Ebola Scan for Sep 21, 2015

News brief

CDC ends special entry screening for Liberia travelers

The US Centers for Disease Control and Prevention (CDC) has stepped down its travel advisory level for Liberia, with the country now more than 2 weeks past achieving Ebola-free status for the second time. The CDC today moved the alert level to the green watch level 1, which recommends practicing the usual precautions, according to a Sep 18 media statement.

The CDC said it is no longer recommending that US residents practice enhanced precautions when traveling to Liberia, though travelers, as usual, should avoid contact with sick people, dead bodies, or blood and body fluids. It added that Liberia's healthcare infrastructure was severely strained by the outbreak, but is now returning to normal.

Though Guinea and Sierra Leone have made much progress against Ebola, the outbreak has not ended there, keeping the CDC's earlier precautions in place for those nations.

Though travelers leaving Liberia will still be screened for fever and Ebola symptoms, as of today enhanced entry screening has ended for travelers coming to the United States from Liberia, and those travelers will no longer be funneled through the handful of US airports conducting enhanced Ebola screening. The CDC is still recommending that people traveling from Liberia monitor their health for fever or other Ebola symptoms for 21 days after they leave Liberia.
Sep 18 CDC media statement
Sep 21 CDC traveler's health update

 

AP investigation details Ebola response missteps in Sierra Leone

Ineffective chlorine, ineptness by government officials, infighting, and problems getting supplies are among the logistical problems uncovered by an Associated Press (AP) investigation into the bungled response by the World Health Organization (WHO) and other groups in Sierra Leone last August.

The report, published yesterday, is based e-mails, conference-call recordings, and interviews obtained by the AP, focusing on events in Kenema last year during the Ebola outbreak.

The report said breakdown in the response in Kenema—which played out in other outbreak areas—may have influenced the course of the outbreak, given the city's proximity to the forested region of Guinea and transportation links to Freetown.

According to the report, the WHO made the decision to use Sierra Leone's chlorine supply, which was found to be defective and likely undermined health workers' resolve and put them at risk. The report also said problems with leadership at the WHO and in Sierra Leone's government led to delays in building treatment centers and procuring crucial supplies such as body bags and personal protective equipment.

The report also described infighting and poor communication between a private US-based response group and the WHO, and hinted at incompetence and bureaucratic red tape in Sierra Leone that led to problems with moving supplies and tracking cases.

Experts interviewed by the AP had a range of opinions about the bungled response in Sierra Leone, from noting that fear and community resistance overshadowed problems by agencies and the government to skepticism that the WHO response will go more smoothly during the next major global public health crisis.
Sep 20 AP story

 

Regeneron, BARDA sign agreement for Ebola drug development

Regeneron Pharmaceuticals, Inc., today announced an agreement with the US government to develop, study, and make a monoclonal antibody treatment for Ebola infection.

The deal with the Department of Health and Human Services (HHS) Biomedical Advanced Research and Development Authority (BARDA) is worth an initial $17 million that could cover preclinical development and antibody manufacturing, according to a press release from the company, based in Tarrytown, N.Y. An option for an additional $21 million would provide for a phase 1 study in healthy volunteers planned for January 2016 and further manufacturing and development.

The company says it uses proprietary technologies that allow the rapid identification and preclinical validation of fully human monoclonal antibodies, which would be used to develop a novel antibody "cocktail" that includes a combination of three antibodies. Regeneron has done preclinical studies in animals, which were found during work stemming from an earlier agreement with Sanofi.

So far treatments for Ebola have been cleared by regulatory bodies, but trials are under way for several. The first clinical trial of ZMapp, a monoclonal antibody treatment that was used for several patients on an emergency bases, launched in Liberia in February. Last week the drug's maker, Mapp Biopharmaceuticals, announced that ZMapp had received fast-track status for US Food and Drug Administration approval.
Sep 21 Regeneron press release
Sep 21 HHS news release
Sep 18 CIDRAP News scan "Possible Ebola treatment ZMapp receives FDA fast-track status"

News Scan for Sep 21, 2015

News brief

PAHO reports 3,000 new chikungunya cases

Chikungunya outbreak cases in the Caribbean and the Americas continued a modest increase for the third straight week, with only 3,085 new infections reported in an update late last week from the Pan American Health Organization (PAHO).

The most recent weekly updates before last week's included 7,156 and 4,857 new cases. The two updates before that noted much higher levels of 34,866 and 27,867 new cases, respectively.

The overall outbreak total now stands at 1,722,188, cases, PAHO said in a Sep 18 update. The total includes 575,419 cases in 2015. The agency adjusted the number chikungunya-related deaths downward by 5, to 62.

As has been the case for many weeks, Colombia reported most of the cases. The South American nation had 1,900 new cases, bringing its 2015 total to 332,232. Mexico had the next-highest total, with 594 new cases, for a total of 6,331 for the year. As in past weeks, many countries have not provided a chikungunya update for weeks.

The epidemic began in December 2013 with the detection of the Americas' first locally acquired cases on St. Martin in the Caribbean.
Sep 18 PAHO update

 

WHO notes H9N2 case in Bangladesh from earlier this year

A 3-year-old girl in Bangladesh contracted H9N2 avian flu in February and has since recovered, the World Health Organization (WHO) said in its latest risk assessment of influenza at the human-animal interface, which it posted Sep 19 though it is dated Sep 4.

The girl developed a mild illness on Feb 1 and had recovered within a week, the agency said. H9 was detected upon testing of a respiratory sample, and the strain was later confirmed to be H9N2. It is the country's second H9N2 case, with the prior one in 2011, the WHO said.

The girl had close contact with poultry, including sick quails, before she became ill, the WHO said. The virus is circulating in Bangladeshi poultry, the agency added.

The WHO said as part of its risk assessment, "Further human cases and small clusters could occur as this virus is circulating in poultry populations across Asia and Middle East. This virus does not seem to transmit easily between humans and tends to result in mild clinical disease, therefore the current likelihood of community-level spread and public health impact of this virus is considered low."

The organization in March reported two H9N2 cases in China that dated to late 2014 and one in Egypt that occurred in January.

The WHO in its latest report also noted that it has received no reports of human H5N1 or H7N9 since its previous update on Jul 17. Global WHO-confirmed cases of H5N1 stand at 844, including 449 deaths (53.2%), while for H7N9 they number 677, including at least 275 deaths (40.6%). The infectious disease news message board FluTrackers, which follows local health department releases closely, puts the H7N9 total at 685 cases.
WHO Sep 4 risk assessment

 

Nigeria reports 19 H5N1 outbreaks as Ghana finds virus in wild birds

Nigeria, which has confirmed dozens of H5N1 avian flu outbreaks this year, added 18 outbreaks from earlier this year that affected 145,000 poultry, while a Ghana official said the country has for the first time this year detected the virus in wild birds.

The Nigeria outbreaks all occurred in the central and northern parts of the country from January through July, according to an update from federal officials posted by the World Organization for Animal Health (OIE) on Sep 19. Previous outbreaks have been concentrated in the south.

The size of the affected farms ranges from 500 to 81,200 poultry. Most farms housed egg-laying chickens. Of 145,425 susceptible birds on the 18 farms, 13,258 were killed by the virus, and the rest were culled to prevent further disease spread, officials said.

Dates of outbreak onset range from Jan 26 to Jul 5, but only one outbreak occurred this summer. Two began in January, 8 in February, 4 in March, 2 in April, 1 in May, and 1 in July. The report did not specify what caused the reporting delay. Nigeria has now confirmed 63 H5N1 outbreaks in poultry this year.
Sep 18 OIE report

In Ghana, a scientist said that H5N1 has been detected in migratory waterfowl and shorebirds in addition to "bridge" species of nonmigratory wild birds, the news service GhanaWeb reported today. The country has reported at least 23 outbreaks in poultry since June.

Presenting at a UN Food and Agriculture Organization workshop, Dr. Richard Suuire, an epidemiologist and manager of Accra Zoo, said that migratory waterfowl like geese, ducks, and swans and shorebirds like herons, egrets, curlews, and plovers have tested positive for H5N1. He added that bridge species such as wild partridge, quail, and pigeons have also been affected.

He asked people to report dead or sick wild birds to help officials track the virus.
Sep 21 GhanaWeb story

 

One tenth of Lyme patients may have post-treatment symptoms

About 11% of Lyme patients reported post-treatment Lyme disease symptoms (PTLDS), some for more than 10 years, a new study in Clinical Infectious Diseases concluded.

New York Medical College investigators analyzed data on 128 treated Lyme disease patients beginning in 1991. They followed up on the cohort 6 months after treatment and annually thereafter, for 11 to 20 years (median, 15).

The researchers found that 14 (10.9%) had possible PTLDS, and 6 (4.7%) had the syndrome at their last visit. None of the 6 were considered to have functional impairment because of their symptoms, they said.

They added that PTLDS was not associated with any particular genotype of Borrelia burgdorferi, the bacterium that causes Lyme disease.
Sep 18 Clin Infect Dis abstract

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