UN head tours Ebola region, warns against let-up

United Nations Secretary-General Ban Ki-moon arrived in Ghana yesterday to begin a 3-day tour of West Africa's Ebola outbreak region, and today reassured Liberians that the global body would stand with the country until it controls the disease and recovers from the epidemic.

Anthony Banbury, who is leading the UN Mission for Ebola Emergency Response (UNMEER) briefed Ban on the Ebola response at UNMEER headquarters in Accra yesterday, and today the UN's top leader meets with officials in both Liberia and Sierra Leone.

A warning against response let-up

In a media briefing today with Liberia's president Ellen Johnson Sirleaf, he said there are reasons to be cautiously optimistic that the disease can be snuffed out and that the country's dropping Ebola levels are a tribute to the dedication and commitment of Liberians, according to a UN statement. Ban said response strategies—such as more treatment access, contact tracing, safe burials, and communities protecting themselves—are working.

However, he warned against easing up on the battle against the disease. "We have a long way to go. Zero cases—in Liberia and this entire region—must be everyone's goal," Ban said, thanking Liberia government and the international responders.

Elsewhere, several health workers have tested positive for Ebola in the main health center in Kerouane, Guinea: the director, a midwife, two nurses, and an ambulance driver, UNMEER said in an update today. News of the infections triggered threats from local youth, who said they would ransack the city's Ebola transit center. The sick workers have been transferred to an Ebola treatment center in Conakry.

Sierra Leone response surge

The World Health Organization (WHO) today provided more details about a response surge under way in western Sierra Leone, an area that currently has the highest transmission of all three affected countries. The key part of the surge is intensifying efforts to identify sick people and isolate them for evaluation and treatment, the agency said.

The country has a hotline team that takes calls from neighborhood residents about sick people, dispatches health workers, including local medical school students, out to investigate, using a standard screening check list. If investigators decide a patient needs care, they call the hotline back to send an ambulance.

One emphasis of the surge is convincing local residents to take personal responsibility in helping end the outbreak. "Ordinary people can save lives by calling the hotline to report possible Ebola cases or request a respectful burial," the WHO said, adding that active case finding is being done by 180 district surveillance officers and 300 community monitors trained by the health ministry, the WHO, and the US Centers for Disease Control and Prevention (CDC).

Other surge steps include staffing new treatment centers with WHO-trained epidemiologists and clinical teams, improving infection control in health settings, and improving protection for healthcare workers and their patients.

The WHO said the surge will continue through December.

February target for vaccine trials

In vaccine developments, a GSK official, commenting on yesterday's WHO report that African countries have asked the company for more information about plans for clinical trials of its Ebola vaccine, said the company's goal now is to launch phase 2 trials in Africa in the second week of February.

The WHO said the request for information came at a meeting earlier this week; the agency predicted that it could take until the end of January for the countries to receive and review the additional information.

Commenting on the development today, GSK spokeswoman Jenni Brewer Ligday told CIDRAP News, "The revised timelines were agreed by all parties and will permit GSK to make requested revisions to our protocols and for regulators to review and provide final approvals. We are now striving for the second week of February for the start of the phase 2 clinical trials."

GSK developed the ChAd3 Ebola vaccine in partnership with the National Institutes of Health. It is one of two experimental vaccines that are now in small phase 1 trials. Some earlier predictions by the WHO had indicated that phase 2 trials could start this month or in January.

Other developments

  • A German medical team yesterday in The Lancet described the treatment of a Ugandan doctor who was airlifted to University Hospital Frankfurt in early October after contracting Ebola while working in Sierra Leone. Three days after admission the patient developed multi-organ failure, showed evidence of vascular leak syndrome, and needed mechanical ventilation. On day 11 doctors gave him a 3-day intravenous treatment course of an Austrian experimental drug called FX06, a fibrin-derived peptide being developed to treat vascular leak syndrome. The medical team also prescribed the antiviral drug favipiravir, but the patient couldn't complete the course, because he couldn't ingest the tablets due to gastrointestinal symptoms. The authors noted that another Ebola patient airlifted to Germany shortly after the Ugandan doctor was given FX06 but died a few days later. They wrote that, based on their patient's experience, the drug warrants further evaluation for vascular leak syndrome. In an accompanying editorial, two experts wrote that though the case shows the challenges of achieving fluid balance in added that it's impossible to know if FX06 directly helped recovery.

  • The CDC yesterday posted two new Ebola resources, a Q and A about Ebola and food safety and interim guidance for Ebola cleaning, disinfection, and waste disposal in commercial passenger aircraft. In the food backgrounder, the CDC said Ebola isn't spread by eating food, with the possible exception of bushmeat. It added that food imported from West Africa shouldn't pose a threat to the United States and that the US Department of Agriculture has import rules designed to protect US livestock. There is no reason to avoid restaurants owned or operated by people from West Africa, the CDC said. It also addressed specific food industry concerns, such as employees who return to work after being in the outbreak region. The aircraft guidance walks airline employees through what to consider if a person exposed to Ebola is a passenger and steps to take if someone exhibits Ebola symptoms during flight.

News editor Robert Roos contributed to this story.

See also:

Dec 19 UNMEER update

Dec 19 secretary-general remarks

Dec 19 WHO feature on Sierra Leone response surge

Dec 18 CIDRAP News story "Data request slows timetable for Ebola vaccine trial"

Dec 18 Lancet report

Dec 18 Lancet editorial

Dec 18 CDC Q and A on Ebola food safety

Dec 18 CDC interim guidance on Ebola and aircraft cleaning

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