Evening Ebola Update, Wed, 12/3: ? Sierra Leone case mortality data/How drugs act on EBOV/Need for RCT   Leave a comment

S12/3/14

Dear Colleagues:

l.  Ebola Deeply reports that a 10th physician in Sierra Leone has become infected with EBOV.  He is being treated at an Ebola Treatment Center in Freetown, Sierra Leone.  Note that the 7 physicians whom I can document being infected by EBOV in Sierra Leone have all died.

2.  Dr. O’Donovan who reported on ‘digital surveillance’ of EBOV in West Africa in The Lancet  (see last evening’s blog) has sent us some interactive graphics from The Economist (3 December) which show the distribution of EBOV cases in West African countries and their corresponding case mortality data.  The Economist reports 17,145 cases and 6,070 deaths from EBOV.  The case mortality rate in Guinea is 61%; in Sierra Leone is 22%; in Liberia is 41%.  These figures are from WHO, but WHO depends on these countries’ health ministries for the data.  See the interactive graphics at: http://www.economist.com/blogs/graphicdetail/2014/12/interactive-ebola-map

3.  The comparatively low case mortality rate for Sierra Leone is striking, given the rapid rise in reported EBOV cases in Sierra Leone recently.  My calculations of SIerra Leone’s case mortality rate for June-August (39%), September (29%), October (29%), November (22%) from WHO Situation Reports show this lower case mortality rate is consistent.  But I am suspicious of the Sierra Leone case mortality data.  In November there were 1,974 new reported EBOV cases, yet only 73 new EBOV deaths.  It may be that many deceased EBOV patients are being buried outside rural villages or hidden from burial teams visiting the villages.  Or, the data reported may be inaccurate.

4.  NEJM on-line only tonight has a Perspective by Edward Cox, et. al. (Dr. Cox is Director of the Office of Antimicrobial Products at the FDA) on the need to ‘stick to’ randomized controlled trials (RCT) to evaluate EBOV experimental therapies.  The authors state that the control group and the treated group should both receive BASC (Best Available Supportive Care).  The authors remind us that most EBOV patients in West Africa will not receive experimental therapies because of the limited doses of these therapies.

5.  The authors are really talking about advanced RCT (let’s abbreviate as: ‘aRCT’) because their aRCT allow therapies proven effective to be added to both the treated and control groups as therapeutic results become available.  See the Perspective at: http://www.nejm.org/doi/full/10.1056/NEJMp1414145?query=TOC.  Cox, et. al. do not specifically address the ‘stepped wedge’ trials described in the NEJM Perspective by Kanapathipillai, et. al. on various means of testing EBOV vaccines.  See that Perspective at: http://www.infovac.fr/index2.php?option=com_docman&task=docget&Itemid=&id=1153

6.  Philip M. Rosoff, MD, MA from Duke University, a pediatric oncologist and chair of the Ethics Committee at Duke, also has an essay on the need for RCT for experimental therapies in Clinical Researcher, December, 2014.  See his essay at: DOI: 10.104524/CR-14-0045

7.  Infectious Diseases of Poverty, 28 November, has an article by Lai, et. al. of the Hospital Authority of Hong Kong (27 hospitals + specialty practices) on where in the life cycle of EBOV various experimental therapies target EBOV.  The article is detailed and directed toward immunologists and drug/vaccine researchers.  See the article at: http://www.idpjournal.com/content/3/1/43/abstract  (Note: Click on ‘provisional pdf’ below the Abstract)

RGL, MD

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Posted December 4, 2014 by levittrg in Ebola

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