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The Individualised versus the Public Health Approach to Treating Ebola

PLOS/Medicine   by  Tom H. Boyles                            July 28, 2015

The mortality rate for patients with Ebola virus disease (EVD) in West Africa is approximately 65% [1]. There are no published figures for high-resource settings, but media sources and individual case reports suggest it is much lower and approaches 0% for those who receive this level of care from the beginning of their illness.

In their article “Ebola Viral Disease: Experience and Decision Making for the First Cases outside of Africa,” David Stephens and colleagues give insight into the care that can be provided when available resources are not the limiting factor [2]. They describe the decision to open the Serious Communicable Diseases Unit (SCDU) of Emory University Hospital (EUH) when two United States patients contracted EVD while working in West Africa. Using a large specialist team, they provided high-quality care in a safe working environment and disseminated their knowledge and experience widely.....

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How West Africa is ramping up food security after Ebola outbreak

Countries in West Africa and the international community are teaming up to fight Ebola's  lingering effects on food security and agriculture.

Volunteers distribute food at a World Food Programme storage center in Monrovia October 16, 2014. Almost a year after the Ebola outbreak garnered strength in West Africa, countries in that region and the international community are teaming up to fight the disease's lingering effects on food security and agriculture. James Giahyue/Reuters/File

CHRISTIAN SCIENCE MONITOR by Clare Algozin                                    July 29, 2015

As the death toll of EVD rose, West African countries began to experience labor shortages, and many fields of crops went unharvested, according to U.N. Food and Agriculture Organization (FAO). As part of the measures to prevent the spread of EVD, many West African governments established quarantine zones and restricted the movements of people.

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CDC - Estimating Ebola Treatment Needs, United States

cdc.gov - Volume 21, Number 7—July 2015

Rainisch G, Asher J, George D, Clay M, Smith TL, Cosmos K, et al. Estimating Ebola treatment needs, United States [letter]. Emerg Infect Dis. 2015 Jul - DOI: 10.3201/eid2107.150286

http://dx.doi.org/10.3201/eid2107.150286

To the Editor: By December 31, 2014, the Ebola epidemic in West Africa had resulted in treatment of 10 Ebola case-patients in the United States; a maximum of 4 patients received treatment at any one time (1). Four of these 10 persons became clinically ill in the United States (2 infected outside the United States and 2 infected in the United States), and 6 were clinically ill persons medically evacuated from West Africa (Technical Appendix 1[PDF - 228 KB - 8 pages] Table 6).

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WHO - Ebola Situation Report - 29 July 2015

                                          

who.int - July 29, 2015 - SUMMARY - (See Links to Situation Reports Below)

There were 7 confirmed cases of Ebola virus disease (EVD) reported in the week to 26 July: 4 in Guinea and 3 in Sierra Leone. This is the lowest weekly total for over a year, and comes after 8 consecutive weeks during which case incidence had plateaued at between 20 and 30 cases per week. Although this decline in case incidence is welcome, it is too early to tell whether it will be sustained. There have been several high-risk events in both Guinea and Sierra Leone in the past 14 days, and past experience has shown that it can take a single high-risk case or missed contact to spark a new cluster of cases. In addition, there are over 2000 contacts still within their 21-day follow-up period in Guinea, Liberia, and Sierra Leone, representing a substantial residual risk of further cases. Refinements to the response continue to yield improvements, with recent weeks seeing a higher proportion of cases arising from contacts and a lower proportion of cases identified post-mortem than at any time previously, but the continued occurrence of high-risk transmission events means that an increase in case incidence in the near term is a strong possibility.

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Addressing therapeutic options for Ebola virus infection in current or future outbreaks

AMERICAN SOCIETY FOR MICROBIOLOGY  by Azizul Haque and others                                July  27, 2015

 Ebola virus can cause severe hemorrhagic disease with high fatality rates. Currently, no specific therapeutic or vaccine has been approved for treatment and prevention of Ebola infection of humans. Although the number of Ebola cases has fallen in the last few weeks, multiple outbreaks of Ebola virus infection and the likelihood of future exposure highlight the need for development and rapid evaluation of pre- and post-exposure treatments.

In this manuscript we briefly review the existing and future options for anti-Ebola therapy, based on the data coming from rare clinical reports, studies on animals and results from in vitro models....

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http://aac.asm.org/content/early/2015/07/21/AAC.01105-15.short?rss=1

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Ebola created a public health emergency—and we weren’t ready for it

Could the international community have done a better job when confronted with the outbreak of Ebola in West Africa? Although the virus appears to be largely contained now, this comes after at least 27,000 people were infected, with 11,000 of them dying. The virus also had the opportunity to spread within the human population for over a year, providing it a potentially dangerous opportunity to adapt to us as hosts.

To find out whether we could have managed the outbreak better, the World Health Organization (WHO) recently convened an Ebola Interim Assessment Panel, which analyzed various aspects of the organization’s response. This panel, commissioned by the WHO Director-General, included the Dean of the Harvard School of Public Health, the founding Director of the UK's national Health Service, and other international public health leaders. It recently released its final report on the crisis.

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Sierra Leone President unveils Ebola "battle plan"

AFP    July 26, 2015
Freetown  - Sierra Leone's President Ernest Bai Koroma has unveiled a post-Ebola "battle plan" to help the west African country turn the page on the devastating epidemic.


Sierra Leone's President Ernest Bai Koroma speaks at an International Ebola Recovery Conference on July 10, 2015 at the United Nations headquarters in New York (AFP Photo/Eduardo Munoz Alvarez)

"Beyond the immediate nine-month recovery period, we will commence a two-year plan during which we must resolve to restore Sierra Leone to the path to prosperity," Koroma said in a statement released Friday.

"We will work to reinvigorate the private sector as a source of growth, create jobs and livelihoods in our economy," he said, emphasising the need to improve roads and market access.

Read complete story.
http://news.yahoo.com/sierra-leone-president-unveils-post-ebola-battle-plan-175118537.html

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Ebola study notes afebrile patients, calls into question WHO criteria

CENTER FOR DISEASE RESEARCH AND POLICY        July 24, 2015

(Also scroll down for: Ebola case definition quandary; Public health worker Ebola unease)

Researchers found that the World Health Organization (WHO) Ebola case definition has a specificity of only 31.5%, and they noted that 9% of Ebola patients reported neither a fever nor any Ebola risk exposure, calling into question WHO norms, according to a large study yesterday in The Lancet Infectious Diseases.

Researchers from Britain and Sierra Leone analyzed data on 850 suspected and 724 lab-confirmed Ebola patients who presented to the holding unit of Connaught Hospital in Freetown from May 29 to Dec 8, 2014. Fever or history of fever (n=599, 83%), intense fatigue or weakness (495, 68%), vomiting or nausea (365, 50%), and diarrhea (294, 41%) were the most common presenting symptoms in suspected cases.

Based on data from these patients, the investigators found the sensitivity of the WHO case definition to be 79.7%, which means about 20% of true Ebola cases would be missed (false-negatives). They found the specificity of the case definition to be 31.5%, which means 68.5% of patients who would be selected for admission would not actually have Ebola virus disease (false-positives).

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Ebola's not done with West Africa

 

This map, dated July 15, shows the number of days since active cases were discovered in the three countries where ebola is still a threat. CDC

SCIENCE  by Nick Stockton                               July 23, 2015

Officially, it’s called the Ebola Outbreak of 2014. But it’s 2015 now, and the disease is still infecting people. For the past two months, that rate was about 15 people a week. But in the past two weeks, the rate has doubled.....

What’s behind the continued spread? Depends on where you go. In Guinea and Sierra Leone, Ebola never died, and the new cases are a continuation of the same strain that first emerged in December of 2013. In Liberia—which declared itself ebola-free on May 12—experts believe the new outbreak was transmitted through sexual intercourse, from latent viral bodies that were alive in a man’s sperm.

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Ebola cases ebb a bit, with Conakry, Freetown as hot spots

CENTER FOR INFECIOUS DISEASE AND POLICY  by Lisa Schnirring     July 22, 2015

The number of new Ebola cases in Guinea and Sierra Leone declined a bit last week, with much of the disease activity centered in the two capital cities for the second week in a row, the World Health Organization (WHO) said in its weekly epidemiologic update today.

Tests confirmed 26 Ebola cases among the two countries, 22 in Guinea and 4 in Sierra Leone. The total is down from 30 reported the previous week, but progress against the disease has been stagnant over the past several weeks, hovering around 25 to 30 cases. Officials, however, said they saw more hopeful signs in contact tracing.

No new cases were reported in Liberia.

Overall, the total in the three countries has reached 27,705 confirmed, probable, and suspected cases, including 11,269 deaths, according to the WHO.

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http://www.cidrap.umn.edu/news-perspective/2015/07/ebola-cases-ebb-bit-conakry-freetown-hot-spots

WHO:  Ebola Situation Report - 22 July 2015

 Read complete report.

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