Ebola: did zMapp cure American healthcare workers?

They are both free of the disease – but doctors are still not sure if the experimental drug works

LAST UPDATED AT 13:04 ON Fri 22 Aug 2014

Two missionary healthcare workers have been released from hospital in Atlanta and cleared of the Ebola virus after receiving the experimental zMapp drug.

After three weeks in an isolation centre, doctors confirmed that Dr Kent Brantly and Nancy Writebol were now free of the disease and pose no health risk to the public.

"I am thrilled to be alive, to be well and to be reunited with my family," said Brantly after his release, calling his recovery "miraculous".

Brantly thanked the medical staff who treated him at Emory University Hospital and credited zMapp for the improvement in his condition. He also said his survival was a "direct answer to thousands and thousands of prayers".

However, doctors are reluctant to directly attribute the patients' recovery to the drug. "We're all very happy Brantly and Writebol have gotten better", Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told the New York Daily News. "But I think it would be a misperception to say that the drug is the thing that made them well.

"We don't have any idea whether this helped them get better, had no impact or even, unlikely, made their recovery delayed," he said.

While Ebola has an extremely low survival rate, ten per cent of people do recover from the disease and Writebol and Brantly could have simply gotten better naturally.

Dr Bruce Ribner, who runs the infectious disease unit at Emory University Hospital, reminded the public that the drugs were still in an experimental phase and much more research was needed before any conclusions on its effectiveness could be made.

Stocks of the drug have now been depleted and scientists warn it could take months to produce more.

What is 'zMapp'? 

Developed by an American biopharmaceutical company, zMapp is a "cocktail" of antibodies harvested from an infected animal's blood and grown in specially-modified tobacco leaves. It works by stopping the virus from entering and infecting healthy cells. This type of drug has already been used in the treatment of some forms of cancer, but takes a long time to produce.

However, according to previous trials, the treatment is only effective within a limited time frame after infection, with optimum results reported when administered within 24-hours.

Who has it been given to? 
  • The two American aid workers would have been among the first humans to take the medication, before them, the drug had only been tested on monkeys.
  • A 75-year-old Spanish priest who was infected in Liberia was given the drug, but he later died in Madrid.
  • zMapp has also been given to three Liberian healthcare workers who are reportedly showing signs of improvement.
Why was it given if it hadn't been approved? 

The US Food and Drug Administration (FDA) allows drugs to be administered without testing under what it calls compassionate use. This "expanded access" is what many suspect happened in this case, as it can only be extended to individuals who are facing an immediately life-threatening condition where no other treatment is possible.

The World Health Organization has also decided that the use of untested drugs to treat the deadly outbreak is ethical.

Ebola: police open fire to enforce Liberia quarantine

21 August

Police in Liberia respond with force as slum residents attempt to break Ebola quarantine to get food and water

Liberian police have fired live rounds and teargas at residents who attempted to leave a government-imposed Ebola quarantine zone in the country's capital, Monrovia.

Officials sealed off the city's West Point slum, home to up to 75,000 people, in order to stop the spread of the Ebola virus. But the introduction of curfews and quarantines has angered residents who say they were given no advance warning of the measures which have stopped them from buying food and water.

Some began throwing rocks at police who were enforcing the quarantine, according to Reuters. The police responded with live rounds, tear gas and beatings. Several serious injuries were reported but no-one is known to have died during the clashes.

The country's president, Ellen Johnson Sirleaf, defended the quarantines, which have been established in areas around the country, saying they were essential to control the spread of the disease. She said that Ebola had continued to spread because of "continued denials, cultural varying practices, disregard for the advice of health workers and disrespect for the warnings by the government".

There are fears that such large scale isolations could lead to widespread unrest as the movement of essential goods is cut off. "I don't have any food and we're scared," said Alpha Barry, a West Point resident.

The World Health Organization has begun working with local authorities to deliver emergency food aid into quarantined regions in an attempt to reduce rising tensions.

In a separate development, a multi-million pound research package has been announced by the UK's Department for International Development and the Wellcome Trust charity. £6.5m in funding will be given to researchers working on ways to tackle the disease.

Welcome Trust Director Dr Jeremy Farrar said the severity of the outbreak demanded an immediate international response.

Ebola: world 'failing to help' as Africa faces 'emergency'

20 Aug

The head of an international medical charity has accused world leaders of doing "almost zero" to help countries affected by the worst outbreak of the Ebola virus in history.

"Leaders in the West are talking about their own safety and doing things like closing airlines –and not helping anyone else," Brice de la Vigne, the operations director of Medecins Sans Frontieres told The Guardian

He argues that containing Ebola is not a complicated task, but requires international intervention. He accused leaders of lacking the political will to take action. "Time is running against us", he warned.

Other healthcare workers have echoed De la Vigne's comments. "We are gone beyond the stage of a health crisis", said Sinead Walsh, head of Irish Aid working in Sierra Leonia's capital. "This is a humanitarian emergency now".

In other developments, the Liberian government has imposed a curfew across the country in order to try and control the spread of the Ebola virus. Health officials have also managed to locate the missing patients who were freed from a quarantine centre last week, the BBC reports.

Separately, the infected health care workers who have been treated with the experimental zMapp drug in Liberia are reportedly recovering, but it is yet unclear if their improving conditions are directly related to the drug.

Ebola virus factfile 

What is the Ebola virus and what are the symptoms? 

The World Health Organization describes Ebola as "a severe acute viral illness". Early symptoms are similar to malaria and include the sudden onset of fever, intense weakness, muscle pain, diarrhoea, vomiting and both internal and external bleeding.

Is there a cure? 

There is no known cure or vaccine for the virus and the disease kills between 25 and 90 per cent of its victims. The only treatment doctors can offer is "supportive intensive care" such as rehydration of infected patients under strict quarantine.

Where did it come from? 

Scientists believe it was initially present in wild animals such as fruit bats living in tropical rainforests in equatorial Africa. The disease spread to humans when they came into contact with the organs, blood or other bodily fluids from infected animals through hunting.

How is it spread? 

Ebola is highly infectious. It can be transmitted through contact with the blood, bodily fluids and organs, including skin, of sufferers or through indirect contact with environments contaminated by the disease. The disease can also have a long incubation period, up to three weeks, which allows it to spread rapidly before diagnosis and quarantine can take place.

Ebola: WHO calls for screening at borders in West Africa

19 Aug

Countries affected by the Ebola outbreak have been asked to introduce exit screenings at all international airports, seaports and major land crossings in order to stop the spread of the disease in West Africa.

The recommendation comes from the World Health Organization [WHO], which has set up a task force to monitor and contain the outbreak, reports Time magazine. The task force will also be responsible for providing information to governments and transport companies, but it has not so far not called for general travel bans.

"Any person with an illness consistent with [the Ebola virus] should not be allowed to travel unless the travel is part of an appropriate medical evacuation", the UN health agency said. It added that non–affected countries in the region "need to strengthen the capacity to detect and immediately contain new cases".

Separately, it has now been confirmed that 17 patients who were freed from a quarantine centre in Liberia last week are indeed missing, the BBC reports. This is despite claims from some health care workers that they had been moved to another facility. The attack on the centre was described as Liberia's "greatest setback" during the current Ebola outbreak by the country's information minister.

"Assaults on health workers and facilities seriously affect access to health care, depriving patients of treatment and interrupting measures to prevent and control contagious diseases", said the WHO's Dr Richard Brennan.

The death toll has now risen to 1,229 with 2,240 confirmed cases across Sierra Leone, Guinea, Liberia and Nigeria. Sierra Leone is currently the worst affected nation with 810 cases of Ebola across 12 of the country's 13 districts.

Ebola: infected patients 'freed' after raid in Liberia

18 Aug

Hundreds of people have reportedly raided an Ebola quarantine centre in the Liberian capital of Monrovia and released infected patients, AFP reports.

An "angry mob" of several hundred people attacked a health centre in city's West Point township on Saturday, but there are conflicting reports about what has happened to the patients.

Some health officials told the BBC that the patients, who have all tested positive for Ebola, had been transferred to another medical facility. But witnesses and the head of the country's health workers association, George Williams, have claimed that 17 escaped and three were taken away by their families.

Those responsible for the raid were heard chanting "there is no Ebola" amid claims from locals that the disease was a hoax. Residents had opposed the centre, saying "we told them not to (build) their camp here. They didn't listen to us."

Blood-stained mattresses, bedding and medical equipment were looted from the health centre, a senior police officer told the BBC. These pose a significant health hazard as the disease is spread by contact with infected bodily fluids. 

"This is one of the stupidest things I have ever seen in my life," the police source said.

If the patients have escaped, there are fears that the outbreak will spread to nearby densely populated slums in West Point, where up to 50,000 people live.

The deadly outbreak has so far killed at least 1,145 people in West Africa, including 413 in Liberia where health officials are struggling to contain the outbreak due to widespread misinformation and fear of the disease.

In a separate development, Kenya has closed its borders to all incoming travel from Sierra Leone, Guinea, and Liberia. Kenya Airways has also suspended flights to the region, despite advice from the World Health Organization (WHO) not to issue travel bans as the risk remains low. Several other airlines including British Airways and Emirates have already cancelled suspended flights to the region.

Ebola: scale of outbreak has been 'vastly underestimated'

15 Aug

The magnitude of the Ebola outbreak in West Africa has been "vastly underestimated", according to the World Health Organization (WHO).

The WHO said it would be coordinating a "massive" scaling up of the international response after it discovered that the number of reported cases and deaths did not reflect the severity of the outbreak.

Almost 2,000 people are reported to have been infected and the latest death toll stands at 1,069 across Sierra Leone, Guinea, Liberia, Nigeria and Spain, where a priest infected in Liberia died earlier this week.

The WHO did not say what it thought the actual number of cases was, but it said it expected the outbreak to continue "for some time", with its response plan extending to several months.

It said "extraordinary measures" were now needed to contain the outbreak affecting countries that are dealing with "extreme poverty, dysfunctional health systems, a severe shortage of doctors, and rampant fear".

However, the organisation reiterated that the risk of transmission via air travel remains low. It has advised against travel or trade bans, instead advising countries to provide citizens travelling to the region with accurate information on how to reduce their risk of infection. 

"Unlike infections such as influenza or tuberculosis, Ebola is not airborne," Dr Isabelle Nuttall, Director of WHO Global Capacity Alert and Response said in a statement. “It can only be transmitted by direct contact with the body fluids of a person who is sick with the disease.”

In a separate development, two people in Nigeria have died after drinking salt water, rumoured to prevent the disease, according the BBC. Ministers warned the public not believe information from social media that had not been issued by the government or health officials, as fear of the disease spreads across the region.

Ebola: Canada sends untested vaccine to West Africa

13 Aug

Canada has announced that it will donate an experimental Ebola vaccine to the World Health Organization (WHO) to be used in West Africa.

It said it would be donating between 800 and 1,000 doses of the vaccine but experts have warned that supplies of the drug are limited as it takes months to produce.

Dr Gregory Taylor, deputy head of Canada's Public Health Agency told Reuters that he believed the drug was a "global resource" to be shared.

The vaccine has never been tested on humans and Taylor admitted that they have no idea how safe the vaccine is or what the side effects will be, "but in this extraordinary circumstance in Africa right now, we're trying to do everything we can to assist."

This follows yesterday's decision by the WHO to allow untested and unlicensed drugs to be used in response to the epidemic. It decided that, with West Africa in the grip of the worst-ever Ebola outbreak, it would be ethical to use extend the use of experimental treatments.

There is currently no proven Ebola vaccine or cure, but several pharmaceutical companies are developing different methods of treating and preventing the disease. 

Treatments
  • zMapp, a cocktail of antibodies harvested from an infected animal's blood and grown in specially-modified tobacco leaves, works by stopping the virus from entering and infecting new cells. It has been used to treat three Western health care workers, including a Spanish priest who died yesterday, and is being sent to doctors in Liberia.
  • Blood serum is another treatment being considered by the WHO. Serum is part of blood plasma taken from a patient who has recovered from Ebola and is used to treat others as it contains essential antibodies against the disease. It has proven effective in previous outbreaks but the WHO wants stricter safety controls to be introduced.
  • The drug TKM-Ebola, developed by a Canadian pharmaceutical company, works by interfering with the virus's genetic code and stopping it from producing disease-causing proteins, the BBC reports. Human trials were halted earlier this year over safety concerns, but the company announced that the US Food and Drug Administration (FDA) had partially lifted the ban, raising hopes that the drug could be made available to combat the current outbreak.
Vaccines

Other vaccines, in addition to the one developed by the Canadian government, are currently in the pipeline. According to the WHO and FDA some clinical trials are being fast-tracked and new vaccines could be made available by 2016.

Ebola: Liberian doctors receive 'last' of untested zMapp drug

12 Aug

Two Liberian doctors will be the first African patients to receive the experimental zMapp drug to treat Ebola, The Guardian reports.

The drug was provided to the West African country "at no cost in all cases", according to the producer Mapp Biopharmaceutical, but it warned that its current supply of the drug had now been exhausted. More of the drug is being produced, but scientists say that it could take several months.

It follows a direct appeal by the Liberian president, Ellen Johnson Sirleaf, to the US government. The country's information minister Lewis Brown told the BBC that the alternative to taking the untested drug was almost certain death.

There has been growing anger in the region as the only patients to have received the potentially life-saving treatment are Westerners. Two US health care volunteers who were given zMapp are reportedly recovering, but it is yet unclear if their improving condition is directly related to the drug. However, a Spanish priest who was also given the drug has now died in Madrid, the BBC reports.

The death toll in the world's deadliest outbreak of Ebola has now exceeded 1,000 in four West African countries.

The BBC's Will Ross warns that the untested use of drugs in Africa can become very controversial, citing the deadly Nigerian meningitis outbreak in 1996. The US drug company Pfizer gave 100 children an experimental antibiotic, but was later sued by the families as well as the government after 12 children died and many more were left with permanent disabilities including brain damage.

The company denied responsibility, saying the outcome was a result of the disease, not the drug, but was forced to pay a multi-million dollar settlement. Ross says that the result contributed to a suspicion of Western medicine in the region.

The World Health Organization is expected to announce the results of its emergency ethics meeting on using untested drugs to try and contain the outbreak.

Ebola: WHO debates ethics of giving untested drug to Africans

11 Aug

A group of specialists are meeting at the World Health Organization (WHO) today to discuss the ethical dilemma of whether or not to make experimental Ebola drugs available to infected patients across West Africa.

The ethics group will include doctors, medical historians, anthropologists, clinicians, epidemiologists, logisticians and other specialists, says the BBC. The diverse group will allow for "a nuanced appreciation of the likely risks and benefits" to be determined.

The deadliest Ebola outbreak ever recorded has so far killed almost 1,000 people in West Africa. Two infected US volunteers were given the untested drug zMapp earlier this month and experts have called for its use to be extended to patients across the region and not just to Western health care workers.

The pharmaceutical company GlaxoSmithKline has said that it will begin trials of a separate vaccine for the disease later this year, Reuters reports. However, even if it is fast-tracked and proven to be safe and effective it is unlikely to be released until 2015.

In other developments:

  • Doctors believe they have traced the outbreak to a two-year old boy in Guinea. 'Patient Zero' went on to infect his mother, sister, and grandmother in a village bordering Sierra Leone and Liberia, the New York Times reports.
  • Guinea has become the latest country to close its borders in order to contain the virus.
  • Health care workers in Liberia have admitted that the "overwhelmed" public health system was responsible for the spread of the disease within the country. Medecins Sans Frontieres told the BBC that the country's health care system was "falling apart".

Ebola declared an 'international health emergency'

08 Aug

The Ebola outbreak which has resulted in over 930 deaths in West Africa has officially been declared a global health emergency by the World Health Organisation.

The outbreak has been placed in the category of "public health emergencies of international concern" at an emergency meeting in Geneva.

WHO officials called the spread of the disease an "extraordinary event" and said the possible global consequences were "particularly serious", the BBC reports.

The announcement will trigger a "coordinated international response" which will aim to contain and control the deadly outbreak. However, action would stop short of a widespread ban on travel or trade.

Containment of the disease is becoming "impossible for these governments to handle themselves", Stephen Morrison, the director of the Global Health Policy Centre at the Centre for Strategic and International Studies told Newsweek.

While health officials at the WHO said the threat was serious, they also said "it is an infection which can be controlled". Much of the blame of the spread of the disease has been placed on the region's poor public health infrastructure.

Ebola: give Africans new experimental drug, say experts

07 August

The World Health Organization (WHO) should extend the use of experimental new treatments for Ebola to patients in West Africa, say the world's leading experts on infectious diseases.

The death toll from the outbreak in West Africa has now reached 932, with Liberia now the second country to officially declare a state of emergency due to the virus.

Three leading Ebola experts, including Dr Peter Piot who co-discovered the disease in 1976, are calling for the experimental new drug zMapp to be used to treat patients across Sierra Leone, Guinea, Liberia and Nigeria , Al Jazeera reports. This comes as doctors report that the two US health workers being treated with the untested drug in Atlanta are continuing to show signs of recovery.

Piot, David Heymann, of Chatham House, and Wellcome Trust director Jeremy Farrar, issued a joint statement saying that African governments should be "allowed to make informed decisions" on whether or not to use the drugs.

They said that people suffering in West Africa were not being afforded the same chance of survival as Westerners, arguing that if Ebola was spreading through the US or the UK "rapid decisions" would be made about extending the use of this potentially life-saving treatment.

The three professors called on the WHO to take on a "greater leadership role" in this crisis, adding, "These dire circumstances call for a more robust international response". 

The pharmaceutical company that created the drug has warned that production is in its early stages and very little of it currently exists, but it said it would be working to increase production.

President Obama said the use of an untested drug to treat Ebola would be "premature", Al Jazeera reports. "We've got to let the science guide us and I don't think all the information is in on whether this drug is helpful", he said. He placed the blame of the outbreak on the overwhelmed public health infrastructure in the affected countries.

The WHO has said that it will meet next week to discuss the merits of extending the use of experimental drugs in West Africa. 

In other developments:

  • Nigeria's health minister says the country is facing a national health emergency after a second person died from the disease in the region's most populous country.
  • A Spanish priest suffering from the disease is to be flown back to Spain this week, the first confirmed case of Ebola to be treated in Europe.
  • The WHO is holding a second day of talks in Geneva to decide whether to declare a global health emergency.

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