Global & Disaster Medicine

Archive for the ‘Ebola’ Category

Statement on the 1st meeting of the IHR Emergency Committee regarding the Ebola outbreak in 2018

Saturday, May 19th, 2018

18 May 2018

Statement

The 1st meeting of the Emergency Committee convened by the WHO Director-General under the International Health Regulations (IHR) (2005) regarding the Ebola Virus Disease (EVD) outbreak in the Democratic Republic of the Congo took place on Friday 18 May 2018, from 11:00 to 14:00 Geneva time (CET).

Emergency Committee conclusion

It was the view of the Committee that the conditions for a Public Health Emergency of International Concern (PHEIC) have not currently been met.

Meeting

Members and advisors of the Emergency Committee met by teleconference. Presentations were made by representatives of the Democratic Republic of the Congo on recent developments, including measures taken to implement rapid control strategies, and existing gaps and challenges in the outbreak response. During the informational session, the WHO Secretariat provided an update on and assessment of the Ebola outbreak.

The Committee’s role was to provide to the Director-General their views and perspectives on:

Whether the event constitutes a Public Health Emergency of International Concern (PHEIC)
If the event constitutes a PHEIC, what Temporary Recommendations should be made

Current situation

On 8 May, WHO was notified by the Ministry of Health of the Democratic Republic of the Congo of two lab-confirmed cases of Ebola Virus Disease occurring in Bikoro health zone, Equateur province. Cases have now also been found in nearby Iboko and Mbandaka. From 4 April to 17 May 2018, 45 EVD cases have been reported, including in three health care workers, and 25 deaths have been reported. Of these 45 cases, 14 have been confirmed. Most of these cases have been in the remote Bikoro health zone, although one confirmed case is in Mbandaka, a city of 1.2 million, which has implications for its spread.

Nine neighbouring countries, including Congo-Brazzaville and Central African Republic, have been advised that they are at high risk of spread and have been supported with equipment and personnel.

Key Challenges

After discussion and deliberation on the information provided, the Committee concluded these key challenges:

The Ebola outbreak in the Democratic Republic of the Congo has several characteristics that are of particular concern: the risk of more rapid spread given that Ebola has now spread to an urban area; that there are several outbreaks in remote and hard to reach areas; that health care staff have been infected, which may be a risk for further amplification.
The risk of international spread is particularly high since the city of Mbandaka is in proximity to the Congo river, which has significant regional traffic across porous borders.
There are huge logistical challenges given the poor infrastructure and remote location of most cases currently reported; these factors affect surveillance, case detection and confirmation, contact tracing, and access to vaccines and therapeutics.

However, the Committee also noted the following:

The response by the government of the Democratic Republic of the Congo, WHO and partners has been rapid and comprehensive.
Interventions underway provide strong reason to believe that the outbreak can be brought under control, including: enhanced surveillance, establishment of case management facilities, deployment of mobile laboratories, expanded engagement of community leaders, establishment of an airbridge, and other planned interventions.
In addition, the advanced preparations for use of the investigational vaccine provide further cause for optimism for control

In conclusion, the Emergency Committee, while noting that the conditions for a PHEIC are not currently met, issued Public Health Advice as follows:

Government of the Democratic Republic of the Congo, WHO, and partners remain engaged in a vigorous response – without this, the situation is likely to deteriorate significantly. This response should be supported by the entire international community.
Global solidarity among the scientific community is critical and international data should be shared freely and regularly.
It is particularly important there should be no international travel or trade restrictions.
Neighbouring countries should strengthen preparedness and surveillance.
During the response, safety and security of staff should be ensured, and protection of responders and national and international staff should prioritised.
Exit screening, including at airports and ports on the Congo river, is considered to be of great importance; however entry screening, particularly in distant airports, is not considered to be of any public health or cost-benefit value.
Robust risk communication (with real-time data), social mobilisation, and community engagement are needed for a well-coordinated response and so that those affected understand what protection measures are being recommended;
If the outbreak expands significantly, or if there is international spread, the Emergency Committee will be reconvened.

The Committee emphasized the importance of continued support by WHO and other national and international partners towards the effective implementation and monitoring of this advice.

Based on this advice, the reports made by the affected States Parties, and the currently available information, the Director-General accepted the Committee’s assessment and on 18 May 2018 did not declare the Ebola outbreak in the Democratic Republic of the Congo a Public Health Emergency of International Concern (PHEIC). In light of the advice of the Emergency Committee, WHO advises against the application of any travel or trade restrictions. The Director-General thanked the Committee Members and Advisors for their advice.

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Ebola, the Democratic Republic of the Congo (DRC), and The WHO

Saturday, May 12th, 2018

WHO

The World Health Organization (WHO) and a broad range of partners are in the Democratic Republic of the Congo (DRC) working with the Government to contain an outbreak of Ebola virus disease (EVD) in Bikoro health zone, Equateur Province. The outbreak was declared three days ago. WHO Director-General Dr Tedros Adhanom Ghebreyesus will travel to the DRC over the week-end to take stock of the situation and direct the continuing response in support of the national health authorities.

As of 11 May, 34 Ebola cases have been reported in the area in the past five weeks, including 2 confirmed, 18 probable (deceased) and 14 suspected cases. Five samples were collected from 5 patients and two have been confirmed by the laboratory. Bikoro health zone is 250 km from Mbandaka, capital of Equateur Province in an area of the country that is very hard to reach.

“WHO staff were in the team that first identified the outbreak. I myself am on my way to the DRC to assess the needs first-hand,” said Dr Tedros. “I’m in contact with the Minister of Health and have assured him that we’re ready to do all that’s needed to stop the spread of Ebola quickly. We are working with our partners to send more staff, equipment and supplies to the area.”

A multidisciplinary team including WHO experts, along with staff from the Provincial Division of Health and Médecins Sans Frontières (MSF), arrived in Bikoro on 10 May. This first group of responders is now gathering more data to understand the extent and drivers of the epidemic. The team will also set up an active case search and contact tracing, establish Ebola treatment units to care for patients, set up mobile labs, and engage the community on safe practices. WHO will also work with national authorities in planning further public health measures such as vaccination campaigns.

“WHO is supporting the Government of the Democratic Republic of the Congo in coordinating this response; this is the country’s ninth Ebola outbreak and there is considerable expertise in-country,” said Dr Matshidiso Moeti, WHO Regional Director for Africa. “However, any country facing such a threat may require international assistance. WHO and its partners including MSF, World Food Programme (WFP), UNICEF, International Federation of Red Cross and Red Crescent Societies (IFRC) and the Congolese Red Cross, UNOCHA and MONUSCO , US Centers for Disease Control and Prevention (US-CDC), the International Organization for Migration (IOM), are all stepping up their support.”

The response plan to the outbreak includes surveillance, case investigation, and contact tracing; community engagement and social mobilization; case management and infection prevention and control; safe and dignified burials; research response including the use of ring vaccination and antivirals; and coordination and operations support.

“It is too early to judge the extent of this outbreak,” said Dr Peter Salama, WHO Deputy Director-General for Emergency Preparedness and Response. “However, early signs including the infection of 3 health workers, the geographical extent of the outbreak, the proximity to transport routes and population centres, and the number of suspected cases indicate that stopping this outbreak will be a serious challenge. This will be tough and it will be costly. We need to be prepared for all scenarios.”

In its latest Disease Outbreak News, WHO lists the risks to surrounding countries as moderate. WHO has however, already alerted those countries and is working with them on border surveillance and preparedness for potential outbreaks. WHO does not at this time advise any restrictions on travel and trade to the Democratic Republic of the Congo.

ENDS

Note to editors:

Current operations:

The first multidisciplinary team comprised of experts from WHO, Médecins Sans Frontières and the Provincial Division of Health arrived in Bikoro on 9 May to strengthen coordination and investigations. More deployments of epidemiologists, logisticians, clinicians, infection prevention and control experts, risk communications experts and vaccination support teams should arrive in Bikoro on Saturday.

WHO is working with Government and key partners – including Médecins Sans Frontières, World Food Programme, the International Federation of the Red Cross, UNICEF and US-CDC – to strengthen coordination of the EVD response at the national level and in the affected Bikoro health zone and is calling on its development partners to ensure a strong, comprehensive and rapid response to support the DRC Government to prevent and control the spreading of the disease.

Two mobile labs are planned to be deployed on 12 May.

Current bed capacity includes 15 beds in Bikoro. MSF is currently establishing isolation on site and has also deployed four mobile isolation units (5 beds each).

WHO is coordinating a major flight plan with UNHAS/WFP to deploy experts, equipment and materials to the field and is working closely with other health partners to prevent further geographical spread, improve surveillance data and reduce deaths by improving treatment of Ebola patients in Bikoro and the epicentre of Ikoko-Impenge. The cost of the air bridge for 3 months is estimated at US$ 2.4 million.

A logistician is expected to arrive in Bikoro this afternoon/evening to arrange accommodation/staff logistics. Additional information on access, transportation, and logistics requirements will be communicated tomorrow.

WHO is in the process of sending (Saturday) medical supplies to Bikoro to support the Ebola response, including:

Personal Protective Equipment kits (PPE)
Interagency Emergency Health Kit (IEHK)
boxes for transportation
body bags

WHO is helping with surveillance of cases by setting up community-based data collection to complement information provided by health facilities.

WHO has alerted neighbouring countries and is supporting the Central African Republic and Republic of Congo to strengthen surveillance in case of cross-border spread of the outbreak.

Funding requirements

WHO released US$ 1 million from its Contingency Fund for Emergencies to kick start the rapid response. Based on current assessment and response needs the estimated budget for the international response is US$ 18 million for a 3-month operation. Wellcome Trust and UK Department for International Development (DFID) announced a commitment of up to £3 million to support a rapid response to the outbreak.

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The Government of the Democratic Republic of the Congo declared a new outbreak of Ebola virus disease (EVD). In the past five weeks, there have been 2 confimred cases, and 21 suspected VHF cases in and around the iIkoko Iponge, including 17 deaths.

Thursday, May 10th, 2018

WHO

New Ebola outbreak declared in Democratic Republic of the Congo

8 May 2018

News Release

Geneva/Brazzaville/Kinshasa

The Government of the Democratic Republic of the Congo declared a new outbreak of Ebola virus disease (EVD) in Bikoro in Equateur Province today (8 May). The outbreak declaration occurred after laboratory results confirmed two cases of EVD.

The Ministry of Health of Democratic of the Congo (DRC) informed WHO that two out of five samples collected from five patients tested positive for EVD at the Institut National de Recherche Biomédicale (INRB) in Kinshasa. More specimens are being collected for testing.

WHO is working closely with the Government of the DRC to rapidly scale up its operations and mobilize health partners using the model of a successful response to a similar EVD outbreak in 2017.

“Our top priority is to get to Bikoro to work alongside the Government of the Democratic Republic of the Congo and partners to reduce the loss of life and suffering related to this new Ebola virus disease outbreak,” said Dr Peter Salama, WHO Deputy Director-General, Emergency Preparedness and Response. “Working with partners and responding early and in a coordinated way will be vital to containing this deadly disease.”

The first multidisciplinary team comprised of experts from WHO, Médecins Sans Frontières and Provincial Division of Health travelled today to Bikoro to strengthen coordination and investigations.

Bikoro is situated in Equateur Province on the shores of Lake Tumba in the north-western part of the country near the Republic of the Congo. All cases were reported from iIkoko Iponge health facility located about 30 kilometres from Bikoro. Health facilities in Bikoro have very limited functionality, and rely on international organizations to provide supplies that frequently stock out.

“We know that addressing this outbreak will require a comprehensive and coordinated response. WHO will work closely with health authorities and partners to support the national response. We will gather more samples, conduct contact tracing, engage the communities with messages on prevention and control, and put in place methods for improving data collection and sharing,” said Dr Matshidiso Moeti, the WHO Regional Director for Africa.

This is DRC’s ninth outbreak of EVD since the discovery of the virus in the country in 1976. In the past five weeks, there have been 21 suspected viral haemorrhagic fever in and around the iIkoko Iponge, including 17 deaths.

“WHO is closely working with other partners, including Médecins Sans Frontières, to ensure a strong, response to support the Government of the Democratic Republic of the Congo to prevent and control the spreading of the disease from the epicentre of iIkoko Iponge Health Zone to save lives,” said Dr Allarangar Yokouide, WHO Representative in the DRC.

Upon learning about the laboratory results today, WHO set up its Incident Management System to fully dedicate staff and resources across the organization to the response. WHO plans to deploy epidemiologists, logisticians, clinicians, infection prevention and control experts, risk communications experts and vaccination support teams in the coming days. WHO will also be determining supply needs and help fill gaps, such as for Personal Protective Equipment (PPE). WHO has also alerted neighbouring countries.

WHO released US$ 1 million from its Contingency Fund for Emergencies to support response activities for the next three months with the goal of stopping the spread of Ebola to surrounding provinces and countries.

Building on the 2017 response

Ebola is endemic to the Democratic Republic of the Congo. The last Ebola outbreak in the Democratic Republic of the Congo occurred in 2017 in Likati Health Zone, Bas Uele Province, in the northern part of the country and was quickly contained thanks to joint efforts by the Government of DRC, WHO and many different partners.

An effective response to the 2017 EVD outbreak was achieved through the timely alert by local authorities of suspect cases, immediate testing of blood samples due to strengthened national laboratory capacity, the early announcement of the outbreak by the government, rapid response activities by local and national health authorities with the robust support of international partners, and speedy access to flexible funding.

Coordination support on the ground by WHO was critical and an Incident Management System was set up within 24 hours of the outbreak being announced. WHO deployed more than 50 experts to work closely with government and partners.

The Ebola virus causes an acute, serious illness which is often fatal if untreated. The average EVD case fatality rate is around 50%. The virus is transmitted to people from wild animals and spreads in the human population through human-to-human transmission.

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The largest patient movement exercise in U.S. Department of Health and Human Services’ history began 4/10/18 to test the nationwide ability to move patients with highly infectious diseases safely and securely to regional treatment centers.

Thursday, April 12th, 2018

HHS

HHS sponsors its largest exercise for moving patients with highly infectious diseases

The largest patient movement exercise in U.S. Department of Health and Human Services’ history began today to test the nationwide ability to move patients with highly infectious diseases safely and securely to regional treatment centers.

“Saving lives during crises requires preparation and training,” explained HHS Assistant Secretary for Preparedness and Response Robert Kadlec, M.D. “A tremendous amount of coordination, synchronization, and skill is needed to move patients with highly infectious diseases safely. We have to protect the patients and the healthcare workers caring for those patients. This type of exercise helps ensure that everyone involved is ready for that level of complexity.”

Coordinated by the HHS Office of the Assistant Secretary for Preparedness and Response, more than 50 organizations will participate, including the Department of State, Department of Transportation, the Regional Ebola Treatment Centers, local and state health and emergency management agencies, hospitals, airport authorities, and non-government organizations.

Throughout the exercise, participants react as if the incident is real. They must take the necessary actions and employ the appropriate resources to manage and protect the patients, the workforce and the environment and safely transport the patients.

The exercise focuses on moving seven people acting as patients with Ebola symptoms in different regions of the country. The patients, including one pediatric patient, first present themselves at one of the following healthcare facilities: CHI St. Luke’s Health-The Woodlands Hospital in The Woodlands, Texas; Medical University of South Carolina in Charleston, South Carolina; Norman Regional Hospital in Norman, Oklahoma; St. Alphonsus Regional Medical Center in Boise, Idaho, and St. Luke’s Regional Medical Center in Boise, Idaho.

At each facility, healthcare workers will collect and ship samples for diagnostic tests to state laboratories, which in turn will practice running the necessary laboratory tests to diagnose the patients with Ebola. As part of the exercise, each patient will receive a positive diagnosis. Using appropriate isolation techniques and personal protective equipment, health care workers then must take steps to have six of the patients transported by air to designated Regional Ebola Treatment Centers. These patients will be placed into mobile biocontainment units for these flights. The pediatric patient will be placed into protective equipment and transported by ground ambulance.

The treatment centers that will receive the patients are Cedars-Sinai Medical Center in Los Angeles, California; Emory University Hospital in Atlanta, Georgia; Providence Sacred Heart Medical Center in Spokane, Washington; and University of Texas Medical Branch in Galveston, Texas. The pediatric patient will be transported to Texas Children’s Hospital West Campus in Houston, Texas.

The participating airports are Boise Airport in Boise, Idaho; Charleston International Airport in Charleston, South Carolina; DeKalb-Peachtree Airport in Atlanta, Georgia; Ellington Field Airport in Houston, Texas; Los Angeles International Airport in Los Angeles, California; Spokane International Airport in Spokane, Washington; and Will Rogers World Airport in Oklahoma City, Oklahoma. Upon arrival, local emergency responders will transfer the patients to ground ambulances for transportation from the airports to the treatment centers.

HHS and the Department of State previously collaborated on exercises to move Americans acting as Ebola patients from West African countries to Ebola treatment centers in the United States. In public health emergencies or disasters, the U.S. government orchestrates the return of Americans to the United States, including Americans who are sick or injured.

This exercise runs through April 12. Participants will gather on April 13 to assess the exercise, compare actions across the country, and share best practices for moving patients with highly infectious diseases.

Note to editors: Video sound bites from Dr. Kadlec are available for download at https://www.dropbox.com/sh/ktvdv44y7z68ly7/AAAf2H_JzzY8i-tzREY6VfaAa?dl=0 .

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Household Transmission of Ebola Virus: risks and preventive factors, Freetown, Sierra Leone, 2015

Tuesday, April 10th, 2018

J Infect Dis

“…..We enrolled 150 index Ebola cases and 838 contacts; 83 (9.9%) contacts developed Ebola during 21-day follow-up. In multivariable analysis, risk factors for transmission included index case death in the household, Ebola symptoms but no reported fever, age <20 years, more days with wet symptoms; and providing care to the index case (P<0.01 for each). Protective factors included avoiding the index case after illness onset and a piped household drinking water source (P<0.01 for each).….”

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Disease X: A pathogen with the potential to spread and kill millions but for which there are currently no, or insufficient, countermeasures available.

Sunday, March 11th, 2018

The Telegraph

“……It was the third time the committee, consisting of leading virologists, bacteriologists and infectious disease experts, had met to consider diseases with epidemic or pandemic potential. But when the 2018 list was released two weeks ago it included an entry not seen in previous years.

Crimean-Congo haemorrhagic fever (CCHF)
Ebola virus disease and Marburg virus disease
Lassa fever
Middle East respiratory syndrome coronavirus (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS)
Nipah and henipaviral diseases
Rift Valley fever (RVF)
Zika
Disease X

*Diseases posing significant risk of an international public health emergency for which there is no, or insufficient, countermeasures. Source: World Health Organization (WHO), 2018

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A new prophylactic vaccine was immunogenic and effective against multiple filoviruses, including Ebola and Marburg, in monkeys

Thursday, February 22nd, 2018

PLOS

A prophylactic multivalent vaccine against different filovirus species is immunogenic and provides protection from lethal infections with Ebolavirus and Marburgvirus species in non-human primates

Benoit Callendret,
Jort Vellinga,
Kerstin Wunderlich, et al.
PLOS
February 20, 2018
https://doi.org/10.1371/journal.pone.0192312

“…..These results demonstrate that it is feasible to generate a multivalent filovirus vaccine that can protect against lethal infection by multiple members of the filovirus family.…….”

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Real-time Assay for the Detection of Filoviruses (Ebola and Marburg viruses)

Saturday, February 17th, 2018

Sensitive Multiplex Real-time RT-qPCR Assay for the Detection of Filoviruses

Dedkov Vladimir G., Magassouba N’Faly, Safonova Marina V., Bodnev Sergey A., Pyankov Oleg V., Camara Jacob, Sylla Bakary, Agafonov Alexander P., Maleev Victor V., and Shipulin German A.. Health Security. February 2018, 16(1): 14-21. https://doi.org/10.1089/hs.2017.0027

“……The high specificity and sensitivity of the assay make it useful for clinical and epidemiologic investigations in the field of filovirus fever diseases and their etiological agents…..”

Colorized negative stained transmission electron micrograph depicting a Marburg virus virion, in the filovirus family.

CDC

Filoviruses belong to a virus family called Filoviridae and can cause severe hemorrhagic fever in humans and nonhuman primates. So far, only two members of this virus family have been identified: Marburgvirus and Ebolavirus. Five species of Ebolavirus have been identified: Taï Forest (formerly Ivory Coast), Sudan, Zaire, Reston and Bundibugyo. Ebola-Reston is the only known Filovirus that does not cause severe disease in humans; however, it can still be fatal in monkeys and it has been recently recovered from infected swine in South-east Asia.

Structurally, filovirus virions (complete viral particles) may appear in several shapes, a biological features called pleomorphism. These shapes include long, sometimes branched filaments, as well as shorter filaments shaped like a “6”, a “U”, or a circle. Viral filaments may measure up to 14,000 nanometers in length, have a uniform diameter of 80 nanometers, and are enveloped in a lipid (fatty) membrane. Each virion contains one molecule of single-stranded, negative-sense RNA. New viral particles are created by budding from the surface of their hosts’ cells; however, filovirus replication strategies are not completely understood.

Colorized negative stained transmission electron micrograph depicting a Marburg virus virion, in the filovirus family.

Filovirus history

The first Filovirus was recognized in 1967 when a number of laboratory workers in Germany and Yugoslavia, who were handling tissues from green monkeys, developed hemorrhagic fever. A total of 31 cases and 7 deaths were associated with these outbreaks. The virus was named after Marburg, Germany, the site of one of the outbreaks. In addition to the 31 reported cases, an additional primary case was retrospectively serologically diagnosed.

After this initial outbreak, the virus disappeared. It did not reemerge until 1975, when a traveler, most likely exposed in Zimbabwe, became ill in Johannesburg, South Africa. The virus was transmitted there to his traveling companion and a nurse. A few sporadic cases and 2 large epidemics (Democratic Republic of Congo in 1999 and Angola in 2005) of Marburg hemorrhagic fever (Margurg HF) have been identified since that time. For information on known Marburg HF cases and outbreaks, please refer to the chronological list.

Ebolavirus was first identified in 1976 when two outbreaks of Ebola hemorrhagic fever (Ebola HF) occurred in northern Zaire (now the Democratic Republic of Congo) and southern Sudan. The outbreaks involved what eventually proved to be two different species of Ebola virus; both were named after the nations in which they were discovered. Both viruses showed themselves to be highly lethal, as 90% of the Zairian cases and 50% of the Sudanese cases resulted in death.

Since 1976, Ebolavirus have appeared sporadically in Africa, with small to midsize outbreaks confirmed between 1976 and 1979. Large epidemics of Ebola HF occurred in Kikwit, Democratic Republic of Congo in 1995, in Gulu, Uganda in 2000, in Bundibugyo, Uganda in 2008, and in Issiro, DRC in 2012. Smaller outbreaks were identified in Gabon, DRC, and Uganda. For information on known Ebola HF cases and outbreaks, please refer to the chronological list.

Animal hosts

It appears that Filoviruses are zoonotic, that is, transmitted to humans from ongoing life cycles in animals other than humans. Despite numerous attempts to locate the natural reservoir or reservoirs of Ebolavirus and Marburgvirus species, their origins were undetermined until recently when Marburgvirus and Ebolavirus were detected in fruit bats in Africa. Marburgvirus has been isolated in several occasions from Rousettus bats in Uganda.

Spreading Filovirus infections

In an outbreak or isolated case among humans, just how the virus is transmitted from the natural reservoir to a human is unknown. Once a human is infected, however, person-to-person transmission is the means by which further infections occur. Specifically, transmission involves close personal contact between an infected individual or their body fluids, and another person. During recorded outbreaks of hemorrhagic fever caused by a Filovirus infection, persons who cared for (fed, washed, medicated) or worked very closely with infected individuals were especially at risk of becoming infected themselves. Nosocomial (hospital) transmission through contact with infected body fluids – via reuse of unsterilized syringes, needles, or other medical equipment contaminated with these fluids – has also been an important factor in the spread of disease. When close contact between uninfected and infected persons is minimized, the number of new Filovirus infections in humans usually declines. Although in the laboratory the viruses display some capability of infection through small-particle aerosols, airborne spread among humans has not been clearly demonstrated.

During outbreaks, isolation of patients and use of protective clothing and disinfection procedures (together called viral hemorrhagic fever isolation precautions or barrier nursing) has been sufficient to interrupt further transmission of Marburgvirus or Ebolavirus, and thus to control and end the outbreak. Because there is no known effective treatment for the hemorrhagic fevers caused by Filoviruses, transmission prevention through application of viral hemorrhagic fever isolation precautions is currently the centerpiece of Filovirus control.

In conjunction with the World Health Organization (WHO), CDC has developed practical, hospital-based guidelines, titled Infection Control for Viral Haemorrhagic Fevers in the African Health Care Setting. The manual can help healthcare facilities recognize cases and prevent further hospital-based disease transmission using locally available materials and few financial resources.

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During the 2014–2015 outbreak of Ebola virus disease in Guinea, 13 type 2 circulating vaccine-derived polioviruses (cVDPVs) were isolated from 6 polio patients and 7 healthy contacts.

Monday, December 18th, 2017

EID

Fernandez-Garcia MD, Majumdar M, Kebe O, Fall AD, Kone M, Kande M, et al. Emergence of vaccine-derived polioviruses during Ebola virus disease outbreak, Guinea, 2014–2015. Emerg Infect Dis. 2018 Jan [date cited]. http://dx.doi.org/10.3201/eid2401.171174

DOI: 10.3201/eid2401.171174

“…Although OPV has many advantages (easy administration by mouth, low cost, effective intestinal immunity, and durable humoral immunity), it has the disadvantage of genetic instability. Because of the plasticity and rapid evolution of poliovirus genomes and selective pressures during replication in the human intestine, vaccine poliovirus can lose key genetic determinants of attenuation through mutation or recombination with closely related polio and nonpolio enterovirus strains, acquiring the neurovirulence and infectivity characteristics of wild-type poliovirus (WPV) (3). Because of this genetic instability, in settings where a substantial proportion of the population is susceptible to poliovirus, OPV use can lead to poliovirus emergence and sustained person-to-person transmission and spread in the community of genetically divergent circulating vaccine-derived polioviruses (cVDPVs). ….”

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

Friday, November 3rd, 2017

AJTDH

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

Authors: Mahamoud Sama Cherif, Shyam Prakash Dumre, Diénaba Kassé, et al.
Publisher: The American Society of Tropical Medicine and Hygiene
Source: The American Journal of Tropical Medicine and Hygiene

“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.”

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