l. WHO reports today on the travels of the 2 y.o. who died in Mali recently. The baby was the daughter of a father who died of undiagnosed disease in Guinea. Several family members died following the father’s death. The presumption is that all of these deaths were due to EBOV. The family traveled to several villages for the various funerals, thereby spreading EBOV. The baby was transported back to Mali by her grandmother who had traveled to Guinea to offer her condolences. The baby was diagnosed in Mali to have EBOV prior to her death. This tragic case shows how tribal customs can transmit EBOV via travel unless education is given to the stricken family. See: http://who.int/mediacentre/news/ebola/10-november-2014-mali/en/ for details of the family’s travels prior to the baby traveling to Mali.
2. The WHO report on the deceased baby in Mali makes an important statement re: safety of HCW in privately-run non-EBOV health care centers in Kenema, Sierra Leone: 87% of new EBOV infections in HCW in Kenema are acquired in these privately-run health care centers; i.e., non-publicly-run and non-MSF health care centers. HCW are exposed to symptomatic EBOV patients presenting to these centers, and these HCW do not have the recommended PPEs.
3. NY Times today makes reference to an article by Yamin, et. al. in the Annals of Internal Medicine on October 28th about the transmission of EBOV to contacts by survivors and non-survivors of EBOV infection in Liberia. The authors found the R0 = 2.36 for the non-survivors and R0 = 0.66 for survivors. The non-survivors infected twice as many contacts as the survivors; the non-survivors had significantly higher viral particle counts than survivors. The infections transmitted by the non-survivors increased greatly after Day #4 of their symptoms. But if 75% of these non-survivors were isolated before Day #4, there was a 74% chance that EBOV could be eliminated from Liberia by mathematical modeling. If 75% of these non-survivors were to self-isolate themselves on Day #1 of their symptoms, then the infections they transmitted to others would be reduced by 60%, and there was a 78% chance that EBOV could be eliminated from Liberia by mathematical modeling. See: http://annals.org/article.aspx?articleid=1919873 for the complete article by Yamin, et. al. The key to eliminating EBOV in Liberia is to isolate (and treat) EBOV patients by Day #4 of their symptoms.
4. CDC’s Emerging Infectious Disease October, 2014, contains an article about biomarker correlates with survival in pediatric patients with EBOV. McElroy, et. al. found that pediatric patients with a chemokine named RANTES which activates and proliferates antigen-specific T-cells is higher in pediatric patients than adults, and highest in non-fatal pediatric patients. The authors also found high levels of PAI-1 and SSA (both endothelial activators) in pediatric patients and suggest that statin use may stabilize the endothelium and prevent bleeding in pediatric patients. See: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4193175/ for this complete article.