Science
21 November 2014 vol 346, issue 6212, pages 885-1028
http://www.sciencemag.org/current.dtl

Feature
Saving lives without new drugs
Jon Cohen
Many people treated for Ebola in West Africa have received bare-bones care in overwhelmed facilities that had few resources, contributing to a case fatality rate (CFR) of about 70%. Of the 20 patients treated in the United States and Europe, only five have died, a CRF of 25%, and the ones who did not recover tended to begin their care at the latest stages of disease. Now, a push is on for what’s dubbed Maximum Use of Supportive Care (MUST), which would offer Ebola patients in West Africa the basic life-saving interventions common in wealthier countries. MUST includes intravenous fluids to combat dehydration; balancing of electrolytes; nasogastric tubes for feedings; and medicines to counter diarrhea, vomiting, and secondary infections like bacterial sepsis and malaria. Estimates suggest that MUST would cost no more than $600 per patient.

Report
Strategies for containing Ebola in West Africa
Abhishek Pandey1,*, Katherine E. Atkins1,2,*, Jan Medlock3, Natasha Wenzel1, Jeffrey P. Townsend4, James E. Childs5, Tolbert G. Nyenswah6, Martial L. Ndeffo-Mbah1, Alison P. Galvani1,5,
Author Affiliations
1Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT, USA.
2Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
3Department of Biomedical Sciences, Oregon State University, Corvallis, OR, USA.
4Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA.
5Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA.
6Ministry of Health and Social Welfare, Monrovia, Liberia.
Abstract
The ongoing Ebola outbreak poses an alarming risk to the countries of West Africa and beyond. To assess the effectiveness of containment strategies, we developed a stochastic model of Ebola transmission between and within the general community, hospitals, and funerals, calibrated to incidence data from Liberia. We find that a combined approach of case isolation, contact-tracing with quarantine, and sanitary funeral practices must be implemented with utmost urgency in order to reverse the growth of the outbreak. As of 19 September, under status quo, our model predicts that the epidemic will continue to spread, generating a predicted 224 (134 to 358) daily cases by 1 December, 280 (184 to 441) by 15 December, and 348 (249 to 545) by 30 December.

Report
Antibody landscapes after influenza virus infection or vaccination
J. M. Fonville1,2,3,*, S. H. Wilks1,2,*, S. L. James1,2, A. Fox4, M. Ventresca1, , M. Aban5,
L. Xue5, T. C. Jones1,2, Le N. M. H.4, Pham Q. T.6, Tran N. D.6, Y. Wong7, A. Mosterin1,2,
L. C. Katzelnick1,2, D. Labonte8, Le T. T.6, G. van der Net3, E. Skepner1,2, C. A. Russell2,9, T. D. Kaplan10, G. F. Rimmelzwaan3, N. Masurel3, J. C. de Jong3, A. Palache11, W. E. P. Beyer3, Le Q. M.6, Nguyen T. H.6, H. F. L. Wertheim4,12, A. C. Hurt5,13, A. D. M. E. sterhaus3,
I. G. Barr5, R. A. M. Fouchier3, P. W. Horby4,12, D. J. Smith1,2,3,
Author Affiliations
1Center for Pathogen Evolution, Department of Zoology, University of Cambridge, Cambridge CB2 3EJ, UK.
2World Health Organization (WHO) Collaborating Center for Modeling, Evolution, and Control of Emerging Infectious Diseases, Cambridge CB2 3EJ, UK.
3Department of Viroscience, Erasmus Medical Center, Rotterdam 3015 CE, Netherlands.
4Oxford University Clinical Research Unit and Wellcome Trust Major Overseas Programme, Hanoi, Vietnam.
5WHO Collaborating Centre for Reference and Research on Influenza, Victorian Infectious Diseases Reference Laboratory at the Peter Doherty Institute for Infection and Immunity, Melbourne VIC 3000, Australia.
6National Institute of Hygiene and Epidemiology, Hanoi, Vietnam.
7Oxford University Museum of Natural History, Oxford OX1 3PW, UK.
8Insect Biomechanics Group, Department of Zoology, University of Cambridge, Cambridge CB2 3EJ, UK.
9Department of Veterinary Medicine, University of Cambridge, Cambridge CB3 0ES, UK.
10bobblewire.com, Saint Louis, MO 63112, USA.
11Abbott Laboratories, Weesp 1380 DA, Netherlands.
12Nuffield Department of Clinical Medicine, Centre for Tropical Medicine, University of Oxford, Oxford OX3 7BN, UK.
13Melbourne School of Population and Global Health, University of Melbourne, Parkville VIC 3010, Australia.
Abstract
We introduce the antibody landscape, a method for the quantitative analysis of antibody-mediated immunity to antigenically variable pthogens, achieved by accounting for antigenic variation among pathogen strains. We generated antibody landscapes to study immune profiles covering 43 years of influenza A/H3N2 virus evolution for 69 individuals monitored for infection over 6 years and for 225 individuals pre- and postvaccination. Upon infection and vaccination, titers increased broadly, including previously encountered viruses far beyond the extent of cross-reactivity observed after a primary infection. We explored implications for vaccination and found that the use of an antigenically advanced virus had the dual benefit of inducing antibodies against both advanced and previous antigenic clusters. These results indicate that preemptive vaccine updates may improve influenza vaccine efficacy in previously exposed individuals.