Evening Ebola Update, Sat, 3/21: Syrian TB, typhus/Gates says what to do next time/Animal model for EBOV/120,000 maternal deaths by October   Leave a comment

3/21/15

Dear Colleagues:

l.  ACAPS has issued a current report on the situation in Syria and the surrounding countries receiving refugees.  Within Syria 25,000 persons need hospital care for injuries each month, but only 1/2 of Syrian hospitals are fully functioning.  TB, typhus, and scabies are endemic in/out of Syria, and cholera is increasing.  Funding requests for Syria and the refugee camps out of Syria were less than 50% fulfilled in 2014.  See the full Syrian report at: http://acaps.org/img/documents/s-acaps-report-syria-4-years-on_13_march_2015.pdf

2.  Nature reports that maternal health in West Africa is suffering terribly as a result of EBOV epidemic.  Pregnant women are especially susceptible to EBOV; fetuses do not survive EBOV infection.  Because of the fluids associated with delivery, many midwives do not perform deliveries now.  The maternal deaths estimated by the U.N. for the first 9 months of 2015 are 120,000 deaths.  See two Nature reports at: http://www.nature.com/news/maternal-health-ebola-s-lasting-legacy-1.17036 and at: http://www.nature.com/news/fatal-fallout-1.17029

3.  Bill Gates has written a Perspective in the NEJM March 18 re: how to deal with the next epidemic.  He uses the experience of the current EBOV epidemic as the basis for his recommendations.  Gates is particularly upset with logistics of the current epidemic.  His recommendations for future epidemics are:

The world needs to build a warning and response system for outbreaks. This system should

• be coordinated by a global institution that is given enough authority and funding to be effective,

• enable fast decision making at a global level,

• expand investment in research and development and clarify regulatory pathways for developing new tools and approaches,

• improve early warning and detection systems, including scalable everyday systems that can be expanded during an epidemic,

• involve a reserve corps of trained personnel and volunteers,

• strengthen health systems in low- and middle-income countries, and

• incorporate preparedness exercises to identify the ways in which the response system needs to improve.”

Read Gates’ NEJM Perspective at: http://www.nejm.org/doi/full/10.1056/NEJMp1502918?query=TOC  The Atlantic also carried an article on Gates’ PerspectiveSee it at: http://www.theatlantic.com/health/archive/2015/03/bill-gates-speaks-out-on-ebola/388120/

4.  PLoS Neglected Tropical Diseases has posted an article by Peterson from University of Kansas re: good and bad news from the current EBOV epidemic.  The author notes that EBOV has moved from ‘neglected tropical disease’ to ’emerging infection’ because of the epidemic in West Africa.  Now research funds, on-site treatment facilities, and vaccine development have all rapidly become available to West Africa. The author states that the basis for surge in monies and people in EBOV is the fact that EBOV showed spread to affluent countries from the underdeveloped countries in West Africa.  Sadly, Peterson is probably right.  See his article at: http://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0003509

5.  ACAPS has issued a report on the effectiveness of quarantine in West Africa to curtail spread of EBOV.  The report says that self-quarantine is effective if food/water are supplied to villagers, if the reasons for quarantine are explained to the people affected, and if coercion is not used to enforce quarantine.  See the ACAPS report at: http://acaps.org/img/documents/t-acaps_thematic_note_ebola_west_africa_quarantine_sierra_leone_liberia_19_march_2015.odf

_2015.pdf

6.  Lancet 21 March has Correspondence from Dhillon from Brigham Hospital re: outsourcing some of WHO’s tasks so that the response to future epidemics is earlier and more complete.  WHO funding has been reduced in recent years because U.N. members have not fulfilled their voluntary contributions to WHO; now WHO depends on non-U.N. contributions for more than 1/2 of its budget.  From my review of the WHO organizational structure, I don’t believe outsourcing is the answer; adequate WHO funding so that adequate staffing of WHO can be maintained is the answer.  Dr. Chan addressed this issue with the Executive Board at its last meeting.  See the Lancet Correspondence at: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)60594-3/fulltext

7.  Lancet March, 2015, has an article by Faye, et. al. of the Pasteur Institute in Dakar, Senegal, re: chains of transmission of EBOV in Guinea.  The authors show how a single EBOV infected individual can start a chain of transmission after all existing EBOV cases are isolated or treated.  See the article at: http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(14)71075-8/abstract

8.  NY Times reports an EBOV case in Liberia two weeks after the last reported EBOV case.  This is an example of a single individual starting a transmission chain (see 7. above).  The infected woman did not come in contact with an infected EBOV patient or attend an unsafe burial.  She may have had sex with a previously EBOV infected male.  See the report at: http://www.nytimes.com/2015/03/21/world/africa/liberia-reports-first-ebola-case-in-weeks.html?ref=health&_r=0

9. WHO reports that mass vaccinations must take place in West Africa for pertussis, measles, and other diseases now.  The EBOV epidemic cut the rates of vaccination significantly.  See the WHO report at: http://who.int/mediacentre/news/releases/2015/vaccination-ebola-countries/en/

10.  Journal of Virology reports that Ludtke, et. al. from Bernard Nocht Institute in Hamburg have transplanted human stem cells into mice in such a way that these mice reproduce the clinical course of human EBOV infection when they are infected with EBOV.  Now there is a small animal model for EBOV infection in humans.  See: http://jvi.asm.org/content/89/8/4700.full?sid=bc66d3ab-71cd-4d92-aa6c-7060d9f5e01c

RGL, MD

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Posted March 22, 2015 by levittrg in Uncategorized

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