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

[1] Democratic Republic of Congo
Date: Sat 13 May 2017
Source: Disease Outbreak News [edited]

Ebola virus disease - Democratic Republic of the Congo
On 9 May 2017, WHO was informed of a cluster of undiagnosed illness and deaths including hemorrhagic symptoms in Likati Health Zone, Bas Uele Province in the north of the Democratic Republic of the Congo (DRC), bordering Central African Republic. Since [Sat 22 Apr 2017], 9 cases including 3 deaths have been reported. Six cases are currently hospitalized.

On [Thu 11 May 2017], the Ministry of Health (MoH) of DRC informed WHO that of the 5 samples collected from suspected cases, 1 tested positive by RT-PCR for Ebola virus subtype Zaire at the Institut National de Recherche Biomédicale (INRB) in Kinshasa. Additional specimens are currently being tested and results, including sequencing, are awaited to describe the outbreak.

On [Wed 10 May 2017], a multidisciplinary team led by the MoH and supported by WHO and partners was deployed to the field and are expected to reach the affected area on 12 or 13 May 2017 to conduct an in depth field investigation.

The investigation is currently ongoing and information is available for only 3 of the suspected cases: The 1st case (and possibly the index case), a 39-year-old male presented onset of symptoms on [Sat 22 Apr 2017] and deceased on arrival at the health facility. He presented with hematuria, epistaxis, bloody diarrhea, and hematemesis. Two contacts of this case are being investigated: a person who took care of him during transport to the health care facility (he has since developed similar symptoms) and a moto-taxi driver (deceased) who transported the patient to the health care facility.

Personal Protective Equipment (PPE) for health care workers has been shipped on [Fri 12 May 2017] to Kisangani. Additional kits are currently being prepared and will be shipped as soon as available. [It would be good for countries with records of Ebola outbreaks to maintain suplies of PPE if at all possible, so health care workers do not need to wait for shipments to arrive. - Mod.LK]

Background and epidemiological situation
On 20 November 2014, as per WHO recommendations, the MoH of DRC and WHO declared the end of the EVD outbreak that started on 24 August 2014 and resulted in a total of 38 laboratories confirmed cases and 28 probable case including 49 deaths in Boende, [Tshuapa] province. This was the 7th outbreak of EVD since its discovery in 1976 in DRC.
• 2014: 66 cases of EVD including 49 deaths diagnosed initially in [Tshuapa] province (Watsi Kengo, Lokolia, Boende, and Boende Muke).
• 2012: 36 cases including 13 deaths Orientale province - Isiro (Bundibugyo virus).
• 2008-2009: 32 cases including 15 deaths in Kasaï-Occidental (Zaire virus).
• 2007: 264 cases including 187 deaths in Kasaï-Occidental (Zaire virus).
• 1995: 315 cases and 250 deaths occurred in Kikwit and surrounding area.
• 1977: 1 case (Zaire virus).
• 1976: 318 cases including 280 deaths in Yambuku (Zaire virus).

There are 5 identified subtypes of Ebola virus. The subtypes have been named after the location where they have been 1st detected. Three of the 5 subtypes have been associated with large Ebola hemorrhagic fever (EHF) outbreaks in Africa. Ebola-Zaire, Ebola-Sudan and Ebola-Bundibugyo. EHF is a febrile hemorrhagic illness which causes death in 25-90 percent of all cases.

Public health response
The following public health response measures have been implemented:
• The national committee against viral hemorrhagic fever has been reactivated and will continue meeting every day to coordinate the response.
• Strengthening of surveillance and investigation including contact tracing are ongoing.
• WHO will provide assistance and technical support. The deployment to DRC of an additional WHO multidisciplinary team is currently considered to support the response of national authorities.
• The Global Outbreak Alert and Response Network (GOARN) has been activated to provide additional support if required.
• The need and feasibility of potential Ebola ring vaccination is being discussed.

WHO risk assessment
To date, the outbreak is reported in a remote and hard to reach area and appears to be geographically relatively limited. However, Investigations are ongoing to assess the full extent of the outbreak and therefore high vigilance still needs to be maintained.
WHO does not recommend any restriction of travel and trade to DRC based on the currently available information.

Communicated by:
ProMED-mail Rapporteur Mary Marshall

[ProMED also thanks Kunihiko Iizuka for submission of information on the Ebola outbreak in DRC.

- 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)

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] Democratic Republic of Congo: vaccine
Date: Fri 12 May 2017
Source: Nature doi:10.1038/nature.2017.21989 [edited]

The Democratic Republic of Congo has reported 9 suspected cases of infection in recent weeks.

An outbreak of the Ebola virus has emerged in the Democratic Republic of Congo (DRC), the World Health Organization (WHO) said on [Fri 12 May 2017]. Congolese authorities have reported 9 suspected cases of Ebola infection in the past 3 weeks; the WHO has confirmed one, and tests are pending on others. Now health officials are considering whether to deploy an experimental Ebola vaccine against the outbreak, for the 1st time since the WHO gave it preliminary approval in April [2017].

The aid group Medecins san Frontieres (MSF, or Doctors Without Borders) is discussing a potential vaccination campaign with the Congolese government, an MSF spokesperson says. That would require the approval of the WHO, which has not decided whether to call on the approved experimental vaccine or others in development, says WHO spokesman Tarik Jašarević. Still, he says, "we are taking this [outbreak] seriously because Ebola is always serious". The last outbreak of the virus, in West Africa from 2014 to 2016, killed 11 325 people; the more than a dozen known outbreaks in the DRC have been less severe.

There are now 12 candidate Ebola vaccines in development. None is yet approved for sale, in part because the vaccine candidates were not ready for testing until the West African Ebola crisis was on the wane. But on 27 April [2017], the WHO's advisory group on immunization recommended that an experimental vaccine called rVSV-SEBOV be deployed promptly should an Ebola outbreak arise.

Developed by the Public Health Agency of Canada and licensed by the drug companies New Link Genetics and Merck, rVSV-SEBOV showed promise in a study published in the Lancet last December. The trial included 11 841 people in Guinea in 2015, near the end of the Ebola outbreak there. None of the 5837 people who received the vaccine got the disease 10 days after vaccination. But there were 23 cases among the thousands of other people included in the trial.

The deployment of rVSV-SEBOV may be warranted in the DRC, because the vaccine is based on the Zaire strain of Ebola that is driving the current outbreak, says Anthony Fauci, director of the US National Institute for Allergy and Infectious Diseases. If public-health authorities decide to proceed, there is a supply of rVSV-SEB at the ready: GAVI, the Vaccine Alliance, signed an agreement with Merck in 2016 to purchase 300 000 doses of vaccine for use in future outbreaks.

Historically, though, outbreaks in the DRC have never approached the historic severity of the recent West Africa epidemic. The last Ebola outbreak in the DRC occurred in the Bas-Uele province -- the site of the current episode -- and killed 49 people over 3 months. The gap in severity is due in part to the DRC's infrastructure and geography. Whereas people, and the viruses they carry, travel fluidly between Guinea, Sierra Leone and Liberia, rough roads impede movement in many parts of the DRC. This means that outbreaks there kill people, but fizzle out without spreading very far geographically.

The DRC also benefits from the Ebola expertise that its doctors and researchers have built up over the years. Jean-Jacques Muyembe-Tamfum, the director of the National Institute on Biomedical Research in Kinshasa, is well-known among Ebola experts for curbing the DRC's 1st outbreak in 1976, and many thereafter. He works to engage the communities affected by an outbreak immediately, to build their trust in medical teams and to help them to understand the importance of not touching others to avoid spreading the virus.

"Muyembe-Tamfum is probably out there already," says David Heymann, an infectious-disease epidemiologist at the London School of Hygiene and Tropical Medicine. He recalls how Muyembe-Tamfum -- who could not be reached for comment -- helped to contain past outbreaks by telling village chiefs that Ebola was an evil spirit, which passes by touching the infected. "Muyembe talks with people in a way that they will understand quickly," Heymann says. "He does whatever he believes is effective, and it is."

Vaccine reference:
Henao-Restrepo, A. M. et al. Efficacy and effectiveness of an rVSV-vectored vaccine expressing Ebola surface glycoprotein: interim results from the Guinea ring vaccination cluster-randomized trial. Lancet. 386(9996): 857-866, 29 August 2015

[Byline: Amy Maxmen]

Communicated by:

[The vaccine rVSV-ZEBOV is a recombinant, replication-competent vesicular stomatitis virus-based vaccine expressing a surface glycoprotein of Zaire Ebolavirus. The results of the Lancet study cited above indicated that rVSV-ZEBOV is most likely effective at the population level when delivered during an Ebola virus disease outbreak via a ring vaccination strategy. This vaccine is a good choice to employ in this current outbreak since it is based on the Zaire strain of Ebola that is driving the current outbreak. Vaccination plus implementation of a strong public health response based on knowledge gained during the previous West African outbreak and prior outbreaks in the DRC show promise of curtailing this latest outbreak quickly. Particularly important are good surveillance including contact tracing, and proper use of PPE. - Mod.LK]


A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/194.]

See Also

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