Evening Ebola Update, Wed, 4/15/15: Frankfurt case report in detail gives ‘pearls’/NewLink vaccine working/ZEBOV mutates with human-human infection   Leave a comment

4/15/15

Dear Colleagues:

l.  The Economist has posted the latest statistics on EBOV cases and deaths to April 5th.  The graphic shows by African country EBOV cases and deaths.  See: http://www.economist.com/blogs/graphicdetail/2015/04/ebola-graphics

2.  NEJM has two articles online April 1st re: the safety and efficacy of rVSV ZEBOV vaccine (Canada and NewLink) in Africa, Europe, and the United States.  Separate trials have shown the vaccine is safe, produces fever and arthritis which is self-limited in 10-30% of volunteers, and elicits an immunogenic response with a single dose.  See these two studies at: http://www.nejm.org/doi/full/10.1056/NEJMoa1502924#t=article and http://www.nejm.org/doi/full/10.1056/NEJMoa1414216#t=article

3.  The Lancet has published in the journal on April 11th an article by Wolf, et. al. of University Hospital, Frankfurt, detailing the course and treatment of the Ugandan doctor who became infected with EBOV in Sierra Leone and was airlifted to Frankfurt, Germany, for intensive treatment after initiating self-treatment with amiodarone and IV fluids.  This article appeared online December 19th, but is posted again because I learned much more from reading the print version than the online version.  The patient received a small peptide called FX06 for his vascular leak syndrome, and the authors believe this peptide was effective against the syndrome.  But the patient was receiving other experimental drugs and mechanical ventilation, renal dialysis, and blood replacement simultaneously, as an accompanying editorial notes.  See the Wolf, et. al. article at: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)62384-9/fulltext and the accompanying editorial at: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)62353-9/fulltext

4.  The Lancet article by Wolf, et. al. above gives readers ‘pearls’ on how to intubate EBOV patients, how to safely take chest radiographs, how to safely handle suction fluids and expectorated material, how to and how not to estimate left ventricular end diastolic pressure.  The article is a real hands-on guide for clinicians caring for patients in Biosafety Level 4 facilities.

5.  mBio has published online a report by Kugelman, et. al. from Fort Detrick stating that mutations to binding sites on EBOV for monoclonal antibodies do occur over time in human-to-human transmission of the disease.  So it is important to continually sequence EBOV over time to determine if antibody-binding sites can still bind mAb directed against EBOV.  See: http://mbio.asm.org/content/6/1/e02227-14.full?sid=c8be238a-e184-4b2b-8350-428e4aa39e88

6.  Washington University in St. Louis Record reports that scientists at the medical school have discovered a means of preventing the protective coat surrounding the EBOV virus from being ‘reattached’ after the coat is removed in the host cell for viral replication.  The original paper in Cell Reports is cited.  See the Record summary at:  https://news.wustl.edu/news/Pages/New-Ebola-study-points-to-potential-drug-target.aspx

7.  The Lancet regularly has Correspondence urging that critical care measures be available for all EBOV patients.  These measures include mechanical ventilation, renal dialysis, and chest compressions in the event of an arrest.  The Lancet believes that treatments available in England and Germany should be made available to African countries as well.  See one particular Correspondence at: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)60712-7/fulltext?elsca1=etoc&elsca2=email&elsca3=0140-6736_20150411_385_9976_&elsca4=Public%20Health%7CInfectious%20Diseases%7CHealth%20Policy%7CInternal%2FFamily%20Medicine%7CGeneral%20Surgery%7CLancet

RGL, MD

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Posted April 15, 2015 by levittrg in Uncategorized

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