Ebola: Reports from the front lines

Dr. Noah Rosenberg “Ebola was never the only killer here, and our ability to appropriately diagnose and treat these patients is woefully limited.”

Alpert Medical School professors Michael Smit and Noah Rosenberg are in Sierra Leone and Liberia respectively, treating Ebola patients. There are some signs of a slowdown in the epidemic, but the doctors emphasize that the virus must be fought “until the last case.”

PROVIDENCE, R.I. [Brown University] — In a limited sense, two Brown University medical professors who have been fighting Ebola in West Africa this winter have good news to report. They have seen some signs of slowing disease transmission. But the broader reality of what Ebola has done in Sierra Leone and Liberia is grim, according to Drs. Michael Smit and Noah Rosenberg.

Ebola shouldn’t just be contained, they note: It must be treated until all cases are resolved.

Smit, assistant professor of pediatrics and a physician at Hasbro Children’s Hospital, arrived in Sierra Leone Dec. 3, 2014, and will remain there through Jan. 18. Rosenberg, clinical assistant professor of emergency medicine and a Lifespan doctor, arrived in Liberia in mid-December and will stay until Jan. 27. They answered questions for medical science writer David Orenstein about what they are doing and seeing, and what people back in the States need to know.

Please describe a typical day.

NR: I arrive at 7 a.m. and meet with the overnight doctor and nurses to discuss our patients. My team pulls on full personal protective equipment and enters the high-risk area. We examine each patient, inquire about their current symptoms, give routine supportive medications and IV fluids if needed. We take blood to test for Ebola. We remove our equipment while being intermittently sprayed with chlorine. Rounds repeat in the afternoon and we often make an additional trip for a new admission. In the evening we meet with the night team and then rest to return in the morning.

Dr. Michael Smit “The effect of the epidemic goes far beyond those infected with Ebola virus. ... The economic impact on the country is devastating.

MS: I am the medical team leader of one of four medical teams at the Mateneh Ebola Treatment Center (ETC). Our days differ depending on which shift we are working. When working the early shift, we eat breakfast around 7 a.m. and drive to the ETC. We change into our work uniforms of scrubs and rubber boots at the ETC. At 7:30 we receive signout on the patients from the overnight team. We then assign personnel to conduct the nursing rounds, physician rounds, admissions, and discharges. During the heat of the day, we try to limit time in the high-risk area in personal protective equipment (PPE) to one hour. We deliver meals, administer medications, place intravenous catheters, and draw blood for laboratory tests. We triage admissions as they come through the ambulance bay. We also process discharges. These include survivors discharged home and deaths transferred to the morgue. At the end of the shift, we sign out the patients to the oncoming team, change back into our civilian clothes, and go back to the compound to eat. The late and overnight shifts are the same as the early shift for the most part.

What do you observe and hear about the status of the epidemic where you are?

NR: The exponential growth of the epidemic is clearly over in Liberia, but sporadic outbreaks are likely to continue until every case has been eliminated from West Africa, which may take months. Most of our new admissions now test negative for Ebola; they frequently die nonetheless. This may seem counterintuitive, but Ebola was never the only killer here, and our ability to appropriately diagnose and treat these patients is woefully limited.

MS: It is difficult to assess the status of the epidemic from here. We have limited access to the Internet, so our updates of what is happening are intermittent. As for what we observe, after a slow start from our opening in mid-December, we saw a steady increase in cases in our district in Bombali. Over the last week, admissions have decreased. The reason for this is not clear. We hope that it reflects a reduction in transmission, but we cannot assume this given the complexities of case identification and transport here.

What do people in the United States most need to know, based on what you are experiencing?

NR: Before the epidemic Liberia suffered from a large disease burden and severely limited health care system. Decades of civil war, sparked by inequality and tension between descendants of indigenous West Africans and freed slaves, wrecked the infrastructure and economy. Not only was the U.S.A. responsible for the founding of Liberia, but many of the struggles here today have their origins in the slave trade. Ebola will soon fade from the news but the epidemic has only worsened an already grave condition. We have a special responsibility to Liberia and it deserves our sustained attention.

MS: People in the United States need to know that the epidemic here is far from over. Even in a situation with diminished transmission, the United States needs to send personnel and resources here to combat Ebola until the last case. The effect of the epidemic goes far beyond those infected with Ebola virus. The schools here in Sierra Leone have been closed for months. Teen pregnancy is increasing as a result. The economic impact on the country is devastating, with some estimates setting the economy back 10 years. Also, people in the United States need to know about the dedication and resilience of the local and international healthcare workers who are fighting the epidemic, often under challenging physical and emotional conditions.

Source: Brown University

WHO contemplates reforms after admitting missteps on Ebola

World Health Organization (WHO) Director-General Margaret Chan addresses the media during a special meeting on Ebola in Geneva on Jan. 25, 2015. Photo by Pierre Albouy/REUTERS.

In a special session on Sunday, the World Health Organization debated how to reform itself after acknowledging the organization had botched its response to the 2014 Ebola emergency. 

“The Ebola outbreak revealed some inadequacies and shortcomings in this organization’s administrative, managerial, and technical infrastructures,” WHO Director-General Margaret Chan said. At its headquarters in Geneva, Chan presented a series of proposals aimed at ending the current outbreak, as well as reinforcing preparedness globally and guaranteeing the WHO’s ability to address future large-scale outbreaks. 

She stressed the need to streamline recruitment for emergencies, as the current process is “too slow” and emphasized the need for a “one WHO” approach that employs universal operating procedures and tools for responding to emergencies. According to Chan, the current rules for reporting outbreaks – International Health Regulations (IHR) – created to prevent national health emergencies from becoming global crises, are too thin. But the largest lesson she and others at WHO learned during the outbreak fight was that well-trained, and appropriately paid health care workers, are essential to stemming the spread of disease. 

To date there have been more than 21,000 Ebola cases and over 8,400 deaths. “The volatile microbial world will always deliver surprises, Chan said. “Never again should the world be caught by surprise, unprepared.”

Source: WHO

Volunteers can now help scientists seek Ebola cure in their (computer's) spare time

The Scripps Research Institute’s Professor Erica Ollmann Saphire is leading the new effort against Ebola. Credit: Photo courtesy of The Scripps Research Institute.

Although some medical therapies show promise as treatments for Ebola, scientists are still looking urgently for a definitive cure.

For the first time, anyone with access to a computer or Android-based mobile device can help scientists perform this critical research -- no financial contribution, passport or PhD necessary. In fact, volunteers can be asleep, traveling or on a coffee break when they help researchers search for an Ebola cure.

Beginning today, anyone can download a safe and free app that will put their devices to work when the machines would otherwise be idle. With their collective processing power, the computers will form a virtual supercomputer to help The Scripps Research Institute (TSRI) screen millions of chemical compounds to identify new drug leads for treating Ebola. 

Meanwhile, the devices will remain fully available for normal use by their owners.

This citizen science effort is possible through a partnership with IBM's (NYSE: IBM) World Community Grid, which has been making similar data-driven health and sustainability initiatives possible for 10 years as a free, philanthropic service to the science community. 

The "Outsmart Ebola Together" volunteer computing project announced today is being run by the Ollmann Saphire laboratory at TSRI, which has mapped the structures and vulnerabilities of the proteins comprising the Ebola virus.

The best candidate compounds that emerge from this crowdsourced effort will be physically tested in the lab to pinpoint their effectiveness against real virus infection. The most promising compounds will then be modified to perform even better, at lower concentrations, and with fewer side effects. Subsequent drug trials could ultimately lead to an approved medicine.

Crowdsourcing this citizen science effort will dramatically accelerate the process of identifying a cure. The speed and scale of a drug search is essential, as this particularly lethal disease continues to spread and mutate. Once believed to be less of a widespread public health risk than other communicable diseases because of its existence in mainly isolated regions, Ebola now carries a higher risk of spreading farther because people are more mobile than ever before.

"Our molecular images of the Ebola virus are like enemy reconnaissance," said Dr. Erica Ollmann Saphire of TSRI, one of the largest private biomedical research institutes in the United States. "These images show us where the virus is vulnerable and the targets we need to hit. In the Outsmart Ebola Together project, we will be able to harness World Community 

Grid's virtual supercomputing power to find the drugs we need to aim at these targets."

IBM's World Community Grid has successfully run other projects that search for drug candidates for both high- and low-profile diseases -- such as AIDS, cancer, malaria, Dengue fever, and influenza. It has enabled multiple breakthroughs, such as helping the Chiba Cancer Center in Japan discover seven new drug candidates to fight childhood neuroblastoma. The IBM-managed program also hosts projects that have led to important scientific advances in renewable energy and water purification technology.

"It is a privilege to partner with The Scripps Research Institute to advance the process of identifying an Ebola cure," said Stanley S. Litow, IBM's vice president of Corporate Citizenship and president of the IBM International Foundation. "It is only fitting that IBM's World Community Grid 10-year anniversary of accomplishments coincide with the launch of perhaps one of the most critical scientific and humanitarian efforts."

Conceived and managed by IBM, and powered by IBM's reliable and secure SoftLayer cloud technology, World Community Grid provides computing power to scientists by harnessing the unused, surplus cycle time of volunteers' computers and mobile devices. The software receives, completes, and returns small computational assignments to scientists. The combined power contributed by hundreds of thousands of volunteers has created one of the fastest virtual supercomputers on the planet, advancing scientific work by hundreds of years.

Nearly three million computers and mobile devices used by more than 680,000 people and 460 institutions from 80 countries have contributed virtual supercomputing power for vitally important projects on World Community Grid over the last 10 years. Since the program's inception, World Community Grid volunteers have powered more than 20 research projects, donating more than one million years of computing time to scientific research, and enabled important scientific advances in health and sustainability. IBM invites researchers to submit research project proposals to receive this free resource, and invites members of the public to donate their unused computing power to these efforts at worldcommunitygrid.org.

TSRI also invites members of the public to support Dr. Saphire's crowdfunding campaign at www.crowdrise.com/CUREEBOLA to secure resources needed to analyze the enormous volume of data generated by Outsmart Ebola Together.

The software used for screenings in the Outsmart Ebola Together project is called AutoDock and AutoDock VINA, developed by the Olson laboratory at TSRI.

World Community Grid is enabled by software developed in 2002 by Berkeley Open Infrastructure for Network Computing (BOINC) at the University of California, Berkeley and with support from the National Science Foundation. The BOINC project choreographs the technical aspects of volunteer computing.

Source: Scripps Research Institute

Computational model: Ebola could infect more than 1.4 million people by end of January 2015

The Network Dynamics and Simulation Science Laboratory at the Virginia Bioinformatics Institute modeled the rate of infections and how interventions would affect the rate.
Credit: Source: CDC / Image courtesy of Virginia Tech

The Ebola epidemic could claim hundreds of thousands of lives and infect more than 1.4 million people by the end of January, according to a statistical forecast released this week by the U.S. Centers for Disease Control and Prevention.

The CDC forecast supports the drastically higher projections released earlier by a group of scientists, including epidemiologists with the Virginia Bioinformatics Institute, who modeled the Ebola spread as part of a National Institutes of Health-sponsored project called Midas, short for Models of Infectious Disease Agent Study.

The effort is also supported by the federal Defense Threat Reduction Agency.

Before the scientists released results, the outbreak in West Africa was expected to be under control in nine months with only about 20,000 total cases. But modeling showed 20,000 people could be infected in just a single month.

The predictions could change dramatically if public health efforts become effective, but based on the virus's current uncontrolled spread, numbers of people infected could skyrocket.

"If the disease keeps spreading as it has been we estimate there could be hundreds of thousands of cases by the end of the year in Liberia alone," said Bryan Lewis, a computational epidemiologist with the Network Dynamics and Simulation Science Laboratory at the Virginia Bioinformatics Institute.

Lewis and his fellow researchers use a combination of models to predict outcomes of the epidemic.

The agent-based models are adaptive, evolving as more information is fed into them to provide an accurate forecast.

Pharmaceutical intervention, which is still on the horizon, is proving less effective in the models than supportive care and personal protection equipment for health care workers.

"The work with Ebola is not an isolated event," said Christopher Barrett, the executive director of the institute. "This research is part of a decades-long effort largely funded by the Defense Threat Reduction Agency to build a global synthetic population that will allow us to ask questions about our world and ourselves that we have never been able to ask before, and to use those answers to prevent or quickly intervene during a crisis."

Barrett and other institute leaders updated U.S. Sen. Tim Kaine and Virginia Tech President Timothy Sands about the Network Dynamics and Simulation Science Lab's role in analyzing the Ebola outbreak at the Virginia Tech Research Center in Arlington on Tuesday morning. That afternoon in Blacksburg they briefed staff members from U.S. Sen. Mark Warner's office.

A university-level Research Institute of Virginia Tech, the Virginia Bioinformatics Institute was established in 2000 with an emphasis on informatics of complex interacting systems scaling the microbiome to the entire globe. It helps solve challenges posed to human health, security, and sustainability. Headquartered at the Blacksburg campus, the institute occupies 154,600 square feet in research facilities, including state-of-the-art core laboratory and high-performance computing facilities, as well as research offices in the Virginia Tech Research Center in Arlington, Virginia.

Source: Virginia Tech

Trial confirms Ebola vaccine candidate safe, equally immunogenic in Africa

"This is the first study to show comparable safety and immune response of an experimental Ebola vaccine in an African population," says lead author Dr Julie Ledgerwood. "This is particularly encouraging because those at greatest risk of Ebola live primarily in Africa, and diminished vaccine protection in African populations has been seen for other diseases." Credit: © nito / Fotolia

Two experimental DNA vaccines to prevent Ebola virus and the closely related Marburg virus are safe, and generated a similar immune response in healthy Ugandan adults as reported in healthy US adults earlier this year. The findings, from the first trial of filovirus vaccines in Africa, are published in The Lancet.

"This is the first study to show comparable safety and immune response of an experimental Ebola vaccine in an African population," says lead author Dr Julie Ledgerwood from the National Institutes of Allergy and Infectious Diseases (NIAID) at the National Institutes of Health, USA. "This is particularly encouraging because those at greatest risk of Ebola live primarily in Africa, and diminished vaccine protection in African populations has been seen for other diseases."

Scientists from the NIAID developed the DNA vaccines that code for Ebola virus proteins from the Zaire and Sudan strains and the Marburg virus protein. The vaccines contain the construction plans for the proteins on the outer surface of the virus. Immune responses against these proteins have shown to be highly protective in non-human primate models.

In this phase 1 trial, the Makerere University Walter Reed Program enrolled 108 healthy adults aged between 18 and 50 from Kampala, Uganda between November, 2009 and April, 2010. Each volunteer was randomly assigned to receive an intramuscular injection of either the Ebola vaccine (30 volunteers), Marburg vaccine (30), both vaccines (30), or placebo (18) at the start of the study, and again 4 weeks and 8 weeks later.

The vaccines given separately and together were safe and stimulated an immune response in the form of neutralising antibodies and T-cells against the virus proteins. Four weeks after the third injection, just over half of the volunteers (57%; 17 of 30) had an antibody response to the Ebola Zaire protein as did 14 of 30 participants who received both the Ebola and Marburg vaccines. 

However, the antibodies were not long-lasting and returned to undetectable levels within 11 months of vaccination.

Both DNA vaccines were well tolerated in Ugandan adults with similar numbers of local and systemic reactions reported in all groups. Only one serious adverse event (neutropenia; low white blood cell count) was reported in a Marburg vaccine only recipient, but was not thought to be vaccine related.

According to Dr Ledgerwood, "These findings have already formed the basis of a more potent vaccine, delivered using a harmless chimpanzee cold virus, which is undergoing trials in the USA, UK, Mali, and Uganda in response to the ongoing Ebola virus outbreak."

Writing in a linked Comment, Dr Saranya Sridhar from the Jenner Institute at the University of Oxford in the UK says, "[This] study deserves to be the focal point around which the broader question of vaccine development, particularly for Africa, must be addressed. With the uncharitable benefit of hindsight in view of the evolving 2014 Ebola outbreak, we must ask ourselves whether a filovirus vaccine should have been in more advanced clinical development. The international response to the present Ebola outbreak is an exemplar of the speed and purpose with which clinical vaccine development can progress and has set the benchmark against which future vaccine development must be judged. This study is the first step on the aspirational road towards the deployment of filovirus vaccines in Africa and must serve to shake the metaphorical cobwebs that can stall our advance towards this destination."

Source: The Lancet

Doctor who survived Ebola received experimental drug treatment

On 28 September, 2014, a 38-year old doctor, who was in charge of an Ebola virus treatment unit in Lakka, Sierra Leone, developed a fever and diarrhea. He tested positive for the virus on the same day. He was placed on a ventilator and on kidney dialysis, and was given antibiotics together with a 3-day course of an experimental drug called FX06 -- a fibrin-derived peptide that has been shown to reduce vascular leakage and its complications in mice with Dengue hemorrhagic shock. Credit: © nito / Fotolia

On 28 September, 2014, the 38-year old doctor, who was in charge of an Ebola virus treatment unit in Lakka, Sierra Leone, developed a fever and diarrhea. He tested positive for the virus on the same day. The doctor was airlifted to Frankfurt University Hospital on the 5th day of his illness and admitted to a specialized isolation unit.

Within 72 hours of admission he developed signs of vascular leakage and severe multi-organ failure, including the lungs, kidneys, and gastrointestinal tract. He was placed on a ventilator and on kidney dialysis, and was given antibiotics together with a 3-day course of an experimental drug called FX06 -- a fibrin-derived peptide that has been shown to reduce vascular leakage and its complications in mice with Dengue hemorrhagic shock.

A marked improvement in vascular and respiratory function was seen under the combined measures of intensive care and drug treatment. After a 30-day observation period, no Ebola virus genetic material was detected in the patient's blood plasma. The patient was released from hospital and is now with his family.
"Even though the patient was critically ill, we were able to support him long enough for his body to start antibody production and for the virus to be cleared by his body's defenses," explains Dr Wolf.

"In terms of improving treatment for Ebola patients, we have shown how intensive care medicine can successfully be applied under strict isolation conditions," adds senior author Professor Zacharowski, head of the Department of Anaesthetics and Intensive Care Medicine at Frankfurt University Hospital."
The authors conclude by calling for FX06 to be evaluated in clinical trials.

Source: The Lancet

Genetic factors behind surviving or dying from Ebola shown in mouse study

In an emerging disease research lab at the University of Washington, Chris Williams, a research scientist who specializes in microbiology laboratory robotics, programs a piece of equipment that can be programmed to performs many lab tasks. Credit: Brian Donohue

A newly developed mouse model suggests that genetic factors are behind the mild-to-deadly range of reactions to the Ebola virus.

People exposed to Ebola vary in how the virus affects them. Some completely resist the disease, others suffer moderate to severe illness and recover, while those who are most susceptible succumb to bleeding, organ failure and shock.

In earlier studies of populations of people who have contracted Ebola, these differences are not related to any specific changes in the Ebola virus itself that made it more or less dangerous; instead, the body's attempts to fight infection seems to determine disease severity.

In the Oct. 30 edition of Science, scientists describe strains of laboratory mice bred to test the role of an individual's genetic makeup in the course of Ebola disease. Systems biologists and virologists Angela Rasmussen and Michael Katze from the Katze Laboratory at the University of Washington Department of Microbiology led the study in collaboration with the National Institutes of Health's Rocky Mountain Laboratories in Montana and University of North Carolina at Chapel Hill.

Research on Ebola prevention and treatment has been hindered by the lack of a mouse model that replicates the main characteristics of human Ebola hemorrhagic fever. The researchers had originally obtained this genetically diverse group of inbred laboratory mice to study locations on mouse genomes associated with influenza severity.

The research was conducted in a highly secure, state-of-the-art biocontainment safety level 4 laboratory in Hamilton, Mont. The scientists examined mice that they infected with a mouse form of the same species of Ebola virus causing the 2014 West Africa outbreak. The study was done in full compliance with federal, state, and local safety and biosecurity regulations. This type of virus has been used several times before in research studies. Nothing was done to change the virus.

Interestingly, conventional laboratory mice previously infected with this virus died, but did not develop symptoms of Ebola hemorrhagic fever.

In the present study, all the mice lost weight in the first few days after infection. Nineteen percent of the mice were unfazed. They not only survived, but also fully regained their lost weight within two weeks. They had no gross pathological evidence of disease. Their livers looked normal.

Eleven percent were partially resistant and less than half of these died. Seventy percent of the mice had a greater than 50 percent mortality. Nineteen percent of this last group had liver inflammation without classic symptoms of Ebola, and thirty-four percent had blood that took too long to clot, a hallmark of fatal Ebola hemorrhagic fever in humans. Those mice also had internal bleeding, swollen spleens and changes in liver color and texture.

The scientists correlated disease outcomes and variations in mortality rates to specific genetic lines of mice.

"The frequency of different manifestations of the disease across the lines of these mice screened so far are similar in variety and proportion to the spectrum of clinical disease observed in the 2014 West African outbreak," Rasmussen said.

While acknowledging that recent Ebola survivors may have had immunity to this or a related virus that saved them during this epidemic, Katze said, "Our data suggest that genetic factors play a significant role in disease outcome."

In general, when virus infection frenzied the genes involved in promoting blood vessel inflammation and cell death, serious or fatal disease followed. On the other hand, survivors experienced more activity in genes that order blood vessel repair and the production of infection-fighting white blood cells.

The scientists note that certain specialized types of cells in the liver could also have limited virus reproduction and put a damper on systemic inflammation and blood clotting problems in resistant mice. Susceptible mice had widespread liver infection, which may explain why they had more virus in their bodies and poorly regulated blood coagulation. The researchers also noticed that spleens in the resistant and susceptible mice took alternate routes to try to ward off infection.

"We hope that medical researchers will be able to rapidly apply these findings to candidate therapeutics and vaccines," Katze said. They believe this mouse model can be promptly implemented to find genetic markers, conduct meticulous studies on how symptoms originate and take hold, and evaluate drugs and that have broad spectrum anti-viral activities against all Zaire ebolaviruses, including the one responsible for the current West African epidemic.

Source: University of Washington Health Sciences/UW Medicine

Experimental Ebola vaccine appears safe, prompts immune response

A 39-year-old woman, the first participant enrolled in VRC 207, receives a dose of the investigational NIAID/GSK Ebola vaccine at the NIH Clinical Center in Bethesda, Md. on September 2. Credit: NIAID

An experimental vaccine to prevent Ebola virus disease was well-tolerated and produced immune system responses in all 20 healthy adults who received it in a Phase 1 clinical trial conducted by researchers from the National Institutes of Health. The candidate vaccine, which was co-developed by the NIH's National Institute of Allergy and Infectious Diseases (NIAID) and GlaxoSmithKline (GSK), was tested at the NIH Clinical Center in Bethesda, Maryland. The interim results are reported online in advance of print in the New England Journal of Medicine.

"The unprecedented scale of the current Ebola outbreak in West Africa has intensified efforts to develop safe and effective vaccines, which may play a role in bringing this epidemic to an end and undoubtedly will be critically important in preventing future large outbreaks," said NIAID Director Anthony S. Fauci, M.D. "Based on these positive results from the first human trial of this candidate vaccine, we are continuing our accelerated plan for larger trials to determine if the vaccine is efficacious in preventing Ebola infection."

The candidate NIAID/GSK Ebola vaccine was developed collaboratively by scientists at the NIAID Vaccine Research Center (VRC) and at Okairos, a biotechnology company acquired by GSK. It contains segments of Ebola virus genetic material from two virus species, Sudan and Zaire. The Ebola virus genetic material is delivered by a carrier virus (chimpanzee-derived adenovirus 3 or cAd 3) that causes a common cold in chimpanzees but causes no illness in humans. The candidate vaccine does not contain Ebola virus and cannot cause Ebola virus disease.

The trial enrolled volunteers between the ages of 18 and 50. Ten volunteers received an intramuscular injection of vaccine at a lower dose and 10 received the same vaccine at a higher dose. At two weeks and four weeks following vaccination, the researchers tested the volunteers' blood to determine if anti-Ebola antibodies were generated. All 20 volunteers developed such antibodies within four weeks of receiving the vaccine. Antibody levels were higher in those who received the higher dose vaccine.

The investigators also analyzed the research participants' blood to learn whether the vaccine prompted production of immune system cells called T cells. A recent study by VRC scientist Nancy J. Sullivan, Ph.D., and colleagues showed that non-human primates inoculated with the candidate NIAID/GSK vaccine developed both antibody and T-cell responses, and that these were sufficient to protect vaccinated animals from disease when they were later exposed to high levels of Ebola virus.

The experimental NIAID/GSK vaccine did induce a T-cell response in many of the volunteers, including production of CD8 T cells, which may be an important part of immune protection against Ebola viruses. Four weeks after vaccination, CD8 T cells were detected in two volunteers who had received the lower dose vaccine and in seven of those who had received the higher dose.

"We know from previous studies in non-human primates that CD8 T cells played a crucial role in protecting animals that had been vaccinated with this NIAID/GSK vaccine and then exposed to otherwise lethal amounts of Ebola virus," said Julie E. Ledgerwood, D.O., a VRC researcher and the trial's principal investigator. "The size and quality of the CD8 T cell response we saw in this trial are similar to that observed in non-human primates vaccinated with the candidate vaccine."

There were no serious adverse effects observed in any of the volunteers, although two people who received the higher dose vaccine did develop a briefly lasting fever within a day of vaccination.

Source: NIH/National Institute of Allergy and Infectious Diseases

Using power of computers to harness human genome may provide clues into Ebola virus

Ramaswamy Narayanan, Ph.D., professor in the Charles E. Schmidt College of Science at Florida Atlantic University.

Ramaswamy Narayanan, Ph.D., professor in the Charles E. Schmidt College of Science at Florida Atlantic University, is working to blend the power of computers with biology to use the human genome to remove much of the guesswork involved in discovering cures for diseases.

In an article titled "Ebola-Associated Genes in the Human Genome: Implications for Novel Targets," published in the current MedCrave Online Journal of Proteomics and Bioinformatics, Narayanan describes how key genes that are present in our cells could be used to develop drugs for this disease.

"Bioinformatics is a powerful tool to help us understand biological data," said Narayanan whose research has focused in this field for more than a decade. "We are mining the human genome for Ebola virus association to develop an understanding of the human proteins involved in this disease for subsequent research and development, and to potentially create a pipeline of targets that we can test and evaluate."

Ebola virus disease is a major healthcare challenge facing the globe today and if left unchecked could become a pandemic. A limited knowledgebase exists about the Ebola virus and companies are hastening to develop vaccines and other forms to treat and cure the virus. There are no FDA-approved drugs, and developing vaccines or antibodies and testing them in clinical trials is an arduous process that takes considerable time. Currently, patients infected with Ebola are only able to receive supportive care such as fluid replacement, nutritional support, pain control, and blood pressure maintenance. In some cases, patients may be fortunate enough to be treated with experimental drugs.

Narayanan's work has helped to identify numerous FDA-approved drugs already used for many other diseases including anti-inflammatory drugs, anticoagulants, cancer, HIV, statins and hormones, which could potentially be used to add to the current supportive care for patients with the Ebola virus.

"With the high mortality rate of this disease, the world urgently needs new ways to treat patients," said Narayanan. "The ability to use drugs that are already approved by the FDA could provide clinicians with more options to treat Ebola patients, rather than just relying on supportive measures like fluid replacement or antibiotics."

According to the World Health Organization (WHO), Ebola virus disease (EVD) is a severe, often fatal illness in humans. The virus is transmitted to people from wild animals and spreads in the human population through human-to-human transmissions. The evolving knowledge of this disease is prompting appropriate attention locally and globally. The 2014 Ebola epidemic has affected multiple countries in West Africa with some cases observed in Europe and the United States.

Source: Florida Atlantic University

Mapping bats could help stop Ebola's spread

Fruit bats (Pteropodidae) are considered the likely host of the Ebola virus. Credit: Satit Srihin

In the fight against Ebola, mapping fruit bat habitats could be one important step, says a geoinformatics researcher at Sweden's Royal Institute of Technology.

Like the Black Death that ravaged medieval Europe, the Ebola virus' progress through remote areas of West Africa is enabled by lack of understanding about the disease, including its causes and transmission.

Mapping technology however will give responders to the crisis in Africa the upper hand in stopping the spread of the deadly disease, says Skog, a researcher in geoinformatics at Sweden's KTH Royal Institute of Technology.

Skog's research has produced a method that medical professionals can use to visualise the geographical distribution of a disease over time. In his research, Skog has explored the relationship between geography and disease distribution in major epidemics of the past, including the Black Death, the Russian Flu pandemic of 1889, the Asiatic Influenza of 1957 and the swine flu. He says the historical data provides a basis for predicting the course of future epidemics and pandemics.

"My research and method can also be used to report the current state of a pandemic, or predict how extensive the spread will be. And where the disease will strike next," Skog says.

In fact, the way in which Black Death spread during the mid 14th, century bears a no small resemblance to today's Ebola epidemic, he says. Both diseases were hosted by small mammals -- black rats and fruit bats, respectively. But ultimately it was humans that enabled its spread.

"The Black Death was very much depending on total lack of knowledge regarding the etiology of the disease and how to avoid further transmission," Skog says. "That is also the case for the mainly remote locations where Ebola now is spread."

Fruit bats are believed to be the natural hosts of Ebola. These bats are among the creatures that residents of rural West Africa hunt for "bush meat." The disease is also spread by the droppings of the bat, and it is believed to have spread to other types of bush meat, as well as monkeys and pigs that are raised for slaughter.

"The local population is getting part of their nourishment from bush hunting, leading to contact with the virus that is transmitted via body fluids," Skog says, suggesting that closer study of the fruit bat could provide vital answers.

"A guess of mine is that the number of infected fruit bats is a determining factor for an Ebola outbreak," he says. "Are there any known factors that may have changed the ecosystem in favor of the bats? Are the bats affected by the virus too? Do fruit bats always carry the Ebola virus or is the virus fatal to them as well? If so the percentage of infected bats will vary over the years also depending on the immunology of the species."

There are a number of geoinformation technology options available to public health organizations that have sent field crews to respond to the crisis. These, Skog says, including equipping field workers with hand-held GPS devices that feed a central database with data and findings regarding locations of bodies, possible infections and diagnosed cases personnel.

"The data can easily be centrally monitored and used for decisions and policies to mitigate the spread," he says. "Using satellite imagery, population centers can be localized. Collected disease data can also be compared and analysed with environmental and climatologic data to support other efforts to control the spread."

For instance, assuming that fruit bats are the reservoir for the ebola virus, Skog says it would be of interest to find out if the first detected cases in an outbreak are located in or close to a fruit bat habitat. "If the environmental and climatologic parameters for fruit bat habitats can be defined, there is a chance these habitats could be mapped using existing map data and satellite or airborne imagery," he says.

"Then risk areas could be monitored and preventive measures could be performed by health authorities. If the natural reservoir is in fact some other animal, positioning the first cases in each outbreak would still give a clue about what to look for."

Source: KTH The Royal Institute of Technology