Nature

**   “…Wild gorillas and chimpanzees in central Africa have experienced occasional Ebola outbreaks. But like humans, these species are too ravaged by the virus to serve as its natural host. Experts say that a reservoir species is likely to harbour the virus only at low levels, and without becoming sick.  The leading candidates are several species of fruit bat from across central and West Africa — where all known Ebola outbreaks have originated — that are often hunted for meat….”

WHO

End of Ebola transmission in Guinea

CDC

Ebola Response: Year in Review

Posted on December 14, 2015 by Blog Administrator

Post-Ebola Signs and Symptoms in U.S. Survivors

N Engl J Med 2015; 373:2484-2486

December 17, 2015

DOI: 10.1056/NEJMc1506576

“…..All survivors reported having had at least one symptom during the recovery period. These symptoms ranged from mild (e.g., alopecia) to more severe complications requiring rehospitalization or treatment.

The most frequently reported symptoms were lethargy or fatigue, arthralgia, and alopecia…….

Three quarters of survivors returned to normal daily activities within 8 weeks after discharge.

Five patients (63%) reported having ocular symptoms, including pain, discomfort, or blurriness; of these patients, four underwent ophthalmologic evaluation, and two were treated for unilateral uveitis that was diagnosed from 2 weeks to 8 weeks after hospital discharge.

Six patients (75%) reported having psychological or cognitive symptoms, including short-term memory loss, insomnia, and depression or anxiety.

Three patients (38%) reported having paresthesia or dysesthesia, and

one received treatment for peripheral neuropathy.

Two patients (25%) were rehospitalized briefly for non–EVD-related febrile illness….”

WHO

CDC

Crowe SJ, Maenner MJ, Kuah S, Erickson BR, Coffee M, Knust B, et al. Prognostic indicators for Ebola patient survival. Emerg Infect Dis. 2016 Feb [date cited]. http://dx.doi.org/10.3201/eid2202.151250

“….Time from symptom onset to healthcare facility admission was not associated with survival, but viral load in the first Ebola virus–positive blood sample was inversely associated with survival: 52 (87%) of 60 patients with a C_t of >24 survived and 20 (22%) of 91 with a C_t of <24 survived. C_t values may be useful for clinicians making treatment decisions or managing patient or family expectations….”

Note:  Cycle threshold (C_t) can serve as an approximation of viral load.

CDC

Volume 22, Number 2—February 2016

Letter

Initial Costs of Ebola Treatment Centers in the United States

Jocelyn J. Herstein, Paul D. Biddinger, Colleen S. Kraft, Lisa Saiman, Shawn G. Gibbs, Philip W. Smith, Angela L. Hewlett, and John J. Lowe(http://wwwnc.cdc.gov/eid/article/22/2/15-1431_article#comment)

Main Article(http://wwwnc.cdc.gov/eid/article/22/2/15-1431_article)

Table

Initial costs in US$ incurred by 45 Ebola treatment centers in the United States*

WHO

• No confirmed cases were reported in the week to 29 November. Investigations are ongoing into the origin of infection of the cluster of 3 confirmed cases of Ebola virus disease (EVD) reported from Liberia in the week to 22 November. The first-reported case in that cluster was a 15-year-old boy who tested positive for EVD after admission to a health facility in the Greater Monrovia area on 19 November. He was then transferred to an Ebola treatment centre along with the 5 other members of his family. Two other members of the family – the boy’s 8-year old brother and his 40-year-old father – subsequently tested positive for EVD whilst in isolation. The 15-year-old boy died on 23 November. In addition to the family of the first-reported case, 165 contacts have been identified so far, including 34 high-risk contacts. Liberia was previously declared free of Ebola transmission on 3 September 2015.
• On 7 November WHO declared that Sierra Leone had achieved objective 1 of the phase 3 framework, and the country has now entered a 90-day period of enhanced surveillance scheduled to conclude on 5 February 2016. As of 29 November it had been 13 days since the last EVD patient in Guinea received a second consecutive EVD-negative blood test. The last case in Guinea was reported on 29 October 2015.
• The recent cases in Liberia underscore the importance of robust surveillance measures to ensure the rapid detection of any reintroduction or re-emergence of EVD in currently unaffected areas. In order to achieve objective 2 of the phase 3 response framework – to manage and respond to the consequences of residual Ebola risks – Guinea, Liberia, and Sierra Leone have each put surveillance systems in place to enable health workers and members of the public to report any case of illness or death that they suspect may be related to EVD to the relevant authorities. In the week to 29 November, 18 014 such alerts were reported in Guinea, with alerts reported from all of the country’s 34 prefectures. Equivalent data are not currently available for Liberia. In Sierra Leone, 1420 alerts were reported from all 14 districts in the week ending 15 November (the most recent week for which data are available).
• As part of each country’s EVD surveillance strategy, blood samples or oral swabs should be collected from any live or deceased individuals who have or had clinical symptoms compatible with EVD. In the week to 29 November, 8 operational laboratories in Guinea tested a total of 631 new and repeat samples from 15 of the country’s 34 prefectures. 82% of all samples tested in Guinea were swabs collected from dead bodies. By contrast, 84% of the 981 new and repeat samples tested in Liberia over the same period were blood samples collected from live patients. In addition, all 15 counties in Liberia submitted samples for testing by the country’s 5 operational laboratories. 1344 new samples were collected from all 14 districts in Sierra Leone and tested by 8 operational laboratories. 89% of samples in Sierra Leone were swabs collected from dead bodies.
• 994 deaths in the community were reported from Guinea in the week to 29 November through the country’s alerts system. This represents approximately 44% of the 2248 community deaths expected based on estimates of the population and a crude mortality rate of 11 deaths per 1000 people per year. Equivalent data are not yet available for Liberia. In Sierra Leone, 1282 reports of community deaths were received through the alert system during the week ending 15 November (the most recent week for which data are available), representing approximately 62% of the 2075 deaths expected each week based on estimates of the population and a crude mortality rate of 17 deaths per 1000 people per year.

• No confirmed cases were reported in the week to 29 November. Investigations are ongoing into the origin of infection of the cluster of 3 confirmed cases of Ebola virus disease (EVD) reported from Liberia in the week to 22 November. The first-reported case in that cluster was a 15-year-old boy who tested positive for EVD after admission to a health facility in the Greater Monrovia area on 19 November. He was then transferred to an Ebola treatment centre along with the 5 other members of his family. Two other members of the family – the boy’s 8-year old brother and his 40-year-old father – subsequently tested positive for EVD whilst in isolation. The 15-year-old boy died on 23 November. In addition to the family of the first-reported case, 165 contacts have been identified so far, including 34 high-risk contacts. Liberia was previously declared free of Ebola transmission on 3 September 2015.
• On 7 November WHO declared that Sierra Leone had achieved objective 1 of the phase 3 framework, and the country has now entered a 90-day period of enhanced surveillance scheduled to conclude on 5 February 2016. As of 29 November it had been 13 days since the last EVD patient in Guinea received a second consecutive EVD-negative blood test. The last case in Guinea was reported on 29 October 2015.
• The recent cases in Liberia underscore the importance of robust surveillance measures to ensure the rapid detection of any reintroduction or re-emergence of EVD in currently unaffected areas. In order to achieve objective 2 of the phase 3 response framework – to manage and respond to the consequences of residual Ebola risks – Guinea, Liberia, and Sierra Leone have each put surveillance systems in place to enable health workers and members of the public to report any case of illness or death that they suspect may be related to EVD to the relevant authorities. In the week to 29 November, 18 014 such alerts were reported in Guinea, with alerts reported from all of the country’s 34 prefectures. Equivalent data are not currently available for Liberia. In Sierra Leone, 1420 alerts were reported from all 14 districts in the week ending 15 November (the most recent week for which data are available).
• As part of each country’s EVD surveillance strategy, blood samples or oral swabs should be collected from any live or deceased individuals who have or had clinical symptoms compatible with EVD. In the week to 29 November, 8 operational laboratories in Guinea tested a total of 631 new and repeat samples from 15 of the country’s 34 prefectures. 82% of all samples tested in Guinea were swabs collected from dead bodies. By contrast, 84% of the 981 new and repeat samples tested in Liberia over the same period were blood samples collected from live patients. In addition, all 15 counties in Liberia submitted samples for testing by the country’s 5 operational laboratories. 1344 new samples were collected from all 14 districts in Sierra Leone and tested by 8 operational laboratories. 89% of samples in Sierra Leone were swabs collected from dead bodies.
• 994 deaths in the community were reported from Guinea in the week to 29 November through the country’s alerts system. This represents approximately 44% of the 2248 community deaths expected based on estimates of the population and a crude mortality rate of 11 deaths per 1000 people per year. Equivalent data are not yet available for Liberia. In Sierra Leone, 1282 reports of community deaths were received through the alert system during the week ending 15 November (the most recent week for which data are available), representing approximately 62% of the 2075 deaths expected each week based on estimates of the population and a crude mortality rate of 17 deaths per 1000 people per year.

• No confirmed cases were reported in the week to 29 November. Investigations are ongoing into the origin of infection of the cluster of 3 confirmed cases of Ebola virus disease (EVD) reported from Liberia in the week to 22 November. The first-reported case in that cluster was a 15-year-old boy who tested positive for EVD after admission to a health facility in the Greater Monrovia area on 19 November. He was then transferred to an Ebola treatment centre along with the 5 other members of his family. Two other members of the family – the boy’s 8-year old brother and his 40-year-old father – subsequently tested positive for EVD whilst in isolation. The 15-year-old boy died on 23 November. In addition to the family of the first-reported case, 165 contacts have been identified so far, including 34 high-risk contacts. Liberia was previously declared free of Ebola transmission on 3 September 2015.
• On 7 November WHO declared that Sierra Leone had achieved objective 1 of the phase 3 framework, and the country has now entered a 90-day period of enhanced surveillance scheduled to conclude on 5 February 2016. As of 29 November it had been 13 days since the last EVD patient in Guinea received a second consecutive EVD-negative blood test. The last case in Guinea was reported on 29 October 2015.
• The recent cases in Liberia underscore the importance of robust surveillance measures to ensure the rapid detection of any reintroduction or re-emergence of EVD in currently unaffected areas. In order to achieve objective 2 of the phase 3 response framework – to manage and respond to the consequences of residual Ebola risks – Guinea, Liberia, and Sierra Leone have each put surveillance systems in place to enable health workers and members of the public to report any case of illness or death that they suspect may be related to EVD to the relevant authorities. In the week to 29 November, 18 014 such alerts were reported in Guinea, with alerts reported from all of the country’s 34 prefectures. Equivalent data are not currently available for Liberia. In Sierra Leone, 1420 alerts were reported from all 14 districts in the week ending 15 November (the most recent week for which data are available).
• As part of each country’s EVD surveillance strategy, blood samples or oral swabs should be collected from any live or deceased individuals who have or had clinical symptoms compatible with EVD. In the week to 29 November, 8 operational laboratories in Guinea tested a total of 631 new and repeat samples from 15 of the country’s 34 prefectures. 82% of all samples tested in Guinea were swabs collected from dead bodies. By contrast, 84% of the 981 new and repeat samples tested in Liberia over the same period were blood samples collected from live patients. In addition, all 15 counties in Liberia submitted samples for testing by the country’s 5 operational laboratories. 1344 new samples were collected from all 14 districts in Sierra Leone and tested by 8 operational laboratories. 89% of samples in Sierra Leone were swabs collected from dead bodies.
• 994 deaths in the community were reported from Guinea in the week to 29 November through the country’s alerts system. This represents approximately 44% of the 2248 community deaths expected based on estimates of the population and a crude mortality rate of 11 deaths per 1000 people per year. Equivalent data are not yet available for Liberia. In Sierra Leone, 1282 reports of community deaths were received through the alert system during the week ending 15 November (the most recent week for which data are available), representing approximately 62% of the 2075 deaths expected each week based on estimates of the population and a crude mortality rate of 17 deaths per 1000 people per year.

WHO

Flare up of Ebola in Liberia

On 19 November 2015, Liberia identified a new “flare-up” of Ebola after stopping transmission in September. There are currently three confirmed cases from the same family being treated in an Ebola treatment unit in Monrovia and 150 contacts being monitored. Dr Bruce Aylward, Special Representative of the Director-General for the Ebola Response, gave a full briefing on the current state of the Ebola outbreak on 20 November.

“We are in a very strong position with the epidemiology of Ebola right now, we are very close to seeing the end of that chain of transmission that began more than nearly two years ago now, in a place called Gueckedou in Guinea. We may have seen the last case associated with that chain, we won’t know for another month and a half.

The virus can persist in some individuals

What we are learning in this Ebola outbreak is that very rarely the virus can persist in a some individuals who have recovered from the disease and from that it can be reintroduced into the population, it’s a rare event, but we have seen it happen, about a half a dozen times. And so as the virus dies out of the community, or the individuals clear the virus over the coming six to nine months, we have to make sure that we have the ability to rapidly find that, to rapidly detect it and rapidly respond to stop the flares.

Of the few flares that we have seen so far, they have been managed very quickly, very rapidly, but again…we have to be on guard, right through 2016, to make sure that any new emergences are stopped.

In Liberia we have received a report that a boy has come down with Ebola, with no obvious history of exposure to the virus, because the child hadn’t travelled or had not been exposed to someone with Ebola, so we believe that this is probably again, somehow, someone who has come in contact with a virus that had been persisting in an individual, who had suffered the disease months ago, and we are hoping that this will be one of the very few last flares we see of the disease.

It is concerning, it has to be managed incredibly aggressively and professionally, because it occurring in a capital city, of an important country in West Africa, that is Monrovia of course, but based on the performance of that programme over the last 12 months we have strong confidence that this will get managed very quickly.

Prevent, detect and respond

The key to making sure that we do not have a major problem with Ebola in West Africa in 2016 will be to prevent, detect and respond to any residual virus as it is cleared from the survivor and convalescent population.

In terms of prevention, it means making sure survivors are educated and have the new information about persistence of the virus, that they have the tools to make sure that they and their families are safe and don’t get exposed to that virus if it is there, they can be screened if they want to, and then of course receive the basic medical care all survivors need.

In terms of detection, that means ensuring that countries have the ability to find a new suspect case very very rapidly, either live cases or through swabbing high risk deaths or even all deaths in some cases to make sure they weren’t due to Ebola. That will need to continue in 2016.

And then finally, the countries will need to have rapid response teams to be able to respond to an event. With that in place, countries will be able to prevent, detect and respond and ensure that Ebola no longer causes the kind of horrific consequences we saw over the last years in these countries.”

REUTERS