the increased prevalence in men in Australia who have sex with men raises questions about treatment as prevention.
special section on HIV
Only 1253 people were diagnosed with HIV in Australia in 2012, shows nearly 3 decades of prevention efforts aggressive. But there is a troubling development Guard: The number of new diagnoses has jumped 10% over the previous year, and cases have steadily increased since 1999. And 70% of new infections among men who have sex with men (MSM)
[Every country in the world has struggled to slow the spread among MSM. But the growing problem in Australia has highlighted the limits of one of the most promising new prevention tools. A 2011 historic study showed that if infected people took their faithfully (ARVs) for antiretroviral drugs and had viral levels undetectable on standard tests, the risk of transmission through heterosexual sex has been almost eliminated, down 96% ( Science , 23 December 2011, p. 1628). Hopes rose that the addition of treatment as prevention to the arsenal of proven interventions could bring AIDS epidemics in the communities stopped.
Australia has universal health care and access to ARVs last, and most people who learn they are infected quickly begin treatment. In a study published in the July 2012 issue PLOS Medicine , epidemiologist David Wilson of the Kirby Institute for Infection and Immunity in society in Sydney noted that up to 75% of MSM in Australia said get tested HIV each year, and 70% of those infected received ARVs. In 0% of people, viral levels have been completely removed. But this did not prevent the increase in new cases among MSM. "Why is there a disconnect with" test and treat? "Ask David Cooper, who heads the Kirby Institute.
One possible answer is that treatment as prevention does not work just as well with MSM. Anal intercourse has a probability 18 times higher HIV transmission than vaginal intercourse, according to a study in 2010. MSM also tend to have more partners, which increases the chance that the virus spreads.
Wilson, a mathematical modeler and Chief Kirby monitoring division, also notes that more treatment means more people with HIV survive that can potentially spread infection, as some undoubtedly remain infectious. treated people can also indulge in behaviors more risk that, in a sense of the people, overwhelming benefits of drugs. and the virus is often transmitted by recently infected people who have yet to develop enough high levels of antibodies to detect on standard tests.
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IMAGE :. Australian AIDS FEDERATION OF ORGANIZATIONS / The NATIONAL ASSOCIATION OF PEOPLE LIVING WITH HIV / AIDS
Clearly, if every infected person has taken ARVs every day and had undetectable viral levels, the transmission would likely fall in MSM communities. But this is unrealistic. So Wilson and his team published an online modeling exercise on February 7 in Sexual Health who explored what it would take to lower HIV infection rates in the MSM population of Australia . The researchers studied the impact of early detection of infection and early treatment. But the factor that stands out the most was the treatment effect on the transmission.
If ARVs indeed lower the risk of transmission among MSM 96% -as much as it does for heterosexual and treat 0% of people would reduce new infections by 55% in 5 years. On the other hand, if ARVs are a simple protection of 26% among MSM, the same scenario would avoid a meager 9% of infections. "The jury is still out regarding the amount of treatment reduces infectiousness with male-male sex," says Wilson.
Even if it works as well for MSM, which Kirby Institute is studying, the country needs to increase significantly the number of people on ARVs and it is notoriously difficult to improve success.
This week, a team from the National Institute on Drug Abuse (NIDA) reports that heavy marijuana use can damage the pleasure center of the brain ?. Meanwhile, UK researchers say they understand why pot makes you paranoid. But to focus research on the "wrong side" of cannabis give little attention to drugs? Science spoke to Ian Mitchell, an emergency physician at the University of Southern Medical Program of British Columbia in Kamloops, Canada, and author of the blog Cannabis clinical context in which said research the influences of politics in this controversial area. As a doctor recommends medical marijuana to patients, it follows the drug research and often critical studies he believes are based on outdated information or are made with a bias of anti-cannabis.
This interview was edited for clarity and brevity.
Q: What do you think of the NIDA study?
A: They said they were given Ritalin abusers of marijuana and nothing happens. One of the ways you could interpret that's OK, these pleasure centers are damaged. But you could also say, perhaps marijuana decreases the effects of [Ritalin] on people. It would also be right to interpret
Q:.? Why do we hear more about studies that show negative effects of marijuana
A: NIDA cannabis is the research center in America. And mandate, clearly, is to study drug abuse. So they mostly fund studies that address abuse. In America, if you want to perform a study that showed a benefit of cannabis, we could not do that because NIDA could not give you samples to use. So there was no testing [on potential medical benefits] did. For example, there has not been a good test to study the potential of marijuana to treat post-traumatic stress disorder. They could not get it done, because of all these political obstacles
Q :. Laws change for Comment example, legalization in Colorado and Washington Uruguay [1945006?] -influencing research on marijuana
A: research on marijuana is flowering. States like Colorado are allocating portions of revenues from marijuana sales for research. This will be very useful, because this money [unlike NIDA funding] will be free to apply to the search of benefits. There are certainly a lot more interest, and the political situation, I think has improved significantly.
I think it's also very important to monitor social data on recreational use. Now, Washington and Colorado, they are monitoring data on traffic accidents and deaths, pedestrian accidents, suicide, homicide rates, that kind of thing. This is an extremely large amount of data that has not really been followed so far. Now that recreational use is legal in these areas, it is much easier to study. In areas where it is illegal, you can not really ask people what kind of behavior because they do not want to get arrested
Q :. Is there a danger that research into the medical benefits of marijuana will be politicized, too? Sometimes you will hear anecdotal evidence of marijuana shrinking tumors , for example
A :. Absolutely, and I think that is a big concern. But this is why research must be done, because we have all these little stories of people saying, "I am this and my cancer better." And it is far from good enough evidence to start changing convenient.
there is a lot of criticism in search of cannabis in all, and I expect to continue. Thus, studies should be good. They must be of excellent quality, and they must be examined. And I'm sure they will, very closely.
hookworms, roundworms, and other parasitic worms known as helminths species thrived in mammals for millions of years. Despite modern advances in sanitation, helminth infections still have a devastating impact on human health and welfare, particularly in developing regions. This week Science has two research papers that explore how parasitic infections can compromise the immune system by awakening latent viruses and prevent the antiviral defenses.
The worms in this slideshow are responsible for some of the worst helminth infections in the world and cause a global burden of disease outweighs the best known infections such as malaria and tuberculosis. For more information, see this week's issue of Science
Fixed August 1, 11:58 :. Because of the mislabeled image of the source of photo T. solium was wrongly identified as Taenia saginata . In addition, a photo of a cat tapeworm misidentified as Ancylostoma braziliense was withdrawn.
Like the Ebola outbreaks raging in West Africa, the World Health Organization (WHO) desperate for a way to help people infected, is to reconsider a potential treatment Ebola tried in 1976, after the first documented outbreak of the deadly viral disease using the blood of people who have recovered from an infection to treat those who are still fighting against the virus. "Convalescent Serum is high on our list of potential therapies and has been used in other homes (eg in China during SARS)," the WHO said in a written statement to Science Insider . "There is a long history of use, a lot of experience of what needs to be done, that the standards and norms must be respected."
There are no official plans to administer the convalescent serum sick, but WHO said it will assess whether the treatment approach was "safe and feasible" and was already working with officials in areas affected by Ebola to strengthen blood banking systems there. These movements are as scientists debate the mixed results of past use of convalescent serum. "The jury is still out" on the approach, said Daniel Bausch, an Ebola expert at Tulane University in New Orleans, Louisiana. However, he and others believe that therapy should be explored. "I think we have a moral imperative to push forward with all scientifically plausible manner, "said Bausch.
the Ebola virus has sickened at least 2,127 people and killed in 1145 them Sierra Leone, Guinea, Liberia and Nigeria. These figures can "significantly underestimate the scale of the epidemic," WHO warned Thursday. It is already the largest Ebola outbreak ever recorded and the unprecedented number of deaths has led to calls to try experimental therapies that are in the early stages of development. on Tuesday, an ethics committee of the wHO said it was ethics in the particular case using unapproved treatments such as Ebola zmapp, a mixture of antibodies that has been tested in animals and has been given to both the US health care workers who fell ill in Liberia. Other experts advocate the use of drugs that are approved to treat other diseases, but they can help patients with Ebola, too. And Nigeria would explores a controversial treatment called Nano Silver.
As for convalescent serum used to treat patients, it is an attractive option for a number of reasons, says Bausch. Get blood transfusions became commonplace; no approval bodies such as the United States Food and Drug Administration or European Medicines Agency is required and affected countries in West Africa many people survived Ebola, which means it can be a serum supply. In fact, the therapy has already been tried in the current epidemic. One of two health workers from the United States that has been treated with zmapp, Kent Brantly, earlier received a transfusion of blood of a boy of 14, he had treated and who had survived Ebola.
But as the other treatments being discussed, it is far from proven that the convalescence serum will help patients Ebola. The idea is simple: Because survivors are usually developed antibodies to fight the virus, the transfer of their blood could help patients. In the past, the strategy was used to treat people with SARS, and Lassa fever, viral hemorrhagic fever, such as Ebola. David Heymann, an epidemiologist at the London School of Hygiene & Tropical Medicine and a former executive director of communicable diseases at WHO, said that the use of the therapy in 1976 is encouraging. Heymann, who was part of a team investigating the outbreak in Zaire, stayed for 2.5 months collecting a unit of blood each week to survivors, he said. The epidemic ended before the serum could be used in Africa, but some of it was given later that year to a researcher in the UK who accidentally pricked himself infected while transferring the blood of a Guinea pig infected with Ebola virus. He survived. "The blood was stored in South Africa and the CDC in Atlanta, but I do not know what happened," says Heymann.
serumof Convalescent tried again in 1995 in an epidemic of Ebola in Kikwit in the Democratic Republic of Congo. Kikwit General hospital doctors treated eight Ebola patients with blood donated by five people who survived their infections. Seven of those receiving the serum also survived. A reanalysis later however, concluded that the patients survived long enough their infection before receiving the serum they would probably have recovered without it. And a study in rhesus macaques, published in 07, found no benefit of transferring blood convalescent monkeys. "There are a lot of variables and quality of immune blood or serum may vary considerably from one person to another," said Thomas Geisbert, a researcher at the University of Texas Medical Branch in Galveston and one of the authors of this study.
WHO clinical Filovirus working group, convened in response to the current outbreak, reviewed the evidence on the serum of convalescents at a meeting in Geneva, Switzerland, at the end of July says Bausch, part of the group. A plan has been proposed to steal the blood of Ebola survivors in the United States and Geisbert or Heinz Feldmann, a researcher at the National Institute of Allergy and Infectious Diseases, try the therapy in non-human primates, says Bausch. But Geisbert, in an e-mail, notes that there are "no current plans to test this in non-human primates" and there was "no formal request from any agency" if he and Heinz "are both willing and ready to do whatever is necessary to support the response. "Tom Solomon, director of the Research Unit of the Health Protection UK in emerging infections based at the University of Liverpool, he said he is also considering a therapy trial in humans." We are in discussions with WHO and an international group of partners to develop a test and looking both convalescent plasma and new therapies ", he said. If the serum is tested on humans, check to advance that can neutralize the virus, said Stephan Günther, a virologist at the Bernhard Nocht Institute for tropical medicine, who is now in Nigeria. "Otherwise, you do not have to give serum." neutralization could be measured in the cell culture with a real virus or a virus of the recombinant vaccine expressing Ebola area virus protein, Günther said.
Although work therapy, there are challenges. the first is the risk of infecting patients with other pathogens such as HIV or hepatitis C. Get the blood of patients cured in the first place can also be a problem, says Bausch. "Blood is an entity that people pay much attention to West Africa. When people feel like they are losing blood, which is an important thing and bad, "he said. Yet try the therapy in non-human primates and then implement in affected countries in West Africa is logical, says Bausch. "It's going to be complicated, it will be difficult to do, but at some point, we'll just try to dive and move forward." Robert Colebunders, a clinical infectious diseases at the University of Antwerp in Belgium , who was involved in treating Ebola patients in the home in 1995, said that if there are survivors willing to donate blood, doctors should try therapy. "And then they need to follow up scientifically, so we learn something. "
However, the WHO warned today in a statement, focus on untested therapies is" creating unrealistic expectations. ... The public needs to understand that these medical products are under investigation. They have not yet been tested in humans and are not approved by regulatory authorities, beyond the use for compassionate care. "
Focusing on therapies is also distracted what really needs to be done, said Steven Riley, an infectious disease epidemiologist disease at Imperial College London. "We do not need to export drugs. We need to export the gold standard public health process, "he said. Infectious disease experts agree that monitoring of those who have been in contact with an infected person and isolate is the key containing the deadly virus
* Ebola files :. given the current Ebola outbreak unprecedented in terms of the number of people killed and the rapid geographic spread, science and science Translational Medicine made a collection of research articles and news on the viral disease available for researchers and the general public.
Alessandro Vespignani hopes his latest book will prove to be false. In July, the physicist at Northeastern University in Boston began modeling how the deadly Ebola virus can spread in West Africa. Extrapolating current trends, the number of sick and dying quickly rises of more than 3000 cases tolls current and 1500 deaths at about 10,000 cases before September 24, and hundreds of thousands in the following months. "The numbers are really scary," he said, although he stressed that the model assumes control efforts are not strengthened. "We all hope to see what is not happening," Vespigani wrote in an e-mail .
Vespignani is not alone in trying to predict how the unprecedented epidemic will progress. last week, the World health Organization (WHO) estimates that the number of cases could ultimately exceed 20,000. and scientists around the world are scrambling to create computer models that accurately describe the spread of the deadly virus. all of them seem not quite as dark as Vespignani of. But all modelers agree that current efforts to fight against the epidemic are not enough to stop the deadly pathogen in its tracks.
the computer models "are incredibly helpful" in the fight against an epidemic, says researcher of infectious diseases Jeremy Farrar, who leads the Wellcome Trust research organization in London. They can help organizations such as WHO predict medical supplies and personnel they need and can indicate what interventions will be better contain the epidemic. Christian Althaus mathematical epidemiologist at the University of Bern, which is also built models of Ebola, says WHO and Samaritan's Purse, a relief organization fight against Ebola, contacted him to learn about its projections.
But modelers are hampered by the lack of data on the current epidemic and the lack of knowledge about how the Ebola virus spreads. The funerals of Ebola victims are known to spread the virus, for example, but how many people are infected in this way is not known. "Before that, we never had much of Ebola, so that epidemiology has not been well developed," says Ira Longini, a biostatistician at the University of Florida in Gainesville. "We are caught with our pants down."
To a mathematician, the fight against any epidemic is at its core a struggle to reduce a number: R e , the effective reproductive rate the pathogen, the number of people a person infected in turn infects on average. E R 1 above, and the disease spreads. Below 1, an epidemic will stall
The Outbreak models typically assume that there are four groups of people :. Those who are susceptible, those who were infected but not yet infectious, those who are sick and can transmit the virus, and those who have recovered. A model, in essence, describes the rate at which people move from one group to another. Thereof, R e can be calculated.
If the disease continues to spread as it has, most modellers Science spoke to say WHO estimate will prove to be conservative. "If the epidemic in Liberia should continue this until 1 December, the cumulative number of cases exceeds 100,000," Althaus predicted. These long-term forecasts are mistakes, he admits. But other modelers are not much more encouraging. Caitlin Rivers Institute and State University of Blacksburg Virginia Polytechnic to expect about 1,000 new cases in Liberia in the next 2 weeks and a similar number in Sierra Leone.
Vespignani analyzed the probability that the Ebola virus will spread to other countries. Using data on millions of air travelers and commuters and mobility patterns based on census data and mobile devices, he built a model of the world in which he can introduce the Ebola virus, then run hundreds of thousands of simulations. In general, the risk of spread beyond West Africa is small, Vespignani said, but the risk increases with the magnitude of the epidemic. Ghana, the United Kingdom and the United States are among the most likely to have a case presented country, depending on model. (Senegal, which reported its first case of Ebola last week, was in ten countries, too.)
The models are only as good as the data entered for them; up to three quarters of Ebola cases may go unreported. Modelers are also assuming that the key parameters, such as the incubation time of the virus are the same as previously occurred. "We could miss the boat and we have no signal to indicate that," said Martin Meltzer of the US Centers for Disease Control and Prevention in Atlanta.
The biggest uncertainty is how many doctors, nurses and others can slow the virus. There are several ways to push down R e , Farrar said hand washing, wearing masks, or quarantine of people, for example. "But given the complexity of the epidemic and limited resources, we need to know what are the two or three things that go help reduce infections," says Farrar, and that is where models can help. For example, would track all contacts all cases be more effective than monitoring the much smaller number that had some type of contact with a case, such as sharing a room?
evaluates Rivers current interventions such as increased use of protective equipment or campaigns to isolate infected people. in the most optimistic scenario, all the contacts of infected people is traced, and transmission in hospitals is reduced by 75 %. Even that, while significantly reducing the number of deaths from Ebola did not push R e below a.
the challenge varies by country, said Althaus . "in Guinea and Sierra Leone, R e is close to 1 and the epidemic could be stopped if the interventions improve a bit." in Liberia, R e was near 1.5 all the time. "This means that the work is just beginning here." But Meltzer says there is no reason to believe that the situation is better in Sierra Leone. "We see no change in the rate of accumulation of cases "he said.
as the models will better differentiate what happens in places, Rivers said," you might be able to stop lines around certain communities. "But these measures are highly controversial. When Liberia last week barricaded off West Point, a sprawling slum with probably more than 100,000 inhabitants, it attracted a largely negative response. "quarantines and curfews tend to instill fear and mistrust to the entire response, including health facilities, "said a representative of Médecins Sans Frontières Science . Paul Seabright, a researcher at the Toulouse School of economics in France, which studied these measures, said they are an incentive for people to keep a secret if they have been in contact with a patient. Liberia tough actions are "the last thing this epidemic needs," he said.
The people in West Africa will change behavior, Meltzer said. "We will not stop this epidemic only by building hospitals. There should be a change in how the community deals with the disease. "Modeling is easy enough, Vespignani said." I can reduce the transmission at the funeral of 40% easily in a model. It's a line of code. But in the area that is really hard "
* Ebola files :. Given the current Ebola epidemic, unprecedented in terms of the number of people killed and the rapid geographic spread, Science and Science Translational Medicine made a collection of research articles and news on the viral disease available for researchers and the general public.
Researchers are closer to unraveling the mystery of Timothy Ray Brown, the only human cured of HIV, the virus defeated , according to a new study. Although the work does not provide a definitive answer, it excludes a possible explanation.
Brown remains one of the most studied case in the history of the HIV epidemic. In 06, after living with the virus for 11 years and control its infection with antiretroviral drugs (ARVs), he learned he had developed acute myelogenous leukemia. (Leukemia has no known relation to infection or HIV treatment.) The chemotherapy has failed, and the following year Brown, an American who lived in Berlin, received the first of two grafts has the common bone marrow treatment for cancer and has abandoned its ARVs. When people with HIV stop taking ARVs, HIV levels go up arrow usually within weeks. Yet researchers scouring the Brown's blood over the last 7 years have found that traces of viral genetic material, none can replicate.
Today, the researchers point out three factors that might independently or in combination have rid the body of HIV Brown. The first is the conditioning process, in which doctors destroyed the Brown immune system with chemotherapy and whole body irradiation to prepare him for his bone marrow transplant. His oncologist, Gero Hütter, who was then at the Free University of Berlin, also took an additional step that he thought might not just cure leukemia, but also help rid the body of HIV Brown. He found a bone marrow donor that has a rare mutation in a gene which paralyzes a key receptor on white blood cells of the virus uses to establish an infection. (For years, conscripts researchers Brown as the "Berlin patient".) The third possibility is his new immune system attacks the remains of his former which held cells infected with HIV, a process known as the graft against the host.
in the new study, a team led by immunologist Guido Silvestri of Emory University in Atlanta, developed a rare monkey experiment to test these possibilities.
bone marrow transplants work because of stem cells. Modern techniques effectively avoid sucking the bone marrow, and instead can sift through blood and pull the stem cells needed for transplantation to "graft". Thus, the researchers first drew blood from three rhesus macaque monkeys, removed the stem cells, and put them in storage cells. They were then infected animals and these three control monkeys with a hybrid virus, known under the name SHIV, which contains part of the human and simian AIDS virus. The six animals soon started receiving ARVs (which better meet SHIVs that SIV itself), and SHIV levels in the blood quickly dropped below the level of detection on standard tests as planned.
A few months later, the three monkeys who had stored stem cells underwent whole body irradiation to condition their bodies and had their own reinfused stem cells. After the grafted cells, a process that took a few months longer, the researchers stopped the ARV in the three animals and three controls. SHIV quickly came screaming back in the three controls and two transplanted animals. (A transplanted monkeys did not have the virus rebound, but his kidneys have failed and the researchers euthanized.)
The team, who published their work online in PLoS Pathogens today, concludes that conditioned by itself is not likely to rid the body of the AIDS virus. Silvestri explained that the monkey study was a validation of experience principle strictly isolated the effects of single package. "There is no way to do this in humans," he said.
"This is an important study, and it is a very useful model," said Daniel Kuritzkes of Brigham & Women's Hospital in Cambridge, Massachusetts, who was not connected to the research.
Kuritzkes and his colleagues are particularly interested in the experience because two of their own patients infected with leukemia HIV received bone marrow transplants from donors who do not have cells resistant to HIV. for several months after discontinuation of ART, HIV has remained distance in men, raising hopes that resistant donor cells are not a factor. but the virus eventually returned in each patient. Kuritzkes suspect transplants have reduced the amount of HIV left in body-experienced patients under the name viral reservoir, but the virus has resurfaced because he continued to copy and finally overwhelmed the immune responses against him.
Although the study shows that the packaging itself probably can not eliminate HIV infection, the study leaves open the possibility that the disease of the graft against the host played a central role in Brown's healing. Unlike Kuritzkes Brown and two patients, the transplanted monkeys received their own stem cells, which do not trigger a response of the graft against the host. "At the end of the day, which could be an important element," says Silvestri. He also thought it could help reduce the size of the reservoir for treating monkeys with ARVs for more than a few months.
Silvestri hopes to make future monkey experiments that test the different variables, including the transplantation of the animals with the viral blood resistant cells that mimic those that Brown received. "the best scientific studies raise as many questions as answers to that," Steven said Deeks, researcher and clinician at the University of California, San Francisco, who has treated and studied Brown. "Unfortunately, the heroic efforts that went into this study failed to provide a definitive answer regarding the patient's enigmas of Berlin. The model will probably need to be optimized, and at the very least, macaques treated with antiretroviral therapy for longer periods of time. But I am convinced that the team will understand it "
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When a traveler Liberia came down with Ebola in Dallas on 24 September, it was a warning to the world: As the number cases in West Africa continues to increase, so does the risk of disease spread beyond Guinea, Sierra Leone and Liberia. The United States was the third country, after Nigeria and Senegal to catch a spark of fire more; it was followed by Spain, which reported the first case of Ebola contracted outside of Africa, October 6. The patient, a nurse, had taken care of a priest who became infected in Sierra Leone.
None of these cases has triggered a generalized epidemic, and most experts are convinced that rich nations can contain introduced cases. "My first reaction was: Well, it had to be somewhere better than Dallas Mumbai." Says Peter Sandman, risk communication consultant based in Brooklyn, New York, on the case of the United States. But developing countries may not be so lucky when Ebola arrives at their door. This could result in entirely new chapters in the spread of the disease.
On October 3, the World Health Organization (WHO) reported 7470 cases and 3431 deaths in the three affected countries. These figures suspected of gross underestimates, are rising exponentially, and the models show they could reach hundreds of thousands in a few months. But the models can not predict unpredictable things like viral mutations, changes in human behavior, the impact of new vaccines and drugs, or where and how the disease will then take root. So researchers are looking beyond the models and scenarios, to prepare for what might happen. Scientists are naturally reluctant to speculate, Sandman said, but "risk communication and crisis communication are what-if."
On the optimistic picture, an effective vaccine could finally check the rise in the classic control cases, something methods such as isolation and quarantine have failed to do. Without a vaccine, "I think the best we can hope for is that the spread slows down a bit," said Alessandro Vespignani, a physicist at Northeastern University in Boston who has modeled the spread of Ebola. "The increase in action public health will have a huge impact, but I think it got to the stage where we need a vaccine to stop this epidemic, "said Jeremy Farrar, an epidemiologist who heads the Wellcome Trust in London.
[vaccineA candidate is already in phase I safety tests, and another will soon; at a meeting at the WHO on 29 and 30 September, experts discussed ways to accelerate the development of vaccines and how to deal with the thorny ethical problems involved in testing a vaccine for efficiency in affected countries (http://scim.ag/Ebolavac). But these tests are not likely to start until January, and they can not give results until April.
Meanwhile, some scientists fear the virus could mutate. In an op-ed piece in The New York Times September 11, Michael Osterholm, director of the Center for Research on Infectious Diseases and politics at the University of Minnesota, Twin Cities, has argued that Ebola could change in such a way "that just breathing would put a risk of getting" it. He was widely criticized for fear mongering. "I do not know of a viral infection whose mode of transmission has changed in this way," says Farrar. WHO issued a statement on October 6, calling the idea "speculation, unsupported by any evidence." Osterholm retorts that "it may be a very remote possibility, but we must be ready even for that."
DATA: MONSTER LAB, Northeastern University
which is more plausible, some researchers say, is a change that makes it less deadly virus, but also more difficult to dispose. the Ebola virus hides most likely in bats and monkeys sometimes spill over into the human population, probably when infected animals are hunted and eaten. Historically, outbreaks have tended to burn in the face aggressive containment efforts and sheer deadliness of Ebola. in essence, humans are dead ends for the virus. This could change if it becomes less fatal. "There's an evolutionary advantage to reduce the virulence and host adaptation," says Farrar. "What happened with many other diseases."
If this happens with Ebola, the only way to get rid of it this time could be a massive effort similar vaccination to those used in eradication campaigns against smallpox and polio. "We will review the vaccination of hundreds of millions of people in Africa," said Farrar.
Even if the virus does not change, the magnitude of the epidemic will lead to new challenges. As the number of beds in treatment units is far, more and more patients will be supported at home, where they are a major risk for the other. This could accelerate the spread of the Ebola virus and make it more difficult to trace its epidemiology . home care kits, which include basic protective equipment such as gloves and bleach, was never widely used before to fight against Ebola, but they could become important in the fight against infection. they must be accompanied by an education campaign, however, and nobody is sure how much protection they offer.
As health care systems already crippled in affected countries in the loop pressure, people are also more likely to die in a larger number of other diseases such as malaria, or during childbirth. "We must begin to look beyond Ebola," says Farrar. The food shortages may occur if crops are missed or commerce is paralyzed. "The whole region could become a failed state," says Osterholm.
Meanwhile, the risk of spreading beyond the three countries develop, said North Vespignani, which listed the most risky countries in an article published in PLOS Currents: Outbreak in September (see table). The three countries where the virus has since landed in Senegal, Nigeria and the United States-were-in the top 16. His most recent calculations also set during an event occurring in the vicinity of Ghana on October 24 nearly 50%, even with an expected 80% reduction in travel. Mali and Ivory Coast are at high risk, too. If the virus gains a new foot addition, a major effort would be needed to avoid a second storm, Osterholm said, even if it means diverting West African resources.
Scientists debate the use of travel bans, which worried many American citizens has asked the Dallas case. WHO and the Centers for Disease Control and Prevention strongly advised against closing borders because it would be difficult to get people and materials in the affected countries. The prohibitions are also difficult to implement, Vespignani said, because many countries should agree; otherwise carry Ebola could just fly to a country that does not impose restrictions and move from there. Those who manage to circumvent a ban could then be more likely to lie about their history of contact if they become ill. Ultimately, Vespignani said, travel bans would likely increase the risk for everyone.
But Sandman said the idea should not be dismissed completely. "It's perfectly reasonable for people to seek the best way to reduce the number of sparks out of Africa and threatening to ignite elsewhere," he said. The world may need to buy time to test vaccine candidates, so it should seek practical ways to reduce the number of travelers carrying Ebola in other places, Sandman said. "These are discussions that we need."
