Infected EBOLA carriers escape quarantine hospital in the Democratic Republic of Congo


Image: Infected EBOLA carriers escape quarantine hospital in the Democratic Republic of Congo

A new and growing Ebola outbreak is hitting the Democratic Republic of Congo, and additional concerns have been raised as three infected people escaped their quarantine hospital, potentially infecting countless others.

The three patients had been quarantined in the northwestern city of Mbandaka, a port city with a population of nearly 1.2 million. Two of the patients have passed away, while a third has been found alive and brought back to the hospital for observation. Medecins Sans Frontieres said that two of the escapees had been brought by their families to a church to pray.

World Health Organization Spokesman Tarik Jasarevic told ABC News that while the incident was very concerning, it isn’t unusual for people to wish to spend their final moments in their homes with loved ones. WHO staff is now redoubling its efforts to track down everyone who might have come into contact with these patients.

The problem is compounded by the fact that Ebola is so easily spread. Exposure to the body, fluids, or even personal items of someone who has died from the disease can spread it easily, something that not everyone there is aware of. The WHO is working with community and religious leaders to get the word out in hopes of keeping infections to a minimum.

Another challenge is the fact that traditional practices in the area don’t match up with health recommendations, particularly when it comes to funeral practices. In addition, some of the rural population does not believe in Ebola in the first place and has no faith in the ability of Western medicine to help.

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Workers from the WHO and Oxfam are going door to door to let everyone know what hygienic precautions they can take to lower their chances of contracting the deadly disease. They’re also letting them know about symptoms to look out for, which include headache, muscle pain, fatigue, fever, diarrhea, vomiting, rash, and bleeding or bruising.

How far will the current outbreak spread?

Until recently, the current Ebola outbreak had been confined to the country’s rural areas, but it has now made its way to bigger cities like Mbandaka, where it has the potential to spread to many more people. The city’s location along the Congo River and its use as a transit hub is raising fears about just how far the outbreak could spread. The city of Kinshasa, which has a population of 10 million, is just downstream, and across the river is the Republic of the Congo’s capital, Brazzaville.

So far, 58 people have reported hemorrhagic fever symptoms in the country, although it’s likely that there are many more cases going unreported given the general mistrust of doctors in the country. Thirty cases have tested positive for Ebola, 14 are suspected, and 14 are considered probable. Some of the infected include health care workers. Twenty-two people have died so far in what is the country’s ninth outbreak since the deadly virus was first identified in 1976, and the outbreak only started earlier this month.

Experts have said that the outbreak has now reached a critical point, with the next few weeks indicating whether they’ll be able to keep the outbreak under control or if it will hit urban areas in full force. Health workers have a list of more than 600 people who are known to have come into contact with confirmed cases, and they are working hard to keep it from becoming a repeat of past outbreaks. One of the biggest Ebola outbreaks struck Guinea, Sierra Leone, and Liberia between 2013 and 2016, killing more than 11,300 people.

Sources for this article include:

DailyStar.co.uk

ABCNews.go.com

CBC.ca

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Ebola – This Is What You Are NOT Being Told.


There is something very, very important that the corporate media and public health officials are not telling you regarding the Ebola outbreak in west Africa.

The information I’m about to present here is frightening. There’s really no way around that. However, I request that you do your very best to maintain a calm state of mind. Right now in West Africa the worst Ebola outbreak in history is in full swing and is jumping borders at an alarming rate. Already it has spread to four countries, Guinea, Liberia, Sierra Leone and now Nigeria.

This latest jump into Nigeria is particularly serious since the infected individual carried the virus by plane to Lagos Nigeria, a city with a population of over 21 million. Doctors without borders has referred to the outbreak as “out of control”.

To make matters worse, there is something very, very important that the corporate media and public health officials are not telling you regarding this crisis. You’ll notice if you read virtually any mainstream article on the topic that they make a point of insisting that Ebola is only transferred by physical contact with bodily fluids.

This is not true, at all. A study conducted in 2012 showed that Ebola was able to travel between pigs and monkeys that were in separate cages and were never placed in direct contact. Though the method of transmission in the study was not officially determined, one of the scientists involved, Dr. Gary Kobinger, from the National Microbiology Laboratory at the Public Health Agency of Canada, told BBC News that he believed that the infection was spread through large droplets that were suspended in the air.

“What we suspect is happening is large droplets; they can stay in the air, but not long; they don’t go far,” he explained. “But they can be absorbed in the airway, and this is how the infection starts, and this is what we think, because we saw a lot of evidence in the lungs of the non-human primates that the virus got in that way.”

Someone pointed out that in medical terms, if the virus is transferred through tiny droplets in the air this would technically not be called an “airborne virus”. Airborne, in medical terms would mean that the virus has the ability to stay alive without a liquid carrier. On one hand this is a question of semantics, and the point is well taken, but keep in mind that the study did not officially determine how the virus traveled through the air, it merely established that it does travel through the air. Doctor Kobinger’s hypothesis regarding droplets of liquid is just that, a hypothesis. For the average person however what needs to be understood is very simple: if you are in a room with someone infected with Ebola, you are not safe, even if you never touch them or their bodily fluids, and this is not what you are being told by the mainstream media. Essentially I am using the word “airborne” as a layman term.

Now I’m not going to speculate as to whether these so called “journalist” and public health agencies who keep repeating the official line regarding the means of transmission are lying, or are just participating in some massive display of synchronized incompetence, but what I will say, is that this shoddy reporting is most likely getting people killed right now, and may in fact put all of humanity in danger.

How so? By convincing people that the virus cannot travel through air, important precautions that could reduce the spread of the virus are not being taken. For example the other passengers on the plane that traveled to Lagos, Nigeria were not quarantined.

According to the AP and the BBC, Patrick Sawyer, the Ebola infected man who traveled to Lagos Nigeria by plane, passed the disease on to eight health workers before being properly isolated. Nigerian health authorities acknowledged Tuesday that they did not immediately quarantine a sick airline passenger who later died of Ebola, announcing that eight health workers who had direct contact with him were now in isolation with symptoms of the disease. In spite of the seriousness of this disease, and in spite of the fact the fact that the BBC itself covered a study in 2012 that demonstrated that Ebola can spread through the air, no one in the corporate media has budged from the official line regarding transmission.

The AP’s spin on it: Experts say people infected with Ebola can spread the disease only through their bodily fluids and after they show symptoms. From CNN: Ebola spreads through contact with organs and bodily fluids such as blood, saliva, urine and other secretions of infected people. And from the BBC itself in their article describing the second confirmed case in Nigeria: The virus spreads by contact with infected blood and bodily fluids – and touching the body of someone who has died of Ebola is particularly dangerous. To put this into context, Ebola kills between 50% and 90% of its victims, so the stakes are very, very high here.

We have reported on the fact that Ebola can spread through the air in three separate articles since March of 2014, here, here and here, however the corporate media has continued to misrepresent the vectors of transmission.

IMPORTANT UPDATE: August 13th: The CDC has admitted that the Ebola virus can travel through air, but they made that admission in a very sneaky and hard to find manner. The following statement is added as a footnote at the very bottom of the page: Casual contact is defined as a) being within approximately 3 feet or within the room or care area for a prolonged period of time while not wearing recommended personal protective equipment or having direct brief contact (e.g., shaking hands) with an EVD case while not wearing recommended personal protective equipment. The implication of this statement is very, very clear: Ebola DOES in fact travel through the air. This is critical information and it should be highlighted in large letters on every page, but instead it is tucked away in fine print where many won’t look. Given the fact that the CDC previously was running infographic campaigns claiming that Ebola does not travel through the air (see image below) this is highly irresponsible on their part. Hat tip to the Pontiac Tribune for making us aware of this information in their article on the topic. Note we saved a cached version of the CDC page just in case they decide to alter the text in the future. Furthermore, if the official vectors of transmission are accurate, please have them explain how 170 of their aid workers have been infected in spite of being covered from head to foot with protective gear? This particular strain of Ebola is not Ebola Zaire. This is a new strain, and it may in fact be more dangerous than the Zaire variety. Not because of any difference in the symptoms (the symptoms are identical), but because this new virus seems to be harder to contain. Whether this is due to some characteristic of the virus itself or merely dumb luck is uncertain at this time, but the rate at which this outbreak has extended its range is unprecedented. According to the CDC this virus is genetically 97% similar to the Zaire strain. However if you are interested in this virus’ phylogenetic relationship (genetic lineage) to the Zaire strain you should look read “Phylogenetic Analysis of Guinea 2014 EBOV Ebolavirus Outbreak” on plos.org. Another study by the New England Journal of medicine (this was the one referenced by the CDC) specifically names the parts of the genetic code which differ: The three sequences, each 18,959 nucleotides in length, were identical with the exception of a few polymorphisms at positions 2124 (G→A, synonymous), 2185 (A→G, NP552 glycine→glutamic acid), 2931 (A→G, synonymous), 4340 (C→T, synonymous), 6909 (A→T, sGP291 arginine→tryptophan), and 9923 (T→C, synonymous). Note that there doesn’t yet seem to be a consensus as to what this new strain is called. One study referred to it as “Guinean EBOV”, another as “Guinea 2014 EBOV Ebolavirus” and others are still referring to it as Zaire. Given that we can specifically name the points where the virus has mutated, using the old name is misleading. Right now the question on everyone’s minds is whether this virus will spread outside of Africa. Considering the fact that Ebola has a three week incubation period, can travel through the air, and has already hitchhiked onto an international flight, this is a very real possibility. There are some that are downplaying the probability of this outcome, and to be honest, I hope that they are right, but the simple fact of the matter is that these people are basing their assessment on the faulty premise that Ebola is not an airborne virus. Now the first thing you might be feeling when looking at this situation is a sense of fear and helplessness, and while that’s a perfectly normal reaction it’s really not helpful. Instead we should be thinking in terms of practical steps we can take to influence the outcome. One thing we can all do is to start confronting journalists and public officials who keep making false statements regarding the way Ebola spreads. Use the links to the original study, the BBC report from 2012 and this video to put them in their place. We also need to confront the fact that there isn’t a full out, coordinated, international effort to contain this. This is being treated like a sideshow but it has the very real potential to become a main event. The doctors on the ground in West Africa don’t have enough staff or resources to deal with this situation. It is absolutely inexcusable for the U.S. and the E.U. to be investing billions of tax payer dollars into their little power games in Ukraine and Syria (which are both in the process of escalating right now by the way) while Ebola is getting a foothold in Africa. Every available resource should be shifted to West Africa in order to contain and extinguish this epidemic right now. This is serious. Call them, write them, heckle them in the streets if you have to, but don’t allow them to ignore this issue. Make it impossible for them to pretend later that they didn’t know. Now whether or not official policy towards the Ebola crisis changes there are some precautions that you should take right now for yourself and your family. 1. Know where you would go if you needed to leave your home on short notice. If Ebola escapes Africa the last place you want to be is in a densely populated metropolitan area. It may be that the most practical destination for your family would be a rural area near your current home, but if you already have concerns about the government you are living under, and how they may handle a crisis like this, then you might want to start looking at alternatives. Finding an alternative location that suits your family’s needs is something that requires a lot of time and research, so don’t put this off. The primary characteristics you should be examining in an alternative destination are geography , political environment, climate, population density and visa terms and requirements. Ideally you would want to end up somewhere that is geographically isolated to some degree. 2. If you don’t have passports for yourself and each of your dependents, get them now. This is not to say that you should leave your country, but you should have the means to do so. In countries where the Ebola outbreak is underway it is getting harder and harder to exit. Borders are being closed down. Flights are being cut off. This didn’t happen right away, but you definitely don’t want to be waiting for your passport to show up if Ebola arrives in your city. 3. Know what you would carry with you if you had to leave on short notice. Have those items ready, and have the luggage to carry them. It would be wise to consider buying a pack of surgical masks as part of this. Now if you think about it, these preparations are wise steps to take regardless of whether the Ebola situation deteriorates or not. Knowing where you would go in an emergency, and having the means to get there on short notice is important for a wide variety of situations. The civilian population of Iraq, Syria, east Ukraine, and Gaza can attest to that. Whatever you do don’t let fear take control of your mind. Take the steps you can take now, monitor the situation calmly, and be prepared to adapt if necessary. [UPDATE July 31st]: A number of people have requested that I comment on the fact that the Americans infected by Ebola are right now being flown into the U.S. My personal opinion is that this particular move will not lead to the virus getting out. This event is going to be highly scrutinized, and the isolation security should be at max. The real danger isn’t in these highly controlled transfers and quarantines, but rather in the ongoing flow of air travel from these regions. Thirty five countries are merely one flight away from an Ebola zone right now. Why is this random air travel more dangerous? Because if it gets in when people aren’t looking, it can spread before containment measures are put into place.

[Update September 30th] The U.S. just had its first confirmed case of Ebola in Dallas today. You should definitely keep an eye on the situation. Ebola is spreading exponentially at this point in west Africa. The number of cases are doubling every three weeks. As the number of infected increases in the hot zone the odds of new cases arriving in the U.S. or Europe increase as well. |

Watch the video. URL: https://youtu.be/JnQVUf775VE

Where Does Ebola Come From?


New clues from Guinea yield tantalizing pieces of the puzzle .

The hollow Cola tree growing in a remote area of southeastern Guinea was once home to thousands of bats routinely hunted and killed by the neighborhood children. It was also a popular spot to play. A year ago, one child in particular lived within fifty meters of the tree: a two-year-old boy who died in December 2013 and later was identified as the first person in west Africa known to have developed Ebola. The tree was one of the few that loomed over his home village of Meliandou, a hamlet of 31 houses. The question that now haunts researchers: were the tree’s occupants behind how that small boy contracted the virus in the first place?

Yet they will never know the answer. By March, Guinean health officials were told that they had an Ebola outbreak on their hands and alerted the public to halt any consumption of bushmeat. Either by coincidence or as a result of that public warning, that tree was burnt down. Thousands of dead bats rained down on the community, but all researchers were left with in the weeks that followed were fragments of bat DNA. By the time a German research group arrived to conduct tests in April 2014 the tree was gone. No bats were left, and thus no answers.

Their scientific sketch of the village is reported in a new study published today in the journal EMBO Molecular Medicine. The fire may have helped keep the virus from spreading but it was also a blow to the research team, which had hoped to test the bats for genetic markers of the Ebola virus. If they had found signs of the virus it would indicate the bats had acquired Ebola, even if they were not necessarily responsible for transferring it to humans. But the fire foiled their plans since no such Ebola genetic information could be garnered from the remains of charred bat. And, making matters worse, there were no other representatives of the same bat species in the area, says Fabian Leendertz, lead author of the research team from the Robert Koch Institute in Berlin, Germany.

The fire was “really unfortunate since we can never pinpoint if [that bat species] was really the reservoir or not,” says Leendertz. His team was able to identify the species of the bat by conducting genetic analysis on fragments of bat DNA – mostly stemming from bat feces – located in soil in and around the tree, but they could not get any information on the virus from those traces of genetic material. The team also culled other bat species from the area, but found those other bats were all Ebola-free. Leendertz was left with only circumstantial evidence to indicate that the insect-eating bat species, called Mops condylurus, may be a candidate to explain how humans contracted Ebola in the first place. “It’s probably the best we can get but we are very unhappy with the data,” he says. And so the search to identify the carrier – or perhaps carriers – of Ebola continues.

Exactly which creature may transfer the Ebola virus to humans has bedeviled scientists since the virus was first identified in 1976. Myriad setbacks, usually related to slow response and notification, have kept scientists from pinning down an answer. Bats have remained a top Ebola carrier suspect because other experimental data have shown that bat species – including the one located in the massive hollow tree in this village – can survive infection with Ebola in the laboratory. But that alone is not definitive since a creature could survive such infection without being the carrier for the disease. In order to better prove that the correct bat reservoir had been identified, the virus would need to be isolated from a bat and grown in a laboratory setting. Still, there are clues that suggest that Mops condylurus could be a strong candidate. This same species of bat was considered a possible suspect for an earlier Ebola virus outbreak. And most scientists believe a close cousin of Ebola, called Marburg virus disease, is transmitted by bats—an observation that bolsters bats’ credentials as the potential animal reservoir for the Ebola virus.

Yet even if bats are the true culprit, researchers still don’t know how the animals transmit the virus to humans. Does the transmission of virus occur when blood spatters into the eyes or cuts during butchering of the bat? Or, perhaps it’s by eating food that the bat had sullied with its own spit, urine or feces? Then again, it could be through some other exposure to the bats’ bodily fluids.

Unraveling these mysteries could save lives. With such information, “I think it will be possible to prevent [Ebola cases] from happening,” says Gary Kobinger, head of the special pathogens program at the Public Health Agency of Canada. Yet getting such answers is enormously complex. “You are looking for this one rare event and trying to understand this one rare event in context and put together the circumstances that lead to this,” he says. “It’s hard to predict because you have to synchronize it with an outbreak.”

One problem in the quest to identify the virus: timing. After a human outbreak is contained researchers usually only then expend resources to go into the field and spend time catching bats, rodents or arthropods they believe may be behind the outbreak. Part of the delay is logistical – it takes time to set up a research team, find contacts to work with in the field and be notified about the outbreak in the first place. Researchers also want to take precautions to keep themselves and the community they are working in safe. And there’s also the matter of ethics and devoting limited resources to protecting human lives. But, with that understandable delay, you could risk missing some information. The risk is “you could miss breeding seasons, humidity or other factors. If you wait you might not find the same thing you could have if you looked right when you had the first introduction of disease,” says Ebola expert Daniel Bausch of Tulane University.

There are other intangibles that have to be weighed when conducting research in such an emotionally charged atmosphere during an outbreak. For example, coming in to do research during the epidemic could lead to misunderstandings and endanger researcher safety. Those types of cultural misunderstandings were on Leendertz’s mind when he was collecting other bat species from Meliandou and elsewhere in Guinea last April. “We don’t want to risk any new rumors coming out,” he toldScientific American in an interview. “Normally we only take blood and small samples and release the bats again but in this case we needed to kill them because people may say ‘look at those white people releasing bad bats.’ We can’t give them any reason to speculate in that sense.”

Trapping bats is no easy feat. Often researchers set up massive nets that resemble volleyball nets with pockets made of netting. The bats fly into the net and then drop into a pocket where they are later collected by human researchers wearing protective equipment, dissected and studied. Researchers may spend weeks trapping hundreds of bats but only catch a small number of various species. Making matters worse, maybe only a fraction of a percent of those bats are infected. And even if they are infected that still would not prove they are the animal reservoir for the virus. “It’s laborious work and it doesn’t lead to easy answers,” says Bausch, who did such work trapping bats to better understand the Marburg virus in the Democratic Republic of the Congo. For his part, Kobinger says that he doubts that Ebola researchers will wait until the massive epidemic is over to get at some of these answers. Instead, he says, the better time to do further animal testing for Ebola will be as the outbreak is in its final stages, which he says will likely be in the coming six to twelve months. But there’s no guarantee, no matter when they go, that researchers will get the answers they’re looking for; even though the Leendertz research team only took a few months to get to the field, it still proved too late.

The new work from Leendertz falls short of fingering the bat species that may be behind Ebola, but it does shed light on other circumstances around the outbreak.  His team also found it’s unlikely that primates – another top candidate for the animal reservoir title – were behind this outbreak. In that small village in Guinea there was no large game to be hunted and any bushmeat consumed there, he found, was packaged and sent there from elsewhere. His team’s tracking of Great Apes living in the area also found there had been no recent drop in their numbers. Those observations suggest there was no outbreak among the local primates of a lethal disease like Ebola, Leendertz says. Beyond primates and bats, however, there still could have been another creature fueling the outbreak that his team and others may not have even thought of, he says. So for now, the mystery remains.

Insect-eating bats implicated as Ebola outbreak source


Tree in Guinea harbored suspects in infection of first victim

A hollow tree

GROUND ZERO  This hollow tree once housed insect-eating bats that may have been the source of the Ebola epidemic. The first person to contract Ebola in the outbreak was a toddler who often played in the tree.

The epicenter of the Ebola epidemic may be a hollow tree in Guinea.

A 2-year-old boy named Emile Ouamouno, who is thought to be the first person to contract Ebola in this outbreak, often played with other children in the hollow tree near his home in the village of Meliandou, Guinea. That tree was inhabited by small insect-eating free-tailed bats of a species (Mops condylurus) that previous research has suggested may harbor Ebola, Fabian Leendertz of the Robert Koch Institute in Berlin and colleagues report December 30 in EMBO Molecular Medicine.

 

Ebola raises profile of blood-based therapy


Convalescent plasma therapy is trialled to fight Ebola, but could also be used for new and emerging pathogens.

Survivors of Ebola carry antibodies that might be used to save the lives of those infected with the virus.

With no drugs available to treat Ebola, eyes are turning to a therapy that had largely been relegated to the history books: transfusing patients with blood plasma donated by survivors, which contains antibodies against the virus.

  • Clinical trials of convalescent plasma therapy (CPT) have started in the past few weeks in Liberia, and are due to begin soon in Guinea and Sierra Leone. If the therapy saves lives, the approach could quickly be scaled up.

Success would also raise awareness of CPT’s potential to treat other new and emerging infectious diseases for which there are no readily available effective drugs or vaccines, such as SARS, avian influenza and Middle East respiratory syndrome (MERS). “Clinical trials of convalescent plasma should be considered in other emerging infections,” says David Heymann, an infectious-disease researcher at the London School of Hygiene and Tropical Medicine, and chair of Public Health England.

Many scientists have long argued that CPT has been wrongly neglected, both as a therapy for emerging diseases and in preparation for future unknown threats. Today, the approach is gaining ground. Trials of convalescent plasma are beginning for the treatment of patients with MERS, which has infected 938 people and killed 343 of them since it was discovered in 2012. And an international protocol aimed at removing hurdles to quickly rolling out trials of convalescent plasma has recently been drafted.

Convalescent plasma was found to effectively treat diphtheria and tetanus at the end of the nineteenth century, and was widely used in the first half of the twentieth century to treat diseases such as measles, mumps and pneumonia. But it fell off the radar after the development of antibiotics, antiviral drugs and vaccines. (An exception was the adoption of CPT in Argentina for Argentine haemorrhagic fever after a successful controlled trial in the 1970s.)

When available, drugs and vaccines are usually a better option. They are easier to mass-produce and administer, and their quality and dosing can be better controlled. CPT is more complicated — it requires collecting survivors’ blood, screening it for pathogens and then organizing patient transfusion. And standardizing batches of plasma is difficult, because antibody levels in donated blood can vary widely.

But an epidemic or pandemic of a new pathogen turns that logic on its head. As in the case of the Ebola epidemic, there are typically no drugs or vaccines available, and developing these usually takes years. By contrast, “convalescent plasma is one of the few things you can get up and running quickly”, says Calum Semple, a paediatrician and clinical virologist at the University of Liverpool, UK, who is involved in the Guinea Ebola trial. Trials for Ebola and other emerging diseases “should have happened years ago”, he adds. He points out that the therapy is often considered old-fashioned and that there are neither big profits to be made nor cutting-edge-science interests at stake. “Convalescent plasma is not attractive to pharma, or the modern model of academia,” he says.

Results from the first safety and efficacy trials in West Africa are expected within weeks. If the therapy is effective, many of the thousands of Ebola survivors there will be potential donors, each capable of giving up to one litre of plasma every two weeks.

There is also growing evidence to support the broader testing of CPT. A 2006 review of 8 studies carried out during the 1918 flu pandemic1, and a review published last July of 32 studies on SARS or severe influenza2, both suggest that plasma can be an effective treatment. And a 2010 modelling study3 concluded that in a full-blown flu pandemic, the infrastructure of developed countries could probably harvest sufficient plasma from survivors for population-wide treatment of the ill. “It’s not the be-all and end-all, but it is certainly a potentially power­ful and effective tool to add to our armamentarium,” says Stephen Hoffman, a co-author of the 2006 review and chief executive of malaria-vaccine company Sanaria in Rockville, Maryland.

Even relatively poor countries often have a good-enough infrastructure for processing blood to use the therapy, says Heymann, who was part of the team that fought the first Ebola outbreak in the Demo­cratic Republic of the Congo in 1976. Plasma extraction can also be done in the field, he adds.

Adequate screening for pathogens in donated blood can be an issue in poorer countries. In the CPT Ebola trials, a chemical is being added to the donated blood. When the mixture is exposed to ultra­violet light, the compound irreversibly crosslinks the DNA and RNA of pathogens, preventing their replication.

It is also getting easier to test CPT more broadly. The International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC), a network of researchers based in Oxford, UK, was set up in 2011 to accelerate clinical research during outbreaks. It has now drafted a protocol for clinical trials of CPT that regulatory bodies can approve before an outbreak starts, allowing trials to be quickly carried out if necessary.

The protocol is being used in the Ebola trials and in clinical trials of CPT for MERS. These have begun in 20 patients in Saudi Arabia, and a larger trial of several hundred is planned over the next few months, says Yaseen Arabi, a physician and researcher at King Saud Bin Abdulaziz University for Health Sciences in Riyadh, who is coordinating the trials in collaboration with the World Health Organization and ISARIC. “Given the severity of illness and the lack of proven therapy, convalescent plasma has the potential of making a substantial difference,” says Arabi. “However, this needs to be tested.”

Blood Transfusions from Survivors Best Way to Fight Ebola


Treating Ebola patients with blood transfusions from survivors of the disease should be the immediate priority among all the experimental therapies under consideration for this outbreak, World Health Organization (WHO) experts said Friday after reviewing the status of all the potential experimental therapies and vaccines. “We agreed that whole-blood therapies and convalescent serum may be used to treat Ebola virus disease and that all efforts must be invested into helping affected countries use them safely,” Marie-Paule Kieny, assistant director general for health systems and innovation at WHO told reporters. “This is something that would be ready near term.” None of the considered Ebola regimes have yet been adequately tested in humans.

Because survivors of an Ebola infection would typically have produced effective antibodies against the virus (otherwise they wouldn’t have survived), transfusions of their blood into a newly infected individual may help that person survive the often fatal disease. Such blood preparations, drawn from volunteers, could be ready before the end of 2014, according to preliminary WHO estimates put out earlier this week. “We have to change the sense that there is no hope in this situation to a realistic hope,” Kieny said during a press conference Friday. She has called for other countries to help affected west African nations to build their capacity to safely do the blood drawing and preparation for what needs to be reinfused into the patients.

Such blood transfusions have not yet been systematically studied in humans for Ebola (although such transfusions have been used in limited circumstances including, reportedly, when U.S. physician Kent Brantly was infected with Ebola in Liberia and on others during an earlier outbreak elsewhere in 1995). Moreover, levels of Ebola fighting antibodies are not uniform in different people and some experts have even speculated that such transfusions could potentially do harm. Still, WHO experts concluded that this is the best approach because it is theoretically feasible to recruit large numbers of Ebola survivors, collect blood from them, screen it for disease and use it to potentially help patients. The edict, from some 200 experts and scientists at WHO headquarters in Geneva, was a follow-up to an earlier Ebola ethics review last month that concluded it would be ethical to give patients experimental therapies when and if they are available.

Meanwhile the two potential Ebola vaccines, currently in clinical trials, will have initial safety data in November 2014. If proved safe, they should immediately be first given to health care workers and other front line staff like burial and sanitation workers, the WHO experts concluded.

The news came on the heels of public statements from top United Nations officials that underscore how challenging it will be to contain the disease in the coming months. A scale-up of the Ebola response is needed at “three to four times” what is currently in place and would take at least $600 million and perhaps a lot more to contain it, David Nabarro, head of the U.N. response to the Ebola outbreak, told reporters on Wednesday. Such a surge of funds and resources—higher than earlier estimates—seems unlikely to materialize fast enough to contain this virus even as new cases erupt in west Africa.

Moreover, any hope of quickly quelling the Ebola outbreak was all but extinguished earlier this week when WHO announced that the virus had spread to Port Harcourt, Nigeria’s oil hub. The grim report confirmed that three individuals were infected in the southern Nigerian city—meaning the outbreak had spread beyond Lagos and the country has now had 21 cases. And more than 200 contacts from the new cases are now being monitored for signs of the disease. So far there have been 1,841 reported Ebola deaths from this outbreak and more than 3,000 cases. WHO estimates suggest the virus will not be contained until 2015. The outbreak is also continuing to spread in Guinea, Sierra Leone and Liberia. In nearby Senegal only one case has been confirmed so far and WHO indicates there have been no reported Ebola deaths or other suspect cases there. And a separate small outbreak has also surfaced in the Democratic Republic of the Congo, in central Africa. “We can and we will bring the Ebola epidemic under control,” Margaret Chan, director general of WHO, said earlier this week. Yet exactly when and with what resources, by all accounts, remains unanswerable. “This Ebola epidemic is the largest and most severe and most complex we have ever seen in the nearly 40-year history of the disease,” she said.

Shortages of everything from medical personnel to protective gloves to beds for patients have riddled the response to this outbreak. Moreover, patients in many communities, either knowing that there are a lack of beds or transport to get them to a care facility or due to distrust of the medical system, have been reluctant to leave their homes—leading to further spread of infection among their families and friends who care for them without proper protective equipment. An additional 980 Ebola treatment center beds are required right now, with 760 of these for Monrovia, Liberia, alone, WHO says. Chan said that foreign medical teams willing and able to deploy to west Africa have also been scant, hindering the response.

The hard-learned lessons from earlier Ebola outbreaks—early case identification, communicating how to protect oneself and tracking all people who may have been exposed—are challenging to apply in this epidemic, which is hobbled by poor health infrastructure, the massive scale of the outbreak and little funding to mount a comprehensive response. If even one person who encountered bodily fluids of an Ebola patient is missed by surveillance, he or she can go on to infect family, friends and medical personnel. WHO has estimated it will take anywhere from six to nine months to contain the outbreak that will likely claim another 20,000 lives.

This week the U.S. Department of Health and Human Services announced it inked a contract with the makers of ZMapp—the experimental Ebola drug administered to a limited number of patients—to support their work. The drug has recently proved successful at treating the virus in monkeys. With the initial contract of $24.9 million over the next 18 months, Mapp Pharmaceutical will manufacture a small amount of the drug for early-stage clinical studies to demonstrate its safety and efficacy in people.

The WHO expert panel that convened on Thursday and Friday considered the outlook for at least another seven potential Ebola therapies beyond ZMapp, but none of the options have yet proved effective at treating Ebola in humans. One option that has already netted U.S. Food and Drug Administration approval for emergency use in Ebola-infected patients, a drug from Tekmira Pharmaceuticals, has a limited stock available now and could have 900 courses ready by early 2015, according to WHO projections. Using so-called small interfering RNA, or siRNA, the drug targets essential viral genes to stop the virus from replicating—at least in monkeys and guinea pigs. Tekmira siRNAs and ZMapp “are both head and shoulders above everything else in terms of demonstrated efficacy in nonhuman primates,” says Thomas Geisbert, an expert on Ebola virus at The University of Texas Medical Branch at Galveston who has worked on most of the experimental treatments and vaccines under consideration.

Other experimental options include:

—AVI-7537, a drug designed to block viral protein from being made, has shown human tolerability in early studies and could have 100 courses available by early 2015. It has been shown to help monkeys survive Ebola some 60 to 80 percent of the time.
—Hyperimmune globulin, prepared by purifying and concentrating plasma of immunized animals or previously infected humans with high titers (concentrations) of neutralizing antibody against Ebola virus, which have been shown to be protective in monkeys but are not currently available and would not be expected before mid-2015.
—Favipivavir, although more than 10,000 treatment doses may be available, this drug approved in Japan for influenza treatment would need to be used at much higher doses than those typically tested for use on the flu. It has been shown to help mice survive, but only one of out six monkeys responded to the tested dosage.
—BioCryst, an antiviral that needs more animal treatment data before it could be considered.
—Interferons, meanwhile, are already commercially available and have been shown to delay time to death in monkeys although they did not increase overall survival. Moreover, it remains unclear which interferon to use, when and at what dosage regimen to yield optimal results.

To date, treatment of Ebola patients has focused on replacing lost electrolytes and monitoring bodily functions and protein deficiencies. Greater action needs to be taken now, Kieny said. More people have died from this outbreak than all prior Ebola outbreaks combined.

Ebola cases in west Africa could rise to 20,000 says WHO


UN health agency say outbreak is accelerating in the region while the death toll has now exceeded 1,500
The WHO’s assistant director-general Bruce Aylward estimates the Ebola outbreak in Liberia will require help from 750 international volunteers. Photograph: EPA

The World Health Organisation (WHO) has warned the number of Ebolacases could rise to 20,000 as doctors in Liberia say the deadly virus is now spreading so rapidly they can no longer deal with the crisis.

The UN health agency said the outbreak is accelerating in west Africa, where the death toll has now reached 1,552, and it believes the numbers who have been hit by Ebola could be two to four times higher than the current 3,069 cases currently reported.

“[It] is a scale that I think has not ever been anticipated in terms of an Ebola outbreak,” said Bruce Aylward, assistant director general of WHO.

He said the increase came from cities including the Liberian capital Monrovia, where a slum was quarantined last week, leading to food shortages and civil unrest.

“It’s really just some urban areas that have outstripped the reporting capacity,” he said. Up to now most efforts have concentrated on rural areas close to the Guinea border. His remarks come as Medecins sans Frontieres said it was struggling to cope with the caseload in Monrovia. MSF has just opened a new Ebola hospital in the Liberian capital and after one week it’s already at capacity of 120 patients.

“The number of patients we are treating is unlike anything we’ve seen in previous outbreaks,” said Lindis Hurum, MSF’s emergency coordinator in Monrovia. “This is not an Ebola outbreak, it is a humanitarian emergency and it needs a full-scale humanitarian response.”

The Ebola outbreak started in Guinea in March and is the 26th since 1976 when the virus was first identified, but is widely recognised to be out of control.

“It is simply unacceptable that, five months after the declaration of this outbreak, serious discussions are only now starting about international leadership and co-ordination,” said MSF director of operations Brice de la Vigne.

MSF said the number of people seeking care at its new Monrovia centre is “growing faster than we can handle both in terms of the number of beds and the capacity of the staff”. It said patients are coming from nearly every district of the city and healthcare workers were “struggling to screen new arrivals, care for admitted patients, safely remove dead bodies and transport them to the crematorium”.

It said it is so overwhelmed it can no longer administer intravenous treatments. MSF has five field hospitals in west Africa, plugging a gap left by the fragile health care systems. It says most of the medical facilities in Monrovia have shut down over fears of the virus among staff, leaving many people with no healthcare at all. This is leading to fears of a secondary health crisis with expectant mothers and malaria patients now going untreated too.

Tom Dannatt is founder of British charity Street Child, which has 650 volunteers in two of the worst stricken countries, Sierra Leone and Liberia. He says the catastrophic spread was not to do with the strength of the virus but the lack of “anti-Ebola measures” being put in place. He also said a food aid programme to help feed those in quarantined areas in eastern Sierra Leone is completely inadequate.

“They are providing food for a standard World Food Programme five heads per household. But in Sierra Leone there are 12 to 15 people living in the majority of households,” said Dannatt. He is offering to lend Street Child’s workers to government task forces to help contain the disease and is launching an emergency appeal later this week.

Dr Anthony Fauci, director of the US National Institute of Allergy and Infectious Diseases told the Guardian that containment could be achieved by “low tech public protection measures”.

“What we have here is porous borders, poverty and big cities. It is the perfect storm. What we need is a massive influx of resources from WHO, from the US, from the UK,” he said.

WHO said it is launching a new $489m (£294m) initiative to try to contain Ebola within six to nine months.

Aylward said it would require the assistance of 750 international workers and 12,000 national workers. He urged airlines, including British Airways, Air France and Gambia Bird, who have suspended flights to the affected countries, to restart services.

Ebola’s changing: Can we keep up with it?


The devastating Ebola outbreak in West Africa will likely grow much worse over the next several months, continuing into 2015. That grim news was delivered Wednesday afternoon by panelists from three San Diego organizations prominent in fighting the lethal disease.

Cases have doubled every 35 days in this year’s outbreak, already the worst since the disease was discovered in 1976. Medical workers are themselves contracting the disease, depleting health care resources that in many regions were already nearly nonexistent.

And the disease itself might be mutating to become less lethal but more contagious, increasing the risk of it spreading elsewhere.

What is Ebola?

A graphic description of what Ebola is, and what it does, from Ebola researcher Erica Ollmann Saphire.

But there’s still a chance some of the damage could be prevented, if governments and private charity give more aid, the panelists told an audience of nearly 200 at The Scripps Research Institute in La Jolla.

Cheap and well-known safeguards, such as gloves, gowns and disinfectant chlorine, can go a long way toward preventing medical worker deaths, said panelist Erica Ollmann Saphire, who studies Ebola and similar diseases at Scripps Research.

“A doctor shouldn’t die because he doesn’t have gloves to wear,” Ollmann Saphire said. “This is a solvable problem.”

Ollmann Saphire and the two other panelists epitomize San Diego’s extensive role in fighting Ebola, in complementary ways.

• The Ollmann Saphire lab focuses on the structure of Ebola and antibodies that neutralize the virus. This research, and that of her international collaborators, aims to find weak spots that can be exploited to stop it.

• Kevin Whaley, chief executive of Mapp Biopharmaceutical, which has developed an experimental Ebola drug called ZMapp, represented the medical role. ZMapp was given to two American medical missionaries who contracted the disease in Liberia. It’s unclear whether ZMapp aided their recovery.

What is Mapp Biopharmaceutical

Mapp Biopharmaceutical CEO Kevin Whaley tells the genesis of his company, which is developing an experimental Ebola drug, ZMapp.

• Mark O’Donnell, chief operating officer of the nonprofit development group PCI, discussed the humanitarian and economic development aspects. The group, also known as Project Concern International, was established more than 50 years ago by a San Diego doctor.

Change in virus?

PCI has been working in Liberia, one of the hardest-hit countries, for about four years, O’Donnell said. That work of economic development has been put aside for the Ebola emergency.

Ebola has periodically caused highly lethal but limited outbreaks. With an extremely high mortality rate, the disease typically burns itself out. People die before they can spread the disease very far.

But this outbreak is different, Ollmann Saphire said. It keeps spreading, doubling in size every 35 days. And the mortality has dropped from about 90 percent in the first outbreak to about 60 percent.

“There’s 68 mutations in the protein level between that (first) virus and this virus,” she said. “Did one of those mutations make it less immunosuppressive, or replicate less efficiently? We don’t know. Could the lower lethality have contributed to its greater scale?”

photo
Ebola researcher Erica Ollmann Saphire holds a model of ZMapp, a three-antibody “cocktail” that neutralize Ebola in animal studies. ZMapp has been given to Ebola patients as an emergency measure, but has not yet been tested in clinical trials. Bradley J. Fikes

The answer will come from more intensive sequencing of viral genomes from patients to correlate mutations with the changes, she said.

In the meantime, development of anti-Ebola drugs, such as ZMapp, is being accelerated. Whaley said his company is getting federal help in preparing the drug for clinical trials, including increasing production. Other drugs are in development.

While ZMapp’s effectiveness remains to be proven in clinical trials, it belongs to a well-known class of antibody-based drugs and is not some “secret serum,” as media reports have called it, Whaley said. ZMapp is a combination of three Ebola-fighting antibodies, which in animals have shown effectiveness in protecting against the virus.

Whaley said the advantage of an antibody-based drug like ZMapp over a vaccine is that it can stop the virus quickly. Vaccines stimulate antibody production, but that process takes weeks, while Ebola can kill in days.

Doing more

Even better antibody combinations might be possible, Ollmann Saphire said, which is the reason for the global collaboration she leads.

“Kevin’s group found these three, and then a group in Japan had two, and a group in Canada had a couple,” Ollmann Saphire said. “Can you make an even more effective combination if you put all these antibodies on the same page? What if the absolute best cocktail is going to be one from San Diego, and one from Winnipeg, and one from Paris? We don’t know until we put them all together.”

She said that while the consortium she leads has been awarded $28 million, and while she’s grateful to have it, that money is spread over five years and 20 universities.

“A lot of that goes to the building rent, the electricity, the biosecurity, janitorial, all that stuff,” she said. “So on average it winds up being about $200,000 a year per lab. From that $200,000, I pay my salary and the 14 people who are working in my lab, and all the test tubes and chemicals. And so that was enough to get this work going, but it wasn’t enough to process all these samples.”

Scientists found the origins of the Ebola outbreak — by tracking its mutations


One of the big mysteries in the Ebola outbreak in West Africa is where the virus came from in the first place — and whether it’s changed in any significant ways. These unanswered questions could be making it more difficult to diagnose the disease and find treatments.

A NEW ANALYSIS COULD HELP SHOW IF EBOLA IS CHANGING OVER TIME

Now scientists are starting to get some answers. In a new paper in Science, researchers reveal that they have sequenced the genomes of Ebola from 78 patients in Sierra Leone who contracted the disease in May and June. Those sequences revealed some 300 mutationsspecific to this outbreak.

The new analysis could help determine if the virus’ behavior has changed — and provide information for future diagnostic tests and treatments.

Among their findings, the researchers discovered that the current viral strains come from a related strain that left Central Africa within the past ten years. And the research confirms that the virus likely spread into Sierra Leone when women became infected after attending the funeral of a traditional healer who had been treating Guinean Ebola patients.

The current Ebola outbreak in West Africa is the worst on record. It has hit four countries, including Sierra Leone, infected approximately 3,000, and killed about 1,500 people. And so far, there is no sign of it slowing down.

The fact that the researchers published the sequence of the Ebola genomes in mere months contrasts with the typically slow pace of scientific research. “We’re trying to do this as fast as possible,” says co-senior author Pardis Sabeti, a biologist at MIT and Harvard. This new data increases the number of public Ebola virus sequences fourfold.

The main impact of the paper will be as the foundation of research for years to come as other projects try to sort out what all of these genetic sequences — and their hundreds of mutations — really mean.

The paper is also a sad reminder of the toll that the virus has taken on those working on the front lines. Five of the authors died of Ebola before it was published. All were affiliated with Kenema Government Hospital in Sierra Leone.

What genetic sequences can tell us about Ebola

Ebola tree lineage

 

Viruses randomly mutate over time. This is completely normal for viruses, and there’s no reason to think that Ebola’s mutation rate is anything weird or unusual.

SCIENTISTS CAN USE MUTATIONS AS MARKERS TO TRACK WHERE EBOLA HAS TRAVELED AND WHEN

Scientists can use these mutations as markers to piece together how the Ebola virus has traveled from person to person. Because they know the general mutation rate of the virus, they can also pin down the dates of when the disease spread.

So what has this analysis revealed? Using genetic sequences from current and previous outbreaks, the researchers mapped out a family tree that puts a common ancestor of the recent West African outbreak some place in Central Africa roughly around 2004. This contradicts an earlier hypothesis that the virus had been hanging around West Africa for much longer than that.

The data, on the whole, supports what epidemiologists have already deduced about how the virus spread into Sierra Leone. More than a dozen women became infected after attending the funeral of a traditional healer who had been treating Guinean Ebola patients and contracted the disease.

One surprise from the paper is that two different strains of Ebola came out of that funeral. This suggests that either the healer was infected with two different strains or that another person at the funeral was already infected.

As Ebola then traveled across Sierra Leone, a third strain of the virus appeared.

Why having Ebola gene sequences is helpful

Some Ebola diagnostic tests have been designed to detect areas that have mutated in the Ebola virus samples from this outbreak, raising the possibility these tests might be losing accuracy. One of the things Sabeti plans to do next is test whether that’s actually the case.

DIAGNOSING EBOLA IS MORE DIFFICULT THAN IT SOUNDS

Diagnosing Ebola can actually be more difficult than it might sound. The disease often looks like a lot of other feverish illnesses that can be common. And at a later stage, only some patients end up bleeding.

However, it’s essential to know who has it as soon as possible, especially so that health-care workers can use appropriate procedures to prevent transmission to themselves and others. So accurate diagnostic tests are absolutely needed.

Researchers are also planning to study the mutations to see if any of them are affecting Ebola’s recent behavior. The number of mutations found is completely normal, and it isn’t necessarily the case that they’ll have a big effect. But it’s possible that something intriguing could turn up.

For example, this outbreak has had a higher transmission rate and lower death rate than others, and researchers are curious if any of these mutations are related to that. (Right now, social factors are thought to be the main causes of these two changes.)

“It sets the stage for the next few years of research that will reveal the differences between this virus and previous versions of Ebola virus,” says Erica Ollmann Saphire, who researches Ebola and similar viruses at The Scripps Research Institute in La Jolla, California.

“My laboratory will be using this sequence information to understand the molecular effects of these mutations,” she says. “We will also be looking at our pool of antibody therapeutics beyond ZMapp to ensure that candidate cocktails are optimally effective against these circulating strains.”

Those working on other long-term projects involving vaccines should also find this information helpful.

The longer Ebola circulates, the more opportunities it has to change — possibly for the worse

Although Ebola’s mutation rate itself isn’t anything unusual, the longer it’s circulating in people, the more chances it will have to randomly come up with a mutation that it will find beneficial — possibly to the detriment of human health.

“You never want to give a virus that kind of opportunity,” Sabeti says. “We hope that this work opens up new doors for more people to work together to stop this virus now.”

Update: Clarified that the speed of publication, not necessarily the speed of sequencing, is remarkable.

CARD 1 OF 11LAUNCH CARDS

Why is Ebola suddenly in the news?

The deadliest Ebola outbreak in recorded history is happening right now. The outbreak is unprecedented both in the number of people who have gotten sick and in geographic scope. And so far, it’s been a long battle that doesn’t appear to be slowing down.

The Ebola virus has now hit four countries: Guinea, Liberia, Sierra Leone, and Nigeria.

The virus — which starts off with flu-like symptoms and sometimes ends with bleeding — has infected about 3,000 people and killed more than 1,500 since this winter, according to estimates on August 28 from the World Health Organization.

Ebola is both rare and very deadly. Since the first outbreak in 1976, Ebola viruses have infected thousands of people and killed roughly 60 percent of them. Symptoms can come on quickly and kill fast.

Journalist David Quammen put it well in a recent New York Times op-ed: “Ebola is more inimical to humans than perhaps any known virus on Earth, except rabies and HIV-1. And it does its damage much faster than either.”

Screen_Shot_2014-08-28_at_12.07.40_PM.0.png

Each bar here represents a different Ebola outbreak. The data is what the CDC has on record. Not every case or death always gets officially recorded, so there is always some wiggle room in numbers like these. The 2014 bar is the WHO’s estimate of the current outbreak as of August 28, 2014.

Keeping Ebola in check


After the H1N1 influenza (swine flu) in 2009 and polio in May 2014, the WHO has now declared the Ebola (Ebola virus disease) outbreak in West Africa as an “extraordinary event” and a “public health risk to other countries.” It has also highlighted that the “consequences” of its spread across the world could be “particularly serious” considering the virulence of the virus. After the first outbreak in December 2013 in the Guéckédou region in Guinea’s remote southeastern forest region, the virus has spread to three other West African countries — Liberia, Nigeria and Sierra Leone. As on August 6, as many as 1,779 people (with 1,134 confirmed cases) were infected and the mortality figure was 961. The death toll this time is much more than the combined count of all previous Ebola epidemics. The biggest threat comes from the extremely high virulence of the Zaire Ebola virus species, the most lethal Ebola virus known, with fatality rates going up to 90 per cent; the Zaire virus species is usually restricted to Central Africa. Though the virulence has been lower at 55 per cent, it is still alarmingly high. The incubation period — the time interval from infection to onset of symptoms — of two to 21 days poses a real danger to public health. In this era of global travel, though infected people would not transmit the virus till they develop the disease, they could facilitate virus spread once symptoms show up.

Despite the deadly characteristics of the virus, transmission occurs only when people come into contact with the body fluids of affected people; there is no scientific confirmation of humans getting infected through airborne transmission. Yet, transmission has been rampant both in the community and in health-care settings. Poor handling practices in weak health-care systems are putting doctors and healthworkers at great risk. Currently, no approved drugs or vaccines are available to prevent infections or treat infected people. But an experimental drug tested only in animals has improved the condition of two Ebola-infected U.S. nationals who were flown back to America. It is highly unlikely that the drug would be used to treat those in the four countries. One way to prevent the spread is to stop symptomatic passengers from travelling in normal passenger aircraft, and to screen and follow up those arriving from or transiting through these countries as the infected people act as carriers of the virus. India has its task cut out as nearly 5,000 Indians who live in Guinea, Liberia and Sierra Leone and about 40,000 in Nigeria may return here. The Union Health Minister has held out the assurance that the Ministry has put into operation “the most advanced surveillance and tracking systems”. Utmost care is called for.

 

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