Posted on 29TH 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
Central African Republic
- Ebola Preparatory Working Group
- Ban on repatriation of bodies
- Preparation for new outbreak
DR Congo
- Infection of pigs
- Ebola virus genetics
- Improved alerts
Zimbabwe: not Ebola
[2] Research
Polymerase Replikin
Operational research
Sierra Leone: asymptomatic infection

[1] News
25 May 2017 DRC: Congo's Ebola outbreak threatens CAR [Central African Republic] after violence forces thousands across border
[An Ebola outbreak in the Democratic Republic of Congo could spread to the neighboring Central African Republic [CAR], where militia violence has forced thousands of people to flee across the border, the World Health Organization [WHO] said on [Thu 25 May 2017].

Since early May [2017], 2 cases of the virus have been confirmed by the WHO in Congo's remote north eastern Bas-Uele province. 4 people have died so far among the 43 suspected and confirmed cases.

The affected area's isolation -- it is about 1400 kilometers (870 miles) from the capital Kinshasa -- has helped contain the spread of the highly contagious hemorrhagic fever, experts say.

Yet recent attacks by Christian militias in Central African Republic's border town of Bangassou have driven about 2750 people into Bas-Uele, raising the risk that the Ebola outbreak could spread across the border, a WHO representative said.

"There is a big concern about Ebola spreading to Central African Republic after this displacement," said Michel Yao, the WHO's representative in the Central African Republic. "We are worried as the refugees are close to the epicenter of the outbreak," he told the Thomson Reuters Foundation, adding they could become infected and carry the virus back home. While this latest Ebola outbreak is Congo's 8th -- the most of any country -- the Central African Republic lacks experience in dealing with such an epidemic, and its health system is weak after 4 years of conflict, Yao said.

More than 60 per cent of its health facilities have been damaged or destroyed by the violence since 2013, when mainly Muslim Seleka rebels seized power, triggering reprisals by Christian "anti-balaka" militias, according to aid agencies. The Central African Republic set up an Ebola treatment center and rapid response team following the West Africa epidemic, which killed more than 11 300 people between 2014 and 2016, mostly in Guinea, Sierra Leone, and Liberia, WHO said. "But there is very limited capacity outside of Bangui (the capital) and it is difficult to travel around the country due to the insecurity," Yao said. "We are concerned about how easily Ebola may spread if it arrives in the Central African Republic."

Health authorities in Congo are monitoring about 365 people who came into contact with sufferers and have dispatched mobile laboratories to the area to speed up testing of people who display symptoms, WHO said in its latest situation report. Asked about the potential for using an experimental vaccine, the WHO last week said the logistics were "complex" but that it was working with Congo's government and regulatory authorities.

[byline: Kieran Guilbert, Thomson Reuters Foundation]

25 May 2017 Nigeria: Guarding against Ebola outbreak
[... In preparation against the spread of the disease to Nigeria this time, the federal government has constituted an Ebola Preparatory Working Group with the mandate to review all protocols and lessons from our response during the last [Ebola virus disease (EVD)] outbreak in the country. The group was also expected to prepare the foundation that the country would build on handling the disease in the event of another outbreak. "The team is working to compile a list of trained Ebola virus disease case managers and get in immediate contact with them. We are identifying isolation wards that can be used immediately especially in Abuja and Lagos," said Professor Isaac Adewole, the health minister.]...

26 May 2017 Nigeria: Government bans repatriation of bodies to check Ebola
[The federal government has banned the repatriation of human remains into the country in a bid to prevent the importation of infectious ailments following the recent outbreak of the Ebola virus disease (EVD) in the Democratic Republic of Congo (DRC).

The embargo was placed yesterday [25 May 2017] on the heels of the transportation into the country by an airline, Kenya Airways, of a dead Nigerian from Kinshasa. The decision of the government is crucial in the light of the fact that in 2014, "PS" introduced [EVD] to Nigeria when he arrived from Liberia.

Addressing a press briefing in Lagos, the minister of health, Prof Isaac Adewole and the Lagos state commissioner for health, Dr Jide Idris, said the decision followed a breach of one of the nation's regulations by the foreign carrier. According to the minister, who was represented by Dr Joshua Obasanya, Kenya Airways flew the corpse into Nigeria without getting the necessary clearance from the Port Health Services of the ministry which issues guidelines for waiver before such repatriation is carried out.

Adewole said, in line with industry practice, a report had been lodged with the Nigerian Civil Aviation Authority (NCAA) to probe the incident and sanction the airline accordingly just as he disclosed that a high-powered investigation has begun to unravel the immediate and remote intentions of the perpetrator." ...

26 May 2017 Nigeria not prepared for another Ebola outbreak
[Contrary to assertion by the Nigeria Center for Disease Control (NCDC), indicating that the country is better prepared for another possible outbreak of Ebola virus disease (EVD) now than in 2014, virologist, Prof Oyewale Tomori, said Nigeria is not prepared for another outbreak. Tomori, former president of the Nigerian Academy of Science (NAS) and vice chancellor, Redeemers University, who worked with WHO, said: "If Ebola strikes in Nigeria, can we rapidly and effectively control it as we did in 2014? My answer is more a 'No' than a 'Yes'.

"The problem is with the poor state of our disease control system -- detection, reporting, sample collection and laboratory diagnosis. It is appreciated that the NCDC is making strenuous efforts to correct this national disaster. However, it will take additional support, funds, and political commitment, to repair the years of damage we have inflicted on our disease surveillance system."] ...

26 May 2017 DRC: Ebola outbreak may be smaller than feared, WHO indicates
[There are signs that the [Ebola virus disease (EVD)] outbreak in the Democratic Republic of Congo may not be as big as was once feared, WHO officials indicated on Thu [25 May 2017].

Alison Clements-Hunt, a WHO spokeswoman currently in Likati, the epicenter of the response, told STAT in an interview that 14 suspected cases have tested negative for the deadly virus.

So far there have been 2 confirmed cases, 4 probable cases, and 4 deaths. Another 40 people are currently listed as suspected cases, said Clements-Hunt. Roughly 300 people who are contacts of known or suspected cases are being monitored to see if they develop symptoms. Clements-Hunt cautioned, though, that in an outbreak the net is cast wide to try to find anyone who might have [EVD], so that they can be isolated and tested. People who are sick with [EVD] but are missed by surveillance can infect family members; if they die and are buried in traditional burial rites, those attending funerals can also be infected.

In the early stages of [EVD], symptoms are vague and could be misattributed to other conditions. In an outbreak, it is not uncommon for some suspect cases to later test positive for malaria, say, and negative for Ebola.

A mobile laboratory is now operating in Likati, Clements-Hunt said. That will speed up the process of determining the actual scale of the outbreak. A response team of about 50 people from the DRC ministry of health, WHO, UNICEF, and Medecins sans Frontieres (Doctors Without Borders) is in Likati, she said. Among those who tested negative are 5 people who were being cared for in the [EVD] treatment unit that was set up in Likati, Clements-Hunt said. 4 have been released; one is still sick with something else and needs medical care.

Given what appears to be the limited scope of the outbreak, the use of an experimental Ebola vaccine may not be required. "For the time, there doesn't seem that there was really a necessity to do so. I hope it remains the case," Dr Marie-Paule Kieny, a WHO assistant director-general, told STAT. That said, Kieny confirmed planning continues to allow for deployment of vaccine, if the government of DRC asks for it. But it may not, she acknowledged.]

[communicated by ProMED-mail rapporteur Mary Marshall]

26 May 2017 DRC: Could pigs be involved in Congo's new Ebola outbreak?
[It might all just be a big coincidence, but scientists and public health officials are investigating whether pigs are somehow involved in the Ebola outbreak now underway in a remote region of the Democratic Republic of the Congo (DRC). If so, it would add a new -- but not totally unexpected -- chapter to the virus's turbulent history.

Scientists' interest stems from 2 data points. An epidemiological investigation has indicated that the 1st person to fall sick was a hunter who had come into contact with a wild boar carcass. In addition, 84 pigs have recently died in 8 villages in Nambwa, the epicenter of the current outbreak, according to a report issued yesterday [25 May 2017] by the DRC's Ministry of Health. Researchers have taken samples from those animals, according to the report, which says a "protocol for investigation of unusual deaths reported in pigs is under development."

"I'm doubtful that the pigs actually carry Ebola, but we have to test them," says epidemiologist Fabian Leendertz of the Robert Koch Institute in Berlin, who has been consulted by the Institute of National Biomedical Research in Kinshasa about the potential link. Indeed, pigs in the DRC frequently die from other pathogens; the country often has outbreaks of African swine fever, which has a very high mortality rate. "Ebola is not even the prime suspect," says Anne Rimoin, an epidemiologist from the University of California, Los Angeles, who has worked in the DRC for 15 years and is there now.] ...

[An earlier study on susceptibility and pathogenicity of Ebola in pigs was conducted by Kobinger GP et al: Replication, pathogenicity, shedding, and transmission of _Zaire ebolavirus_ in pigs. J Infect Dis. 2011; 204(2): 200-8; https://academic.oup.com/jid/article-lookup/doi/10.1093/infdis/jir077, which demonstrated laboratory infection of pigs with _Zaire ebolavirus_ [ZEBOV]. They went on to show in Weingartl HM: Transmission of Ebola virus from pigs to non-human primates. Sci Rep. 2012;2:811; https://www.nature.com/articles/srep00811] that infected pigs can efficiently transmit ZEBOV to NHPs [non-human primates] in conditions resembling farm setting. [Their] findings support the hypothesis that airborne transmission may contribute to ZEBOV spread, specifically from pigs to primates, and may need to be considered in assessing transmission from animals to humans in general. The present experimental findings would explain REBOV [_Reston ebolavirus_] seropositivity of pig farmers in Philippines that were not involved in slaughtering or had no known contact with contaminated pig tissues. The results of this study also raise a possibility that wild or domestic pigs may be a natural (non-reservoir) host for EBOV participating in the EBOV transmission to other species in sub-Saharan Africa. See full article for references - Mod.LK]

26 May 2017 DRC: Genetic testing under way on virus behind new Ebola outbreak
[Tests are under way to determine the genetic sequence of the [Ebola virus disease (EVD)] behind an outbreak in central Africa, a US Centers for Disease Control [CDC] researcher said on [Fri 26 May 2017]. Dr Barbara Knust, an epidemiologist, told VOA's [Voice of America] Horn of Africa service that scientists are looking for "clues" about where this strain of Ebola originated and how to treat it. "That could help [us] understand how this virus is related to other viruses that have caused other Ebola outbreaks," she said.

Staff from CDC, WHO, the Congolese Ministry of Health, and other agencies are in Congo's Bas Uele province, working to contain the spread of the virus. Knust said the international response was going "fine". The latest Ebola outbreak is in northern Democratic Republic of the Congo, in a remote area near the border with the Central African Republic. WHO said that as of [24 May 2017], Ebola had killed 4 people in the area and the number of suspected cases stood at 44.] ...

26 May 2017 (DRC): New Ebola cases may show effect of improved alerts, global official says
[The rapid reaction by the Democratic Republic of Congo [DRC] to recent cases of Ebola showed lessons were learned from earlier outbreaks, a top global health official said on [Fri 26 May 2017], stressing the need to factor health into disaster risk plans.

Since early May [2017], 2 cases of the virus have been confirmed by the [WHO] in DRC's remote north eastern Bas-Uele province. 4 people have died so far among the 43 suspected and confirmed cases.

With the improved activation of early alert systems and emergency teams in Congo, "hopefully we will not get into a full-blown outbreak like it was a few years before", the secretary general of the International Red Cross and Red Cross Societies told the Thomson Reuters Foundation in an interview. "This is very different from what we experienced in Liberia, Senegal, and Guinea, where the outbreak was happening for the 1st time ever," said Elhadj As Sy. "People couldn't recognize it in time," he said. [Ebola virus disease (EVD)] in West Africa killed more than 11 300 between 2014 and 2016. Sy said the remote location in Congo -- about 1400 kilometers (870 miles) from the capital Kinshasa -- meant the highly contagious hemorrhagic fever was "quasi-quarantining itself." "One is this time building on the past experience in the Democratic Republic of Congo in the last outbreak as well as lessons learned in the last outbreak," he said.] ...

23 May 2017 Zimbabwe: no Ebola in Zimbabwe - Health Ministry
[The Ministry of Health and Child Care has dismissed reports of an outbreak of Ebola or "Ebola like" diseases in Hwange District in Matabeleland North Province. Matabeleland North provincial medical director, Dr Nyasha Masuka, said members of the public must not panic as there had been no deaths related to Ebola in the province. He said some tests conducted on patients showed that some of the 42 people who were recently admitted to Lukosi Hospital complaining of headaches, high temperatures among others were suffering from malaria.

They were also waiting for results for the other patients. Dr Masuka said the 42 cases were recorded in April [2017] and early this month [May], but no new cases were reported in the last 2 weeks. "There is no [Ebola virus disease (EVD)] or 'Ebola like' symptoms that have been detected within the province and people must not panic as it is not true. Yes, about 42 people from five villages in Hwange District were tested after they showed some kind of symptoms, although none of them showed [EVD] symptoms," he said.

"Most patients were admitted for 3 to 4 days and were given antibiotics and paracetamol. In some people, tests for malaria turned out negative." Dr Masuka said a health team was on the ground investigating. "We want to establish if the cases came from one village or a cluster of homesteads. We are also conducting investigations if there were any public gatherings like funerals or church meetings in those areas where the cases came from to see whether there might be a certain bug that might have hit the area. "Our health team is on high alert towards the seasonal changes, especially after so much rain. A lot of bugs may manifest and naturally people are bound to suffer from diseases such as viral colds, malaria and others," he said. - state media.]

[2] Research
23 May 2017: An increase in the Ebola gene polymerase Replikin Count from 2014-2015 preceded the current Ebola outbreak
[A similar increase in Replikin Count in 2012-13 preceded the 2014 [Ebola virus disease (EVD)] outbreak and no other data-driven genomic analysis is known for predicting the onset of a viral outbreak or pandemic. Ebola resurfaces in the Democratic Republic of Congo with 4 deaths and 20 suspected cases now reported, a new analysis of the Ebola gene polymerase Replikin Count, via the PubMed database, showed a correlation between the 2014 and 2017 outbreaks of the disease.

Ebola gene Replikin Counts rose sharply in 2012-13, which preceded the 2014 outbreak. An analysis of the latest data showed another rise in the [EVD] gene Replikin counts in 2014-15, which again precedes the current outbreak in the DRC. Sequence data for 2016 and 2017 are not yet available from PubMed.

"The ability to predict an outbreak or pandemic a year or more before its onset can help save hundreds if not thousands of lives," noted Samuel Bogoch, chairman of Replikins Ltd, a Boston-based biotechnology firm that has analyzed and tracked the genomic sequences of some of today's most lethal infectious diseases including SARS coronavirus [SARS-CoV disease], MERS-CoV Middle East respiratory syndrome coronavirus [MERS-CoV ] and others.

The objective, quantitative, automated Ebola gene Replikin Count measure of an increase may be the only such gene data available and has been submitted for publication in The Lancet and Science. It suggests that there should be no hesitation in instituting the maximal immediate response to the current outbreak of the Ebola virus with its 40-70 per cent lethality rate.

The genomic data Dr Bogoch and his colleagues have analyzed may be useful in the current debate about how and when to respond to the present Ebola outbreak. "Uncertainty about the severity and course of the current Ebola outbreak may again delay implementation of maximal defensive moves," he added.

Time is being lost, as was the case in the 2014 Ebola outbreak when 11 000 people died. Public health officials are addressing these questions:
- Is it time to advise against travel to the area?
- Should maximal efforts be made at this time to obtain WHO and national government clearance for the immediate application of early promising ring vaccine candidates?

Replikins are a group of gene peptides discovered by Drs Sam and Elenore Bogoch that are associated with rapid replication; they are 7 to 50 amino acids long and are sequences that are specific to amino acids, and spaces between that are identified and counted by an automated process. The Bogochs' research has shown that Replikin concentration increases before outbreaks and decreases before cessation.]

26 May 2017: Operational research during the Ebola emergency
[ref: Fitzpatrick G, Decroo T, Draguez B, et al. Operational research during the Ebola emergency. Emerg Infect Dis. 2017; 23(7); doi: 10.3201/eid2307.161389

Abstract. Operational research aims to identify interventions, strategies, or tools that can enhance the quality, effectiveness, or coverage of programs where the research is taking place. Médecins Sans Frontières admitted less than/equal to 5200 patients with confirmed Ebola virus disease during the Ebola outbreak in West Africa and from the beginning nested operational research within its emergency response. This research covered critical areas, such as understanding how the virus spreads, clinical trials, community perceptions, challenges within Ebola treatment centers, and negative effects on non-Ebola healthcare. Importantly, operational research questions were decided to a large extent by returning volunteers who had first-hand knowledge of the immediate issues facing teams in the field. Such a method is appropriate for an emergency medical organization. Many challenges were also identified while carrying out operational research across 3 different countries, including the basic need for collecting data in standardized format to enable comparison of findings between treatment centers.] ...

[communicated by ProMED-mail rapporteur Mary Marshall]

June 2017. Sierra Leone: asymptomatic Ebola virus infection http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(17)30111-1/fulltext
[ref: Glynn JR, Bower H, Johnson S, et al. Asymptomatic infection and unrecognised Ebola virus disease in Ebola-affected households in Sierra Leone: a cross-sectional study using a new non-invasive assay for antibodies to Ebola virus. Lancet Infect Dis. 2017; 17(6): 645-53; pii: S1473-3099(17)30111-1. (Published: 27 Feb 2017)
"...we have used a non-invasive assay to show that asymptomatic Ebola virus infection occurs, but accounted for only a small proportion of infections, so would have little effect on herd immunity. It is unknown whether those with asymptomatic Ebola virus infection are infectious, or could harbour virus in the long term, like some survivors. In that respect, the low proportion of asymptomatic infections is reassuring because these transmissions would be challenging to prevent. We also identified missed symptomatic cases, some of which were mild. Many questions remain, including why some people escape infection or disease despite high exposure, and whether those asymptomatically infected will have any immunity in future outbreaks.] ..."

[communicated by ProMED-mail rapporteur Mary Marshall]

[compiled by: Celeste Whitlow ]

communicated by:

[A map of the affected area in north east Congo DR 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

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