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URL: http://www.avianflutalk.com/forum_posts.asp?TID=37385 Printed Date: April 24 2024 at 12:56pm
Topic: New Ebola Treatments Bring New Problems.Posted By: John L.
Subject: New Ebola Treatments Bring New Problems.
Date Posted: May 26 2018 at 1:56am
https://www.nytimes.com/column/global-health" rel="nofollow - 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/column/global-health" rel="nofollow - Global Health
New Ebola Tactics Raise Hope but May Sow Confusion
By http://www.nytimes.com/by/donald-g-mcneil-jr" rel="nofollow -
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.
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 http://www.bbc.com/news/world-africa-29256443" rel="nofollow - 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.
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 https://cen.acs.org/articles/93/i45/ve-Learned-Race-Ebola-Cure.html" rel="nofollow - roll out experimental drugs that could save many lives if they work. But these medications have their own caveats.
ZMapp, a cocktail of three antibodies that attack the surface of the Ebola virus, was http://www.cidrap.umn.edu/news-perspective/2016/10/trial-offers-mixed-view-ebola-drug-zmapp" rel="nofollow - 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 https://www.nejm.org/doi/full/10.1056/NEJMoa1604330" rel="nofollow - could save 15 of every 100 victims in a future outbreak .
The other possibility is remdesivir, a https://cen.acs.org/articles/94/i28/Study-launched-Gileads-Ebola-antiviral.html" rel="nofollow - 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, http://www.cidrap.umn.edu/news-perspective/2015/11/youngest-ebola-survivor-leaves-guinea-hospital" rel="nofollow - 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. https://medicalxpress.com/news/2018-05-superstition-ebola-victims-medical.html" rel="nofollow - 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.
http://on.fb.me/1paTQ1h" rel="nofollow - Like the Science Times page on Facebook. | http://bit.ly/2lBqhqv" rel="nofollow - Follow @NYTHealth on Twitter.