Health workers spray themselves with chlorine disinfectants after removing the body a woman who died of Ebola virus in the Aberdeen district of Freetown, Sierra Leone, October 14, 2014.  Credit: Reuters/Josephus Olu-Mammah

reuters.com - by Emma Farge - November 26, 2014

(Reuters) - Sierra Leone appealed to the United States on Wednesday to send military aid to help it battle Ebola as it falls behind its West African neighbors Guinea and Liberia in the fight against the virus.

The worst recorded Ebola outbreak has killed at least 5,689 people, the World Health Organization said on Wednesday, as the virus has overwhelmed African countries with weak infrastructure and healthcare systemS.

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REUTERS      By Kate Kelland                                                                                                  Nov. 26, 2014

LONDON --West Africa's Ebola epidemic could worsen further before abating but new infections should start to decline in all affected countries by the end of this year, a leading specialist on the disease said on Wednesday.

Peter Piot, one of the scientists who first identified the Ebola virus almost 40 years ago, said the outbreak was far from over, but said that "thanks to now massive efforts at all levels" what had been an exponential growth in numbers should soon begin to recede.

The death toll in the worst Ebola epidemic on record has risen to 5,459 out of 15,351 cases identified in eight countries by November 18, latest data from the World Health Organization (WHO) showed. Almost all those cases are in Guinea, Sierra Leone and Liberia.

"By the end of the year we should start seeing a real decline everywhere," Piot, who is now director of the London School of Hygiene and Tropical Medicine, told a meeting of public health experts, non-governmental organizations and officials.

http://www.reuters.com/article/2014/11/26/us-health-ebola-piot-idUSKCN0JA1AQ20141126

NATIONAL PUBLIC RADIO   By Kelly Mcevers                                                  Nov. 25, 2014
There's a new phase of Ebola in Liberia. Epidemiologists call it pingponging.

Back in March, the disease was found in the rural areas. Then as people came to the capital to seek care, it started growing exponentially there. Now, some sick people are going back to their villages, and the disease has pingponged to the rural areas again.

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http://www.npr.org/blogs/goatsandsoda/2014/11/25/366381386/as-ebola-ping-pongs-in-liberia-cases-disappear-into-the-jungle

THE TELEGRAPH   By Colin Freeman                                                                                         Nov. 26, 2014British medics who have volunteered to fight the Ebola outbreak in Sierra Leone have accused the Government of failing to offer them proper emergency back-up if they get infected.

SCIENCE        By Jon Cohen                                                                                         Nov. 21, 2014

...Just a handful of basic interventions to fight the killer effects of Ebola, including dehydration and secondary infections, could dramatically lower the CFR there, says Michael Callahan, an infectious disease specialist at Massachusetts General Hospital in Boston..

With so much room for improvement in supportive care, the current international focus on drugs is “misguided,” says Callahan, who has recently worked in Monrovia and provided care in four previous Ebola outbreaks. “While we wait for months for forthcoming experimental therapies, many lives can be saved, certainly hundreds and possibly thousands, using inexpensive and simple therapies,” he says.

Callahan is helping an international team develop guidelines dubbed Maximum Use of Supportive Therapy (MUST), aimed at keeping more patients alive. It includes intravenous (IV) drips to replace massive fluid loss from diarrhea and vomiting, a risk factor for shock; balancing of electrolytes such as calcium or potassium, which prevents kidney and heart failure; nasogastric tubes for feeding; and testing and treatment of secondary infections such as malaria. Introducing MUST will also make it easier to study new treatments, Callahan says...

Description of efforts by the big drug companies to develop an Ebloa vaccine
THE NEW YORKER    By Vauhine Vara                        Nov. 25, 2014

"...why this race to create an Ebola vaccine among Merck, GlaxoSmithKline, and Johnson & Johnson—three of the world’s biggest drug manufacturers? For years, pharmaceutical companies didn’t invest much in vaccines, partly because they were so costly and complicated to produce: they’re often made out of live bacteria, which are notoriously difficult to work with. But, over the past several years, companies have realized that the difficulties of making vaccines could be an asset, because they can make it more difficult for generic-drug companies to create copycat versions than for prescription drugs. The vaccine market has also been growing more quickly than the prescription-drug market. The World Health Organization estimates, based on various sources, that global vaccine sales rose from five billion dollars in 2000 to twenty-four billion dollars last year...."

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http://www.newyorker.com/business/currency/race-ebola-vaccine

PLOS CURRENT OUTBREAKS                                                                              Nov. 21, 2014
By David Fisman and Ashleigh Tuite, Dalla Lana School of Public Health, University of Toronto

As removal of population-level susceptibility through vaccination could be a highly impactful control measure for this epidemic, we sought to estimate the number of vaccine doses and timing of vaccine administration required to reduce the epidemic size. Our base model was fit using the IDEA approach, a single equation model that has been successful to date in describing Ebola growth. We projected the future course of the Ebola epidemic using this model. Vaccination was assumed to reduce the effective reproductive number. We evaluated the potential impact of vaccination on epidemic trajectory under different assumptions around timing of vaccine availability.

TIME MAGAZINE By Alexandra Sifferlin                          Nov. 25, 2014
 By  Alexandra Sifferlin                       

Scientists are scurrying to get their Ebola vaccines through the necessary safety trials before they can be used widely. That includes the University of Maryland School of Medicine, which recently kicked off the latest step in their research: figuring out the appropriate dosing for the vaccine that’s both effective and safe.

The University of Maryland is one of a handful of institutions involved in the testing of an experimental but promising vaccine developed by the National Institutes of Health’s Vaccine Research Center (VRC) and GlaxoSmithKline (GSK). The hope is that the vaccine will pass through early trials needed by end of December so that the World Health Organization (WHO) and a panel of outside experts can decide whether to move on to a large efficacy trial, which would mean vaccinating a lot of people in West Africa to see how well it works.

Manufacturers Strain to Meet Demand Amid Rising Anxiety

WALL STREET JOURNAL                                                                                                       Nov. 25, 2014
 By Drew Hinshaw in Accra, Ghana, and Jacob Bunge in Chicago

Protective suits were running low in Sierra Leone this month, when a Christian charity decided to ship some over. The charity turned to American medical-wear suppliers, which came back with bad news: The suits needed to treat Ebola are running low in America, too.

A worker wearing Personal Protective Equipment has his name written on his suit before leaving an Ebola treatment center in Guinea last week. Agence France-Presse/Getty Images

“There’s been some sleepless nights,” said Jennifer Mounsey, director of corporate engagement for World Vision, the Christian humanitarian group based in Monrovia, Calif. “We’re all sweating bullets.”

BBC                                                                                                    Nov. 25, 2014  

Burial workers in the Sierra Leonean city of Kenema have dumped bodies in public in protest at non-payment of allowances for handling Ebola victims.

The workers, who went on strike over the issue, left 15 bodies abandoned at the city's main hospital.

             Burial workers are especially at risk of becoming infected

One of the bodies was reportedly left by the hospital manager's office and two others by the hospital entrance.

A BBC reporter in Sierra Leone says the striking workers have now been sacked. The hospital has not commented.

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http://www.bbc.com/news/world-africa-30191938

REUTERS    By Matthew Mpoke Bigg                                                                              Nov. 24, 2014

The U.N. Ebola Emergency Response Mission will not fully meet its Dec. 1 target for containing the virus due to escalating numbers of cases in Sierra Leone, Anthony Banbury, the head of UNMEER, said on Monday.

The mission set the goal in September of having 70 percent of Ebola patients under treatment and 70 percent of victims safely buried. That target will be achieved in some areas, Banbury told Reuters, citing progress in Liberia.

INTERNAL DISPLACEMENT MONITORING CENTRE                                                                            Nov.19, 2014

When a whole town was displaced in the south of Guinea during the Ebola crisis, the link between disease and displacement began to emerge. With IDMC monitoring the crisis across the three countries most affected since the outbreak took place, we have identified five key displacement trends emerging.

On 14 November 2014 the UN Mission for Ebola Emergency Response (UNMEER) reported that the Guinean government had announced the withdrawal of troops from Womey, Nzérékoré prefecture, in the south of the country when a group of people raising awareness about the Ebola Virus Disease (EVD) were killed by angry residents.

Since the army’s deployment in September, there have been accusations of human rights violations at the hands of military personnel, resulting in the displacement of the whole town, with some 6,000 residents fleeing to forests in the surrounding area. This is the single largest reported incident of displacement during the Ebola crisis.

NBC NEWS    By Maggie Fox                                                                              Nov. 24, 2014

Two outbreaks, two entirely different outcomes. The World Health Organization has declared an outbreak of Ebola over in the Democratic Republic of Congo after just 66 cases and 49 deaths. It lasted three months.

Yet the epidemic in Liberia, Sierra Leone and Guinea’s been going for nine months, with more than 15,000 cases, 5,000 deaths and no end in sight.

What’s the difference? Experts say experience matters — it was the seventh outbreak in the former Zaire. But equally important is the fact that the village where it started was extremely remote, and the country has a rudimentary system of healthcare workers who know to look out for Ebola.

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http://www.nbcnews.com/storyline/ebola-virus-outbreak/tale-two-outbreaks-why-congo-conquered-ebola-n253911

THE NATIONAL JOURNAL   By Maria Koren           Nov. 24, 2014

...Nine people have been treated for the virus in the U.S. since August. Seven recovered. The National Institutes of Health Clinical Center, which treated one of them, estimates treatment for patients diagnosed with Ebola costs $50,000 a day. Officials at the University of Nebraska Medical Center, which cared for two patients, put the daily cost at $30,000, and the totalat $1.16 million for a single patient. Most patients have been hospitalized for more than two weeks.

The U.S. has shown it can beat Ebola. But who will pay for the expensive care it takes to do it?

It's a tough question, and one that the people holding the bills seem reluctant to answer. Hospitals that have treated patients in Georgia, Nebraska, New York, and Texas did not respond to requests for comment, nor did the governors' offices of these states. NIH was forthcothcoming about cost of care, but the feds pick up the tab for treatment there.

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NEW YORK TIMES    By Anemona Hartocollis                                                          NOV. 24, 2014

NEW YORK   ...since Kaci Hickox, a nurse, flew into Newark’s airport on Oct. 24 and was kept at a hospital for three days, no one else has been caught up in the quarantine dragnet at the New York and New Jersey airports.

The absence of quarantines is striking, not only because both governors emphatically defended the policy as a necessary precaution, but also because most people returning from Ebola-stricken countries arrive in the United States through Kennedy and Newark Liberty International Airports.

...New York and New Jersey officials say no one coming through the two airports since Ms. Hickox has reported direct contact with Ebola patients.