Case isolation, safe burial key to curbing Ebola in Sierra Leone

A nationwide campaign to isolate 100% of Ebola cases and conduct all burial safely, alongside a global response plan, was a key intervention that helped curb transmission in Sierra Leone, according to a study of illness patterns in chiefdoms and households.

An international team of researchers from China, Sierra Leone, and the United States published their findings in the Mar 28 edition of the Proceedings of the National Academy of Sciences (PNAS).

Their analysis was based on a database they made of suspected and confirmed cases reported from May 2015 through September 2015. Tracking case timing and location, they found that at the chiefdom level, cases dropped by 43% after October 2014, when the United Nations Mission for Emergency Ebola Response launched its strategy. Cases dropped by 65% after December 2014, when Sierra Leone achieved its 100% case isolation and safe burial goal.

Factors associated with Ebola transmission included population density, proximity to Ebola treatment centers, crop coverage, and outdoor temperature, the team found.

Overall household secondary attack rate was 0.059, which was reduced by 82%—from 0.093 to 0.017—after Sierra Leone reached its case isolation and safe burial goal.

The researchers concluded that the interventions seemed to help contain the epidemic and cut transmission in households, and they suggested that the type of analysis they did could help other scientists measure the impact of Ebola vaccines in clinical trials in the outbreak region.
Mar 28 PNAS abstract

Fecal transplants reduce antibiotic resistance in C diff patients

Fecal microbial transplantation (FMT) reduced the number and diversity of antibiotic-resistance (ABR) genes in patients with recurrent Clostridium difficile (C diff) infections, according to a study yesterday in Clinical Infectious Diseases. Also, another study published yesterday showed that FMT may transfer relatively harmless bacterial viruses (bacteriophages) to human cells.

In the ABR study, 20 patients at the University of Alberta Hospital who had experienced at least three C diff infections within 6 months received FMT from healthy donors. Microbial results were compared with samples from three donors and 87 healthy controls.

Before FMT, C diff patients had a greater number and diversity of ABR genes, demonstrating increased resistance to beta-lactams and fluoroquinolones and increases in multi-drug efflux pumps (proteins that can expel antibiotics from bacterial cells). Patients with recurrent C diff infections also had all 31 of the identified ABR gene classes and high fecal counts of species in the Proteobacteria phylum, including Escherichia coli and Klebsiella, the authors said.

Eleven patients experienced symptom resolution and a match to the microbial profile of the donor after a single FMT, while nine required a second transplant. Patients who received one treatment had an average decrease of 22.3 ABR genes in the 3 weeks following FMT, and those who required a second treatment had an average decrease of 10.9. ABR gene profiles were maintained in C diff patients for up to a year following FMT, the authors said.

FMT also reduced counts of Proteobacteria in C diff patients, while increasing counts of healthy intestinal bacteria. The authors said that FMT should be considered effective in eliminating ABR genes from patients with a history of recurrent C diff infections and antibiotic treatment.
Mar 29 Clin Infect Dis study

In the other study, published yesterday in mBio, researchers found that bacteriophages can be transferred to human cells via FMT. In a study of 22 to 33 FMTs performed on three children with ulcerative colitis, bacteriophages from several virus groups were identified from samples following transplant.

No viruses that infect human cells were identified, though the authors note that bacteriophages may play a role in fostering antibiotic resistance within the human gut.
Mar 29 mBio study

Long-term Lyme symptoms more likely with comorbid conditions

People with comorbid conditions, especially those related to mental health, are more likely to experience long-term symptoms of Lyme disease, according to a study yesterday in Clinical Infectious Diseases.

Researchers affiliated with the National Institutes of Health (NIH) evaluated self-reported quality of life (QoL) for 101 Lyme disease patients between 2001 and 2014. Lyme disease was early and localized in 35 patients, disseminated in 46, and late-stage in 20.

Of 75 patients with more than 2 years of follow-up data, 42 (57%) reported long-term Lyme disease symptoms (lasting more than 2 years), including fatigue (64%), muscle soreness (67%), joint pain (55%), sleep disturbances (45%), and poor memory (38%), the authors said.

At patients’ first visits, mean QoL scores were low (below 50) for physical health (score of 45.6) and mental health (47.3), but they surpassed national averages after 3 years of follow-up, yielding scores of 50.7 and 50.1 for physical and mental health, respectively, the authors said.

More than half of patients (57%, or 58) had one or more comorbidities related to cardiovascular disease (25), chronic pain (22), or mental and behavioral health (16). Compared with fully recovered patients, those with long-term symptoms were 1.7 times more likely to report having a mental or behavioral health condition, 1.6 time more likely to be taking a mental health medication, and 1.6 times more likely to be obese.

Given the relationship between comorbidities and QoL, management of comorbid conditions should play a role in Lyme disease treatment and monitoring, the authors said.
Mar 29 Clin Infect Dis study