Posted on 19TH 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] DR Congo: Suspected cases increase to 29
[2] News
Kenya alert
[3] Vaccine

[1] DR Congo: suspected cases increase to 29
Date: Thu 18 May 2017
Source: New York Times [edited]

The number of suspected cases of Ebola has risen to 29 from 9 in less than a week in an isolated part of Democratic Republic of Congo, where 3 people have died from the disease since [22 Apr 2017], the World Health Organization said on [Thu 18 May 2017].

The WHO was criticized for responding too slowly to an outbreak in West Africa in 2014 that left more than 11 000 people dead, and Dr. Peter Salama, the executive director of the organization's health emergencies program, said at a briefing that it was essential to "never, ever underestimate Ebola" and to "make sure we have a no-regrets approach to this outbreak".

The risk from the outbreak is "high at the national level," the WHO said, because the disease was so severe and was spreading in a remote area in northeastern Congo with "suboptimal surveillance" and limited access to health care. "Risk at the regional level is moderate due to the proximity of international borders and the recent influx of refugees from Central African Republic," the organization said, but it nonetheless described the global risk as low because the area is so remote.

About a week ago, in addition to the 9 suspected cases, 125 patients who had come into close contact with the disease were being monitored. Now about 400 patients are being followed, even as 9 new cases were reported on [Thu 18 May 2017], according to the WHO.

The Ebola virus causes fever, bleeding, vomiting and diarrhea, and it spreads easily by contact with bodily fluids. The death rate is high, often surpassing 50 percent, particularly with the Zaire strain, which has been confirmed in 2 cases in this outbreak.

The outbreak was reported in a densely forested part of Bas-Uele Province, near the border with the Central African Republic. Cases have occurred in 4 separate parts of a region called the Likati health zone. Aid groups and the WHO have struggled to reach the affected area, which has no paved roads and can be reached only by a motorcycle ride through the forest, or by helicopter or light aircraft.

The first known case occurred on [22 Apr 2017], when a 39-year-old man who had fever, vomiting, diarrhea and bleeding died on the way to a hospital in the Likati zone. The person caring for him and a motorcyclist who transported him also died.

The first 6 months of the response to the outbreak are expected to cost the WHO and aid groups USD 10 million, Dr. Salama said at the briefing. He said telecommunications networks would have to be established and airstrips repaired so that aid workers can provide the necessary medical care.

The WHO, aid groups and the Congolese government are discussing the possibility of using an experimental Ebola vaccine, made by the American pharmaceutical company Merck that proved effective in Guinea. The response would involve a "ring vaccination," in which contacts of patients, contacts of contacts, and health workers would be vaccinated. There would be no mass public vaccination. The vaccine has not yet been licensed, and its use would require permission on several fronts. Nonetheless, Dr. Salama said that if permission were granted, the vaccine could be made available in a week or so. Other experimental antiviral drugs may also be considered.

The Ebola virus is considered endemic in the Democratic Republic of Congo, where 8 outbreaks, the largest involving about 300 patients, have been recorded since 1976.

Inside Hospital's Ebola Battle
The country "has considerable experience and capacity in confronting these outbreaks," Dr. Daniel Bausch, an Ebola expert at the WHO, said in an email. He added, "I think there is a very good probability that control can be rapidly achieved."

Dr. Salama said that aid workers had reached a town in the Likati zone, which was as close as they had been able to come to the epicenter of the outbreak. He said aid groups were setting up centers for treatment and isolation, and mobile labs.

The first aid group to arrive was the Alliance for International Medical Action, which was already in the region, responding to cholera. In a telephone interview from Conakry, Guinea, the group's executive director, Matthew Cleary, said that 7 people who were believed to have contracted Ebola had been taken to a district hospital in the Likati zone that was not equipped to deal with the virus. "It's urgent to get them into a proper isolation center," Mr. Cleary said, adding that the group is preparing to build a treatment unit. It will include windows that allow families to see patients, a response to past outbreaks in which people feared and sometimes shunned sealed-up isolation units into which patients seemed to disappear.

Brienne Prusak, a spokeswoman for Doctors Without Borders said on [Wed 17 May 2017] that the group had sent a team of about 20 doctors, nurses and other experts to the Likati zone, and that it was still trying to figure out how to reach the epicenter. "Transport is extremely difficult in the area, and helicopter flights may be the only way to get there," she said by email. "We considered motorbikes but are now thinking of helicopters because we need to get so many materials there. We're expecting to get to the epicenter by the weekend."

The Centers for Disease Control and Prevention in the United States is also sending a renowned Ebola expert, Dr. Pierre Rollin, to Congo, along with epidemiologists, a spokeswoman said.

[Byline: Denise Grady]

Communicated by:
ProMED-mail Rapporteur Mary Marshall

[The online article contains a review of the 2 dozen recorded Ebola outbreaks, which suggests some common themes. It also contains an open interactive feature. - Mod.LK]

[2] News
18 May 2017 DRC: Tackling Ebola outbreak in remote Congo presents huge challenge: WHO
[An Ebola outbreak affecting up to 20 people in an extremely remote area in the Democratic Republic of Congo presents a high risk at a national level, the World Health Organization (WHO) said on [Thu 18 May 2018].

In an update on an outbreak that officials believe began in late April, the United Nations health agency said there were 2 confirmed and 18 suspected cases of Ebola infection. A total of 3 people have died among the suspected and confirmed cases, including a 39-year-old man thought to be the first, or so-called "index," case. Peter Salama, the WHO's executive director for health emergencies, said the agency's risk assessment on the outbreak was that it is high at a national level, medium at African regional level and low at global level. However, he added: "We cannot underestimate the logistic and practical challenges associated with this response in a very remote and insecure part of the country.

"As of now, we do not know the full extent of the outbreak, and as we deploy teams over the next few weeks, we will begin to understand... exactly what we're dealing with," Salama told reporters on a telephone briefing. He said the immediate priority would be to trace the around 400 recorded contacts of the suspected and confirmed cases.

This latest Ebola outbreak is Congo's 8th, the most of any country. The deadly hemorrhagic fever was first detected in its dense tropical forests in 1976 and named after the nearby river Ebola.

The WHO said the outbreak is centered in the Likati Health Zone in the remote province of Bas-Uele in northeastern Congo near the border with Central African Republic.

Salama described the area, which is around 1400 km [approx. 870 mi] from the capital Kinshasa, as isolated and hard-to-reach, with virtually no functioning telecommunications and few paved roads.] ...more
[Byline: Kate Kelland]

18 May 2017 DRC: WHO--400 contacts being traced in Congo's Ebola outbreak
[Health workers are monitoring more than 400 people amid an Ebola outbreak in a remote corner of Congo where already 3 deaths have been blamed on the virus, the World Health Organization said [Thu 18 May 2017]. Authorities believe 3 deaths are linked to the outbreak: a 39-year-old man who died before he could reach a hospital, the motorcyclist transporting him and a caregiver traveling with them. So far just 2 cases have been confirmed by laboratory testing. There are 18 other suspected cases.] ...more

18 May 2017 DRC: Government [Lusaka, Zambia] installs scanners to detect SARS, Zika and Ebola at entry points
[The government] has installed 14 thermography scanners at international airports and various border posts to scan and detect infectious diseases such as severe acute respiratory syndrome (SARS), Zika and Ebola] ...more

17 May 2017 DRC: Kenya issues Ebola alert after DR Congo outbreak
[The Kenyan Government has issued an Ebola alert following an outbreak of the viral disease in the Democratic Republic of Congo (DRC). A statement from the Ministry of Health said that holding rooms at the Jomo Kenyatta International Airport and other border points have been reactivated to isolate suspected cases. Director of Medical Services Jackson Kioko stated that the ministry has also re-activated rapid response teams and will follow up cases of travellers with elevated body temperature, and asymptomatic cases.] ...more
[Byline: Simon Ndonga]

[A ProMED/Healthmap of Kenya can be found at http://healthmap.org/promed/p/174]

17 May 2017 DRC: Tanzania: Rukwa Residents Cautioned On Ebola
[Sumbawanga -- The Rukwa Regional Government leadership has cautioned its residents, particularly those living in border areas, about the Ebola disease outbreak. The move comes after some people in the neighboring country of the Democratic Republic of Congo (DRC) were discovered recently to be suffering from the deadly disease.] ...more
[Byline: Mussa Mwangoka]

[A ProMED/Healthmap of Tanzania can be found at http://healthmap.org/promed/p/200]

18 May 2017 DRC: As Ebola outbreak grows, question of using vaccine becomes more urgent
[As health officials and aid workers head to a remote corner of the Democratic Republic of Congo (DRC) to respond to an outbreak of Ebola virus disease, a key question remains: Will the government authorize the use of a promising experimental vaccine? The vaccine had stunning results in a clinical trial in Guinea in 2015, but it has yet to be licensed for broad use.

As DRC officials weigh whether to use the vaccine, new details are emerging about the outbreak, which so far includes 20 suspected cases and 3 deaths, including the 1st, or "index," case. Most cases are in the Bas-Uélé health zone that borders the Central African Republic. A total of 3 teams there are working on identifying suspect cases, educating the communities, and investigating villages where "non-secure" funerals have taken place. They are also contacting a traditional healer in Nambwa who "received the index case"--a 45-year-old man who first sought help on 22 Apr 2017--for 6 days.

In Likati, the largest town in the area, another team is overseeing a database of the cases. Two mobile laboratories are on their way, as are personal protective equipment for frontline responders, reagents for 100 tests, and GPS's for field crews. More experts from the government, the WHO, Doctors Without Borders (MSF), and the Alliance for International Medical Action are on the way, and a helicopter is being arranged to bridge Likati to other places.

A WHO situation report issued [16 May 2017] ups the ante further: it says health workers are following about 400 close contacts of cases--a jump from 125 in the report from the day before. And one of the latest suspected cases inexplicably is several hundred kilometers from the confirmed outbreak--in the Haut-Uélé province that borders South Sudan.

Some experts question why DRC officials have been slow to request deployment of the vaccine. WHO's Strategic Advisory Group of Experts on Immunization (SAGE) met [25-27 Apr 2017] and, in meeting notes that are publicly available, explicitly spells out recommendations for deploying the still unlicensed Ebola vaccine, technically known as rVSVAG-ZEBOV-GP. The vaccine is manufactured by Merck, which has some 700 000 doses on ice in the United States. According to SAGE recommendations, the vaccine should "be promptly deployed" if a confirmed case of Ebola occurs that matches the Zaire-strain used to make the vaccine--which is the case in DRC (2 cases have been confirmed to date). Given that it's unlicensed, the vaccine must be used in a clinic study, and SAGE specifically suggests countries use the same "ring vaccination" design used in the Guinea trial that vaccinates people who came in contact with cases, and frontline responders like doctors, nurses, and funeral staff.

Epidemiologist Michael Osterholm, who directs the Center for Infectious Disease Research and Policy at the University of Minnesota in Minneapolis, says DRC--and every country at risk of Ebola virus--should have approved the use of the vaccine months ago and it should be given to contacts and frontline responders as soon as possible. Osterholm co-chaired a group of experts known as Team B that in January [2017] published a report, "Completing Development of Ebola Vaccines," which warned that critical gaps stood in the way of using rVSVAG-ZEBOV-GP before it receives approval.

"This gets down to granular planning," says Osterholm. "We want the initial response to be overwhelming so we never give an outbreak a chance to do what it did in West Africa. We want to throw everything at it in reasonable way and a vaccine is part of that."] ...more

[Byline: Jon Cohen]

[Compiled by: Celeste Whitlow ]

Communicated by:
ProMED-mail Rapporteur Mary Marshall

- 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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