Posted on 23RD JAN 2017
tagged Ebola, West Africa

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

In this update:
- Research
West Africa: ophthalmic sequelae
Rapid detection
Predictor of survivorship


16 Jan 2017 West Africa: Vision impairment and eye diseases continue to be concerns for Ebola survivors
[The acute outbreak of Ebola virus disease (EVD) has subsided in West Africa, but the medical community continues to learn about long-term complications for survivors -- including the potential for blinding eye disease. One particular condition of concern is uveitis, according to research published in the December 2016 issue of _Ophthalmology_ by physicians from the Emory Eye Center and ELWA Hospital in Monrovia, Liberia [Citation: Shantha JG, Crozier I, Hayek BR, et al. Ophthalmic Manifestations and Causes of Vision Impairment in Ebola Virus Disease Survivors in Monrovia, Liberia Ophthalmology. 2016. pii: S0161-6420(16)31510-X. doi: 10.1016/j.ophtha.2016.10.011: abstract available at: http://www.aaojournal.org/article/S0161-6420(16)31510-X/abstract]. After studying a cohort of survivors of Ebola virus disease (EVD) in Monrovia, Liberia, using a retrospective, uncontrolled, cross-sectional study, the investigators concluded that survivors of EVD are at risk for uveitis, which may lead to 2ary structural complications, visual impairment, and blindness. Eye care resources should be mobilized for EVD survivors in West Africa because of the frequency of this spectrum of disease complication and its potential for severe VA impairment and blindness.

A _Current Opinion in Ophthalmology_ paper reports on nearly 100 EVD survivors in Monrovia, Liberia. Liberia, along with Sierra Leone and Guinea, are the 3 countries most affected by the 2014 EVD outbreak. More than 10 000 cases of EVD were reported in Liberia alone during the recent outbreak; over 28 000 cases were reported during the West African EVD outbreak between 2013 and 2016. Of the 96 patients examined, 21 had developed an EVD-associated uveitis and 3 developed an EVD-associated optic neuropathy. In addition, nearly 40 percent of the patients with uveitis were legally blind, based on the World Health Organization (WHO) classification. Other findings include cataract and vitreous opacity (floaters or flashes of light), which can both be complications of untreated uveitis.
Citation: Shantha JG, Yeh S and Nguyen QD: Ebola virus disease and the eye. Curr Opin Ophthalmol. 2016;27(6):538-544; abstract available at: https://www.ncbi.nlm.nih.gov/labs/articles/27585217/

The world has witnessed the largest Ebola virus disease (EVD) epidemic in West Africa with an unprecedented number of infected individuals and survivors. Many systemic and ocular complications have been reported in survivors. Herein, we review the ophthalmic complications associated with Ebola virus.

Recent findings: EVD causes ocular disease during acute infection and during convalescence. Acute patients manifest with conjunctivitis, subconjunctival hemorrhages, and acute vision loss of unclear cause. The most common complication during recovery is uveitis with live virus implicated in the pathogenesis in one case.

Summary: this epidemic has brought to surface the spectrum of medical complications in EVD survivors with ophthalmic disease being one of the most critical because of its impact on individual functional status and its long-term economic implications. Future studies and programs are needed to appropriately evaluate the spectrum of ophthalmic disease in this at-risk population.
- Mod.LK]

16 Jan 2017. A bioengineered positive control for rapid detection of the Ebola virus by reverse transcription loop-mediated isothermal amplification (RT-LAMP)
[Citation: Lam P, Keri RA and Steinmetz NF: A bioengineered positive control for rapid detection of the Ebola virus by reverse transcription loop-mediated isothermal amplification (RT-LAMP). ACS Biomater. Sci. Eng. DOI: 10.1021/acsbiomaterials.6b00769.

The Ebola virus (EBOV) causes a highly virulent and deadly disease. The 2014 Ebola outbreak in West Africa was the largest in history. The rapid spread highlighted the need for a quick and accurate diagnostic method that can be employed in resource-limited conditions. In this study, we developed a probe that can be used as an internal positive control, coupled with a reverse transcription loop-mediated isothermal amplification (RT-LAMP) assay to accurately detect EBOV. This RT-LAMP assay is a simple 1-step reaction performed at a constant temperature, and the results can be visualized by a colorimetric change from violet to sky blue. Our assay enabled detection of 10 copies of synthetic EBOV RNA within 1 hour. Compared to traditional RT-qPCR, RT-LAMP requires no sophisticated equipment, the results are easier to interpret, and they can be obtained in less time. These features make RT-LAMP an ideal method for detection of EBOV in low-resource settings.]

[Rapid detection of Ebola is important to separate infected individuals from those with similar symptoms but different etiology as early as possible after presentation at a clinic. Correct rapid diagnosis protects individuals not infected with Ebola virus and allows for more rapid treatment of Ebola patients. - Mod.LK]

19 Jan 2017: Scientists identify 'molecular barcode' in blood samples that can predict survival of Ebola patients
[Scientists have identified a 'molecular barcode' in the blood of patients with Ebola virus disease that can predict whether they are likely to survive or die from the viral infection. A team at the University of Liverpool, in collaboration with Public Health England, Boston University, and other international partners, used blood samples taken from infected and recovering patients during the 2013-2016 West Africa outbreak to identify gene products that act as strong predictors of patient outcome.

Funded by the [UK] National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections and the US Food and Drug Administration, the new research provides data on the underlying causes of Ebola virus infection and suggests that this type of blood analysis could be integrated into future outbreak responses as a diagnostic tool to help guide treatment strategies.

Since the Ebola outbreak in West Africa much research has been done to further understand the biology of the Ebola virus. In particular, the processes that lead to survival or a fatal infection are unknown, although the amount of virus present in the body (viral load) can be a key determinant. However, while this premise worked well for predicting outcomes for people with extreme viral loads, it was less clear for people with mid-range counts, the majority of cases, where the outcome prediction was approximately equal between survival and a fatal infection.

The results of this new study, which are published in _Genome Biology_, identified a small number of genes whose expression accurately predicts patient survival, independent of viral load.

Citation: Liu X, Speranza E, Muñoz-Fontela C, et al: Transcriptomic signatures differentiate survival from fatal outcomes in humans infected with Ebola virus. Genome Biol. 2017;18(1):4. doi: 10.1186/s13059-016-1137-3; available at: http://bit.ly/2juxExj]

[If this tool for outcome prediction is proven to be efficacious, it could help guide treatment, suggesting more aggressive treatment where the patient seems most at risk. - Mod.LK]

March 2017: Spatiotemporal fluctuations and triggers of Ebola virus spillover
[Citation: Schmidt JP, Park AW, Kramer AM, Han BA, Alexander LW and Drake JM: Spatiotemporal fluctuations and triggers of Ebola virus spillover. CDC Emerg Infect Dis. 2017; 23(3). doi: 10.3201/eid2303.160101

Because the natural reservoir of Ebola virus remains unclear and disease outbreaks in humans have occurred only sporadically over a large region, forecasting when and where Ebola spillovers are most likely to occur constitutes a continuing and urgent public health challenge. We developed a statistical modeling approach that associates 37 human or great ape Ebola spillovers since 1982 with spatiotemporally dynamic covariates including vegetative cover, human population size, and absolute and relative rainfall over 3 decades across sub-Saharan Africa. Our model (area under the curve 0.80 on test data) shows that spillover intensity is highest during transitions between wet and dry seasons; overall, high seasonal intensity occurs over much of tropical Africa; and spillover intensity is greatest at high (greater than 1000/km2) and very low (less than 100/km2) human population densities compared with intermediate levels. These results suggest strong seasonality in Ebola spillover from wild reservoirs and indicate particular times and regions for targeted surveillance.]

[Compiled by: Celeste Whitlow ]

Communicated by:

Distribution of EVD cases as of 27 Mar 2016 http://apps.who.int/ebola/sites/default/files/thumbnails/image/sitrep_ca...
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 (03): news, research http://promedmail.org/post/ 20170115.4767977
Ebola update (02): news, research, vaccine, comment http://promedmail.org/post/ 20170108.4750411
Ebola update (01): News, research, vaccine http://promedmail.org/post/ 20170103.4738060
Ebola update (72): vaccine, research, NGO, media http://promedmail.org/post/ 20161226.4724859
Ebola update (71): research, economy http://promedmail.org/post/ 20161218.4706276
Ebola update (70): news, research, economy, funding http://promedmail.org/post/ 20161211.4690740
Ebola update (69): news, NGO, research, economy, funding, vaccine http://promedmail.org/post/ 20161204.4675615
Ebola update (68): news, economy http://promedmail.org/post/ 20161127.4657148
Ebola update (67): news, research, funding http://promedmail.org/post/ 20161120.4642402
Ebola update (66): news, research, funding, economy http://promedmail.org/post/ 20161115.4629793
Ebola update (65): news, research, commentary, economy, funding, vaccine http://promedmail.org/post/ 20161106.4609611
Ebola update (64): news, research http://promedmail.org/post/ 20161030.4595759
Ebola update (63): news, research http://promedmail.org/post/ 20161023.4579436
Ebola update (62): news, research, treatment, funding http://promedmail.org/post/ 20161017.4564066
Ebola update (61): news, funding, economy http://promedmail.org/post/ 20161009.4547627
Ebola update (60): news, research, economy http://promedmail.org/post/ 20161002.4531285
Ebola update (59): news, research, funding http://promedmail.org/post/ 20160925.4514591
Ebola update (58): news, research, funding, vaccine http://promedmail.org/post/ 20160918.4497393
Ebola update (57): news, research, funding http://promedmail.org/post/ 20160911.4481043
Ebola update (56): news, vaccine, research http://promedmail.org/post/ 20160904.4465145
Ebola update (55): research, funding http://promedmail.org/post/ 20160828.4446844
Ebola update (54): rapid test recall, nurse, research http://promedmail.org/post/ 20160821.4431433
Ebola update (53): Guinea, research http://promedmail.org/post/ 20160814.4415032
Ebola update (52): funding, research http://promedmail.org/post/ 20160808.4400521
Ebola update (51): funding, research, miscellaneous http://promedmail.org/post/ 20160731.4383179
Ebola update (50): Liberia, Sierra Leone, research http://promedmail.org/post/ 20160724.4366266
Ebola update (49): Sierra Leone, research, history http://promedmail.org/post/ 20160717.4350351
Ebola update (48): CDC, research, funding, economy http://promedmail.org/post/ 20160710.4336146
Ebola update (47): Liberia, US preparedness, funding, research http://promedmail.org/post/ 20160703.4323924
Ebola update (46): Liberia, Sierra Leone, treatment comment, research, funding http://promedmail.org/post/ 20160626.4310569
Ebola update (45): Liberia, vaccine, treatment, funding, research http://promedmail.org/post/ 20160619.4296380
Ebola update (44): Liberia, WHO, funding, research http://promedmail.org/post/ 20160612.4283379
Ebola update (43): digital wallet response, Guinea, diagnostic assay http://promedmail.org/post/ 20160605.4266788
Ebola update (42): Guinea, vaccine, research http://promedmail.org/post/ 20160529.4253046
Ebola update (41): update, funding http://promedmail.org/post/ 20160522.4238249
Ebola update (40): Liberia, Sierra Leone, research, vaccines http://promedmail.org/post/ 20160514.4222416
Ebola update (39): Guinea persistence in semen, Liberia, research, vaccine http://promedmail.org/post/ 20160508.4209313
Ebola update (38): WHO sitrep. evolution rate, Liberia, Sierra Leone, research http://promedmail.org/post/ 20160501.4195742
Ebola update (37): Guinea, Liberia, diagnostics, vaccine, funding, research http://promedmail.org/post/ 20160427.4187854
Ebola update (36): Guinea, Liberia, vaccine, research http://promedmail.org/post/ 20160421.4172812
Ebola update (35): vaccine, comment http://promedmail.org/post/ 20160418.4167038
Ebola update (34): Guinea, Liberia, comment, vaccine funding http://promedmail.org/post/ 20160417.4165862
Ebola update (33): Guinea, Liberia, Sierra Leone, research, funding, vaccine http://promedmail.org/post/ 20160413.4158203
Ebola update (32): Liberia, Guinea, support http://promedmail.org/post/ 20160410.4150454
Ebola update (31): Liberia, Guinea re-emergence, research, funding http://promedmail.org/post/ 20160406.4142990
Ebola update (30): Liberia re-emergence, Uganda NOT, RFI http://promedmail.org/post/ 20160404.4136987
Ebola update (29): Liberia re-emergence, Guinea contacts, news, RFI http://promedmail.org/post/ 20160402.4134878
Ebola update (28): news, research, vaccine http://promedmail.org/post/ 20160330.4128527
Ebola update (27): Ebola Reston virulence, Africa suspicious deaths RFI, news http://promedmail.org/post/ 20160327.4121931
Ebola update (26): Guinea flare-up, Liberia http://promedmail.org/post/ 20160324.4114807
Ebola update (25): Guinea flare-up, Liberia, Sierra Leone, research http://promedmail.org/post/ 20160320.4107350
Ebola update (24): Guinea, confirmed http://promedmail.org/post/ 20160317.4101955
Ebola update (23): comment, pregnant women, news, research http://promedmail.org/post/ 20160316.4098040
Ebola update (22): long-term sequelae, news, research http://promedmail.org/post/ 20160313.4090091
Ebola update (21): Sierra Leone, herd immunity, possible new drug http://promedmail.org/post/ 20160310.4081498
Ebola update (20): new antiviral, prevention http://promedmail.org/post/ 20160306.4073116
Ebola update (19): WHO, relapse in UK (Scotland), prevention, research, funding http://promedmail.org/post/ 20160302.4064754
Ebola update (18): WHO, susp, research, funding, NGO, corr http://promedmail.org/post/ 20160229.4058786
Ebola update (17): UK nurse readmitted, EVD survivor complications, research http://promedmail.org/post/ 20160224.4047552
Ebola update (16): WHO comment, funding, vaccine http://promedmail.org/post/ 20160221.4039174
Ebola update (15): WHO response comment, vaccine http://promedmail.org/post/ 20160218.4030271
Ebola update (14): research, funding, vaccine, NGO http://promedmail.org/post/ 20160214.4021318
Ebola update (13): rapid test, research, funding http://promedmail.org/post/ 20160210.4010884
Ebola update (12): Sierra Leone, research, funding, vaccine http://promedmail.org/post/ 20160207.4002006
Ebola update (11): Sierra Leone, new case, controversy http://promedmail.org/post/ 20160203.3990396
Ebola update (10): Sierra Leone, vaccine, funding http://promedmail.org/post/ 20160131.3981594
Ebola update (09): funding, correction http://promedmail.org/post/ 20160127.3970963
Ebola update (08): Sierra Leone, vaccine, research, video http://promedmail.org/post/ 20160124.3962240
Ebola update (07): Sierra Leone, 2nd new case http://promedmail.org/post/ 20160121.3955860
Ebola update (06): 5 mysteries about EVD, Sierra Leone new case, followup http://promedmail.org/post/ 20160117.3944673
Ebola update (05): WHO declares Liberia free, Sierra Leone new case http://promedmail.org/post/ 20160115.3938471
Ebola update (04): WHO, prevention, research, drugs & vaccines http://promedmail.org/post/ 20160113.3933860
Ebola update (03): WHO, prevention, survivors, stigma, research, drugs, vaccines http://promedmail.org/post/ 20160110.3924235
Ebola update (02): WHO, monitoring, lessons, research http://promedmail.org/post/ 20160106.3915785
Ebola update (01): management, vaccine, treatment, monitoring http://promedmail.org/post/ 20160103.3908196
[and other items in the archives