Moving Lassa Fever Research and Care into the 21st Century

Lassa fever, a viral hemorrhagic disease, is a growing threat to public health in West Africa and beyond. While Ebola virus disease (EVD) recently captured the attention of the global community, Lassa fever arguably represents an even more concerning cause of viral hemorrhagic fever (VHF). Unlike EVD, which causes sporadic outbreaks, Lassa virus (LASV) is endemic in West Africa and is responsible for an estimated 300 000 infections and >5000 deaths annually—figures that are likely underestimates, given the challenge of collecting epidemiologic data due to civil conflict and limited clinical research infrastructure in endemic countries

Responding to the global threat of high-consequence pathogens: Protecting health care workers and caring for patients

In the 40 years since the discovery of the Ebola virus, there have been 24 outbreaks, none of which has ever infected more than 450 people at a time (1). The 2014 to 2016 epidemic, which spread quickly across West Africa, infected more than 28,000 people and killed at least 11,000, quickly eclipsing all previous outbreaks combined. What was initially believed to be an isolated outbreak in Guinea crossed international borders for the first time, sparking outbreaks in neighboring Sierra Leone and Liberia and even in noncontiguous countries such as Nigeria, Senegal, and Mali. Sporadic cases among travelers returning from the region to North America or Europe elicited tremendous fear and exposed significant underlying susceptibilities within the North American and European infection control systems (1). Ebola has put the world on notice that rapid globalization has connected communities in such a way that emerging infectious diseases, once categorized as “tropical” in nature, are now worldwide threats that require urgent global responses

Screening of genital fluid for Ebola virus

Moses Soka and colleagues (October, 2016)1 describe their semen testing programme for survivors of Ebola virus disease. This programme provides an important service to male survivors of this disease in Liberia; however, we are concerned that the real-time RT-PCR assay used might not be validated for the detection of Ebola virus in semen. Although the assay was granted emergency use authorisation by the US Food and Drug Administration for the detection of Ebola virus RNA in blood, plasma, serum, and urine, Soka and colleagues do not include supporting data for the use of this assay with semen

Fractal Theory Space: Spacetime of Noninteger Dimensionality

We construct matter field theories in ``theory space'' that are fractal, and invariant under geometrical renormalization group (RG) transformations. We treat in detail complex scalars, and discuss issues related to fermions, chirality, and Yang-Mills gauge fields. In the continuum limit these models describe physics in a noninteger spatial dimension which appears above a RG invariant ``compactification scale,'' M. The energy distribution of KK modes above M is controlled by an exponent in a scaling relation of the vacuum energy (Coleman-Weinberg potential), and corresponds to the dimensionality. For truncated-s-simplex lattices with coordination number s the spacetime dimensionality is 1+(3+2ln(s)/ln(s+2)). The computations in theory space involve subtleties, owing to the 1+3 kinetic terms, yet the resulting dimensionalites are equivalent to thermal spin systems. Physical implications are discussed.Comment: 28 pages, 6 figures; Paper has been amplified with a more detailed discussion of a number of technical issue

Gaps in the clinical management of influenza a century since the 1918 pandemic

This year marks the centennial of the devastating 1918 influenza A(H1N1) pandemic, which killed an estimated 50 million people worldwide. Prevention and control activities were limited in 1918 because global surveillance did not exist, influenza viruses were not yet discovered, and no influenza vaccines had been developed. Diagnostic tests for influenza were unavailable prior to isolation of influenza viruses in the 1930s, so spread of the pandemic virus was tracked by news reports of increased respiratory disease and related deaths. Establishment of the World Health Organization’s Global Influenza Surveillance Network in 1952 has contributed substantially to coordinated surveillance, vaccine development, and influenza vaccine strain selection

To the editor

To the Editor: In their study, van Griensven et al. (Jan. 7 issue)1 found no significant survival benefit of using convalescent plasma with unknown levels of neutralizing antibodies in patients with Ebola virus disease (EVD)

Global burden of influenza as a cause of cardiopulmonary morbidity and mortality

Severe acute respiratory infections, including influenza, are a leading cause of cardiopulmonary morbidity and mortality worldwide. Until recently, the epidemiology of influenza was limited to resource-rich countries. Emerging epidemiological reports characterizing the 2009 H1N1 pandemic, however, suggest that influenza exerts an even greater toll in low-income, resource-constrained environments where it is the cause of 5% to 27% of all severe acute respiratory infections. The increased burden of disease in this setting is multifactorial and likely is the result of higher rates of comorbidities such as human immunodeficiency virus, decreased access to health care, including vaccinations and antiviral medications, and limited healthcare infrastructure, including oxygen therapy or critical care support. Improved global epidemiology of influenza is desperately needed to guide allocation of life-saving resources, including vaccines, antiviral medications, and direct the improvement of basic health care tomitigate the impact of influenza infection on the most vulnerable populations

Modeling the Impact and Costs of Semiannual Mass Drug Administration for Accelerated Elimination of Lymphatic Filariasis

The Global Program to Eliminate Lymphatic Filariasis (LF) has a target date of 2020. This program is progressing well in many countries. However, progress has been slow in some countries, and others have not yet started their mass drug administration (MDA) programs. Acceleration is needed. We studied how increasing MDA frequency from once to twice per year would affect program duration and costs by using computer simulation modeling and cost projections. We used the LYMFASIM simulation model to estimate how many annual or semiannual MDA rounds would be required to eliminate LF for Indian and West African scenarios with varied pre-control endemicity and coverage levels. Results were used to estimate total program costs assuming a target population of 100,000 eligibles, a 3% discount rate, and not counting the costs of donated drugs. A sensitivity analysis was done to investigate the robustness of these results with varied assumptions for key parameters. Model predictions suggested that semiannual MDA will require the same number of MDA rounds to achieve LF elimination as annual MDA in most scenarios. Thus semiannual MDA programs should achieve this goal in half of the time required for annual programs. Due to efficiency gains, total program costs for semiannual MDA programs are projected to be lower than those for annual MDA programs in most scenarios. A sensitivity analysis showed that this conclusion is robust. Semiannual MDA is likely to shorten the time and lower the cost required for LF elimination in countries where it can be implemented. This strategy may improve prospects for global elimination of LF by the target year 2020