Posted on 02/18/2025 12:02:35 PM PST by nickcarraway
In praise of virus-fighters and global collaborations by Claire Panosian Dunavan, MD, Contributing Writer, MedPage Today
Claire Panosian Dunavan is a professor of medicine and infectious diseases at the David Geffen School of Medicine at UCLA and a past-president of the American Society of Tropical Medicine and Hygiene.
On the first day of President Trump's second term, he signed an executive order withdrawing the U.S. from the World Health Organizationopens in a new tab or window (WHO). In an ironic twist of fate just 10 days later, a 32-year-old Ugandan nurseopens in a new tab or window had a positive post-mortem test for a deadly filovirusopens in a new tab or window. But unlike Ebola Zaire virus, its close viral kin, this man's killer -- the so-called Sudan virus (SV) -- had no approved treatments or vaccines.
By Feb. 4, Uganda identified 298 close contactsopens in a new tab or window of the deceased nurse, including six other people who tested positive. Around the same time, WHO and Uganda's Makerere University launched a first-ever ring-vaccination trialopens in a new tab or window using a vaccine candidate from the International AIDS Vaccine Initiativeopens in a new tab or window (IAVI). The rapid deployment of the vesicular stomatitis virus-based jab at an early (phase I) stage of development followed a recent phase I human trialopens in a new tab or window, which, according to data shared at last November's annual meeting of the American Society of Tropical Medicine and Hygiene (ASTMH), indicated that the investigational vaccine was both safe and immunogenic.
"It's a great example ... for a new vaccine that has enough preclinical safety and manufacturing quality control to be brought into the field at such an early stage," former ASTMH president Thomas Monath, MD, told me last week.
Monath should know. In 2023, he received the prestigious Sabin Vaccine Institute Gold Medalopens in a new tab or window for developing other innovative vaccines for Ebola Zaire, smallpox, Japanese encephalitis, and West Nile virus, among others.
"After we recognize deadly new viruses with a high potential for human-to-human transmission, there is always a long gap to effective interventions, and this gap really needs to be narrowed," Monath added. "Advances in technology can accelerate such measures."
Of course, given SV's incubation period (2 to 21 days), it's impossible to say right now whether the new vaccine plus other countermeasures will stop SV in its tracks -- or if the virus will continue to spread. Either way, the still-unfolding story demonstrates how scientific, technical, and humanitarian collaboration by local and international partners can greatly facilitate urgent efforts to contain a global health threat.
The latest eruption in Uganda also underscores another undeniable need: urgently responding to emerging pathogens that can travel thousands of miles in people who are not yet symptomatic, then endanger health workers and citizens right here at home.
A Short Primer on Sudan Virus
Sudan virus (species Orthoebolavirus sudanense), which has felled roughly 50%opens in a new tab or window of its victims in previous outbreaks, is one of four Ebola viruses that commonly cause a devastating hemorrhagic fever in humans. Its first known outbreakopens in a new tab or window occurred in South Sudan in 1976, when SV infected 284 people in three towns and one city, killing 151. Subsequent studies have shown that, as with all Ebola viruses, a person who is SV-infected is not contagious until developing symptoms, which can range from fever, headache, and musculoskeletal pain to anorexia, diarrhea, and unexplained bleeding. At that point, transmission follows direct contact with bodily fluids of the infected individual, who may still be living or dead, or through contact with contaminated objects such as needles.
Before last month's eruption, Uganda declared its previous SV outbreakopens in a new tab or window on Sept. 20, 2022 after six suspicious deaths occurred in the country's Mubende district. The final toll (excluding 21 probable cases that preceded Sept. 20) numbered 142 confirmed infectionsopens in a new tab or window, including 19 in healthcare workers, and 49 confirmed deaths.
Further telling details about the 2022 outbreak? In retrospect, an emergency laparotomy performed on Sept. 15 in a patient suspected to have a perforated bowel was the likely event leading to SV infections in five operating room personnel. Nonetheless, because the patient died during surgery, it was only later that public health investigators realized he belonged to the same household as the outbreak's first officially-confirmed case.
Given our modern volume of global travel, a similar scenario could easily play out anywhere in the world. This leads to other questions recently posed by Monath who, prior to his career developing new vaccines, was a senior scientist and epidemiologist with CDC. "Do you think that an imported SV case [here in the U.S.] would not have a significant number of contacts just as in Uganda?" he said. "And would our public health system be able to track everybody down? [Finally,] if there's no real countermeasure, then what?"
The Challenge of Diagnosis
Let's return to key details about Uganda's current index case, namely: 1) the patient initially suffered fever, chest pain, and labored breathing, followed by bleeding and multi-organ failure; and 2) prior to his final hospitalization, he visited multiple health facilities including Kampala's Mulago Referral Hospital, Saidina Abubakar Hospital, and Mbale Regional Referral Hospital.
As a long-time infectious diseases specialist, I can easily imagine the many erroneous diagnoses that were likely entertained or treated at the medical facilities where the man first sought help. Pneumonia, malaria, typhoid, meningococcemia, yellow fever -- the list goes on. In short, filovirus infections frequently mimic other illnesses. This is one more reason we need international collaborations to continue developing and distributing not just SV vaccines but also rapid diagnostic tests and anti-viral remediesopens in a new tab or window based on monoclonal antibodies similar to those now used for Ebola.
I also can't help wondering if the dying nurse harbored private fears about a possible recent exposure to another patient with a mysterious, hemorrhagic illness. And one more question that may never be answered: When and where did an SV-shedding animal -- be it a bat, antelope, or non-human primate -- infect the first human in this outbreak chain?
Honoring Unsung Heroes
In closing, rather than dwelling on recent, discouraging shifts in our country's commitments to public and global health, I'd like to strike a more positive note. All around the world, many people devote their time and talents to helping underserved people who continuously face health-related threats most of us can barely imagine. Speaking for myself, I count it as a privilege to have met some of them, both overseas and through my decades-long membership in the ASTMH. But today, there are countless more heroes I will never meet who will continue to carry this torch well beyond my lifetime.
So, let us hold to a larger vision that, before long, America will once again collaborate with WHO and other nations to promote hope, health, and a better life, not only for its own citizens but for our entire world.
There's your problem right there. And one which maybe can be fixed.
IT IS NOT the role of the US Government to play Doctor around the world.
If the EU, the UN and the African Nation needs this addressed let them pay for it.
Let all the fat cat multibillionaires donating endlessly to the US Democrat party, like Bill Gates and Mark Cuban, pay for it
The US hits the Debt Limit March 2025. The credit card is maxed out. The rest of the world is going to have to grow up and start taking care of themselves
The rest of the world doesn’t give a #### if they send someone here with a disease that would cause a disaster.
It’s the rule of the US govt to protect us.
So people can get full blood tests before they come here and we can hope they don’t get anything in between.
Or we can spend a few bucks to keep an eye on the worst areas aroudn the world.
Not billions.
But not nothing.
If Obama had a son he would be called Ebola Obama.
Its a Yoruba name.
What does this corpse in Africa have to do with President Trump getting us out of the feckless and necrotic WHO?
“David Geffen School of Medicine?” What sort of “medicine” does David Geffen actually know about, other than the kinds of “medicine” that are generally purchased from shady individuals on sidewalks? Pffft!
I quit reading as soon as he said Trump got us out of WHO .
Nope
This is how we got into the mess. Everyone got their “good idea” that “must be funded” and so everything gets a blank check payable by the USA. NO MORE.
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