Global & Disaster Medicine

Archive for the ‘Ebola’ Category

Ebola and the bush meat trade

CTV

“…….For 25 years, Patrick Matondo has earned a living buying and selling monkeys, bats and other animals popularly known as bush meat along the Congo River. Standing on the riverbank in Mbandaka, a city affected by the deadly new outbreak of the Ebola virus, the father of five said that for the first time he’s worried he won’t be able to support his family.

“Since Ebola was declared, business has decreased by almost half. It’s really, really bad,” the 47-year-old said, hanging his head…..”


DRC & Ebola: the overall outbreak total to 59 cases, which include 38 confirmed illnesses, 14 probable, and 7 suspected with no new deaths were reported, keeping the fatality count at 28.

WHO

 


14 more suspected cases have been reported in the Democratic Republic of Congo (DRC) Ebola outbreak

PS-Twitter

Peter Salama:  Deputy Director-General for Emergency Preparedness and Response

DRC update as of 9 June:
38 confirmed cases
14 probable cases
14 suspected cases
Total: 66 cases, including 28 deaths

New developments:
3 new suspected cases
11 suspected cases from 8 June reported today
12 samples tested negative
1 death in a known confirmed case


WHO: Ebola outbreak in Congo is stabilizing

WHO

 


DRC: WHO presents how experimental treatments will be used and studied among those sickened by Ebola.

WHO

Ebola treatments approved for compassionate use in current outbreak

6 June 2018

On 4 June, an ethics committee in the Democratic Republic of the Congo (DRC) approved the use of five investigational therapeutics to treat Ebola, under the framework of compassionate use/expanded access. This is the first time such treatments are available in the midst of an Ebola outbreak.

Clinicians working in the treatment centres will make decisions on which drug to use as deemed helpful for their patients, and appropriate for the setting. The treatments can be used as long as informed consent is obtained from patients and protocols are followed, with close monitoring and reporting of any adverse events.

Four of the five approved drugs are currently in the country. They are Zmapp, GS-5734, REGN monoclonal antibody combination, and mAb114.

 


DRC: Ebola outbreak total grows to 53 cases at least

DRC

SITUATION ÉPIDÉMIOLOGIQUE Dimanche 03 juin 2018

La situation épidémiologique de la Maladie à Virus Ebola en date du 02 juin 2018 :

 

  • Au total, 53 cas de fièvre hémorragique ont été signalés dans la région, dont 37 confirmés, 13 probables et 3 suspects.
  • 1 nouveau cas suspect à Iboko
  • 5 échantillons se sont révélés négatifs, dont 2 à Bikoro, 1 à Iboko et 2 à Wangata
  • Aucun nouveau cas confirmé ce jour
  • Aucun nouveau décès rapporté ce jour

Les analyses épidémiologiques ont permis d’identifier des contacts qui vivent dans les zones de santé voisines à Bikoro et Iboko. Ces contacts sont suivis et ont été conseillés de limiter leurs mouvements durant toute la période de suivi qui est de 21 jours.

 

Remarques

  • Les tests négatifs sont systématiquement retirés du tableau récapitulatif.
  • La catégorie des cas probables reprend tous les décès notifiés pour lesquels il n’a pas été possible d’obtenir des échantillons biologiques pour confirmation au laboratoire.
Actualité de la riposte Ebola

 

Vaccination

  • Depuis le lancement de la vaccination le 21 mai dernier, 1,112 personnes ont été vaccinées, dont 567 à Mbandaka, 269 à Bikoro et 276 à Iboko.
  • La ceinture de vaccination à Mbandaka a été bouclée. Toutes les personnes cibles pour la vaccination à Mbandaka, à savoir les professionnels de santé, les contacts des cas confirmés et les contacts des contacts, ont été vaccinées.

Sensibilisation

  • Ce samedi 2 juin 2018, le Ministère de la Santé à travers sa Division Provinciale de la Santé de Kinshasa, avec l’appui de l’OMS, a organisé une journée de sensibilisation auprès de 50 relais communautaires dans la zone de santé de la N’sele et celle de Maluku, à Kinshasa.
  • Ces deux sites sont les principales zones à risque dans la ville de Kinshasa en raison des différents ports qu’ils renferment et de l’aéroport de Ndjili, qui reçoivent des nombreux voyageurs faisant des navettes entre la province de Kinshasa et la province de l’Equateur, actuellement touchée par l’épidémie d’Ebola.
  • Les populations vivant dans ces zones ont été sensibilisées sur les moyens préventifs contre Ebola, tel que le lavage fréquent des mains à l’eau et au savon ou à la cendre. Les habitants ont également été invités à se rendre le plus tôt possible au centre de santé le plus proche en cas de maladie.
  • Cette journée de sensibilisation a connu la participation de plusieurs notables de ces zones, notamment les chefs des quartiers, les cadres de l’Agence Nationale de Renseignements et de la Direction Générale de Migration, les Chefs des ports, et les commissaires provinciaux.

WHO discusses Ring Vaccination in the fight against Ebola in the DRC>


A yound physician on Ebola duty in Africa: Her story.

NPR

“…..What does the center look like?

It’s our standard set-up for an Ebola treatment center. Tents are the most rapid thing we can put up. They are very large, 47-square-meter tents, divided into different zones, with toilets, showers, orange fencing. It’s a very nice structure.

Do you run a test to see if someone who’s sick actually has Ebola before admitting them to the center?

We don’t wait for test results. We start treating [suspected Ebola] patients as soon as they enter the treatment center.

What kind of treatments?

We give anti-malaria treatment, antibiotics and then symptomatic treatment as well as hydration, fever and nausea management. With Ebola you give the maximum you can in terms of supportive care. If the person gets a negative result [from the lab test] and is not an Ebola case and they’re still sick, we send them to the hospital for proper care…..

The taking of the sample is exactly the same as for any nurse who does a blood sample anywhere — but be very, very careful with the needle. Make sure you have all your materials with you before start, then just take a normal blood sample. What’s different is the way we send it to the lab.

What’s the procedure?

First when we take the blood [container] and decontaminate it — spray it with chlorine, then put it in another container sprayed with chlorine, then put it in a third container that’s sprayed before it goes to the lab.

When it gets to the lab, the lab technician is in the low-risk zone, sitting behind plexiglass. And in the plexiglass are two gloves that go into high-risk zone. So the lab tech’s hands go into the gloves and they’re manipulating [the blood sample] in the high-risk zone………”


Ebola virus disease – Democratic Republic of the Congo (May 23, 2018); 58 Ebola virus disease (EVD) cases, including 27 deaths (case fatality rate = 47%)

WHO

Disease outbreak news
23 May 2018

On 8 May 2018, the Ministry of Health (MoH) of the Democratic Republic of the Congo declared an outbreak of Ebola virus disease (EVD). This is the ninth outbreak of Ebola virus disease over the last four decades in the country, with the most recent outbreak occurring in May 2017 (Figure 1). Additional information on this outbreak is available from situation reports in the links below.

Since the last Disease Outbreak News on 17 May 2018, an additional fourteen cases with four deaths have been reported. On 21 May 2018, eight new suspected cases were reported, including six cases in Iboko Health Zone and two cases in Wangata Health Zone. On 20 May, seven cases (reported previously) in Iboko Health Zone have been confirmed. Recently available information has enabled the classification of some cases to be updated1.

As of 21 May 2018, a cumulative total of 58 Ebola virus disease (EVD) cases, including 27 deaths (case fatality rate = 47%), have been reported from three health zones in Equateur Province. The total includes 28 confirmed, 21 probable and 9 suspected cases from the three health zones: Bikoro (n=29; ten confirmed and 19 probable), Iboko (n=22; fourteen confirmed, two probable and six suspected cases) and Wangata (n=7; four confirmed and three suspected case). Of the four confirmed cases in Wangata, two have an epidemiological link with a probable case in Bikoro from April 2018. As of 21 May, over 600 contacts have been identified and are being followed-up and monitored field investigations are ongoing to determine the index case. Three health care workers were among the 58 cases reported. Figure 2 shows the geographic location of cases by health zone, as of 21 May 2018.

Figure 1: Past Ebola virus disease outbreaks in the Democratic Republic of the Congo, 1976 through 2018.

Figure 2: Geographical distribution of Ebola virus disease cases by health zone, Equateur Province, Democratic Republic of the Congo, 21 May 2018.

Public health response

The Ministry of Health is leading the response in affected health zones with the support of WHO and partners. Priorities include the strengthening of surveillance and contract tracing, laboratory capacity, infection prevention and control, case management, community engagement, safe and dignified burials, response coordination, and vaccination.

  • WHO is working with the Ministry of Health, Gavi, the Vaccine Alliance, Médecins Sans Frontières (MSF), UNICEF and other partners, including the Ministry of Health of Guinea, to conduct vaccination against Ebola for people at high risk of infection in affected health zones.
  • On 21 May 2018, ring vaccination started along with vaccination of health workers in Mbandaka (WHO) and Bikoro (MSF). Merck has provided WHO with 8 640 doses of the rVSVΔG-ZEBOV vaccine of which 7 540 doses are available in the Democratic Republic of the Congo (approximately enough for 50 rings of 150 people). An additional 8 000 doses will be available in the coming days.
  • WHO continues to strengthen surveillance and contract tracing activities. The Early Warning Alert and Response (EWAR) System was deployed to Wangata to improve the collection and management of information cases and contacts.
  • Staff in health facilities in Wangata and Bikoro continue to be trained to use EWARS and enhance surveillance activities. A hotline was re-established to assist the detection of new cases, and an alert system was setup with MSF in Wangata. Rapid Response Teams (RRT) and “relais communautaires” have been trained and activated to investigate new cases and conduct contract tracing.
  • WHO continues to coordinate with the UN Humanitarian Air Service (UNHAS) for daily air transport between Mbandaka and Bikoro. In Iboko, an airstrip has been cleared for helicopters to land.
  • Case management and infection, prevention and control activities continue to be scaled up with the establishment, stocking and staffing of Ebola Treatment Units (ETUs) within affected areas. MSF-Belgium continues support case management within the Bikoro Reference Hospital. WHO is coordinating with clinical teams (EMTs) to be on standby should further ETUs be required, and to mobilize four teams to support triage, IPC and maintenance of essential health services for the population at the major health facilities in Mbandaka, as well as a team to support a safe ambulance referral system for patients.
  • WHO, UNICEF and partners are supporting the Ministry of Health to raise awareness and engage affected communities to promote the early identification of signs and symptoms of EVD, seek prompt treatment, and practice safe and dignified burials. Risk communication activities are continuing in the affected areas and Kinshasa.
  • As of 21 May, WHO has deploymed 123 personnel. WHO is working with the Global Outbreak Alert and Response Network (GOARN) partners and technical networks, including the Emerging Diseases Clinical Assessment and Response Network (EDCARN) and the WHO Emerging and Dangerous Pathogen Laboratory Network (EDPLN) to coordinate response planning and technical support, and to deploy additional technical support. As of 21 May, 15 exerts from GOARN partners are being deployments to strengthen field teams.
  • Preparation Support Teams (PST) missions are underway in several priority countries in the region to enhance preparedness and readiness in the event of further spread.

WHO risk assessment

Information about the extent of the outbreak is still limited and investigations are ongoing. The confirmed case in Mbandaka, a large urban centre located on major national and international rivers, roads and domestic air routes, increases the risk of spread within the Democratic Republic of the Congo and to neighbouring countries. WHO has, therefore, revised the assessment of public health risk to very high at the national level and high at the regional level. Nine neighbouring countries, including Congo-Brazzaville and Central African Republic, have been advised that they are at high risk of spread, and preparedness activities are being undertaken. At the global level the risk currently remains low. This risk assessment is continuously being review as further information becomes available.

Based on the current situation and information available, the WHO Director-General convened an Emergency Committee under the International Health Regulations (IHR) (2005) on Friday 18 May to provide advice on whether the current outbreak constitutes a public heath event of international concern2. It was the view of the Committee that the conditions for a Public Health Emergency of International Concern have not currently been met.

WHO advice

In light of the advice of the Emergency Committee, WHO continues to advise against the application of any travel or trade restrictions. WHO continues to monitor travel and trade measures in relation to this event, and currently there are no restrictions on international traffic in place.

The Emergency Committee while noting that the conditions for a PHEIC are not currently met, issued the following Public Health Advice:

  • Government of the Democratic Republic of the Congo, WHO, and partners remain engaged in a vigorous response – without this, the situation is likely to deteriorate significantly. This response should be supported by the entire international community.
  • Global solidarity among the scientific community is critical and international data should be shared freely and regularly.
  • It is particularly important there should be no international travel or trade restrictions.
  • Neighbouring countries should strengthen preparedness and surveillance.
  • During the response, safety and security of staff should be ensured, and protection of responders and national and international staff should prioritised.
  • Exit screening, including at airports and ports on the Congo river, is considered to be of great importance; however entry screening, particularly in distant airports, is not considered to be of any public health or cost-benefit value.
  • Robust risk communication (with real-time data), social mobilisation, and community engagement are needed for a well-coordinated response and so that those affected understand what protection measures are being recommended.
  • If the outbreak expands significantly, or if there is international spread, the Emergency Committee will be reconvened.

For more information on Ebola virus disease, please see the link below:


1 The total number of cases is subject to change due to ongoing reclassification, retrospective investigation, and availability of laboratory results. Data reported in the Disease Outbreak News are official information reported by the Ministry of Health.

2 “Public health emergency of international concern” means an extraordinary event which is determined, as provided in these Regulations: (i) to constitute a public health risk to other States through the international spread of disease and (ii) to potentially require a coordinated international response”. International Health Regulations (2005).


Ring Vaccination against Ebola in Democratic Republic of the Congo

WHO

Ebola virus disease – Democratic Republic of the Congo: Update on Ring Vaccination

Disease outbreak news
21 May 2018

In response to the ongoing outbreak of Ebola in Equateur Province, Democratic Republic of the Congo, WHO is working with the Ministry of Health, Médecins Sans Frontières (MSF), UNICEF and other partners including the Ministry of Health of Guinea, to conduct vaccination against Ebola for people at high risk of infection in affected health zones.

On 21 May 2018, ring vaccination started along with vaccination of health workers in Mbandaka (WHO) and Bikoro (MSF). As of 21 May, Merck has provided WHO with 8640 doses of the rVSVΔG-ZEBOV vaccine of which 7540 doses are available in the Democratic Republic of the Congo (approximately enough for 50 rings of 150 people). An additional 8000 doses will be available in the coming days.

In 2017, the Strategic Advisory Group of Experts on Immunization (SAGE) recommended, that for outbreaks of Zaire ebolavirus, the rVSVΔG-ZEBOV vaccine should be used under the Expanded Access framework, with informed consent and in compliance with Good Clinical Practice. The rVSVΔG-ZEBOV vaccine is highly protective against Zaire ebolavirus and is the first with demonstrated efficacy.

Several study trials that included more than 16 000 volunteers in Europe, Africa and America show that the vaccine has a good safety profile among persons six years of age and above. In Guinea and Sierra Leone, the vaccine was used in an efficacy trial of 7500 adults in 2015 and found safe and protective against Zaire ebolavirus infection. The evidence from all 117 rings in Guinea and Sierra Leone showed that no cases of Ebola virus disease occurred 10 days or more after vaccination among all immediately vaccinated contacts and contacts of contacts versus 23 cases among eligible contacts and contacts of contacts who were not vaccinated or for whom vaccination was delayed. The estimated vaccine efficacy was 100% (95% CI 79·3–100·0, p=0·0033). This trial was conducted by WHO, with the Guinean Ministry of Health, MSF, and the Norwegian Institute of Public Health, in collaboration with other international partners. The vaccine works by replacing a gene from a harmless virus known as vesicular stomatitis virus (VSV) with a gene encoding an Ebola virus surface protein. The vaccine does not contain any live Ebola virus.

In March 2016, following a newly identify chain of Ebola virus transmission in Guinee Forestiere, 1510 individuals were vaccinated in four rings, including 303 individuals aged between 6–17 years and 307 front-line workers. It took 10 days to vaccinate the first participant following the confirmation of the first case of Ebola virus disease. No secondary cases of Ebola virus disease occurred among persons who received the vaccine.

Given the remote location and limited road access to the populations affected in the current outbreak, implementing ring vaccination and maintaining the required -80⁰C cold chain presents major logistical challenges for the Ministry of Health, MSF, WHO and other partners on the ground.

Vaccination will be implemented using a ring approach, similar to that used in Guinea in 2015, whereby the vaccine will be offered to people at risk, including but not limited to: (i) contacts and contacts of contacts; (ii) local and international health-care and front-line workers in the affected areas and (iii) health-care and front-line workers in areas at risk of expansion of the outbreak. With their agreement and consent, the individuals in the ring will be considered for the vaccination. After receiving the vaccine, individuals will be followed up for a period of time.

Each vaccination team is trained and knowledgeable of Good Clinical Practices. The team includes Guinean researchers that conducted the Ring Trial in Guinea and Sierra Leone and the intervention under Compassionate use/Expanded Access in Guinea. Any adverse effects will be treated by qualified physicians and all serious adverse effects will be reported to authorities in the Democratic Republic of the Congo, Merck and Data and Safety Monitoring Board (DSMB). They are supported by experienced logisticians. The steps for the ring vaccination are clearly defined and include:

  • 1–2 social mobilizers in the vaccination team will visit the community and explain the process to people potentially eligible for the vaccine.
  • The definition of the ring is made by two members of the vaccination team who are trained and will list all the contacts and contacts of contacts of a patient confirmed with Ebola virus (including absent residents).
  • Eligibility of participants is assessed.
  • Informed consent of each individual eligible person is sought.
  • Vaccination of eligible persons who have given their consent.
  • Persons vaccinated will be monitored by a doctor for 30 minutes following vaccination and then followed up by home visits on days 3 and 14 after vaccination.

The use of the investigational rVSVΔG-ZEBOV vaccine in the Democratic Republic of the Congo marks a milestone for the control of Ebola virus outbreaks. Nonetheless, the vaccine is just one of several outbreak control measures, including case finding, contact tracing, isolation of suspected cases, prompt laboratory diagnosis, infection control in routine healthcare facilities, safe and dignified burials, community mobilization, and effective response coordination.


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