Ebola Scan for Nov 05, 2014

News brief

Work on Ebola being thwarted by difficulties getting virus samples

US scientists don't lack motivation to track changes that might be occurring in the Ebola virus and to develop new drugs, vaccines, and diagnostics, but obtaining a steady supply of fresh samples of the virus for study and testing is proving problematic, Reuters reported today.

The shortage of samples stems from two general problems: limited resources in the areas from which the samples are sought as the countries struggle to manage patients, and growing caution on the part of regulators and transport companies for the actual handling of specimens even when they are made available.

"All the companies working on vaccines, diagnostics and treatment are complaining about lack of access to viral samples," Laurie Garrett, senior fellow for global health at the Council on Foreign Relations in New York, said.

Garrett points out that safe transport of samples is an especially sensitive issue in view of mismanagement of anthrax and H5N1 avian flu specimens by high-containment US laboratories this past summer.

Since Ebola mutates as it spreads, experimental pharmaceuticals need to be tested against the current strains circulating to make sure any changes in the virus do not render them ineffective, the story points out.

Importing the virus into the United States has become more difficult since Thomas Duncan brought the first case of Ebola to Dallas in early October and safety concerns skyrocketed. "You can divide the outbreak into pre-Dallas and post-Dallas," remarked John Schieffelin, MD, a Tulane University physician who has treated patients in West Africa.

The US Centers for Disease Control and Prevention claims to have agreements with Guinea, Sierra Leone, and Liberia to obtain live samples in "a matter of weeks," says the story, and plans to share them with other institutions.

Given the bottleneck in importing African samples of Ebola virus, US patients who have recovered from the infection, such as two nurses who treated Duncan, are being sought after for blood samples.
Nov 5 Reuters story
Most recent (Aug 15) CIDRAP News story on mishandling of lethal agents


Guinea case series: Younger Ebola patients fared better

Ebola patients who were 40 and older had 3.5 times the risk of death compared with those under 40, according to a case series published today on 37 patients in Conakry, Guinea's capital.

The 37 patients had lab-confirmed Ebola virus disease (EVD), out of 80 who had Ebola-like symptoms from Mar 25 to Apr 26 of this year. The median age of confirmed case-patients was 38; 24 (65%) were men and 14 (38%) were healthcare workers, 12 of whom contracted the disease in a healthcare setting.

Those with confirmed EVD sought medical care a median of 5 days after symptom onset. The most common symptoms were fever (84%), fatigue (65%), and diarrhea (62%). All of the patients received antibiotics, and 28 (76%) were treated with intravenous fluids.

Sixteen (43%) of the patients died. The risk of death was 3.49 in those 40 and older compared with the younger patients.

The authors conclude, "Greater capacity to deliver supportive care and monitor the response to therapy may improve clinical outcomes."
Nov 5 N Engl J Med study


Ebola outbreak overwhelms West African economies

The ongoing West African outbreak of Ebola is projected to cause massive losses in gross domestic product (GDP), rising food costs, and increased hunger in the region, according to a recent United Nations Development Programme (UNDP) report.

The UNDP projects that the three nations primarily affected by the outbreak—Guinea, Sierra Leone, and Liberia—will lose a combined $1.17 billion in GDP due to the effects of Ebola.

Many of the socioeconomic consequences of the disease are being felt in the agricultural sector. The price of cassava, a food staple in much of West Africa, has increased 150% since the outbreak began in March. High food prices and loss of livelihood because of disease or lack of investment may lead to rising hunger in West Africa, the UNDP said.

In addition to agricultural-sector disruptions, the Ebola outbreak has also caused declines in economic growth in the tourism industry. The UNDP reported that government costs associated with keeping the disease contained with quarantine, border control, and effective personal protective equipment have also drained national funds in West Africa.

The UNDP is deploying an additional 130 staff to the affected countries to assist in disease containment and mitigate economic effects. Proposed UNDP projects include engaging communities to help with Ebola disease containment and security in Guinea, training and providing telecommunications equipment to security personnel in Liberia, and providing basic goods to Ebola survivors in Sierra Leone.

The UNDP also plans to facilitate cash transfers and other programs to rebuild the affected economies.
Nov 5 UNDP Ebola update

News Scan for Nov 05, 2014

News brief

Saudi Arabia confirms 3 new MERS cases

After confirming two new MERS-CoV cases yesterday, Saudi Arabia's Ministry of Health (MOH) reported three more cases today in Riyadh and Taif.

The first MERS-CoV (Middle East syndrome coronavirus) case is in a 75-year-old woman in Taif who is in an intensive care unit. The MOH reports that she had preexisting disease and no additional risk factors such as contact with animals or human cases.

The second patient is a 32-year-old woman in Riyadh who is hospitalized in a general ward. She had no preexisting disease, and the MOH is investigating whether she had healthcare contact with a suspected or confirmed MERS patient.

The third case involves a 33-year-old male in Riyadh who is hospitalized in a general ward. He had preexisting disease and no additional risk factors, the MOH said.

Today's report pushes the Saudi MERS-CoV case count to 796 total cases (18 active). Of the 796 cases, 338 have proved fatal.
Nov 5 Saudi MOH update
Nov 4 CIDRAP News scan on recent Saudi MERS cases


CDC reports 7 new EV-D68 cases

The Centers for Disease Control and Prevention (CDC) has reported seven new cases of enterovirus D68 (EV-D68) in the past 2 days, bringing the US total to 1,112 cases in 47 states and the District of Columbia.

The agency added that EV-D68 has been detected in nine patients who died, but it has not determined whether the virus was responsible for those deaths. The number of deaths has not changed in recent days.

Of the more than 2,000 specimens the CDC's lab has tested, about 40% have tested positive for EV-D68, while about a third have tested positive for another enterovirus or a rhinovirus. The CDC has yet to update its state-by-state activity page this week, which still lists seven states reporting elevated EV-D68 activity.
CDC EV-D68 outbreak page
CDC EV-D68 activity by state

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