Global & Disaster Medicine

Archive for the ‘Ebola’ Category

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)


New technology for rapid diagnosis of Ebola in the Democratic Republic of the Congo

WHO

New technology allows for rapid diagnosis of Ebola in the Democratic Republic of the Congo

Laboratory testing of samples is essential to rapidly assess the scope and spread of any Ebola outbreak. Since the major outbreak in West Africa in 2014, an increasing number of diagnostic tools have become available to perform rapid initial testing of samples. The Democratic Republic of the Congo is using these new tools, as well as classic ones, to respond to an ongoing outbreak of the virus in a very remote area of the north east of the country.

The National Institute of Biomedical Research (INRB) in Kinshasa, DRC. Patient samples from suspected cases of Ebola are sent here for testing.
WHO/A. Clements-Hunt

A small cluster of undiagnosed illness and deaths with haemorrhagic signs was reported in the Province of Bas-Uele in early May. Congolese scientists quickly gathered samples, shipped them to Kinshasa and tested them at the National Institute of Biomedical Research (INRB). The results, subsequently confirmed by the Centre International de Recherche Médicale de Franceville (CIRMF), a WHO collaborating centre in Gabon, showed this is an outbreak due to Ebola virus disease (Ebolazaire).

WHO/J. Polonsky
A mobile lab in Likati Health Zone, where the current outbreak of Ebola is occuring. This type of laboratory safely allows outbreak response teams to rapidly test suspected cases onsite.

As soon as the outbreak was detected, the Ministry of Health, together with WHO and other partners, mobilized laboratory resources to ensure investigations could be conducted as quickly as possible to guide the response. In addition to the testing facilities available at the INRB in Kinshasa, an INRB mobile field lab was quickly dispatched to the affected health zone of Likati.

To control the outbreak, multi-disciplinary field teams in Likati have been actively searching for suspect cases. Anyone presenting with certain pre-defined symptoms, such as sudden onset of fever and/or unexplained bleeding, is considered a suspect Ebola case until laboratory results prove otherwise. Discarding suspect cases that test negative for Ebola allows response teams to focus on tracing only the contacts of those who have either tested positive or whose status is unknown.

The MOH, WHO and partners have rapidly set up an intensified field alert and response system in Likati. This is resulting in early identification of suspect cases detected in the affected zone. The field laboratory provides the capability to rapidly test samples on site and focus support and follow-up on any new laboratory confirmed cases and contacts. In this extremely remote and challenging area, this mobile lab is providing a core element of robust surveillance, which is essential to bringing this outbreak to an end as quickly as possible.

A GeneXpert diagnostic testing set-up in the INRB lab in Kinshasa. This diagnostic tool was adapted during the outbreak of Ebola in West Africa to rapidly test for the disease. Results are ready in one hour.
WHO/A. Clements-Hunt

One of the technologies being used to detect Ebola in DRC is GeneXpert, which was primarily developed to detect cases of tuberculosis, but has been adapted to enable rapid testing of many pathogens – HIV, malaria, STIs, and Ebola. At the INRB laboratory in Kinshasa – with support from USAID, WHO, Canada, the Global Outbreak Alert and Response Network (GOARN) and the Emerging and Dangerous Pathogens Laboratory Network (EDPLN) – technicians can use GeneXpert to test for the Zaire strain of Ebola in just one hour. For samples that are negative, further testing is then undertaken to check for other strains of Ebola, other viral haemorrhagic fevers, or other diseases.

OraQuick was also developed during the West African outbreak. This test produces results in just 30 minutes.
WHO/A. Clements-Hunt

Other tests developed during the West African outbreak are also being deployed, such as OraQuick — a rapid diagnostic test, which has been developed with the support of the US Centers for Disease Control and Prevention and GOARN. In the field, OraQuick can test blood or saliva samples for Ebola in just half an hour.

Even if many or all suspect cases now being tested are negative, it remains vital to actively follow contacts of all confirmed, probable, and suspect cases for 21 days, and then to continue enhanced surveillance for an additional 21-day period. Any period of calm is an opportunity to continue building and reinforcing local and country preparedness and response capacities and ensuring rapid investigation teams are ready in case the virus should resurface.

This is the eighth outbreak of Ebola virus disease in the Democratic Republic of the Congo since the disease was discovered in the 1970s in DRC. Health authorities in this country are recognized throughout the African region and the world as experts in responding to outbreaks of this disease.


rVSVΔG-ZEBOV-GP: A pretty safe Ebola vaccine

J. Infectious Diseases

Six-Month Safety Data of Recombinant Vesicular Stomatitis Virus–Zaire Ebola Virus Envelope Glycoprotein Vaccine in a Phase 3 Double-Blind, Placebo-Controlled Randomized Study in Healthy Adults

Scott A. Halperin

J Infect Dis jix189.
Background.

This study (NCT02503202) evaluated the safety of recombinant vesicular stomatitis virus–Zaire Ebola virus envelope glycoprotein vaccine (rVSVΔG-ZEBOV-GP).

Methods.

Overall, 1197 subjects were randomized 2:2:2:2:1; 1194 were vaccinated with 1 dose of 1 of 3 lots of rVSVΔG- ZEBOV-GP (2 × 107 plaque-forming units [pfu], n = 797; combined-lots group), a single high-dose lot of rVSVΔG-ZEBOV-GP (1 × 108 pfu, n = 264; high-dose group), or placebo (n = 133). Daily temperatures and adverse events (AEs) were recorded days 1 to 42 postvaccination. Solicited AEs included injection-site AEs from days 1 to 5, and joint pain, joint swelling, vesicular lesions (blisters), and rashes from days 1 to 42. Serious AEs (SAEs) were recorded through 6 months postvaccination.

Results.

Fever (≥38.0°C) was observed in 20.2% of combined lots (3.2% with ≥39.0°C), 32.2% of high-dose (4.3% with ≥39.0°C), and 0.8% of placebo (0.8% with ≥39.0°C). Incidences of AEs of interest (days 1–42) were arthralgia (17.1% combined lots, 20.4% high-dose, 3.0% placebo), arthritis (5.1% combined lots, 4.2% high-dose, 0.0% placebo), and rash (3.8% combined lots, 3.8% high-dose, 1.5% placebo). Twenty-one SAEs and 2 deaths were reported, all assessed by investigators as unrelated to vaccine.

Conclusions.

rVSVΔG-ZEBOV-GP was generally well-tolerated, with increased rates of injection-site and systemic AEs compared to placebo, and no vaccine-related SAEs or deaths. These findings support the use of rVSVΔG-ZEBOV-GP vaccine in persons at risk for Ebola virus disease.

Clinical Trials Registration.

NCT02503202.


Asymptomatic Ebola: A Rare Event

Glynn JR, Bower H, Johnson S, et al. Asymptomatic infection and unrecognized Ebola virus disease in Ebola-affected households in Sierra Leone: a cross-sectional study using a new non-invasive assay for antibodies to Ebola virus. Lancet Infect Dis 2017;17:645-653.

“…..By using control subjects, Glynn and colleagues incorporated appropriate rigor into their low overall estimate of 2.6% asymptomatic infection. If asymptomatic infection is a rare event, as this study suggests, then outbreak control should be focused on identifying symptomatic individuals and initiating the appropriate infection control measures to halt an outbreak.

Additionally, the novel assay used in the study, which requires just oral swabbing, is an important new tool that can be employed in similar studies and to understand where Ebola has occurred in the past. As a new outbreak of Ebola has been identified in the DRC, it will be important to use this near real-time approach to target efforts on tasks that have the highest yield. As USAMRIID’s Kuhn and Bavari write in an accompanying editorial, “The biggest threat to human populations therefore remains another introduction of Ebola virus from its natural host–and not transmission from an apparently healthy person infected with Ebola virus…….”

 


The Ebola outbreak in the Democratic Republic of the Congo (DRC) grew by 9 more cases

WHO

“…..As of 18 May 2017, a total of 29 EVD cases [two confirmed, two probable and 25 suspected] have been reported.  To date, three deaths have been reported, giving a case fatality rate of 10%. Most of the cases presented with fever, vomiting, bloody diarrhea and other bleeding symptoms and signs. The cases have been reported from four health areas, namely Nambwa (11 cases and two deaths), Mouma (three cases and one death), Ngayi (13 cases and no deaths), and Azande (two cases and no deaths). According to available ….”


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