Senegal's first Ebola case has links to Guinea

Senegal's health ministry today announced the country's first Ebola virus disease (EVD) case, in a student from Guinea who was located in a Dakar hospital as part of a contact investigation by Guinean health officials.

The case is the second imported EVD illness detected as a result of West Africa's outbreak, which started in March. A similar detection in Nigeria triggered a chain of disease transmission that has so far included 19 people and led to the deaths of 7, many of them healthcare workers.

Like the Nigeria case, the imported infection poses a risk of introducing the disease to another populous African city. The greater Dakar area is home to 2.45 million people and is an important international air travel destination and seaport.

Man has sick relatives in Guinea

Senegalese Health Minister Awa Coll-Seck, MD, PhD, said in a statement today, machine-translated from French, that the student, who attends the University of Guinea in Conakry, disappeared 3 weeks ago during a case contact investigation, and Guinean officials notified Senegalese authorities that the man had had contact with infected relatives and could be in Senegal. 

She said the man was found at Fann Hospital in Dakar, where he sought treatment on Aug 26 with no hemorrhagic symptoms and without disclosing that he had contacts in Guinea who had EVD. He was quarantined and tested, and his samples were positive for EVD in lab studies done at the Pasteur Institute in Dakar. Seck added that the patient is in satisfactory condition.

Senegal closed its land border with Guinea on Aug 21 and has since extended the closure to aircraft and ships from all three of the main outbreak countries. It's unclear when and how the patient entered Senegal. The World Health Organization (WHO) has urged countries not to order travel and trade restrictions and has noted that the actions are choking the supply of outbreak responders, food, and supplies to Guinea, Sierra Leone, and Liberia.

WHO posts first roadmap update

In other developments today, the World Health Organization (WHO) posted the first Ebola response roadmap situation update, designed to provide more detailed and regular information about response actions and gaps, as well as a better epidemiological picture of the event. The agency said the first update provides a baseline for gauging progress on its response goals.

Though the numbers of new EVD cases in Guinea and Sierra Leone had been relatively stable over the past 6 weeks, last week brought the highest weekly increase of the outbreak so far in all three of the hardest-hit countries. "This highlights the urgent need to reinforce control measures and increase capacity for case management," the WHO said.

In Guinea, priorities are to continue to battle the disease at the hot spot in Gueckedou and address the threat to Conakry, the capital, according to the WHO. Liberia is experiencing EVD increases at its outbreak epicenter in Lofa and in the capital, Monrovia. Sierra Leone is having problems scaling up response measures in two main hot spots, Kenema and Kailahun. The WHO also said infections are increasing in Freetown, the capital.

Nigeria so far has reported 19 EVD cases, 7 of them fatal. The WHO said the first 14 cases were all linked to people—many of them health workers--who had close contact with a traveler from Liberia. However, on Aug 27 a case was confirmed in Port Harcourt, and a WHO team is on the scene to investigate and assist with contact tracing.

Today's situation update also details how outbreak patterns are impacting treatment centers and labs. For example, it said Liberia's capacity to manage its increasing caseload is still "dramatically low," especially in Monrovia. Also, more lab support is needed in Guinea, which has been handling the bulk of specimens from Liberia, and in Sierra Leone. It noted that a South African mobile lab has been deployed to help in Freetown.

Ebola drug developments

In new treatment developments, researchers today reported promising findings from a study of ZMapp in monkeys, and US pharmaceutical company BioCryst announced that it has received funding to study its experimental broad-spectrum antiviral as a possible treatment for EVD.

ZMapp is an experimental monoclonal antibody treatment that has been given to seven people sickened during their involvement with West Africa's EVD outbreak response, including two Americans. Health officials have said supplies are depleted. Two of the patients who received the drug have died—a Spanish priest and a Liberian health worker. 

The ZMapp study was published today in Nature. Eighteen monkeys received three doses of the drug at various intervals, starting 3, 4, and 5 days after they were given a normally lethal dose of the Ebola virus. All of the monkeys that received the drug lived, and all three that didn't get the drug died.

Investigators used the Kikwit variant of the Zaire strain of the virus, because the one implicated in West Africa's outbreak wasn't available at the time. However, their cell culture tests showed that ZMapp inhibits replication of the outbreak's Zaire strain.

BioCryst, based in Research Triangle Park, N.C., today announced that it has received $2.4 million in additional funding from the National Institute of Allergy and Infectious Diseases (NIAID) to study its RNA inhibitor BCX4430 in nonhuman primates for treating EVD. The trial, designed to test dose range efficacy of an intramuscular formulation, is expected to begin within weeks, the company said in a press release.

NIAID's original award to the company in 2013 totaled $22 million over 5 years, with the aim of developing broad-spectrum antivirals for viral threats to health and national security. BCX4430 is BioCryst's lead compound and has shown activity against more than 20 RNA viruses in nine different families, including filoviruses, which include Ebola.

Canada to fly lab team home

Meanwhile, Canada's government announced plans to bring three lab workers back from Sierra Leone on a charter plane, the Canadian Press reported today. 

The Public Health Agency of Canada (PHAC) said the three scientists are in good health and are at a low risk of infection, according to the report. It said that upon arrival back in Canada the team will be evaluated by quarantine and border services officers. Once officials clear them for entry, the lab workers will voluntarily quarantine themselves at home for the rest of their 21-day isolation period.

According to earlier media reports, Canada's team worked in a field lab unit with a WHO employee who was infected with the virus. Also, some people at the hotel complex the group was staying at were diagnosed with EVD.

See also:

Aug 29 Senegal health ministry statement

Aug 29 WHO Ebola response roadmap situation update

Aug 29 Nature abstract

Aug 29 Nature editorial

Aug 29 BioCryst press release

Aug 29 Canadian Press story

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