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False Negatives Muddy the Waters for Ebola Detectives

Posted on October 25, 2014
A survey of recent news here in the United States, reveals a growing number of ‘catch and release’ sorts of stories. Nigerian passenger on airline who vomits, but who tests negative for Ebola; a child who has just returned from West Africa vomits on an airline in Chicago, who then tests negative; a man with a nosebleed who lands at Washington Dulles, who then tests negative. You get the picture. Well, this morning we have the story of a female health care worker who has just returned to the US after working with Ebola patients in West Africa and is put in a holding room according to brand new New York and New Jersey rules for incoming passengers who might pose a risk. The woman developed a fever, but she has now tested negative for Ebola. Is this good news?

Perhaps. Perhaps not. You see, it is quite possible for an Ebola patient to test negative but later test positive.  Currently, the ‘gold standard’ test uses PCR amplification of a small amount of blood from the patient. PCR stands for ‘polymerase chain reaction’, and it is an elegant machine that makes thousands of copies of a tiny fraction of DNA–or in this case, it’s looking for RNA within the blood. Ebola is a negative sense RNA virus, and an infected person should have lots and lots of that RNA in his or her blood. But not always.

A study in 2002 showed that false negative results can occur in some patients:

False-negative RT-PCR results are likely to occur for patients with severe viral hemorrhagic fevers, especially in the acute phase of the disease where a rapid confirmation is required. Their plasma may contain large amounts of RT-PCR inhibitors, probably resulting from the decay of tissue. These inhibitors can be detected by control reactions with spiked samples (low copy numbers of control RNA, 1 log10 above detection limit of the PCR) (5). Control reactions to detect inhibitors of RT-PCR are mandatory for a safe diagnosis for patients with suspected VHF [Viral Hemorrhagic Fever].

I pray that every negative test is a correct result, but wouldn’t it be prudent of the health profession to conduct additional tests over a period of days before releasing someone who may actually be infected? Just my two cents.

Expired Supplies, No Planning: OIG Audit Reveals DHS Is Unprepared for Any Pandemic, Much-Less an Ebola Outbreak

Posted on October 24, 2014

Photo taken by the OIG of the outdated PPEs and respirator masks stored at the DHS. (source: OIG) Click to enlarge.

Back in August of this year, a scathing report was issued by the Office of the Inspector General (OIG) regarding the inventory and budgetary accountability of the Department of Homeland Security (DHS). Titled “DHS Has Not Effectively Managed Pandemic Personal Protective Equipment and Antiviral Medical Countermeasures”, the report reveals the poor management within the DHS for pandemic materials and supplies such as Personal Protection Equipment (PPEs) and items needed for Medical Countermeasures (MCM).

In 2006, according to the report, DHS requested and received $47 Million to plan, train, and equip personnel in advance of a nationwide epidemic such as influenza—or in our current state, Ebola virus (EBOV).

According to the report:

DHS did not adequately conduct a needs assessment prior to purchasing pandemic preparedness supplies and then did not effectively manage its stockpile of pandemic personal protective equipment and antiviral medical countermeasures. Specifically, it did not have clear and documented methodologies to determine the types and quantities of personal protective equipment and antiviral medical countermeasures it purchased for workforce protection. The Department also did not develop and implement stockpile replenishment plans, sufficient inventory controls to monitor stockpiles, adequate contract oversight processes, or ensure compliance with Department guidelines. As a result, the Department has no assurance it has sufficient personal protective equipment and antiviral medical countermeasures for a pandemic response. In addition, we identified concerns related to the oversight of antibiotic medical countermeasures. [Emphasis added]

Read the rest of this entry →

H3N2 Influenza outbreak among vaccinated sailors

Posted on October 24, 2014

Graphic depicting how influenza strains are named (Wikimedia Commons) Click to enlarge.

This week’s MMWR (Morbidity and Mortality Weekly Report) from the CDC included a puzzling report concerning a US Naval minesweeper. In February of this year, 25 sailors from the 102 member crew aboard the USS Ardent, an Avenger class minesweeper, began to complain of fever, chills, and cough. Doctors conducted nasal swab PCR tests and diagnosed influenza, 20 of which were influenza A, and of those 20, 18 were H3N2. Here’s the other shoe: All but one of these men had been vaccinated against influenza A. Sequencing revealed that the strain infecting most of the men had a 99% similarity to A/Texas/50/2012, but 7 of the cases showed marked mutations with 5 amino acid substitutions in the HA1 protein.

So, what happened? Why did these men, nearly all of whom had been vaccinated about 3 months prior to the outbreak, become infected with influenza A? The report seems to imply that patient zero may have been a sailor who lived in San Diego, where the minesweeper was docked, who had developed vague symptoms in January. This sailor suffered from pyelonephritis (a kidney infection), so it had been assumed that his symptoms were somehow connected to his kidney ailment. In fact, a CT scan was performed of his lungs on the assumption that he had a pulmonary embolism! This CT scan showed nothing abnormal. The sailor in question had a roommate, who also served on the Ardent, so even though patient zero remained on shore due to his illness, the roommate reported for duty according to rotation, and it’s assumed that the disease was spread in common areas or through surface contamination (hand rails, etc.).

The sub was decontaminated thoroughly, we’re told, and all the sailors recovered nicely after a round of antivirals. The source of the vaccination failure is a mystery that may never be solved.

To read the entire MMWR report, go here.

It’s Official! SkyWatch TV will air soon, and I can now talk about it!

Posted on October 24, 2014
I have been keeping very quiet about plans to visit Crane, Missouri at the end of this month, because I didn’t want to upstage this official announcement. On October 31, 2014, I’ll be in the big red chair talking with Gary Stearman about my upcoming book, Ebola and the Fourth Horseman of the Apocalypse. I’m honored to be on of his ‘pilot’ guests, and I pray that this show goes on until the Lord returns for His Bride! Thank you, Tom Horn, for inviting me to Crane and for publishing my book. Here’s a sneak peek at SkyWatchers TV!

What’s in the Needle #2: Rabies and Ebola Combined

Posted on October 23, 2014
You might wonder whether or not I’ve added rabies just to put a ‘scare’ in my readers, but the truth is that the DoD, the NIH, NIAID, and Thomas Jefferson University have teamed up to produce a genuine vaccine candidate built on the rabies vaccine.

In a way, it makes sense. In Africa, many animals contract both rabies and Ebola and can spread both diseases to human through a bite. And until recently, very few with deep pockets felt inclined to put their investment dollars into a vaccine that might be used or not (vaccines do have a shelf life). Let’s face it, most pharmaceutical companies prefer to make a profit, and their investors expect one, so it makes selling the idea much easier if you can guarantee sales year after year. Rabies vaccines must be repeated every 1-2 years (at least in our dog they do), so it’s probable that wildlife managers and zoos would line up to buy something that protected against rabies and filoviruses.

So, how is a rabies vaccine going to work against Ebola—a very different type of virus. Put simply, it has to be genetically modified, which makes this a recombinant vaccine.  Dr. Joseph Blaney who works for the NIAID (National Institute of Allergy and Infectious Diseases) is listed as a lead author on some of the research that first appeared in publication around August, 2011 (I say ‘around’ because this is the earliest version I could find online, but I’m not precluding and earlier publication). Another researcher on the project is Dr. Peter Jahrling, one of the giants in filovirus research—and a name familiar to anyone who has read ‘The Hot Zone’. These two along with many other diligent researchers have found what appears to be a ‘bivalent’ (confers immunity for two serotypes) vaccine with income potential, which means it might actually be produced.

To create their little chimera, the researchers took what is called an attenuated rabies virus. Read the rest of this entry →

A New Twist to an Old Serpent? Ebola reinfection?

Posted on October 23, 2014
In my upcoming book on Ebola, I often refer to the virus as a ‘blood serpent’. This isn’t hyperbole or fear-raking on my part, it’s just an apt description of the virus’s appearance and predilection. It also reflects what I as a Christian who just happens to understand a bit of biology (even the most renowned scientists only know ‘a bit’ when it comes to God’s design) believe that our battle against disease is but one manifestation of a larger spiritual battle. Hence the ‘blood snake’, but this snake make be changing its tactics.

This new twist is reported by a physician who cared for patients in Monrovia, Liberia. In an article published at Medscape today, Dr. Paul Farmer of Boston is quoted as saying this:

Paul Farmer, MD, PhD, from Partners in Health, Boston, Massachusetts, added, “In Monrovia, a couple of children under 5 who had negative [polymerase chain reactions (PCRs) after treatment] then returned some weeks later with positive PCR.

“These are children who had a normal course of illness…and had a clinical recovery, and both of these children became ill in a day or two,” Dr Sprecher continued. “They came back and were found to be febrile and [PCR] positive again. Both children had some neurologic signs. The feeling amongst the virologists is…the virus gets into some parts of the body with immunologic protection, like the central nervous system. The immune response clears the virus from the periphery, the patient has a clinical recovery, while the viral infection progresses in the [central nervous system] and eventually returns and reemerges as a renewed positivity. At least one of the children became negative again.” [emphases added]

This idea of a dormant/reactivation cycle for Ebola is relatively unstudied. Dr. Farmer’s observation is an important one, because it is possible that Ebola infection in humans may be changing. This might actually explain a comment made by CDC Director Dr. Tom Frieden, who recently indicated that the current Ebola epidemic may prove to be ‘the next HIV’. If you’re old enough to recall the panic in the early 1980s when patients presenting with Kaposi’s Sarcoma and no underlying cause but with practically no T-cells began showing up in doctor’s offices in France, New York, and San Francisco. Initially, it was believed that the new pathogen had a preference for those living a fringe lifestyle, either drug-abusers or sexually risky (homosexuals who populated gay baths, for instance), but in France and eventually Haiti and Africa, doctors began to see patients who did not fit the early models. Once the HIV virus was isolated, the disease which had killed patients in just a few months seemed to become less aggressive. Though still life-threatening and sexually transmitted, virologists have discovered that HIV mutates, sometimes even within the same host. Some people who are HIV+ never become sick, and still others carry the virus and exhibit only mild symptoms. It’s a trickster virus. So is Ebola. If Farmer is right, then Ebola may be much more complex than we’ve thought.

Is there any research to back up Farmer’s observation. Yes. In 2008, James E. Strong, et al, published research that indicates that Ebola virus can reactivate. Their research was conducted on mice, but mice are often used to model disease processes in humans. There’s precious little other research done on this topic, but there needs to be.

For more from the quoted article, see A Turning Point for Ebola? Possible Reinfection?.

Did the DoD prepare for a US Ebola pandemic before April?

Posted on October 17, 2014
BioFire Diagnostic s BioSurveillance Program   JBAIDS System

BioFire Diagnostics JBAIDS System. Click image to see full size.

Many will probably accuse me of wearing my tinfoil hat while I write this, but I’m about to ask a legitimate question: With Ebola only beginning to spread in West Africa, why did Congress issue biological diagnostics kits to our National Guard in all 50 states before April? Oh, you didn’t know that? Here’s a quote from a House of Representatives Armed Services Committee document relative to a statement to them by Carmen J. Spencer, Joint Program Exec. Officer for Chemical and Biological Defense:

To address the need for a near term capability to combat emerging threat materials, we have already provided Domestic Response Capability kits to the National Guard weapons of mass destruction civil support teams resident in all 50 states. These kits provide emerging threat mitigation capability that includes detection, personnel protection, and decontamination. [emphasis added]

If I understand the purpose of this document, the statement is part of an explanation for budgetary requests for FY 2015. Syria and the threat of biological/chemical warfare is also mentioned, but why send the biokits to the National Guard? This document is dated April 8, 2014, and it states that these kits had already been distributed.

President Obama has just signed an Executive Order that activates reserve and guard troops for deployment to West Africa. Are they going to help or to learn? Probably both.

I can’t say for certain if the kits sent to the Guard units are the same as the brand pictured in this article, but here is a picture of a unit that must be similar, and the description at the website, lists Ebola as one of the pathogens that can be detected using the kit. What can we take away from this?  At the very least, it indicates that the DoD has been preparing the National Guard for a biological or chemical event, either overseas (during a planned deployment) or domestically.

Let’s pray that neither becomes a reality.

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