Emergence of #human #monkeypox in west #Africa (Lancet Infect Dis., summary)

[Source: The Lancet Infectious Diseases, full page: (LINK). Summary, edited.]

Emergence of human monkeypox in west Africa

Giovanni Rezza

Published: July 05, 2019 / DOI: https://doi.org/10.1016/S1473-3099(19)30281-6


Human monkeypox is a zoonotic disease that is endemic to central and western Africa. It is caused by an orthopoxvirus that was first identified in captive monkeys in 1958, and in a child from DR Congo in 1970. There are two variants of the virus: the Congo Basin clade and the west African clade. Unlike the variola virus, the monkeypox virus has a wide range of hosts and a reservoir in wild animals. 1


Keywords: Orthopoxvirus; Monkeypox; Human; West Africa.


#Conceptions within #misconceptions: #Pluralisms in an #Ebola #vaccine #trial in West Africa (Glob Public Health., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Glob Public Health. 2019 Jun 25:1-9. doi: 10.1080/17441692.2019.1632368. [Epub ahead of print]

Conceptions within misconceptions: Pluralisms in an Ebola vaccine trial in West Africa.

Alenichev A1,2, Peeters Grietens K3, Gerrets R1.

Author information: 1a Department of Anthropology , University of Amsterdam , Amsterdam , Netherlands. 2b The Barcelona Institute for Global Health , Barcelona , Spain. 3c Department of Public Health , Institute of Tropical Medicine , Antwerp , Belgium.



Ensuring that biomedical information about research procedures is adequately understood by participants and their communities is key for conducting ethical research. This article explores participants’ understanding of trial procedures for an experimental vaccine against Ebola virus disease (EVD) in a West African context. We found that some trial participants believed there was a chance of contracting Ebola and other sicknesses from the vaccine, and others believed both the vaccine and the placebo control would be able to prevent other illnesses than EVD. While these beliefs might be understood as misconceptions about the vaccine trial, this paper shows that such a conclusion is problematic because it excludes local explanatory health models and logics of causality. The paper invites bioethicists to work with anthropologists to take seriously different models of health knowledge in global health research. Investigating and addressing such differences could be the key to understanding human subjects’ motives for participation, and to creating space for studies of empirical ethics.

KEYWORDS: Ebola; clinical trial; misconceptions; pluralism

PMID: 31237180 DOI: 10.1080/17441692.2019.1632368

Keywords: Ebola; Vaccines; Society; Africa region; Bioethics.


Quantifying the seasonal #drivers of #transmission for #Lassa fever in #Nigeria (Philos Transact Roy Soc B., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Philos Trans R Soc Lond B Biol Sci. 2019 Jun 24;374(1775):20180268. doi: 10.1098/rstb.2018.0268.

Quantifying the seasonal drivers of transmission for Lassa fever in Nigeria.

Akhmetzhanov AR1, Asai Y1, Nishiura H1.

Author information: 1 Graduate School of Medicine, Hokkaido University , Sapporo, Hokkaido , Japan.



Lassa fever (LF) is a zoonotic disease that is widespread in West Africa and involves animal-to-human and human-to-human transmission. Animal-to-human transmission occurs upon exposure to rodent excreta and secretions, i.e. urine and saliva, and human-to-human transmission occurs via the bodily fluids of an infected person. To elucidate the seasonal drivers of LF epidemics, we employed a mathematical model to analyse the datasets of human infection, rodent population dynamics and climatological variations and capture the underlying transmission dynamics. The surveillance-based incidence data of human cases in Nigeria were explored, and moreover, a mathematical model was used for describing the transmission dynamics of LF in rodent populations. While quantifying the case fatality risk and the rate of exposure of humans to animals, we explicitly estimated the corresponding contact rate of humans with infected rodents, accounting for the seasonal population dynamics of rodents. Our findings reveal that seasonal migratory dynamics of rodents play a key role in regulating the cyclical pattern of LF epidemics. The estimated timing of high exposure of humans to animals coincides with the time shortly after the start of the dry season and can be associated with the breeding season of rodents in Nigeria. This article is part of the theme issue ‘Modelling infectious disease outbreaks in humans, animals and plants: approaches and important themes’. This issue is linked with the subsequent theme issue ‘Modelling infectious disease outbreaks in humans, animals and plants: epidemic forecasting and control’.

KEYWORDS: Arenaviridae; Lassa haemorrhagic fever; multimammate rat; reservoir host; seasonality

PMID: 31056054 DOI: 10.1098/rstb.2018.0268

Keywords: Arenavirus; Lassa fever; West Africa.


Impact of #Intravenous #Fluid #Therapy on #Survival Among Patients with #Ebola Virus Disease: An #International Multisite Retrospective Cohort Study (Clin Infect Dis., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Clin Infect Dis. 2019 May 3. pii: ciz344. doi: 10.1093/cid/ciz344. [Epub ahead of print]

Impact of Intravenous Fluid Therapy on Survival Among Patients with Ebola Virus Disease: An International Multisite Retrospective Cohort Study.

Aluisio AR1, Yam D2, Peters JL3, Cho DK3, Perera SM4, Kennedy SB5, Massaquoi M5, Sahr F6, Smit MA7, Liu T2, Levine AC1.

Author information: 1 Department of Emergency Medicine, Brown University Alpert Medical School, Providence, RI, USA. 2 Center for Statistical Sciences, Department of Biostatistics, Brown University School of Public Health, Providence, RI, USA. 3 Brown University, Providence, RI, USA. 4 International Medical Corps, Washington, DC, USA. 5 Ministry of Health, Monrovia, Liberia. 6 Sierra Leone Ministry of Defense, Freetown, Sierra Leone. 7 Division of Infectious Diseases, Children’s Hospital Los Angeles, Los Angeles, CA, USA.




Intravenous fluid (IVF) is a frequently recommended intervention in Ebola Virus Disease (EVD), yet its impact on patient outcomes remains unclear.


This retrospective cohort study evaluated patients with EVD admitted to five Ebola Treatment Units (ETU) in West Africa. The primary outcome was the difference in 28-day survival between cases treated and not treated with IVF. To control for demographic and clinical factors related to both IVF exposure and survival, cases were compared using propensity score matching. To control for time-varying patient and treatment factors over the course of ETU care, a marginal structural proportional hazards model (MSPHM) with inverse probability weighting was used to assess for 28-day survival differences.


Among 424 EVD positive cases with data for analysis, 354 (83.5%) were treated with IVF at some point during their ETU admission. Overall, 146 (41.3%) cases treated with IVF survived, while 31 (44.9%) cases not treated with any IVF survived (p=0.583). Matched propensity score analysis found no significant difference in 28-day survival between cases treated and not treated with IVF during their first 24 and 48 hours of care. Adjusted MSPHM survival analyses also found no significant difference in 28-day survival for cases treated with IVF (27.3%) compared to those not treated with IVF (26.9%) during their entire ETU admission (p=0.893).


After adjustment for patient and treatment-specific time varying factors, there was no significant difference in survival among patients with EVD treated with IVF as compared to those not treated with IVF.

© The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

KEYWORDS: Ebola Virus Disease; West Africa; intravenous fluid; marginal structural models; survival

PMID: 31050703 DOI: 10.1093/cid/ciz344

Keywords: Ebola; West Africa.


#Determinants of #transmission #risk during the late stage of the West African #Ebola #epidemic (Am J Epidemiol., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Am J Epidemiol. 2019 Apr 3. pii: kwz090. doi: 10.1093/aje/kwz090. [Epub ahead of print]

Determinants of transmission risk during the late stage of the West African Ebola epidemic.

Robert A1, Edmunds WJ1, Watson CH1, Henao-Restrepo AM2, Gsell PS2, Williamson E3, Longini IM4, Sakoba K5, Kucharski AJ1, Touré A5, Nadlaou SD5, Diallo B6, Barry MS5, Fofana TO5, Camara L5, Kaba IL5, Sylla L5, Diaby ML5, Soumah O5, Diallo A5, Niare A5, Diallo A5, Eggo RM1.

Author information: 1 Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, UK. 2 World Health Organization, Geneva, Switzerland. 3 Department of Medical Statistics, London School of Hygiene &Tropical Medicine, UK. 4 Department of Biostatistics, University of Florida, USA. 5 WHO Ebola vaccination team, Guinea. 6 WHO Ebola vaccination team, Guinea, Ministry of Health, Guinea.



Understanding risk factors for Ebola transmission is key for effective prediction and design of interventions. We used data on 860 cases in 129 chains of transmission from the latter half of the 2013-16 Ebola outbreak in Guinea. Using negative binomial regression, we determined characteristics associated with the number of secondary cases resulting from each infected individual. We found that attending an Ebola Treatment Unit was associated with a 38% decrease in secondary cases (Incident rate ratio (IRR) 0.62, 95%CI: 0.38, 0.99) in individuals that did not survive. Unsafe burial was associated with a higher number of secondary cases (IRR 1.82, 95%CI: 1.10, 3.02). The average number of secondary cases was higher for the first generation of a transmission chain (mean = 1.77), compared with subsequent generations (mean = 0.70). Children were least likely to transmit (IRR 0.35 (95%CI: 0.21, 0.57) compared with adults, whereas older adults were associated with higher numbers of secondary cases. Men were less likely to transmit than women (IRR 0.71 (95%CI: 0.55, 0.93)). This detailed surveillance dataset provided an invaluable insight into transmission routes and risks. Our analysis highlights the key role that age, receiving treatment, and safe burial played in the spread of EVD.

© The Author(s) 2019. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health.

KEYWORDS: Ebola; Guinea; Multiple imputation; Regression analysis; Risk factors

PMID: 30941398 DOI: 10.1093/aje/kwz090

Keywords: Ebola; Ebola-Makona; West Africa.


#Technologies of #trust in #epidemic response: #openness, reflexivity and #accountability during the 2014-2016 #Ebola outbreak in West #Africa (BMJ Glob Health, abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

BMJ Glob Health. 2019 Feb 13;4(1):e001272. doi: 10.1136/bmjgh-2018-001272. eCollection 2019.

Technologies of trust in epidemic response: openness, reflexivity and accountability during the 2014-2016 Ebola outbreak in West Africa.

Ryan MJ1, Giles-Vernick T2, Graham JE1.

Author information: 1 Pediatrics (Infectious Diseases), Dalhousie University, Halifax, Nova Scotia, Canada. 2 Unité d’Epidémiologie des Maladies Emergentes, Institut Pasteur, Paris, France.



Trust is an essential component of successful cooperative endeavours. The global health response to the 2014-2016 West Africa Ebola outbreak confronted historically tenuous regional relationships of trust. Challenging sociopolitical contexts and initially inappropriate communication strategies impeded trustworthy relationships between communities and responders during the epidemic. Social scientists affiliated with the Ebola 100-Institut Pasteur project interviewed approximately 160 local, national and international responders holding a wide variety of roles during the epidemic. Focusing on responder’s experiences of communities’ trust during the epidemic, this qualitative study identifies and explores social techniques for effective emergency response. The response required individuals with diverse knowledges and experiences. Responders’ included on-the-ground social mobilisers, health workers and clinicians, government officials, ambulance drivers, contact tracers and many more. We find that trust was fostered through open, transparent and reflexive communication that was adaptive and accountable to community-led response efforts and to real-time priorities. We expand on these findings to identify ‘technologies of trust’ that can be used to promote actively legitimate trustworthy relationships. Responders engaged the social technologies of openness (a willingness and genuine effort to incorporate multiple perspectives), reflexivity (flexibly responsive to context and ongoing dialogue) and accountability (taking responsibility for local contexts and consequences) to facilitate relations of trust. Technologies of trust contribute to the development of a framework of practical techniques to improve the acceptance and effectiveness of future emergency response strategies.

KEYWORDS: health policy; health services research; prevention strategies; qualitative study; viral haemorrhagic fevers

PMID: 30899567 PMCID: PMC6407545 DOI: 10.1136/bmjgh-2018-001272

Keywords: Ebola; West Africa; Society; Public Health.


#HIV #prevalence in suspected #Ebola cases during the 2014-2016 Ebola #epidemic in #SierraLeone (Infect Dis Poverty, abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Infect Dis Poverty. 2019 Mar 4;8(1):15. doi: 10.1186/s40249-019-0525-9.

HIV prevalence in suspected Ebola cases during the 2014-2016 Ebola epidemic in Sierra Leone.

Liu WJ1,2, Hu HY3,4, Su QD5,4, Zhang Z6,4, Liu Y5,4, Sun YL7,4, Yang XD8,4, Sun DP9,4, Cai SJ10,4, Yang XX6,4, Kamara I11,4, Kamara A11, Lebby M11, Kargbo B11, Ongpin P12, Dong XP5, Shu YL5, Xu WB5, Wu GZ5, Gboun M12, Gao GF13,14,15.

Author information: 1 NHC Key Laboratory of Biosafety, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention(China CDC), Beijing, 102206, China. liujun@ivdc.chinacdc.cn. 2 Sierra Leone-China Friendship Biological Safety Laboratory, Freetown, Sierra Leone. liujun@ivdc.chinacdc.cn. 3 Jiangsu Provincial Center for Disease control and Prevention, Nanjing, 210009, China. 4 Sierra Leone-China Friendship Biological Safety Laboratory, Freetown, Sierra Leone. 5 NHC Key Laboratory of Biosafety, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention(China CDC), Beijing, 102206, China. 6 Beijing Institute of Biotechnology, Beijing, 100071, China. 7 Beijing Center for Disease Prevention and Control, Beijing, 100013, China. 8 Jilin Provincial Center for Disease control and Prevention, Changchun, 130021, China. 9 Shandong Provincial Center for Disease control and Prevention, Jinan, 250014, China. 10 Fujian Provincial Center for Disease control and Prevention, Fuzhou, 350001, China. 11 The Ministry of Health and Sanitation, Freetown, Sierra Leone. 12 UNAIDS, Freetown, Sierra Leone. 13 NHC Key Laboratory of Biosafety, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention(China CDC), Beijing, 102206, China. gaofu@chinacdc.cn. 14 Chinese Center for Disease Control and Prevention, Beijing, 102206, China. gaofu@chinacdc.cn. 15 CAS Key Laboratory of Pathogenic Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences (CAS), Beijing, 100101, China. gaofu@chinacdc.cn.




The 2014-2016 Ebola virus epidemic in West Africa was the largest outbreak of Ebola virus disease (EVD) in history. Clarifying the influence of other prevalent diseases such as human immunodeficiency virus infection and acquired immune deficiency syndrome (HIV/AIDS) will help improve treatment and supportive care of patients with EVD.


We examined HIV and hepatitis C virus (HCV) antibody prevalence among suspected EVD cases from the Sierra Leone-China Friendship Biological Safety Laboratory during the epidemic in Sierra Leone. HIV and HCV antibodies were tested in 678 EVD-negative samples by enzyme-linked immunosorbent assay. A high HIV prevalence (17.6%) and low HCV prevalence (0.22%) were observed among the suspected cases. Notably, we found decreased HIV positive rates among the suspected cases over the course of the epidemic. This suggests a potentially beneficial effect of an improved public health system after assistance from the World Health Organization and other international aid organizations.


This EVD epidemic had a considerable impact on the public health system and influenced the prevalence of HIV found among suspected cases in Sierra Leone, but also provided an opportunity to establish a better surveillance network for infectious diseases.

KEYWORDS: Ebola; HCV; HIV; Prevalence; Sierra Leone

PMID: 30827277 DOI: 10.1186/s40249-019-0525-9

Keywords: Ebola-Makona; West Africa; Sierra Leone; HIV; Hepatitis C.