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Summary Background A record number of people survived Ebola virus infection in the 2013–16 outbreak in west Africa, and the number of survivors has increased after subsequent outbreaks. A range of post-Ebola sequelae have been reported in survivors, but little is known about subsequent mortality. We aimed to investigate subsequent mortality among people discharged from Ebola treatment units. Methods From Dec 8, 2015, Surveillance Active en ceinture, the Guinean national survivors' monitoring programme, attempted to contact and follow-up all survivors of Ebola virus disease who were discharged from Ebola treatment units. Survivors were followed up until Sept 30, 2016, and deaths up to this timepoint were recorded. Verbal autopsies were done to gain information about survivors of Ebola virus disease who subsequently died from their closest family members. We calculated the age-standardised mortality ratio compared with the general Guinean population, and assessed risk factors for mortality using survival analysis and a Cox proportional hazards regression model. Findings Of the 1270 survivors of Ebola virus disease who were discharged from Ebola treatment units in Guinea, information was retrieved for 1130 (89%). Compared with the general Guinean population, survivors of Ebola virus disease had a more than five-times increased risk of mortality up to Dec 31, 2015 (age-standardised mortality ratio 5·2 [95% CI 4·0–6·8]), a mean of 1 year of follow-up after discharge. Thereafter (ie, from Jan 1–Sept 30, 2016), mortality did not differ between survivors of Ebola virus disease and the general population. (0·6 [95% CI 0·2–1·4]). Overall, 59 deaths were reported, and the cause of death was tentatively attributed to renal failure in 37 cases, mostly on the basis of reported anuria. Longer stays (ie, equal to or longer than the median stay) in Ebola treatment units were associated with an increased risk of late death compared with shorter stays (adjusted hazard ratio 2·62 [95% CI 1·43–4·79]). Interpretation Mortality was high in people who recovered from Ebola virus disease and were discharged from Ebola treatment units in Guinea. The finding that survivors who were hospitalised for longer during primary infection had an increased risk of death, could help to guide current and future survivors' programmes and in the prioritisation of funds in resource-constrained settings. The role of renal failure in late deaths after recovery from Ebola virus disease should be investigated. Funding WHO, International Medical Corps, and the Guinean Red Cross.

The radiolytic stability of two ligands, CyMe 4 -BTBP and CyMe 4 -BTPhen in system with the FS-13 (phenyl trifluoromethyl sulfone) diluent was investigated under irradiation by accelerated electrons to study impact of the degradation products on the separation process efficiency and safety. Irradiation experiments were carried out up to the absorbed dose of 200 kGy. The irradiated samples were analysed by HPLC for the degree of extractant degradation. In addition, the effect of the presence of HNO 3 during the irradiation was studied. Extraction properties of the irradiated solvents were evaluated and compared with the extraction properties of non-irradiated solvents to assess the impact of the degradation products on extractions properties. The results obtained show that the stabilities of these ligands are higher in FS-13 than in the cyclohexanone-type solvents. The extraction properties are significantly influenced by degradation products contained in these systems. Surprisingly, both the distribution ratios for americium and europium, and the Am/Eu separation factor increase with the absorbed dose for the system withCyMe 4 -BTPhen in FS-13. Obviously, the degradation products of this ligand are efficient extractants too. In the next phase, an attempt will be done to identify the main degradation products, synthesise them and study their extraction properties.

Summary Background A recombinant, replication-competent vesicular stomatitis virus-based vaccine expressing a surface glycoprotein of Zaire Ebolavirus (rVSV-ZEBOV) is a promising Ebola vaccine candidate. We report the results of an interim analysis of a trial of rVSV-ZEBOV in Guinea, west Africa. Methods For this open-label, cluster-randomised ring vaccination trial, suspected cases of Ebola virus disease in Basse-Guinee (Guinea, west Africa) were independently ascertained by Ebola response teams as part of a national surveillance system. After laboratory confirmation of a new case, clusters of all contacts and contacts of contacts were defined and randomly allocated 1:1 to immediate vaccination or delayed (21 days later) vaccination with rVSV-ZEBOV (one dose of 2 × 10 7 plaque-forming units, administered intramuscularly in the deltoid muscle). Adults (age ≥18 years) who were not pregnant or breastfeeding were eligible for vaccination. Block randomisation was used, with randomly varying blocks, stratified by location (urban vs rural) and size of rings (≤20 vs >20 individuals). The study is open label and masking of participants and field teams to the time of vaccination is not possible, but Ebola response teams and laboratory workers were unaware of allocation to immediate or delayed vaccination. Taking into account the incubation period of the virus of about 10 days, the prespecified primary outcome was laboratory-confirmed Ebola virus disease with onset of symptoms at least 10 days after randomisation. The primary analysis was per protocol and compared the incidence of Ebola virus disease in eligible and vaccinated individuals in immediate vaccination clusters with the incidence in eligible individuals in delayed vaccination clusters. This trial is registered with the Pan African Clinical Trials Registry, number PACTR201503001057193. Findings Between April 1, 2015, and July 20, 2015, 90 clusters, with a total population of 7651 people were included in the planned interim analysis. 48 of these clusters (4123 people) were randomly assigned to immediate vaccination with rVSV-ZEBOV, and 42 clusters (3528 people) were randomly assigned to delayed vaccination with rVSV-ZEBOV. In the immediate vaccination group, there were no cases of Ebola virus disease with symptom onset at least 10 days after randomisation, whereas in the delayed vaccination group there were 16 cases of Ebola virus disease from seven clusters, showing a vaccine efficacy of 100% (95% CI 74·7–100·0; p=0·0036). No new cases of Ebola virus disease were diagnosed in vaccinees from the immediate or delayed groups from 6 days post-vaccination. At the cluster level, with the inclusion of all eligible adults, vaccine effectiveness was 75·1% (95% CI −7·1 to 94·2; p=0·1791), and 76·3% (95% CI −15·5 to 95·1; p=0·3351) with the inclusion of everyone (eligible or not eligible for vaccination). 43 serious adverse events were reported; one serious adverse event was judged to be causally related to vaccination (a febrile episode in a vaccinated participant, which resolved without sequelae). Assessment of serious adverse events is ongoing. Interpretation The results of this interim analysis indicate that rVSV-ZEBOV might be highly efficacious and safe in preventing Ebola virus disease, and is most likely effective at the population level when delivered during an Ebola virus disease outbreak via a ring vaccination strategy. Funding WHO, with support from the Wellcome Trust (UK); Medecins Sans Frontieres; the Norwegian Ministry of Foreign Affairs through the Research Council of Norway; and the Canadian Government through the Public Health Agency of Canada, Canadian Institutes of Health Research, International Development Research Centre, and Department of Foreign Affairs, Trade and Development.

International audience; Lamins A and C are nuclear intermediate filament proteins expressed in most differentiated somatic cells. Previous data suggested that prelamin A, the lamin A precursor, accumulates in some lipodystrophy syndromes caused by mutations in the lamin A/C gene, and binds and inactivates the sterol regulatory element binding protein 1 (SREBP1). Here we show that, in vitro, the tail regions of prelamin A, lamin A and lamin C bind a polypeptide of SREBP1. Such interactions also occur in HeLa cells, since expression of lamin tail regions impedes nucleolar accumulation of the SREBP1 polypeptide fused to a nucleolar localization signal sequence. In addition, the tail regions of A-type lamin variants that occur in Dunnigan-type familial partial lipodystrophy of (R482W) and Hutchison Gilford progeria syndrome (∆607-656) bind to the SREBP1 polypeptide in vitro, and the corresponding FLAG-tagged full-length lamin variants co-immunoprecipitate the SREBP1 polypeptide in cells. Overexpression of wild-type A-type lamins and variants favors SREBP1 polypeptide localization at the intranuclear periphery, suggesting its sequestration. Our data support the hypothesis that variation of A-type lamin protein level and spatial organization, in particular due to disease-linked mutations, influences the sequestration of SREBP1 at the nuclear envelope and thus contributes to the regulation of SREBP1 function.

For the control of the Onchocerca volvulus vector in West Africa, up to 18,000 km of rivers from 1975 and up to 50,000 km from 1989 had been partly sprayed weekly with insecticides as part of the Onchocerciasis Control Programme (OCP). To evaluate the possible short-term and long-term effects of the application of insecticides on the non-target fauna, an aquatic monitoring programme was set up during the initial phase of the programme. By analysing the invertebrate data, which were collected using various sampling strategies from four different countries between 1977 and 1996, this paper evaluates the long-term changes of the invertebrate populations with respect to their taxonomic composition as well as their trophic structures. The discussed results of the applied numerical analysis strategy suggest that neither the taxonomic nor the trophic structures are greatly altered from the range of biological, flow-related variation that normally occurs in the studied river systems. This allows us to conclude that the biological variation found here is ecologically acceptable.

Among the countries situated in the African meningitis belt, Burkina Faso is usually the one which pays the highest toll to this disease in terms of morbidity and mortality. Until 2002, the causal agent of the epidemic was usually Neisseria meningitidis serogroup A. At the onset of the 2002 epidemic, N. meningitidis W135 was identified as the predominant serogroup by the national reference hospital and the WHO, and this was confirmed by the WHO collaborating centre on meningitis in Oslo, Norway. Due to the nonavailability of an affordable and effective vaccine, the only adequate strategy was proper case management, taking advantage of the sensitivity of the bacteria to the currently used antibiotics. In order to avoid the repetition of such a situation, WHO and GlaxoSmithKline, with the financial support of the Bill and Melinda Gates Foundation, planned and actually realized the production of a trivalent ACW135 vaccine in anticipation of the 2003 epidemic season. In order for the vaccine to be effectively used in the field, it was imperative that various ethical, managerial and technical conditions be fulfilled. The successful use of the trivalent polysaccharide vaccine ACW135 in Burkina Faso during the 2003 outbreak was essentially due to the high level of leadership demonstrated by the national authorities of Burkina Faso, the facilitating role of WHO, the effective coordination of partners and activities, the transparency in the response to the epidemic and the management of the resources.