TIME Infectious Disease

Ebola Vaccines Are Being Expedited

Professor Adrian Hill, Director of the Jenner Institute, and Chief Investigator of the trials, holds a phial containing the Ebola vaccine at the Oxford Vaccine Group Centre for Clinical Vaccinology and Tropical Medicine (CCVTM) in Oxford, southern England on Sept. 17, 2014.
Professor Adrian Hill, director of the Jenner Institute and chief investigator of the trials, holds a vial containing the Ebola vaccine at the Oxford Vaccine Group Centre for Clinical Vaccinology and Tropical Medicine in Oxford, southern England, on Sept. 17, 2014 Steve Parsons—Reuters

"Nothing can be allowed to delay this work"

International experts want a fully tested and licensed Ebola vaccine scaled up for mass use in the near future, according to a recent World Health Organization (WHO) meeting.

WHO organized a panel of more than 70 experts, from scientists to medical ethicists, to reach consensus over the status of Ebola vaccines currently being tested. WHO released news from the meeting on Wednesday, the day after the U.S. confirmed its first patient with Ebola. According to the WHO statement, the mission is to “accomplish, within a matter of months, work that normally takes from two to four years, without compromising international standards for safety and efficacy.”

Two vaccines have great potential and are ready for safety testing. The first vaccine is developed by the U.S. National Institute of Allergy and Infectious Diseases (NIAID) and GlaxoSmithKline. That vaccine is currently undergoing a human-safety trial at the National Institutes of Health (NIH) campus in Bethesda, Md., as well as at the University of Oxford. The second vaccine is under development by the Public Health Agency of Canada in Winnepeg. That vaccine will start a human-safety trial in early October. Canada has already donated 800 vials of their vaccine to WHO, the organization says. Once more data is available on what dosing should be used, WHO says these vials could translate to around 1,500 to 2,000 doses of the vaccine.

The goal of the safety trials is to confirm that the vaccines are safe enough to move on to a larger human trial. Dr. Anthony Fauci, director of NIAID and the lead on the NIH vaccine, tells TIME the safety trial is so far “uneventful,” which is a good thing. “There really [are] no red flags so it seems to be going along quite well,” he says. The vaccine had already been tested in monkeys and showed very promising results.

WHO and other organizations have been expediting the testing and approval processes for these drugs since early summer, but the NIH’s vaccine has been under development since 2003. At the time, it did not have the pharmaceutical funding to move forward. “[In 2003] there was very little interest for the obvious reasons that there was no disease around,” says Fauci. “Recently, we now have a much more vigorous interest from pharmaceutical companies.”

WHO hopes that in October and November, the vaccines will make it through their safety trials and into next-stage human testing. Between January and February 2015, the goal is to have next-phase human trials approved and initiated in countries affected with Ebola. People at a higher risk for the disease, like health care workers, are a priority.

The meeting did not highlight ZMapp, the drug given to two American patients who were evacuated from Liberia to Emory University in Atlanta. Mapp Biopharmaceutical, the company that produces ZMapp, is a small team that says its resources are now exhausted. Their drug is grown in tobacco plants and requires waiting for a crop in order to produce more of it.

One of the ways trials could be quickened is if the researchers take a “wedge” approach, which means that a wedge or slice of the study population is selected for a first step in the trial, and what is learned in that step is then used on the next slice of the participants. While trials are ongoing, there are still significant technical obstacles that need to be addressed once a vaccine is ready for mass use: how vaccines will be distributed, for instance, and how low-resource health systems can ensure that vaccines are stored below –100 degrees.

In the WHO meeting, the phrase “Nothing can be allowed to delay this work” was repeated multiple times, and since Ebola has now infected more than 7,000 people and even made it to the U.S., the race to develop an effective vaccine is becoming all the more frantic.

TIME Infectious Disease

CDC Received Over 90 Calls About Potential Ebola Cases Before Dallas Patient

The Dallas patient is the 13th patient in the U.S. tested by the CDC

On the afternoon of Sept. 28, U.S. Centers for Disease Control and Prevention (CDC) epidemic intelligence officers—sometimes referred to as disease detectives—received a call from Texas Health Presbyterian Hospital of Dallas concerned about a patient the hospital thought could be at risk for Ebola. This was at least the 90th call the team had received during the Ebola outbreak from hospitals concerned that one of their patients could possibly be infected. But until Tuesday, there had never been a diagnosed case.

CDC director Dr. Tom Frieden said in a press conference on Tuesday that “As long as the outbreak continues in Africa, we need to be on-guard.” The statement rings true since the U.S. now has its first patient, but the CDC has been awaiting the possibility that Ebola would make it to American soil for months.

On Sunday afternoon, an epidemic intelligence service officer took the hospital through a decision-tree of sorts that helps the CDC determine whether the patient is at a real risk for Ebola. Factors that are taken into account are where the patient had traveled in the past and what their symptoms were. Since the patient continued through the CDC’s algorithm with enough red flags, the CDC requested that the patient be isolated and that a blood specimen be sent to the CDC’s level 4 testing lab for confirmation.

MORE: Inside the CDC’s Emergency Operations Center Tackling Ebola

The Dallas patient is the 13th person that the CDC has actually tested for Ebola. “Every morning, Dr. Frieden is updated on all of the individuals that we have looked at and the numerous individuals under investigation,” a CDC spokesperson told TIME. There have been a few false alarms already, including patients in New York City and Miami—all eventually tested negative.

The CDC campus is in Atlanta, Georgia, and since early August, the headquarters has had its Emergency Operations Center on a Level 1 response—the highest possible level for a public health crisis. Just a couple days after the CDC kicked operations into high gear, the World Health Organization (WHO) declared the outbreak in West Africa a global public health emergency. In the Emergency Operations Center, several epidemic intelligence officers sit in rows of long tables tapping away at their computers facing a wall of computer screens that show where Ebola clusters are in West Africa, as well as graphs of the disease’s trajectory. The officers offer aid both domestically and to their colleagues in the field. Many have been traveling in and out of West Africa since the spring.

After the CDC determined that the patient, reportedly a man named Thomas Eric Duncan, was indeed at a very high risk for the disease, the hospital sent blood specimens for testing to both the CDC’s lab as well as a Texas Health Department lab. The specimens arrived at the CDC around 10 a.m. on Tuesday morning, and by Tuesday afternoon, both the CDC and the Texas Health Department had confirmed that the patient was in fact positive for Ebola. “We made sure the hospital spoke with the patient and their family first,” said a CDC spokesperson to TIME.

Once the patient was told they were positive, the CDC quickly informed the public by sending out a confirmation to media late Tuesday afternoon and holding a press conference an hour later. During that time, CDC disease specialists were already deploying to Dallas—landing on Tuesday evening to begin the process of tracking down and monitoring all the people that the patient with Ebola had come in contact with while infectious. It’s a process that will continue until the 21-day incubation period of the disease ends.

Though the Dallas patient is the first patient to have confirmed Ebola, the CDC has long said that an Ebola patient making it to the U.S. was always a possibility. However, due to the quality of health care in the United States, patients are not facing the same dire situations as patients in Liberia, Sierra Leone or Guinea, and Ebola in the states will likely have a much different prognosis.

TIME Infectious Disease

First U.S. Ebola Patient Identified

His sister identified him

The first patient to be diagnosed with Ebola in the U.S. was identified Wednesday as Thomas Eric Duncan.

Duncan’s sister Mai Wureh told the Associated Press it was her brother who is at the center of the country’s latest Ebola scare. Wureh said her brother went to the emergency room on Friday complaining of fever and a nurse asked about whether he had recently been in Ebola-affected countries. He said yes, but, according to Dr. Mark Lester, a clinical leader for Texas Health Resources, the “information was not fully communicated throughout the whole team.”

Duncan was sent home with antibiotics, and returned two days later in an ambulance with more severe symptoms. He is currently in serious but stable condition at Texas Health Presbyterian Hospital.

[AP]

TIME Infectious Disease

Second Patient Monitored for Ebola in Texas

Ebola
Transmission electron micrograph of an Ebola virus virion Getty Images

Health officials assure the public that only friends and family of the first patient are at serious risk

Health officials in Texas are monitoring a second patient for Ebola, as they investigate over a dozen individuals who were in contact with the first person diagnosed with the disease in the United States.

“Let me be real frank to the Dallas County residents: The fact that we have one confirmed case, there may be another case that is a close associate with this particular patient,” Zachary Thompson, director of Dallas County Health and Human Services (DCHHS), said in a morning interview with WFAA-TV. “So this is real. There should be a concern, but it’s contained to the specific family members and close friends at this moment.”

The Dallas County bureau later underscored that there had been no confirmation of a second case, as some media outlets had reported:

Officials have said the man came into contact with 12 to 18 people after returning from Liberia, all of whom are being investigated.

The first case of Ebola was confirmed at the Texas Health Presbyterian Hospital Dallas on Tuesday. The patient had flown from Liberia to Texas on Sept. 19 and sought treatment for symptoms on Sept. 26. Health officials say they have contained the virus to the area and are working closely with the Dallas County school district.

[WFAA-TV]

TIME Infectious Disease

This Is the 21-Day Process for Stopping Ebola

Texas Hospital Patient Confirmed As First Case Of Ebola Virus Diagnosed In US
Dr. Edward Goodman, epidemiologist at Texas Health Presbyterian Hospital Dallas, and Dr. Mark Lester, Southeast Zone clinical leader for Texas Health Resources, answer questions during a media conference at Texas Health Presbyterian Hospital Dallas where a patient has been diagnosed with the Ebola virus on Sept. 30, 2014 in Dallas. Mike Stone—Getty Images

Experts are tracking anyone who could have come in contact with the first patient to be diagnosed in the U.S.

U.S. health officials were working Wednesday to determine whether the first diagnosis of Ebola on American soil is an isolated case—or whether the patient may have infected others.

The Centers for Disease Control and Prevention (CDC) dispatched a nine-person epidemiology team to Dallas on Tuesday night. Their job is to contain any potential spread of the virus by working with local health officials to document whether the patient had contact with other people—who, where and when. How they’ll do this is less like the movie Outbreak and more of a labor-intensive process of interviews and monitoring.

The trail they will investigate starts Sept. 26, when a man came into Texas Health Presbyterian Hospital in Dallas for medical care. For two days, he had been feeling ill with fever and muscle aches—generally not concerning, which is why he was sent home. Two days later, he was worse, and was brought back to the hospital by ambulance.

It wasn’t immediately clear if doctors had asked the patient the critical question they should be asking all people who seek medical care for fevers, which is whether he had recently been outside of the U.S., and whether he had traveled to any of the countries in West Africa—including Guinea, Liberia or Sierra Leone—now battling the worst Ebola outbreak in the disease’s history. A Texas health official clarified Wednesday that a nurse had indeed asked the patient if he’d been to Africa and that he said he had, but hospital staff never factored that into their initial treatment.

MORE: How U.S. Doctors Can Contain Ebola

It turned out he had. Four days before he began feeling sick, the patient had been in Liberia before flying to the U.S. This time, based on his symptoms and his travel history, the doctors admitted him into an isolated room and called the state health department and the CDC’s 24-hour hotline; officials recommended testing the patient’s blood for the Ebola virus.

It tested positive, and now health officials from national and local agencies are on the scene. Their job is to contain any potential spread of the virus by documenting who, where and when the patient had contacted other people who might have been exposed via the patient. Because Ebola is only transmitted by droplets—in urine, blood or other body fluids—and only contagious when patients become symptomatic, those at highest risk are people who would have had the closest and most direct contact with the patient. Those who are exposed would also have to have direct mucous contact with infected fluids, such as via the eyes, nasal passages, or through a cut in the skin. So the passengers on the patient’s flights from Liberia to the U.S., for example, aren’t considered at high risk of exposure since he was not experiencing symptoms then.

MORE: Ebola in the United States: What You Need to Know

But the emergency medical personnel who brought the patient to Texas Health Presbyterian in the ambulance might be. They, and the man’s close family members, are being monitored for the virus’ longest incubation period—21 days—for any symptoms of Ebola, such as fever, nausea, vomiting or muscle weakness. If they don’t show any symptoms after that time, they’re likely in the clear.

Epidemiologists take a ring approach to tracing contacts of patients—starting with the circle of people with the most direct contact, such as family members or those who share close living arrangements. Each contact is asked about their own recent interactions with people, and this information is built into a contact tree of folks, not all of whom would be put on watch. Depending on how direct the contact with the patient was, even family members may not be quarantined but asked to refrain from traveling out of the city or country, for example, and avoiding public areas like movie theaters or shopping malls. A handful of children who were in the home with the patient are being monitored, local health officials said at a news conference on Wednesday, but they were allowed to attend school as usual.

MORE: Containing Ebola Is Extremely Labor Intensive, Former CDC Researcher Says

If anyone in the first circle of contacts develops symptoms, then doctors would step up their monitoring of the next ring of contacts, asking them to stay away from public gatherings for 21 days. This pattern continues until no one in a ring reports symptoms in the incubation period; that suggests they were not exposed and therefore don’t have the infection.

All of this, of course, depends on honest and accurate information from the patient and his contacts about where they have been and with whom—something that has been an issue in west Africa, where stigma against Ebola has led patients to flee health volunteers who are attempting to trace contacts, or fail to report people they have interacted with.

That shouldn’t be a problem here, CDC director Tom Frieden said. “We have identified all the people who could have had contact with the patient while he was infectious,” he said during a news conference. “We are stopping it in its tracks in this country. There is no doubt in my mind that we will stop it here.”

TIME Infectious Disease

Liberia Hopes Ebola Diagnosis in the U.S. Will Lead to More Help

“Now the Americans know Ebola can go there, maybe they will send more doctors to Liberia”

The news that a man who recently traveled from Liberia to Dallas has been diagnosed with Ebola, the first diagnosis on American soil, was met with mixed reaction Wednesday in one of the West African countries struggling to contain the deadly disease.

Government officials in the capital Monrovia said they have no knowledge of the man’s identity, and have privately expressed frustration that the United States, citing patient confidentiality laws, has not revealed his name or even his nationality. Liberians, ever sensitive to the stigma of Ebola, repeatedly point out that just because the man departed from the capital’s international airport on Sept. 19, it does not necessarily mean he is, in fact, Liberian.

That frustration is reflected on the country’s lively call-in radio talk show. Callers want to be able to identify the man, and pinpoint his nationality, because they say they want to “clear Liberia’s name.” Liberians feel they have been unfairly identified with the Ebola outbreak, which, many point out, started in neighboring Guinea and Sierra Leone, even if Liberia now has the majority of cases. Other call-in guests are taking a longer view, expressing hopes that the case, which is already getting around the clock U.S. media attention, may elicit further American support for the Ebola effort in Liberia.

“Now the Americans know Ebola can go there, maybe they will send more doctors to Liberia,” one caller said. Another brought up the case of American-Liberian Patrick Sawyer, who caught Ebola while working in Liberia, and took it to Lagos, Nigeria, on July 20. He died five days later, unleashing a chain of transmission that ultimately infected 20 and killed eight. Nigerian officials are now saying that the outbreak has been contained. Like the Sawyer case, the caller said, this just further “proves to the world that Ebola is real, and a global threat.” The host agreed. “It is good,” he said, that the patient was getting good treatment in Dallas. It was also good, he added, that Americans can now see the reality of Ebola for themselves: “This will raise international attention, this will let Americans know that Ebola is real.”

TIME Cancer

The New HPV Vaccine Could Be 90% Effective

hpv image
Getty Images

An even more effective vaccine against human papillomavirus (HPV), which can cause cervical cancer, may be on the horizon, according to new research published in Cancer Epidemiology, Biomarkers & Prevention. Merck announced that it’s investigating a 9-valent HPV vaccine that protects against nine total types of HPV—five more than the current one on the market.

The current vaccine, GARDASIL, also manufactured by Merck, is effective against 70% of cervical and other HPV-related cancers and protects against two of the main types that cause cancer—type 16 and 18—as well as two more that cause most cases of genital warts, types 6 and 11. The potential new vaccine, which isn’t named yet, will protect against approximately 90% of cervical cancers, says study author Elmar Joura, an associate professor of gynecology at the Medical University of Vienna in Austria (who received grant support, lecture fees and advisory board fees from Merck). It protects against the HPV types 6, 11, 16, 18, 31, 33, 45, 52 and 58.

MORE: HPV Vaccine Cuts Rates of Genital Warts 61%

Coverage against those extra strains could be good news for women worldwide, as some races are prone to different types of HPV. In East Asia, HPV 52 and 58 are more common than in the U.S. or Europe, Joura writes in an email to TIME. “The good thing is that the nine valent vaccine will equalize these differences,” Joura writes. “The grade of protection will be the same worldwide.”

In the study, Joura and his team analyzed data from 12,514 women and found that of those ages 15-26 who had precancers, 32% had more than one type of HPV—that number was 19% for women between the ages of 24 to 45.

MORE: There’s a Vaccine Against Cancer, But People Aren’t Using It

The FDA is currently reviewing the vaccine, and Joura expects them to reach a decision by the end of 2014. “The vaccine will hopefully be available soon after,” he wrote.

TIME Infectious Disease

Dallas EMS Crew Tests Negative For Ebola

The EMS crew that transported the patient with Ebola in Dallas has tested negative for the disease, according to the City of Dallas.

The crew that took the patient to Texas Health Presbyterian Hospital Dallas was undergoing medical evaluation yesterday, though none of them were symptomatic. The crew has been sent home.

The CDC and Texas Department of Health will continue to track down people the Ebola patient in Dallas came in contact with while they were infectious. CDC director Dr. Tom Frieden said on Tuesday that he is confident that Ebola will be cared for and contained.

MORE: Ebola in the United States: What You Need to Know

TIME Infectious Disease

How Ebola is Changing Liberia: A First Person Account From the Ground

TIME's Africa bureau chief talks about the situation in West Africa

Monrovia, the capital of Liberia, is the epicenter of an Ebola outbreak that has killed nearly 3,000 people in the West African countries of Liberia, Sierra Leone and Guinea.

TIME’s Africa bureau chief, Aryn Baker, is on the ground in the West African city. She has reported on musicians who educate crowds on the infectious disease, the stigma dead body management teams face, the United States’ responsibility to assist Liberia, among other stories.

In the video above, Baker discusses everyday life in the densely packed seaside city of Monrovia, where the stench of chlorine and the sight of thermometers and rubber boots have become commonplace as locals attempt to stem the Ebola outbreak.

TIME Infectious Disease

Dallas Keeps Calm and Carries On After Ebola Arrives

Dr. Edward Goodman, left, epidemiologist at Texas Health Presbyterian Hospital Dallas, points to a reporter for a question as Dr. Mark Lester looks on during a news conference about an Ebola infected patient they are caring for in Dallas, Sept. 30, 2014.
Dr. Edward Goodman, left, epidemiologist at Texas Health Presbyterian Hospital Dallas, points to a reporter for a question as Dr. Mark Lester looks on during a news conference about an Ebola infected patient they are caring for in Dallas, Sept. 30, 2014. LM Otero—AP

Officials search for answers and urge calm in Dallas

A Dallas hospital patient is battling Ebola, it emerged Tuesday, the first victim of the deadly disease to be diagnosed on American soil. But Texans have resisted the urge to panic at the news, and, contrary to type, have so far been subdued and measured in their public reaction.

Within minutes of the news that a man who had flown from Liberia to Dallas had fallen ill with the deadly virus, a chorus of Texas officials took to the airways to call for calm and insist that this invasion would be defeated. “Take a deep breath,” urged Jay M. Bernhardt, PH. D., director of the University of Texas Center for Health Communication. The former director of the National Center for Health Marketing at the US Centers for Disease Control and Prevention (CDC) suggested on Austin television that the state’s media had a responsibility to be measured and informative in its response — a stance most media outlets appear to be taking, so far. The Dallas Morning News urged readers to take a calm approach to the alarming news: “Time for panic? Absolutely not. This is a time to stay informed and follow the instructions of health professionals so they can ensure that the virus doesn’t spread.”

Even Texas Gov. Rick Perry, usually a ready voice when it comes to expounding on the issue of the day, be it Iranian nukes or border security, took a decidedly low key approach. No immediate statement was forthcoming from the governor’s office, but he did offer a few offhand comments in New York –“we will continue to monitor the situation” — while campaigning for New York Republican gubernatorial candidate Rob Astarino.

But while the call for calm has gone forth, questions are beginning to pile up in Texas — the most serious being why was the patient was originally sent home after initial treatment. The patient first came to Texas Health Presbyterian Hospital on Sept. 26, and was treated, given antibiotics, and discharged, according to numerous local news reports. He then returned on Sunday, Sept. 28. Dallas Mayor Mike Rawlings confirmed Tuesday that the EMS crew that transported the patient back to the hospital after his condition worsened had been placed in quarantine and the ambulance decontaminated. It also was unclear how the patient had travelled to the U.S., what his itinerary had been, and what were his activities upon arrival.

Texans were given some assurances Tuesday. Health officials had been on alert for the possibility of an Ebola outbreak, they were told — after all, the state is home to two significant African immigrant communities in Dallas and Houston, both home to major international airports. Texas Health Presbyterian Hospital, where the patient presented himself, had a run through of Ebola-response activities last week, according to hospital officials.

“We were prepared,” Dr. Edward Goodman, an epidemiologist at Texas Health Presbyterian, said Tuesday in a news conference. “We have had a plan in place for some time now in the event of a patient presenting with possible Ebola. We are well-prepared to deal with this crisis.” The Texas Department of State of Health Services also had been alert to the possible crisis and was certified to do Ebola testing on Aug. 22, David L. Lakey, state health commissioner said Tuesday, enabling a speedy analysis of the patient’s blood.

The news that Ebola had landed in Dallas, while anticipated in an abstract sense by the medical community, was little surprise to some in Dallas’ African immigrant community. Dallas is home to a vibrant African immigrant population, many of them well-educated West Africans who have escaped the poverty of their ancestral homes to build new lives in the U.S, often as healthcare workers or small business owners. The community includes between 5,000 and 10,000 Liberians, according to one Liberian community group, many of whom regularly return to the African country that has been worst hit by the disease. Carolyn Woahloe, head of the Dallas Liberian Nurses Association told KXAS, the Dallas NBC affiliate: “We have people going and coming every day, so like I said, this is shocking, because they take all the necessary precautions over there at the airport and even when they get here.”

But for another established member of the Dallas community, there was a sense of inevitability about this week’s developments. Foday Fofanah has lived in the U.S. for 30 years, and recently returned from his native Sierra Leone after burying his mother. Over the years, he has built up a non-profit, dubbed Sankofa, to help pull his native county out of extreme poverty, and lately he has focused on the impact of Ebola on one of the world’s poorest nations. Sierra Leone has 2,021 cases of the disease and 605 deaths, according to the CDC.

Fofanah told KTVT, the Dallas CBS affiliate, that he wasn’t surprised by the arrival of Ebola in Texas. “There are 5,000 Sierra Leonians in the Dallas area. They know about Ebola,” he said. “I just knew it was bound to happen because people travel every day. It’s a small globe. It was bound to happen.”

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