Extent of Ebola outbreak in DRC may not be known for weeks

The extent of the Ebola virus outbreak in the Democratic Republic of the Congo may not be known for weeks as more teams are deployed to the remote area where cases are occurring, health officials said.

As of this week, WHO said there had been 20 suspected cases and three suspected deaths since April 22 in the northeast province of Bas-Uele. Two of the deaths were confirmed by laboratory testing to be from Ebola infection.

The outbreak is occurring in a hard-to-reach area about 800 miles from the capital of Kinshasa. While the area’s remoteness may ultimately help limit the spread of the outbreak, Peter Salama, MBBS, MPH, director of WHO’s Health Emergencies Program, said in a briefing on Thursday that it is also complicating the response.

According to Salama, the area has no functioning telecommunications infrastructure and only about 12 miles of paved roads. He said WHO would draw $10 million from an emergency fund established in the wake of the West Africa Ebola epidemic to help pay for planes and helicopters to transport people and supplies to the area. The money will also be used to repair airstrips, scale up epidemiologic teams doing contract tracing, and set up treatment centers and mobile labs.

Salama said security is an issue, too, due to the presence of Lord’s Resistance Army fighters and displaced persons from the neighboring Central African Republic.

“We cannot underestimate the logistic and practical challenges associated with this response in a very remote and insecure part of the country,” Salama said. “As of now, we do not know the full extent of the outbreak. As we deploy teams over the next few weeks we will begin to understand more and more exactly what we are dealing with.”

Salama said the risk of spread beyond the region is low because of Congo’s experience managing Ebola. It is the country’s eighth Ebola outbreak since the virus was discovered there in 1976. The last one, in 2014, killed 49 people and was unrelated to the epidemic in West Africa.

For the first time, there is an experimental vaccine that could prevent Ebola infection, but the government of Congo has still not asked to use it, according to Salama and Matshidiso R. Moeti, MB, BS, MSc, WHO’s regional director for Africa.

Gavi, the Vaccine Alliance, has said it has 300,000 doses of the vaccine, rVSV-ZEBOV, stockpiled and ready to use under an agreement signed last year with the drug’s developer, Merck. The vaccine, developed in Canada, was 100% effective at preventing Ebola infection during a 2015 ring vaccination trial in Guinea, where the West African epidemic started. It targets the same strain of the virus that WHO said is causing the current outbreak in Congo.

But it also needs to be kept at –80 C to be effective, Salama said.

“As you can imagine, in an area without telecommunications, without road access, without large-scale electrification, this is going to be an enormous challenge to mount,” he said.

There are other road blocks to using the vaccine. Because it is unlicensed, it would first have to be approved by the national regulatory agency. A study protocol that involves getting informed consent from potential recipients and monitoring them for adverse events would also have to be in place before the vaccine can be used.

Merck has said it is ready to ship the vaccine. But until these things are in place, Salama said the company would not allow any doses to leave the U.S. Still, he said WHO is preparing to move quickly if a request is made from the government.

“We could potentially mount a campaign within around a week given all of the conditions are met and all of the partners are supporting,” he said.

In the meantime, leading health agencies continued the process of mounting a response to the outbreak. Salama said Doctors Without Borders has set up one Ebola treatment center in the outbreak zone and was in the process of establishing a second one. And CDC spokeswoman Amy Rowland told Infectious Disease News that the agency was sending two epidemiologists and Ebola expert Pierre Rollin, MD, from the agency’s Viral Special Pathogens branch, to the area following a request from Congo’s ministry of health. Rowland said three CDC workers currently in Congo conducting a monkeypox vaccination campaign for health care workers would not be deploying to the outbreak area at this time.

Moeti said the initial experts deployed to the area were from staff that were in place to support polio eradication efforts in several African countries, including in Congo. – by Gerard Gallagher

Disclosures: Salama and Moeti work for WHO.

The extent of the Ebola virus outbreak in the Democratic Republic of the Congo may not be known for weeks as more teams are deployed to the remote area where cases are occurring, health officials said.

As of this week, WHO said there had been 20 suspected cases and three suspected deaths since April 22 in the northeast province of Bas-Uele. Two of the deaths were confirmed by laboratory testing to be from Ebola infection.

The outbreak is occurring in a hard-to-reach area about 800 miles from the capital of Kinshasa. While the area’s remoteness may ultimately help limit the spread of the outbreak, Peter Salama, MBBS, MPH, director of WHO’s Health Emergencies Program, said in a briefing on Thursday that it is also complicating the response.

According to Salama, the area has no functioning telecommunications infrastructure and only about 12 miles of paved roads. He said WHO would draw $10 million from an emergency fund established in the wake of the West Africa Ebola epidemic to help pay for planes and helicopters to transport people and supplies to the area. The money will also be used to repair airstrips, scale up epidemiologic teams doing contract tracing, and set up treatment centers and mobile labs.

Salama said security is an issue, too, due to the presence of Lord’s Resistance Army fighters and displaced persons from the neighboring Central African Republic.

“We cannot underestimate the logistic and practical challenges associated with this response in a very remote and insecure part of the country,” Salama said. “As of now, we do not know the full extent of the outbreak. As we deploy teams over the next few weeks we will begin to understand more and more exactly what we are dealing with.”

Salama said the risk of spread beyond the region is low because of Congo’s experience managing Ebola. It is the country’s eighth Ebola outbreak since the virus was discovered there in 1976. The last one, in 2014, killed 49 people and was unrelated to the epidemic in West Africa.

For the first time, there is an experimental vaccine that could prevent Ebola infection, but the government of Congo has still not asked to use it, according to Salama and Matshidiso R. Moeti, MB, BS, MSc, WHO’s regional director for Africa.

Gavi, the Vaccine Alliance, has said it has 300,000 doses of the vaccine, rVSV-ZEBOV, stockpiled and ready to use under an agreement signed last year with the drug’s developer, Merck. The vaccine, developed in Canada, was 100% effective at preventing Ebola infection during a 2015 ring vaccination trial in Guinea, where the West African epidemic started. It targets the same strain of the virus that WHO said is causing the current outbreak in Congo.

But it also needs to be kept at –80 C to be effective, Salama said.

“As you can imagine, in an area without telecommunications, without road access, without large-scale electrification, this is going to be an enormous challenge to mount,” he said.

There are other road blocks to using the vaccine. Because it is unlicensed, it would first have to be approved by the national regulatory agency. A study protocol that involves getting informed consent from potential recipients and monitoring them for adverse events would also have to be in place before the vaccine can be used.

Merck has said it is ready to ship the vaccine. But until these things are in place, Salama said the company would not allow any doses to leave the U.S. Still, he said WHO is preparing to move quickly if a request is made from the government.

“We could potentially mount a campaign within around a week given all of the conditions are met and all of the partners are supporting,” he said.

In the meantime, leading health agencies continued the process of mounting a response to the outbreak. Salama said Doctors Without Borders has set up one Ebola treatment center in the outbreak zone and was in the process of establishing a second one. And CDC spokeswoman Amy Rowland told Infectious Disease News that the agency was sending two epidemiologists and Ebola expert Pierre Rollin, MD, from the agency’s Viral Special Pathogens branch, to the area following a request from Congo’s ministry of health. Rowland said three CDC workers currently in Congo conducting a monkeypox vaccination campaign for health care workers would not be deploying to the outbreak area at this time.

Moeti said the initial experts deployed to the area were from staff that were in place to support polio eradication efforts in several African countries, including in Congo. – by Gerard Gallagher

Disclosures: Salama and Moeti work for WHO.

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