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Schaefer A, Yang B, Schroeder HA, Harit D, Humphry MS, Zeitlin L, Whaley KJ, Ravel J, Fischer WA, Lai SK. ZMapp reduces diffusion of Ebola viral particles in fresh human cervicovaginal mucus. Emerg Microbes Infect 2024; 13:2352520. [PMID: 38713593 PMCID: PMC11100441 DOI: 10.1080/22221751.2024.2352520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 05/02/2024] [Indexed: 05/09/2024]
Abstract
Vaginal transmission from semen of male Ebola virus (EBOV) survivors has been implicated as a potential origin of Ebola virus disease (EVD) outbreaks. While EBOV in semen must traverse cervicovaginal mucus (CVM) to reach target cells, the behaviour of EBOV in CVM is poorly understood. CVM contains substantial quantities of IgG, and arrays of IgG bound to a virion can develop multiple Fc-mucin bonds, immobilizing the IgG/virion complex in mucus. Here, we measured the real-time mobility of fluorescent Ebola virus-like-particles (VLP) in 50 CVM specimens from 17 women, with and without ZMapp, a cocktail of 3 monoclonal IgGs against EBOV. ZMapp-mediated effective trapping of Ebola VLPs in CVM from a subset of women across the menstrual cycle, primarily those with Lactobacillus crispatus dominant microbiota. Our work underscores the influence of the vaginal microbiome on IgG-mucin crosslinking against EBOV and identifies bottlenecks in the sexual transmission of EBOV.
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Affiliation(s)
- Alison Schaefer
- UNC/NCSU Joint Department of Biomedical Engineering, Chapel Hill, NC, USA
| | - Bing Yang
- Division of Pharmacoengineering and Molecular Pharmaceutics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Holly A. Schroeder
- Division of Pharmacoengineering and Molecular Pharmaceutics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Dimple Harit
- Division of Pharmacoengineering and Molecular Pharmaceutics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Mike S. Humphry
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | | | - Jacques Ravel
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - William A. Fischer
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Chapel Hill, NC, USA
| | - Samuel K. Lai
- Division of Pharmacoengineering and Molecular Pharmaceutics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Microbiology & Immunology; University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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2
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Izudi J, Bajunirwe F. Case fatality rate for Ebola disease, 1976-2022: A meta-analysis of global data. J Infect Public Health 2024; 17:25-34. [PMID: 37992431 DOI: 10.1016/j.jiph.2023.10.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 10/07/2023] [Accepted: 10/22/2023] [Indexed: 11/24/2023] Open
Abstract
An up-to-date pooled case fatality rate (CFR) for Ebola disease (EBOD) at the global level is lacking. We abstracted EBOD data from 1976 to 2022 for 16 countries and 42 outbreaks to conduct a meta-analysis. The pooled CFR was 60.6% (95% confidence interval (CI) 51.6-69.4; 95% prediction interval 12.9-99.1). Of the four ebolaviruses, Zaire virus was the most lethal (CFR = 66.6%, 95% CI 55.9-76.8), then Sudan virus (CFR=48.5%, 95% CI 38.6-58.4), Bundibugyo virus (CFR=32.8%, 95% CI 25.8-40.2) and Tai Forest virus (CFR= 0%, 95% CI 0.0-97.5). The CFR in sub-Saharan Africa was 61.3% (95% CI 52.8-69.6) and for the rest of the world was 24.5% (95% CI 0.0-67.9%). CFR declined over time but stabilized at 61.0% (95% CI, 52.0-69.0) between 2014 and 2022. Overall, the EBOD CFR is still high and heterogeneous. Accordingly, early diagnosis, early treatment if available, and supportive care are important to prevent significant morbidity and mortality.
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Affiliation(s)
- Jonathan Izudi
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda; Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda.
| | - Francis Bajunirwe
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
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3
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Manno D. Developing a vaccine against Sudan virus disease. THE LANCET. INFECTIOUS DISEASES 2023; 23:1333-1335. [PMID: 37544325 DOI: 10.1016/s1473-3099(23)00360-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 05/25/2023] [Indexed: 08/08/2023]
Affiliation(s)
- Daniela Manno
- London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK.
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4
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Parish LA, Stavale EJ, Houchens CR, Wolfe DN. Developing Vaccines to Improve Preparedness for Filovirus Outbreaks: The Perspective of the USA Biomedical Advanced Research and Development Authority (BARDA). Vaccines (Basel) 2023; 11:1120. [PMID: 37376509 DOI: 10.3390/vaccines11061120] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/13/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
Outbreaks of viral hemorrhagic fever caused by filoviruses have become more prevalent in recent years, with outbreaks of Ebola virus (EBOV), Sudan virus (SUDV), and Marburg virus (MARV) all occurring in 2022 and 2023. While licensed vaccines are now available for EBOV, vaccine candidates for SUDV and MARV are all in preclinical or early clinical development phases. During the recent outbreak of SUDV virus disease, the Biomedical Advanced Research and Development Authority (BARDA), as part of the Administration for Strategic Preparedness and Response within the U.S. Department of Health and Human Services, implemented key actions with our existing partners to advance preparedness and enable rapid response to the outbreak, while also aligning with global partners involved in the implementation of clinical trials in an outbreak setting. Beyond pre-existing plans prior to the outbreak, BARDA worked with product sponsors to expedite manufacturing of vaccine doses that could be utilized in clinical trials. While the SUDV outbreak has since ended, a new outbreak of MARV disease has emerged. It remains critical that we continue to advance a portfolio of vaccines against SUDV and MARV while also expediting manufacturing activities ahead of, or in parallel if needed, outbreaks.
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Affiliation(s)
- Lindsay A Parish
- CBRN Vaccines, Biomedical Advanced Research & Development Authority (BARDA), Administration for Strategic Preparedness and Response (ASPR), U.S. Department of Health and Human Services (HHS), Washington, DC 20201, USA
| | - Eric J Stavale
- CBRN Vaccines, Biomedical Advanced Research & Development Authority (BARDA), Administration for Strategic Preparedness and Response (ASPR), U.S. Department of Health and Human Services (HHS), Washington, DC 20201, USA
| | - Christopher R Houchens
- CBRN Vaccines, Biomedical Advanced Research & Development Authority (BARDA), Administration for Strategic Preparedness and Response (ASPR), U.S. Department of Health and Human Services (HHS), Washington, DC 20201, USA
| | - Daniel N Wolfe
- CBRN Vaccines, Biomedical Advanced Research & Development Authority (BARDA), Administration for Strategic Preparedness and Response (ASPR), U.S. Department of Health and Human Services (HHS), Washington, DC 20201, USA
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5
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Baum SD, Adams VM. Pandemic refuges: Lessons from 2 years of COVID-19. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2023; 43:875-883. [PMID: 35648882 PMCID: PMC9347849 DOI: 10.1111/risa.13953] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
This paper relates evidence from the COVID-19 pandemic to the concept of pandemic refuges, as developed in literature on global catastrophic risk. In this literature, a refuge is a place or facility designed to keep a portion of the population alive during extreme global catastrophes. COVID-19 is not the most extreme pandemic scenario, but it is nonetheless a very severe global event, and it therefore provides an important source of evidence. Through the first 2 years of the COVID-19 pandemic, several political jurisdictions have achieved low spread of COVID-19 via isolation from the rest of the world and can therefore classify as pandemic refuges. Their suppression and elimination of COVID-19 demonstrates the viability of pandemic refuges as a risk management measure. Whereas prior research emphasizes island nations as pandemic refuges, this paper uses case studies of China and Western Australia to show that other types of jurisdictions can also successfully function as pandemic refuges. The paper also refines the concept of pandemic refuges and discusses implications for future pandemics.
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Affiliation(s)
- Seth D. Baum
- Global Catastrophic Risk InstituteWashingtonDistrict of ColumbiaUSA
| | - Vanessa M. Adams
- School of Geography, Planning, and Spatial SciencesUniversity of TasmaniaHobartTasmaniaAustralia
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Cui X, Zhang XF, Jagota A. Penetration of Cell Surface Glycocalyx by Enveloped Viruses Is Aided by Weak Multivalent Adhesive Interaction. J Phys Chem B 2023; 127:486-494. [PMID: 36598427 DOI: 10.1021/acs.jpcb.2c06662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Viral infection usually begins with adhesion between the viral particle and viral receptors displayed on the cell membrane. The exterior surface of the cell membrane is typically coated with a brush-like layer of molecules, the glycocalyx, that the viruses need to penetrate. Although there is extensive literature on the biomechanics of virus-cell adhesion, much of it is based on continuum-level models that do not address the question of how virus/cell-membrane adhesion occurs through the glycocalyx. In this work, we present a simulation study of the penetration mechanism. Using a coarse-grained molecular model, we study the force-driven and diffusive penetration of a brush-like glycocalyx by viral particles. For force-driven penetration, we find that viral particles smaller than the spacing of molecules in the brush reach the membrane surface readily. For a given maximum force, viral particles larger than the minimum spacing of brush molecules arrest at some distance from the membrane, governed by the balance of elastic and applied forces. For the diffusive case, we find that weak but multivalent attraction between the glycocalyx molecules and the virus effectively leads to its engulfment by the glycocalyx. Our finding provides potential guidance for developing glycocalyx-targeting drugs and therapies by understanding how virus-cell adhesion works.
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Affiliation(s)
- Xinyu Cui
- Department of Bioengineering, Lehigh University, Bethlehem, Pennsylvania 18015, United States
| | - X Frank Zhang
- Department of Bioengineering, Lehigh University, Bethlehem, Pennsylvania 18015, United States
| | - Anand Jagota
- Department of Bioengineering, Lehigh University, Bethlehem, Pennsylvania 18015, United States.,Department of Chemical and Biomolecular Engineering, Lehigh University, Bethlehem, Pennsylvania 18015, United States
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7
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Kiggundu T, Ario AR, Kadobera D, Kwesiga B, Migisha R, Makumbi I, Eurien D, Kabami Z, Kayiwa J, Lubwama B, Okethwangu D, Nabadda S, Bwire G, Mulei S, Harris JR, Dirlikov E, Fitzmaurice AG, Nabatanzi S, Tegegn Y, Muruta AN, Kyabayinze D, Boore AL, Kagirita A, Kyobe-Bosa H, Mwebesa HG, Atwine D, Aceng Ocero JR. Notes from the Field: Outbreak of Ebola Virus Disease Caused by Sudan ebolavirus - Uganda, August-October 2022. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2022; 71:1457-1459. [PMID: 36355610 PMCID: PMC9707349 DOI: 10.15585/mmwr.mm7145a5] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
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Natural History of Sudan ebolavirus to Support Medical Countermeasure Development. Vaccines (Basel) 2022; 10:vaccines10060963. [PMID: 35746571 PMCID: PMC9228702 DOI: 10.3390/vaccines10060963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/09/2022] [Accepted: 06/11/2022] [Indexed: 11/23/2022] Open
Abstract
Sudan ebolavirus (SUDV) is one of four members of the Ebolavirus genus known to cause Ebola Virus Disease (EVD) in humans, which is characterized by hemorrhagic fever and a high case fatality rate. While licensed therapeutics and vaccines are available in limited number to treat infections of Zaire ebolavirus, there are currently no effective licensed vaccines or therapeutics for SUDV. A well-characterized animal model of this disease is needed for the further development and testing of vaccines and therapeutics. In this study, twelve cynomolgus macaques (Macaca fascicularis) were challenged intramuscularly with 1000 PFUs of SUDV and were followed under continuous telemetric surveillance. Clinical observations, body weights, temperature, viremia, hematology, clinical chemistry, and coagulation were analyzed at timepoints throughout the study. Death from SUDV disease occurred between five and ten days after challenge at the point that each animal met the criteria for euthanasia. All animals were observed to exhibit clinical signs and lesions similar to those observed in human cases which included: viremia, fever, dehydration, reduced physical activity, macular skin rash, systemic inflammation, coagulopathy, lymphoid depletion, renal tubular necrosis, hepatocellular degeneration and necrosis. The results from this study will facilitate the future preclinical development and evaluation of vaccines and therapeutics for SUDV.
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9
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Utilization of Viral Vector Vaccines in Preparing for Future Pandemics. Vaccines (Basel) 2022; 10:vaccines10030436. [PMID: 35335068 PMCID: PMC8950656 DOI: 10.3390/vaccines10030436] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/09/2022] [Accepted: 03/10/2022] [Indexed: 02/04/2023] Open
Abstract
As the global response to COVID-19 continues, government stakeholders and private partners must keep an eye on the future for the next emerging viral threat with pandemic potential. Many of the virus families considered to be among these threats currently cause sporadic outbreaks of unpredictable size and timing. This represents a major challenge in terms of both obtaining sufficient funding to develop vaccines, and the ability to evaluate clinical efficacy in the field. However, this also presents an opportunity in which vaccines, along with robust diagnostics and contact tracing, can be utilized to respond to outbreaks as they occur, and limit the potential for further spread of the disease in question. While mRNA-based vaccines have proven, during the COVID-19 response, to be an effective and safe solution in terms of providing a rapid response to vaccine development, virus vector-based vaccines represent a class of vaccines that can offer key advantages in certain performance characteristics with regard to viruses of pandemic potential. Here, we will discuss some of the key pros and cons of viral vector vaccines in the context of preparing for future pandemics.
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10
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Kolhe R, Sahajpal NS, Vyavahare S, Dhanani AS, Adusumilli S, Ananth S, Mondal AK, Patterson GT, Kumar S, Rojiani AM, Isales CM, Fulzele S. Alteration in Nasopharyngeal Microbiota Profile in Aged Patients with COVID-19. Diagnostics (Basel) 2021; 11:diagnostics11091622. [PMID: 34573964 PMCID: PMC8467337 DOI: 10.3390/diagnostics11091622] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/26/2021] [Accepted: 08/30/2021] [Indexed: 02/07/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) is an infectious virus that causes coronavirus disease 2019 (COVID-19) transmitted mainly through droplets and aerosol affecting the respiratory tract and lungs. Little is known regarding why some individuals are more susceptible than others and develop severe symptoms. In this study, we analyzed the nasopharyngeal microbiota profile of aged patients with COVID-19 (asymptomatic vs. symptomatic) vs. healthy individuals. We examined the nasopharynx swab of 84 aged-matched patients, out of which 27 were negative asymptomatic (NegA), 30 were positive asymptomatic (PA), and 27 patients were positive symptomatic (PSY). Our analysis revealed the presence of abundant Cyanobacterial taxa at phylum level in PA (p-value = 0.0016) and PSY (p-value = 0.00038) patients along with an upward trend in the population of Litoricola, Amylibacter, Balneola, and Aeromonas at the genus level. Furthermore, to know the relationship between the nasal microbiota composition and severity of COVID-19, we compared PA and PSY groups. Our data show that the nasal microbiota of PSY patients was significantly enriched with the signatures of two bacterial taxa: Cutibacterium (p-value = 0.045) and Lentimonas (p-value = 0.007). Furthermore, we also found a significantly lower abundance of five bacterial taxa, namely: Prevotellaceae (p-value = 7 × 10−6), Luminiphilus (p-value = 0.027), Flectobacillus (p-value = 0.027), Comamonas (p-value = 0.048), and Jannaschia (p-value = 0.012) in PSY patients. The dysbiosis of the nasal microbiota in COVID-19 positive patients might have a role in contributing to the severity of COVID-19. The findings of our study show that there is a strong correlation between the composition of the nasal microbiota and COVID-19 severity. Further studies are needed to validate our finding in large-scale samples and to correlate immune response (cytokine Strome) and nasal microbiota to identify underlying mechanisms and develop therapeutic strategies against COVID-19.
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Affiliation(s)
- Ravindra Kolhe
- Department of Pathology, Augusta University, Augusta, GA 30912, USA; (R.K.); (N.S.S.); (S.A.); (A.K.M.); (A.M.R.)
| | - Nikhil Shri Sahajpal
- Department of Pathology, Augusta University, Augusta, GA 30912, USA; (R.K.); (N.S.S.); (S.A.); (A.K.M.); (A.M.R.)
| | - Sagar Vyavahare
- Department of Cellular Biology and Anatomy, Augusta University, Augusta, GA 30912, USA; (S.V.); (S.K.)
| | - Akhilesh S. Dhanani
- Department of Pharmacology, Dalhousie University, Halifax, NS B3H 4R2, Canada;
| | - Satish Adusumilli
- Department of Pathology, University of Notre Dame, Notre Dame, IN 46556, USA;
| | - Sudha Ananth
- Department of Pathology, Augusta University, Augusta, GA 30912, USA; (R.K.); (N.S.S.); (S.A.); (A.K.M.); (A.M.R.)
| | - Ashis K. Mondal
- Department of Pathology, Augusta University, Augusta, GA 30912, USA; (R.K.); (N.S.S.); (S.A.); (A.K.M.); (A.M.R.)
| | - G. Taylor Patterson
- Department of Orthopedics, Augusta University, Augusta, GA 30912, USA; (G.T.P.); (C.M.I.)
| | - Sandeep Kumar
- Department of Cellular Biology and Anatomy, Augusta University, Augusta, GA 30912, USA; (S.V.); (S.K.)
| | - Amyn M. Rojiani
- Department of Pathology, Augusta University, Augusta, GA 30912, USA; (R.K.); (N.S.S.); (S.A.); (A.K.M.); (A.M.R.)
- Department of Pathology, Penn State University, State College, PA 16802, USA
| | - Carlos M. Isales
- Department of Orthopedics, Augusta University, Augusta, GA 30912, USA; (G.T.P.); (C.M.I.)
- Department of Medicine, Augusta University, Augusta, GA 30912, USA
- Center for Healthy Aging, Augusta University, Augusta, GA 30912, USA
| | - Sadanand Fulzele
- Department of Cellular Biology and Anatomy, Augusta University, Augusta, GA 30912, USA; (S.V.); (S.K.)
- Department of Orthopedics, Augusta University, Augusta, GA 30912, USA; (G.T.P.); (C.M.I.)
- Department of Medicine, Augusta University, Augusta, GA 30912, USA
- Center for Healthy Aging, Augusta University, Augusta, GA 30912, USA
- Correspondence:
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11
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Lehrer AT, Chuang E, Namekar M, Williams CA, Wong TAS, Lieberman MM, Granados A, Misamore J, Yalley-Ogunro J, Andersen H, Geisbert JB, Agans KN, Cross RW, Geisbert TW. Recombinant Protein Filovirus Vaccines Protect Cynomolgus Macaques From Ebola, Sudan, and Marburg Viruses. Front Immunol 2021; 12:703986. [PMID: 34484200 PMCID: PMC8416446 DOI: 10.3389/fimmu.2021.703986] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 07/29/2021] [Indexed: 11/23/2022] Open
Abstract
Ebola (EBOV), Marburg (MARV) and Sudan (SUDV) viruses are the three filoviruses which have caused the most fatalities in humans. Transmission from animals into the human population typically causes outbreaks of limited scale in endemic regions. In contrast, the 2013-16 outbreak in several West African countries claimed more than 11,000 lives revealing the true epidemic potential of filoviruses. This is further emphasized by the difficulty seen with controlling the 2018-2020 outbreak of EBOV in the Democratic Republic of Congo (DRC), despite the availability of two emergency use-approved vaccines and several experimental therapeutics targeting EBOV. Moreover, there are currently no vaccine options to protect against the other epidemic filoviruses. Protection of a monovalent EBOV vaccine against other filoviruses has never been demonstrated in primate challenge studies substantiating a significant void in capability should a MARV or SUDV outbreak of similar magnitude occur. Herein we show progress on developing vaccines based on recombinant filovirus glycoproteins (GP) from EBOV, MARV and SUDV produced using the Drosophila S2 platform. The highly purified recombinant subunit vaccines formulated with CoVaccine HT™ adjuvant have not caused any safety concerns (no adverse reactions or clinical chemistry abnormalities) in preclinical testing. Candidate formulations elicit potent immune responses in mice, guinea pigs and non-human primates (NHPs) and consistently produce high antigen-specific IgG titers. Three doses of an EBOV candidate vaccine elicit full protection against lethal EBOV infection in the cynomolgus challenge model while one of four animals infected after only two doses showed delayed onset of Ebola Virus Disease (EVD) and eventually succumbed to infection while the other three animals survived challenge. The monovalent MARV or SUDV vaccine candidates completely protected cynomolgus macaques from infection with lethal doses of MARV or SUDV. It was further demonstrated that combinations of MARV or SUDV with the EBOV vaccine can be formulated yielding bivalent vaccines retaining full efficacy. The recombinant subunit vaccine platform should therefore allow the development of a safe and efficacious multivalent vaccine candidate for protection against Ebola, Marburg and Sudan Virus Disease.
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Affiliation(s)
- Axel T. Lehrer
- Department of Tropical Medicine, Medical Microbiology & Pharmacology, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI, United States
| | - Eleanore Chuang
- Department of Tropical Medicine, Medical Microbiology & Pharmacology, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI, United States
| | - Madhuri Namekar
- Department of Tropical Medicine, Medical Microbiology & Pharmacology, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI, United States
| | - Caitlin A. Williams
- Department of Tropical Medicine, Medical Microbiology & Pharmacology, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI, United States
| | - Teri Ann S. Wong
- Department of Tropical Medicine, Medical Microbiology & Pharmacology, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI, United States
| | - Michael M. Lieberman
- Department of Tropical Medicine, Medical Microbiology & Pharmacology, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI, United States
| | | | | | | | | | - Joan B. Geisbert
- Galveston National Laboratory, Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX, United States
| | - Krystle N. Agans
- Galveston National Laboratory, Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX, United States
| | - Robert W. Cross
- Galveston National Laboratory, Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX, United States
| | - Thomas W. Geisbert
- Galveston National Laboratory, Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX, United States
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12
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Comparison of Zaire and Bundibugyo ebolavirus polymerase complexes and susceptibility to antivirals through a newly developed Bundibugyo minigenome system. J Virol 2021; 95:e0064321. [PMID: 34379503 DOI: 10.1128/jvi.00643-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Members of the genus Ebolavirus cause lethal disease in humans with Zaire ebolavirus (EBOV) being the most pathogenic (up to 90% morality) and Bundibugyo ebolavirus (BDBV) the least pathogenic (∼37% mortality). Historically, there has been a lack of research on BDBV and there is no means to study BDBV outside of a high-containment laboratory. Here, we describe a minigenome replication system to study BDBV transcription and compare the efficacy of small molecule inhibtors between EBOV and BDBV. Using this system, we examined the ability of the polymerase complex proteins from EBOV and BDBV to interact and form a functional unit as well as the impact of the genomic untranslated ends, known to contain important signals for transcription (3'-untranslated region) and replication (5'-untranslated region). Varying levels of compatibility were observed between proteins of the polymerase complex from each ebolavirus resulting in differences in genome transcription efficiency. Most pronounced was the effect of the nucleoprotein and the 3'-untranslated region. These data suggest that there are intrinsic specificities in the polymerase complex and untranslated signaling regions that could offer insight regarding observed pathogenic differences. Further adding to the differences in the polymerase complexes, post-transfection/infection treatment with the compound remdesivir (GS-5734) showed a greater inhibitory effect against BDBV compared to EBOV. The delayed growth kinetics of BDBV and the greater susceptibility to polymerase inhibitors indicate that disruption of the polymerase complex may be a viable target for therapeutics. Importance Ebolavirus disease is a viral infection and is fatal in 25-90% of cases, depending on the viral species and the amount of supportive care available. Two species have caused outbreaks in the Democratic Republic of the Congo, Zaire ebolavirus (EBOV) and Bundibugyo ebolavirus (BDBV). Pathogenesis and clinical outcome differ between these two species but there is still limited information regarding the viral mechanism for these differences. Previous studies suggest that BDBV replicates slower than EBOV but it is unknown if this is due to differences in the polymerase complex and its role in transcription and replication. This study details the construction of a minigenome replication system which can be used in a biosafety level (BSL) 2 laboartory. This system will be important for studying the polymerase complex of BDBV and comparing it with other filoviruses and can be used as a tool for screening inhibitors of viral growth.
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13
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Population Mobility and the Transmission Risk of the COVID-19 in Wuhan, China. ISPRS INTERNATIONAL JOURNAL OF GEO-INFORMATION 2021. [DOI: 10.3390/ijgi10060395] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
At the beginning of 2020, a suddenly appearing novel coronavirus (COVID-19) rapidly spread around the world. The outbreak of the COVID-19 pandemic in China occurred during the Spring Festival when a large number of migrants traveled between cities, which greatly increased the infection risk of COVID-19 across the country. Financially supported by the Wuhan government, and based on cellphone signaling data from Unicom (a mobile phone carrier) and Baidu location-based data, this paper analyzed the effects that city dwellers, non-commuters, commuters, and people seeking medical services had on the transmission risk of COVID-19 in the early days of the pandemic in Wuhan. The paper also evaluated the effects of the city lockdown policy on the spread of the pandemic outside and inside Wuhan. The results show that although the daily business activities in the South China Seafood Wholesale Market and nearby commuters’ travel behaviors concentrated in the Hankou area, a certain proportion of these people were distributed in the Wuchang and Hanyang areas. The areas with relatively high infection risks of COVID-19 were scattered across Wuhan during the early outbreak of the pandemic. The lockdown in Wuhan closed the passageways of external transport at the very beginning, largely decreasing migrant population and effectively preventing the spread of the pandemic to the outside. However, the Wuhan lockdown had little effect on preventing the spread of the pandemic within Wuhan at that time. During this period, a large amount of patients who went to hospitals for medical services were exposed to a high risk of cross-infection without precaution awareness. The pandemic kept dispersing in three towns until the improvement of the capacity of medical treatment, the management of closed communities, the national support to Wuhan, and the implementation of a series of emergency responses at the same time. The findings in this paper reveal the spatiotemporal features of the dispersal of infection risk of COVID-19 and the effects of the prevention and control measures during the early days of the pandemic. The findings were adopted by the Wuhan government to make corresponding policies and could also provide supports to the control of the pandemic in the other regions and countries.
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Kawuki J, Musa TH, Yu X. Impact of recurrent outbreaks of Ebola virus disease in Africa: a meta-analysis of case fatality rates. Public Health 2021; 195:89-97. [PMID: 34077889 DOI: 10.1016/j.puhe.2021.03.027] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/19/2021] [Accepted: 03/30/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Between 2010 and 2020, Africa witnessed several outbreaks of Ebola virus disease (EVD), each presenting with varying case fatality rate (CFR) and other socio-economic impacts. This study aims to summarize the CFR and identify potential factors that influenced the severity of EVD outbreaks in Africa. STUDY DESIGN This was a systematic review and meta-analysis of EVD outbreaks published between January 2010 and March 2020, using Web of Science, Scopus, and PubMed databases. METHODS Only English-language articles and reports, including the number of cases and deaths during the outbreak in Africa, were considered. The quality of the included articles was assessed using Murad's quality assessment tool. The analysis was conducted using Stata (version 12), pooled effect sizes were calculated using the random-effects model, and heterogeneity was tested for using the I2 statistic. RESULTS Thirteen studies with 32,300 cases and 13,727 deaths were identified, whose pooled CFR was 60% (95% confidence interval [CI]: 47-73%). The most EVD-affected countries were the Democratic Republic of Congo with five outbreaks and a pooled CFR of 65% (95% CI: 59-71%), followed by Uganda with three outbreaks and CFR of 83% (95% CI: 60-99%). Zaire ebolavirus caused the most outbreaks (10), with a CFR of 58% (95% CI: 45-71%). Besides, outbreaks with fewer than 1000 cases reported a higher CFR rate (65%, 95% CI: 54-75%) compared with those with more cases (51%, 95% CI: 33-69%). CONCLUSION The study has revealed a considerably high CFR caused by the recurrent EVD outbreaks in Africa. It also notes an implementation gap in the prevention and control strategies and thus identifies a need to strengthen the surveillance systems and response mechanisms to enable early detection and prompt control of future outbreaks.
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Affiliation(s)
- J Kawuki
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, Global Health, School of Public Health, Southeast University, Nanjing, 210009, Jiangsu Province, China; Centre for Health Behaviours Research, Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
| | - T H Musa
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, Department Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, 210009, Jiangsu Province, China; Biomedical Research Institute, Darfur College, Nyala, Sudan
| | - X Yu
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, Global Health, School of Public Health, Southeast University, Nanjing, 210009, Jiangsu Province, China; Key Laboratory of Environmental Medicine Engineering, Ministry of Education, Department Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, 210009, Jiangsu Province, China.
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15
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Wang LL, Palermo N, Estrada L, Thompson C, Patten JJ, Anantpadma M, Davey RA, Xiang SH. Identification of filovirus entry inhibitors targeting the endosomal receptor NPC1 binding site. Antiviral Res 2021; 189:105059. [PMID: 33705865 DOI: 10.1016/j.antiviral.2021.105059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/27/2021] [Accepted: 03/04/2021] [Indexed: 12/20/2022]
Abstract
Filoviruses, mainly consisting of Ebola viruses (EBOV) and Marburg viruses (MARV), are enveloped negative-strand RNA viruses which can infect humans to cause severe hemorrhagic fevers and outbreaks with high mortality rates. The filovirus infection is mediated by the interaction of viral envelope glycoprotein (GP) and the human endosomal receptor Niemann-Pick C1 (NPC1). Blocking this interaction will prevent the infection. Therefore, we utilized an In silico screening approach to conduct virtual compound screening against the NPC1 receptor-binding site (RBS). Twenty-six top-hit compounds were purchased and evaluated by in vitro cell based inhibition assays against pseudotyped or replication-competent filoviruses. Two classes (A and U) of compounds were identified to have potent inhibitory activity against both Ebola and Marburg viruses. The IC50 values are in the lower level of micromolar concentrations. One compound (compd-A) was found to have a sub-micromolar IC50 value (0.86 μM) against pseudotyped Marburg virus. The cytotoxicity assay (MTT) indicates that compd-A has a moderate cytotoxicity level but the compd-U has much less toxicity and the CC50 value was about 100 μM. Structure-activity relationship (SAR) study has found some analogs of compd-A and -U have reduced the toxicity and enhanced the inhibitory activity. In conclusion, this work has identified several qualified lead-compounds for further drug development against filovirus infection.
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Affiliation(s)
- Leah Liu Wang
- School of Veterinary Medicine and Biomedical Sciences, University of Nebraska-Lincoln, Lincoln, NE, 68583, USA; Nebraska Center for Virology, University of Nebraska-Lincoln, Lincoln, NE, 68583, USA
| | - Nicholas Palermo
- Computational Chemistry Core Facility, VCR Cores, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Leslie Estrada
- Nebraska Center for Virology, University of Nebraska-Lincoln, Lincoln, NE, 68583, USA
| | - Colton Thompson
- Nebraska Center for Virology, University of Nebraska-Lincoln, Lincoln, NE, 68583, USA
| | - J J Patten
- National Emerging Infectious Diseases Laboratories, Boston University, Boston, MA, 0211, USA
| | - Manu Anantpadma
- National Emerging Infectious Diseases Laboratories, Boston University, Boston, MA, 0211, USA
| | - Robert A Davey
- National Emerging Infectious Diseases Laboratories, Boston University, Boston, MA, 0211, USA
| | - Shi-Hua Xiang
- School of Veterinary Medicine and Biomedical Sciences, University of Nebraska-Lincoln, Lincoln, NE, 68583, USA; Nebraska Center for Virology, University of Nebraska-Lincoln, Lincoln, NE, 68583, USA.
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16
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Systematic review of Marburg virus vaccine nonhuman primate studies and human clinical trials. Vaccine 2020; 39:202-208. [PMID: 33309082 DOI: 10.1016/j.vaccine.2020.11.042] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 11/12/2020] [Accepted: 11/13/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND Recent deadly outbreaks of Marburg virus underscore the need for an effective vaccine. A summary of the latest research is needed for this WHO priority pathogen. This systematic review aimed to determine progress towards a vaccine for Marburg virus. METHODS Article search criteria were developed to query PubMed for peer-reviewed articles from 1990 through 2019 on Marburg virus vaccine clinical trials in humans and pre-clinical studies in non-human primates (NHP). Abstracts were reviewed by two authors. Relevant articles were reviewed in full. Discrepancies were resolved by a third author. Data abstracted included year, author, title, vaccine construct, number of subjects, efficacy, and demographics. Assessment for risk of bias was performed using the Syrcle tool for animal studies, and the Cochrane Collaboration risk of bias tool for human studies. RESULTS 101 articles were identified; 27 were related to Marburg vaccines. After full text review, 21 articles were selected. 215 human subjects were in three phase 1 clinical trials, and 203 NHP in 18 studies. Vaccine constructs were DNA plasmids, recombinant vesicular stomatitis virus (VSV) vectors, adenovirus vectors, virus-like particles (VLP), among others. Two human phase 1 studies of DNA vaccines had 4 adverse effects requiring vaccine discontinuation among 128 participants and 31-80% immunogenicity. In NHP challenge studies, 100% survival was seen in 6 VSV vectored vaccines, 2 DNA vaccines, 2 VLP vaccines, and in 1 adenoviral vectored vaccine. CONCLUSION In human trials, two Marburg DNA vaccines provided either low immunogenicity or a failure to elicit durable immunity. A variety of NHP candidate Marburg vaccines demonstrated favorable survival and immunogenicity parameters, to include VSV, VLP, and adenoviral vectored vaccines. Elevated binding antibodies appeared to be consistently associated with protection across the NHP challenge studies. Further human trials are needed to advance vaccines to limit the spread of this highly lethal virus.
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17
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Forna A, Dorigatti I, Nouvellet P, Donnelly CA. Spatiotemporal variability in case fatality ratios for the 2013-2016 Ebola epidemic in West Africa. Int J Infect Dis 2020; 93:48-55. [PMID: 32004692 PMCID: PMC7191269 DOI: 10.1016/j.ijid.2020.01.046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 01/21/2020] [Accepted: 01/22/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND For the 2013-2016 Ebola epidemic in West Africa, the largest Ebola virus disease (EVD) epidemic to date, we aim to analyse the patient mix in detail to characterise key sources of spatiotemporal heterogeneity in the case fatality ratios (CFR). METHODS We applied a non-parametric Boosted Regression Trees (BRT) imputation approach for patients with missing survival outcomes and adjusted for model imperfection. Semivariogram analysis and kriging were used to investigate spatiotemporal heterogeneities. RESULTS CFR estimates varied significantly between districts and over time over the course of the epidemic. BRT modelling accounted for most of the spatiotemporal variation and interactions in CFR, but moderate spatial autocorrelation remained for distances up to approximately 90 km. Combining district-level CFR estimates and kriged district-level residuals provided the best linear unbiased predicted map of CFR accounting for the both explained and unexplained spatial variation. Temporal autocorrelation was not observed in the district-level residuals from the BRT estimates. CONCLUSIONS This study provides new insight into the epidemiology of the 2013-2016 West African Ebola epidemic with a view of informing future public health contingency planning, resource allocation and impact assessment. The analytical framework developed in this analysis, coupled with key domain knowledge, could be deployed in real time to support the response to ongoing and future outbreaks.
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Affiliation(s)
- Alpha Forna
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK.
| | - Ilaria Dorigatti
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Pierre Nouvellet
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK; School of Life Sciences, University of Sussex, Brighton, UK
| | - Christl A Donnelly
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK; Department of Statistics, University of Oxford, Oxford, UK
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18
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Wasik S, Jaroszewski M, Nowaczyk M, Szostak N, Prejzendanc T, Blazewicz J. VirDB: Crowdsourced Database for Evaluation of Dynamical Viral Infection Models. Curr Bioinform 2019. [DOI: 10.2174/1574893614666190308155904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:Open science is an emerging movement underlining the importance of transparent, high quality research where results can be verified and reused by others. However, one of the biggest problems in replicating experiments is the lack of access to the data used by the authors. This problem also occurs during mathematical modeling of a viral infections. It is a process that can provide valuable insights into viral activity or into a drug’s mechanism of action when conducted correctly.Objective:We present the VirDB database (virdb.cs.put.poznan.pl), which has two primary objectives. First, it is a tool that enables collecting data on viral infections that could be used to develop new dynamic models of infections using the FAIR data sharing principles. Second, it allows storing references to descriptions of viral infection models, together with their evaluation results.Methods:To facilitate the fast population of database and the ease of exchange of scientific data, we decided to use crowdsourcing for collecting data. Such approach has already been proved to be very successful in projects such as Wikipedia.Conclusion:VirDB builds on the concepts and recommendations of Open Science and shares data using the FAIR principles. Thanks to this storing data required for designing and evaluating models of viral infections which can be freely available on the Internet.
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Affiliation(s)
- Szymon Wasik
- Institute of Computing Science, Poznan University of Technology, Poznan, Poland
| | - Marcin Jaroszewski
- Institute of Computing Science, Poznan University of Technology, Poznan, Poland
| | - Mateusz Nowaczyk
- Institute of Computing Science, Poznan University of Technology, Poznan, Poland
| | - Natalia Szostak
- Institute of Computing Science, Poznan University of Technology, Poznan, Poland
| | - Tomasz Prejzendanc
- Institute of Computing Science, Poznan University of Technology, Poznan, Poland
| | - Jacek Blazewicz
- Institute of Computing Science, Poznan University of Technology, Poznan, Poland
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19
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Herrick C. Geographic charisma and the potential energy of Ebola. SOCIOLOGY OF HEALTH & ILLNESS 2019; 41:1488-1502. [PMID: 31155737 DOI: 10.1111/1467-9566.12960] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The Ebola virus is unparalleled in its charismatic ability to ignite fear, anxiety and disgust at a scale grossly disproportionate to the number of lives it claims. As an archetypal 'Emerging Infectious Disease' (EID), this designation and the politics that have encircled it have provided Ebola with a conceptual space in which epidemiology and geography to splice together in the genesis and maintenance of its charismatic valence. Even before the West African outbreak of 2013-2016, Ebola was an 'exceptional' and 'master status' disease around which media attention mobilised to an unparalleled degree and effect. This paper argues that even if never directly conceptualised as such, Ebola is uniquely charismatic among EIDs and, more, this charisma can be understood geographically. To do so, the paper proceeds in three parts to explore how Ebola's geographic charisma emerges from: (i) it being fixed 'in place' as something innately African; (ii) fears about the virus moving 'out of place' and (iii) its 'potential energy' or the persistent unease generated by the uncertainty of when and where the virus's potential geographies will become actual.
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Affiliation(s)
- Clare Herrick
- Department of Geography, King's College London, London, UK
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20
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Mudatsir M, Anwar S, Fajar JK, Yufika A, Ferdian MN, Salwiyadi S, Imanda AS, Azhars R, Ilham D, Timur AU, Sahputri J, Yordani R, Pramana S, Rajamoorthy Y, Wagner AL, Jamil KF, Harapan H. Willingness-to-pay for a hypothetical Ebola vaccine in Indonesia: A cross-sectional study in Aceh. F1000Res 2019; 8:1441. [PMID: 32399182 PMCID: PMC7194337 DOI: 10.12688/f1000research.20144.2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/29/2020] [Indexed: 11/20/2022] Open
Abstract
Background: Some Ebola vaccines have been developed and tested in phase III clinical trials. However, assessment of whether public have willingness to purchase or not, especially in unaffected areas, is lacking. The aim of this study was to determine willingness to pay (WTP) for a hypothetical Ebola vaccine in Indonesia. Methods: A cross-sectional study was conducted from 1 August to 30 December 2015 in five cities in Aceh province of Indonesia. Patients’ family members who visited outpatient departments were approached and interviewed about their sociodemographic characteristics, knowledge of Ebola, attitude towards vaccination practice and their WTP for a hypothetical Ebola vaccine. A multivariable linear regression model assessed the relationship between these explanatory variables and WTP. Results: During the study, 500 participants were approached and interviewed. There were 424 (84.8%) respondents who completed the interview and 74% (311/424) expressed their acceptance for an Ebola vaccine. There were 288 participants who were willing to pay for an Ebola vaccine (92.6% out of 311). The mean of WTP was US$2.08 (95% CI: 1.75-2.42). The final multivariable model indicated that young age, high educational attainment, working as a private employee, entrepreneur or civil servant (compared to farmers), being unmarried, and residing in a suburb (compared to a city) were associated with higher WTP. Conclusions: Although the proportion of the participants who would accept the Ebola vaccine was relatively high, the amount they were willing to pay for Ebola vaccine was very low. This finding would indicate the need of subsidies for Ebola vaccine in the country.
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Affiliation(s)
- Mudatsir Mudatsir
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia.,Tropical Diseases Centre, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia.,Department of Microbiology, School of Medicine, Universitas Syiah Kuala, Bnada Aceh, Indonesia
| | - Samsul Anwar
- Department of Statistics, Faculty of Mathematics and Natural Sciences, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Jonny K Fajar
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Amanda Yufika
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia.,Department of Family Medicine, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Muhammad N Ferdian
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Salwiyadi Salwiyadi
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Aga S Imanda
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Roully Azhars
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Darul Ilham
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Arya U Timur
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Juwita Sahputri
- Department of Microbiology, Faculty of Medicine, Malikussaleh University, Lhokseumawe, Indonesia
| | | | | | - Yogambigai Rajamoorthy
- Department of Economics, Faculty of Accountancy and Management, Universiti Tunku Abdul Rahman, Selangor, Malaysia
| | - Abram L Wagner
- Department of Epidemiology, Department of Epidemiology, University of Michigan, Ann Arbor, USA
| | - Kurnia F Jamil
- Department of Internal Medicine, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Harapan Harapan
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia.,Tropical Diseases Centre, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia.,Department of Microbiology, School of Medicine, Universitas Syiah Kuala, Bnada Aceh, Indonesia
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21
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Mudatsir M, Anwar S, Fajar JK, Yufika A, Ferdian MN, Salwiyadi S, Imanda AS, Azhars R, Ilham D, Timur AU, Sahputri J, Yordani R, Pramana S, Rajamoorthy Y, Wagner AL, Jamil KF, Harapan H. Willingness-to-pay for a hypothetical Ebola vaccine in Indonesia: A cross-sectional study in Aceh. F1000Res 2019; 8:1441. [PMID: 32399182 PMCID: PMC7194337 DOI: 10.12688/f1000research.20144.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/12/2023] [Indexed: 06/24/2023] Open
Abstract
Background: Some Ebola vaccines have been developed and tested in phase III clinical trials. However, assessment of whether public have willingness to purchase or not, especially in unaffected areas, is lacking. The aim of this study was to determine willingness to pay (WTP) for a hypothetical Ebola vaccine in Indonesia. Methods: A cross-sectional study was conducted from 1 August to 30 December 2015 in five cities in Aceh province of Indonesia. Patients' family members who visited outpatient departments were approached and interviewed about their sociodemographic characteristics, knowledge of Ebola, attitude towards vaccination practice and their WTP for a hypothetical Ebola vaccine. A multivariable linear regression model assessed the relationship between these explanatory variables and WTP. Results: During the study, 500 participants were approached and interviewed. There were 424 (84.8%) respondents who completed the interview and 74% (311/424) expressed their acceptance for an Ebola vaccine. There were 288 participants who were willing to pay for an Ebola vaccine (92.6% out of 311). The mean of WTP was US$2.08 (95% CI: 1.75-2.42). The final multivariable model indicated that young age, high educational attainment, working as a private employee, entrepreneur or civil servant (compared to farmers), being unmarried, and residing in a suburb (compared to a city) were associated with higher WTP. Conclusions: Although the proportion of the participants who would accept the Ebola vaccine was relatively high, the amount they were willing to pay for Ebola vaccine was very low. This finding would indicate the need of subsidies for Ebola vaccine in the country.
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Affiliation(s)
- Mudatsir Mudatsir
- Tropical Diseases Centre, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
- Department of Microbiology, School of Medicine, Universitas Syiah Kuala, Bnada Aceh, Indonesia
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Samsul Anwar
- Department of Statistics, Faculty of Mathematics and Natural Sciences, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Jonny Karunia Fajar
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Amanda Yufika
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
- Department of Family Medicine, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Muhammad N. Ferdian
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Salwiyadi Salwiyadi
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Aga S. Imanda
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Roully Azhars
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Darul Ilham
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Arya U. Timur
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Juwita Sahputri
- Department of Microbiology, Faculty of Medicine, Malikussaleh University, Lhokseumawe, Indonesia
| | | | | | - Yogambigai Rajamoorthy
- Department of Economics, Faculty of Accountancy and Management, Universiti Tunku Abdul Rahman, Selangor, Malaysia
| | - Abram L. Wagner
- Department of Epidemiology, Department of Epidemiology, University of Michigan, Ann Arbor, USA
| | - Kurnia F. Jamil
- Department of Internal Medicine, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Harapan Harapan
- Tropical Diseases Centre, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
- Department of Microbiology, School of Medicine, Universitas Syiah Kuala, Bnada Aceh, Indonesia
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
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22
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Mudatsir M, Anwar S, Fajar JK, Yufika A, Ferdian MN, Salwiyadi S, Imanda AS, Azhars R, Ilham D, Timur AU, Sahputri J, Yordani R, Pramana S, Rajamoorthy Y, Wagner AL, Jamil KF, Harapan H. Willingness-to-pay for a hypothetical Ebola vaccine in Indonesia: A cross-sectional study in Aceh. F1000Res 2019; 8:1441. [PMID: 32399182 DOI: 10.12688/f1000research.20144.1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/09/2019] [Indexed: 11/20/2022] Open
Abstract
Background: Some Ebola vaccines have been developed and tested in phase III clinical trials. However, assessment of whether public have willingness to purchase or not, especially in unaffected areas, is lacking. The aim of this study was to determine willingness to pay (WTP) for a hypothetical Ebola vaccine in Indonesia. Methods: A cross-sectional study was conducted from 1 August to 30 December 2015 in five cities in Aceh province of Indonesia. Patients' family members who visited outpatient departments were approached and interviewed about their sociodemographic characteristics, knowledge of Ebola, attitude towards vaccination practice and their WTP for a hypothetical Ebola vaccine. A multivariable linear regression model assessed the relationship between these explanatory variables and WTP. Results: During the study, 500 participants were approached and interviewed. There were 424 (84.8%) respondents who completed the interview and 74% (311/424) expressed their acceptance for an Ebola vaccine. There were 288 participants who were willing to pay for an Ebola vaccine (92.6% out of 311). The mean of WTP was US$2.08 (95% CI: 1.75-2.42). The final multivariable model indicated that young age, high educational attainment, working as a private employee, entrepreneur or civil servant (compared to farmers), being unmarried, and residing in a suburb (compared to a city) were associated with higher WTP. Conclusions: Although the proportion of the participants who would accept the Ebola vaccine was relatively high, the amount they were willing to pay for Ebola vaccine was very low. This finding would indicate the need of subsidies for Ebola vaccine in the country.
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Affiliation(s)
- Mudatsir Mudatsir
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia.,Tropical Diseases Centre, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia.,Department of Microbiology, School of Medicine, Universitas Syiah Kuala, Bnada Aceh, Indonesia
| | - Samsul Anwar
- Department of Statistics, Faculty of Mathematics and Natural Sciences, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Jonny K Fajar
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Amanda Yufika
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia.,Department of Family Medicine, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Muhammad N Ferdian
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Salwiyadi Salwiyadi
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Aga S Imanda
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Roully Azhars
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Darul Ilham
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Arya U Timur
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Juwita Sahputri
- Department of Microbiology, Faculty of Medicine, Malikussaleh University, Lhokseumawe, Indonesia
| | | | | | - Yogambigai Rajamoorthy
- Department of Economics, Faculty of Accountancy and Management, Universiti Tunku Abdul Rahman, Selangor, Malaysia
| | - Abram L Wagner
- Department of Epidemiology, Department of Epidemiology, University of Michigan, Ann Arbor, USA
| | - Kurnia F Jamil
- Department of Internal Medicine, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Harapan Harapan
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia.,Tropical Diseases Centre, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia.,Department of Microbiology, School of Medicine, Universitas Syiah Kuala, Bnada Aceh, Indonesia
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Xu MJ, Stanford-Moore G, Czechowicz JA. Association of Ebola Virus Infection With Hearing Loss in Regions Where Ebola Virus Infection Is Endemic: A Systematic Review. JAMA Otolaryngol Head Neck Surg 2019; 145:669-675. [PMID: 31095264 DOI: 10.1001/jamaoto.2019.0710] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Many survivors of Ebola virus infection describe new-onset hearing loss after infection. The prevalence, severity, and pathophysiologic features of hearing loss in this population have not been well characterized. Objective To perform a systematic review of the current literature to characterize hearing loss in survivors of Ebola virus infection. Evidence Review This study adhered to the relevant sections of the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Searches through PubMed, Embase, and Google Scholar were performed to include publications written in English from January 1, 1965, to October 1, 2018. Relevant vocabulary terms and key terms related to Ebola and hearing loss were used. Two investigators independently screened the eligible studies, extracted data, and assessed quality and risk of bias. Findings Of 127 publications reviewed, 15 met the criteria for inclusion; 3 were retrospective case-control studies (level of evidence, 3), and 12 were cross-sectional studies or case reports (level of evidence, 4). Studies included 1775 survivors of Ebola virus infection (993 female [55.9%]) and 363 uninfected controls (186 female [51.2%]) from the Democratic Republic of the Congo, Uganda, Guinea, Liberia, and Sierra Leone. The duration of follow-up ranged from 0 to 29 months (median, 5 months). Hearing loss was reported in 147 survivors of Ebola virus infection (8.3%). Among studies that compared survivors with controls, the reported odds ratios for hearing loss in survivors was 7.50 (95% CI, 3.91-14.39; range, 1.4-12.1). Including all studies, the odds ratio of hearing loss in survivors vs controls in countries where Ebola virus infection is endemic was 1.84 (95% CI, 1.10-3.08). Conclusions and Relevance Survivors of Ebola virus infection had higher rates of hearing loss than uninfected controls in regions where the infection is endemic. Further research with consistent objective methods and pure-tone audiometry may be needed to better characterize the hearing loss, understand its pathophysiologic features, and develop treatments.
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Affiliation(s)
- Mary Jue Xu
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco
| | - Gaelen Stanford-Moore
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco
| | - Josephine A Czechowicz
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco
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Kakooza-Mwesige A, Tshala-Katumbay D, Juliano SL. Viral infections of the central nervous system in Africa. Brain Res Bull 2019; 145:2-17. [PMID: 30658129 DOI: 10.1016/j.brainresbull.2018.12.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 12/17/2018] [Accepted: 12/19/2018] [Indexed: 12/26/2022]
Abstract
Viral infections are a major cause of human central nervous system infection, and may be associated with significant mortality, and long-term sequelae. In Africa, the lack of effective therapies, limited diagnostic and human resource facilities are especially in dire need. Most viruses that affect the central nervous system are opportunistic or accidental pathogens. Some of these viruses were initially considered harmless, however they have now evolved to penetrate the nervous system efficiently and exploit neuronal cell biology thus resulting in severe illness. A number of potentially lethal neurotropic viruses have been discovered in Africa and over the course of time shown their ability to spread wider afield involving other continents leaving a devastating impact in their trail. In this review we discuss key viruses involved in central nervous system disease and of major public health concern with respect to Africa. These arise from the families of Flaviviridae, Filoviridae, Retroviridae, Bunyaviridae, Rhabdoviridae and Herpesviridae. In terms of the number of cases affected by these viruses, HIV (Retroviridae) tops the list for morbidity, mortality and long term disability, while the Rift Valley Fever virus (Bunyaviridae) is at the bottom of the list. The most deadly are the Ebola and Marburg viruses (Filoviridae). This review describes their epidemiology and key neurological manifestations as regards the central nervous system such as meningoencephalitis and Guillain-Barré syndrome. The potential pathogenic mechanisms adopted by these viruses are debated and research perspectives suggested.
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Affiliation(s)
- Angelina Kakooza-Mwesige
- Department of Paediatrics & Child Health, Makerere University College of Health Sciences and Mulago Hospital, Kampala, Uganda; Astrid Lindgren Children's Hospital, Neuropediatric Research Unit, Karolinska Institutet, Sweden.
| | - Desire Tshala-Katumbay
- Department of Neurology and School of Public Health, Oregon Health & Science University, Portland, OR, USA; Department of Neurology, University of Kinshasa, and Institut National de Recherches Biomedicales, University of Kinshasa, Democratic Republic of the Congo.
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25
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Nasution MAF, Toepak EP, Alkaff AH, Tambunan USF. Flexible docking-based molecular dynamics simulation of natural product compounds and Ebola virus Nucleocapsid (EBOV NP): a computational approach to discover new drug for combating Ebola. BMC Bioinformatics 2018; 19:419. [PMID: 30453886 PMCID: PMC6245692 DOI: 10.1186/s12859-018-2387-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background Ebola still remains as one of the most problematic infectious diseases in Africa with a high rate of mortality. Although this disease has been known for an almost half-century, there are no vaccines and drugs available in the market to treat Ebola. Zaire ebolavirus (EBOV), a single-stranded RNA virus which belongs to Filoviridae family and Mononegavirales order, is one of the virus causing Ebola. As one of seven proteins that EBOV encodes, Ebola virus nucleoprotein (EBOV NP) plays an imperative role in EBOV proliferation cycle. Therefore, the development of a new Ebola treatment can be targeted towards EBOV NP. Results In this work, we screened about 190,084 natural product compounds from ZINC15 database through in silico virtual screening and flexible docking simulation. Furthermore, the bioavailability and toxicity prediction have been conducted as well. Two best ligands according to the simulation and prediction tests were progressed into the molecular dynamics simulation. Conclusion In the end, we found that our proposed ligands, namely α-lipomycin (ZINC56874155) and 3-(((S)-1-amino-1,2,3,4-tetrahydroisoquinolin-5-yl)methyl)-5-((5-((5R,7S)-5,7-dihydroxy-3-oxodecyl)-2-hydroxyphenoxy) methyl)pyrrolo[3,4-b]pyrrol-5-ium (ZINC85628951), showed the promising results to be developed as a lead compounds for treating Ebola. Therefore, an experimental study is required to validate their inhibition activities against EBOV NP.
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Affiliation(s)
- Mochammad Arfin Fardiansyah Nasution
- Bioinformatics Research Group, Department of Chemistry, Faculty of Mathematics and Natural Science, Universitas Indonesia, Kampus UI, Depok, 16424, Indonesia
| | - Erwin Prasetya Toepak
- Bioinformatics Research Group, Department of Chemistry, Faculty of Mathematics and Natural Science, Universitas Indonesia, Kampus UI, Depok, 16424, Indonesia
| | - Ahmad Husein Alkaff
- Bioinformatics Research Group, Department of Chemistry, Faculty of Mathematics and Natural Science, Universitas Indonesia, Kampus UI, Depok, 16424, Indonesia
| | - Usman Sumo Friend Tambunan
- Bioinformatics Research Group, Department of Chemistry, Faculty of Mathematics and Natural Science, Universitas Indonesia, Kampus UI, Depok, 16424, Indonesia.
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Cross RW, Fenton KA, Geisbert TW. Small animal models of filovirus disease: recent advances and future directions. Expert Opin Drug Discov 2018; 13:1027-1040. [DOI: 10.1080/17460441.2018.1527827] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Robert W. Cross
- Galveston National Laboratory, The University of Texas Medical Branch, Galveston, TX, USA
- Department of Microbiology and Immunology, The University of Texas Medical Branch, Galveston, TX, USA
| | - Karla A. Fenton
- Galveston National Laboratory, The University of Texas Medical Branch, Galveston, TX, USA
- Department of Microbiology and Immunology, The University of Texas Medical Branch, Galveston, TX, USA
| | - Thomas W. Geisbert
- Galveston National Laboratory, The University of Texas Medical Branch, Galveston, TX, USA
- Department of Microbiology and Immunology, The University of Texas Medical Branch, Galveston, TX, USA
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27
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Findlater A, Bogoch II. Human Mobility and the Global Spread of Infectious Diseases: A Focus on Air Travel. Trends Parasitol 2018; 34:772-783. [PMID: 30049602 PMCID: PMC7106444 DOI: 10.1016/j.pt.2018.07.004] [Citation(s) in RCA: 105] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 07/08/2018] [Accepted: 07/09/2018] [Indexed: 12/21/2022]
Abstract
Greater human mobility, largely driven by air travel, is leading to an increase in the frequency and reach of infectious disease epidemics. Air travel can rapidly connect any two points on the planet, and this has the potential to cause swift and broad dissemination of emerging and re-emerging infectious diseases that may pose a threat to global health security. Investments to strengthen surveillance, build robust early-warning systems, improve predictive models, and coordinate public health responses may help to prevent, detect, and respond to new infectious disease epidemics.
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Affiliation(s)
- Aidan Findlater
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Isaac I Bogoch
- Department of Medicine, University of Toronto, Toronto, Canada; Divisions of General Internal Medicine and Infectious Diseases, Toronto General Hospital, University Health Network, Toronto, Canada.
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Brettin A, Rossi–Goldthorpe R, Weishaar K, Erovenko IV. Ebola could be eradicated through voluntary vaccination. ROYAL SOCIETY OPEN SCIENCE 2018; 5:171591. [PMID: 29410863 PMCID: PMC5792940 DOI: 10.1098/rsos.171591] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 12/11/2017] [Indexed: 05/04/2023]
Abstract
Ebola virus disease (EVD) is a severe infection with an extremely high fatality rate spread through direct contact with body fluids. A promising Ebola vaccine (rVSV-ZEBOV) may soon become universally available. We constructed a game-theoretic model of Ebola incorporating individual decisions to vaccinate. We found that if a population adopts selfishly optimal vaccination strategies, then the population vaccination coverage falls negligibly short of the herd immunity level. We concluded that eradication of Ebola is feasible if voluntary vaccination programmes are coupled with focused public education efforts. We conducted uncertainty and sensitivity analysis to demonstrate that our findings do not depend on the choice of the epidemiological model parameters.
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Affiliation(s)
- Andrew Brettin
- Department of Mathematics, University of Minnesota—Twin Cities, Minneapolis, MN 55455, USA
| | | | - Kyle Weishaar
- Department of Mathematics, Regis University, Denver, CO 80221, USA
| | - Igor V. Erovenko
- Department of Mathematics and Statistics, University of North Carolina at Greensboro, Greensboro, NC 27402, USA
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29
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Impact of Comorbidity on Fatality Rate of Patients with Middle East Respiratory Syndrome. Sci Rep 2017; 7:11307. [PMID: 28900101 PMCID: PMC5596001 DOI: 10.1038/s41598-017-10402-1] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 08/07/2017] [Indexed: 01/17/2023] Open
Abstract
To date, 1841 cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection have been reported worldwide, with 652 deaths. We used a publically available case line list to explore the effect of relevant factors, notably underlying comorbidities, on fatal outcome of Middle East respiratory syndrome (MERS) cases up to the end of October 2016. A Bayesian Weibull proportional hazards regression model was used to assess the effect of comorbidity, age, epidemic period and sex on the fatality rate of MERS cases and its variation across countries. The crude fatality rate of MERS cases was 32.1% (95% credibility interval (CI): 29.9%, 34.3%). Notably, the incremental change of daily death rate was most prominent during the first week since disease onset with an average increase of 13%, but then stabilized in the remaining two weeks when it only increased 3% on average. Neither sex, nor country of infection were found to have a significant impact on fatality rates after taking into account the age and comorbidity status of patients. After adjusting for age, epidemic period, MERS patients with comorbidity had around 4 times the risk for fatal infection than those without (adjusted hazard ratio of 3.74 (95% CI: 2.57, 5.67)).
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30
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Nyakarahuka L, Kankya C, Krontveit R, Mayer B, Mwiine FN, Lutwama J, Skjerve E. How severe and prevalent are Ebola and Marburg viruses? A systematic review and meta-analysis of the case fatality rates and seroprevalence. BMC Infect Dis 2016; 16:708. [PMID: 27887599 PMCID: PMC5124280 DOI: 10.1186/s12879-016-2045-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 11/17/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Ebola and Marburg virus diseases are said to occur at a low prevalence, but are very severe diseases with high lethalities. The fatality rates reported in different outbreaks ranged from 24-100%. In addition, sero-surveys conducted have shown different seropositivity for both Ebola and Marburg viruses. We aimed to use a meta-analysis approach to estimate the case fatality and seroprevalence rates of these filoviruses, providing vital information for epidemic response and preparedness in countries affected by these diseases. METHODS Published literature was retrieved through a search of databases. Articles were included if they reported number of deaths, cases, and seropositivity. We further cross-referenced with ministries of health, WHO and CDC databases. The effect size was proportion represented by case fatality rate (CFR) and seroprevalence. Analysis was done using the metaprop command in STATA. RESULTS The weighted average CFR of Ebola virus disease was estimated to be 65.0% [95% CI (54.0-76.0%), I2 = 97.98%] whereas that of Marburg virus disease was 53.8% (26.5-80.0%, I2 = 88.6%). The overall seroprevalence of Ebola virus was 8.0% (5.0%-11.0%, I2 = 98.7%), whereas that for Marburg virus was 1.2% (0.5-2.0%, I2 = 94.8%). The most severe species of ebolavirus was Zaire ebolavirus while Bundibugyo Ebolavirus was the least severe. CONCLUSIONS The pooled CFR and seroprevalence for Ebola and Marburg viruses were found to be lower than usually reported, with species differences despite high heterogeneity between studies. Countries with an improved health surveillance and epidemic response have lower CFR, thereby indicating need for improving early detection and epidemic response in filovirus outbreaks.
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Affiliation(s)
- Luke Nyakarahuka
- Norwegian University of Life Sciences, Oslo, Norway
- Makerere University, Kampala, Uganda
- Uganda Virus Research Institute, Entebbe, Uganda
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31
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Cherif MS, Koonrungsesomboon N, Diallo MP, Le Gall E, Kassé D, Cherif F, Koné A, Diakité M, Camara F, Magassouba N. The predictor of mortality outcome in adult patients with Ebola virus disease during the 2014-2015 outbreak in Guinea. Eur J Clin Microbiol Infect Dis 2016; 36:689-695. [PMID: 27888403 DOI: 10.1007/s10096-016-2850-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 11/16/2016] [Indexed: 11/29/2022]
Abstract
The purpose of this study was to examine the association of any demographic and clinical factors with mortality outcome among adult patients with Ebola virus disease (EVD) in Guinea. This retrospective observational study analyzed medical records of laboratory confirmed EVD adult patients during the 2014-2015 EVD outbreak in Guinea. The associations between any demographic or clinical variables and mortality outcome of EVD were assessed using univariate and multivariate logistic regression analyses. Of 2,310 EVD adult patients included for analysis, the overall case fatality rate was 68.1%. Univariate analyses identified factors possibly associated with mortality outcome, including patient age (p < 0.001), history of visiting or close contact with a suspected or confirmed EVD patient (p = 0.035), and seven clinical symptoms on admission, i.e., fever (p = 0.003), hiccups (p < 0.001), vomiting (p = 0.003), diarrhea (p < 0.001), cough (p = 0.001), sore throat (p = 0.016), and unexplained bleeding (p = 0.021). The multivariate analysis showed that patient age was independently associated with mortality outcome of EVD (OR = 1.06; 95%CI = 1.03-1.09; p < 0.001), while none the of clinical symptoms on admission were significantly associated with the mortality outcome. Our analysis indicates that older age was the only independent factor associated with death among EVD adult patients in Guinea. This suggests that older EVD patients should receive intensive medical care and be carefully monitored.
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Affiliation(s)
- M S Cherif
- Faculty of Medicine, University Gamal Abdel Nasser of Conakry, Conakry, Guinea. .,Department of Immunogenetics, Institute of Tropical Medicine (NEKKEN), Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan.
| | - N Koonrungsesomboon
- Department of Immunogenetics, Institute of Tropical Medicine (NEKKEN), Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
| | - M P Diallo
- Faculty of Medicine, University Gamal Abdel Nasser of Conakry, Conakry, Guinea
| | - E Le Gall
- Faculty of Medicine, University Gamal Abdel Nasser of Conakry, Conakry, Guinea.,Pôle Régional de Cancérologie Bretagne, Rennes, France
| | - D Kassé
- Faculty of Medicine, University Gamal Abdel Nasser of Conakry, Conakry, Guinea
| | - F Cherif
- Ministry of Health and Public Hygiene, Conakry, Guinea
| | - A Koné
- Faculty of Medicine, University Gamal Abdel Nasser of Conakry, Conakry, Guinea
| | - M Diakité
- Faculty of Medicine, University Gamal Abdel Nasser of Conakry, Conakry, Guinea
| | - F Camara
- Faculty of Medicine, University Gamal Abdel Nasser of Conakry, Conakry, Guinea
| | - N Magassouba
- Faculty of Medicine, University Gamal Abdel Nasser of Conakry, Conakry, Guinea
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Samaranayake L, Scully C, Nair RG, Petti S. Viral haemorrhagic fevers with emphasis on Ebola virus disease and oro-dental healthcare. Oral Dis 2016; 21:1-6. [PMID: 25399654 DOI: 10.1111/odi.12298] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Clinical profile and containment of the Ebola virus disease outbreak in two large West African cities, Nigeria, July-September 2014. Int J Infect Dis 2016; 53:23-29. [PMID: 27575939 DOI: 10.1016/j.ijid.2016.08.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 08/16/2016] [Accepted: 08/18/2016] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION The Ebola virus disease (EVD) outbreak in Nigeria began when an infected diplomat from Liberia arrived in Lagos, the most populous city in Africa, with subsequent transmission to another large city. METHODS First-, second-, and third-generation contacts were traced, monitored, and classified. Symptomatic contacts were managed at Ebola treatment centers as suspected, probable, and confirmed EVD cases using standard operating procedures adapted from the World Health Organization EVD guidelines. Reverse transcription PCR tests confirmed EVD. Socio-demographic, clinical, hospitalization, and outcome data of the July-September 2014 Nigeria EVD cohort were analyzed. RESULTS The median age of the 20 EVD cases was 33 years (interquartile range 26-62 years). More females (55%), health workers (65%), and persons <40 years old (60%) were infected than males, non-health workers, and persons aged ≥40 years. No EVD case management worker contracted the disease. Presenting symptoms were fever (85%), fatigue (70%), and diarrhea (65%). Clinical syndromes were gastroenteritis (45%), hemorrhage (30%), and encephalopathy (15%). The case-fatality rate was 40% and there was one mental health complication. The average duration from symptom onset to presentation was 3±2 days among survivors and 5±2 days for non-survivors. The mean duration from symptom onset to discharge was 15±5 days for survivors and 11±2 days for non-survivors. Mortality was higher in the older age group, males, and those presenting late. CONCLUSION The EVD outbreak in Nigeria was characterized by the severe febrile gastroenteritis syndrome typical of the West African outbreak, better outcomes, rapid containment, and no infection among EVD care-providers. Early case detection, an effective incident management system, and prompt case management with on-site mobilization and training of local professionals were key to the outcome.
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Smither SJ, Eastaugh L, Ngugi S, O'Brien L, Phelps A, Steward J, Lever MS. Ebola Virus Makona Shows Reduced Lethality in an Immune-deficient Mouse Model. J Infect Dis 2016; 214:S268-S274. [PMID: 27471321 DOI: 10.1093/infdis/jiw145] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 04/04/2016] [Indexed: 11/14/2022] Open
Abstract
Ebola virus Makona (EBOV-Makona; from the 2013-2016 West Africa outbreak) shows decreased virulence in an immune-deficient mouse model, compared with a strain from 1976. Unlike other filoviruses tested, EBOV-Makona may be slightly more virulent by the aerosol route than by the injected route, as 2 mice died following aerosol exposure, compared with no mortality among mice that received intraperitoneal injection of equivalent or higher doses. Although most mice did not succumb to infection, the detection of an immunoglobulin G antibody response along with observed clinical signs suggest that the mice were infected but able to clear the infection and recover. We hypothesize that this may be due to the growth rates and kinetics of the virus, which appear slower than that for other filoviruses and consequently give more time for an immune response that results in clearance of the virus. In this instance, the immune-deficient mouse model is unlikely to be appropriate for testing medical countermeasures against this EBOV-Makona stock but may provide insight into pathogenesis and the immune response to virus.
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Affiliation(s)
- Sophie J Smither
- Chemical, Biological, and Radiological Division, Defence Science and Technology Laboratory (Dstl), Salisbury, United Kingdom
| | - Lin Eastaugh
- Chemical, Biological, and Radiological Division, Defence Science and Technology Laboratory (Dstl), Salisbury, United Kingdom
| | - Sarah Ngugi
- Chemical, Biological, and Radiological Division, Defence Science and Technology Laboratory (Dstl), Salisbury, United Kingdom
| | - Lyn O'Brien
- Chemical, Biological, and Radiological Division, Defence Science and Technology Laboratory (Dstl), Salisbury, United Kingdom
| | - Amanda Phelps
- Chemical, Biological, and Radiological Division, Defence Science and Technology Laboratory (Dstl), Salisbury, United Kingdom
| | - Jackie Steward
- Chemical, Biological, and Radiological Division, Defence Science and Technology Laboratory (Dstl), Salisbury, United Kingdom
| | - Mark Stephen Lever
- Chemical, Biological, and Radiological Division, Defence Science and Technology Laboratory (Dstl), Salisbury, United Kingdom
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Weppelmann TA, Donewell B, Haque U, Hu W, Magalhaes RJS, Lubogo M, Godbless L, Shabani S, Maeda J, Temba H, Malibiche TC, Berhanu N, Zhang W, Bawo L. Determinants of patient survival during the 2014 Ebola Virus Disease outbreak in Bong County, Liberia. Glob Health Res Policy 2016; 1:5. [PMID: 29202055 PMCID: PMC5675064 DOI: 10.1186/s41256-016-0005-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 06/16/2016] [Indexed: 11/22/2022] Open
Abstract
Background The unprecedented size of the 2014 Ebola Virus Disease (EVD) outbreak in West Africa has allowed for a more extensive characterization of the clinical presentation and management of this disease. In this study, we report the trends in morbidity, mortality, and determinants of patient survival as EVD spread into Bong County, Liberia. Methods An analysis of suspected, probable, or confirmed cases of EVD (n = 607) reported to the Liberian Ministry of Health and Social Welfare (MOHSW) between March 23rd and December 31st 2014 was conducted. The likelihood of infection given exposure factors was determined using logistic regression in individuals with a definitive diagnosis by RT-PCR (n = 321). The risk of short-term mortality (30 days) given demographic factors, clinical symptoms, and highest level of treatment received was assessed with Cox regression and survival analyses (n = 391). Results The overall mortality rate was 53.5 % (95 % CI: 49 %, 58 %) and decreased as access to medical treatment increased. Those who reported contact with another EVD case were more likely to be infected (OR: 5.7), as were those who attended a funeral (OR: 3.9). Mortality increased with age (P < 0.001) and was higher in males compared to females (P =0.006). Fever (HR: 6.63), vomiting (HR: 1.93), diarrhea (HR: 1.99), and unexplained bleeding (HR: 2.17) were associated with increased mortality. After adjusting for age, hospitalized patients had a 74 % reduction in the risk of short term mortality (P < 0.001 AHR: 0.26; 95 % CI AHR: 0.18, 0.37), compared to those not given medical intervention. Conclusion Even treatment with only basic supportive care such as intravenous rehydration therapy was able to significantly improve patient survival in suspected, probable, or confirmed EVD cases.
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Affiliation(s)
- Thomas A Weppelmann
- Department of Environmental and Global Health, University of Florida, Gainesville, FL USA.,Emerging Pathogens Institute, University of Florida, 2055 Mowry Rd, Gainesville, FL USA
| | - Bangure Donewell
- African Union Support to Ebola Outbreak in West Africa (ASEOWA), Monrovia, Liberia
| | - Ubydul Haque
- Emerging Pathogens Institute, University of Florida, 2055 Mowry Rd, Gainesville, FL USA.,Department of Geography, University of Florida, Gainesville, FL USA
| | - Wenbiao Hu
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | - Ricardo J Soares Magalhaes
- School of Veterinary Science, The University of Queensland, Brisbane, Australia.,Children's Health Research Centre, The University of Queensland, St Lucia, Australia
| | - Mutaawe Lubogo
- African Union Support to Ebola Outbreak in West Africa (ASEOWA), Monrovia, Liberia
| | - Lucas Godbless
- African Union Support to Ebola Outbreak in West Africa (ASEOWA), Monrovia, Liberia
| | - Sasita Shabani
- African Union Support to Ebola Outbreak in West Africa (ASEOWA), Monrovia, Liberia
| | - Justin Maeda
- African Union Support to Ebola Outbreak in West Africa (ASEOWA), Monrovia, Liberia
| | - Herilinda Temba
- African Union Support to Ebola Outbreak in West Africa (ASEOWA), Monrovia, Liberia
| | - Theophil C Malibiche
- African Union Support to Ebola Outbreak in West Africa (ASEOWA), Monrovia, Liberia
| | - Naod Berhanu
- African Union Support to Ebola Outbreak in West Africa (ASEOWA), Monrovia, Liberia
| | - Wenyi Zhang
- Institute of Disease Control and Prevention, Academy of Military Medical Science, Beijing, People's Republic of China
| | - Luke Bawo
- Liberian Ministry of Health and Social Work (MOHSW), Monrovia, Liberia
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Bower H, Smout E, Bangura MS, Kamara O, Turay C, Johnson S, Oza S, Checchi F, Glynn JR. Deaths, late deaths, and role of infecting dose in Ebola virus disease in Sierra Leone: retrospective cohort study. BMJ 2016; 353:i2403. [PMID: 27188404 PMCID: PMC4870382 DOI: 10.1136/bmj.i2403] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To assess the frequency of fatal recrudescence from Ebola virus disease after discharge from treatment centres, and explore the influence of infecting dose on case fatality rates. DESIGN Retrospective cohort study. SETTING Western Area, Sierra Leone. PARTICIPANTS 151 survivors treated for Ebola virus disease at the Kerry Town treatment centre and discharged. Survivors were followed up for a vital status check at four to nine months after discharge, and again at six to 13 months after discharge. Verbal autopsies were conducted for four survivors who had died since discharge (that is, late deaths). Survivors still living in Western Area were interviewed together with their household members. Exposure level to Ebola virus disease was ascertained as a proxy of infecting dose, including for those who died. MAIN OUTCOME MEASURES Risks and causes of late death; case fatality rates; odds ratios of death from Ebola virus disease by age, sex, exposure level, date, occupation, and household risk factors. RESULTS Follow-up information was obtained on all 151 survivors of Ebola virus disease, a mean of 10 months after discharge. Four deaths occurred after discharge, all within six weeks: two probably due to late complications, one to prior tuberculosis, and only one after apparent full recovery, giving a maximum estimate of recrudescence leading to death of 0.7%. In these households, 395 people were reported to have had Ebola virus disease, of whom 227 died. A further 53 people fulfilled the case definition for probable disease, of whom 11 died. Therefore, the case fatality rate was 57.5% (227/395) for reported Ebola virus disease, or 53.1% (238/448) including probable disease. Case fatality rates were higher in children aged under 2 years and adults older than 30 years, in larger households, and in infections occurring earlier in the epidemic in Sierra Leone. There was no consistent trend of case fatality rate with exposure level, although increasing exposure increased the risk of Ebola virus disease. CONCLUSIONS In this study of survivors in Western Area, Sierra Leone, late recrudescence of severe Ebola virus disease appears to be rare. There was no evidence for an effect of infecting dose (as measured by exposure level) on the severity of disease.
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Affiliation(s)
- Hilary Bower
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Elizabeth Smout
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | | | | - Shefali Oza
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Judith R Glynn
- London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
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Toward sustainable and effective control: Experience of China Ebola Treatment Center in Liberia. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2016; 50:1-3. [PMID: 27262211 PMCID: PMC7105052 DOI: 10.1016/j.jmii.2016.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 01/21/2016] [Accepted: 04/19/2016] [Indexed: 11/24/2022]
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Lehmann M, Bruenahl CA, Addo MM, Becker S, Schmiedel S, Lohse AW, Schramm C, Löwe B. Acute Ebola virus disease patient treatment and health-related quality of life in health care professionals: A controlled study. J Psychosom Res 2016; 83:69-74. [PMID: 26423938 DOI: 10.1016/j.jpsychores.2015.09.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 09/06/2015] [Accepted: 09/07/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This study aimed to identify predictors of health-related quality of life (HrQoL) and to investigate infection-related concerns in health professionals during the acute treatment episode for one Ebola virus disease (EVD) patient in tertiary care. METHODS In a cross-sectional controlled study, validated self-report questionnaires were completed by three groups of health care professionals: (1) staff from standard internal medicine inpatient wards of a tertiary care center, (2) staff from the isolation unit of the same center responsible for Ebola patient treatment, and (3) staff from a research laboratory with contact to the Ebola virus and other highly infectious pathogens. Outcomes were HrQoL (SF-12), infection-related concerns, global health status, fatigue (FACIT), depression (PHQ-9), anxiety (GAD-7), and somatic symptoms (SSS-8). RESULTS Comparisons between groups (n1=42, n2=32, n3=12) yielded no significant differences in HrQoL, subjective risk of infection, and most other psychosocial variables. However, the Ebola patient treatment group experienced significantly higher levels of social isolation than both other groups. The best predictors of poor physical and mental HrQoL were perceived lack of knowledge about the Ebola virus disease (physical: B=-1.2, p=0.05; mental: B=-1.3, p=0.03) and fatigue (physical: B=-0.3, p=0.02; mental: B=-0.53, p<0.001). CONCLUSION Ebola patient treatment in tertiary care does not seem to be associated with lower HrQoL and enhanced subjective risk of infection, but seems to yield feelings of social isolation in health-care professionals.
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Affiliation(s)
- Marco Lehmann
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf and Schön Klinik Hamburg Eilbek, Hamburg, Germany.
| | - Christian A Bruenahl
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf and Schön Klinik Hamburg Eilbek, Hamburg, Germany
| | - Marylyn M Addo
- Medical Department, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; German Center of Infection Research (DZIF), Standort Hamburg-Lübeck-Borstel, Germany
| | - Stephan Becker
- Institute of Virology, Philipps University Marburg, Germany
| | - Stefan Schmiedel
- Medical Department, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ansgar W Lohse
- Medical Department, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Schramm
- Medical Department, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf and Schön Klinik Hamburg Eilbek, Hamburg, Germany
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Lever RA, Whitty CJM. Ebola virus disease: emergence, outbreak and future directions. Br Med Bull 2016; 117:95-106. [PMID: 26872858 DOI: 10.1093/bmb/ldw005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/05/2016] [Indexed: 12/27/2022]
Abstract
BACKGROUND The West African Ebola crisis of 2013-15 is the largest outbreak since Ebola was first identified; Ebola has high case fatality. SOURCES OF DATA Pubmed with terms 'Ebola' and 'EVD' from January 1976 to June 2015. Public domain material. AREAS OF AGREEMENT The emergence of Ebola virus, virology, clinical features and the major elements of the 2014 outbreak and the public health response. Ebola is only transmitted by direct contact with infected individuals (including dead bodies) and their body fluids. Methods of control in hospitals and burials, and protection of healthcare workers are well established if difficult to achieve. AREAS OF CONTENTION There remains uncertainty surrounding specific public health interventions and novel therapies (including vaccines). How best to reduce transmission in the community during major outbreaks remains unclear. FUTURE DIRECTIONS The potential of vaccine and therapeutic candidates in the event of another outbreak on this scale. . SEARCH STRATEGY We searched all entries on the MedLine database/PubMed from 1976-2015 with the MeSH terms 'ebola', 'EVD', 'haemorrhagic fever'. We also reviewed publically available information via institutional websites from Governmental, NGOs and news organizations pertaining to the above search terms.
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Affiliation(s)
- Robert A Lever
- Hospital for Tropical Diseases, 2B Maple House, 149 Tottenham Court Road, London W1T 7DN, UK
| | - Christopher J M Whitty
- Hospital for Tropical Diseases, 2B Maple House, 149 Tottenham Court Road, London W1T 7DN, UK
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Jemimah C, Lilly Sheeba S. Analysis of Bodily Fluids and Fomites in Transmission of Ebola Virus Using Bigdata. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.procs.2016.07.323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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41
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Petti S, Messano GA, Vingolo EM, Marsella LT, Scully C. The face of Ebola: changing frequency of haemorrhage in the West African compared with Eastern-Central African outbreaks. BMC Infect Dis 2015; 15:564. [PMID: 26653293 PMCID: PMC4676861 DOI: 10.1186/s12879-015-1302-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Accepted: 12/01/2015] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The West-African (WA) Zaire Ebolavirus disease (EVD) outbreak was characterized by an exceptionally high number of cases and deaths as compared with the Eastern-Central African (ECA) outbreaks. Despite the Zaire Ebolavirus being the most lethal for humans, case-fatality rate, close to 80 % in ECA outbreaks, almost halved to 47 % in Guinea-Liberia-Sierra Leone (WA). Such an improvement was due to the remarkable implementation of international humanitarian aids. Some studies also suggested that the long human-to-human transmission cycle occurred in WA, gave rise to human adaptation and consequent immune escape. Haemorrhage, the main feature in seriously infected EVD patients, is due to the immune system that triggers the infected endothelial cells which expose the spike-like glycoprotein (GP) of the virion on their surface. If the human adaptation hypothesis holds true, the proportion of EVD patients with haemorrhage in the WA outbreak should be lower than in the ECA outbreaks due to immune escape. Therefore, the aim of this meta-analysis was to compare the relative frequencies of three typical haemorrhagic symptoms (conjunctival -CB, nasal -NB, gingival -GB- bleedings) in the ECA and WA outbreaks. METHODS Literature searches were performed through PubMed and Scopus using generic keywords; surveys including at least ten patients reporting CB, NB, GB relative frequencies were extracted and split into ECA and WA. The meta-analytical methods chosen were based on the levels of between-study heterogeneity and publication bias. Pooled CB, NB, GB relative frequencies in ECA and WA were estimated and compared. Subgroup analysis including only studies on Zaire Ebolavirus also was performed. RESULTS Fifteen studies (10 ECA, 5 WA) were located with 4,867 (CB), 3,859 (NB), 4,278 (GB) EVD patients overall. GB pooled relative frequency was 45.3 % (95 % confidence interval -95 CI, 34.7-56.1 %) and 18.0 % (95 CI, 6.0-34.5 %), in ECA and WA; NB was 10.6 % (95 CI, 5.7-16.8 %) and 1.3 % (1.0-1.8 %); GB was 24.2 % (95 CI, 11.9-39.2 %) and 1.9 % (95 CI, 1.4-2.4 %). Subgroup analysis confirmed these results. CONCLUSIONS During the WA outbreak the relative frequency of GB decreased by two thirds, while NB and GB almost disappeared, suggesting that the Zaire Ebolavirus human adaptation hypothesis is plausible.
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Affiliation(s)
- Stefano Petti
- Department of Public Health and Infectious Diseases, Sapienza University, Piazzale Aldo Moro 5, 00185, Rome, Italy.
| | - Giuseppe Alessio Messano
- Department of Public Health and Infectious Diseases, Sapienza University, Piazzale Aldo Moro 5, 00185, Rome, Italy.
| | - Enzo Maria Vingolo
- Ophthalmology Department, Sapienza University, Viale del Policlinico 155, 00186, Rome, Italy.
| | - Luigi Tonino Marsella
- Department of Biomedicine and Prevention, Tor Vergata University, Viale Oxford 81, 00133, Rome, Italy.
| | - Crispian Scully
- University College London, Gower Street WC1E 6BT, London, UK.
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Faye O, Andronico A, Faye O, Salje H, Boëlle PY, Magassouba N, Bah EI, Koivogui L, Diallo B, Diallo AA, Keita S, Konde MK, Fowler R, Fall G, Cauchemez S, Sall AA. Use of Viremia to Evaluate the Baseline Case Fatality Ratio of Ebola Virus Disease and Inform Treatment Studies: A Retrospective Cohort Study. PLoS Med 2015; 12:e1001908. [PMID: 26625118 PMCID: PMC4666644 DOI: 10.1371/journal.pmed.1001908] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 10/19/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The case fatality ratio (CFR) of Ebola virus disease (EVD) can vary over time and space for reasons that are not fully understood. This makes it difficult to define the baseline CFRs needed to evaluate treatments in the absence of randomized controls. Here, we investigate whether viremia in EVD patients may be used to evaluate baseline EVD CFRs. METHODS AND FINDINGS We analyzed the laboratory and epidemiological records of patients with EVD confirmed by reverse transcription PCR hospitalized in the Conakry area, Guinea, between 1 March 2014 and 28 February 2015. We used viremia and other variables to model the CFR. Data for 699 EVD patients were analyzed. In the week following symptom onset, mean viremia remained stable, and the CFR increased with viremia, V, from 21% (95% CI 16%-27%) for low viremia (V < 104.4 copies/ml) to 53% (95% CI 44%-61%) for intermediate viremia (104.4 ≤ V < 105.2 copies/ml) and 81% (95% CI 75%-87%) for high viremia (V ≥ 105.2 copies/ml). Compared to adults (15-44 y old [y.o.]), the CFR was larger in young children (0-4 y.o.) (odds ratio [OR]: 2.44; 95% CI 1.02-5.86) and older adults (≥ 45 y.o.) (OR: 2.84; 95% CI 1.81-4.46) but lower in children (5-14 y.o.) (OR: 0.46; 95% CI 0.24-0.86). An order of magnitude increase in mean viremia in cases after July 2014 compared to those before coincided with a 14% increase in the CFR. Our findings come from a large hospital-based study in Conakry and may not be generalizable to settings with different case profiles, such as with individuals who never sought care. CONCLUSIONS Viremia in EVD patients was a strong predictor of death that partly explained variations in CFR in the study population. This study provides baseline CFRs by viremia group, which allow appropriate adjustment when estimating efficacy in treatment studies. In randomized controlled trials, stratifying analysis on viremia groups could reduce sample size requirements by 25%. We hypothesize that monitoring the viremia of hospitalized patients may inform the ability of surveillance systems to detect EVD patients from the different severity strata.
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Affiliation(s)
- Oumar Faye
- Arbovirus and Viral Hemorrhagic Fever Unit, Institut Pasteur de Dakar, Dakar, Senegal
| | - Alessio Andronico
- Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, Paris, France
| | - Ousmane Faye
- Arbovirus and Viral Hemorrhagic Fever Unit, Institut Pasteur de Dakar, Dakar, Senegal
| | - Henrik Salje
- Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, Paris, France
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Pierre-Yves Boëlle
- INSERM, UMR-S 1136, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Paris, France
- Sorbonne Universités, UPMC Univ Paris 06, UMR-S 1136, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Paris, France
| | - N’Faly Magassouba
- Laboratoire de Fièvres Hémorragiques de Guinée, Hôpital Donka, Conakry, Guinea
| | - Elhadj Ibrahima Bah
- Service des Maladies Infectieuses, Médecins Sans Frontières, Conakry, Guinea
| | | | | | | | | | - Mandy Kader Konde
- Centre d’Excellence de Formation & Recherche sur le Paludisme & les Maladies Prioritaires en Guinée, Conakry, Guinea
| | | | - Gamou Fall
- Arbovirus and Viral Hemorrhagic Fever Unit, Institut Pasteur de Dakar, Dakar, Senegal
| | - Simon Cauchemez
- Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, Paris, France
- * E-mail:
| | - Amadou Alpha Sall
- Arbovirus and Viral Hemorrhagic Fever Unit, Institut Pasteur de Dakar, Dakar, Senegal
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Virion-associated phosphatidylethanolamine promotes TIM1-mediated infection by Ebola, dengue, and West Nile viruses. Proc Natl Acad Sci U S A 2015; 112:14682-7. [PMID: 26575624 DOI: 10.1073/pnas.1508095112] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Phosphatidylserine (PS) receptors contribute to two crucial biological processes: apoptotic clearance and entry of many enveloped viruses. In both cases, they recognize PS exposed on the plasma membrane. Here we demonstrate that phosphatidylethanolamine (PE) is also a ligand for PS receptors and that this phospholipid mediates phagocytosis and viral entry. We show that a subset of PS receptors, including T-cell immunoglobulin (Ig) mucin domain protein 1 (TIM1), efficiently bind PE. We further show that PE is present in the virions of flaviviruses and filoviruses, and that the PE-specific cyclic peptide lantibiotic agent Duramycin efficiently inhibits the entry of West Nile, dengue, and Ebola viruses. The inhibitory effect of Duramycin is specific: it inhibits TIM1-mediated, but not L-SIGN-mediated, virus infection, and it does so by blocking virus attachment to TIM1. We further demonstrate that PE is exposed on the surface of apoptotic cells, and promotes their phagocytic uptake by TIM1-expressing cells. Together, our data show that PE plays a key role in TIM1-mediated virus entry, suggest that disrupting PE association with PS receptors is a promising broad-spectrum antiviral strategy, and deepen our understanding of the process by which apoptotic cells are cleared.
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Requirements within the Ebola Viral Glycoprotein for Tetherin Antagonism. Viruses 2015; 7:5587-602. [PMID: 26516900 PMCID: PMC4632396 DOI: 10.3390/v7102888] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 10/06/2015] [Accepted: 10/14/2015] [Indexed: 11/17/2022] Open
Abstract
Tetherin is an interferon-induced, intrinsic cellular response factor that blocks release of numerous viruses, including Ebola virus, from infected cells. As with many viruses targeted by host factors, Ebola virus employs a tetherin antagonist, the viral glycoprotein (EboGP), to counteract restriction and promote virus release. Unlike other tetherin antagonists such as HIV-1 Vpu or KSHV K5, the features within EboGP needed to overcome tetherin are not well characterized. Here, we describe sequences within the EboGP ectodomain and membrane spanning domain (msd) as necessary to relieve tetherin restriction of viral particle budding. Fusing the EboGP msd to a normally secreted form of the glycoprotein effectively promotes Ebola virus particle release. Cellular protein or lipid anchors could not substitute for the EboGP msd. The requirement for the EboGP msd was not specific for filovirus budding, as similar results were seen with HIV particles. Furthermore trafficking of chimeric proteins to budding sites did not correlate with an ability to counter tetherin. Additionally, we find that a glycoprotein construct, which mimics the cathepsin-activated species by proteolytic removal of the EboGP glycan cap and mucin domains, is unable to counteract tetherin. Combining these results suggests an important role for the EboGP glycan cap and msd in tetherin antagonism.
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Ocular Manifestations of Ebola Virus Disease: An Ophthalmologist's Guide to Prevent Infection and Panic. BIOMED RESEARCH INTERNATIONAL 2015; 2015:487073. [PMID: 26557674 PMCID: PMC4628748 DOI: 10.1155/2015/487073] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 03/11/2015] [Indexed: 11/27/2022]
Abstract
Ebola virus disease (EVD—formerly known as Ebola hemorrhagic fever) is a severe hemorrhagic fever caused by lipid-enveloped, nonsegmented, negative-stranded RNA viruses belonging to the genus Ebolavirus. Case fatality rates may reach up to 76% of infected individuals, making this infection a deadly health problem in the sub-Saharan population. At the moment, there are still no indications on ophthalmological clinical signs and security suggestions for healthcare professionals (doctors and nurses or cooperative persons). This paper provides a short but complete guide to reduce infection risks.
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Schooley RT. Editorial Commentary: All's (Almost) Quiet on the Western Front: Will We Be Ready for the Next War? Clin Infect Dis 2015; 61:503-5. [DOI: 10.1093/cid/civ337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 04/16/2015] [Indexed: 11/13/2022] Open
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Shrivastava SR, Shrivastava PS, Ramasamy J. Ebola disease: Infection prevention and control in hospital and community settings. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2015; 20:526-7. [PMID: 26257812 PMCID: PMC4525355 DOI: 10.4103/1735-9066.161010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Saurabh R Shrivastava
- Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Ammapettai, Chennai, Tamil Nadu, Karnataka, India
| | - Prateek S Shrivastava
- Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Ammapettai, Chennai, Tamil Nadu, Karnataka, India
| | - Jegadeesh Ramasamy
- Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Ammapettai, Chennai, Tamil Nadu, Karnataka, India
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Abstract
Ebola is a highly dangerous infectious disease seen mainly in West Africa or travellers from there. All healthcare workers should check the recent travel history of their patients and follow formal guidance issued. Clinical Relevance: This article discusses the relevance of the Ebola virus in dentistry.
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50
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Van Kerkhove MD, Bento AI, Mills HL, Ferguson NM, Donnelly CA. A review of epidemiological parameters from Ebola outbreaks to inform early public health decision-making. Sci Data 2015; 2:150019. [PMID: 26029377 PMCID: PMC4443880 DOI: 10.1038/sdata.2015.19] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 04/13/2015] [Indexed: 11/09/2022] Open
Abstract
The unprecedented scale of the Ebola outbreak in West Africa has, as of 29 April 2015, resulted in more than 10,884 deaths among 26,277 cases. Prior to the ongoing outbreak, Ebola virus disease (EVD) caused relatively small outbreaks (maximum outbreak size 425 in Gulu, Uganda) in isolated populations in central Africa. Here, we have compiled a comprehensive database of estimates of epidemiological parameters based on data from past outbreaks, including the incubation period distribution, case fatality rate, basic reproduction number (R 0 ), effective reproduction number (R t ) and delay distributions. We have compared these to parameter estimates from the ongoing outbreak in West Africa. The ongoing outbreak, because of its size, provides a unique opportunity to better understand transmission patterns of EVD. We have not performed a meta-analysis of the data, but rather summarize the estimates by virus from comprehensive investigations of EVD and Marburg outbreaks over the past 40 years. These estimates can be used to parameterize transmission models to improve understanding of initial spread of EVD outbreaks and to inform surveillance and control guidelines.
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Affiliation(s)
- Maria D. Van Kerkhove
- MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, Imperial College London, London W2 1PG, UK
- Center for Global Health, Institut Pasteur, Paris 75015, France
| | - Ana I. Bento
- MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, Imperial College London, London W2 1PG, UK
| | - Harriet L. Mills
- MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, Imperial College London, London W2 1PG, UK
| | - Neil M. Ferguson
- MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, Imperial College London, London W2 1PG, UK
| | - Christl A. Donnelly
- MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, Imperial College London, London W2 1PG, UK
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