2018 Ebola Outbreaks in Democratic Republic of Congo - Brighton Microbiology Journal Club

Journal Club

26th September 2018

Ebola Update

Hello Everyone,

I was going to suggest reviewing the Ebola outbreak in the North West of the Democratic Republic of Congo a couple of months ago, but I bumped it to make way for other interesting topics that people were kind enough to present. 

At that time it was a (fairly) good news story as the outbreak was quickly brought under control, using lessons learned from the West African epidemic (1) and by vaccinating some 3400 people, allowing the outbreak to be declared over with 53 cases and 29 deaths. (2)

Shortly afterwards, another outbreak was declared, this time in the Kivu district in the North East of the DRC, which is ongoing. The difference with this outbreak is that it takes place against the backdrop of an ongoing conflict in the area, which is near the Ugandan and Rwandan borders. The conflict has been fought since 2004 between the DRC military, Tutsi forces, a Hutu group, an Islamist militia, a group calling themselves The National Congress for the Defence of the People and a 21000 strong UN peacekeeping force. As well as the fighting a “range of conspiracy theories” concerning Ebola, the DRC government and the United Nations are being spread as propaganda. (3) The outbreak has been confirmed to be caused by the same strain as in the north-west and as of 21st September there are 116 confirmed cases, 99 deaths and 1641 contacts (DRC Ministry of Public Health).

We talked about the vaccine being used (rVSVDG-ZEBOV-GP) which, although as yet unlicensed, is the most advanced candidate. It seems to offer very good protection, but with some side effects (there is a viral arthritis associated with it, but I can’t remember where I read that and don’t know any more details). It’s proving a useful tool in breaking the chain of infection, but work is only just starting on what to measure to judge how long the protection will last. (4)

Along these lines, a signature group of five plasma proteins mediated by monocytes appears to be useful in gauging  rVSVDG-ZEBOV-GP effectiveness. (5) is a link to the paper and (6) is a link to a friendlier to read article about the paper.

Jackie was kind enough to share a link (7) to a UK Public Health Rapid Support Team (UK-PHRST) whose role will be to monitor infectious diseases and other hazards globally, offering advice and help to mitigate threats in their early stages, as well as being prepared to deploy a response made up of core personnel and a reservist team, already trained to standards and protocols.

Many thanks, that was an enjoyable discussion. If you click on the list below, the links should take you to the appropriate articles.

Ade.

1. How West Africa’s Ebola outbreak shapes response in DRC: AlJazeera
2. DRC Ebola outbreak is officially declared over
3. WHO extremely concerned about Ebola ‘perfect storm’ in Congo
4. Correlates of vaccine-induced protective immunity against Ebola virus disease
5. A dose-dependent plasma signature of the safety and immunogenicity of the rVSV-Ebola vaccine in Europe and Africa.
6. Measuring the safety, efficacy of a vaccine against Ebola virus disease
7. UK Public Health Rapid Support Team Appoints first director

Why I hate Eating Middle Aged

It's not a competition.

Me. 

Slumped in a chair, glowering at the television like a hypnotised toad, lit (metaphorically) from behind by rose-tinted after images of years gone by, and from the front (literally) by the flickering cold, blue of arse cream and indigestion tablet advertisements. What else could I do but brood on my middle aged diet. If I was less of a gentleman I would have passed wind basso profundo at this point.

Tchaikovsky’s sixth symphony is a visceral, emotional affair, all of life is in it. He never named the movements publicly, but in his notes they were referred to as Life, Love, Disillusionment and Death, which seemed a reasonable overview of a person’s span. The movements of a similar symphony for our age would possibly be Ignorance, Denial, Panic and Death. Dietwise I feel I’m in the beginnings of “Panic” since the driving force behind my food choices is no longer entirely the joie de vivre of the young man who is gone, but more and more the peur de mourir of the husk that he left to count down his heartbeats.

I have just had some chocolate, which should have cheered

me up, but it wasn’t nice chocolate; its taste recalled the sense of bitterness with which I threw it into the supermarket trolley. It was definitely chocolate, definitively chocolate, in fact, in an Aztec sort of way, but with none of the normal chocolatey joy put into it. No, that had all been held back, presumably to make into drugs to fuel young people running around nightclubs, laughing. This is methadone chocolate. Good for the heart.

I should stress that I’m not ill. No doctor has encouraged me to think like this, with the possible exception of that bastard Michael Mosley.  My cholesterol is normal and my blood pressure is normal. At least they were three years ago when I last had a medical. (Since I feel I “won” that one, I’ve not seen the need to go again). I don’t even wear glasses. I just feel as though it might be a wise plan to act as though I’ve had alarming news before I get alarming news, if you see what i mean.

Applying a great deal of optimism it’s not impossible that I’m still only halfway through my long walk to (hopefully) oblivion, although statistically, if I were honest with myself, I’m probably a little further along than I like to think. In any case,

middle age for me is no longer an oncoming thing, to be worried about in the future, the threat from the alleyway is now a knife at my throat and moneys are being demanded with menaces.

Earlier, I had salad. No one is happy to see a salad. Again, this wasn’t one of the nice salads, soaked with good stuff to make it taste of something and salty cheeses of the world to discover under every leaf. No. This was a salad you sit and stare at quietly, for a full minute before bleakly masticating its grassy goodness.

Everything in my fridge, in fact, has had its reason for existing taken out of it before I get it. In a sort of dark, Einsteinian joke, the louder and more insistent the footsteps of the reaper behind you in the corridor of life, the heavier and slower you get and the more of life’s happy little lights and sparkles you have to discard to lessen your load and run a little farther into the dark. To my dismay, the things I’ve always been told should be an occasional treat are now an occasional treat. Even sugar must come with fibre, so fruit is my good thing now and not the thing I have instead of a good thing. 

The bottom line is that we all have choices to make about how we live our lives and how we earn our deaths. Yes, your food choices will be the death of you. (How did you think you were going to go? In a space battle?) I’ve no particular fear of being dead, I’m a nihilist, I don’t believe I’m part of a grand plan, I accept death will occur at a time and date most inconvenient to me and that things will be left undone, mountains unclimbed, that sort of thing, I just hope it’s not tomorrow and that I haven’t left anything embarrassing lying

Sweet

about at home. The only thing that will upset me is any kind of afterlife. No, it’s the dying bit that that preoccupies me, the actual process. I hate being ill and I don’t like pain. I’ve long advocated for a safari park style health system where, after being diagnosed with something, you leave the surgery and then at some point in the future you’re darted in the street like a poorly rhino and the next thing you know you wake up on your own couch a few weeks later with a scar and lovely clean teeth. Maybe a mint on the table.

That said, quite a lot of my middle age thus far seems to be taken up with strategies for crawling ahead of death’s spectre for a few more metres when I get to the end of this awful chase. Even then, I have to consider if I’m just saving myself for a worse death later on? So what if I do “win” and get to sit alone at 110 years old, staring exhausted at whatever depraved, alien world I find myself in? A world which I will no longer understand or about which give the slightest shit. Meanwhile monstrously contorted gene products coded for by what’s left of my DNA will be chewing me from the inside out. Perhaps in comparison it wouldn’t be so bad to go out clutching at my chest in a park somewhere at the age of 55 (“Dead before he hit the ground, they say”), only a smashed bottle of cheap rum to mark the event, perhaps a cold bag of chips abandoned on a bench and doughnuts still lying where they rolled, the litter of a joyous man. At least there might be someone alive who could still get to my funeral.

I won't keep it up.


                                                                                                 AA