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Ebola Updates

updated: 31 January, 2015


The Lancet: Ebola Updates

Too Little, Too Late - Politico
Last September—eight months into the Ebola epidemic—Barack Obama launched a $750 million initiative to coordinate and strengthen international aid efforts, which had come under intense criticism from disaster response and global health experts.

In a photo essay that includes images of newly built and empty Ebola treatment facilities, Politico reports that Operation United Assistance came too late, long after the worst of the epidemic had passed.

Related: An Empty, Underused Medical Outpost Could Be the Future of the Ebola Fight – Foreign Policy
Related: Weekly Ebola cases below 100, WHO says endgame begins – Reuters
Related: Do Ebola educators make a difference? – The Guardian

After Ebola: What next for West Africa's health systems

Lessons in Survival - Jhpiego
Guinean doctor Thierno Souleymane Diallo survived a grueling fight with Ebola, and now he is dedicated to spreading the word about lifesaving infection prevention and control (IPC) skills.

Thierno contracted the virus working in a maternity ward, not with known Ebola patients—and he blames the fact that he used only 1 glove on 1 hand, as well as an improperly prepared chlorine solution used for disinfection. Upon his recovery, he attended an IPC update and refresher training for health workers organized by USAID and led by Jhpiego, in conjunction with Guinea's Ministry of Health.

Subsequently, Thierno has made it his mission to share the knowledge from the training, spreading the word to colleagues that 1 glove is not an acceptable practice.

Related: First GSK Ebola vaccine shipment due to arrive in Liberia – Reuters
Related: Sierra Leone lifts Ebola quarantines as crisis eases – Agence France Presse via ReliefWeb

Vaccine Challenges - The Lancet
Though the global focus on Ebola is fading, the disease still looms large in the global health community, and prevention of the next epidemic is a top priority.

Central to the effort is the development of an Ebola vaccine, the subject of a piece in The Lancet that proposes 7 key challenges to consider early in the process.

Among the questions raised by international vaccine experts: Who will be vaccinated? How will a vaccine reach the target populations? How safe does the vaccine need to be?

It's Not the City Air - Reuters
City living appears to be far less important than being poor, black or Puerto Rican in determining a US child's asthma risk, according to Johns Hopkins University research published in the Journal of Allergy and Clinical Immunology that contradicts long-held public health assumptions.

Comparing asthma rates in US inner city areas, the research, led by Corinne Keet, a pediatric allergy and asthma specialist, found no statistically significant difference between inner-city children and those living elsewhere. But Keet's team learned that black or Puerto Rican children had far higher asthma rates, at 17 and 20%, respectively, compared with white children (10%), other Hispanic children (9%) and Asian children (8%).

EBOLA

Straight from Liberia's MoH: Q&A w/ Tolbert Nyenswah
Tolbert Nyenswah, Liberia's National Ebola Incident Manager and Assistant Minister/Deputy Chief of the Ministry of Health & Social Welfare, updates GHN on the country's response. Come back tomorrow for Part II.—Dayna Kerecman Myers

Q. Are you concerned that as Ebola cases fall in Liberia, interest and support from abroad will fade and with it hopes for rebuilding the health system?
We are having these conversations with donors as we speak. We have built very strong relationships with organizations… and they understand that the need for donors during the post-Ebola time of rebuilding will be great.

To ensure that plans are in place … the Ministry of Health, along with other government agencies and partners, is conducting an assessment to review progress toward the 10 Year National Health Policy and Plan established in 2011. The assessment will provide updated objectives and short- and long-term cost estimates in terms of the restoration of essential health services and strategies.

Q. Why did health workers and the public distrust the government at the beginning of the outbreak?
Initially, Infection Prevention & Control (IPC) training and materials were slow to roll out to health facilities, leading to infections among health workers who lacked information—or the proper materials—to protect themselves when an Ebola patient presented. This has been addressed through widespread IPC trainings across the country, and by overcoming logistical hurdles to distribute IPC materials to health facilities. As logistics and training have improved, we've seen a significant reduction in health care worker infections, with few, if any, being reported at this stage of the outbreak.

In terms of the public, the outbreak was unprecedented and hit us hard, causing panic; other countries in the world could not have been prepared for what Liberia faced, either. We had to work very hard to engage the affected communities, to educate them and to gain their trust as we scaled up our response. That took time and patience, but now we have a sufficient number of Ebola treatment facilities, beds and laboratory capacity to test specimens more quickly and communities are largely pleased.

Currently are in Phase II of the EVD outbreak in Liberia, emphasizing intense community engagement. We have seen remarkable acceptance and action on the part of the Liberian public. For example, recently we've had an average of about 1.4 cases confirmed per day, but an average of about 25 cases reported a day. This is good; this shows that the public is being proactive about reporting illnesses, and that suspected cases are not languishing in communities, potentially infecting others. Now, cases are being isolated sooner, and people are receiving treatment earlier—ensuring a better chance at survival. Thus, I would say at this stage that we have the public's trust – and are continuing to earn it.

Q. Has the Ebola crisis led to stronger ties with other countries?
To a large extent, the crisis has prompted the development of stronger health communication and surveillance ties with other governments across Africa. With experience in EVD management, East Africa has contributed human resources to Liberia. A Ugandan government team of medical experts has played a key role in the fight against Ebola. Besides the African Union joint support to Liberia, Nigeria, Uganda, Kenya, Egypt, South Africa and Namibia have been tremendously helpful in supporting Liberia.

Q. You've been working with colleagues at Johns Hopkins to connect to drug manufacturers for experimental treatments and vaccines. How is that going?
In the past months we've been working to reach consensus regarding protocol, ethics and regulation. Phase 1 data from studies conducted in the US, Europe and sub-Saharan Africa shared with the Liberian Technical and Consultative Advisory Groups clearly indicated promising immunogenic responses. [This] led to a proposal to combine the Phase II/III approach in Liberia. Now, Liberia-US Technical Teams are finalizing protocols to submit to ethical and regulatory entities for approval, recruiting and hiring hundreds of Liberians to support the project structure, rehabilitating designated health centers, upgrading lab facilities, developing a clinical research program at the Liberian Institutes for Biomedical Research (LIBR), and providing mentoring and training opportunities to Liberians. Discussions are underway to ensure acceptable liability insurance for Liberian investigators and study volunteers, and the government is developing a legal framework.

Q. Could the (thankfully) dwindling number of cases in Liberia make it harder to prove the efficacy of the vaccine?
Vaccine trials are still set for implementation. The Official Launch of the EVD vaccine trial is expected to commence by the end of January or early February, at either JFK or Redemption Hospital. A reduction in the cases could be a challenge for the vaccine trial, but will not necessarily affect the quality of the study.

Q. Earlier you mentioned that you'd like to see the use of cell phone data and geo-spatial mapping to better understand patterns and boost the government response. Are you seeing that yet?
We've been working with partners on several technology-driven initiatives. For example, the CDC analyzed cell phone tower traffic in Liberia to pinpoint potential outbreaks (where clusters of people called the national Call Center), and to gauge the effectiveness of social mobilization campaigns. UNMEER/UNFPA are equipping contact tracers with close to 3,000 mobile phones. And the US National Geospatial Intelligence Agency (NGA) has compiled data through geospatial mapping, placed online to boost the international response to Ebola. We're confident that many of these initiatives will last beyond the EVD response, and will support the broader health system as we continue to rebuild essential health services.

Related: The Fight To The Finish And The Post-Ebola Agenda – Daily Observer (Liberia)
Related: Economic impact of Ebola less severe than first thought: World Bank – Reuters
Related: UN: African Countries 'Vital' in Fight Against Ebola – VOA
Related: Ebola Aid Workers Said to Get Protections in Cuomo's N.Y. Budget – Bloomberg
Related: Global Communities opens new burial site for Ebola victims near Monrovia – Washington Post

Preparation of at-risk west African countries for Ebola - The Lancet

Social science intelligence in the global Ebola response - The Lancet

It's not Ebola … it's the systems - Global Health: Science and Practice

Courage is not the absence of fear: responding to the Ebola outbreak in Liberia - Global Health: Science and Practice

Microbiologists and virologists weigh in on whether Ebola is destined to become an endemic disease, and what that would mean for the world—from the need for better surveillance tools, to adaptations, and to health systems and hospitals. Discover

The WHO Ebola emergency committee is meeting today to review recent developments and assess whether the outbreak in West Africa still amounts to a public health emergency of international concern.CIDRAP

In Guinea, schools closed during the worst of the Ebola crisis reopened today, but many frightened parents still kept their kids at home. The New York Times

USAID: Eyes on Guinea as Liberia, Sierra Leone Improve on Ebola - Reuters Health Information
Ebola Health Workers Face Life or Death Decision on Pregnant Women - Experts - Reuters Health Information
New Ebola Cases Slump in All Three Worst-Hit Countries: WHO - Reuters Health Information
Liberia Aims to Be Ebola-Free by End-February as Cases Fall to 10 - Reuters Health Information

Ebola treatment centers built in Liberia by the U.S. military are nearly empty as the epidemic recedes. While other centers are being closed, some centers are still being built, mostly by UNICEF. –Washington Post

Related: US-built Ebola treatment centers in Liberia are nearly empty as outbreak fades – H5N1
Related: Ebola is leaving a new generation of orphans – Public Radio International
Related: The secret to curing West Africa from Ebola is no secret at all – Op-ed by Paul Farmer, Washington Post
Related: Health Minister: All schools in Guinea that were closed amid Ebola are to reopen on Monday – U.S. News & World Report

The secret to curing West Africa from Ebola is no secret at all - Paul Farmer - The Washington Post

The Hidden Barrier - Bulletin of the Atomic Scientists
Africa's real need for successfully fending off epidemics like Ebola? End corruption, argues Laura H. Kahn in a well-reasoned op-ed for the Bulletin of the Atomic Scientists (there's a pub we don't often cite. Good find, Dayna!).

As corruption increases, sanitation and health decrease, Kahn argues, citing an interesting report from Transperancy International. She notes that Liberia has received billions in aid support for more than a decade but it has made little difference in people's lives. Not coincidentally it is near the bottom of the UN Human Development Index and Transparency International's Global Corruption Barometer.

Change, Kahn argues, requires "leadership, disincentives, transparency, and accountability."

Related: Prediction: All Predictions About Ebola Are Unpredictable – NPR Goats and Soda

Ebola & Nutrition: How Programs Are Responding and the SBC Tools they are Using - Presented in collaboration with the CORE Group Social & Behavior Change and Nutrition Working Groups

World Report: Ebola vaccine trials back on track
Comment: Is the world ready for an Ebola vaccine?

Good News: Falling Incidence - CIDRAP
New Ebola cases dipped last week in all 3 of West Africa's worst-hit countries last week, although hot spots persist—especially in the western part of Sierra Leone, according to the WHO's January 14 situation report.

Sierra Leone continues to be most affected; it reported 184 new confirmed cases last week, while Guinea and Liberia reported 42 and 8 respectively. That takes the total for the epidemic to 21,296 cases, and 8,429 deaths.

And Now, the Dose of Reality - H5N1
New cases may be falling, but lest our hopes swell prematurely, let's head over to Crawford Kilian's H5N1 blog for another perspective. He points us to an important article in The Atlantic, Ebola's Hidden Costs as "a useful antidote to the premature euphoria I sense in the reports about declining (or even level) case incidence."

Thanks for keeping it real, Craw.

Related: Could the Ebola epidemic end this year? – PLOS Health Perspectives
Related: West Africa - Ebola Outbreak, Fact Sheet #16 – USAID & CDC via ReliefWeb
Related: Study to examine Ebola's survival rate, disinfection in sewage – UNC Gillings School of Global Public Health
Related: Wonks disagree over whether IMF contributed to Ebola crisis – Humanosphere

Special Challenges for Pregnant Women - Thomson Reuters
In Ebola-hit countries, health workers must make snap life-or-death judgments about how to care for pregnant women, according to research published in BJOG: An International Journal of Obstetrics and Gynaecology.

Pregnant women with Ebola are at increased risk of spontaneous abortion, pregnancy-related hemorrhage, stillbirth and death. But health workers coping with poor infrastructure and limited access to labs have little time to wait for test results to decide whether a pregnant women should receive the necessary interventions, or may have Ebola—and thus should only receive minimal procedures.

Ebola stigma and fear cause pregnant women to postpone seeking treatment until they are critical. Meanwhile, health workers dealing with childbirth face greater infection risks, because they are often exposed to large quantities of body fluids.

Related: Ebola crisis update - 13th January 2015 – MSF
Related: Ebola Cases and Health System Demand in Liberia – PLOS Biology
Related: Probe of Ebola burial practices pinpoints risks, triggers changes – CIDRAP
Related: CDC director 'confident' world can get to zero Ebola cases – Reuters
Related: The Ebola epidemic in West Africa is showing signs of moderation: Q&A w/Peter Salama, UNICEF global emergency co-ordinator for Ebola – Australian Broadcasting Corporation

It's Not Gone Yet … - Vox
This sweeping overview reminds us that even if mainstream Western media interest in Ebola is waning, West Africa is still in the throes of a devastating outbreak. Julia Belluz presents data to back up some key issues:
  - Why the outbreak is unprecedented and why Ebola will likely never be eradicated
  - Different, worrisome patterns of transmission persist in the 3 hardest-hit countries
  - The case numbers are unreliable
  - Despite recent promising signs, a vaccine is a long way off.

Highlighting Ebola's intractability, infectious disease modeler David Fisman explains, "There's going to be a last-mile problem here … You have this thing smouldering away in the jungle. It's going to be very difficult to stamp out the last few embers and — given that an epidemic can start up from the last few embers — that's going to be an issue."

Related: After Ebola, WHO blames governments and seeks more clout – Reuters
Related: Trial By Ebola – Vanity Fair
Related: Report maps complex challenges to Ebola vaccine efforts – CIDRAP
Related: Ebola takes mental health toll where 'life has frozen' in Sierra Leone – The Guardian
Related: China sending large Ebola relief team to West Africa – Associated Press

Signs That Ebola 'May Be Leveling Off' in Sierra Leone - Reuters Health Information

Pivotal Ebola Vaccine Trials to Start This Month or Next - Reuters Health Information

Lessons from Haiti - Minneapolis Star Tribune (Opinion)
On the 5th anniversary of Haiti's devastating earthquake, it's clear that while we can't prevent earthquakes, better infrastructure could have saved more lives, according to Augie Lindmark, a student at the University of Minnesota Medical School.

While 250,000 died in Haiti's 2010 earthquake, the 1989 Loma Prieta earthquake in the San Francisco Bay area, by contrast, took only 63 lives. The major difference? Haiti didn't have the infrastructure to withstand such an earthquake—and was crippled by poverty.

"Today's story of Ebola is eerily similar," writes Lindmark, comparing patient outcomes in West Africa to those of Americans treated on US soil. She emphasizes the clear need to invest in health systems and infrastructure to avoid the next outbreak, concluding, "As globalization presses onward, our ability to treat disease will depend on the equity of systems that develop."

Related: Ebola Clue May Lurk in 10 Million Bats in Zambian Fig Trees – Bloomberg
Related: Medical charity MSF opens Ebola clinic for pregnant women – Reuters
Related: Back In D.C. From The Ebola Hot Zone, I Broke Out In A Fever – NPR Goats and Soda

Correspondence: WHO must remain a strong global health leader post Ebola - The Lancet

Comment: Beyond Ebola: a new agenda for resilient health systems - The Lancet

Ebola death toll rises in West Africa while Americans' interest wanes
Data from Google Trends and the World Health Organization reinforces a simple, and some might say disheartening, reality of human behavior: Most of us aren't that interested in a crisis until it hits very close to home.

The January 7 WHO Ebola Situation Report provides not just the latest numbers, but country-specific updates and UNMEER targets. WHO

AHEAD IN 2015: VIRUSES, EPIDEMICS AND UNITED NATIONS HAGGLING—PART ONE: The Ebola Epidemic in West Africa

WHO's to Blame? - The New York Times
The WHO, and Margaret Chan's leadership, has drawn sharp criticism over the Ebola outbreak and the world's failure to act early. The full story, however, is complex, and this NYT piece digs into the details like WHO's actual mission, the diplomatic challenges and the missed opportunities.

Critics charge that Chan let governments drive the agenda and has been too accommodating. Chan maintains that she followed protocol by leaving it to the WHO regional office for Africa to respond.

"The interests of the member states bubble up, and they guide WHO," said Wafaa El-Sadr, a Columbia University Mailman School of Public Health professor. "On the other hand, the world's expectation of the WHO is that it's leading from above. That's a conflict."

Peter Piot, director of the London School of Hygiene and Tropical Medicine, notes, "The world needs a WHO … but it has to become a better one. My concern is once this epidemic is over, things go back to business as usual."

Related: Strike over risk pay at Sierra Leone Ebola hospital called off – The Guardian
Related: Ebola drug trial under way in Liberia – Al Jazeera
Related: Is the Ebola Crisis a Reason to Skip RCTs? – Science-Based Medicine
Related: Breaking New Ground: A Different Approach to Building Ebola Clinics in Liberia – USAID Impact Blog

Evidential Oomph Against the IMF - Washington Post
IMF policies came under fire last month for undermining health systems and contributing to the spread of Ebola in West Africa, as a commentary in The Lancet Global Health articulated (GHN summarized the commentary on December 22).

The commentary prompted some defense of the IMF's role (see Did the International Monetary Fund help make the Ebola crisis?), but now Adia Benton and Kim Yi Dionne offer 5 important readings from medical anthropology and public health that provide some evidence backing up The Lancet's claims. They argue that IMF policies, and the international political economic context in general, weakened health systems and helped create an environment conducive to the spread of Ebola.

Ignoring the role of foreign aid, say Benton and Dionne, "is to miss an important part of the story—the transnational part of this story—that needs to be told."

Related: Liberia close to beating Ebola as cases dwindle – The Guardian
Related: Battling Ebola with Data – Voice of America
Related: Ebola shuts schools in Sierra Leone but teachers use skills to stop disease – The Guardian
Related: Ebola death toll goes past 8,000: WHO – Deutsche Welle
Related: Ebola: as ZMapp stocks run out doctors turn to alternative treatments – The Guardian

Airport Exit and Entry Screening for Ebola - Morbidity & Mortality Weekly Report

Healthcare Worker in UK Diagnosed With Ebola - Reuters Health Information

UK Ebola Patient Being Treated With Survivor Blood Plasma - Reuters Health Information

Liberia Sees Surge in New Ebola Cases in Border County - Reuters Health Information

Ebola Wrecks Years of Aid Work in Worst-Hit Countries - Reuters Health Information

IMF Focus on Debt Over Health Spending Worsened Ebola in Africa - Reuters Health Information

Ebola Fears in Pregnant Women Reducing Healthcare Use - Medscape Medical News

Ebola: When to Intervene in Life-Threatening Events, Guidance - Medscape Medical News

Ebola Spreads in Sierra Leone as Global Cases Top 20,000: WHO - Reuters Health Information

Mysteries Surround Transfusion Therapy - The Independent
While a small 1995 study in Kinshasa in the Democratic Republic of Congo showed that transfusion therapy, one of the few treatment options available to people suffering from Ebola, can work, the reasons why remain unclear.

Called passive immunotherapy, it takes antibodies circulating in the blood of Ebola survivors and injects them into patients in a bid to curb the virus's replication. In the 1995 study, just 1 of 8 patients treated with blood transfusions from survivors died—a 12.5% fatality rate vs. the typical 80% for that outbreak.

In the absence of many alternatives in the current West Africa outbreak, some doctors have advocated wider use of passive immunotherapy—but others say more caution is needed. Peter Horby of the University of Oxford, said it is unclear whether convalescent plasma treatments "are effective, useless, or perhaps even harmful… This underlines the urgent need to properly evaluate experimental therapies for Ebola, including convalescent plasma, so we know what works and what does not."

No Plan B - Agence France Presse via Yahoo News
Ending Ebola will be difficult but is within reach, said the UN's new mission chief on Ebola, Ismail Ould Cheikh Ahmed, and it is the only option.

"We have no plan B, we have to get rid of this virus," he said, adding, "We need to keep going until we don't have even one case, because even one case is too many."

Ahmed, from Mauritania, formerly served as deputy special representative and deputy head of the UN mission in Libya. He is taking over leadership of UN Mission for Ebola Emergency Response (UNMEER) from American Anthony Banbury at a point when there are more than 20,200 cases of Ebola and just over 7,900 deaths according to the latest WHO figures.

Ebola doctors are divided sharply over the practice of intravenous rehydration, which the WHO cites as the main reason that almost all Ebola patients treated in western hospitals have survived, but can be dangerous for overworked doctors and nurses and patients if given carelessly. The New York Times


Ebola Virus 2014: Timeline of the World's Largest Outbreak

Top Stories of 2014
  • How a Virus Outsmarted the World (Ebola) –Washington Post
  • Nigerian virologist delivers scathing analysis of Africa's response to Ebola –Science Magazine
  • Inside the Ebola Wars –The New Yorker
  • Why Is Guinea's Ebola Outbreak So Unusual?NPR


Where Could Ebola Strike Next? Scientists Virus Hunt In Asia – NPR Goats and Soda
WHO: Ebola spreads in Sierra Leone as global cases top 20,000 – Reuters
2014 West African Ebola outbreak: feature map and timeline – WHO

Last spring, the West Africa Ebola epidemic might have been stopped—but despite the efforts of the world's best Ebola experts, like the CDC's Pierre Rollin, this outbreak would prove different in several key, catastrophic ways, and chances to stop the virus in its tracks were lost. The New York Times

Has Ebola found a permanent foothold among humans? Even top scientists are perplexed. Scientific American

Rely on local leadership; be sensitive to other peoples' cultures; don't forget that simple changes can yield significant results; and we're all connected—and ultimately unprepared: these are some of the key lessons from the costly effort to fight the 2014 Ebola outbreak. Washington Post

Related: Ebola case numbers top 20,000, deaths approach 8,000: WHO – Reuters
Related: The Ebola Crisis That Never Ended – The Atlantic
Related: Insect-Eating Bat May Be Origin of Ebola Outbreak, New Study Suggests – National Geographic
Related: Kono District: Newest Ebola hotspot in Sierra Leone – Reliefweb
Related: After Slow Ebola Response, WHO Seeks to Avoid Repeat –Wall Street Journal

Ebola Remains a 'Long, Hard Fight,' CDC Chief Says - Medscape Medical News

Can the Blood of Ebola Survivors Create a Cure? - Reuters Health Information

Exhausted Sierra Leone Medics Battle Ebola in the 'Red Zone' - Reuters Health Information

Medical Detective Work Is Next Phase in Ebola Fight - Reuters Health Information

Ebola Crisis Could Last Through 2015 - Reuters Health Information

CDC Worker Monitored for Possible Ebola Exposure in Lab Error - Reuters Health Information

Efforts to fight Ebola in West Africa might be inadvertently hurting efforts to stop preventable deaths from malaria, which kills thousands more than the Ebola virus; doctors in Guinea report that the apparent drop in malaria cases by up to 40% likely stems from people's fear of visiting hospitals and seeking treatment for malaria amid the Ebola upheaval. Associated Press

Ebola is showing varied patterns in Guinea, Sierra Leone, and Liberia, but activity is still intense in all 3 countries' capitals, and in last week's UNMEER update Peter Piot said West Africa's outbreak will likely last until the end of 2015. CIDRAP

Untested Ebola drug given to patients in Sierra Leone causes UK walkout – The Guardian

The IMF Impact on Health Care - The Lancet Global Health
International Monetary Fund (IMF) policies might have played a role in weakening health systems in Guinea, Liberia, and Sierra Leone, argue the authors of a commentary in the Lancet Global Health.

The authors reviewed IMF policies, sifting through archives of IMF lending agreements between 1990-2014, to back their argument that IMF economic policies required recipient governments to adopt policies that could have emphasized short-term economic objectives over health care investment.

Approaching 20,000 Cases: The WHO reported a total of 19,031 Ebola cases in Sierra Leone, Liberia, and Guinea, and 7373 deaths, as of December 19. - WHO

Related: Ebola response in rural Sierra Leone not yet rapid enough – Reuters
Related: Liberia Holds Senate Vote Amid Ebola Fears – Associated Press
Related: U.N.'s Ebola mission should be closed once battle won – Reuters

Global Compact Business Action Pledge on Ebola Elimination
This pledge reflects actions and commitments of the Ebola Private Sector Mobilization Group (EPSMG), a coalition of over 50 companies with major interests in Western Africa. The UN Global Compact, in collaboration with EPSMG, other business associations, and UN partners, is circulating the pledge with the goal of reaching every company with a footprint in Western Africa and increasing business contributions to Ebola response.

Recognizing that Ebola is a global challenge requiring global solutions, we call on governments and intergovernmental organizations to continue raising international awareness and mobilizing resources in a coordinated global effort to combat the outbreak.

Recognizing that the private sector also has an important role to play in Ebola response, we call on all businesses with operations or interests in Ebola-affected and neighbouring countries to sign this pledge and demonstrate leadership.

Severe Ebola virus disease with vascular leakage and multiorgan failure: treatment of a patient in intensive care
A case study of adoctor who contracted Ebola and survived thanks to experimental drug treatment.

Editorial: Ebola: protection of health-care workers
Correspondence: Ebola and the social media
Correspondence: Ebola: national health stakeholders are the cornerstones of the response
Correspondence: Ebola and the UN's responsibility to protect

The Next Horror - Thomson Reuters
The evolving Ebola crisis is now spinning out a secondary horror: mass hunger. 500,000 people in Guinea, Liberia and Sierra Leone are going hungry and another half million people could join them if food supplies do not improve, UN agencies reported yesterday.

Ebola fear has caused labor shortages on farms, kept people away from markets and disrupted supply chains, worsening access and exacerbating the economic fallout from the crisis. Exports have dropped, leaving many without money to buy food, Thomson Reuters reports.

The Quote: "The outbreak has revealed the vulnerability of current food production systems and value chains in the worst Ebola-affected countries," Bukar Tijani, the Food and Agriculture Organisation's (FAO) representative for Africa said in a statement.

Related: Ebola total tops 18,000, with hints of slowing in Sierra Leone – CIDRAP
Related: How Rutgers and World of Warcraft 'corrupted blood' could help Ebola response – NewsWorks
Related: Lessons From an Outbreak: How Ebola Shaped 2014 – The Atlantic
Related: Year in review: Science faces Ebola epidemic – ScienceNews

Preventing Dehydration in Ebola Outbreaks - CeraLyte® for Ebola Aid through Direct Relief
Seventeen tons of ready to drink CeraLyte® rice-based oral rehydration solution (ORS) was donated by Cera Products, Inc. of Hilton Head, SC to humanitarian organization Direct Relief to send to Liberia and Sierra Leone to help keep Ebola patients from dehydration and shock, enabling them to have a better chance to fight the disease. CeraLyte ORS helps reduce fluid losses as it hydrates and provides needed calories for the people affected by the virus. The value of these gifts was nearly $72,142.

87 Ethiopian health workers arrived in Liberia to join an African Union (AU) mission to fight Ebola; they will team up with more than 175 Nigerian medics already deployed to Liberia and Sierra Leone. Reuters

Ebola patients in Sierra Leone demonstrate how gestures of humanity and the will to survive might make more of a difference than any medicine in fighting Ebola. Wired

Just as the US panic over Ebola diminishes, the US Congress allocated more than $800 million last week to prepare and compensate states for readying for Ebola in the US. Bloomberg

For Survivors, It Isn't Over - Al Jazeera
40% of Ebola survivors have developed eye problems, and a host of other difficulties, according to a recent survey carried out by the WHO and Kenema's District Health Management Team in Sierra Leone.

Al Jazeera saw a copy of the survey, which details numerous physical, social and psychological problems among survivors: 79% cite joint pain; 42% report trouble sleeping, and over a third have experienced skin peeling. Many others reported reproductive problems.

The Quote: "There is so little written about post-Ebola problems," said Maggie Nanyonga, a WHO consultant working with Ebola survivors in Kenema district. "We don't know if it's the drugs that are causing it, or the disease, or just stress."

Related: Endless Ebola Epidemic? That's The 'Risk We Face Now,' CDC Says – NPR Goats and Soda
Related: Ebola: UN forum urges debt relief for hard-hit countries, as search for faster diagnostics gets underway – UN News Centre

Sierra Leone Bans Parties - Reuters
Struggling to slow Ebola's spread, Sierra Leone plans to ban holiday parties, and is planning a "surge" in response around Freetown.

Not only are parties and other gatherings from Christmas through New Year's banned, but soldiers will be enforcing an order to keep people indoors, according to a government spokesman.

The surge, set to launch this Wednesday, will last a month and focus on contact-tracing—complete with door-to-door visits—according to according to Palo Conteh, the head of Sierra Leone's National Ebola Response Center (NERC).

WHO numbers released Friday showed 6,583 people have died from the disease in Guinea, Sierra Leone and Liberia out of 18,188 cases.

Shock Treatment - Reuters
WHO Ebola response leader Bruce Aylward said Sierra Leone has the infrastructure, organization and aid needed to contain the disease. What is missing, he said, is a big shock to spark a change in people's risky behavior such as keeping infected loved ones close and touching the bodies of the dead.

The Quote: "Every new place that gets infected goes through that same terrible learning curve where a lot of people have to die ... before those behaviors start to change," Aylward told Reuters.

Related: Waiting for Ebola news from Guinea-Bissau – H5N1
Related: In Guinea-Bissau, bracing for Ebola to cross the border – Oxfam
Related: Reintegration of Ebola Survivors into Their Communities — Firestone District, Liberia, 2014 – CDC MMWR
Related: Johns Hopkins team wins award for improved suit to fight Ebola – Daily Herald
Related: Ebola: Basic hygiene to contain virus dumped in some states- report – Peoples Daily (Nigeria)

An Ebola Orphan's Plea in Africa: 'Do You Want Me?'

Vaccine Trial Temporarily Halted - Reuters
Complaints of joint pain from several volunteers brought a clinical Ebola vaccine trial in Geneva to a temporary halt.

This is a precautionary step, not a setback, according to Marie-Paule Kieny of the WHO. The trial will resume in early January after investigators have a chance to determine the scope of the problems and make sure the symptoms are "benign and temporary," according to the University of Geneva Hospital.

59 volunteers have been vaccinated so far in the trial of the vaccine, developed by Merck and NewLink. Separately, safety data from a trial of a GlaxoSmithKline Ebola vaccine on 120 volunteers has been satisfactory.

GAVI, the global vaccines alliance, stated its commitment to buy Ebola vaccines as soon as they're ready, pledging $300 million.

Related: Red Cross urges vigilance to avert holiday spike in Ebola cases – Reuters
Related: Ebola in Liberia: Outbreak contained in Lofa County, MSF hands over activities – H5N1
Related: Ebola in Africa: beyond epidemics, reproductive health in crisis – The Lancet
Related: Saudi King gives $35 million grant for Ebola fight – Reuters
Comment: Ebola and human rights in west Africa
Correspondence: Provision of care for Ebola

The Hero's Heart - TIME
Ebola fighters have risked and persisted, sacrificed and saved. Now TIME magazine has chosen the unsung heroes—doctors, ambulance drivers, burial teams and others on the frontline—for Person of the Year 2014.

"Ask what drove them and some talk about God; some about country; some about the instinct to run into the fire, not away," writes editor Nancy Gibbs, who is candid about how the Ebola epidemic brought out the best and worst of us as humans and global citizens.

When the global health system buckled under the virus's assault and its devastation, tireless health care workers stood by the sick and dying to protect us all—and they deserve the world's gratitude and recognition.

Related: US firms to be given special dispensation in bid to boost search for Ebola vaccine – The Guardian
Related: Emergency Ebola funding will safeguard global health and security – The Hill
Related: Ebola Virus Persistence in the Environment: State of the Knowledge and Research Needs –Environmental Science & Technology Letters: Via H5N1 Blog
Related: Debt and Hunger at Birthplace of Ebola – Associated Press
Related: Ebola diary: 'We knew if Ebola takes root in Nigeria, all Africa will be on fire' – Sarah Boseley, The Guardian

Right Back Atcha - International Journal of Epidemiology
Wouldn't it be great if there were a cadre of people who could take on the Ebola virus, helping treat the highly infectious sick without fear? There obviously is: Survivors.

In an International Journal of Epidemiology editorial, Zena A Stein, of the New York State Psychiatric Institute and Columbia University, construct a persuasive argument for deploying this overlooked resource—" the only people in the world who are 'vaccinated' against further Ebola infection with the strain in circulation."

In addition to caring for the sick, survivors can also donate blood and their likely protective antibodies that might provide passive immunotherapy (still not proven to work). Survivors can also play key roles in community-based responses.

Related: Ebola survivors crucial to containing the epidemic: experts – Reuters

White Saviors and Voluntourists - Pacific Standard
In the fight against Ebola, foreign intervention comes with cultural baggage. For example, Liberian researcher Robtel Neajai Pailey sees "international efforts against Ebola as a 'white savior complex,' 'a pathology of white privilege' based on the ill-conceived concept that Africans can't survive without Western interventions," writes journalist M. Sophia Newman.

Change may be slow in coming, according to Newman's excellent essay that weaves in her personal experience in Ghana, where she was viewed not as a genuine collaborator, but rather as a pampered money tree from America.

"My time there showed me that meaningful collaborations are often constrained due to long-standing inequality—but they are possible," writes Newman.

Life After Ebola - The Washington Post
Recovering from one of the most fearsome infections known to humankind should provide a time of unsurpassed joy. But it doesn't always work out that way.

Lenny Bernstein documents the powerful stories of 5 Liberian survivors in this Washington Post article. The struggles they now face, from shattered families to suspicions that the virus is a scam, show what it's like to survive the worst Ebola outbreak in history.

Striking black and white photographs of the 4 women and 1 man, with brief video interviews, bring faces and voices to the horror of Ebola.

Outbreak Hits 17,800 Cases - CIDRAP
The WHO reported 17,800 cases in the hardest-hit countries, and 6,331 deaths, with Sierra Leone appearing to bear the highest caseload now.

CIDRAP reports that following MSF's announcement late last week of a shifting strategy in Liberia, where cases have declined, MSF is tailoring its response there—deploying transit units and pushing for a "more agile approach to stamp out fresh hot spots."

For details on political developments, response in specific areas, and logistics, see also a situation report from the UN Mission for Ebola Emergency Response, UNMEER.

Beds Needed - Ebola Deeply
With Sierra Leone now the epicenter of the outbreak, the country is struggling to find enough beds. The country is seeking to apply lessons from Liberia's efforts, but the lack of beds now is a serious concern as the government tries to keep up with the virus as it moves from region to region, according to Sidi Yayah Tunis, who directs communications for Sierra Leone's Ebola response.

Related: In Ebola outbreak, bad data adds another problem – Associated Press
Related: Ebola: An eyewitness account from Sierra Leone – Nature
Related: Ebola diary: 'There are reports of people disappearing into the forest to die' – Sarah Boseley's Ebola Diary, The Guardian

Hand hygiene for health workers caring for Ebola patients
WHO recommendations for hand hygiene - 9 December 2014

Fighting Ebola - The key to stopping the virus: Behavior change.

Ebola Batters Liberia, Guinea, Sierra Leone Economies -- World Bank
December 03, 2014

Ebola: Your Clinical Questions Answered
December 01, 2014

Nigerian Care - Globe and Mail
In addition to keeping a potentially horrific outbreak from spreading, Nigeria also delivered hospital care for people infected with Ebola that reduced the potential 70-90% death rate to 40%, according to a Global and Mail article.

How? Canadian medical officer Eilish Cleary interviewed six patients who survived and told him of drinking 5-6 liters of water and with oral rehydration solution [ORS] daily "to fend off the cascade of internal failures typically caused by the virus." IV fluids were administered to only one of the six Cleary interviewed.

The article argues that the keys to improved survival are quick intervention after symptoms begin, keeping patients hydrated, and maintaining electrolyte balance.

Related: Sierra Leone threatens to jail families in Ebola crackdown – Al Jazeera America
Related: An Ebola Doctor's Return From the Edge of Death – The New York Times
Related: Ebola Czar Ron Klain to Return to Private Sector – NBC

NIAID/GSK Experimental Ebola Vaccine Appears Safe, Prompts Immune Response - NIH News
This news release provides an overview of a clinical trial for an experimental vaccine to prevent Ebola virus. The vaccine, which was co-developed by the NIH's National Institute of Allergy and Infectious Diseases (NIAID) and GlaxoSmithKline (GSK), was tested at the NIH Clinical Center.

Health Information Compilation of Ebola Materials
We are continuing to add the latest Ebola health information documents to the Disaster Lit: Resource Guide for Disaster Medicine and Public Health. In the last week we have added over 60 Ebola-related documents on a variety of topics and in various formats, including a series of guidance documents for those working in the airline industry from the U.S. Centers of Disease Control and Prevention National Institute for Occupational Safety and Health.

Doctors Without Borders: Military must do more against Ebola outbreak
MSF had harsh words for the US military effort to counter West Africa's Ebola threat, saying it must do more than "transport cement."

While emphasizing the military's contributions were welcome from the beginning, MSF's Executive Director Sophie Delaunay especially criticized the US for leaving too much of the work to NGOs, doctors, and nurses—focusing on buildings at the staffing. Furthermore, she said that the funds promised 3 months ago were so slow to start flowing that by the time they arrived, the needs had profoundly shifted.

A key problem is that most US resources were concentrated in Liberia, but now the needs are greater in Sierra Leone. "Now that [the funding] is being implemented on the ground, due to evolving nature of the outbreak, the needs have changed," Delaunay said.

MSF criticized the pace of international funding in general in a report it released earlier this week.

Related: Ebola in graphics: The toll of a tragedy – The Economist
Related: Ebola in Liberia: An Epidemic of Rumors – New York Review of Books
Related: Ebola Free-for-All Could Trigger Bad Science and Wasted Efforts – Scientific American
Related: New 15-minute test for Ebola to be trialled in Guinea – Global Health Hub
Comment: Ebola virus disease: clinical care and patient-centred research
Correspondence: Ebola control: the Cuban approach
Correspondence: Ebola, International Health Regulations, and global safety
Correspondence: Ebola: should we consider influenza vaccination?

Star statistician Hans Rosling takes on Ebola
For the last month and a half now, he's been in Monrovia, Liberia doing what he can to help in the Ebola fight. In a brisk, riveting profile for ScienceInsider, Kai Kupferschmidt chronicles the unassuming intellectual giant's work there. He started off proofreading the health ministry's epi reports and organizing a fund that gave health workers phone cards so they could call in their reports. He's now helping improve the data collection process so workers will have more accurate contact lists for Ebola patients—a huge boost to contact tracing efforts.

Related: 35 U.S. hospitals designated as Ebola treatment centers – US Department of Health & Human Services
Related: North Korea says U.S. created the Ebola outbreak – Washington Post
Related: World's Ebola response slow, patchy and inadequate, Médecins sans Frontières says – The Guardian
Related: Sierra Leone widens Ebola quarantine – AFP

Genetic Research, Factory-Style - The New York Times
Ace science writer Gina Kolata embeds in a former beer distribution center in Cambridge that has a second life as a high-tech gene-analyzing factory. Think 10,000 test tubes in line for processing 24/7.

The Broad Institute's latest challenge: Ebola. With samples from West Africa, technicians and scientists are tracking the virus's mutations, finding if some strains are deadlier than others, determining if some people are more resistant than others—and why. They also are studying Lassa fever.

"The research is emblematic of a new direction in public health, which uses powerful genetic methods and applies them to entire populations. The aim is to get a detailed picture of disease epidemiology, as the disease is happening," writes Kolata.

Related: Life on the Ebola frontline: 'Fear is overpowering even the health workers' -– The Guardian Poverty Matters Blog
Related: Obama to urge Congress to loosen purse strings for Ebola fight –-Reuters

Outbreaks of Ebola virus disease in Africa: the beginnings of a tragic saga
The tremendous outbreak of Ebola virus disease occurring in West Africa since the end of 2013 surprises by its remoteness from previous epidemics and dramatic extent. This review aims to describe the 27 manifestations of Ebola virus that arose after its discovery in 1976. It provides an update on research on the ecology of Ebola viruses, modes of contamination and human transmission of the disease that are mainly linked to close contact with an infected animal or a patient suffering from the disease. The recommendations to contain the epidemic and challenges to achieve it are reminded.

Displacement Themes Emerging
The International Displacement Monitoring Center is monitoring displacement of people across the three countries in West Africa most affected by Ebola. This is the first time they havemonitored displacement related to disease or biological hazard. They have identified five patterns of Ebola-related displacement: 1) Fleeing the virus; 2) Fleeing quarantine; 3) Seeking health care; 4) Forced evictions and fleeing stigma; and 5) Fleeing violence and rights violations.

Sierra Leone Now Bearing the Brunt: - Associated Press
Out of 16,000 Ebola cases, nearly 7,000 people have died, according to WHO numbers released Friday. Sierra Leone, which is now enduring the highest caseload, needs more beds. A number of treatment centers are set to open in December, including 5 British-built treatment centers, but the UN expressed concern over who will staff the centers.

Ebola Vaccine Shows Promising Results: - Science AAAS
A fast-tracked small study of an Ebola vaccine developed by GlaxoSmithKline and the US National Institute of Allergy and Infectious Diseases found that 20 people vaccinated developed immune responses against Ebola and no serious side effects. Next, the vaccine could move to trials among 15,000 people in Liberia and Sierra Leone, possibly by mid-January. The New England Journal of Medicine published the preliminary report.

Ebola Virus Found in Semen, WHO Warns: - WHO
The Ebola virus may persist in the semen of men who have recovered from the virus for as long as 3 months, according to the WHO, based on a review of 4 earlier studies. Although the sexual transmission of Ebola virus disease has not been documented, such men should ideally abstain from sex (including oral sex) for 3 months after onset of symptoms.

Is Liberia Ready for Campaign Rallies? - NPR
New Ebola cases are falling in Liberia, but the risk hasn't passed—prompting concern over the resumption of crowds attending campaign rallies and parties related to the mid-December Senate election.

America Learned All the Wrong Lessons in its First Brush with Ebola: - Salon
America's obsession with "at-risk" populations missed the point, recalling how the obsession with stigmatized gay men set back efforts to check HIV/AIDS, argues Hali Felt in this piece.

Correspondence: Ebola virus in the semen of convalescent men
Correspondence: Ebola control: rapid diagnostic testing
Correspondence: Ebola: should we consider influenza vaccination?
World Report: First trials for Ebola treatments announced
Correspondence: Is Canada patent deal obstructing Ebola vaccine development?
Perspectives: Ebola: epidemic echoes and the chronicle of a tragedy foretold
Correspondence: Effectiveness of screening for Ebola at airports

Emergency Access Initiative Extended through December 12, 2014
The Emergency Access Initiative (EAI) is a collaborative partnership between the National Library of Medicine and participating publishers to provide free access to full-text from over 650 biomedical journals, over 4,000 reference books and online databases to healthcare professionals and libraries affected by disasters. It serves as a temporary collection replacement and/or supplement for libraries affected by disasters that need to continue to serve medical staff and affiliated users. It is also intended for medical personnel responding to the specified disaster. EAI is not an open access collection. It is only intended for those affected by the disaster or assisting the affected population. EAI has been activated for the West Africa Ebola Outbreak, and will remain active through December 12, 2014.

Developing an Ebola Therapeutic
Much work is being done to close the gap in vaccines and therapeutics needed in the current Ebola outbreak. The Office of Assistant Secretary for Preparedness and Response (ASPR) and the World Health Organization (WHO) have written up summaries of work they are focusing on. In addition, we have added sections to the NLM Ebola Outbreak webpage on diagnostic testing for Ebola, and Ebola treatment drugs in development and trials.

* ASPR Blog Developing an Ebola Therapeutic
* WHO News Release: New study sheds light on the importance of supportive care for Ebola patients
* National Library of Medicine (NLM) 2014 Ebola Outbreak Topic Page
* NLM Ebola Outbreak Page: Diagnostic Testing for Ebola
* NLM Ebola Outbreak Page: Ebola Treatment Drugs in Development & Trials

NGA Creates Website to Support Ebola Relief Efforts
The National Geospatial-Intelligence Agency (NGA) is providing access to unclassified geospatial intelligence products to lead federal agencies and their partners through a public-facing website the NGA created to support the Ebola outbreak. This map allows information about new patients, communication, ground transportation, clinic locations and more, to be added dynamically. In this way, the map provides real time data to organizations responding. We have included a link to the map on NLM Ebola Outbreak webpage

NGA Press Release
NGA Ebola Support
NLM Ebola Outbreak Page: Maps

APHA Fighting Ebola with #FactsOverFear
The American Public Health Association (APHA) held a special session at its 2014 meeting in New Orleans this past week on the Ebola outbreak. Six presenters covered a variety of topics including community measures being taken, epidemiology, and ethics. A summary of the event, along with photos, is available on the APHA Annual Meeting Blog.
APHA Blog Entry
APHA Program Description

Perspectives: Ebola: epidemic echoes and the chronicle of a tragedy foretold
Correspondence: Effectiveness of screening for Ebola at airports
Editorial: Rationality and coordination for Ebola outbreak in west Africa
Editorial: The medium and the message of Ebola
Correspondence: Ebola: fever definitions might delay detection in non-epidemic areas
Perspectives: Adrian Hill: accelerating the pace of Ebola vaccine research
World Report: International community ramps up Ebola vaccine effort
Focus: Ebola containment in Montserrado, Liberia
Podcast: David Heymann outlines Ebola response and management priorities for the next two months
Correspondence:Ebola in urban slums: the elephant in the room
Correspondence: Hyperimmune serum from healthy vaccinated individuals for Ebola virus disease?
Correspondence: Ebola control: effect of asymptomatic infection and acquired immunity


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