The Lancet-Ebola

Ebola Outbreak Response and Challenges in Africa

WHO Ebola Situation Report – DRC

The WHO’s response to the EVD outbreak in DRC represents a notable shift in the organization’s role. Its EVD Programme offers a clearer, more operationally focused leadership role in responding to health emergencies where states are not able to demonstrate the necessary management and control.

The programme aims to maintain surveillance, support survivors, and advance vaccine and therapeutics research.

What is Ebola?

Ebola is a severe and often deadly viral hemorrhagic fever. It is caused by several species of viruses in the genus Ebolavirus. The symptoms start out as flu-like and get worse, including vomiting, bleeding and neurological (brain and nerve) problems. The disease spreads from person to person, mostly by close contact with the blood or body fluids of a sick patient. Outbreaks usually happen in parts of West, Central and East Africa.

Health care workers who treat a person with Ebola should wear protective equipment, such as masks, gloves and gowns. They should follow strict infection control and sterilization practices, and isolate patients. Vaccines are being developed to prevent and treat the disease.

Symptoms of the disease typically last for 21 days. People who have been infected with the virus can remain contagious for weeks or months, even after they have recovered. The virus can stay in certain parts of the body, including the eyes, central nervous system and placenta.

Ebola in Uganda

On 11 September 2022, Uganda announced its first Ebola outbreak, caused by the Sudan ebolavirus species. The virus is transmitted to people from fruit bats and spreads between communities through contact with blood, secretions, organs or other bodily fluids of infected humans or primates, or with surfaces, materials or animals contaminated with these fluids.

Previously successful infection control mechanisms for haemorrhagic fevers were overwhelmed by the unprecedented scale of this outbreak, which was driven by a number of factors including delays in declaring a public health emergency of international concern (PHEIC), weak national health systems and mis-trust between local populations and their government and humanitarian partners. [1]

WHO has been supporting Ugandan authorities from the start of this outbreak, deploying experts and providing training in contact tracing, testing and patient care, as well as building isolation and treatment centres. At a media briefing on October 12, WHO Director-General Tedros Adhanom Ghebreyesus announced that WHO would mobilize funds to prepare neighbouring countries in case the outbreak spreads to them.

Ebola in the Democratic Republic of the Congo

The DRC has experienced 10 Ebola outbreaks since 1976. This current outbreak is the largest and most complex in its history. It is occurring in the epicenter of ongoing conflict between armed groups and has resulted in widespread degradation of water, sanitation, hygiene and health care systems.

Despite these challenges, the epidemic remains under control. Recent trends suggest that the disease is fading and current response capacity is sufficient to contain it if these positive developments continue.

Vaccination efforts are also progressing, and the DRC has begun to see declining transmission rates in Butembo and Katwa. However, if this trend does not continue, the DRC will need to ramp up its efforts, including by strengthening health system capacities and focusing on high-risk populations. In addition, the DRC must improve security for health workers to access people and conduct screenings, contact tracing, vaccination and community engagement.

Ebola in Guinea

The outbreak of Ebola in Guinea has stirred memories of the devastating epidemic that affected neighbouring West Africa from 2013 to 2016. That outbreak, which also impacted Liberia and Sierra Leone, killed over 11,000 people.

The Guinea outbreak has prompted criticism of the World Health Organization, which failed to act quickly enough and missed opportunities to prevent the outbreak from escalating into a humanitarian disaster. These criticisms have highlighted tensions between the normative and operational roles of the WHO.

The virus in Guinea is related to a Zaire strain, which was responsible for the 2014–2016 epidemic. However, partial and full genome sequencing, phylogenetic analysis, and epidemiologic links suggest that the current outbreak in Guinea is not a re-emergence of the same EBOV strain. Instead, it seems that the new virus may be a novel variant of EBOV, possibly introduced into human populations by someone who harboured a latent infection for some time. This raises the prospect of further epidemics in the region.

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Connecting Fans Worldwide: The Magic of 해외축구중계

The world of sports is an ever-spinning whirlwind of excitement, and at its heart lies the pulse-pounding action of 해외축구중계 – international soccer broadcasts. Imagine the electrifying atmosphere as legions of fans are glued to their screens, watching in awe as the globe’s finest athletes display their prowess on the pitch.

Yet, what makes these broadcasts so enthralling? It’s the way they shrink distances, bringing distant stadiums right into our living rooms, providing us with a front-row seat to witness the spectacular ballet of soccer. It’s the sheer joy of seeing top-tier talent from different leagues – be it the EPL, La Liga, Serie A, or the Bundesliga. The way the ball dances on the field, the roar of the crowd, the tension of a penalty kick – this is the magic of 해외축구중계.

For avid soccer enthusiasts, having access to 해외축구중계 is a non-negotiable. It surpasses being a mere hobby—it becomes a lifeline to a beloved sport. With state-of-the-art technology, fans can stream live games in high definition, ensuring they catch every meticulous play, every heart-stopping goal, every deft save. It’s more than watching a game; it’s an immersive experience that connects fans across continents, cultures, and languages.

Just as a symphony dazzles the senses with its layers of sound, 해외축구중계 captivates viewers with its complexity and depth. The strategies employed by different teams, the styles of play, the individual flair of each soccer maestro—all under the umbrella of universal passion for the game.

In conclusion, 해외축구중계 is not merely a testament to soccer’s ability to inspire and unite. It’s a dynamic canvas, constantly evolving, etching indelible memories in the hearts of fans worldwide. It’s where the unpredictable nature of sports meets the predictable passion of its followers, creating a spectacular maelry of emotions and excitement.

FAQs:

1. What makes 해외축구중계 so popular globally?
2. Can 해외축구중계 be streamed in high definition?
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5. Is there a difference in the viewing experience of watching 해외축구중계 at home versus in the stadium?

Answers:

1. 해외축구중계’s popularity stems from its capacity to bring international soccer action directly to fans around the world, eliminating geographical barriers and providing a shared experience for many.

2. Yes, many platforms offer high-definition streaming options for 해외축구중계, ensuring a high-quality viewing experience.

3. Absolutely, international soccer broadcasts include a range of leagues such as the EPL, La Liga, Bundesliga, and Serie A, catering to a diverse audience.

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5. While stadium experiences are unmatched in terms of live atmosphere and camaraderie, 해외축구중계 allows for comfort, close-up replays, and the convenience of enjoying the game from anywhere.…

The Importance of 먹튀검증 in Ensuring Safe and Credible Online Betting.

In the bustling online world where virtual transactions are as common as the air we breathe, one term that’s gaining traction among the savvy netizens is 먹튀검증. The concept is simple yet so pivotal in the realm of online betting; it’s a guardian, an assurance that when you lay down your money, it’s on a platform that’s safe and credible.

Why is 먹튀검증 critical, you ask? Picture this: you’ve found an online betting site that promises huge returns. You’re excited, your heart is racing, and you can almost taste victory. But as quick as those dreams appeared, they vanish when the site vanishes with your money. That’s a 먹튀 (eat and run) scenario, a fraudulent practice that’s all too common in the unregulated corners of the internet.

That’s where 먹튀검증 steps in. It’s a verification process, a seal of approval. It tells you that the platform you are about to entrust with your hard-earned cash has been put through a rigorous vetting process. They’ve been tested for authenticity, reliability, and honesty. This verification isn’t just a cursory glance over the terms and conditions; it’s an in-depth dive into the site’s history, transaction reliability, and overall reputation.

Engaging in online betting without this process is akin to walking blindfolded on a busy street. 먹튀검증 is your guide, your protector, ensuring that you walk into your online betting endeavors with your eyes wide open.

Now, imagine a world where every betting site you come across has undergone the 먹튀검증 process. It’s a world with fewer risks, where trust is not a commodity but a given. This is the environment that every online bettor deserves. Sadly, it’s not the reality we live in… yet. But as awareness about 먹튀검증 grows, and with platforms dedicated to this vital task, the future looks promising.

In conclusion, whether you’re a seasoned pro at online betting or taking your first tentative steps, remember that 먹튀검증 is your best bet at securing a safe and fair betting experience. It’s the difference between playing the game and being played.

FAQs:
1. What does 먹튀검증 mean?
– 먹튀검증, a Korean term, translates to “eat-and-run verification” and refers to the process of verifying the credibility and reliability of online betting sites to protect users from fraud.

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– 먹튀검증 is conducted through a series of checks on an online betting platform, including reviewing the site’s transaction history, tracking records for any fraudulent activities, and confirming the legitimacy of operation licenses.

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– It ensures that bettors engage with trustworthy platforms, secures their funds from fraud, and maintains a fair online betting environment.

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– While users can perform basic checks, specialized services exist with tools and resources to conduct in-depth verifications, providing a more secure assessment.

5. Is 먹튀검증 a guarantee against all risks in online betting?
– While it significantly reduces the risk of fraud, no system is foolproof. Bettors should remain vigilant and use 먹튀검증 as part of their security measures while engaging in online betting.…

The Global Phenomenon of Evolution Powerball: A Thrilling Blend of Lottery Excitement and Technological Accessibility.

In the dynamic world of online gaming, 에볼루션파워볼 중계, or Evolution Powerball broadcast, has become a thrilling focal point for enthusiasts seeking both entertainment and potentially lucrative rewards. This phenomenon isn’t just a game of chance; it’s a cultural pivot that blends strategy, anticipation, and the adrenaline rush of real-time results.

Imagine the scene: a digital arena where numbers whirl and fortunes are decided with the drop of a ball. Here, the Evolution Powerball broadcast is more than just a passive experience—it’s an interactive spectacle. Participants from all corners of the globe tune in, hoping their numbers will align with destiny’s favor. This isn’t merely a lottery; it’s a communal event that brings together a myriad of players, each with their own aspirations.

Why does 에볼루션파워볼 중계 captivate so many? Perhaps it’s the seamless blending of traditional lottery excitement with the convenience of modern technology. In the comfort of one’s home or on the move, players can engage with this phenomenon. Real-time streaming technologies enable a broadcast that’s accessible on various devices, ensuring a resilient connection to the heart-pumping action.

The rules of Evolution Powerball are straightforward, but the strategies are as diverse as the players themselves. Some rely on patterns, others on pure chance, while a few may even consult historical data to guide their choices. No matter the approach, the anticipation remains the same with each draw. The experience is punctuated by the draw coordinator’s call—a moment when time seems to freeze and all eyes fixate on the emerging results.

Engagement doesn’t end with the draw. Talking points abound as players dissect their outcomes, share near-misses, and regale each other with what-could-have-beens. Communities form in this shared pursuit of fortune, some lasting no longer than the draw itself, others enduring and growing with each subsequent game.

As our attention draws to a close, let’s ponder: What draws us to games of chance? Is it the dream of a life-changing win, or the pure enjoyment of participation? For many, it might be a blend of both—each draw a fresh slate, an untapped potential for success, wrapped in the suspenseful packaging of the Powerball broadcast.

FAQs:

1. What is 에볼루션파워볼 중계?
It’s a live broadcast of the Evolution Powerball game, where participants can watch the Powerball numbers being drawn in real-time.

2. How can one participate in the Evolution Powerball game?
To participate, one needs to purchase a ticket and choose their numbers before the next scheduled draw.

3. Is 에볼루션파워볼 중계 accessible internationally?
Yes, the Evolution Powerball broadcast can be accessed from many locations globally via the internet.

4. Are there strategies for playing Evolution Powerball?
Players employ various strategies, although winning is ultimately determined by chance. Some players analyze historical data, while others look for patterns or use random selections.

5. Can the Evolution Powerball results impact communities?
Yes, each draw creates a buzz, forming temporary or long-lasting communities among participants who share the experience and discuss outcomes.…

Deadly Ebola Outbreaks: A Summary

Ebola Summary

Since 1976, there have been 34 outbreaks of Ebola virus disease in 11 countries in Africa.

Ebola virus disease is a deadly viral hemorrhagic fever that can kill in just days. It is caused by infection with a strain of the Filoviridae family of viruses.

The virus enters the body through contact with an infected animal or human (blood, saliva, feces, vomit). The virus then attacks white blood cells called monocytes and macrophages.

Symptoms

Ebola is a deadly disease caused by infection with a virus from the family Filoviridae, genus Ebolavirus. It causes a severe, often fatal illness in humans and other primates (monkeys, gorillas and chimpanzees) that is similar to malaria and typhoid fever.

The virus spreads through direct contact, including touching the blood or body fluids (including urine, saliva, sweat, feces, vomit and semen) of a person sick with the disease or the bodies of dead people. It also can be spread by touching objects or surfaces contaminated with these fluids.

The virus can remain in body fluids after a person recovers from the illness, especially in semen for up to 3 months. Men should use a condom and women should not have sex until they talk with their doctor. This is to help prevent the transmission of the disease to others. Symptoms appear 2-21 days after exposure, with an average of 8-10 days. They start with fever, weakness, muscle or joint pain, and a sore throat.

Diagnosis

Diagnosis is difficult because early symptoms, such as a low fever and flu-like symptoms, can be seen in patients with other common diseases. A maculopapular rash appears on the fifth day after exposure and is more obvious on fairer skin, especially in Caucasians.

During this time, standard contact and droplet precautions must be used in treating symptomatic patients. During medical evaluation, doctors will take into account the patient’s risk factors (i.e., residing in or having travelled to an outbreak-prone region or country), their predominant symptoms and vaccination history.

Laboratory testing is done in Biosafety Level 4 laboratories using reverse transcription polymerase chain reaction, serology including immunoglobulin M and immunoglobulin G, antigen detection, electron microscopy, histopathology and virus isolation. Patients with suspected EVD will be quarantined until tests are completed. Other diagnostic tests will include coagulation (clotting) abnormalities which are typically associated with the more advanced stages of EVD, such as intravascular haemorrhage. This is because the virus disrupts normal clotting and inhibits the liver’s production of clotting factors.

Treatment

The first step in treating EVD is early recognition. This involves screening all people who enter healthcare facilities in geographic areas where EVD is circulating, using no-touch technique and observing strict isolation for patients.

Patients can be treated with fluids and electrolytes, blood transfusions and supportive care, such as balancing blood pressure, oxygen saturation, heart rate and temperature. Early rehydration improves survival. Antibiotics and medicines that reduce vomiting and diarrhea can also help. Two monoclonal antibodies have been FDA approved to treat Ebola Zaire strain and more are being developed.

It is important to educate communities on risk factors, including safe and dignified burial practices, so that the virus can be prevented from spreading. In addition, people should avoid contact with forest antelopes, rodents and bats, both alive and dead. Early and culturally relevant community engagement and mobilisation is essential. Ebola viruses are classified as biosafety level 4 pathogens and require special containment and barrier protection for laboratory personnel, healthcare workers and those who handle dead animals.

Prevention

Ebola is a very severe disease that occurs when an infected person becomes very sick. It can be prevented by not visiting or travelling to areas with an ongoing outbreak.

The disease is spread through direct contact with the blood or body fluids of an infected person, animal or corpse. Infection can also occur through sexual transmission and pregnancy related transmission (including the use of unprotected breast milk).

During an outbreak, health care workers must follow strict infection control practices. They must wear protective equipment like gloves and gowns, and regularly wash their hands with soap and water or an alcohol-based hand rub solution. They should not touch the eyes, nose or mouth of anyone who is sick. They must also be prepared to trace contacts and attend burial ceremonies.

A vaccine for the disease is being developed. The virus that caused the 2014-2016 outbreak in West Africa belongs to the Zaire species of ebolavirus.

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Ebola: RNA or DNA?

Is Ebola RNA Or DNA?

The Ebola virus (EBOV) is a nonsegmented, negative-strand RNA virus that encodes eight proteins. Like other members of the Filoviridae family, EBOV genomes are tightly coated by a complex of proteins known as the nucleocapsid.

Replication of the viral genome involves two steps and requires significant involvement of host-cell proteins. Viral protein synthesis, or translation, also requires the involvement of host proteins.

Viruses have RNA or DNA

Most viruses have RNA, not DNA, as their genetic material. Viruses that have a DNA genome use it to control the formation of proteins needed to coat the viral DNA, which they then insert into host cells. These proteins are known as capsids. When a cell is infected by DNA viruses, the viruses are enclosed within a membrane derived from the phagocytic host cell.

After the RNA is uncoated, it is converted by the viral enzyme reverse transcriptase into complementary strands of DNA. This DNA is then integrated into the host cell’s genome using the viral enzyme integrase. This process results in the production of new viruses.

EBOV has a 19-kilobase negative-sense RNA genome that encodes eight proteins. It also has a nucleocapsid that is composed of the proteins VP30, VP35, and NP. The NP protein is responsible for the attachment of the virus to its host cells and evasion of the host immune response.

Viruses have a negative-sense RNA genome

Viruses have a negative-sense RNA genome, which makes them different from cellular DNA. This genome is complementary to mRNA, allowing viral mRNA to be translated into proteins by host cell ribosomes. Viruses with positive-sense RNA genomes are called “positive-strand” viruses. Those with negative-sense RNA genomes are called negative-strand viruses. RNA-containing viruses also have a higher mutation rate than their DNA-containing counterparts, because they use RNA polymerases that do not have proofreading abilities.

The Ebola virus enters cells through receptor-mediated endocytosis, where it attaches to a molecule on the surface of the cell membrane. The protein encoded by the viral RNA binds to this molecule and is then transported to the cell’s acidic endosome.

The virus-encoded RNA-dependent RNA polymerase, or L protein, then uses the negative-sense RNA to make a positive-sense copy of the RNA genome. This new RNA acts as the template for synthesis of viral mRNAs, which contain information about the virus’s structure and function.

Viruses have a positive-sense RNA genome

Ebola virus carries its negative-sense RNA genome in a viron, a tubular structure that combines matrix, envelope, and nucleocapsid proteins. It is one of five viruses in the genus Ebolavirus, and causes severe hemorrhagic fever in humans.

The ebolavirus envelope contains a membrane stolen from the host cell and studded with viral glycoproteins. Matrix proteins support the membrane and hold a cylindrical nucleocapsid, which stores and delivers the RNA genome to new hosts.

Unlike most nonsegmented negative-strand RNA viruses, the ebolavirus genome does not have complementary 3’ and 5’ terminal nucleotides. This difference suggests that a viral polymerase is responsible for genomic replication.

During viral entry, ebolavirus proteins attach to receptors on the surface of the host cell. The GP protein, a sugar-coated molecule, then binds to the receptor, dragging the host and virus membranes close enough to fuse. This is the crucial step that leads to a viral entry into the host cell. The GP protein also functions as a viral ligand that mediates viral attachment to cells and engulfs them.

Viruses have a nucleocapsid

Viruses have a nucleocapsid, which is an envelope of protein that surrounds the viral DNA. The capsid is formed by protein subunits that repeat, much like bricks fit together to create a wall. It is physically strong and protects the nucleic acid from harsh environmental conditions.

After a new viral genome is transcribed, it needs to be surrounded by proteins and assembled into virions that can leave the cell that produced them and infect new cells. The first step is the formation of the nucleocapsid, which includes the NP protein and a host-cell-bound complex consisting of VP35, VP40, VP24, and L.

Once the nucleocapsid is formed, a protein called GP forms on its surface. This glycoprotein is sugarcoated and enables the virus to attach itself to a host cell and enter it. Once inside a host cell, the virus replicates to high levels and causes severe hemorrhagic fever in its victims. This is achieved by the interaction of several different gene products mediated by GP.

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New Antibody Drugs Show Promise in Ebola Outbreak

Ebola Cure Research Continues

Scientists have had a harder time developing treatments for viruses, compared with bacterial diseases. But two relatively new experimental drugs—a combination of antibodies made by Regeneron and Ridgeback, as well as remdesivir made by Gilead Sciences—have shown promise in an ongoing clinical trial that could end the yearlong Ebola outbreak in the Democratic Republic of Congo.

REGN-EB3

In a trial during the Ebola outbreak in the Democratic Republic of Congo, REGN-EB3, a triple antibody cocktail made by Regeneron Pharmaceuticals, drastically reduced the mortality rate. Now, more than two-thirds of people who get sick with the Zaire strain survive if they receive the drug early enough.

The therapy combines three fully human monoclonal antibodies—atoltivimab, maftivimab, and odesivimab—that target different parts of the Ebola virus’s surface glycoprotein. It was approved by the U.S. Food and Drug Administration (FDA) in October 2020 under the brand name Inmazeb.

The antibody cocktails were developed in “humanized” mice genetically engineered to have parts of the human immune system that resemble the specialized cells that create human antibodies. Scientists then screened the antibodies for their ability to glom onto the Ebola virus and prevent it from entering cells. mAb114, a single antibody, was sourced directly from an Ebola survivor’s antibodies. All three drugs were administered along with an antiviral agent, remdesivir, in the Pamoja Tulinde Maisha (PALM) study.

mAb114

mAb114 is a single antibody that binds to the core receptor binding domain of the Zaire ebolavirus surface protein. It prevents the virus from entering cells and causing infection. The antibody was isolated from a human survivor of the 1995 ebola outbreak in Kikwit, DR Congo. The drug has helped protect monkeys from lethal Ebola infection.

The PALM trial’s preliminary results show that mAb114 and REGN-EB3 dramatically reduce death rates in people with low viral loads. This is the first time that a treatment has been shown to significantly reduce death rates in an outbreak setting. BARDA supports the advanced development of both antibodies.

Frederick National Laboratory’s Vaccine Clinical Materials Program (VCMP) quickly shipped mAb114 to the DRC for the trial, which will now shift to an extension phase. The lab’s specialized production and testing capabilities are key to supporting public health responses to infectious disease emergencies.

Vaccines

Vaccines work by stimulating the immune system to produce antibodies, the Y-shaped proteins that recognize and bind to Ebola’s surface. These antibodies block the virus from entering a patient’s cells and making them sick.

The vaccines BNT162b2 and mRNA-1273 are already available in Ontario, with priority given to higher risk populations such as older adults living in communal settings and healthcare workers. The data collected by the PALM trial will aid efforts to establish vaccination recommendations during Zaire ebolavirus outbreaks and inter-epidemic periods.

The Department of Defense combat support agency DTRA began its work on a potential EVD vaccine during the 2014 West African outbreak to mitigate the threat that the disease poses to national security interests abroad and U.S. citizens at home in the event of a pandemic. The agency’s investment strategy led to the development of a prototype vaccine that was then tested in a Phase 2 randomized, placebo-controlled clinical trial. This trial ultimately enrolled 1500 participants and found that the vaccine was safe and induced an immune response.

Treatments

Despite skepticism, researchers have developed two treatments that have shown strong signs of stopping the deadly Ebola virus. Both are antibody drugs, a class of Y-shaped immune proteins that recognize and bind to the virus and block it from entering cells. The top performers are REGN-EB3 and mAb114, which are both monoclonal antibodies based on the blood of survivors of the 1995 outbreak in the Democratic Republic of Congo.

NIH’s infectious disease scientists helped develop both drugs. REGN-EB3 and mAb114 are part of a larger clinical trial known as PALM, which is testing multiple investigational therapies alongside the antibody cocktail ZMapp.

A cure for Ebola would transform the epidemic, giving public health officials a new tool to use to convince people to seek treatment. Until now, many patients have been reluctant to enter Ebola treatment centers because they feared that they would die there. Offering them the chance to be cured will help them to overcome their fears and make the centers safer for everyone involved.

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