Posted on 18TH MAY 2017
tagged Ebola, Democratic Republic of Congo; Nigeria

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

In this update:
[1] News
Democratic Republic of Congo: challenges
Nigeria: surveillance at airport
Nigeria: surveillance at borders
European Union commitment
[2] Research
Effective measures for containment
[3] Vaccine
WHO preparation

[1] News
Date: Mon 15 May 2017 07:21
Source: Radio Okapi [in French, machine trans., edited]

[The isolation of the Northeast area of the Democratic Republic of the Congo affected by Ebola poses a considerable logistical challenge to the deployment of medical aid but also acts as a natural barrier limiting the progression of the highly contagious disease.

The authorities said on [Fri 12 May 2017] that the country was facing its 8th epidemic of Ebola since the discovery of this virus on its soil in 1976. The disease was detected in the province of Bas-Uélé, about 1300 km [807.78 miles] northeast of Kinshasa, in the health zone of Likati, in the equatorial forest.

A total of 9 suspected cases of people infected with the virus have already been reported. Three of them died and the presence of the Ebola virus (Zaire strain) was detected in 1 of the 5 blood samples taken from patients suspected of contracting the disease, associated with high mortality among people it infects.

The DRC is one of the least developed countries in the world, and it lacks infrastructure. While it is relatively easy to transport aid by air to Kisangani, the big city in the north-east of the country, on the Congo River, and then by road to Buta, the capital of the Bas-Uélé, "after that, it gets complicated," says Régis Billaudel, head of mission of the medical aid NGO Alima in the DRC.

"We are going to study several possibilities of access" to cover the distance of about 150 km [93.20 miles] separating Buta from Likati, combining "canoe or fast boat" along the Itimbiri, tributary of Congo, and 2-wheeled," adds M Billaudel, while a team of Alima is already en route.

There is no question of considering transport by car: "4x4s do not pass" on the local forest tracks, which are too narrow, agrees Eugene Kabambi, communication officer of the World Health Organization (WHO) in the DRC. "Bringing heavy equipment to all these areas is an enormous challenge," says Billaudel. "It's a world of motorcycles, bicycles and stretchers. Nothing is impossible, however, in his eyes when one knows the unlikely loads perched on older bicycles that the inhabitants of the remote areas of the Congo are able to transport for kilometers and kilometers.

The Médecins Sans Frontières (MSF) Belgium-Congo team, which is also preparing to send teams, equipment and medicines to support the Congolese authorities, says there are "many logistical constraints" and prefers not to communicate too much about its action before having encountered the reality of the ground.

According to Kabambi, the United Nations Mission in the Congo (Monusco) and the World Food Program (WFP) should "facilitate aerial rotations" to transport equipment, medical personnel and medicines to Buta, using helicopters and light aircraft they operate in the DRC.]

Communicated by:
ProMED-mail Rapporteur Mary Marshall

[This report provides insight into the logistical problems (and advantages) caused by the geographical isolation and lack of infrastructure.]

Date: Tue 16 May 2017
Source: Aviationpros [edited]

[Following the outbreak of Ebola in the Democratic Republic of Congo on [Fri 12 May 2017], the Nigerian government has beefed up checks at its various airports... more]

[Byline: Nike Adebowale and Oladende Olawoyin]

Date: Tue 16 May 2017
Source: AllAfrica.com [edited]

[Lagos -- Following the recent outbreak of Ebola in Democratic Republic of Congo, the Nigerian Medical Association, NMA, yesterday [Mon 15 May 2017], called on the Federal Government to step up surveillance and strengthen response team across the borders and other national routes of entry into the country.

In a statement jointly signed by the President, Dr Mike Ogirima and Secretary General, Dr Yusuf Sununu, the NMA also called for vigilance on the part of the Federal Government.

According to them, NMA is ready to partner with the Federal Ministry of Health to achieve another resounding success on the prevention and control of the fresh outbreak. The statement read: "We also wish to call on all health teams to refresh their knowledge on clinical presentation of Ebola, apply universal basic precautions in patients' care and use the standard protocols of management and reporting of suspected cases." It further urged Nigerians not to panic but cooperate with government in securing the nation, especially during surveillance at entry points if the need arises.]

[Byline: Chioma Obinna]

Date: Tue 16 May 2017
Source: WiredGov LTD [edited]

[Statement by Commissioner for Humanitarian Aid and Crisis Management and EU Ebola Coordinator Christos Stylianides on the Ebola outbreak in the Northeast of the Democratic Republic of Congo.

Following the declaration of an Ebola outbreak in the Northeast of the Democratic Republic of Congo, the EU is fully committed to provide all support necessary. The national authorities, with the support of the World Health Organization (WHO), and the European Commission's experts in the country as well as international medical NGOs, have set in motion initial measures to respond to the situation.

The European Commission's Emergency Response Coordination Centre (ERCC) is taking necessary preparedness measures for a potential EU intervention in case the European Medical Corps and logistical capacities would be needed. In this regard we are in close contact with our Member States.

In these early days of the outbreak our priority must be to maintain close and efficient coordination with the national authorities, the WHO, EU Member States, international partners and NGOs on the ground.

The EU was at the forefront of the response to the Ebola outbreak in Western Africa in 2013-2016. This new outbreak is a stark reminder that we can never let our guard down.

Vigilance, early warning, coordination and preparedness are the best tools to prevent further spread of the outbreak.]

[2] Research
Date: Mon 15 May 2017 5:32 PM
Source: Voa Newletter [edied]

[A small outbreak of Ebola virus in Democratic Republic of the Congo is causing alarm among public health officials. A new study outlining containment strategies may help prevent an epidemic similar to the one that engulfed a number of western African countries 2 years ago. Pennsylvania State University biology professor Katriona Shea, co-author of the study, said, "The best strategy that we found out of the 5 that we looked at were funeral containment and public information campaigns [for the] sort of care in the community."

Shea said investigators found the [best] way to prevent transmission was for loved ones to avoid washing bodies of the deceased prior to burial.

Shea said that information is best conveyed through public health campaigns that also stress the importance of handwashing, personal hygiene and self-quarantine in high-transmission areas.

People suspected of being infected with Ebola, the report found, should also not hesitate to go to the hospital or clinic for evaluation and treatment. However, researchers concluded building more hospitals in response to an epidemic to be the least effective way to prevent spread of Ebola within communities.

Shea said investigators undertook the study in response to the Ebola epidemic of 2014-2015, when 28646 people became infected. Of these, 11 323 people in Guinea, Liberia and Sierra Leone died as of March 2016, according to the report.

Using the prevention strategies outlined in the study and the incidence data from the epidemic, researchers estimated that there would have been a reduction of 3266 cases of Ebola and 1633 lives saved.]

[Byline: Jessica Berman]

Communicated by:
ProMED-mail Rapporteur Mary Marshall

[compiled by: Celeste Whitlow ]

[3] Vaccine
Date: Tue 16 May 2017
Source: STAT [edited]

[The World Health Organization [WHO] and outside experts are making arrangements to send an experimental Ebola vaccine to the Democratic Republic of Congo, should officials there say they need it to quell an outbreak there.

The DRC has not yet formally requested the vaccine, and it's unclear if or when it will. The country's drug regulatory agency would also have to authorize emergency use of the vaccine, which is not yet licensed.

But the WHO and Gavi, the Vaccine Alliance, told STAT that preparations to have the experimental vaccine ready for use are being made on a parallel track with investigations in DRC into the scale of the outbreak.

"If the question is: Is it going to be used in this particular outbreak? It's not clear yet," said Dr Seth Berkley, CEO of Gavi, a public-private partnership that provides vaccines to lower income countries.

"That being said, everything is being put in place to use the vaccine if it is requested or if it turns out the need accelerates." The outbreak, reported to the WHO last week [week of Sun 7 May 2017], has grown to 20 suspected cases, 3 of whom have died.

" ... everything is being put in place to use the vaccine if it is requested or if it turns out the need accelerates."

It will also be challenging to get doses of vaccine to the area if the government decides to use it. The experimental Ebola vaccine must be stored at -80 Celsius [-112 F], which would involve transporting it in freezers.

The vaccine, which goes by the working name rVSV-ZEBOV, is being developed by pharmaceutical giant Merck. Although there are other experimental Ebola vaccines at various stages of development, this is the only one so far which has been shown to protect people from the deadly virus.

That evidence comes from a clinical trial conducted in Guinea during the West African Ebola outbreak of 2014 -- 2015. The trial showed the vaccine induced quick protection, a desirable characteristic for a vaccine designed for use in controlling outbreaks.

That study used what is known as a ring vaccination design, in which people who had been in contact with a confirmed case were vaccinated to prevent ongoing spread. The WHO has said if DRC uses the Ebola vaccine, it should vaccinate using the ring technique, said Tarik Jašarević, a spokesman for the WHO.

In an agreement with Gavi, Merck is required to have on hand at all times at least 300 000 doses of the Ebola vaccine. There is also currently a small number of doses -- around 800 or 1000 -- in Geneva, Berkley said.

A spokeswoman for Merck said the company is in contact with WHO, Doctors without Borders -- which has sent a response team to the outbreak site -- and other organizations about the outbreak.

"We stand ready to ship our investigational vaccine for Ebola Zaire ... once appropriate approvals are in place," she said in an email.

Berkley pointed out that because the vaccine has not yet been licensed, there are regulatory hurdles to clear before it can be used, and that can take some time.]

[Byline: Helen Branswell]

Communicated by:
ProMED-mail Rapporteur Mary Marshall

[compiled by: Celeste Whitlow ]

Communicated by:

- 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.

A map of Nigeria can be found at http://healthmap.org/promed/p/62 - Mod.LK

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/62.]

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