Trial and Error - Ebola Cure Offers Cautious Optimism - Heartbreak By Rodney D. Sieh

On 28/Aug/2014 / In Medical News

Hopes were high recently when a consignment of the experimental drug ZMAPP arrived in Ebola-stricken Liberia to treat doctors suffering from the deadly virus, which has so far sickened more than 2,600 and killed more than 1,400, since it started in March. That was before the death, last Sunday of Dr. Abraham Borbor, Deputy Chief Medical Doctor at the John F. Kennedy Hospital in Monrovia, the only recorded internist in the post-war nation.
Dr. Borbor is only the second person to have died after receiving the ZMAPP. Father Miguel Pajares, a Spanish priest working at the St. Joseph's Catholic Hospital, also received the drug, but died, a few days after he was airlifted to Spain. Seven persons in total have received the ZMAPP: The drug has also been administered to a Nigerian doctor, Dr. Aroh Cosmos Izchukwu and an unnamed Ugandan doctor assisting the JFK Hospital.
The improved conditions of two American medical workers previously infected in the outbreak, Nancy Writebol and Kent Brantly, who were transported from Liberia to Atlanta for care and released from Emory University Hospital last week, further raised the expectations of many that the ZMAPP could be the answer that West Africa has been looking for to deter the outbreak wreaking havoc and drawing attention from the rest of the world.
Seventh Person Receives ZMapp
On Wednesday, Britain announced that its first confirmed Ebola patient had been treated with an experimental drug. The Huffington Post UK reports that doctors caring for William Pooley at the Royal Free Hospital in north London said he had been given ZMapp. Describing him as a "resilient and remarkable young man", medics said he was sitting up, reading and chatting to staff.
The 29-year-old volunteer nurse was flown back to the UK for emergency treatment after contracting the virus in Sierra Leone. ZMapp has been dubbed by some as the "cure" after two aid US workers were successfully treated for Ebola after taking it.
Similar responses were said of Dr. Borbor, whose death, however, appears to have slowed the momentum and dimmed hopes about the ZMAPP's ability at least for now, of becoming the clearest hope yet for a cure for the deadly virus. The Liberian government's chief spokesman, Lewis Brown, a former high school classmate of Dr. Borbor, said Monday that it was not possible to know from anecdotal reports whether the ZMAPP drug helps or hurts.
Dr. Borbor's Death Dimmed Hopes
Dr. Moses Massaquoi, Case Management coordinator of the Ebola Task Force, also a colleague of the late medical practitioner who contracted the virus while caring for other persons infected with the disease at the John F. Kennedy Medical center in Monrovia, confirmed that Dr. Borbor was administered the full dose of the experimental drug Z-Mapp, but died just when everyone thought he was making a recovery. "He finished the full course. He also had some co-mobility. He had other problems than just Ebola," said Dr. Massaquoi. That I don't know that is why we are doing the test. His sample was taken yesterday (Saturday, August 23, 2014) and we want to know whether it worked. Three people took it. Two doctors, one nurse." The mystery continues as Dr. Borbor died, leaving medical practitioners skeptical or unsure that the ZMapp works.
Jonathan Lai, a Scientist, and Associate Professor in the Department of Biochemistry at the Albert Einstein College of Medicine in New York, whose group has developed new antibodies against the Sudan Ebolavirus as a potential therapy to Ebola, says while the possibilities are endless, full cure for Ebola may still many trials away.
"I can say that the published animal studies for antibody therapeutics in general against Ebola (including components of ZMapp) suggest that antibody therapies are possible," Lai told FrontPageAfrica via email this week.
"Although ZMapp has been administered in several human cases for this outbreak, there is not enough data to know whether or not it is efficacious. Clinical trials in general require larger studies to know whether or not there is a significant improvement in the presence of the drug."
Jonathan Lai, a Scientist, and Associate Professor in the Department of Biochemistry at the Albert Einstein College of Medicine in New York. Adds Lai: "Our group has developed new antibodies against the Sudan Ebola virus as a potential therapy (note: not a vaccine); the antibodies have demonstrated efficacy in mice. Although these results are promising, there are many steps before they could be considered for human use. We are hopeful we will be able to contribute to an Ebola therapeutic in the long run." But even amid the cautious optimism, some remain hopeful that drugs like the ZMapp could be ready now. Writebol offer that much shortly after her release from Emory when she said she believes that ZMapp contributed to her recovery, her son said on Friday. "And the suffering of the people in West Africa is still very deep for them."
Ebola is transmitted by direct contact with the body fluids of an infected person. Initial flu-like symptoms can lead to external hemorrhaging from areas such as eyes and gums, and internal bleeding which can cause organ failure. The outbreak began in Guinea and has since spread to Liberia, Sierra Leone and Nigeria.
ZMapp is manufactured by a U.S. Biotech company Mapp Biopharmaceutical. WHO said only around 10 to 12 doses of the drug have been made. Canada has also pledged to donate 800 to 1,000 doses of an experimental Ebola vaccine developed in its government lab to the WHO for use in West Africa.
Several Untested Drugs Pitched to Liberia
In addition to the ZMapp has made several overtures to company in trial stages of drugs aimed at combating Ebola, but the Ministry of Health and Social Welfare has not been transparent in revealing the extent of its reach, which companies have been approached and which drugs, other than ZMapp have been requested. FrontPageAfrica recently came in possession of an email from a manufacture which revealed that Health Minister Walter Gwenigale had made a request for trial Ebola drugs.
The communication from Dr. Alessandro Manini, President of the International Emergency Management Organization (IEMO) informed the Liberian embassy in Italy that it had dispatched the trial drug upon the request of Health & Social Welfare Minister Dr. Gwenigale, in a letter dated August 18, 2014, to the Liberian Ambassador to Italy, Ambassador Mohammed Sheriff, obtained by FrontPageAfrica, reveals that the package had been sent by EMS. The letter does not state the name of the drug and FrontPageAfrica has been unable to determine whether the organization has been successful with a trial drug of this magnitude in the past.
The IEMO is an international body having its provisional head office in Italy and was established through the Intergovernmental Convention on food micro-algae, university research and emergency prevention, first ratified by Benin, Madagascar and Somalia. Dr. Manini, according to the IEMO website, supervises and coordinates the activities of the Organization and, in coordination with the Chairman of the IEMO Council, directs the various areas of competence, relevant to the fulfillment of the Organizational's Mandate (work for natural and man-made emergency prevention, preparedness, mitigation and response).
Fabipiravir, a Japanese-developed anti-influenza drug, is potential treatment to fight the rapidly expanding Ebola outbreak. (Fukijilm Holdings/Associated Press) The expressed Post EMS Package of 3 kg is said to contain sufficient dose amount for 30 people/patients (5 people per bottle) according to the relevant annexed Protocol. "I have also doubled the expedition to your Embassy and put the photocopy of the envelope and a copy of the Note to the Minister for your perusal, together with 4 four) treatments for Ebola (2 of 0°UB and 2 of 25000° UB) and the relevant Protocol, just in case that the envelope for Monrovia should not arrive in time," Dr. Manini explained. To date, the Ministry of Health has not yet made public the name of the drug or whether it had arrived in Liberia.
This week, Japan announced that it would be sending another brand of trial drug to Liberia. The drug, with the brand name Avigan, was developed by Fujifilm subsidiary Toyama Chemical Co. to treat new and re-emerging influenza viruses, but according to the Associated Press, has not been proven to be effective against Ebola. Favipiravir was approved by Japan's health ministry in March for use against influenza. Fujifilm is in talks with the U.S. Food and Drug Administration on clinical testing of the drug in treating Ebola, company spokesman Takao Aoki said.
Japan, Canada Offer Trial drugs
He said Ebola and influenza viruses are the same general type, and a similar response can theoretically be expected from Ebola. Favipiravir inhibits viral gene replication within infected cells to prevent propagation, while other anti-viral drugs often are designed to inhibit the release of new viral particles to prevent the spread of infection, the company said. The company has enough stock of favipiravir for more than 20,000 patients, Aoki said. Japan is said to be awaiting a decision by the World Health Organization (WHO) that would provide more details on the use of untested drugs against Ebola. In case of an emergency, Japan may respond to individual requests before any further decision by WHO.
WHO said earlier this month that it is ethical to use untested drugs on Ebola patients given the magnitude of the outbreak. Several drugs are being developed for the treatment of Ebola. They are still in the early stages and there is no proven treatment or vaccine for the often fatal disease. The Canadian government has also promised a shipment from one experimental vaccine, but it remains at a Canadian laboratory, but officials have been tightlipped on how many weeks it could be before those are given to volunteers.
Other drug makers are also moving ahead with possible solutions in hopes of finding the right formula that works. GlaxoSmithKline and U.S. Scientists at the National Institute of Allergy and Infectious Diseases hope to start a clinical trial of an experimental Ebola vaccine as soon as next month, after promising test results in primates.
Another experimental vaccine from Johnson & Johnson's Crucell unit should enter Phase I clinical trials in late 2015 or early 2016, while Profectus Biosciences is also working with U.S. Scientists on another preclinical vaccine. The outbreak is the world's largest and deadliest and the U.N. agency last week declared it an international health emergency. The WHO has appealed for funds and medical staff to supplement health care in one of the poorest regions in the world.
In the absence of a cure and amid cautious optimism, some have turned to unproven traditional medicine, religious figures promising to have a remedy or other unproven drugs, also promising to be the perfect antidote to Ebola. One such drug is Nano, a trial drug recently introduced in Liberia by a group of concerned Liberians as a possible cure for the deadly Ebola virus. FrontPageAfrica later uncover that the drug is nothing more than a pesticide which was recently rejected by health authorities in Nigeria.
The drug was rejected by the Nigerian government, which had initially struck a deal to accept Nano Silver solutions to treat Ebola from a yet to be named "Diaspora Nigerian" who claimed to have "invented" Nano Silver. Nigeria rejected the drug after the US Food and Drugs Administration has stated that the Nano Silver solution being paraded in Nigeria as a cure for Ebola is classified as a pesticide. For now, lingering hope is keeping many infected Ebola patients on a tight rope, desperately hoping that a solution to their Ebola ailment is in sight. But in the absence of a known, the only treatment that has worked so far is prevention, containment and quarantine with Nigeria apparently on the verge of proving what many countries including Liberia, Sierra Leone and Guinea failed to do.
ZMapp 'Has Run Out', CDC Chief Says
On Wednesday, Nigeria announced that it had contained the virus from spreading further and has brought the disease under control. Two treated patients, a male doctor and a female nurse, were discharged on Monday evening, having satisfied the criteria for discharge. The lone confirmed case as a secondary contact of Mr. Patrick Sawyer, the Liberian-American who took the disease into Nigeria, and a spouse of one of the physicians who participated in the management of the index case.
Since the outbreak entered Nigeria, through Sawyer, there have so far been 13 cases of EVD, including the index case. Of these thirteen (13), five (5), including the index case, unfortunately did not survive the disease. However, seven (7) of the infected persons were successfully managed at the Isolation ward in Lagos and have been discharged home, a point U.S. President Barack Obama hit home recently when he praised Nigeria for the way it has handled the Ebola outbreak.
For those still hanging on to hope, the most publicized ZMapp has run out, according to Dr. Tom Frieden, head of the U.S. Center for Disease Control, who's visiting Liberia this week, along with a team of health experts: "A handful of patients received it, we hope it helped them, but we don't know if the medicine works and there is no more of it and it is very difficult to make so; it'll take a long time to make more." "We do know that the standard medical care can save your life if you have Ebola. Yesterday the WHO issued an appeal for Ebola control for 438 million dollars for just a few months," Dr. Tom Frieden, says.

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