Ebola Update: What’s New

As more cases of Ebola are identified each day, apprehension mounts about whether or not the epidemic can be contained. The Centers for Disease Control (CDC) acknowledge that the battle to control the virus is going to be a “long, hard fight.” Knowing the facts helps to minimize fear and keep the perceived danger in perspective.

A Growing Threat

The current outbreak involves the most deadly of the five Ebola virus strains. So far, Ebola has infected 7,400 people in Guinea, Sierra Leone and Liberia, killing more than 3,400 victims. The numbers are increasing steadily every day.

In the most recent developments:

  • Thomas Eric Duncan, a man with Ebola who traveled to the United States from Liberia, has died at Texas Health Presbyterian Hospital in Dallas. His was the first case of Ebola virus to be diagnosed in the U.S. Duncan was at first discharged from the ER but then admitted a few days later, prompting questions about whether or not the health system was adequately prepared to deal with an Ebola patient. The commissioner of the Texas Department of State Health Services described Duncan’s case as an “enormous test of our health system.” Over the weekend, one of the nurses who cared for Duncan was confirmed to have also contracted Ebola.
  • Another case that was diagnosed outside West Africa also involves a nurse who had treated two Ebola Questions have arisen about how she might have become infected.
  • Ashoka Mukpo, a freelance cameraman working in Liberia, has been diagnosed with Ebola and is receiving treatment at the University of Nebraska Medical Center, the same medical center that treated Rick Sacra, an American aid worker. This medical center houses the largest of four high-level biocontainment patient care units in the U.S.

Top of Mind

As part of the effort to stop the spread of Ebola, the CDC has issued a warning to health care professionals: Ebola should be “top of mind” for all hospitals and care providers. Any patient with a fever, particularly one who has been in West Africa or who has had contact with someone who is infected with the Ebola virus, should be treated as a potential Ebola victim. The CDC has provided guidelines for health care professionals and a detailed Ebola checklist to prepare facilities in the event that they receive Ebola-infected patients. Public health officials are confident that the U.S. isn’t at risk for a major Ebola outbreak because of this country’s sophisticated health care delivery system and isolation procedures and well-developed public health infrastructure.

Drug Options

There is no treatment specific to Ebola. Treatment focuses on providing intensive supportive care—including balancing fluids and electrolytes, maintaining oxygen levels, managing pain, and administering antibiotics or antimycotics to treat secondary infections—and treating symptoms as they arise. However, some experimental drugs are being used. One of these is ZMapp, which was administered to the first two American patients who were brought to Emory University Hospital for treatment.

ZMapp is made up of three monoclonal antibodies that are humanized using genetic engineering. The drug’s neutralizing antibodies provide passive immunity to the Ebola virus. ZMapp has not yet been subjected to randomized clinical trials. Dr. Kent Brantly, the first American Ebola patient who was brought back from West Africa for treatment at Emory University Hospital, received ZMapp. He improved dramatically within an hour of receiving the first dose. Nancy Writebol, the second American Ebola patient brought back from West Africa for treatment, was also given ZMapp. Her condition improved more gradually after receiving a second dose. ZMapp was created by San Diego-based Mapp Biopharmaceutical, Inc., with U.S. government agency funding. The supply of ZMapp is currently depleted. Pharmaceutical researchers are trying to devise alternative methods that will allow them to create more of this drug in less time than it takes now to produce.

Another experimental drug, TKM-Ebola, was used successfully to treat Richard Sacra, who has been discharged virus-free from the University of Nebraska Medical Center. Early studies on TKM-Ebola have shown “100-percent protection from an otherwise lethal dose of Zaire Ebola virus.” The FDA has given the drug a fast track designation to speed up the testing process.

Brincidofovir, an experimental antiviral drug originally developed to treat smallpox, was administered to both Ashoka Mukpo, the freelance photographer, and Thomas Duncan in Dallas. Chimerix, the biopharmaceutical company that is developing the drug, obtained approval from the FDA for emergency use of Brincidofovir so it could be used to treat Ebola.

Good News

If there is any good news in all of the tragedy that has surrounded the Ebola epidemic it is that Ebola can be contained. Nigeria provides a hopeful example. Ebola was introduced into Nigeria when a Liberian-American man contracted Ebola while in Liberia and then traveled to Lagos, Nigeria. The infection spread to 19 other cases, but there have been no new cases in Nigeria since August 31. Doctors in Nigeria worked closely with the CDC to follow strict isolation procedures, trace contacts, and successfully shut down what might have been a widespread epidemic. The thinking is: If Ebola can be stopped in Nigeria, it can be stopped in the U.S. as well.

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