Posted on 21ST MAY 2017
tagged Ebola, Worldwide

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

In this update:
[1] News
DR Congo (screening at borders, no travel advisory, residents flee, bushmeat consumption)
[2] Research
[3] Vaccine

[1] News
19 May 2017 Nigeria: Ebola -- no screening points, machines at Seme border - report
[Screening points, detecting machines, hand sanitizers, and other measures to prevent an [Ebola virus disease (EVD)] outbreak in [Nigeria] have yet to be provided at the Seme border [settlement in Nigeria on the border with Benin]. Several measures have been put in place at major airports in Nigeria to prevent and curtail the dreaded disease, but no such action was seen to prevent the disease at the border.

The reports also said travelers and residents are also yet to be sensitized on the re-emergence of [EVD] in DRC [Democratic Republic of the Congo] and measures the government is putting into place to curtail its spread to Nigeria. In addition, Port Health officials were not screening people going in and out of the country through the border. A port health official, who pleaded for anonymity, told NAN [News Agency of Nigeria] that there is no equipment to screen people. "We are aware of the recent outbreak of Ebola and the need to put measures on ground since this is the busiest border in the country, but there is no equipment for us.

In addition, commuters around the border area who spoke to NAN do not have knowledge of the recent outbreak of Ebola in DRC. A commercial bus driver said that he was not aware of the recent outbreak. "I have not heard about anything. As a matter of fact, I'm just hearing this from you but I'm glad I know so I will be careful," he said.]

19 May 2017 DRC: [Ebola virus disease (EVD)] in DR Congo: CDC not ready to issue travel advisory
[The US Centers for Disease Control and Prevention (CDC) is still mulling over whether to issue a travel advisory regarding the developing Ebola outbreak in the Democratic Republic of Congo. When asked whether the agency planned to recommend restricting travel to the country and surrounding regions, a spokesperson from the CDC told Newsweek "not at this point."

The agency says several factors are considered when deciding on the timing of a travel advisory, "including the size of the outbreak and number of people infected. As we learn more that will guide the decision to issue an advisory or not," the CDC spokesperson added. "It comes down to risk/threat assessment and so far risk does not warrant advisory." On [Fri 19 May 2017], [the World Health Organization, WHO] confirmed through lab testing that there are no cases of Ebola outside the DR Congo.] ...more

19 May 2017 DRC: Residents flee as suspected cases of Ebola outbreak in Congo grow
[Ebola drove KB, his wife, and 3 children to get to this capital city [Kinshasa] as fast as they could to try to outrun a suspected new outbreak.
"We can't stay here because there are no hospitals, and once you get the virus you simply die," said KB, from Bas-Uele province in the north of the country, about 51 hours away from Kinshasa. "Residents are still not aware of the virus and they do not know the precautions (to take)," he added. "Very many people are going to die here."

KB was among residents from the northern regions of the Democratic Republic of Congo who are hitting the road after the World Health Organization (WHO) said suspected cases of Ebola have killed 3 and sickened 20 [now 29 - Mod.LK] people in the country's north since late April [2017]. Officials are tracking another 125 people thought to have contracted the virus.] ...more]
[Byline: Ameen Auwalii, Tonny Onyulo]

[As always, it is important that public educational materials are distributed widely to make the population aware of the risks, and prevention measures to take. - Mod.LK]

20 May 2017 DRC: Ebola threat -- bushmeat vendors panic, advocate prevention
[With news of fresh Ebola outbreak in the Democratic Republic of Congo, bushmeat vendors in Nigeria have called on the Federal Government to tighten measures aimed at preventing a resurgence of the epidemic in Nigeria.

The businesses of bushmeat vendors in Nigeria, where meat sourced from feral animals is a delicacy across the country, were particularly hit by lack of patronage during the Ebola epidemic in 2014. This was a result of the fear that wild animals and bush meat could carry the deadly virus, which according to health officials originated from baboons and bats.] ...more

[Consumption of bushmeat presents a major threat to the population. It is a difficult situation since people must eat to survive, but bushmeat consumption is dangerous to people's health and destructive of wildlife. -Mod.LK]

20 May 2017 DRC: Govt introduces screening at borders in response to Ebola outbreak in DRC
[The Ministry of Health has begun screening for temperature at all border posts with DR Congo in Rubavu and Rusizi districts in response to Ebola outbreak in the neighboring country's northern region. The screening uses non-contact infrared laser thermometers, according to a statement by the ministry.

The border points are estimated to have between 40 000 and 45 000 people crossing daily.

Ebola has so far claimed 2 lives in northern DR Congo, according to the World Health Organization, while 29 people are suspected to have the virus.

In a statement, health minister Diane Gashumba said [all of those traveling] to Rwanda from DR Congo with fever will not be allowed to enter the country, while those who have been in the Bas Uele Province within the last 22 days will be stopped from boarding flights to Rwanda.
Congolese health officials and their partners are also monitoring about 400 people who could have come into contact with the suspected cases.] ...more

[2] Research
18 May 2017: Researchers identify antibodies that hold promise as Ebola treatments
[The fight to contain the 2013-16 Ebola outbreak in West Africa was hampered by the lack of an effective treatment or vaccine. Researchers funded in part by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health (NIH), have studied the blood of an Ebola survivor, searching for human antibodies that might effectively treat not only people infected with Ebola virus, but those infected with related viruses as well. Now the researchers have identified 2 such antibodies that hold promise as Ebola treatments. Previously, researchers had discovered only one antibody -- from a mouse -- capable of protecting mice against multiple different species in the ebolavirus lineage. To find similar broadly protective human antibodies, researchers surveyed 349 human monoclonal antibodies derived from the blood of one survivor of the recent West African Ebola outbreak, which was caused by Zaire ebolavirus. They searched specifically for antibodies that might neutralize all 5 common ebolavirus species.

The researchers mined the human immune response to natural infection by the Ebola virus and found 2 antibodies, ADI-15878 and ADI-15742, which recognized the GP fusion loop -- a section of a protein found on the surface of the Ebola virus. By analyzing the structure of these antibodies and testing their action on the viruses, the researchers determined that when given access to the GP fusion loop, the antibodies could likely block the 5 related ebolaviruses from entering a host cell. Moreover, when tested with human cells in a laboratory setting, the antibodies protected the cells from becoming infected with several different virulent ebolaviruses.] ...more
[Also see https://www.niaid.nih.gov/news-events/antibodies-ebola-survivor-protect-...

[3] Vaccine
19 May 2017: WHO seeking to bring Merck Ebola vaccine to latest outbreak area
[The World Health Organization (WHO) is laying the groundwork for Merck & Co Inc's unlicensed VSV-ZEBOV Ebola vaccine to be used to combat the new outbreak of the virus that started last month in the Democratic Republic of Congo (DRC). If all the pieces fall into place, a vaccination campaign could start "in about a week," according to Peter Salama, WHO executive director, Health Emergencies Program. However, there are significant hurdles to be navigated first. The outbreak is in an extremely remote, strife-torn part of DRC where there are only 20 kilometers [12.5 miles] of paved roads, no telecommunications network, and limited health facilities.

The difficulties posed by the lack of infrastructure are further compounded by the fact that the vaccine needs to be kept at -80 deg C [-112 deg F]. "In an area without roads and communications that is going to be an enormous challenge," Salama said. Before any VSV-ZEBOV can be moved from the stockpile in the US, the government of DRC will have to make a formal request to allow compassionate use of the unlicensed product. There will also have to be a detailed, ethically approved study protocol, subjects must give informed consent and the systems must be in place to track adverse events. That calls for skilled people to be on the ground and WHO is working with partners, including Médecins Sans Frontières and the Red Cross to pull teams together.

Salama said the government of DRC has been made aware VSV-ZEBOV is available. "They are in the process of considering it. The health minister [Oly Ilunga Kalenga] has asked regulators to look at the protocol," he said. WHO is committed to working with Merck and others to implement a vaccination program if the government gives the go-ahead.

As of [Wed 17 May 2017], there have been 20 cases of Ebola [29 now - Mod.LK] of which 2 have been confirmed by laboratory tests and 18 are suspected. The index case was a man who died on [22 Apr 2017]. Since then, his carer, and a motorcycle driver who took him to seek medical assistance have died, too.

WHO was first alerted to a cluster of unexplained hemorrhagic illness and deaths on [9 May 2017] and the 1st case was confirmed as Ebola virus infection on [11 May 2017].

The emergency management team at WHO was then activated and other partners mobilized. On [17 May 2017] Kalenga and Allarangar Yokouidé, WHO's representative in the DRC, carried out a 1st visit to assess the outbreak in Nambwa, epicenter of the disease, in the Likati health district, Bas-Uele province, which is located more than 1400 kilometers [870 mi] from the country's capital, Kinshasa.

On that visit, the health officials were accompanied by 12 experts, including epidemiologists, logisticians, psychologists and data managers, who conducted a rapid assessment of outbreak.

Salama said the immediate focus is on surveillance, community engagement and following the 400-plus contacts of the 20 identified cases. The 1st Ebola treatment center has been established, a mobile laboratory is being deployed and protective clothing and equipment is being shipped in.

This is the 8th outbreak of Ebola in DRC since the 1st-ever case of the infection was identified there in 1976. During the 2013-2016 epidemic there were 66 cases in the country. "We believe the government has strong experience of dealing with Ebola outbreaks," Salama said. "But you can't underestimate the logistical challenges -- as of now we don't know the extent of the outbreak."

Ring vaccination trial
The proposed VSV-ZEBOV program will not involve the whole population, but will be a ring vaccination, in which immediate contacts of patients infected with Ebola are immunized. That was the approach used in the phase III study of VSV-ZEBOV, which took place in Guinea during the 2013-2016 Ebola epidemic. That trial, published in December 2016, showed the vaccine to be 100 percent effective, with no one who received VSV-ZEBOV contracting the virus. (See BioWorld Today, 27 Dec 2016; http://www.bioworld.com/content/mercks-ebola-vaccine-remarkable-final-ri....)

Salama said the work on contact chasing and epidemiology will form an important pillar in deploying VSV-ZEBOV. "This detective work is critical for implementing a ring vaccination program," he said.

In the Guinea trial, 10 000 people were vaccinated. GAVI, the vaccine alliance, gave Merck USD 5 million to manufacture a stockpile of 300 000 doses on the understanding that VSV-ZEBOV would be submitted to the FDA and EMA for approval by the end of 2017. The vaccine has FDA breakthrough therapy and EMA Prime (priority medicine) designations.

Merck also submitted VSV-ZEBOV to WHO's emergency use and assessment listing procedure. The application was considered by WHO's strategic advisory group of experts (SAGE), meeting in Geneva from 25-27 Apr 2017.

The group recommended that in the case of outbreaks the vaccine be promptly deployed under the expanded access framework, using ring vaccination. That should include contacts and contacts of contacts; local and international health care and front line workers in the affected areas.

An expanded access study protocol should be implemented and the study should be used as an opportunity to accumulate additional information on VSV-ZEBOV's safety, efficacy and effectiveness, SAGE said.

VSV-ZEBOV, a recombinant, replication competent vesicular stomatitis virus expressing a surface glycoprotein of Zaire Ebola virus, was initially engineered by scientists at Canada's Public Health Agency. It was subsequently licensed to Newlink Genetics Corp, of Ames, Iowa, which did a deal with Merck in late 2014. (See BioWorld Today, 25 Nov 2014; http://www.bioworld.com/content/merck-takes-50m-license-newlink-ebola-va....)

The phase III Guinea ring trial was funded by WHO, the Wellcome Trust, the UK Department for International Development, the Norwegian Ministry of Foreign Affairs, the Norwegian Institute of Public Health, the Public Health Agency of Canada, and Médecins Sans Frontières.]

[Byline: Nuala Moran]

[Compiled by: Celeste Whitlow ]

Communicated by:

- Democratic Republic of the Congo (4 deg 18' 38" S, 15 deg 17' 22" E)
- Democratic Republic of the Congo (2 deg 52' 34" S, 23 deg 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]

See Also

Ebola update (23): DRC, news, vaccine 20170519.5047049
Ebola update (22): WHO sit rep, news, research, vaccine 20170518.5044073
Ebola update (21): Congo DR, News, Research, Vaccine
Ebola update (20): Congo DR, news, vaccine, update 20170515.5037761
Ebola update (19): Congo DR, Nigeria preparedness 20170514.5035550
Ebola update (18): Congo DR, vaccine 20170513.5034029
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