Evening Ebola Update, Fri, 10/24: Mali death/Vaccine understanding at WHO/Ms. Pham w/o EBOV   Leave a comment

10/24/14

Dear Colleagues:

l.  WHO has published on-line the summary (and extensive meeting notes) of the high-level meeting in Geneva yesterday on access to EBOV vaccines and financing for EBOV vaccines.  See: http://who.int/mediacentre/news/ebola/23-october-2014/en/ for a complete summary and meeting notes.  Here are the some of the key take-away points:  access to vaccines will be fair-HCW and janitors and burial teams, etc to get vaccine; cost will not prevent distribution of vaccines-money will be found to pay for vaccines; a liability fund will be set up with the World Bank (headed by Dr. Jim Kim) to protect vaccine producers and others; regulatory requirements will be ‘harmonized’; i.e., simplified and standardized; WHO/CDC will set up testing protocols now for Phase 2 and Phase 3 trials so that no vaccine sits on a shelf; keeping vaccines frozen during distribution in West Africa will be a big problem; vendors will work together so that >1 vaccine can be tested in a given protocol; Dr. Chan will ‘clear her agenda’ and make EBOV vaccines her priority.  I see WHO deciding to proceed as if the worst scenario is the most likely EBOV scenario in the future.  I believe China should ‘forgive’ the fine of $490 Million to GSK by accepting GSK vaccine for West Africa as ‘payment in kind’.

2.  NEJM has produced a video of its webcast on Wednesday on the Ebola Outbreak.  You will find the webcast at: http://cdn.nejm.org/editorial/collections/20141022-ebola-webcast/webcast.htm.  The webcast is about 1.5 hours in length.

3.  Ms. Pham was discharged from NIH Clinical Center without EBOV in her blood today (Thank you, Dr. Tara Palmore).  A press conference was given; senior NIH officials were overjoyed at this good news.  Ms. Pham visited the President today and was given a hug by him.  Now she asks for privacy so she can return to some normality and get back her strength.

4.  Dr. Spencer is hospitalized with EVOV at Bellevue Hospital in NYC and NY authorities are doing contact tracing.  Note that Dr. Spencer does not wear a hood in photographs of his PPE on the Internet.  EBOV Guidelines in the MSF Guidelines Manual call for protective clothing, masks, googles, boots, etc., but not hoods or PAPRs (on pages 204-5 of the Manual).

5.  The 2-3 y.o. child with typhoid who also tested positive for EBOV in Mali after traveling from Guinea has died.  The border between Guinea and Mali is 285 miles long and not closed.  Many workers in Mali travel to Guinea daily to work in the mines.  WHO has sent a total of 7 experts to Mali for contact tracing and completing the treatment center in progress in Mali.

6.  NY Times lists 12 patients with EBOV outside of Africa today; 9 have recovered (8 received experimental drugs, 3 received convalescent blood or serum); 2 died (both received experimental drugs); I is being treated (? drugs or serum).  See: http://www.nytimes.com/interactive/2014/10/23/world/africa/ebola-drugs.html for beautiful graphics of the stage of testing of specific drugs, predicted caseloads/country, distribution of EBOV cases in and out of Africa.

7.  EU has tripled its contribution to the Ebola fight to $1.2 Billion.  China has sent $82 Million in goods to West Africa.

8.  PLoS has published on-line an article by Votz, et. al. on the phylodynamics of the 78 genomes from EBOV patients in Sierra Leone reported by Gire, et. al. in Science this summer.  Votz found the R0 = 2.4 days if the latent period was 5.3 days (one estimate) and R0 =3.8 if the latent period was 12.7 days (another estimate).  The longer the latent period, the greater the R0.  In part, this is due to the short generation times of RNA viruses and their high mutation rate.  I’ve asked colleagues to help me understand Volz, et. al. article; phylodynamics of viruses is computational biology and mathematics beyond my understanding.

Some sad news in Mali today, but some happy news on the vaccine front as well.

RGL, MD

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Posted October 24, 2014 by levittrg in Ebola

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