Ebola

International Journal of Human Nutrition and Functional Medicine: Best of 2014
1)  Assessment of the Diagnostic Accuracy of Recently Introduced DNA Stool Screening Test, Gingras, Duncan, Schueller, Schreckenberger
2) Chronic Diseases as Inborn Errors of Metabolism: The Metabolic Correction Therapy Approach, Gonzalez, Miranda-Massari, Duconge, Arroyo
3) ISIFMC* Position Paper on the HPS2-THRIVE Study (*International Society of Integrative, Functional and Metabolic Cardiovascular Medicine), Houston, Guarneri, Kahn
4) Unifying Antiviral Strategy, Vasquez

Background

The West African Ebola epidemic has demonstrated that the existing range of medical and epidemiological responses to emerging disease outbreaks is insufficient, especially in post-conflict contexts with exceedingly poor healthcare infrastructures. In this context, community-based responses have proven vital for containing Ebola virus disease (EVD) and shifting the epidemic curve. Despite a surge in interest in local innovations that effectively contained the epidemic, the mechanisms for community-based response remain unclear. This study provides baseline information on community-based epidemic control priorities and identifies innovative local strategies for containing EVD in Liberia.

Methodology/Principal Findings

This study was conducted in September 2014 in 15 communities in Monrovia and Montserrado County, Liberia – one of the epicenters of the Ebola outbreak. Findings from 15 focus group discussions with 386 community leaders identified strategies being undertaken and recommendations for what a community-based response to Ebola should look like under then-existing conditions. Data were collected on the following topics: prevention, surveillance, care-giving, community-based treatment and support, networks and hotlines, response teams, Ebola treatment units (ETUs) and hospitals, the management of corpses, quarantine and isolation, orphans, memorialization, and the need for community-based training and education. Findings have been presented as community-based strategies and recommendations for (1) prevention, (2) treatment and response, and (3) community sequelae and recovery. Several models for community-based management of the current Ebola outbreak were proposed. Additional findings indicate positive attitudes towards early Ebola survivors, and the need for community-based psychosocial support.

Conclusions/Significance

Local communities’ strategies and recommendations give insight into how urban Liberian communities contained the EVD outbreak while navigating the systemic failures of the initial state and international response. Communities in urban Liberia adapted to the epidemic using multiple coping strategies. In the absence of health, infrastructural and material supports, local people engaged in self-reliance in order to contain the epidemic at the micro-social level. These innovations were regarded as necessary, but as less desirable than a well-supported health-systems based response; and were seen as involving considerable individual, social, and public health costs, including heightened vulnerability to infection.

In this paper we develop a deterministic compartmental mathematical model for the spread of the Ebola virus disease (EVD) in the community. Our model incorporates education campaigns, quarantine, safe burial and therapeutic treatment as control strategies to bring the disease to an end. We derived the effective reproductive number for the model, and proved the stability of equilibrium points. We performed numerical simulations of the model and our results show that all control measures under consideration have an effect of decreasing severity of the epidemic when constantly administered. Furthermore, we found that reducing the number of contacts with infectious individuals in the general population is the most effective intervention method for mitigating an EVD epidemic.

The severe Ebola virus disease epidemic occurring in West Africa stems from a single zoonotic transmission event to a 2‐year‐old boy in Meliandou, Guinea. We investigated the zoonotic origins of the epidemic using wildlife surveys, interviews, and molecular analyses of bat and environmental samples. We found no evidence for a concurrent outbreak in larger wildlife. Exposure to fruit bats is common in the region, but the index case may have been infected by playing in a hollow tree housing a colony of insectivorous free‐tailed bats (Mops condylurus). Bats in this family have previously been discussed as potential sources for Ebola virus outbreaks, and experimental data have shown that this species can survive experimental infection. These analyses expand the range of possible Ebola virus sources to include insectivorous bats and reiterate the importance of broader sampling efforts for understanding Ebola virus ecology.

The summer of 2014 witnessed a seemingly endless series of massive global events: the epidemic spread of Ebola through West Africa; the rise of ISIS and its declaration of a worldwide caliphate; the continuing simmer of tensions between Russia and Ukraine; the kidnapping of nearly 300 Nigerian school girls by Boko Haram; an immigration crisis along the U.S.– Mexico border as tens of thousands of undocumented and unaccompanied minor children arrived seeking refuge in the U.S.; a(nother) lopsided war in Gaza as the Israeli Defense Forces bombarded that densely populated 5 9 25-mile strip of desert along the Mediterranean Sea; a record-breaking drought in California, symptomatic of a changing global climate and a sign that humanity could be getting dangerously close to an environmental point of no return. This is, by no means, an exhaustive list.

In our digital age of the 24-hour news cycle, it should come as no surprise that the media (broadly defined) played, and continues to play, an important role in shaping our individual and collective understanding of these events. Or, it might be more accurate to say, the media has played an outsized role in shaping our fundamental misunderstanding of them. To play on McLuhan’s much- quoted (and often misinterpreted) quip: the medium is still the message (McLuhan 1964). And while McLuhan’s influential tome is a much broader foray into the philosophy and theory of the development of human communication, there is something about this pithy quote that still resonates when applied more narrowly to the 21st century digital media environment in which we find ourselves today. In a 1960 interview with the Canadian Broadcasting Corporation, McLuhan stated:

The world is now like a continually sounding tribal drum where everybody gets the message all of the time [...] A princess gets married in England and boom, boom, boom go the drums. We all hear about it. An earthquake in North Africa, a Hollywood star gets drunk—away go the drums again (CBC 1960).

That is, as Paul Hiebert (2014: np) wrote on the 50th anniversary of the publication of McLuhan’s opus, ‘‘the content of the message isn’t what matters; what matters is the medium, because it is the medium that modifies our senses when processing the received information.’’ Or, as McLuhan elaborated in a 1969 interview with Playboy, this new media ‘‘context’’ is invisible to us, which makes it all the more powerful in shaping the messages received:

I call this peculiar form of self-hypnosis Narcis- sus narcosis, a syndrome whereby man remains as unaware of the psychic and social effects of his new technology as a fish of the water it swims in. As a result, precisely at the point where a new media-induced environment becomes all perva- sive and transmogrifies our sensory balance, it also becomes invisible (quoted in Hiebert 2014: np).

And while we hesitate to take this kind of ‘‘media determinism’’ to the degree that McLuhan did—Guy Debord famously accused McLuhan of being an ‘‘apologist’’ of the spectacle and ‘‘the most convinced imbecile of the century’’ (Debord 1983: 57; in MacDonald 2006: 505)—what is perfectly clear to us is that in this emergent age of digital media, the omnipresence of (increasingly digital) media, and the content that it delivers, has a radical impact on our individual and collective geographical understanding of the world that we inhabit.

Objective: The objective of this study was to identify the pace of Ebola-related social learning in urban and peri-urban areas around Monrovia, Liberia during August 2014, the onset of the emergency phase of the epidemic. Data: Research teams collected data in 13 discrete neighborhood sites over fourteen consecutive days via focus groups, community discussions, and key informant interviews for the purpose of program development. Data was de-identified and shared with research partners for analysis. Findings: The study’s findings indicate that within a two-week period, community members demonstrated rapid social learning of correct information about the source of the Ebolavirus and methods for prevention, as well as the rapid dismissal of of incorrect information about the virus. The data also suggest that a critical moment for a shift in social learning took place after the research midpoint, during days 7-10 (of a total of 14). Conclusion: The research demonstrates that under conditions of accelerating health crises, low income and low-resource communities can rapidly assimilate correct health information and dispel incorrect information, even in a context of heightened instability, suspicion, and
misinformation.

Introduction: Bats are among the most poorly studied mammals, despite their diversity and important
ecological services. The ongoing Ebola epidemic in western Africa underscores the increasingly recognized role of bats as reservoirs for emerging human diseases. An understanding of the mechanisms supporting pathogen maintenance in bat hosts is essential to informing future public health measures, as well as conservation efforts for wild bat populations. This is crucial in Africa, where the human population is burgeoning, increasing habitat loss and human contact with wildlife.
The importance of natural history. The natural history and ecology of bats, especially in Africa, is poorly
understood, making responsible management decisions difficult. Metrics for guiding management of pathogens and their host populations, such as critical community size and minimum viable population size, often require more natural history knowledge than we currently have available. We argue that management action without adequate research can lead to counterproductive results.
In the past, fear-based management responses such as culling
campaigns have counterintuitively increased the prevalence of pathogens in the target host population, as has been observed in the vampire bat-rabies system and the Egyptian fruit bat-Marburg system.
Bat conservation in the time of Ebola. Many of the same anthropogenic stressors that are threatening bat
populations, such as habitat loss and hunting, are also likely drivers of zoonotic pathogen emergence. Given this, and given that reducing bat populations can increase rather than decrease pathogen prevalence, we argue that conservation measures for bats should be strengthened in this time of Ebola. We offer a few potential first steps.
Conclusions and Future Directions: We advocate the precautionary principle, and encourage significant and
urgent increases in natural history studies, education, and conservation measures for African bats.

As the Ebola outbreak in West Africa wanes, it is time for the international scientific community to reflect on how to improve the detection of and coordinated response to future epidemics. Our interdisciplinary team identified key lessons learned from the Ebola outbreak that can be clustered into three areas: environmental conditions related to early warning systems, host characteristics related to public health, and agent issues that can be addressed through the laboratory sciences. In particular, we need to increase zoonotic surveillance activities, implement more effective ecological health interventions, expand prediction modeling, support medical and public health systems in order to improve local and international responses to epidemics, improve risk communication, better understand the role of social media in outbreak awareness and response, produce better diagnostic tools, create better therapeutic medications, and design better vaccines. This list highlights research priorities and policy actions the global community can take now to be better prepared for future emerging infectious disease outbreaks that threaten global public health and security.

Purpose
Ebola virus (EBOV) is such kind of virus which is responsible for 23,825 cases and 9675 deaths worldwide only in 2014 and with an average diseases fatality rate between 25 % and 90 %. Although, medical technology has tried to handle the problems, there is no Food and Drug Administration (FDA)-approved therapeutics or vaccines available for the prevention, post exposure, or treatment of Ebola virus disease (EVD).

Methods
In the present study, we used the immunoinformatics approach to design a potential epitope-based vaccine against the RNA-dependent RNA polymerase-L of EBOV. BioEdit v7.2.3 sequence alignment editor, Jalview v2 and CLC Sequence Viewer v7.0.2 were used for the initial sequence analysis for securing the conservancy from the sequences. Later the Immune Epitope Database and Analysis Resource (IEDB-AR) was used for the identification of T-cell and B-cellepitopes associated with type I and II major histocompatibility complex molecules analysis. Finally, the population coverage analysis was employed.

Results
The core epitope “FRYEFTAPF” was found to be the most potential one, with 100 % conservancy among all the strains of EBOV. It also interacted with both type I and II major histocompatibility complex molecules and is considered as nonallergenic in nature. Finally, with impressive cumulative population coverage of 99.87 % for the both MHC-I and MHC-II class throughout the world population was found for the proposed epitope.

Conclusion
To end, the projected peptide gave us a solid stand to propose for vaccine consideration and that might be experimented for its potency in eliciting immunity through humoral and cell mediated immune responses in vitro and in vivo.

Purpose:
This paper provides an analysis of the disproportionate impact of the 2014 West Africa Ebola virus disease (EVD) epidemic on women, presenting an assessment of how this impact in particular is linked with violence against women and women's right to health, and a critique of improvements that could avoid discrimination against women in healthcare crises.

Design/methodology/approach:
This paper covers conceptual understandings of, and utilises a human rights law and public health lens to analyse how the Ebola virus disease (EVD) epidemic in West Africa both directly and indirectly caused greater harm to women and girls. All these factors which represent intersectional violations of the human rights of women are examined with a focus on violence against women and the right to health.

Findings:
There are multiple reasons why the EVD outbreak harmed women disproportionately, and this intersectionality of discrimination must be considered in any response to a public health crisis. Addressing the vulnerability of women and girls to all forms of violence involves the coordinated efforts of public health, legal, and political actors to empower women.

Originality/value:
Specific issues of the 2014 West Africa EVD outbreak have been examined in medical journals, but there have been no academic studies that present a cross-disciplinary analysis of the gender concerns. This paper combines a public health perspective with a human rights law viewpoint in order to consider the impact of the EVD outbreak on women and provide suggestions as to how discrimination and disadvantage of women in such health crises can be avoided.

The international response to Ebola has been decried for being ‘too slow, too little, too late’. As well as racing to respond, we need to consider what has happened over the past decades to leave exposed fault lines that enabled Ebola to move so rapidly across boundaries of people’s bodies, villages, towns and countries.

Gender is important to these fault lines in two related spheres. Women and men are differentially affected by Ebola, with women in the region taking on particular roles and responsibilities as they care for the ill and bury the dead, and as they navigate ever-diminishing livelihood options and increasingly limited health resources available to pregnant women. Furthermore, structural preconditions in ‘development’ itself have deepened these gendered fault lines.

A currently powerful set of ideas in gender and development discourse locates certain patterns of ‘non-modern’ gender relationships as the root cause of poverty and underdevelopment. This has encouraged development actors to underplay the much deeper forms of structural violence that underpin the vulnerability of men as well as women, in some of the world’s poorest communities. By focusing on the current health crisis in Sierra Leone, Liberia and Guinea, the dangers of this form of ‘gender scapegoating’ are revealed to be tragically stark.