Global & Disaster Medicine

Archive for the ‘Ebola’ Category

Ebola Virus Disease Outcome in Elderly People during the 2014 Outbreak in Guinea

AJTDH

Prognostic and Predictive Factors of Ebola Virus Disease Outcome in Elderly People during the 2014 Outbreak in Guinea

“Elderly people occupy a prominent position in African societies; however, their potential linkage to high case fatality rate (CFR) in Ebola virus disease (EVD) was often overlooked. We describe the predictive factors for EVD lethality in the elderly. A total of 2,004 adults and 309 elderly patients with confirmed EVD were included in the analysis. The median age (interquartile range) was 35 years (23–44) in adults and 65 years (60–70) in the elderly. The proportion of funeral participation was significantly higher in the elderly group than in the adult group. Duration (in days) between the onset of symptoms and admission was significantly longer in elderly. CFR in the elderly people was also significantly higher (80.6%) than in the adult group (66.2%). Funeral participation constituted a risk factor for the transmission of EVD in elderly people.”

 


Ebola’s survivors: Cataracts

NY Times

“….Cataracts usually afflict the old, not the young, but doctors have been shocked to find them in Ebola survivors as young as 5. And for reasons that no one understands, some of those children have the toughest, thickest cataracts that eye surgeons have encountered, along with scarring deep inside the eye….”

PHIL Image 17772

Under a magnification of 25,000X, this scanning electron microscopic (SEM) image depicts numerous filamentous Ebola virus particles budding from a chronically-infected VERO E6 cell.

 


Predicting Ebola in a patient: Headache, diarrhea, difficulty breathing, nausea and vomiting, loss of appetite, and conjunctivitis. The laboratory tests most useful were creatinine, creatine kinase, alanine aminotransferase, and total bilirubin.

Oza, S., Sesay, A. A., Russell, N. J., Wing, K., Boufkhed, S., Vandi, L….Checchi, F. (2017). Symptom- and Laboratory-Based Ebola Risk Scores to Differentiate Likely Ebola Infections. Emerging Infectious Diseases, 23(11), 1792-1799. https://dx.doi.org/10.3201/eid2311.170171.

“…..This risk score correctly identified 92% of Ebola-positive patients as high risk for infection; both scores correctly classified >70% of Ebola-negative patients as low or medium risk. Clinicians can use these risk scores to gauge the likelihood of triaged patients having Ebola while awaiting laboratory confirmation…..”


Guidelines focusing on the delivery of supportive care measures to patients in Ebola treatment units where health care resources are limited

Evidence-based guidelines for supportive care of patients with Ebola virus disease
Lamontagne, François et al.
The Lancet


There is evidence to support that Ebola virus may have a direct role in muscular damage and imbalance of the coagulation system.

Clinical Infectious Diseases

“….Though the study provided no evidence that Ebola affected the kidneys, kidney damage is often seen in Ebola patients.
The authors said this was because Ebola viremia was strongly related to evidence of rhabdomyolysis, the rapid breakdown of muscles, which stresses the kidneys….”

 


Researchers followed 27 Ebola survivors in Sierra Leone for 1 year after diagnosis and found they were seven times more likely than their close contacts to report a disability.

Clinical Infectious Diseases

“….Major limitations in vision, mobility, cognition, and affect were observed in survivors one year following the 2014-6 Ebola outbreak, highlighting the need for long-term rehabilitation…..”


The National Ebola Training and Education Center

Health Secur. 2017 May/Jun;15(3):253-260. doi: 10.1089/hs.2017.0005.
The National Ebola Training and Education Center: Preparing the United States for Ebola and Other Special Pathogens.

Abstract

The National Ebola Training and Education Center (NETEC) was established in 2015 in response to the 2014-2016 Ebola virus disease outbreak in West Africa. The US Department of Health and Human Services office of the Assistant Secretary for Preparedness and Response and the US Centers for Disease Control and Prevention sought to increase the competency of healthcare and public health workers, as well as the capability of healthcare facilities in the United States, to deliver safe, efficient, and effective care to patients infected with Ebola and other special pathogens nationwide. NYC Health + Hospitals/Bellevue, Emory University, and the University of Nebraska Medical Center/Nebraska Medicine were awarded this cooperative agreement, based in part on their experience in safely and successfully evaluating and treating patients with Ebola virus disease in the United States. In 2016, NETEC received a supplemental award to expand on 3 initial primary tasks: (1) develop metrics and conduct peer review assessments; (2) develop and provide educational materials, resources, and tools, including exercise design templates; (3) provide expert training and technical assistance; and, to add a fourth task, create a special pathogens clinical research network.


FDA develops rapid and sensitive assay to assess antibody response to Ebola virus vaccine without using the virus

FDA

Scientists at the U.S. Food and Drug Administration (FDA) have developed an assay that assesses the ability of antibodies to neutralize Ebola virus, using a technique that does not require the use of Ebola virus itself and can be automated for rapid testing of large numbers of samples.

The new FDA assay is important because the effectiveness of most licensed viral vaccines is based on their ability to trigger production of neutralizing antibodies. Therefore, methods for assessing neutralization activity of antibodies will likely be an important component for evaluating the effectiveness of Ebola virus vaccines and identifying correlates of protection (measurable signs of immunity).

The assay is based on a widely used technique called micro-neutralization, which measures the ability of antibodies to prevent viruses from infecting animal cells and reproducing themselves. The greater the neutralization of a virus by antibodies, the fewer the number of viruses are able to infect cells and the less the viruses can replicate themselves by making copies of viral genetic material.

A key attribute of the assay is built upon the use of a genetically modified, non-disease-causing virus called vesicular stomatitis virus (VSV). The modified VSV carries part of the genome from Ebola virus and can substitute for Ebola virus in certain assays—an approach previously used at FDA.

The use of genetically engineered VSV eliminates the need for additional precautions, like a BSL-4 laboratory, because the modified virus is incapable of causing Ebola disease. These laboratories are designed for working with pathogens that pose a high risk of life-threatening disease through aerosol transmission and for which there is no vaccine or treatment. The FDA assay is appropriate for BSL-2 laboratories, which are widely available and do not require the more elaborate containment requirements of BSL-4. The need for BSL-4 laboratories for scientists to work with Ebola virus has complicated the worldwide effort to study the virus and develop and assess the effectiveness of Ebola virus vaccines.

The FDA scientists genetically modified different versions of VSV, so each one carried on its surface one of four variations of a molecule called an envelope glycoprotein (GP) found on different strains of the Ebola virus. Then they used a technique called quantitative polymerase chain reaction to measure the amount of genetic material produced by the hybrid VSV after it had been exposed to commercially available antibodies to Ebola virus. Automating the process should offer an important time advantage to public health scientists during investigations of an outbreak. The assay can determine within 6 to 16 hours if antibodies are effective against the Ebola virus.

The scientists showed that the assay was able to assess whether specific antibodies targeting each GP neutralized the different hybrid VSV variants, preventing the virus from infecting the cells and multiplying. Moreover, the results of the Ebola antibody assays agreed with those obtained by other, more complex assays, now used for such testing. This suggests that the assay will be useful in evaluating the ability of antibodies, triggered either by vaccines or natural infection, to neutralize specific varieties of the virus. Moreover, it might be possible to adapt the assay to assess neutralizing antibodies against other viral pathogens.

 

Title

Development of a micro-neutralization assay for ebolaviruses using a replication-competent vesicular stomatitis hybrid virus and a quantitative PCR readout

Vaccine 17 April 2017

DOI: 10.1016/j.vaccine.2017.03.019disclaimer icon

Authors

Stella S. Lee, Kathryn Phy, Keith Peden ⇑, Li Sheng-Fowler

Laboratory of DNA Viruses, Division of Viral Products, Office of Vaccines Research and Review, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD 20993, United States

⇑ Corresponding author at: Building 52/72, Room 1220, CBER, FDA, 10903 New Hampshire Avenue, Silver Spring, MD 20993, United States.
E-mail address: keith.peden@fda.hhs.gov (K. Peden).

 


Red Cross’ safe and dignified burial (SDB) activities in the three West African outbreak countries prevented from 1,411 to 10,452 secondary Ebola cases

PLOS

Tiffany A, Dalziel BD, Kagume Njenge H, Johnson G, Nugba Ballah R, James D, et al. (2017) Estimating the number of secondary Ebola cases resulting from an unsafe burial and risk factors for transmission during the West Africa Ebola epidemic. PLoS Negl Trop Dis 11(6): e0005491. https://doi.org/10.1371/journal.pntd.0005491

“……Red Cross safe and dignified burial (SDB) activities….may have reduced the epidemic by 4.9% to 36.5%…..”

 

 

 


USA: High-level isolation units in select Ebola hospitals report struggling to fund ongoing operations and sustain readiness.

CDC-EID

Volume 23, Number 6—June 2017

Dispatch

Sustainability of High-Level Isolation Capabilities among US Ebola Treatment Centers

Jocelyn J. Herstein, Paul D. Biddinger, Shawn G. Gibbs, Aurora B. Le, Katelyn C. Jelden, Angela L. Hewlett, and John J. Lowe
 

Main Article(https://wwwnc.cdc.gov/eid/article/23/6/17-0062_article)

Figure 1

Diseases that 31 HLIUs reported they would treat, United States, 2016. HLIU, high-level isolation unit.

Figure 1. Diseases that 31 HLIUs reported they would treat, United States, 2016. HLIU, high-level isolation unit.

Main Article(https://wwwnc.cdc.gov/eid/article/23/6/17-0062_article)


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