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What ‘100 Percent Effective’ Means for That Ebola Vaccine

Analysis
WIRED.COM by Katie M. Palmer                                                            Aug. 4, 2015

Last week, the medical journal the Lancet published preliminary results on the efficacy of an Ebola vaccine in Guinea, and everybody got really excited—especially about one particular figure. The vaccine, the results suggested, was 100 percent effective at protecting against Ebola, a thrilling prospect in the face of an epidemic that has killed more than 11,000 people. ...

But that number probably means less than you think it does. It’s based on incomplete data, so it doesn’t have the statistical clout it should. And it never will. Based on the vaccine’s early success, the trial’s runners decided that all participants in the study should get it immediately after exposure. That’s a perfectly reasonable, humane reaction, but it also means that the researchers will never be able to collect better data on the vaccine’s efficacy, which is what regulators look for when they’re deciding to approve a drug. In other words, the vaccine’s early success could make it harder for people to get it down the line.

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UN Ebola mission winds down, WHO takes reins in West Africa

ASSOCIATED PRESS by MARIA CHENG and RAPHAEL SATTER   July 31, 2015

LONDON — The United Nations Mission for Ebola Emergency Response is officially winding down Friday, handing its leadership role and senior staff to the Geneva-based World Health Organization as efforts to contain the deadly virus continue.

"We have reached an important milestone in the global Ebola response," U.N. Secretary-General Ban Ki-moon said in a statement Friday, while noting that that crisis "is not yet over."

The Ebola mission, also called UNMEER, was established last year as WHO struggled to get a handle on an outbreak that has killed more than 11,000 people, mainly in Guinea, Sierra Leone and Liberia. WHO had been strongly criticized for fumbling its response to the epidemic, and the creation of UNMEER was widely seen as a rebuke to its leadership.

Speaking to reporters Friday, UNMEER chief David Nabarro said he had seen signs that WHO had already absorbed some of the lessons of the Ebola disaster, recovering its coordination role in West Africa and deploying more 1,000 staffers to the field.

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http://www.seattlepi.com/news/medical/article/WHO-works-to-reform-itself-after-fumbling-Ebola-6416880.php

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WHITE HOUSE FACT SHEET: The Global Health Security Agenda

The U.S. Government announces it intends to invest more than $1 billion in resources to expand the Global Health Security Agenda to prevent, detect, and respond to future infectious disease outbreaks overseas.

THE WHITE HOUSE PRESS OFFICE                       July 28, 2015

The Ebola epidemic in West Africa continues to galvanize global attention and resources as the international community strives to eliminate active cases and help the affected countries recover.  African leaders and African Union officials have shown extraordinary leadership in addressing the outbreak. The epidemic highlighted the urgent need to establish global capacity to prevent, detect, and respond to biological threats – to prevent future outbreaks from becoming epidemics. 

Beginning with the release of the National Strategy for Countering Biological Threats in 2009, and outlined in his 2011 speech at the United Nations General Assembly, President Obama has called upon all countries to come together to prevent, detect, and respond to infectious disease threats, whether naturally occurring, accidental or deliberately spread.  Today, the President underscored the unwavering U.S. commitment to partnering with Africans, their governments, and all who will join the effort to improve health security across the continent and for all people.

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The Individualised versus the Public Health Approach to Treating Ebola

PLOS/Medicine   by  Tom H. Boyles                            July 28, 2015

The mortality rate for patients with Ebola virus disease (EVD) in West Africa is approximately 65% [1]. There are no published figures for high-resource settings, but media sources and individual case reports suggest it is much lower and approaches 0% for those who receive this level of care from the beginning of their illness.

In their article “Ebola Viral Disease: Experience and Decision Making for the First Cases outside of Africa,” David Stephens and colleagues give insight into the care that can be provided when available resources are not the limiting factor [2]. They describe the decision to open the Serious Communicable Diseases Unit (SCDU) of Emory University Hospital (EUH) when two United States patients contracted EVD while working in West Africa. Using a large specialist team, they provided high-quality care in a safe working environment and disseminated their knowledge and experience widely.....

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How West Africa is ramping up food security after Ebola outbreak

Countries in West Africa and the international community are teaming up to fight Ebola's  lingering effects on food security and agriculture.

Volunteers distribute food at a World Food Programme storage center in Monrovia October 16, 2014. Almost a year after the Ebola outbreak garnered strength in West Africa, countries in that region and the international community are teaming up to fight the disease's lingering effects on food security and agriculture. James Giahyue/Reuters/File

CHRISTIAN SCIENCE MONITOR by Clare Algozin                                    July 29, 2015

As the death toll of EVD rose, West African countries began to experience labor shortages, and many fields of crops went unharvested, according to U.N. Food and Agriculture Organization (FAO). As part of the measures to prevent the spread of EVD, many West African governments established quarantine zones and restricted the movements of people.

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Addressing therapeutic options for Ebola virus infection in current or future outbreaks

AMERICAN SOCIETY FOR MICROBIOLOGY  by Azizul Haque and others                                July  27, 2015

 Ebola virus can cause severe hemorrhagic disease with high fatality rates. Currently, no specific therapeutic or vaccine has been approved for treatment and prevention of Ebola infection of humans. Although the number of Ebola cases has fallen in the last few weeks, multiple outbreaks of Ebola virus infection and the likelihood of future exposure highlight the need for development and rapid evaluation of pre- and post-exposure treatments.

In this manuscript we briefly review the existing and future options for anti-Ebola therapy, based on the data coming from rare clinical reports, studies on animals and results from in vitro models....

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http://aac.asm.org/content/early/2015/07/21/AAC.01105-15.short?rss=1

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Ebola study notes afebrile patients, calls into question WHO criteria

CENTER FOR DISEASE RESEARCH AND POLICY        July 24, 2015

(Also scroll down for: Ebola case definition quandary; Public health worker Ebola unease)

Researchers found that the World Health Organization (WHO) Ebola case definition has a specificity of only 31.5%, and they noted that 9% of Ebola patients reported neither a fever nor any Ebola risk exposure, calling into question WHO norms, according to a large study yesterday in The Lancet Infectious Diseases.

Researchers from Britain and Sierra Leone analyzed data on 850 suspected and 724 lab-confirmed Ebola patients who presented to the holding unit of Connaught Hospital in Freetown from May 29 to Dec 8, 2014. Fever or history of fever (n=599, 83%), intense fatigue or weakness (495, 68%), vomiting or nausea (365, 50%), and diarrhea (294, 41%) were the most common presenting symptoms in suspected cases.

Based on data from these patients, the investigators found the sensitivity of the WHO case definition to be 79.7%, which means about 20% of true Ebola cases would be missed (false-negatives). They found the specificity of the case definition to be 31.5%, which means 68.5% of patients who would be selected for admission would not actually have Ebola virus disease (false-positives).

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Ebola's not done with West Africa

 

This map, dated July 15, shows the number of days since active cases were discovered in the three countries where ebola is still a threat. CDC

SCIENCE  by Nick Stockton                               July 23, 2015

Officially, it’s called the Ebola Outbreak of 2014. But it’s 2015 now, and the disease is still infecting people. For the past two months, that rate was about 15 people a week. But in the past two weeks, the rate has doubled.....

What’s behind the continued spread? Depends on where you go. In Guinea and Sierra Leone, Ebola never died, and the new cases are a continuation of the same strain that first emerged in December of 2013. In Liberia—which declared itself ebola-free on May 12—experts believe the new outbreak was transmitted through sexual intercourse, from latent viral bodies that were alive in a man’s sperm.

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Ebola cases ebb a bit, with Conakry, Freetown as hot spots

CENTER FOR INFECIOUS DISEASE AND POLICY  by Lisa Schnirring     July 22, 2015

The number of new Ebola cases in Guinea and Sierra Leone declined a bit last week, with much of the disease activity centered in the two capital cities for the second week in a row, the World Health Organization (WHO) said in its weekly epidemiologic update today.

Tests confirmed 26 Ebola cases among the two countries, 22 in Guinea and 4 in Sierra Leone. The total is down from 30 reported the previous week, but progress against the disease has been stagnant over the past several weeks, hovering around 25 to 30 cases. Officials, however, said they saw more hopeful signs in contact tracing.

No new cases were reported in Liberia.

Overall, the total in the three countries has reached 27,705 confirmed, probable, and suspected cases, including 11,269 deaths, according to the WHO.

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http://www.cidrap.umn.edu/news-perspective/2015/07/ebola-cases-ebb-bit-conakry-freetown-hot-spots

WHO:  Ebola Situation Report - 22 July 2015

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Experimental Ebola drug shelved; study explores virus clearance

CENTER FOR INFECTIOUS DISEASE POLICY AND RESEARCH by Lisa Schnirring     July 20, 2015

Tekmira Pharmaceuticals  announced that it has suspended development of TKM-Ebola, a drug cocktail that showed disappointing human trial results in West Africa, as a convalescent plasma trial at a Doctors Without Borders (MSF) facility in Guinea proceeded with no ill effects in patients so far...

In suspending TKM-Ebola development, the company said that a joint reevaluation of its contract with the US Department of Defense is under way.

In another development, MSF said a convalescent serum trial at its facility in Nongo, Guinea, has enrolled 101 people over the last few months, with no ill effects reported so far, according to a Jul 17 update on the outbreak. Patients at the Nongo treatment unit have the option to receive plasma donated by Ebola survivors....

Meanwhile, detailed testing at a Swiss hospital on a 43-year-old doctor infected with Ebola in Sierra Leone found that viral decay occurred in two phases, once starting 72 hours after symptom onset before any antiviral interventions, with acceleration in viral load decay after ZMAb infusion and oral favipiravir treatments began..

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