CROI 2016: Scale of Ebola crisis led to knowledge, new questions, ongoing research, and need for unprecedented community healthcare delivery

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At least 10,000 survivors open opportunity to “dig little bits of hope out of an enormous tragedy,” and leave imperative to gauge scope, meet needs

Science Speaks is in Boston this week covering the Conference on Retroviruses and Opportunistic Infections

Science Speaks is in Boston this week covering the Conference on Retroviruses and Opportunistic Infections

By the time the crisis of West Africa’s Ebola outbreak dwindled to a close without closure this year, with expectations of flares of infection, leaving untold and unmet needs in its wake, it had killed more than 11,000 people,  500 to a 1,000 of them health care providers, Kevin De Cock of the U.S. Centers for Disease Prevention and Control reminded an audience here Tuesday.

But it was the survivors, and those who lived with and tended the sick, who were the focus of a session here to follow what has happened in the year since this conference first held a session focused on the dynamics of a disease not directly linked to  to HIV.

“We’ve had the opportunity to dig little bits of hope out of an enormous tragedy,” said Nancy Sullivan of the U.S. National Institute of Allergies and Infectious Diseases, who co-chaired the session.

It was, in fact the scale of the tragedy, as well as the participation of those who survived it that enabled research to avert future tragedies and to determine the scope of the challenges stemming from the outbreak that remain.

The news Tuesday included encouraging news on a vaccine, as well as daunting news about the ongoing health challenges of survivors, their risks of transmitting the virus, and, in fact how many survivors exist.

The outbreak is estimated to have infected more than 20,000 people, leaving more than  10,000 survivors, but as research from a survey of households in a Sierra Leone village found, that number, and its ramifications likely represent a significant underestimation — with unknown impacts.

The village, in the Kona district of Sierra Leone, was home to 34 known Ebola patients, 16 who were confirmed to have died from the disease, 12 who likely had, and six survivors. Findings from the survey, presented by Eugene Richardson of Partners in Health however found 14 more residents whose blood showed evidence they had been infected, although none had shown the full range of symptoms associated with the virus, and while only two reported having had a fever, 12 reported no symptoms at all. All said they had avoided getting tested during house to house surveillance during the outbreak.

The survey raised questions, Richardson noted, not only of how many were infected and asymptomatic in the course of the outbreak but whether their infection was transmissable.

It was a question that hung over other findings presented during the session, of continuing health needs and risks of survivors. While by far the most common across several surveys were found to be head and joint pain, eye disorders as well as neurological issues have been the most severe. Depression also poses a significant threat to survivors.

At the same time semen testing has found the virus as long as a year after patients left care for the virus, but whether that virus is transmissable remains unclear.

Results from two vaccine trials brought promising news but also highlighted another challenge, however welcome, to trials that only got off the ground when responses to quell the spread were finally underway. While the candidates have shown promise in early trials, a phase 3 trial among 28,000 volunteers was scaled back when a decline in new Ebola cases made it impossible to conduct the larger study.

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