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Congo faces 9th Ebola outbreak with new tools, including vaccine
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On May 8, health officials in the Democratic Republic of the Congo declared a new Ebola virus outbreak — the ninth in the country’s history — after the confirmation of two cases in the rural northwestern town of Bikoro.
Remoteness is generally considered a reassuring characteristic of Ebola outbreaks in the Democratic Republic of the Congo (DRC). While complicating the process of getting supplies and help to the affected area, hard-to-reach places can help to isolate the spread of the virus, experts have said. Last year, a rural outbreak of Ebola in a different part of the country was brought under control after infecting eight people and killing four.
But officials raised fears of a much larger outbreak this time after new cases were reported 80 miles away from Bikoro in the provincial capital of Mbandaka, a city of more than 1 million people on the Congo River. Trade routes connect Mbandaka with several even larger cities, including the DRC capital of Kinshasa, with a population approaching 10 million.
“You must think about the river as if it’s a highway — that’s what it is in that area,” Peter Salama, MBBS, MPH, WHO deputy director-general for emergency preparedness and response, told reporters.
According to Salama, officials responded by setting up dozens of screening points along the river, where people were checked for infection. The outbreak response also included tracking hundreds of contacts in Bikoro, Mbandaka and another town, Iboko, and establishing isolation facilities not only in these places but also in other areas where cases could potentially show up, including the small town of Liranga, which sits downriver from Mbandaka in the DRC. Salama said personal protective equipment was sent to Liranga to prepare for the eventuality that Ebola may show up there.
“The logistics and demands on the teams in the field are pretty extreme — urban and deep field operations at the same time,” said Michael J. Ryan, MB, BCh, MPH, WHO assistant director-general for emergency preparedness and response.
In addition to traditional response measures, the DRC also has new tools to fight its most recent Ebola outbreak, including a pioneering vaccine and several investigational therapies.
The vaccine, Merck’s V920, was tested at the height of the West African Ebola epidemic and found to be highly protective against the Zaire strain of the virus — the same one causing the current outbreak in the DRC. Merck has stockpiled more than 300,000 doses of V920 for emergency use, but because the vaccine is not registered anywhere, it can be used only as part of a clinical trial. The DRC was prepared to use it in last year’s outbreak but ultimately deemed it unnecessary.
Secured by a complicated cold chain, vaccinations in the current outbreak began May 21 in Mbandaka, as the combined case count in all areas reached 50. The vaccine was given on a voluntary basis, first to front-line health care workers and then to anyone who had contact with confirmed Ebola cases or their contacts. Among the vaccinated were several motorcycle taxi drivers who had transported patients to health centers.
The approach, known as ring vaccination, was also used to test the vaccine in West Africa. After initially prioritizing vaccine use in Mbandaka to prevent a large urban outbreak — and with the city “relatively safeguarded,” Salama said — officials refocused on the rural towns of Bikoro and Iboko, where the overwhelming majority of cases were occurring.
“The vaccination campaigns really offer a whole new way forward,” Ryan said. “It’s the first time in my experience where walking into villages with vaccination teams, you see hope and not terror.”
Additionally, the DRC also planned to test five investigational therapies for Ebola virus infection during the outbreak, including a monoclonal antibody developed by the NIH in the United States from antibodies taken from a survivor of the 1995 Ebola outbreak in Kikwit, DRC.
“It’s kind of nice that it came full circle,” National Institute of Allergy and Infectious Diseases Director Anthony S. Fauci, MD, told Infectious Disease News. “An antibody that we derived from one of their citizens is now going back there to potentially help them.” – by Gerard Gallagher
Disclosures: Fauci, Ryan and Salama report no relevant financial disclosures.