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Published Date: 2016-02-10 20:45:17
Subject: PRO/AH/EDR> Ebola update (13): rapid test, research, funding
Archive Number: 20160210.4010884
EBOLA UPDATE (13): RAPID TEST, RESEARCH, FUNDING
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A ProMED-mail post
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International Society for Infectious Diseases
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In this update:
[1] Opinion: Rapid test for Ebola
[2] Updates, research, funding
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[1] Opinion: Rapid test for Ebola
Date: Tue 9 Feb 2016
Source: International New York Times Opinion pages [edited]
http://www.nytimes.com/2016/02/10/opinion/testing-for-ebola.html?_r=1
To the Editor:
"Ebola Case Is Reported in West Africa" (news article, 16 Jan 2016) describes a resurgent case of Ebola in which a woman's illness was not diagnosed until after her death despite her having gone to at least one hospital.
Ebola causes generic symptoms, like fever, seen with common illnesses like malaria, and needs to be identified by blood testing. You report that Bruce Aylward of the World Health Organization says rapid tests capable of diagnosis within minutes with just a few drops of blood have not been used because they are prone to false positives. But patients like the one described received diagnoses only after presenting to multiple hospitals and exposing numerous people to infection.
Rapid tests should have been used to screen patients, with all who test positive sent for confirmatory testing by polymerase chain reaction (PCR), the conventional test for Ebola, to minimize the possibility of false positives. This approach mirrors what we do for many diseases, including HIV.
Instead of using rapid tests in this way, patients were screened using a checklist of symptoms known as "clinical case definition," which misses 20 percent of patients who actually have Ebola, while almost 70 percent of the patients it does identify do not have Ebola.
As a result, up to 40 percent of people admitted to Ebola treatment units did not actually have Ebola, yet were hospitalized alongside and exposed to patients who did. At the same time, in one study, rapid tests did not miss a single patient with actual Ebola, and only about 8 percent were false positives.
Rapid tests would have been a game-changer during the peak of the epidemic and should now be used to screen patients.
[Byline: Ranu S. Dhillon, Devabhaktuni Srikrishna, Robert F. Garry]
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[Dr. Dhillon, an internist and health systems/policy specialist in developing countries, served as an adviser to the president of Guinea during the Ebola epidemic.
Mr. Srikrishna is the founder of Patient Knowhow, which curates patient educational content on YouTube. He worked with Dr. Dhillon on the Ebola response in Guinea.
Mr. Garry is a professor of microbiology and immunology at Tulane University and a member of the Viral Hemorrhagic Fever Consortium, a public-private partnership developing countermeasures for emerging viral diseases, including rapid diagnostics. He may receive royalties from sales of products produced by the consortium.
Rapid tests may not have been readily available during the peak of the epidemic, but should be brought into use in clinics now and accuracy determined. If false positivity is the problem, the rate can be ascertained when there are few cases. - Mod.LK]
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[2] Updates, research, funding
8 Feb 2016: Sierra Leone grave robbers plundering tombs of Ebola victims
http://www.japantimes.co.jp/news/2016/02/08/world/social-issues-world/sierra-leone-grave-robbers-may-be-plundering-tombs-of-ebola-victims/#.Vrj5u0_LLnk
[New security measures were in place Sun [7 Feb 2016] at cemeteries in the Sierra Leone capital Freetown after grave robbers used pickaxes and sledgehammers to pry open tombs and steal coffins and jewelry. Around 250 graves were targeted in 3 of Freetown's 7 cemeteries over the past 2 months, Freetown City Council said in a statement on Sat [6 Feb 2016].
At one of the cemeteries targeted, Kingtom, 60 percent of the more than 6000 graves were those of Ebola victims. According to Abdul Rahman, caretaker of Kingtom cemetery, when speaking to the radio station, the robbers forced "open concrete graves and vaults to steal ornaments, chains, wedding rings and clothes from the dead.
According to the council's environment and social officer Sulaiman Zainu-Parker, who spoke on national radio, 24-hour security is now in place at all the city cemeteries, including armed police guards, to challenge the robbers. "The vandals sometimes remove corpses from expensive mahogany and polished coffins, and I suspect the coffins are later sold off to some local undertakers," he added.]
8 Feb 2016 Sierra Leone: Maternal health crisis in Sierra Leone
http://news.trust.org/slideshow/?id=8ed0e44f-5386-447f-b3ad-e0efd2c19598&source=hpPlaylistSlideshow
[A WaterAid - VSO [Voluntary Service Overseas] study,
http://www.vsointernational.org/news/higher-maternal-and-newborn-death-rates-in-sierra-leone-due-to-ebola-fears
- 18 percent decrease in women accessing antenatal care.
- 22 percent decrease in women accessing postnatal care.
- 11 percent decrease in deliveries at health care centres.
- 30 percent increase in maternal deaths.
- 24 percent increase in newborn deaths.
- 7 out of 9 critical areas of maternity care were still provided.
About 87 percent of homes in Sierra Leone do not have toilets and 37 percent do not have access to clean water.]
[Ebola funding should be directed to rebuilding infrastructure for basic healthcare in West Africa. Furthermore, access to clean water is basic to assuring good health. - Mod.LK]
9 Feb 2016 Sierra Leone: Latest Sierra Leone Ebola case cured but more testing needed--officials
http://medicalxpress.com/news/2016-02-latest-sleone-ebola-case-neededofficials.html
[According to health authorities who spoke on Tue [9 Feb 2016], Sierra Leone's most recent case of Ebola virus disease (EVD) has been cured, but more testing is required before the latest outbreak can be seen as resolved.
Ministry of Health Director of Disease Prevention and Control, Dr Foday Dafai, told AFP, "The last known Ebola patient in Sierra Leone, a 38-year-old, has been discharged from the 34 Military Hospital in the capital after 2 rigorous tests proved negative." Dafai added that the case discharged last Fri [5 Feb 2016] is back in her central northern home district of Tonkolili. This starts the 42-day period which is hoped will end with a renewed declaration from the World Health Organization (WHO) of Sierra Leone being declared free from EVD transmission.
However, health officials told AFP that only 10 of 48 potential exposed contacts around the northern city of Kambia near the Guinean border have been traced to date, 18 of whom are thought to be high risk. Officials urged them to report for precautionary testing. Four contacts who were residing in the same quarantine zone as the case when she became ill will remain under observation until Thu [11 Feb 2016], 21 days after their last possible exposure.]
8 Feb 2016 USA (CT): Malloy, health officials sued over Ebola quarantines
http://www.norwichbulletin.com/news/20160208/malloy-health-officials-sued-over-ebola-quarantines
[Several people quarantined in Connecticut (CT) after returning from West Africa during the 2014 Ebola outbreak are suing Gov. Dannel P. Malloy and state health officials, saying they were essentially imprisoned based on politics and not for any legal or scientific reasons.]
9 Feb 2016 West Africa: Ebola Still Takes Mental Toll on West Africa's "Burial Boys"
http://www.wsj.com/articles/ebola-still-takes-mental-toll-on-west-africas-burial-boys-1455080341
"Few services are available for people who worked on front lines and are now ravaged by addiction and depression, including the burial boys.
Now, many of the Ebola fighters are battling their own, quieter afflictions. Alcoholism, depression and drug addiction are raging, health officials say, in countries that have even fewer psychiatrists than doctors.
Their ranks include a 30-year-old former child soldier who signed up in 2014 to bury the bodies of Ebola victims in coastal Liberia's chest-high grass and mud. Three months into the job, he helped inter a body bag containing his 2-year-old daughter.
These days, like hundreds of other so-called burial boys, he no longer spends his days dressed in hazmat clothing, removing the dead from their homes. His USD 350 monthly paycheck for the dangerous assignment no longer comes.
Instead, he sleeps in a church, screams in his sleep and worries he might be somehow responsible for his daughter's death. By day, he sells sand and sometimes pawns his clothes to buy cheap rum and Italian White, as heroin is called here. He left home, he says, to give his family some relief.
Non-government organization
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8 Feb 2016: Special Report: The World Health Organization's critical challenge - healing itself
http://www.reuters.com/article/us-health-who-future-special-report-idUSKCN0VH0ZI
[...For years the WHO has talked about streamlining its complex structure, governance and financing to make it more efficient. Critics say the organization needs deep reforms to allow it to show clear leadership in promoting health and to respond decisively to disease emergencies that may span many countries. But progress has been painfully slow.
Margaret Chan, Director General of the WHO since 2007, acknowledged the concerns of delegates and agreed: "Yes, it's time to stop talking," she said.
She promised to act swiftly on reforming the WHO's emergency responses. "We are committed to implementing a single program, with a single line of accountability, a single budget, a single set of business processes, a single cadre of staff and a single set of performance benchmarks," she said. ... -more]
January 2016: World Health Organization (WHO) Clinical care for survivors of Ebola virus disease [Interim guidance
http://apps.who.int/iris/bitstream/10665/204235/1/WHO_EVD_OHE_PED_16.1_eng.pdf?ua=1]
[EVD survivors need comprehensive support for the medical and psychosocial challenges they face and also to minimize the risk of continued Ebola virus transmission, especially from sexual transmission. This document provides guidance on providing the necessary care and services for clinical care and virus testing and should be used to guide the planning and delivery of ongoing health services to people who have recovered from EVD.]
Research
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9 Feb 2016: Bacterial sequences detected in 99 out of 99 serum samples from Ebola patients
http://biorxiv.org/content/early/2016/02/09/039107
Citation.
Manrique M, Pareja-Tobes E, Pareja-Tobes P, et al. Bacterial sequences detected in 99 out of 99 serum samples from Ebola patients. _Bio Rxiv_. 9 Feb 2016. On-line pub. doi: http://dx.doi.org/10.1101/039107
[Abstract
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Evolution and clinical manifestations of Ebola virus (EBOV) infection overlap with the pathologic processes that occur in sepsis(1). Some viruses certainly compromise the immune system, leading to a breach in the integrity of the mucosal epithelial barrier, thus allowing bacterial translocation(2,3). Guided by these facts, we wondered if bacteria could be involved in the pathogenesis of some of the septic shock-like symptoms typical of EBOV infected patients, something that could have a dramatic impact on the design of new treatment approaches. We decided to search for bacteria in available EBOV patient sequence datasets. Given that EBOV is an RNA virus and that, hence, some NGS sequencing experiments carried out to sequence the EBOV genomes were RNA-Seq experiments, we thought that, if there were any bacteria in patient serum, at least some bacterial RNA might probably be detected in the sequenced material from Ebola patients. Thus, we searched for bacteria in a RNA-Seq public dataset from 99 Ebola samples from the last outbreak(4), and surprisingly, in spite of the certainly suboptimal experimental conditions for bacterial RNA sequencing, we found bacteria in all of the 99 samples.
New perspective in Ebola disease clinical intervention
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This work could open a new perspective in both the pathogenesis and the treatment of EBOV infections. These findings suggest that sepsis therapies, specific antibiotics and mucosal epithelial barrier protectors could be considered. It is possible that, as in other immunocompromised patients, the crucial interventions would be targeting those bacteria. This is especially important in the case of EVD because there is not a specific treatment for Ebola virus.
References cited above.
1 Bray M, Mahanty S. Ebola Hemorrhagic Fever and Septic Shock. J Infect Dis. 2003; 188(11):1613-1617
2 Nazli A, Chan O, Dobson-Belaire WN, et al. Exposure to HIV-1 Directly Impairs Mucosal Epithelial Barrier Integrity Allowing Microbial Translocation. PLoS Pathog 2010; 6 (4) doi:10.1371/journal.ppat.1000852
3 Fitzgerald F, Harris K, Doyle R, Alber D, Klein N. Short Communication: Evidence That Microbial Translocation Occurs in HIV-Infected Children in the United Kingdom. AIDS Res Hum Retroviruses. 2013; 29(12):1589-1593.
4 Gire SK, Goba A, Andersen KG, et al. Genomic surveillance elucidates Ebola virus origin and transmission during the 2014 outbreak. Science 2014; 345(6202): 1369-1372
Funding
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9 Feb 2016: Obama administration says it won't use Ebola funding to combat Zika
http://www.macleans.ca/news/world/obama-administration-says-it-wont-use-ebola-funding-to-combat-zika/
[The Obama administration on Tue [9 Feb 2016] rejected a Republican suggestion to use money Congress provided to fight the Ebola virus to combat the Zika virus and mosquitoes that spread it.
President Obama is asking Congress for more than USD 1.8 billion in emergency funding to respond to the Zika virus. There has been no transmission of the virus by mosquitoes within the U.S., but at least 50 travelers have returned home with the infection. At least 16 cases have been confirmed in Florida.]
[To clarify, the Florida cases are all imported to date. - Mod.LK]
[Compiled by: Celeste Whitlow <whitlow.celeste@gmail.com>]
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[A zoonotic niche map of the countries where cases have occurred in the field or been imported is at http://healthmap.org/ebola. Use the + tab at bottom left of the map to zoom in until the dots separate. - Mods.LK/JW
A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/46.]
See Also
Ebola update (12): Sierra Leone, research, funding, vaccine 20160207.4002006Ebola update (11): Sierra Leone, new case, controversy 20160203.3990396
Ebola update (10): Sierra Leone, vaccine, funding 20160131.3981594
Ebola update (09): funding, correction 20160127.3970963
Ebola update (08): Sierra Leone, vaccine, research, video 20160124.3962240
Ebola update (07): Sierra Leone, 2nd new case 20160121.3955860
Ebola update (06): 5 mysteries about EVD, Sierra Leone new case, followup 20160117.3944673
Ebola update (05): WHO declares Liberia free, Sierra Leone new case 20160115.3938471
Ebola update (04): WHO, prevention, research, drugs & vaccines 20160113.3933860
Ebola update (03): WHO, prevention, survivors, stigma, research, drugs, vaccines 20160110.3924235
Ebola update (02): WHO, monitoring, lessons, research 20160106.3915785
Ebola update (01): management, vaccine, treatment, monitoring 20160103.3908196
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