Posted on 30TH 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 border
DR Congo death
[2] Research
Zoonotic spillovers
Clinical laboratory values
[3] Non-Government Organizations
Role in W African Ebola outbreak
[4] Vaccines
rVSV (delta)G-ZEBOV-GP
Ad26.ZEBOV and MVA-BN-Filo

[1] News
21 Jun 2017 Democratic Republic of Congo: Tombura reopens border with Congo as Ebola rates decrease
[Tombura State has officially reopened its border with neighboring Democratic Republic of Congo [DRC] after several weeks of closure due to reports of [Ebola virus disease (EVD)] infections in DRC, a local official said.

Speaking to Radio Tamazuj on [Tue 20 Jun 2017], Deputy Governor of Tombura State, Lino Utu said the border is now open to allow free movement of people and goods.

Utu explained that the state government decided to reopen the common border after the situation had returned to normal in Congo. However, he said precautionary measures, which include surveillance and screening of people crossing into South Sudan, are still in place.]

22 Jun 2017 DR Congo: WHO confirms death of 4th patient in DR Congo
[A 4th person has died in an [Ebola virus disease (EVD)] outbreak in the Democratic Republic of Congo, a spokesman from the World Health Organization (WHO) said on Mon 22 May. Since the WHO declared the outbreak on 12 May in north-eastern Bas-Uele province, 37 suspected cases are being monitored, WHO's Eugene Kabambi said.

Of these suspected cases, 2 were confirmed in the laboratory and 3 were regarded as probable [EVD] cases, Kabambi said. Community health agents are monitoring 400 people who may have come into contact with those killed by the [viral disease]. "People who were in contact with the 1st case reported on [22 April 2017] came out unscathed after the 21 days of observation," Kabambi said.

The Democratic Republic of the Congo has suffered 7 previous outbreaks of [EVD] since the [viral disease] was discovered in the country in 1976. The last outbreak, in 2014, left 49 people dead.

West Africa was worst affected during 2014 [outbreak], with the hemorrhagic fever claiming more than 11 000 lives, most of those in Guinea, Liberia and Sierra Leone.]
[This case does not appear to represent further spread of the virus, but rather one of the cases being monitored. - Mod.LK]

25 Jun 2017 Liberia: MOH issues alert as strange disease emerges in Liberia
[The Ministry of Health (MOH) has directed all agencies under its jurisdiction to increase surveillance at all health facilities following an emergence of what it described as a "strange" disease in Liberia.

A memo issued to all concerned agencies of the ministry said the Ministry of the Interior had advised the MOH to increase disease surveillance at all levels of the national health system to prevent the spread of the strange disease.

The Interior Ministry has underscored the need to promote infection prevention and control mechanism at health facilities as part of preparations to prevent the spread of the unknown disease to Ghana through the borders and the airport.

The disease, yet to be identified, according to the Ghana Immigration Service, has claimed 11 lives in Liberia while at least 9 more people have been infected by the disease.

"The symptoms reported by the victims mainly are headache, weakness, diarrhea, vomiting, mental confusion, abdominal pain and fever," the Ministry of the Interior has said. ...more]

[Such non-specific symptoms could be caused by many etiologic agents. Any further information a ProMED reader may have is welcome. - Mod.LK]

[2] Research
21 Jun 2017: Scientists locate where the most deadly 'missing viruses' are hiding
[Citation. Olival K.J., Hosseini C.Z-T, et al. (21 Jun 2017). Host and viral traits predict zoonotic spillover from mammals. Nature 2017. doi:10.1038/nature22975

Abstract. The majority of human emerging infectious diseases are zoonotic, with viruses that originate in wild mammals of particular concern (for example, HIV, Ebola and SARS). Understanding patterns of viral diversity in wildlife and determinants of successful cross-species transmission, or spillover, are therefore key goals for pandemic surveillance programs. However, few analytical tools exist to identify which host species are likely to harbour the next human virus, or which viruses can cross species boundaries. Here we conduct a comprehensive analysis of mammalian host-virus relationships and show that both the total number of viruses that infect a given species and the proportion likely to be zoonotic are predictable. After controlling for research effort, the proportion of zoonotic viruses per species is predicted by phylogenetic relatedness to humans, host taxonomy and human population within a species range--which may reflect human-wildlife contact. We demonstrate that bats harbour a significantly higher proportion of zoonotic viruses than all other mammalian orders. We also identify the taxa and geographic regions with the largest estimated number of 'missing viruses' and 'missing zoonoses' and therefore of highest value for future surveillance. We then show that phylogenetic host breadth and other viral traits are significant predictors of zoonotic potential, providing a novel framework to assess if a newly discovered mammalian virus could infect people.]
[See full article and references in the Nature publication referred to above. - Mod.LK]

July 2017. Clinical Laboratory Values as Early Indicators of Ebola Virus Infection in Nonhuman Primates
[Citation. Reisler R.B., Donofrio M.J., Warren T.K., et al. Clinical Laboratory Values as Early Indicators of Ebola Virus Infection in Nonhuman Primates. Emerg Inf Dis. 23(8)--August 2017 https://doi.org/10.3201/eid2308.170029

Abstract. The Ebola virus (EBOV) outbreak in West Africa during 2013-2016 demonstrated the need to improve Ebola virus disease (EVD) diagnostics and standards of care. This retrospective study compared laboratory values and clinical features of 3 nonhuman primate models of lethal EVD to assess associations with improved survival time. In addition, the study identified laboratory values useful as predictors of survival, surrogates for EBOV viral loads, and triggers for initiation of therapeutic interventions in these nonhuman primate models. Furthermore, the data support that, in nonhuman primates, the Makona strain of EBOV may be less virulent than the Kikwit strain of EBOV. The applicability of these findings as potential diagnostic and management tools for EVD in humans warrants further investigation.]

[3] Non-governmental organization
17 Jun 2017. Non-government organizations and the fight Against Ebola: Identifying the types of aid most provided by non-Government organizations during the 2013-2015 Ebola crisis
[Citation. Cook B. (17 Jun 2017). Non-government organizations and the fight against Ebola: Identifying the types of aid most provided by non-government organizations during the 2013-2015 Ebola crisis. Alleghany College. https://dspace.allegheny.edu/handle/10456/42901

Abstract. The purpose of this project is to identify what was the most given type of aid by non-government organizations (NGOs) was in response to the 2013-2015 [Ebola virus disease (EVD)] outbreak in the countries of Sierra Leone, Liberia and Guinea. The types of aid were split into 20 separate categories. Data was collected on 67 NGOs who were listed on The Center for International Disaster Information's website. The actual data was retrieved from the websites and affiliate sites of the NGOs being examined. The format of the data was usually self-reported, and was in other varying formats depending on the organizations. The data was then put into a spreadsheet on Microsoft Excel for analysis. It was determined at the end of the study that providing community education to communities who were at risk of coming into contact with the virus, or who already had been affected by the virus, was the most frequently given type of aid by NGOs. Several other areas of aid that had large contributions of aid were training healthcare workers and providing personal protective equipment. Several patterns were also found within the community education data regarding how the community education was provided or supplemented. It was found that many NGOs also made use of pamphlets and radio messages to educate populations about the virus. ]

[4] Vaccines
19 Jun 2017: Ebola vaccine developed in Canada shows promising results
[A phase 1 randomized controlled trial has found an Ebola virus disease (EVD) vaccine, developed in Canada, was well-tolerated with no safety concerns, and high antibodies were present in participants 6 months after immunization. The study, led by Canadian researchers, is published in CMAJ (Canadian Medical Association Journal):
Citation. ElSherif M.S., Brown C., MacKinnon-Cameron M., et al. (19 Jun 2017) Assessing the safety and immunogenicity of recombinant vesicular stomatitis virus Ebola vaccine in healthy adults: a randomized clinical trial. CMAJ June 19, 2017. 189(24) doi: 10.1503/cmaj.170074

--Background. The 2013-2016 Ebola virus [disease] outbreak in West Africa was the most widespread in history. In response, a live attenuated recombinant vesicular stomatitis virus (rVSV) vaccine expressing Zaire Ebolavirus glycoprotein (rVSVÎ"G-ZEBOV-GP) was evaluated in humans.

--Methods. In a phase 1, randomized, dose-ranging, observer-blind, placebo-controlled trial, healthy adults aged 18-65 years were randomized into 4 groups of 10 to receive one of 3 vaccine doses or placebo. Follow-up visits spanned 180 days post-vaccination for safety monitoring, immunogenicity testing and any rVSV virus shedding.

--Results. Forty participants were injected with rVSV-deltaG-ZEBOV-GP vaccine (n = 30) or saline placebo (n = 10). No serious adverse events related to the vaccine or participant withdrawals were reported. Solicited adverse events during the 14-day follow-up period were mild to moderate and self-limited, with the exception of injection-site pain and headache. Viremia following vaccination was transient and no longer detectable after study day 3, with no virus shedding in saliva or urine. All vaccinated participants developed serum immunoglobulin G (IgG), as measured by Ebola virus envelope glycoprotein-based enzyme-linked immunosorbent assay (ELISA). Immunogenicity was comparable across all dose groups, and sustained IgG titers were detectable through to the last visit, at study day 180.
--Interpretation. In this phase 1 study, there were no safety concerns after a single dose of rVSV-deltaG-ZEBOV-GP vaccine. IgG ELISA showed persistent high titers at 180 days postimmunization. There was a period of reactogenicity, but in general, the vaccine was well tolerated. This study provides evidence of the safety and immunogenicity of rVSV-deltaG-ZEBOV-GP vaccine and importance of its further investigation.]

14 Mar 2017 Ebola vaccine has been shown to induce a durable immune response 1 year after vaccination
[A prime-boost Ebola vaccine regime has induced a persistent antibody response of at least one year in 100 percent of the healthy volunteers. Partners behind the development of the vaccine include the EU's Innovative Medicines Initiative.

Citation. Winslow R.L., Milligan I.D., Voysey M., et al. (14 Mar 2017) Immune Responses to Novel Adenovirus Type 26 and Modified Vaccinia Virus Ankara-Vectored Ebola Vaccines at 1 Year. JAMA. 2017;317(10):1075-1077. doi:10.1001/jama.2016.20644

Abstract. The Ebola virus vaccine strategies evaluated by the World Health Organization in response to the 2014-2016 outbreak in West Africa included a heterologous primary and booster vaccination schedule of the adenovirus type 26 vector vaccine encoding Ebola virus glycoprotein (Ad26.ZEBOV) and the modified vaccinia virus Ankara vector vaccine, encoding glycoproteins from Ebola, Sudan, Marburg, and Tai Forest viruses nucleoprotein (MVA-BN-Filo). This schedule has been shown to induce immune responses that persist for 8 months after primary immunization, with 100 percent of vaccine recipients retaining Ebola virus glycoprotein-specific antibodies.]

Communicated by:

[compiled by: Celeste Whitlow ]

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

Maps of the 3 countries affected by the 2014 Ebola outbreak in W. Africa can be accessed at:
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 (29): news, vaccine, research, funding 20170618.5113468
Ebola update (28): DR Congo, Uganda, research 20170607.5090956
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Ebola update (21): Congo DR, News, Research, Vaccine
Ebola update (20): Congo DR, news, vaccine, update 20170515.5037761
Ebola update (19): Congo DR, Nigeria preparedness 20170514.5035550
Ebola update (18): Congo DR, vaccine 20170513.5034029
Ebola update (17): Congo DR, vaccine, research 20170512.5031411
Ebola update (16): news, research, vaccines, funding 20170428.5000661
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