What’s Going On With Ebola? Quite a Bit.

“What’s going on with Ebola,” a friend asked me today. “We hear nothing in the US.”   Actually quite a bit of good news happened in the last couple weeks.  And some not so good.

Good News The lowest level of new Ebola cases in over a year were reported last week. Guinea and Sierra Leone both reported only one new case in each country! The previous week there were only a total of seven new cases. Liberia had none.

This comes after four or five months of results stubbornly plateauing out at 20 to 30 new cases per week. All new cases came from the same few areas where it has not been stamped out, like the densely packed slums in Freetown and the same few rural villages. http://www.nytimes.com/2015/08/05/world/africa/ebola-cases-fall-sharply-un-reports.html?ref=topics

New cases have also been coming from “known chains of transmission.”  ie., from the contacts of a person previously confirmed as Ebola positive. If they can keep focusing on known contacts, there’s more likelihood of stamping out the disease. When new cases pop up without any connection to a previously confirmed Ebola case, the epidemic is not under control.

Bad News –  Three of Sierra Leone’s recent new cases were in Tonkolili District in the north which hadn’t had a new case in over 150 days, like most of the country.

From WHO - contact tracers conduct interviews in Tonkolili District

From WHO – contact tracers conduct interviews in Tonkolili District

A man from a village there fell ill while in Freetown and carried Ebola back to his Tonkolili village. Family believed his illness was due to sorcery and a curse, and when he died, buried him (illegally) without following Ebola burial procedures.  Two of his family have since been confirmed as Ebola positive and moved to an Ebola treatment center.

This shows how easily Ebola can again spread, with just one case traveling across country. With new cases way down, this becomes a less likely event.

Good NewsRapid response teams are in place and immediately quarantined over 500 people in the affected Tonkolili village. They identified 29 high risk contacts to closely monitor. Rapid response teams are in place with WHO coordination and react quickly when new cases and any new chain of transmission are identified. The quarantined village has no additional new cases after a week. This is light years ahead of where things were last year at this time.

Farmers in this village will unfortunately be separated from their fields for 21 days during the rainy season, a critical time for planting rice and other crops. People understand the critical need for the quarantine and are cooperating. They’ll hopefully get support for the condition of their farms.  http://www.who.int/features/2015/tracing-ebola-tonkolili/en/

Great NewsA trial of a new vaccine was found to be 100% successful in protecting against Ebola!  Ring vaccinations were conducted because Ebola cases have dwindled to such a low level. This technique was used years ago in testing small pox vaccines.

Ring vaccinations means people at risk within the ring of known contacts of an Ebola case were vaccinated, instead of just random people. So, you’re testing and hopefully protecting at the same time – which proved to be the case now.  A control group of potentially Ebola exposed people were also vaccinated, but not until 10 days after potential exposure. Sixteen Ebola positive cases were found in this group, prompting study leaders to recommend immediately vaccinating all participants in future studies. They asked for the vaccine to be made available for all exposed people during the period of continued testing and vaccine approval. http://allafrica.com/stories/201508051574.html

And there needs to be expanded studies.. The two groups in the study had only about 2000 participants each. A large group for initial human trials, but not enough for high statistical confidence. In larger study groups, the effectiveness will likely drop below 100%. But even 80% effective is a real break through.  http://www.wired.com/2015/08/100-percent-effective-means-ebola-vaccine/

Good NewsThe vaccine was fast tracked by a global team of collaborators. This included the Division of Infectious Disease Control at the Norwegian Institute of Public Health, the Wellcome Trust, the government of Canada, Doctors Without Borders (MSF), the London School of Hygiene and Tropical Medicine and manufacturers Merck and NewLink.

It took only eleven months to reach this point of human trials with demonstrated efficacy. Other less promising trial vaccines were discarded along the way. The study team also had to coordinate with Guinea officials to reach urban slums and rural villages not easy to incorporate into a high profile study on short timing.

It shows this can be done. It’s not common for a new vaccine to be tested in the midst of an active epidemic. But this was no usual epidemic. It had global implications.

You’ll note the US doesn’t figure into the team of global collaborators. Our FDA drug testing procedures are more conservative and approval procedures more bureaucratic. I read under normal conditions, this kind of vaccine development and human testing could have taken a decade. US FDA take note.  http://www.nature.com/news/how-ebola-vaccine-success-could-reshape-clinical-trial-policy-1.18121

Still, the statisticians will have the last say.  http://www.wired.com/2015/08/100-percent-effective-means-ebola-vaccine/

So-so NewsHaving a vaccine quickly available in large quantities and easy to use in remote, difficult to reach rural villages remains a challenge. It’s hard today to administer well established vaccinations and health care in general in the affected Ebola countries. Rolling out a new vaccine to remote places with no refrigeration will not be easy.

Convincing suspicious and illiterate people traumatized by the Ebola epidemic will also take a strong outreach and education approach.

It’s not known how long protection from a new Ebola vaccine would last.  Small pox is a one time vaccination. Yellow fever lasts for ten years. Typhoid is only good for 3-5 years depending on oral or injection administration, and it’s only about 60% effective.

Hopefully, the global aid community will address vaccine cost as they have the vaccine study design and testing. Everyone has learned the whole world is at risk of Ebola until it’s permanently stamped out everywhere. Like small pox.

It was one year ago now that the Ebola epidemic in Sierra Leone was a run-away train. We watched paralyzed in fear, not knowing what action to take. What a difference a year makes. Especially when the best minds around the world join up together.

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