Posted on 16TH 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] News
Africa Centers for Disease Control: Emergency Operational Center
Ebola virus disease
[2] Vaccine DRC
[3] Update: DRC vaccine usage

[1] News
15 May 2017 DR Congo: Africa Centers for Disease Control and Prevention activates the Emergency Operational Center to monitor the [Ebola virus disease (EVD)] outbreak in the Democratic Republic of Congo.
[The Africa Centers for Disease Control and Prevention on Sat [13 May 2017] activated the Emergency Operational Center to monitor the Ebola Outbreak in the Democratic Republic of Congo and developed a concept of operations for the emergency.

The Africa Centers for Disease Control and Prevention has activated its Emergency Operation Center to closely monitor the situation. A team of experts is on standby for deployment to respond to the emergency based on the needs on the ground as we work on the modalities with the government authorities in the DRC and coordinate with the WHO and partners', said Dr. John Nkengasong, the Director of the Africa CDC.

The Africa Centers for Disease Control and Prevention Surveillance and Response Unit is an Africa-wide mechanism to monitor disease outbreaks on the continent. Since 22 Apr 2017, the ministry of health of the DRC reported 11 suspected Ebola cases in the Likati health zone, Bas Uele Province in the north, bordering the Central Africa Republic. The National Institute of Biomedical Research in Kinshasa on 11 May 2017 confirmed 1 positive case [WHO confirmed a 2nd positive case on 14 May 2017. - Mod.LK] among the 5 samples collected. The 1st suspected case is of a 39-year-old male who presented onset symptoms on 22 Apr 2017 and died on arrival at a health facility.

The DRC has reactivated the inter-agency national committee against Ebola that is meeting every day to coordinate the response. Strengthening of surveillance and investigation, including contact tracing, are ongoing.

The DRC has experienced Ebola outbreaks since 1976. The previously reported outbreaks in the DRC include in 2014 when 66 cases of Ebola including 49 deaths occurred in the Equateur province; 2012 where 36 cases including 13 deaths were reported in Orientale province; 2008 to 2009 were 32 cases including 15 deaths were reported in Kasai; 2007 where 264 cases including 187 deaths were reported in Kasai; 1995 were 315 cases and 250 deaths occurred in Kikwit and in 1976 where 318 cases including 280 deaths were reported in Yambuku. ...more]

15 May 2017 Ebola returns to Congo: WHO assessing extent of outbreak; things to know about the disease
[...Ebola virus disease - What is it? Is there a cure for the disease? Signs and symptoms

Ebola virus disease (EVD) is a severe, highly infectious virus that is spread through contact with bodily fluids. It causes bleeding inside and outside the body as wells as organ failure.

Initial symptoms may include high fever, headache, joint pain and muscle aches, weakness, sore throat, stomach pain, etc.

As the disease advances, symptoms may get worse, causing bleeding inside the body as well as from the eyes, ears, and nose. Some people may vomit or cough up blood, have bloody diarrhea, and get a rash.

The disease, also known as Ebola hemorrhagic fever, kills up to 90% of people who are infected.

To date, there is no approved vaccine to prevent the virus or treatment or cure (But 12 vaccines are in development. - Mod.LK)].

[Submitted by: ProMED-mail Rapporteur Kunihiko Iizuka ]

[2] Vaccine
15 May 2017: WHO preparing authorization, logistics for Ebola vaccination in Congo if needed
http://www.reuters.com/article/us-health-ebola-congo-idUSKCN18B1UM?rpc=401& and https://www.businesslive.co.za/bd/world/africa/2017-05-15-no-vaccine-rol...
[The World Health Organization (WHO) said on Mon [15 May 2017] its experts have not yet decided whether to use newly developed vaccines to try to contain an outbreak of Ebola in Congo, but officials are making preparations just in case.

A 2nd case of Ebola in Democratic Republic of Congo was confirmed by the WHO on Sun [14 May 2017] after an outbreak this week of 17 other suspected cases. Three people have so far died among the 19 suspected and confirmed cases. A spokesperson for the Geneva-based U.N. health agency told Reuters the WHO was working with specialists to conduct an epidemiological investigation "to better understand the extent of the current outbreak" and to establish who is at risk of becoming infected with Ebola.

The GAVI global vaccine alliance said on Friday [12 May 2017] that some 300 000 emergency doses of an Ebola vaccine developed by Merck could be available in case of a largescale outbreak, but it would be up to the WHO and others to determine "if and when deployment of vaccine into this outbreak is warranted."

The WHO spokesman said: "preparations are being accelerated to ensure that vaccine and equipment be available on site," and "appropriate ethical and regulatory authorization are being sought."

He added that "if pertinent," an immunization strategy known as ring vaccination would be the recommended approach. Ring vaccination involves tracing all the people who might have been in recent contact with a newly diagnosed Ebola patient and offering them the vaccine. Results of a trial using this technique with the Merck shot in Guinea showed 100 percent protection in those vaccinated immediately. Health officials in Congo are trying to trace 125 people thought to be linked to the cases identified in the remote northeastern province of Bas-Uele province in northeastern Congo near the border with Central African Republic. [more...]

[Compiled by: Celeste Whitlow ]

Communicated by:

[3] Update: DRC vaccine usage
Date: Mon 15 May 2017
Source: Science Magazine [edited]

Ebola has surfaced in a remote part of the Democratic Republic of the Congo (DRC), the 1st outbreak of the disease since the West African epidemic that killed more than 11 000 people before it came to an end 2 years ago. A vaccine proved its worth in that epidemic -- which hit major cities -- but it is still awaiting approval from regulatory agencies, and the DRC government has yet to request the vaccine's use to quell this outbreak.

As of 14 May 2017, there were 19 people suspected of having been infected with the virus, and 3 of them have died, according to Eugéne Kabambi, an emergency communications officer for the World Health Organization (WHO) who is based in Kinshasa. The National Institute for Biomedical Research in Kinshasa has confirmed with the polymerase chain reaction test that blood samples from 2 of the cases were positive for Ebola-Zaire virus. An additional 125 people are believed to have had contact with infected people and are under surveillance, according to Kabambi.

The outbreak began on 22 Apr 2017 in the Nambwa Health Center of the Bas Uélé Province, which is in the northern region of the DRC that borders the Central African Republic.

WHO reports issued 13 May 2017 noted that the 1st case, a 45-year-old man (initially described as 39 years old) 1st presented to a health facility with bloody urine, diarrhea, nose, and vomiting. He had to travel by motorbike across the large province to reach a hospital in Likati, says Susan Shepherd, a clinician with a humanitarian aid group, ALIMA, which has a team in DRC and plans to respond to the outbreak. (This was 1st reported by The Washington Post.) He also was transported in a taxi. According to WHO, the man had died by the time he reached the hospital in Likati. The people who transported him also became ill and died.

Shepherd, who spoke from ALIMA's headquarters in Dakar, says the 1st victim's blood was drawn 1 May 2017. It took 10 days for the man's sample to reach Kinshasa, which is about 1400 km from Likati. (The DRC has no roads that span the country, and long-distance travel largely is restricted to river boats and private airplanes.) WHO notes that it "was informed" about the cluster of cases on 9 May 2017, and the confirmation of the 45-year-old man occurred 2 days later.

Marie-Paule Kieney, an assistant director general at WHO in Geneva, Switzerland, who played a central role during the West African epidemic, says Merck, the maker of the vaccine that appeared to work in a trial held in Guinea in 2015, is ready to provide the product if necessary. "Discussions are ongoing with the government on whether vaccination should be undertaken or not," Kieney says. "The outbreak is very small, so it may be stopped through containment only."

Traditional containment efforts include isolating and confirming cases, providing protective gear for health care workers, using safe burial procedures, and educating the public about how to reduce their risks.

One person helping with the response, who asked not to be identified because of the political sensitivity created by the outbreak, said some were deeply frustrated that a decision has yet to be made about whether to use the vaccine. "If it were up to me I'd already be using it," the person says. "It's hard to dream up a rationale for not using the vaccine as quickly as possible."

Plenty of the Merck vaccine exists, though its experimental status would require what's known as an "Expanded Access" study protocol to be approved by national and international regulatory bodies before it could be shipped to the DRC. WHO has some 10 000 doses in Geneva, Switzerland, left over from the West Africa outbreak, sources tell Science Insider, and Merck has some 700 000 doses on ice in the United States.

Before the DRC outbreak became known, experts who serve on WHO's Strategic Advisory Group of Experts on Immunization (SAGE) recommended that the Merck vaccine "be promptly deployed" if the Ebola-Zaire strain of the virus surfaces. Experts attending a 25-27 Apr 2017 SAGE meeting in Geneva also suggested that an Expanded Access study "be implemented promptly after the confirmation of a case" and that the vaccine be used in the same "ring vaccination" strategy that worked in Guinea, which gave shots to people (including health care workers) who were in close contact with each confirmed case.

When asked about the vaccine's status, a WHO spokesperson in Geneva told Science Insider in an email on 15 May 2017 that "WHO and partners are completing the epidemiological investigation to better understand the extent of the current outbreak and who are potentially at risk of Ebola." The spokesperson emphasized that "preparations are being accelerated to ensure that vaccine and equipment be available on site" and that the "appropriate ethical and regulatory authorisation" was being sought. WHO's Kabambi noted on 15 May 2017 that the DRC's Ministry of Health "has provided a comprehensive National Plan of Response, but still lacks a detailed budget to move forward."

Doctors Without Borders (MSF) -- which led the initial health care response in West Africa during the last outbreak -- have 14 people en route to Likati, including doctors, nurses, logisticians, water and sanitation experts, health promoters, and an epidemiologist. Another 10 people from the DRC's Ministry of Health also left Kinshasa on Saturday [13 May 2017] for Likati. A cargo plane with 15 tons of medical and logistical supplies flew to Kisangani, and MSF says it expects all people and equipment to arrive in Buta by tomorrow [16 May 2017]. It is a rugged 150 km from Buta to Likati.

MSF's Armand Sprecher, an experienced Ebola clinician based in Brussels, says the group would like to make the vaccine available to its workers, but he stresses that they know how to protect themselves from the virus. "We've been managing Ebola outbreaks for 25 years in the absence of a vaccine," Sprecher says. "Even with folks vaccinated, we'll have the same risk-management plan in place. It's not like an either/or thing."

He notes, too, that vaccinated people often spike a slight fever, which could be confused for Ebola, which means healthcare workers ideally would be vaccinated several days before they arrive. ALIMA's Shepherd agrees. "The 1st task is to get supplies to health workers so they can protect themselves," she says.

Sprecher's main concern is that the vaccine be made available for people living in the Likati Health Zone. "It may be a big help in shutting down transmission," he says.

Sprecher says it's always difficult to move unlicensed medicines into countries. "I've been part of the process," says Sprecher. "As hard as you push, things move only as fast as the most tardy organization."

[Byline: Jon Cohen]

Communicated by:
ProMED-mail Rapporteur Mary Marshall

[This report adds a little more detail to the news reports that have been circulating. Problems being encountered in this outbreak include delay in diagnosis due to lengthy transport of specimens to the lab, decision-making regarding employment of the vaccine, and remoteness of the region, which may actually be beneficial to containment of spread.

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

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