'Superspreaders' - Ebola Virus

Most people infected with Ebola in the world's worst outbreak of the deadly virus contracted it from just a tiny fraction of patients known as "superspreaders", researchers have said.
Six in 10 cases of the disease, which ravaged the West African nations of Guinea, Liberia and Sierra Leone between 2013 and 2016, were caused by just 3% of infected people, according to research carried out by several health experts.

The Ebola epidemic infected more than 28,600 people

and killed around 11,300 before coming under control last year

If these superspreaders, who were most likely to be under 15 and over 45, had been identified and quarantined promptly, most Ebola cases could have been avoided, the study published in the Proceedings of the National Academy of Sciences found.
The slow international response to the epidemic outbreak was criticised in 2015 by medical charity Médecins Sans Frontières (MSF), which first raised the alarm over Ebola, for having created an avoidable tragedy that cost thousands of lives.

"It was the infected people who didn't make it to health centres, and into isolation, that drove the epidemic," said Amanda McClelland, emergency health adviser at the International Federation of Red Cross and Red Crescent Societies (IFRC).
"The lesson to be learned is that you need to find every single case if you are going to stop an outbreak," McClelland told the Thomson Reuters Foundation.
The Ebola epidemic infected more than 28,600 people and killed around 11,300 before coming under control last year.
Children under 15 years old and adults over 45 were the biggest spreaders of Ebola, according to the study, which examined 200 cases in and around the capital of Sierra Leone, Freetown.
Younger and older patients were more likely to have been looked after by many relatives and caregivers, thus fuelling the spread of the disease, several of the researchers said.
Many people in the three Ebola-hit countries contracted the virus, which is passed on through blood and bodily fluids, by holding and embracing the infected, and washing and touching the bodies of the deceased at traditional burials.
"People between the ages of 15 and 45 were most likely to be carers and caring for someone with Ebola is a big risk factor in contracting the virus," said Sebastian Funk, assistant professor at The London School of Hygiene & Tropical Medicine (LSHTM).
Superspreaders also fuelled epidemics of Severe Acute Respiratory Syndrome, or SARS, in 2003 and Middle East Respiratory Syndrome (MERS) in 2012, according to the study.

New Ebola drug clears virus from monkeys - results published in 'Nature'

More than 26,000 people have been infected with Ebola since the outbreak began

An experimental Ebola drug cured three monkeys intentionally infected with the virus, according to a study published in Nature magazine.

The development marks the first such success against the strain of Ebola that killed up to 10,000 people in West Africa’s 2014-2015 outbreak.

Although other experimental treatments appeared to help Ebola patients last year, especially in the United States, those one-time uses cannot prove efficacy against the “Makona” strain, since patients’ recovery might be due to other causes.

Similarly, drugs, including Mapp Biopharmaceutical’s ZMapp, cured monkeys in lab experiments, but in a strain of Ebola different from that responsible for the current outbreak, the worst ever recorded.

“We can’t say for certain that an experimental drug that works against one strain will work in another, even if they’re almost identical genetically,” said Thomas Geisbert of the University of Texas Medical Branch, senior author of the study published in the journal Nature.

In the experiment, six rhesus monkeys were infected with huge doses of the Makona strain. Three days later, three received an infusion of a drug developed by Tekmira Pharmaceuticals Corp, a cocktail of “small-interfering RNAs” (siRNAs) encapsulated in a fat droplet called a lipid nanoparticle.

The siRNAs bind to two of the virus’s seven genes, silencing them and thereby preventing the virus from replicating.

All three treated monkeys survived despite fevers and enormous blood levels of virus. 

The drug can be adapted to target any strain of Ebola and produced in as little as eight weeks (compared with the months required for ZMapp), Geisbert said, in what he called “plug and play”: sequence any Ebola genome and custom-make a siRNA cocktail.

“There is a need for treatments that can be quickly modified if the strain changes,” he said.

A clinical trial of the new cocktail began last month in Ebola patients in Sierra Leone. A study of an earlier version was partly halted after healthy volunteers developed side effects at high doses. 

Results from human trials with the drug are expected in the second half of this year.

Read more on Irish Times/ Health here

Communicable Diseases Update

Communicable Diseases Update Vol. 14 (1) February 2015 available via Lenus, Irish Health Repository

Click here to access PDF of the February 2015 issue

Pioneering Ebola clinical trials to start next month

Médecins Sans Frontières/Doctors Without Borders (MSF) will host the first clinical trials of Ebola treatments in three treatment centres in West Africa, the international medical humanitarian organisation has announced.

The separate trials, which are aimed at quickly finding an effective therapy for the disease that has so far resulted in 5,000 deaths in the current outbreak in the region, will be led by three different research partners.

The French National Institute of Health and Medical Research (INSERM) will lead a trial using antiviral drug favipiravir in Guéckédou, Guinea; the Antwerp Institute of Tropical Medicine (ITM) will lead a trial of convalescent whole blood and plasma therapy at the Donka Ebola centre in Conakry, Guinea; and the University of Oxford will lead, on behalf of the International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC), a Wellcome Trust-funded trial of the antiviral drug brincidofovir at a site yet to be determined.

The World Health Organ-ization (WHO) and health authorities of the affected countries are also taking part in this collaborative effort.

The trials’ protocols are in the final stages of development and are designed with a simple target of 14-day survival and with broad inclusion criteria.

The main principles and designs have been shared with the respective countries’ ethical authorities, with the goal of starting the first trials next month.

Initial results could be available in February.

The two drugs, brincidofovir and favipiravir, were selected from WHO’s shortlist of potential Ebola treatments after review of safety and efficacy profiles, product availability, and ease of administration to patients, MSF said.

View more information here

‘Ebola – The Facts’ Lecture at NUI Galway

NUI Galway’s School of Nursing and Midwifery is running a free public lecture on Ebola: how it spreads, how it affects the human body, and how the outbreak can be contained. The lecture, on Tuesday, 18 November from 7-9pm in Áras Moyola, will also focus on hand washing and its importance in preventing the spread of infections in the community.

Dr Diarmuid O’Donovan, senior lecturer in NUI Galway’s School of Medicine and the Director of Public Health for the HSE West, will be delivering the lecture alongside Evelyn Byrne, lecturer from the School of Nursing and Midwifery. Evelyn Byrne will explain why hand washing is important, including a demonstration on effective hand washing. Dr O’Donovan recently returned from working with the World Health Organisation (WHO) on the Ebola response.

‘Ebola – The Facts’ is the second event of a public lecture series, an innovative community outreach initiative started in NUI Galway’s School of Nursing & Midwifery this year. The series aims to share knowledge and expertise on health matters with local communities.

Dr Adeline Cooney, Head of NUI Galway’ School of Nursing and Midwifery, said: “This public lecture series is interactive in nature, allowing full community engagement and we look forward to active and lively discussions and debates.”

If there are any future topics you would like covered during the lecture, please contact john.quinlivan@nuigalway.ie or mary.e.gannon@nuigalway.ie.

Diagnosis and Treatment of Ebola in 'UpToDate'

• Search for the most UpToDate information on the Ebola virus disease
• Topic search on UpToDate in another language

Connect to UpToDate in the library catalogue here

Irish online course helps spread awareness of Ebola

A representative of the Pan American Health Organization shows the media how to put on a protective suit that would be used to treat patients suffering from Ebola. Photograph: Jose Cabezas/Reuters

An Irish online learning community has set up a free certified course to educate people on Ebola and the precautions needed to contain the disease.

The Galway-based “Alison” group launched the Understanding the Ebola Virus e-learning course in late July 2014, following the success of its 2013 global health initiative which provides courses on malaria, hypertension and diabetes awareness.

Mike Feerick, social entrepreneur and chief executive of Alison, says he was “frustrated” with the “lack of new thinking” when it came to teaching people how to avoid contracting Ebola.

“There are new tools and methodologies that can be used to fight the onslaught of a disease like this; we need to embrace these tools,” says Mr Feerick, who founded Alison in 2007 as a site where people can learn free of charge.

Alison has four million registered users worldwide, 250,000 of whom are in west Africa.

Mr Feerick says the interactive Ebola course, which only takes 20-30 minutes to complete, was compiled using specific guidelines from the World Health Organisation and the Centre for Disease Patrol and Prevention. It was then reviewed by Irish medical doctors. The training, which is also available in French, gives information on the history of Ebola, how it spreads, what treatments are available and the best way to avoid contracting the disease.

View Press Release here

EU states 'can do more' to battle Ebola virus

Former Irish European commissioner David Byrne has called on Ireland and other EU states to do more to fight the outbreak of the deadly Ebola virus in west Africa.

Mr Byrne, who held the health portfolio in the European Commission from 1999 to 2004, is one of 44 prominent public health experts who signed a letter in The Lancet medical journal that urged Western governments to “mobilise all possible resources” to assist west Africa in controlling the epidemic. On Friday, the death toll from the disease passed the 3,000 mark, six months after the outbreak began.

The Irish Government could help by facilitating medical staff to take career breaks so they can volunteer to work fighting the disease, and by providing medical supplies to control the spread of infection, Mr Byrne told The Irish Times yesterday.

The EU Commission has donated more than €180 million to help fight the epidemic, he said. “It’s for the governments of the member states now to up their game. The EU doesn’t have the ability to send health personnel into west Africa in the numbers needed, but the health communities in each country can.”

Ireland is a long-standing supporter of the WHO and enjoys a good reputation internationally for its aid work, he pointed out. It is also a signatory of an international agreement that requires countries to be supportive when the WHO declares an outbreak a “public health emergency of international concern,” as it has done in the case of the current Ebola outbreak.“We’re now dealing with an outbreak of a serious disease in developing countries that don’t have the resources to fight it. Meanwhile, the developed world hasn’t given enough attention to the problem, probably because it doesn’t think the disease will spread further,” said Byrne.

Irish Aid has made donations totalling about €460,000 in response to the Ebola outbreak.

The Lancet letter said the Ebola epidemic has “spiralled completely out of control” after months of “inaction and neglect” from the international community.

“Today, the virus is a threat not only to the countries where the outbreak has overwhelmed the capacity of national health systems, but also to the entire world.

“The Ebola epidemic represents a public health imperative; unchecked, it might very well become a geopolitical one.”
View article in Irish Times here

Ebola vaccine trial begins

A trial of an experimental vaccine against the Ebola virus is to begin in Oxford.

The first of 60 healthy volunteers will be injected with the vaccine.  It contains only a small portion of genetic material from the virus, so it cannot cause the disease.

Normally it would take years of human trials before a completely new vaccine was approved for use.  But such is the urgency of the Ebola outbreak in west Africa that this experimental vaccine is being fast tracked at an astonishing rate.

If the trials are successful, it could be used to immunise health workers in affected areas by the end of the year.  By then, around 10,000 doses should be available.

The vaccine is being developed by GlaxoSmithKline and the US National Institutes of Health.

Blood tests from the volunteers will reveal the extent of their antibody response within two to four weeks.

Further volunteers will be given the vaccine in Africa next month and there are trials in the United States of a different formulation - both vaccines could be used if they prove safe and effective.

Promising results from animal studies were published earlier this month.

The United States has said it will send 3,000 troops to West Africa to build treatment clinics and to train health workers in how to halt the spread of the deadly virus.

The official death toll now stands at more than 2,400 people, although the outbreak may have killed many times that number.

View more here on BBC/Health

Science AAAS journals and Ebola research

Given the current widespread and lethal outbreak of the Ebola virus, AAAS' journals Science and Science Translational Medicine offer a freely available collection of research and news articles on the viral disease to researchers and the general public.

Click here to view