Ebola, the day after / Ebola, le jour d'après

Ebola, the day after A total of 28,616 cases (confirmed, probable, and suspected) and 11,310 deaths were reported in Guinea, Liberia, and Sierra Leone from March 2014 to June 2016. At first, the clinical picture dominated by severe gastroenteritis baffled clinicians trained to diagnose viral hæmorrhagic fever based on bleeding. And there was another problem: samples had to be sent abroad for laboratory confirmation of the diagnosis. From the start, the outbreak elicited strong reactions in the different social strata and within public and private institutions, their scope extending far beyond the mere biological dimension of the phenomenon. By the summer of 2014, the winds of panic were blowing. Public health recommendations were issued, in authoritarian fashion, to the population, in some cases prompting a violent response. Accustomed to locally-confined Ebola outbreaks causing a few dozen deaths in several months, the world discovered forecast models that, in one case, suggested the possibility of a million cases with half a million deaths. Though it did not get to that point, by the late 2015 there were over 215,000 people needing to be monitored due to contact with a patient. Clinicians had no rapid diagnostic test that could be used in their consultations to deal with the situation. No antiviral drugs had proven effective, and symptomatic and palliative treatments were limited by the care providers' fear of infection. There are no data proving that such treatments reduced the death rate. The impact of public health measures on the course of the outbreak at the population level is also unclear. Despite this rather bleak picture, early trials of a vaccine against the Zaire strain suggest that the response to such outbreaks will soon be more effective.

Ebola, le jour d'après Au total, 28 616 cas dont 11 310 décès (confirmés, probables et suspects) de maladie à virus Ebola ont été notifiés en Guinée, au Liberia et en Sierra Leone, entre mars 2014 et juin 2016. Dans un premier temps, le tableau clinique dominant de gastro-entérite sévère a déconcerté des cliniciens formés à évoquer le diagnostic de fièvre hémorragique virale devant des saignements. Difficulté supplémentaire, la confirmation biologique du diagnostic nécessitait l'envoi des prélèvements à l'étranger. Dès son démarrage, l'épidémie a provoqué de vives réactions dans les différentes catégories sociales et au sein des institutions publiques et privées dont l'ampleur a dépassé de loin la seule dimension biologique du phénomène. À l'été 2014, souffla un vent de panique. Les recommandations de santé publique furent transmises de matière autoritaire aux populations, provoquant parfois des réactions violentes en retour. Habitué à des épidémies d'Ebola cantonnées à l'échelon local et responsables de quelques dizaines de décès en quelques mois, le monde découvrait des modélisations prévisionnelles dont l'une suggérait que le million de cas et donc le demi-million de morts puissent être atteints. Sans en arriver à ce stade, le nombre de personnes à surveiller pour avoir été en contact avec un malade dépassait les 215 000 à la fin 2015. Pour faire face à la situation, les cliniciens ne disposaient pas d'un test diagnostique rapide et utilisable en consultation. En outre, aucun médicament antiviral n'avait fait ses preuves alors que les traitements symptomatiques et palliatifs étaient limités crainte d'infecter le personnel soignant. Il n'existe pas de données apportant la preuve que l'administration de ces traitements ait fait chuter la létalité. À l'échelle des populations, l'incertitude est la même au sujet du résultat des interventions de santé publique sur le cours de l'épidémie. Dans ce tableau plutôt sombre, les premiers essais d'un vaccin contre la souche Zaïre indiquent cependant que la réponse à ces épidémies sera bientôt plus efficace.

User Feedback on the MSF Tele-Expertise Service After a 4-Year Pilot Trial - A Comprehensive Analysis.

We surveyed all users of the Médecins Sans Frontières (MSF) tele-expertise service, approximately four years after it began operation. The survey contained 50 questions and was sent to 294 referrers and 254 specialists. There were 163 responses (response rate 30%). There were no significant differences between the responses from French and English users, so the responses were combined for subsequent analysis. Most of the responders were doctors (133 of 157 who answered that question), and most had completed field missions for MSF, i.e., both specialists and referrers. The majority stated that the system was user friendly and that they found it self-explanatory (i.e., they did not need to be shown how to use it). Almost all the referrers found that the telemedicine advice that they received was helpful, changed diagnosis and management, and/or reassured the patient. Similar feedback came from the specialists, who also felt that there was educational value for the field doctor. Although there was general satisfaction with the service, the survey identified various problems. The main concerns of the referrers were the lack of promotion of the system at headquarters' level, and the main concerns of the specialists were the lack of feedback about patient follow-up. Nonetheless, both referrers and specialists recognized the benefits of telemedicine in improving patient management, providing education, and reducing isolation in the field.

The drug and vaccine landscape for neglected diseases (2000-11): a systematic assessment.

BACKGROUND: In 1975-99, only 1·1% of new therapeutic products had been developed for neglected diseases. Since then, several public and private initiatives have attempted to mitigate this imbalance. We analysed the research and development pipeline of drugs and vaccines for neglected diseases from 2000 to 2011. METHODS: We searched databases of drug regulatory authorities, WHO, and clinical trial registries for entries made between Jan 1, 2000, and Dec 31, 2011. We defined neglected diseases as malaria, tuberculosis, diarrhoeal diseases, neglected tropical diseases (NTDs; WHO definition), and other diseases of poverty according to common definitions. FINDINGS: Of the 850 new therapeutic products registered in 2000-11, 37 (4%) were indicated for neglected diseases, comprising 25 products with a new indication or formulation and eight vaccines or biological products. Only four new chemical entities were approved for neglected diseases (three for malaria, one for diarrhoeal disease), accounting for 1% of the 336 new chemical entities approved during the study period. Of 148,445 clinical trials registered in Dec 31, 2011, only 2016 (1%) were for neglected diseases. INTERPRETATION: Our findings show a persistent insufficiency in drug and vaccine development for neglected diseases. Nevertheless, these and other data show a slight improvement during the past 12 years in new therapeutics development and registration. However, for many neglected diseases, new therapeutic products urgently need to be developed and delivered to improve control and potentially achieve elimination. FUNDING: None.

A large-scale distribution of milk-based fortified spreads: evidence for a new approach in regions with high burden of acute malnutrition.

BACKGROUND: There are 146 million underweight children in the developing world, which contribute to up to half of the world's child deaths. In high burden regions for malnutrition, the treatment of individual children is limited by available resources. Here, we evaluate a large-scale distribution of a nutritional supplement on the prevention of wasting. METHODS AND FINDINGS: A new ready-to-use food (RUF) was developed as a diet supplement for children under three. The intervention consisted of six monthly distributions of RUF during the 2007 hunger gap in a district of Maradi region, Niger, for approximately 60,000 children (length: 60-85 cm). At each distribution, all children over 65 cm had their Mid-Upper Arm Circumference (MUAC) recorded. Admission trends for severe wasting (WFH<70% NCHS) in Maradi, 2002-2005 show an increase every year during the hunger gap. In contrast, in 2007, throughout the period of the distribution, the incidence of severe acute malnutrition (MUAC<110 mm) remained at extremely low levels. Comparison of year-over-year admissions to the therapeutic feeding program shows that the 2007 blanket distribution had essentially the same flattening effect on the seasonal rise in admissions as the 2006 individualized treatment of almost 60,000 children moderately wasted. CONCLUSIONS: These results demonstrate the potential for distribution of fortified spreads to reduce the incidence of severe wasting in large population of children 6-36 months of age. Although further information is needed on the cost-effectiveness of such distributions, these results highlight the importance of re-evaluating current nutritional strategies and international recommendations for high burden areas of childhood malnutrition.