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

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Posted February 22, 2015 by levittrg in Ebola

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