Ebola/EVD: CDC, NIH, EMA [to 25 October 2014]

CDC/MMWR Watch [to 25 October 2014]

Ebola Outbreak – 2014
:: CDC Announces Active Post-Arrival Monitoring for Travelers from Impacted Countries – Press Release WEDNESDAY, OCTOBER 22, 2014
:: CDC update on Ebola Response, 10-22-2014 – Media Advisory WEDNESDAY, OCTOBER 22, 2014
:: Innovative Response by Firestone Health Officials May Have Limited Ebola Spread in a Part of Liberia – Press Release TUESDAY, OCTOBER 21, 2014
:: CDC update on Ebola Response and PPE: 10-20-2014 – Transcript MONDAY, OCTOBER 20, 2014
:: Tightened Guidance for U.S. Healthcare Workers on Personal Protective Equipment for Ebola – Fact Sheet – Media StatementMONDAY, OCTOBER 20, 2014

MMWR October 24, 2014 / Vol. 63 / No. 42
:: Control of Ebola Virus Disease —Firestone District, Liberia, 2014
NIH Watch [to 25 October 2014]
:: Texas nurse free of Ebola virus; discharged from NIH Clinical Center
October 24, 2014 — NIH Clinical Center discharges Nina Pham who is free of Ebola virus disease.
:: NIH media briefing on discharge of Ebola patient from its Clinical Center Special Clinical Studies Unit
October 24, 2014 — NIH officials will brief reporters about the discharge of Nina Pham.
:: NIH begins early human clinical trial of VSV Ebola vaccine
October 22, 2014 — Researchers at NIAID are conducting the early phase trial to evaluate the vaccine, called VSV-ZEBOV.
European Medicines Agency Watch [to 25 October 2014]

:: EMA ready to start assessment of Ebola vaccines and treatments as soon as data are made available
Rapid scientific advice to speed up development
During the past months, the European Medicines Agency (EMA) has put in place a system to give the best possible scientific advice to companies that are currently developing possible vaccines and/or treatments to fight Ebola virus disease.
The Agency has also established a form of rolling review that allows experts to continuously assess incoming data and develop increasingly robust scientific opinions based on the additional data provided during the process. The initial review and subsequent updates will be shared with healthcare decision-makers in the most affected and other countries. This will enable them to take informed decisions on whether and how they want to use the vaccines/medicines in the current Ebola outbreak taking into account their specific situation.
“We are ready and keen to assess data as soon as companies start submitting them,” explains EMA Executive Director Guido Rasi. “We have put in place regulatory processes that allow the best experts from across Europe to accelerate the assessment of data once we receive them.”…

:: Speeding up development of Ebola treatments and vaccines
EMA encourages companies to apply for orphan designation
The European Medicines Agency (EMA) encourages developers of treatments or vaccines against Ebola to apply for orphan designation. Medicines with recognised orphan status have access to a range of incentives to stimulate development and facilitate placing on the market. This includes free scientific advice from EMA, fee waivers and 10 years of market exclusivity once the medicine is authorised.
Applications for orphan designation of Ebola medicines will be treated as a priority and EMA has committed to fast-tracking their evaluation…

:: Johnson & Johnson Announces Major Commitment to Speed Ebola Vaccine Development and Significantly Expand Production

Industry Watch [to 25 October 2014]
Selected media releases and other selected content from industry.

:: Johnson & Johnson Announces Major Commitment to Speed Ebola Vaccine Development and Significantly Expand Production
NEW BRUNSWICK, N.J., Oct. 22, 2014 /PRNewswire/ — Johnson & Johnson (NYSE: JNJ) today announced that it has made a commitment of up to $200 million to accelerate and significantly expand the production of an Ebola vaccine program in development at its Janssen Pharmaceutical Companies. The company is closely collaborating with the World Health Organization (WHO), the National Institute of Allergy and Infectious Diseases (NIAID), as well as other key stakeholders, governments, and public health authorities on the clinical testing, development, production and distribution of the vaccine regimen…

UNMEER [UN Mission for Ebola Emergency Response] – [to 25 October 2014]

UNMEER [UN Mission for Ebola Emergency Response] @UNMEER #EbolaResponse
UNMEER’s website is aggregating and presenting content from various sources including its own External Situation Reports, press releases, statements and what it titles “developments.” We present a composite below from the week ending 25 October 2014.

UNMEER site: Statements
:: WHO Key messages on the Ebola outbreak in West Africa (24 October 2014)
13 pages of “key messages” underscore the complexity of the EVD crisis.

:: Statement attributable to the Spokesman for the Secretary-General on contributions to the UN Ebola Multi-Partner Trust Fund (21 October 2014)


UNMEER External Situation Reports
UNMEER External Situation Reports are issued daily (excepting Saturday) with content organized under these headings:
– Highlights
– Key Political and Economic Developments
– Human Rights
– Medical
– Logistics
– Outreach and Education
– Resource Mobilisation
– Essential Services
– Upcoming Events
The “Week in Review” will present selected elements of interest from these reports. The full daily report is available as a pdf using the link provided by the report date.

24 October 2014
Human Rights
3. 43 people quarantined for EVD monitoring in western Liberia are reportedly threatening to break out of an isolation center because of a lack of food.
4. Work has commenced on an EVD holding facility at Freetown’s largest prison. With almost 2,000 inmates, EVD could spread quickly among this vulnerable population. With support from UNDP, the correctional facility will refurbish two holding centres – one for women and one for men – that will house new inmates and keep them separate from the general population for 21 days. UNDP also handed over equipment like buckets, soap, blankets and mosquito nets that will help inmates and guards at Freetown’s prison and all 17 prisons in Sierra Leone.
7. Guinea has started paying compensation to the families of health workers who have died of EVD. Eight families have already been paid a USD 10,000 lump sum. The families of 42 victims, including doctors, nurses, drivers and porters, have been identified to receive compensation.
Outreach and Education
18. Reportedly more than half the beds in treatment centers in Monrovia, Liberia, remain empty because of the government’s order that the bodies of all suspected EVD victims be cremated. Cremation violates Liberians’ values and cultural practices leading to the sick often being kept at home and buried in secret, increasing the risk of more infections.
Resource Mobilisation
23. Billionaire Paul Allen will contribute at least USD 100 million to help stop EVD.

23 October 2014
Many WHO staff, including Assistant Director General for Health Systems and Innovation,
Dr Marie-Paule Kieny, are volunteering to test experimental EVD vaccines.
6. The WHO reported that meeting the overall EVD crisis response target of isolating 70 per cent of EVD cases by 1 December, and 100 per cent of cases by 1 January, requires effective case identification, isolation and treatment. In terms of case identification, WHO estimates that 28 laboratories are required across the three most affected countries. At present, 12 laboratories are operational (three in Guinea, five in Liberia, and four in Sierra Leone). Up to 20 000 contact tracing staff may also be needed. In regard to case isolation and treatment, the WHO estimates that 4388 beds are required in 50 Ebola treatment units (ETUs) across the three most affected countries. At present, 1126 (25 per cent) are in place. In addition, there remains a gap in the availability of foreign medical teams to manage and staff ETUs – there are firm commitments from teams for 30 of the planned 50 ETUs.

22 October 2014
7. France’s Atomic Energy Commission reported that a new device similar to a simple pregnancy
home-test could allow doctors to diagnose a patient with suspected EVD in under 15 minutes. Trials have validated the technique and prototype kits should be available in affected countries by the end of October for a clinical trial.
9. The European Commission confirmed that under its Humanitarian Aid Regulation medical
evacuations of international workers can be covered up to 100 per cent of their cost, and recalled that other elements such as existing insurance coverage will need to be taken into account to determine the exact percentage on a case by case basis.

21 October 2014
Human Rights
6. A UNICEF survey of 1,400 households across Sierra Leone found that EVD survivors face high
levels of stigma, shame, and discrimination from communities, undermining their ability to rebuild their lives. About 96 per cent of households in the study reported some discriminatory attitudes toward people with suspected or confirmed EVD, and 76 per cent said they would not welcome someone who was infected with EVD back into their community, even if that person has recovered. Children are particularly vulnerable, especially when they or their parents have to be isolated for treatment.
12. The Director General of the World Health Organization, Dr. Margaret Chan, says the agency will be transparent about its handling of the Ebola outbreak, following an internal report that details failures in containing the virus.
Outreach and Education
16. The FAO has opened an online discussion, until 10 November 2014, on EVD and food security and nutrition in West Africa. Comments can be sent via email to FSN-moderator@fao.org or uploaded directly, upon registration to the FSN Forum in West Africa (register here).
Essential Services
18. A rapid assessment survey in Sierra Leone conducted by the FAO found that 47 per cent of farmers have had their work “considerably disrupted” by the EVD outbreak.
19. Médecins Sans Frontières has decided to temporarily suspend its pediatric and maternal medical activities at its Gondama hospital (located near Bo, Sierra Leone), because of the strain of responding to EVD in the country.
20. During the Ebola crisis, securing continuity of access to anti-retroviral drugs and essential HIV prevention interventions is critical to reduce morbidity and mortality of people living with HIV and to prevent new infections. The UNAIDS Inter Agency Task Team is advocating for a minimum HIV service package as part of efforts to restore public health services during this EVD outbreak.

20 October 2014
Key Political and Economic Developments
2. Liberia’s President, Ms. Ellen Johnson Sirleaf, has made an impassioned plea for all nations to
commit to the fight against Ebola ahead of a meeting of EU foreign ministers today. She said a
generation of Africans were at risk of “being lost to economic catastrophe” because of the epidemic, warning that the “time for talking or theorising is over”.
4. Food prices have risen by an average of 24 per cent across Guinea, Liberia and Sierra Leone
forcing some families to reduce their intake to one meal a day. The FAO and WFP said that
decisions by these three governments to quarantine districts and restrict movements to contain the spread of EVD have also impacted markets and reduced food security.
9. Médecins Sans Frontières (MSF) will work in collaboration with key partners in the affected
countries, including the WHO, in order to implement fast-tracked clinical trials for some of the new treatments for Ebola at existing treatment sites. Experimental treatments are currently being selected and trial designs are being developed to ensure that disruption to patient care is minimal, that medical and research ethics are respected, and that sound scientific data is produced. MSF does not usually engage in research and trials for drug development, but faced with this massive outbreak, it is taking exceptional measures.
Essential Services
33. The WFP has begun food distribution on the outskirts of Freetown, Sierra Leone, to 265,000 people. This is the biggest one-off food distribution in the country since the start of the EVD outbreak.
34. UNICEF signed a project cooperation agreement valued at over USD 1 million with Save the
Children for the provision of health, nutrition and WASH interventions Liberia.
35. The Ministry of Agriculture in Guinea, FAO and the WFP have initiated a rapid assessment of the impact of the EVD outbreak on agriculture and food security.

19 October 2014
Summary of Key Gaps and Needs
13. Safe and dignified burials are also of critical importance as they are responsible for a very significant number of new infections. We are aiming at 70 per cent of safe burials by 1 December. Recruiting, training and remunerating safe burial teams is vital, as well as community outreach and education. The US Centers for Disease Control (CDC) has observed in Liberia that It is becoming increasingly apparent that people are not going to ETCs due to the fear of cremation.


UNMEER site: Press Releases
:: WFP And World Bank Scale Up Government Logistical Capacity In Response To Ebola (21 October 2014)

UNMEER site: Developments
:: Mali confirms its first case of Ebola
24 October 2014 – Mali’s Ministry of Health has confirmed the country’s first case of Ebola virus disease. The Ministry received positive laboratory results, from PCR testing, on Thursday and informed WHO immediately. In line with standard procedures, samples are being sent to a WHO-approved laboratory for further testing and diagnostic work.

:: In town hall, Ban cites UN efforts against Ebola threat
24 October 2014 – New York The United Nations is moving rapidly to deploy resources and personnel to stem the outbreak of the Ebola virus disease in West Africa and to ensure that UN staffers are protected, Secretary-General Ban Ki-moon said Friday in a town hall meeting attended by hundreds of UN staffers here and, by video, around the world.

:: Why I am volunteering to test the Ebola vaccine
21 October 2014 – Ebola is not a West African problem, it is a problem for mankind. To that end I strongly feel that the world should stand in solidarity with West Africa and be part of the development and testing of Ebola vaccines.

:: In Sierra Leone, getting back to school – on the airwaves
21 October 2014 – Freetown, Sierra Leone With schools closed throughout the country as a result of the Ebola epidemic, Sierra Leone is bringing the classroom into students’ homes through the use of educational radio broadcasts.

:: UN Women mourns loss of Sierra Leone colleague to Ebola
20 October 2014 – New York UN Women is deeply saddened by the passing away of our colleague Mr. Edmond Bangura-Sesay on Saturday, 18 October, after testing positive for the Ebola virus. Mr. Bangura-Sesay served with great dedication since 2005 as the driver for the UN Women Office in Sierra Leone.

:: Pregnant in the shadow of Ebola: Deteriorating health systems endanger women
20 October 2014 – MONROVIA, Liberia Thirty-six year old Comfort Fayiah, in Monrovia, Liberia, never imagined her pregnancy would end the way it did – with her giving birth on the side of the road, in a heavy downpour, to twins.

Ebola/EVD: UNFPA, UN Women, DFID [to 25 October 2014]

UNFPA United Nations Population Fund
20 October 2014 – Dispatch
Pregnant in the shadow of Ebola: Deteriorating health systems endanger women
MONROVIA, Liberia – Thirty-six year old Comfort Fayiah, in Monrovia, Liberia, never imagined her pregnancy would end the way it did – with her giving birth on the side of the road, in a heavy downpour, to twins. Throughout the three countries worst affected by the Ebola crisis, many women are refusing to seek care from health centres, and some overwhelmed, undersupplied health facilities are turning away those who arrive.
UN Women
UN Women mourns loss of Sierra Leone colleague to Ebola
Date : October 20, 2014
UN Women is deeply saddened by the passing away of our colleague Mr. Edmond Bangura-Sesay on Saturday, 18 October, after testing positive for the Ebola virus. Mr. Bangura-Sesay served with great dedication since 2005 as the driver for the UN Women Office in Sierra Leone.


Selected Releases
:: UK secures €1 billion European Ebola commitment
24 October 2014 DFID and Number 10 Press release
The Prime Minister, David Cameron, has secured a €1 billion (£800 million) funding pledge at the European Council meetings in Brussels, following a call for European leaders to do more to fight the disease in West Africa.
As part of the commitment, the UK has boosted its own response to the Ebola crisis in West Africa by £80 million, bringing its total contribution to more than £200 million.
The Prime Minister wrote to the President of the European Council, Herman Van Rompuy, and fellow leaders last week to warn of the need to act fast to contain and defeat this deadly virus, stating that “if we do not significantly step up our collective response now, the loss of life and damage to the political, economic and social fabric of the region will be substantial and the threat posed to our citizens will also grow.”…

:: Tenth British aid flight delivers medicines for Ebola treatment facilities in Sierra Leone
23 October 2014 DFID Press release

:: Better global disability data needed to ensure no one is left behind
23 October 2014 DFID Press release
The international community needs to do more to stop people with disabilities being left behind, International Development Minster Lynne Featherstone said today.
Development Minister Lynne Featherstone has called for better data collection on disability prevalence in order to improve support for those affected in developing countries.
Speaking at the Disability Data Conference today in London (23 October 2014), Ms Featherstone, alongside co-hosts Akiko Ito, Chief of the Secretariat for the UN’s Convention on the Rights of Persons with Disabilities and Director of the Leonard Cheshire Disability Research Centre, called on international development donors, civil society organisations and academics to strengthen the quality of information they collect about disability by using a single method of data collection….

MSF/Médecins Sans Frontières – Ebola/EVD [to 25 October 2014]

MSF/Médecins Sans Frontières
:: MSF aims to start drug trials in Ebola clinics next month
Reuters | 22 October 2014
The medical charity Medecins Sans Frontieres (MSF) intends to start trials of experimental Ebola drugs in its treatment centers in West Africa next month, as it steps up measures to tackle the worst outbreak of the disease on record. Bertrand Draguez, medical director of MSF Belgium, said academics and the World Health Organization (WHO) were currently assessing which drugs to include in the tests. Meanwhile, a team of experts in West Africa was assessing which treatments should be tested in which MSF clinic, he said.

:: Ebola: MSF Urges Immediate Action on Vaccines and Treatments for Frontline Workers
October 24, 2014
Geneva—Following a high-level meeting on access and funding for Ebola vaccines convened yesterday by World Health Organization (WHO), Doctors Without Borders/Médecins Sans Frontières (MSF) has urged that plans to get forthcoming Ebola vaccines and treatments to frontline workers must be rapidly implemented. Significant investment and incentives are needed now to accelerate these steps.

“The message we heard from WHO that the people fighting the epidemic will be among the first to test Ebola vaccines and treatments is exactly the one we needed to hear,” said Dr. Bertrand Draguez, medical director for MSF. “Now urgent action is needed to get those promises delivered in West Africa as soon as possible. This needs to be followed by massive roll out of vaccines to the general population once their efficacy is proven.”

“It crucial that people from Ministries of Health, aid agencies, and communities who are holding the response to the epidemic together, and ensuring access to essential health care, are protected,” Dr. Draguez added. “Resources everywhere are stretched to almost breaking point; everyone is at capacity, but it is extremely hard for the people treating and sustaining the response to do it with absolutely no safety net. Safe and effective treatments and vaccines could offer just that.”

Staff who should be prioritized to test the vaccines include health care workers, community workers, and people who support the Ebola response such as hygiene personnel, ambulance drivers, health promoters, contact tracers, and people in charge of funerals. Medical staff providing care for other diseases than Ebola should also be prioritized to receive test vaccines.

While the focus of the WHO meeting was on Ebola vaccines, new treatments and diagnostics for the disease are also urgently needed to allow people treating the epidemic to do their jobs effectively and efficiently.

“The rapid development and deployment of safe and effective experimental treatments is also critical,” said Dr. Draguez. “Today, doctors and nurses involved in the struggle against Ebola are getting more and more frustrated as they have no treatment for patients with a disease that kills up to 80 percent of them.”…

…Large-scale investment in all front-running vaccines, drugs, and diagnostics is vital and sufficient resources for clinical trials and post-trial access need to be mobilized by donors now. The scientific data generated for each product under clinical trials should be published in real time, and a pooled bank of samples should be established to facilitate open research. But the lack of approved Ebola products to this point highlights a key issue that must be urgently addressed; the lack of sufficient investment and incentives to develop them.

“Appropriate incentives that give industry a reason to develop these vital tools for Ebola are needed now—government and donors must line up to help here,” Dr. Balasegaram said. “We need researchers and developers to conduct clinical trials in parallel with scaling up production supply, which we know has its inherent risks. Governments and donors must help incentivize this risk, and the path to regulation in getting approved, safe and effective vaccines and treatments on the ground in West Africa needs to be a smooth one.”

WHO & Regionals [to 25 October 2014]

WHO & Regionals [to 25 October 2014]
:: Improved data reveals higher global burden of tuberculosis
22 October 2014 — Recent intensive efforts to improve collection and reporting of data are shedding new light on the epidemic, revealing almost half a million more cases than previously estimated. WHO’s “Global tuberculosis report 2014” shows that 9 million people developed TB in 2013, and 1.5 million died, including 360 000 people who were HIV positive.

:: Global Alert and Response (GAR) – Disease outbreak news
Middle East respiratory syndrome coronavirus (MERS-CoV) – Turkey 24 October 2014
Chikungunya – France 23 October 2014

:: The Weekly Epidemiological Record (WER) 24 October 2014, vol. 89, 43 (pp. 465–492) includes:
– Human papillomavirus vaccines: WHO position paper, October 2014
In an updated position paper published today, WHO revised the number of doses recommended for human papillomavirus (HPV) vaccines for different age groups:
Vaccination schedule: Following a review of the evidence demonstrating that post-vaccination antibody GMCs were shown to be non-inferior, and recognizing cost-saving and programmatic advantages, WHO has changed its previous recommendation of a 3-dose schedule to a 2-dose schedule, with increased flexibility in the interval between doses which may facilitate vaccine uptake.
WHO reiterates its recommendation that HPV vaccines should be included in national immunization programmes, provided that: prevention of cervical cancer and other HPV-related diseases constitutes a public health priority; vaccine introduction is programmatically feasible; sustainable financing can be secured; and the cost-effectiveness of vaccination strategies in the country or region is considered.

:: EURO – Crown Princess Mary of Denmark underlines importance of universal vaccination in address to Tajik medical students
Today, on World Polio Day, as part of her visit to Tajikistan to draw attention to maternal and child health issues throughout the WHO European Region, HRH Crown Princess Mary of Denmark underlined that access to immunization at every stage of life is the right of every individual.

Herpes zoster vaccine (HZV): utilization and coverage 2009 – 2013, Alberta, Canada

BMC Public Health
(Accessed 25 October 2014)

Research article
Herpes zoster vaccine (HZV): utilization and coverage 2009 – 2013, Alberta, Canada
Xianfang C Liu, Kimberley A Simmonds, Margaret L Russell and Lawrence W Svenson
Author Affiliations
BMC Public Health 2014, 14:1098 doi:10.1186/1471-2458-14-1098
Published: 23 October 2014
Abstract (provisional)
Herpes zoster vaccine (HZV) is not publicly funded in the province of Alberta, Canada. We estimated vaccine coverage among those aged 60 years or older for 2013, as well as vaccine utilization rates per hundred thousand population over the period 2009 – 2013. We explored for factors associated with HZV dispensing rates.
We used administrative data from the Alberta Pharmaceutical Information Network (PIN) database to identify unique persons for whom HZV had been dispensed from community pharmacies over 2009 – 2013. PIN data were also used to estimate the pharmacy/population ratios for rural and urban Alberta over the period. Denominators for rates were estimated using mid-year population estimates from the Alberta Health Care Insurance Plan Registry. Income quintile data were estimated from the 2006 Census of Canada. Crude, age, sex, geographic (rural vs. urban), income-quintile and year specific rates of HZV vaccine dispensing were estimated per 100,000 population. Rates were adjusted for pharmacy/population ratio. Vaccine coverage for persons aged 60 years or older was estimated using counts of all unique persons for whom the vaccine was dispensed over the period in the numerator and a 2013 mid- year population denominator.
HZV dispensing rates rose annually from 2009 – 2013. Vaccine coverage was estimated to be 8.4% among persons aged 60 years or older. Rates of dispensing were highest for persons aged 60-69 years and were higher for females than males and for persons from higher compared to lower income quintiles. Dispensing rates were lower for rural than for urban residents. About 2% of vaccine was dispensed for persons aged less than 50 years.