EBOLA VIRUS AND LIBERIA; A CASE STUDY

Thousands of new cases of Ebola are expected in the coming weeks as the disease spreads "exponentially" through Liberia, the World Health Organisation (WHO) has warned.

SHARE
More than 2,000 people have been killed in West Africa by Ebola since the outbreak began this year, including 79 health workers.

The UN's health agency has now warned that the response to the crisis is "not having an adequate impact" and efforts to contain the virus must be stepped up "three-to-four fold".

It added that a shortage of beds for infected patients in Liberia'sMontserrado county and the use of public transport by Ebola sufferers turned away from hospital would likely cause a surge in transmission rates.

"Transmission of the Ebola virus in Liberia is already intense and the number of new cases is increasing exponentially," WHO said in a statement.

"In Monrovia, taxis filled with entire families, of whom some members are thought to be infected with the Ebola virus, crisscross the city, searching for a treatment bed. There are none.

"As WHO staff in Liberia confirm, no free beds for Ebola treatment exist anywhere in the country.

"When patients are turned away, they have no choice but to return to their communities and homes, where they inevitably infect others."

The virus is transmitted through contact with infected blood or bodilyfluids, or through contact with areas where contaminated bodily fluids have recently been left.

The international response to the epidemic has been intensified in recent weeks, with more aid being pledged to affected countries and the imposition of stricter travel restrictions.

The British military has pledged to build a 50-bed centre in Sierra Leone and the US announced the construction of a 25-bed field hospital inLiberia at a cost of €24m.

Liberia has been the worst affected with 1,000 deaths from the virus so far, while hundreds have also died in Guinea and Sierra Leone. The outbreak has a mortality rate of 55pc.

Meanwhile, the fourth American aid worker ill with the Ebola virus arrived yesterday morning to a mostly calm scene at a US hospital, where two others have been successfully treated.

The patient walked from the ambulance to the hospital.
 

Ebola cases in Nigeria

The Rivers State Government has said the sister to the late Dr. Iyke Samuel Enemuo, Chinyere, who fled to Abia State after her brother died of the Ebola virus, has returned to Port Harcourt and has developed symptoms of the disease.

Briefing journalists on the efforts by the Rivers State Government to combat the spread of the virus in Nigeria’s oil hub, the state Commissioner for Health, Dr. Sampson Parker, also disclosed that the corpse of the late Enemuo would be buried this week in Port Harcourt “in accordance with World Health Organisation (WHO) protocol”.

He said Chinyere had been quarantined at the isolation centre at Oduoha in Emuoha Local Government Area of the state.

“She (Chinyere) earlier ran to Abia State apparently because of the stigma which people arrogate to the Ebola virus. We were able to trace her with the help of our brother commissioner in Abia State. She developed feverish symptoms and she has been admitted at the isolation unit at Oduoha for observation and treatment.

“She is among the 50 high-risk contacts on our list. We decided to take her to the isolation unit to make assurance surer. We are currently running a test on her and the result will be out by Tuesday (today) or thereabouts. We chose to isolate her because we don’t want to go through the same experience we had with the diplomat, Olubukun Koye,” he stated.

The commissioner commended Chinyere for summoning the courage to come out from hiding, but said: “The major problem we are having is that some of the primary and secondary contacts are hiding. We are grateful to the operatives from the Department of State Security (DSS) for assisting us in tracking them.”
On the remains of the late Enemuo, Parker said his corpse and the other corpses that were in the morgue when his remains were brought to the University of Port Harcourt Teaching Hospital, including those that were brought after his body was deposited, would be buried in Port Harcourt this week.

9 questions about this new Ebola drug

 Two American missionary workers infected with the deadly Ebola virus were given an experimental drug that seems to have saved their lives.

Dr. Kent Brantly was given the medication, ZMapp, shortly after telling his doctors he thought he would die, according to a source familiar with his case. Within an hour, doctors say his symptoms -- labored breathing and a widespread rash -- dramatically improved. Nancy Writebol, another missionary working with Samaritan's Purse, received two doses of the medication and has also shown significant improvement, sources say.

As there is no proven treatment and no vaccine for Ebola, this experimental drug is raising lots of questions.

How the experimental Ebola serum works

1. Who makes the drug?

The drug was developed by the biotech firm Mapp Biopharmaceutical Inc., which is based in San Diego. The company was founded in 2003 "to develop novel pharmaceuticals for the prevention and treatment of infectious diseases, focusing on unmet needs in global health and biodefense," according to its website.

Mapp Biopharmaceutical has been working with the National Institutes of Health and the Defense Threat Reduction Agency, an arm of the military responsible for countering weapons of mass destruction, to develop an Ebola treatment for several years.

2. Are there other experimental Ebola drugs out there?

Yes. In March, the NIH awarded a five-year,$28 million grant to establish a collaboration between researchers from 15 institutions who were working to fight Ebola.

"A whole menu of antibodies have been identified as potentially therapeutic, and researchers are eager to figure out which combinations are most effective and why," a news release about the grant said.

Tekmira, a Vancouver-based company that has a $140 million contract with the U.S. Department of Defense to develop an Ebola drug, began Phase 1 trials with its drug in January. But the FDA recently halted the trial, asking for more information.

Map: The Ebola outbreak

At least one potential Ebola vaccine has been tested in healthy human volunteers, according to Thomas Geisbert, a leading researcher at the University of Texas Medical Branch. And last week, the NIH announced a safety trial of another Ebola vaccine will start as early as September.

3. How does ZMapp work?

Antibodies are proteins used by the immune system to mark and destroy foreign, or harmful, cells. A monoclonal antibody is similar, except it's engineered in a lab so it will attach to specific parts of a dangerous cell, according to the Mayo Clinic, mimicking your immune system's natural response. Monoclonal antibodies are used to treat many different types of conditions.

West African Ebola epidemic

Second Ebola patient heading to U.S.

Can camera help detect Ebola?

Sources told CNN the medicine given to Brantly and Writebol abroad was a three-mouse monoclonal antibody, meaning that mice were exposed to fragments of the Ebola virus and then the antibodies generated within the mice's blood were harvested to create the medicine.

However, the drug can also be produced with proteins made from tobacco plants. ZMapp manufacturer Kentucky BioProcessing in Owensboro has been working with Samaritan's Purse and Emory University Hospital to provide limited quantities of the drug to Emory, according to company spokesman David Howard.

4. Why did American missionary workers get the drug?

Many have asked why these two workers received the experimental drug when so many -- around 1,600 -- others in West Africa also have the virus.

The World Health Organization says it was not involved in the decision to treat Brantly and Writebol. Both patients had to give consent to receive the drug, knowing it had never been tested in humans before.

The process by which the medication was made available to the American patients may have fallen under the U.S. Food and Drug Administration's "compassionate use" regulation, which allows access to investigational drugs outside clinical trials.

5. Did doctors know it would work?

No. The drug had shown promise in primates, but even in those experiments, just eight monkeys received the treatment. In any case, the human immune system can react differently than primates', which is why drugs are required to undergo human clinical trials before being approved by government agencies for widespread use.

The two Americans' cases will be studied further to determine how the drug worked with their immune systems.

6. Will the drug be made available to other Ebola patients?

It's unclear. Rolling out an untested drug during a massive outbreak would be very difficult, Doctors Without Borders said in a statement. Experimental drugs typically not mass-produced, and tracking the success of such a drug if used would require extra medical staff where resources are already scarce.

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, says scientists have to be careful about assuming this drug will work in other patients as it appears to have worked in Brantly.

"Having worked with administering antibodies for people for a really long time, that would be distinctly unusual," he told CNN. "As we all know in medicine ... you have to withhold judgment."

7. Does the company have more vials of the drug?

The company has very few doses ready for patient use, Fauci told CNN.

"(Kentucky BioProcessing) is working closely with Mapp, various government agencies, and other parties to increase production of ZMapp, but this process will take several months," Howard said.

8. Who paid for the drug and how much did it cost?

We don't know. Samaritan's Purse covered the cost of Brantly and Writebol's evacuations but did not pay for the drug, according to a spokesman.

When a patient gets an experimental drug, the drug company can donate the product under compassionate use. Mapp Biopharmaceutical Inc. might have done that in this case.

Health insurance companies typically do not pick up the tab for treatments that have not been approved by the FDA. But they usually would cover the cost of any doctor fees associated with giving the drug and any costs associated with monitoring how the drug is working.

9. Would this drug stop the Ebola epidemic?

If it were widely available, it certainly couldn't hurt. An effective Ebola drug could help doctors treat the deadly virus, which is killing about 60% of the people infected in West Africa. But a vaccine would be a much more effective tool in stopping this, and future, epidemics.

Vaccines are given to healthy people to prevent them from ever becoming infected. One challenge with Ebola, experts say, is that companies don't believe they could make much money from developing a vaccine, so few companies show interest.

Ebola virus: Nine things to know about the killer disease

Hundreds of people are dead as the worst Ebola virus outbreak in history sweeps through West Africa.

It began as a handful of cases in Guinea in March but quickly spread to neighboring Sierra Leone and Liberia.

Here are nine things to know about what the World Health Organization calls "one of the world's most virulent diseases."

Why does Ebola generate such fear?

Medecins Sans Frontieres (MSF) describes Ebola as "one of the world's most deadly diseases."

"It is a highly infectious virus that can kill up to 90% of the people who catch it, causing terror among infected communities," it says.

There is also no vaccination against it.

Of Ebola's five subtypes, the Zaire strain -- the first to be identified -- is considered the most deadly.

The WHO said preliminary tests on the Ebolavirus in Guinea in March suggested that the outbreak there was this strain, though that has not been confirmed.

What is Ebola?

The Ebola virus causes viral hemorrhagic fever, which according to the U.S. Centersfor Disease Control and Prevention (CDC), refers to a group of viruses that affect multiple organ systems in the body and are often accompanied by bleeding.

The virus is named after the Ebola River in the Democratic Republic of Congo (formerly Zaire), where one of the first outbreaks occurred in 1976. The same year there was another outbreak in Sudan.

The WHO says there are five different strains of the virus -- named after the areas they originated in. Three of these have been associated with large outbreaks of hemorrhagic fever in Africa.

These are the Bundibugyo -- an area of Uganda where the virus was discovered in 2007 -- Sudan and Zaire sub-types.

There has been a solitary case of Ivory Coast Ebola. This subtype was discovered when a researcher studying wild chimpanzees became ill in 1994 after an autopsy on one of the animals. The researcher recovered.

Finally, Reston Ebola is named after Reston in the U.S.state of Virginia, where this fifth strain of the Ebola virus was identified in monkeys imported from the Philippines. The CDC says while humans have been infected with Ebola Reston, there have been no cases of human illness or death from this sub-type.

What areEbola's symptoms?

Early symptoms include sudden onset of fever, weakness, muscle pain, headaches and a sore throat. These symptoms can appear two to 21 days after infection.

The WHO says these nonspecific early symptoms can be mistaken for signs of diseases such as malaria, typhoid fever, meningitis or even the plague.

MSF says some patients may also develop a rash, red eyes, hiccups, chest pains and difficulty breathing and swallowing.

The early symptoms progress to vomiting, diarrhea, impaired kidney and liver function and sometimes internal and external bleeding.

Ebola can only be definitively confirmed by five different laboratory tests.

How is it treated?

There are no specific treatments for Ebola. MSF says patients are isolated and then supported by health care workers.

"This consists of hydrating the patient, maintaining their oxygen status and blood pressure and treating them for any complicating infections," it says.

There have been cases of health care workers contracting the virus from patients, and the WHO has issued guidance for dealing withconfirmed or suspected cases of the virus.

Caregivers are advised to wear impermeable gowns and gloves and to wear facial protection such as goggles or a medical mask to prevent splashes to the nose, mouth and eyes.

MSF says it contained a 2012 outbreak in Uganda by placing a control area around its treatment center. An outbreak is considered over once 42 days -- double the incubation period of the disease -- have passed without any new cases.

What drugs exist to combat the disease?

Two American missionary workers infected with Ebola were given an experimental drug called ZMapp, which seems to have saved their lives. The drug, developed by a San Diego firm, had never been tried before on humans, but it showed promise in small experiments on monkeys.

But rolling out an untested drug during a massive outbreak would also be very difficult, according to MSF. Experimental drugs are typically not mass-produced, and tracking the success of such a drug if used would require extra medical staff where resources are already scarce. ZMapp's maker says it has very few doses ready for patient use.

There are other experimentaldrugs. Tekmira, a Vancouver-based company that has a $140 million contract with the U.S. Department of Defense to develop an Ebola drug, began Phase 1 trials with its drug in January. But the FDA recently halted the trial, asking for more information.

At least one potential Ebola vaccine has been tested in healthy human volunteers, according to Thomas Geisbert, a leading researcher at the University of Texas Medical Branch. And last week, the NIH announced that a safetytrial of another Ebola vaccine will start as early as September.

And in March, the U.S. National Institutes of Health awarded a five-year, $28million grant to establish a collaboration between researchers from 15 institutions who were working to fight Ebola.

"A whole menu of antibodies have been identified as potentially therapeutic, and researchers are eager to figure out which combinations are most effective and why," a news release about the grant said.

How does Ebola virus spread?

The WHO says it is believed that fruit bats may be the natural host of the Ebola virus in Africa, passing on the virus to other animals.

Humans contract Ebola through contact with the bodily fluids of infected animals or the bodily fluids of infected humans.

MSF says that while the virus is believed to be able to survive for some days in liquid outside an infected organism, chlorine disinfection, heat, direct sunlight, soaps and detergents can kill it.

MSF epidemiologist Kamiliny Kalahne said outbreaks usually spread in areas where hospitals have poor infection control and limited access to resources such as running water.

"People who become sick with it almost always know how they got sick: because they looked after someone in their family who was very sick -- who had diarrhea, vomiting and bleeding -- or because they were health staff who had a lot of contact with a sick patient," she said.

Can plane passengers become infected?

While the CDC acknowledges it's possible a person infected with Ebola in West Africa could get on a plane and arrive in another country, the chances of the virus spreading during the journey are low.

"It's very unlikely that they would be able to spread the disease to fellow passengers," said Stephen Monroe, deputydirector of CDC's National Center for Emerging Zoonotic and InfectiousDiseases.

"The Ebola virus spreads through direct contact with the blood, secretions, or other body fluids of ill people, and indirect contact -- for example with needles and other things that may be contaminated with these fluids."

He added that most people who have become infected with Ebola lived with or cared for an ill patient.

"This is not an airborne transmission," said Dr. Marty Cetron, director of CDC's Division of Global Migration and Quarantine. "There needs to be direct contact frequently with body fluids or blood."

Travelers should take precautions by avoiding areas experiencing outbreaks and avoid contact with Ebola patients.

"It is highly unlikely that someone suffering such symptoms would feel well enough to travel," IATA said in a statement.

"In the rare event that a person infected with the Ebola virus was unknowingly transported by air, WHO advises that the risks to other passengers are low. Nonetheless, WHO does advise public health authorities to carry out contact tracing in such instances."

This means determining who had contact with the affected person.

What should flight crew do if Ebola infection is suspected?

The CDC has issued guidance for airline crews on Ebola virus infections.

"As with many other global infectious disease outbreaks, airline carriers, crew members, airports can be very important partners in that front line," said Cetron. "Being educated, knowing the symptoms, recognizing what to do, having a response protocol, knowing who to call, those are really, really important parts of the global containment strategy to deal with threats like this."

The CDC advises that when flight crew members encounter a passenger with symptoms that they suspect could be Ebola, such as fever and bleeding, that they keep the sick person away from other passengers. They've been instructed to wear disposable gloves and to provide the sickened person with a surgical mask to prevent fluids from spreading through talking, sneezing or coughing.

The airline cleaning crew are also instructed to wear disposable gloves, wipe down surfaces including armrests, seat backs, trays and light switches. The CDC says that packages and cargo should not pose a risk, unless the items have been soiled with blood or bodily fluids.

When someone becomes ill on a flight, the captain is required by aviation regulations to report the suspected case to air traffic control, according to IATA.

What is the risk of catching Ebola on a plane?

How many cases have there been?

The CDC estimates there have been more than 3,000 cases of Ebola and more than 2,000 deaths since 1976.

The last recorded outbreaks before the current one in Guinea were in 2012 -- in Uganda and Democratic Republic of Congo.

The Uganda outbreak involved a total of 24 probable and confirmed cases, and 17 deaths, according to the WHO, which declared it had ended in October 2012.

MSF said the Uganda outbreak had been the Sudan strain, while the virus found in DRC was the Bundibugyo sub-type.

Before 2014, the most deadly outbreak was the 1976 outbreak in then Zaire, when 280 of 318 infected people died, according to the CDC. In 2000, there were 425 cases of Ebola Sudan in Uganda, which resulted in 224 fatalities.