Ebola Virus Disease: One year on

A year after the virus first appeared in the Republic of Guinea (in February 2014), then spread to neighboring countries Liberia, Sierra Leone, Mali and Senegal, and also to Nigeria), 9.604 people have died among 23.729 cases. 99 new cases were reported in the week to February 22 and transmission remains widespread.

Without doubt, the battle is being won as healthcare teams from around the world pool resources and work side by side to help the people in the affected areas of Guinea, Liberia and Sierra Leone, where according to the World Health Organization, transmission remains "widespread". 63 of the 99 confirmed cases came from this country, 20 of these in Bombali and 14 in Freetown. In Liberia there was only one new case in the same period. In Guinea the rate of new infections has slowed to 35 per week (until February 22), down from 53 the previous week.

Despite the combined efforts of the national, regional and world healthcare authorities, a significant number of people are still unwilling or unable to seek treatment once they fall ill and unsafe burials (handling the victims or placing the hands on the body) continue: in the same week, 19 unsafe burials were reported in Guinea and 15 in Sierra Leone.

This year's Ebola Virus Disease outbreak is the worst in history. The latest figures indicate 23.729 cases and 9.604 deaths (Guinea 3.155 cases and 2.091 deaths; Liberia (9.238 cases and 4.037 deaths; Sierra Leone, 11.301 cases and 3.461 deaths; Mali, 8 cases and 6 deaths; Nigeria 20 cases and 8 deaths; Senegal, Spain and UK 1 case and 0 deaths each; USA 4 cases and 1 death).

837 healthcare workers have been infected, while 490 of these have died.

EVD, contagion and symptoms

The Ebola fever virus is named after the river Ebola in the Republic of Zaire (now DR Congo) where it was discovered in 1976. Around 1,200 people have lost their lives from the Ebola virus since it was discovered in 1976. There have been serious outbreaks in the DR Congo/Zaire in 1976 (218 cases), 1995 (315) and 2007 (264); Sudan in 1976 (284), and Uganda in 2000 (425).

EVD is not (yet) an airborne virus like the Influenza viruses, although it is transmitted by contact with bodily fluids, such as blood, faeces and vomit, milk, urine and semen, possibly also saliva and tears, more especially in the later stages of the illness, and from sweat, studies are inconclusive, according to the WHO. However, the information is unclear because the same source, the WHO, states that EVD can be caught from touching contaminated surfaces. Some say that the virus then needs to be passed to mucous membrane through touching the mouth, nose or eyes, others say it can be transmitted through lesions in the skin, while others state that it can be absorbed directly through the skin, in which case it is enough to touch an infected and contagious person. A common source of infection in some parts of Africa is when people place their hands on the deceased person at funerals.

The incubation period is between two to twenty-one days, after which the temperature rises sharply to 30/39C. Contagion occurs when a patient is infectious, in other words displaying the first symptoms, which is a sudden high fever, extreme fatigue, headache, sore throat, body pain and lack of appetite. This develops into nausea, then diarrhea and vomiting. As the virus takes hold and destroys the blood vessels, the central nervous system takes control from the digestive system and tells the body to expel as much fluid as it can through violent and sustained, copious projectile vomiting and diarrhea, which in the terminal stage can include blood. The patient becomes a human volcano of bodily fluids and torrents of blood.

Treatment

While as yet there are claims that effective treatment does not exist, there is the experimental drug Brincidofovir, administered to Thomas Eric Duncan unsuccessfully, there is the plasma treatment in which a patient receives a transfusion from an EVD survivor with the same blood type (as was the case of Nina Pham receiving plasma from Dr. Kent Brantly, one of the first two American citizens infected), and there is Z-Mapp, which was successfully administered to these two patients, Dr. Brantly and aid worker Nancy Writebol.

What is ZMapp?

ZMapp is a treatment composed of the use of cultures of cells which make monoclonal antibodies, mAbs. The experimentation began with MB-003, a cocktail of three human/human-mouse mAbs, namely c13C6, h13F6 and c6D8, which showed promising results when administered to rhesus monkeys infected with EVD. The process evolved to the creation of ZMab, a cocktail of three mouse mAbs, namely m1H3, m2G4 and m4G7. These also proved very promising in trials on Ebola-infected macaque monkeys. ZMapp humanized the three ZMab antibodies and tested these with combinations of MB-003 first in guinea pigs and then in monkeys. The best and most successful therapeutic combinations were the c13C6 from MB-003 and the humanized mAbs c2G4 and c4G7, from ZMab, and the result is what is known today as ZMapp.

Russia's contribution

The Russian Federation has been present fighting this pandemic at all levels. President Vladimir Putin has met the WHO Director-General Margaret Chan and has pledged full support. A medical team of Russian virologists, epidemiologists and bacteriologists is in the field in the Republic of Guinea, to date 19 million USD has been provided, alongside humanitarian aid. Russia is ready to send large numbers of doses of the anti-viral drug Triazavirin, which is effective in 70 to 90% of cases of infections with 15 strains of Influenza, including A H1N1 (Swine Flu) and H5N1 (Avian flu), at any stage of the infection.

Russia is also working on a vaccine and is ready to begin trials on primates. After this the human trials will begin and it may be ready for massive operations by Summer 2015.

Timothy Bancroft-Hinchey

Pravda.Ru

([email protected])

*Timothy Bancroft-Hinchey has worked as a correspondent, journalist, deputy editor, editor, chief editor, director, project manager, executive director, partner and owner of printed and online daily, weekly, monthly and yearly publications, TV stations and media groups printed, aired and distributed in Angola, Brazil, Cape Verde, East Timor, Guinea-Bissau, Portugal, Mozambique and São Tomé and Principe Isles; the Russian Foreign Ministry publication Dialog and the Cuban Foreign Ministry Official Publications. He has spent the last two decades in humanitarian projects, connecting communities, working to document and catalog disappearing languages, cultures, traditions, working to network with the LGBT communities helping to set up shelters for abused or frightened victims and as Media Partner with UN Women, working to foster the UN Women project to fight against gender violence and to strive for an end to sexism, racism and homophobia. He is also a Media Partner of Humane Society International, fighting for animal rights.