Ebola

�鶹��Ƶ immunologist's new drug shows promise in treating Ebola

ullahnor — Wed, 22 Mar 2017 15:57:09 +0000

�鶹��Ƶ immunologist's new drug shows promise in treating Ebola

ullahnor Wed, 03/22/2017 - 11:57

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Two women in Liberia walk in front of a billboard enocuraging people to take steps to fight Ebola (photo by Emmanuel Tobey/UNMIL via Flickr)

Topic

Breaking Research

Ebola

Medicine

Immunology

Drugs

A pilot study of a class of drugs used to treat hepatitis and some forms of multiple sclerosis has been shown to ease symptoms of Ebola patients and increase their chances of survival.

The study, entitled, “Interferon ß-1a for the treatment of Ebola virus disease: A historically controlled, single-arm proof of concept trial,” was recently published in PLOS ONE.

Interferons are a family of naturally occurring proteins, produced in response to viral infections. They have widespread potential as therapeutic agents for the treatment of viral infections, and are currently used for chronic hepatitis B and C infections and some forms of multiple sclerosis (MS).

They inhibit viral infection by preventing viral entry into target cells and by blocking different stages of the viral replicative cycle for different viruses. And because they are already in use, researchers know that they have a favourable safety profile.

Since there is no vaccine or specific approved treatment for Ebola virus disease (EVD), there is a “moral obligation” to collect and share all data generated, to understand the safety and efficacy of any intervention and to evaluate promising interventions to inform future research, says Eleanor Fish, the senior author of the study and a professor of immunology at �鶹��Ƶ.

Eleanor Fish (fourth from left, bottom row) trained 11 Guinean health-care workers to do clinical trials during the pilot study (photo courtesy of Eleanor Fish)

To date, no treatments or post-exposure prophylaxis are available for Ebola. Clinical trials for several vaccines are in various phases, with promising published results in humans.

Nine individuals with Ebola virus were treated with Interferon ß-1a, and compared retrospectively with a matched cohort of 21 infected individuals receiving standardized supportive care at a treatment centre in Guinea, Africa, from March 26, 2015 to June 12, 2015.

When compared to patients who received supportive treatment only, 67 per cent of the Interferon-treated patients were still alive at 21 days. In contrast, 19 per cent of the supportive treatment patients survived at 21 days. Additionally, the blood cleared of the virus faster in patients treated with Interferon. Many clinical symptoms such as abdominal pain, vomiting, nausea and diarrhea also disappeared earlier in the Interferon-treated patients.

An additional 17 patients in other Guinean treatment centres who matched the Interferon-treated patients based on age and the amount of Ebola virus in their blood were included in the analysis. These patients, who did not receive Interferon, more than doubled their risk of dying as a result of not being treated with the drug.

“Despite the limitations of a single arm, non-randomized study, we infer from these data that Interferon ß-1a treatment is worth further consideration for the treatment of Ebola virus disease,” said Fish, who is also senior scientist at the Toronto General Hospital Research Institute, noting that the decision to undertake the clinical trial was based on previous preliminary scientific data and the fact that currently no approved antivirals exist to treat Ebola.

In earlier work on human cells led by Fish, researchers compared how eight different drugs, in different combinations and at different doses, were able to inhibit the Ebola virus. As a result of using a mini-genome system to rapidly evaluate drugs, the most potent inhibitor of Ebola turned out to be Interferon.

Fish also pointed out that the on-site team for this pilot study was composed of 11 Guinean health-care workers who received, for the first time, relevant training in all aspects of conducting a clinical trial according to international standards. This team is now working with Fish to monitor Ebola survivors and the impact of treatment with Interferon.

An original outbreak of Ebola virus disease that began in West Africa in December 2013, mainly affecting Guinea, Liberia and Sierra Leone has now ended, but the risk of sporadic cases remain.

More than 11,000 deaths occurred as a result of that outbreak, with a high mortality rate of the disease estimated at around 60 per cent. The World Health Organization (WHO) declared the outbreak in 2014-15 a public health emergency of international concerns, and it is the largest outbreak to date.

This pilot study was funded by the Canadian Institutes of Health Research and supported by the European Mobile Laboratory, a partner of the (WHO) Emerging and Dangerous Pathogens Laboratory Network and the Global Outbreak Alert and Response Network.

Zika virus shows desperate need for global health equity, says �鶹��Ƶ professor

sgupta — Tue, 05 Apr 2016 10:53:38 +0000

Zika virus shows desperate need for global health equity, says �鶹��Ƶ professor sgupta Tue, 04/05/2016 - 06:53

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The Zika virus is spread by the Aedes Aegypti mosquito (photo by Marcos Freitas via flickr)

Nicole Bodnar

Author legacy

Nicole Bodnar

Topic

Dalla Lana School of Public Health

Global

Two days following an announcement by the World Health Organization (WHO) that Ebola is no longer an international public health emergency, two �鶹��Ƶ public health leaders spoke to alumni about the latest global infectious disease epidemic, the Zika virus.

Among the subjects discussed by Dr. Ross Upshur and Dr. Vanessa Allen were Zika's link to microcephaly and whether the 2016 Summer Olympics should be cancelled.

“It’s not a coincidence that Ebola and Zika outbreaks happened in poor countries and poorer areas of developing counties," said Upshur, a professor of clinical public health at the Dalla Lana School of Public Health. "This underlines the desperate need for global investment in health equity.”

Close to 100 alumni, students and faculty attended In the Loop – the first of a new event series hosted by the Public Health �鶹��Ƶ Association where alumni, students and friends will learn about cutting-edge public health issues – on March 30 at the Dalla Lana School of Public Health.

“The biggest lesson learned from Ebola is that we need to create health systems on the basis of strong primary care with close links to public health,” Upshur continued, noting that WHO officials declared Zika a public health emergency much sooner than they did in the context of Ebola, which accelerated the response.

“Brazilian health authorities are handling this outbreak reasonably well by linking surveillance with public health action, which generates good data on which authorities can make informed policy decisions,” he said. "And we’re seeing better forward planning from neighbouring countries like Colombia, which is very promising.”

Allen, who is Public Heath Ontario’s chief microbiologist, explained that although many believed Zika arrived in South America during the 2014 World Cup in Brazil, a study published on March 24 in Science suggests the virus likely arrived in Brazil through increased travel patterns from the South Pacific region between May and December 2013, more than a year before the outbreak was detected.

The study – the first genomic analysis of Zika – was conducted by a large international team of researchers, including Dalla Lana associate professor Kamran Khan and assistant professor Marisa Creatore. Read more about the study in the Toronto Star.

Between 2013 and 2015, there have been more than 190,000 suspected and confirmed cases globally, with the vast majority occurring in rural areas of Brazil. Scientists believe that up to 80 per cent of people infected with Zika never experience symptoms, which means its link to microcephaly – a birth defect associated with underdeveloped brains – is particularly challenging to understand.

“Microcephaly has many potential causes and its connection to the Zika virus is an association,” said Allen, an assistant professor in �鶹��Ƶ’s department of laboratory medicine and pathobiology. “It’s not a proven fact that mothers infected with the virus will have babies with microcephaly.”

Before Zika, there were 100-150 microcephaly cases each year in Brazil. In 2015, there were more than 5,000 cases, Allen said.

Allen also touched on the sexual transmission of the virus. Scientists have found that the virus can be transmitted through sexual contact and it remains active in semen up to 62 days after symptom onset. She noted a handful of cases where females whose husbands had travelled to South America tested positive for the virus even thought they had not travelled anywhere affected.

This emerging sexual transmission link has important considerations for those of reproductive age attending the 2016 Summer Olympics in Rio de Janeiro.

“I don’t think the Olympics should be cancelled, but all athletes and visitors should consult public health organization websites for the latest information on how to reduce risks,” said Upshur, noting that it’s a dynamic situation and organizations such as the Public Health Agency of Canada and the Center for Disease Control and Prevention will have the most up-to-date information.

Regardless of the imminent influx of global Olympic travellers, health professionals and policy-makers consistently face challenges when making evidence-based decisions during epidemics because of the emerging nature of research. One student asked the speakers how public health professionals can overcome this challenge.

“During an infectious disease outbreak, strong relationships between government and public health agencies, like Public Health Ontario and the Ministry of Health, is particularly crucial,” said Upshur. Ontario has done a good job at creating systems with a two-way flow of knowledge and policy.”

(Visit flickr to see the original of the photo used at top)

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�鶹��Ƶ public health students send Ebola equipment to Sierra Leone hospitals

sgupta — Tue, 13 Jan 2015 11:12:47 +0000

�鶹��Ƶ public health students send Ebola equipment to Sierra Leone hospitals sgupta Tue, 01/13/2015 - 06:12

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students Tonya Campbell, Courtney Smith and Garvin Leung spearheaded the delivery of Ebola protective equipment to Sierra Leone (photo by Nicole Bodnar)

Nicole Bodnar

Author legacy

Nicole Bodnar

Topic

Dalla Lana School of Public Health

Collaboration

Global

Front-line health workers in Sierra Leone now have protective equipment, thanks to three University of Toronto public health students.

Working with Save the Children – a global NGO dedicated to children’s rights – three first-year epidemiology students in �鶹��Ƶ’s Dalla Lana School of Public Health successfully facilitated the delivery of masks, gloves, disinfectant and other much-needed Ebola protective supplies to Njala University in Bo, Sierra Leone.

“The growing mentality is that the Ebola outbreak is over. It’s not,” said Courtney Smith, a member of the occupational preparedness subgroup of the Ebola Working Group and master of public health candidate in the Dalla Lana School of Public Health (DLSPH).

“To stop the outbreak, it’s crucial to support occupational preparedness in the countries most affected,” Smith continued, noting that December 2014 marked the one-year anniversary of the first identified Ebola case linked to the current outbreak.

Smith and her Occupational Preparedness subgroup peers, Garvin Leung and Tonya Campbell, reached out to Workplace Health Without Borders (WHWB) in late October with the support of Professors Ross Upshur, head of the School’s clinical public health division, and David Fisman. WHWB – a local NGO led by DLSPH lecturer Marianne Levitsky – was approached by Njala University with a list of needs.

“With so many different hospitals and organizations asking for help, we wanted to be a voice for Njala University and help it acquire the protective equipment it desperately needed,” said Leung, adding that Njala University has teaching hospitals in the hardest hit areas of the Ebola outbreak.

With a tangible goal in mind, the group then contacted 10 Canadian NGOs to see who could purchase or donate the supplies. Save the Children Canada responded within weeks and connected the group with their Sierra Leone office, which shipped the supplies to Njala University the first week of January.

“On behalf of the staff and students of the School of Community Health Sciences… I wish to express my profound gratitude and appreciation for the positive response of all partners to our request,” wrote Bashiru Koroma, dean of Njala University’s School of Community Health Sciences in an e-mail to DLSPH’s Ebola Working Group.

“Our professors stress that public health is an interdisciplinary field. This has given us first-hand, global experience collaborating with people in different sectors towards one common goal: containing the West African Ebola outbreak,” said Campbell, who also works at Toronto East General Hospital as an infection prevention and control data analyst.

The DLSPH Ebola Working Group also has a community outreach subgroup that hosts a bi-weekly Lunch and Learn series. The first event, on Friday, January, 16 (12-1pm, Health Sciences Building, Room 108), will feature Professors Upshur and Fisman discussing the Ebola outbreak.

Learn more about how DLSPH faculty, students and alumni are helping curb the Ebola outbreak.

Nicole Bodnar is a writer with the Dalla Lana School of Public Health at the University of Toronto.

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Fighting Ebola in West Africa: alumna Stefanie Carmichael

sgupta — Tue, 16 Dec 2014 13:19:44 +0000

Fighting Ebola in West Africa: alumna Stefanie Carmichael sgupta Tue, 12/16/2014 - 08:19

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Alumna Stefanie Carmichael works for the United Nations Mission for Ebola Emergency Response (all photos courtesy Stefanie Carmichael)

Terry Lavender

Author legacy

Terry Lavender

Topic

Subheadline

"When I was called to join the Ebola response, I couldn’t say no"

Reactions to the ongoing Ebola crisis in West Africa have been varied – from cancelled flights to highly-publicized quarantines to heroic efforts by nurses and doctors to treat the afflicted. Many people are trying to help out however they can, including Stefanie Carmichael, a �鶹��Ƶ alumna now working for the United Nations.

Carmichael recently left a communications position at U.N. headquarters in New York to return to Africa, where she’s working with an Ebola response team. Writer Terry Lavender interviewed her by email about her new role.

What is your role in Ghana?
I work as a public information officer with the United Nations Mission for Ebola Emergency Response (UNMEER). We are a small team that helps get the word out about what all of the Ebola Response partners – UN and other – are doing to stop the outbreak. We try to both help raise awareness about the situation, and also keep up the momentum and public support for all of our partners, so that they have the resources they need to keep up the fight.

How long will you be in Ghana?
UNMEER was created due to the urgent need for fast action, but we don’t plan on being here long. As soon as the outbreak is under control, all of us at UNMEER will pack up and go. That’s not to say the work will be over – there is going to be a long recovery process after everything these countries have been through – but the emergency needs will have been met.

What are conditions like there?
Ghana is actually a nice change from some of the other places I’ve lived in, like Libya and the Democratic Republic of the Congo, where we were under curfew and sometimes couldn’t leave our compounds. We don’t need armoured cars in Ghana. You can walk in the streets here and not feel threatened. The people here – and throughout West Africa – are amazing and it doesn’t take long before you start to feel at home.

Why did you go to Ghana to fight Ebola?
I had been living in Africa for almost eight years and thought it would be nice to be closer to my family in Toronto again, so I accepted a short-term position in New York this summer. But when I was called to join the Ebola response, I couldn’t say no. Especially as I used to work for the UN Mission in Liberia (UNMIL), the issue and the people it was affecting were very close to my heart. My family and my team in New York understood that I had to go.

What did you study at �鶹��Ƶ?
I did my honours bachelor of arts at �鶹��Ƶ from September 2000 to June 2004. My majors were political science and African studies. I went on to do my master's in international development studies in Halifax, but �鶹��Ƶ is in my blood – my mom, Annamarie Castrilli, is a former chair of the Governing Council of �鶹��Ƶ and my father, brother and sister all went to St. Mike’s, too.

Did �鶹��Ƶ help prepare you for your current career?
In my second year, I was living on campus with some students from Tanzania. They kept telling me such amazing stories about their country that over Christmas break I decided to go visit. I was 19 and my parents thought I was nuts – I think they even called the RCMP when they didn’t hear from me for the first few days – but it was the best experience. I came back, added a major in African studies to my program, started volunteering with NGOs all over the place, even started studying Swahili at New College, and never looked back. I really do owe my career to the diversity of �鶹��Ƶ and those international students that I used to live with.

Any other �鶹��Ƶ alumni helping out with the current mission?
So far, I’ve met one �鶹��Ƶ alum, Noah Sempiira, who also works with UNMEER doing information management in Sierra Leone. He’s in the epicentre of the Ebola outbreak right now and helping with things like contact tracing to make sure we contain the virus as fast as we can.

Is it important for people in the West to help with the fight against Ebola? What can we do?
We’ve already seen Ebola spread to other countries, including the U.S., and the chances of more countries, including Canada, to see some cases is not unlikely given air travel these days.

But even if Canada wasn’t at risk, even if it was somehow guaranteed that Ebola would never leave this continent, I think we have a responsibility as fellow human beings to care. It’s cliché but it’s why I do what I do. And the great thing is that caring doesn’t even have to take much. Sure, people can volunteer as healthcare workers or donate money to any of the Ebola response partners, but it could also be as simple as sending message of thanks to people on the frontlines, or writing to Prime Minister Harper to say you support Canada’s involvement in the response efforts. All of those little things will add up and help us end this thing faster. Plus, I like when Canada steps up because then I get to brag a little over here!

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Ebola: understanding when to quarantine

sgupta — Fri, 07 Nov 2014 15:40:55 +0000

Ebola: understanding when to quarantine sgupta Fri, 11/07/2014 - 10:40

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A bio safety officer evaluates two students as they sanitize their personal protective equipment during training at the San Antonio Military Medical Center in Texas, Oct. 24, 2014. (Department of Defense photo by Army Sgt. 1st Class Tyrone C. Marshall Jr

Liam Mitchell

Author legacy

Liam Mitchell

Topic

To quarantine or not to quarantine?

That is the question that surrounded nurse Kaci Hickox after she returned to the United States from Sierra Leone where she treated Ebola patients. While some (notably New Jersey Governor Chris Christie) insisted that she be quarantined for 21 days, others, including an editorial from the New England Journal of Medicine, argued that position isn’t supported by the underlying science. The controversy has raised ethical considerations about when quarantine is justified and how best to carry it out.

Writer Liam Mitchell discussed the subject with University of Toronto bioethicist Dr. Ross Upshur, a member of the World Health Organization expert panel on Ebola ethics. A professor in the department of family and community medicine, the Dalla Lana School of Public Health and the �鶹��Ƶ Joint Centre for Bioethics, as well as scientific director of the Bridgepoint Collaboratory in Research and Innovation, Upshur holds the Canada Research Chair in Primary Care Research.

What is quarantine?
First it’s important to separate the ideas of “isolation” and “quarantine.” They’re often considered synonymous, but they’re not. “Isolation” is when someone who is known to be sick is separated from the general public. Just about every jurisdiction recognizes this as necessary to safeguard the public. A “quarantine” is when someone who has been exposed to an illness, but isn’t sick yet, is kept away from the general public during the incubation period to see if they become ill.

So why shouldn’t we quarantine everyone who has been potentially exposed to Ebola?
We know a lot about the transmission of Ebola. For example, we know that someone with Ebola doesn’t become infectious until after they first show symptoms of the disease. Fever is the first reliable sign of infection. So if someone who may have been exposed to Ebola regularly monitors his or her temperature, at the first sign of an increase in their temperature, they should seek medical assessment and enter isolation if deemed necessary. Until that point, they don’t pose a threat to public health.

Can we trust everyone to accurately self-monitor and report their conditions?
This is an important point that I think was missed in the New England Journal of Medicine editorial. We assume returning health care workers will be reliable and truthful in their conduct, particularly with regard to symptom monitoring. However, until we have reason to believe people are being deceptive, we have to give them the benefit of the doubt. Once they are found to be deceptive, however, that’s when we can justify more stringent measures being taken.

Who makes the decision about whether isolation or quarantine is necessary?
In Ontario the decision to enforce isolation or quarantine is made by the medical officer of health. I often say they are one of the most important positions in a democracy and also one of the most powerful. Under the Ontario Health Protection and Promotion Act, if a medical officer believes a communicable disease exists – or may exist – he or she has the power to order people detained, have the premises closed, order that people be examined by a physician; a wide range of steps that may be necessary to protect the public. Although such powers are rarely used, it is important that they exist and that they be used judiciously. In addition, physicians have a duty to report people who are diagnosed with communicable diseases to the medical officer of health. This includes Ebola, but also TB, HIV/AIDS, West Nile and others.

When it’s determined a quarantine is necessary, what are the ethical considerations?
I had the opportunity to reflect on that after the SARS outbreak in Toronto. As someone with public health training, I was asked to join the York Region Public Health response to SARS and found myself on the frontlines enforcing quarantine orders. In that circumstance, we didn’t know a lot about SARS – how it spread, what was the incubation period – all things we know with Ebola. In a paper I wrote after that experience, I argued that there are four principles that should guide our action: the harm principle, proportionality, reciprocity and transparency. First, we should only take action to prevent a greater harm to society. Second, we should use the least restrictive or coercive means necessary. Third, we have a duty to ensure that those in quarantine receive appropriate care and ensure their needs are met. And finally, the decision made needs to be clear and accountable.

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�鶹��Ƶ team launches search for new Ebola treatments using artificial intelligence

sgupta — Wed, 05 Nov 2014 09:34:11 +0000

�鶹��Ƶ team launches search for new Ebola treatments using artificial intelligence sgupta Wed, 11/05/2014 - 04:34

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“What we are attempting would have been considered science fiction, until now,” says Abraham Heifets

Michael Kennedy

Author legacy

Michael Kennedy

Topic

Global Lens

Ebola: controlling outbreak in West Africa most effective way to decrease international risk, paper says

sgupta — Tue, 21 Oct 2014 11:15:42 +0000

Ebola: controlling outbreak in West Africa most effective way to decrease international risk, paper says sgupta Tue, 10/21/2014 - 07:15

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Placing international travel restrictions on countries with high rates of Ebola could compromise efforts to control the outbreak, says Associate Professor Kamran Khan (photo by Nelson L via Flicker)

Leslie Shepherd

Author legacy

Leslie Shepherd

Topic

Breaking Research