Recently News

Ebola virus disease

Key facts

• Ebola virus disease (EVD), formerly known as Ebola haemorrhagic fever, is a severe, often fatal illness in humans.
• The virus is transmitted to people from wild animals and spreads in the human population through human-to-human transmission.
• The average EVD case fatality rate is around 50%. Case fatality rates have varied from 25% to 90% in past outbreaks.
• The first EVD outbreaks occurred in remote villages in Central Africa, near tropical rainforests, but the most recent outbreak in west Africa has involved major urban as well as rural areas.
• Community engagement is key to successfully controlling outbreaks. Good outbreak control relies on applying a package of interventions, namely case management, surveillance and contact tracing, a good laboratory service, safe burials and social mobilisation.
• Early supportive care with rehydration, symptomatic treatment improves survival. There is as yet no licensed treatment proven to neutralise the virus but a range of blood, immunological and drug therapies are under development.
• There are currently no licensed Ebola vaccines but 2 potential candidates are undergoing evaluation.

---

Background

The Ebola virus causes an acute, serious illness which is often fatal if untreated. Ebola virus disease (EVD) first appeared in 1976 in 2 simultaneous outbreaks, one in Nzara, Sudan, and the other in Yambuku, Democratic Republic of Congo. The latter occurred in a village near the Ebola River, from which the disease takes its name.
The current outbreak in west Africa, (first cases notified in March 2014), is the largest and most complex Ebola outbreak since the Ebola virus was first discovered in 1976. There have been more cases and deaths in this outbreak than all others combined. It has also spread between countries starting in Guinea then spreading across land borders to Sierra Leone and Liberia, by air (1 traveller only) to Nigeria, and by land (1 traveller) to Senegal.
The most severely affected countries, Guinea, Sierra Leone and Liberia have very weak health systems, lacking human and infrastructural resources, having only recently emerged from long periods of conflict and instability. On August 8, the WHO Director-General declared this outbreak a Public Health Emergency of International Concern.
A separate, unrelated Ebola outbreak began in Boende, Equateur, an isolated part of the Democratic Republic of Congo.
The virus family Filoviridae includes 3 genera: Cuevavirus, Marburgvirus, and Ebolavirus. There are 5 species that have been identified: Zaire, Bundibugyo, Sudan, Reston and Taï Forest. The first 3, Bundibugyo ebolavirus, Zaire ebolavirus, and Sudan ebolavirus have been associated with large outbreaks in Africa. The virus causing the 2014 west African outbreak belongs to the Zaire species.

Transmission

It is thought that fruit bats of the Pteropodidae family are natural Ebola virus hosts. Ebola is introduced into the human population through close contact with the blood, secretions, organs or other bodily fluids of infected animals such as chimpanzees, gorillas, fruit bats, monkeys, forest antelope and porcupines found ill or dead or in the rainforest.
Ebola then spreads through human-to-human transmission via direct contact (through broken skin or mucous membranes) with the blood, secretions, organs or other bodily fluids of infected people, and with surfaces and materials (e.g. bedding, clothing) contaminated with these fluids.
Health-care workers have frequently been infected while treating patients with suspected or confirmed EVD. This has occurred through close contact with patients when infection control precautions are not strictly practiced.
Burial ceremonies in which mourners have direct contact with the body of the deceased person can also play a role in the transmission of Ebola.
People remain infectious as long as their blood and body fluids, including semen and breast milk, contain the virus. Men who have recovered from the disease can still transmit the virus through their semen for up to 7 weeks after recovery from illness.

Symptoms of Ebola virus disease

The incubation period, that is, the time interval from infection with the virus to onset of symptoms is 2 to 21 days. Humans are not infectious until they develop symptoms. First symptoms are the sudden onset of fever fatigue, muscle pain, headache and sore throat. This is followed by vomiting, diarrhoea, rash, symptoms of impaired kidney and liver function, and in some cases, both internal and external bleeding (e.g. oozing from the gums, blood in the stools). Laboratory findings include low white blood cell and platelet counts and elevated liver enzymes.

Diagnosis

It can be difficult to distinguish EVD from other infectious diseases such as malaria, typhoid fever and meningitis. Confirmation that symptoms are caused by Ebola virus infection are made using the following investigations:

• antibody-capture enzyme-linked immunosorbent assay (ELISA)
• antigen-capture detection tests
• serum neutralization test
• reverse transcriptase polymerase chain reaction (RT-PCR) assay
• electron microscopy
• virus isolation by cell culture.

Samples from patients are an extreme biohazard risk; laboratory testing on non-inactivated samples should be conducted under maximum biological containment conditions.

Treatment and vaccines

Supportive care-rehydration with oral or intravenous fluids- and treatment of specific symptoms, improves survival. There is as yet no proven treatment available for EVD. However, a range of potential treatments including blood products, immune therapies and drug therapies are currently being evaluated. No licensed vaccines are available yet, but 2 potential vaccines are undergoing human safety testing.

Prevention and control

Good outbreak control relies on applying a package of interventions, namely case management, surveillance and contact tracing, a good laboratory service, safe burials and social mobilisation. Community engagement is key to successfully controlling outbreaks. Raising awareness of risk factors for Ebola infection and protective measures that individuals can take is an effective way to reduce human transmission. Risk reduction messaging should focus on several factors:

• Reducing the risk of wildlife-to-human transmission from contact with infected fruit bats or monkeys/apes and the consumption of their raw meat. Animals should be handled with gloves and other appropriate protective clothing. Animal products (blood and meat) should be thoroughly cooked before consumption.
• Reducing the risk of human-to-human transmission from direct or close contact with people with Ebola symptoms, particularly with their bodily fluids. Gloves and appropriate personal protective equipment should be worn when taking care of ill patients at home. Regular hand washing is required after visiting patients in hospital, as well as after taking care of patients at home.
• Outbreak containment measures including prompt and safe burial of the dead, identifying people who may have been in contact with someone infected with Ebola, monitoring the health of contacts for 21 days, the importance of separating the healthy from the sick to prevent further spread, the importance of good hygiene and maintaining a clean environment.

Controlling infection in health-care settings:

Health-care workers should always take standard precautions when caring for patients, regardless of their presumed diagnosis. These include basic hand hygiene, respiratory hygiene, use of personal protective equipment (to block splashes or other contact with infected materials), safe injection practices and safe burial practices.
Health-care workers caring for patients with suspected or confirmed Ebola virus should apply extra infection control measures to prevent contact with the patient’s blood and body fluids and contaminated surfaces or materials such as clothing and bedding. When in close contact (within 1 metre) of patients with EBV, health-care workers should wear face protection (a face shield or a medical mask and goggles), a clean, non-sterile long-sleeved gown, and gloves (sterile gloves for some procedures).
Laboratory workers are also at risk. Samples taken from humans and animals for investigation of Ebola infection should be handled by trained staff and processed in suitably equipped laboratories.

WHO response

WHO aims to prevent Ebola outbreaks by maintaining surveillance for Ebola virus disease and supporting at-risk countries to developed preparedness plans. The document provides overall guidance for control of Ebola and Marburg virus outbreaks:

• Ebola and Marburg virus disease epidemics: preparedness, alert, control, and evaluation

When an outbreak is detected WHO responds by supporting surveillance, community engagement, case management, laboratory services, contact tracing, infection control, logistical support and training and assistance with safe burial practices.
WHO has developed detailed advice on Ebola infection prevention and control:

• Infection prevention and control guidance for care of patients with suspected or confirmed Filovirus haemorrhagic fever in health-care settings, with focus on Ebola

Table: Chronology of previous Ebola virus disease outbreaks

Year	Country	Ebolavirus species	Cases	Deaths	Case fatality
2012	Democratic Republic of Congo	Bundibugyo	57	29	51%
2012	Uganda	Sudan	7	4	57%
2012	Uganda	Sudan	24	17	71%
2011	Uganda	Sudan	1	1	100%
2008	Democratic Republic of Congo	Zaire	32	14	44%
2007	Uganda	Bundibugyo	149	37	25%
2007	Democratic Republic of Congo	Zaire	264	187	71%
2005	Congo	Zaire	12	10	83%
2004	Sudan	Sudan	17	7	41%
2003 (Nov-Dec)	Congo	Zaire	35	29	83%
2003 (Jan-Apr)	Congo	Zaire	143	128	90%
2001-2002	Congo	Zaire	59	44	75%
2001-2002	Gabon	Zaire	65	53	82%
2000	Uganda	Sudan	425	224	53%
1996	South Africa (ex-Gabon)	Zaire	1	1	100%
1996 (Jul-Dec)	Gabon	Zaire	60	45	75%
1996 (Jan-Apr)	Gabon	Zaire	31	21	68%
1995	Democratic Republic of Congo	Zaire	315	254	81%
1994	Cote d'Ivoire	Tai Forest	1	0	0%
1994	Gabon	Zaire	52	31	60%
1979	Sudan	Sudan	34	22	65%
1977	Democratic Republic of Congo	Zaire	1	1	100%
1976	Sudan	Sudan	284	151	53%
1976	Democratic Republic of Congo	Zaire	318	280	88%

---

Fujifilm Holdings Corp said it expects its influenza drug Avigan to be approved by international government bodies to treat Ebola as early as the end of the year.
Fujifilm has been growing its pharmaceutical division through a series of mergers and acquisitions as its photography business wanes. In 2008, it bought Toyama Chemical Co, whose drug Avigan has been drafted to the global fight against Ebola.
Avigan, approved in Japan earlier this year to counter new forms of influenza, has been used in France, Germany, Spain and Norway to treat Ebola patients. Fujifilm had said its Avigan stockpile would be sufficient to treat 20,000 patients, and it has enough ingredients to make tablets to treat 300,000 people. 
"So far, four Ebola patients have recovered after being treated with the drug," Fujifilm Chairman and Chief executive Shigetaka Komori told reporters in Tokyo on Tuesday.
France and Guinea plan to conduct clinical trials of Avigan 200 mg tablets in Guinea to treat Ebola this month.
If it proves effective, the drug will likely be approved to treat Ebola as early as the end of the year, said Takatoshi Ishikawa, who heads the company's pharmaceutical business.
Japan's Prime Minister Shinzo Abe, who is in Beijing for the Asia Pacific Economic Cooperation (APEC) summit, said he is committed to helping fight the Ebola war.
"Ebola is a threat to international peace and stability. Japan will add up to $100 million in aid, on top of $40 million already announced," Abe said in Beijing on Tuesday.
"Furthermore, it's been said the drug made by a Japanese drugmaker is effective, so we'd like to make big contributions on this front," he said.
Fujifilm shares rose 3.2 percent in Tokyo trading on Tuesday to 3,837 yen, the highest close since May 2008.
Fujifilm plans to spend 400 billion to 500 billion yen in M&A deals over the next three years as it strengthens its healthcare operation, which consists of medical equipment, drugs and cosmetics businesses, the company said on Tuesday.
The firm expects to post 220 billion yen in operating profit for the year ending March 2017. It also expects to return more than 200 billion yen to shareholders through such programs as buying back its own shares worth 150 billion yen in the next three years.

North Korea Seeing Loss of Internet Access, Researcher Says

An undated picture released by the North Korean Central News Agency on 17 shows North Korean leader Kim Jong-un presiding over a meeting of the Central Military Commission of the ruling Workers' Party in Pyongyang, North Korea, to discuss ways to improve combat readiness and military capabilities. (Bloomberg) -- North Korea’s access to the Internet has been hit with outages and is offline today, according to a network-monitoring company, days after the U.S. government accused the country of hacking into Sony Corp.’s files.
North Korea, which has four official networks connecting the country to the Internet -- all of which route through China -- began experiencing intermittent problems yesterday and today went completely black, according to Doug Madory, director of Internet analysis at Dyn Research in Hanover, New Hampshire.
U.S. President Barack Obama said last week that Sony Pictures Entertainment had suffered significant damage and vowed to respond. North Korea warned yesterday that any U.S. punishment over the hacking attack on would lead to a retaliation “thousands of times greater.” North Korea has said it doesn’t know the identity of the hackers -- who call themselves “‘Guardians of Peace’’ -- claiming responsibility for breaking into Sony’s computer network and divulging internal e-mail messages.
‘‘The situation now is they are totally offline,’’ Madory said. ‘‘I don’t know that someone is launching a cyber-attack against North Korea, but this isn’t normal for them. Usually they are up solid. It is kind of out of the ordinary. This is not like anything I’ve seen before.”
The attack on Sony’s computers exposed Hollywood secrets, destroyed data and caused the studio to cancel the release of “The Interview,” a comedy about a fictional assassination of North Korean leader Kim Jong Un. The hackers rendered thousands of computers inoperable and forced Sony to take its entire computer network offline.
Global AccessThe outage probably isn’t a cut of a fiber-optic cable, which would be shown in an immediate loss of connectivity, and other possible explanations include a software meltdown on North Korea’s Web routers or denial-of-service hacking attacks, Madory said.
Marie Harf, a spokeswoman for the U.S. State Department, told reporters in Washington today she can’t confirm reports of cyber-attacks on North Korea and won’t say what steps the U.S. may take in response to the Sony attack.
“We are considering a range of options in response,” Harf said at a State Department briefing. “Some will be seen. Some may not be seen.”
While North Korea has four networks connected to the Internet, the U.S. has more than 152,000 such networks, according to Dyn Research.
“We have no new information regarding North Korea today,” White House National Security Council spokeswoman Bernadette Meehan wrote in an e-mail today. “If in fact North Korea’s Internet has gone down, we’d refer you to that government for comment.”
China has started an investigation into a possible North Korean role in the Sony hacking following a request from the U.S. government, a person with direct knowledge of the matter has said. The foreign ministry will cooperate with other Chinese agencies including the Cyberspace Administration to conduct a preliminary investigation, said the person, who asked not to be identified because the probe hasn’t been made public.
North Korea’s Internet outage was earlier reported by the North Korea Tech blog.
--With assistance from Chris Strohm and David Lerman in Washington.
To contact the reporter on this story: Jordan Robertson in Washington at jrobertson40@bloomberg.net To contact the editors responsible for this story: Reed Stevenson at rstevenson15@bloomberg.net Jillian Ward