Archive for May 2015

Evening Ebola Update, Sat, 5/15: WHO World Assembly to define funding, new mission/ Conflict over low number of EBOV pts for vaccine testing/Need for 15 min. EBOV dx in all health centers   Leave a comment

5/16/15

Dear Colleagues:

l.  CDC MMWR 15 May has a report by Nyenswah, et. al. from the Ministry of Health, Liberia, and WHO and CDC about the last cluster of EBOV cases in Liberia last January.  Most interesting fact to me was the large number of contacts (745 persons) was established by the lack of immediate EBOV diagnostics at health care clinics in Liberia.  Thus, the index case spread EBOV to her family and friends who in turn by hiding themselves or crossing borders or refusing to seek help spread EBOV widely.  The immediate EBOV paper tests need to be widely available for the case count in West Africa to go to zero.  See the report at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6418a5.htm?s_cid=mm6418a5_e

2.  A disturbing report re: Phase 3 vaccine trials in West Africa appears in The Lancet 12 May under World Report.  The author reports on conflict between NIH and WHO because of a shortage of EBOV patients in Liberia.  NIH has a Phase 3 vaccine trial going on in Liberia and wishes to move the trial to Guinea where more EBOV patients are located.  Problem is that WHO is conducting its own Phase 3 vaccine trials in Guinea and says that moving the NIH trial to Guinea from Liberia will confound both trials.  See: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)60938-2/fulltext?elsca1=etoc&elsca2=email&elsca3=0140-6736_20150516_385_9981_&elsca4=Public%20Health%7CInfectious%20Diseases%7CHealth%20Policy%7CInternal%2FFamily%20Medicine%7CGeneral%20Surgery%7CLancet

3.  WHO World Health Assembly will meet in Geneva on 18 May.  Dr. Chan will present her agenda for WHO for the near future.  This agenda will include: a call for member countries to make good on their mandatory and voluntary contributions to WHO; full funding for a Rapid Response Team for emerging pathogens; recognition of WHO’s new ‘job description’ going beyond ‘coordination’ between member countries.  See the WHO announcement at: http://www.who.int/en/  Note that the announcement provides a means to get daily updates from WHO on the World Health Assembly.  Nature 13 May has a summary of what they think will be discussed at the 18 May meeting: http://www.nature.com/news/ebola-failures-prompt-who-rethink-1.17528?WT.ec_id=NEWS-20150514.  (I’d like to see ‘universal’ flu vaccine put on the agenda and ramped up.  See: http://www.sciencemag.org/site/special/h5n1/index.xhtml)

4.  PLoS One has an article by Barlow, et. al. from the University of California at Merced re: how to cycle antibiotics to reduce antibiotic resistance to commonly used hospital antibiotics.  The authors used a mathematical formula to determine how to best cycle antibiotics.  See: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0122283

5.  For those readers like me who do not have a strong math background, an explanatory summary of the PLoS One article appears in Laboratory Equipment at: http://www.laboratoryequipment.com/news/2015/05/researchers-reverse-antibiotic-resistance. 

RGL, MD

Posted May 17, 2015 by levittrg in Uncategorized

Ebola Update, Fri, 5/8/15: Lancet Lessons Learned from EBOV epidemic/Horton Comment way off base   Leave a comment

5/8/15

Dear Colleagues:

Today’s Ebola Update focuses on The Lancet 9 May issue received online in my Inbox this morning.  This issue has a Public Policy Forum by Professor Heymann from the London School of Hygiene and Tropical Medicine on the Lessons Learned from the EBOV epidemic; two Viewpoints by other EBOV authorities on Lessons Learned; and a Comment by The Lancet editors:

1.  Professor Heymann’s Public Policy Forum includes many world wide infection and epidemiology experts as participants.  The Forum is a very lengthy article which presents so much information and so many recommendations that I refer you to two graphics within the Forum: Key Messages and Mock Dashboard for Health Services Agenda.  These two graphics summarize the Forum nicely.  Heymann, et. al. conclude that the world needs to do more now to prepare for the future and that African countries need to be self-reliant when it comes to the health of their populations. (RGL: The world has moved on to the next health crises in the Middle East).  See the entire Forum at:

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)60858-3/abstract?elsca1=etoc&elsca2=email&elsca3=0140-6736_20150509_385_9980_&elsca4=Public%20Health%7CInfectious%20Diseases%7CHealth%20Policy%7CInternal%2FFamily%20Medicine%7CGeneral%20Surgery%7CLancet

2.  Kruk, et. al. from the Harvard School of Public Health in a Viewpoint identify the type of health system that all countries contending with the threat of emerging infectious diseases need to have in place.  The health systems need to be aware of what’s coming down the road; diverse in composition; self-regulating-must depend upon itself-not the international community; integrative; and adaptive.  These characteristics are the same characteristics that military forces strive to have.  See the Kruk, et. al. article at: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)60755-3/fulltext

3.  Professor Heymann, et. al. have a second Lancet Viewpoint re: how to avoid being behind the curve with vaccine development for emerging pathogens. He recommends:

“Serious consideration should also be given to the creation of an internationally supported facility dedicated to rapidly developing vaccines against known emerging pathogens, such as a multivalent Filovirus vaccine that could protect against multiple Ebola virus strains and the Marburg virus.”

The authors have other recommendations as well.  See: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)60645-6/abstract

4.  Horton, et. al., editors of the Lancet, have a Comment which nicely summarizes the Heymann, et. al. and Kruk, et. al. articles in general terms.  But Horton, et. al. are way off base in declaring:

“It is, sadly, also deeply hostile to WHO, which, one senior US State Department official told us recently, has been “overwhelmed” by Ebola. The US Government remains fully committed to global health. But another government adviser tells us that the US administration is “furious” about the way existing international health arrangements failed to contain the Ebola outbreak. The USA will now “go it alone”, he said. It will protect its homeland through bilateral responses, such as the announcement of an African Centres for Disease Control and Prevention through a partnership with the African Union, not WHO. The USA will no longer be interested in UN, let alone WHO, reform, he suggests. Instead, it will do what it needs to do to protect its own interests—domestically and overseas.”

Horton, et. al. have two un-named sources and no corroborating evidence from official HHS documents or speeches that what the un-named sources said is anything more than hearsay.  The editor has shown very poor editorial judgment in including this ‘slam’ against the U.S. and President Obama in his Comment.  The U.S. remains committed to the WHO and UN.  Whatever deficiencies are present at WHO and the UN would quickly be remedied if the member nations made good on their voluntary contributions to WHO and UN.  Remember that WHO is funded >50% now by Bill Gates, Paul Allen, and their friends. I believe the Lancet should do a Erratum of this Comment and apologize to its readers.

See the entire Comment at: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)60909-6/fulltext

RGL, MD

Posted May 8, 2015 by levittrg in Uncategorized

Evening Ebola Update, Sat, 5/2/15: African ‘CDC’ w/o sufficient funds & staff/Fate of Mideast science post Arab Spring/How EBOV enters host cells   Leave a comment

5/2/15

Dear Colleagues:

l.  Nature 23 April has and Editorial re: the newly set up pan-continental African Centres for Disease Control and Prevention (ACDC).  This organization established by the African Union (AU) will not be modeled after the U.S. CDC, but after the European Center for Disease Prevention and Control (ECDC).  The U.S. CDC is massive in budget and staff and has in-house laboratories; the ECDC has no in-house labs, small staff and budget, and acts as coordinator of research labs and national health bodies in the event of an infectious epidemic.  The ACDC will have a small budget and only 11 staff members (including 5 epidemiologists).  Yet the ACDC is supposed to prevent and treat epidemics and strengthen health systems and do national risk assessments.  Experts say the ACDC needs 40x it current budget and 6x its current staff to do these tasks.  The AU will need to find the money to make the ACDC a success.  (RGL: The U.S. Congress funded HHS with much more money than needed to prevent and treat EBOV in the U.S; ACDC would be a good recipient for some of that money.)  See the Nature editorial at: http://www.nature.com/news/highway-to-health-1.17362. 

2.  NPR News May 1st reports on a CDC warning that condoms should be used for all sex with a male EBOV survivor.  The EBOV lasts longer than thought in semen of male survivors.  See:  http://www.npr.org/blogs/goatsandsoda/2015/05/01/403600464/a-man-said-to-be-ebola-free-could-still-infect-a-partner-during-sex

3.  PLoS Pathogens 30 April has posted a review article by Moller-Tank, et. al. from the Gene Therapy Center at University of North Carolina on the entry of EBOV into host cells.  The diagrams are well described and make most of the article useful to a non-viral researcher.  Here is the legend for Figure 3:

Fig 3. Steps of Ebola Virus Entry.

(A) Cell surface receptors bind EBOV particles through interactions with either virion-associated phosphatidylserine or viral glycoprotein glycans. (B) Virus is internalized through ruffling of the plasma membrane and macropinocytosis. (C) During trafficking through endosomes, the EBOV glycoprotein is cleaved by proteases that remove the mucin-like domain (MLD) and glycan cap, exposing the receptor binding domain (RBD). Shown is a stepwise removal of those sequences, although in the cell these cleavage events may occur concurrently. (D) The RBD interacts with NPC1 in the late endosome/lysosome. (E) Binding of the NPC1 C-loop by the glycoprotein is followed by one or more triggers that release the fusion loop, allowing for its insertion into the target membrane. Subsequent transition of the EBOV GP into a six helix bundle results in the host and viral membranes being brought together, leading to fusion. (F) Release of the viral nucleoprotein into the cytoplasm prior to the initiation of virus replication.

doi:10.1371/journal.ppat.1004731.g003″

See: http://journals.plos.org/plospathogens/article?id=10.1371/journal.ppat.1004731

4.  Nature 29 April has a report on the fate of science in Tunisia, Egypt, and Syria since the Arab Spring.  Tunisia has fared much better than the other two countries.  Obtaining materials and international collaboration is a major problem for young scientists in all these countries.  See: http://www.nature.com/news/science-in-turmoil-after-the-arab-spring-1.17428?WT.ec_id=NATURE-20150430

5.  Nature 29 April has an interview with a Hong Kong researcher on the situation for science in Hong Kong compared to mainland China.  See: http://www.nature.com/nature/journal/v520/n7549_supp/full/520S37a.html?WT.ec_id=NATURE-20150430

RGL, MD

Posted May 2, 2015 by levittrg in Uncategorized