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The Need to Fast-Track Promising Vaccines

Ebola virus is among the most deadly pathogens, with case fatality rates of up to 90%.1 Ebola virus is categorized as a tier 1 pathogen by the US government because of its potential for deliberate misuse with significant potential for mass casualties. The current outbreak of Ebola virus in West Africa with more than 23 000 cases and 9000 deaths2 also demonstrates the long-underestimated public health threat that Ebola virus poses as a natural human pathogen. There are no licensed vaccines or postexposure treatments for combating Ebola virus. However, substantial progress has been made in developing vaccines and antivirals that can protect laboratory animals against lethal disease.1,3 Advancing these interventions for human use is a matter of utmost urgency.

In this issue of JAMA, Lai et al4 report the use of a first-generation recombinant vesicular stomatitis virus–based Ebola vaccine (VSVΔG-ZEBOV)5 to treat a physician who experienced a needlestick in an Ebola treatment unit in Sierra Leone during the current Ebola virus outbreak. A single dose of the VSVΔG-ZEBOV vaccine was administered approximately 43 hours after the potential exposure. The patient experienced a transient febrile syndrome after vaccination. Importantly, no evidence of Ebola virus infection was detected, and the vaccine elicited strong innate and Ebola virus–specific adaptive immune responses. Most significantly, the vaccine, which expresses the surface glycoprotein of Ebola virus, was able to induce an IgG antibody response against the Ebola virus glycoprotein at a level that has been associated with protection of nonhuman primates.5

It is difficult to draw any definitive conclusions from a single case report. The inability to detect evidence of Ebola virus infection most likely is because there was not an actual exposure; however, it cannot be completely ruled out that the intervention was effective in controlling Ebola virus replication. Even though this patient experienced some adverse events after vaccination, the patient reported having traveler’s diarrhea prior to receiving the VSVΔG-ZEBOV vaccine; therefore, it is also not possible to draw any strong conclusions regarding any adverse events from this case in regard to the safety of the vaccine. This is the second time that the VSVΔG-ZEBOV vaccine has been used to treat a potential exposure to Ebola virus. The initial use occurred in 2009 for a laboratory worker in Germany6 and also involved a needlestick injury. The results of that incident were nearly identical; however, the severity of adverse events following vaccination was less notable in the German case compared with the patient in the case report by Lai et al.4

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The spread of Ebola

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A panicky response in the West may worsen conditions in west Africa

Oct 11th 2014 | From the print edition

THE death toll from Ebola in Guinea, Liberia and Sierra Leone, the three most affected countries in west Africa, now stands at around 3,900. Among cases diagnosed outside Africa, the total is one: Thomas Duncan, a Liberian national, who died in Texas on October 8th. Yet fear of Ebola in relatively unaffected countries risks making the tragedy in Africa worse.

On October 3rd Bobby Jindal, the Republican governor of Louisiana, called for flights from “Ebola-stricken” countries to America to be suspended. Other Republican politicians have done the same. Plenty of African countries have already introduced flight bans. Some Western airlines have also altered their schedules. Read more

Stuck in the waiting room

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A long-touted health-care revolution may at last be about to arrive

Oct 11th 2014 | ROME | From the print edition

THE idea of telemedicine—health care provided using telecommunications equipment—has a lengthy history. Radio News, an American magazine, devoted its cover to a patient at home consulting a doctor in his surgery via a television link as long ago as 1924. When NASA began monitoring astronauts in space in the 1960s, fantasy became reality. It has been touted as health care’s future ever since.

But even smartphones and tablets have failed to usher in the telemedicine revolution: most health care still happens face to face. Now, enthusiasts think the wait is nearly over. Governments have been slow to embrace an approach that could improve coverage and outcomes, as well as saving money. But they are under increasing pressure from ageing populations and a surge in chronic diseases, just as public budgets are being squeezed.

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The Ebola Outbreak in West Africa

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Guinea, Liberia and Sierra Leone have been struggling since March to stop what has become the largest Ebola outbreak ever recorded. The disease is causing widespread fear and disruption in West Africa, and shows no signs of being brought under control.

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