27 Nov 2014

#Haïti: le #choléra continue de faire des victimes (Le Figaro, November 27 2014)

[Source: Le Figaro, full page: (LINK).]

Haïti: le choléra continue de faire des victimes [      ]

L'épidémie de choléra continue de faire des victimes en Haïti où 132 personnes sont mortes et près de 15.000 ont été touchées par la maladie en 2014, a révélé aujourd'hui un rapport de l'agence onusienne chargée de l'urgence humanitaire (OCHA). Depuis l'apparition de l'épidémie en Haïti en...

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#Chikungunya: 2 #morts en en #Polynésie française (Le Figaro, November 27 2014)

[Source: Le Figaro, full page: (LINK).]

Chikungunya: 2 morts en en Polynésie française [      ]

L'épidémie de chikungunya qui sévit en Polynésie française a fait deux nouvelles victimes, a annoncé jeudi le gouvernement de la collectivité. Il s'agit d'un homme de 80 ans souffrant d'insuffisance rénale et d'un nourrisson de huit jours...

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#Taiwan, #H7N9 #avian #influenza virus detected in fecal #samples from wild #ducks (Ifeng, November 27 2014, edited)

[Source: Ifeng, full page in Chinese: (LINK). Automatic translation, edited.]

#Taiwan, #H7N9 #avian #influenza virus detected in fecal #samples from wild #ducks [      ]

At 10:35 on November 27, 2014  / Source: 华夏经纬网

November 27 news: According to Taiwan media reports, the autumn and winter is the peak of bird flu, the island once again duck feces detected H7N9 avian influenza virus.

Taiwan … released last night, Tainan four grass wetlands ducks feces detected H7N9, … subtype avian influenza virus, the preliminary conclusion and ravaged the continent, resulting in the death of the gene sequence of human infection with H7N9 viruses, further analysis will announced tomorrow.

According to reports, the island's routine monitoring of bird flu, has been detected as of the end of October twenty-three thousand pieces. "Prevention and Quarantine Bureau," 17 Wild Bird Society of Taipei entrusted execution excrement routine monitoring of migratory birds, wetland grass in Tainan four ducks collected 20 stool tests after animal health inspection, the 25th confirmed detection of H7N9, H7N5 two kinds virus.

"Prevention and Quarantine Bureau deputy director," said …, initially confirmed the two viruses are "low pathogenic" and would not result in a large number of infected birds, dead, prima facie gene sequences from the mainland H7N9 virus strain is different, but there is another two required analysis to confirm that the test results will be announced tomorrow.

This is not the first time the island detected H7N9, H7N5 virus in migratory bird feces. Both viruses have in Tainan four ducks grass excrement detected in 2009, 2010 Ilan Chiaohsi excrement in birds has detected H7N9.

Because there were three hectares of wetlands around six poultry farms, animal epidemic prevention Tainan Protection Division on the 25th to start the epidemic visits, only a chicken. … that confirmed not infected with both viruses detected, and no antibodies, represent the past have not been infected, the next three months will strengthen the sampling.

Currently the island's poultry farms if detected H7N9, low pathogenic still listed after counseling, the principle of full high disease culled. Animal Health Research Institute, former director Liu Peibo reminder, although mainland H7N9 low pathogenic for poultry, but it will cause human deaths, the "anti-CIQ" should strengthen the island's poultry H7N9 serum antibody test, even if the detection of low pathogenic should full culled.

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#Allergic #reactions after #egg-free recombinant #influenza #vaccine: reports to the #US Vaccine Adverse Event Reporting System (Clin Infect Dis., abstract, edited)

[Source: Clinical Infectious Diseases Journal, full page: (LINK). Abstract, edited.]

Allergic reactions after egg-free recombinant influenza vaccine: reports to the US Vaccine Adverse Event Reporting System [      ]

Emily Jane Woo

Author Affiliations: Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland USA

Correspondence: jane.woo@fda.hhs.gov, 10903 New Hampshire Avenue, Building 71, Room 1028, Silver Spring, Maryland 20993 USA, Telephone (240) 402-8828, Fax (301) 595-1240

 

Abstract

The Vaccine Adverse Event Reporting System has received reports of allergic reactions following immunization with egg-free recombinant influenza vaccine, among patients with a self-reported egg allergy or previous allergic reaction to inactivated influenza vaccine. These results suggest that allergic reactions following influenza vaccination are not necessarily related to egg proteins.

Received September 18, 2014. Accepted November 14, 2014.

Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2014. This work is written by (a) US Government employee(s) and is in the public domain in the US.

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One #Step Closer to an #Ebola Virus #Vaccine (N Engl J Med., extract)

[Source: The New England Journal of Medicine, full page: (LINK). Extract.]

Editorial

One Step Closer to an Ebola Virus Vaccine [      ]

Daniel G. Bausch, M.D., M.P.H.&T.M.

November 26, 2014 / DOI: 10.1056/NEJMe1414305

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Despite cautious optimism from the apparent recent slowing of the spread of Ebola virus disease (EVD) in some parts of West Africa,1 the remaining pockets of intense transmission and the recent incursion of the virus into Mali 2 remind us that the battle for control is still on. This is no time to be complacent. The scale of this outbreak, in which every few days about the same number of cases accrue as occurred during the entire 3-month outbreak in Gulu, Uganda, in 2000–2001 — previously the largest outbreak on record — has prompted us to pull out all the stops, albeit after a slow start.3 Vaccines constitute a key, but still theoretical, weapon in our armamentarium against EVD. For some years, a number of promising vaccine candidates have been identified, with many more in development. The two leading candidates are vectored vaccines in which the Ebola virus glycoprotein is presented in a replication-incompetent chimpanzee adenovirus 3 (cAd3) or a replication-competent vesicular stomatitis virus (VSV). Both vaccines have shown 100% protection in nonhuman primates at 4 to 5 weeks after single doses were administered and have now been rushed into phase 1 trials in hopes that the promise of a vaccine to help stem the crisis in Africa can be more than theoretical.

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#Chimpanzee #Adenovirus Vector #Ebola #Vaccine — Preliminary #Report (N Engl J Med., abstract, edited)

[Source: The New England Journal of Medicine, full page: (LINK). Abstract, edited.]

Original Article

Chimpanzee Adenovirus Vector Ebola Vaccine — Preliminary Report [      ]

Julie E. Ledgerwood, D.O., Adam D. DeZure, M.D., Daphne A. Stanley, M.S., Laura Novik, M.A., Mary E. Enama, M.A., Nina M. Berkowitz, M.P.H., Zonghui Hu, Ph.D., Gyan Joshi, M.S., Aurélie Ploquin, Ph.D., Sandra Sitar, M.S., Ingelise J. Gordon, R.N., Sarah A. Plummer, C.R.N.P., LaSonji A. Holman, F.N.P., Cynthia S. Hendel, C.R.N.P., Galina Yamshchikov, M.S., Francois Roman, M.D., Alfredo Nicosia, Ph.D., Stefano Colloca, Ph.D., Riccardo Cortese, M.D., Robert T. Bailer, Ph.D., Richard M. Schwartz, Ph.D., Mario Roederer, Ph.D., John R. Mascola, M.D., Richard A. Koup, M.D., Nancy J. Sullivan, Ph.D., Barney S. Graham, M.D., and the VRC 207 Study Team

November 26, 2014 / DOI: 10.1056/NEJMoa1410863

 

Abstract

Background

The unprecedented 2014 epidemic of Ebola virus disease (EVD) has prompted an international response to accelerate the availability of a preventive vaccine. A replication-defective recombinant chimpanzee adenovirus type 3–vectored ebolavirus vaccine (cAd3-EBO), encoding the glycoprotein from Zaire and Sudan species that offers protection in the nonhuman primate model, was rapidly advanced into phase 1 clinical evaluation.

Methods

We conducted a phase 1, dose-escalation, open-label trial of cAd3-EBO. Twenty healthy adults, in sequentially enrolled groups of 10 each, received vaccination intramuscularly in doses of 2×1010 particle units or 2×1011 particle units. Primary and secondary end points related to safety and immunogenicity were assessed throughout the first 4 weeks after vaccination.

Results

In this small study, no safety concerns were identified; however, transient fever developed within 1 day after vaccination in two participants who had received the 2×1011 particle-unit dose. Glycoprotein-specific antibodies were induced in all 20 participants; the titers were of greater magnitude in the group that received the 2×1011 particle-unit dose than in the group that received the 2×1010 particle-unit dose (geometric mean titer against the Zaire antigen, 2037 vs. 331; P=0.001). Glycoprotein-specific T-cell responses were more frequent among those who received the 2x1011 particle-unit dose than among those who received the 2×1010 particle-unit dose, with a CD4 response in 10 of 10 participants versus 3 of 10 participants (P=0.004) and a CD8 response in 7 of 10 participants versus 2 of 10 participants (P=0.07).

Conclusions

Reactogenicity and immune responses to cAd3-EBO vaccine were dose-dependent. At the 2×1011 particle-unit dose, glycoprotein Zaire–specific antibody responses were in the range reported to be associated with vaccine-induced protective immunity in challenge studies involving nonhuman primates. Clinical trials assessing cAd3-EBO are ongoing. (Funded by the Intramural Research Program of the National Institutes of Health; VRC 207 ClinicalTrials.gov number, NCT02231866.)

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26 Nov 2014

#Alabama #health officials begin #investigation of contaminated #dietary #product (ADPH News Releases, November 26 2014, edited)

[Source: State of Alabama Department of Health, full PDF document: (LINK). Edited.]

Alabama health officials begin investigation of contaminated dietary product [      ]

FOR IMMEDIATE RELEASE / CONTACT: Mary McIntyre, M.D., M.P.H., (334) 206-5971

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The Alabama Department of Public Health is participating with other local, state and federal health agencies in an investigation of a dietary supplement product following the death of a premature infant in Connecticut from gastrointestinal (GI) mucormycosis.

The infant had received ABC Dophilus® Powder, a dietary supplement product containing viable microbial ingredients purchased from Solgar, Inc., Leonia, N.J.

The product claimed to have “probiotic” properties and is marketed for infants and children.

A Health Alert Notification is being sent to Alabama health care workers in neonatal intensive care units, hospital pharmacies, pediatricians and primary care providers, as well as to microbiology and pathology laboratories.

Mucormycosis is a rare infection caused by mold. GI mucormycosis is a very rare manifestation of this disease and occurs when mucormycosis involves the GI tract causing signs and symptoms such as the following:

  • Abdominal pain
  • Abdominal distension
  • Nausea
  • Vomiting

The Alabama investigation began after the U.S. Food and Drug Administration was notified of the death of the infant who had ingested the contaminated product.

The FDA listed Alabama as being one of the states that received this product.

Anyone who has used the product and has developed symptoms is asked to contact FDA MedWatch and the Alabama Department of Public Health. This investigation is still very early and rapidly evolving. Information is subject to change.

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Middle East respiratory syndrome #coronavirus [#MERS-CoV]: #Implications for #health care #facilities (ScienceDirect, abstract, edited)

[Source: Science Direct, full page: (LINK). Abstract, edited.]

American Journal of Infection Control, Volume 42, Issue 12, December 2014, Pages 1261–1265 / State of the Science Review

Middle East respiratory syndrome coronavirus: Implications for health care facilities [      ]

Helena C. Maltezou, MD, PhDa, Sotirios Tsiodras, MD, PhDb

doi:10.1016/j.ajic.2014.06.019

Referred to by: Ziad A. Memish, Jaffar A. Al-Tawfiq, Middle East respiratory syndrome coronavirus infection control: The missing piece?, American Journal of Infection Control, Volume 42, Issue 12, December 2014, Pages 1258-1260, PDF (234 K)

 

Highlights

  • Health care–associated transmission plays a pivotal role in the Middle East respiratory syndrome coronavirus epidemic.
  • Gaps in infection control were noted in all health care–associated events.
  • There is a need to increase infection control capacity.
  • Studies about the effectiveness of infection control measures are needed.
  • Vaccines and antiviral agents against Middle East respiratory syndrome coronavirus are urgently needed.

 

Background

Middle East respiratory syndrome coronavirus (MERS-CoV) is a novel coronavirus that causes a severe respiratory disease with high case fatality rate. Starting in March 2014, a dramatic increase of cases has occurred in the Arabian Peninsula, many of which were acquired in health care settings. As of May 9, 2014, 536 laboratory-confirmed cases and 145 deaths have been reported globally.

Methods

Review of publicly available data about MERS-CoV health care–associated transmission.

Results

We identified 11 events of possible or confirmed health care–associated transmission with high morbidity and mortality, mainly among patients with comorbidities. Health care workers are also frequently affected; however, they tend to have milder symptoms and better prognosis. Gaps in infection control were noted in all events. Currently, health care–associated outbreaks are playing a pivotal role in the evolution of the MERS-CoV epidemic in countries in the Arabian Peninsula.

Conclusion

There is a need to increase infection control capacity in affected areas and areas at increased risk of being affected to prevent transmission in health care settings. Vaccines and antiviral agents are urgently needed. Overall, our knowledge about the epidemiologic characteristics of MERS-CoV that impact health care transmission is very limited. As the MERS-CoV epidemic continues to evolve, issues concerning best infection control measures will arise, and studies to better define their effectiveness in real life are needed.

Key Words: Middle East respiratory syndrome coronavirus; Middle East respiratory syndrome; Hospital; Health care associated; Outbreak; Health care workers

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The opinions presented in this article are those of the authors and do not necessarily represent those of their institutions.

Conflicts of interest: None to report.

Address correspondence to Helena C. Maltezou, MD, PhD, Department for Interventions in Health-Care Facilities, Hellenic Center for Disease Control and Prevention, 3-5 Agrafon St, Athens, 15123 Greece.

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#Ebola #response roadmap–#Situation #report, 26 November 2014 (@WHO, edited)

[Source: World Health Organization, full page: (LINK). Edited.]

Ebola response roadmap - Situation report, 26 November 2014 [      ]

Now available in an interactive map journal that shows the evolution of the outbreak and the global response. [Download PDF]

 

HIGHLIGHTS

  • There have been 15 935 reported cases of Ebola virus disease (EVD), with 5689 reported deaths.
  • 600 cases were reported in the three most-affected countries in the past week.
  • Case incidence is stable in Guinea, stable or declining in Liberia, but may still be increasing in Sierra Leone.
  • Uncertainties in data preclude firm conclusions about progress towards UNMEER goals.
  • Over 70% of patients with EVD in Guinea are isolated, while over 80% of required safe and dignified burial teams are in place.
    • Liberia and Sierra Leone report that fewer than 70% of patients are isolated, though there is wide variation among districts.
    • Approximately 25% of the required safe burial teams are in place in both countries, though this does not include military burial teams.

View data http://apps.who.int/gho/data/node.ebola-sitrep.ebola-summary?lang=en

 

Summary

A total of 15 935 confirmed, probable, and suspected cases of Ebola virus disease (EVD) have been reported in six affected countries (Guinea, Liberia, Mali, Sierra Leone, Spain and the United States of America) and two previously affected countries (Nigeria and Senegal) up to the end of 23 November.

There have been 5689 reported deaths.

Cases and deaths continue to be under-reported in this outbreak.

Reported case incidence is stable in Guinea (148 confirmed cases reported in the week to 23 November), stable or declining in Liberia (67 new confirmed cases in the week to 23 November), and may still be rising in Sierra Leone (385 new confirmed cases in the week to 23 November).

The total number of cases reported in Sierra Leone since the outbreak began will soon eclipse the number reported from Liberia.

The case fatality rate across the three most-affected countries in patients with a recorded definitive outcome is approximately 60%.

Three health-care workers were reported infected with EVD in Guinea in the week to 23 November. 

Response activities continue to intensify in line with the UNMEER aim to isolate 70% of EVD cases and safely bury 70% of EVD-related deaths by 1 December.

Guinea isolates over 70% of all reported cases of EVD, and has more than 80% of required safe burial teams.

Progress on isolation and safe burials has apparently been slower in parts of Liberia and Sierra Leone, although uncertainties in data preclude firm conclusions.

At a national level, both countries are apparently unable to isolate 70% of patients, although data on isolation is up to 3 weeks out of date.

Every EVD-affected district in the three intense-transmission countries has access to a laboratory for case confirmation within 24 hours of sample collection.

All three countries report that more than 80% of registered contacts associated with known cases of EVD are traced, though the low mean number of contacts registered per case suggests that contact tracing is still a challenge in areas of intense transmission.  

 

OUTLINE

This situation report on the Ebola Response Roadmap contains a review of the epidemiological situation based on official information reported by ministries of health, and an assessment of the response measured against the core Roadmap indicators where available. Substantial efforts are ongoing to improve the availability and accuracy of information about both the epidemiological situation and the implementation of response measures.

Following the Roadmap structure, country reports fall into three categories:

  1. those with widespread and intense transmission (Guinea, Liberia and Sierra Leone);
  2. those with or that have had an initial case or cases, or with localized transmission (Mali, Nigeria, Senegal, Spain and the United States of America); and
  3. those countries that neighbour or have strong trade ties with areas of active transmission. A separate, unrelated outbreak of EVD in the Democratic Republic of the Congo has now been declared over.

 

1. COUNTRIES WITH WIDESPREAD AND INTENSE TRANSMISSION

A total of 15 901 confirmed, probable, and suspected cases of EVD and 5674 deaths have been reported up to the end of 23 November 2014 by the Ministries of Health of Guinea and Sierra Leone, and 22 November by the Ministry of Health of Liberia (table 1). The data are reported through WHO country offices.

 

Table 1: Confirmed, probable, and suspected cases in Guinea, Liberia, and Sierra Leone

[Country - Case definition - Cumulative cases - Cases in past 21 days - Cumulative deaths]

  • Guinea
    • Confirmed – 1850 – 374 – 1050
    • Probable – 210 – * – 210
    • Suspected – 74 – * – 0
      • Total – 2134 – 374 – 1260
  • Liberia
    • Confirmed – 2727 - 319** – ‡
    • Probable – 1754 – * – ‡
    • Suspected – 2687 – * – ‡
      • Total – 7168 - 319** – 3016
  • Sierra Leone
    • Confirmed – 5441 – 1339 – 1189
    • Probable – 79 – * – 174
    • Suspected – 1079 – * – 35
      • Total – 6599 – 1339 – 1398
  • Total - 15 901 – 2032 – 5674

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Data are based on official information reported by ministries of health, through WHO country offices. These numbers are subject to change due to ongoing reclassification, retrospective investigation and availability of laboratory results.

*Not reported due to the high proportion of probable and suspected cases that are reclassified.

**Data available for past 20 days only.

Data not available.

§Data missing for 23 November.

View data http://apps.who.int/gho/data/node.ebola-sitrep.ebola-summary?lang=en

 

Guinea

A total of 148 new confirmed cases were reported nationally during the week to 23 November (figure 1), compared with 81 cases the week before.

The south-eastern districts of Macenta (26 new confirmed cases), N’Zerekore (29 new confirmed cases), and Kerouane (8 new confirmed cases) accounted for 43% of all new cases reported in the country during the past week (figure 4).

However, the district at the outbreak’s epicentre, Gueckedou, which neighbours Macenta, reported only 2 new confirmed cases in the week to 23 November, and has reported no more than 3 confirmed cases in any one of the past 6 weeks.

Similar to the districts of Kenema in Sierra Leone and Lofa in Liberia, Gueckedou, is one of several districts in the outbreak to date to have successfully brought down a very high case incidence to a level low enough to end local chains of transmission.

 

Figure 4: Geographical distribution of new and total confirmed and probable* cases in Guinea, Liberia, Mali and Sierra Leone

image2

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Data are based on situation reports provided by countries. The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement. Data are missing from Liberia for 23 November.

*Data for the past 21 days represent confirmed cases in Guinea, Sierra Leone, and Mali. Data for the past 21 days represent probable cases in Liberia due to the unavailability of systematic district-level data on laboratory confirmed cases before 16 November.

View interactive map  http://maps.who.int/SimpleViewer_WHO?appid=3ada31510f2046d0939f0a1f362b241f

In the west of the country, the capital, Conakry, reported 6 new confirmed cases in the week to 23 November (figure 1). The neighbouring districts of Coyah (10 confirmed cases), Dubreka (6 confirmed cases), and Kindia (11 confirmed cases) all reported an increase in the number of new reported cases compared with each of the previous 2 weeks.

In the centre of the country, the district of Dabola reported its first confirmed case for 3 weeks, while the neighbouring district of Faranah, on the border with Sierra Leone, reported 16 new confirmed cases in the week to 23 November: more than the combined total of confirmed cases for the previous 6 weeks. The district of Siguiri, which borders Mali, reported 3 new confirmed cases, and has now reported between 1 and 3 cases for each of the past 6 weeks.

Of a total of 34 districts in Guinea, 10 are yet to report a case of EVD.

 

Figure 1: Confirmed and probable Ebola virus disease cases reported each week from Guinea and Conakry

image3

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The graphs in figures 1-3 show the number of new cases reported each week in country situation reports (in dark blue; beginning from epidemiological week 38, 15-21 September) and from patient databases (light blue). The patient databases give the best representation of the history of the epidemic, and include confirmed and probable cases. However, data for the most recent weeks are sometimes less complete than in the weekly situation reports. Situation reports contain confirmed cases only. These numbers are subject to change due to ongoing reclassification, retrospective investigation and availability of laboratory results.

View data http://apps.who.int/gho/data/node.ebola-sitrep.ebola-country-GIN-latest?lang=en

 

Liberia

Case incidence has stabilized over the past 5 weeks, after declining from mid-September until mid-October. A total of 67 confirmed cases were reported in the week to 23 November.

The district of Montserrado, which includes the capital Monrovia, reported 40 confirmed cases: 60% of all cases reported in Liberia in the week to 23 November. Bomi (2 cases), Bong (10 cases), Grand Bassa (1 case), Grand Cape Mount (12 cases), and Margibi (2 cases) are the only other districts to report a case during the same period.

The district of Lofa, in the north of the country and on the border with Guinea and Sierra Leone, reported no cases for the fourth consecutive week.

 

Figure 2: Confirmed and probable* Ebola virus disease cases reported each week from Liberia and Monrovia

image4

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*Situation report data are laboratory confirmed cases only. Systematic data on laboratory confirmed cases have been available since 3 November nationally, and since 16 November for each district. Data missing for 23 November.

View data http://apps.who.int/gho/data/node.ebola-sitrep.ebola-country-SLE-latest?lang=en

 

Sierra leone

EVD transmission remains intense in Sierra Leone, with 385 new confirmed cases reported in the week to 23 November, compared with 533 cases the previous week.

Much of this was driven by intense transmission in the country’s west and north.

The worst affected area remains the capital, Freetown, which reported 118 new confirmed cases (figure 3).

Transmission remains persistent and intense across the country with the exception of the south east, with the districts of Bo (14 cases), Bombali (54 cases), Kono (16 cases), Moyamba (10 cases), Port Loko (72 cases), Tonkolili (31 cases), and Western Rural Area (55 cases) all reporting high numbers of new confirmed cases.

By contrast, several districts in the south east have reported very few new cases in recent weeks.

Kenema and Kailahun reported 1 and 2 cases, respectively. The single case in Kenema was its first since 1 November. Bonthe was the only district not to report a case in the week to 23 November.

 

Figure 3: Confirmed Ebola virus disease cases reported each week from Sierra Leone and Freetown

image5

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View data http://apps.who.int/gho/data/node.ebola-sitrep.ebola-country-LBR-latest?lang=en

 

RESPONSE IN COUNTRIES WITH WIDESPREAD AND INTENSE TRANSMISSION

A comprehensive 90-day plan has been implemented to control and reverse the EVD outbreak in West Africa (see UN Mission for Ebola Emergency Response: Annex 2). Among the plan’s key objectives is to isolate at least 70% of EVD cases and bury at least 70% of patients who die from EVD in a safe and dignified manner by 1 December 2014 (the 60-day target). The ultimate goal is to have capacity to isolate 100% of EVD cases and safely bury 100% of patients who die from EVD by 1 January 2015 (the 90-day target). Tables 2 to 4 provide information on progress for each of the three countries with widespread and intense transmission.

 

Table 2. Key performance indicators for the Ebola response in Guinea

image6

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*Priority indicator. Targets are as per original UNMEER planning figures. Definitions for each indicator are found in Annex 2.

 

Table 3. Key performance indicators for the Ebola response in Liberia

image7

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*Priority indicator. Due to a lack of available data, isolation is reported for the 21 days to 9 November for Liberia, and should not therefore be taken as an indication of the current isolation rate.

 

Table 4. Key performance indicators for the Ebola response in Sierra Leone

image8

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*Priority indicator. Due to complications with the patient database in Sierra Leone, isolation data are reported for the 21 days to 2 November, and should not therefore be taken as an indication of the current isolation rate.

 

Case management

Isolation of patients with EVD in Ebola Treatment Centres (ETCs) and Community Care Centres (CCCs) is necessary to prevent further transmission of the disease. CCCs provide an alternative to care in ETCs in areas where there is insufficient ETC capacity, and remote areas that are not yet served by an ETC. Compared with ETCs, CCCs are smaller, with 8 to 15 beds per facility. This means they are easier to set up, which enables response coordinators to provide more rapid, flexible coverage dispersed over a wider geographical area.

In Guinea, 253 of 256 (99%) probable and confirmed EVD cases reported during the 21 days to 16 November, and whose hospitalization status is known, were hospitalized and isolated (table 2). This equates to 75% of all 336 EVD cases reported in Guinea during the same period, including those cases whose records do not contain data on isolation or hospitalization. Approximately 78% of all cases reported during the same period are recorded as hospitalized.

In Liberia, 57 of 245 (23%) probable and confirmed EVD cases reported during the 21 days to 9 November, and whose hospitalization status is known, were hospitalized and isolated (table 3). This equates to 20% all 282 EVD cases reported in Liberia during the same period, including those cases whose records do not contain data on isolation or hospitalization. Just under 30% of all cases reported during the same period are recorded as hospitalized.

In Sierra Leone, 308 of 773 (40%) probable and confirmed EVD cases reported during the 21 days to 2 November, and whose hospitalization status is known, were hospitalized and isolated (table 4). This equates to 19% of all 1582 EVD cases reported in Sierra Leone during the same period, including those cases whose records do not contain data on isolation or hospitalization. Approximately 27% of all cases reported during the same period are recorded as hospitalized.

As of 26 November, 1188 ETC beds were operational and able to receive patients (160 in Guinea, 672 in Liberia, and 356 in Sierra Leone; figure 5) across the three intense-transmission countries. According to recent data there are around 600 new reported cases of EVD every week across the three countries with widespread and intense transmission.

As at 5 November, 60 CCC beds were operational in Liberia and Sierra Leone. This number is likely to have increased, but more current data is not available. WHO is working with key partners, including the US Centers for Disease Control and Prevention, UNICEF, Médecins Sans Frontières, and others, to establish additional CCCs. Guidelines on the implementation of CCCs are being finalized.

 

Figure 5. Ebola Treatment Centres in Guinea, Liberia and Sierra Leone

image9

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View interactive map  http://maps.who.int/SimpleViewer_WHO/?appid=db5b7dd7dcb448ec8a2e50620f3d5e09

 

Case fatality

As at 23 November, the case fatality rate among all patients recorded as hospitalized in the three intense-transmission countries since the outbreak began, and for whom there is a definitive outcome recorded, is 60% in Guinea, 61% in Liberia, and 60% in Sierra Leone. In a subset of 282 HCWs for whom a definitive outcome has been reported, the case fatality rate is 63%.

 

Safe and dignified burials

The bodies of patients who have died from EVD are extremely infectious. Therefore, conducting burials in a safe and dignified manner is a crucial component of efforts to halt the transmission of the disease.

An estimated 370 trained burial teams are needed to provide adequate coverage across the three countries with widespread and intense transmission. As of 9 November, 131 trained teams were operational: 50 teams in Guinea, 57 teams in Liberia, and 24 teams in Sierra Leone. All reported burial teams in Guinea are organized by the International Federation of Red Cross and Red Crescent Societies (IFRC). Burial teams in Sierra Leone and Liberia are coordinated by multiple organizations, including the IFRC, the ministries of health and international non-governmental organizations.

During the week to 18 November, there were 151 safe and dignified burials in Guinea, 40 in Liberia, and 365 in Sierra Leone reported by IFRC. Data is not reported on how many of these burials were of patients who did not die from EVD, and the number includes some EVD-suspected deaths that were later laboratory-confirmed as negative for the disease. The figures do not exclude burials carried out by military teams.

 

Case confirmation and surveillance

Providing capacity for prompt and accurate diagnosis of cases of EVD is an integral part of the response to the EVD outbreak. All 53 EVD-affected districts (those that have ever reported a probable or confirmed case) have access to laboratory support (figure 6). Access is defined as having the logistical capacity to transport a sample to a laboratory by road within 24 h of sample collection.

Fourteen laboratories have the capacity to confirm EVD cases – 3 in Guinea, 6 in Liberia, and 5 Sierra Leone. These laboratories currently serve 24 affected districts in Guinea, 15 in Liberia and 14 in Sierra Leone.

Between 1150 and 1170 samples are tested daily in laboratories in the three countries. The maximum testing capacity for each laboratory ranges from 50 to 100 samples per day.

Effective contact tracing ensures that the reported and registered contacts of confirmed EVD cases are visited daily to monitor the onset of symptoms during the 21-day incubation period of the Ebola virus. Contacts presenting symptoms should be promptly isolated, tested for EVD, and if necessary treated, to prevent further disease transmission.

During the week to 23 November, 4559 new contacts were identified and traced in Guinea, Liberia and Sierra Leone, compared with 5301 new contacts in the previous week. Overall, 89% of all registered contacts were visited on a daily basis between 17 and 23 November. In Guinea, 96% (25 926 of 26 963) of registered contacts were reached on a daily basis. In Liberia, 94% (35 183 of 37 539) of registered contacts were reached on a daily basis. 86% of contacts (104 454 of 122 108) were reached daily in Sierra Leone. However, the proportion of contacts reached was lower in many districts. Each district is reported to have at least one contact-tracing team in place.

On average, 6 contacts were listed per new case in Guinea during the past week, 21 in Liberia, and 6 in Sierra Leone. These numbers are relatively low, and suggest that in districts with high case incidence fewer contacts are currently registered in connection with each new case than is necessary to accurately monitor chains of transmission. Active case finding teams are being mobilized as a complementary case-detection strategy in several areas.

 

Figure 6. Status of laboratories deployed in the affected countries to support the Ebola outbreak response

image10

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View interactive map  http://maps.who.int/SimpleViewer_WHO?appid=8d828018a301404ab018a6a55a5fcd5a

 

Health-care workers

A total of 592 health-care workers (HCWs) are known to have been infected with EVD up to the end of 23 November, 340 of whom have died (table 5). The total case count includes 2 HCWs in Mali, 11 HCWs infected in Nigeria, 1 HCW infected in Spain while treating an EVD-positive patient, and 3 HCWs in the US (including a HCW infected in Guinea, and 2 HCWs infected during the care of a patient in Texas).

 

Table 5: Ebola virus disease infections in health-care workers in the three countries with intense transmission

[Country – Cases – Deaths]

  • Guinea – 97  - 56
  • Liberia – 342 – 172
  • Sierra Leone – 136 – 105
  • Total – 575 – 333

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Data are based on official information reported by ministries of health. These numbers are subject to change due to ongoing reclassification, retrospective investigation and availability of laboratory results.

Extensive investigations to determine the source of exposure in each case are being undertaken. Early indications are that a substantial proportion of infections occurred outside the context of Ebola treatment and care centres. This reinforces the need to adhere to infection prevention and control measures at all health-care facilities, not just EVD-related facilities. WHO has conducted a review of personal protective equipment (PPE) guidelines for HCWs who provide direct care to patients, and has updated its guidelines in the context of the current EVD outbreak. Comprehensive mandatory training in the use of PPE, and mentoring for all users before engaging in clinical care, is considered fundamental for the protection of HCWs and patients.

 

Social mobilization and community engagement

UNICEF is the lead agency in social mobilization during this outbreak. A joint WHO-UNICEF team has visited the three intense-transmission countries to review and assist them with their social mobilization plans.

 

Budget

As at 24 November, WHO had received US$162 million, with a further $35 million pledged.

 

2. COUNTRIES WITH AN INITIAL CASE OR CASES, OR WITH LOCALIZED TRANSMISSION

Five countries (Mali, Nigeria, Senegal, Spain and the United States of America) have reported a case or cases imported from a country with widespread and intense transmission (table 6).

A total of 8 cases (7 confirmed and 1 probable), including 6 deaths (5 confirmed, 1 probable), have now been reported in Mali (figure 1).

The most recent cases are in the Malian capital Bamako, and are not related to the country’s first EVD case, who died in Kayes on 24 October.

All identified contacts connected with the initial case have now completed 21 day follow-up.

On 24 November 2014, 285 of 288 current contacts linked with the outbreak in Bamako were followed-up.

 

Table 6: Ebola virus disease cases and deaths in Mali, Spain and the United States of America

[Country - Cumulative cases - Contact tracing – Confirmed – Probable – Suspect – Deaths - Health-care workers - Listed contacts to be followed - Contacts completing 21 days of follow up - Date of the second negative test or death - Number of days since second negative test/discharge]

  • Mali – 7 – 1 – 0 – 6 - 25% – 288  - 118 - N/A - N/A
  • Spain – 1 – 0 – 0 – 0 - 100% – 0 – 83 - 21/10/2014 – 36
  • United States of America – 4 – 0 – 0 – 1 - 75% – 0 – 177 - 11/11/2014* – 16

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*Includes two HCWs infected in the USA while treating a patient with EVD from Liberia, and a HCW infected in Guinea.

Data are based on official information reported by ministries of health. These numbers are subject to change due to ongoing reclassification, retrospective investigation and availability of laboratory results.

In Spain, 36 days have passed since the HCW infected while caring for a patient with EVD in Madrid tested negative twice and was discharged from hospital. Spain will therefore be declared free of EVD 42 days (double the 21-day incubation period of the Ebola virus) after the date of the second negative test if no new cases are reported. All 83 contacts of the HCW have completed 21-day follow-up.

In the United States of America, there have been 4 cases of EVD and 1 death. One HCW in New York and 2 HCWs in Texas have tested negative for EVD twice and have been released from hospital. All contacts in the country have completed the 21-day follow-up period.

In Nigeria, there were 20 cases and 8 deaths. In Senegal, there was 1 case and no deaths. However, following a successful response in both countries, the outbreaks of EVD in Senegal and Nigeria were declared over on 17 October and 19 October 2014, respectively.

 

3. PREPAREDNESS OF COUNTRIES TO RAPIDLY DETECT AND RESPOND TO AN EBOLA EXPOSURE

The evolving EVD outbreak highlights the considerable risk of cases being imported into unaffected countries. With adequate levels of preparation, however, such introductions of the disease can be contained before they develop into large outbreaks.

The success of Nigeria and Senegal in halting the transmission of EVD highlights the critical importance of preparedness. Key factors in preventing the spread of EVD in both countries included strong political leadership, early detection and response, public awareness campaigns, and strong support from partner organizations.

Fifteen countries that neighbour countries with widespread and intense transmission, or that otherwise have strong trade and travel ties with countries with widespread and intense transmission, have been prioritized for technical assistance on preparedness from specialist WHO teams and partners. These countries are: Benin, Burkina Faso, Cameroon, Central African Republic, Cote D’Ivoire, Democratic Republic of Congo, Gambia, Ghana, Guinea Bissau, Mali, Mauritania, Nigeria, Senegal, South Sudan, and Togo.

WHO and partners are supporting these countries to help increase their level of preparedness. A team was deployed to Mali and Cote d’Ivoire in October. As of 26 November teams have visited Benin, Burkina Faso, Cameroon, Gambia, Ghana, Guinea Bissau, Senegal, Mauritania, and Togo. Visits to the Central African Republic, Niger, and Ethiopia are planned for the week beginning 1 December.

WHO has developed the Consolidated Ebola Virus Disease Preparedness Checklist to help countries ensure they are ready to respond, should there be a case or cases of EVD. The checklist, along with other tools such as simulation exercises, help countries to assess and test their level of readiness. They can be used as the basis to identify action to be taken by countries and the international community to close potential gaps. The consolidated checklist identifies 10 key components and tasks for countries and the international community that should be completed within 30, 60 and 90 days from the date of issuing the list. Components include overall coordination, rapid response, public awareness and community engagement, infection prevention and control, case management of ETCs, safe burials, epidemiological surveillance, contact tracing, laboratory capacity, and capacity building for points of entry.

WHO, the UN and other partners are accelerating the deployment of international preparedness strengthening teams to help countries build upon their existing work and planning. At the end of each mission, technical experts remain in country to support and maximize capacity-building efforts to prepare for public health emergencies, including EVD.

(…)

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#Euthanasia #assessment in #ebola virus infected nonhuman #primates. (Viruses., abstract, edited)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Viruses. 2014 Nov 24;6(11):4666-82. doi: 10.3390/v6114666.

Euthanasia assessment in ebola virus infected nonhuman primates. [      ]

Warren TK1, Trefry JC2, Marko ST3, Chance TB4, Wells JB5, Pratt WD6, Johnson JC7, Mucker EM8, Norris SL9, Chappell M10, Dye JM11, Honko AN12.

Author information: 1US Army Medical Research Institute for Infectious Diseases, 1425 Porter St., Fort Detrick, MD 21702, USA. travis.k.warren.ctr@mail.mil. 2US Army Medical Research Institute for Infectious Diseases, 1425 Porter St., Fort Detrick, MD 21702, USA. john.c.trefry.ctr@mail.mil. 3US Army Medical Research Institute for Infectious Diseases, 1425 Porter St., Fort Detrick, MD 21702, USA. shannon.t.marko.mil@mail.mil. 4US Army Medical Research Institute for Infectious Diseases, 1425 Porter St., Fort Detrick, MD 21702, USA. taylor.b.chance.mil@mail.mil. 5US Army Medical Research Institute for Infectious Diseases, 1425 Porter St., Fort Detrick, MD 21702, USA. jay.b.wells.ctr@mail.mil. 6US Army Medical Research Institute for Infectious Diseases, 1425 Porter St., Fort Detrick, MD 21702, USA. william.d.pratt4.civ@mail.mil. 7US Army Medical Research Institute for Infectious Diseases, 1425 Porter St., Fort Detrick, MD 21702, USA. joshua.johnson@nih.gov. 8US Army Medical Research Institute for Infectious Diseases, 1425 Porter St., Fort Detrick, MD 21702, USA. eric.m.mucker.ctr@mail.mil. 9US Army Medical Research Institute for Infectious Diseases, 1425 Porter St., Fort Detrick, MD 21702, USA. sarah.l.norris2.civ@mail.mil. 10US Army Medical Research Institute for Infectious Diseases, 1425 Porter St., Fort Detrick, MD 21702, USA. mark.chappell@usuhs.edu. 11US Army Medical Research Institute for Infectious Diseases, 1425 Porter St., Fort Detrick, MD 21702, USA. john.m.dye1.civ@mail.mil. 12US Army Medical Research Institute for Infectious Diseases, 1425 Porter St., Fort Detrick, MD 21702, USA. anna.honko@nih.gov.

 

Abstract

Multiple products are being developed for use against filoviral infections. Efficacy for these products will likely be demonstrated in nonhuman primate models of filoviral disease to satisfy licensure requirements under the Animal Rule, or to supplement human data. Typically, the endpoint for efficacy assessment will be survival following challenge; however, there exists no standardized approach for assessing the health or euthanasia criteria for filovirus-exposed nonhuman primates. Consideration of objective criteria is important to (a) ensure test subjects are euthanized without unnecessary distress; (b) enhance the likelihood that animals exhibiting mild or moderate signs of disease are not prematurely euthanized; (c) minimize the occurrence of spontaneous deaths and loss of end-stage samples; (d) enhance the reproducibility of experiments between different researchers; and (e) provide a defensible rationale for euthanasia decisions that withstands regulatory scrutiny. Historic records were compiled for 58 surviving and non-surviving monkeys exposed to Ebola virus at the US Army Medical Research Institute of Infectious Diseases. Clinical pathology parameters were statistically analyzed and those exhibiting predicative value for survival are reported. These findings may be useful for standardization of objective euthanasia assessments in rhesus monkeys exposed to Ebola virus and may serve as a useful approach for other standardization efforts.

PMID: 25421892 [PubMed - in process]

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