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August 2018 (Reuters [Tom Miles and
Gareth Jones])-Efforts to halt an outbreak of the deadly Ebola virus in the Democratic Republic of Congo appear to be working, but substantial risks remain, the World Health Organization (WHO) said.
As of the report of 31 August, the outbreak has killed 77 people in Congo's North Kivu and Ituri provinces; there have been 116 cases, of which 15 were health workers.
"Recent trends suggest that control measures are working, " a WHO statement said, citing improving figures for tracing patients' contacts, rapid treatment of Ebola patients with therapeutic drugs, and vaccinations of people at risk.
A previous outbreak in Congo this year was swiftly stopped, despite the remote location and difficult terrain.
The latest outbreak presents a different challenge, occurring in a more densely populated area with dozens of armed groups. Some areas are off-limits to health workers due to the security risks, making it more difficult to ring-fence each Ebola case by vaccinating all the patient's contacts.
WHO chief Tedros Adhanom Ghebreyesus said it was too soon to say whether the outbreak was stabilizing, due to the difficulty of identifying new cases near rebel-controlled areas.
"Substantial risks remain, posed by potential undocumented chains of transmission, " the WHO statement said, adding that 4 of the 13 new probable and confirmed cases in the past week were not known to have had contact with any Ebola patients.
There were also risks from unsafe burial practices and people's reluctance to accept contact tracing, vaccination, and healthcare, as well as poor standards in some health centers and delays in getting patients to treatment.
Copyright © 2018 Reuters Limited. All rights reserved.
Editorial comment: It is really too early to state "mission accomplished, " but the trend of confirmed and probable cases has been strikingly downwards. The peak was 40 new cases during the week of 8-12 August, with far fewer new cases from 20-30 August. As of 31 August, there have been 120 cases of haemorrhagic fever reported in the region: 90 confirmed and 30 probable. The patient is a resident of the Middle East, where they were believed to have contracted the infection before traveling to Britain, PHE said on its website.
MERS is thought to be carried by camels and comes from the same family as the coronavirus that caused China's deadly Severe Acute Respiratory Syndrome outbreak in 2003.
Most of the known human-to-human transmission has occurred in healthcare settings, and the World Health Organization has said hospitals and medical workers should adopt stringent precautions as their standard to stop the disease spreading.
PHE said it was the fifth case of the disease diagnosed in England, with the others having been identified in 2012 and 2013.
PHE deputy medical director Jenny Harries said it would monitor those who had been in close contact with the patient. "It is important to emphasize that although a case has been identified, the overall risk of disease transmission to the public is very low, " she added.
Copyright © 2018 Reuters Limited. All rights reserved.

Editorial comment:
The significance of 1 case of MERS and the potential of MERS to spread within health care facilities should be remembered in terms of what happened in South Korea in 2015. There were a total of 186 cases, with 36 deaths traced back to an index case who had travelled to the Arabian Peninsula on business, returned home, and developed a febrile illness. The illness escaped diagnosis during multiple visits to multiple healthcare facilities over a period of 9 days prior to a diagnosis of MERS being made. To further complicate matters, a number of the secondary and tertiary cases ended up being "super-spreaders, " infecting numerous individuals in the healthcare environment. Lessons learned through this experience included the importance of the ascertainment of clear travel histories when a patient presents with a febrile illness, the need to consider isolating a patient with an undiagnosed severe febrile respiratory illness, and the need to reduce the crowding of emergency departments and hospital rooms with visiting family members and caretakers that are not trained in infection control procedures.

27
August 2018 (Tetraphase Pharmaceuticals, Inc. Press Release)-Tetraphase announced that the US Food and Drug Administration has granted approval of eravacycline for the treatment of complicated intra-abdominal infections (cIAI). In clinical trials, it was well tolerated and achieved high clinical cure rates in patients with cIAI, demonstrating statistical non-inferiority to 2 widely-used comparators: ertapenem and meropenem.
Eravacycline, an intravenous fluorocycline, is indicated for the treatment of complicated intra-abdominal infections in patients 18 years of age and older.
Philip S. Barie, MD, MBA, Professor of Surgery and Professor of Public Health in Medicine at Weill Cornell Medicine, said, "Eravacycline also has a favorable safety profile as observed in clinical trials, and no dose adjustment is required when given to patients with renal impairment. This new and novel treatment may be of great benefit to patients with complicated intra-abdominal infections. " Different bacterial pathogens are responsible for cIAI, including Gramnegative aerobic bacteria, Gram-positive bacteria, and anaerobic bacteria. Early detection, containment, and appropriate antimicrobial treatment are essential to the successful treatment of cIAI. This is even more critical with the increasing rates of infections caused by drug-resistant bacteria, which limit the effectiveness of currently-available antibiotics.
Eravacycline is a tetracycline class (fluorocycline) antibacterial indicated for the treatment of complicated intra-abdominal infections in patients 18 years of age and older. Its use during tooth development (last half of pregnancy, infancy, and childhood to the age of 8 years) may cause permanent discoloration of the teeth (yellow, gray, brown) and enamel hypoplasia. Its use during the second and third trimesters of pregnancy, infancy, and childhood up to the age of 8 years may cause a reversible inhibition of bone growth. The most common adverse reactions observed in clinical trials (incidence ≥3%) were infusion site reactions, nausea, and vomiting.
Eravacycline is structurally similar to tetracycline-class antibacterial drugs and may have similar adverse reactions. Adverse reactions, including photosensitivity, pseudotumor cerebri, and anti-anabolic action, which has led to increased BUN, azotemia, acidosis, hyperphosphatemia, pancreatitis, and abnormal liver function tests, have been reported for other tetracycline-class antibacterial drugs, and may occur with eravacycline.
Editorial comment: Eravacycline is active against aerobic and anaerobic Gram-negative and Gram-positive bacteria. Pseudomonas aeruginosa and Burkholderia cenocepacia are resistant. It is active against carbapenemresistant Enterobacteriaceae (both KPC metallo-β-lactamase producers) and Acinetobacter spp. It must be noted that in 2 complicated urinary tract infection trials, eravacycline did not achieve noninferiority for the primary end point of a clinical and microbiological cure.

Russian Trolls Fan Flames in US Vaccine Debate
30 August 2018 (Reuters [Lisa Rapaport])-Some of the same Twitter accounts that tried to influence the outcome of the 2016 US presidential election have sent messages to amplify strong views-both pro and con-about the safety and effectiveness of vaccines, a US study (https://bit.ly/2NgRvhE) suggests.
The biggest problem with this is that there shouldn't be a debate at all, said lead study author David Broniatowski, a professor of engineering management and systems engineering at George Washington University in Washington, D.C.
"There is widespread consensus in favor of vaccines, yet that is not the impression you would get from looking at Twitter, " Broniatowski said.
"Exposure to the 'vaccine debate' erodes public trust in healthcare providers and leads people to delay vaccination, exposing us to the risk of epidemics, " Broniatowski added. "Just 'amplifying' debate can therefore have real consequences. "

Examples of Antivaccine Tweets
In the antivaccine camp, there were #vac-cinateUS tweets like this: "Dont get #vaccines. Illuminati are behind it. " And like this: "At first our government creates diseases then it creates #vaccines. What's next?!" Or this, designed to target socioeconomic tensions: "Apparently only the elite get 'clean' #vaccines. And what do we, normal ppl get?!"