The Economist explains: How Nigeria stopped Ebola, Oct 20th 2014

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How Nigeria stopped Ebola

Oct 20th 2014

http://www.economist.com/blogs/economist-explains/2014/10/economist-explains-6

WHEN Patrick Sawyer arrived at Murtala Muhammed International Airport in Lagos, Nigeria's capital, on July 20th he promptly collapsed. About two weeks earlier, he had been exposed to the Ebola virus in Liberia. Now he had brought it to Nigeria. The outbreak resulted in 19 confirmed cases and eight deaths in Nigeria, including that of Sawyer. But unlike Guinea, Liberia and Sierra Leone, where Ebola has so far killed over 4,500 people, Nigeria was able to stop the virus. On October 20th the country was declared Ebola-free. How did it do it?

Nigeria is home to 177m people, the most in Africa. Lagos, its commercial hub, has over 20m residents, many who live in teeming slums. So there was great potential for the disease to spread, and not just inside the country. Thousands of people pass through the international airport in Lagos each day, on their way to China, India and America. Many international businesses have their African headquarters in the city. International health officials feared that an Ebola outbreak in Nigeria would lead to a truly global pandemic.

In some ways Nigeria got lucky. Of the roughly 200 people on the flight with Sawyer, none came down with Ebola. When Sawyer himself insisted on leaving the hospital where he was being treated, a doctor called Ameyo Adadevoh stopped him. She would later die. The government was slow to act, in part because Sawyer was not immediately diagnosed with Ebola. But once the authorities recognised the virus, they were able to mount a robust response. Nigeria has more doctors and hospitals per person than most African countries. It also has teams in place to investigate outbreaks of diseases like cholera and Lassa fever. These tools were simply redirected.

A command centre financed by the Bill and Melinda Gates Foundation to fight polio was used to co-ordinate the Ebola response. Experts from America's Centres for Disease Control (CDC) were already training 100 Nigerian doctors in epidemiology, so 40 of them led the process of tracing Sawyer's contacts. The government worked with airlines to find people whom he could have infected. Then health workers repeatedly took the temperature of nearly 900 possible contacts, paying them more than 18,500 visits in total.

“For those who say it’s hopeless, this is an antidote-you can control Ebola,” said Thomas Frieden, the director of the CDC. Other countries at risk can learn from Nigeria's experience. They should be preparing themselves by creating rapid intervention teams and improving their surveillance systems, says Chris Stokes of Médecins Sans Frontières, an NGO. But Dr Frieden warns: “Some countries that could well be the next Lagos still don’t have a clue about how to deal with this.”

Worse, most of the lessons from Nigeria are not applicable to the countries where Ebola is now raging out of control. Guinea, Liberia and Sierra Leone do not have the same resources and are anyway too late to stamp out the virus quickly. It will be some time before those countries are declared Ebola-free, which means Nigeria-and the rest of the world-are still at risk.

Dig deeper:
http://www.economist.com/blogs/economist-explains/2014/10/economist-explains-6

The Ebola epidemic in west Africa poses a catastrophic threat to the region, and could yet spread further (October 2014)
How Ebola kills with just seven genes (October 2014)

Ebola in graphics

 

[Coded-Dude]

Because this couldn't go into one of the other 300 Ebola threads...

Transmitted via Tactical Telecommunications Device

 

[Spata]

Because this couldn't go into one of the other 300 Ebola threads...

Transmitted via Tactical Telecommunications Device

BadgeBunny was right.

 

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Because this couldn't go into one of the other 300 Ebola threads...

Transmitted via Tactical Telecommunications Device

almost put this into another thread .. but felt this information stood out and needed it's own thread.

Nigeria has a huge population of some 117 million, the most in Africa. lessons from how they controlled Ebola are transferable to USA or any other highly populated areas.

whereas control measures used in remote/hot Ebola infected zones like Liberia with very limited medical resources .. may have little resemblance to how Ebola will be handled in the USA.

 

[BadgeBunny]

BadgeBunny was right.

GC says "Welcome to his world" ...

 

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Portrait of a virus
A killer in close up
You can do a lot of damage with just seven genes
Oct 18th 2014 | From the print edition

EBOLA is a simple virus, but also a subtle one. The stringy looking particles consist of a genome wrapped up in two layers of protein (see diagram). This long, thin package, along with a large protein called a polymerase, is packed into a membrane that is studded with a glycoproteins—that is, proteins with sugar stuck to them.
In this section

When the virus infects a cell the polymerase makes copies of the genome and the cell is tricked into using these to make the proteins that the virus needs. These include two, called VP35 and VP24, which stymie interferons, a class of molecule that alerts the immune system to infection. VP35 prevents interferons from being made; VP24 stops their cries for help from being heard. The sugars on the virus’s outside make it hard for other parts of the immune system to get to grips with; to confuse things more, the virus makes infected cells produce more glycoprotein than it needs for its coat, with the surplus simply secreted into the bloodstream. Antibodies which would otherwise attack the virus stick to this decoy protein instead.

Immune cells which the virus attacks in the bloodstream early on carry the infection to the liver, the spleen and lymph nodes. Symptoms may manifest themselves in a day or two or may wait weeks (see chart). Eventually the virus’s spread triggers an immune overreaction known as a cytokine storm. Blood-vessel walls become leaky, blood pressure and core temperature drop, organs fail and the body goes into shock. Various combinations of those and other symptoms kill about 70% of those who get ill.
Ebola in graphics: examining the data behind the crisis so far

Some of the sick weather the storm, but most who survive infection do so by never getting to its direst straits. Some do not succumb at all: a study of people who had direct contact with patients during outbreaks in Gabon in 1996 showed that some had definitely been infected, but never fallen ill.

 

[FamousAJ]

You yawned didn't you?

 

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You yawned didn't you?

I get it .. you like Fox news better ///

 

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How to stop the spread of Ebola

 

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The Ebola virus
Leaked documents reveal behind-the-scenes Ebola vaccine issues

23 October 2014

Extensive background documents from a meeting that took place today at the World Health Organization (WHO) have provided new details about exactly what it will take to test, produce, and bankroll Ebola vaccines, which could be a potential game changer in the epidemic.

ScienceInsider obtained materials that vaccinemakers, governments, and WHO provided to the 100 or so participants at a meeting on “access and financing” of Ebola vaccines. The documents put hard numbers on what until now have been somewhat fuzzy academic discussions. And they make clear to the attendees—who include representatives from governments, industry, philanthropies, and nongovernmental organizations—that although testing and production are moving forward at record speed, knotty issues remain.

At the meeting, GlaxoSmithKline (GSK) of Rixensart, Belgium, which has the vaccine furthest in development, spelled out how it might scale up production in parallel with the safety and efficacy trials now under way so that the product could be ready for wider distribution by April if warranted. The company expects to have preliminary data in November from phase I studies that analyze safety and immune response in small numbers of people not at risk of contracting Ebola. If those data are positive, efficacy trials could start as early as January in Guinea, Sierra Leone, and Liberia, the three West African countries hard hit by the epidemic.

Earlier discussions suggested that efficacy trials should recruit health care workers and first-line responders like those who do burials or track contacts of known infected people. WHO estimates that there are about 12,000 health care workers in the three affected countries and another 17,500 “community” responders.

GSK is considering two efficacy trials. The largest would take place in Liberia and involve 12,000 people. This study, which could begin in mid-January, would randomize half of the participants to receive the vaccine and the other half a placebo. The study could also have a third arm, GSK said: A vaccine made by NewLink Genetics of Ames, Iowa, that has just entered phase I studies in the United States. The U.S. National Institutes of Health indicated that it was interested in leading this study.

A second trial would start simultaneously in Sierra Leone, Ripley Ballou, who is heading the GSK Ebola vaccine project, told ScienceInsider. “One of the trials may fail for logistics reasons,” he explained. “We only have one shot to get this right.” The trial in Sierra Leone would not use a placebo but instead would offer groups of health care workers the vaccine at different points in time. This “stepped-wedge” trial could involve up to 8000 people, and the U.S. Centers for Disease Control and Prevention has had preliminary discussions with affected countries about staging these studies. Although Guinea is also hard hit, it has the least infrastructure in place to do a trial, Ballou says. “It would be the most challenging place to do a phase III study.”

GSK estimates (see table below, and here) that it will have 24,000 doses of its vaccine ready by January for the efficacy trials. If it cranks up production to full capacity before the those trials are complete, the company could have 230,000 doses available in April, and then could steadily increase capacity to produce more than 1 million doses a month by December 2015.

GSK has made modest investments in scaling up production of its vaccine, and this table projects what it might be able to produce over the next year if it went all out and added several new production lines. The "at risk" noted by the asterisks refers to the company doing quality control without needing to wait for regulatory agencies to repeat the tests.

In one of the background documents, GSK noted that a “critical issue” is what’s known as fill capacity. GSK said there is a shortage of facilities that can fill vaccine vials under sterile conditions in a facility that meets what are known as biosafety level 2 conditions. It suggested the regulatory agencies relax their biosafety requirements. If GSK alone must do the filling, this will affect the company’s ability to produce other vaccines already on the market, including ones that protect against rotavirus, measles, mumps, and rubella, the document said.

The GSK document also outlines a number of proposals to make the first batches of vaccine quickly available, like running some of the quality control tests in parallel and changing the test used to prove sterility of the vaccine from one that takes 14 days to an assay that takes half the time.

Additional studies of the NewLink vaccine will start soon in Geneva, Switzerland, and Hamburg, Germany. A first lot of the vaccine arrived in Geneva on Wednesday, Marie-Paule Kieny, an assistant director-general at WHO, told ScienceInsider. The Canadian government has donated 800 vials of the vaccine to WHO, but is sending them in three separate shipments, Kieny explained. “It just felt too risky to put all eggs in one basket,” said Kieny, who has volunteered as a subject for testing the vaccine herself.

Janssen, a division of Johnson & Johnson, described its plans to speed development of yet another Ebola vaccine strategy that has yet to enter human studies. A delegation from Russia planned to discuss Ebola vaccines being made there, too.

A highly detailed, 28-page document by the Norwegian Institute of Public Health offered “crude cost estimates” for scaling up mass production of Ebola vaccines. By these calculations, 27 million doses of vaccine would cost up to $73 million, and the cost of the vaccination campaigns themselves will add another $78 million to the bill.

Several analyses laid out the complex regulatory and liability issues. The U.K. government argued that “there is a need to provide some form of relief of liability for the producers and distributors of the vaccines” and that WHO should coordinate discussions with regulators. The U.K. government also noted that “affected African countries will have the primary role of authorising or allowing use of investigational vaccines” and said “buy in” from those communities about the clinical trials must be obtained as soon as possible.

As far as financing, the U.K. government contends that a “multi-donor club” should pay for the vaccine development in “the medium term.” But for now, the United Kingdom says it will “unilaterally” cover the costs for purchasing vaccines in Sierra Leone, and it asks the governments of the United States and France to make the same commitment for Liberia and Guinea, respectively.

In a planning document, WHO pointed out multiple logistical issues, including “the ability to safely and securely transport the intervention to the delivery site, the existence of safe and secure storage facilities with appropriate cold chain capacity, the availability of sterile equipment to administer injections.” But to Ballou the greatest question hanging over the vaccine trials is the stability of the countries. “The thing that is going to have the biggest impact is what is happening to the trajectory of the epidemic curve,” he says. “If you progress the current trends 2 months into the future are we still in an environment where you can even consider doing a trial?”

http://news.sciencemag.org/health/2014/10/leaked-documents-reveal-behind-scenes-ebola-vaccine-issues