Evening Ebola Update, Fri, 1/23: Need anthropologists in the field/HHS should sue ZMapp/TKM-Ebola makers/Transmission dynamics: get symptomatic into hospital in <4 days   Leave a comment

1/23/15

Dear Colleagues:  Wow!  Suddenly a flood of EBOV articles have been published on-line and in The Lancet.  All are important to ending this African EBOV epidemic, so I will summarize all of them today:

l.  The Lancet has Correspondence from Vora, et. al. from the CDC and USPHS in Atlanta reminding us that it was case isolation and contact tracing that stopped the EBOV spread in Nigeria and Senegal in its tracks.  The authors call for more partnership between African countries and international partners, especially the CDC, to prevent spread beyond West Africa in the future.  CDC has 150 workers in health ministries in 13 African countries helping set up infection prevention and tracing programs.  CDC has a contract tracing training module for HCW in Africa.  See: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)60118-0/fulltext

2.  The Lancet has Correspondence from Abramowitz from the Department of Anthropology in Gainesville, Florida, stating that social sciences have not been integrated into treatment of the EBOV epidemic by the U.S.A.  Social sciences have been integrated into treatment of the epidemic by WHO and MSF.  The author is correct; we are missing the boat here.  The failure of parents to enroll children in reopened schools in Liberia because masked men were spraying the school walls (with what turned out to be insecticide) is a perfect example of the need for social scientists in the EBOV fight.  See: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)60119-2/fulltext

3.  The Lancet has an Article on EBOV transmission dynamics in Conakry, Guinea, by Faye, et. al. from the Pasteur Institute in Senegal, followed by a Comment by Drosten of the University of Bonn.  Faye, et. al. ‘drilled down’ on the specific transmission chains of disease spread in Conakry, Guinea, to determine which interventions had the greatest effect on R0, the infection rate of EBOV.  Results showed that the EBOV viremia continues to rise the first week of symptoms in exponential fashion, so that R0 is doubled in the first week of symptoms.  EBOV patients must be removed from the community (especially families) within 4 days of symptom onset and hospitalized.  Do this and R0 decreases to <1 to control the epidemic. Look at Figure 2 re: transmission trees (most transmission within families) and Figure 3 re: effect of hospitalization on R0.  See: Faye, et. al. Article at: http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(14)71075-8/fulltext.  See Drosten’s Comment athttp://www.thelancet.com/journals/laninf/article/PIIS1473-3099(14)71088-6/fulltext

4.  Time Magazine on-line reports that the WHO has said EBOV epidemic is at a ‘turning point’:

“I would have identified the turning point as the beginning of the decline, first in Liberia and then later in Sierra Leone and Guinea,” Dr. Christopher Dye, the director of Ebola strategy for the WHO director general, told the BBC. “The incidence is pretty clearly going down in all three countries now.”

See: http://time.com/3679701/ebola-who-turning-point-liberia-guinea-sierra-leone/

5.  PeerJ, an open-sourced journal, has an article by Walsh, et. al. on landscape in West Africa and transmission of zoonotic EBOV.  The more vegetation and the more rain, the greater the chance of zoonotic EBOV because of ‘spillover’.  The population mass near the forests does not need to be great; infection of just one person can ‘feed’ an EBOV epidemic.  See Table 1 in: https://peerj.com/articles/735/

5.  NY Times reports that ZMapp and TKM-Ebola are not in sufficient supply despite the hundreds of Millions that HHS has spent on building facilities for these drugs’ production.  Someone or some company has dropped the ball and dropped it badly.  I’m hoping Secretary Burwell can straighten this mess out.  See the NY Times article at: http://www.nytimes.com/2015/01/23/business/fast-track-on-drug-for-ebola-has-faltered.html?ref=health

6.  WHO reports that the Executive Board (39 members) will meet in the next few days to map out a plan for EBOV to ‘zero’ in 2015 and hopefully to put in place a better funding agreement for WHO.  The WHO depends on private donors and foundations for much too much of its budget because member countries do not pay their voluntary contribution.  WHO is running out of money to fight EBOV and other worse killers like malaria.  The Board meeting is preceded by a meeting on EBOV.

7.  PLoS Biology has published on-line a ‘primer’ on EBOV transmission dynamics by Chowell, et. al. at Georgia State University and NIH.  Figure 3 and Figure 5 are beautiful because transmission dynamics are explained in two illustrations that do not require a virology degree or any medical knowledge.  It is a wonderful article: http://journals.plos.org/plosbiology/article?id=10.1371/journal.pbio.1002057

RGl,MD

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Posted January 23, 2015 by levittrg in Ebola

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