The WHO just released the latest statistics on what has turned into the largest ever outbreak of Ebola virus (EBOV) in Africa.\u00a0 The epidemic started in Guinea around\u00a0December 2013.
CDC director has expressed confidence that health officials will be able to contain the spread of the virus in the U.S.
\n– Ref. ii<\/span><\/p>\n<\/div><\/p>\nAs of 7\/27\/2014, Guinea, Liberia, Nigeria, and Sierra Leone have reported a total of 1323 cases, with 729 fatalities [i].\u00a0 Most patients are from Guinea and Sierra Leone.\u00a0 The 1 Nigerian case was an international traveller, a major concern as the epidemic unfolds and drastic containment measures are taken by the countries affected.<\/p>\n
Since first posted here, things have worsened considerably. \u00a0As of Sept. 28, 2014, there were\u00a07157 cases and 3330 deaths from the epidemics. \u00a0This is more than twice the count from only 1 month earlier (Aug 26, 2014) when a total of 3069 cases and 1552 deaths were reported.<\/p>\n
As the first\u00a0case has now been diagnosed in the US, we can observe first hand\u00a0how successfull our hospital system is in managing Ebola, and how successful we are in tracing\u00a0contacts. \u00a0I wish our representatives from CDC and NIH were a little bit less self-assured when they proclaim on TV that we are not likely to see Ebola gaining a foothold in the US, that spread of the disease in the US is highly unlikely.<\/p>\n
Why should we have a lot of respect for the ingenuity of the Filovirus family?
\nReason #1: \u00a0they have survived and outfoxed us a few times already;
\nReason #2: \u00a0our state of blissful ignorance: we just know so little about their survival strategies and virulence factors;
\nReason #3: \u00a0the early disease symptoms are fever and non-specific signs\/symptoms. Hence, by the time we can suspect infection and\u00a0quarantine a potential case, it’s already too late.<\/p>\n
<\/p>\n
<\/p>\n
EBOV GP glycans direct the immune system to produce antibodies against highly variable or dispensable regions on the viral surface
\nRef: J. Cook. PLoS<\/p>\n<\/div><\/span><\/p>\nBelow a table of major\u00a0virologic and clinical facts relating to\u00a0Ebola virus infection. Some therapeutic approaches are mentioned without any claim of completeness.<\/p>\n\n
\n\n\n\t| Category<\/th> | Core Facts<\/th>\n<\/tr>\n<\/thead>\n |
\n\n\t| Epidemiol<\/td> | Named after Ebola river in Zaire where the first documented outbreak occurred (in 1976)<\/td>\n<\/tr>\n |
\n\t| Epidemiol<\/td> | Almost all outbreaks in sub-Saharan Africa<\/td>\n<\/tr>\n |
\n\t| Epidemiol<\/td> | Reservoir unknown<\/td>\n<\/tr>\n |
\n\t| Epidemiol<\/td> | Infection through direct contact with body fluids (blood, organs, secretions, breast milk) of infected animals (monkeys, other) or humans<\/td>\n<\/tr>\n |
\n\t| Epidemiol<\/td> | Vector unknown (bats?)<\/td>\n<\/tr>\n |
\n\t| Epidemiol<\/td> | Close personal contact and Iatrogenic spread = major contributing factors<\/td>\n<\/tr>\n |
\n\t| Virology<\/td> | Lipid-enveloped filovirus with neg. strand RNA; 7 genes, 19 kb<\/td>\n<\/tr>\n |
\n\t| Virology<\/td> | Cell attachment via GP transmembrane glycoprotein<\/td>\n<\/tr>\n |
\n\t| Virology<\/td> | Viral cell entry via the Nieman-Pick NPC1 receptor, a cholesterol transporter protein <\/td>\n<\/tr>\n |
\n\t| Pathogenesis<\/td> | Immune response impaired and late<\/td>\n<\/tr>\n |
\n\t| Pathogenesis<\/td> | Envelope glycoprotein GP1 helps evade host immune responses<\/td>\n<\/tr>\n |
\n\t| Pathogenesis<\/td> | Essential adherence factor masked by \u2018mucin shield\u2019 from neutralizing abs<\/td>\n<\/tr>\n |
\n\t| Pathogenesis<\/td> | Secreted GP antigens trap virus-directed antibodies<\/td>\n<\/tr>\n |
\n\t| Clinical<\/td> | Mortality 80-90% (the Zaire strain has the highest mortality)<\/td>\n<\/tr>\n |
\n\t| Clinical<\/td> | Initially flu-like syndrome, later hemorrhagic fever with DIC and organ failure (liver, kidney)<\/td>\n<\/tr>\n |
\n\t| Clinical<\/td> | Coagulopathy occurs early but findings are usually subtle (conjunctival hemorrhage)<\/td>\n<\/tr>\n |
\n\t| Clinical<\/td> | Labs: leukopenia, thrombopenia, abnl LFT<\/td>\n<\/tr>\n |
\n\t| Clinical<\/td> | PCR of viral RNA = best tool<\/td>\n<\/tr>\n |
\n\t| Clinical<\/td> | Virus can persist in semen for 3 months after recovery<\/td>\n<\/tr>\n |
\n\t| Therapy<\/td> | Current therapy is non-specific \/ supportive<\/td>\n<\/tr>\n |
\n\t| Therapy<\/td> | Vaccines and Therapeutics in Phase 1 testing:<\/td>\n<\/tr>\n |
\n\t| Therapy<\/td> | Adeno-vector<\/td>\n<\/tr>\n |
\n\t| Therapy<\/td> | NPC1 attachment inhibitors - Benzylpiperazine adamantane diamide derivatives,<\/td>\n<\/tr>\n |
\n\t| Therapy<\/td> | DNA plasmid vaccine (VRC-EBODNA023-00-VP, VRC-EBODNA012-00-VP)<\/td>\n<\/tr>\n |
\n\t| Therapy<\/td> | Phosphorodiamidate morpholino antisense oligomer (AVI-6002) - Sarepta Therapeutics<\/td>\n<\/tr>\n |
\n\t| Therapy<\/td> | Interrupting PI3K-Akt\/Rac1 signaling pathway<\/td>\n<\/tr>\n |
\n\t| Therapy<\/td> | RNAi (interfering RNA) (TKM-300803) \u2013 Tekmira, a lipid nanoparticle formulation was protective in monkey models and given FDA Fast Track status; put on hold in 2014 to clarify issues related to cytokine release<\/td>\n<\/tr>\n |
\n\t| Other<\/td> | Bioterrorism agent<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n References:<\/strong><\/p>\nM Salvaggio.\u00a0 Other viral bioweapons: Ebola and Marburg hemorrhagic fever.\u00a0 Dermatol Clin 22 (2004) 291 \u2013 302<\/p>\n Cote. Small molecule inhibitors reveal Niemann-Pick C1 is essential for Ebolavirus infection.\u00a0 Nature 2011; 477: 344<\/p>\n J. Cook.\u00a0 The Secret Life of Viral Entry Glycoproteins: Moonlighting in Immune Evasion.\u00a0 PLoS Pathog 9(5): e1003258. doi:10.1371\/journal.ppat.1003258<\/p>\n [i] http:\/\/www.afro.who.int\/en\/clusters-a-programmes\/dpc\/epidemic-a-pandemic-alert-and-response\/outbreak-news\/4236-ebola-virus-disease-west-africa-29-july-2014.html<\/p>\n [ii]\u00a0http:\/\/www.politico.com\/story\/2014\/10\/ebola-us-border-111581.html#ixzz3F72LYrCE<\/p>\n","protected":false},"excerpt":{"rendered":" The WHO just released the latest statistics on what has turned into the largest ever outbreak of Ebola virus (EBOV) in Africa.\u00a0 The epidemic started in Guinea around\u00a0December 2013. As of 7\/27\/2014, Guinea, Liberia, Nigeria, and Sierra Leone have reported a total of 1323 cases, with 729 fatalities [i].\u00a0 Most Continue reading Ebola \u2013 Fact Sheet (Updated 10\/3\/2014)<\/span>→<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2}},"categories":[3,18],"tags":[376,378,377,368,365,364,372,281,366,373,370,375,371,226,374,369,367,29],"class_list":["post-661","post","type-post","status-publish","format-standard","hentry","category-the_news","category-the_viewpoint","tag-antisense","tag-bioterror-agent","tag-bsl-4","tag-clinical-features","tag-ebola","tag-ebov","tag-epidemic","tag-epidemiology","tag-flavivirus","tag-glycoprotein","tag-gp1","tag-hemorrhagic-fever","tag-immune-evasion","tag-mortality","tag-np-c1-receptor","tag-pathogenesis","tag-therapy","tag-who"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"","jetpack_shortlink":"https:\/\/wp.me\/p4KWFr-aF","jetpack_sharing_enabled":true,"jetpack-related-posts":[{"id":885,"url":"https:\/\/allphasepharma.com\/dir\/2014\/09\/17\/885\/new-pathogens-outbreaks-epidemics-2014\/","url_meta":{"origin":661,"position":0},"title":"Bugs and Outbreaks That Scared Us in 2014","author":"Harald","date":"September 17, 2014","format":false,"excerpt":"At the end of every year, some of us tally \u2013 in a retrospective \u2013 the most remarkable epidemics, newly recognized pathogens or resistance issues that occupied the headlines in the past 12 months.\u00a0 Here a sneak preview what you are likely to see in the coming December issue of\u2026","rel":"","context":"In "The Viewpoint"","block_context":{"text":"The Viewpoint","link":"https:\/\/allphasepharma.com\/dir\/category\/the_viewpoint\/"},"img":{"alt_text":"","src":"https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2014\/09\/Outbreak.gif?fit=638%2C230&ssl=1&resize=350%2C200","width":350,"height":200,"srcset":"https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2014\/09\/Outbreak.gif?fit=638%2C230&ssl=1&resize=350%2C200 1x, https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2014\/09\/Outbreak.gif?fit=638%2C230&ssl=1&resize=525%2C300 1.5x"},"classes":[]},{"id":1067,"url":"https:\/\/allphasepharma.com\/dir\/2014\/10\/13\/1067\/ebola-and-breach-of-protocol-makes-me-bristle\/","url_meta":{"origin":661,"position":1},"title":"Ebola and “Breach of Protocol”: Makes Me Bristle\u2026","author":"Harald","date":"October 13, 2014","format":false,"excerpt":"We are told by\u00a0Tom Frieden \/ CDC that it was a \u201cprotocol breach\u201d when a nurse in Texas taking care of US Ebola patient no. 1 got infected? \u00a0At the same news conference, he tells us he doesn\u2019t know what kind of breach actually occurred. \u00a0So what is he talking\u2026","rel":"","context":"In "The Viewpoint"","block_context":{"text":"The Viewpoint","link":"https:\/\/allphasepharma.com\/dir\/category\/the_viewpoint\/"},"img":{"alt_text":"","src":"https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2014\/10\/BSL4-nurses-slider.jpg?fit=640%2C200&ssl=1&resize=350%2C200","width":350,"height":200,"srcset":"https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2014\/10\/BSL4-nurses-slider.jpg?fit=640%2C200&ssl=1&resize=350%2C200 1x, https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2014\/10\/BSL4-nurses-slider.jpg?fit=640%2C200&ssl=1&resize=525%2C300 1.5x"},"classes":[]},{"id":1092,"url":"https:\/\/allphasepharma.com\/dir\/2014\/10\/31\/1092\/ebola-transmission-prevention\/","url_meta":{"origin":661,"position":2},"title":"Preventing Ebola Transmission","author":"Harald","date":"October 31, 2014","format":false,"excerpt":"Chapter 166\u00a0[1] in the new Mandell textbook was written before the current Ebola outbreak, so I thought it would be interesting to read View Postit again and check whether the \u2018old\u2019 recommendations for personal protection were still valid now that we have learned much more during the ongoing outbreak. 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