Coconut oil against Alzheimer's Disease?

Quite a lot of topics are caught in the Internet. I have asked recently, if coconut oil could be used against Alzheimer's. I had to confess my ignorance. But then I couldn’t just lean back and I had to investigate this topic.

A "Health Center" (in Germany) promoted coconut oil: "in addition to all its advantages for weight, a healthy cholesterol level, an active metabolism and a strong immune system, coconut oil can relieve even the symptoms of Alzheimer's disease. Not only scientific studies, but also case studies demonstrate this as the Alzheimer's disease patient Steve Newport."

Advantages in weight reduction still lack proof. Saturated fatty acids, and that’s what coconut oil is, raise cholesterol levels. What is behind the idea of an active metabolism? What is a strong immune system? How is it measured? And what is this related to Alzheimer's disease?

If you look further and the whole hype is based on one case study (Steve Newport). The hypothesis that that coconut oil could reduce Alzheimer symptoms was developed by his wife, and now serves as the basis for all providers who wish to bring coconut oil to consumers. If it were so effective, there must be no Alzheimer's dementia in Germany anyway, at least not in households where Palmin is used as frying fat, because it consists of coconut oil. But let's search for studies. But there aren’t scientific studies on coconut oil and Alzheimer's disease, at least not known to the medical public.

However, there are studies in mouse models of Alzheimer's dementia (OT: it hurts me in the soul, to speak of mice!). Y. Kashigawa and colleagues found improvements in testing learning and memory in mice under a ketone ester diet, however, these effects were only weakly expressed (http://www.ncbi.nlm.nih.gov/pubmed/23276384).

Have a look at coconut oil/fat, it shouldn’t be expensive. You shouldn't spend more than € 20 per kilogram for organic coconut oil or € 5 for non-organic coconut oil. I think you shouldn’t use coconut oil at all, frying at high temperature increases cancerous substances. And it won’t act prophylactic on Alzheimer's.

(partly rewritten after a German text on this blog)

Side effects

I’ll tell you more about the possible side effects of a new drug.

This new drug has a well known profile of side effects:

- it may lead to tooth decay

- nausea

- constipation

- abdominal pain

- headaches.

- obesity

- high blood pressure

- diabetes

- loss of consciousness

- stroke

- myocardial infarction

- neuropathy

- renal failure

- blindness,

- loss of limbs because of artery disease and/or gangrene

- death

Would you take this drug?

Oh – you want to know, which drug I’m talking of. Please look here:

http://rheumatologe.blogspot.de/2009/04/rrz-termine-2009.html

FDA Approval for Apremilast (Otezla) in Patients with Psoriatic Arthritis (PsA)

The FDA has approved apremilast (Otezla) to treat adult patients with active psoriatic arthritis (PsA). The currently approved DMARDs include biologics like THN-alpha-inhibitors and an IL-12/IL-23 inhibitor (ustekinumab).

The safety and effectiveness of apremilast (Otezla), a phosphodieasterase-4-inhibitor (PDE-4), were evaluated in three clinical trials involving 1,493 patients with active PsA. Patients treated with apremilast (Otezla) showed improvement in signs and symptoms of PsA compared to placebo. Link: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm390091.htm

There has been a study by Arthur Kavanaugh and colleagues (Abstract No. L13) at the 2012 ACR Meeting in Washington: “Apremilast, an Oral Phosphodiesterase 4 Inhibitor, in Patients with Psoriatic Arthritis: Results of a Phase 3, Randomized, Controlled Trial”. Conclusion: “Apremilast significantly improved signs and symptoms of PsA and resulted in statistically and clinically meaningful improvements in physical function. Apremilast was generally well tolerated and no new safety or laboratory signals were detected.” Lets look at some side effects: diarrhea (placebo: 2.4%; apremilast 20 mg BID: 11.3%; and apremilast 30 mg BID, 19.0%), nausea (high dose: 18.5%), headache (10.1%, and 10.7%), and more.

At the 2013 ACR Meeting in San Diego we saw even more studies.

C.J. Edwards and colleagues presented the following study [Abstract No. 311]: “Long-Term (52-Week) Results Of a Phase 3, Randomized, Controlled Trial Of Apremilast, An Oral Phosphodiesterase 4 Inhibitor, In Patients With Psoriatic Arthritis and Current Skin Involvement (PALACE 3).” Conclusion: “Over 52 wks, APR continued to demonstrate efficacy in the treatment of PsA and associated psoriasis, including clinically meaningful improvements in signs and symptoms and physical function. APR demonstrated an acceptable safety profile with up to 52 wks of treatment and was generally well tolerated.”

M. Cutolo and colleagues presented the following study [Abstract No. 317]: “Apremilast, An Oral Phosphodiesterase 4 Inhibitor, Is Associated With Long-Term (52-Week) Improvement In Tender and Swollen Joint Counts In Patients With Psoriatic Arthritis: Results From Three Phase 3, Randomized, Controlled Trials.” Conclusion: “Over 52 wks, APR continued to demonstrate efficacy in the treatment of PsA, including clinically meaningful improvements in SJC and TJC. APR demonstrated an acceptable safety profile and was generally well tolerated for up to 52 wks.”

G. Schett and colleagues presented the following study [Abstract No. 331]: “Apremilast, An Oral Phosphodiesterase 4 Inhibitor, Is Associated With Long-Term (52-Week) Improvement In Physical Function In Patients With Psoriatic Arthritis: Results From Three Phase 3, Randomized, Controlled Trials.” Conclusion: “Over 52 wks, APR continued to demonstrate meaningful clinical response in PsA pts, including measures of physical function. APR demonstrated an acceptable safety profile and was generally well tolerated for up to 52 wks.”

There were some more studies shown at the  ACR 2013 Meeting in San Diego, for long-term safety look at the following study.

A. Kavanaugh and colleagues presented the following study [Abstract No. 310]: “ Long-Term Safety and Tolerability Of Apremilast, An Oral Phosphodiesterase 4 Inhibitor, In Patients With Psoriatic Arthritis: Pooled Safety Analysis Of Three Phase 3, Randomized, Controlled Trials.” Conclusion: “APR demonstrated an acceptable safety profile and was generally well tolerated for up to 52 wks with no new safety concerns identified with long-term exposure. These data do not indicate a need for laboratory monitoring.”

We now must look, which group of patients really benefits from the new drug. We must compare efficacy and costs in everyday life. And we still need some head to head evaluation against established biologics. How about radiographic changes erosions as well as proliferations? Still some work to be done and still a long way to go, but

Welcome Otezla!

There sure are patients waiting for you! And hopefully Otezla will get EMEA approval soon.

Ebola – recent outbreak in West Africa

I've started this post on the outbreak of ebola virus on March 23rd 2014. It already is the most severe outbreak of this virus! You will have to scroll downwards to get to the earlier entrances of this post.
Ebola virus causes a hemorrhagic fever. It has a high lethality. Ebola is transmitted by contact with blood or bodily fluids of humans or infected animals. Ebola isn’t naturally transmitted through the air, which makes isolation of infected people easier. First symptoms are headache, myalgia, fatigue, and fever as in many viral infections. Later patients develop disseminated intravascular haemorrhage and multiple organ failure. WHO fact sheet: 
http://www.who.int/mediacentre/factsheets/fs103/en/. Wikipedia: http://en.wikipedia.org/wiki/2014_West_Africa_Ebola_outbreak. There is no drug available!
Detailed information for German speaking people by the Robert-Koch-Institut: 
http://www.rki.de/DE/Content/InfAZ/E/Ebola/Ebola_node.html

30.10.2014

13703 infected people, ~5000 people dead, 2 months ago: 3071 / 1553. There are some problems with correct statistics, but as the actual numbers are expected to be three times as high, 13703 reflects better, what is happening in West Africa.

03.12.2014
I had been on vacation.
16869 infected people, 6319 people dead, 3 months ago: 3071 / 1553.

I've just seen the following tweet:
RT ‏@RT_com 2h2 hours ago
Obama says #Ebola fight not over, requests $6 billion to combat virus http://on.rt.com/hbsmhh
Yes, the fight isn't over. The media is going to sleep again concerning ebola.

Bob Geldof got into contact with German singer Campino of Die Toten Hosen (@dietotenhosen), who produced together with other German stars an ebola version of band aid. Criticism against this was the same as in the UK. That's strange as any help is needed and any effort to spread awareness on what's happening in West Africa is welcome.

The "newer" old entries are at the end of this blogpost.

Start of this blogpost on 23rd of March 2014:

A couple of days ago I had been joking about Ebola virus on twitter, as it looks like the cartoon figure Marsupilami. And now we have another epidemic, the 16^th by modern count (since we know to detect the virus).

https://twitter.com/Rheumatologe/status/446167487714172928

Ebola virus causes a hemorrhagic fever. It has a high lethality. First symptoms are headache, myalgia, fatigue, and fever as in many viral infections. Later patients develop disseminated intravascular haemorrhage and multiple organ failure.

Right now there is an outbreak in Southern Guinea. BBC news report 59 dead out of 80 infected persons; link: http://www.bbc.com/news/world-africa-26701733.

If you want to know more on the virus, look at Wikipedia: http://en.wikipedia.org/wiki/Ebola_virus_disease. “As an outbreak of ebola progresses, bodily fluids from diarrhea, vomiting, and bleeding represent a hazard.” The disease is highly infectious and contagious. More information on the recent outbreak also here: http://www.cbc.ca/news/world/ebola-epidemic-confirmed-in-guinea-death-toll-quickly-rising-1.2582861 - there’s also a good electronic microscope picture of the virus.

It's unlikely that the disease will spreat around the world, though you shouldn't go to the risk area if your not part of a team of experts. Terrorists could use this virus, but as you need specific labs to produce this virus and first of all you need the virus, let's not start a buzz. This dream of terrorists won't become our nightmare.

25.03.2014:

Yahoo News tells us that the epidemic is thought to have spread into Liberia. Liberian Health Minister Walter Gwenigale speaks of sic infected people, of whom five are already dead. http://news.yahoo.com/ebola-epidemic-spreads-guineas-capital-173304833.html.

In Conakry (Guinea) there have been three people with hemorrhagic fever, who all tested negative for Ebola.

31.03.2014:
This recent outbreak has already spread to Liberia and Sierra Leone. 70 people are dead out of 111 infected persons. There might be 11 victims of the disease in Sierra Leone and in Liberia, but only 2 have been tested positive for Ebola so far.
Link: http://www.theverge.com/us-world/2014/3/31/5565482/ebola-kills-70-in-guinea-spreads-to-liberia-west-africa CBCNews has a story titled: "Ebola epidemic could become global crisis, experts warn" - "Health officials warn that the arrival of Ebola in this sprawling city of some 2 million people with an international airport could spell disaster. Among the poorest countries in the world, Guinea has severely limited medical facilities and a large population living in slums where the virus could spread quickly."
The whole story is here: http://www.cbc.ca/news/world/ebola-epidemic-could-become-global-crisis-experts-warn-1.2591338


03.05.2014:
"On April 29, 2014, the Ministry of Health (MoH) of Guinea’s reported 221 suspect and confirmed cases of Ebola hemorrhagic fever (EHF), including 146 deaths."
http://www.cdc.gov/vhf/ebola/outbreaks/guinea/
The Detroid Free Press tells us, "Why Ebola isn't just Africa's problem".
http://www.freep.com/article/20140503/OPINION05/305030017 - thanks ‏@DrJenGunter on Twitter.

13.05.2014:
I've checked CDC's page: "The Ministry of Health (MoH) of Guinea’s reported on May 3, 2014, a cumulative total of 231 suspect and confirmed cases of Ebola hemorrhagic fever (EHF), including 155 deaths. ... According to the World Health Organization (WHO), the Ministry of Health and Social Welfare (MOHSW) of Liberia reported no change to the 13 suspect and confirmed EHF cases (11 deaths) in Liberia as of May 2, 2014."
http://www.cdc.gov/vhf/ebola/outbreaks/guinea/

No new development according to the news.


05.06.2014
Here's the most recent data on the outbreak: http://www.promedmail.org/direct.php?id=20140526.2498287. "Since the beginning of the outbreak, the cumulative total number of clinical cases of EVD is 258, including 174 deaths."
And here is an article on a vaccine: "The Ebola vaccine for chimps works but may never be used", Link: http://www.vaccinews.net/2014/06/the-ebola-vaccine-for-chimps-works-but-may-never-be-used/ 

23.06.2014
Thank you, 

Michelle Fay Cortez ‏@FayCortez  

The ebola outbreak in West Africa is terrifying. Baffled as to why it's not 

getting more attention in the US/Europe. http://www.who.int/csr/don/2014_06_22_ebola/en/ …

WHO is taking steps, including a high-level meeting for the Ministers of Health in the sub-region to be held 2–3 July in Accra, Ghana. A total of 567 persons have been infected in Guinea, Sierra Leone and Liberia. 350 people have already died of these. BTW: "WHO does not recommend any travel or trade restrictions be applied to Guinea, Liberia, or Sierra Leone based on the current information available for this event."
http://www.who.int/csr/don/2014_06_22_ebola/en/


02.07.2014:
There's a good map on  Guinea with the areas marked, whe people were infected. http://www.cdc.gov/vhf/ebola/resources/distribution-map-guinea-outbreak.html
A total of 599 persons have been infected in Guinea, Sierra Leone and Liberia. 362 people have already died of these. 

04.07.2014:
If you add also the supected and probable cases, then 759 people of Guinea, Sierra Leone and Liberia have been infected, of whom 467 have already died as of 30th of June. Link: http://www.who.int/csr/don/2014_07_01_ebola/en/.
It's important to note, that the "WHO does not recommend any travel or trade restrictions be applied to Guinea, Liberia, or Sierra Leone based on the current information available for this event."
If you look at the Wikipedia article, you can see that the recent outbreak is already the largest in the known history of the disease. Link: http://en.wikipedia.org/wiki/Ebola_virus_disease. The case fatality risk has been calculated at 64%!

07.07.2014:
BBC reports, that a US citizen has been quarantined and is being tested for ebola virus in Accra (Ghana). Ghana had no confirmed cases of the virus during the current outbreak in West Africa.
So ebola might have reached Ghana, but this still needs to be confirmed as there are other virus infections, which show initially the same symptoms. Link: http://www.bbc.com/news/world-africa-28192398

18.07.2014:
WHO gives new numbers: 964 people of Guinea, Sierra Leone, and Liberia have been infected, of whom 603 have already died as of 14th of July. "WHO does not recommend any travel or trade restrictions be applied to Guinea, Liberia, or Sierra Leone based on the current information available for this event." There has been an article in the New York Times two days ago: http://www.nytimes.com/2014/07/16/world/africa/death-toll-from-ebola-surges-in-west-africa-prompting-alarm.html?_r=0. Though it doesn't add much to what we already know, any article is welcome as not to let this outbreak go on unnoticed by world public.

20.07.2014:
In the latest edition of Deutsches Ärzteblatt (Journal of the German Association of Physicians) more awareness is called for on ebola, especially in people returning from West Africa, who develop haemorrhagic fever ("Bei Reiserückkehrern an Ebola denken"). Behind this call is the Robert-Koch-Institute, which is the German equivalent of the CDC in the US.

25.07.2014:

Liz Szabo ‏@LizSzabo  5m

Top Ebola doctor in Sierra Leone infected with virus http://usat.ly/1mKya2K  via @usatoday

Sad to hear that Sheik Umar Khan has to be treated himself.

WHO gives new numbers: 1093 people of Guinea, Sierra Leone, and Liberia have been infected, of whom 660 have already died as of 20th of July. 

28.07.2013:
Now that some of the people working against Ebola have been infected by ebola virus, this deadly disease might receive more attention. New York's Daily News has more on the second american aid worker, who has tested positive for ebola virus: http://www.nydailynews.com/life-style/health/ebola-outbreak-kills-senior-doctore-liberia-official-article-1.1881734.
For an update look at the WHO page:
http://www.who.int/csr/don/2014_07_24_ebola/en/ - 1093 people are infected with ebola virus, 660 have already died!

29.07.2014:
1201 people are infected with ebola virus, 672 have already died!
The CDC has a page informing travelers:
http://wwwnc.cdc.gov/travel/notices/alert/ebola-guinea. Important would be to avoid contact with blood or body fluids from obviously sick people or someone who has died from Ebola, also sick wildlife, or bats, who are the most likely reservoir for the virus, meat from infected animals, like cynomolgous monkeys. Cynomolgous monkeys are used in medicine in animal testing, but I guess that these animals are tested for diseases. I myself object animal testing, but these testings are required by FDA and EMEA for instance.

30.07.2014:
"COULD EBOLA SNEAK ACROSS U.S. BORDER?" asks Drew Zahn on WND: http://www.wnd.com/2014/07/could-ebola-sneak-across-u-s-border/. The CDC has issued a warning on close contact: "Examples of close contact include kissing or embracing, sharing eating or drinking utensils, close conversation (less than 3 feet), physical examination and any other direct physical contact between persons,” the guidelines clarify. “Close contact does not include activities such as walking by a person or briefly sitting across a room.” Read more in the article. Maybe the disease gets more attention.
In 60 seconds: What is Ebola? BBC News explains why the disease is so dangerous. http://www.bbc.com/news/health-28105531

31.07.2014:
Wikipedia has a graph on how many people are infected and have already died because of ebola virus: http://en.wikipedia.org/wiki/2014_West_Africa_Ebola_outbreak. Nigeria is now on the list, too. This outbreak shows a new quality, it doesn't stay in remote rural areas but has entered the bigger cities. And these cities are much nearer to the rest of the world than one would like.
Local Liberians collect donations to help fight the disease: http://www.wsbt.com/news/local/local-liberians-collecting-donations-to-help-fight-ebola-virus-in-africa/27237354. I hope that the wealthier nations will help, too.
"Nancy Writebol, a missionary from Charlotte working in West Africa to help fight Ebola, was diagnosed with the virus on July 25 and has been receiving care since being isolated in an outbreak that has affected more than 1,200 people in three countries." Read and see more here: http://www.today.com/news/son-american-ebola-patient-says-mom-fighting-through-it-1D79994691.
BBC on "Can social media help prevent the spread of Ebola?" See: http://www.bbc.com/news/blogs-trending-28552917.

Liberia: President Ellen Johnson Sirleaf has closed all schools, and she also presented a National Action Plan against Ebola. The boundaries have been closed.

Sierra Leone: Sierra Leons is mourning for the head of the anti-Ebola campaign, Sheikh Umar Khan, who has died of the disease. Sierra Leone's President Ernest Bai Koroma has canceled his participation in the United States-Africa Summit in Washington; and he declared a state of emergency.

Guinea: It seems that the information campaigns on Ebola virus are successful. Guinea is experiencing a lower incidence of new infections.

The German Ministry of Foreign Affairs just has issued a warning on (unnecessary) travels to Guinea, Sierra Leone, and Liberia.

03.08.2014:
1440 people have been infected by Ebola virus, of whom 826 people already have died (data until July, the 30th).
"West Africa's Ebola-hit nations have agreed to impose a cross-border isolation zone at the epicentre of the world's worst-ever outbreak, amid warnings that the deadly epidemic is spiralling out of control." Read more here: http://news.yahoo.com/african-states-launch-100mn-ebola-response-plan-170858040.html

04.08.2014:

TKM-Ebola, an anti-Ebola virus RNAi therapeutic, is being developed by Tekmira.The US Food and Drug Administration (FDA) had granted Fast Track designation for the development of TKM-Ebola in March this year. However in July, the FDA had requested additional information on drug is safety at higher doses (phase 1 study on healthy volunteers). At this outbreak Tekmira hopes for being allowed a phase 2 study, which means testing the drug on patients suffering from ebola virus infection. Nancy Writebol and Dr. Kent Brantly, who had been flown out to the US, did’t get the drug.

Links:
http://investor.tekmirapharm.com/releasedetail.cfm?ReleaseID=830680
http://www.bloomberg.com/news/2014-07-03/tekmira-ebola-drug-trial-placed-on-hold-by-u-s-fda.html
http://www.businessinsider.com/tekmira-pharmaceuticals-ebola-treatment-2014-8
http://in.reuters.com/article/2014/08/04/us-health-ebola-tekmira-idINKBN0G41EW20140804?feedType=RSS&feedName=health&utm_source=dlvr.it&utm_medium=twitter&dlvrit=309303

05.08.2014:
1603 people have been infected by Ebola virus, of whom 888 people already have died. This is bad news as the graph shows that the curve gets steeper, meaning the disease is spreading more quickly than before.
I have contacted the CDC, if they knew a substitute for virucidal hand disinfectants people could use in rural areas in West Africa.
WHO: “National authorities in Ghana, Nigeria, and Togo continue to work closely with WHO and it partners in identification of contacts and contact tracing as well as in preparing response plans as a result of the recent visit by and death of a Liberian national to Nigeria from EVD and the new Nigerian EVD probable case, who travelled to Guinea.” Link: http://www.afro

06.08.2014:

Lots of information on the Wikipedia article: "2014 West Africa Ebola outbreak", link: http://en.wikipedia.org/wiki/2014_West_Africa_Ebola_outbreak
Isolation of infected people and common-sense hygiene can stop the spread of the Ebola virus. Ebola is easily inactivated with virucidal disinfectants, which are available in every hospital. We need education in hygienic measures in rural areas, where the disease is spreading. Hygienic hand disinfection with a virucidal agent is necessary after contact with ebola infected material.
One highly effective virucidal hand disinfectant is Sterillium® Virugard. One should look for locally available alternatives. I'd like to know more about what is possible in rural areas of West Africa. From my experience in Mali I doubt that much is available in the villages. But the disease has to be stopped there!

07.08.2014:
1711 people have been infected by Ebola virus, of whom 932 people already have died. If Ebola goes on spreading with this rate, we soon have an equivalent to the pest during the middle ages.
There are people combining conspiracy theory and orthomolecular medicine (high dose vitamin C). There's no scientific basis to this.If you want to look at it yourself, here's the link: http://jimstonefreelance.com/ebola.html, but I think it's a waste of time.
Miguel Pajares, 75, a Spanish missionary priest is one of three missionaries in Liberia, who tested positive for Ebola. He is currently repatriated to Spain. Link: http://www.telegraph.co.uk/news/worldnews/europe/spain/11017332/Ebola-outbreak-Spain-to-accept-Europes-first-confirmed-case-of-the-virus.html.
"A Saudi man who was being treated for Ebola-like symptoms has died at a hospital in Jeddah, Saudi Arabia's health ministry says." Ebola hasn't been confirmed, yet. Link: http://www.bbc.com/news/health-28678699.

US FDA authorizes use of diagnostic test (DoD EZ1 Real-time RT-PCR Assay) to detect Ebola. “The FDA can issue an "emergency use authorization" for an unapproved medical product or the unapproved use of an approved medical product during emergencies when there are no adequate, approved and available alternatives.”
http://www.gmanetwork.com/news/story/373720/scitech/technology/us-fda-authorizes-use-of-diagnostic-test-to-detect-ebola

08.08.2014:
TKM-Ebola, the anti-Ebola virus RNAi therapeutic by Tekmira, targets three of the seven genes of Ebola virus. The FDA had placed a hold on the trials for an interim analysis of the drug’s safety profile. Tekmira announced that the FDA will be allowing the drug to be used in people infected with Ebola. There still are ethical concerns, but as the disease is fatal in 55% according to actual statistics, these should be talked about quickly. There is a second drug by Sarepta Therapeutics, called AVI-7537, which targets only one of the three genes of Ebola. There's a good coverage on Forbes: http://www.forbes.com/sites/davidkroll/2014/08/07/fda-moves-on-tekmiras-ebola-drug-while-sareptas-sits-unused/
A cocktail of three plant derived antibodies seems to be tested on the two American Ebola patients. ZMapp has only been tested on monkey before.

#FactsOnEbola: The Facts versus The Nigerian Merchants of Misinformation – JJ, Omojuwa
http://omojuwa.com/2014/08/factsonebola-the-facts-versus-the-nigerian-merchants-of-misinformation/

1779 people have been infected by Ebola virus, of whom 961 people already have died. If you look at the incidence rates, Guinea has hardly seen any new infected people, the real increase seems to be hitting Sierra Leone and to a lesser degree Liberia; both countries surpassed Guinea in numbers. The death rate in Guniea had been calculated 64% so far. It feels a little reassuring that the governments of both Liberia and Sierra Leone have declared a state of emergency.

09.08.2014:
People are asking if the declaration by the World Health Organisation (WHO) of the Ebola outbreak in West Africa to be an international public health emergency doesn’t come too late. I have started to write on this Ebola outbreak on March 23rd and have been wondering more than once on Twitter, why this catastrophe isn’t getting more attention. Doctors Without Borders (MSF) think that the of declaration international public health emergency comes to late. Nevertheless we have this declaration and let’s hope that more will be done to stop further spreading of Ebola virus.

What about face masks? In principle these aren’t necessary, if you don’t have contact with infected people or materials. Ebola is transmitted by smear infection. So you need rubber gloves. Since you might touch your face by chance after having touched infectious materials with the glove, you’d better wear a face mask. 

Let’s talk again about the question of disinfection in rural Africa or also in the poorer quarters of the cities. What can someone do, if a contamination of the hand has occurred? Virucidal disinfectant is best, no questioning, but might not be available. Washing your hands with soap and water, better more than once, will reduce the risk of infection. I still hope that the WHO in collaboration with local health authorities will issue guidelines for the general public.

10.08.2014:
The WHO didn't issue new statistics.
Let's talk about fears. "Ebola fears seem to be as contagious as the virus itself" says the Liberty Voice. http://guardianlv.com/2014/08/ebola-fears-as-contagious-as-the-virus/

As the virus is highly contagious and very deadly, the fears aren't without ground. But we need not get hysterical. It is possible to end the desaster by consequent quarantine.
The German paper DIE WELT published an interview how Ebola might get to Europe. They interviewed Prof. Dirk Brockmann, who published an interactive network analysis: "2014 Ebola Outbreak: Worldwide Air-Transportation, Relative Import Risk and Most Probable Spreading Routes". Link: http://rocs.hu-berlin.de/projects/ebola/index.html (text is in English). The risk assessment takes into account air traffic. How about the idea of 200 boat people reaching Europe clandestinely? There are risks that can be calculated, and some risks refuse calculation.

11.08.2014:
WHO Director general Margaret Chan said: "The outbreak is moving faster than we can control it".
Lindis Hurum (Physicians without Borders) said: "Our capacity is stretched beyond anything that we ever done before in regards to ebola response. We are definitely seeing the whole health care system that is falling apart (Liberia)". Full text: http://www.express.co.uk/news/world/497380/Ebola-Nigeria-Emergency-British-Airways-Goodluck-Jonathan-Kent-Brantly
Deutsche Welle has alarming news on a famine evolving in Liberia due to quarantined regions. Farmers can’t get to their field, merchants can’t go to the markets. “Many people do not know how to get food or can no longer afford it.” Link: http://www.dw.de/wer-stoppt-das-ebola-virus/a-17844429
I hope that we get new statistics today as the available ones are five day old. That is far to long! 


12.08.2014:
We have an update on the statistics. 1848 people have been infected by Ebola virus, of whom 1013 people already have died. Within three days guinea had 11 new patients, Liberia 6, Sierra Leone 13, and Nigeria had none.
ZMapp will be tested in Liberia. All supplies have been sent to Liberia. The drug hasn’t been evaluated in humans, safe for the three evacuated patients. Liberian President Ellen Johnson Sirleaf requested the drug, albeit there still are ethical concerns. BBC has the whole story: http://www.bbc.com/news/world-africa-28749615. “The drug is composed of three humanized monoclonal antibodies that are produced transgenically and subsequently grown in large numbers in the tobacco plant Nicotiana in the bio-production process known as "pharming".”More on ZMapp at Wikipedia: http://en.wikipedia.org/wiki/ZMapp. 

13.08.2014:

Ebola virus disease update - west Africa by the WHO: http://www.who.int/csr/don/2014_08_11_ebola/en/

A German student in Ruanda has been tested negative for Ebola, link (in German): http://www.focus.de/gesundheit/news/entwarnung-deutscher-student-hat-kein-ebola_id_4054536.html

The Swiss online 20 Minutes discusses “Will refugees bring Ebola to Europe?” Link: http://www.20min.ch/ausland/news/story/Bringen-Fluechtlinge-Ebola-nach-Europa--20311564. Background for this article are fears in Italy that the masses of boat people might bring Ebola to Europe as more than 100,000 people have reached Italy this year. Right wing politician seem to use Ebola as a pretext to stop the refugee operation “Mare Nostrum”. Beatrice Lorenzin, the Italian Minister of Health, stated: „Not every African with fever has Ebola”.

WHO issued the following statement concerning ethics: “In the particular circumstances of this outbreak, and provided certain conditions are met, the panel reached consensus that it is ethical to offer unproven interventions with as yet unknown efficacy and adverse effects.”

1975 people have been infected by Ebola virus, of whom 1069 people already have died. The curve of new infections is getting steeper again.

Old chart removed, new chart see above.

14.08.2014:

Liberia Becomes Epicenter Of West Africa Ebola Crisis. Jason Beaubien and Steve Inskeep talk about the crisis in Liberia. “In recent weeks, Liberia has reported the largest number of cases. It is also a country from which the virus has spread. A traveler from Liberia carried the virus to Nigeria.“ „When you look around, every shop has a small barrel out front with a little tap on the bottom of it where you can wash your hands as you go in and out.” Link: http://www.npr.org/2014/08/13/340005056/liberia-becomes-epicenter-of-west-africa-ebola-crisis.

USA Today is also covering news of Ebola: “In Liberia, which had 71 of the new cases, contact tracing has proved much more difficult, the WHO said, and more international help is needed.” “Now doses of ZMapp have been allocated to two Liberian doctors and could arrive as soon as Wednesday in Liberia, according to Liberian Health Minister Walter Gwenigale. They would be the first Africans known to receive the treatment.” Link: http://www.usatoday.com/story/news/world/2014/08/13/ebola-doctors-sierra-leone/14003411/.

16.08.2014:
2,127 people have been infected by Ebola virus, of whom 1,145 people already have died. Not only are these new statistics alarming, but also the beginning of people sensing that these numbers are only the tip of an iceberg. It’s uncertain how many infected people are off the grid, and therefore pose a much greater risk of being the nucleus for further infections. 

All other outbreak summed up together had less people infected (985) than the current one; link: http://www.cdc.gov/vhf/ebola/resources/outbreak-table.html.

17.08.2014:
Alarming news!
"Twenty-nine Ebola patients have fled a clinic in Liberia following an attack by armed men, reports suggest." Link: http://www.itv.com/news/story/2014-08-17/ebola-patients-flee-liberia-clinic-after-attack-by-armed-men/
The German tagesschau (news on Ch. One / ARD) has the same story: http://www.tagesschau.de/ausland/ebola-liberia-101.html
This is alarming as it might spread the disease more quickly.

19.08.2014:

Today the news on Ebola is sparse. The world moves on to other topics, but here is the topic that needs attention. Syria and Sudan aren’t as present in the news as these countries should be, the world lost interest. The WHO should issue daily statistics. The last statistics are a six days old. We should get Ebola into the news again, help to stop the outbreak before it becomes a threat to the world.

Later: the new statistics up to the 16th of August are available now.
2240 people have been infected by Ebola virus, 1229 people of whom already have died.

Old chart removed, new chart see above.

21.08.2014:
Here is the new chart:

Old chart removed, new chart see above.
The curve is getting steeper, meaning we're getting into geometric progression. 2473 people have been infected by Ebola virus, 1350 people of whom already have died.
WHO twittered: "An #Ebola case in a previously unaffected area of #Guinea was reported last week, indicating continuing spread to new area".

The German press is occupied with someone in Berlin, who luckily has been tested negative for Ebola; link: http://www.rbb-online.de/panorama/beitrag/2014/08/ebola-verdacht-arbeitsamt-storkower-strasse.html.

BBC News has an optimistic note as three physicians in Liberia seem to recover after taking ZMapp. More information on ZMapp below. Link for the BBC article here: http://www.bbc.com/news/world-africa-28860204.

ZMapp
The people getting ZMapp are doing better, but it isn’t clear whether this is due to the experimental drug or good intensive care or a better immune system.

Favipirapir
Favipiravir (T-705) is a RNA polymerase inhibitor, which has been developed in Japan against influenza. The drug has shown efficacy against Ebola in animal experiments.

Other drugs
Other drugs such as amiodarone, verapamil, that statins, ACE inhibitors, and angiotensin receptor blockers are discussed to be effective against Ebola by working as immunomodulators. WHO: “Decades of scientific research have failed to find a curative or preventive agent of proven safety and effectiveness in humans, though a number of promising products are currently under development.”
WHO: “WHO has advised that the use of experimental medicines and vaccines under the exceptional circumstances of this outbreak is ethically acceptable. However, existing supplies of all experimental medicines are either extremely limited or exhausted.” Link: http://www.who.int/mediacentre/news/ebola/15-august-2014/en

German readers
There is lots of information on the homepage of the Bernhard-Nocht-Institut für Tropenmedizin in German: http://www.bnitm.de/aktuelles/aktuelle-informationen-zu-ebola/

25.08.2014:

2615 people have been infected by Ebola virus, 1427 people of whom already have died. The largest increase is seen in Liberia.

The is another outbreak of Ebola in the Democratic Republic of Congo. It seems to be a different strain of Ebola and therefore not connected to the current outbreak in West Africa. It would be the 7th outbreak. Link: http://www.aljazeera.com/news/africa/2014/08/congo-ebola-outbreak-2014824183430461469.html

BBC News: "Dr Numbi said a quarantine zone would be set up in a 100-km (62-mile) radius in Boende [Equateur province] where the cases had been registered." Link: http://www.bbc.com/news/world-africa-28922290

NBC News has the story that the outbreak in Congo isn't related to West Africa. But I'm not sure about the validity of this statement though it comes from Felix Kabange Numbi, Congo’s health minister. Link: http://www.nbcnews.com/storyline/ebola-virus-outbreak/new-outbreak-two-people-die-ebola-congo-n187921

28.08.2014:
The WHO didn't issue new statistics on the development of the Ebola outbreak in the West African countries.
There is some relevant information on the outbreak in Congo:
http://www.afro.who.int/en/clusters-a-programmes/dpc/epidemic-a-pandemic-alert-and-response/outbreak-news/4263-ebola-virus-disease-drc.html
The index case has bee a pregnant woman from Ikanamongo Village, Boende [Equateur province]. The local health authorities are supported by a field team of the Ministry of Health from Kinshasa. 24 suspected cases of haemorrhagic fever, including 13 deaths, have been identified. "The index case and the 80 contacts have no history of travel to the EVD-affected countries in West Africa (Guinea, Liberia, Nigeria, or Sierra Leone) or history of contact with individuals from the affected areas." "At this time, it is believed that the outbreak in DRC is unrelated to the ongoing outbreak in West Africa.Contact tracing has begun and 80 individuals are currently being followed-up."
There's an interesting article in German on ZMapp and why it's good to not use it: 
http://www.scilogs.de/fischblog/kein-zmapp-hamburger-ebola-patienten/ 
Please use a translation program.

New statistics released today: 3069 people infected by Ebola virus, 1552 people already have died.


29.08.2014:
According to Spiegel-Online WHO fears that more than 20,000 people have been infected and that the outbreak will last 6-9 months. I call this an optimistic view. Not only will there be more infected and dead patients, but in the wake the already weak economics of the West African States will collapse and even more people will die in the following famine. Helping with the infrastructure now would be a good investment.
Link: http://www.spiegel.de/gesundheit/diagnose/ebola-in-westafrika-who-befuerchtet-mehr-als-20-000-faelle-a-988574.html. 
I haven't seen any new information on the Ebola outbreak in Congo.

01.09.2014:

UNICEF has “airlifted 68 tonnes of supplies to Liberia, ramping up Ebola response”. “UNICEF has already provided over US$2 million in material and technical support, including: health supplies, protective gear for health workers; chlorine, sprayers and other water, sanitation and hygiene equipment to support infection control, motorcycles and other logistical support to enable community health workers and other partners to move around the communities.” Link: http://www.unicef.org/media/media_74868.html

“Ebola's heavy toll on study authors”. “At Kenema Government Hospital (KGH) in Sierra Leone, where the country’s first case was diagnosed, more than 2 dozen nurses, doctors, and support staff have died of Ebola.” Link: http://news.sciencemag.org/health/2014/08/ebolas-heavy-toll-study-authors

“Genomic surveillance elucidates Ebola virus origin and transmission during the 2014 outbreak” by Stephen K. Gire and colleagues: “In its largest outbreak, Ebola virus disease is spreading through Guinea, Liberia, Sierra Leone, and Nigeria. We sequenced 99 Ebola virus genomes from 78 patients in Sierra Leone to ~2,000x coverage. We observed a rapid accumulation of interhost and intrahost genetic variation, allowing us to characterize patterns of viral transmission over the initial weeks of the epidemic. This West African variant likely diverged from Middle African lineages ~2004, crossed from Guinea to Sierra Leone in May 2014, and has exhibited sustained human-to-human transmission subsequently, with no evidence of additional zoonotic sources. Since many of the mutations alter protein sequences and other biologically meaningful targets, they should be monitored for impact on diagnostics, vaccines, and therapies critical to outbreak response.” Link: http://www.sciencemag.org/content/early/2014/08/27/science.1259657

02.09.2014:

Again we’re waiting for new statistics!

Which drugs are in the pipeline?

ZMapp – much hype around the antibodies prepared using tobacco plants. Right now all ZMapp is gone. It had been tested in monkeys and three humans, whereof one died (Miguel Pajares, a 75-year-old Spanish missionary) and two survived. This could be the ratio of optimal intensity care.

TKM-Ebola uses small interfering RNAs (siRNAs), which interfere with the production of certain proteins Ebola needs. It has been tested on monkeys, too. The FDA had stopped a study on humans (phase 1 study) because of safety concerns, but the study is going on again.

Two vaccines are under development and should be tested in 2015 on humans.

FAO:
"West Africa: Ebola outbreak puts harvests at risk, sends food prices shooting up" - the interesting article to be found here:
http://www.fao.org/news/story/en/item/242177/icode/

04.09.2014:

3706 infected / 1847 dead. The numbers of Nigeria might be incorrect, because there seem to be at least 60 infected people in Port Harcourt as Spiegel online (German source) just published: 
http://www.spiegel.de/gesundheit/diagnose/ebola-who-fuerchtet-ausbreitung-in-nigeria-a-989936.html

WHO: Ebola death toll tops 1,900, surpassing all previous outbreaks combined
http://www.washingtonpost.com/news/world/wp/2014/09/03/who-ebola-death-toll-tops-1900-surpassing-all-previous-outbreaks-combined/ 

05.09.2014:

On the Ebola outbreak in Congo:

“The DRC outbreak, first reported to WHO on 26 August, has so far sickened 53 people and killed 31, according to WHO. Early test results suggested the two outbreaks were caused by two different species of Ebola.” Link:

http://news.sciencemag.org/africa/2014/09/congo-outbreak-ebola-unrelated-escalating-west-african-epidemic

On the West African Ebola outbreak in Nigeria:

Too bad, the outbreak in Nigeria seemed to be very contained, but a doctor had secretly treated an infeceted diplomat, got Ebola himself, spreaded the disease, and died. He even operated patients.

 “Experts are now following hundreds of the doctor’s contacts, 60 of which had “high-risk or very high-risk exposure,” WHO says.” Link:

http://news.sciencemag.org/africa/2014/09/nigerias-ebola-outbreak-spreads

Forbes lies a little behind actual developments. “Fortunately, Nigeria does not have an Ebola problem.” I see that Nigeria has a problem, too. Link:

http://www.forbes.com/sites/realspin/2014/09/03/nigeria-is-containing-the-ebola-outbreak/

Who has an Ebola problem?

We all have as it developes with increasing speed. 

07.09.2014:

Funkhaus Europa, a world music station in Germany, just mentioned Sierra Leone's Refugee All Stars, who are Sierra Leone 's most famous band. Together with a television production company tey started a campaign eo increase awareness on Ebola. "They want to warn their countrymen against the Ebola epidemic with small video clips."
http://www.funkhauseuropa.de/musik/globalpopnews/refugeeallstars106.html

Senegal has the first Ebola patient!

I guess the numbers on Nigeria are much higher than the ones given by WHO.

3,967 infected / 2,105 dead. 

09.09.2014:

4293 people infected by Ebola virus, 2296  people already have died. The curves get steeper! 

Blue: new infection / pink: deaths

11.09.2014:
The BBC has some well done charts to illustrate, what is happening in Africa. The title is:
Ebola: Mapping the outbreak
Link: http://www.bbc.com/news/world-africa-28755033

I’d like to talk about the three newest studies concerning Ebola virus shown on PubMed.

T.K. Warren an colleagues published a study: “Protection against filovirus diseases by a novel broad-spectrum nucleoside analogue BCX4430”  The study is on BCX4430, a novel synthetic adenosine analogue, which inhibits infection of distinct filoviruses like Ebola in human cells. “Post-exposure intramuscular administration of BCX4430 protects against Ebola virus and Marburg virus disease in rodent models. Most importantly, BCX4430 completely protects cynomolgus macaques from Marburg virus infection when administered as late as 48 hours after infection.” This would be very helpful as post contact protection, because lots of health workers have died in the recent outbreak. Link: http://www.ncbi.nlm.nih.gov/pubmed/24590073

L.M. O’Brien and colleagues look at a new mouse model: “Vaccination with recombinant adenoviruses expressing Ebola virus glycoprotein elicits protection in the interferon alpha/beta receptor knock-out mouse.” And they concluded: “These results indicate that the IFNR(-/-) mouse is a relevant small animal model for studying ebolavirus-specific therapeutics.” Link: http://www.ncbi.nlm.nih.gov/pubmed/24461913

C.E. Mire and colleagues published: “Vesicular stomatitis virus-based vaccines protect nonhuman primates against Bundibugyo ebolavirus.” They come to the conclusion: “Fortunately, our results demonstrate that heterologous rVSV-based filovirus vaccine vectors employed in the prime-boost approach can provide protection against BEBOV [Bundibugyoebolavirus ]using an abbreviated regimen, which may have utility in outbreak settings.” Link: http://www.ncbi.nlm.nih.gov/pubmed/24367715

All these studies weren’t triggered by the current outbreak!

16.09.2014:
Have a look at the chart that Wikipedia provides: http://en.wikipedia.org/wiki/Ebola_virus_epidemic_in_West_Africa
Wikipedia changes to log scale view! 5072 people have been infected by Ebola virus, 2459 people already have died. The statistics show no reduction in the rate of new infections, actually one can see an increased rate. And WHO has stated the reported numbers "vastly underestimate the magnitude of the outbreak".

Nigeria still has 22 infected people of whom 8 have died. I'm still wondering about the possible carriers in the Port Harcourt region.As of Congo (different strain of Ebola virus) CDC reports:
"As of September 9, 2014, there have been 31 more cases of Ebola reported in the Democratic Republic of the Congo (DRC), increasing the total number of cases to 62 and the total number of deaths reported to 35."
http://www.cdc.gov/vhf/ebola/outbreaks/drc/2014-august.html

19.09.2014:

As of 14th of September 5339 people have been infected by Ebola virus, 2586 people already have died.
I won't be able to look after my blog during the next days.

10.10.2014 (back from my vacation):
8033 people infected by Ebola virus, 3865 people already have died. 
Though Spain and the USA have entered the countries being affected, it doesn’t mean that the disease is spreading across borders. Senegal, Spain, and, the USA each have had only one patient each so far. Nigeria is promising as the disease has been contained there. I have been very upset by the physician, who could have spread Ebola. But luckily this hasn’t happened. The cases of the Nigerian physician and the Spanish nurse show the importance of meticulous hygienic measures – a break might cost a life, maybe even lives. The Spanish case also show how much education still is needed as nobody suspected Ebola, even as the nurse told she had been in contact with the Spanish missionary, who had been evacuated because of Ebola. 
Let’s learn from mistakes! I’ll see that our hospital will be prepared.

15.10.2014:

The recent Ebola cases in health care personel in Spain and the USA show that we still need more awareness of Ebola and information on Ebola to reduce the risk further spreading the disease; not only in Western Africa but world wide. On the one hand there are irrational fears, on the other hand there’s also a lack of information, by the way not only in the nursing staff  but also among physicians. But nurses and doctors are good multipliers for information. The case in Houston open other dimensions: instruction in self-protection must be refreshed and current instruction in self-protection have to be re-evaluated. Maybe Ebola needs more precautions such as using bleach on the gloves before removing them.

8399 people infected by Ebola virus, 4033 people already have died. That makes death rate of 48%, but this number doesn’t count in the patients, who still fight the disease and of those some more will die.

A.J. Kesel and colleagues presented the following study: “Retinazone inhibits certain blood-borne human viruses including Ebola virus Zaire.” Conclusions: “RTZ represents the first reported antiviral agent capable of eradicating HIV and HBV proviruses from their human host. Furthermore, RTZ represents a potent and efficacious small-molecule in vitro inhibitor of Ebola virus Zaire 1976 strain Mayinga replication.” There might be a chance having at least a drug with some potency against Ebola, but it’s still too early and might be too late for this Ebola outbreak as in vivo studies have to conducted first.

Link: http://www.ncbi.nlm.nih.gov/pubmed/23636868

19.10.2014:

9216 people infected by Ebola virus, 4555 people already have died. That makes death rate of 49%, but this number doesn’t count in the patients, who still fight the disease and of those some more will die. Please bear in mind that I started this blogpost half a year ago with 111 people infected by Ebola!

If you follow the news, you see that we're now at a stage of panic and paranoia. First we had neglect and avoidance. The came a phase with "promising drugs" - none had been adequately tested, but some people and companies always look for holes in the system to circumvent proper research. But now it's the worst we had so far. People are calling for measures that satisfy their paranoia and won't take anything off the risks Ebola bears. Someone went near an Ebola patient without a protective suit and "everyone" knew he was stupid. He was stupid showing off this way in public, but he wasn't taking any risks as the patient wore a protective suit and Ebola isn't tranmitted airborne. I hope politicians will follow professional advice instead of the paranoid cries of the streets.

23.10.2014:
9936 people infected by Ebola virus, 4877 people already have died. That makes death rate of 49%, but this number doesn’t count in the patients, who still fight the disease and of those some more will die. 

Lots of hope is put into new vaccinations, which are indeed promising, but will only be tested in the near future and will come too late for this outbreak. So other measures have to be taken immediately and this means educating the rural population in the West African countries.

Today I received a mail by the German Association of Internal Medicine covering the subject of Ebola. 
"There is concern about the occurrence of EBOLA in Germany. Fear scenarios are constructed increasingly in its’ wake of, which are not very productive or helpful. What is fact and how should we deal with this issue?”
(„Die Sorge um das Auftreten von EBOLA in Deutschland geht um. Im Gefolge werden zunehmend Angstszenarien aufgebaut, die wenig zielführend oder hilfreich sind. Was ist nun Fakt und wie müssen wir mit diesem Thema umgehen?)
Three key points are mentioned: 
• The initial assessment is made by the general practitioner, the emergency service is not suited for it.
• The physician must take his/her time. There is no reason , to act hecticly and thereby neglect the patient and self-protection 
• In most cases it will be another known tropical disease , usually malaria. For persons who have entered this year from a West African Ebola territory to Germany, malaria was diagnosed in 14 cases, but in no case Ebola.
(„Die Ersteinschätzung erfolgt durch den niedergelassenen Arzt, der Rettungsdienst ist dafür nicht zuständig. / Der Arzt muss sich Zeit nehmen. Es besteht kein Grund, hektisch zu agieren und dadurch den Patienten und den Eigenschutz zu vernachlässigen. / In den meisten Fällen wird es sich um eine bekannte Tropenkrankheit handeln, in der Regel Malaria. Bei Personen, die in diesem Jahr aus einem westafrikanischen Ebolagebiet nach Deutschland eingereist sind, konnte in 14 Fällen Malaria diagnostiziert werden, jedoch in keinem Fall Ebola.“)
„If the critically done diagnosis points to Ebola, special protection is required (www.rki.de/ebola-massnahmen) and the appropriate treatment center (Berlin, Frankfurt Main, Düsseldorf, Leipzig, Hamburg, Stuttgart, Munich) will be notified. 
(„Sollte die kritisch gestellte Verdachtsdiagnose auf Ebola hinweisen, sind besondere Schutzmaßnahmen erforderlich (www.rki.de/ebola-massnahmen) und das zuständige Behandlungszentrum (Berlin, Frankfurt/Main, Düsseldorf, Leipzig, Hamburg, Stuttgart, München) wird informiert.“)

24.10.2014
9964 people infected by Ebola virus, 4881 people already have died (49%).
Another infection in the US and an infected infant in Mali show that Ebola can spread across borders.

27.10.2014
10141 people infected by Ebola virus, 4922 people already have died (49%).
Countries affected: Liberia, Sierra Leone, Guinea, Nigeria, United States of America, Mali, Senegal, Spain.
Please note that about half a year ago there had been less than 200 people with Ebola.

28.10.2014
12008 people infected by Ebola virus, 5078 people already have died (42%) [?]. Maybe it should be 10208 and the death rate would be 50%. Source: Wikipedia.