Post-ebola syndrome

October 29, 2014

WHO: Need for more information on post-Ebola syndrome

“We need to understand why these symptoms persist, whether they are caused by the disease or treatment, or perhaps the heavy disinfection,” says Dr Nanyonga who has developed an assessment tool that will be used to establish the most common and disabling symptoms and what can be done to help survivors with these problems.

Dr Andrew Ramsay, field coordinator for WHO in Kenema, says it is essential that potentially disabling physical and psychological problems be diagnosed and, where possible, treated as quickly as possible.

“Eye problems might be caused by damage to the cornea, to the nerves or something else. At this point we do not have enough information to know exactly what is going on. But we need to find out urgently so we can do whatever we can to preserve the eyesight for people who have to try to pick up their lives again.”

Western Norway and parts of Northern Norway are particularly vulnerable to rock avalanches.
(Source: NORSAR)

Rock avalanches and rock falls
08.11.2012 14:28

Rock avalanches occur when a large volume of stone blocks loosens from a mountainside.

Once in a great while, large sections of a mountainside will come loose. This can have enormous consequences on both settlement and infrastructure in large areas around the location of the slide. The greatest threat posed by a slide is when large sections of a mountain crash into fjords, creating towering tidal waves.

Slides consisting of one or more smaller stone blocks is called rock falls.

Where do rock avalanches occur?

Rock avalanches commonly occur on steep, unstable mountainsides. In some locations, cracks in the mountain increase the risk of avalanches, while in other locations it could be large stone blocks that slide on weaker layers of the bedrock.

In Norway, counties in Western Norway, Nordland and Troms in Northern Norway are particularly vulnerable to rock avalanches.

What triggers rock avalanches?

The combination of steep mountainsides and bedrock zones with weaknesses are important preconditions for triggering rock avalanches.

Finding out exactly what triggered an avalanche can be difficult. The most common causes are considered to be water pressure, rock pressure, frost wheathering or earthquakes.

Number 9953 | Oct 25, 2014
p1477 – 1548

Globally in 2013, there were 1·8 million new HIV infections (95% uncertainty interval 1·7 million to 2·1 million), 29·2 million prevalent HIV cases (28·1 to 31·7), and 1·3 million HIV deaths (1·3 to 1·5). At the peak of the epidemic in 2005, HIV caused 1·7 million deaths (1·6 million to 1·9 million). Concentrated epidemics in Latin America and eastern Europe are substantially smaller than previously estimated. Through interventions including PMTCT and ART, 19·1 million life-years (16·6 million to 21·5 million) have been saved, 70·3% (65·4 to 76·1) in developing countries. From 2000 to 2011, the ratio of development assistance for health for HIV to years of life saved through intervention was US$4498 in developing countries.

Including in HIV-positive individuals, all-form tuberculosis incidence was 7·5 million (7·4 million to 7·7 million), prevalence was 11·9 million (11·6 million to 12·2 million), and number of deaths was 1·4 million (1·3 million to 1·5 million) in 2013.

In the same year and in only individuals who were HIV-negative, all-form tuberculosis incidence was 7·1 million (6·9 million to 7·3 million), prevalence was 11·2 million (10·8 million to 11·6 million), and number of deaths was 1·3 million (1·2 million to 1·4 million). Annualised rates of change (ARC) for incidence, prevalence, and death became negative after 2000. Tuberculosis in HIV-negative individuals disproportionately occurs in men and boys (versus women and girls); 64·0% of cases (63·6 to 64·3) and 64·7% of deaths (60·8 to 70·3).

Globally, malaria cases and deaths grew rapidly from 1990 reaching a peak of 232 million cases (143 million to 387 million) in 2003 and 1·2 million deaths (1·1 million to 1·4 million) in 2004. Since 2004, child deaths from malaria in sub-Saharan Africa have decreased by 31·5% (15·7 to 44·1). Outside of Africa, malaria mortality has been steadily decreasing since 1990.
Our estimates of the number of people living with HIV are 18·7% smaller than UNAIDS’s estimates in 2012. The number of people living with malaria is larger than estimated by WHO. Incidence rates for HIV, tuberculosis, and malaria have all decreased since 2000. At the global level, upward trends for malaria and HIV deaths have been reversed and declines in tuberculosis deaths have accelerated. 101 countries (74 of which are developing) still have increasing HIV incidence.

Substantial progress since the Millennium Declaration is an encouraging sign of the effect of global action.

Ps. 91 ZelZach

October 23, 2014

Emerg Infect Dis. 2013 Feb;19(2):270-3. doi: 10.3201/eid1902.120524.
Ebola virus antibodies in fruit bats, bangladesh.
Olival KJ1, Islam A, Yu M, Anthony SJ, Epstein JH, Khan SA, Khan SU, Crameri G, Wang LF, Lipkin WI, Luby SP, Daszak P.
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To determine geographic range for Ebola virus, we tested 276 bats in Bangladesh. Five (3.5%) bats were positive for antibodies against Ebola Zaire and Reston viruses; no virus was detected by PCR. These bats might be a reservoir for Ebola or Ebola-like viruses, and extend the range of filoviruses to mainland Asia.

[PubMed – indexed for MEDLINE]

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Arch Virol. 2014 May;159(5):1129-32. doi: 10.1007/s00705-012-1477-6. Epub 2012 Sep 21.
Reston virus in domestic pigs in China.
Pan Y1, Zhang W, Cui L, Hua X, Wang M, Zeng Q.
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Historically, Reston virus (RESTV) has been found to be associated with outbreaks of disease only in nonhuman primates. Its spread to domestic pigs was reported for the first time in 2008. In this study, we report the discovery, molecular detection, and phylogenetic analysis of Reston virus (RESTV) in domestic pigs in China. A total of 137 spleen specimens from pigs that died after showing typical clinical signs of porcine reproductive and respiratory syndrome (PRRS), and for which infection with porcine reproductive and respiratory syndrome virus (PRRSV) was confirmed by RT-PCR, were collected from three farms in Shanghai from February to September 2011. Of these samples, 2.92 % (4/137) were found to be positive for RESTV. All of the positive piglets were under the age of 8 weeks and were co-infected with PRRSV. Sequences were found that shared 96.1 %-98.9 % sequence similarity with those of two RESTV variants that had been discovered previously in domestic pigs and cynomolgus macaques from the Philippines. We therefore conclude that RESTV was present in domestic pigs in Shanghai, China.

[PubMed – indexed for MEDLINE]

Science. 2009 Jul 10;325(5937):204-6. doi: 10.1126/science.1172705.
Discovery of swine as a host for the Reston ebolavirus.
Barrette RW1, Metwally SA, Rowland JM, Xu L, Zaki SR, Nichol ST, Rollin PE, Towner JS, Shieh WJ, Batten B, Sealy TK, Carrillo C, Moran KE, Bracht AJ, Mayr GA, Sirios-Cruz M, Catbagan DP, Lautner EA, Ksiazek TG, White WR, McIntosh MT.
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Since the discovery of the Marburg and Ebola species of filovirus, seemingly random, sporadic fatal outbreaks of disease in humans and nonhuman primates have given impetus to identification of host tropisms and potential reservoirs. Domestic swine in the Philippines, experiencing unusually severe outbreaks of porcine reproductive and respiratory disease syndrome, have now been discovered to host Reston ebolavirus (REBOV). Although REBOV is the only member of Filoviridae that has not been associated with disease in humans, its emergence in the human food chain is of concern. REBOV isolates were found to be more divergent from each other than from the original virus isolated in 1989, indicating polyphyletic origins and that REBOV has been circulating since, and possibly before, the initial discovery of REBOV in monkeys.

[PubMed – indexed for MEDLINE]

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J Infect Dis. 2011 Nov;204 Suppl 3:S757-60. doi: 10.1093/infdis/jir296.
Reston ebolavirus in humans and animals in the Philippines: a review.
Miranda ME1, Miranda NL.
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The 2008 Reston ebolavirus infection event in domestic pigs has triggered continuing epidemiologic investigations among Philippine health and veterinary agencies in collaboration with international filovirus experts. Prior to this, there were only 3 known and documented Reston ebolavirus outbreaks in nonhuman primates in the world, all traced back to a single geographic source in the Philippines in a monkey breeding/export facility. The first one in 1989 was the first-ever Ebola virus that emerged outside of Africa and was also the first known natural infection of Ebola virus in nonhuman primates. When it was first discovered among laboratory monkeys in the United States, the source was immediately traced back to the farm located in the Philippines. The second outbreak was in 1992-93. The third episode in 1996 was the last known outbreak before Reston ebolavirus reemerged in pigs in 2008. The isolated outbreaks involving 2 animal species bring forth issues requiring further investigations, and highlight the significance of intersectoral collaboration to effectively address zoonoses prevention and control/response in the interest of minimizing public health risk.

[PubMed – indexed for MEDLINE]

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BMC Vet Res. 2012 Oct 11;8:189. doi: 10.1186/1746-6148-8-189.
Analysis of the humoral immune responses among cynomolgus macaque naturally infected with Reston virus during the 1996 outbreak in the Philippines.
Taniguchi S1, Sayama Y, Nagata N, Ikegami T, Miranda ME, Watanabe S, Iizuka I, Fukushi S, Mizutani T, Ishii Y, Saijo M, Akashi H, Yoshikawa Y, Kyuwa S, Morikawa S.
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Ebolaviruses induce lethal viral hemorrhagic fevers (VHFs) in humans and non-human primates, with the exceptions of Reston virus (RESTV), which is not pathogenic for humans. In human VHF cases, extensive analyses of the humoral immune responses in survivors and non-survivors have shown that the IgG responses to nucleoprotein (NP) and other viral proteins are associated with asymptomatic and survival outcomes, and that the neutralizing antibody responses targeting ebolaviruses glycoprotein (GP1,2) are the major indicator of protective immunity. On the other hand, the immune responses in non-human primates, especially naturally infected ones, have not yet been elucidated in detail, and the significance of the antibody responses against NP and GP1,2 in RESTV-infected cynomolgus macaques is still unclear. In this study, we analyzed the humoral immune responses of cynomolgus macaque by using serum specimens obtained from the RESTV epizootic in 1996 in the Philippines to expand our knowledge on the immune responses in naturally RESTV-infected non-human primates.

The antibody responses were analyzed using IgG-ELISA, an indirect immunofluorescent antibody assay (IFA), and a pseudotyped VSV-based neutralizing (NT) assay. Antigen-capture (Ag)-ELISA was also performed to detect viral antigens in the serum specimens. We found that the anti-GP1,2 responses, but not the anti-NP responses, closely were correlated with the neutralization responses, as well as the clearance of viremia in the sera of the RESTV-infected cynomolgus macaques. Additionally, by analyzing the cytokine/chemokine concentrations of these serum specimens, we found high concentrations of proinflammatory cytokines/chemokines, such as IFNγ, IL8, IL-12, and MIP1α, in the convalescent phase sera.

These results imply that both the antibody response to GP1,2 and the proinflammatory innate responses play significant roles in the recovery from RESTV infection in cynomolgus macaques.

[PubMed – indexed for MEDLINE]

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