Reston Ebola: NOVA’s Namesake Emerging Infectious Disease

By Chris Healey

Almost 25 years before the 2014 Ebola epidemic began spreading through West Africa – and the resulting treatment of two American Ebola patients on U.S. soil – public health officials responded to an Ebola outbreak inside the U.S.

Reston Ebola is the name given to an Ebola species discovered among macaque monkeys in a pharmaceutical research company’s primate quarantine unit in Reston, VA.

In 1989, a veterinarian at Hazelton Research Products, a pharmaceutical research company, contacted the United States Army Institute of Infectious Diseases at Fort Detrick, MD, concerning an unusually high mortality rate among macaques in a shipment from the Philippines. The veterinarian wanted USAMRIID to confirm suspected simian hemorrhagic fever, a viral illness lethal to primates but innocuous to humans. Tests on macaque carcasses unexpectedly showed signs of a deadly filovirus infection – Ebola hemorrhagic fever virus.

Initially, Ebola species Zaire – with mortality rates as high as 90%, and the cause of the 2014 African Ebola epidemic – was implicated as the agent at work. Faced with an unprecedented public health threat, state and federal health agencies converged on the primate quarantine facility in Reston. The Centers for Disease Control and Prevention monitored quarantine facility employees for Ebola symptoms. USAMRIID euthanized primates and sterilized the quarantine facility.

Comprehensive tests later identified the Zaire species identification as an error – Reston Ebola was a new species incapable of infecting humans. However, the enormous public health response was not unwarranted.

Unlike other Ebola species, researchers suspected Reston Ebola demonstrated airborne transmission at the quarantine facility. The longer the virus remained in human presence, the longer it was given opportunities to adapt. If Reston Ebola were to adapt to humans with airborne communicability it would pose a catastrophic public health risk.

Although no quarantine facility employees demonstrated Ebola-like symptoms during the 1989 outbreak, six workers produced Reston Ebola antibodies, meaning the virus elicited an immune response. Reston Ebola’s quick eradication was paramount to ensure that the virus—with its suspected airborne communicability—did not adapt to humans.

Restriction of the 2014 African Ebola epidemic to only a few countries has been attributed to the limited means of Ebola virus transmission. All Ebola species which affect humans are communicable only through direct contact with an infected person or their bodily fluids. Airborne transmission would increase viral spread and undermine containment efforts.

 

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Pandora Report 8.31.14

Fall classes at George Mason have already started and this Labor Day weekend marks the official end of summer. This week, we have stories covering a wide range of topics—an Ebola update (of course), a fascinating article on vaccinia infections acquired through shaving, Haj precautions, and the ISIS “laptop of doom.”

Best wishes for a safe and enjoyable holiday!

Ebola Virus Outbreak Could Hit 20,000 Within Nine Months, Warns WHO

There were many stories this week covering the continuing Ebola outbreak in West Africa. Senegal saw its first (imported) case of the virus this week and has banned flights to and from the affected countries while shutting its land border with Guinea and Nigeria saw its first death outside of the capital city of Lagos. In the Democratic Republic of Congo, where Ebola first emerged in 1976, there have been reported cases of a hemorrhagic gastroenteritis similar to Ebola. I read conflicting accounts this week of the “patient zero” for the Ebola outbreak—a young boy or an older traditional healer. There were reports of some U.S. universities screening students from West Africa for Ebola. There was coverage of a Toronto medical isolation unit ready for patients and information about GlaxoSmithKline’s experimental ebola vaccine which would be tested on humans in the next few weeks.

All of this news came among World Health Organization estimates that this West African outbreak could affect 20,000 people over the next nine months and that half a billion dollars would be needed to stop the spread of the disease.

The Wall Street Journal—“The WHO program will likely cost around $490 million and require contributions from national governments, some U.N. and non-governmental agencies, as well as humanitarian organizations, it said.”

First Reported Spread of Vaccinia Virus Through Shaving After Contact Transmission

This week, reports in the August issue of Medical Surveillance Monthly Report from the Armed Forces Health Surveillance Center covered vaccinia virus infection—the virus used for smallpox vaccinations—within the U.S. Air Force. The infections in the report occurred in June 2014, and affected four individuals.

Infection Control Today—“Over the past decade, most cases of contact vaccinia (i.e., spread of the virus from a vaccinated person to an unvaccinated person) have been traced to U.S. service members, who comprise the largest segment of the population vaccinated against smallpox. Most involve women or children who live in the same household and/or share a bed with a vaccinee or with a vaccinee’s contact. Of adult female cases, most are described as spouses or intimate partners of vaccinees or secondary contacts. Of adult male cases, most involve some type of recreational activity with physical contact, such as wrestling, grappling, sparring, football, or basketball. Household interactions (e.g., sharing towels or clothing) and “unspecified contact” are also implicated.”

Government to Keep Haj Infection-Free 

This week, the Saudi Arabian Ministry of Health announced mandatory measures for Haj and Umrah pilgrims coming from countries with active outbreaks or high rates of infectious diseases. The Health Ministry sent information to embassies outlining health requirements for those seeking pilgrim visas.

Arab News—“‘Although we do not issue Haj visas for pilgrims coming from endemic countries, we will still be monitoring pilgrims coming from other African countries for Ebola symptoms,’ said [Sami] Badawood [Jeddah Health Affairs director.]

He said the ministry would also focus on diseases such as yellow fever, meningitis, seasonal influenza, polio and food poisoning.”

Is the ISIS Laptop of Doom an Operational Threat?

Discovery of a laptop, which has been linked to ISIS, raises new questions about the organization’s plans relating to use of WMD—specifically chemical or biological weapons. Over 35,000 files on the laptop are being examined and has offered new insight into ISIS and their WMD aspirations.

Foreign Policy—“Most troubling is a document that discusses how to weaponize bubonic plague. But turning that knowledge into a working weapon requires particular expertise, and it’s not clear that the Islamic State has it.”

 

Image Credit: Wikimedia Commons

Pandora Report 8.2.14

What a mess, right? While we here at the Pandora Report have been watching the Ebola outbreak in West Africa since March, it seems coverage in the news media has reached a fever pitch as the effects of the virus reach further and further.

This week we cover Ebola—a case in Nigeria, the evacuation of Peace Corps, the transfer of patients to the U.S. and treating the disease.

Nigeria Isolates Hospital in Lagos as Obama Briefed on Ebola Outbreak

Early in the week we learned of the first case of Ebola in Nigeria. It is important to note in this case, that the virus was imported from an American man, Patrick Sawyer, who travelled from Liberia. Fears rose over the importation to Africa’s most populous capital city—Lagos—and the hospital he was in was evacuated and is going through the process of decontamination.

Reuters UK—“Authorities were monitoring 59 people who were in contact with Sawyer, including airport contacts, the Lagos state health ministry said, but it said the airline had yet to provide a passenger list for the flights Sawyer used.

Derek Gatherer, a virologist at Britain’s University of Lancaster, said anyone on the plane near Sawyer could be in “pretty serious danger,” but that Nigeria was better placed to tackle the outbreak than its neighbors.”

Peace Corps Evacuates Ebola-Affected Region, With Two Volunteers in Isolation 

On Wednesday, the Peace Corps announced the evacuation of 340 volunteers from Guinea, Liberia, and Sierra Leone. Two volunteers from Liberia, however, were unable to leave. It is reported that the volunteers had contact with an individual who died from Ebola; they have to remain in an isolation ward for 21 days before leaving.

The Peace Corps—“The Peace Corps has enjoyed long partnerships with the government and people of Liberia, Sierra Leone and Guinea and is committed to continuing volunteers’ work there. A determination on when volunteers can return will be made at a later date.”

First Ebola Patient Arrives in U.S.

News came this week that two Americans infected with Ebola would be transferred to the U.S. for treatment at Emory University Hospital in Atlanta, GA.  Dr. Kent Brantly, who had been working at a treatment center in Liberia, was flown on a jet with a special containment area for patients with infectious diseases. He walked into Emory Hospital on Saturday unaided and is the first case of Ebola to arrive in the U.S.

Emory has an isolation unit built 12 years ago to treat patients exposed to highly infectious diseases.

Wall Street Journal—“Bruce Ribner, an infectious-diseases doctor and head of a special isolation unit at Emory University Hospital, said Friday there were good reasons to airlift the two to Emory. “We can deliver a substantially higher level of care, a substantially higher level of support, to optimize the likelihood that those patients will survive this episode,” he said.

Dr. Ribner added that he was “cautiously optimistic” the two have a good chance of recovery once they reach Emory, and that the transfer would be safe.”

Ebola Vaccine Possible, but Many Doubts Persist 

Vaccine development for Ebola has been being worked on for years, but with the increasing severity of this outbreak in West Africa, there has been discussion in the U.S. about fast-tracking vaccine trials for this virus. Even with this option—once approval is received from the FDA—many doubts persist and scientists who study the virus warn that the success is hardly guaranteed. Even if the vaccine proves to be effective in tests, questions remain as to who would receive it and how to figure out optimal dosages.

In short, even the development of vaccine candidates does not ensure success or virus eradication.

The New York Times—“The vaccine to be tested in humans relies on a benign virus that carries two proteins from the surface of the Ebola virus. The proteins help the virus penetrate human cells. If successful, the immune system will be trained to recognize the proteins and to mount a strong response should it encounter the virus.”

 

Image Credit: Atlanta Better Buildings Challenge

Pandora Report 4.18.14

I think I was coming down with something yesterday. It manifested as a pretty debilitating headache, so I am pretty sure it wasn’t Ebola, but I also had no desire to drink water, so it might have been rabies. Either way, I’m feeling much better today, and am excited to bring you a Saturday issue of Pandora Report. In fact, I’m pretty sure there is nothing that is more fun on the weekend…so let’s get into it!


Highlights include Bird Flu in North Korea, a TB drug that may be the answer to drug resistance, a new strain of Ebola, MERS CoV’s spread to Asia, and Tamiflu’s real utility. Have a great weekend and see you here next Friday!

Highly Pathogenic Avian Influenza (HPAI) outbreak in North Korea

On April 16, the North Korean veterinary authority sent a notice to the World Organization for Animal Health (OIE) alerting them to two H5N1 outbreaks among poultry in the isolated nation. This is a surprisingly transparent move. The first outbreak occurred at the Hadang chicken factory in Hyongjesan starting on March 21. All 46,217 birds died. A second outbreak occurred on March 27 in the same region at the Sopo chicken factory where an unreported number of birds died in the same cage. The source of the infection remains unknown.

The Poultry Site—“Usual control measures have been put in place to control the spread of infection: quarantine, movement control inside the country, screening and disinfection of infected premises/establishment(s). There is no vaccination and no treatment of affected birds.”

Could a new TB drug be the answer to resistance?

A research study at the University of Illinois shows that a new drug under clinical trials for tuberculosis treatment—SQ109—may be the basis for an entirely new class of drugs that could act against bacterial, fungal, and parasite infection and yet evade resistance. Lead researcher, chemistry professor Eric Oldfield, believes that multiple-target drugs like SQ109 and its analogs hold the key to new antibiotic development in the era of drug resistance and “the rise of so-called ‘superbugs’.” His claim is bolstered by experiments with SQ109 and TB where no instances of resistance have been reported.

Science Codex—“’Drug resistance is a major public health threat,” Oldfield said. “We have to make new antibiotics, and we have to find ways to get around the resistance problem. And one way to do that is with multi-target drugs. Resistance in many cases arises because there’s a specific mutation in the target protein so the drug will no longer bind. Thus, one possible route to attacking the drug resistance problem will be to devise drugs that don’t have just one target, but two or three targets.’”

Outbreak in West Africa is caused by a new strain of Ebola virus

As the death toll from the Ebola outbreak in West Africa climbs above 120, scientists are reporting that the virus is not the same strain that has killed in other African nations.  While the source of the virus is still unknown, blood samples from Guinea victims has confirmed that it is not imported strains of Ebola Zaire—the original strain of the virus discovered in Democratic Republic of Congo (formerly known as Zaire.)

The Huffington Post—“‘It is not coming from the Democratic Republic of Congo. It has not been imported to Guinea” from that country or from Gabon, where Ebola also has occurred, [Dr. Stephan] Gunther [of the Bernhard Nocht Institute for Tropical Medicine in Hamburg, Germany] said.

Researchers think the Guinea and other strains evolved in parallel from a recent ancestor virus. The Guinea outbreak likely began last December or earlier and might have been smoldering for some time unrecognized. The investigation continues to try to identify “the presumed animal source.’”

MERS CoV leaves the Middle East and travels to Asia

Though the method of transmission of Middle East Respiratory Syndrome (MERS) remains unknown—a report last week from the CDC finds the virus can stay alive in Camel milk—and thankfully, transmission from human to human has been rare, the disease has now spread beyond the Middle East to Asia via an infection emerging in Malaysia. A Malaysian man returning from Mecca, in Saudi Arabia, tested positive for, and died from, MERS on April 13. So far, a reported 33 people who have travelled to the Middle East for the Haj have tested negative for presence of the virus in neighboring Singapore.

Today Online—“There is currently no advisory against travel to countries of the Arabian Peninsula, or to countries reporting imported cases of MERS-CoV (including Malaysia).

Frequent travellers to the Middle East and Umrah/Haj pilgrims have been advised to take precautions, such as being vaccinated against influenza and meningitis. Those aged 65 years and above or with chronic medical conditions should also get vaccinated against pneumococcal infections before travelling. Pilgrims with pre-existing chronic medical conditions like diabetes, chronic heart and lung conditions should consult a doctor before traveling, to assess whether they should make the pilgrimage.”

A closer look at Tamiflu

With seasonal flu season behind us in the U.S., maybe it is time to look at better treatment options. A study published last week in the British Medical Journal, calls into question the effectiveness of Oseltamivir—brand name, Tamiflu. The international team of researchers found that while Tamiflu can shorten flu symptoms it does not reduce hospital admissions or medical complications. The study also demonstrated that Tamiflu can also cause nausea and vomiting and increases the risk of headaches and renal and psychiatric symptoms.

Global Biodefense—“‘The trade-off between benefits and harms should be borne in mind when making decisions to use oseltamivir for treatment, prophylaxis, or stockpiling,” concludes the study authors from The Cochrane Collaboration, an independent global healthcare research network. “There is no credible way these drugs could prevent a pandemic,” Carl Heneghan, one of the lead investigators of the review and a professor at Oxford University, told reporters. “Remember, the idea of a drug is that the benefits should exceed the harms. So if you can’t find any benefits, that accentuates the harms.’”

(Image credit: Robert Sharp/Flickr)