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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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Ebola crisis update MSF

 

MSF                                                  July 17, 2015

Though Ebola has faded from the news headlines, the epidemic in West Africa continues to claim lives today. Around 30 people become infected each week in Sierra Leone and Guinea – a number that would be considered a major disaster under normal circumstances – and the outbreak has recently re-emerged in Liberia.

  • Liberia: After being declared Ebola-free on 9May, six (6) new cases have been confirmed since the re-emergence of the virus at the end of June.
  • Guinea: 13 confirmed cases in the country in the week to 12July in three main hotspots (Forecariah, Boké/Fria, Conakry)
  • Sierra Leone: 14 confirmed cases in the country in the week to 12July in three main hotspots (Freetown, Port Loko, Kambia).  

Read complete report:

http://www.msf.org/article/ebola-crisis-update-17-july-2015

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RECORDED VIDEO - Ebola Innovation for Impact 2015 - Game Change in Global Health Crisis Management

Side Event in Support of the UN Secretary-General’s International Ebola Recovery Conference July 9-10 2015

United Nations Headquarters - Conference Room 3, 13.15-14.30 pm (1:15pm-2:30pm, ET), 10 July 2015

As a side-event in support of the United Nations Secretary-General’s International Ebola Recovery Conference, Ebola Innovation for Impact 2015: Game Change in Global Health Crisis Management will bring together thought leaders in global health and technology to stimulate creative, collaborative and catalytic action, and to address the Ebola crisis with innovative solutions in the key, inter-linked areas of: Community Engagement and Mobilization; Private Sector Contribution and Collaboration; Data Systems Strengthening and Coordination; and, Emergency Infrastructure and Logistics.

Speakers include:

Dr. Barbara Bentein, UNICEF

Dr. Arnaud Bernaert, World Economic Forum (WEF)

Dr. Vinton G. Cerf, Google

Dr. Denis Gilhooly, Global Digital Health Initiative (GDHI)

Dr. Michael D. McDonald, Global Health Response & Resilience Alliance (GHRRA)

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International Ebola Recovery Conference, 9-10 July 2015

                                                            

ebolaresponse.un.org/recovery-conference

The road towards recovery

Guinea, Liberia and Sierra Leone have undertaken a remarkable effort to defeat the devastating Ebola outbreak. Thanks to those efforts and the support of the international community, the affected countries have seen a significant decline in the number of new cases. Recovery must now be pursued as part of the goal of “getting to zero and staying at zero,” as the response changes from emergency operations to multi-faceted, long-term support.

To this end, UN Secretary-General Ban Ki-moon is hosting an International Ebola Recovery Conference in New York to ensure that recovery efforts go beyond redressing direct development losses to build back better and ensure greater resilience.

The Conference will be held in cooperation with the Governments of Guinea, Liberia and Sierra Leone, and in partnership with the African Union, the African Development Bank, the European Union and the World Bank.

Aims of the Conference

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Guinea's president on global aid push: 'Ebola forced us to change completely'

After the international community pledged $3.4bn for West Africa, Alpha Condé is cautiously optimistic and taking stock of lessons learned

Guinean president Alpha Conde speaks to UN members during an International Ebola Recovery Conference on 10 July. Photograph: EDUARDO MUNOZ ALVAREZ/AFP/Getty Images

THE GUARDIAN by Raya Jababi                        June 11, 2015
NEW YORK--More than a year after the charity Médecins Sans Frontières sounded the alarm on the Ebolaepidemic that would claim more than 11,000 lives, the international community on Friday pledged $3.4bn to help affected West African countries recover.

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Ebola Survivors May Be the Key to Treatment - For Almost Any Disease

submitted by George Hurlburt

      

A group of volunteer medical workers carry the bodies of Ebola victims to a car in order to bury them in Kptema graveyard in Kenema, Sierra Leone, on August 24, 2014. Mohammed Elshamy/Anadolu Agency/Getty Images

wired.com - by Erica Check Hayden - June 30, 2015

. . . The patients held the answer. If they survived, they carried antibodies that targeted the very viruses that had almost killed them. The samples he’d been working with didn’t contain antibodies, but if he could get blood from survivors, he might be able to figure out how to make the same antibodies that their immune systems had produced. It would not be easy or fast, but he couldn’t stand by while more people lost their lives—if not in this outbreak, then in the next one, or the next one after that. It was time for a new plan. . . .

. . . Once your body knows how to make antibodies specific to a disease, it never forgets . . . So physicians use survivor serum in the hope that amid the trillions of antibodies an adult human can make, the ones that fight a specific disease will be in the mix. It’s not a new idea.

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Finger-prick, blood test for Ebola takes just minutes

THE WASHINGTON POST by

Public health officials may soon be able to screen patients for Ebola at border crossings and hospitals with a finger-prick blood test that takes mere minutes.

The development of the rapid diagnostic test, reported in The Lancet Thursday, represents a significant victory for scientists around the world who have been experimenting over the past year with all manner of vaccines, treatments and other ways of eradicating the virus.

Developing a way of confirming Ebola in a patient has been one of the top priorities. In the early stages the symptoms -- chest pain, cough, nausea -- can look like many other illnesses, making it very difficult for doctors to triage -- to determine who should be quarantined and who to send home. It can often take days or longer for laboratory tests, the current standard, to return a positive or negative result.

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