The Guardian (Lagos)

24 July 2014

Nigeria: Lagos Probes Alleged Case of Ebola Virus, Urges Caution

Photo: Premium Times
Ebola Virus

THE Lagos State government has begun an investigation into the alleged case of Ebola virus in the state. There was a widely circulated but unconfirmed report that a hospital in Obalende has a patient with the dreaded Ebola Virus Disease (EVD). .

Also, researchers have uncovered a way the malaria parasite becomes resistant to an investigational drug. The discovery, at Washington University School of Medicine in St. Louis, United States, also is relevant for other infectious diseases including bacterial infections and tuberculosis.

According to the report, which was not confirmed by the Lagos State Ministry of Health or the Federal Ministry of Health, a Liberian who came into the country a few days ago was admitted with symptoms such as high fever, headache, severe abdominal pain, diarrhea and bleeding.

However, Special Adviser to the Governor on Public Health, Dr. Yewande Adeshina, told journalists yesterday that the ministry has begun investigation into the alleged case of Ebola virus even as she called on residents to remain calm and take appropriate measures to prevent and control an outbreak of the disease in the state.

On the suspected case of EVD in Lagos, Adeshina noted that the State Ministry of Health received information from a private facility in the state concerning a suspected case three days ago, precisely on Tuesday ,July 22, 2014.

According to her, details of the suspected case were obtained from the health facility, and the suspect, a 40 year-old Liberian working for a West African organisation in Monrovia who arrived Lagos on a flight from Monrovia via Lome on Sunday, July 20, 2014 at 4p.m. had no contact with any case of EVD.

Adeshina explained: "History taken revealed that he had no contact with any case of EVD, did not visit any person with EVD in the hospital and neither did he partake in the burial of any person who died of EVD. However, on account of his working and living in an endemic region for EVD like Liberia; and the presentation of non-specific constitutional symptoms and signs of fever, malaise, body aches, vomiting, diarrhea, etc associated with EVD, a high index of suspicion was raised."

The aide explained further that based on the high index of suspicion raised, the patient was admitted and detained on suspicion for possible Ebola virus disease infection, stressing that blood sample collection and testing was initiated which include samples to the Virology Reference Laboratory, Lagos University Teaching Hospital (LUTH), Idi-Araba and World Health Organisation (WHO) Reference Laboratory in Dakar, Senegal which she stressed are actively in process.

She further stated: "Presently, the patient's condition is stable and is in recovery. The diarrhea and vomiting has stopped. Intravenous infusion has also been stopped; while the health facility has since initiated universal safety precautionary measures to prevent spread of the disease and guaranteed the safety of other patients. Meanwhile, the Federal Ministry of Health including Port Health Services partners with the State Government in areas of contact tracing and other specialized care."

Adeshina urged residents of the state to reduce risk of infection by observing high standard of personal and environmental hygiene by washing their hands often with soap and water; avoiding close contact with people who are sick and ensuring that objects used by the sick are decontaminated and properly disposed.

While noting that all fluids from an infected person are extremely dangerous, Adeshina advised health workers to be on alert, wear personal protective equipment; observe universal basic precautions when attending to suspected or confirmed cases; and report same to their local government areas or the Ministry of Health immediately or call 08023169485; 08033086660; 08033065303; 08055281442; 08055329229.

Minister of Health, Prof. Onyebuchi Chukwu, advised Nigerians to report any suspected case to the nearest health facility including General Hospitals, Federal Medical Centres (FMCs) or teaching hospitals where non-specific and symptomatic drugs against the disease have been prepositioned.

He said that all Nigerian Port Health posts and border medical centres have been put on the high alert to screen travellers from countries with confirmed Ebola Haemorrhagic Fever occurrences , pointing out that Nigerians travelling to these countries are advised to be careful and should report any illnesses with the above stated symptoms to the nearest health facility.

National Coordinator of the Nigerian Centre for Disease Control (NCDC), Dr. Abdulsalami Nasidi, had told The Guardian that the laboratories have the capacity to contain the Dengue Heamorrhagic Fever and other Viral Hemorrhagic fevers like Ebola virus and that the Federal Ministry of Health has intensified surveillance activities on the disease and all State Ministries of Health are alerted.

Minister of Information, Labaran Maku, had declared that there had not been any reported case of Ebola virus outbreak in Nigeria. He said the Health Ministry has assured it is prepared to contain the virus in the advent of an outbreak in the country.

According to the study which was published yesterday, July 24, in Nature Communications,

many organisms, including the parasite that causes malaria, make a class of molecules called isoprenoids, which play multiple roles in keeping organisms healthy, whether plants, animals or bacteria.

In malaria, the investigational drug fosmidomycin blocks isoprenoid synthesis, killing the parasite. But over time the drug often becomes less effective.

Senior author and assistant professor of paediatrics, Dr. Audrey R. Odom, said: "In trials testing fosmidomycin, the malaria parasite returned in more than half the children by the end of the study. We wanted to know how the parasite is getting around the drug. How can it manage to live even though the drug is suppressing these compounds that are necessary for life?"

Fosmidomycin, an antibiotic, is being evaluated against malaria in phase 3 clinical trials in combination with other antimalarial drugs.

Using next-generation sequencing technology, the research team compared the genetics of malaria parasites that responded to the drug to the genetics of malaria parasites that were resistant to it. With this approach, Odom and her colleagues found mutations in a gene called PfHAD1. With dysfunctional PfHAD1, malaria is resistant to fosmidomycin.

"The PfHAD1 protein is completely unstudied," Odom said. "It's a member of a larger family of proteins, and there are almost no biological functions assigned to them."

In malaria parasites, Odom's team showed that the PfHAD1 protein normally slows down the synthesis of isoprenoids. In other words, when present, PfHAD1 is doing the same job as the drug, slowing isoprenoid manufacturing. Since isoprenoids are necessary for life, it's not clear why the organism would purposefully slow down isoprenoid production.

The research team also defined the crystal structure of the PfHAD1 protein, above. When PfHAD1 is dysfunctional, the malaria parasite is resistant to fosmidomycin, an antibiotic in clinical trials for the treatment of malaria.

"We don't know why the protein puts the brakes on under normal conditions," Odom said. "Perhaps simply because it's an energetically expensive pathway. But loss of PfHAD1 releases the brakes, increasing the pathway's activity, so that even when the drug is there, it doesn't kill the cells."

Odom said isoprenoid synthesis is an attractive drug target not just for malaria but for tuberculosis and other bacterial infections because these organisms also rely on this same isoprenoid pathway. While people make isoprenoids, these vital compounds are manufactured entirely differently in animals compared with many infectious pathogens likely to cause disease.

Inhibiting isoprenoid manufacturing in malaria, bacteria or tuberculosis, for example, would in theory leave the human pathways safely alone. In people, perhaps the most well-known isoprenoid is cholesterol, with statin drugs famously inhibiting that manufacturing pathway.

Odom, who treats patients at St. Louis Children's Hospital, said she sees a handful of malaria cases each year, mostly in patients who have recently traveled to parts of the world where malaria is common. The parasite remains a massive global health problem, causing about 627,000 deaths in 2012 alone, according to the World Health Organisation. Most deaths are in children under age five .

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