Distinguishing viruses responsible for influenza-like illness

Ebola Can Hide In Humans For Years Before Killing Again, New Research Finds

New genetic research appears to confirm a fear scientists had about a deadly outbreak of Ebola in Guinea this February: The source of the outbreak was likely the dormant remnants of the virus in a survivor who caught it at least five years earlier. The discovery could complicate efforts to contain the viral emerging disease.

In late January 2021, a 51-year-old female nurse in the West African country came down with Ebola (formally known as Ebola virus disease, or EVD). Like many victims, she initially experienced vague symptoms like headache, nausea, and general weakness. Though she was hospitalized, her doctors unfortunately misdiagnosed her with malaria and a salmonella infection, and she was sent home after two days. She became sick again at home and died three days later.

Following her death, her husband and other family members who attended her funeral became sick as well, and four would ultimately die. These cases finally alerted national health officials. By mid-February, blood samples confirmed the outbreak, and health care workers rushed to control it. Between February to June 2021, when the outbreak was formally declared over, 16 confirmed cases were reported, along with 12 deaths.

Typically, Ebola outbreaks start with zoonotic transmission from an infected animal to a person, with certain bats thought to be the primary host of the virus. But early analysis of the first blood samples collected from victims during this outbreak suggested something else was going on. The virus seen in their blood looked very similar to a variant collected from survivors of the 2013-2016 West African outbreak of Ebola, the largest and most deadly epidemic of the virus to date, with over 11,000 deaths. Scientists soon suspected the virus had somehow reemerged from a human host years later and was killing again.

This new study, published Wednesday in Nature, all but seals that hunch as being right. Researchers in Guinea, France, and Germany conducted next-generation genetic sequencing of the virus collected from 12 victims of the outbreak, using it to construct complete or near-complete genomes of the virus. They then used this information to build a family tree of the strains and compared them to the virus that was floating around five years ago.

The virus found in Guinea this year was indeed closely related to the virus seen during the earlier West African outbreak, the authors said, indicating "that the new outbreak was not the result of a new spillover event from an animal reservoir." Moreover, they didn't find signs of much genetic divergence between then and now, suggesting that it wasn't being heavily transmitted between humans all that time. Instead, the source virus may have been causing a persistent but slow-moving infection with reduced reproduction in a survivor, or it could have gone completely latent, then reactivated for some unknown reason, making the survivor contagious again.

Scientists have known since the West African outbreak that the virus can survive unnoticed in victims for some time after they've fully recovered, especially in pockets of the body where the immune system is less active, such as the eyes or sperm. But the longest known time between someone contracting the virus and passing it on to someone else or becoming sick again, prior to this, was around a year and a half. A much larger window of transmission for the virus means that communities may be more vulnerable to future outbreaks than currently thought. It may also make the lives of survivors, who already tend to experience discrimination and prejudice from others, even harder, the authors warn.

"The human origin of the 2021 EVD outbreak, and the associated shift in our perception of EBOV emergence, call for careful attention to survivors of the disease," they wrote. "The concern that survivors will be stigmatized as a source of danger should be a matter of scrupulous attention."

In this case, it's possible that the unknown patient zero may have transmitted the virus during sexual intercourse. But given that the first new victim was a nurse, the patient may also have experienced a reemergence of symptoms that led to a health care visit and transmission at that point. The nurse herself may have had a dormant infection return, though that's less likely, since she had no previously documented case.

On the big-picture level, the authors say these findings should fuel research into finding a way to keep survivors virus-free and protecting communities after an outbreak has subsided.

"In addition to the importance of appropriate healthcare measures focused on survivors, the late resurgence of the virus also highlights the urgent need for further research into potent antiviral agents that can eradicate the latent virus reservoir in patients with EVD, and into efficient vaccines that provide long-term protection," they wrote.

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Ebola Vaccines For High-Risk Workers, Antitrust Allegations, And Abortion Pill Rulings

Following is a summary of current health news briefs.

High-risk health workers can get routine Ebola vaccine, Gavi says

A global stockpile of Ebola vaccines can be used to protect frontline health workers in high-risk countries routinely, rather than just as an emergency measure during outbreaks, international vaccine group Gavi said on Thursday. A stockpile of half-a-million Ebola vaccine doses was established by Gavi and other global health partners in 2019 for use in outbreaks of haemorrhagic fever, which has an average fatality rate of roughly 60%. Around 11,000 people died in a 2014-16 outbreak in West Africa, the largest ever.

Alchem accused of pharma price fixing by EU watchdog

EU antitrust regulators has accused Indian drugmaker Alchem International of taking part in a pharmaceutical cartel to fix prices of a key ingredient, which could lead to a hefty fine for the company. The European Commission, which acts as the EU competition watchdog, said it had sent a statement of objections to Alchem, laying out its charges.

Employer coverage for weight-loss drugs rises sharply, survey finds

About one-third of U.S. Employer health plans are offering coverage of GLP-1 drugs for both diabetes management and weight loss, up from last year, according to a survey of global employers released on Thursday by the International Foundation of Employee Benefit Plans. GLP-1 drugs for weight loss grew as a portion of employers' overall medical claims spending to 8.9% in 2024 from 6.9% in 2023, the trade group's survey found. Only about 26% of employers offered the drugs last year.

Reactions to US Supreme Court ruling to preserve access to abortion pill

The U.S. Supreme Court rejected a bid by anti-abortion groups and doctors to restrict access to the abortion pill, handing a victory on Thursday to President Joe Biden's administration in its efforts to preserve broad access to the drug. The justices, two years after ending the recognition of a constitutional right to abortion, ruled 9-0 to overturn a lower court's decision to roll back Food and Drug Administration steps in 2016 and 2021 that eased how the drug, called mifepristone, is prescribed and distributed.

Moderna says next-generation COVID vaccine efficacy non-inferior to current shot

Moderna said on Thursday its next-generation COVID-19 vaccine candidate showed it was not inferior in efficacy compared to its approved shot in a late-stage study. The experimental vaccine, which met the main trial goal, was being tested in more than 11,000 people aged 12 years and older. The shot showed superior efficacy in adults than the current vaccine sold under the brand Spikevax.

More US bird flu spread would heighten human infection risk, officials say

Further spread of bird flu among U.S. Dairy herds presents additional opportunities for human infections, federal officials said on Thursday while urging farms to take enhanced biosecurity measures to contain the virus. Bird flu has been reported in 94 dairy herds across 12 states since late March, according to the U.S. Department of Agriculture.

US charges executives at ADHD startup in Adderall fraud

The founder and the top doctor of a San Francisco-based telehealth startup were charged by the U.S. Department of Justice on Thursday with running a fraudulent $100 million scheme to distribute Adderall and other stimulants online. Done Global founder Ruthia He and clinical president David Brody are the first to be federally prosecuted in connection with alleged illegal drug distribution related to a telehealth company.

US Supreme Court preserves access to abortion pill mifepristone

The U.S. Supreme Court rejected a bid by anti-abortion groups and doctors to restrict access to the abortion pill, handing a victory on Thursday to President Joe Biden's administration in its efforts to preserve broad access to the drug. The justices, two years after ending the recognition of a constitutional right to abortion, ruled 9-0 to overturn a lower court's decision to roll back U.S. Food and Drug Administration steps in 2016 and 2021 that eased how the drug, called mifepristone, is prescribed and distributed. The decision was authored by conservative Justice Brett Kavanaugh.

Abortion pill still under legal threat despite US Supreme Court ruling

The U.S. Supreme Court's ruling on Thursday keeping the abortion drug mifepristone on the market with no new restrictions ends one chapter of the legal fight over the drug, but efforts by abortion opponents to restrict its use may not be over. In rejecting a lawsuit by anti-abortion medical groups and doctors, the Supreme Court did not rule on their claim that the U.S. Food and Drug Administration (FDA) acted improperly when it eased restrictions on mifepristone, including allowing it to be prescribed by telemedicine and dispensed by mail. Instead, the court found that they had not shown that they had suffered the kind of harm that would allow them to bring a lawsuit.

Medicare will recalculate quality ratings of Medicare Advantage Plans, WSJ reports

The federal government plans to redo this year's quality ratings of private Medicare plans, the Wall Street Journal reported on Thursday, citing people familiar with the matter. The move could deliver hundreds of millions in additional bonus payments to insurers next year, benefiting Medicare insurers at a time when their business is under pressure from rising healthcare costs and lower-than-expected rates for next year, according to the report.

(This story has not been edited by Devdiscourse staff and is auto-generated from a syndicated feed.)

Gavi Launches Preventive Ebola Vaccine Programme

Move is part of wide programme that involves routine multivalent meningitis, human rabies, and hepatitis B birth dose vaccination

ANALYSISTHE INDEPENDENTIn a historic step, preventive Ebola vaccination will become the norm in the highest-risk countries, courtesy of GAVI, the public-private partnership Vaccine Alliance that brings together developing country and donor governments, the World Health Organization, UNICEF, the World Bank, the vaccine industry, technical agencies, civil society, the Bill & Melinda Gates Foundation and other private sector partners.

Gavi will also support lower-income countries for routine administration of human rabies vaccine for post-exposure prophylaxis, as well as multivalent meningococcal conjugate and hepatitis B birth dose vaccines

Gavi announced on June 13 that the lower-income countries it supports can now apply to introduce four additional vaccines: preventive Ebola, human rabies vaccine for post-exposure prophylaxis, multivalent meningococcal conjugate and hepatitis B birth dose.

These four vaccine programmes were previously approved by the Gavi Board but put on hold either due to the COVID-19 pandemic (in the case of human rabies for post-exposure prophylaxis and hepatitis B birth dose); pending availability of suitable products (multivalent meningococcal conjugate); or appropriate policy recommendations (preventive Ebola).

Gavi said the latest expansion of its vaccine portfolio is in line with its commitment to ensure lower-income countries have access to impactful vaccines as soon as possible.

The portfolio will be further expanded in Gavi's next strategic period, from 2026–2030, which will seek to protect more people, against more diseases, faster than ever before.

Historic progress against Ebola

Gavi said its move to begin funding preventive vaccination against Ebola in countries most at risk of outbreaks of the deadly viral disease, Ebola, is an historic milestone for global health security and the protection of health care workers and frontline workers.

The move was made possible by a decision by the World Health Organisation's Strategic Advisory Group of Experts on Immunization (SAGE) in May to officially recommend the use of the two licensed Ebola vaccines for preventive use in populations at high risk of being exposed to Ebola through their duties as frontline care providers and in response to outbreaks. The decision was based on new data on effectiveness, duration of protection and supply availability.

Gavi first committed to supporting Ebola vaccination in 2014, during the deadly 2014–2016 West Africa outbreak – thereafter facilitating the use of investigational doses for outbreak response and accelerating the pathway to prequalification and the establishment of a global stockpile, which was launched in 2021. In addition to supporting outbreak response from the Gavi-funded global stockpile, Gavi will now make available vaccines for preventive vaccination, and will continue to additionally fund operational costs for vaccination delivery in lower-income countries.

Ebola virus is a rare but severe illness in humans, with the average Ebola case fatality rate around 60% – in some cases much higher depending on the response to an outbreak. However, the availability of safe and effective vaccines has dramatically reduced the number of cases and deaths during outbreaks – helping to bring them quickly under control.

The additional support for preventive vaccination of those at highest risk is significant, as data increasingly indicates that, in addition to risk of spillover events from infected animals to humans, viral resurgence in survivors of Ebola virus disease can also trigger new outbreaks several years later. Preventive vaccination will ensure critical frontline professionals are already protected against infections and death before outbreaks begin – saving lives and avoiding the disruption of services in health care facilities – thus decreasing the risk of further spread among communities.

Ebola response

In 2014, during the deadly 2014–2016 West Africa Ebola outbreak, which took over 11,000 lives and created global health security concerns as cases spread to countries outside the African continent, Gavi announced its commitment to purchase any suitable vaccine candidates. Subsequently, Gavi invested in the acceleration of development of vaccines and the global stockpile – to ensure vaccines were available to countries as quickly as possible.

In 2016 Gavi signed an Advance Purchase Commitment (APC) with Merck that enabled 300,000 investigational doses to be deployed in outbreaks, pending the availability of a WHO-prequalified product. In 2019, upon recommendation by WHO SAGE, Gavi formally approved the launch of an Ebola vaccination programme and establishment of a global Ebola vaccine stockpile of 500,000 doses. The stockpile was established in 2021, once vaccines received WHO prequalification. In approving an Ebola vaccination programme, Gavi also committed to supporting preventive vaccination in the countries at highest risk, pending a better understanding about the durability of the immunological protection of the vaccine and a WHO SAGE recommendation for preventive use – both of which are now in place.

To date, more than 130,000 doses of the Merck ERVEBO® vaccine from the global stockpile have been shipped for preventive vaccination campaigns in the Democratic Republic of the Congo, Guinea-Bissau and Uganda, in addition to the 7,000 vaccines shipped for outbreak response vaccination. The International Coordinating Group (ICG) on Vaccine Provision, hosted by WHO, makes decisions on allocation and deployment of Ebola vaccines from the global stockpile based on country requests for outbreak response; countries can now apply to Gavi for preventive vaccination support.

Gavi's role is to fund doses, transport and vaccination activities, while UNICEF manages procurement of doses and delivery of vaccines to countries. Gavi also funds global stockpiles of cholera, meningococcal and yellow fever vaccines, and in the future will look to establish stockpiles of vaccines against mpox and hepatitis E.

ICG had approved using these doses preventively based on strong evidence: successful clinical trials, real-world use showing high effectiveness and safety, and existing interim SAGE recommendations to use the vaccine in advance for at-risk populations. Consequently, given availability of doses in the stockpile, and with Gavi and WHO support, some frontline service providers and health workers have already received a single dose. With the new SAGE recommendation, this can now become standard practice.

"Gavi's ability as an Alliance to protect health and save lives hinges on its ability to ensure vaccines are accessible, as quickly as possible, to who that need them the most. The new programmes launching today demonstrate the impact of this work," said Dr Sania Nishtar, CEO of Gavi, the Vaccine Alliance. "For example, Ebola is a terrible disease that can lay waste to whole communities. In one decade, we have been able to progress from having no approved vaccines during a deadly outbreak, to having a global stockpile that has helped cut down cases and deaths – and now vaccines even used preventively to protect those at highest risk."

New tools against deadly infectious diseases

In July 2023, a new multivalent meningococcal conjugate vaccine that protects against the five main serogroups of meningococcal meningitis impacting Africa – meningococcal serogroups A, C, W, Y, and X – received WHO prequalification. It is the only vaccine that protects against serogroup X. The vaccine, MenFive®, is available in the global Gavi-funded stockpile of meningococcal vaccines and has already been used in campaigns aiming to protect over 5 million people in response to meningococcus serogroups C and W outbreaks in Nigeria and Niger. With the opening of today's application window, countries at high risk can officially roll out this new vaccine through routine programmes and preventive campaigns.

Gavi's 2018 Vaccine Investment Strategy (VIS) also identified human rabies vaccines for post exposure prophylaxis (PEP) as a highly impactful vaccine to add to the portfolio. With implementation delayed due to the COVID-19 pandemic, Gavi and partners have been working since 2018 to prepare for the launch of the programme, which will support the provision of human rabies for PEP in Gavi-supported countries which are rabies endemic. Rabies is a serious public health problem in more than 150 countries, mainly in Asia and Africa, causing tens of thousands of deaths each year. Children between 5 and 14 years account for almost half of all fatalities. Once someone is symptomatic after exposure to the rabies virus, the disease is 100% fatal – meaning that vaccination in high-risk areas is critical, especially as access to rabies immunoglobulins is unlikely in most countries.

Similarly, Gavi's 2018 VIS recommended the inclusion of the hepatitis B birth dose vaccine within the Gavi portfolio. Gavi-supported countries already provide routine vaccination against hepatis B through the pentavalent and hexavalent vaccines, which are delivered to children as part of the primary series of vaccinations. However, increasing evidence has shown that a dose given at birth provides critical additional protection. Hepatitis B kills an estimated 884,000 people a year. Newborn babies are most at risk of hepatitis B; and nine out of ten infected infants will develop chronic hepatitis B, while a quarter develop severe liver disease. Vaccination is critical, because while the virus can be transmitted in body fluids, many infants become infected in the womb or during delivery when their mother is carrying the virus. Children can be silent carriers of the infection that doesn't become symptomatic until their 40s or 50s, when they discover they have liver failure (as the inflammation causes cirrhosis) or liver cancer.

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