Posted on 19TH JUN 2017
tagged Ebola, Worldwide

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

In this update:
[1] News
DR Congo: Research Triangle Park response
DR Congo: new suspected case
[2] Vaccine
Advances in Ebola virus vaccination
Merck vaccine
[3] Research
Modeling zoonotic factors
Risk factors
Delta peptide
Survivors' eyes
[4] Funding
Sierra Leone

[1] News
13 Jun 2017 DRC: RTI International addressing Ebola outbreak in Democratic Republic of Congo
[Research Triangle Park, NC - With funding from the U.S. Centers for Disease Control [CDC] and Prevention, RTI International is responding to the [Ebola virus disease (EVD)] outbreak in the Democratic Republic of the Congo (DRC).
EVD, a severe, often fatal illness in humans, was 1st discovered in DRC (formerly Zaire) in 1976. The virus is transmitted to people from wild animals and spreads in the human population through human-to-human transmission. The average EVD case fatality rate is around 50 percent. There have been 11 confirmed cases of EVD in the United States, originating from outbreaks in Africa. This is the 8th outbreak in DRC since the disease was discovered.
On 11 May 2017, the Ministry of Health declared an EVD outbreak in the Bas-Uele Province of Northern DRC, based on one laboratory-confirmed case and a cluster of patients with EVD-like symptoms. The latest World Health Organization [WHO] update reports 2 confirmed cases, 3 probable cases, and 14 suspected cases of EVD, with another 101 contacts under daily monitoring. As the leading surveillance partner for CDC's Global Health Security Agenda activities in DRC, RTI rapidly mobilized to support the Ministry of Health's EVD response activities.
As one of the 1st responders to the outbreak epicenter, RTI is part of the Surveillance Coordination Committee, working with epidemiologists and lab specialists from the Ministry of Health, WHO, Medecins Sans Frontieres, and other partners to strengthen local capacity to detect, report, and manage information about suspected EVD cases and their contacts.
"Strengthening a country's ability to prevent and respond to epidemics like Ebola is essential not just for the affected country, but for everyone around the globe," said Pia MacDonald, Ph.D., senior epidemiologist at RTI. "We saw in 2014 just how fast an EVD outbreak can spread worldwide. It's essential that we work together to stop this threat as quickly as possible."] ...more..

15 Jun 2017: DRC reports new suspected case of Ebola
[The World Health Organization (WHO) African regional office released a new situation report on the current outbreak of [Ebola virus disease (EVD)]in the Democratic Republic of the Congo (DRC), noting one additional suspected case of the viral disease since the last report on [9 Jun 2017].
In the last week, DRC health officials have investigated 33 suspected cases, with only one being a possible infection.
The last confirmed case was isolated on [17 May 2017]. To date, there have been 5 confirmed, 3 probable, and 1 suspected case. 90 percent of simulated modeling predictions show no more cases in the next 30 days, the WHO said.
In addition, the overall national risk of [EVD] has been downgraded from "high" to "moderate." All cases have been in the Likati Health Zone, a remote part of northern DRC.]
[This suspected case was one of the 33 suspected cases. - Mod.LK]

[2] Vaccine
9 Jun 2017: Advances in Ebola virus vaccination
[The Ebola virus outbreak in western Africa between 2013 and 2016 was the largest and deadliest since the discovery of the virus in 1976. The epidemic provided the impetus to fast-track several promising vaccines into clinical trials during the tail-end of the outbreak, including the rVSVG-ZEBOV-GP viral vector vaccine, which was used in ring vaccination trials in Guinea.]...more...
Citation. Clarke E.C., S. B. Bradfute . (9 Jun 2017). Advances in Ebola virus vaccination. The Lancet Infectious Diseases, DOI: http://dx.doi.org/10.1016/S1473-3099(17)30320-1]

14 Jun 2017: Response to Merck's Ebola vaccine lasts at least a year, study finds
[In a Phase 3 trial in West Africa, Merck's Ebola vaccine rVSV-ZEBOV has already shown it can elicit a quick immune response. Now, a new study in the U.S. found that the vaccine's protective qualities can last for at least a year.
A team of scientists from Merck and partner NewLink Genetics conducted a Phase 1-b trial at 8 U.S. study sites on 512 healthy adults. All 7 doses produced a robust antibody response, according to the investigators, and neutralizing antibodies persisted for at least a year after immunization.
Adverse events included joint pain and headache, but most were mild to moderate and passed quickly. Based on the results, the team confirmed the selection of the 2 x 107 plaque-forming-unit dose used in the previous Phase 3 outbreak clinical trial.
In that 7651-participant "ring vaccination" trial, Merck's shot protected 100 percent of vaccinated subjects from Ebola infection within 6-10 days, interim results showed; full results are expected later this year [2017].
While Merck hasn't yet submitted its shot to regulatory agencies, health officials have considered using the vaccine to combat a recent Ebola outbreak detected in the Democratic Republic of the Congo. Local health authorities approved rVSV-ZEBOV for emergency use under trial settings, but the government is holding off on deploying the experimental vaccine, and deployment is not yet advised by the World Health Organization, according to the Wall Street Journal.
Earlier this month [June 2017], a Doctors Without Borders spokesperson said preparations for vaccination are underway "in order to rapidly initiate a ring vaccination should an [Ebola virus disease] laboratory-confirmed case be identified outside of the already defined contacts."
Merck has said it will submit its vaccine for approval by the end of 2017.
Citation. Heppner DG Jr et al. Safety and immunogenicity of the rVSVG-ZEBOV-GP Ebola virus vaccine candidate in healthy adults: a phase 1b randomised, multicentre, double-blind, placebo-controlled, dose-response study. Lancet Infect Dis. 2017 Jun 9. pii: S1473-3099(17)30313-4. doi: 10.1016/S1473-3099(17)30313-4. [Epub ahead of print]

[3] Research
12 Jun 2017: Modeling the Ebola zoonotic dynamics: Interplay between enviroclimatic factors and bat ecology
[Citation. Buceta J., Johnson K. (12 Jun 2017). Modeling the Ebola zoonotic dynamics: Interplay between enviroclimatic factors and bat ecology. PLoS One, https://doi.org/10.1371/journal.pone.0179559
Abstract. Understanding Ebola necessarily requires the characterization of the ecology of its main enzootic reservoir, i.e. bats, and its interplay with seasonal and enviroclimatic factors. Here we present a SIR compartmental model where we implement a bidirectional coupling between the available resources and the dynamics of the bat population in order to understand their migration patterns. Our compartmental modeling approach and simulations include transport terms to account for bats mobility and spatiotemporal climate variability. We hypothesize that environmental pressure is the main driving force for bats' migration and our results reveal the appearance of sustained migratory waves of Ebola virus infected bats coupled to resources availability. Ultimately, our study can be relevant to predict hot spots of Ebola outbreaks in space and time and suggest conservation policies to mitigate the risk of spillovers.]

14 Jun 2017: Region level risk factors for the Ebola virus disease in West Africa.
[Citation. Levy B., Odoi A. (14 Jun 2017). Region level risk factors for the Ebola virus disease in West Africa. PeerJPrints.
---Background. The Ebola virus disease (EVD) is a highly infectious disease that has claimed over 25 000 cases in the past 50 years. While many past outbreaks of EVD resulted in relatively few incidents, the 2014 outbreak in West Africa was the most deadly occurrence of EVD to date producing over 15 000 confirmed cases.
--Objective. In this study, we relate total confirmed case counts of EVD to predictor variables at the region level in Sierra Leone, Liberia, and Guinea.
--Methods. We used a Poisson framework and negative binomial framework to relate the predictors to the outcome. A spatial analysis was conducted to further our understanding and help interpret results.
--Results. Results indicate that the percent of the population living in urban areas, percent of household with a bad quality or no toilet, and percent of married men working in blue collar jobs protect against the transmission of EVD. Our study also shows that mean years of education contributes to increased case counts of the disease.
--Conclusion. Each significant predictor are associated with the types of dynamics that either protect against, or exacerbate, the spread of EVD. While having limited contact with the bodily fluids of others, reduced person-to-person contact, and isolated population clusters protect against the spread of EVD, the types of daily interactions an educated individual will experience leads to higher incidence rates. This information can be used to identify potential transmission routes and prevent future outbreak of this deadly disease. ...more...]

12 Jun 2017. Small protein found in Ebola virus may be responsible for its rapid spread, study says
[A Tulane University-lead study recently revealed how a small protein found within the Ebola virus may be responsible for the virus' ability to spread rapidly from person-to-person.
Ebola-infected patients are known to produce large quantities of a compound known as delta peptide.
"Our leading hypothesis is that the delta peptide affects the gastrointestinal (GI) tract by damaging cells after its release from infected cells," William Wimley, professor of biochemistry and molecular biology at the Tulane University School of Medicine, said. "This effect may be a major contributor to the severe GI illness of patients with the Ebola virus."...-more]

16 Jun 2017: Ebola leaves unique scar inside survivors' eyes
In some Ebola [Ebola virus disease (EVD] survivors, EVD leaves a unique scar at the back of the eye that can be seen long after they are cured of the disease, according to a new study.
Researchers analyzed information from 82 [EVD survivors] in Sierra Leone and 105 people who lived in the area but never had EVD. All participants took a vision test and had the back of their eyes examined with an ophthalmoscope. Among EVD survivors, more than a year had passed, on average, between the time they were cured of the disease and the time of the eye examination.
When asked to read letters on an eye chart, the EVD survivors tended to perform just as well as those who'd never had the disease, meaning their infection didn't seem affect their vision.]
However, approximately 15 percent of EVD survivors had a unique scar on their retina, the light-sensitive tissue at the back of the eye. The people who had never contracted EVD did not have this particular type of scar, the study found.
This scar, "often resembling a diamond or wedge shape, appears unique," the researchers said. The scar was next to the eye's optic disc, the spot where nerve fibers exit the eye to connect to the brain. This suggests that the EVD virus enters the eye by traveling along the optic nerve, the researchers said.
Previous studies have found that up to 60 percent of Ebola survivors experience eye symptoms, including eye inflammation and temporary vision loss, but little is known about the patients' long-term vision outcomes, the researchers said.
About 7 percent of the EVD survivors in the new study had white cataracts, or cloudy areas in the lens of the eye that can affect vision. In contrast, no white cataracts were found in the participants who'd never had Ebola, the researchers said.
However, it's not clear whether EVD survivors could safely have surgery to remove cataracts, because there is concern that the virus can linger in the eye and might pose a risk to doctors performing the surgery.
But in the new study, the researchers tested the eye fluid of 2 Ebola survivors with cataracts, and the fluid tested negative for the virus. This finding suggests that Ebola does not necessarily remain in eye fluid in survivors with cataracts, and that in some patients, cataract surgery could be performed safely, the researchers said.
Citation. Steptoe P.J., Scott J.T., Baxter J.M. (July 2017). Novel Retinal Lesion in Ebola Survivors, Sierra Leone, 2016. Emerg Infec Dis 23(7)--July 2017. https://dx.doi.org/10.3201/eid2307.161608
Abstract. We conducted a case-control study in Freetown, Sierra Leone, to investigate ocular signs in Ebola virus disease (EVD) survivors. A total of 82 EVD survivors with ocular symptoms and 105 controls from asymptomatic civilian and military personnel and symptomatic eye clinic attendees underwent ophthalmic examination, including widefield retinal imaging. Snellen visual acuity was under 6/7.5 in 75.6 percent (97.5 percent CI 63 percent-85.7 percent) of EVD survivors and 75 percent (97.5 percent CI 59.1 percent-87.9 percent) of controls. Unilateral white cataracts were present in 7.4 percent (97.5 percent CI 2.4 percent-16.7 percent) of EVD survivors and no controls. Aqueous humor from 2 EVD survivors with cataract but no anterior chamber inflammation were PCR-negative for Zaire EVD virus, permitting cataract surgery. A novel retinal lesion following the anatomic distribution of the optic nerve axons occurred in 14 percent (97.5 percent CI 7.1 percent-25.6 percent) of EVD survivors and no controls, suggesting neuronal transmission as a route of ocular entry.]

[4] Funding
12 Jun 2017 Nigeria: Fear of Ebola: Why Nigeria lost USD 186 million to the Ebola outbreak
[Ebola viral disease [EVD] spread across several African states including Nigeria in 2014. After 93 days and several deaths, Nigeria was declared Ebola free on 20 Oct 2014. Nevertheless, its impact on the economy lingered on as revealed by a recent study suggesting that the fear of Ebola and widespread misinformation cost Nigeria USD 186 million. This may have had a huge impact on the economy.
This 1st in-depth look on how the fear of Ebola affected the economy was recently published in BMJ global health [Bali S, Stewart KA, Pate MA. Long shadow of fear in an epidemic: fearonomic effects of Ebola on the private sector in Nigeria. BMJ Global Health 2016;1:e000111. doi:10.1136/bmjgh-2016-000111, a paper from 2016, but important in that it points out the far reaching impact of perception of a disease. - Mod.LK].
According to the [study] led by Sulzhan Bali, the fear of EVD had a lot of impact on the following sectors of the Nigerian economy:
Health services; Hospitality and retail; Telecoms; Aviation; Consumer goods; Pharmaceuticals; Oil and gas.
Using in-depth interviews and surveys in Lagos, Nigeria, the researchers found that lack of information and misinformation contributed significantly to the fear of Ebola, which had ripple effects on the economy. ...-more]

13 Jun 2017 Sierra Leone: ADRA Sierra Leone directs USD 80 000 of relief to Ebola survivors
https://atoday.org/adra-sierra-leone-directs-80 000-of-relief-to-ebola-survivors/
[The Sierra Leone office of the Adventist Development and Relief Agency [ADRA] has partnered with US-based aid agency Cross International to provide relief to EVD survivors in the country.
Two containers of goods, worth a combined USD 80 000, were directed to EVD survivors.
Sierra Leone's capitol Freetown's Concord Times reports that EVD survivors in 8 districts of Sierra Leone were being sent new clothing, fortified rice, soy blend and water.
ADRA Sierra Leone Director David Kabia confirmed that some of the supplies had already reached the recipients. ...- more]

[Compiled by: Celeste Whitlow ]

Communicated by:
ProMED-mail Rapporteur Mary Marshall

[A map of the affected area in northeast Congo DR can be seen at https://www.independent.co.ug/ebola-in-drc/ and a HealthMap/ProMED-mail map of Congo DR at http://healthmap.org/promed/p/194.

A HealthMap of Nigeria can be found at http://healthmap.org/promed/p/62.

HealthMap/ProMED-mail maps:
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
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