Posted on 14TH MAY 2017
tagged Ebola, Democratic Republic of Congo

A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases

In this update:
[1] Democratic Republic of Congo
[2] Vaccine
[3] Research
- Insight from clinical research
- Population movement
- Low potential for mechanical transmission
- High-level isolation capabilities

[1] Democratic Republic of Congo
Date: Fri 12 May 2017
Source: Sky News [edited]

An Ebola epidemic has been declared in the northeast region of the Democratic Republic of Congo [DRC].

The World Health Organisation says 3 deaths are being linked to the virus, and it is taking the situation "very seriously". One of those killed had tested positive for Ebola after coming down with a haemorrhagic fever last month [April 2017] in Bas-Uele, a province which borders the Central African Republic.

Spokesman Eric Kabambi said: "The case is in a very remote zone, very forested, so we are a little lucky."

The DRC suffered a 3-month outbreak of Ebola in 2014. Although it was quickly contained, 49 people were killed.

Ebola occasionally jumps from animals including bats and monkeys to humans -- and without preventative measures, the virus can spread quickly between people.

The virus is fatal in up to 90 percent of cases, and the WHO recently developed an experimental vaccine for use in emergencies.

In a statement, the DRC's health ministry said: "Our country must confront an outbreak of the Ebola virus that constitutes a public health crisis of international significance."

Ebola caused alarm around the world in 2013 when the world's worst outbreak began in West Africa -- killing more than 11 300 people and infecting an estimated 28 600 as it swept through Liberia, Guinea, and Sierra Leone.

Liberia was only declared free of active Ebola virus transmission last June [2016].

- Democratic Republic of Congo (4° 18′ 38″ S, 15° 17′ 22″ E)
- Democratic Republic of the Congo (2° 52′ 34″ S, 23° 39′ 18″ E)

Communicated by
GPHIN (Global Public Health Intelligence Network)

[ProMED also thanks rapporteur Mary Marshall for bringing this new outbreak to our attention.

In 2014, there were 2 parallel outbreaks of Ebola virus disease in Africa. The West African outbreak -- which began in December 2013 and mainly affects Guinea, Liberia, and Sierra Leone; and a separate and unrelated outbreak in Boende, [Tshuapa province], in the Democratic Republic of the Congo (DRC), first reported to WHO on 24 Aug 2014, officially declared at an end on 21 Nov 2014, less than 3 months later.

As soon as the Ebola outbreak was discovered in Boende in August [2014], the country's Minister of Health, Dr Félix Kabange Numbi Mukwampa, made a personal visit to the district with Dr Cabore to assess the situation and take leadership. The 2 visits he undertook within the 1st month of the outbreak were a great opportunity to motivate the personnel at the front, sensitize the population and advocate with local authorities.

In addition to WHO, Médecins Sans Frontières, the US Centers for Disease Control and Prevention, UNICEF, Canadian National Microbiology Laboratory in Winnipeg, and other partners supported the government with expertise for outbreak investigation, risk communications, social mobilization, mobile lab testing, safe burial, contact tracing, and clinical care.

Swift action contributed to contain the outbreak [excerpted from WHO http://www.who.int/features/2014/drc-beats-ebola/en/].

The DRC has the experience to stop virus transmission rapidly; nonetheless, it will be important to keep an eye on this new outbreak.

A map of the affected area can be seen at https://www.independent.co.ug/ebola-in-drc/ and a HealthMap/ProMED-mail map of the DRC at http://healthmap.org/promed/p/194. - Mod.LK]

[2] Vaccine
4 May 2017 Guinea: Leaders gather in Guinea to celebrate Ebola vaccine successes

["The world is far better prepared for another [Ebola virus disease (EVD)] outbreak," said Dr Margaret Chan, Director-General of the World Health Organization, today [4 May 2017] at a celebratory event to recognize the Governments and people of the 3 most-affected countries for their contribution to the control of the Ebola outbreak in 2014-15.

In December 2016, The Lancet published results of the WHO-led Guinea ring vaccination trial, showing that the world's 1st [EVD vaccine] provides substantial protection. Among more than 11 000 people who were vaccinated in the trial, no cases of EVD occurred.
Building on the work done to fast-track the development and testing of this vaccine, WHO established the R and D Blueprint to help cut the time in future for the development of new vaccines and treatments against new and emerging infectious diseases including Lassa Fever [Lassa hemorrhagic fever (LHF) ] and MERS [Middle East respiratory syndrome MERS coronavirus].

Dr Chan presented certificates to selected individuals for their remarkable contribution to the vaccine trial as well as the control of the Ebola outbreak in Guinea, Liberia and Sierra Leone.]

[3] Research
28 Apr 2017: Insights from clinical research completed during the West Africa Ebola virus disease epidemic
[Citation. Rojek A, Horby P, Dunning J, et al: Insights from clinical research completed during the West Africa Ebola virus disease epidemic. The Lancet Infectious Diseases; doi.org/10.1016/S1473-3099(17)30234-7.

Summary. The West Africa Ebola virus disease (EVD) epidemic was extraordinary in scale. Now that the epidemic has ended, it is a relevant time to examine published studies with direct relevance to clinical care and, more broadly, to examine the implications of the clinical research response mounted. Clinically relevant research includes literature detailing risk factors for and clinical manifestations of EVD, laboratory and other investigation findings in patients, experimental vaccine and therapeutic clinical trials, and analyses of survivor syndrome. In this review, we discuss new insights from patient-oriented research completed during the West Africa epidemic, identify ongoing knowledge gaps, and suggest priorities for future research.]

2 May 2017: Learning from the Ebola response in cities: population movement
[Executive summary. Population mobility is a critical area of concern in any infectious disease crisis, and particularly in those spread through human-to-human contact, such as Ebola. During the West African Ebola Virus Disease (EVD) outbreak in 2014/15, population mobility within and between urban and rural areas became a key challenge for humanitarian response. Despite restrictions at border crossings, attempts to control population mobility proved largely unsuccessful. This paper explores the urban dimensions of population mobility, including forces for and drivers of mobility as well as the implications for humanitarian response.

As part of ALNAP's [Active Learning Network for Accountability and Performance] Learning from the Ebola response in cities project, this paper identifies the following key messages to take forward into future public health crises in urban environments:
- urban spaces see a high number of anonymous, untraceable interactions every day, and it is easy for people to disappear. This problematises contact tracing and surveillance efforts;
- people move across porous and fluid national and urban borders quickly and easily;
- the drivers of population movement are diverse, encompassing labor, livelihoods, social and familiar connections, cultural activity, legal differentiation and fear. Research about the drivers and motivations behind population mobility in urban areas could enhance future public health responses;
- the success of small-scale community-level surveillance and self-reporting suggests this may be a more effective area towards which to direct efforts. As such, we should pay more attention to ways of incorporating communities in surveillance and encouraging self-monitoring behavior.]

3 May 2017: Low potential for mechanical transmission of Ebola virus via house flies (_Musca domestica_)
[Citation. Haddow AD, Nasar F, Schellhasc CW, et al: Low potential for mechanical transmission of Ebola virus via house flies (_Musca domestica_). Parasites and Vectors; doi: 10.1186/s13071-017-2149-x

- Background. Ebola virus (EBOV) infection results in high morbidity and mortality and is primarily transmitted in communities by contact with infectious bodily fluids. While clinical and experimental evidence indicates that EBOV is transmitted via mucosal exposure, the ability of non-biting muscid flies to mechanically transmit EBOV following exposure to the face had not been assessed.

- Results. To investigate this transmission route, house flies (_Musca domestica_ Linnaeus) were used to deliver an EBOV/blood mixture to the ocular/nasal/oral facial mucosa of 4 cynomolgus macaques (_Macaca fascicularis_ Raffles). Following exposure, macaques were monitored for evidence of infection through the conclusion of the study, days 57 and 58. We found no evidence of systemic infection in any of the exposed macaques.

- Conclusions. The results of this study indicate that there is a low potential for the mechanical transmission of EBOV via house flies -- the conditions in this study were not sufficient to initiate infection.]

[This study is consistent with the findings of Bausch et al, who concluded, after testing a variety of bodily fluids from Ebola patients during the acute phase of illness, that the "absence of EBOV in the urine, low prevalence on the skin, and rapid clearance from the saliva in surviving patients provides some reassurance that the risk of secondary transmission from casual contacts, fomites, or the sharing of toilet facilities in the home after discharge from the hospital is minimal. This conclusion is supported by previous empirical observations." DG Bausch et al: Assessment of the risk of Ebola virus transmission from bodily fluids and fomites. J Infect Dis (2007) 196 (Supplement_2): S142-S147. - Mod.LK]

11 May 2017: Sustainability of high-level isolation capabilities among US Ebola treatment centers
[Citation. Herstein J, Piddinger PD, Gibbs SG, et al (June 2017). Sustainability of high-level isolation capabilities among US Ebola treatment centers. Emerg Infect Dis. 23(6); doi: 10.3201/eid2306.170062.

Abstract. To identify barriers to maintaining and applying capabilities of US high-level isolation units (HLIUs) used during the Ebola virus disease outbreak, during 2016 we surveyed HLIUs. HLIUs identified sustainability challenges and reported the highly infectious diseases they would treat. HLIUs expended substantial resources in development but must strategize models of sustainability to maintain readiness. ...more]

[Compiled by: Celeste Whitlow ]

Communicated by:

[ProMED HealthMaps:
Liberia http://healthmap.org/promed/p/54
Guinea http://healthmap.org/promed/p/45
Sierra Leone http://healthmap.org/promed/p/46]

See Also

Ebola update (16): news, research, vaccines, funding 20170428.5000661
Ebola update (15): news, research, vaccine 20170416.4974553
Ebola update (14): news, research, vaccine 20170410.4959931
Ebola update (13): news, treatment, research, funding 20170402.4943034
Ebola update (12): news, research, vaccine 20170326.4927435
Ebola update (11): news, vaccine, research 20170312.4896304
Ebola update (10): news, research 20170305.4881172
Ebola update (09): news, research, funding 20170226.4866142
Ebola update (08): news, research, vaccine 20170219.4850524
Ebola update (07): research, economy 20170213.4836546
Ebola update (06): research, treatment, funding 20170206.4819835
Ebola update (05): news, vaccine, funding, documentary films 20170129.4801064
Ebola update (04): research 20170123.4786222
Ebola update (03): news, research 20170115.4767977
Ebola update (02): news, research, vaccine, comment 20170108.4750411
Ebola update (01): News, research, vaccine 20170103.4738060
Ebola update (72): vaccine, research, NGO, media 20161226.4724859
Ebola update (71): research, economy 20161218.4706276
Ebola update (70): news, research, economy, funding 20161211.4690740
Ebola update (69): news, NGO, research, economy, funding, vaccine 20161204.4675615
Ebola update (68): news, economy 20161127.4657148
Ebola update (67): news, research, funding 20161120.4642402
Ebola update (66): news, research, funding, economy 20161115.4629793
Ebola update (65): news, research, commentary, economy, funding, vaccine 20161106.4609611
Ebola update (64): news, research 20161030.4595759
Ebola update (63): news, research 20161023.4579436
Ebola update (62): news, research, treatment, funding 20161017.4564066
Ebola update (61): news, funding, economy 20161009.4547627
Ebola update (60): news, research, economy 20161002.4531285
Ebola update (59): news, research, funding 20160925.4514591
Ebola update (58): news, research, funding, vaccine 20160918.4497393
Ebola update (57): news, research, funding 20160911.4481043
Ebola update (56): news, vaccine, research 20160904.4465145
Ebola update (55): research, funding 20160828.4446844
Ebola update (54): rapid test recall, nurse, research 20160821.4431433
Ebola update (53): Guinea, research 20160814.4415032
Ebola update (52): funding, research 20160808.4400521
Ebola update (51): funding, research, miscellaneous 20160731.4383179
Ebola update (50): Liberia, Sierra Leone, research 20160724.4366266
Ebola update (49): Sierra Leone, research, history 20160717.4350351
Ebola update (48): CDC, research, funding, economy 20160710.4336146
Ebola update (47): Liberia, US preparedness, funding, research 20160703.4323924
and other items in the archives