Archive for February 2015

Evening Ebola Update, 2/27: MSF says viral counts down 50% in their EBOV pts./Why resp. transmission is not ‘very likely’/ZMapp gets RCT in Liberia   Leave a comment

2/27/15

Dear Colleagues:

l.  Dr. Racaniello of Virology Blog has written a rebuttal to Osterholm’s recent Ed/Op in the NY Times which stated that EBOV respiratory transmission is ‘very likely’.  Dr. Racaniello argues that the same facts that Osterholm used to say respiratory transmission is ‘very likely’ can be used to say that respiratory transmission is very unlikely.  See the rebuttal arguments at: http://www.virology.ws/2015/02/21/ebolavirus-will-not-become-a-respiratory-pathogen/

2.  NIH announced today that a trial of ZMapp will begin in Liberia as a randomized clinical trial (RCT).  Both arms of the trial will receive optimized medical care, but one arm will also receive ZMapp.  Once this trial is completed (100 volunteers in each arm), another experimental drug will be tested against the more effective of the ZMapp and no ZMapp arms.  After this second RCT, another experimental drug will be tested against the more effective of the second RCT.  And so on.  See a understandable explanation of the RCT of ZMapp and several other experimental drugs to follow the original ZMapp RCT at: http://www.nih.gov/news/health/feb2015/niaid-27.htm

3.  Nature 25 February in Comments has published on-line an article by Yozwiak, et. al. from The Broad Institute at Harvard on the value of immediate open-sourcing of genomes of infectious agents in the current EBOV epidemic and future infectious outbreaks.  The Broad Institute has immediately open-sourced all of the EBOV genomes sequenced from West Africa, starting last August and continuing to today at virological.org  (Fifty one new EBOV genomes from the Kenema Hospital in Sierra Leone sequenced last December and January were added today).  See the Yozwiak, et. al. Comment at: http://www.nature.com/news/data-sharing-make-outbreak-research-open-access-1.16966 and all 96 EBOV genomes from The Broad Institue at: http://virological.org/t/mid-early-release-96-ebov-genomes-from-sierra-leone/96.  The authors are calling for a meeting of all the ‘big name’ Infectious disease associations/organizations to make open-sourcing of infectious agent genomes the norm.

4.  The Guardian reports today that an infected person escaped from quarantine in Freetown, Sierra Leone, and returned to his village thereby infecting as many as 50 other persons with EBOV.  The village has now been quarantined.  This tragedy shows how a single infected person can restart a outbreak or epidemic.  See: http://www.theguardian.com/world/2015/feb/27/ebola-sierra-leone-village-lockdown-31-new-cases

5.  NY Times reports on a AIDS conference in Seattle where MSF stated that their number of EBOV treatment centers has decreased from 22 to 8 centers; that the EBOV viral counts in their patients have decreased by 50%; and that EBOV mortality in their centers has decreased from 62% to 52%.  The viral counts may have decreased because of better EBOV precautions so patients receive a lesser EBOV inoculation or because EBOV has mutated to a less lethal form.  See: http://www.nytimes.com/2015/02/27/health/fatality-rate-in-west-africa-ebola-clinics-is-dropping.html?_r=0

RGL, MD

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Posted February 28, 2015 by levittrg in Ebola

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Evening Ebola Update, 2/26: Klain writes on management lessons from EBOV epidemic/Women affected more than men by EBOV/EBOV health effects will last for years   Leave a comment

2/26/15

Dear Colleagues:

l.  CDC’s MMWR today carries several reports of various interventions in Liberia, Sierra Leone, and Guinea which have been successful in improving case finding, contact tracing, and maintaining quarantines.  Several of these reports have been previously cited in blog postings.  See the MMWR at: https://col128.mail.live.com/?tid=cm0dN-ueO95BGhdAAjfeP1Rg2&fid=flinbox

2.  ACAPS has issued a detailed report on the effects of EBOV in Liberia, Sierra Leone, and Guinea.  The greatest ‘hits’ have occurred in diagnosis and treatment of non-EBOV diseases or conditions.  For instance, the number of preventive health visits to clinics in Sierra Leone dropped by 42% in 2014; in Liberia 60% of HIV Clinics were closed during 2014.  The health fallout of this EBOV epidemic will be felt for years in West Africa.  See: http://acaps.org/img/documents/b-20150226_ebola_health_system.pdf

3.  Ebola Deeply reports on an article in Fortune Magazine by Ron Klain, EBOV czar in the U.S., on 5 management lessons learned from the experience of EBOV here in the U.S.  The 5 lessons include: the need for current and accurate data; ‘turn the telescope around’ (meaning that any one time the maximum number of persons in the U.S. from West Africa within 21 days was 1200 persons, so U.S. response should be directed at those 1200 persons, rather than making every hospital in the U.S. an EBOV treatment center); face to face regular meetings of all high officials in U.S. EBOV response; recognize and address the effects of fear in the U.S, population (Dr. Fauci did this very well); don’t oversolve the problem (keep solutions simple not complex).  See the entire Fortune article at: http://fortune.com/2015/02/25/ex-ebola-czar-ron-klain-5-management-lessons-from-the-ebola-outbreak/

4.  The Lancet Global Health, March, 2015, has an article by Menendez, et. al. from the University of Barcelona re: the increased health risk to women from EBOV, although there is no biological reason for women to be infected more than men.  The increased health risk to women is due to: women are primary caregivers to family members with EBOV; lack of maternal services for pregnant women during the EBOV epidemic (1.3 million pregnancies in West Africa in 2014); women perform the burial preparation of the decreased EBOV patient in West Africa.  See the article at: http://www.thelancet.com/journals/langlo/article/PIIS2214-109X(15)70009-4/fulltext

RGL, MD

Posted February 27, 2015 by levittrg in Ebola

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Evening Ebola Update, 2/25: UN supplies food to quarantined Aberdeen/Dr. Spencer expresses his dismay/Villagers tell WHO how to make tracing work/Science vs faith in Muslim religion   Leave a comment

2/25/15

Dear Colleagues:

l.  Ebola Deeply reports that UN Ebola Emergency Response has supplied the quarantined area Aberdeen in Freetown, Sierra Leone, with food for 600 families for the past month.  This effort is to prevent ‘breaks’ in the quarantine in efforts for residents to obtain food.  See a detailed report of UN efforts in West Africa this past month at: https://ebolaresponse.un.org/sites/default/files/150225-_unmeer_external_situation_report.pdf

2.  NEJM on-line 25 February has a Perspective by Dr. Craig Spencer, an EBOV HCW who contracted EBOV and was hospitalized at BellevueHospital in NYC after developing fever upon his return to the U.S. from Guinea.  The author says he lost 20# in 2 weeks of febrile illness.  He believes he acted appropriately before and after he developed a fever in NYC.  He explains the poor opinion of himself by the politicians and press as political and fear responses.  He knew he would not be infectious unless he developed a fever upon his return to NYC.  His Perspective is a moving personal account: http://www.nejm.org/doi/full/10.1056/NEJMp1501355?query=TOC

3.  The Lancet Global Health, March, 2015, has an article by Kutalek, et. al. of WHO in Liberia and the Medical University of Vienna telling us what Liberians say must be done to get cooperation of villagers for case finding and contact tracing to end EBOV in Liberia.  The villagers say: food must be provided to families in quarantine; EBOV treatment centers must communicate with family members of EBOV patients; basic health services must be restored; psychological help must be provided to family members; EBOV survivors must become part of case finding and contact tracing teams.  See: http://www.thelancet.com/journals/langlo/article/PIIS2214-109X(15)70010-0/fulltext

4.  Nature in the section News and Comment 24 February has an article by D. Rochmyaningsih from Jakarta, Indonesia, on the effect Muslim groups such as the Muslim Brotherhood (MB) are having on teaching science in Indonesian schools.  Some Muslim groups such as the MB see an inherent conflict between science and religious faith.  Other Muslim groups do not see such a conflict.  Read this eye-opening article at: http://www.nature.com/news/focus-on-political-islamic-groups-to-boost-science-1.16986?WT.ec_id=NATURE-20150226

RGL, MD

Posted February 26, 2015 by levittrg in Ebola

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Evening Ebola Update, 2/24: MMWR shows EBOV spreads from urban to rural/Favipiravir reduces deaths if viral counts low or moderate   Leave a comment

2/24/15

Dear Colleagues:

l.  CDC MMWR 24 February states there are 23,235 reported EBOV cases (as of 2/18) including 9,380  deaths (as of 2/15).  The reported EBOV cases include confirmed, probable, and suspected cases.  The CDC data comes from health officials of reporting countries.  The Figure in the CDC MMWR shows by district how long since the last reported EBOV case in Guinea, Liberia, and Sierra Leone.  This Figure shows the EBOV is spreading from urban areas to rural areas. See the MMWR at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm64e0224a1.htm?s_cid=mm64e0224a1_e

2.  Science Magazine reports that favipiravir given to 40 patients with low or moderate viral countsreduced EBOV mortality from 30% to 15% compared to a historical control.  The drug was not of benefit in EBOVpatients with high viral counts.  See: http://news.sciencemag.org/africa/2015/02/many-caveats-promising-ebola-drug-trial

RGL, MD

Posted February 25, 2015 by levittrg in Ebola

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Evening Ebola Update, 2/23: Both orphans & non-orphans in same boat in West Africa/Cholera vaccine recommended for EBOV countries/See Cave Paintings to cheer up   Leave a comment

2/23/15

Dear Colleagues:

l.  The Lancet 22 February has Correspondence by Evan, et. al. of the World Bank in Washington, D.C. re: the fate of orphans produced by the EBOV epidemic in West Africa.  The authors computed that 9600 orphans now are present in the three EBOV affected countries in West Africa; 600 of these orphans have lost both parents.  This EBOV epidemic has infected the 15-44 year old age group almost 3x as frequently as the under 15 year old age group.  The authors have found that the extended families of West Africa are caring for these orphans.  The real problem is not housing the orphans but providing food for orphans and non-orphans alike in West Africa.  The economies of these countries has been hit hard by the epidemic.  See: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)60179-9/fulltext

2. The Lancet 19 February has Correspondence by Azman, et. al. from Johns Hopkins School of Public Health re: prevention of a cholera epidemic in the same West African countries affected by the EBOV epidemic.  Cholera epidemics occur every 3-5 years in these countries.  The symptoms of cholera mimic the symptoms of EBOV.  These countries are not likely to be able to repel a cholera epidemic because ‘EBOV kills health care systems’ (from WHO year end report on EBOV).  The authors recommend that the scarce oral cholera vaccine (OCV) be given first to those persons in the areas of Liberia, Guinea, and Sierra Leone which had the greatest number of EBOV cases, then to others, including neighboring countries.  See: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)60178-7/fulltext

3.  If you are in need of an uplifting story after watching the news of TV or social media (as I am), I recommend the short essay in The Week, February 27, on France’s Niaux Caves on page 36,37.  The essay is titled ‘13,000-year-old Masterpieces’.  The author makes the case that these cave painting match the quality of paintings in the Louvre.  Perspective was invented 13,000 years ago.  The author notes no war subjects are present among the cave paintings.  See: http://www.magastack.com/issue/view?id=6014&page=36.  Click on page 37 to see the other half of the essay.

RGL, MD

Posted February 23, 2015 by levittrg in Ebola

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Evening Ebola Update, 2/22: New RNA virus in Kansas/Nature issue on epigenetics/Fluorescence flow cytometry helps vaccine development   Leave a comment

2/22/15

Dear Colleagues:  Today is Sunday so my web sources are ‘quiet’.  I have posted two interesting and important articles re: a new virus and epigenetics respectively:

l.  CDC Emerging Infectious Disease May, 2015, has released a report by Kosoy, et. al. of CDC re: a novel RNA virus which has killed a Kansas man.  The virus is believed to have infected the man via a tick bite.  The filamentous form of the virus looks very much like EBOV (see Figure 1A in article cited).  See: http://wwwnc.cdc.gov/eid/article/21/5/15-0150_article

2.  Nature 19 February issue is devoted to an update on epigenetics.  The articles relate to: ‘Insights into three fundamental aspects of epigenetics: how the epigenome affects gene expression; how the epigenome changes during stem-cell differentiation… and how it changes during disease’.  See the lead Editorial at: http://www.nature.com/news/beyond-the-genome-1.16929

3.  This same issue of Nature has a Technology Feature ‘Measure for Measure’ about use of mass cytometry and fluorescence flow cytometry to identify proteins on immune cells which are attracted to specific antibodies.  This information can shorten the time to development of new vaccines.  See the article by Kling at: http://www.nature.com/nature/journal/v518/n7539/full/518439a.html

RGL, MD

Posted February 22, 2015 by levittrg in Ebola

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Evening Ebola Update, Sat, 2/21: Stigma of contact lists prevents ‘zero’ cases/Substitutes for PPEs in villages/Drug trials have problems   Leave a comment

2/21/15

Dear Colleagues:

1.  NY Times reports that WHO and UN high officials have reported ‘getting to zero’ is made more difficult by contacts of known EBOV patients doing all sorts of things to stay off the contact tracing lists.  There is great stigma associated with being on the contact tracing lists.  See: http://www.nytimes.com/2015/02/21/world/africa/leaders-of-ebola-fight-at-un-express-worry-about-eradication.html?ref=health

2.  The Lancet Infectious Disease February, 2015, has an article by Salmon, et. al. from the University of New South Wales, Sydney, Australia, re: community-based care of EBOV patients in West Africa.  The authors have taught teams in country to become teachers of EBOV to their village populations.  The authors say that PPEs are not feasible in villages for family members caring for an EBOV patient.  So the authors teach disinfection (how to mix bleach with water in proper proportions), handwashing, and hand protection (with plastic bags).  Families must care for some EBOV patients when EBOV treatment centers are far from their village or EBOV beds are filled and patients are turned away.  See: http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(14)71080-1/fulltext

3.  Science Magazine 13 February has an in-depth article about troubles with EBOV drug trials in West Africa.  Chimerix has stopped the drug trial of brincidofovir in Liberia because of ‘trouble recruiting patients’.  More patients are available in Sierra Leone though.  Chimerix refused to make public its communications with the FDA re: this matter.  ZMapp has plans to start a drug trial in Liberia also, where there are few patients.  Sierra Leone and Guinea will not join the ZMapp trial because that trial involves a placebo arm.  Farrar of the Wellcome Trust agrees with these two countries’ decision.  Surely, the ZMapp drug trial can be redesigned to eliminate the placebo arm.  ZMapp has worked so well to date in treating EBOV that a redesigned trial would still have great power without the placebo arm.  See: http://www.sciencemag.org/content/347/6223/701.summary?sid=2117f983-f3e2-40bc-b6f1-51db31d60821

RGL, MD

Posted February 22, 2015 by levittrg in Ebola

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