Posted on 10TH JUL 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 outbreak over
[2] Vaccines
- Genomic vaccines
[3] Research
- Personal protective equipment
- Spillover
[4] Funding
- World Bank

[1] News
7 Jul 2017 Ebola Outbreak Officially Over in DRC
[On 2 Jul 2017, the World Health Organization (WHO) officially declared that the recent Ebola outbreak that has plagued the Democratic Republic of Congo (DRC), was over. The last confirmed case of Ebola tested negative for the disease 47 days ago.

The outbreak, which was confirmed to have infected 8 individuals, 4 of whom died, also impacted the lives of 583 contacts of those infected. These individuals, "were registered and closely monitored, but no known contacts developed signs or symptoms of Ebola virus disease," according to a press release from WHO.

WHO was 1st notified of the outbreak by Ministry of Public Health in the DRC after a "cluster of undiagnosed illnesses and deaths with hemorrhagic signs in the Likati Health Zone," according to the release. The 2017 outbreak marked the 8th outbreak of the virus in the DRC since 1976.

WHO then notified the public of the first case with a tweet: On 11 May 2017, the Min of Health of the Democratic Republic of the Congo notified WHO and partners of a lab-confirmed case of #Ebola#DRC

Officials believe that the outbreak was able to remain effectively contained due to not only the remote location of those infected, but also "the timely alert by local authorities of suspect cases, immediate testing of blood samples due to strengthened national laboratory capacity, the early announcement of the outbreak by the government, rapid response activities by local and national health authorities with the robust support of international partners, and speedy access to flexible funding," according to the release. The Centers for Disease Control and Prevention (CDC) also commended the efforts put forth by WHO and its partners, stating in an official media statement that, "The CDC commends the dedicated efforts of those in the DRC whose hard work and commitment stopped the most recent Ebola Virus Disease (EVD) outbreak in Africa in less than 2 months. This highlights what is possible when countries are prepared to prevent, detect, and respond to disease outbreaks." A total of 9 disease detectives from the CDC contributed to the control of the outbreak in the DRC.

WHO Director-General, Tedros Adhanom Ghebreyesus, MD, is quoted in the release as stating, "With the end of this epidemic, DRC has once again proved to the world that we can control the very deadly Ebola virus if we respond early in a coordinated and efficient way."

According to the WHO press release, "enhanced surveillance in the country will continue, as well as strengthening of preparedness and readiness for Ebola outbreaks." In addition, WHO will continue to work with partners and local officials to ensure that all of those affected by the outbreak continue to have access to medical care (including psycho social care), and that they receive education on how to successfully integrate back into their family and community to reduce the risk of further transmission and the stigma carried by the disease.

[The world health community learns from each new outbreak, strengthening the response to the next one. One hopes even if the next outbreak is not in a remote region, response will be rapid and well informed. - Mod.LK]

[2] Vaccine

29 Jun 2017: The New Vaccines

[Genomic vaccines are poised to make a splash, writes Geoffrey Ling from the Uniformed Services University of Health Science and Johns Hopkins University at Scientific American.

"Genomic vaccines promise to offer many advantages, including fast manufacture when a virus, such as Zika or Ebola, suddenly becomes more virulent or widespread," Ling says.

Rather than being made up of weakened or killed viruses or their antigens, genomic vaccines include DNA or RNA that encode proteins, Ling says. Then the cells of the person receiving the vaccine make the proteins.

At the same time, Ling says that genomics is also enabling a different kind of vaccine called a passive immune transfer. In that, gene sequences encoding antibodies -- identified from resistant people -- are given to patients rather than antigens.

A number of clinical trials testing safety and immunogenicity are ongoing for bird flu, HIV, Ebola, and more, he says.]
[DNA vaccines have the advantages stated above, and in addition, they do not revert, they can be generated in large volumes at a lower cost than most live attenuated or killed vaccines, and DNA vaccines are also easier to transport as theoretically, a cold chain does not need to be maintained. However, problems still exist such as whether the protein the recipient makes is immunogenic. There is also the issue of the vector, against which the immune response might be directed in error. - Mod.LK]

[3] Research
29 Jun 2017: Ebola: Challenge of Liquid Stressed Protective Materials and Environmental Persistence

[Citation. Nikiforuk A.M., Cutts T.A., Theriault S.S., et al. (29 Jun 2017). : Challenge of Liquid Stressed Protective Materials and Environmental Persistence. Nature,Scientific Reports 7, Article number: 4388 (2017). doi:10.1038/s41598-017-04137-2

The possible penetration of Ebola virus through liquid stressed (saturated) PPE [personal protective equipment] should impact future concepts and strategies of infection prevention and control in tropical environments. The negative impacts of saturation on the protection afforded by PPE should be considered and mitigated. PPE could either be re-designed for increased temperature transfer/gaseous exchange to reduce perspiration or to offer more complete protection. The use of powered air purifying respirators should be discussed as they provide air circulation and liquid impermeable shielding to the wearer's face. The face is considered the most vulnerable region of the body to Ebola virus infection due to mucosal membranes of the eyes, nose and mouth. Even the use of highly protective PPE does not guarantee safety of HCWs [health care workers] or others exposed to Ebola virus because user error (i.e. improper donning/doffing or use of the equipment) may lead to exposure or heighten exposure risk. - ...more]

[Decreasing risk of infection of health care workers [HCW] is essential to their safety as well as the safety of the patients they are treating, thus studies such as this one are important. Because HCW are on the front line of treatment, the factors contributing to their high incidence of infection are likely multifactorial, including temperature of the working environment, material makeup and design of the PPE, among others - Mod.LK].

5 Jul 2017 Ebola spillover events

[Citation. Wollenberg Valero K.C., Isokpehi R., Douglas N.E., et al. (5 Jul 2017). Phenology supports the eco-environmental hypothesis for Ebola spillover events. bioRxiv

Abstract. Ebola virus disease outbreaks in mammals (including humans and great apes) start with sporadic host switches from unknown reservoir species. The factors leading to such spillover events are not clearly understood. Filoviridae have a wide range of natural hosts and are unstable once outside hosts. Spillover events, which involve the physical transfer of viral particles across species, could therefore be directly promoted by conditions of host ecology and environment. In this report we outline a proof of concept that temporal fluctuations of a set of eco-environmental variables describing the dynamics of the host ecosystem are able to predict such events of Ebola virus spillover to humans and animals. We newly compiled a dataset of climate and phenology variables and Ebola virus disease spillovers in humans and animals. We identified critical biotic and abiotic conditions for spillovers via multiple regression and neural-networks-based time series regression. Phenology variables proved to be overall better predictors than climate variables. African phenology variables are not yet available as a comprehensive online resource. Given the likely importance of phenology for forecasting the likelihood of future Ebola spillover events, our results highlight the need for more phenology monitoring to supply data for predictive modelling efforts.]

28 Jun 2017 World Bank launches pandemic bond to tackle major disease outbreaks

[The World Bank has launched a "pandemic bond" to support an emergency financing facility intended to release money quickly to fight a major health crisis like the 2014 Ebola outbreak.

The catastrophe bond, which will pay out depending on the size of the outbreak, its growth rate and the number of countries affected, is the 1st of its kind for epidemics. It should mean money is disbursed much faster than during West Africa's crisis.

[Ebola virus disease] spread across the region in the early months of 2014. Michael Bennett, head of derivatives and structured finance at the World Bank's capital markets department, said that if the pandemic emergency financing facility (PEF) had existed in 2014, some USD 100 million could have been mobilized as early as [July 2017].

In reality, money did not begin to flow on this scale until 3 months later, by which time the number of deaths from [EVD] had increased tenfold.

"In the end about 11 000 people died in that pandemic and it's estimated that the cost to the countries most affected - Guinea, Liberia and Sierre Leone - was about USD 2.8 billion," Bennett said.

The PEF will offer coverage to all countries eligible for financing from the International Development Agency (IDA), the arm of the World Bank dedicated to the world's poorest countries.

It covers outbreaks of infectious diseases most likely to cause major epidemics, including pandemic influenza strains; coronaviruses, including SARS; filoviruses, which include Ebola and Marburg; plus others such as Crimean Congo fever, Rift Valley fever and Lassa fever.

Bennett said the PEF as a whole would provide more than USD 500 million of coverage against pandemics over the next 5 years. This includes today's USD 425 million transaction, comprising USD 320 million raised through the bond market and USD 105 million through swaps transactions. ...-more]

[This is an excellent idea, but it is regrettable it took 11 000 deaths to initiate it. - Mod.LK]

6 Jul 2017 Editorial on World Bank

[Opinion : A worthy legacy of the Ebola catastrophe

One of the most disturbing lessons to emerge from the Ebola virus disease epidemic in West Africa in 2014-2015 was how unprepared the world was for it. David Nabarro, special adviser to the U.N. secretary general, told a Senate panel recently that the virus was missed in late 2013 and played down in 2014, even in July of that year when numbers of cases were doubling every 3 weeks. Ultimately, 11 314 people died in Guinea, Liberia and Sierra Leone.

When it was over, several studies concluded that the world needs a well-funded, rapid-reaction mechanism, a firefighting team ready to deploy quickly in the face of spreading disease. The World Health Organization proposed a USD 100 million contingency fund but so far has raised only USD 31.5 million, Mr Nabarro said. "In multilateral work, funding is oxygen," he added. "When it comes to responding to outbreaks, WHO is starved of oxygen."

Now comes the World Bank with a novel program that could help realize the goal of rapid response to such emergency health threats and save lives. The bank has announced the issuance of USD 500 million in specialized bonds and derivatives that will help poor countries cope with a pandemic such as Ebola. The effort will create a trust fund, the Pandemic Emergency Financing Facility that can be quickly deployed for pandemic response, complementing the WHO fund. Investors who buy the bonds and provide the trust-fund financing upfront will reap premiums (at first, Japan and Germany are covering the premiums) but will also be taking a risk. If there is a major outbreak, the investors will lose some or all of their cash. This is the 1st time such an approach has been tried for pandemic risk, but a similar idea underlies insurance against other natural disasters and catastrophes. One big advantage is that instead of waiting around for slow-moving national governments to fund a disease response, the resources necessary for saving lives will be available quickly, when they can do the most good. The trust-fund money will be used to respond to 6 viruses that are most likely to cause a pandemic, including influenza, Ebola, severe acute respiratory syndrome and Middle East respiratory syndrome. The financing to 77 eligible countries will be triggered depending on how far and fast a disease spreads and whether it crosses international borders]

[Submitted by Rapporteur Mary Marshall mjm2020@googlemail.com]

Compiled by Celeste Whitlow

Communicated by:

[A map of the DR Congo 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

See Also
Ebola update (30): news, research, non-governmental organization, vaccines 20170629.5140988
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Ebola update (20): Congo DR, news, vaccine, update 20170515.5037761
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