL: www.doctorswithoutborders.org/our-work/medical-issues/ebola
4. The Network for Public Health Law – Primer: Emergency Legal Preparedness Concerning Ebola Virus Disease: www.networkforphl.org/resources_collecti..._ebola_virus_disease
5. University of Pittsburgh Medical Center (UPMC) UPMC Center for Health Security – SEEK Forum: seekebolainfo.com/

VIII. Information posted by C4D Network (viz., Communication For Development Network)

1. @HealthCommCap: Infographics, prevention tips, key messages + more #health communication materials specific to #Ebola: bit.ly/1t09mbB
2. @claireekt: Register now - free teleclass on #ebola by @WHO expert @Sergey_Eremin 16 Sept 2014http://tinyurl.com/pdbs57h
3. @CDACN: Providing accurate info about #Ebola in W Africa. Listen 2 @BBCAfrica shows bit.ly/1kV8fed
4. @PStollICRC: #commisaid #ebola: our friends of @BritishRedCross organise a #mapthon to #map4ebola w/@hotosm & @TheMissingMaps - www.eventbrite.co.uk/e/humanitarian-open...-tickets-12691180663 ...
5. @HealthCommCap: Social and behavior change communication resources on #Ebola in the Health COMpass:http://bit.ly/1sYF2hU " so useful!
6. @BexThomas92 : Take a look at @OnOurRadar's interactive timeline of the story of Ebola, from the perspective of affected communities bit.ly/ebolatimeline
7. @GSMAm4d check out our interactive timeline compiled by SMS reports by our citizen journalists around Sierra Leone www.tiki-toki.com/timeline/entry/315694/...the-Ebola-Epicentre/ ...
8. @HealthCommCap : Together We Can Prevent Ebola by @CDCgov; project materials/examples #Ebola social and behavior change communication bit.ly/1sYF2hU
9. @HealthCommCap : Communication is critical in stemming the #Ebola outbreak; list of publicly available com. materials and resources: bit.ly/1sYF2hU

IX. Media initiatives posted by C4D Network:

1. @bbcmediaaction: New #radio shows join the fight against #Ebola in #SierraLeone: latest blog from @musasangarie in Freetown bbc.in/1t7KfUo #mediadev
2. @bbcmediaaction: Listen: a nurse who survived #Ebola and kept her family safe in #SierraLeone. From our new radio show bbc.in/1lkRlWz #c4d #commisaid
3. @bbcmediaaction: How radio is responding to #Ebola in #SierraLeone: our Africa director Caroline Ford on @bbc_world bbc.in/1lvL7n8 #commisaid
4. @bbcmediaaction: Uplifting account of a nurse's recovery from #ebola in Sierra Leone read:http://bbc.in/1qUfMXE & listen: bbc.in/1lt9T7k

X. Other initiatives and resources posted by C4D Network:

1. @K4Health: How to Make a Hit Song About #Ebola - theatln.tc/1C27y8j @TheAtlantic
2. @CDACN: Read how @TranslatorsWB helping to save lives with Ebola information in 4 local African languageshttp://bit.ly/1BKx5CM
3. @Internews is working to bridge the gap in information about Ebola in Guinea, Sierra Leone + Liberiahttp://goto.gg/projects/internews-west-africa/updates/ ...
4. Visit C4D Network at: c4dnetwork.ning.com/?xg_source=msg_mes_network

Volunteering:
If you are aware of medical professionals interested in volunteering in response to the Ebola outbreak, please refer them to the following:
U.S. Agency for International Development is registering expressions of interest and contact information from medical professionals. Contact information will be shared with U.S. government and non-governmental organizations.
www.usaid.gov/ebola/volunteers

CDC Safety Training Course for Healthcare Workers Going to West Africa in Response to the 2014 Ebola Outbreak
www.cdc.gov/vhf/ebola/hcp/safety-trainin...x.html?s_cid=cs_3923

Ebola Communication Network (ECN):
(accessible at URL www.ebolacommunicationnetwork.org)
The ECN is an online collection of Ebola resources, materials and tools from and for the global health community.

The ECN (www.ebolacommunicationnetwork.org) is populated with more than 120 resources, including not only SBCC materials like posters, brochures and infographics, but also Demographic and Health Surveys of affected regions, customized maps and peer-reviewed journal articles. The site is responsive to mobile devices and optimized for low bandwidth situations. It includes an RSS feed of Ebola-related news that is updated in real time.

ECN’s faceted search allows users to find materials based on language, type (e.g., public service announcements, posters, and fact sheets), topic (e.g., prevention, treatment, safe burial practices), audience (e.g., community health workers, governments, health care providers) and any other facets deemed necessary. Users can also upload their own materials, which are posted after a brief review process.

ECN continues to expand as new resources are added each day. Because it is built on an open-source platform, ECN can be enhanced with a host of new features as the crisis unfolds.

Those working in the fight against Ebola can use ECN to search and share resources, and help build the collection by uploading quality communication materials they have developed for use in the field.

The ECN was developed by the Health Communication Capacity Collaborative (HC3) with input from UNICEF, CDC, USAID, IFRC and WHO. HC3 is a USAID-funded project designed to strengthen developing country capacity to implement state-of-the-art health communication programs.


Updates on 9 Nov 2014:

1. How to conduct safe and dignified burial of a patient who has died from suspected or confirmed Ebola virus disease, WHO publication ( please see URL );

2. Drumbeat's publication on Ebola (Drumbeat is a newsletter published by Communication Initiative);

3. Grant opportunities for broadband internet access provided by NetHope ("This is a heads up for anyone whose organization is combating Ebola in Liberia, Sierra Leone, or Guinea and is having problems with Internet connectivity (a must have for social media for global health). My organization, NetHope, is offering $75,000 to $100,000 grants (including hardware, installation and three to six months of Internet service) to Ebola fighters in need of Satellite broadband Internet access due to working in areas with no access to a fiber network (see attached and below). Any international or national nonprofit organization responding to the Ebola crisis in Liberia, Sierra Leone or Guinea may apply and can apply for more than one grant.") Please read Monica Jerbi's message to HIFA2015 on 6 Nov 2014 titled "Broadband internet support to fight Ebola in Liberia, Sierra Leone and Guinea";

4. Ebola training videos from Medicines Sans Frontiers (MSF);

5. New guidelines: WHO updates personal protective equipment guidelines for Ebola response;

6. MSF Guidance for Android and iPhone ("For those with smartphones, you can install the free 'MSF Guidance' app by the Open Medicine Project from the app store. It includes the MSF guidelines on Ebola and Marburg"): (a) MSF Guidance for Android devices and (b) MSF Guidance for Apple devices ;

7. ALISON launched the free online course in Aug 2014 ' Understanding Ebola and How You Can Avoid It ';

8. WHO publication: Psychological First Aid during Ebola Virus Disease Outbreaks ;

9. Ebola Response Anthropology Platform ("We are a network of anthropologists from around the world providing advice on how to engage with crucial socio-cultural and political dimensions of the Ebola outbreak and build locally-appropriate interventions. One of our primary activities is to provide a rapid, anthropologically and locally informed advice service for policy and practice partners involved in the broader Ebola repsonse in West Africa. We are currently focusing in particular (but not exclusively) on five themes: Identification and Diagnosis, Care of the sick, Attending to the dead, Clinical trials and interventions, Preparedness of neighbouring/at risk countries") The website is temporarily hosted at URL and ;

10. IDS has also created a 'Hot Topic' on its website with links to various research outputs, blogs and other resources connected to its work on Ebola and zoonoses;

11. ESRC Steps Centre (based at IDS and the University of Sussex) hot topics page which can be found at this link which also includes many useful resources;

12. Ebola Resources website ("As an extension of our website on Disaster Relief Resources​ [ disaster-relief.org ], ​we​'ve just launched the Ebola Resources website [ ebolaresources.org]. It is an early draft; information will be cleaned up and updated​, content added and curated in the weeks and months ahead.");

13. BMJ's entire collection of Ebola related articles ( please see URL );

14. Cutting edge lecture on Ebola from Supercourse ("We have created a cutting edge lecture on Ebola for you to teach your students, share with your faculty and distribute to your friends. The Lecture has been translated by 20 scientific experts into Arabic, Chinese, English, Farsi, French, Hebrew, Japanese, Malay, Pashtu, Russian, Spanish and Urdu. It present the best possible scientific knowledge about this disease.");

15. Elsevier Provides Free Online Access to Medical Information for West African Countries Stricken with Ebola Outbreak ("The African countries that are part of this free ClinicalKey [www.clinicalkey.com/] access program include the four in West Africa currently affected – Liberia, Nigeria, Sierra Leone and Guinea – plus other African countries where the outbreak has the potential to spread, including Cameroon, Central African Republic, Ghana, Angola, Togo, United Republic of Tanzania, Ethiopia, Mozambique, Burundi, Equatorial Guinea, Madagascar and Malawi. All IPs originating from these countries will be granted free access for the next two months... Access to Elsevier’s ClinicalKey is IP-validated through West and Central Africa* for hospitals, institutional libraries and other healthcare entities supporting those battling the Ebola outbreak. Healthcare and disaster aid workers in West Africa will be able to access ClinicalKey by going to www.clinicalkey.com. Access will be valid for the next two months.");

16. BBC's Ebola WhatsApp service ("The service will provide audio, text message alerts and images to help people get the latest public health information to combat the spread of Ebola in the region. Content will be limited to three items a day, and the service will be in English and French. To subscribe, send 'JOIN' via WhatsApp to +44 7702 348 651. To unsubscribe, send 'STOP' via WhatsApp to the same number.");

17. Ebola articles from John Wiley & Sons ("John Wiley & Sons will provide free access to biomedical literature in support of the Ebola outbreak relief efforts in West Africa, aiding responders across the affected population... As part of this initiative, Wiley is partnering with the Emergency Access Initiative (EAI), which includes the National Library of Medicine, the National Network of Libraries of Medicine, and the Professional/Scholarly Publishing Division of the Association of American Publishers... For further information or questions regarding EAI resources, please email This email address is being protected from spambots. You need JavaScript enabled to view it., or call 1-888-346-3656 in the United States, or +1-301-594-5983 internationally. To view the site visit: eai.nlm.nih.gov/");

Did you get any response to this Arno?

Note good letter from Arno on Lancet ebola site.
Carol


Note by moderator:
You can see the letter that Carol means here on the right column in the comments section and I have also copied it below:
ebola.thelancet.com/

Sanitation?

Inadequate health care facilities is one central aspect and obviously the top priority. But what about the inadequate sanitation systems, including transport and treatment of faecal material? The % population using improved sanitation facilities in Guinea is 19% (11% rural), Liberia 17% (6% rural), and Sierra Leone 13% (7% rural) (WHO-UNICEF JMP, 2014). All three countries are off track from the MDG target for sanitation. The bigger battle is thus to safeguard the 25 million people in Sierra Leone, Liberia and Guinea plus the neighboring countries.

There are little data on resilience in sewage and low temperatures but the virus can remain virulent outside the body in bodily fluids for 6 days (CDC) and for 5 weeks at 4 degrees C according to www.ebola.org.za . Because sanitation coverage and functionality is so poor, most of the necessary protection will need to come from hand washing, treatment of drinking water, proper cooking of food and similar measures. Sanitation (containment and treatment) in the health care units where infected persons are being taken require secure toilet systems like dry (lime-treated) or incineration. Exactly how excreta and vomitus is being dealt with in the health care centres is a question.

Arno Rosemarin PhD
Stockholm Environment Institute
Sustainable Sanitation Alliance
www.forum.susana.org

Hello everyone, my virologist contact has sent me the following paper "Assessment of the Risk of Ebola Virus Transmission from Bodily Fluids and Fomites" jid.oxfordjournals.org/content/196/Supplement_2/S142.full

This might also give a useful method if anyone is considering testing faeces for the virus.

Joe
Nothing on the Lancet site about persistence in human faeces. Most of the research on viruses doesn't take up this question.

But the answer may lie in what happens with these viruses in bat guano, an important vector.
www.cdc.gov/Features/Bats/
www.ncbi.nlm.nih.gov/pmc/articles/PMC3559038/
www.ncbi.nlm.nih.gov/pmc/articles/PMC2639914/
www.sciencedirect.com/science/article/pii/S1879625712001861

And old churches are not immune to bat excreta either
www.bbc.com/news/uk-england-norfolk-27140007

As we find out more what is happening on the ground we will obviously share. Currently we are just putting together items for a 13 m container to send disinfectant, hand wash liquid and plastic (water) containers (among other things) to maintain hygiene to the highest possible level within the villages and chiefdoms where we work.

arno, have you seen anything in that Lancet coverage about the virus in faeces?