One facet of preparedness and mitigating disease transmission is health facility accessibility, linking infected persons with health systems and vice versa. Where potential patients can access care, local facilities must ensure they can appropriately diagnose, treat, and contain disease spread to prevent secondary transmission; where patients cannot readily access facilities, alternate plans must be developed. Here, we use travel time to link facilities and populations at risk of viralhemorrhagic fevers (VHFs) and identify spatial variation in these respective preparedness demands.

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The weekly trend in R _t displays fluctuations while our recent national-level R _t falls slightly above 1.0 with substantial uncertainty, which suggests improvements in epidemic control.

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La evidencia sugiere que los murciélagos frutales juegan un papel en ambos casos, sin embargo, los datos siguen siendo escasos y los murciélagos exhiben una amplia gama de rasgos de historia de vida. Aquí agrupamos datos escasos y usamos un enfoque mecanicista para examinar cómo los ciclos de parto de los murciélagos africanos de fruta, murciélagos molossid y microbates no molossid informan la ocurrencia espacio-temporal de la propagación de EVD

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We developed a quadrivalent formulation of VesiculoVax that contains recombinant vesicular stomatitis virus (rVSV) vectors expressing filovirus glycoproteins and that also contains a rVSV vector expressing the glycoprotein of a lineage IV strain of LASV. Cynomolgus macaques were vaccinated twice with the quadrivalent formulation, followed by challenge 28 days after the boost vaccination with each of the 3 corresponding filoviruses (Ebola, Sudan, Marburg) or a heterologous contemporary lineage II strain of LASV. Serum IgG and neutralizing antibody responses specific for all 4 glycoproteins were detected in all vaccinated animals. A modest and balanced cell-mediated immune response specific for the glycoproteins was also detected in most of the vaccinated macaques. Regardless of the level of total glycoprotein-specific immune response detected after vaccination, all immunized animals were protected from disease and death following lethal challenges. These findings indicate that vaccination with attenuated rVSV vectors each expressing a single HF virus glycoprotein may provide protection against those filoviruses and LASV most commonly responsible for outbreaks of severe HF in Africa.

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Esta es una infección zoonótica grave, a menudo mortal, causada por la infección por un virus de la familia Filoviridae (género Ebolavirus). Las etapas iniciales de la infección son inespecíficas, lo cual hace que el diagnóstico diferencial sea amplio; por lo tanto, la sospecha clínica de la infección con el aislamiento rápido es muy importante en el contexto de una historia de exposición.

El manejo se centra en la aplicación de los cuidados de soporte y en el control. Las tasas de letalidad se sitúan entre 25% y 90% pero la tasa promedio fue aproximadamente del 50% en la mayor parte de los centros de tratamiento durante el brote de 2014 en África Occidental. A menudo, los sobrevivientes presentan un estado de saludo frágil acompañado de discapacidad significante.

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Realizamos una revisión de la literatura para identificar artículos que incluían la nutrición como parte integral de la atención de apoyo. Encontramos poca información sobre la atención nutricional específica o los desafíos prácticos dentro de una ETU. Esta revisión mostró que la atención nutricional para los pacientes con EVD está mal descrita y, por lo tanto, la composición óptima y la implementación de la atención nutricional siguen siendo desconocidas. Recomendamos que los investigadores y los profesionales compartan detalles específicos y prácticos de sus experiencias al brindar apoyo nutricional dentro de las ETU para expandir la base de conocimiento y, en última instancia, mejorar la atención nutricional para una población de pacientes cada vez más frecuente.

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IMPORTANCE During the Ebola virus (EBOV) disease outbreak in West Africa in 2014-2016, it was discovered that several mutations in the virus emerged and became prevalent in the human population. This suggests that these mutations may play a role impacting viral fitness. We investigated three of these previously identified mutations (in the glycoprotein [GP], nucleoprotein [NP], or RNA-dependent RNA polymerase [L]) in cell culture, as well as in mice and ferrets, by generating recombinant viruses (based on an early West African EBOV strain) each carrying one of these mutations. The NP and L mutations appear to decrease virulence, whereas the GP mutation slightly increases virulence but mainly impacts viral tropism. Our results show that these single mutations can impact EBOV virulence in animals and have implications for the rational design of efficacious antiviral therapies against these infections

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For 8 events, a recipient case was identified; possible source cases were identified for 5 of these 8. For 5 events, a recipient case or chain of transmission could not be confidently determined. Five events met our criteria for sexual transmission (male-to-female). One VPDTe event led to at least 4 generations of cases; transmission was limited after the other events. VPDTe has increased the importance of Ebola survivor services and sustained surveillance and response capacity in regions with previously widespread transmission.

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While a number of predictors for Ebola mortality have been identified, less is known about post-viral symptoms. The identification of acute-illness predictors for post-viral symptoms could allow the selection of patients for more active follow up in the future, and those in whom early interventions may be beneficial in the long term. Studying predictors of both mortality and post-viral symptoms within a single cohort of patients could also further our understanding of the pathophysiology of survivor sequelae.

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We performed a historical cohort study using data collected as part of routine clinical care from an Ebola Treatment Centre (ETC) in Kerry Town, Sierra Leone, in order to identify predictors of mortality and of post-viral symptoms. Variables included as potential predictors were sex, age, date of admission, first recorded viral load at the ETC and symptoms (recorded upon presentation at the ETC). Multivariable logistic regression was used to identify predictors. Of 263 Ebola-confirmed patients admitted between November 2014 and March 2015, 151 (57%) survived to ETC discharge. Viral load was the strongest predictor of mortality (adjusted OR comparing high with low viral load: 84.97, 95% CI 30.87-345.94). We did not find evidence that a high viral load predicted post-viral symptoms (ocular: 1.17, 95% CI 0.35-3.97; musculoskeletal: 1.07, 95% CI 0.28-4.08). Ocular post-viral symptoms were more common in females (2.31, 95% CI 0.98-5.43) and in those who had experienced hiccups during the acute phase (4.73, 95% CI 0.90-24.73).

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As of June 18, 2018, 36 completed trials, seven active and not recruiting, and seven recruiting Ebola vaccine studies are registered on ClinicalTrials.gov . The only study that has been able to provide data on clinical efficacy is the Ebola Ça Suffit vaccination trial in Guinea. This open-label, cluster-randomised trial evaluated vaccine effectiveness in case contacts, where clusters of contacts of Ebola cases were randomised for immediate or delayed vaccination with the recombinant, replication-competent, vesicular stomatitis virus-based vaccine expressing the glycoprotein of a Zaire Ebolavirus (rVSV-ZEBOV). Although the authors estimated the vaccine efficacy to be 100% (95% CI 68·9–100, p=0·0045) in individuals vaccinated in the immediate group compared with those eligible and randomised to the delayed group, the extent of this efficacy has been debated. A report by the US National Academies of Sciences, Engineering, and Medicine stated that “the results suggest that the vaccine most likely provides some protection to recipients—possibly ‘substantial protection,’ as stated in the final report. However, we remain uncertain about the magnitude of its efficacy”