Evening Ebola Update, Fri, 1/16: Amiodarone trial/Vaccine trials/Drug trials/7 questions before all trials begin   Leave a comment

1/16/15

Dear Colleagues:

1.  Somatosphere has posted a new essay by Grey, et. al. from the Department of Anthropology at University of Northern Iowa re: the U.S. and the “Global Other”.  The authors note that our health services were ill-prepared to deal with the West African community in Dallas when Mr. Duncan was diagnosed with EBOV in Dallas.  Health officials did not know that West Africans in Dallas were close knit and lived in ‘dense households’.  Mr. Duncan had >100 contacts since he had returned from West Africa.  The authors point to a need for health agencies to partner with immigrant communities before an infectious disease erupts in these communities.  In that way, the infectious disease can be stopped before it spreads widely.  See: http://somatosphere.net/series/ebola-fieldnotes

2.  Time Magazine on-line says that MSF (Doctors Without Borders) will begin its second mass distribution of malarial drugs in West Africa in 2 months to ease the burden of patients presenting to EBOV treatment centers with malarial symptoms.  Many symptoms of malaria are also symptoms of EBOV.  See: http://time.com/3671597/doctors-without-borders-malaria-ebola/

3.  Wall Street Journal (WSJ) has an article on the various drugs and vaccines that will be in trials in West Africa in the first quarter of 2015.  ZMapp is now one of those drugs to be tested.  “Dozens of doses” are now available according to the vendor.  The WSJ article is complete, including stock market abbreviations and stock prices of vendors.  Johnson & Johnson has now obtained 100 Million Euros for development and testing of its new vaccine against EBOV.  If you wish to read the status of several drugs and vaccines to be tested very soon, see: http://www.wsj.com/articles/study-of-ebola-drug-zmapp-set-for-west-africa-1421439426?autologin=y

4.  Pharmacy Times has an article on a trial of amiodarone in Sierra Leone as a anti-EBOV drug. The article lists the protocol to be used and the two possible mechanisms for amiodarone’s effectiveness against viral disease.  See: http://www.pharmacytimes.com/contributor/monica-v-golik-mahoney-pharmd-bcps-aq-id/2015/01/common-generic-drug-may-cure-ebola

5.  Science reports on a new trial of a yet-unnamed vaccine in Guinea sometime in February.  This article is pertinent because it discusses the manner in which vaccine trials will be conducted in West Africa.  Liberia, Guinea, and Sierra Leone will have different trial protocols:

“How to design the studies has been the subject of intense ethical and methodological debates. In the end, researchers settled on very different designs for each country. In Liberia, the NIH-led study will use a classic randomized controlled trial with three arms, one for each of the two vaccines and a third in which people receive neither. It will target the general population in the capital, Monrovia. CDC’s plan for Sierra Leone is to recruit workers at Ebola treatment units; everyone will receive the vaccine, but some earlier than others. The trial has yet to select the vaccine it will test.”

“The Guinea study will feature an old vaccine strategy, never used before in a clinical trial, which may yield results more quickly. Inspired by the global campaign that eradicated smallpox in the 1960s, it rests on a concept called ring vaccination. Researchers will search for people newly infected with Ebola, then attempt to vaccinate a “ring” of people living around them—most likely their village or neighborhood. In half of the rings, researchers will administer the vaccine immediately to an average of 50 people; they will compare their outcomes to other rings where researchers wait between 4 and 8 weeks to administer the vaccine, says John-Arne Røttingen of the Norwegian Institute of Public Health in Oslo, who leads the study’s steering group. (It was designed by a coalition including WHO, Doctors Without Borders, Longini, and several other academic partners.) Front-line health workers will also receive the vaccine, without a control group.” 

See the entire Science article at: http://www.sciencemag.org/content/347/6219/219.full

6.  My final posting tonight is a Comment from The Lancet today.  Lee, et. al. from the Vaccine Access Center at Johns Hopkins School of Public Health asks vaccine researchers, trial coordinators, and vendors seven specific questions about testing any vaccine in West Africa.  The trial protocols look clear cut in Methodology on trial protocols; Dr. Lee poses seven questions re: the reality of vaccine trials in West Africa which are not that clear cut to answer.  See his article at: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)62398-9/fulltext

RGL, MD

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Posted January 17, 2015 by levittrg in Ebola

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