Date: Thu, 22 Jun 1995 16:45:14 -0400 (EDT)
Re: EBOLA -ZAIRE: PRIORITIES (2)
================================
Reuters news service out of Kinshasa reported on June 18 that "blood"
from recovered patients was in fact being used to treat exposed
individuals.
Date: Thu, 22 Jun 1995 08:43:41 -0400
From: John Kellar
.........................................................................
Date: Thu, 22 Jun 1995 16:47:07 -0400 (EDT)
Re: EBOLA - ZAIRE: INDEX CASE (4)
=================================
In the MMWR (1995;44:381-382) (as reprinted in the 14 June JAMA) the
first patient in the Kikwit Ebola outbreak was identified as a hospital
lab technician. Is he the actual index patient? If so, what has been learned
regarding his contact with the virus?
Naturally, the first suspicion (admittedly, only an assumption)
would be exposure to a contaminated patient specimen. Was he exposed
(needle stick, spatters on mucosa, etc.) to a patient who later presented
with Ebola symptoms?
If not, can we explain away his occupation (and its attending
risk of infection) as mere coincidence? Or has anyone else considered
the chilling possibility of long-term, asymptomatic human carriers?
I realize that it may be premature to answer with any
conviction. But even preliminary data would be appreciated.
Date: Wed, 21 Jun 1995 14:47:34 -0400 (EDT)
John Trainer, MSI
Bowman Gray School of Medicine
jtrainer@isnet.is.wfu.edu
..........................
[See below - Moderator]
Excerpt from: Press Release WHO/33, 17 May 1995
WHO TEAM IN ZAIRE REPORTS FURTHER RISE IN EBOLA CASES
.....
The first case at Kikwit General Hospital in the current epidemic
concerned a 36 year-old male laboratory worker who underwent an
abdominal operation at the hospital on 10 April 1995. He died on 14
April from a massive intra-abdominal haemorrhage. Medical personnel
who took care of this patient, either in the operating theatre or in
hospital wards, became ill a few days later. A total of three
operating theatre nurses and two nurse anaesthetists became ill, as
well as ward nurses and other hospital workers. Approximately, 73% of
the first 70 patients in the epidemic appear to have been health
workers and among them the case fatality rate has been high. It is
understood that the Mother Superior of a group of nursing sisters,
three of whom are known to have died, has also developed the disease.
.....
Excerpt from: Press Release WHO/38, 22 May 1995
RESEARCHERS SEEK SOURCE OF EBOLA EPIDEMIC
.....
The active surveillance team is meeting twice daily to piece together
all the information, which at present seems to lead back to a
middle-aged male forest worker who was an early, or possibly the
first, case in this epidemic. Three Zairean veterinarians along with
members of the International Commission will go to the forest site
where this possible first case worked preparing charcoal. They will
trap animals, insects and rodents, including bats, in search of a
possible reservoir for the Ebola virus in nature.
.........................................................................
Date: Fri, 23 Jun 1995 10:32:28 -0400 (EDT)
Re: EBOLA - ZAIRE: INDEX CASE (5)
=================================
Date: Thu, 22 Jun 95 19:03:00 EST
The laboratory technician who was admitted to Kikwit General Hospital, Zaire
was the index case for a number of subsequent nosocomial cases of Ebola
hemorrhagic fever among the staff of KGH which led to the recognition of
this outbreak. He is believed to have been infected while processing or
drawing specimens on other EHF patients.
The index case for the outbreak was probably a charcoal worker who died in
mid-January of a documented febrile hemorrhagic illness and is linked to a
chain of transmission that includes 12 other deaths in his extended family
(many with hemorrhagic disease). He had no links to other ill individuals
suggesting his infection was associated with his 20km daily trek into the
forest. An almost complete chain of transmission has been identified from
this individual to most of the subsequent cases.
Ali Khan
Special Pathogens Branch, CDC
From: "Khan, Ali S."
.........................................................................
Date: Fri, 23 Jun 1995 17:11:37 -0500 (EDT)
EBOLA - ZAMBIA
==============
I have a second-hand report that CNN(?) said last night (Thurs. 22 June)
that there were 2 women (nuns?) in quarantine in Zambia with suspected
Ebola, 700 miles from the focus in Zaire.
Can anyone confirm?
Jack
--
Jack Woodall, ProMED List Moderator, New York State Dept.of Health, Albany
NY, USA
e-mail: jack.woodall@wadsworth.org
Date: Fri, 23 Jun 1995 17:12:44 -0500 (EDT)
EBOLA: SERUM THERAPY
====================
Date: Fri, 23 Jun 1995 13:01:49 -0400
Subject: EBOLA -ZAIRE- PRIORITIES
To: "majordomo"
X-Mailer: Mail*Link SMTP-QM 3.0.2
REGARDING EBOLA -ZAIRE: PRIORITIES
From: George R. Siber, M.D.
c/o Claudette Thompson
To: John P. Woodall
Re: Ebola - Zaire: Priorities
I'm intrigued by serum therapy for Ebola.
The obvious problems with using individual units are safety and variability in
titer. The therapeutic results will be anecdotal and thus difficult to
interpret. I recognize that in an epidemic setting it may be difficult to do
better. However, I would propose the following possibilities:
1. Pool plasma and virally inactivate it. There is a good deal of experience
with solvent-detergent inactivated pooled plasma. This method inactivates
enveloped viruses (e.g. HIV, hepatitis C) but not non-enveloped viruses
(HepA, parvoviruses). The latter pose relatively little risk.
The pool could be well characterized for antibody activity, ? animal
protection and a uniform material could be evaluated in humans. The New
York Blood Center could produce it relatively quickly.
2. Pool plasma and prepare a human intravenous immune globulin (IVIG). Our
laboratories (Massachusetts Public Health Biologic Laboratories) have an FDA
licensed process to prepare IVIG. The product has never transmitted viral
infection, but we have recently added a solvent-detergent inactivation step
for additional safety.
We are willing to consider preparing such a globulin. The issues are
worker safety (i.e. could the plasma contain infectious Ebola virus?) and
availability of sufficient plasma (30 to 50 liters is the absolute minimum,
100 to 300 liters would be preferred). Could we get a plasmapheresis team to
Zaire?
The advantages to Ebola IVIG are that it has very low risk (and could
therefore be safely used for pre- or post-exposure prophylaxis as well as
therapy), is uniform and well-characterized, and can be given in high dosage
(up to 1000-2000 mg/kg). Making IVIG also would be a real step on the way
towards making a biologic product for evaluation in future epidemics. It
would take about 3 to 4 months to manufacture and QC the IVIG, once plasma
arrives at our lab.
I'd be pleased to explore this further!
Dana-Farber Cancer Institute
Tel (617) 632-3366
Fax (617)632-4265
Mass. Biologic Labs
Tel (617) 983-6416
Fax (617) 983-9081
From: "Claudette Thompson"
............................................................................
Date: Mon, 26 Jun 1995 10:46:18 -0500 (EDT)
Re: EBOLA - ASYMPTOMATIC CARRIAGE?
==================================
On Friday 23 June 1995 D.WARHURST@lshtm.ac.uk (David Warhurst) wrote:
>I believe the man who aquired the UK lab infection excreted virus in
>body fluids 6 months? after recovery. Is this correct?
Nope, but at least one Marburg patient had virus in semen for up to about
three months.
Date: Sat, 24 Jun 1995 20:07:59 -0800
From: umbkj@gemini.oscs.montana.edu (Karl Johnson)
.......................................................................
Date: Mon, 26 Jun 1995 10:47:18 -0500 (EDT)
Re: EBOLA - ZAMBIA
==================
Date: Mon, 26 Jun 95 2:34:43 EDT
On 21 June, 1995, local radio and television in Zambia reported three persons
admitted in Nchelenge, Zambia (a small town in Luapula Province, on Lake
Mweru near the Zaire border) with suspected EHF. Very little information was
available, but the patients were said to have fevers and oral/nasal bleeding.
At 13:15 local, the same day, a radio message quoted the Minister of Health,
Mr. Sata as saying that the cases mistaken for Ebola were, in fact, 1)
bilharzia [schistosomiasis - a water-snail-borne parasitic disease], 2) gum
disease and 3) pneumonia. This information apparently came from the
Provincial Medical Officer who was dispatched to the area.
This is all the information I have -- there have been no other reports to date.
Steven Wiersma, MD, MPH
Senior Technical Advisor
USAID Zambia
From: "Steve Wiersma"
..........................................
Date: Mon, 26 Jun 95 11:55:03 CET
The WHO Representative in Zambia has informed that of the three patients
reported by CNN and AP as suspected Ebola: one patient with bleeding
gums was treated and has been discharged from the hospital, the
second had blood in urine diagnosed as bilharzia and has also been
discharged, the third patient had pneumonia and was still in hospital
22 June. The alarm was raised by a panicking clinical officer. The
Provincial Medical Officer and his team visited the St Paul Hospital
in Nchelenge, The Ministry of Health and the Ministry of Health
epidemiologist conclude that none of the three patients were ill with
Ebola and have reported this on the national radio.
Karin Esteves
Communicable Diseases Division, WHO Geneva
From: estevesk@who.ch
............................................................................
Date: Mon, 26 Jun 1995 10:48:40 -0500 (EDT)
Re: EBOLA: SERUM THERAPY
========================
On Friday 23 June 1995 George R. Siber wrote:
> 1. Pool plasma and virally inactivate it. There is a good deal >of
experience with solvent-detergent inactivated pooled plasma. >This method
inactivates enveloped viruses (e.g. HIV, hepatitis C) >but not non-enveloped
viruses (HepA, parvoviruses). The latter >pose relatively little risk. The
pool could be well characterized >for antibody activity.
This will probably require maximum containment (P4) laboratory
facilities, at least initially to determine antobody levels and
document neutralisation of ebola virus.
> 2. Pool plasma and prepare a human intravenous immune globulin
>(IVIG).
This would certainly provide a product with a long shelflife, but as
you remark, the plasma pool would have to be large in terms of donors,
requiring at least 30 litres per run, so that plasmaphoresis would be
required on site. I wonder how many convalescent (survivors) donors there
actually are given an 80% mortality?
I have no experience with Ebola and do not know for how long the
viraemia persists but in our experience with Congo-Crimean
Haemorrhagic Fever and an extensive nosocomial outbreak in a large
teaching hospital (1984) we were able to utilize convalescent fresh
frozen plasma with considerable benefit in those cases whose
prognosis was poor as judged by the lack of antibody response.
Immediate clinical improvement and I believe each transfusion
resulted in a drop in circulating virus. The frozen plasma was
administered repetitively, usually daily for as long as it took and
no special plasmaphoresis or fractionation procedures were required.
Like Karl Johnson , I hope that plasma from convalescent patients has been
frozen away.
"Moodie, JW, John, Prof."
...................................................................
Jack Woodall, ProMED List Moderator, New York State Dept.of Health, Albany
NY, USA
e-mail: jack.woodall@wadsworth.org
-- End --