Posted on 08/10/2014 12:46:23 AM PDT by Smokin' Joe
and
Pathology of Experimental Aerosol Zaire Ebolavirus Infection in Rhesus Macaques
Lethal experimental infections of rhesus monkeys by aerosolized Ebola virus.
Links lifted from references at Pissin' On The Roses blogspot
(Thanks, Larousse2 for the heads' up)
Keep in mind that an artificially generated aerosol is not indicative of what goes on in the natural course of infection. Ebola is not a respiratory virus in humans; thus, humans do not generate aerosols.
An artificial aerosol would be more along the lines of terrorism.
I really appreciate the link to the countermeasures workshop proceedings. I had not seen that one before. Thank you.
You’re welcome. We may not always agree, but I value your input.
_Pissin’ on the Roses_ has the right idea in tracking federal spending here. That is how I followed the feds’ anthrax preparations in 2002.
(Fictional "what if?")
Thanks for the links. Pretty much aprioristic with winter season on the way.
In case it is related...
Ebola Death Rate 70 Percent, WHO Says in Dire New Forecast
BY MAGGIE FOX
First published September 22nd 2014, 10:55 pm
http://www.nbcnews.com/storyline/ebola-virus-outbreak/ebola-death-rate-70-percent-who-says-dire-new-forecast-n209226
World Health Organization researchers issued a dire new forecast for the Ebola epidemic Tuesday, one that sees 20,000 cases by November. And 70 percent of patients are dying.
That’s a big increase over the previous estimates of a 50 percent fatality rate.
“These data indicate that without drastic improvements in control measures, the numbers of cases of and deaths from Ebola virus disease are expected to continue increasing from hundreds to thousands per week in the coming months,” the WHO Ebola Response Team, led by Dr. Christopher Dye, wrote in a report rushed into print by the New England Journal of Medicine.
This projection includes nearly 10,000 people in Liberia alone. WHO said earlier Monday that more than 5,800 people had been infected with Ebola and more than 2,800 had died of it since the virus first broke out in Guinea in December. “The true numbers of cases and deaths are certainly higher,” they wrote.
But forget about the tales of horrific bleeding from the eyes nose and mouth. Bleeding is one of the most unusual symptoms, the team of experts from around the world said.
Still, it’s looking so bad that Ebola could take permanent hold in West Africa, they said — something that’s never happened before. “For the medium term, at least, we must therefore face the possibility that Ebola virus disease will become endemic among the human population of West Africa,” they said.
“The true case load, including suspected cases and undetected cases, will be higher still.”
What could change that? Quick action by the world, the experts said. That means sending more people to track down potential Ebola cases so they can be isolated and treated, providing better hospital treatment and safer burials, and getting better buy-in from the community. In some places, residents still don’t believe Ebola is a virus, and they have attacked and even killed health workers trying to spread the word about the danger.
Patients are also running away and spreading the disease that way.
To stop the epidemic, transmission must be cut in half, they said. “Considering the prospects for a novel Ebola vaccine, an immunization coverage exceeding 50 percent would have the same effect,” they wrote.
The United States is leading a new response, sending troops and supplies and offering to help coordinate help. WHO and the UN are urging other countries to help. Germany, France, Cuba and China are among countries also sending teams and equipment.
To make the forecast, the team looked at all the available data on the epidemic, which has spread more widely than any previous outbreak of Ebola, in part because it broke out in an area where people travel widely across borders.
It remains clear that close contact with an infected person or their bodily fluids are needed for infection to happen. There’s nothing mysterious about how Ebola spreads, and it’s not as easily transmitted as influenza or measles.
Caregivers and health care workers have a high risk. More than 300 health care workers have been infected, and half of them have died.
The most common first symptoms are fever and fatigue. Hemorrhage — the most feared symptom — is seen in fewer than 5 percent of patients, although about 18 percent had unexplained bleeding, the WHO team said.
“There will be more epidemics and outbreaks of Ebola and other new or re-emerging infections.”
Ebola has an incubation period of 11 days, and people cannot infect others before they begin to show symptoms — unlike flu, which people can pass along before they even feel ill.
One important number is how many other people each patient infects. It’s different for each country, Dye says — an average of 1.7 in Guinea and 1.8 in Liberia. In Sierra Leone, an infected person sickens two other people on average. Some patients infect many more people than that — than a dozen mourners were infected at the funeral of a single traditional healer who died in Sierra Leone, for instance. And some die or recover without infecting anybody else.
Another important number is what’s called doubling time — how long it takes the number of cases to double. This varies greatly from country to country; in Guinea it’s just under 16 days, in Liberia it’s nearly 23 days and in Sierra Leone it’s 30 days. That’s what leads to the projection of 20,000 cases by Nov. 2. “The true case load, including suspected cases and undetected cases, will be higher still,” the WHO team wrote.
Most of those infected are ages 15 to 44, although people those ages only account for 44 percent of the population in those countries. Older patients are more likely to die, and those who have diarrhea, hemorrhage, difficulty breathing or confusion also seem more likely to die.
Most of those who died succumbed on average four days after they were admitted to a hospital or clinic, and if someone survived, it was usually 11 days before they were better enough to go home, on average. It’s possible that patients who get hospital care live longer, the researchers said, but there’s not enough information to say that for sure.
Patients get vastly different care, depending on where they are treated. Three out of four patients treated in the U.S. have recovered or nearly recovered and the fourth has released little information about his condition. They all got the best possible care, including carefully measured and balanced rehydration, 24-hour nursing care, immaculate conditions and experimental treatments, including drugs and transfusions of blood from patients who have recovered.
In West Africa, some lucky patients get good hospital care that includes saline to replace fluids lost to vomiting and diarrhea, antibiotics to prevent other infections, and pain control. But many are given little more than a bed or a space on the floor, and many are also turned away to die at home or in the streets. So it’s hard to say what will save someone’s life.
The report strongly suggests what doctors is saying is true — there’s nothing unusual about the virus itself, say Dr. Peter Piot of the London School of Hygiene and Tropical Medicine, who helped discovered Ebola, and Dr. Jeremy Farrar of Britain’s Wellcome Trust.
It’s spreading because of dysfunctional health systems, a lack of action by local and international governments and a population that hasn’t caught on immediately to the dangers and what to do about Ebola, they wrote in a commentary in the journal.
“Classic ‘outbreak control’ efforts are no longer sufficient for an epidemic of this size,” they added.
“Rather, what’s required is a large-scale, coordinated humanitarian, social, public health and medical response, combining classic public health measures with safe and effective interventions including behavioral changes, therapies and, when possible, vaccination.”
It will take both a “massive” response and, probably, the use of new treatments and vaccines to control the epidemic, Farrar and Piot wrote.
“But we must also look to the future. There will be more epidemics and outbreaks of Ebola and other new or re-emerging infections,” they added. “Yet our response to such events remains slow, cumbersome, poorly funded, conservative and ill-prepared.”
As for ZMAPP I never said ZMAPP contains EBO glycoproteins (that was an actual facepalm moment.) But since you asked, here is one of the studies that started the researchers' move from CF gene therapy research to Ebola post-exposure treatment research.
Journal of Virology May 2003: Lentivirus Vectors Pseudotyped with Filoviral Envelope Glycoproteins Transduce Airway Epithelia from the Apical Surface Independently of Folate Receptor AlphaAbstract
The practical application of gene therapy as a treatment for cystic fibrosis is limited by poor gene transfer efficiency with vectors applied to the apical surface of airway epithelia. Recently, folate receptor alpha (FRα), a glycosylphosphatidylinositol-linked surface protein, was reported to be a cellular receptor for the filoviruses. We found that polarized human airway epithelia expressed abundant FRα on their apical surface. In an attempt to target these apical receptors, we pseudotyped feline immunodeficiency virus (FIV)-based vectors by using envelope glycoproteins (GPs) from the filoviruses Marburg virus and Ebola virus. Importantly, primary cultures of well-differentiated human airway epithelia were transduced when filovirus GP-pseudotyped FIV was applied to the apical surface. Furthermore, by deleting a heavily O-glycosylated extracellular domain of the Ebola GP, we improved the titer of concentrated vector severalfold. To investigate the folate receptor dependence of gene transfer with the filovirus pseudotypes, we compared gene transfer efficiency in immortalized airway epithelium cell lines and primary cultures. By utilizing phosphatidylinositol-specific phospholipase C (PI-PLC) treatment and FRα-blocking antibodies, we demonstrated FRα-dependent and -independent entry by filovirus glycoprotein-pseudotyped FIV-based vectors in airway epithelia. Of particular interest, entry independent of FRα was observed in primary cultures of human airway epithelia. Understanding viral vector binding and entry pathways is fundamental for developing cystic fibrosis gene therapy applications.
I first heard about the CF to Ebola to ZMAPP link during a BBC Horizons episode regarding this outbreak. The relevant portion begins at around the 37:00 mark. I'm sure you'll forgive my propensity for giving Dr. Kosinger far more credence than an anonymous stranger on the internet. He says Ebola glycoprotein spikes effectively adhere to airway epithelial cells and I have no reason to doubt him given his CV and the results of his work.
As I've written earlier, we will have much more data on transmission in a year. At that time those of us looking at that topic can revisit the current dogma surrounding the issue and determine how much of what is claimed to be known is accurate given new data. My bet is that much current dogma will be upended.
The announcement of only 300 Ebola survivors in Liberia by the Health Minister put the cat out of the bag such that even a Western Reporter could understand the WHO has been misrepresenting the data.
See:
Liberia Ebola Case Fatality Rate At 84%
Recombinomics Commentary
September 23, 07:00
http://www.recombinomics.com/News/09231401/Ebola_Liberia_CFR_84.html
“...However, the CFRs for the prior outbreaks were based on outcomes (all reported cases had either died or had recovered), while the 47% survival used by WHO in the current outbreak represented cases who had recovered, as well as those hospitalized, those at holding centers, and those who had been sent home because all beds at hospitals and holding centers were full. Thus, the 47% survival would only be accurate if all of the live patients who had not been discharged subsequently recovered, which had no scientific or historic basis.
As seen above, less than 300 cases in Liberia have survived, based on the September 18 comment by the Assistant Health Minister in Liberia. The September 17 report from the Liberia Ministry of Health cited 3022 cases and 1578 deaths (which were also cited in the latest WHO Road Map). Thus, although Liberia reported 1444 live Ebola cases, less than 300 represented recovered cases. The more than 1144 active live cases included approximately 300 in hospitals receiving treatment and less than 100 in holding centers. Thus, more than 744 cases had been identified as Ebola cases, but had been sent home because all available beds were full.
The Ebola CFR based on outcomes (1578 deaths and 300 recovered cases) is 84% (1578/1878), which is among the highest Ebola CFRs (only the 90% for the 2003 outbreak and the 88% for the 1976 outbreaks in the DR Congo were higher).
The low frequency of recovered cases among the live Ebola cases in Liberia highlights the problems associated with the lack of beds. Most of the identified cases are in the community, posing a threat of further spread. Moreover, WHO has estimated that the true number of cases was 2-4 times the reported numbers, suggesting 1000-3000 additional cases were not being treated and were further spreading the virus in Liberia, in addition to such cases in Sierra Leone and possibly Guinea.
The absence of reports on recovered Ebola cases in WHO reports is glaring. Although they have removed the claim of a 47% survival rate from their website, the number of recovered cases should be include in updates, including road map reports.”
We don't really have lots of sound data of what period people start shedding virus and from what tissues. And so that would be incredibly valuable data.
I haven't found much at all regarding viral shedding phases, etc. I find a lot of assumptions based on epidemiological findings but not much data. Until now it hasn't been a real public health issue anywhere in the world, much less in first world countries, so very few researchers spent time on it. As often happens, the ZMAPP drug came about as a result of research into cystic fibrosis therapies.
So here we are, facing a serious viral disease about which little is known but much is assumed. I suppose a lot of research facilities are scrambling to start the studies that will eventually provide data on issues like transmission, immune responses, etc.
Key considerations for the implementation of an Ebola Care Unit at community levelComplementary approach - West Africa Ebola Outbreak
FIRST VERSION – SEPTEMBER 2014 - To be reviewed in October 2014
This document has been developed by WHO with the inputs from CDC, DFID, GOARN, IFRC, IRC, MSN, PHAC, Save the Children, and UNICEF
Introduction
The standard recommended public health actions implemented for stopping the Ebola outbreak include the early identification of cases, isolating and treating all patients in Ebola Treatment Centers (ETCs), rigorous contact tracing, and safe burial practices, supported by strong social mobilization and sound risk communication practices. These actions remain critical for stopping the Ebola outbreak in West Africa and should continue to underpin operational response plans. However, over the past few weeks, the epidemic has evolved rapidly and there has been an exponential rise in the number of Ebola cases reported with half of the approximately 5,000 total cases in this outbreak reported in the last three weeks. Available epidemiological data and modelling suggests that the number of cases will continue to rise in the coming weeks. Even with the current case load, the capacity of the ETC’s have been stretched and the number of beds in available ETC’s are inadequate to treat all reported case patients. In many places, infected patients remain in their family homes, with no other option of care, increasing the risk of infection for their families and contributing to continued transmission of Ebola.
Consequently, WHO, with the support from a variety of UN, NGO and government partners is proposing a complementary strategy to slow down and eventually stop transmission in affected areas. This will be done through the establishment of controlled settings, called Ebola Care Units (ECU), where infected persons can be moved to so that they do not further transmit the virus within their households and communities and where they can receive basic curative and palliative care in an environment supported by members of their family and their respective communities.
Such an approach would complement, and not replace, current disease control efforts including the ETC’s. If properly implemented it will slow down the progression of the epidemic by reducing community contact with infected persons and offering care to Ebola patients close to their homes, thus reducing transportation of infectious patients which, in some instances has led to significant infections among taxi drivers.
Home-based care has been put forward as an option. However, this will likely require an intense medical supervision and unmanageable medical supply chain of personal protective equipment (PPE) to families and significant challenges for dangerous waste management. Unless large-scale decentralised laboratory testing is available, it would leave families guessing as to whether an ill household member should be treated as an Ebola-infected patient at home or has another illness that can perhaps be treated by seeking care outside the house. In addition, this approach may present greater risks to other members of the family as it is unrealistic to expect families, living in a confined environment to adequately protect themselves from infection even if extensive awareness raising and community training of infection control can be rolled out quickly at community level.
By contrast, a well-run ECU may be a realistic option and one that could draw upon community will and support, and at the same time offer a level of basic care above what can be provided at home, including presumptive treatment for malaria and infection prevention and control. Another major advantage of this approach is the fact that ECU could be operated via trained community health workers rather than a reliance on formal health workers thus minimizing the risk of pulling out already health workers, who are already limited in number, from essential functions (e.g., operating ETCs or in primary health care facilities) in order to run the ECUs.
This brief paper provides the guidance and considerations that need to be taken into account when introducing the ECU strategy. The document is not prescriptive in nature but aims to provide the parameters within which these ECUs can successfully operate. While flexibility in the strategy is paramount to allow its adaptation and delivery in a range of different environments and contexts the document hopes to ensure that certain safety standards are maintained.
USA Today 9/22/14: WHO: 21,000 Ebola cases by November if no changes(large snip)
Dye and colleagues wrote they expected the numbers of cases and deaths from Ebola to continue rising from hundreds to thousands of cases per week in the coming months — and reach 21,000 by early November. He said it was worrisome that new cases were popping up in areas that hadn't previously reported Ebola, like in parts of Guinea.
"The picture is too unclear at the moment," he said, noting the outbreak is continuing to double in size about every three weeks.
CNN 9/23/14: Desperation grows in the Ebola zoneDressed from head to toe in white protective suits and thick goggles, the burial teams try to stay safe, but nothing can shield them from the unspeakable horrors they've seen when they make their regular rounds. On Friday, Kiyee described what he saw when he entered a home:
"I took the key and opened the door and went in and saw a 6-month-old child licking on the mother's skin," said Kiyee. The mother was lying on her stomach. She had died from Ebola. The baby was searching for the mother's milk. "Right away I started shedding tears."
Disclaimer: Opinions posted on Free Republic are those of the individual posters and do not necessarily represent the opinion of Free Republic or its management. All materials posted herein are protected by copyright law and the exemption for fair use of copyrighted works.