Ebola is an episodic disease. But that doesn't mean we can't learn from seasonal viruses like influenza on how to deal with Ebola. Infectious diseases expert Dr. Abdullah Brooks shares how this might be possible.
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DW: You're one of the speakers at a major conference convened by the European Scientific Working Group on Influenza. The conference comes at a time when we're all focused on the outbreak of Ebola in West Africa. How do you see influenza in this context - in terms of infectious diseases that we are having to combat on a regular basis and, to some extent, are struggling to combat?
Abdullah Brooks: One has to look at these regular infectious diseases, such as influenza - which also has pandemic potential - as well as new and emerging infections such as Ebola - which are more episodic - and take lessons and learn from each of these, because they are not independent. They are instructive as to how something [can be] a standing infection, whether in a zoonotic or animal host that crosses over into humans, or a human infection that can mutate and become something different and take on a pandemic or epidemic potential.
So the lessons we have learnt with flu have been very instructive. Influenza has time and again taken the academic community to school. [It asks questions like:] How do you understand and regulate a seasonal infection and yet prepare for its pandemic expression when and if that should occur? What are the signs that indicate you may be heading towards a pandemic? And what can you do? When you begin to see something that does potentially infect humans, then pay attention to it and track it.
The same thing is true here with Ebola, where we're learning that we have to look at the animal reservoirs and see when and if they cross over into humans, and also see whether the virus can take on new expressions such as respiratory spread.
We're hearing that scientists are looking at the potential for mutation in Ebola, and we know that influenza does mutate all the time. If we develop a drug or a vaccine one year, we're going to have to renew that soon - if not within 12 months. So are there lessons we can learn and use right now?
Yes, there are lessons we can learn. But it's one thing to understand the theory of how viruses mutate and what you need to do in order to be able to address that, and at the same time to be able to develop an effective drug or vaccine. These are two very different disciplines.
So we can understand how influenza acquires resistance to Tamiflu. But coming up with something that is actually going to replace Tamiflu, to be as easily given as Tamiflu, is a different proposition altogether, and takes a longer lead time. One of the frustrating things we have in dealing with Ebola is that we have things that we've tested in the simian or monkey model, things that appear to be safe or even effective - but to go from [that] to a human is a huge leap. And as I was telling some colleagues, monkeys lie all the time - something that works in a monkey, doesn't necessarily mean it's going to work in a human.
What we have got a bit better at is trying to detect as early as possible (because of more extensive surveillance) emerging drug resistance when it happens. That's an early warning system. But again, it doesn't address the backend, which is: Now, let's come up with something else.
It is interesting that you have this active, international experience - you work in Bangladesh, the US, you're with the WHO. And it seems that one of the ironies, as epidemics become more global, that we do have to look specifically at local problems while bearing in the mind the global risk factor. That's got to be incredibly hard.
Yes, it is. And what it requires is that we have effective communication between all the various parties. For example, at the Ebola meeting we had in Geneva (September 4 and 5), it was vital - absolutely vital - to have the West Africans present because they are the ones on the ground and they understand. And their perspective was quite different from some of the Western perspectives, even from those who have actually been in West Africa, because they're not there every day, whereas these fellows are.
The other thing is that it helps us to spot global trends. When you can compare results, you can see how something is spreading from one place to another and how it changes.
But finally, it also provides us with an opportunity to learn from each other - the experiences we had in one place and being able to translate those into another place, and better understand the infection.
Abdullah Brooks, MD, is a pediatrician on faculty at the Johns Hopkins University Hospital in Baltimore, Maryland, United States. He's also an infectious diseases experts at the International Centre for Diarrhoeal Disease Research (ICDDR,B) in Bangladesh, and part of the World Health Organization's taskforce on Ebola.