Monday Micro – Ebola outbreak in Guinea

By Siouxsie Wiles 24/03/2014 36


The news is full of reports of an outbreak of Ebola in the west African country of Guinea. Ebola is one of a group of related viruses which cause viral haemorrhagic fever. There is no vaccine or treatment for these viruses. So far reports are that there have been at least 80 cases with 59 deaths.

Here’s a little FAQ for those of you wanting to know more about these amazing and terrifying viruses.

1. What is Ebola?

Ebola is one of two members of the Filoviridae family of single-stranded RNA viruses. The other member is Marburg. There are five types of Ebola virus, named after where outbreaks first appeared, and which differ in their mortality rates:
(i) Zaire ebolavirus (ZEBOV) – most frequent cause of outbreaks (last in the Democratic Republic of Congo 2008) and highest mortality rate (47-100%)
(ii) Sudan ebolavirus (SEBOV) – mortality rate of 42-65%, last outbreak in 2012 in Uganda
(iii) Reston ebolavirus (REBOV) – Discovered in 1989 when there was an outbreak of disease in laboratory macaques in Reston, Virginia, USA. Has since been found in nonhuman primates in Pennsylvania, Texas and Italy. Did not cause disease in exposed human laboratory workers*
(iv) Côte d’Ivoire ebolavirus (CIEBOV) (or Tai ebolavirus) – killed chimpanzees in Tai national park in 1994, only human case was in one of the scientists performing the necropsies on the infected chimps but they recovered
(v) Bundibugyo ebolavirus – two outbreaks to date (2007 in Uganda and 2012 in the Democratic Republic of Congo), mortality rate of 34-50%

2. How is Ebola transmitted?

The primary mode of transmission of Ebola is unknown. Bats are thought to be the most likely reservoir (1). Some people have caught Ebola from contact with or by eating infected bushmeat. Secondary spread occurs through direct contact with infected patients, their body fluids or remains, so family members, hospital workers and those burying the dead are at greatest risk. The incubation period for infection ranges from 2 to 21 days (mean 4-9 days).

An interesting paper was published in the journal Scientific Reports in 2012 in which piglets were inoculated oronasally with Zaire ebolavirus (2). The piglets had a high temperature and rapid breathing for a few days but soon recovered. But they were infectious, spreading the virus through the air to macaques who developed symptoms of Ebola infection and had to be euthanised.

3. What’s the largest recorded Ebola outbreak?

The biggest outbreak to date was in Uganda in 2000, when 425 people were infected with Sudan ebolavirus – 224 died. Ebola is a little like the great white shark of the virus world. Before this current outbreak, there had only been 2317 clinical cases and 1671 confirmed deaths in the last 50 years (3), a negligible number compared to many other infectious diseases.

4. Do people with viral haemmorrhagic fever really bleed out of every orifice before they die?

The name viral haemorrhagic fever is a bit of a misnomer. In less than 10% of Ebola cases, patients will experience bleeding from their mucous membranes, including those in the nose, gums, gastrointestinal tract and vagina. Death occurs by multiple organ failure. Most frequently infected people will have a fever with chills, malaise, joint and muscle pain. They also may have a rash. Other symptoms include nausea, diarrhoea, vomiting, stomach pains, throat and chest pain, a cough. From there patients experience severe headaches and confusion which can progress to delirium and coma.

5. Why is this such a big story?

With the exception of the dead chimps and the scientist who recovered in the Ivory Coast, Ebola has never been reported from west Africa; the majority of outbreaks have been in central Africa. What has alarmed many is that the cases have moved from forest communities to the capital city, Conakry. The capital has a port and airports and, with an estimated population of 2 million, will be difficult to quarantine should the need arise.

6. Can survivors continue to shed virus?

Yes. Survivors from an outbreak in 1995 in the Democratic Republic of the Congo which killed 244 of the 315 people infected, were followed for several months afterwards. Researchers tested their tears, sweat, faeces, urine, saliva, semen, and vaginal secretions. For semen, 4 of the 5 convalescents tested had at least 1 specimen that tested positive for Ebola genetic material. The latest semen sample was obtained over 3 months after the onset of infection (4). There were no cases of transmission from those individuals with positive semen samples.

* Go read Richard Preston’s book The Hot Zone, which is all about the outbreak in Reston.

Reference:
1. Leroy EM, Kumulungui B, Pourrut X, Rouquet P, Hassanin A, Yaba P, Délicat A, Paweska JT, Gonzalez JP, Swanepoel R (2005). Fruit bats as reservoirs of Ebola virus. Nature. 2005 Dec 1;438(7068):575-6.
2. Weingartl HM, Embury-Hyatt C, Nfon C, Leung A, Smith G, Kobinger G (2012). Transmission of Ebola virus from pigs to non-human primates. Sci Rep. 2012;2:811. doi: 10.1038/srep00811. Epub 2012 Nov 15.
3. Leroy EM, Gonzalez JP, Baize S (2011) Clin Microbiol Infect. 17(7):964-76. doi: 10.1111/j.1469-0691.2011.03535.x
4. Rowe A1, Bertolli J, Khan AS, Mukunu R, Muyembe-Tamfum JJ, Bressler D, Williams AJ, Peters CJ, Rodriguez L, Feldmann H, Nichol ST, Rollin PE, Ksiazek TG (1999). Clinical, virologic, and immunologic follow-up of convalescent Ebola hemorrhagic fever patients and their household contacts, Kikwit, Democratic Republic of the Congo. Commission de Lutte contre les Epidémies à Kikwit. J Infect Dis. 1999 Feb;179 Suppl 1:S28-35.


36 Responses to “Monday Micro – Ebola outbreak in Guinea”

  • Sounds like the Ebola virus puts the body into an acute state of scurvy. Massive dosses of IV vitamin C should be given , at least to try to save these patients since modern medicine has no cure.

  • This may be the same Jim who has touted vitamin C as a remedy for other illnesses on my blog.

    Irrespective of that, the idea that vitamin C (or it’s high-dose equivalent) is going to ‘cure’ Ebola is, to be polite, a bad idea.

  • I could ask you to first say why you think it’s a good idea (you should answer this really, you’re reversing the natural burden of proof as it were), but what you are suggesting is not much different to this homeopath who thinks that homeopathic remedies should be given to them. Everyone with a ‘favourite’ cure-all elixir rushes out and suggests it as the answer to the latest big medical story…

  • Hi Grant I suggest you google this study and read it
    Phase I safety trial of intravenous ascorbic acid in patients with severe sepsis
    Since patients die of multiple organ failure from the ebola virus this study shows that IV vitamin C not only is proof of safety but also helps prevent against organ failure.
    Not to give IV vitamin C to help these patients leaves me flabbergasted. Please tell why doing so is a bad idea?

  • Jim –

    I replied earlier; my point there stands.

    I haven’t time to read others’ papers as I have other things to do but it’s worth remembering that phase I trials don’t test for efficiacy (useful effect), but lack of obvious [short-term, direct] harm. (Which is likely why their conclusion re organ failure” reads “may”, not “does”.)

  • Interesting when you only read the conclusion to a trial as you miss the important bits
    SOFA scores are robust indicators of mortality during critical illness. SOFA score increases during the first 48 hours of ICU care predict a mortality rate of at least 50% [26]. In this study, the extent of organ failure accompanying patients with severe sepsis was high with an average SOFA score for all patients equal to 11.4±3 confirming that multiple organ failure was present at enrollment. Given that the mean plasma ascorbic acid levels on admission were subnormal (17.9±2.4 μM), a mean initial SOFA score of 11.4±3 in patients with severe sepsis was not surprising. This study is in agreement with other studies which show that plasma ascorbic acid levels in severe sepsis correlate inversely with the incidence of multiple organ failure [13]. We showed that the addition of ascorbic acid to standard of care practice (i.e., fluid resuscitation, antibiotics, vasopressor medication) for patients with severe sepsis significantly reduced organ injury. Ascorbic acid treated patients exhibited prompt and sustained reductions in SOFA scores during the 4-day treatment regimen unlike placebo controls where SOFA scores slowly increased over time. SOFA score reduction was most remarkable in patients receiving the high dose ascorbic acid infusion (Figure 2).

    C-reactive protein (CRP) [19] and procalcitonin (PCT) [20] levels are known to correlate with the overall extent of infection and higher levels of both have both been linked to higher incidences of organ injury and death in the critically ill. CRP in circulation has a short half-life of approximately 19 hours. Thus, the kinetics of CRP make it a useful monitor for tracking the inflammatory response produced by infection, and the response to antibiotic treatment. Lobo et al. reported that patients with CRP levels greater than 10 mg/dL at ICU admission exhibited significantly higher rates of multiple organ failure as well as higher mortality rates [34]. A decrease in CRP levels in Lobo’s study after 48 hours was associated with a mortality rate of only 15.4%, while a persistently high CRP level was associated with a mortality rate of 60.9%. Both low and high dose ascorbic acid infusion in this trial promptly reduced serum CRP levels in septic patients (Figure 3A). Thus, the findings in this study support the findings of Lobo et al. with descending CRP levels being associated with lower mortality rate and reduced levels or organ failure.
    Sorry about the copy an paste however as I have stated all along , these patients will have extremely low ascorbic levels, correcting that would lead to a more positive outcome than what medicine is doing for them at present. This in a nut shell is administering the essentials of life. Failure to do so in newzealand carries a seven year jail term from what I have been told.

  • @Jim – you seemingly arbitrarily decide that ebola is scurvy, then cut & paste a small part of a paper that is about sepsis and wonder why people don’t treat with vitamin C.

    You can’t draw a sensible conclusion without ensuring a sensible assumption at every single point in your argument.

    Human beings don’t like to be guinea pigs in experiments, you can’t just guess at what sounds good for a treatment (especially from such a flimsy basis) and apply it. In the past people did run things like this, bad stuff happened and now we have rigorous medical regulations to ensure proper processes.

  • Just found this chain of posts after searching for the term Ebola and Vitamin C.

    Very interesting topic and I find it strange that the comments against Vitamin C and possible treatment to improve the outcome of a high fatality disease such as Ebola is met with such resistance and scorn. On the basis of ‘People do not like to be treated like Guinea Pigs’ I am afraid lots of people would like the option of something that might work against doing nothing and dying a horrible death. It’s interesting that Andrea uses the term Guinea Pig as they are also one of the 4 mammalian groupings that do not create Vitamin C in their Livers (Science Fact) the others are Apes, Fruit Bats and Humans (Science Fact). It is therefore a very strange coincidence that of the 3 carrier groups Fruit Bats are a confirmed reservoir for Ebola and the disease is transmitted through Apes and humans. All these groups do not produce Vitamin C themselves. It would be very interesting to see how Guinea Pigs fair when exposed to Ebola (this completes the 4 mammal set). Either you are ignorant of this fact or you choose to ignore it (ie in Science, Opinions don’t count). In terms of the other points that Jim made yes I agree that the Sepsis treatment was not related to Ebola as a potential treatment, it just demonstrates that High Doses of Ascorbic acid (Vitamin C) can be consumed with no perceived detrimental effect to health. As you are aware no Healthcare Professional or Scientist can use ‘does’ as with ‘cure’ but have to include ‘may’ as the terminology as this outcome ‘may’ not be the case in the future or requires further scientific analysis. The response to this from Grant is that you don’t have time to read research but back up your opinion with spurious evidence ie the reference to Homeopathy (non-science, this still doesn’t mean it doesn’t work) versus using Vitamin C as a possible treatment for Ebola. Vitamin C is a key constituent of Collagen making up skin and capillaries, veins and arteries (Science Fact). It also is the energy carrier to get energy to the mitochondria within the cell by its conversion to Coenzyme A and then plays an important part of the Krebs cycle (don’t worry about Research just knowledge of basic Human Biochemistry will do). This reinforces the significant part Ascorbic Acid (Vitamin C) plays in the Human Body any reduction in Vitamin C ingestion will significantly affect processes in the body at a cellular level something like Ebola would and does wreak havoc.
    So connecting the fact that Ebola presents haemorrhaging as a symptom which is basically blood seeping through the gaps in the collagen it would be entirely reasonable to relate the symptom to weakening or destruction of the capillaries transporting the blood. So let’s theorise for a moment (an integral part of Science methodology and advancement) the Ebola virus is so virulent that the body reacts by first using all of the available vitamin c (the human body does not manufacture and store, therefore only can use what is ingested). The Ebola Virus or the body then starts to consume the ascorbic acid in the capillaries. This leads to blood seeping through the cracks in the collagen presenting haemorrhaging. A possible treatment to this presentation is high doses of Vitamin C which would absorb the virus growth and result in the time to recovery extending. I agree that this is a theory but it is based upon scientific fact about Vitamin C, not opinion. If it doesn’t work what have you lost as you already have a disease with one of the highest mortality rates so whoever catches the disease is more likely to die and using a High Dose of Ascorbic Acid is the least of their worries. Given the option, in that position where all Western Medical Approaches have failed, would I try it, every time.
    Please, Please send me links to research that refutes this I would like to see it. Papers, Academic research, images, trials etc etc as I always will review and compare my current knowledge against evidence. PS I bet this doesn’t even posted.

  • Massive doses of vitamin C are a proven treatment for diverse viral illnesses. See the 1949 publication by Dr Fred R Klenner, a Duke University Medical School graduate. The fact that Dr Klenner’s work has been ignored by mainstream medicine is tragic.

  • Steve P- I was hunting around on the internet to see if anyone else had wondered about Vitamin C and Ebola. I remembered reading how serious infection radically depletes the body of this vitamin, and about Linus Pauling’s experiments, and about how intravenous vitamin C has saved people when suffering from an overwhelming infective condition. I also thought about how important vitamin C is in the maintenance of the vascular system, and it seemed likely to me that the bleeding caused by Ebola may indeed be caused by this vitamins depletion. As it’s not a harmful treatment, someone who contracted Ebola may be grateful if someone gave it a go – the alternative isn’t great.

  • “So let’s theorise for a moment (an integral part of Science methodology and advancement) ” – let’s hypothesise – because you are simply floating an idea.

    It seems to me that what’s being argued for here is a very rapid onset of the symptoms of scurvy. For the hypothesis to be accepted, someone would need to present actual evidence that this is the case. Has such evidence been published?

  • Just for thought –

    Those propounding “mega” vitamin C often mix or confuse consequence and cause.

    Many things will depleted as a consequence of illness, vitamin C levels will be just one. (Notice how advocating “mega” vitamin C don’t mention any others, cherry-picking and favouring their interest.)

    Supplementing what is depleted might contribute to helping patients (I’m not medical), but a cure would want to tackle the unlying cause and, as Alison said you’d want evidence that it does that.

  • Megadose intravenous Vitamin C might be helpful in fighting the Ebola virus at its onset. I have recommended it to the health authorities in my country following 1 confirmed case of the virus in the city of Lagos (there are 2 more unconfirmed cases). I hope they follow up on it as it might just help.

  • Grant Jacob’s responses are reasonable and expected since no known results of even a test-tube study of IVC (Intravenous Vitamin C) vs. Ebola have ever been published, let alone has there been an RDBPC study.

    Jacob’s consideration that “Supplementing what is depleted might contribute to helping patients” is also spot on and deserves considerable esteem. Indeed he is “not medical”, but a recently comprehensive review found only 1/200 patients with an adverse reaction to high-dose IVC (PMC 2898816, PMD 20628650).

    And … ebola symptoms are identical with scurvy and there are a number of other reasons suggesting that patients are massively depleted of vitamin C – so mega-supplementation for QOL seems judicious.

    Of all the peer-reviewed studies of high-dose IVC (40+ g/dose) NONE have ever indicated decreased patient quality of life regardless of the condition treated. In fact. rather the opposite has been observed in many published studies: decreased nausea, pain, fatigue, dizziness, bleeding, fever, and anxiety (see http://goo.gl/4odny8).

    In a perfect world we would have an ebola cure, but in the meantime we should be strengthening the patient and improving their quality of life. I have long thought that the refusal to integrate IVC despite it’s low cost, amazing safety record and unsurpassed ability to improve QOL should be astonishing to everyone.

    IVC may not fight ebola itself, but let’s not forget that happy, energized and confident patients fight disease better than do their miserable, exhausted, and despondent counterparts.

    • Thanks for the link.

      It’s a case report of 8 patients, one of whom is the patient you describe. This patient was the only one given vitamin C although it is unclear whether she received intravenous high dose vitamin C. What she did receive was a transfusion of blood taken from people who had survived Ebola. So did the other seven people. Only one of the eight died. The doctors noted though that the patients all received good care which also included infusions of glucose and electrolytes, treatment with antibiotic and antimalaria drugs, and food supplementation.

      To put that one patient’s survival down to vitamin C is cherry-picking, to say the least.

  • If I remember correctly large doses of vitamin C cause diarrhoea which would be the last thing a patient with Ebola needed. This could possibly only be with oral doses, but to assume large doses of vitamin C would have no negative effects is assuming a lot.
    Any substance in high enough doses would be harmful

    “Ebola symptoms are identical to scurvy”

    Says who? Sounds like we are entering the territory of sympathic pseudo medicine.
    Survey is a deficiency disease, Ebola is caused by a micro-organism. What you are erroneously suggesting is that Ebola could be dealt with by treating the symptoms rather than the cause – isn’t that what alternative “medicine” proponents usually use as an argument to complain about “western” medicine?

  • David Austin

    In the study you listed regarding one patient being given vitamin C and surviving did you notice that some of the other patients who survived received other supplements/drugs/transfusions and also survived? So how do you decide a treatment with vitamin C is better than one with vitamin K or paracetamol or sodium salts?
    To call it cherry picking is an understatement

  • Michael Edmonds 3 days ago

    Mark,
    I think when you are dealing with a disease that has such a high fatality rate that the need for placebo’s is unnecessary. If a treatment works, the results tend to be obvious

    I take it then that IV vitamin C would apply here as well?

  • jim

    I said placebos are unnecessary, not that any substance can be used to try and treat Ebola.
    It is not clear to me what the value IV vitamin C would be – there needs to be a more convincing argument than that Ebola and scurvy have some similar symptoms.

  • Jim, I a distinction needs to be drawn between not requiring a placebo control (as Michael was talking about in that comment) and not requiring a large sample size when testing a treatment.

    For deadly diseases such as this, where there is no existing standard treatment, I can definitely see how it would be unethical to randomise patients to receive either placebo or a potentially lifesaving new treatment as part of a clinical trial. Testing a treatment would still need a decent sample size for us to be able to draw reliable conclusions, and its results would presumably be compared to the statistics for untreated patients.

  • David Austin’s reply gives empty praise (and his quote mines somewhat misrepresent, too!), seemingly in the hope of giving credence to his later suggestions. These suggestions are poor.

    I didn’t have time to reply at the time (was travelling) and still haven’t much time, so very briefly:

    ‘not medical’ should read ‘not a medic’ – I was still grappling with the spell-checker on a new smartphone I’d just purchased. There’s nothing lacking on my part in writing this, the reference is simply that I don’t want to be offering a medical prescription. I would imagine this goes for everyone else writing here, including David Austin – i.e. no-one writing here is a medic. (Put another way, at least I have the decency to acknowledge it!)

    “ebola symptoms are identical with scurvy”

    Not correct, as a few minutes research would show. In any event they’re quite different diseases as most people realise. I see Michael has tackled this. (Thanks.) As he noted, one is a deficiency and the other an infection.

    “regardless of the condition treated”

    Grand sweeping claims like this are invariably false and almost always hallmark of trying too hard to make something true.

    (Off-topic: Why is it that people think that the apostrophe on Jacobs, should be rendered as Jacob’s, not the correct Jacobs’? I’ve seen this a few times and am left wondering why these people don’t realise their misplaced apostrophe has them changing my surname from Jacobs to Jacob, which it clearly isn’t! It’s really quite bizarre.)

  • Grant
    What you and others don’t seem to understand is that Ebola creates scurvy. A simple blood test would confirm this. Do you not think that by correcting this deficiency the patient may have a better chance of survival.

  • ZMapp is manufactured in the tobacco plant nicotiana in the bioproduction process known as “pharming” by Kentucky BioProcessing, a subsidiary of Reynolds American.Monoclonal antibodies (mAbs) were first created in mice by injecting them with antigens from Ebola, harvesting their spleens, and fusing mature B-cells producing monoclonal antibodies (mAbs) with cancer cell lines to create hybridomas. After the best antibody is selected, the gene encoding the antibody was extracted, and certain portions were replaced with portions encoding human proteins, in the process called humanization. To create a system to produce the humanized mAbs at commercial scale, Mapp used a process called “Rapid Antibody Manufacturing Platform” (RAMP), using magnICON (ICON Genetics) viral vectors. In a process called “magnifection,” tobacco plants are infected with the viruses, using Agrobacterium cultures.Subsequently, antibodies are extracted and purified from the plants. Once the genes encoding the humanized mAbs are in hand, the entire tobacco production cycle is believed to take a few months.

  • Trying to dress others down really just suggests you wish to push your own interests irrespective of what evidence might show. (Anyone pointing out issues is dismissed out-of-hand—”just doesn’t understand”—but dismissal out-of-hand doesn’t make a case.)

    You’re welcome to point to scientific papers (from sound authors in reputable journals) that show ebola is a form of scurvy or induces scurvy.

    If true, you’d expect there to be some scientific articles in reputable journals relating the Ebola and scurvy and for their to be some sort of consensus on this.

    The latter (consensus) is why I have previously generally suggested that people try review papers, but unfortunately you (or I) can’t get that far because…

    A simple check of PubMed shows that while PubMed holds over 1800 papers on Ebola and over 2300 papers on scurvy, not a single paper in PubMed mentions both Ebola and scurvy.

    Not one scientific paper.

    On the face of it, this looks to be a very clear and simple illustration that the idea that Jim and others are suggesting is not supported by those that work on Ebola or scurvy.

    Similarly, a quick google search suggests this belief that Ebola = scurvy, or variants of that, have arisen because someone has promoted the idea that scurvy is hemorrhagic fever amongst those that advocate ‘high-dose vitamin C’ as, essentially, a cure-all. It’s pretty clear that they’re trying too hard to string a line of dots between Ebola and their favourite treatment/remedy/supplement.