Saturday, 11 February 2017


Tanvir MedicalCare



The recent West Africa Ebola Virus epidemic was and is, not only massive but a very dangerous precedent in the management of such cases, epidemics in Africa in particular and the world in general.
By now, the world knows that Ebola virus is very dangerous, easily transmissible and Ebola Virus Disease (EVD) is lethal in significant number of cases.
Ebola Virus Disease (EVD) or Ebola Hemorrhagic Fever (EHF) is caused by Ebola virus, which is a member of Filoviridae (B Genera). It has five known important species, Zaire, Bundibugyo, Sudan, Reston, Tai Forest. Fruit bats of Pteropodidae family are known to be the carriers and vectors.
The transmissions occur through close contact with the blood, secretions, organs and other body fluids of infected animals such as chimpanzees, gorillas, fruit bats, monkey, and antelopes, Porcupines etc. It can be sexually transmitted through semen and breast milk.
The main clinical features of Ebola Virus Disease (EVD) are fever, fatigue, muscle pain, headache, sore throat, vomiting, diarrhea, rash, impaired kidney and liver function tests, both external and internal bleeding (oozing from the gums, blood in the stools), leucopenia.
Its generally differential diagnosed with Malaria, Typhoid fever, and Meningitis.
But the aim of this article, even though partly is to educate the public about this deadly Ebola Virus Disease (EVD), is much more. It aims to research ways to cure the disease and how to develop more effective vaccines than available, not only for Ebola but also for other such deadly diseases.
Now, in most cases of vaccine development, the antigen is circulated through human clone cells, horse serum, or cow serum. I think, this technique is essentially flawed, especially when dealing with diseases that have a base in Africa.

Now, though monkeys are present all around the world but animals like Gorilla, Chimpanzees are native to Africa. They also share a large percentage of their DNA with Humans, particularly Human Africans.
Because of this large sharing of common DNA with Human Africans, the Gorillas and Chimpanzees serve as very useful hosts to develop vaccines, particularly to infectious diseases originating in Africa.
But, a very important point to note is that Ebola Virus Disease (EVD) is widely prevalent in the Gorillas and Chimpanzees of Africa, without proving lethal in most cases. This means that these animals are able to develop very active immunity against Ebola virus.
Since animals like Gorillas are very large in size and Chimpanzees are in plenty, Immune sera can be isolated from both Gorillas and Chimpanzees in sufficient quantities to treat infected cases and these can further be used to produce vaccines at a later date.
The hallmark of a good vaccine is that it produces sufficient immunity in the vaccinated person to protect it from infection. For this, the pathogenic antigen, in this case Ebola Virus antigen is first attenuated. This is done by putting it at lower temperature than human body, whereby it loses its pathogenicity at human temperature after many growth cycles.
But in Gorillas and Chimpanzees of Africa, we already have a host that by their immune system, attenuate the virus to produce sufficient antibodies but not the disease.
Thus, Gorilla and Chimpanzee sera will serve twin purposes. First, it will give us sufficient antibody sera to cure already infected Ebola Virus Disease (EVD) patients and second, it will provide the attenuated form of the Ebola Virus antigen, which can be used to develop meaningful and effective vaccines.
Once, the antibody sera treatment and Gorilla/Chimpanzee Ebola antigen produced vaccine proves effective in trials against Ebola Virus Disease (EVD) in humans, than similar attempts can be made with other infectious diseases prevalent in Africa.
However, I must add that similar use of Gorillas and or Chimpanzees can be made for contagious diseases outside of Africa.
Another advantage of using Gorilla/Chimpanzee produced antibodies and antigen vaccine is that because of  the close proximity and sharing of DNA between Gorilla/Chimpanzees and Human Africans, its possible that it will confer immunity against related diseases and pathogens.
In the prevailing health care system in Africa, the above advantages that Gorilla/Chimpanzees derived antibodies and vaccine offer, cannot be neglected. Hence, its very important that immediate steps are taken to start producing such sera antibodies and antigen vaccines as I have described above. This will serve the situation of Africa best.
But, there are important lessons to be learnt from previous outbreaks of Ebola epidemics in Africa.
I will give the data in a preconceived and formatted form so that the reader can interpret the data in a meaningful way.
The Ebola outbreak originated and started near Ebola River in DR Congo, Yambuku. Congo is also known as Zaire.
In previous years, the Ebola outbreaks have affected central Africa, with DR Congo, Uganda and South Sudan being majorly affected.
The present epidemic which has consumed more than 8304 lives and more than 21121 cases with 13408 of them confirmed, has been mostly hovering over west Africa, Guinea, Sierra Leone, Liberia. This is very different from previous infections. The culprit species of Ebola in the present West Africa (Guinea, Sierra Leone, Liberia) epidemic is the Zaire species, which is the most virulent and lethal of all Ebola virus species.
Now, I will take up Case Fatality Rate (CFR) in previous epidemics. The Case Fatality Rate (CFR) is the number of confirmed cases who have died of a particular infection, generally expressed as a percentage.
For the previous majorly affected countries, the Case Fatality Rate (CFR) are as follows:
CONGO: 88% in 1976 caused by Zaire species; 100% in 1977, one case, caused by Zaire species; 81% in 1995, caused by Zaire species; 75% in 2001-2002 caused by Zaire species; 90% in January-April 2003, caused by Zaire species; 83% in November-December 2003, caused by Zaire species; 83% in 2005, caused by Zaire species, 71% in 2007, caused by Zaire species, 44% in 2008, caused by Zaire species; and 51% in 2012, caused by Bundibugyo species.
UGANDA: 53% in 2000, caused by Sudan species; 25% in 2007, caused by Bundibugyo species; 100% in 2011, one case, caused by Sudan species; 71% in 2012, caused by Sudan species; and 57% in 2012, caused by Sudan species.
SUDAN: 53% CFR in 1976, caused by Sudan species; 65% CFR in 1979, caused by Sudan species; 41% CFR in 2004, caused by Sudan species.
GABON: 60% CFR in 1994, caused by Zaire species; 68% CFR in January-April 1996, caused by Zaire species; 75% CFR in July-December 1996, caused by Zaire species; 82% CFR in 2001-2002, caused by Zaire species.
From the data above and other data presented by the WHO and other health organizations, it’s clear that many times more people are infected with Ebola Virus than those who actually develop the disease. And, of those diseased patients, only a certain percentage die, others are saved.
This is very significant data in so far as my assertions in the use of Gorillas/Chimpanzees is concerned for the production of a viable anti sera treatment and a viable vaccine for preventive purposes.
The Case Fatality Rate or CFR does not show us actually how many people got infected and how many developed the disease. But I have used other reliable sources to come to the conclusion that in all epidemics of Ebola that have taken place, a very large population got infected with the Ebola virus, but of these a very small fraction actually got the disease and still a fraction of it actually died.
The reason I believe the above given statistical prevalence of  Ebola infection, disease and CFR to be true is that more near the DNA of humans is to Gorilla, better protected it is from Ebola virus. It also means that further your DNA matching is with the Gorilla/Chimpanzee DNA, more likely it is that your Ebola infection will become a disease and may result in fatality.
Hence, because of the above reason, it is imperative that Ebola virus is not allowed out of Africa. The results will be catastrophic. Rest of the world population has no protection against Ebola virus and will develop the disease in almost 100% cases and the Case Fatality Rate (CFR) can be as high as close to 100%.
The above facts have important lessons in the management of Ebola virus epidemic now prevailing in West Africa. However, countries and organizations should continue to provide financial, medical, logistic support but it won’t be wise to allow non-African medical personnel to be in the Ebola epidemic zone. There are a large number of countries in Africa, who are unaffected by the present Ebola epidemic and have a reasonable size of trained medical personnel. These trained medical personnel should be used wisely in the Ebola epidemic zone. Non-Africans should be banned from going to this Ebola epidemic zone.
A selected group of medical personnel from Africa can be brought to Europe, America etc., trained in a short course, and provided all the equipment. They can than proceed to the Ebola epidemic zone for managing the patients.
Under the circumstances and facts I have been able to research, the above course of action is the wisest and the best.
But, what to do with actual patients who have the Ebola Virus Disease (EVD). At present, there is no treatment.
I suggest the following treatment protocol for diagnosed and suspected Ebola Virus Disease (EVD):
*Intravenous fluids as necessary
*ORS as necessary
*Injection Tetanus Toxoid 0.5 ml intramuscular in all cases
*Tablet ACICLOVIR 800mg BD x 15 days in all cases
The treatment can be extended by another one month in very severe cases.
All precautions should be taken to maintain the highest standards of hygiene in the hospital. This should include providing isolation room to each single patient and starting the treatment at the earliest, even without the confirmation of the disease.
In some very severe cases, even higher doses of ACICLOVIR, up to 1600mg twice daily can be used.
But it’s important that the treatment is started at the earliest and completed until cure without any exception. This is the only way to contain and cure the present Ebola virus epidemic.
However, ethical concerns are an issue here. There are many more Africans who are infected by Ebola virus but never develop the disease. It’s my surmise that similar to Gorillas and Chimpanzees, the immune system of these people produces enough antibodies to contain the Ebola virus infection. In addition, it’s my surmise that the Ebola virus is attenuated because of this antibody attack.
If a consensus can be reached, than sera from such persons can be used to cure Ebola virus disease patients. Also, because Ebola virus is much attenuated in these persons, it can be isolated to be used for making an effective vaccine against Ebola virus.
The above program is very important and if it can be done under high ethical standards, has the potential to provide both the cure and the vaccine. Thus, Human attenuated Ebola virus can provide the vaccine and Human generated Ebola anti sera can provide the cure. Both are within the grasp of human science and present levels of technology.
Have a healthy day!

COPYRIGHT               © Tanvir Nebuchadnezar

Use of ectopic animals in vaccine development, west Africa Ebola outbreak, case study, west Africa Ebola virus outbreak, Ebola virus disease (EVD), Ebola Hemorrhagic Fever (EHF), Filoviridae, Zaire Ebola species, Budibugyo Ebola species, Sudan Ebola species, Reston Ebola species, Tai Forest Ebola species, Fruit bats, Pteropodidae, Clinical features, Differential diagnosed, effective vaccines, Gorilla, Chimpanzees, Human Africans, Common DNA, good vaccine, antibody sera, attenuated form, Ebola virus, Outbreaks of Ebola epidemics, Ebola outbreak, DR Congo, Yambuku, Case Fatality Rate, CFR, Congo, Uganda, Sudan, Gabon, Gorilla/Chimpanzee DNA, Tetanus Toxoid, Acyclovir, ethical concerns, Human attenuated Ebola virus, Human generated Ebola antisera, Ebola epidemic zone

                                              TANVIR NEBUCHADNEZAR

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