Posts Tagged ‘West Africa’

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ISIS may already be thinking of using Ebola as a low-tech weapon of bio-terror, says a national security expert, who notes that the “Islamic State of Iraq and Syria” and terror groups like it wouldn’t even have to weaponize the virus to attempt to wreak strategic global infection.

Such groups could simply use human carriers to intentionally infect themselves in West Africa, then disseminate the deadly virus via the world’s air transportation system. Or so says Capt. Al Shimkus, Ret., a Professor of National Security Affairs at the U.S. Naval War College.

“The individual exposed to the Ebola Virus would be the carrier,” Shimkus told Forbes. “In the context of terrorist activity, it doesn’t take much sophistication to go to that next step to use a human being as a carrier.”

And with a significant portion of West Africa now in an open epidemic, it arguably wouldn’t be difficult for a terrorist group to simply waltz in and make off with some infected bodily fluids for use at a later time elsewhere.

They wouldn’t even have to “isolate” it, says Shimkus, who teaches a course in chemical and biological warfare. He says that if ISIS wanted to send half a dozen of its operatives into an Ebola outbreak region and intentionally expose themselves to the virus, they very well could. The idea is then once they had intentionally infected themselves, they would try to interact with as many people in their target city or country of choice.

The average fatality rate from Ebola, classified as a hemorrhagic fever, is 50 percent; but without medical treatment, that figure can range as high as 90 percent, reports the U.N. World Health Organization (WHO). The WHO also notes that although there are two potential vaccines undergoing “evaluation,” at present none are licensed.

The virus was first documented in humans in 1976 during two simultaneous outbreaks, one in Sudan and the other in the Congo, in a village near the Ebola River. The WHO reports that a type of fruit bat is thought to act as the virus’ natural host.

The virus apparently spreads into the human population via direct contact with infected animals — ranging from chimpanzees, gorillas, monkeys, forest antelope and porcupines; as well as the fruit bat itself — be they found ill or dead in the rain forest. According to the WHO, Ebola can then be spread via contact with the infected’s bodily fluids; even bedding and clothing “contaminated” with such fluids.

The idea of using human carriers to intentionally spread deadly pathogens has been around for centuries. As Shimkus points out, in the Middle Ages, adversaries threw infected corpses over their enemy’s city walls in order to spread the deadly Bubonic Plague.

If ISIS or another terrorist actor were to use Ebola in a similar manner today, Shimkus says the possibility of identifying those infected as they enter and leave the country is excellent but not 100 percent.

Even in the event of terrorists using carriers to spread Ebola in western countries like the U.S., Shimkus doesn’t think the virus would spread exponentially simply because, in theory, advanced health care systems would be equipped to identify, isolate and stop the virus.

In the May 2013 issue of the journal Global Policy, however, Amanda Teckman, author of the paper “The Bioterrorist Threat of Ebola in East Africa and Implications for Global Health and Security” concluded that “the threat of an Ebola bioterrorist attack in East Africa is a global health and security concern, and should not be ignored.”

Teckman, who holds a master’s in diplomacy and international relations at Seton Hall University, told Forbes that because ISIS’ recent beheadings are aimed at garnering attention for their self-proclaimed goal of creating an Islamic state under Sharia Law, the group is unlikely to go through the trouble of using Ebola as a weapon of terror.

“They already have our attention,” said Teckman. “But just because this is not probable for ISIS, I do believe others will at least contemplate using such suicide infectors.”

http://www.forbes.com/sites/brucedorminey/2014/10/05/ebola-as-isis-bio-weapon/

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by Richard Knox

It’s only a matter of time, some researchers are warning, before isolated cases of Ebola start turning up in developed nations, as well as hitherto-unaffected African countries.

The current Ebola outbreak in West Africa has killed more people than all previous outbreaks combined, the World Health Organization said Wednesday. The official count includes about 3,600 cases and 1,800 deaths across four countries.

Meanwhile, the authors of a new analysis say many countries — including the U.S. — should gear up to recognize, isolate and treat imported cases of Ebola.

The probability of seeing at least one imported case of Ebola in the U.S. is as high as 18 percent by late September, researchers reported Tuesday in the journal PLOS Currents: Outbreaks. That’s compared with less than 5 percent right now.

These predictions are based on the flow of airline passengers from West Africa and the difficulty of preventing an infected passenger from boarding a flight.

As with any such analysis, there’s some uncertainty. The range of a probable U.S. importation of Ebola by Sept. 22 runs from 1 percent to 18 percent. But with time — and a continuing intense outbreak in West Africa — importation is almost inevitable, the researchers told NPR.

“What is happening in West Africa is going to get here. We can’t escape that at this point,” says physicist Alessandro Vespignani, the senior author on the study, who analyzes the spread of infectious diseases at Northeastern University.

To be clear, the projection is for at least one imported case of Ebola — not for the kind of viral mayhem afflicting Guinea, Liberia and Sierra Leone.

“What we could expect, if there is an importation, would be very small clusters of cases, between one and three,” Vespignani says.

But the probability increases as long as the West African epidemics keep growing. And that means U.S. hospitals, doctors and public health officials need to heighten their vigilance.

The same is true for a roster of 16 other nations, from the U.K. to South Africa, which are connected to West Africa through air traffic, Vespignani and his colleagues say.

There’s a 25 to 28 percent chance that an Ebola case will turn up in the U.K. by late September. Belgium, France and Germany will have lower risk. “But it’s not negligible,” Vespignani says. “Sooner or later, they will arrive.”

The probability of imported cases in Africa is higher, not surprisingly. There’s more than a 50 percent probability Ebola will show up in the West African nation of Ghana by late September, according to the study. Gambia, Ivory Coast, Morocco, South Africa and Kenya are among 11 African countries where Ebola could pop up.

Officials at the U.S. Centers for Disease Control and Prevention had a presentation on the numbers on Tuesday. The CDC has deployed teams of personnel in West Africa to help bring Ebola under control. And here at home, the agency is charged with preparing both the U.S. medical system and the American public for the possibility that the deadly virus could sneak into this country.

Biostatistician Ira Longini from the University of Florida agrees that Ebola doesn’t pose a public health threat in the U.S. and other developed nations. But that doesn’t mean that preparation isn’t urgent.

“We certainly need to make sure that staff and leadership of American medical centers understand the implications of Ebola,” says Longini, who also worked on the study. “We need to have diagnostics in place to identify Ebola quickly. We need quite a few local labs to do this and not just rely on sending samples to the CDC. And we need to make sure isolation and quarantine of contacts takes place. If it doesn’t, we could have a small cluster of cases.”

The analysis by Longini, Vespignani and their colleagues takes into account the number of airline passengers coming from West Africa to various countries. For instance, more than 6,000 a week arrive in Britain from Nigeria, many of them originating in other African countries.

Hundreds to several thousands travel every week from West Africa to France, Germany, Spain, Italy, South Africa, Egypt, Saudi Arabia, India, China and other countries.

The researchers calculated the impact of severe restrictions on flights from Ebola-affected regions. An 80 percent reduction in air travelers would do no more than delay the impact of Ebola by a few weeks. (A 100 percent choke-off of air travel is considered impossible.)

“Unless you can completely shut down the transportation systems, these kinds of efforts will, at best, buy you a little time,” Longini says. “And they can be quite counterproductive because you’re interrupting the flow of help, goods and services. It can make the epidemic worse in the country that’s being quarantined.”

The basic problem with confining Ebola is that, like any infectious disease, people can be infected without showing symptoms. In Ebola’s case, the average incubation period is 7 days, though it can be longer. That’s more than enough time for an infected traveler to land on the other side of the world.

Fortunately, an Ebola-infected person can’t infect others unless he’s obviously sick. At that stage, the virus can spread by direct contact with the infected person or bodily fluids. On average, each case of Ebola infects about two other people. That spread rate is similar to that of the flu, and roughly half the rate of smallpox.

Vespignani, from Northeastern University, says screening airline passengers is not going to prevent Ebola from traveling across the globe. “I don’t trust screening too much,” he says. “It’s difficult. Intercepting passengers that are really not sick is not easy.”

http://www.npr.org/blogs/goatsandsoda/2014/09/04/345767439/a-few-ebola-cases-likely-in-u-s-air-traffic-analysis-shows

Thanks to Ray Gaudette for bringing this to the attention of the It’s Interesting community.

Because Kent Brantly is a physician who has watched people die of Ebola, there was an especially chilling prescience to his assessment last week, between labored breaths: “I am going to die.”

His condition was grave. But then on Saturday, we saw images of Brantly’s heroic return to U.S. soil, walking with minimal assistance from an ambulance into an isolation unit at Emory University Hospital.

“One of the doctors called it ‘miraculous,'” Dr. Sanjay Gupta reported from Emory this morning, of Brantly’s turnaround within hours of receiving a treatment delivered from the U.S. National Institutes of Health. “Not a term we scientists like to throw around.”

“The outbreak is moving faster than our efforts to control it,” Dr. Margaret Chan, director of the World Health Organization, said on Friday in a plea for international help containing the virus. “If the situation continues to deteriorate, the consequences can be catastrophic in terms of lost lives, but also severe socioeconomic disruption and a high risk of spread to other countries.”

In that light, and because Ebola is notoriously incurable (and the strain at large its most lethal), it is overwhelming to hear that “Secret Serum Likely Saved Ebola Patients,” as we do this morning from Gupta’s every-20-minute CNN reports. He writes:

Three top secret, experimental vials stored at subzero temperatures were flown into Liberia last week in a last-ditch effort to save two American missionary workers [Dr. Kent Brantly and Nancy Writebol] who had contracted Ebola, according to a source familiar with details of the treatment.

Brantly had been working for the Christian aid organization Samaritan’s Purse as medical director of the Ebola Consolidation Case Management Center in Monrovia, Liberia. The group yesterday confirmed that he received a dose of an experimental serum before leaving the country.

In Gupta’s optimistic assessment, Brantly’s “near complete recovery” began within hours of receiving the treatment that “likely saved his life.” Writebol is also reportedly improved since receiving the treatment, known as zMapp. But to say that it was a secret implies a frigid American exceptionalism; that the people of West Africa are dying in droves while a classified cure lies in wait.

The “top-secret serum” is a monoclonal antibody. Administration of monoclonal antibodies is an increasingly common but time-tested approach to eradicating interlopers in the human body. In a basic monoclonal antibody paradigm, scientists infect animals (in this case mice) with a disease, the mice mount an immune response (antibodies to fight the disease), and then the scientists harvest those antibodies and give them to infected humans. It’s an especially promising area in cancer treatment.

In this case, the proprietary blend of three monoclonal antibodies known as zMapp had never been tested in humans. It had previously been tested in eight monkeys with Ebola who survived—though all received treatment within 48 hours of being infected. A monkey treated outside of that exposure window did not survive. That means very little is known about the safety and effectiveness of this treatment—so little that outside of extreme circumstances like this, it would not be legal to use. Gupta speculates that the FDA may have allowed it under the compassionate use exemption.

A small 2012 study of monoclonal antibody therapy against Ebola found that it was only effective when administered before or just after exposure to the virus. A 2013 study found that rhesus macaques given an antibody mix called MB-003 within the 48-hour window had a 43 percent chance of surviving—as opposed to their untreated counterparts, whose survival rate was zero.

This Ebola outbreak is the largest in the history of the disease, in terms of both cases and deaths, 729 887 known so far. As Chan warned in her call for urgent international action, the outbreak is geographically the largest, already in four countries with fluid population movement across porous borders and a demonstrated ability to spread by air travel. The outbreak will be stopped by strategic quarantines and preventive education, primarily proper handling of corpses. More than 60 aid workers have become infected, but many more will be needed to stem the tide.

Dr. Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Disease (NIAID), is encouraged by the antibody treatment.

“Obviously there are plans and enthusiasm to expand this,” Fauci told me. “The limiting factor is the extraordinary paucity of treatment regimens.” Right now the total amount available, to Fauci’s knowledge, is three treatment courses (in addition to what was given to Brantly and Writebol).

NIAID did some of the original research that led to the development, but this is owned by Mapp Biopharmaceuticals. “They are certainly trying to scale up,” Fauci said, “but I’ve heard that their capability is such that it’s going to be months before they have a substantial number of doses, and even then they’re going to be limited.”

“We’re hearing that the administration of this cocktail of antibodies improved both Dr. Brantly and Ms. Writebol, but you know, we don’t know that,” Fauci said, noting the sample size (two) of this small, ad hoc study. Proving effectiveness would require a much larger group of patients being compared to an untreated group. “And we don’t know that they weren’t getting better anyway.”

Thanks to Kebmodee for bringing this to the attention of the It’s Interesting community.

http://www.theatlantic.com/health/archive/2014/08/the-secret-ebola-treatment/375525/