Fight against Ebola continues. What about the cure?

Read few comments.

Questions:

1. As the outbreak continues would you say that the world reacts sufficiently, how would you evaluate the risk of further spreading of Ebola (maybe also beyond the West Africa)?

2. Could Zmapp (or similar drug) be a hope for the future?

Answers:

Daniel BauschHead, Virology and Emerging Infections Department, U.S. Naval Medical Research Unit No.6, Associate Professor, Department of Tropical Medicine, Tulane School of Public Health and Tropical Medicine

1. The scale of this outbreak has outstripped the resources. The world is now recognizing that and making an effort to catch up, but it takes time, and there is no time to lose. The risk of spread to other areas of West Africa is very real and would be a major problem. Introduction to other areas of the world through travelers on airplanes (“imported cases”) could also happen. However, you are very unlikely to have much, if any continued transmission in places where the healthcare infrastructure is good and where healthcare workers routinely practice the routine precautions that limit contact with blood and other bodily fluids.

2. ZMapp and some other experimental compounds look promising. However, there are many steps that have to occur to make these products widely available. They have not yet gone through the full range of safety and efficacy testing in humans and there is very little supply of most of these compounds at present. We are taking steps to accelerate this process as much as possible, but it is not easy.

Derek GathererLecturer, Division of Biomedical and Life Sciences, Lancaster University

1. I think that we are doing as much as we can under the circumstances.  There is no precedent for an Ebola outbreak of this size, so consequently we can only use the tools we have used in the past (quarantine, contact tracing, hygiene education) but on a far larger scale than ever before – and hope that they work.  It is good to see that the WHO is recommending temperature screening and exposure questionnaires on flights leaving the three most affected countries.  This will hopefully reduce the number of infected people getting on flights to the EU and elsewhere.  Regarding spread to other parts of Africa, the places most at risk are the neighbouring countries.  Nigeria, of course, has already had a case arrive but seems to be on top of the outbreak for the moment, with all 9 contact cases in hospital.  There is no reason to believe that there is another “wild” Ebola focus in Nigeria.  However, Nigeria is an exception within the region, as no other country in that area has the resources and power that Nigeria has.  The smaller countries like Togo, Benin, Cote d’Ivoire and Ghana are much more vulnerable.  I’m sure the WHO are watching them closely.

2. In the present outbreak, I don’t think it will represent anything more than an experimental treatment used on a very small number of people who are almost certain to die otherwise.  However, for future outbreaks, ZMapp and similar drugs might be ready for a more general distribution.  The clinical trials process will need to be completed first, so we are looking at a few years before we reach that stage.

Viruses have always lagged behind bacteria in treatments.  They evolve much faster, and so present “moving targets” for vaccines and drugs.  They are also smaller in terms of their genome size, thus presenting fewer potential targets for attack by drug molecules.  There are very few good antiviral drugs, even for common things like influenza.  Viruses are inherently difficult opponents.

Benjamin Neuman, Lecturer, Virologist, Director of Outreach, School of Biological Sciences, University of Reading

1. As the outbreak goes on, I think the most likely way that Ebola may leave West Africa will be in the form of foreign aid workers who are sent home for treatment.  We have seen three cases like this, and so far all have been safely treated without anyone else becoming infected.  Hospitals, monitoring and the way people in Europe usually respond to being sick mean that even if someone with Ebola comes to Europe, the infection will likely be dealt with quickly and without much risk of the virus spreading.

2. ZMapp is an interesting potential treatment that shows a lot of promise under the right circumstances.  It is similar enough to other medical treatments that it will probably be safe, but it will be most effective if given immediately after exposure.  By the time that a person has started to show the symptoms of Ebola, that person may have been infected for two or three weeks, giving the virus a head start.  ZMapp is a hope for the future, but it is unlikely that enough will be ready in time to make a meaningful difference in this outbreak.  Ebola will be contained, as it always is, by public health measures like quarantining infected people.

 

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