Ebola update: Dec. 2015



The struggle to defeat Ebola virus disease continues globally, although it may not always make the headlines. To catch up on what you may have missed over the past month, ID Practitioner is offering some notable news items and journal articles.

Three studies published online in Emerging Infectious Diseases addressed multiple clinical concerns related to treating Ebola virus disease (EVD). Samuel Crowe, Ph.D., of the Centers for Disease Control and Prevention and his colleagues found that two readily available indicatorspredicted survival among patients with EVD in Sierra Leone and may be useful for clinicians making treatment decisions or managing patient or family expectations. The indicators were time from symptom onset to health care facility admission and quantitative real-time reverse transcription polymerase chain reaction cycle threshold, a surrogate for viral load, in first Ebola virus–positive blood sample tested.

Stringlike Ebola virus particles are shedding from an infected cell in this electron micrograph. ©NIAID/Creative Commons License

Stringlike Ebola virus particles are shedding from an infected cell in this electron micrograph.

In another research dispatch, an international team led by Thomas Hoenen, Ph.D., of the Friedrich-Loeffler-Institut in Greifswald–Insel Riems, Germany, successfully used a novel, pocket-sized nanopore sequencer at a field diagnostic laboratory in Liberia during the current Ebola virus outbreak. The tool was used for rapid sequencing of RNA/DNA from pathogen samples and may offer “tremendous potential” for use in remote and resource-limited areas by revolutionizing the capacity of public health professionals to perform sequencing during future disease outbreaks.

Finally, Dr. J.J. Mark Haverkort of the University Medical Centre of Utrecht, the Netherlands, and his coauthors detailed his hospital’s preparations for an outbreak of viral hemorrhagic fever and its experience during admission of a patient with EVD. The patient’s admission proceeded without incident but put considerable demands on hospital staff. The researchers found that the use of a buddy system, frequent training, and information sessions for staff and their relatives greatly increased the sense of safety and motivation among staff.

The eighth annual G-FINDER report, released in early December by the Australia-based research group Policy Cures, found that $3.4 billion was invested in neglected disease research and development in 2014, but that new funding for Ebola R&D (generated in response to the West African Ebola outbreak) was entirely responsible for the $150 million increase in overall neglected disease R&D funding. Funding for all other neglected diseases dropped by $14 million, or 0.4%. A total of $165 million was invested in Ebola R&D in 2014, more than for any other neglected disease except HIV/AIDS, malaria, tuberculosis and diarrheal diseases. Most of the funding ($101 million) came from the U.S. government, representing 86% of all public funding for Ebola R&D.

According to a studypublished in the journal Infection Control & Hospital Epidemiology, the United States has sufficient capacity for treating another outbreak of the Ebola virus, but financial, staffing, and resource challenges remain a hurdle for hospitals and health systems. Researchers found that the designation of 55 Ebola treatment centers in 2014 heightened nationwide preparedness levels, but challenges remained for those sites providing treatment, which strained institutional capacity in key areas such as waste disposal, staffing, and pediatric care.

The ongoing West African outbreak of EVD is the largest ever recorded, with more than 28,000 reported cases. In a studyrecently published in Cell Host & Microbe, researchers used genome sequencing to trace the introduction and spread of the virus in Liberia, the second-worst–affected country. It seems the majority of Liberian EVD cases are consistent with a single introduction, followed by spread and diversification within the country. Reintroductions of the virus from Liberia served as an important source for the continuation of the already-ongoing EVD outbreak in Guinea. The study suggested that the Ebola virus did not appear to further adapt to humans during the outbreak, but the authors said additional research is needed to understand how the virus transitioned to humans at the beginning of the outbreak.

A meta-analysis published in BMC Infectious Diseases compared the relative frequencies of three typical hemorrhagic symptoms (conjunctival, nasal, and gingival bleedings) in the East-Central African and West African Ebola virus outbreaks. The study found that, along with the increased Ebola virus mutation rate and the decreased case-fatality rate that occurred during the West African outbreak, that outbreak was also characterized by a significant decrease in the proportion of patients with bleeding features. Both nasal and gingival bleeding almost disappeared. The authors concluded that the data support their hypothesis that in West Africa, the Ebola virus’ long human-to-human transmission cycle occurred and gave rise to human adaptation and consequent immune escape.

A study in Clinical Infectious Diseases concludes that current field experience supports the use of convalescent plasma (CP) against EVD as acceptable, feasible, and safe, although efficacy data are pending. Researchers performing an overview of nonrandomized comparative clinical trials in Guinea, Sierra Leone, and Liberia said that CP sourced from within the outbreak is the most readily available source of anti-EVD antibodies, and until the advent of effective antivirals or monoclonal antibodies, CP merits further evaluation by clinicians treating the disease. But longer-term follow-up as well as data from non–trial settings and evidence on the scalability of the intervention are required.


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