Posted on 18TH JAN 2017
tagged Ebola

A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases

In this update:
- News
Sierra Leone
- Research
Congenital infection
Commentary on congenital infection
Long term effects

15 Jan 2017 Sierra Leone: Health and Agriculture collaborate
[As part of the global commitment to help Sierra Leone recover from the impact of the [Ebola virus disease (EVD)] epidemic, the World Bank met with the Ministry of Health and Sanitation yesterday [14 Jan 2017] to initiate 2 health-service delivery projects.
Officials from the Ministries of Health and Sanitation, and Agriculture, Forestry and Food Security, together with health donor partners, launched the health service delivery and systems support project (HSDSSP) and the Regional Disease Surveillance Systems Enhancement Program (RDSSEP), all aimed at supporting the 10-24 months Ebola recovery plan and the President's Recovery Priorities.]

11 Jan 2017. 1st baby born with congenital Ebola survives infection
A new study published today [11 Jan 2017] in The Journal of Infectious Diseases details how doctors working for Doctors Without Borders saved the life of a baby born with congenital Ebola virus. The baby was born in Guinea and had no symptoms of Ebola virus 20 days after her birth.
The baby was diagnosed immediately after birth, and doctors treated her with a novel combination of 3 treatments: monoclonal antibodies (ZMapp), a buffy coat transfusion from an Ebola survivor, and a broad-spectrum antiviral.

Five days before her birth, that baby's mother was diagnosed with Ebola and treated with favipiravir, an antiviral. The infant was born at 35-36 weeks gestation and appeared healthy, but suffered intermittent fevers through day 10. ZMapp was infused on days 2, 5, and 8, and the baby had reduced viral loads. On day 11, the baby got a buffy coat transfusion to boost her immune response to ZMapp. On Day 19, the broad-spectrum antiviral GS-5734 was administered (the 1st time it was used in a pediatric patient). By day 20, blood tests were negative for Ebola, and the baby went home on day 33.

Pregnant women and neonates suffered the highest mortality rates during the 2013-2016 Ebola outbreak in West Africa, with 70% of pregnant women perishing from the disease and nearly 100% of Ebola-affected pregnancies ending in miscarriage or stillbirth.

The authors concluded their report by suggesting a variety of factors may have helped saved the baby's life. "Viral transmission might have occurred late in the pregnancy and been limited during the brief labor and delivery, resulting in the neonate having a low viral load at birth. It cannot be excluded that the favipiravir given to the mother had an effect on the viral replication in the fetus," they write.]

Jan 11 J Infect Dis commentary "1st baby born with congenital Ebola survives infection"
Hayden G, Friede M, Bausch DG (January 2017 EPub). Experimental Therapies for Ebola Virus Disease: What Have We Learned? The Lancet Infectious Diseases.
DOI: http://dx.doi.org/10.1016/S1473-3099(16)30516-3.

[The terrible mortality rate of Ebola virus (EBOV) disease (EVD) is most pronounced in the vulnerable groups of pregnant women and neonates. During the 2013-2016 West African outbreak, hundreds of EBOV-infected pregnant women were reported, with maternal mortality rate estimated at over 70% and neonatal mortality rate nearly 100%. Thus, Dornemann et al's interesting case report in this issue of The Journal of Infectious Diseases [reported above], describing an EBOV-infected neonate who not only survived but had no apparent sequelae at 8 months of age, represents a 1st. The surviving baby, one of the last cases of EVD seen in Guinea, gives hope that perhaps we are finally turning the corner in finding effective treatments for this disease. Of course, one case does not constitute scientific proof of effectiveness, and it remains possible that she is simply a very fortunate outlier. The report is not only instructive in itself, but also raises a number of points with respect to clinical management and assessment of investigational EVD therapeutics.

In addition to aggressive supportive care, the baby received 3 experimental therapies for EVD--ZMapp (a cocktail of 3 human-mouse chimeric anti-EBOV monoclonal antibodies), a buffy coat infusion, and GS-5734, the prodrug of a nucleoside viral RNA polymerase inhibitor. In addition, the fetus may have also been exposed in utero to the RNA polymerase inhibitor favipiravir, which the mother received for 3 days before delivery and her subsequent death. Thus, like most patients with EVD who received care in hospitals in the United States and Europe [2], this infant received several investigational therapeutic agents, making it very difficult to determine the impact of any particular one.
Mortality in EVD correlates directly with blood viral load [3-5]... - more

14 Jan 2017: Ebola's long-term effects revealed
[This study, published in Lancet Infectious Diseases, is the largest and longest-running assessment of [EVD] survivors to date.
Citation. Etard JF, Mamadou SS, Sandrine L, et al. (January 2017 EPub). Multidisciplinary assessment of post-Ebola sequelae in Guinea (Postebogui): an observational cohort study. The Lancet Infectious Diseases. DOI: http://dx.doi.org/10.1016/S1473-3099(16)30516-3.
The research group's findings showed 75 percent of survivors had post-Ebola [Ebola virus disease (EVD)] symptoms, when they enrolled for the trial about a year, on average, after they were discharged from hospital, researchers reported Sat [14 Jan 2017].

According to the study, people who survive [EVD] may still battle debilitating health problems a year after being declared infection-free, according to an ongoing trial in Guinea which highlighted the need for patient follow-up.

According to the study, 75 percent of survivors had post-Ebola symptoms when they enrolled for the trial about a year, on average, after they were discharged from hospital, researchers reported Sat [14 Jan 2017]. 18 percent experienced eye problems, including 8 individuals who went blind, a team wrote in The Lancet Infectious Diseases. 2 percent -- 19 people -- were deaf. In addition, nearly 25 percent participants suffered joint and muscle pain, 35 percent had headaches, and 22 percent stomach pain when they enrolled. 17 percent suffered symptoms of depression.

The study also confirmed previous observations that Ebola virus can remain in the semen of infected men for 18 months or longer, raising the possibility of sexual transmission. Other revelations of the study included none of the breast-milk or vaginal fluid samples contained the [Ebola virus (EBOV)]. Urine tested positive for Ebola in 2 cases, and saliva in only one. There were more eye problems by the time patients enrolled in the trial than when they had left hospital, the team said, "implying that ophthalmological screening should continue long after discharge." In addition, children retained fewer serious health problems than adults. Researchers noted the scarcity of medical laboratories in the affected region to keep tabs on Ebola survivors' health and any potential for renewed virus spread. According to the research team: "Our results indicate that a close follow-up of convalescent patients might be warranted for at least 18 months after discharge... and perhaps even longer."]

[According to the research group's findings, reported on Sat [14 Jan 2017], when the patients enrolled for the trial, 75 percent of survivors reporting having had EVD symptoms for about a year, on average, after they were discharged from the hospital.
According to the study, people who survive [EVD] may still battle debilitating health problems a year after being declared infection-free, according to an ongoing trial in Guinea which highlighted the need for patient follow-up.]

[Compiled by: Celeste Whitlow ]

Communicated by:

[A map showing the distribution of EVD cases as of 27 Mar 2016 can be seen at http://apps.who.int/ebola/sites/default/files/thumbnails/image/sitrep_ca....

ProMED-mail HealthMaps:
Liberia http://healthmap.org/promed/p/54
Guinea http://healthmap.org/promed/p/45
Sierra Leone http://healthmap.org/promed/p/46
- Mod.LK]

See Also

Ebola update (02): news, research, vaccine, comment 20170108.4750411
Ebola update (01): News, research, vaccine 20170103.4738060
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Ebola update (71): research, economy 20161218.4706276
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Ebola update (22): long-term sequelae, news, research 20160313.4090091
Ebola update (21): Sierra Leone, herd immunity, possible new drug 20160310.4081498
Ebola update (20): new antiviral, prevention 20160306.4073116
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Ebola update (01): management, vaccine, treatment, monitoring 20160103.3908196