Evening Ebola Update, Sun, 1/18: Paul Farmer on how to rid Africa of EBOV/Need to investigate zoonotic virus-reservoir host lack of attack/U.S. should evacuate Americans from Nigeria   Leave a comment

1/18/15

Dear Colleagues:

l.  The Washington Post published a commentary by Dr. Paul Farmer, founder of Partners in Health, in which Farmer clarified his comments re: MSF in a previous NY Times commentary and also stated what was needed in West Africa to rid the region of EBOV:

“Doctors Without Borders deserves special praise, since it was the first to sound the alarm and has brought thousands of volunteers and staff into the battle. When I noted to The New York Times recently that Doctors Without Borders wasn’t “doing enough“, what I meant was that we all need to provide better supportive care to increase survival.”

“The quality of care in this part of West Africa – not simply for Ebola but for more common ailments and injuries – must be improved. Improving care means introducing capacity to monitor electrolytes, which we’ve recently done in rural Sierra Leone, instead of doing a single lab test for Ebola.

It means cooler units – even fans would help – and personal protective gear made for tropical conditions. It means improved nutrition and a lot more support for the public health delivery system.”

Read the entire Farmer commentary at: http://www.stuff.co.nz/world/africa/65166983/secret-to-ridding-west-africa-of-ebola-is-no-secret-at-all

2.  The UN News Centre 15 January reported that the UN, EU, World Bank, and African Development Bank were sending teams of officials to Liberia, Sierra Leone, and Guinea to determine what measures might be taken to prevent economic collapse of these countries once the EBOV epidemic is halted and cases go to zero.  All three countries have taken a severe economic ‘hit’, and renegotiation of debt is necessary in each country.  See: http://www.un.org/apps/news/story.asp?NewsID=49811#.VLw6o3I3N9D

3.  Mandel, et. al. from NIH published in Cell 15 January a review of virus-reservoir host interactions in zoonotic diseases.  The authors say we need to concentrate on how these reservoir hosts ‘tolerate’ and/or benefit from the viruses instead of being attacked by the viruses.  In this way, we may learn how to defend humans from attack by these viruses:

“A number of nonmutually exclusive hypotheses might explain why many reservoir hosts of viruses capable of causing disease in humans or other animal hosts do not show severe clinical or behavioral signs of infection (Table 1): (1) the virus is cytopathic in the nonnatural host, but not in its reservoir, (2) viral tropism differs between natural and non-natural hosts, (3) differences in the interaction between the viral genome or viral gene products and host resistance mechanisms alter the infection outcome between natural and non-natural hosts, (4) the virus confers a benefit to the host that is not conferred to humans or other animal host species, (5) interactions within the zoonotic host between the virus and other elements of the microbiome alter the pathogenesis of infection in a manner that does not apply to humans, (6) reservoir host responses control viral replication more effectively, or (7) viral infection is better tolerated by reservoir hosts even when viral loads are high. In most cases, knowledge about the features of viral infections in their reservoir hosts and immune responses elicited is incomplete, and it remains unclear which of these explanations holds for particular zoonotic viruses (Table 1). Moreover, as-yet-undiscovered mechanisms may exist which the study of reservoir hosts could reveal.”

See the Mandl, et. al. article at: http://www.cell.com/cell/fulltext/S0092-8674(14)01573-6

4.  NY TImes 16 January reported that avian influenza (H5) had been reported in two areas in Northern Nigeria.  This is not the first outbreak of avian influenza in Nigeria.  Further characterization of the H5 virus is underway to determine if it is H5N1.  So Nigeria now has avian influenza in the North and Boko Haram in the East and South.  Some EBOV researchers from Tulane are in Nigeria now: I urge them to return home now.  I cannot understand why the U.S. has not evacuated all Americans from NIgeria.  President Goodluck Jonathan’s government cannot stop Boko Haram in my opinion.  See: http://www.nytimes.com/2015/01/17/world/africa/nigeria-2-regions-report-new-outbreaks-of-bird-flu.html?ref=health&_r=0

RGL, MD

Infectious Disease Fact of the Day:  In 1665, with the plague in England, coins were not touched.  All coins for transactions were dropped into containers of vinegar.  (From Michael Crichton’s ‘Pirate Latitudes’)

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Posted January 18, 2015 by levittrg in Ebola

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