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Ebola Again

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Post Options Post Options   Thanks (0) Thanks(0)   Quote Technophobe Quote  Post ReplyReply Direct Link To This Post Posted: September 13 2018 at 2:05pm
Officials pin hope on experimental drugs in latest Ebola outbreak

13 September 2018 • 1:12pm



The latest outbreak of Ebola in Democratic Republic of Congo is still a long way from being brought under control, a senior World Health Organization official has said.

In an interview with the Telegraph, Peter Salama, WHO's deputy director-general for emergency preparedness and response, said that in the original epicentres of the disease – around the towns of Mangina and Beni in the north east of the country – there were "promising signs" that the disease was coming under control.

But in the city of Butembo – where there have been four cases – the situation was less certain.

“Until we have traced every contact we cannot say for certain that the disease is under control,” he said.

The latest figures from WHO show that there have been 133 cases of the disease, including 91 deaths – making it the eighth largest Ebola outbreak in history.

The outbreak has been ongoing since the beginning of August in the north east of the country, where a number of militant groups operate and security is poor.

The Nord-Kivu and Ituri provinces of DRC, where the outbreak is occurring, are among the country's most densely populated areas with a combined population of around 11 million.

The area borders both Rwanda and Uganda and, because of the poor security situation, there is a constant flow of refugees out of the country.

Working in an area where security is such a concern has complicated the response, said Dr Salama. All responders have had to undergo security training and they are sent out with radios so staff at base can keep track of them.
"If the outbreak was to move further north or eastwards then we would be facing more complicating factors"Dr Peter Salama, WHO

Some 40 contacts living in the high-security "red zones" have been given mobile phones and asked to call in twice a day giving their temperature readings.

WHO and other responders have had to use a military escort to reach people around Oicha where there is considerable unrest.

"If the outbreak was to move further north or eastwards then we would be facing more complicating factors," said Dr Salama.

Dr Salama said that he hoped the use of experimental treatments would have an impact on the control of the disease.

As of September 11 around 29 people had been treated with the new therapies, 14 of whom had recovered and been discharged, eight have died and seven are still on treatment.

"Almost half of patients have been successfully treated so that's good news," said Dr Salama

The five therapies fall into two broad categories: monoclonal antibodies such as ZMapp and broad spectrum anti-viral drugs.

They have been approved for emergency use by the Congolese authorities and a team of clinicians, including representatives from WHO, the DRC ministry of health and NGOs such as Médecins Sans Frontières (MSF), take a range of factors into account before deciding whether to administer them.

François Esmyop, a doctor working in an MSF-run Ebola treatment centre in Mangina, said: "The first choice of drug is ZMapp but that's complex to administer so if we don't have enough capacity we will choose a second-line drug."

ZMapp is administered via an intravenous infusion and the patient needs to be continually monitored to ensure that they're getting the correct dose.

This is the first time such a range of therapies have been available during a live outbreak and doctors are keeping a close eye to work out the impact of the drugs. In previous outbreaks doctors have only been able to offer supportive care.

Dr Esmyop said: "Data is being collected but not in the same way as in a clinical trial. Setting up a clinical trial takes a lot of time and while they're being organised patients that may benefit would be left without access. We're operating under a monitored emergency use framework which allows the drugs to be used."


Sourcehttps://www.telegraph.co.uk/news/2018/09/13/officials-pin-hope-experimental-drugs-latest-ebola-outbreak/
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An Update on the Current Ebola Outbreak in the Democratic Republic of the Congo

Sep 13, 2018 | Lauren Goodwin | Outbreak News


Since the 2014 West African Ebola outbreak that claimed more than 11,000 lives, the mere mention of Ebola hemorrhagic fever is enough to send the public health world into a frenzy. The thought of another outbreak is alarming enough, but an actual confirmed epidemic calls for immediate action. Since May 2018, there have been two confirmed outbreaks of Ebola in the Democratic Republic of the Congo (DRC). The first occurred in the northwest region of the country, with 54 cases and was declared over on July 24, 2018 (1). Relief swept through the health community, but this was short-lived because on August 1, 2018, a new Ebola outbreak was confirmed by the World Health Organization (WHO), in the northeast region of the country (2). More than a month into this current epidemic, the number of cases has surpassed the previous outbreak, with no definite end in sight.



As of September 11th, 2018, nine cities have reported cases of Ebola, including Masereka, Kalunguta, Beni, Butembo, Goma, Oicha, Mabalako and Musienene in North Kivu, and Mandima in Ituri. There have been 102 confirmed cases of Ebola in the North Kivu and Ituri provinces along the Ugandan border, 61 of which have died from the infectious disease (3). Simultaneously, there are 31 probable cases and 19 suspected cases, of which 31 have died (3). Promisingly, there have been 37 cases of Ebola that have been cured (3). Most Ebola cases have been reported in Mabalako, where there have been 66 confirmed cases and 43 confirmed deaths (3).



Despite advances in the development of a vaccine for the treatment of Ebola, this particular outbreak has a unique challenge. Physicians and public health workers during this outbreak face red zones around the city of Oicha and the Ituri province, making infiltration dangerous. A red zone is a region deemed unsafe to travel by the United Nations, with a high risk of attack and the recommendation that people should not enter the area under any circumstance. Both Oicha and Ituri are active militant zones. However, with this outbreak, there is no choice but to risk safety in order to deliver life-saving care and begin work on tracking the disease. For protection, World Health Organization workers require an armed escort through these to deliver vaccines and prepare outposts for controlling the epidemic (4). The UN peacekeeping force, which has around 20,000 personnel in the DRC has provided critical support in allowing medical teams to reach these regions (5).

Source and links to more information:   http://www.healthmap.org/site/diseasedaily/article/update-current-ebola-outbreak-democratic-republic-congo-91318
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What about that new vaccine for Ebloa? Are any of the people treating Ebola patients willing to take the vaccines developed?
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UPDATE

Ebola virus disease – Democratic Republic of the Congo: Disease outbreak news, 14 September 2018

Six weeks into the Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo, the overall situation has improved since the height of the epidemic; however, significant risks remain surrounding the continued detections of sporadic cases within Mabalako, Beni and Butembo health zones in North Kivu Province. While the majority of communities have welcomed response measures, such as daily contact monitoring and vaccination where appropriate, in some, risks of transmission and poor disease outcomes have been amplified by unfavourable behaviours, with reluctance to adopt prevention and risk mitigation behaviours. There have been challenges with contact tracing activities due to the constant movement of people between health zones, individuals hiding when symptoms develop and reports of community resistance. Risks are heightened by continued transmission in local health facilities because of poor infection prevention and control (IPC) measures, sporadic reports of unsafe burials, and the detection of cases in hard-to-reach and insecure areas.

Since the last Disease Outbreak News (data as of 5 September), eight new EVD cases, all of which are confirmed, have been reported: three from Beni, three from Butembo and two from Mabalako health zones. All eight new cases have been directly linked to an, ongoing transmission chain stemming from a community in Beni.

Of the three new cases in Butembo, one was an adult male from Mangina who reported an earlier illness and then was laboratory confirmed post-recovery via testing of a semen sample when his spouse was diagnosed with EVD. Given that he was asymptomatic since travelling to Butembo, the risk of onward transmission from this individual is minimal. The other two cases were health workers who cared for a subsequently-confirmed case (reported in the last Disease Outbreak News) at a small health post and assisted in her transfer to a tertiary hospital. This brings the total to 19 reported cases among health workers: 18 were laboratory confirmed and three have died. All 19 exposures occurred in local health facilities outside of dedicated Ebola treatment centres (ETCs).

As of 12 September 2018, a total of 137 EVD cases (106 confirmed and 31 probable), including 92 deaths (61 confirmed and 31 probable)1 have been reported in seven health zones in North Kivu Province (Beni, Butembo, Kalunguta, Mabalako, Masereka, Musienene and Oicha), and Mandima Health Zone in Ituri Province (Figure 1). An overall decreasing trend in weekly case incidence continues (Figure 2); however, these trends must be interpreted with caution given the expected delays in case reporting and the ongoing detection of sporadic cases. Of the 130 probable and confirmed cases for whom age and sex information is known, adults aged 35–44 years (22%) and females (57%) accounted for the greatest proportion of cases (Figure 3).

Alerts for suspected viral haemorrhagic fever cases in the outbreak-affected areas, other provinces of the Democratic Republic of the Congo, and in neighbouring countries continue to be closely monitored and rapidly investigated. In the outbreak-affected areas, 15–31 new alerts were reported each day during the past week, of which 4–16 alerts were verified as new suspected cases requiring further investigation and testing. As of 12 September, 17 suspected cases are currently pending testing to confirm or exclude EVD. Moreover, EVD was ruled out for recent alerts from Kasaji, Tanganyika, Tshopo and Kinshasa provinces, as well as for all alerts from neighbouring countries.

Public health response

The MoH continues to strengthen response measures, with support from WHO and partners. Priorities include coordinating the response, surveillance, contact tracing, laboratory capacity, IPC, clinical management of patients, vaccination, risk communication and community engagement, safe and dignified burials, cross-border surveillance, and preparedness activities in neighbouring provinces. WHO and partners are also conducting preparedness activities in neighbouring countries.

As of 13 September, 190 experts are deployed by WHO to support response activities including emergency coordinators, epidemiologists, laboratory experts, logisticians, clinical care specialists, communicators, and community engagement specialists.

Over 5500 contacts have been registered to date, of which 1751 remain under surveillance as of 12 September 1. Of these, 75–92% were followed-up daily during the past week. A dip in contact tracing performance rates observed earlier in the week was partly attributed to delays and challenges in establishing contact tracing teams around recent cases in Butembo and Masereka health zones.

Response teams are working to address these challenges and improvements in the proportion of contacts successfully reached have been observed in recent days. Strategies are being reviewed to ensure those at high risk of disease are prioritized, rapidly detected, isolated and admitted for treatment if symptoms develop.

As of 13 September, 52 vaccination rings have been defined, in addition to 17 rings of health workers and other frontline workers. These rings include the contacts (and their contacts) of 55 confirmed cases from the last three weeks. To date, 8902 people consented and were vaccinated, including 2951 health care or frontline workers, and 2054 children.

To support the MoH, WHO is working intensively with a wide range of, multisectoral and multidisciplinary regional and global partners and stakeholders for EVD response, research and urgent preparedness, including in neighbouring countries. The includes the UN secretariat, sister Agencies, including International Organization for Migration (IOM), the United Nations Children's Fund (UNICEF), World Food Programme (WFP), United Nations Office for the Coordination of Humanitarian Affairs (OCHA), Inter-Agency Standing Committee (IASC), multiple Clusters, and peacekeeping operations; World Bank and regional development banks; African Union, and Africa Centres for Disease Control and Prevention (CDC) and regional agencies; Global Outbreak Alert and Response Network (GOARN), Steering Committee, technical networks and operational partners, and the Emergency Medical Team Initiative. GOARN partners continue to support the response through deployment for response, and readiness activities in non-affected provinces and in neighbouring countries.

ETCs are fully operational in Beni and Mangina with support from The Alliance for International Medical Action (ALIMA) and Médecins Sans Frontières (MSF), respectively. MSF Switzerland and the MoH are building a 10-bed ETC in Butembo, which is expected to be operational by 15 September and will replace the current transit centre. In Beni, ALIMA is planning to expand treatment capacity over the next two weeks. A 20-bed ETC is being constructed in Makeke in Ituri Province with the support of International Medical Corps (IMC), which is expected to be operational during the week of 17 September. A MSF transit centre is already operational in Makeke. Samaritan's Purse continues to support the isolation unit in Bunia.

ETCs continue to provide therapeutics under the monitored emergency use of unregistered and experimental interventions (MEURI) protocol in collaboration with the MoH and the Institut National de Recherche Biomédicale (INRB). WHO is providing technical clinical expertise onsite and is assisting with the creation of a data safety management board.

The MoH, WHO, UNICEF, Red Cross and partners are intensifying activities to engage with local communities in Beni, Butembo and Mangina. Local leaders, religious leaders, opinion leaders, and community networks such as youth groups and motorbike taxi drivers are being engaged on a daily basis to support community outreach for Ebola prevention and early care seeking through active dialogues on radio and interpersonal communication. Community feedback is being systematically collected and their concerns are being addressed. Local frontline community outreach workers are working closely with Ebola response teams to strengthen community engagement and psychosocial support in contact tracing, patient care and safe and dignified burials (SDBs). The current focus is to intensify activities aimed at addressing community concerns through direct partnership with community members.

The Red Cross of the Democratic Republic of the Congo, with support from the International Federation of Red Cross (IFRC) and International Committee of the Red Cross (ICRC), are coordinating SDB. As of 12 September, Red Cross has established three operational bases in Beni, Mangina and Butembo; in total, 10 SDB teams are operational. To date, 124 SDBs are reported to have been successfully conducted. Red Cross has supported the training of civil protection SDB teams to ensure operational capacity in hard-to-reach areas.

Health screening has been established at 37 Points of Entry (PoE) and more than three million travellers have been screened at these PoE.

WHO risk assessment

This outbreak of EVD is affecting north-eastern provinces of the Democratic Republic of the Congo, which border Uganda, Rwanda and South Sudan. Potential risk factors for transmission of EVD at the national and regional levels include the transportation links between the affected areas, the rest of the country, and neighbouring countries; the internal displacement of populations; and the displacement of Congolese refugees to neighbouring countries. The country is concurrently experiencing other epidemics (e.g. cholera, vaccine-derived poliomyelitis), and a long-term humanitarian crisis. Additionally, the security situation in North Kivu and Ituri continues to hinder the implementation of response activities. Based on this context, the public health risk was assessed to be high at the national and regional levels, and low globally.

As the risk of national and regional spread remains high, it is important for neighbouring provinces and countries to enhance surveillance and preparedness activities. WHO will continue to work with neighbouring countries and partners to ensure health authorities are alerted and are operationally ready to respond.

WHO advice

WHO advises against any restriction of travel and trade to the Democratic Republic of the Congo based on the currently available information. WHO continues to closely monitor and, if necessary, verify travel and trade measures in relation to this event. Currently, no countries have implemented any travel restriction to and from the Democratic Republic of the Congo. Travellers should seek medical advice before travel and should practice good hygiene.

Source:   https://reliefweb.int/report/democratic-republic-congo/ebola-virus-disease-democratic-republic-congo-disease-outbreak-15
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