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PostPosted: Tue Aug 12, 2014 8:38 am 
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rumored that 10 courses were available with 3 to Liberia

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PostPosted: Tue Aug 12, 2014 8:42 am 
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details on priority use of vaccines in at risk populations still to be determined

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PostPosted: Tue Aug 12, 2014 8:45 am 
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audio and video transcripts available soon
http://who.int/mediacentre/en/

conference over

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PostPosted: Tue Aug 12, 2014 9:32 am 
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Audio

http://terrance.who.int/mediacentre/pre ... UG2014.mp3

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PostPosted: Wed Aug 13, 2014 7:15 am 
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WHO: It's ethical to use untried drugs in Ebola outbreak

A World Health Organization (WHO) ethics panel said today that it's ethical to use unlicensed experimental drugs and vaccines to fight West Africa's Ebola epidemic, as media reports said the last available doses of one such drug are being sent to Liberia to treat two doctors stricken by the disease.

At a press conference, Marie-Paule Kieny, PhD, the WHO's assistant director-general for health systems and innovation, said a committee of a dozen experts who conferred by phone yesterday agreed that it's appropriate to use the interventions now in development, provided patients are fully informed of the risks and that health workers gather maximal data about the results.

The panel didn't suggest criteria for deciding who should have priority for use of the products, but the group will consider that at a later meeting, Kieny said. She speculated that November or December may be the earliest that any additional doses of any of the drugs could be available.

http://www.cidrap.umn.edu/news-perspect ... a-outbreak
Deaths top 1,000
Meanwhile the epidemic continued to grow. Late yesterday the WHO said 69 more confirmed, probable, and suspected cases of Ebola virus disease (EVD) were reported by the four affected countries from Aug 7 through 9. The total count reached 1,848 cases and 1,013 deaths.

Liberia reported 45 of the new cases and 29 deaths, the WHO said. Sierra Leone had 13 cases and 17 deaths, while Guinea reported 11 cases and 6 deaths. Nigeria had no new cases or deaths.

Those hit by EVD include nearly 170 healthcare workers (HCWs), more than 80 of whom have died, WHO Director-General Margaret Chan, MD, MPH, said today in an Ebola briefing to United Nations member state representatives. She said those casualties weaken the healthcare response, can prompt closure of hospitals, and drive public fear "to new extremes."

Ethics panel consensus
In a statement, the WHO said Ebola outbreaks can be contained through the standard methods of early case detection and isolation, contact tracing, and strict infection control, but added that a specific treatment or vaccine would be a "potent asset to counter the virus."

"In the particular circumstances of this outbreak, and provided certain conditions are met, the panel reached consensus that it is ethical to offer unproven interventions with as yet unknown efficacy and adverse effects, as potential treatment or prevention," the agency said.

"Ethical criteria must guide the provision of such interventions. These include transparency about all aspects of care, informed consent, freedom of choice, confidentiality, respect for the person, preservation of dignity, and involvement of the community."

The committee also advised that when any unlicensed products are used, "there is a moral obligation to collect and share all data generated," including that resulting from "compassionate use," meaning use apart from a clinical trial.

Kieny told reporters, "This is an opportunity to right a wrong of history—it's only relatively recently that researchers began investigating treatments for Ebola," a disease that was first recognized in 1976.

The ethics panel also agreed unanimously that there is a moral duty to conduct the best possible clinical trials in the context of the epidemic to gather the best evidence on their worth, the WHO said.

Three subjects that need more detailed analysis and discussion, the panel decided, are:

Ethical ways to gather data while providing optimal care
Criteria to prioritize the use of drugs and vaccines
Criteria for fair distribution of products in communities and among countries, given that all of them are likely to remain scarce in the near term
Though the group didn't suggest prioritization guidelines, said Kieny, there was some support for the view that HCWs should have priority, since they put their lives in danger. But others observed that the families of patients also face life-threatening risks and should have priority along with HCWs, she said.

How many products?
Responding to questions, Kieny said the untried products in question include ZMapp, the antibody mixture that has been given to two Americans and is being sent to Liberia to treat two doctors, along with several antivirals and two vaccines.

Mapp Biopharmaceutical, the maker of ZMapp, has used up all the doses it had but is working to make more, according to a Bloomberg Business Week report today. The antibodies are produced in genetically engineered tobacco plants.

Kieny said the number of EVD antivirals that have shown promise in monkey trials is more than three but fewer than 10. There are two vaccines, clinical trials of which could begin as soon as the end of September, she added.

When she was pressed about how soon any drugs might be available, she said that there is so much effort to advance development right now that the likely date keeps getting closer. "It's in flux right now," she said, but went on to suggest that some supplies might be available by November, December, or January.

"The fact that there is not a treatment for Ebola is a market failure," Kieny said. "It's a disease of poor people in countries where there is no market. . . . If it hadn't been for the investment of a few governments in the development of these drugs and vaccines, we'd be nowhere."

The US government has financed most of the research on Ebola interventions, along with the Canadian government and private companies, she added later.

In response to a question about whether the WHO would "broker" supplies of any Ebola drugs or vaccines, Keiny said, "We don't get involved in decisions as to who should get which drug at which moment. Discussion can occur between someone who has a drug or vaccine and someone who would like to obtain it."

Safety risks for HCWs?
Kieny acknowledged that the safety of HCWs could be at risk if an EVD treatment is made available but only to some, or if a vaccine becomes available but some people mistake it for a treatment. "It will be of utmost importance to have the right communication and also to engage with the community and healthcare workers to explain what these are and their scope," she said.

She also acknowledged that legal liability for adverse effects of an untried drug would be a concern for the manufacturing and others involved in providing it. "But I see a lot of good will by many stakeholders who want to do their utmost best to help patients in this terrible outbreak," she added.

Kieny also stressed that standard public health interventions like patient isolation, contact tracing, and infection control are the main tools for fighting EVD: "It's very important not to give false hope to anybody that Ebola can be treated. This is absolutely not the case now."

Doses for Liberian doctors
In other developments, the Liberian government said today it would treat two infected doctors with ZMapp, which would make them the first Africans to receive the treatment, according to a Chicago Tribune report. Lester Brown, Liberia's information minister, said the two physicians gave their consent to be treated, and the US Food and Drug Administration also approved the step.

Brown said the drug was expected to reach Liberia within 2 days.

Also today, a Spanish missionary priest who was flown home from Liberia after contracting EVD died in a Madrid hospital, the Associated Press (AP) reported. Media reports yesterday said Spain had obtained ZMapp for the 75-year-old man, but the hospital would not confirm that he had been treated with it, according to the AP.

At the WHO press conference, Kieny said she didn't know if the priest was given the drug.

See also:

Aug 12 WHO statement on ethics panel recommendations

Aug 11 WHO update on cases and deaths

Aug 12 Chan briefing

Aug 12 Business Week story

Aug 12 Chicago Tribune story

Aug 12 AP story

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PostPosted: Wed Aug 13, 2014 1:23 pm 
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Transcript

http://www.who.int/mediacentre/multimed ... 4.pdf?ua=1

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PostPosted: Thu Aug 14, 2014 7:24 am 
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niman wrote:
rumored that 10 courses were available with 3 to Liberia

[2] Sierra Leone: official
Date: Tue 12 Aug 2014
From: Emergency Operations Center (EOC), Ministry of Health and Sanitation, Sierra Leone
Via ProMED Submit Info tab on <www.promedmail.org> [edited]


Ebola Virus Disease, Sierra Leone: Press Release
---------------------------
Ebola outbreak update: As of today, 12 Aug 2014, we have a total of 184 patients who have survived Ebola Virus Disease and were subsequently discharged. The total number of new confirmed cases is 21: Kailahun 2, Kenema 15; Bombali 1; Port Loko 2 and Tonkolili 1.

The total number of cumulative number of deaths is 259 and cumulative number of confirmed cases is 703 with Kailahun 378, Kenema 250; Kono 1; Kambia 1; Bombali 7; Tonkolili 2; Port Loko 22; Pujehun 3; Bo 22; Moyamba 4; Bonthe 1; Western Area Urban [Freetown] 11; Western Area Rural 1. As of today, Koinadugu district is the only district that has not registered confirmed cases of EVD in Sierra Leone

The cumulative number of probable cases is 38 and probable deaths 34, while the total cumulative number of suspected cases is 39 and suspected deaths is 5.

The World Health Organization has approved the use of the unregistered intervention for EVD in the 3 Ebola affected Mano River Union Countries of Guinea, Liberia and Sierra Leone. Meanwhile, the Government of Sierra Leone through the Emergency Operations Center has written a formal letter to the Director General of the WHO to request the drugs and to ascertain the number of doses available to the country.

The Indian Mercantile Association has donated 500 bucket sets with attached taps and basins to the Ministry of Health and Sanitation as their contribution towards the fight against the Ebola Virus Disease, meanwhile World Vision Sierra Leone also donated 300 million Leones [nearly USD68 000] to the Ministry of Health and Sanitation on behalf of World Vision International as their contribution in the war against the Ebola Virus Disease. World Vision also informed the Ministry of Health and Sanitation that it is in the process of procuring protective gear to be supplied to frontline health workers in health facilities across the country.

Ebola Viral Disease Situation Report: Ministry of Health and Sanitation, Sierra Leone
For more information please contact: District Health Management Team at District level
National level - Directorate of Disease Prevention and Control
<dpcsurveillance@gmail.com>
Mobile:- +23276913000

--
Sidie Yahya Tunis
Director, Information Communication Technology (ICT)
Ministry of Health and Sanitation, Sierra Leone

http://www.promedmail.org/direct.php?id=2680534

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PostPosted: Thu Aug 14, 2014 7:35 pm 
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WHO pushes back against Ebola-related flight bans
Filed Under: Ebola
Lisa Schnirring | Staff Writer | CIDRAP News | Aug 14, 2014

With some airlines suspending flights to West Africa's Ebola outbreak region, the World Health Organization (WHO) today restated its position that the risk of disease transmission during air travel remains low, as a few doses of an investigational drug reached Africa.

Korean Air Lines (KAL) announced today that it would suspend flights to Nairobi, Kenya, starting Aug 20 to prevent the spread of Ebola virus disease (EVD), according to a report today from Reuters. KAL operates three return flights from Nairobi each week. Kenya has not reported any Ebola cases and does not border the affected area, though the WHO has urged it to take extra precautions, given the volume of travel between it and the outbreak countries.

Earlier this month, British Airways said it was suspending service to Liberia and Sierra Leone because of the EVD outbreak. Emirates Airlines, based in Dubai, has also suspended flights to Guinea.

So far, only one travel-related illness has been detected, in an airline passenger from Liberia who was sick upon his arrival in Nigeria, an event that sparked a transmission chain in the capital, Lagos. However, some airlines are concerned about the safety of passengers and staff who might need to seek care in a medical facility in outbreak countries.

WHO repeats advice against flight suspensions
Isabelle Nuttall, MD, director of the WHO Global Capacity Alert and Response, said in a WHO statement today that unlike flu and tuberculosis, Ebola doesn't spread through the air. "It can only be transmitted by direct contact with the body fluids of a person who is sick with the disease."

The WHO added that on the small chance that someone on a plane is sick with Ebola, the likelihood of other passengers and crew having contact with their body fluids is even smaller. Typically, when a person is sick with Ebola, they are so unwell that they can't travel. Health experts also say people who are infected with Ebola can't shed the virus until they have symptoms.

Last week the WHO's emergency committee on Ebola said the outbreak developments in West Africa qualify as a public health emergency of international concern (PHEIC), and it recommended a set of measures to curb the spread of the disease. The panel urged no bans on international travel or trade and that countries make sure they have the capacity to identify and care for travelers from Ebola-affected areas who arrive at travel hubs or destinations with unexplained fevers or other symptoms.

On its Twitter account today, the WHO said international airlines in affected countries are putting systems in place to screen passengers for possible infections. Global health officials have said exit screening in outbreak countries is likely to be more effective for flagging illnesses than entry screening in destination countries, because nonstop flights from African countries aren't the most common route, and it's more difficult to track passengers when they take multi-leg flights.

The WHO also tweeted that it is disappointed when airlines stop flying to West Africa: "Hard to save lives if we and other health workers cannot get in." (??)

Treatment, vaccine developments
In treatment developments, the first three doses of the experimental drug Zmapp arrived in Liberia last night, with two of them earmarked for two of the country's doctors who are in an isolation center at a hospital in Monrovia, the capital, AllAfrica reported today.

A Liberian health official said the government negotiated with the company, with the approval of the US Food and Drug Administration (FDA), to explore how the drugs could be given to the patients in Liberia. He also said negations are underway with other firms developing experimental Ebola drugs, including the Canadian company Tekmira, which makes the only Ebola treatment that has entered clinical trials.

Meanwhile, the president of NewLink Genetics Corp., which is developing an experimental Ebola vaccine based on technology developed by Canadian government researchers , said at least two contract manufacturers have been found to produce "tens of thousands" of doses in the next month or two, according to Reuters.

Charles Link, MD, told Reuters that the company's subsidiary has received funding from the US Department of Defense to speed up clinical trials and manufacturing. Canada's government recently announced that it will donate 800 to 1,000 doses of the vaccine that it has on hand to the WHO for use in battling the outbreak.

In another move that could speed development of an experimental treatment, BioCryst Pharmaceuticals, based in Research Triangle Park, N.C., announced yesterday that it has received an additional $4.1 million from the National Institute of Allergy and Infectious Diseases (NIAID) to conduct a phase 1 clinical trial of an intramuscular treatment for Ebola and other viral hemorrhagic fever diseases.

The additional funding for the treatment, called BXC4430, will also cover studies in nonhuman primates to gauge effective dose ranges and schedules.

The NIAID made its initial grant to BioCryst , valued at up to $22 million over 5 years, in September 2013.

In other developments, the FDA today warned consumers about online companies that are selling products to prevent or treat Ebola. In a statement it said it has received consumer complaints about a variety of products.

Though Ebola vaccines and treatments are under development, in early stages with very limited supply, there are no approved products that have been tested for safety or effectiveness, the FDA noted. The agency added that by law, dietary supplements can't claim to prevent or cure disease.

The FDA also mentioned that the CDC doesn't view the outbreak as a significant threat to the US public and noted that during outbreaks, fraudulent products that purport to prevent or treat the disease often appear on the market.

Latest African developments
Guinea's government has declared a national health emergency to tamp down the spread of Ebola, BBC News reported today, based on information from Guinea's state radio. The action is meant to trigger tighter border controls, order the immediate isolation of people with suspected infections, and prevent the movement of dead bodies from one town to another.

When the WHO declared a PHEIC on Aug 8, it urged the outbreak countries to declare national emergencies. Sierra Leone, Liberia, Nigeria had already declared national emergencies.

Sierra Leone has lost its second top doctor to EVD, Dr Modupeh Cole, who died yesterday at a Doctors Without Borders treatment center in Kailahun, the New York Times reported.

The health ministry said he was exposed to the virus while working in a hospital in Freetown, the capital, according to the Times report.

Nigerian health officials also today reported another death of a health worker, a nurse who had helped care for the country's first EVD case, a man whose illness was detected in Lagos after he had flown in from Liberia, the Associated Press (AP) reported today.



See also:

Aug 14 Reuters story

Aug 14 WHO statement

WHO Twitter feed

Aug 14 AllAfrica story

Aug 13 Reuters story

Aug 14 FDA statement

Aug 14 BBC News story

Aug 13 Times story

Aug 14 AP story
http://www.cidrap.umn.edu/news-perspect ... light-bans

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