Ebola in Africa: U-M experts available to discuss
Ebola in the Democratic Republic of Congo has spread from rural Bikoro to Mbandaka, a city of 1.2 million on the Congo River, and health officials have begun distributing an experimental vaccine. University of Michigan experts are available to discuss the outbreak.
Patricia Abbott, associate professor at the School of Nursing, served on a national expert panel convened by Texas Health Resources to analyze the response of Texas Health Presbyterian Hospital Dallas, where the first case of Ebola was diagnosed in the U.S. four years ago.
“Ebola usually takes longer to transmit from human-to-human as villagers travel slowly from town-to-town. But now, it’s entered an ‘expressway’ called the Congo River, and the disease and its transmission are just a boat trip away from thousands of people,” she said. “Similarly, the ease with which Thomas Duncan was able to transfer the first case of Ebola to the U.S. in 2014 was enabled by rapid plane transport, from Liberia to Dallas. What was constrained in West Africa in 2014 to some extent by geography was accelerated by a 747 airliner. What I see in the DRC is similar, with the Congo River serving as the transmission expressway.
“Acute situational awareness will be required to control this. That is gained by immediate and intense public awareness heightening, combined with containing the risk, which will be difficult due to the DRC’s porous borders and an uncontrolled river. It will also require huge communication efforts to get the word out to the populace. Here in the U.S., we need to heighten our own awareness and be prepared for the next person to innocently step off of an international flight and turn our emergency departments upside down—again.”
Abbott on the importance of situational awareness:
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Sue Anne Bell, clinical associate professor at the School of Nursing, is an expert on the health effects of disasters and the impact of climate change on human health. She is interested in the long-term impact of disasters on women’s health, and has practiced nursing and conducted research in Africa, Asia and the Caribbean.
“As reports emerge that a nurse has died after contracting Ebola, it’s important to consider that health care providers are at the highest risk for contracting Ebola because of the risks of coming in contact with contaminated bodily fluids,” she said. “Challenges in accessing and using personal protective equipment are often at the heart of this. Preparedness and education is key to preventing these deaths.”
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Wei Cheng, associate professor of pharmaceutical sciences at the College of Pharmacy, can address questions on the Ebola vaccine development. His lab develops and applies single-molecule techniques to fundamental questions in biology and disease, with a focus on mechanisms of viral infection and recognition by the immune system.
“The Ebola vaccine, called rVSV-ZEBOV, to be distributed in Africa, is a virus-based recombinant vesicular stomatitis vaccine that expresses the surface antigen of the Zaire Ebola virus,” he said. “Previously in a randomized trial of this vaccine that involved over 4,000 participants in Guinea, this vaccine was proven to approach 100 percent efficacy with only minor adverse reactions. This result is highly significant and suggests that benefits associated with this vaccine likely significantly outweigh all the known risks.”
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Peter Jacobson, professor of health management and policy at the School of Public Health, can discuss the legal issues involving the spread of infectious diseases, including quarantine. His research focuses on the relationship between law and health care delivery, law and public health systems, and health equity. He commented on tensions after the 2014 Ebola outbreak, when several states imposed quarantines exceeding guidelines from the federal Centers for Disease Control and Prevention.
“The tension between due process protections and political concerns about the spread of disease animated the 2014 response,” he said. “I don’t think much has been resolved or changed since then. Perhaps public health practitioners will be more forceful in asserting due process concerns while protecting the public from the spread of Ebola.”
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Laraine Washer, associate professor of infectious diseases and a hospital epidemiologist at Michigan Medicine, led infection control for the U-M Health System during the 2014 outbreak.
“The WHO and DRC health ministries have reported they are employing a number of public health responses to control the Ebola virus disease outbreak in the Democratic Republic of the Congo,” she said. “These include early diagnosis of patients with Ebola infection and infection-prevention practices to limit spread to others, including safe care of patients in the health care and home environment and focus on safe burials.
“They are also targeting identification of persons who had contact with patients infected with Ebola so they can be followed for symptoms of infection. They are engaging expert international partner organizations to set up Ebola treatment centers and doing ring vaccination to those at greatest risk, including contacts of patients with Ebola virus disease and health care workers.
“Vaccination has significant promise to limit transmission of the Ebola virus disease within a population but the deployment of vaccine in the DRC is the first use outside of a clinical trial. The vaccine only provides protection before Ebola virus infection has occurred and information on the extent of the outbreak in the DRC is still limited.”
Michael Imperiale, professor of microbiology and immunology, can discuss the potential efficacy the Ebola vaccine and how likely it is for Ebola to spread.
On the vaccine’s potential effectiveness:
“In a trial at the end of the 2014-15 outbreak, in which they did ring vaccination (i.e., vaccination of people surrounding individuals who have confirmed infections), researchers reported 100 percent efficacy of this vaccine. So, I think it will work.,” he said.
On the likelihood of Ebola spreading:
“That’s hard to answer. Since it can take up to three weeks for symptoms to appear, a person can get on a plane or use other mode of travel before they know they are infected,” he said. “You may recall that this happened during the last outbreak.
“I know that the WHO has monitoring in place at Mbandaka airport and the port there. The question is, then, how likely is a person to have come in contact with a contagious individual, get infected and move around before getting sick themselves. DRC has had Ebola in the past and they are better prepared to deal with it than West Africa was in 2014-2015, not to mention that new procedures were put into place by the WHO after the West Africa outbreak.”