Posted on 16TH APR 2017
tagged Ebola, Worldwide

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

In this update:
- Safety of sewer workers
- post Ebola national health reconstruction
- Liberia: Ebola threat
- Persistence in semen
- Ebola spillover
- Host response
- Genetic analysis
- Research hurdles
- review of Phase 1 trials
- Phase 2 clinical trials
- DNA vaccine

11 Apr 2017: CDC/WHO Ebola guidelines could put sewer workers at risk
[Research from Drexel University and the University of Pittsburgh suggests that guidelines for safe disposal of liquid waste from patients being treated for the Ebola virus might not go far enough to protect water treatment workers from being exposed. In a study recently published in the journal Water Environment Research, a group of environmental engineering researchers reports that sewer workers downstream of hospitals and treatment centers could contract Ebola via inhalation, a risk that is not currently accounted for in the Centers For Disease Control and Prevention or World Health Organization Ebola response protocol.] ...more...

Citation. Haas CN, Rycroft T; Bibby K; Casson L (11 Apr 2017). Risks from Ebolavirus discharge from hospitals to sewer workers. Water Environment Research 89 (4), 1 April 2017 DOI: https://doi.org/10.2175/106143017X14839994523181

[This surely calls for further evaluation of compliance with protective measures necessary to lessen risk of infection by inhalation exposure to Ebolavirus-contaminated waste in the sewer; and the actual risk faced by a worker downstream from a hospital treating an Ebola patient warrants further attention. National Institute for Occupational Safety and Health (NIOSH)-approved N-95 respirators that cover the nose and mouth are recommended for workers handling untreated sewage (CDC, 2014b). N-95 respirators are engineered to filter at least 95% of particles that would be inhaled. - Mod.LK]

13 Apr 2017 West Africa: Ecowas Ministers want special attention on post-Ebola era
[A 2-day ECOWAS [Economic Community of West African States] Ministers of Health meeting has adopted a 5-count resolution that would allow Member States to pay special attention to the necessary interventions required for post Ebola national health reconstruction. The resolution also calls for the necessary support for all the Member States of the community, in particular countries which were most affected by the Ebola virus disease: Guinea, Liberia and Sierra Leone.]

13 Apr 2017 Liberia: Ebola threats still exist
[A 3-day international health conference on post Ebola virus disease in the sub-region has ended in Monrovia with President Ellen Johnson-Sirleaf indicating that threats of the virus still exist in the region.
Speaking Wed [12 Apr 2017] at the close of the meeting, the President said unlike during the Ebola outbreak in the region, the 3 most affected countries have put in place resilient health systems that can withstand any outbreak. But she was quick to point out that designing a system to deal with any outbreak is the 1st step, adding "we must make it functional." She said there exists a risk that the Ebola virus could return in the region considering its history. The Liberian leader said the recent Ebola outbreak in the region raised serious questions "about our preparedness and capacity to deal with it."]

April 2017. Purpura LJ, Rogers E, Baller A, et al. Ebola Virus RNA in Semen from an HIV-Positive Survivor of Ebola. Emerg Infect Dis. 2017;23(4):714-715. https://dx.doi.org/10.3201/eid2304.161743
[Ebola virus is known to persist in semen of male survivors of Ebola virus disease (EVD). However, maximum duration of, or risk factors for, virus persistence are unknown. We report on an EVD survivor with preexisting HIV infection, whose semen was positive for Ebola virus RNA 565 days after recovery from EVD... -more. This case highlights the need for a better understanding of the role that co-infection with HIV might play in persistent detection of Ebola virus RNA in male survivors of EVD.]

10 Apr 2017: New model maps likelihood of Ebola spillovers
[Ecologists at the University of Georgia have developed a model that maps the likelihood of Ebola virus "spillovers" -- when the virus jumps from its long-term host to humans or animals such as great apes -- across Africa on a month-by-month basis.
Their findings, published recently in the journal _Emerging Infectious Diseases_, reveal seasonal and regional patterns that could help public health officials decide when and where to target Ebola disease surveillance most effectively. The model predicts that the risk of a spillover in Central Africa, where most [Ebola virus disease (EVD)] cases have occurred, remains relatively steady throughout the year. It also predicts that spillovers are possible in West and East Africa, with the level of risk varying depending on the season; in both areas, a spillover is most likely during transitions between dry and rainy periods.

"That's important because before the 2014 epidemic, people hadn't really thought of West Africa as a high-risk region at all," said lead author J.P. Schmidt, an assistant research scientist in UGA's Odum School of Ecology. The 2014 epidemic that originated in Guinea, Liberia and Sierra Leone was the worst in history, killing at least 11 325 people, according to the U.S. Centers for Disease Control and Prevention.

"I don't think people generally think of East Africa as at risk either, but what our results show is that for some months of the year, East Africa may indeed be at significant risk," Schmidt said.
Note: Maps show shifts in the geographic pattern of Ebola spillover intensity from month to month.

Citation. JP Schmidt, AW Park, AM Kramer, et al. Han, Spatiotemporal Fluctuations and Triggers of Ebola Virus Spillover. Emerg Infec Dis http://www.cdc.gov/eid, 23(3), March 2017. 415-422.

12 Apr 2017: NIH study provides unprecedented detail on host response to Ebola virus disease
[Analysis of daily gene activation in a patient with severe Ebola virus disease cared for at the National Institutes of Health (NIH) in 2015 found changes in antiviral and immune response genes that pinpointed key transition points in the response to infection. The changes included a marked decline in antiviral responses that correlated with clearance of virus from white blood cells. The analysis also showed that the preponderance of host responses shifted rapidly from activation of genes involved in cell damage and inflammation toward those linked to promotion of cellular and organ repair. This pivot came before the 1st signs of clinical improvement in the patient, who was admitted to the NIH Clinical Center on day 7 of illness and remained for 26 days. Researchers from the NIH's National Institute of Allergy and Infectious Diseases (NIAID) led the study. The patient received intensive supportive care, including fluids and electrolytes, but did not receive any experimental Ebola drugs. The research team used blood samples taken daily throughout the patient's hospitalization and recovery to measure the rise and decline of virus replication inside white blood cells and serum and to track the timing, intensity and duration of expression of numerous immune system genes. This allowed the team to correlate changes in gene expression with subsequent alterations in the patient's clinical condition. For example, the study characterized changes associated with the development and resolution of blood clotting dysfunction and multiple organ failure during the critical phase of illness.

Although this study represents only a single case, it provides unprecedented detail on the host response to Ebola virus disease and may inform the development of therapeutics designed to boost or accelerate host factors that most effectively counter the virus and promote healing. It may also lead to better prognostic criteria to enable clinicians to tailor the treatment of patients with Ebola virus disease in ways that can best promote recovery.]

Source. https://www.niaid.nih.gov/news-events/nih-study-ebola-patient-traces-dis...

[The study is very thorough and informative, but one should be cautious with conclusions, as it represents a single case who received extensive treatment. - Mod.LK]

12 Apr 2017: Report highlights Ebola research hurdles, recommends steps
[An expert committee assembled by the U.S. government to sort out thorny clinical research issues that arose during West Africa's 2013-2016 Ebola outbreak published its report today [12 Apr 2017], weighing in on the trials that took place and recommending steps for streamlining the process in future outbreak settings.

The 16-member group's work was sponsored by the US Assistant Secretary for Preparedness and Response (ASPR), the Food and Drug Administration (FDA), and the National Institute of Allergy and Infectious Diseases (NIAID). The team held a series of public workshops and committee meetings, did an extensive literature review, and considered written submissions. Findings and recommendations were published in a report from the National Academies of Sciences, Engineering, and Medicine.

Ethics, other clinical trial challenges: As West Africa's Ebola outbreak spiraled quickly out of control -- with no drugs or vaccines to battle the disease -- the World Health Organization (WHO) was swamped with proposals for possible treatments, as well as vaccines, and with them, the need for clinical testing...more]

14 Apr 2017: Huge genome study dissects Ebola outbreak's spread
[The largest genome sample ever analyzed for a human epidemic reveals that the West Africa epidemic unfolded with small, overlapping outbreaks as the virus spread over short distances and that urban settings amplified the spread. Meanwhile, another study harnessed different advanced scientific tools in the blood of a single sick patient to detail gene-level response during infection.

Factors fueling outbreak spread: In a massive international collaboration, 93 scientists from 53 institutions in 16 countries contributed to the analysis of 1610 Ebola virus genomes from the outbreak, composing 5 percent of all known cases." ...more...

Citation. Dudas G., Carvalho M., Bedford T., et al. (12 April 2017). Virus genomes reveal factors that spread and sustained the Ebola epidemic. Nature, doi:10.1038/nature22040

Abstract. The 2013-2016 West African epidemic caused by the Ebola virus was of unprecedented magnitude, duration and impact. Here we reconstruct the dispersal, proliferation and decline of Ebola virus throughout the region by analysing 1610 Ebola virus genomes, which represent over 5percent of the known cases. We test the association of geography, climate and demography with viral movement among administrative regions, inferring a classic "gravity" model, with intense dispersal between larger and closer populations. Despite attenuation of international dispersal after border closures, cross-border transmission had already sown the seeds for an international epidemic, rendering these measures ineffective at curbing the epidemic. We address why the epidemic did not spread into neighboring countries, showing that these countries were susceptible to substantial outbreaks but at lower risk of introductions. Finally, we reveal that this large epidemic was a heterogeneous and spatially dissociated collection of transmission clusters of varying size, duration and connectivity. These insights will help to inform interventions in future epidemics.]

10 Apr 2017: A review of Phase I trials of Ebola virus vaccines: what can we learn from the race to develop novel vaccines?
[Citation. Lambe T., Bowyer G., Ewer K.J. (10 Apr 2017). A review of Phase I trials of Ebola virus vaccines: what can we learn from the race to develop novel vaccines? The Royal Society Publishing, DOI: 10.1098/rstb.2016.0295
Abstract. "Sporadic outbreaks of Ebola virus infection have been documented since the mid-1970s, and viral exposure can lead to lethal haemorrhagic fever with case fatalities as high as 90%. There is now a comprehensive body of data from both ongoing and completed clinical trials assessing various vaccine strategies, which were rapidly advanced through clinical trials in response to the 2013-2016 Ebola virus disease (EVD) public health emergency. Careful consideration of immunogenicity post vaccination is essential but has been somewhat stifled because of the wide array of immunological assays and outputs that have been used in the numerous clinical trials. We discuss here the different aspects of the immune assays currently used in the Phase I clinical trials for Ebola virus vaccines, and draw comparisons across the immune outputs where possible; various trials have examined both cellular and humoral immunity in European and African cohorts. Assessment of the safety data, the immunological outputs and the ease of field deployment for the various vaccine modalities will help both the scientific community and policy-makers prioritize and potentially license vaccine candidates. If this can be achieved, the next outbreak of Ebola virus, or other emerging pathogen, can be more readily contained and will not have such widespread and devastating consequences.
This article is part of the themed issue 'The 2013-2016 West African Ebola epidemic: data, decision-making and disease control' ".

10 Apr 2017 West Africa: New Phase II trial begins in West Africa to assess various Ebola vaccine candidates
[A new Phase II clinical trial has begun in West Africa to evaluate 3 vaccination strategies for the prevention of Ebola virus. The French National Institute of Health and Medical Research (Inserm), the US National Institutes of Health (NIH) and the London School of Hygiene and Tropical Medicine (LSHTM) are conducting the trial under the Partnership for Research on Ebola Vaccination (PREVAC) international consortium. The vaccine candidates for the PREVAC trial are being supplied by pharmaceutical firms Janssen Vaccines & Prevention, Bavarian Nordic and Merck Sharp & Dohme. The 2-stage, randomized, Phase II trial will compare the 3 vaccination strategies with placebo regimens in more than 5000 adults and children to determine the most potential strategy. ...more]

11 Apr 2017: Inovio Ebola vaccine demonstrates robust immune responses with favorable safety profile in expanded clinical trial
[Inovio Pharmaceuticals, Inc. (NASDAQ:INO) announced today [11 Apr 2017] preliminary results from the expanded stage of its phase I study, EBOV-001. The expanded study examined different regimens of its Ebola DNA vaccine INO-4201 using intradermal (skin) administration. The results across both stages of the trial, including both intramuscular and intradermal delivery, demonstrated that 95 percent (170/179) of evaluable subjects generated an Ebola-specific antibody immune response, with the mean antibody titer comparable or superior to those reported from viral vector-based Ebola vaccines.
Importantly, Inovio's Ebola vaccine was well-tolerated with a favorable safety profile compared to viral vector-based Ebola vaccines, some of which have been associated with serious adverse events including myalgia, arthralgia, fever, and rash. Furthermore, their faster construct design, ability to continue to boost immune responses and protection with additional administrations, easier scalability of manufacturing, and better product thermal stability make DNA vaccines an attractive platform to rapidly respond to emerging global infectious diseases.] ...more

[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

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