URI public health, infectious disease experts available to discuss Ebola

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KINGSTON, R.I. – August 4, 2014 – University of Rhode Island Professors Jef Bratberg and Annie De Groot have been at the forefront of several public health emergencies during their careers, but they agree that in the United States, Ebola won’t be one of them.


“We should not be worried in the United States for a number of reasons,” said Bratberg, an expert in responding to bioterrorism, pandemics and natural disasters. “The Ebola virus is not transmitted by an airborne route, like tuberculosis is. So, if you are on a plane and someone with tuberculosis is sitting a row away and coughs, you could still be infected. Ebola doesn’t behave that way.”


A member of URI’s pharmacy faculty for 12 years, Bratberg is part of the Rhode Island Disaster Medical Assistance Team, which responded to the Hurricane Katrina disaster and assisted in Rhode Island’s response to the H1N1 (swine flu) outbreak several years ago.


“Ebola captures people’s imaginations,” Bratberg said. “Although the disease initially presents with influenza-like symptoms about 10 days after exposure, in half of the cases it’s a horrible looking disease, which makes people bleed out of every orifice, and the infection persists in bodily fluids even after a person dies.”


In remote areas of Africa, people might touch a stricken person’s body to prepare it for burial and then become infected. “But if a person has no visible symptoms of Ebola, and does not have a fever, it is extraordinarily unlikely a person could acquire the disease from that person,” Bratberg said.


Meanwhile, as world health experts work to contain the disease and educate the public, URI scientists like De Groot are working to develop vaccines for a number of exotic tropical diseases, including Ebola. She has conducted preliminary studies of an Ebola vaccine in collaboration with scientists at the U.S. Army Medical Research Institute of Infectious Diseases.


Using Ebola epitopes, she demonstrated an immune response in what she described as a humanized mouse model. While that initial study was limited in scope, she said she is confident she could produce an effective vaccine if her studies were expanded to additional Ebola antigens.


“Not only would this approach be safer than whole-antigen approaches that are currently being explored, but it would be more rapid,” she said. Director of the URI Institute for Immunology and Informatics, De Groot is also medical director of Clinica Esperanza in Providence and CEO of biotechnology company EpiVax, Inc.


“The key to making an effective Ebola vaccine, I believe, is to trick the immune system into producing robust immune response to Ebola antigens while avoiding any components that might cause adverse effects,” she said. “That’s the best attribute of epitope-based vaccines, which are well-accepted in cancer therapy but have faced unanticipated barriers to entry in infectious diseases.”


While De Groot and others work on vaccines, people are asking why Kent Brantly, the doctor working in Liberia, contracted the disease even though he wore protective gear while working with patients. Bratberg said the doctor was working at ground zero for Ebola for a charity and was being bombarded by the disease.


“But the thinking at this point was that he was exposed to someone while not wearing protective equipment,” Bratberg said. “In other words he was not working in a clinical capacity. The breakdown was likely related to the overwhelming numbers of infected and exposed patients in the area, perhaps even a member of his health care team, as health care workers taking care of patients infected with Ebola are among those at the highest risk.”


Aid worker Nancy Writebol also contracted the disease while working in Liberia.


Bratberg said U.S. residents should not be worried that the two patients are being treated at Emory University Hospital because they will be in a state-of-the-art isolation unit.


“If you are a nurse or a doctor at Emory Hospital, you are at zero risk because of the precautions, the technology and the specially designed unit to isolate and treat these illnesses.”


So what about the frenzy being spread by folks who argue the doctor and health aide should not have been brought to the United States for treatment.


“It’s this simple, if you are not around people who are symptomatic, you are not at risk,” Bratberg said.


But what about the statistic that 6 in 10 people are dying from the disease?


“Yes, that is true, but the high rate of mortality is driven by people in very remote areas with little access to quality health care. It’s thought that if these patients had access to the standard supportive care provided in the United States, this would be a far lower ratio. In fact, this is the primary reason that the U.S. citizens are being treated in the U.S.


“In addition, the residents of villages where modern infection control has never been practiced become alarmed when they see people dressed in personal protection suits. Some villages have run health workers out because they think the workers are bringing the disease instead of preventing its spread and educating villagers about Ebola, which has never been seen before in many of the affected areas.”