Spain Investigates First Case of Ebola Infection Outside West Africa

The first case of Ebola transmission outside West Africa was under investigation at a Madrid hospital on Tuesday after a Spanish nurse who had treated two infected missionaries was herself found to have contracted the disease.

The nurse, a 40-year-old woman who has not been named, was one of around 30 medical staff who attended to Manuel Garcia Viejo and Miguel Pajaras at the capital's Carlos III hospital, to where they had been evacuated after catching the virus while working with patients in West Africa's outbreak zone.

The most recent case — and the most likely source of infection — was that of Garcia Viejo, 69, who contracted Ebola in Sierra Leone and died in Madrid on September 25. The nurse, who fell ill on September 30, had only twice gone into his room and both times was wearing full protective clothing. No accidental exposures were known to have occurred, medical staff said.

The European Commission has asked Spain for an explanation as to how she became infected despite all protocols apparently being followed.

Not only is the nurse is the first person in the world confirmed to have contracted the virus outside West Africa, the apparent manner of her infection, with no known physical contact with an Ebola sufferer, will concern medical experts studying the spread and mutation of the disease. It could also have serious implications for frontline efforts to treat and isolate patients.

David Evans, a virology professor at the University of Warwick told Britain's Science Media Centre that the case "is of concern as it suggests that the barrier methods and training were not sufficient to protect healthcare workers and prevent secondary infection."

The Ebola virus, which has killed some 3,400 people in the current outbreak — around half of all cases — is transmitted by direct physical contact with the bodily fluids of a symptomatic patient. But some experts have raised the possibility that as the strain mutates it could become airborne.

Anthony Banbury, the head of the United Nations Ebola mission, told The Telegraph last week that such a prospect was "a nightmare scenario" but could not be ruled out, in comments that drew criticism as irresponsible from some British virologists.

Looking Back at the First Ebola Outbreak As the Virus Continues to Spread. Read more here.

Antonia Alemany, Madrid's health care director, told reporters in the Spanish capital: "The nurse went into the room wearing the individual protection gear and there's no knowledge of an accidental exposure to risk."

However health workers who spoke to the Spanish daily El Pais raised questions over the efficacy of the protection being used. They said that instead of level 4 gear, which is completely impermeable and allows for independent breathing, the hospital was using just level 2 protection. The facility insisted the protective kit complied with Ebola protocols.

As officials in Madrid said that three other people had been hospitalised and were being monitored for the disease — the nurse's husband, a fellow health worker, and a traveler from Nigeria — health workers protested outside the Carlos III hospital, demanding the dismissal of the country's health minister and the hospital director over what they said was "inadequate and insufficient" management of the virus.

The incubation period of the West Africa Ebola period is from two to 21 days, according to the World Health Organization. The nurse had gone on holiday to an unknown location after Garcia Viejo's death and fell ill five days later on September 30. She was taken to a hospital in the south of the capital on Monday, where she tested positive for the virus, and was transferred to the Carlos III facility under a police escort on Tuesday morning.

The fight against Ebola. Part 2. Watch here.

The Alcorcan hospital where she was first admitted has identified twenty-one people including ambulance and medical staff with whom she had contact and is watching them for signs of the disease, El Pais reported. All 30 staff members at Carlos III who treated the infected missionaries are also being monitored. However, with a period of six days between the nurse's first symptoms and her presentation to hospital, authorities are also trying to track down others at risk of infection.

Health Minister Ana Mato attempted to calm an anxious populace over the risk of further contagion. "Each and every of the necessary measures are being taken to give the best case to the nurse and to guarantee the security of those who attend to her and all citizens," she said, adding that authorities were investigating whether the correct protocols had been strictly followed.

Mercedes Vinuesa, director-general of public health, told reporters that there was some danger the virus could spread though the country was not at great risk. "Risk is a probability, and this can never be zero. In the case of Spain, it is less than for other countries."

Last week a Liberian man was diagnosed with the virus in a Texas hospital days after flying in from Monrovia, in the first case detected outside the region. He had told airport officials that he had not come into contact with any Ebola patients; however family members later contradicted that claim, saying he had helped a stricken woman to hospital four days before flying to the United States.

On Monday, Barack Obama announced plans to begin screening incoming airline passengers. He said the risk to the US was "extremely low", but admitted "we don't have a lot of margin of error."

Follow Hannah Strange on Twitter: @hannahkstrange