Posted on 03RD APR 2017
tagged Ebola, Worldwide

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

In this update:
Convalescent plasma
Chimpanzee vaccine
Sierra Leone

30 Mar 2017: Survivors remember Ebola epidemic as Samaritan's Purse releases documentary
[Rev. Franklin Graham recounts the story in "Facing Darkness," a documentary produced by Samaritan's Purse recounting its fight to save the 1st American doctor diagnosed with Ebola [Ebola virus disease (EVD)] during the epidemic in West Africa. The film debuts in select theaters on Thursday [30 Mar 2017] and will return for encore showings on 10 Apr 2017.]
[This doctor, KB, was director of the Ebola treatment unit at ELWA (Eternal Love Winning Africa) Hospital when he was infected with the virus. - Mod.LK]

Citation. Burnouf T, Dhe JM, Abayomi A (30 Mar 2017). Convalescent Plasma and the Dose of Ebola Virus Antibodies. N Engl J Med 2017; 376:1296-1297 DOI: 10.1056/NEJMc1700090
[Letter to the editor:
After the clinical evaluation of convalescent plasma for Ebola virus (EBOV) disease in Guinea, van Griensven and colleagues [van Griensven J, Edwards T, de Lamballerie X, et al. Evaluation of convalescent plasma for Ebola virus disease in Guinea. N Engl J Med 2016;374:33-42] now provide additional data showing that the dose of neutralizing antibodies in the donations was low and that there was no apparent association between the dose of neutralizing antibodies and human survival. [van Griensven J, Edwards T, Baize S. Efficacy of convalescent plasma in relation to dose of Ebola virus antibodies. N Engl J Med 2016;375:2307-2309]. In our opinion, it is essential that the authors clarify precisely the stage of the procedure at which samples for neutralizing antibodies were taken. Was it at the time of plasma donation, after pathogen-inactivation treatment, or at the time of transfusion (after 40 days of storage, a delay that may possibly affect the efficacy of antibodies)? This information is critical because there is no publicly accessible documentation regarding the estimated effect that handling convalescent plasma processes have on the stability and activity of neutralizing EBOV antibodies. It is also important that the authors document how samples for antibody assessment were handled. This will help in defining standards required for handling convalescent plasma against emerging infectious agents in regions with limited available technology.

Reply by the author and colleagues: We thank Burnouf et al. for the pertinent questions. Donor samples sent to France for EBOV antibody testing were peripheral-blood samples collected on the day that donors came for automated plasma collection. These blood samples had not undergone pathogen reduction, because this process was applied only to the plasma bags collected for administration. The blood samples were stored at -30 deg C [-22 deg F] in Guinea, shipped on dry ice to the biosafety level 4 laboratory in France, and stored at 80 deg C [-112 deg F]. Samples had been thawed twice when antibody testing was done. Most of the plasma used in the trial was administered shortly after collection; the median time of plasma storage before administration was 8 days (interquartile range, 4 to 15). Plasma was stored for clinical use at 2 to 8 deg C [36 to 46 deg F] for up to 40 days and frozen at -30 deg C [-22 deg F] after that. We used a pathogen-reduction process, because when this study was conducted, there were many gaps in our knowledge of EBOV persistence and the presence of other transfusion-transmissible infections that could not be excluded under field conditions. Recently, Geisen et al. reported in a single donor that levels of IgG protein, EBOV IgG, and neutralizing antibodies were only slightly reduced after pathogen-reduction treatment with S59 amotosalen-ultraviolet A. We agree that more research is needed on the potential effect of pathogen reduction on the stability and activity of anti-EBOV neutralizing antibodies. (J van Griensven, P Gallian, X de Lamballerie for the Ebola-Tx Consortium)]

[See full report with references at DOI cited above. - Mod.LK]

[Information on the pathogen inactivator S59 amotosalen can be found here: https://www.ncbi.nlm.nih.gov/pubmed/12534321 - Mod.JH]

2 Apr 2017 The trick to saving chimps from Ebola
[A new study has shown great promise for an oral Ebola vaccine for chimpanzees and gorillas. But limits on testing are hampering the effort. The Ebola vaccine for chimps is made of a weakened rabies virus -- used in oral vaccines for animals -- with an added gene for the main surface glycoprotein from the Ebola virus. The vaccine was invented by Prof. Matthias Schnell's lab at Thomas Jefferson University in Philadelphia. The trial, consisting of oral and injected vaccines on 10 captive chimpanzees at a research centre at the University of Louisiana Lafayette, showed promising results for both. The chimpanzees developed immunity for Ebola, and suffered no side effects, said Dr. Peter Walsh, a biological anthropologist at the University of Cambridge who conducted the trials. However, the problem lies in recent changes in U.S. law stating that biomedical testing on chimpanzees is no longer legal.]
[The restrictions on medical testing on chimps in the wild need to be weighed on a case by case basis. A vaccine trial in this situation shows promise of benefiting them, as well as gorillas, as the chimps in this study would not be experimental subjects for humans, but rather they are being evaluated for a vaccine that shows strong potential to protect their species as soon as possible. - Mod.LK]

28 Mar 2017 Sierra Leone: IMF considers possible finance for Sierra Leone as economy goes into reverse
[The economy of Sierra Leone is now going through its toughest phase, since the end of the Ebola [Ebola virus disease (EVD) epidemic. The government has run out of cash; donor funds have declined massively; inflation is rising out of control, unemployment remains chronically high; the taxation base has declined; public sector workers are going without pay; public services are facing huge financial constraints, and government contractors are not getting paid. The government has now realized that without private sector investments, it cannot diversify the economy and expand growth. Yet, public sector borrowing is rising fast, now standing at over USD 2 billion.]
[The Ebola outbreak in West Africa continues to have serious effects, not only on physical and psychological recovery of infected individuals but equally on the economy of the affected countries. - Mod.LK]

[Compiled by: Celeste Whitlow ]

Communicated by:

[ProMED HealthMaps:
Liberia: http://healthmap.org/promed/p/54
Guinea: http://healthmap.org/promed/p/45
Sierra Leone: http://healthmap.org/promed/p/46]

See Also
Ebola update (12): news, research, vaccine 20170326.4927435
Ebola update (11): news, vaccine, research 20170312.4896304
Ebola update (10): news, research 20170305.4881172
Ebola update (09): news, research, funding 20170226.4866142
Ebola update (08): news, research, vaccine 20170219.4850524
Ebola update (07): research, economy 20170213.4836546
Ebola update (06): research, treatment, funding 20170206.4819835
Ebola update (05): news, vaccine, funding, documentary films 20170129.4801064
Ebola update (04): research 20170123.4786222
Ebola update (03): news, research 20170115.4767977
Ebola update (02): news, research, vaccine, comment 20170108.4750411
Ebola update (01): News, research, vaccine 20170103.4738060
Ebola update (72): vaccine, research, NGO, media 20161226.4724859
Ebola update (71): research, economy 20161218.4706276
Ebola update (70): news, research, economy, funding 20161211.4690740
Ebola update (69): news, NGO, research, economy, funding, vaccine 20161204.4675615
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Ebola update (31): Liberia, Guinea re-emergence, research, funding 20160406.4142990
Ebola update (30): Liberia re-emergence, Uganda NOT, RFI 20160404.4136987
Ebola update (29): Liberia re-emergence, Guinea contacts, news, RFI 20160402.4134878
Ebola update (28): news, research, vaccine 20160330.4128527
Ebola update (27): Ebola Reston virulence, Africa suspicious deaths RFI, news 20160327.4121931
Ebola update (26): Guinea flare-up, Liberia 20160324.4114807
Ebola update (25): Guinea flare-up, Liberia, Sierra Leone, research 20160320.4107350
Ebola update (24): Guinea, confirmed 20160317.4101955
Ebola update (23): comment, pregnant women, news, research 20160316.4098040
Ebola update (22): long-term sequelae, news, research 20160313.4090091
Ebola update (21): Sierra Leone, herd immunity, possible new drug 20160310.4081498