PACEMAKER - TUESDAY, SEPTEMBER 23, 2014 West Africa’s Ebola Epidemic


By Cressie Moxey CONTINUED FROM COVER - Médecins Sans Frontières (Doctors Without Borders) (MSF) implored the WHO, health authorities and other organisa- tions to “scale up their response” in areas most affected by the epidemic. Irish doctor, Gabriel Fitzpatrick, working for MSF, told the BBC that “the current Ebola outbreak can be stopped if infected patients are found and isolated, and if comprehensive contact tracing and health promotion are carried out in the community”. In the absence of an effective treat- ments, these measures are the only ways to minimise human infection and death from a virus transmitted through bodily fluids. However, tak- ing these measures requires resourc- es, which have already been drained in Liberia and Sierra Leone due to malaria treatment programmes and economic suffering


resulting from


years of civil war. This situation is further compounded as many of the health systems are shut down for fear of Ebola amongst staff and patients. Furthermore, a lack of health workers and basic protective gear


such as gloves has been widely re- ported. The charity MSF has an isola- tion facility with 160 beds in Monro- via, but asserts that with the growing numbers of cases they need another 800 beds to treat those already sick. People are being turned away from treatment centres and told to return home, where they may spread the vi- rus. This is hardly a framework for containing an epidemic. In a bid to control the outbreak the


WHO has approved the first Ebola treatment, which uses convalescent serum and whole blood products of those recuperating from Ebola. The WHO have also announced that two promising vaccines, chimpanzee ad- enovirus vaccine and vesicular soma- titis virus vaccine, may be introduced as early as November for priority use amongst healthcare workers. Ten other potential treatments ex- ist, including monoclonal antibodies, RNA based drugs and small antivi- ral molecules. One of these potential treatments is the experimental drug ZMapp, which was used to treat Brit- ish Nurse, William Pooley. Pooley was flown back for treatment on a


The Ashya King Case


By Cressie Moxey CONTINUED FROM COVER - Rather


than returning Ashya to the ward following a visit to the hospital gar- den, his parents, Brett King, 51 and Naghemeh King, 45 drove their son to Portsmouth ferry terminal, where they borded a ferry to Cherbourg in France, along with their six other children. Legally, parents have the right to remove their children from hospital unless they are prevented by a court order. However, when Ashya was not returned to the ward, concerns for his wellbeing mounted. The bat- tery on his feeding unit was only designed for temporary use, and the medical team at Southampton Gen- eral Hospital were concerned that Ashya’s condition would rapidly de- teriorate, as his parents had not taken the power cord.


More than six hours after Ashya


and his parents left Southampton General Hospital, the medical team responsible for the child’s care con-


tacted Hampshire police. Hampshire police launched a social media cam- paign and widespread media alerts across Europe. Interpol were in- formed and a missing persons alert to all 190 of its member countries was issued. A European arrest warrant was issued for his Jehovah Witness parents “based around neglect”. On Sunday 30 August, following the release of a YouTube video by his father, Ashya King was found in the family’s flat in Spain. Mr and Mrs King were arrested for a judge to rule on extradition to the UK, and Ashya was taken to a hospital in Malaga, without his parents. In the video, Mr King explained that the family had travelled to the flat to raise funds themselves to finance proton beam radiotherapy at the Proton Therapy Centre in Prague. Clinicians at South- ampton


General Hospital recom-


mended chemotherapy and standard radiotherapy, but the King’s wanted Ashya to have proton beam therapy. Mr King said in the video, “Proton


high-level isolation unit at The Royal Free Hospital in London, after con- tracting Ebola while caring for pa- tients in Sierra Leone. He is now free of the virus, but doctors do not know whether ZMapp contributed to his re- covery.


The drug has been shown to pro- vide a survival advantage in non-hu- man primates experimentally infected with the virus, and has been adminis- tered to human subjects with Ebola in recent weeks on an emergency basis. Five of these patients have survived and two have died. The US govern- ment has signed a contract with the maker of ZMapp to accelerate the drug’s development. In spite of such advances, up until this point treatment has been limited to supportive therapy, which includes intravenous and oral rehydration ther- apy. This helps the patient to replace fluids lost to diarrhoea, vomiting and internal and external bleeding. It is this bleeding that differentiates the later course of Ebola from the non- specific symptoms that make EVD hard to diagnose. These include sud- den onset fever, feeling week, muscle


beam is so much better for children with brain cancer”, but the health au- thorities in Southampton told them it would have “no benefit whatsoev- er”. Despite pleading, they were not granted the treatment. Medulloblastoma is not an uncom-


mon brain tumour found in paediat- ric patients, and is commonly treated with radiotherapy. Some childhood brain tumours are discrete and do not infiltrate into surrounding brain tis- sue. For these, targeted therapy such as proton beam therapy can be useful to ensure that only the discrete tumour and a small surrounding area are ir- radiated, minimising risk of damage to healthy brain tissue. However, me- dulloblastomas are fast growing, in- discrete tumours that spread through cerebrospinal fluid and metastasise to different parts of the brain and spinal cord. Thus, the whole brain has to be irradiated, rendering little benefit from the unique advantages of the proton beam. Proton beam therapy is currently only available in the UK to treat eye cancers, but the NHS has an arrange- ment whereby any child who would


pain, headaches and sore throat. Ac- cording to the WHO, the case fatal- ity rate is 25-90% depending on the strain of virus, usually resulting from organ failure or low blood pressure as a consequence of extreme fluid loss. To date, five different strains


of Ebola have been identified and named after their places of origin: Bundibugyo ebolavirus (BDBV), Taï Forest ebolavirus (TAFV), Reston ebolavirus (RESTV), Sudan ebola- virus (SUDV) and Zaire ebolavirus (EBOV). With an incubation period of 2-21 days, symptoms typically appear 8-10 days after exposure to the virus. Early symptoms are non-specific, meaning that standard precautions for infec- tion control should be applied to all patients until a conclusive test for EVD can be run in the laboratory. There are five different lab tests each carrying extreme biohazard risks for health workers. Ebola remains a serious concern


in West Africa and, whilst the risk to the United Kingdom is low, more re- sources are required in West Africa to further minimise the risk to the UK.


benefit from it is funded and sent abroad to places such as the US and Switzerland for treatment. In De- cember 2011, the UK Department of Health said


that proton beam


therapy would be made available for patients in London and Manchester from 2018. Doctors at Southampton Gen- eral Hospital have now sent Ashya’s medical records to the Proton Ther- apy Centre in Prague, and a cancer charity has raised the required funds. Mr Justice Baker of the High Court agreed that Ashya could be taken to Prague for the “entirely reasonable” proton beam therapy wanted by his parents. Mr Justice Baker said “both courses (radiotherapy and proton beam therapy) are reasonable, and it is the parents who bear the heavy re- sponsibility of making the decision”. Ashya reached Motol University Hospital in Prague, where he arrived by private jet on Monday 8 Sep- tember. It is thought that Ashya will need approximately 30 irradiation visits combined with chemotherapy overseen by specialist oncologists at Motol University Hospital.


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