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However, a recent study that confirms EBOV survives longer in liquids than in dried blood, also
suggests that hospital conditions, as opposed to warmer and more humid conditions, seem to enhance
survival outside the host. 38 Hypothetically, climate conditions involving high humidity and high
temperatures would hence not be promoting outside-host survival. Participants said that scientists
and developers should “assess themselves whether further investigation is warranted” ( WHO, 2014d
); others later said that the list was not helpful, as it showed products “that barely worked in a
mouse... in the same column as something that was shown in a non-human primate to be very. Grey
literature not published in scientific journals was included to consider research from key actors in the
EVD response. Only by increasing the knowledge base about Ebola and about the merits of various
treatment or prevention strategies could clinicians be sure that their efforts improved patient
outcomes and communities be reassured that their scarce resources were used wisely and efficiently
( UNESCO, 2006 ). If trial teams rush to enter a community in order to rapidly implement a trial
without having a proper engagement strategy, it can backfire, as observed during the latter months of
2014. The heightened awareness and attention to the disease in the United States has also led to
questions from affected communities on specific characteristics of the virus, how the virus behaves,
and personal protective equipment and personal protective behaviors that can be used to prevent its
spread and reduce exposure. Additionally, early discontinuation of a trial may decrease the precision
of results with fewer data points. More advanced supportive care, such as monitoring electrolytes
and blood chemistry or respiratory and renal support, was often not possible, as it required
nonexistent equipment and technical and laboratory support. As per WHO guidelines, contacts are
not to be isolated until they show signs and symptoms of EVD and are able to continue work.
Searches were repeated until final drafting of the manuscript, in order to capture emerging evidence
from the ongoing epidemic (see online supplementary appendix 2). A Liberian national, he was
treated at the Texas Presbyterian hospital after initially being sent home, but died on 8 October.
Forty-Two years of responding to Ebola virus outbreaks in sub-Saharan Africa: a review. Searches
were designed to be broad and comprehensive initially (see online supplementary appendix 1). After
having conversations with numerous people from Uganda in early June, one of the common reasons
the WHO had not declared this sooner was in anticipation of the impact on trade and travel
restrictions. Due to the time and resource constraints of taking care of Ebola patients, some frontline
providers appeared convinced that it was impossible to both provide effective clinical care and
conduct useful clinical research. Prompt education and training to HCWs and communities is
necessary to facilitate continued access to MHS. That's why our journalism is free for everyone, even
though other newsrooms retreat behind expensive paywalls. Much can be learned from prior debates
over research involving desperately ill patients, research conducted during humanitarian or public
health emergencies, research in emergency room situations and with an unconscious patient, and
research in resource-poor settings ( Wainberg et al., 2014 ). Similarly, lessons learned from the Ebola
epidemic will provide insights for the future. Teresa Romero Ramos helped treat one of two Spanish
missionaries who were brought to the hospital after becoming infected in West Africa. PRISMA,
Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Since in many trials it would
be unethical to refrain from monitoring the accumulating data, statistical methods have been
developed to allow such monitoring and the possible early termination based on interim efficacy or
safety findings, while maintaining the false positive rate at the desired low level. Patterns in the
literature yielded three themes: fear and mistrust; health system and service constraints; and poor
communication. The potential risks to participants are not just related to the intervention itself, but
also include harms resulting from breaches of confidentiality, violations of privacy, or discrimination
or stigma as a consequence of participation ( HHS, 2009 ). This argument springs from the principle
of beneficence—the notion that medical care providers should seek to help patients. Then select one
point of view (e.g., victims’ families or health care workers) and gather evidence using this graphic
organizer (PDF) to document what people in this group think, see, feel and hear relating to the Ebola
crisis. What factors might have led to the emergence of Ebola in West Africa. Safe sex practices
including sexual abstinence, or else condom use, are recommended by WHO until semen has tested
negative twice, or in absence of testing for at least 6 months post-symptom onset. The primary
limitation of the review is the scarcity of published and unpublished evidence on viral persistence in
the body fluids of survivors over time, including a paucity of thorough investigations into suspect
sexual transmission chains. Research and development for novel diagnostic tool, drugs and safe
vaccines Building early warning indicators and rapid response to adequately prevent or respond to
the EVD outbreak is needed. Education to HCWs and communities regarding EVD was insufficient.
After months in the affected zone, he worries that the outside world still doesn’t quite get it. Others
argued that because so little was known about the agents, it was necessary to conduct formal clinical
trials in order to quickly and efficiently identify beneficial therapies or vaccines. Notably, for the
investigational therapeutic interventions tested during the Ebola epidemic, the available preclinical
data were insufficient to determine that a product was more likely to provide a therapeutic
advantage to recipients than to worsen their already fragile condition. The strongest argument for
providing expanded access to unproven therapies during the Ebola epidemic is that the high lethality
of the disease tipped the ethical scales in favor of providing interventions that could be helpful,
however remote that prospect of benefit may have been and even given the potential for harm. The
impact of the West Africa Ebola outbreak on obstetric health care in Sierra Leone. The first study of
the vaccine regimen in a West African country affected by the Ebola epidemic began in Sierra Leone
in October 2015. Each ward only had a few bottles of near empty hand sanitizer and a limited
supply of gloves. As per WHO guidelines, contacts are not to be isolated until they show signs and
symptoms of EVD and are able to continue work. The long-term solutions would be to make
primary healthcare the centre platform of response. Jones SA, Gopalakrishnan S, Ameh CA, et al.
'Women and babies are dying but not of Ebola': the effect of the Ebola virus epidemic on the
availability, uptake and outcomes of maternal and newborn health services in Sierra Leone.
Traditionally, a hierarchy of controls has been used as a means of determining how to implement
feasible and effective controls. In the recent outbreak in DRC, the first case was confirmed in Goma,
the capital of North Kivu, and a city of one million people. If the planning does not occur early in
the epidemic, the epidemic may be waning—or over—by the time a study is designed, approved,
and ready to be implemented. The health worker is happy, and everybody is happy. The multivalent
heterologous prime-boost regimen is intended to protect against multiple filoviruses that cause
disease in humans, including the Ebola, Sudan and Marburg viruses. The U.S. study will test the
safety, tolerability and immunogenicity of this vaccine regimen in varying dosing schedules among
healthy volunteers. There are several types of arms, including ( NIH, 2016 ). Combined efforts and
international collaborations are needed to provide possibilities for advanced laboratory investigations.
Since early mortality rates were high and the agents offered at least the possibility of benefit some
argued that experimental therapies should be given to as many patients as possible. The
unprecedented scale of recent Ebola virus disease (EVD) epidemics is attributed to a combination of
factors, including large urban population, minimal public health infrastructure, political instability,
extensive connectivity of the population and livelihood practices. Overall estimates of mortality from
emerging infectious diseases are often uncertain and influenced by many factors. However, the
provision of such resources reinforces the need for a concurrent control group, as such interventions
are likely to affect mortality” ( Nelson et al., 2015 ) (see Chapter 6 for further discussion on
community engagement). Contributors control their own work and posted freely to our site. I don’t
think any of that is true” ( Hayden, 2014, p. 178). Viral persistence in faeces, saliva, sweat and urine
were included as sexual acts can involve mucosal contact of one partner with another's body fluids
and would be of interest in discussions on possible routes of sexual transmission. How does Ebola
compare with other infectious diseases in the news. An essential part of this goal is to ensure
effective case finding, by contact tracing, so that “each and every chain of transmission can be
tracked and terminated.” 1 Transmission of Ebola virus happens primarily while in direct contact
with acute sick patients or with individuals who have died of EVD. Beyond Ebola: a new agenda for
resilient health systems. Two papers reported on different aspects of follow-up and analyses of semen
in Ebola survivors from the same epidemic setting. Provenance and peer review Not commissioned;
externally peer reviewed. He called on them to use their influence to bring stronger commitments to
the Ebola fight, which has plagued Sierra Leone, Guinea and Liberia, and has spread as far as the
United States and Europe.
Specifically, the desire to find a highly effective treatment that could be deployed in the epidemic at
hand, the belief that the mortality rates from Ebola were extremely high, the potential conflict
between research and patient care, and the perception that communities would not agree to study
designs in which they were denied access to potentially helpful investigational agents no doubt
played a strong role in the support for nonrandomized, uncontrolled study designs. The PREVAIL II
trial also demonstrated that individuals would consent to participation in an RCT when it was clearly
explained to them. The Nuffield Council’s position is that “wherever appropriate, participants should
be offered the best standard of care available in the world for the disease being studied. Finally, he
highlighted the need for engaging the greater global health network and interfacing with
organizations such as the World Health Organization, World Bank, and others to fully coordinate
efforts and future activities to mitigate the impact of EVD and future public health emergencies.
Funding The authors have not declared a specific grant for this research from any funding agency in
the public, commercial or not-for-profit sectors. The New York Times reporter Adam Nossiter
ventured right into a. It involves giving an initial dose to prime the immune system, followed by a
booster dose at a later date with the goal of potentially strengthening and optimizing the duration of
immunity. The Ebola outbreak, 2013-2016: old lessons for new epidemics. Health systems should be
equipped to continue routine services during EVD outbreaks. Implications of laboratory tests of
condom integrity. It's something that can be done, even in the simplest environment, with just soap
and water. This type of design would then be used to address the goal of identifying a highly
efficacious intervention that could effectively stop the epidemic. Preventing these studies would
reduce our ability to efficiently form an accurate picture of the relative merits and hazards of novel
interventions. The nine articles, and the unpublished and non-peer-reviewed materials included, were
scrutinised for information on: epidemic study setting, sexual transmission chains from recovered
patients and EBOV persistence in any of the body fluids of interest. To help stop the virus, health
workers are putting up Ebola awareness posters around the country. Scaling up access to medical
supplies and vaccine stockpiles is equally important. The types of literature included were: four
quantitative studies, five qualitative studies, eight mixed methods studies, one academic
commentary and one modelling study. Thus, it may be particularly important to consider whether
and under what circumstances these groups may be included in clinical trials. Identifying a surrogate
virus, categorized at or below BSL-2, would allow many more studies to be done, informing a
variety of concerns. Fear of Ebola's sexual transmission drives abstinence, panic: Reuters. 2015. ?
Devnani M, Guo Y. The vaccination that protects both human communities and the fauna they
interact with (shared immunity) can be one of the novel intervention approaches. Possible sexual
transmission of Ebola virus - Liberia, 2015. This caused an outcry among hospital staff as they didn’t
think the contacts should be working in outpatients with the risk of missing a sign or symptom and
potentially contaminating hundreds of new patients. Children, however, are not little adults and their
age-related differences in metabolism and excretion of medications make the extrapolation of
pharmacokinetic data from adults to children problematic. The study found that 12 of 470 (2.6%)
tested latex condoms leaked despite being intact in a regular water leakage test. Results Evidence of
persisting Ebola virus in semen Evidence suggestive of persistent Ebola viruses in semen has been
found in five different Ebola outbreaks, including the current epidemic. There were no therapeutic
treatments or vaccines for Ebola that were proven safe or effective, and the Ebola-specific agents
that were furthest along in development had only reached the stage of preclinical studies in
nonhuman primates. Others thought that “availability was not a reason to study drugs with weak
supporting data” and favored prioritizing drugs that had shown strong preclinical evidence of
efficacy, such as monoclonal antibodies and small inhibitory RNA, even if they were less readily
available ( WHO, 2014d ). Life goes on: the resilience of maternal primary care during the Ebola
outbreak in rural Sierra Leone.
You will be able to get a quick price and instant permission to reuse the content in many different
ways. Published literature in scientific journals was first searched and extracted from PubMed and
Web of Science databases for the period between 1 January 2014 and 27 June 2020. Other important
points brought up by various participants throughout the different discussions included the creation
of a culture of preparedness in our society; integration. I spent four weeks on the maternity ward of a
rural hospital in Western Uganda, overlooking the Rwenzori Mountains where the Democratic
Republic of the Congo (DRC) border is located. When the World Heath Organization declared the
2014-2015 epidemic a public health emergency of international concern in August 2014, several
teams began conducting formal clinical trials in the Ebola affected countries during the outbreak.
However, these challenges notwithstanding, collecting and categorizing samples now that may
eventually be used in research could greatly augment future studies that are mobilized after the event
has declined. A few participants also noted that virus detection is based on the presence of viral
nucleic acid material and that transmission epidemiology could be improved by the ability to
perform actual virus titration. After the preliminary Ebola test came back negative earlier this week,
the second test on the missionary also came back negative, a hospital source with direct knowledge
said. Methods A literature search of relevant articles on EVD was done in PubMed, Web of Science
and Google Scholar electronic databases. If fewer agents were proposed it is possible that more
comprehensive data would have been available on the more promising agents. That statement has to
be made by the health authorities or the health workers that have treated that particular individual. A
civil servant Patrick Sawyer, travelled by air from Monrovia to Lagos on 20 July, triggering a series
of cases in southern Nigeria. Of those, 67 were at home under observation and have not displayed
symptoms. At Carlos III Hospital, two patients with symptoms were being monitored along with 15
others who have not displayed any symptoms. In the Canary Islands, three other people were under
observation. It's a nationwide campaign, and so rural areas also have these posters out there. Its
Public Health Agency announced it will ship 800 vials of an experimental Ebola vaccine to the WHO
in Geneva beginning Monday. Knowledge, attitude and practice of medical laboratory practitioners
in the fight against Ebola virus disease. The technology and staffing that would have been required
was far beyond what was feasible. Virus was detected neither by RT-PCR nor by virus isolation in
the saliva and throat specimens from convalescent patients. 8, 9, 12, 13, 17 In a study of Ebola
detection in Congo during the outbreaks in 2003, oral fluid samples of acutely sick patients were
analysed for both antigen and antibody detection. 18 While RT-PCR was positive in all specimens
from patients with acute Ebola disease, no antigen was detected from the same specimens. And the
corpse has been well-wrapped, inside a body bag. Ebola virus disease control (in West Africa): an
ecological, one health approach. Additionally, she said, the current response related to PPE has been
very prescriptive and overlooks important risk assessments that each organization should be doing to
make thoughtful decisions about matching of PPE to exposure. Services for mothers and newborns
during the Ebola outbreak in liberia: the need for improvement in emergencies. Viable EBOV has
reportedly never been isolated from vaginal secretions, but EBOV RNA was detected on day 33 in
the vaginal secretions of one of six women tested in the Kikwit epidemic. 8, 9 Additionally, viable
EBOV has been isolated in urine from one patient 26?days following his symptom onset and Ebola
RNA from his sweat on day 40 after symptom onset. 17 We identified one report of Ebola RNA in
faeces on day 29, but no reports of viable virus in faeces. In the event of a death, the deceased or the
corpse has a high tendency of being a reservoir of the virus if that person died of Ebola. Because of
this, Peters said, he expects that a small percentage of people could fall outside of the distribution,
with some surpassing the 21-day incubation period (Eichner et al., 2011). It will be important to
continue to assess how the virus is transmitted, especially within the tail ends of the distribution, to
ensure safe practice. Currently, the Ebola collection holds 37 high-quality systematic reviews ranging
from topics such as the assessment of health systems in affected countries to ethical guideline
coherence of the Ebola treatment clinical trials. Two priests with Ebola were repatriated to Spain and
treated in Madrid. Both died. On 6 October, Spanish authorities said that a nurse, Teresa Romero
Ramos, part of the team treating the Spanish missionaries, had tested positive for the disease. He also
added that research studies about the survivability of the virus on fomites should be revisited, as
well as survivability during human burials; most of the current information has been extrapolated
from animal studies, and further study would be helpful. The need for a risk assessment was brought
forward by a participant from the National Science Foundation (NSF), especially related to viability
in water and wastewater and corresponding needs for disinfection and decontamination. Students
may choose to weave in quotations and descriptions.
Click here to buy this book in print or download it as a free PDF, if available. Peters described what
he thought would be important research issues of therapeutic modalities and treatment options.
Because there is a limited capacity in the United States to handle EVD-contaminated waste, said
Lemieux, more data are needed on effective methods of treatment and disposal. With your help,
we'll bring you hard-hitting investigations, well-researched analysis and timely takes you can't find
elsewhere. In most of the EVD outbreaks, most healthcare facilities were unable to safely provide
the services needed, as they lacked staff, medicine and health information. 48 During the EVD
outbreak in West Africa, the health system was unable to handle an emergency, let alone continue to
run existing services. 47 Affected countries were unable to contain EVD within their borders.
Conducting research in these situations raises important challenges, such as the need to generate
knowledge quickly, maintain public trust, and overcome practical obstacles to implementing research.
Available: ? Hamid KM, Yusuf I, Onoja BA, et al. In 2013, three therapeutic products (ZMapp,
small inhibitory RNA and antisense phosphorodiamidate morpholino oligomers) which were
reported to provide 100% protection in infected monkeys were submitted to WHO to be used during
the West African epidemic. In this regard, such designs seem most reasonable when there are
preliminary data from preclinical or clinical trials that are highly suggestive of efficacy, the natural
history of the disease is uniform and well understood, and there is a stable and high mortality rate.
She stated this as an important concern for hospitals trying to transport the waste once it has been
autoclaved or chemically disinfected. It can also jeopardize trust and relationships that permit clinical
care to be delivered, and for vaccine trials, it can jeopardize trust in the whole immunization system.
For more on hierarchy of controls, see (accessed November 10, 2014). Assessment of the risk of
Ebola virus transmission from bodily fluids and fomites. In this regard, there is a strong, default
presumption in favor of the strongest research design that is feasible to implement, considering both
logistical constraints and cultural acceptance together with. In a recent article, ScienceWatch's
medicine correspondent, David Sharp, examines foundational literature on Ebola since the initial
outbreak in 1976. She highlighted the consideration of other hosts or vectors as transmission risks
(for example, companion animals) and the uncertainty of potential risk. National data collection for
syphilis began in 1941. In Sierra Leone, the treatment of male Ebola survivors has included isolation
and punitive measures. If you are short on time, students can work individually or in pairs to answer
one or two. Community engagement, in particular, is an essential element to the conduct of
successful clinical trials; a. The document also said WHO experts failed to recognize that traditional
containment methods wouldn’t work in the region. This could occur, for example, if the availability
of investigational products off protocol depleted the supply of individuals willing to enroll in studies
that could yield generalizable knowledge about the product’s safety and efficacy. The perspective of
gender on the Ebola virus using a risk management and population health framework: a scoping
review. The multivalent heterologous prime-boost regimen is intended to protect against multiple
filoviruses that cause disease in humans, including the Ebola, Sudan and Marburg viruses. The U.S.
study will test the safety, tolerability and immunogenicity of this vaccine regimen in varying dosing
schedules among healthy volunteers. Clinical, virologic, and immunologic follow-up of convalescent
Ebola hemorrhagic fever patients and their household contacts, Kikwit, Democratic Republic of the
Congo. Combined efforts and international collaborations are needed to provide possibilities for
advanced laboratory investigations. Results The internet search retrieved a total of 2539 articles.
With Goma being the capital of the North Kivu province and a transportation hub for both domestic
and international travel it seemed obvious the declaration was needed. However, there was no
statistically significant change over time (OR in 2019 vs 1976: 1.6 (95% CI 1.5 to 1.6)). The overall
trend from 1976 to 2019 outbreaks shows a linear rate of change over time ( table 3, figure 3 ). If
fewer agents were proposed it is possible that more comprehensive data would have been available on
the more promising agents.