Tuesday, 25 March 2014

Ebola outbreak in Guinea: 13-lab confirmed cases, 73 more suspect, includes 59 deaths

Schematic of an Ebola virus virion.
Its a work in progress but feel free to use.
Just cite Ian M. Mackay, PhD and
http://virologydownunder.blogspot.com.au/

Click to enlarge.
There's an outbreak of Ebola virus (species Zaire ebolavirus) haemorrhagic fever going on in Guinea just now (see the map for where that is within Africa).

Haemorrhagic fever? That's the scary stuff that books get written about and movies based on - bleeding from tissues and person-to-person spread to infected healthcare workers and grieving family carers...horrible, scary stuff for those in the thick of it. If anything can be said to be good news to this, it is that usually (to date) cases do not pass several hundred (see Storify article of tonight's Twitter information [5]) because the virus does not transmit as easily as influenza for example (no aerosol route; spread is by bodily secretions);  scary bleeding from everywhere is not as common as the movie make out and there are survivors of infection. 

A very digestible backgrounder on Ebola that will get you up to speed on this virus and disease can be found at Mike Coston's Avian Flu Diary, here [9].

On 22-March, the World Health Organization (WHO) was made aware of an outbreak in the west African country by its Ministry of Health [1]. The outbreak of febrile disease commenced 9-Feb. When the Minister of Health released a statement, 22-Mar, he noted the disease was characterized by fever, diarrhoea, vomiting, fatigue and sometimes bleeding. 


Guinea and surrounds, Africa.
Maps purchased from maptorian.
Click on image to enlarge.
Since then, haemorrhagic fever cases in the country's capital, Conakry, have been shown to be due to something other than the Ebola virus according to testing results from the Pasteur Institute Dakar [3]. 

The Institut Pasteur in Lyon had earlier identified Ebola virus (so far in 13 cases) in Guekedou, Macenta, Nzerekore and Kissidougou districts; they also genotyped some strains using the L gene as a PCR target[10]. This led to identifying the species Zaire ebolavirus.
The Emerging and Dangerous Pathogens Laboratory Network (EDPLN) is working with the Guinean VHF Laboratory in Donka, the Institut Pasteur in Lyon, the Institut Pasteur in Dakar, and the Kenema Lassa fever laboratory in Sierra Leone to make available appropriate Filo-virus diagnostic capacity in Guinea and Sierra Leone [1]
There is no specific treatment or vaccine for Ebola disease. The first Ebola virus outbreak was identified in 1976. Ebola virus is the conversational name of the viruses that are members of the Family Filoviridae, Genus Ebolavirus and exist as 5 species [4]:
  1. Species: Tai Forest ebolavirus ("Tai Forest virus")
  2. Species: Reston ebolavirus ("Reston virus")
  3. Species: Sudan ebolavirus ("Sudan virus")
  4. Species: Zaire ebolavirus ("Ebola virus")
  5. Species: Bundibugyo ebolavirus ("Bundibugyo virus")
"Multidisciplinary teams have been deployed to the field to actively search and manage cases; trace and follow-up contacts; and to sensitize communities on the outbreak prevention and control. Médecins Sans Frontières, Switzerland (MSF-CH) is working in the affected areas and is assisting with establishment of isolation facilities, and also supported transport of the biological samples from suspect cases and contacts to international reference laboratories for urgent testing." [1]
But where was the crack team of experts laden with ultra cool tech capable of diagnosing the tiny beast within minutes, containing it within hours and saving more people from becoming afflicted in days? 

Unfortunately no such crack team or timeline exists, except in the movies anyway. But as we are going to see in the coming days as diagnostic delays cause headaches for those multidisciplinary teams trying to educate the locals and begin helping contain, confirm cases and trace the disease, there is a real need for faster identification of the causes of acute and serious disease outbreaks worldwide. 

Wouldn't it be great if the world's governments and biotech industries could come together to assemble and maintain some sort of rapidly deployable multinational pathogen detection force? Several teams of scientists and healthcare workers assembled and trained by the world's best, and remaining linked to them, carrying with them all the (perhaps bespoke) tech they'd need to identify any pathogen (unbiased molecular methods). They could analyse their data on the fly or rapidly send it to others for help using satellite links. The "Force" could be funded by the contributing States, biotech and Pharma; coordinated by the WHO perhaps. I'd love to see a dedicated set-up for pathogen identification; a kind of virus/bacteria/parasite-hunting fire department that can down its regular tools and jump on a plane ASAP; someone whose number is on every country's speed dial. 

Ahh 'tis to dream. 

In the meantime, I have a lot to learn about Ebola; something that is more nightmare than dream to me.


References..

  1. WHO situation report as of 22-Mar-2014 [PDF]
    http://www.afro.who.int/en/clusters-a-programmes/dpc/epidemic-a-pandemic-alert-and-response/outbreak-news/4063-ebola-hemorrhagic-fever-in-guinea.html
  2. Epidemic hemorrhagic fever in Guinea after 29 deaths, the Health Minister announces new measures
    http://www.lejourguinee.com/index.php/fr/societe/3072-epidemie-de-fievre-virale-hemorragique-en-guinee-apres-29-morts-le-ministre-de-la-sante-annonce-des-nouvelles-mesures
  3. Guinea: fever cases detected in Conakry are not due to Ebola.
    http://www.france24.com/fr/20140324-guinee-conakry-ebola-virus-fievre-hemorragique-epidemie-institut-pasteur/
  4. Prof Vincent Racaniello's Virology blog on Ebola virus naming
    http://www.virology.ws/2012/08/07/is-it-ebolavirus-or-ebola-virus/
  5. Storify: Early timeline of the events in the Guinea Fever outrbreak
    http://storify.com/MackayIM/early-timeline-of-the-eventsin-the-guinea-fever-ou
  6. WHO webpage on the Guinea Ebola outbreak
    http://www.afro.who.int/en/clusters-a-programmes/dpc/epidemic-a-pandemic-alert-and-response/outbreak-news/4063-ebola-hemorrhagic-fever-in-guinea.html
  7. WHO primer on Ebola haemorrhagic fever
    http://www.who.int/mediacentre/factsheets/fs103/en/
  8. Avian Flu Diary (Mike Coston) on WHO Twitter Messaging On Ebola
    http://afludiary.blogspot.com.au/2014/03/who-twitter-messaging-on-ebola.html
  9. Avian Flu Diary (Mike Coston) on A Brief History Of Ebola
    http://afludiary.blogspot.com.au/2014/03/a-brief-history-of-ebola.html
  10. Guinea Ebola outbreak believed to be deadly Zaire strain
    http://www.reuters.com/article/2014/03/24/us-guinea-ebola-idUSBREA2L0MI20140324