Blog dedicated primarily to randomly selected news items; comments reflecting personal perceptions

Thursday, October 16, 2014

Coping and Hoping

"This provides hope because if the Canadian vaccine is shown to be safe and effective, it will stop this devastating outbreak."
Health Minister Rona Ambrose, Canada

"It does change substantially how we approach it [Ebola virus transfer]. We have to rethink the way we address Ebola infection control. Even a single infection is unacceptable."
"There could be additional cases, particularly among the health-care workers who provided care [for Liberian man who entered the U.S. infected with Ebola]."
"We worked through the night with staff there [Texas Health Presbyterian Hospital] to implement the [new infection-safety] procedures."
Dr. Thomas R. Frieden, director, Centers for Disease Control and Prevention, U.S.

"The health-care workers on the ground are the most likely target to do the next step. Clearly if those studies show that it's effective in health-care workers, the world would go into mass production."
Dr. Gregory Taylor, Canada's chief public health officer

"You're going to see many instances like this over the next few weeks as health-care workers and others return from the area [West Africa]. We're going to become very used to it [Belleville patient recently returned from West Africa]."
Dr. Richard Schabas, medical health office, Belleville, Ontario
ebola liberia
Sophia Doe sits with her grandchildren, while watching the arrival of an Ebola burial team to take 
away the body of her daughter for cremation in Monrovia. The children seen in the photo are daughters 
of the deceased. The woman died outside her home earlier in the morning while trying to leave her 
home and walk to a treatment centre, according to her relatives(John Moore/Getty Images)

An experimental Canadian-made Ebola vaccine that has shown great promise in animal-model trials is set to begin clinical trials which, if expectations for success are confirmed, will lead the way to shipping the formula's results for the vaccine in sufficient amounts to help in the international effort to stem Ebola's deadly tide. The Walter Reed Army Institute of Research in Maryland has received twenty vials of the vaccine to begin testing it on some forty healthy volunteers, according to Health Minister Ambrose.

The vaccine, created by Public Health Agency of Canada, identified as VSV-EBOV will be tested for safety and efficacy for human use through the Phase 1 trial. The trials will determine proper dosage levels, and test as well for evidence of possible side effects. Initial studies showed the vaccine works in non-human primates, succeeding in both preventing infections when given before exposure, and in its capability to increase survival when quickly administered after exposure to the virus.

It will be December before firm results can be anticipated, according to Canada's chief public health officer. With success, the following stage would be its testing in a larger human sample, inclusive of those directly handling Ebola cases in West Africa. A small American pharmaceutical company called NewLink Genetics holds the vaccine licence and is preparing  to arrange trials at the U.S. military laboratory.

According to NewLink Genetics five clinical trials will be geared shortly to initiate in the United States, Germany, Switzerland and an as-yet unnamed African country that is Ebola-free. Yet another leading Ebola vaccine created in the laboratories of the U.S. National Institutes of Allergy and Infectious Diseases, has been licensed to pharmaceutical giant GlaxoSmithKline with the first clinical trial for that vaccine, cAd3, already underway, since September.

Both Canada and the United States have initiated screening measures at airports and arranged for the posting of quarantine officers at designated airports. In the United States about one thousand people weekly arrive from Africa, whereas with no direct flights to Canada, about 30 people a week arrive on connecting flights from Guinea, Sierra Leone and Liberia, the three countries most impacted by Ebola on Canadian soil.

Data from a 12-year survey published in Family Practice journal revealed that those Americans who return with illness travelled to sub-Saharan Africa (25%), Central America/Mexico (18%) and South America (14%). Most travel-acquired illnesses were gastrointestinal (58%) and fever (18%). Among those with fever, 27% had malaria and 12% Dengue.

People who travel to visit friends and relatives generally tend to take fewer health precautions when they travel, and travel deeper into the country. Only 40.5% of travellers who became ill after such trips had seen a doctor before embarking according to a recent study in the Annals of Internal Medicine. According to a PloS One study climate change will be responsible for the Asian tiger mosquito entering North America, capable of transmitting Dengue fever and the chikungunya virus.

With a greater awareness of the dangers inherent in picking up infectious disease, there is incumbent on the international traveler a greater responsibility to avoid exposure, and to honestly inform health authorities on return where they have been and whether they have been exposed to areas where such health threats as Ebola exist.

Toronto emergency room physician Dr. Brett Belchetz, who had experience with the SARS outbreak recently wrote of his experience with patients presenting with symptoms denying just about anything related to exposure and personal responsibility.  
"Which brings me to my greatest concern with regard to the current Ebola epidemic. While Ebola is quite difficult to catch, requiring direct physical contact with the bodily fluids of a symptomatic patient, in its early stages it is virtually indistinguishable from the common flu, with non-specific symptoms like fever, headache, sore throat, vomiting and diarrhea. The only instrument we have to separate early Ebola from the flu, at our borders and our hospitals, is a history of fever and travel to an affected area. Laboratory testing is expensive and time-consuming, and only conducted when we are already suspicious. As fevers can easily be masked with common medications such as acetaminophen or ibuprofen, our process of risk stratification is based on history alone, and relies -- in fact, depends 200% -- upon the honesty of patients.

"When the largest single reason for the failure to contain Ebola in Western Africa was the lack of recognition of the disease before it spread too widely, when our only current method for distinguishing Ebola from the common flu is a truthful history, and when experience tells us patients will lie to doctors, I worry deeply that our over-reliance on patient honesty may be our undoing. Consequently, when it comes to an Ebola outbreak in our nation, the question, terrifyingly, may not be if it happens, but when."

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