Perspective

Health care workers first to get Ebola vaccine in Congo outbreak

Health care workers operating in affected areas of the Ebola outbreak in the Democratic Republic of the Congo are the first to receive an experimental Ebola vaccine that experts hope will contain the spread of the virus.

WHO announced that the vaccination of front-line health care workers began today and that preparations were being made for a ring vaccination trial, in which contacts of confirmed Ebola cases, and contacts of contacts, will receive Merck’s V920 vaccine.

It is the first time an Ebola vaccine is being given to help stop an outbreak of the deadly disease. The vaccine was tested during the West African Ebola epidemic and found to be very effective against the strain of the virus that is causing the current outbreak. The Democratic Republic of the Congo (DRC) also authorized use of the unlicensed vaccine during an outbreak last year but ultimately chose not to use it.

According to WHO, Merck donated more than 7,500 doses of the vaccine from an emergency stockpile and Gavi, the Vaccine Alliance, contributed $1 million for operational costs. WHO said it is working with the health ministry of the DRC, Doctors Without Borders, UNICEF and others to implement the ring vaccination trial.

“Today marks a turning point in how we deal with Ebola — we are moving from a strategy of containment to one of offering communities protection and care,” Peter Salama, MBBS, MPH, WHO deputy director-general for emergency preparedness, tweeted as the vaccination campaign got underway.

There have been 49 reported cases of Ebola as of May 19 — 22 confirmed, 21 probable and six suspected, according to Salama. The latest update from the DRC health ministry included two confirmed deaths and 24 more suspected deaths.

The outbreak is centered in the remote town of Bikoro but has spread to Mbandaka, a city near the Congo River with more than 1 million people, worrying experts. However, an expert panel convened by WHO has recommended against declaring the outbreak a Public Health Emergency of International Concern.

Distribution of the vaccine is challenged by the climate. To be effective, it needs to be kept at temperatures between –60°C (–140°F) and –80°C (–176°F). But WHO said it has sent special vaccine carriers that can keep contents in subzero temperatures for up to 1 week and has set up freezers to store the vaccines in Mbandaka and Bikoro. – by Gerard Gallagher

Disclosure: Salama reports no relevant financial disclosures.

Health care workers operating in affected areas of the Ebola outbreak in the Democratic Republic of the Congo are the first to receive an experimental Ebola vaccine that experts hope will contain the spread of the virus.

WHO announced that the vaccination of front-line health care workers began today and that preparations were being made for a ring vaccination trial, in which contacts of confirmed Ebola cases, and contacts of contacts, will receive Merck’s V920 vaccine.

It is the first time an Ebola vaccine is being given to help stop an outbreak of the deadly disease. The vaccine was tested during the West African Ebola epidemic and found to be very effective against the strain of the virus that is causing the current outbreak. The Democratic Republic of the Congo (DRC) also authorized use of the unlicensed vaccine during an outbreak last year but ultimately chose not to use it.

According to WHO, Merck donated more than 7,500 doses of the vaccine from an emergency stockpile and Gavi, the Vaccine Alliance, contributed $1 million for operational costs. WHO said it is working with the health ministry of the DRC, Doctors Without Borders, UNICEF and others to implement the ring vaccination trial.

“Today marks a turning point in how we deal with Ebola — we are moving from a strategy of containment to one of offering communities protection and care,” Peter Salama, MBBS, MPH, WHO deputy director-general for emergency preparedness, tweeted as the vaccination campaign got underway.

There have been 49 reported cases of Ebola as of May 19 — 22 confirmed, 21 probable and six suspected, according to Salama. The latest update from the DRC health ministry included two confirmed deaths and 24 more suspected deaths.

The outbreak is centered in the remote town of Bikoro but has spread to Mbandaka, a city near the Congo River with more than 1 million people, worrying experts. However, an expert panel convened by WHO has recommended against declaring the outbreak a Public Health Emergency of International Concern.

Distribution of the vaccine is challenged by the climate. To be effective, it needs to be kept at temperatures between –60°C (–140°F) and –80°C (–176°F). But WHO said it has sent special vaccine carriers that can keep contents in subzero temperatures for up to 1 week and has set up freezers to store the vaccines in Mbandaka and Bikoro. – by Gerard Gallagher

Disclosure: Salama reports no relevant financial disclosures.

    Perspective
    Daniel R. Lucey

    Daniel R. Lucey

    This vaccine was given to over 5,000 study participants in Guinea during the recent Ebola epidemic where, as reported later in The Lancet, the vaccine prevented infection in people who received it soon after having contact with persons with Ebola virus infection. This postexposure ring vaccination strategy worked to eradicate smallpox epidemics in the 1970s.

    Of note, the vaccine can never cause Ebola disease because it only contains one small part of the entire Ebola virus. Also, the vaccine is still investigational. Thus, it had to be approved by the DRC both from a medical and ethical perspective. Nearly 8,000 doses of the vaccine are now in the DRC. Earning the trust of persons in the DRC who are most at risk for Ebola exposure, and thus who will be offered the vaccine, is essential. All contacts of patients and contacts of contacts will be offered the vaccine, including in the provincial capital of Mbandaka, where four  infections have been lab-confirmed.

    Whereas in the West African epidemic approximately 900 health care workers were infected and over 510 died due to Ebola, now in the DRC front-line health workers, laboratory workers, surveillance teams and burial teams will be offered the single-dose vaccine. Follow-up health monitoring is planned for at least 84 days after vaccination. This vaccine can be one new major tool to stop Ebola, along with the traditional tools DRC has used to stop its prior eight outbreaks since 1976.

    • Daniel R. Lucey, MD, MPH
    • Adjunct professor, medicine/infectious diseases, Georgetown University Hospital Research associate in anthropology, Smithsonian National Museum of Natural History

    Disclosures: Lucey reports no relevant financial disclosures.

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