Now, a 10-min strip test for Ebola, dengue

New Delhi: Researchers at the Massachusetts Institute of Technology have created a simple paper strip device similar to a pregnancy test capable of diagnosing Ebola and viral hemorrhagic fevers such as yellow fever and dengue fever, described in a paper that appears in the journal Lab on a chip. “As we saw with the recent Ebola outbreak, sometimes people have symptoms and it’s not clear what they have,” said Kimberly Hamad-Schifferli, a visiting scientist in MIT’s department of mechanical engineering and a member of the technical staff at MIT’s Lincoln Laboratory.

 “We wanted to come up with a rapid diagnostic that could differentiate between different diseases,” Hamad-Schifferli added in a statement. Ebola diagnostic kits used in West Africa send patient blood samples to a lab that can perform advanced techniques such as polymerase chain reaction (PCR), which can detect genetic material from the Ebola virus. The whole process takes around two hours, while the paper test can diagnose the viral in 10 minutes. 

“For many hemorrhagic fever viruses, like West Nile and dengue and Ebola, and a lot of other ones in developing countries, like Argentine hemorrhagic fever and the Hantavirus diseases, there are just no rapid diagnostics at all,” said Lee Gehrke, a professor at MIT’s Institute for Medical Engineering and Science (IMES), in a press release by MIT. The MIT strips are colour-coded in a way that they can differentiate between several diseases. Researchers used triangular silver nanoparticles that can take on different colours. They used red, orange, and green nanoparticles and linked them to antibodies that recognize Ebola, dengue fever, and yellow fever. 

When the patient’s blood serum is dropped on the strip, any viral proteins that match the antibodies painted on the stripes will get caught, and those nanoparticles will become visible. “When we run a patient sample through the strip, if you see an orange band you know they have yellow fever, if it shows up as a red band you know they have Ebola, and if it shows up green then we know that they have dengue,” Hamad-Schifferli explained. The researchers are expecting to get the approval of Food and Drug Administration to begin using the device in areas where the Ebola outbreak is still ongoing. 

Ebola crisis: World 'dangerously unprepared' for future pandemics

THE president of the World Bank has warned that the world is "dangerously unprepared" for future deadly pandemics like the Ebola outbreak in West Africa.

Jim Yong Kim, speaking in Washington, said it was vital that governments, corporations, aid agencies and insurance companies worked together to prepare for future outbreaks.

He said they needed to learn lessons from the Ebola crisis.

More than 8,500 people have died, most in Sierra Leone, Guinea and Liberia.

"The Ebola outbreak has been devastating in terms of lives lost and the loss of economic growth," Mr Kim told an audience at Georgetown University.

"We need to make sure that we get to zero cases in this Ebola outbreak. At the same time, we need to prepare for future pandemics that could become far more deadly and infectious than what we have seen so far with Ebola. We must learn the lessons from the Ebola outbreak because there is no doubt we will be faced with other pandemics in the years to come."

Mr Kim said the World Bank Group had been working with the World Health Organisation (WHO), other UN agencies, academics, insurance company officials and others to work on a concept of developing a financial "pandemic facility".

He said he expected a proposal for this to be presented to leaders of developed and developing countries in the coming months.

Mr Kim said the proposal would probably involve a combination of bonds and insurance plans but that, in some ways, the facility could be similar to a homeowner's insurance policy.

"This could work like insurance policies that people understand, like fire insurance," he said.

"The more that you are prepared for a fire, such as having several smoke detectors in your house, the lower the premium you pay.

"The more that countries, multi-lateral institutions, corporations and donors work together to prepare for future pandemics - by building stronger health systems, improved surveillance and chains of supply and transportation, and fast-acting medical response teams - the lower the premium as well.

"That would benefit donors and others who would pay the premium, but the greatest benefit would be that market mechanisms would help us to push improvements in our preparedness for epidemics."

He said that one possible outcome of a pandemic facility would be a stronger World Health Organisation. He said disease-control agencies in developing countries could also develop greater capacity.

Mr Kim said informal talks on the subject had also been held at last week's World Economic Forum in Davos, Switzerland.

His talk, "Lessons from Ebola: Toward a post-2015 strategy for pandemic response", was the inaugural Global Futures Lecture at Georgetown.

Correspondents say there is general acknowledgement among governments and global health agencies that the international response to the Ebola crisis was belated and disorganised.

The WHO recently announced a series of reforms, admitting that it had been too slow to respond to the outbreak in West Africa.

At an emergency session in Geneva, director-general Margaret Chan said Ebola had taught the world and the WHO how they must act in the future.

She said the corner had been turned on infections but warned against complacency.

Reforms announced included a dedicated contingency fund "to support rapid responses to outbreaks and emergencies".

There would also be improvements in international co-ordination and greater support for countries that needed to respond quickly to emergencies.

Another Ebola battle won

On January 18, the World Health Organization and the Malian government declared Mali free of the Ebola virus disease. Mali is the third country after Nigeria and Senegal to become free of the deadly disease. A country should have had no new cases of Ebola for a continuous period of 42 days, which is a cycle of two incubation periods of 21 days, for it to be declared free of the virus. This is a particularly remarkable achievement for Mali, given the fact that it shares a porous, 800-km-long border with Guinea. After all, on December 26, 2013, the first case of Ebola virus that led to the unprecedented crisis in West Africa was found in a remote village in Guinea. 

Also, Mali became the sixth West African country to record a case of Ebola when a two-year-old girl with symptoms arrived from Guinea in October last year. Even in this moment of victory, Mali has to remember that it has now only won a battle. As long as the war against Ebola remains unfinished in West Africa as a whole, Mali must not lower its guard as new cases can always come up. After all, the country once experienced a similar situation in November 2014 when it came so close to being declared free of the Ebola virus, before a “second wave” of infections delayed such a declaration.

 The good news is that there has been a “turning point” in the Ebola crisis with the number of new cases reported in the three worst-affected countries — Liberia, Sierra Leone and Guinea — falling in recent weeks. According to the WHO, as on January 21, 2015 all of 8,683 people have died of Ebola, and the number of cases so far is more than 21,759.

In all, if only eight cases and six deaths occurred in Mali, which are fewer than Nigeria with 20 cases and eight deaths, the reason for that is the unprecedented efforts to contain the disease from the very beginning. Starting with tracing every person who had come in contact with the sick girl on her journey from Guinea and, at one point, placing nearly 600 people under daily observation, the government, health workers and citizens acted aggressively to stamp out the disease before it turned into a crisis situation. 

The massive public awareness campaign, monitoring along the border, a fully geared public health system and precautions taken by people on their own helped Mali to stamp out the virus. Of course, the sombre awareness of the crisis playing out in the three worst-affected countries had a major role to play in this process. India has a lesson to learn from the way Nigeria and Mali have handled the Ebola outbreaks. 

Though some vital precautionary steps were taken, the small number of centres that are capable of testing for the virus and the lack of quarantine facilities at major airports indicate a low level of preparedness to counter the virus.

Ebola is mutating; could evade current treatment

Researchers over at US Army Medical Research Institute of Infectious Diseases (USAMRIID) have found that the Ebola strain as we currently know it is mutating and several identified mutations will interfere with effectiveness of drugs and vaccines against the deadly virus.

Jeffrey Kugelman, the lead author of the study titled “Evaluation of the Potential Impact of Ebola Virus Genomic Drift on the Efficacy of Sequence-Based Candidate Therapeutics” published in mBio, said that the “The (Ebola) virus mutates rapidly and it`s an ongoing concern.”

In the study researchers have described the “genomic drift” or natural evolution of the virus and how it could interrupt the action of potential therapies designed to target the virus’ genetic sequence.

The researchers analysed three types of genetic sequence-based treatments currently evaluated for Ebola including monoclonal antibody; small-interfering RNA; and phosphorodiamidate morpholino oligomer drugs. All these three treatments have been developed using Ebola virus strains from two smaller outbreaks that occurred in 1976 and 1995.

USAMRIID team collaborated with investigators from Harvard University and the Massachusetts Institute of Technology to compared the current Ebola strain known as EBOV/Mak, with the two previous strains that caused outbreaks in 1976 and 1995. Researchers found more than 600 genetic mutations, which account for about three percent of the genome.

Researchers found 10 new mutations that might interfere with the mechanisms of the sequence-based drugs currently being tested and that three of these mutations appeared during the current West African outbreak.

“Ten of the observed mutations modify the sequence of the binding sites of monoclonal antibody (MAb) 13F6, MAb 1H3, MAb 6D8, MAb 13C6, and siRNA EK-1, VP24, and VP35 targets and might influence the binding efficacy of the sequence-based therapeutics, suggesting that their efficacy should be reevaluated against the currently circulating strain”, the study abstract notes.

“The virus has not only changed since these therapies were designed, but it`s continuing to change,” Kugelman said. “Ebola researchers need to assess drug efficacy in a timely manner to make sure that valuable resources are not spent developing therapies that no longer work.”

So far, there have been more than 21,000 Ebola cases with more than 8,300 deaths since the outbreak began last year in Liberia, Sierra Leone and Guinea, according to the WHO.

Why the Obamas’ State of the Union guest is ‘cautiously optimistic’ on Ebola

A doctor back from the front lines of the Ebola epidemic in west Africa will sit with first lady Michelle Obama during the president’s State of the Union Address on Tuesday

Dr. Pranav Shetty is the global emergency health coordinator for the nonprofit International Medical Corps, which the White House called “a critical partner in the U.S.-supported effort to bring the Ebola epidemic under control in west Africa.” He will join nearly two dozen other strategically selected guests in the first lady’s box, including a 13-year-old who wrote a letter asking Santa Claus for safety, an astronaut and a man who spent five years behind bars in Cuba. Each personifies a key piece of the president’s agenda; most are expected to be mentioned or shown during important applause points in the president’s speech.

Shetty — who will likely signify the Obama administration’s continuing commitment to ending the outbreak — deployed to Liberia last August to help establish and oversee two Ebola treatment units and a training center for health care workers. He arrived back in the U.S. in December.

The PBS NewsHour caught up with Shetty at a breakfast honoring Ebola health care workers at the U.S. Capitol on Tuesday. Hosted by the Paul G. Allen Family Foundation and its #TackleEbola Campaign, the event highlighted the need for sustained investment from the international community and paid tribute to a number of famous survivors of the epidemic, including Dr. Kent Brantly and Nancy Writebol, American health workers who contracted the virus in Liberia and were successfully treated in the United States.

Afterward, Shetty told the NewsHour he’s “cautiously optimistic” about the current international response and shared some thoughts on how the world can achieve “zero new infections” in the coming months. He also described what he expects to find when he travels to Guinea — another Ebola hotspot in west Africa — later this week.

Watch a clip from the interview above, and read the full transcript below.

Dr. Pranav Shetty is the global emergency health coordinator for International Medical Corps, a partner in the U.S.-backed effort to control the Ebola outbreak in West Africa. Photo by International Medical Corps

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PBS NEWSHOUR: How would you assess the current international response to the Ebola crisis?

DR. PRANAV SHETTY: Well I think the international response has gone through stages since the beginning — since the middle of last year. It’s certainly ramped up very quickly. We’re in a stage now that we’re at kind of the cautious optimism stage. We’re very much aware that we really need to get to zero cases to get to the end of this outbreak. And campaigns like the #TackleEbola Campaign really keep the attention there that needs to be there to fund and support the overall response. There’s also the sense that we can’t be complacent at this time. So really, what our strategy now is is to focus on our successes and build up those until we get to zero cases in the region.

PBS NEWSHOUR: What needs do you feel aren’t being met on the ground?

DR. PRANAV SHETTY: Well I think the needs are shifting. The focus on the response now needs to focus more on one of preparedness and health system strengthening for the future. I think we know that in this age of globalization and emerging infectious diseases, something like this epidemic could surface again in any region in the world, and especially in west Africa, where the health systems are inherently weak. So the response now needs to turn to one of preparedness. And strengthening the health system to deal with these types of crises in the future.

PBS NEWSHOUR: How, specifically?

DR. PRANAV SHETTY: There are a lot of components to a health system, and when we talk about health system strengthening in general, there are a lot of different pillars that needs to fall upon. I think we need to focus on health worker training in the region, to make sure people are educated and aware of these types of illnesses, so they can be recognized sooner. I think we need to work on surveillance systems, so cases are detected early and identified early so they can be taken care of. And then we also need to work on the back end, with the care of patients, because if we can provide good care to patients, then the trust will be there in the community, within their health system and within their own authorities and their health systems. So it’s a very kind of broad range or response that really needs to be a concerted effort to make sure that it moves forward as one movement or one piece.

PBS NEWSHOUR: Zero new infections seems like an ambitious goal in the short-term. How long do you think that’s going to take?

DR. PRANAV SHETTY: The length of time is difficult to predict. The focus now needs to be on moving forward as aggressively as possible, and really building off the gains that have been had in the past few months. To get to zero cases, we just need to focus on the pillars of the response that we had been focusing on. As an international community, as a national community, as a public health system, as humanitarian workers, we know what to do and we’re focusing on how to do that most effectively. The pillars of responsibility include early case finding and case detection, case identification, isolation and treatment of those cases, the surveillance part — which is the contact tracing and making sure cases are identified as soon as possible, working on burials to make sure that burials are done in a safe and dignified fashion, and all underpinned by a social mobilization and community engagement. Because these cases start in the community, and to address these types of issues, it has to be community-led and community-driven. And with that package of interventions, we will get to zero cases, as we have in every ebola outbreak in the past.

PBS NEWSHOUR: What do you expect to find in Guinea. You’re going there later this week, correct?

DR. PRANAV SHETTY: I think the setting for each Ebola outbreak is different. It’s different in every country. There are different social factors and cultural factors that have allowed Ebola to spread in each of these countries. And so I think what we need to do is we know the pillars of our response. As International Medical Corps, we are focused on those pillars in the best way that we can. And I think that it’s adapting this response to the particular context. And so what we expect to find is a different situation than we saw in some of the other locations I’ve been. And we’ll do the best we can to address the issues as effectively as possible.

PBS NEWSHOUR: And finally, you’re going to be sitting with the First Lady tonight. What do you hope the president is going to say about the Ebola crisis?

DR. PRANAV SHETTY: I hope that the administration recognizes the value of their contribution so far. I think without this huge intervention on the part of the United States government, and USAID, we would not be at the stage we are now, which is the optimistic stage. We see the end in sight, and we really want to work towards that. And I really hope that the administration focuses on continuing the effort, making sure that we aren’t complacent and that this is the time to really ramp up as much as possible and stamp out the remaining cases to get to zero.