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New Ebola Treatments Bring New Problems.

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John L. View Drop Down
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    Posted: May 26 2018 at 1:56am

The new vaccine is great but is in short supply.  But as usual, it is people who are the problem according to the New York Times:

https://www.nytimes.com/2018/05/24/health/ebola-vaccine-congo.html?hpw&rref=health&action=click&pgtype=Homepage&module=well-region&region=bottom-well&WT.nav=bottom-well

Global Health

New Ebola Tactics Raise Hope but May Sow Confusion

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A worker at the entrance of the Wangata Reference Hospital in Mbandaka, Democratic Republic of Congo, where an outbreak of Ebola has claimed 58 confirmed or suspected victims.CreditJunior Kannah/Agence France-Presse — Getty Images

Although there is optimism that the Ebola outbreak in central Africa can still be quickly contained, the fight is already becoming more complex, health experts said this week.

Novel tactics — a new vaccine already in use, and new antibody or drug treatments that may be deployed — raise hopes that the outbreak will be quickly extinguished. Nonetheless, they may sow confusion because the treatments are unfamiliar to a wary and terrified population.

There are now 58 confirmed or suspected victims in the Democratic Republic of Congo, of whom 27 have died, the World Health Organization said on Wednesday. Three cases were in health care workers.

In one alarming development, three patients fled from an Ebola ward overseen by Doctors Without Borders in a hospital in Mbandaka, a city of more than one million about 60 miles from the outbreak’s rural epicenter.

The first patient, who was about to be discharged, left Sunday night, and two others were removed by their families late Monday night despite pleas from hospital workers that they stay.

One patient then died at home, and the family returned the body to the hospital for burial. Another was brought back to the hospital on Tuesday morning and died that night. A third patient reportedly was returned by the police.

It was not clear why they left, but Reuters reported that some had gone to a church.

In Africa, hospitals are often feared as places where people go to die.

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Nurses with the World Health Organization preparing the rVSV-ZEBOV vaccine in Mbandaka on Monday.CreditJunior Kannah/Agence France-Presse — Getty Images

Also, they are often so short-staffed that family members sleep in patients’ rooms to provide food and nursing care. That is impossible in Ebola wards, however, because proximity to the sick is too dangerous for anyone who is not fully gowned, gloved, masked and goggled — and trained to remove all those items safely.

If Congolese police are forcing patients into hospitals, their tactic may backfire.

“Forced hospitalization is not the solution to this epidemic,” Doctors Without Borders said in a statement issued Wednesday. “Patient adherence is paramount.”

Medical teams, the group said, were working hard to explain to locals that their families were more likely to survive if they brought sick members to treatment centers as quickly as possible.

In the early days of the 2014-2016 West Africa outbreak, some villagers were so suspicious of medical workers that one eight-member team was hacked and clubbed to death in Guinea.

The initial rollout of the new Merck vaccine against Ebola, rVSV-ZEBOV, has gone smoothly thus far, said Dr. Seth Berkley, chief executive of Gavi, the Vaccine Alliance, which has a contract to purchase a stockpile of doses. Quick initial acceptance was expected, since the first recipients were likely to be eager for it: medical workers, lab technicians, members of burial details, and others who are the most likely to be exposed to Ebola victims.

Others may not be so eager to try the vaccine. “There will be some real challenges ahead,” Dr. Berkley said.

First, the campaign will have to explain why only a few people can have the vaccine. The 16,000 doses in the first two shipments are intended only for people at high risk: health workers and family members, friends and funeral-goers who have had contact with Ebola victims.


In an effort to help contain the outbreak, children washed their hands before entering a classroom in Mbandaka.CreditMark Naftalin/UNICEF, via Associated Press

At the moment, the list of people known to have contacted someone with Ebola numbers only about 600, but it is expected to grow into the thousands.

More worrisome, Dr. Berkley said, is the possibility that someone vaccinated will get infected anyway, and a rumor will start that the vaccine either doesn’t work or contains Ebola.

Infection after vaccination could happen, he said, because it takes about 10 days to build immunity.

“The message has been that it’s 100 percent effective,” he said. “But we have to be careful about that, because it’s only that effective after 10 days. You don’t want the feeling to grow that it’s a silver bullet and then have something go wrong.”

The vaccine also has side effects. Some recipients develop brief fevers, which may make them fear they are falling seriously ill.

(The same dilemma occurs in the United States with flu vaccine. People often fall ill right after getting flu shots, and assume the shots either didn’t work or gave them the flu.)

Eventually, it is also likely that the treatment centers will roll out experimental drugs that could save many lives if they work. But these medications have their own caveats.

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Oly Ilunga, Congo’s health minister, standing, wearing a vest, spoke with workers administering the rVSV-ZEBOV vaccine this week.CreditStr/EPA, via Shutterstock

ZMapp, a cocktail of three antibodies that attack the surface of the Ebola virus, was infused into 36 patients during the 2014-2016 West African outbreak. Eight of them died.

But many were assumed to have begun the lengthy infusion regimen too late — after the five-day window in which it worked in monkeys. And the 28 survivors who received the cocktail was still more than survived in a control group of 36 victims who got roughly identical medical care.

In 2016, researchers estimated that ZMapp could save 15 of every 100 victims in a future outbreak.

The other possibility is remdesivir, a drug developed by Gilead Sciences and better known as GS-5734. It was tested even later in the waning days of the West Africa epidemic than ZMapp was, so its effectiveness is unclear. But it was found safe in human testing and is easier to make because it is a small molecule chemically similar to anti-H.I.V. drugs.

In late 2015, remdesivir was given for 14 days to Pauline Cafferkey, a Scottish nurse who suffered a dangerous relapse of an Ebola infection she had caught in Sierra Leone but had been thought cured. She survived. The drug was also given, in combination with ZMapp, to a baby girl in Guinea, who also survived.

The campaign in Congo is now using helicopters to reach remote areas. Freezers that can keep the vaccine at 80 degrees below 0 Celsius (-112 degrees Fahrenheit) have been set up in Mbandaka and the market town of Bikoro, Dr. Berkley said.

After the vaccine leaves such super-freezers, it remains viable for two weeks at normal freezer temperatures.

The W.H.O. has asked for $26 million for the first three months of the response, and it appears on track to get it. The World Bank has contributed $12 million and will redirect another $15 million intended for three years of surveillance in Congo.

The United States has pledged up to $8 million, Germany offered $6 million, and Britain’s Wellcome Trust and its government pledged a total of $4 million.

As is often the case in outbreaks, rumors circulated. Agence France-Presse reported that some Mbandaka residents believed Ebola was incurable because it involved witchcraft, and others said it was a curse placed by wild-game hunters on villagers who stole their bushmeat.

John L.
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