Evening Ebola Update, Tues, 12/16: Caseload overestimates for Jan. and why/Who should lead?/Rural challenges still present   Leave a comment

12/16/14

Dear Colleagues:

l.  Dr. Racaniello’s website Microbe TV this week has an excellent video on PCR (polymerase chain reaction) for those readers unfamiliar with this technique for identifying infectious agents including EBOV in blood by searching for specific RNA or DNA genomes of these agents.  See Ricardo’s mini-lecture at: http://www.twiv.tv/

2.  NY Times reports on an important article in Clinical Infectious Disease by Scarpino, et. al. from Yale University re: the accuracy of previous estimates of the EBOV caseload in West Africa using mathematical modeling.  The authors state the largest published estimate of EBOV cases by January, 2015 – 500,000 to 1.5 million cases – is inaccurate because the percentage of unreported EBOV cases is less than estimated in this and other articles.  In fact, Scarpino, et..al. report that the percentage of unreported cases is one-half of what was estimated.  The reason for this significant reduction is the fact that EBOV cases are clustered in families, hospitals, and funerals.  The Scarpino, et. al. article can be found at: DOI: 10.1093/cid/ciu1131.  (Oxford Publications requires a fee for access to the complete article)

3.  A more detailed explanation of the over-estimation of caseloads by January, 2015, in published articles is given in Science 12 December on page 1294-1295 by Andy Dobson of Princeton University.  Dobson states that mathematical modeling is “accurate when there is a time series of data for previous outbreaks”.  In our current EBOV epidemic there is not much data available form previous outbreaks, which were very much smaller than our current epidemic.  Dobson goes into detail about what data is needed now to make accurate predictions about EBOV caseloads in the future.  (Unfortunately, Science requires payment for access to this article)

4.  In the same Science 12 December  is an Editorial on page 1271 from University of Edinburgh and WHO which addresses the zero EVOV infection goal of Dr. JIm of the World Bank.  His Ed/Op in the NY Times was posted last week.  The Editorial authors note that the technical networks to respond to EBOV have been established and will be made more efficient with time.  But what is needed they say is an over-arching framework of leadership; it could be the WHO, MSF, World Bank, World Organization for Animal Health (EBOV is a zoonotic infection), or the IMF.  In my opinion, it would be more effective to have an African health organization as the overarching leader with support from all of the above named organizations.

5.  CDC MMWR 16 December on the West African EBOV epidemic reports nearly 18,000 cases and 6300 deaths.  The graphics in this MMWR show that the highest case rate is within the capital cities of Guinea, Liberia, and Sierra Leone.  See: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm63e1216a1.htm?s_cid=mm63e1216a1_e for more details and revealing graphics.

6.  CDC MMWR 16 December also reports on the challenges in rural Liberia in stopping the EBOV epidemic.  There is inadequate training of HCW, inadequate supplies, poor communication networks, and poor transportation.  See the disappointing news in: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm63e1216a2.htm?s_cid=mm63e1216a2_e

7.  Ebola Deeply reports that 64 new EBOV cases were reported yesterday in Sierra Leone.  That country has only 608 EBOV beds.

RGL, MD

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Posted December 17, 2014 by levittrg in Ebola

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