We Were There – Ebola

[ Music ]>>Good afternoon
thank you so much for joining us for
We Were There. It’s my pleasure this. The series was series
was created so that the original
investigators can share their stories and insights and inspire
us to continue their work. Without further ado,
it is my pleasure to introduce Dr. Anne Schuchat, Principal Deputy
Director of CDC.>>Well thanks so much
Phoebe and welcome everybody to our We Were There session. In the midst of the
2019 Ebola outbreak, today’s We Were There
presentation takes us back to our very first experience
with the deadly virus, in a remote part of the
DRC then known as Zaire. Today’s Ebola outbreak
occurs in the midst of multiple other
challenging CDC responses. The opioid overdose epidemic, the effort to end HIV
transmission in America, investigations into severe
lung injury occurring in association with vaping. And in 1976 the deadly
Ebola outbreak was relegated to the back pages
of US newspapers. Because that February, a cluster
of severe respiratory illness in soldiers in Fort Dix seemed to herald a new flu
pandemic, with echoes of 1918. In July of 1976, just a month
before the first reports of Ebola in Yambuku, it seemed
the pandemic had arrived, as dozens of men and women who attended the
American Legion Convention in Philadelphia developed
severe pneumonia. By August, shortly before the WHO reported a second
Ebola outbreak in Sudan, hundreds of legionnaires
fell ill and many died. Influenza was ruled out
quickly, but it would take until Christmas for CDC to discover the bacterial
cause of that outbreak. When we faced the unprecedented
urban Ebola epidemic in West Africa in 2014,
and authorities raced to develop a vaccine
against the virus, a leader from Sierra Leone
wondered how serious this race could be if this virus had
been known for 40 years. Today we’ll hear about that
initial sprint to understand and stop a deadly
Ebola outbreak. Today we know that Ebola is not
the only challenge the Congo leaders are battling, nor the
only public health response that CDC is tackling. Some of the roots of
today’s outbreak were also at play back in 1976. And then hearing from
those who were there, as well as those who’ve been
returning to DRC since then, I hope we’ll discover some
insights to the way forward. Thank you. [ Applause ]>>Thank you Dr. Schuchat. And now it’s my pleasure to
introduce today’s speakers. Dr. James Lang, Dr. Joel
Freeman and Dr. Jonathan Towner if you’ll please
come to the stage. Thank you.>>Good afternoon. Welcome all. I will relate to you a little
bit of experience that I had through my involvement in the
initial discovery of what came to be known as the Ebola
virus, although we didn’t learn that right away, it
— it took some time. But the — the primary theme
of this is that we were there. And so I will try to
show you where there was and what the basis is for
saying that we have had 50 years of high containment
laboratories on this campus. I tried and tried to find
pictures of this first facility that was put in to
operation in 1969. The best I could
do is a schematic that consisted of a trailer. I’ve heard two descriptions
of it, one being similar to an Airstream trailer and
another being the trailer that you see on the highways
in the tractor trailer tandem. Whether — which one is correct,
I do not know but this — this gives you a little bit of
a layout where people entered, exited and the showered
out of this facility. The reason it was
placed here was because of the initial discovery
of a virus called Marburg virus which involves outbreaks in
three different European cities, one of which was
Marburg, Germany. And that’s where the — the namesake, wound up
in the literature and — and approved by all of
nomenclature committees. So this 1969 facility
is the basis for our saying we’ve had
containment facilities on this campus for 50 years. The second iteration of a
high containment lab was when I first arrived called
Building 5A, and then 7A, and finally after another
nomenclature scramble, Building 8. And that’s what we call it
to this day, Building 8. It consisted of two
levels, the red level that you see contained
an inner laboratory, the bio-containment concepts
were being applied even then, a box in a box in a box. This outer shell was simply
to protect the inner shell from the elements because
it didn’t function as a — a barrier per se, but
the inner hallways and then the room itself that were contained therein
were negatively pressurized so that nothing in the air moved
away or outside the facility. It was commissioned in 1972. I want to give you an idea of
what it was like to work in. It was strictly a class
three glove box line, consisting of stainless
steel and Plexiglas under very high negative
pressure. I forgot to point
out that the — the brick portion of this
contained the support systems for the upper level laboratory. And the most important part
of which was an incinerator that incinerated all
of the exhaust air out of the glove boxes to a
temperature of 1500 degrees. This is where anyone who worked
in the lab started their day through this double door
autoclave, a confounding and limiting factor working in
such facilities as it you have to plan down to almost
the minutest detail so that you bring in all of your
materials that you’ll be needing on that given work day through
this double door autoclave. Once you put — place it in from
the outside it closed the door. That outer door can’t open until
this one is opened and then run, so that you can safely open
the outer door, that — that’s at the end of the workday when you shove all the
contaminated materials back in it, so that you
can start the process. This is a photograph of
typical workstations. It doesn’t show the
stools we used to sit on. Working in them was cumbersome
but not totally uncomfortable. The gloves themselves consisted
of neoprene 32 inch long lengths of either 30 thousandths
of an inch or 15 thousandths of an inch. The 30,000 were at the
transfer point so that when you were handling
potentially sharper or edgy materials that you
would be safe handling those. And of course when you
worked in the lab you worked in a laboratory supplied gown
or jumpsuit along with a pair of gloves inside
these neoprene gloves. But these functioned quite well. We could do almost anything
other than molecular — ultracentrifugation,
you know we had — we had standard incubators,
standard laboratories, centrifuges, microscopes,
refrigerators, freezers, and they — they all did the
job for us as over the years that we operated this facility. Up at the top, you
can see magma helix, that were telling us what level
the negative pressure was inside each and every cabinet. And — and they did
vary from one to another depending
on the type of work. The animal corridors
were the ones that — that had the strongest
negative pressure. I’ve labeled these to show that we had both a standard
light microscope on the side that — that this
picture shows you as well as incubator cabinets. We had separate incubators so that we could vary
temperatures depending upon our needs. On the other side of the
— this microscope cabinet, we installed a fluorescence
microscope after I arrived. So that gave us a little
bit better capability. I do want to highlight the
fact that this facility, when it was commissioned was
largely the responsibility of the Office of Biosafety,
and the Division of virology. This is a photograph
of Dr. Robert Huffaker. He’s a veterinarian who
was the boss of Biosafety. He not only put it in
motion, but he kept — helped us keep it in motion. He gave us excellent support, assign one of his permanent
personnel to us to work strictly with us and — and to take
care of any needs that we have. And — and anytime you
have mechanical things such as centrifuges,
refrigerators, freezers, you — you have breakdowns
and we had lots of good support anytime
we needed it, thanks to Bob Huffaker. This is a picture of Bill
Gary, Dr. Bill Gary was the in charge person of
laboratory operations when I arrived in 1974. He did my left seat, right
seat briefing to take me through all the functional
systems, to tell me how things
were supposed to work. And to explain to me how to make
sure we operated things safely. One of the ironies when we
first started is everything that we did, no matter
whether it was from a lab operation standpoint, or just a logistical
standpoint, was not in writing. So we had to — we had to start
from scratch and put all of this into a written form and
produce an operations manual for this particular lab. And the person who I
worked most closely with on that is Lee Alderman. He was invited here, but
could not make it today. And he — he was an Office
of Biosafety employee. But I show you this in
particular to highlight the fact that the room itself
had an autoclave. And this little box here
was an ultraviolet light box that we would pass things in and
out of the lab if we happened to forget something that
could be used outside. And it is the UV box that I
passed through a centrifuge to with a suspension of
virus infected cells, suspended in power
formaldehyde that I handed to Fred Murphy on
the other side. And this is the Squawk Box. This is a good little
communications device that you pressed the talk
and you released to listen. And on the day that
we did the work, that’s what we use
to communicate. What was — what was
known that given time. This is not an —
an ideal slide, but it shows what tissue culture
cells is supposed to look like when nothing’s happening
to them, nothing is going wrong. It’s a confluent monolayer
fibroblast that are slightly out of focus, I apologize
for that. But I wanted to show you
that in 1976 when the — the initial Ebola response began
my branch chief, Carl Johnson, went to head up the International
Commission in Zaire. And my immediate supervisor,
Patricia Web, who I’ll describe in detail in — in a
minute, took out the — the shipment that
we had received and there were sister shipments
sent to laboratories in — in England, in France
and in Belgium. So four facilities
received specimens. I — I assumed that they were
split among the four of us. We looked through the manifest,
we looked at the specimen, we made sure what they
said was there was there and then we begin the task of
deciding which one we would pick to inoculate into a
confluent monolayer of African green
monkey kidney cells, which — which I did myself. Forty-eight hours later,
about 24, I checked them, they look okay, 48 hours
later they look sick. What do sick cells look like? They start looking pyknotic. They disperse. They form giant cells. They don’t look the same
as that previous slide. They’re not healthy. So at 48 hours I was
jumping on my high horse and asking Patricia if I could
go ahead and do the harvest. And Patricia said no,
let’s wait 24 hours. So she being the
boss, I said aye aye. And next waited another
24 hours, did the harvest, went through a whole series
of standard protocol measures, saving lots of stuff back
in the freezer, passing some to another passage
of vero cells. And most importantly from our
perspective, making slides of that material that you put into what we call a
Teflon coated slide that had punch holes in them
that served as literally a well that would hold liquid in them. Place those on there,
dry them, fix them. And you can do lots of things
with that after you have them. Made a — a box of
slides like that. Now when I did that, while they
were — were drying and we — we talked about what
else we were going to do. The first thing we
did was take that — a preparation of that suspension
that I explained that I passed through the — the glove
box to Fred Murphy. And less than 30 minutes
after that Fred was on that little Squawk Box
saying it’s loaded with Marburg. So when we heard Fred say
that, that got us very excited. We thought we had
solved the riddle. We were the first ones to
discover the causative agent of the outbreak in
northern Zaire. Patricia wasn’t a high
five or anything like that. So we — we just had a
mutually comfortable and — and giddy feeling about it. So once — once we —
once we knew what we had, I took one of those slides
and then went into the freezer and pulled out some of
the referenced antisera against Marburg that the
previous two years I had been working on building
up a stockpile of. And I did what’s called an
indirect immunosuppressant’s test on the slide, on a slide,
along with controls, of course. And after the — the
proper procedure took a look under the fluorescence
microscope on the other side of the cabinet I showed you,
and didn’t see anything. It was negative. And so I looked at Patricia and
said, oh no, am I so stupid, I can’t do a simple IFA test? So the two of us and shoulder to shoulder did another IFA
tests on replicant slide. And it turned out
to be negative. And we said, oh man what
have we got going on here? It looks like Marburg but
antigenically it’s not. So that’s when we were put
on to the right pathway, once Fred said Marburg, we looked for Marburg,
confirmed not Marber. And I’ll give you an idea of
what that process looked like. Now this is the one that Fred
published and is seen thousands of time over the years. But what he described
to us on his screen on the electron microscope
was literally a bird’s nest of filoviruses. Not this particular one. He said there was
virus in between cells, attached to cells,
everywhere once we got to talk to him afterward. And interestingly, 35 years
later, I road in an elevator with David Center and
introduced myself and said, you were my first boss and
I’ve worked for Fred Murphy, when I started and Carl Johnson,
he said yeah — yeah I remember. Fred ran into my office telling
me they had Marburg virus, going on in northern Zaire. So I said yup, that we heard —
we heard it before you though. [ Laughter ] This is what a slide should look
like if there’s nothing going on immunologically that
is no fluorescence. Oops. And a juxtapose one here
to show you the green lights that are fluorescent, that indicate there’s an
antigen antibody reaction along with a reaction with
the tag of FITC, fluorescein isothiocyanate, that
is used to detect what works, what reacts with a given
antibody or antigen. I — I do want to make
sure I recognize Dr. Webb. She was a — a very good mentor. She took excellent care of
those of us who worked for her. If you worked as — in
her supervisory chain, she could make life
miserable for you because she was constantly
asking and — and trying to get more
resources for our group and fighting the
bureaucrats too. She — she was a good
bureaucratic infighter. She — she’s an interesting
and she’s British to the core. Her father sent her here
during the Blitz in 1941, when she was a teenager. She wound up at Agnes
Scott College at age 16, graduating in three
and a half years. Was the only female
in her medical class at Tulane Medical School. And let us — she
explained to me that many of the male counterparts
let her know that she was stealing a seat
from a fully qualified male. But if you knew Patricia,
she gave as good as she got. But she’s a terrific
supervisor to work for and I — I do want to highlight the fact. And the other thing I
want to bring up that’s — that’s not known to other
than a very few of us is that after this initial
discovery, Patricia worried about my welfare, and
decided that she would do all of the remaining work herself. But she was too chicken
to tell me, which if you knew her,
you would understand. So she got Bill Fagin
to tell me, which — which is hilarious when
you think about it. And we both laughed
about this years later. But Patricia then went — went
back to the original manifest and looked at the very
limited clinical information that was available. And I — I did participate now because it was noninfectious
work. And we — we found one
serum from a patient that had survived, my memory
says to day 11 in the hopes that IGM antibodies would
have started showing up. And so she did the subsequent
tests, using that pa — a drip of that patient’s serum
that she squeezed out of a — a blood clot, of course, mechanically not
with her fingers. And it lit up those
slides that I had made. And so that’s — that’s when
we had immunologic confirmation that we had a new
agent that looked like Marburg, but
wasn’t Marburg. And then my recollection
is that Carl used as a — a CIA map, we used to have a
— a whole library of CIA books on country — countries. And some of them
came with good maps. And he pulled out a map
trying to pick out a — a location that would not be
associated with either Zaire or that part of the country,
and found a very small tributary of the Congo River
called the Ebola River. And that’s how, my understanding
is the virus got its name. The next iteration of high
containment laboratory came as Building Nine. It was purchased from the
National Cancer Institute, came down in modules. CDC can — well contractors through CDC constructed
again the outer shell, which is the metal upper
part and then the — the red brick lower
supporting part. This particular laboratory
came to us as what was called a virus
tissue processing lab. It consisted of a glove
box line, and offices, and all that you see around
the glove box cabinet line, rectangular laboratory,
was retrofitted over an excruciatingly
long three year period by engineering services here
at CDC and some contractors into a suit laboratory. And of course when it came in,
said ’75 Carl Johnson asked, how soon can we have
it, and I had no idea. He wanted it next week. As the years went on, it
drove him to distraction. But we finally put it into
operation and ’78, and it — it operated quite well, having
been completely retrofitted from office space
to suit lab space, which is quite remarkable
in and of itself. Now everyone has seen these, this is where we
stored our suit’s. The chemical shower was
just to the left of here. Each person of course
had their own suit’s. We were a small group, there were only nine
of us in the branch. And that ended my
association with that. I — I went on to
do other things, after 14 years in Biosafety. And toward the end of my career,
I was given the opportunity to do ploy to West
Africa to participate in the 2014 Liberia outbreak in
support of an EPI in Bong County and then 2015 and ’16, while
working for Jane Seaward in the immunogenicity sub-study
of the Ebola vaccine trial. And this is the facility
we worked at upstairs where another lab was
retrofitted to suit our needs. And that is it. I always pay honor to my
spouse of 50 years now and our first grandchild. [ Applause ]>>So EIS officer is
in an autopsy room in Detroit during the
1976 swine flu campaign that Ann introduced us to —
to see whether the patient, the person who died,
had swine flu or had a complication
following swine flu vaccination. So he walks out of the room and says there’s a phone
call from Atlanta for you. And Lyle Conrad’s on the end
of the line, who is chief of Field Services, and said,
Joel, I was that EIS officer, there’s a terrible epidemic
going on in northwest at that time in Zaire. And we don’t know
what’s going on. The calls come in to the
embassy and then to CDC, and the government has asked
CDC to participate in this. And I said, wait a minute
Lyle, what — what’s going on. He said, well we know
very little information, only 100% of the villages are
infected, 100% of the people in the villages are sick and
all those people have died. He said, do you want to
go for just a few days. [ Laughter ] That’s how CDC operates, for
those of you who don’t know, just a few days to find out. And I said, well you know
I’ve lived in Africa. He said, we know you did, that’s why we’re calling
you, you speak French. And we’d like you to go with
someone from the laboratory. And — and by the way, there
is a concurrent epidemic in South Sudan, we don’t
know what’s going on. So a glutton for
adventure, I go home, talk with my wife
and two small kids. They couldn’t talk much then. But my wife said, I know
you’re a glutton for you like adventure, you know. I said, also I have
never been to Zaire. Oh anyway. I call all around to find
out what could be going on. And they said, well
you’re going, first of all they say
you’re going with Pat Webb, from the laboratory who —
who I had been introduced to. So I had two or three
conversations with Pat. And then I called all around, a number of people said what
could be going on in Africa at that time, CDC didn’t know
much about Africa at that time in the ’70s, other than
those of us who had worked on smallpox eradication. And so they said, well the
visas have come through, you’re ready to roll. And just before I
left I get a call from one Carl Johnson,
who I had never met. And we met at JFK in New York. He said, I’m going because Dr.
Sensor has concluded this is so hot in growing, because
messages that come in, and there’s a great amount
of disorder in the capital of Kinshasa that we
want to send the chief of the lab to go with you. So Carl, at JFK, shows me
this virus, which you’ve seen. A very important
photo micrograph that Fred Murphy had taken. And I said, well nothing
kills 100%, maybe rabies, but you know not so many
people as had been reported. But even though there had
been one survivor from rabies. So anyway, we’re on the
airplane with 17 packages and — and we arrive in Kinshasa,
picked up by the US Embassy. And immediately taken to
Fometro, which is the Belgian Center
for Medical Activities. They had been there over 100
years in the former Congo. And sitting around the table
where people from a variety of countries, and from WHO. And we were told the
city is in turmoil because now two nuns
had come in to Kinshasa from the epidemic area. Both of them had died. And a Zarian nurse who
had taken care of one of the nuns herself is
sick and in the hospital. And the Minister of
Health, Dr. [inaudible] says around to the table,
the airplane is ready to take the team out
to the epidemic area, and to tell us more
about what’s going on. So Carl, who doesn’t — still
doesn’t speak any French but was following this, I’m
translating as best I can. I said, Carl these people
are really organized here. A team is going out,
we’re going to learn, go to the hospital,
see the patient. Everyone’s looking
at Carl and me. We were the people to
go out to the field. And by the way, leave
your 17 cartons of scientific equipment here. So simultaneously Carl
and I said no way we — we’ve got to find
out what’s going on. The Embassy, ours and
others are hollering. And then the Minister says
something has to be done. Now on the airplane
coming in to Kinshasa from actually Geneva,
was one Bill Close. Anyone hear of Bill Close? No Bill Close. Several people. Bill Close had come
to Zaire in 1961. Anyway and ultimately
became president of Mobutu’s personal physician. Ran Mama Yemo Hospital. Had been a mentor to Dr. Ken
Kella, the Minister of Health. And Bill on the airplane
sat with us and said I will help
during the event. He was now director of
the largest hospital at that time in Africa. So we said we had met the
right guy and was precious. Anyway, the Minister said,
you got to do something. The next day I’m on an airplane
with [inaudible] from France, Peter [inaudible], first
mission to Africa, from Belgium. Andy Cook from Zaire and
John Frances Lepone [assumed spelling] from Belgium
who ran this mission, the Belgian mission
with 400 Belgian doctors around the country. John Frances Lepone had been
born there, spoke the languages. He was on the airplane with us. And here we are. In — flying over the
Congo River going, within 24 hours I’m now on an
airplane going off to the area. What were we supposed
to do there? We’re just supposed to,
again, go for just a few days to do find out actually
how far this epidemic, whatever it was comprised
of in signs and symptoms, how far it had spread up from
this rural mission hospital. To find out if there
were active cases. Three, if there were people
who recovered, and four, to find out if we could equip
this rural mission hospital of 120 beds with
adequate facilities to bring forward
a treatment team, a surveillance epidemiology
team, a laboratory team. To find out what’s
going on out there. And so then the airplane
was supposed to come back and pick us up. So having had some exposure to
epidemiology and CDC, the — everyone said, yeah that’s
good, now what do we do? Well I said well
we’d go, you know, finally they’re talking to me. They had known I had worked on
smallpox and had some experience with field experience. And Carl quickly became
the scientific director because he was renowned
for discovering Venezuelan and Bolivian, Argentinian
hemorrhagic fevers. And so he quickly became
our scientific director. Now here we are coming
into the Boma zone. The villages spread along
these tropical roads. Navigation is not easy, and
there is the mission, empty, barren, because everyone
in that hospital, if they were still
alive, had run away. Seventeen staff at the
hospital of those 13, had gotten the illness
and 11 had died. And obviously it was hospital
centered because several of the patients who were there for other things now
started getting this, what they call it a
hemorrhagic syndrome. There were three nuns and
one priest left there, but five of the religious
order had died. And they had a picture, the
nuns showed us this picture on the right, here are
four sisters and a father who had died of this disease, two of them in Kinshasa
having been evacuated, and then one father there. And there are their
graves in the lower left. So Sister Marcella, in
front of all the beds, because they didn’t
know what it was, they exterminated
the empty hospital, brought out all the
mattresses to burn. And that was — they
were very glum. So our initial plan designed on
the run was for each four teams of us as I described, to go
north, south, east and west with a sister who spoke Lingala and some Botza [assumed
spelling], with us. And so forth three
days in a driving rain, under the conditions
that you’ve seen, went from village to village. And I was struck early on in
talking to some folks who said, some well people had come
to the hospital or come from a village had
received an injection. And the injection was
for whatever it was, aches and pains,
particularly prenatal care. And then a week later
this syndrome had begun and they died. Well that was unusual. I said, well tell me about
the needles and syringes. They said well, you
know 120 bed hospital, several hundred people a
day we have five needles and syringes used in the
outpatient, glass and metal. And you know, we just kept using
the same one for each patient. And I said well sterilization? They said, well we have soapy
water in the pan at night. Unbelievable. So this, you know, the hair
in the back of my neck raised. And then when we started
going to the villages, the nuns had gone
giving prenatal care out to the villages
and the same story. They got injection
with calcium, vitamins, antibiotics in those days and
even now injections are favored. So my first — this is
the second day I was out in the field. And here’s a patient,
first patient with Ebola. I said, you know, we had defined
what a probable case was, what a possible case was, and of course a confirmed
case would be one with immunofluorescence
antibodies because that was all that equipment was with us. So this is a 25 year old
gentleman was complaining of belly pain, pharyngitis,
he had conjunctivitis and he had some bleeding from
his rectum and around his gums. But he — and abdominal
pain was very severe. So I talked to him and of course
we carried, not of course, but after a while
we were carrying with us paracetamol Tylenol,
chloroquine and quinine, tetracycline things that
could cause this fever, headache, and unusual syndrome. There is [inaudible] in the
personal protection equipment of the time, paper, mask and
gloves, but oppressively hot and humid, very hard
even to wear this stuff. And so this gentleman
died the next day. Now we — they knew
about smallpox and about isolating sick
people, and several other people who had some of the villages
isolated the patients in that way. Quarantine-able disease
was an unknown here. So we moved on. And then we went back
to Boma where we were to give our report,
we did an inventory. The plane didn’t come. The plane didn’t come
for, two or three days. So by that time Joe McCormick
had flown in from Sierra Leone to help with the epidemic. And he got through, Joe
knew his way around Africa. And when — and another
mission came to us. We were at the Catholic
mission waiting for the plane. Who would say, we’re
from the mission. We said, well we’re
at the mission. They said we’re at the
Protestant mission. Protestant, Catholic missions,
weren’t in good communication. He — he said, what’s going on? So we gave him our
preliminary information. And at that time, a plane came
everyone had, you know a lot of people had run away
because they were afraid. And the pilot said runaway. President Mobutu
had sent his family with a couple of
planes to Europe. So it was tough to get
an airplane and pilot. Finally the plane came,
after about almost a week, and the pilot said do not
come anywhere near the cabin, sit in the back. And then we went back
with our information. Now when we came back we were
loaded with sand fly bites and a — and a rash
on our sleeves, on our arms and elsewhere. And of course it was
black humor all the time. Eleven by Primus the
medicine, the beer of the place. And if you look carefully
there’s a bottle or two of Jack Daniels. That we always had to have. And so here is Marguerite
Isaacson from South Africa who had experienced
treating Marburg in 1975. She came with two units of
convalescent Marburg serum. And that didn’t work other
than land you in the hospital. And there is Bill Close,
director of the hospital and so he is now
part of the team. And that’s a thermometer in
my mouth, not a cigarette. [ Laughter ] Bill was a chain
smoker, but anyway. The — the guidance that
each person on the team and you’ll hear more about that, take their temperature
twice a day, and if they were sick tell
the chief of their team. Well what are the teams? We quickly formed into clinical
team, logistics and equipment. That was Bill, board certified
Harvard Columbia trained surgeon, who said I’ll do
the logistics communication. John Frances Lepone
was the chief of the Belgian medical mission,
said I will do communications because every embassy,
every business, every society person was
clamoring, do we leave Kinshasa? Some did or not? John Frances handled that. Ito Vandenberg handled
the immunofluorescence, that Pat Webb and team were
now sending him [inaudible] fixed slides. And we did those right
out in the field. Could we go back, we told
the sisters who so many — over so many years that mission
have been there 19, since ’35. They — and so people had gone
out there and never come back, often is the case is rural
health facilities and issues. And we said we will be back in
ten days, I said I’ll be back. And I told the minister I was
going back because we needed to do surveillance far and wide. And the other team, the
scientific backup team also had to come up to do the
things I mentioned. And no one wanted to
go, except a few others. But Dr. [inaudible] ordered
now some great clinicians from the hospital. We got the smallpox,
the monkey pox, the vaccination,
the public health. A few people came out to do
mainly the surveillance work because we had to now
go to many villages. So here’s Dr. M. Mbuyi,
an immunologist in training, and nurse Cocteau,
who had recovered, and his serum had come. And that’s one of the ones
that Pat Webb had that — his serum cross-reacted with
the new virus and didn’t react with Marburg which the CDC
hot lab had archived from, not only from ’75 in
South Africa, but from ’67 in Yugoslavia, and Germany. And so [inaudible]
was a convalescent. And here we are going
from village to village. One of our six surveillance
teams going over these ten routes that
I show — showed you before. And asking people with our
paper forms, village form, individual patient form,
epidemiologic forms, history, signs, symptoms. And this gentleman has a
shaved head, that was a sign — is a sign — will be a sign
of mourning in these villages. So we could identify people who had recently had
a death in the family. And they’re very, very
cooperative during our visit’s. So in — after, we were
there from mid-October, to the end of January. Now our whole team
wasn’t there, we had a — a major part of our
team left in December, but then David Heiman came and continued the Plasmapheresis program. We’ll talk more about that. And the Sudan team
couldn’t get in there because civil war was going on in the south, it
was a WHO mission. And Don Francis from CDC
was part of that team. But when they finally got in
they did some case counting. And it was curious, it
was a different center, it was about 50%
case fatality rate, a lot of pulmonary
signs and symptoms. And then it turned out the
virus is a different strain. So here is our epidemic
curve, I don’t know if I’ve got a — here we go. This on it. So you see the green
here are those that had received the
injection at the hospital. And early in the
epidemic, the majority of patients had received that
was it, feeling well or had come in for malaria, fever dropped and the they developed
this terrible syndrome, a lot of them with
severe bleeding. But classic systemic
signs and symptoms. And then as we went
on it was person to person mainly
in the villages. Of course we came
in now in October, but we didn’t know that. You know that when you
come into an epidemic, you think you’re here, but you
want to come in when you’re here at the end of the epidemic also
try and do that it’s safer. But — [ Laughter ] But we didn’t know
where we were. So that’s why we were
now moving through and gathering information,
really ensuring it as we got it. So let’s move here to
the incubation period. And again the villagers were
very cooperative, saying yes, the woman or man
got their injection on such and such a date. And then — or they had contact with the patient
that you describe. And so the mean incubation
period we found with 6.3 days or so. And for person to person
was over nine days. However, we counted, we used the
first contact with the patient, they could have gotten the
infection at a later date and had a shorter
incubation period, similar to that of injection. So this is important. Note that the last incubation
period we calculated was, we’re told was 21 days, that’s
still used today isn’t it? Incubation 21. Like lifting quarantine
42, three periods. This hasn’t changed guys. So this information still used. Now okay you can see
better over there. Symptoms, I’m still using my
clinical background, symptoms, what you feel, signs
are what you see. So what I described with
that patient is clear, fever, headache, sore throat,
all classic, a few had. Now the nuns had this
rash that I mentioned. On black folks, you sort of a more [inaudible]
rash you can’t see. But the signs were
as I described with vomiting and diarrhea. Diarrhea very important
because we’re looking, and then bleeding. RO lesions, and of course many of them had a lot
of other things. Now epidemiology. I was told every village
had cases, every case died. That wasn’t the case. We went around to 550
villages, several times over this several month period,
and we found that a third of the villages only had one
case and over 90% had less than 20 cases, and only two
had more than 30 patients. So it wasn’t so explosive in
the way that we were told. Next, age and sex. Well females here were
over 60, were close to 60%. And newborns died
if the woman — pregnant woman picked
up the disease. So but particularly in the
young childbearing age they were heavily infected. Why is that? Of course young women, women
of any age, are caregiving. Now risk factors. So we spent a fair amount
of time trying to find out and these are very tight
communities socially. In the family everyone’s
involved with touching, caring, sleeping in the same room,
preparing the cadaver, attending the funeral, you could
say even those in the village who weren’t in the family,
everyone was at the funeral. And aiding in the delivery
that was very high risk there. But the other factors, and there
were many more risk factors that we have listed, animal, food and the rest,
nothing spun up. So this is maybe the most
important epidemiologic slide I consider from this
first outbreak. And that is the term
that I’ve used a lot. The secondary attack rate
can be used for R zero, your basic reproduction. But Ebola is not a highly
transmissible disease. I will stamp my foot from
our first outbreak on that, that if you’re an injection, we
spent quite a bit of time trying to find out how many contacts
there were for these patients. And the attack rate for
injection was less than 10%. And that the few transmission
chains that we tracked down before the epidemic
withered was overall 5.6. But each generation, the secondary attack
rate was very low, except if you delivered
as a midwife or were the caregiving spouse,
you had a much higher chance of getting the disease. Now here’s one of our
volunteers Dell Conn, a Peace Corps volunteer,
a laboratory technician, who was collecting blood. On the right Danny Courtois and
Marguerite Isaacson taking — doing Plasmapheresis
from nurse [inaudible]. Don’t do this at home or
in the field, wear gloves. Of course we didn’t know
everything there is to know. Because you can get fever
and chills and headache when you’re working
in these conditions. And Dell Conn did. That may have been the
saddest day for many of us out in the field
when Dell got sick. We gave him a unit
of convalescent and we did have a
plan for evacuation, A and B. Of course we
didn’t know exactly how that plan would work. But Dell was — got into a
transport isolator in the back of a Land Rover,
evacuated to Kinshasa and then to Johannesburg. He did not have anything
that they could find, certainly didn’t
have Ebola Marburg. We never did find out. But for those of you who have
been in the field, you know, or even here in the US, young,
you know, there are 3% or 4% of children will have fever
in a community all the time. Out in the tropics it’s
maybe eight or 10%. Fevers are out there
mainly arboviruses. So where did this
begin, this outbreak? Well my hypothesis was that
it came from the Sudan. We’ll talk more about that. But we looked through
the outpatient in the — well the inpatient
registry, there was a page from an inpatient
register at the hospital. All of the outpatient records, thousands of them had been
burned or thrown away. But here in the inpatient
we looked through for the past year. is a patient [inaudible], from
Yondong, who had a nosebleed and diarrhea, and fever, who
came in at the end of August. And we went to the village
found out, tried to find where that contacts
of that patient. And we couldn’t go
any further back. We had some other history
of people moving around, but no village reported
earlier epidemic. Now Joe McCormick, we airlifted
Joe to North East Zaire to find out if there were outbreaks
occurring along the frontier. Between — and that
was the hypothesis, that there would be
smoldering disease connecting. Joe found nothing. He actually penetrated
into Pinjara and Marabe [assumed spelling],
Pinjara in particular. Was there before the WHO team. And Joe came back
and was very tough, but he could find no connection. So that hypothesis, even before
we knew Sudan was a separate outbreak, was very
helpful to us. And Simon Van Nevenhoof
[assumed spelling] went on the North East border
with actually South Sudan, but also down into Ivo, Iturbi,
seems familiar to you all. So here are the major
findings what I’ve talked about from the first outbreak, summarizing the manifestations,
the incubation. Clinically we collected
over 200 units of serum. On the epidemiology we defined
the geographic extent having covered these 550 villages. We found 55 of which
were infected. We defined if that
person’s at risk the mode of transmission,
transmissibility. A couple of teams that had
been there before we had had recommended that the
commissar de zoom, the county chief put
the area in quarantine, this was very helpful. They were isolating patients. They also had rapid
burial, which we reinforced. And with the medicines, we
would rule out other diseases, if anyone had this fever. In the laboratory we did
basic tests right there in the hospital. We did IFA. In one patient we did serial
viral culture, nurse [inaudible] from France did — collected
mosquitoes, a few rodents. We didn’t turn anything up then. So in ’76, we left
not knowing anything about the animal
transmission to humans. We had no treatments. Although we had some
plasma, no vaccine. We didn’t know the extent even within the DR Congo
or elsewhere. Although we were getting now
calls from all over the country, and Peter Piot
and others would go out, carbon monoxide poisoning,
a bleeding ulcer, you know, sleeping sickness, so many
things that people in the — malaria, malaria,
malaria in these villages. So here’s a slide, one of the
slides of our team out there, and I — I want to show you, you
haven’t seen Dr. Johnson yet. Maybe you saw him in
— in the laboratory. But he sends his greetings. I just talked to him two
days ago, couldn’t travel. But I do want to show
you Dr. Miatudila here, who was a clinician, a
microbiologist, who was part of our team taking care of
patients at the hospital that we immediately
tried to open, because we needed
confidence in our team in — in the hospital to
take care of — and somebody to take care
of malaria, diarrhea, the usual things that folks in
these rural communities suffer, including obstructed labor. That was important. One of our doctors had done a,
on the door out in the opening, fracture of a simplest pubis to
deliver a new baby from a woman who was in dire condition. I don’t — the names
are down below, young Peter Piot
above me. So what are the lessons here? You’ve seen scientific. Each person had a task and a
group of people under her or him to work, clearly defined during
this several month period. On the equally important,
at times more important, the what I call delivery
component of science, of public health programs. We had leadership,
we had organization, the communications,
transparency, partnerships, all the groups that were at
the original table contributed, coordination, supplies,
transport, selective quarantine, isolation. And then we took care of the
people, the few survivors because we wanted them to
cooperate for Plasmapheresis, but also to learn
more from them. Now here is Johnson with not
a CIA map, but with a map used for human monkey pox, which
was also in that area. And when we went through
Geneva on our way to Zaire, we stopped by the smallpox
office on the weekend in [inaudible] Henderson
were there — they gave us this map which we
used and here’s Carl looking at the circuit that
Joe McCormick used. And then one day when
things were calmer, we took an excursion
on the Ebola river. It was really sort of an
effluent of the Congo. And here it is. Now, so I’m going to
summarize all this with a slide I’ve used before,
relating emotion in activity. So there was terror
in — everywhere. People didn’t know. There was fear, there was
confusion, leaving the country, what should I do, to inactivity. And there are some, many people who left chaos running
around without focus. And local investigations. There had been some people
who had gone up there and collected specimens
particularly the local doctor, who was honest in saying, we had
all these signs and symptoms, and I don’t know what it is. Another person went up
and said, it’s typhoid and brought typhoid vaccine and start giving shots
in the usual way. So these local vaccinations
even before we arrived, and the specimens collected
and sent to identify, were key. So we didn’t have
much information. Then as time went on, there
was even more uncertainty, anger of all the
deaths, sorrow, shock, then isolation quarantine. The virus was identified. Our international
commission was formed. And by that time anxiety
was being modified with understanding,
trust, focus. And then we did the rapid and then the more
detailed investigations. And confidence was
being developed. Partnerships and trust and,
you know, our band of brothers and sisters was really forming. And at the end, we
had a huge celebration because there hadn’t been cases
now for a couple of months. And it continued afterwards
and the epidemic was over. Now in 1996 NIH in Antwerp
is through tropical medicine, had a conference in Antwerp
because 1995 we had Kittaka, second big outbreak in
DR Congo, it was huge. And a year after that
outbreak we had a symposium. Some of you were there. And now Dr. Muyembe who worked with us initially came and he,
again another one of the heroes, and he is leading the
Congolese effort today. And I do want to show
at that ceremony, Pat, who was already getting sick,
Pat Webb, who is the discoverer of Ebola virus, I’ll
define that, as the person who sees something new
and knows that it’s new. Everyone else saw what
they called Marburg virus and called it Marburg virus. But Pat knew something new by
the indirect fluorescence test. And here’s Peter. So let me dedicate this
part of the talk to all of those who participated. First and foremost are
the people who suffered up in northwest Ecuador
province, and then the six countries
who are our collaborators, including the World
Health Organization. So thank you all very much. This is dedicated
to over 100 people. [ Applause ]>>Okay so for the record,
in 1976, I was not there. [ Laughter ] I was ten years old and trying
to figure out what I was going to do as I was starting
fifth grade. So I think my — my job is to —
to bring you up to present day. So and a lot has —
has changed from 1976. One you can see from — from this slide here
showing Ebola outbreaks, that Ebola’s reemerged in
different forms, quite a number of times since — since 1976. And I say that because
if you look at here, the current nomenclature,
I mean there — there’s a lot more
known species of Ebola. In 1976, we knew about Marburg
virus, as we just heard Ebola in Sudan, although we didn’t
know there were two different viruses at that time. But since then, we’ve discovered
Ravn virus, Reston virus of hot zone fame in
’89 which Tom Kazakh and [inaudible] were
quite heavily involved in, and read at the time. Tai Forest virus. When the Bundibugyo virus, the newest Ebola known to
be pathogenic in humans, and just last year, Bombali
virus which was found in bats, for which there hasn’t
been any known association with — with human disease. So I came to the branch,
special pathogens branch, in 1997 to develop a genetic
system for studying Ebola virus to try and pick apart genetic
determinants of virulence. Inspired by the finding
a couple years before by Carl Klaus Conzelman, where
we’re finally, after many years of looking, or of — of
trying to develop a — a genetic system for a negative
strand already virus he was successful with rabies. So I toiled with that
for a couple of years. And then in 2000 it was
one of those instances where your life is taking a left
turn but you don’t know it yet. And Ebola emerged in Gulu
in — in northern Uganda. And overall the —
the outbreak was — was large, 425 cases that up until the 2014 outbreak was
the largest Ebola outbreak on record. Was — this was Ebola Sudan. I went there with
five other folks, with Tony Sanchez,
who is here in the audience. Scott Doyle, Scott Harper
and — and Dan Bausch. And the, I’m not going
to tell you — I’m — I’m a lab guy so I
can give you this from the laboratory perspective. And so one of the main things
we wanted to do was to set up the diagnostics right there
at the site of the outbreak and we knew from previous
work that they, you know, the serology their
engine capture to ask me that Tom Kaziak had
developed, as well as him and [inaudible] were
— were field Ebola, we weren’t sure about PCR. And so as a molecular dude,
that was my job to set up the — the PCR based diagnostics. And of course, at that time
there wasn’t real time PCR, this was submarine gels
and sort of old school PCR. So we set up shop
in the diagnostic, or in the laboratory wing of St. Mary’s Lacor
Hospital in — in Gulu. You can see in the corner
— circle there in the red, picked out room that had a good
open window and there was a sort of a non-functioning biosafety
cabinet, the light went on but I don’t think there’s
all that much airflow. So — and you see in the upper
part there, there’s Pierre and Tony, who do most of
— do all the hot lab work, doing engine capture, IDG and IGM handling all
the — the material. And they will pass it out to me,
I’d stick to samples in TriPure which worked great for all
of you on the LSRP board, TriPure works just fine. And do the PCR across the
hall to do the RNA extraction and then at the top part, let’s see if I can get
this thing to go here. Up here, we do the product
analysis, this is summary and gels we want to
keep this stuff as — as separate as possible. And in all toll we tested
over 1,000 specimens. We were the first of — of
three teams to — to show up. And in the subsequent
study of the specimens, once the outbreak was over,
one of the things we learned and the reason why I
mentioned this now is because it’s pertinent to
how we’re evaluating some of the therapeutics for
the ongoing outbreak. And that is that the fatal cases
would have much higher viral loads than nonfatal cases. And this is evident very
early on the orders of two or more logs higher in
fatal versus nonfatal cases. So moving on it — a
couple years later, Marburg virus emerged in Angola,
and this was in 2005, 252 cases and a 90% case fatality. And this emerged in — in [inaudible] the northern
part of — of Angola. And so the difference
here in terms of fielding diagnostic assays
was that in addition to the — the Eliza based methods, now
real time PCR was involved, and we had developed
high throughput platforms for real time PCR. A lot of that actually
was developed as a result of the anthrax outbreaks
where we needed to develop high throughput
capacity for select agents. And so this we set up in the
— the bottom floor of the — of the Public Health Institute there in Luanda, Angola. I should mention
that Health Canada at the time also was
doing some diagnostic work in [inaudible] in
the northern part. And so we set up
in the bottom floor at what was then the Global
AIDS Program, diagnostic lab that was run by Amocar Tierney. And so in that space
there was a — a functioning biosafety cabinet
which we then piped out the — the window to generate some
— some negative airflow. And somewhere along the lines,
I guess someone realized that the INSP wasn’t
paying the electrical bill, so they cut the cord,
so we had no power. And fortunately, Tom Kaziak got
on the phone, because Chevron, Shell, BP all have a
financial stake in Angola because there’s lots
of oil there. So Chevron produced 100
KVA diesel generator and 2,000 liters of diesel
fuel within about 24 hours. So we are eternally
grateful to them. So in the end, I think
we tested a little over 500 samples
of various sorts. And they said this was the first
time we sort of set up sort of a higher throughput
real time PCR. And also it was the first
widespread use of oral swabs as a — as a diagnostic
specimen. This comes with some
limitations, obviously, a lot less things you can do
with oral swabs, but this is — this is when it started. Moving forward into, there
were a couple of years of what we call banner years
of field virus activity. Starting in 2007 with
the Marburg virus emerged in a small mine in
— in Western Uganda, this small outbreak
too only three cases. And this — the small size
of that allowed us to engage in an ecological investigation
which proved to be very fruitful which I’ll talk a
little bit about later. And then a couple of months
later a second minor went in surreptitiously got
infected with Rabin virus. So the other Marburg virus. And about the same time in
the Weibo [assumed spelling] in the middle of DRC,
Ebola had — had emerged. And this is a fairly
large outbreak, a little over 264 cases. And our — their branch CDC
effort led by Tom Kaziak, there on the motorbike,
assisted by Stuart Nickel riding on the back of the motorbike. There’s no helmet laws. And so anyway they
— they lead the — the CDC effort there
in — in Weibo. And as we’re always in
a situation we’re trying to improve upon the
situation, the — there was a fan that was
set up in the window to try and create some rudimentary
negative airflow, where the — the hot samples were
— were run. And then at the end of the year, another Ebola virus
outbreak emerged. And this was a brand new
species of Ebola called, that we then later
named, Bundibugyo virus. And this was a — the
newest to date species of human pathogenic
Ebola virus discovered. And it’s also notable because
it was the first time the NGS, or Next Generation Sequencing,
which is very commonplace now, then it was 454 and
alumina based, was used to characterize
a — a new phenyl virus. 2008 it didn’t get
much of a break. In July, Marburg reemerged in a
nearby place called Python Cave, not too far from Kittaka which
I just talked about previously. And in fact, there were two
cases independent, one was a, see the first one was from a
woman from the Netherlands. The second one was a
woman from Colorado, that actually had been — been
infected six months prior. And then it was later on
that year, we discovered, along with our colleagues
at USDA in Plum Island, that swine would serve
as a very good host for Reston Ebola virus. And so I, you know,
that went on. Today there’s still
no known pathogenicity in humans with — with Reston. Interestingly, in 2014, at
the time that many of us in this room were buried in
the West Africa outbreak, there is a report in
archives of orology that the Chinese
had detecting — detected Reston virus
circulation in pigs in 2011 in Shanghai, China. They were screening
those pigs for PRRS Virus or Porcine Reproductive
Respiratory Virus, which actually was
how the samples ended up at the USDA in
the first place. So I guess if you go to Shanghai
next, beware of the pig meat. And then Ebola reemerged
in the Weibo, again, about a year later. So there were a couple
years off. And then in 2012, we — we had another banner year where
Ebola Sudan, this time in Jabaal and sort of the middle,
sort of northern part of — of Uganda emerged was a small
case, we’re able to do some — some ecological studies. Ebola Bundibugyo emerged
for the second time, this time in North Eastern DRC
actually about 200 miles north of where the current
outbreak is now. And so this was the
Bundibugyo variety. You can see Christina there
being taught by Brian Bird how to fuel a — a generator. And then just to cap it
off, Marburg emerged in — in Umbanda [assumed
spelling] which is the town that services the Kittaka mine, that had appeared
seven years prior. And then Ebola Sudan reemerged in Luararo [assumed
spelling] again. And so a lot of activity
going on. And what you may have noticed, at least in those
Uganda episodes, that — that the overall
number of cases was — was quite small and
this is not by accident. It is in large part due
to the fact that starting in 2010 we had — our
branch had invested majorly in establishing the VHF
surveillance program at Uganda Virus Research
Institute in Entebbe there in — in Uganda not too far from — from the Red Star
there in Kampala. And as evidence of
this effectiveness, you can see in this
slide here on — on the left sort of outside
of the shading area are the — shows a couple of
outbreaks, where you can see in the blue are the number of probable confirmed
cases are quite large. And the — on the — on the
— the bottom part of in — in the pink is the time it takes
to detect that — that outbreak. And you can see that once
the VHF surveillance got established, both of those
become much, much smaller. And again proof in the pudding
that if you put in the — the effort here as — as we
did and — and have maintained, it’s very effective
at being able to detect these outbreaks
quite quickly, which obviously minimizes the
— the public health impact. So moving on to — to West
Africa, and obviously, this — this changed everything, at least from the diagnostic
challenges in response. It was a — it was
a major effort. I think as most of us in
the room here are aware that it started, at least
it was first detected, came to our consciousness in
— in March of — of 2014. But we think it probably started
back in December of 2013. And from the lab — the standpoint, this turned into
a United Nations of — of labs. In the end, over I guess 27
different field labs were established and operated
all over West Africa. These labs were provided by multiple countries
besides the United States. The US agencies involved, besides CDC included
National Institutes of Health. And — and [inaudible]. So for the CDC lab
we operated two labs. One was at Ella in — in Liberia, we helped run
that along with the NIH guys at Rocky Mountain Labs. But probably most of the effort
was devoted to the Bough lab in the central part
of Sierra Leone. And you can see in the — in
the center there our hot lab was about as rudimentary
as you could ask for. It was four posts and a
tarp and a corrugated roof and natural ventilation. But it proved to
be very effective. And they — the —
the PPE or the — the protection, we just
used pappers, and the — it worked quite well and
had a very high throughput. And you know, this lab was
embedded in the NSF ETU there in — in Bough, this is a shot
from the — from the helicopter. And so how we set this up,
so I showed you the hot lab and then the rest of the — of the laboratory for the
RNA extraction and the — the PCR part, and all
the paperwork and — and specimen sectioning. That was all done in a
nearby two bedroom house that we essentially
repurposed, the bedrooms and the — the main living area. So the clean room was a
bedroom, there you can see some of the before and the after. You have your unmade
bed and then on the right turned
into the clean area. And then the other bedroom,
you can see the bed there on the left and this turned
into the RNA extraction room. And this is a — a slide
showing that at least in the — in the middle part, at least
through January of 2015, the — the Bough lab tested
over 7,000 cases. And so a relative
contribution of the other labs, it was quite significant. So there were a lot
of samples that — that went through this lab. This is one of my
favorite slides. So the specimens came
in multiple types. There’s lots of confusion and
so lots of different ideas about how to send a specimen. Some of them came in a
plastic jar, some of them came in a coffee urn,
plastic bottles. The — getting the
paperwork there in the upper right
was always a challenge because sometimes there was a
little bit of a reddish smear and you weren’t quite
sure what that was. So we always disinfected the
paperwork that came with it. Some things came in Falcon
tubes and some tubes were shoved in the — in gloves or
other bags of various sorts. Sample transport was
a challenge and — and had to be scaled
up dramatically. They came on motorbikes,
ambulances. And at one point we had a —
a helicopter circuit running by [inaudible] of — of either
the Russian illusion helicopters or these Bell helicopters. So in the end the — the
accomplishments for the — of the Bough lab were over
27,000 samples tested. The lab remained operational for
over 400 days without a day off. And the agency can be
pretty proud of itself. In — in the end there were
28 teams of personnel pulled from 17 different branches
that were all trained in special pathogens,
and were deployed in — in series to operate
the Bough lab. So it was a major agency effort. So I thought I have
next kind of series of slides here just
a commemorate — commemoration of
the 50th anniversary of — of HCO activity here. So we just learned about the
Ebola Zaire in — in ’76. And showing here
is a picture of — of Carl Johnson working
here at — at CDC. And this is kind of from
the — the midpoint on, starting in 1993 with
identification and isolation of Sonomry [assumed
spelling] virus, which is the four corners virus. Here’s the Hanna virus, caused
a lot of panic at that period. Since then many Hanna viruses
have since been discovered and Stuart Nicole was in the
— in the lead with that one, NEPA virus, which was a —
it’s a bat born paramyxovirus that emerged in — in pigs. We now know it comes from bats, and if that sounds a
little bit familiar, that’s because this sort of
scenario was the inspiration for the movie Contagion. SARS virus was identified
here with an — in — in VSPB and also with IBPD,
and I should say with many of these virus discoveries the
infectious disease pathology branch was working hand
in hand with VSPB in terms of in identifying
many of these agents. Bundibugyo Ebola virus
that we already mentioned, Ludgovirus [assumed spelling]
first discovered is South African arena virus
that killed four out of five people
that were infected. In 2012, Heartland virus, now you see quite a few
cases of that every year. Some of them are — are fatal. So supravirus is a — a bat
born paramyxovirus discovered in 2014. And I’m sensing to
— to move forward. [ Laughter ] All right.>>We have two minutes.>>Two minutes. Great. All right. So vaccines, do you
want me to finish or no?>>Sure.>>All right. The first vaccine
established was operated in — in Building 15. This is now the —
the J&J vaccine, the current vaccine
going on it’s being used, it’s looking quite promising over 200,000 doses
given, 97% efficacy. There’s a couple of — of therapeutics that are
looking promising this — they’re both monoclonal
antibody based. And a few slides about where
does Ebola come from bringing. So bringing you up
— fully up to date. And a couple bats, that’s
the prevailing theory. We don’t, at this point
still don’t know what the reservoir is. A couple of bats tested
positive, but we still — that data hasn’t been
reproduced since then, in 2005. However, there was a
story at least the — the Zaire or the outbreak in
West Africa started in Guinea, at this tree that a two
year old kid played in. [Inaudible] bats
inhabited that tree. They all tested negative
however, that’s the same species that turns out looks like
it hosts Bombali virus. A finding that’s been confirmed
in Kenya and also nearby Guinea. And then I’ll just finish
with saying however, we do know a lot
about Marburg virus. So it’s the — the
close sister to Ebola where we’ve identified
the Egyptian Rosetta bat as the natural reservoir
for — for Marburg virus. And this was started
with studies carried out by Botswana [inaudible]
in Rumba in a Rumba mine in eastern DRC and
then followed up. And first isolated by us
here in Building 15 in 2007. And this is a discovery that we’ve now confirmed
again in Sierra Leone. So it turns out [inaudible]
bats in Sierra Leone, they too carry Marburg virus. So in two minutes, I’ll stop
there and say that there’s a — a lot of lessons learned
that we can apply to Ebola. And we’re — we’re
working on it now. I mean, it’s — it’s
going to be a long effort. One of the main lessons is
just that the percentage of animals are actively
infected is low. Which means that you could
combine that with the fact that there’s over 250 different
bat species throughout Africa, that’s a lot of bats that
— that need to be tested, if in fact bats are
the reservoir for — for Ebola virus. And so I think with
that, I’m going to stop. I sense Phoebe next
me, and we’re going to move into the questions.>>Yes well — [ Applause ] It and thank you so
much for joining us. And I would like to
again thank the speakers for their excellent
presentations. It — it is 2:00 p.m., and I’m
sorry that we do not have time for question and answer now but
you are free to stay in the room for a few minutes and — and come up and talk
to the speakers. And then there is
something again at 3:00 p.m., if you want to talk
there’s room outside too. Thank you again so
much for joining us. Appreciate it.

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