EBOLA VIRUS DISEASE OUTBREAK UPDATE, THE HARD LESSONS AND INTERVENTIONS: FROM NPHCDA LABS & SURVEILLANCE DESK In a sobering assessment of the ongoing Ebola outbreak in Liberia, World Health Organization (WHO) experts said Monday that thousands more people are likely to fall ill with the deadly Ebola virus within a matter of weeks. The number of new cases is moving far faster than the capacity to manage them in Ebola-specific treatment centers, the WHO said. Transmission of the Ebola virus in Liberia is already intense and the number of new cases is increasing exponentially. The assessment comes from a team of WHO experts who worked with the Liberian government and aid organizations to take stock of the response to the Ebola outbreak in the West African nation. Along with several other countries, Liberia has been hard hit by the outbreak since it began in March. The assessment paints a picture of a country completely overwhelmed by the needs of combating the outbreak, and an anemic international response compared to what will be needed in order to bring the outbreak under control. All agreed that the demands of the Ebola outbreak have completely outstripped the government’s and partners’ capacity to respond. the WHO said. Liberian health care facilities have been particularly hard hit, with 152 workers infected, 79 of whom have died. When the outbreak began, Liberia had only one doctor to treat nearly 100,000 people in a total population of 4.4 million people, the WHO assessment says. Every infection or death of a doctor or nurse depletes response capacity significantly. In other countries, doctors and nurses have also developed Ebola, illustrated by the announcement on Monday that a WHO doctor in Sierra Leone is being evacuated for treatment. The WHO said Liberias Ebola treatment facilities are overflowing with patients, which points to a large but previously invisible caseload. Liberia has the highest cumulative number of reported cases and deaths, with about 2,000 cases and more than 1,000 deaths. The fatality rate, 58%, is among the highest of the countries affected. The ongoing outbreak began in Guinea and spread to Sierra Leone, Liberia and Nigeria. A separate outbreak has also been reported in the Democratic Republic of Congo. The WHO investigative team focused on Montserrado County, Liberia, which includes the capital of Monrovia. In Montserrado County, the team estimated that 1000 beds are urgently needed for the treatment of currently infected Ebola patients. At present only 240 beds are available, with an additional 260 beds either planned or in the process of being put in place. These estimates mean that only half of the urgent and immediate capacity needs could be met within the next few weeks and months. For example, an Ebola treatment facility, hastily improvised by WHO for the Ministry of Health, was recently set up to manage 30 patients but had more than 70 patients as soon as it opened. The WHO assessment found that non-Ebola patients and medical personnel are continuing to be exposed to the disease, since its early symptoms mimic other illnesses, leading patients to be treated in non-isolation wards. 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, the WHO said. The assessment says that intervention efforts are working better in other hard-hit countries, like Sierra Leone and Guinea, compared to Liberia, and that development partners working in Liberia need to prepare to scale up their current efforts by three- to four-fold. Last week, WHO Director-General Margaret Chan said officials need to be prepared for an exponential increase in Ebola cases in countries that are experiencing high rates of disease spread, including Liberia. WHO and its Director-General will continue to advocate for more Ebola treatment beds in Liberia and elsewhere, and will hold the world accountable for responding to this dire emergency with its unprecedented dimensions of human suffering, the assessment says. A recent study published in the journal Science found that the Ebola virus is mutating as the outbreak goes on. It is unclear if these mutations are affecting its virulence or ease of transmission. While mutations in the virus genes are not unusual, the study found a rapid accumulation of them as the virus spreads. In an interview with NBC News on Sunday, President Barack Obama said the virus could change in ways that make it more of a threat to the U.S., if the outbreak is allowed to continue to fester. He said the U.S. military needs to get involved to help set up isolating units and bring other resources to affected countries. If we dont make that effort now, and this spreads not just through Africa, but other parts of the world, theres the prospect then that the virus mutates, it becomes more easily transmittable, and then it could be a serious danger to the United States, Obama said. Reuters is reporting that the US military will set up a 25-bed field hospital in Liberia to treat Ebola patients, at a cost of $22 million. Ebola Virus Likely Entered Sierra Leone After Funeral in Guinea, Study Finds An international team of scientists — some of whom succumbed to the virus during the course of their research — has sequenced 99 Ebola virus genomes from 78 patients in Sierra Leone, creating a valuable trove of genetic data for scientists and health care workers struggling to bring the growing outbreak under control. The study increased the amount of genomic data available on the Ebola virus by four-fold, according to a press release. According to the World Health Organization, the Ebola outbreak in West Africa eventually could exceed 20,000 cases, more than six times as many as are now known, and vastly higher than the largest outbreak-to-date, which included about 400 cases. The study, published Thursday in the journal Science Express, provides clues to the origin of the outbreak in Sierra Leone, in much the same way as police detectives use fingerprints at a crime scene to track down a suspect. The data points to the introduction into Sierra Leone of two genetically distinct lineages of the Ebola virus, officially known as EBOV, from Guinea at about the same time, traced to a dozen individuals who attended the same funeral of an Ebola patient in Guinea. Map of Sierra Leone, including the capital city of Kenema. The genetic data shows that the Ebola strains responsible for the current outbreak are distinct, with unique mutations, but that they likely have a common ancestor traced to the first recorded outbreak in 1976. The ongoing outbreak began in Guinea and spread to Sierra Leone, Liberia and Nigeria. A separate outbreak has also been reported in the Democratic Republic of Congo. We were able to sequence and analyze our samples with about a 10-day turnaround. This is unprecedented, as earlier studies have usually taken many months with much smaller datasets, says Daniel J. Park, a co-author and computational biologist at the Broad Institute, in an email interview with Mashable. The research, which used an advanced genetic analysis technique known as deep sequencing, reveals that the disease is rapidly accumulating mutations as it spreads. The team found 395 genetic changes, including 341 that make this outbreak distinct from the viral genomes tied to previous Ebola outbreaks, and 50 that are unique to the West African outbreak more broadly. Of particular interest are mutations that alter protein sequences, since they could potentially change the accuracy of diagnostic tests for the virus as well as vaccines and therapies. It is unclear if these mutations are related to the severity of the current outbreak, but further genetic analysis could determine this. What we know is that as the virus continues to change during an outbreak. As a result, it might stumble upon evolutionary opportunities that it hasn’t experienced before, Park said. The longer the outbreak continues, the more opportunities the virus has. Whether this will lead to changes that affect disease transmission or progression, we are unable to say. Deep sequencing means that researchers read the Ebola virus genome to a very high level of accuracy and depth, Park said. The EBOV genome (like many other viral genomes) consists of a strand of RNA composed of individual nucleotides (called bases). When we sequence to such a high median coverage, it means the average base in the genome is read over 2000 times. Park says that this technique is extremely accurate since it allows researchers to sequence every single base multiple times, leading to a higher detection rate of mutations that would go unnoticed by conventional sequencing techniques. We can see how the virus changes within an individual. Each infected patient has a very large number of viral particles, and some of these might be slightly different, he said. Using ‘deep sequencing’ we are able to see these differences and therefore get a much better picture of the viral population within an individual host. The new genetic data, which were made freely available in June for researchers online at the National Center for Biotechnology Informations (NCBIs) DNA sequence database, also allowed scientists to trace the diseases entry into Sierra Leone and subsequent spread. According to the study, the Ebola virus disease that is affecting Sierra Leone likely spread from Central Africa about a decade ago. It says the three most recent outbreaks are independent events in which the virus spread from its natural reservoir, which is thought to be fruit bats, to humans. It’s impossible to know for sure how the virus traveled from locations where it’s ancestral variants were located in Central Africa, Park says. Scientists are still struggling to identify the disease reservoir and determine how many different genetic variants of the virus are circulating within it. The only way to really unravel this story would be to sequence the reservoir for Ebola, which is currently thought to be bats, Park says. This deserves deeper investigation, but this may be very difficult technically, as most bats will not carry the virus at a given moment in time. This means that a large number of bats (perhaps thousands) would have to be captured, samples taken, and sequencing performed — all under safe conditions. Our hope is that this effort establishes a precedent for how sequencing can be used in emergency response efforts for an outbreak. Sequencing the pathogen should be an integral part of outbreak response, as it can be very practical in providing insights into disease control, epidemiology, diagnostics, and treatments, Park told Mashable. With sequencing, medical professionals and researchers could, in theory, more quickly identify a pathogens original source, changes its undergoing as it spreads, and deploy changed testing and treatment protocols to take into account any mutations. Sequencing can now be produced very quickly and cheaply, and with negligible disruption in the field. These efforts help to develop scientific and laboratory capabilities on the ground, making for a far more rapid and effective response to epidemics, Park said. Illustration of blood cells. The study was the result of a collaboration between the Broad Institute and Harvard University, as well as European universities and the Sierra Leone Ministry of Health and Sanitation. The five researchers who died of Ebola virus disease before the paper was published were all Sierra Leonean collaborators. According to Park, many of these researchers had family members who contracted the disease, while others were infected while caring for patients. Among the deceased researchers were senior disease experts, such as Sheik Humarr Khan, who was the Director of the National Lassa Fever Program for the Ministry of Health and Sanitation in Sierra Leone. Lassa Fever is another dangerous viral hemorrhagic fever that affects parts of Africa. In addition, Mbalu Fonnie was a senior matron of nursing at the Kenema Government Hospital who specialized in treating Lassa cases in pregnant women. There is an extraordinary battle still ahead, and we have lost many friends and colleagues already like our good friend and colleague Dr. Humarr Khan, a co-senior author here, said study co-author Pardis Sabeti of the Broad Institute. By providing this data to the research community immediately and demonstrating that transparency and partnership is one way we hope to honor Humarrs legacy. We are all in this fight together. The mutational dynamism of Ebolavirus is a challenge in diagnostic tests kit production as well as a major determinant in containment! We are encouraged to buy into the various research opportunities in this area and maintain strict personal hygiene and ensure active surveillance. God is with us! Thank you, Chris Elemuwa Deputy Directo/ Headr, Labs & Surveillance NPHCDA. elemuwachris@yahoo
Posted on: Sun, 14 Sep 2014 18:01:41 +0000
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