I survived Ebola, but villagers shunned me

Saa Sabas, Ebola survivor from southern Guinea: "I felt so tired and uncomfortable."

The Ebola outbreak in West Africa has hit "unprecedented" proportions, according to relief workers on the ground, with the WHO reporting 844 cases including 518 deaths since the epidemic began in March.

There is no cure or vaccine to treat Ebola, but the aid agency MSF has shown it doesn't have to be a death sentence if treated early. Ebola typically kills 90% of patients but the death rate in this outbreak has dropped to roughly 60%.

One man who survived the disease describes how the virus took hold.

How did you contract Ebola?
Map: Ebola spreads in West AfricaMap: Ebola spreads in West Africa
Inside an Ebola clinic in Guinea

I am an agronomist and I have two children, one boy and one girl. I work in the pharmacy at the health center of Gueckedou in southern Guinea. When my father was hospitalized at the health center I naturally volunteered to be at his bedside so other family members would not have to make the daily trek of tens of kilometers, traversing the trails between their village and the facility. I cleaned him when he vomited and also did his laundry. I also often gave him food and drink. He had diarrhea at least eight times per day but I did not know he was suffering from Ebola.

Five days after being hospitalized, [my father] passed away. After his death the medical staff realized he had presented Ebola symptoms and as I had close contact with him, it meant that I was at risk. So they told me that I needed to be followed up for 21 days and if ever I felt a small fever I had to come to the health center. The countdown then started for me: after nine days I got fever and this persisted until the 11th day. Finally I went to the treatment center -- where I did an Ebola test which was positive.

What were the symptoms? How did you feel while you were ill?

I first got a fever which persisted. My body temperature reached nearly 40C (104 degrees Fahrenheit). After that I had diarrhea, vomits, dysentery and hiccups [all symptoms of Ebola]. I went to the toilet several times a day and I felt so tired and uncomfortable.
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How and where were you treated?

I received medical assistance at the Ebola treatment center, put in place at the health centre of Gueckedou. The medical staff provided me with oral medications and infusions. They also provided me with food. I suffered at lot in the beginning with diarrhoea and hiccups but with the treatment I started to feel better.

What was the initial reaction in your home village after you recovered?

Joy, for my family because everyone thought that I would not survive this disease as many others people had died. However before the medical staff released me to go back to my family they tested me three times to make sure that I really had recovered. Afterwards they gave me a certificate of discharge. They also visited my family, the leaders and elders of my community to inform them that I had recovered and I was no longer contagious. Despite this, I was stigmatized. Some people avoided me in the beginning but now, over time, they have learned to accept me. Now they call me "anti-Ebola."
Some people avoided me in the beginning but now, over time, they have learned to accept me. Now they call me 'anti-Ebola'
Saa Sabas

You're now working with Red Cross volunteers in Guinea to raise awareness of the disease: what lessons are passing on?

I am part of a team of Red Cross volunteers, visiting communities, raising awareness on how to prevent the spread of the disease. One of the messages I try to pass on to the communities is to go early to the health center when sufferers first feel symptoms. The treatment is free of charge. People there will give you food and clothes and you can get a chance to survive.

What's your message for the outside world about Ebola? How can they help?

Everyone should be mobilized. We need to educate people and increase the sensitization. This is the key to stop the dangerous disease Ebola.

Many people have already died, that is why I participate in activities [to educate people]. I urge people to go the isolation and treatment centres if they experience the earliest symptoms of the disease, to increase their chance of being cured and surviving.

Questions about this new Ebola drug

Two American missionary workers infected with the deadly Ebola virus were given an experimental drug that seems to have saved their lives.

Dr. Kent Brantly was given the medication, ZMapp, shortly after telling his doctors he thought he would die, according to a source familiar with his case. Within an hour, doctors say his symptoms -- labored breathing and a widespread rash -- dramatically improved. Nancy Writebol, another missionary working with Samaritan's Purse, received two doses of the medication and has also shown significant improvement, sources say.

As there is no proven treatment and no vaccine for Ebola, this experimental drug is raising lots of questions.

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The drug was developed by the biotech firm Mapp Biopharmaceutical Inc., which is based in San Diego. The company was founded in 2003 "to develop novel pharmaceuticals for the prevention and treatment of infectious diseases, focusing on unmet needs in global health and biodefense," according to its website.

Mapp Biopharmaceutical has been working with the National Institutes of Health and the Defense Threat Reduction Agency, an arm of the military responsible for weapons of mass destruction, to develop an Ebola treatment for several years.

Are there other experimental Ebola drugs out there?

Yes. In March, the NIH awarded a five-year $28 million grant to establish a collaboration between researchers from 15 institutions who were working to fight Ebola.

"A whole menu of antibodies have been identified as potentially therapeutic, and researchers are eager to figure out which combinations are most effective and why," a news release about the grant said.

Tekmira, a Vancouver-based company that has a $140 million contract with the U.S. Department of Defense to develop an Ebola drug, began Phase 1 trials with its drug in January. But the FDA recently halted the trial, asking for more information.

At least one potential Ebola vaccine has been tested in healthy human volunteers, according to Thomas Geisbert, a leading researcher at the University of Texas Medical Branch. And last week, the NIH announced a safety trial of another Ebola vaccine will start as early as September.

How does ZMapp work?

Antibodies are proteins used by the immune system to mark and destroy foreign, or harmful, cells. A monoclonal antibody is similar, except it's engineered in a lab so it will attach to specific parts of a dangerous cell, according to the Mayo Clinic, mimicking your immune system's natural response. Monoclonal antibodies are used to treat many different types of conditions.

This medicine is a three-mouse monoclonal antibody, meaning that mice were exposed to fragments of the Ebola virus and then the antibodies generated within the mice's blood were harvested to create the medicine.

Why did American missionary workers get the drug?

Many have asked why these two workers received the experimental drug when so many -- around 1,600 -- others in West Africa also have the virus.

Samaritan's Purse reached out to an NIH scientist who was on the ground in West Africa, according to the National Institute of Allergy and Infectious Diseases. "The scientist was able to informally answer some questions and referred them to appropriate company contacts to pursue their interest in obtaining experimental product," NIAID said.

The World Health Organization says it was not involved in the decision to treat Brantly and Writebol. Both patients had to give consent to receive the drug, knowing it had never been tested in humans before.

The process by which the medication was made available to the American patients may have fallen under the U.S. Food and Drug Administration's "compassionate use" regulation, which allows access to investigational drugs outside clinical trials.

Did doctors know it would work?

No. The drug had shown promise in primates, but even in those experiments, just eight monkeys received the treatment. In any case, the human immune system can react differently than primates', which is why drugs are required to undergo human clinical trials before being approved by government agencies for widespread use.

The two Americans' cases will be studied further to determine how the drug worked with their immune systems.

Will the drug be made available to other Ebola patients?
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It's unclear. Doctors "cannot start using untested drugs in the middle of an outbreak, for various reasons," World Health Organization spokesman Gregory Hartl said.

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, says scientists have to be careful about assuming this drug will work in other patients as it appears to have worked in Brantly.

"Having worked with administering antibodies for people for a really long time, that would be distinctly unusual," he told CNN. "As we all know in medicine ... you have to withhold judgment."

Does the company have more vials of the drug?

The company has very few doses ready for patient use, Fauci told CNN. "Apparently the company is trying to scale up, (but) it's not easy to scale up to very large number of doses."

Who paid for the drug and how much did it cost?

We don't know. Samaritan's Purse covered the cost of Brantly and Writebol's evacuations but did not pay for the drug, according to a spokesman.

When a patient gets an experimental drug, the drug company can donate the product under compassionate use. Mapp Biopharmaceutical Inc. might have done that in this case.

Health insurance companies typically do not pick up the tab for treatments that have not been approved by the FDA. But they would usually cover the cost of any doctor fees associated with giving the drug and any costs associated with monitoring how the drug is working.

Would this drug stop the Ebola epidemic?

If it were widely available, it certainly couldn't hurt. An effective Ebola drug could help doctors treat the deadly virus, which is killing about 60% of the people infected in West Africa. But a vaccine would be a much more effective tool in stopping this, and future, epidemics.

Vaccines are given to healthy people to prevent them from ever becoming infected. One challenge with Ebola, experts say, is that companies don't believe they could make much money from developing a vaccine, so few companies show interest.


http://edition.cnn.com/2014/08/04/health/ebola-drug-questions/index.html?hpt=hp_c1

Experimental drug likely saved Ebola patients

It's a story that could have come from a cinematic medical thriller: Two American missionary workers contract Ebola. Their situation is dire. Three vials containing a highly experimental drug are flown into Liberia in a last-ditch effort to save them.

And the drug flown in last week appears to have worked, according to a source familiar with details of the treatment.

Dr. Kent Brantly's and Nancy Writebol's conditions significantly improved after receiving the medication, sources say. Brantly was able to walk into Emory University Hospital in Atlanta after being evacuated to the United States last week, and Writebol is expected to arrive in Atlanta on Tuesday.

On July 22, Brantly woke up feeling feverish. Fearing the worst, Brantly immediately isolated himself. Writebol's symptoms started three days later. A rapid field blood test confirmed the infection in both of them after they had become ill with fever, vomiting and diarrhea.
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It's believed Brantly and Writebol, who worked with the aid organization Samaritan's Purse, contracted Ebola from another health care worker at their hospital in Liberia, although the official Centers for Disease Control and Prevention case investigation has yet to be released.

As the Americans' conditions worsened, Samaritan's Purse reached out to a National Institutes of Health scientist who was on the ground in West Africa, according to the National Institute of Allergy and Infectious Diseases.

"The scientist was able to informally answer some questions and referred them to appropriate company contacts to pursue their interest in obtaining the experimental product," NIAID said.

The experimental drug, known as ZMapp, was developed by the biotech firm Mapp Biopharmaceutical Inc., which is based in San Diego. The patients were told that the treatment had never been tried before in a human being but had shown promise in small experiments with monkeys.

Questions about this new Ebola drug

According to company documents, four monkeys infected with Ebola survived after being given the therapy within 24 hours after infection. Two of four other monkeys that started therapy within 48 hours after infection also survived. One monkey that was not treated died within five days of exposure to the virus.

Brantly and Writebol were aware of the risk of taking a new, little-understood treatment and gave informed consent, according to two sources familiar with the care of the missionary workers. In the monkeys, the experimental serum had been given within 48 hours of infection. Brantly didn't receive it until he'd been sick for nine days.

The medicine is a three-mouse monoclonal antibody, meaning that mice were exposed to fragments of the Ebola virus and then the antibodies generated within the mice's blood were harvested to create the medicine. It works by preventing the virus from entering and infecting new cells.

The Ebola virus causes viral hemorrhagic fever, which refers to a group of viruses that affect multiple organ systems in the body and are often accompanied by bleeding.

Early symptoms include sudden onset of fever, weakness, muscle pain, headaches and a sore throat. They later progress to vomiting, diarrhea, impaired kidney and liver function -- and sometimes internal and external bleeding.

The ZMapp vials, stored at subzero temperatures, reached the hospital in Liberia where Brantly and Writebol were being treated Thursday morning. Doctors were instructed to allow the serum to thaw naturally without any additional heat. It was expected that it would be eight to 10 hours before the medicine could be given, according to a source familiar with the process.

Brantly asked that Writebol be given the first dose because he was younger and he thought he had a better chance of fighting it, and she agreed. However, as the first vial was still thawing, Brantly's condition took a sudden turn for the worse.

Brantly began to deteriorate and developed labored breathing. He told his doctors he thought he was dying, according to a source with firsthand knowledge of the situation.

Knowing his dose was still frozen, Brantly asked if he could have Writebol's now-thawed medication. It was brought to his room and administered through an IV. Within an hour of receiving the medication, Brantly's condition dramatically improved. He began breathing easier; the rash over his trunk faded away. One of his doctors described the events as "miraculous."

By the next morning, Brantly was able to take a shower on his own before getting on a specially designed Gulfstream air ambulance jet to be evacuated to the United States.

Writebol also received a vial of the medication. Her response was not as remarkable, according to sources familiar with the treatment. However, doctors on Sunday administered Writebol a second dose of the medication, which resulted in significant improvement.

She was stable enough to be evacuated back to the United States.

The process by which the medication was made available to Brantly and Writebol is highly unusual.

World Health Organization spokesman Gregory Hartl cautioned that health authorities "cannot start using untested drugs in the middle of an outbreak, for various reasons."

Doctors Without Borders similarly weighed in on the side of caution.

"It is important to keep in mind that a large-scale provision of treatments and vaccines that are in very early stages of development has a series of scientific and ethical implications," the organization said in a statement.

"As doctors, trying an untested drug on patients is a very difficult choice since our first priority is to do no harm, and we would not be sure that the experimental treatment would do more harm than good."

ZMapp has not been approved for human use and has not even gone through the clinical trial process, which is standard to prove the safety and efficacy of a medication. It may have been given under the U.S. Food and Drug Administration's "compassionate use" regulation, which allows access to investigational drugs outside clinical trials.

Getting approval for compassionate use is often long and laborious, but in the case of Brantly and Writebol, they received the medication within seven to 10 days of their exposure to the Ebola virus.

On July 30, the Defense Threat Reduction Agency, an arm of the military responsible for any chemical, biological, radiological, nuclear and high-yield explosive threats, allotted additional funding to MAPP Biopharmaceutical due to "promising results."

http://edition.cnn.com/2014/08/04/health/experimental-ebola-serum/index.html?hpt=hp_c1