Posted on 29TH SEP 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
- Ebola data site
[2] Research
- Long-term effects of Ebola virus infection revealed
- Assessing relapse of Ebola virus disease in the central nervous system
- Persistence of viruses in semen
- Health system resilience
- Rapid diagnostic Ebola virus assay
[3] Research/funding
- Vaccine against Ebola, Sudan, Marburg, and Lassa fever viruses
- 3-strain Ebola virus vaccine
- Universal surveillance platform

[1] News
4 Sep 2017. Citation. Maxmen A. Massive Ebola data site planned to combat outbreaks. Nature. 2017; 549(7670): 15. doi: 10.1038/nature.2017.22545.
[An international partnership seeks African leadership to organize information about the disease.
More than 11 000 people died when [Ebola virus disease (EVD)] tore through West Africa between 2014 and 2016, and yet clinicians still lack data that would enable them to reliably identify the disease when a person first walks into a clinic. To fill that gap and others before the next outbreak hits, researchers are developing a platform to organize and share Ebola data that have so far been scattered beyond reach.
The information system is coordinated by the Infectious Diseases Data Observatory (IDDO; https://www.iddo.org/), an international research network based at the University of Oxford, UK, and is expected to launch by the end of the year [2017]. At a meeting to discuss Ebola in September [2017] in Conakry, Guinea, the team heading the platform will seek input from West African scientists, health officials and advocacy groups.
"We are looking for West African leadership in this initiative," says Laura Merson, associate director of the IDDO. Africans must be involved in the platform's creation so that they can not only use the existing data, but also improve their capacity to conduct research during future outbreaks, says John Amuasi, an infectious-diseases researcher at the Kumasi Centre for Collaborative Research in Tropical Medicine in Ghana and a member of the platform's steering committee. A true partnership would also lessen the general public's mistrust of scientists, he adds.
Merson and her collaborators want to avoid the kind of data fragmentation that hindered efforts to stop the outbreak in Liberia, Guinea, and Sierra Leone. As the Ebola crisis was escalating in October 2014, she visited treatment units in the three countries to advise on research. Merson found tremendous variation in practices, which complicated attempts to merge and analyse the information. For instance, some record books listed lethargy and hiccups as symptoms, whereas others recorded fatigue but not hiccups.
"People were just collecting what they could," she recalls. " ...]

[2] Research
15 Sep 2017. Long-term effects of Ebola virus infection revealed
[Citation. Jagadesh S, Sevalie S, Fatoma R, et al. Disability among Ebola survivors and their close contacts in Sierra Leone: a retrospective case-controlled cohort study. S Jagadesh et al. Clin Infect Dis. 2017. cix705; https://doi.org/10.1093/cid/cix705
Although the 2014-2016 West African Ebola outbreak may have ended, a new study out of the University of Liverpool's Institute of Translational Medicine and the Liverpool School of Tropical Medicine has found that many survivors are suffering with "major limitations in mobility, cognition, and vision," according to a press release on the research, from the university.
For the study, S Jagadesh, from Liverpool University, led a team of researchers in assessing disability in a cohort of 27 survivors "12 months following their discharge from the Ebola Survivors Clinic in Freetown, Sierra Leone and compared with [54 of their unaffected] close contacts," according to the press release. The Washington Group-Disability Extended Questionnaire (WG ES-F), which measures "self-reported physical and mental impairments" was used to assess disability across 6 domains: "vision, hearing, mobility, self-care, communication and cognition." Severity and frequency of mental conditions (including anxiety, depression, pain and fatigability) were used to establish functionality scores. The results showed that significantly more survivors reported a disability in at least 1 of the 6 domains (78 percent), compared with the close contacts (11 percent). ...]
[The data continue to accumulate showing long term sequelae following "recovery" from Ebola infection. - Mod.LK]

19 Sep 2017. Assessing relapse of Ebola virus disease in the central nervous system
[Citation. Billioux BJ, Nath A, Stavale EJ, et al. Cerebrospinal fluid examination in survivors of Ebola virus disease. JAMA Neurol. 2017; 74(9): 1141-43. doi:10.1001/jamaneurol.2017.1460; http://jamanetwork.com/journals/jamaneurology/article-abstract/2643981
Ebola virus disease has the ability to persist in the central nervous system (CNS) even after it has been cleared from the rest of the body and can cause a relapse. Researchers tested whether recovered patients with neurologic symptoms still had viral loads in the central nervous system.
After the recent Ebola virus disease epidemic in West Africa, it has become clear that many complications of the disease have long-term effects. In particular, it has become clear that Ebola virus can persist in the central nervous system (CNS) and ultimately cause a relapse.
In JAMA Neurology (see citation above), Billioux and colleagues investigated the cerebrospinal fluid (CSF) of patients who had survived Ebola virus disease. The researchers evaluated 165 patients who had recovered from Ebola virus disease for neurological symptoms and examined the CSF of 7 of these patients who had stable symptoms and no other conditions (such as HIV). The patients had been discharged from Ebola treatment between 364 and 459 days before the lumbar punctures took place. The researchers then used RT-PCR to detect, amplify and copy Ebola virus genes.
This important study provides the 1st systematic evaluation of CSF in Ebola virus disease survivors. Billioux and colleagues found no evidence of Ebola virus in any of the CSF samples. This may be a result of the relatively long period of time since discharge. It is also possible that the Ebola virus is present in the central nervous system but dormant. However, patients who show symptoms of Ebola virus disease relapse should have their cerebrospinal fluid monitored for the virus.]
[Byline: CI Villamil]

23 Sep 2017. Persistence of viruses in semen
[Citation. Salam AP, Horby PW. The breadth of viruses in human semen. Emerg Infect Dis. 2017. 23(11); https://doi.org/10.3201/eid2311.171049.
According to a report by the Centers for Disease Control and Prevention (CDC; see citation above), male bodily fluids can be riddled with harmful viruses.
Researchers were able to detect at least 27 viruses -- including Ebola, Zika, Lassa fever, influenza, and smallpox -- in human semen, many of which can cause chronic, or latent, infection. "Virus may persist even if incapable of replicating within the male reproductive tract because the testes are immunologically privileged," said the CDC article. That is, within the testes, the immune response is restricted to enable the survival of sperm, which are immunogenic."
According to NPR.org, common viruses and STDs are know to spread through sexual contact, but scientists and doctors are not sure whether the less common illnesses can spread in the same way.
There is still more research to be done, but with this new information in mind it's better to be safe than sorry"...]
[Recognition that the testes are an immunologically privileged site is important to keep in mind following infection with these other pathogens, in addition to those already recognized to be sexually transmitted such as Ebola and Zika viruses, among others.- Mod.LK]

30 Aug 2017. Citation. Sochas L, Dannon AA, and Nam S, et al. Counting indirect crisis-related deaths in the context of a low-resilience health system: the case of maternal and neonatal health during the Ebola epidemic in Sierra Leone. Health Policy and Planning. ISSN 0268-1080 (In Press). LSE Research Online; http://eprints.lse.ac.uk/84134/
[Abstract. While the number of direct Ebola-related deaths from the 2013--16 West African Ebola outbreak has been quantified, the number of indirect deaths, resulting from decreased utilisation of routine health services, remains unknown. Such information is a key ingredient of health system resilience, essential to adequate allocation of resources to both "crisis response activities" and "core functions". Taking stock of indirect deaths may also help the concept of health system resilience achieve political traction over the traditional approach of disease-specific surveillance. This study responds to these imperatives by quantifying the extent of the drop in utilisation of essential reproductive, maternal and neonatal health services in Sierra Leone during the Ebola outbreak by using interrupted time-series regression to analyse HMIS [Health Management Information Systems] data. Using the Lives Saved Tool, we then model the implication of this decrease in utilisation in terms of excess maternal and neonatal deaths, as well as stillbirths. We find that antenatal care coverage suffered from the largest decrease in coverage as a result of the Ebola epidemic, with an estimated 22 percentage point decrease in population coverage compared to the most conservative counterfactual scenario. Use of family planning, facility delivery and post-natal care services also decreased but to a lesser extent (-6, -8 and -13 p.p. respectively). This decrease in utilisation of life-saving health services translates to 3600 additional maternal, neonatal and stillbirth deaths in the year 2014-15 under the most conservative scenario. In other words, we estimate that the indirect mortality effects of a crisis in the context of a health system lacking resilience may be as important as the direct mortality effects of the crisis itself.]

28 Sep 2017. New fast test developed to diagnose Ebola by Northumbria University, UK
[Citation. Northumbria University. Breakthrough in rapid, mass screening for the Ebola virus. ScienceDaily, 2017.
A new, faster and safer way of diagnosing the Ebola virus has been developed by an academic from Northumbria University, Newcastle.
Research led and carried out by Dr Sterghios Moschos at Northumbria means that patients with Ebola-like symptoms can be identified and treated much sooner and at the point of care, helping to reduce the spread of the disease and risks to others.
During the Ebola outbreak in Africa in 2014, patients tested for the disease had to provide a blood sample for testing in a specialist lab by highly trained staff. There are only a few of these facilities in the world, including Public Health England's Lab in Porton Down in the UK, with each diagnosis of the Ebola virus genome taking between 5-8 hours to confirm.
Thanks to the efforts of Dr Moschos' research team, working with a manufacturer of innovative diagnostic solutions, a new point of care diagnostic platform -- EbolaCheck -- has been developed, which can be deployed to the scene of an outbreak. The test can now be carried out on an amount of blood that is 700 times smaller than previously needed -- literally a drop obtained by 'pin pricking' a finger -- and it now takes less than 70 minutes to complete. As a result, the test is much safer to administer, requires minimal training and reduces the cost of diagnosis significantly. Crucially, its performance is comparable to laboratory testing, meaning any patient with symptoms of Ebola can be safely and reliably diagnosed. ...]
[Byline: Katie Dickinson]
[If the technology is successful, it could be expanded to include rapid diagnosis of other high-risk viruses. Point-of-care diagnosis would save patients from having go to clinics and risk infecting others, as well as exacerbating their own condition by arduous travel. - Mod.LK]
[Ref. Shah K, Bentley E, Tyler A, et al. Field-deployable, quantitative, rapid identification of active Ebola virus infection in unprocessed blood. Chem Sci, 2017. doi: 10.1039/C7SC03281A; http://tinyurl.com/ybmgy6wn]

[3] Research/funding
28 Sep 2017. Jefferson awarded a USD 30 million contract to develop Ebola vaccine
[The National Institutes of Health has awarded a 5-year contract worth up to USD 30 million to Thomas Jefferson University [Philadelphia, Pennsylvania, USA] to prepare and test a vaccine formulation designed to protect against the Ebola, Sudan, Marburg, and Lassa fever viruses.
The National Institute of Allergy and Infectious Diseases, part of the NIH, made an initial award of USD 2.6 million to Jefferson for the global project that will be led by principal investigator Matthias Schnell, the chairman of Jefferson's department of microbiology and immunology and director of the Jefferson Vaccine Center at the Sidney Kimmel Medical College at Thomas Jefferson University.
The additional funding of up to USD 30 million will be made available over the course of the contract if all its options are exercised.
If successful, the vaccine would be the 1st to induce protection against 4 hemorrhagic fever viruses, which can damage blood vessels, cause internal bleeding, and result in high mortality rates -- as seen in the West African Ebola outbreak.
'Our approach is to create a broad scope of coverage with a tetravalent vaccine -- one that covers 4 of these deadly viral diseases,' Schnell said.
Schnell will lead the project team composed of experts in the field of vaccine development and testing from IDT Biologika, a German vaccine and pharmaceutical manufacturer; the Seattle [Washington]-based Infectious Disease Research Institute; Immune Design, also of Seattle; Exxell Bio Inc of Minnesota; the US Army Medical Research Institute of Infectious Diseases; and The Geneva Foundation [Tacoma, Washington].

28 Sep 2017. NIH awards USD 6 million to develop 3-strain Ebola vaccine
[The National Institutes of Health (NIH) has awarded researchers at the University of Hawaii, the University of Texas Medical Branch, and 3 biotech companies USD 6.3 million to develop a trivalent Ebola vaccine, the University of Hawaii said in a news release yesterday [27 Sep 2017].
University of Hawaii scientist Axel Lehrer, PhD, has already created a heat-stable vaccine that does not require refrigeration, which would be a major benefit in transporting the vaccine to hard-to-reach places. Expanding the vaccine to work against three related Ebola viruses could enhance the protection of healthcare workers and others as soon as outbreaks occur. That is because the first inoculations could occur even before public health experts know which exact type of hemorrhagic fever has struck.
Lehrer believes that, with adequate funding and the necessary regulatory approvals, the heat-stable vaccine could be on the market in 5-10 years.
Researchers at the 2 universities will work with teams from Honolulu-based Hawaii Biotech, Inc.; New Jersey-based Soligenix, Inc.; and Maryland-based Bioqual, Inc.]

Communicated by:
ProMED-mail Rapporteur Mary Marshall

28 Sep 2017. Partners receive USD 4.25 million to develop universal surveillance platform for disease outbreaks
[Tasso, Inc. (Tasso), Ceres Nanosciences (Ceres), George Mason University (Mason), and the United States Army Medical Research Institute of Infectious Diseases (USAMRIID) today [28 Sep 2017] announced the commencement of a USD 11.7 million program, funded by the Defense Threat Reduction Agency (DTRA), to develop a reliable, safe, and simple universal surveillance platform for infectious disease outbreaks.
During this multi-year program, which will be initiated with USD 4.25 million in funding from DTRA, Ceres will integrate its Nanotrap® particle technology, which can capture, concentrate, and preserve pathogens and other biomolecules, into Tasso's HemoLink™ device for simple and painless collection of large-volume capillary blood samples in remote environments.
Tasso and Ceres will work in close collaboration with infectious disease experts and advanced biodefense laboratories at Mason and USAMRIID to develop an effective disease surveillance platform that can be rapidly deployed in the field, operated by untrained users, and improve early response. The platform will combine the Nanotrap® and HemoLink™ technologies to safely and reproducibly collect, preserve, and transport blood-borne pathogens.
"Infectious diseases remain one of the main causes of death worldwide and a significant threat to national security," said Dr Kylene Kehn-Hall of Mason. "In just the last 5 years, for example, epidemics of [Ebola virus disease (EVD)], chikungunya, [CHIKV], and Zika viruses [ZIKV], usually restricted to tropical climates, have reached the United States."
"When a new outbreak occurs, public health officials quickly need as much information as possible about the pathogen(s) causing the outbreak to determine how to control it," said Dr. Louis Altamura of USAMRIID. "Analyzing clinical samples from infected patients is one of the best ways to get that information, but existing blood sample collection and screening methods can expose healthcare workers and laboratory technicians to pathogens, presenting safety concerns for these workers and potentially contributing to the spread of the epidemic."
"We have demonstrated already that Nanotrap® particles can be used to enrich pathogens like influenza from biological samples and stabilize them for improved downstream analysis," said Ben Lepene, CTO of Ceres Nanosciences. "We're very excited to work with Tasso, Mason, and USAMRIID to apply that same approach to enrich and stabilize from blood a wide range of host biomarkers along with viral and bacterial pathogens that represent a risk to the US Department of Defense."
"There is an urgent need for an easier way to reach people in rural or hard-to-reach environments to provide health experts with the information they need to make effective decisions in a timely manner. Integrating the Nanotrap® particle technology and the simple HemoLink™ blood collection technology will enable acquiring samples from populations in outbreak regions without putting phlebotomists or patients at risk or requiring burdensome logistical networks," said Dr Erwin Berthier, VP of R&D at Tasso. "The integrated device will be rapidly and safely deployable in any environment and will collect a large volume of capillary blood that can be shipped over long distances while retaining its clinical relevance."]
[Because it is difficult to predict pathogen emergence, a universal assay that is field-deployable and can be used at point-of-care is the most effective approach to take. - Mod.LK]

[Compiled by Celeste Whitlow ]

Communicated by:

[Maps of the West African countries affected by the 2014 Ebola outbreak 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]

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