Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Human cytomegalovirus wikipedia , lookup
Foot-and-mouth disease wikipedia , lookup
Taura syndrome wikipedia , lookup
Influenza A virus wikipedia , lookup
Hepatitis C wikipedia , lookup
Orthohantavirus wikipedia , lookup
Hepatitis B wikipedia , lookup
Canine distemper wikipedia , lookup
Canine parvovirus wikipedia , lookup
Henipavirus wikipedia , lookup
EBOLA 2014 OUTBREAK, EXPERIMENTAL TREATMENTS AND RISK MANAGEMENT 1 Presentation plan Virus and disease West African outbreak in 2014 Cases outside West Africa and experimental treatments Risk management Other treatments and vaccines 2 Virus and disease 3 Ebola virus = EBOV Family : Filoviridae, RNA virus, 5 species, specie now: Zaire Ebola Virus : ZEBOV Ebola virus disease (EVD): fatal hemorrhagic fever in humans and other mammals Ebola was discovered in 1976 in two outbreaks: one in Sudan and the other near the Ebola river in the Democratic Republic of Congo Scientists believe that bats are the natural reservoir for the virus http://www.who.int/mediacentre/factsheets/fs103/en/ 4 Transmission Rupa Kanapathipillai et al., N England J Med 2014 ; 371 5 Symptoms Ebola can only be spread to • Fever fatigue • Muscle pain others after symptoms • Headache begin. • Sore throat Symptoms can appear from 2 to 21 days after exposure. Followed by : • Diarrhea • Vomiting • Rash • Symptoms of impaired kidney and liver function • In some cases : internal and external bleeding cdc.gov 6 After diagnosis Quarantine Symptoms of Ebola are treated as they appear Providing IV fluids balancing electrolytes (body salts) Maintaining oxygen status and blood pressure Treating other infections if they occur Experimental vaccines and treatments for Ebola are under development Recovery from Ebola depends on good supportive care and the patient’s immune response Countries affected do not have the capacity to manage an outbreak of this size cdc.gov 7 Historic of outbreaks 8 West African outbreak in 2014 9 West African outbreak in 2014 Seems to have started in a village near Guéckédou, Guinea, where bat hunting is common. 10 West African outbreak in 2014 11 West African outbreak in 2014 12 West African outbreak in 2014 13 West African outbreak in 2014 14 West African outbreak in 2014 15 West African outbreak in 2014 CDC : last update October 25, 2014 16 Cases of Ebola outside West Africa and experimental treatments 17 Cases of Ebola outside West Africa 18 August, 2 2 aid workers (Dr Brantly), from Liberia, treated by Z-mapp, both recovered 19 3 humanized monoclonal antibodies Manufactured in tobacco plant Nicotiana benthamiana Z-mapp Mapp Biopharmaceutical, Kentucky BioProcessing subsidiary of Reynolds American, USA Experimental biopharmaceutical drug Under development as treatment for Ebola virus disease Tested in primates Not been subjected to a randomized clinical trial to prove its safety or its efficacy Tested in humans during the 2014 West Africa Ebola virus outbreak 9 persons treated: 5 recovered and 4 died Out of stock In trials : Z-mabs (Mapp) : similar to Zmapp 20 September 5, Dr Sacra, American, from Liberia August, 2 Treated with TKMEbola and Brantly’s blood 2 aid workers (Dr Brantly), from Liberia, treated by Z-mapp, both recovered 21 TKM-EBOLA (TKM 100802) Tekmira Pharmaceuticals, Vancouver with the department of USA defense 3 small interfering RNA (siRNA) cause the destruction of 3 proteins in Ebola virus Effectiveness in non human primates against Zaire Ebola virus (Geisbert et al., Lancet 2010 ; 375 : 1896) Clinical trials: Phase I: in January 2014 : safety, tolerability and PK, healthy subjects, single ascending dose tested Consortium TKM with WHO to provide a clinical trial in West Africa 22 Bloodtherapy Transfusion of serum of recovered infected patient Contains antibodies against Ebola virus Dr Brantly’s blood who recovered from the disease was used on compatible patients 23 September 5, Dr Sacra, American, from Liberia August, 2 Treated with TKMEbola and Brantly’s blood 2 aid workers (Dr Brantly), from Liberia, treated by Z-mapp, both recovered 7, Missionary Parajes from Liberia to Spain, treated by Z-mapp, died 22, missionary Garcia from Sierra Leone to Spain, treated by ? Died 24 September 5, Dr Sacra, American, from Liberia August, 2 2 aid workers (Dr Brantly), from Liberia, treated by Z-mapp, both recovered 7, Missionary Parajes from Liberia to Spain, treated by Z-mapp, died Treated with TKMEbola and Brantly’s blood 9 : French nurse from Liberia, treated (?), recovered - Favipiravir - Z-mapp - TKM-Ebola 22, missionary Garcia from Sierra Leone to Spain, treated by ? Died 25 = Avigan ® Favipiravir =T-705 Developed by FujiFilm subsidiary Toyama Chemicals Co., Japan Oral anti-viral against RNA viruses Approved against seasonal influenza Inhibits replication of Zaire Ebola Virus in cell culture In mouse model : effective even if initiated at day 6 post infection November: trials in Guinea Production to treat 20 000 potential patients 26 September 5, Dr Sacra, American, from Liberia August, 2 2 aid workers (Dr Brantly), from Liberia, treated by Z-mapp, both recovered 7, Missionary Parajes from Liberia to Spain, treated by Z-mapp, died Treated with TKMEbola and Brantly’s blood 30 : Mr Duncan, Liberian man, tested positive in Dallas, treated with brincidofovir 9 : French nurse from Liberia, treated (?), recovered - Favipiravir - Z-mapp - TKM-Ebola 22, missionary Garcia from Sierra Leone to Spain, treated by ? Died 27 Oral anti-viral drug active against DNA viruses Brincidofovir (CMX001) Chimerix (USA) In phase III for adenovirus and cytomegalovirus Potential treatment of Ebola virus disease shown in preliminary in vitro tests (RNA virus) Patient in US (Mr Duncan) received it but was very ill and died Approval by FDA in October 16 to start Phase II trials for Ebola (emergency investigational new drug applications) 28 October 8, Mr Duncan died September 5, Dr Sacra, American, from Liberia August, 2 2 aid workers (Dr Brantly), from Liberia, treated by Z-mapp, both recovered 7, Missionary Parajes from Liberia to Spain, treated by Z-mapp, died Treated with TKMEbola and Brantly’s blood 9 : French nurse from Liberia, treated (?), recovered 30 : Mr Duncan, Liberian man, tested positive in Dallas, treated with brincidofovir October: Contamination of 2 nurses Vinson and Pham, recovered - Favipiravir - Z-mapp - TKM-Ebola 22, missionary Garcia from Sierra Leone to Spain, treated by ? Died October: Contamination of spanish nurse Romero, treated with Z-mapp, recovered 29 Risk management 30 Outbreak control Prevention : Reduce the risk of wildlife-to-human transmission Contact with infected fruits, animals Animal products should be cooked Reduce the risk of human-to-human transmission Direct contact with people with Ebola symptoms Gloves, personal protective equipment Outbreak containment measures Prompt and safe burial of the dead Identifying people in contact and monitoring Who.int 31 Health-care settings Health-care workers have frequently been infected while treating patients Precautions: Basic hand hygiene Personal protective equipment Safe injection practices Safe burial practices Guidelines from CDC (USA), eCDC (Europe), Ministery of health (France) … procedure for personal protective equipment caring for suspect or confirmed patients environmental infection control in hospitals safe handling of human remains … Who.int 32 cdc.org 33 Other treatments 34 AVI-6002 Developped by Sarepta Therapeutics, Cambridge,USA Antisense drug Combinaison AVI-7537 and AVI-7539 against viral matrix proteins VP 24 and VP 35 Effectiveness in non human primates against Zaire Ebolavirus Phase I: favorable safety 35 cAd3ZEBOV Vaccine GSK (UK) Adenovirus carrying two genes of the Ebola virus Animal testing: production of proteins that stimulate the immune system to produce antibodies Fast tracked in human studies in August First Phase I in USA, UK and Mali Results by the end of 2014 If successful: vaccination of healthcare workers in Sierra Leone, Guinea and Liberia 36 VSV-ZEBOV Vaccine Developped by the Canadian National Microbiology Laboratory, collaboration with NewLink Genetics Vesicular stomatitis virus and Ebola gp provoke an immune response Protective efficacy against Ebola in animals (80-100 %) Phase I allows in USA, Canada results previous December 2014 October: 800-1000 vials sent to WHO: 3 shipments for precautions, (-80°), tested previous with volunteers from Germany, Switzerland, Gabon, Kenya 37 Conclusion 38 Conclusion Important Ebola outbreak Experimental treatments and vaccines USA, UK, France, Germany, Italy : discussion for organization : aid workers and resources 39 Thanks for your attention Any questions ? 40