MEDICAL NEWS TODAY                                                                                                 Dec. 9, 2014

LONDON --Thanks to increased disease control, global deaths to malaria have fallen dramatically, and the number of new cases is steadily declining, say the World Health Organization in a new report. Also, an increasing number of countries are moving toward eliminating the mosquito-borne disease altogether. But the UN agency warns these gains are fragile, and no more so than in countries worse-affected by the Ebola crisis.

The 2014 World Health Organization (WHO) report says deaths to malaria worldwide fell by 47% between 2000 and 2013. In the WHO African Region, where 90% of deaths to malaria occur, the reduction is 54%.

A few months ago the U.S. Centers for Disease Control and Prevention predicted that up to 1.4 million people in Liberia and Sierra Leone could become infected with Ebola by mid-January. In a recent address to the Senate, CDC director Tom Frieden said that worst-case scenario would not pan out.

That is partly because health care workers in the Ebola hot zone are engaged in a battle to contain the epidemic. It is also because of assumptions about human and viral behavior that are built into the mathematical models used to predict the spread of infectious diseases. Assumptions are inherent in these models. “You take islands of data from different places and build bridges of assumptions that link up all these islands,” says Martin Meltzer, senior health economist at the CDC. Meltzer’s model, which predicted the 1.4 million infections in Liberia and Sierra Leone, worked on the assumption that things would not improve. “Our forecasts are based on the idea that nothing will change,” he says.

wwwnc.cdc.gov/eid

Schoepp RJ, Rossi CA, Khan SH, Goba A, Fair JN. Undiagnosed acute viral febrile illnesses, Sierra Leone. Emerg Infect Dis [Internet]. 2014 Jul [date cited]. http://dx.doi.org/10.3201/eid2007.131265

DOI: 10.3201/eid2007.131265

CLICK HERE - RESEARCH - Undiagnosed Acute Viral Febrile Illnesses, Sierra Leone

Table of Contents – Volume 20, Number 7—July 2014

Abstract

Archived Video - Watch the meeting held on Tuesday, December 9, 2014, from 1:00 to 2:00 p.m. (ET).

Speakers: Nancy A. Aossey, President and Chief Executive Officer, International Medical Corps

Laurie Garrett, Senior Fellow for Global Health, Council on Foreign Relations; Author, Ebola: Story of an Outbreak

David Nabarro, Special Envoy on Ebola, United Nations

Presider: Richard E. Besser, Chief Health and Medical Editor, ABC News

Experts recently returned from trips to West Africa with medical teams operating Ebola-treatment units there discuss the situation on the ground and developments in the international response to the crisis.

CLICK HERE - Council on Foreign Relations - Ebola Update: Assessment From Africa

CLICK HERE - YouTube - Council on Foreign Relations - Ebola Update: Assessment From Africa

Decontee Davis: She won her battle with Ebola. Her 5-year-old son, though, paid a price. She didn’t want other kids to suffer the same way, so she embarked on a difficult new job.

washingtonpost.com

Decontee Davis, 23, works at a child-care center, where any of the 13 children could be coming down with Ebola.  All are from homes where parents or guardians have been taken away to treatment centers or died of Ebola, and now the youngsters must be monitored for 21 days to determine whether they are infected as well.

The job falls to a staff of 10, all survivors of Ebola like Davis, who watch them 24 hours a day.

(READ COMPLETE ARTICLE)

REPORTS Of RESEARCH ON TWO METHODS OF RAPID TESTING FOR EBOLA

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MEDICAL PRESS                                                                                     Dec. 8, 2014

Rutgers researcher David Alland, working with the California biotechnology company Cepheid, has received a grant of nearly $640,000 from the National Institutes of Health to develop a rapid test to diagnose Ebola as well as other viruses that can cause symptoms similar to Ebola.

Researchers will adapt this cartridge, now used worldwide for tuberculosis screenings, to collect and test samples from potential Ebola patients. Credit: John Emerson

Alland, a professor of medicine and associate dean for clinical research at Rutgers New Jersey Medical School and the principal investigator of the project, says health workers would be able to take the test to small villages and other remote locations where the spread of Ebola has been especially rampant and diagnose patients where they live...

ASSOCIATED PRESS -By MARIA CHENG and SARAH DiLORENZO Dec. 14, 2014

LONDON--As health officials struggle to contain the world's biggest-ever Ebola outbreak, their efforts are being complicated by another problem: bad data.

Having accurate numbers about an outbreak is essential not only to provide a realistic picture of the epidemic, but to determine effective control strategies. Dr. Bruce Aylward, who is leading the World Health Organization's Ebola response, said it's crucial to track every single Ebola patient in West Africa to stop the outbreak and that serious gaps remain in their data.

"As we move into the stage of hunting down the virus instead of just slowing the exponential growth, having good data is going to be at the heart of this," Aylward said. "We are not there yet and this is something we definitely need to fix."

THE TORONTO GLOBE AND MAIL by Kelly Grant                Dec.7, 2014

When the World Health Organization declared Nigeria officially Ebola-free in October, most of the fanfare centred on how Africa’s most populous country had managed to keep the virus from spreading.

But there was another, less heralded aspect of Nigeria’s success story that a Canadian doctor and her colleagues wanted to explore in more depth: How had 12 of Nigeria’s 20 Ebola patients beaten the virus?

The hospitals in Nigeria weren’t maybe to the standards of a Western hospital in terms of equipment, but the staff were phenomenal. They managed to get a very high survival rate,” said Eilish Cleary, a New Brunswick chief medical officer of health who travelled to Nigeria to provide epidemiological support to the World Health Organization during the outbreak. “Case fatality rate for Ebola can be up to 70 to 90 per cent. In Nigeria, it was 40 per cent.”

Dr. Cleary conducted detailed, videotaped interviews with six of the Nigerian patients to learn more about their treatment and recovery. The key to their survival seemed to be guzzling a stunning amount of water with oral rehydration solution [ORS] to fend off the cascade of internal failures typically caused by the virus.

THE WEEK -- by S.E. Smith                                                                                                     Dec. 5, 2014
While West Africa battles Ebola, another outbreak is striking just across the continent. In Madagascar, cases of plague are erupting in the small village of Mandritsara and the disease is spreading to neighboring communities. The two outbreaks are related by more than simple surface similarities, though. In fact, fighting the first has provided an invaluable blueprint for containing the second.

THE ECONOMIST                                                                                                      Dec. 4, 2014

THE first reported case in the Ebola outbreak ravaging west Africa dates back to December 2013, in Guéckédou, a forested area of Guinea near the border with Liberia and Sierra Leone. Travellers took it across the border: by late March, Liberia had reported eight suspected cases and Sierra Leone six. By the end of June 759 people had been infected and 467 people had died from the disease, making this the worst ever Ebola outbreak. The numbers keep climbing. As of November 30th, 17,145 cases and 6,070 deaths had been reported worldwide, the vast majority of them in these same three countries. Many suspect these estimates are badly undercooked.

Read complete posting
http://www.economist.com/blogs/graphicdetail/2014/12/ebola-graphics

Link to an interactive map of the virus's current global reach:

http://www.economist.com/blogs/graphicdetail/2014/12/interactive-ebola-map

Clinical Trials Are Being Launched in Africa but Face Challenges in Designing Ethical Studies, Compensating Donors

WALL STREET JOURNAL                                                                                                    Dec. 5, 2014
by Betsy McKay in Atlanta, David Gauthier-Villars in Conakry, Guinea, and Patrick McGroarty in Monrovia, Liberia

...Nearly a year after Ebola began spreading in West Africa, and with a proven drug or vaccine still far off, researchers are launching clinical trials on a product at hand: the blood of survivors.

 They want to determine whether so-called convalescent plasma or serum, chock full of antibodies, can help fight off the disease. But they face a number of complexities in carrying out the trials, including persuading survivors to participate....

Additonal  Nigerian and British health workers arrive in Liberia and Sierra Leone to help counter Ebola

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REUTERS  by James Harding Giahyue and Umaru Fofana   Dec. 5, 2014
MONROVIA/FREETOWN --More than 175 Nigerian medics arrived in Liberia and Sierra Leone on Friday to join the fight against Ebola, the first of 600 volunteers promised by the regional giant which contained its own outbreak earlier this year.

An army medic teaches NHS staff how to dispose of potentially contaminated waste last month, before their deployment to Sierra Leone. Photograph: Simon Davis/AFP/Getty Images

The medics will boost weak local health systems that are also struggling to contain other preventable diseases as Ebola discourages people from going to clinics for fear of contracting the fever.

"This is the African spirit you are showing, this is the Nigerian spirit,” Nigeria's ambassador to Liberia, Chigozie Obi-Nnadozie, told 76 Nigerian medics who landed there.

Another 100 volunteers landed in Freetown, Sierra Leone. Months into the Ebola response, experts say they are still short of medical personnel to staff treatment centers.

ASSOCIATED PRESS by EDITH M. LEDERER                                                                             Dec. 5, 2014

UNITED NATIONS -- Sierra Leone said Friday that between 80 and 100 new cases of Ebola are being reported every day and the country now hardest-hit by the deadly virus desperately needs over 1,000 beds to treat victims.

Sierra Leone's Finance Minister Kaifalah Marah painted a grim picture to the U.N. Economic and Social Council Friday of the challenges facing his West African nation which failed to meet a World Health Organization interim goal of isolating 70 percent of Ebola patients and safely burying 70 percent of victims by Dec. 1.

The two other hard-hit countries, Liberia and Guinea, did meet the deadline, and the U.N.'s Ebola chief Dr. David Nabarro said the number of new cases in Liberia has dropped from 60 per day in September to 10 per day. ...

VOICE OF AMERICA                                      Dec. 3, 2014

New data shows the Ebola outbreak intensifying in Sierra Leone, even as it stabilizes or drops off in other West African countries.   (Scroll down for link to WHO roadmap.)

The World Health Organization says Sierra Leone reported 537 new confirmed cases in the week ending November 30, a jump of more than 150 over the week before.  

In its latest update Wednesday, the WHO says "transmission remains persistent and intense across the country with the exception of the south."  The worst affected area was the capital, Freetown, where more than 200 new cases were reported.  

According to the WHO, the number of Ebola cases worldwide is more than 17,000, with all but a few dozen in Sierra Leone, Guinea and Liberia.  The overall death toll is up to 6,070.

Read complete story
http://www.voanews.com/content/ebola-spreading-faster-in-sierra-leone/2544743.html?utm_source=December+4+2014+EN&utm_campaign=12%2F4%2F2014&utm_medium=email

THE NEW ENGLAND JOURNAL OF MEDICINE                                                                                 Dec. 3, 2014
By Edward Cox, M.D., M.P.H., Luciana Borio, M.D., and Robert Temple, M.D.

...Studying investigational therapies for EVD presents scientific, practical, and ethical challenges. Not surprisingly, there has been substantial debate about the best and most appropriate study approaches.2,3 It is generally agreed that a trial with a concurrent control group, in which patients are randomly assigned to receive the test drug plus the best available supportive care (BASC) or to BASC alone, would be the most efficient and reliable way to evaluate the safety and effectiveness of candidate products.

 Some people in the health care community, however, have argued against such trials, urging instead use of a historical control — that is, making investigational drugs as widely available as their supply allows and then comparing mortality rates among treated patients with rates that would have been expected absent the drugs, on the basis of past experience with EVD.