Posted on 06TH JUN 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
- Challenge from undocumented immigrants
Sierra Leone
- Ebola nurse returns
- BSL-3 laboratory
Congo DR
- MOH: outbreak over
- Radio network warning and tracking system
[2] Vaccine
Congo DR
- Vaccine trial
- Authorities holding off deployment of experimental vaccine
- Opinion piece on vaccine development

[1] News
29 May 2017 Tanzania: Health Minister fears Ebola coming in through undocumented immigrants
[Tanzania Police force has been urged to strengthen security at the borders as a way of managing undocumented immigrants and in turn, prevent [Ebola virus disease (EVD)] from entering the country.

Speaking to reporters at a press event today [29 May 2017], Health minister, Ms Ummy Mwalimu, said undocumented immigration was the key challenge facing the government in combating [EVD]. "There are some people who are entering the country illegally. This is hard for us when it comes to monitoring the actual number of people who are entering the country. I am afraid that people who are affected with Ebola might as well come in without being screened," she said.] ...

Sierra Leone
30 May 2017: Ebola nurse [PC] returns to Sierra Leone for the 1st time after contracting disease [in the 2014 Ebola virus disease outbreak], to get 'closure'.
[She] says despite her horrific ordeal, it was worth it after meeting the teenage girl she saved while volunteering in the West African country.] ...

1 Jun 2017 Sierra Leone: P3 biosafety lab has been a success - Dr Song
[Team leader of the Chinese CDC, Dr Jingdong Song, working at the P3 Biosafety lab in Jui [Western Area of Sierra Leone, just outside the capital Freetown], has said that since the Chinese government built the lab in Sierra Leone, it has been very successful and has been working to develop the health system in the country.

Dr Song said they came in December [2016] and they will be leaving on [28 Jun 2017]. He said 5 of them were sent from China and they have been doing Ebola, Zika, yellow fever, and monkeypox testing.

'We are now trying to establish [Lassa virus (LASV)] detection and we have already spoken with Ministry of Health officials to start doing it here. The only lab doing it is in Kenema [Eastern Province of Sierra Leone] and it is far from the city. It takes time to go and it can be dangerous, so that is the reason why we want to start doing it at Jui."

Dr Song said they have been testing [Ebola virus disease (EVD)] survivors along with [Center for Disease Control], MOHS [Ministry of Health and Sanitation] and [World Health Organization]. He said they have done 54 tests and all of them have proved negative. He also said they conduct routine Ebola detection tests on new patients. They have done 94 tests and all were negative.

"Also we have done 45 yellow fever tests and 4 tests for monkeypox and all of them were negative. We are happy that these tests were all negative because it shows that Sierra Leoneans are safe to travel and the country is safe for investment."

Dr Song said since they arrived they have also been giving lectures to staff and doing training for all so that all of them will continue to develop their skills.

The team leader said they have been working with 4 Sierra Leonean staff [who have] been exceptional in their job. He said they are doing all they can to make sure they are given scholarships to go to China and continue to specialize so that they will be able to take over the lab.

"The next team coming will work on the West Africa Tropical Research centre and they will be working for 3 years to get it done. That lab will help us build confidence between our 2 nations when we travel and do business. Also it will help develop the sub-region in tropical diseases and combat them at the earliest stage.

Talking to Mr Kamara, who has been working in the lab since 2015, he said he went to China for 6 weeks training with his colleagues and they have been working very well.

"Now we can work independently as we have been trained well. The Chinese teams that we have been working with over the years have been excellent and they have trained us to be professionals. We do hope to continue our studies in the future.

The 5 Chinese doctors working in the lab are Dr Jingdong Song, the team leader, Dr Lian Xu Xia, Dr Fei Ye, Dr Yi Zhang, and Dr Lingwei Zhu. The local staff in the lab are Idrissa Laybor Kamara, Sheku Mustapha Koroma, Ali Brima Tia, and Aminata Brima Daramy.]

[It is an excellent idea to have staff undergoing training now to prepare for future medical emergencies when outbreaks of not only Ebola, but also other dangerous viruses such as Lassa and yellow fever, may occur. - Mod.LK]

Congo DR
2 Jun 2017: Democratic Republic of Congo health minister says Ebola outbreak under control
[DR Congo's health minister says there have been no new confirmed cases of Ebola and the outbreak has been controlled. Health Minister Oly Ilunga Kalenga said on [Fri 2 Jun 2017] no new cases of the deadly virus have been confirmed in the Likati zone for more than 21 days, the maximum incubation period. However, he says experimental vaccines to fight the virus have not yet arrived. Likati is some 1400 kilometers (870 miles) from Congo's capital, Kinshasa.

The World Health Organization says 3 deaths have been blamed on the virus since it emerged [11 May 2017] in Congo's far north. Only 2 have been laboratory-confirmed as Ebola.

WHO says this was the 8th outbreak in Congo since 1976. Congo has a long track record with the hemorrhagic fever.]

2 Jun 2017: For remote African villages, radio network both warns of attacks and tracks Ebola
[In a remote region where bridges are often little more than a couple of felled trees and motorcycles are the fastest way to get around, a network of solar-powered radios is doing double duty: warning of imminent extremist attacks, as well as keeping tabs on [Ebola virus disease (EVD)] outbreaks. The network of FM and high-frequency radios in the Democratic Republic of Congo (DRC) has been growing since 2012 with funding from the US Agency for International Development [USAID], according to aid workers. It came in handy in May [2017], when EVD killed at least 3 people in an extremely remote region where there are almost no roads, no telephones, and no internet. 2 days after the 1st case was confirmed on [11 May 2017], radio operators started transmitting warnings, Catholic Relief Services said. "There is an epidemic of Ebola," they said. "It is real and it is near our villages. If a member of your family or neighbor in our community has fever, fatigue, vomits blood, has diarrhea with blood, or blood coming from the nose, do not touch it and notify the nearest health team." The broadcasts include advice on wearing protective equipment. "We were the first to report the outbreak of the disease to the humanitarian community," said Driss Moumane of Catholic Relief Services (CRS), who designed the system.] ...

[2] Vaccine
29 May 2017: Congo DR authorizes trial of experimental Ebola vaccine
[The Democratic Republic of Congo has approved using an experimental Ebola vaccine to combat an outbreak of the virus in the northeast, the government said Mon 29 May 2017.

"The DRC accepts the use of vaccines against the [Ebola virus disease (EVD)]," a source in the health ministry told AFP [Agence France-Presse], adding that the government concluded it had no objections to the tests being conducted in the country. "We're waiting for an operational plan from our partners which will determine what steps need to be taken, in which geographic areas we could vaccinate," the source added, on condition of anonymity.

A definitive decision on how the vaccine would be deployed will be released in 24 hours, the source said.

There is no licensed vaccine for the Ebola virus, but the World Health Organization said this month [May 2017] that a promising candidate vaccine exists and could be deployed within a matter of days if the DR Congo government gave its approval.] ...

[It will be difficult to test vaccine efficacy with the outbreak under control, as has been declared by the Health Minister. - Mod.LK]

2 Jun 2017: Authorities holding off deployment of experimental Ebola vaccine in Congo
[International health authorities and the Democratic Republic of the Congo are holding off on deploying an experimental Ebola vaccine to the site of the country's latest outbreak of the virus, indicating that it may now not be needed. In a statement [Thu 1 Jun 2017], medical-aid organization Doctors Without Borders said that preparations are under way for vaccination in Congo, but suggested that it will be used only if a new Ebola case arises.] ...

[As I commented earlier, it would be difficult to show efficacy of the vaccine at this time, and it appears not to be needed. This outbreak of Ebola in the DRC was well contained, mostly likely a consequence of the remoteness of the region, the expertise of the health care workers, and the experience of the population with EVD. - Mod.LK]

30 May 2016: Ebola strikes back in the DRC (opinion piece on vaccine development)
[Western governments need to realize that to completely rely on the for-profit pharmaceutical sector to drive the process to develop vaccines will be disastrous for public health.

Just when you thought it was safe to go back to the African subcontinent, [Ebola virus disease (EVD] strikes back. The World Health Organization (WHO) confirmed that a new outbreak of the disease had occurred in the Democratic Republic of Congo (DRC) on [12 May 2017]. On [21 May 2017], it revealed that a 4th person -- one of the 43 believed to have been affected and the 400 now being tracked as potential patients -- was believed to have died as a result of the virus.

However, unlike the chaos that surrounded the 1st Ebola outbreak, the authorities seem largely in control. Despite the significant logistical challenge of getting the right medical help deep into the jungles of the Democratic Republic of Congo, Matshidiso Rebecca Moeti, the WHO Regional Director for Africa says that she is "optimistic" that the outbreak can be halted quickly. She also notes that WHO Africa has learned lessons from the last outbreak to become a "more responsive, accountable, effective, and transparent organization."

This time, doctors are coming armed with the rVSV-ZEBOV vaccine candidate, developed by pharmaceutical giant Merck. The drug is slated to be 100 percent effective against one of the 5 strands of the virus and has demonstrated "compelling results" in previous trials, but it has not been licensed yet.

Undeterred by this minor detail, the WHO has 300 000 doses on hand and Moeti as indicated that the WHO "could potentially mount a campaign within a week if all of the conditions are met and personnel, financing and logistics are in place." And on [23 May 2017] the DRC submitted a formal vaccine trial protocol to an ethical review board, the 1st step towards deploying the vaccine.

Recent reports have cast a long shadow over Merck's vaccine. Indeed, the US National Academy of Medicine has challenged the methodology of the 4160-patient clinical trial and made the lukewarm statement that while the vaccine "most likely provides some protection to recipients," the protection "could in reality be quite low". Not only is the vaccine ineffective against 4 [strains] of the Ebola virus [It is effective against the Zaire strain, but it is ineffective against the strains of Sudan and Bundibugyo. - Mod.LK], but also it might be altogether useless on people with compromised immune systems (HIV positive) [but this is the case for many vaccines. - Mod.LK] or pregnant women.

Luckily, the Merck vaccine is just one of several candidates now in different phases of development. Among the most promising is GSK's [GlaxoSmithKline] cAd3-ZEBOV vaccine, with the company touting "very encouraging" findings after the 1st tests, albeit with the caveat that it will only be available in the 2nd half of 2018. And earlier in May [2017], scientists at New York's Albert Einstein College of Medicine have also indicated that they have identified 2 antibodies -- ADI-15878 and ADI-15742 -- that they believe will be able to thwart the 5 known Ebola viruses. Johnson and Johnson is developing a 2-dose vaccination approach, while China has also thrown down the gauntlet and is working on the Ad5-EBOV vaccine, based on work done by a Chinese military research unit.] ...

[Byline: Amanda Clarkson]

[There are no vaccines registered for Ebola yet, but the vaccine rVSV-ZEBOV developed by the Merck laboratory is considered the most promising one according to the WHO. In a statement dated December 2016, the organization explained that it had been "studied in a trial involving 11 841 people in Guinea during the year 2015" and that "among the 5837 subjects who received the vaccine, no case of Ebola had been recorded 10 days or more after vaccination" [excerpted from http://bit.ly/2s88I5A submitted by Roland Hübner and machine translated by SH - Mod.LK]

[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 Congo DR at http://healthmap.org/promed/p/194. - Mod.LK]

See Also

Ebola update (26): news, research 20170529.5068444
Ebola update (25): news, research, vaccine 20170524.5057906
Ebola update (24): news, research, vaccine 20170521.5050743
Ebola update (23): DRC, news, vaccine 20170519.5047049
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
Ebola update (17): Congo DR, vaccine, research 20170512.5031411
Ebola update (16): news, research, vaccines, funding 20170428.5000661
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Ebola update (14): news, research, vaccine 20170410.4959931
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Ebola update (02): news, research, vaccine, comment 20170108.4750411
Ebola update (01): News, research, vaccine 20170103.4738060
Ebola update (72): vaccine, research, NGO, media 20161226.4724859
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Ebola update (50): Liberia, Sierra Leone, research 20160724.4366266
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Ebola update (48): CDC, research, funding, economy 20160710.4336146
Ebola update (47): Liberia, US preparedness, funding, research 20160703.4323924
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