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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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Experimental Ebola drug shelved; study explores virus clearance

CENTER FOR INFECTIOUS DISEASE POLICY AND RESEARCH by Lisa Schnirring     July 20, 2015

Tekmira Pharmaceuticals  announced that it has suspended development of TKM-Ebola, a drug cocktail that showed disappointing human trial results in West Africa, as a convalescent plasma trial at a Doctors Without Borders (MSF) facility in Guinea proceeded with no ill effects in patients so far...

In suspending TKM-Ebola development, the company said that a joint reevaluation of its contract with the US Department of Defense is under way.

In another development, MSF said a convalescent serum trial at its facility in Nongo, Guinea, has enrolled 101 people over the last few months, with no ill effects reported so far, according to a Jul 17 update on the outbreak. Patients at the Nongo treatment unit have the option to receive plasma donated by Ebola survivors....

Meanwhile, detailed testing at a Swiss hospital on a 43-year-old doctor infected with Ebola in Sierra Leone found that viral decay occurred in two phases, once starting 72 hours after symptom onset before any antiviral interventions, with acceleration in viral load decay after ZMAb infusion and oral favipiravir treatments began..

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The Really Big One

The next full-margin rupture of the Cascadia subduction zone will spell the worst natural disaster in the history of the continent. Credit Illustration by Christoph Niemann; Map by Ziggymaj / GettyImage: The next full-margin rupture of the Cascadia subduction zone will spell the worst natural disaster in the history of the continent. Credit Illustration by Christoph Niemann; Map by Ziggymaj / Getty

newyorker.com - July 20th, 2015 - Kathryn Schulz

When the 2011 earthquake and tsunami struck Tohoku, Japan, Chris Goldfinger was two hundred miles away, in the city of Kashiwa, at an international meeting on seismology. As the shaking started, everyone in the room began to laugh. Earthquakes are common in Japan—that one was the third of the week—and the participants were, after all, at a seismology conference.

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Surge of Ebola in Liberia May Be Linked to a Survivor

NEW YORK TIMES  by Sheri Fink                   July 10, 2015

A resurgence of Ebola in the last week in Liberia, which had been declared free of the disease, may have originated with a survivor still carrying the virus, according to scientists who analyzed the genetic sequence of the virus from the body of a 17-year-old Liberian boy who died of Ebola last week.

The boy’s virus did not match strains still circulating in the continuing outbreak in Guinea and Sierra Leone, meaning he was unlikely to have caught the virus through cross-border travel.

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Finger-prick, blood test for Ebola takes just minutes

THE WASHINGTON POST by

Public health officials may soon be able to screen patients for Ebola at border crossings and hospitals with a finger-prick blood test that takes mere minutes.

The development of the rapid diagnostic test, reported in The Lancet Thursday, represents a significant victory for scientists around the world who have been experimenting over the past year with all manner of vaccines, treatments and other ways of eradicating the virus.

Developing a way of confirming Ebola in a patient has been one of the top priorities. In the early stages the symptoms -- chest pain, cough, nausea -- can look like many other illnesses, making it very difficult for doctors to triage -- to determine who should be quarantined and who to send home. It can often take days or longer for laboratory tests, the current standard, to return a positive or negative result.

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Malaria morbidity and mortality in Ebola-affected countries caused by decreased health-care capacity, and the potential effect of mitigation strategies: a modelling analysis

LANCET by Patrick G. T. Walker and others                               Volume 15, No. 7, p825–832, July 2015
The ongoing Ebola epidemic in parts of west Africa largely overwhelmed health-care systems in 2014, making adequate care for malaria impossible and threatening the gains in malaria control achieved over the past decade. We quantified this additional indirect burden of Ebola virus disease.

We estimated the number of cases and deaths from malaria in Guinea, Liberia, and Sierra Leone from Demographic and Health Surveys data for malaria prevalence and coverage of malaria interventions before the Ebola outbreak. We then removed the effect of treatment and hospital care to estimate additional cases and deaths from malaria caused by reduced health-care capacity and potential disruption of delivery of insecticide-treated bednets. We modelled the potential effect of emergency mass drug administration in affected areas on malaria cases and health-care demand....

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Vaccine trial won’t cause Ebola - WHO

GRAPHIC ONLINE by Rebecca Quisacde-Duho and Rhodaline Oppong                              June 20, 2015

Rebecca Quaicoe-Duho & Rhodaline Oppong
Rebecca Quaicoe-Duho & Rhodaline Oppong
Rebecca Quaicoe-Duho & Rhodaline Oppong
Rebecca Quaicoe-Duho & Rhodaline Oppong

The World Health Organisation (WHO) has assured Ghanaians that the proposed Ebola vaccine trial will not cause Ebola in the country.

WHO says it views the safety of people as paramount and would, therefore, not overlook any wrongdoing in the development of a vaccine.

 The WHO Country Representative, Dr Magda Robalo, gave the assurance at a public sensitisation forum in Accra last Thursday....

 Recently, following public agitations, the Minister of Health, Mr Alex Segbefia, called for more consultation on the proposed Ebola vaccine trial which was to be undertaken at Hohoe in the Volta Region.

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Trial of Canadian Ebola drug stopped; no overall benefit shown

CANADIAN PRESS  by  Helen Branswell                       June 19, 2015

TORONTO -- A Canadian company that had been developing an Ebola drug says a clinical trial of the experimental product has been stopped.

Tekmira Pharmaceuticals says the trial was halted because it seemed clear that continuing was not likely to show that the drug works.

The drug is called TKM-Ebola. It was being tested with Ebola patients in Sierra Leone.

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http://www.ctvnews.ca/health/trial-of-canadian-ebola-drug-stopped-no-overall-benefit-shown-1.2430501

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Ebola genetic code analysed to show evolution of worst ever outbreak

THE GUARDIAN   by Ian Sample                                                                             June 18, 2015

Scientists have analysed the genetic code of Ebola viruses from patients across west Africa and pieced together the evolution of the worst ever outbreak of the killer disease.

Experts from Public Health England at Porton Down in Britain, the World Health Organisation (WHO), and other leading labs, used DNA from 179 Ebola samples to reconstruct the spread of the virus from Guinea into surrounding countries last year.

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Blood, Sweat and Tears: Study Will Watch Ebola Survivors

NBC NEWS   by Maggie Fox                              June 17, 2015         

Does Ebola stay in your eyes after you recover? Can it spread via semen? Why does it cause achey joints?

U.S. researchers are launching a study in Liberia to take a look at survivors of the deadly virus to see just how common these long-term effects are, and whether they contribute to outbreaks.

"To unravel the many unknowns, we have expanded the focus of our partnership with Liberia's Ministry of Health to include research on the long-term health effects of Ebola virus disease, in addition to our ongoing efforts to find an effective preventive vaccine and treatments for Ebola virus disease," said Dr. Tony Fauci, director of the National Institute of Allergy and Infectious Disease.

Liberia's health ministry and the NIAID will be studying 1,500 Ebola survivors and 6,000 of their close contacts. They'll look at sweat, tears, semen and other bodily fluids in the survivors and follow everyone for as long as five years.

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