DRC – Ebola

Milestones :: Perspectives

DRC – Ebola

 

Ebola response in Democratic Republic of the Congo risks slowdown – WHO
26 February 2019 – News Release
Geneva, Switzerland
WHO Director-General Dr Tedros Adhanom Ghebreyesus today called on donors to continue funding the response to the Ebola outbreak in the Democratic Republic of the Congo or risk backsliding. There is an urgent need for US $148 million for all partners involved in the response to continue their work. So far, under US $10 million has been pledged.

The call comes a week ahead of Dr Tedros’ next mission to DRC. He is scheduled to meet President Tshisekedi in Kinshasa before travelling to the Ebola-stricken areas of Butembo and Katwa.

“The situation is unprecedented: there has never been  an Ebola outbreak in these conditions, with such a highly mobile population and  with many gaps in the health system.” said Dr Tedros.

“The security context is another major concern. I am deeply saddened by reports that a health facility run by Médecins Sans Frontières in Katwa was attacked on Sunday night. Nevertheless, together with partners and with the Democratic Republic of the Congo government in the lead, we have made major gains. Hundreds of deaths have been averted, maybe even thousands. But the outbreak is not over and we urgently need additional funding to see it through.”

Over 80,000 people have been vaccinated and over 400 have received treatment. Thousands of suspect cases have been monitored, tested and transferred to other centres once they were confirmed to not have Ebola. More than 40,000 contacts have been identified and reached daily for three weeks each to ensure they did not fall sick as well. WHO alone has shipped over 300 metric tons of supplies, including vaccination supplies and 470,000 sets of personal protective equipment for partners running treatment centres.

Alongside the response in the country, hundreds of health workers, border officers and other responders in neighbouring countries have been trained and prepared for a responding to a potential case…

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Medical activities suspended after Ebola treatment centre attack
Democratic Republic of Congo
MSF Statement 28 Feb 2019
Médecins Sans Frontières (MSF) has put on stand-by its medical activities in the epicentre of the Ebola epidemic, in Butembo and Katwa, in the province of North Kivu, Democratic Republic of the Congo. This follows an attack on an Ebola treatment centre in Butembo city during the evening of 27 February.

Unidentified assailants set some of the compound’s facilities and vehicles on fire. The blazes were contained, but the teams were obliged to immediately cease patient care. At the time of the attack, there were 57 patients admitted in the treatment centre, which was run alongside the Ministry of Health; 15 of the patients were confirmed to have Ebola.

This incident comes only days after another Ebola treatment facility, also supported by MSF teams in the neighbouring district of Katwa, was attacked on 24 February – also forcing its suspension. MSF has evacuated our staff from the area for their safety pending a thorough analysis of the risks associated with continuing to provide medical care there.

“We are extremely saddened by these attacks on our medical facilities. Not only did they endanger the lives of our staff members, they also endangered the most vulnerable people at the heart of our response: the patients,” said MSF emergency desk manager Hugues Robert.

“In light of these two violent incidents, we have no choice but to suspend our activities until further notice. As medical responders, it is very painful to have to leave behind patients, their families and other members of the community at such a critical time in the Ebola response.”

No staff or patients were harmed, but both attacks were traumatic for patients, their relatives and staff who were inside the centres at the time. The caretaker of one patient died during the attack on the centre in Katwa, allegedly when he tried to flee.

Almost seven months after the beginning of the current Ebola outbreak in the provinces of North Kivu and Ituri, there have been 879 confirmed cases of Ebola and 553 people have died (488 deaths are confirmed cases).

In addition to the treatment centres in Butembo and Katwa, MSF also manages Ebola-related activities in the North Kivu towns of Kayna and Lubéru, and runs two Ebola isolation facilities in Ituri province, in the towns of Bwanasura and Bunia. In the city of Goma, MSF has been supporting emergency preparedness by reinforcing the surveillance system and ensuring there is adequate capacity to isolate suspected cases.

DRC 2018 Ebola outbreaks
Crisis update – February 2019
Crisis Update 28 Feb 2019

DRC 2018 Ebola outbreaks
Second Ebola treatment centre in North Kivu attacked
Statement 28 Feb 2019

DRC 2018 Ebola outbreaks
North Kivu: Ebola centre inoperative after violent attack
Press Release 26 Feb 2019 

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Statement
Statement by UNICEF Executive Director Henrietta Fore on the recent attacks against Ebola treatment centers in the DRC
NEW YORK, 28 February 2019 – “I am appalled by the latest violent attack against an Ebola treatment center that was providing care to children and families in Butembo, in the eastern Democratic Republic of the Congo (DRC). During the incident yesterday – the second such attack in less than a week – a police officer was killed and part of the facility set ablaze.

“I offer my heartfelt condolences to the family members and colleagues of the officer who lost his life in yesterday’s attack, and to the Médecins Sans Frontières (MSF) staff who are providing care to people under very difficult conditions. I also commend the ongoing efforts of partners on the ground – including WHO, MSF, ALIMA and other organizations – for their ongoing work under the leadership of the DRC Government and Ministry of Health to stop the Ebola epidemic and assist children and families affected by the disease.

“Each day, the staff of UNICEF and our partners, including health workers at the treatment centers and in the communities are making truly heroic efforts to save the lives of children and adults infected with the Ebola virus. This work stands as a bulwark against the deadly outbreak – now the second largest in history – stopping it from spiraling out of control. It is unconscionable that anyone would seek to rob children and families of a service that could mean their very survival.

“The only way we can end this outbreak together is for health workers, UNICEF and our partners, to be able to operate safely in all communities affected by the disease, including in the most remote areas. Medical facilities should not be collateral damage of the insecurity in eastern DRC.

“More than 800 people in the DRC have already been infected with Ebola during this latest outbreak, 500 of whom have died. Children account for one third of all confirmed Ebola cases, more than any previous outbreak. Reprehensible attacks against lifesaving treatment centers, health care and humanitarian workers, could make the situation much worse.

“There is some hope: the disease is now largely under control in the former hotspots of Mangina, Beni, Komanda; more than 250 people have been cured and 80,000 protected through vaccination. UNICEF and our partners have reached more than 10 million people with information about preventive measures to protect themselves from infection and prevent further spread. We’ve also identified more than 1,000 Ebola orphans and separated children and are helping to provide them with care.

“Now is the time to build on those achievements and bring this outbreak to an end. UNICEF urges those who use violence against the Ebola response to cease these activities immediately, and to enter into dialogue with local communities and authorities to better understand the true nature of the Ebola epidemic and become part of the solution in the fight against the deadly Ebola virus disease.”

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WHO – Ebola Outbreak
Interim recommendations for Ebola vaccines pdf, 273kb
20 February 2019
[Excerpt]
…SAGE also reviewed data on all Ebola candidate vaccines currently undergoing clinical evaluation. There are three candidate vaccines other than the rVSV-ZEBOV-GP vaccine, that are in advanced stages of clinical evaluation or have been licensed. Two of them are licensed in their country of origin (Ad5-EBOV, monovalent Zaire Makona, licensed in China; and GamEvac-Combi, monovalent Zaire Makona, licensed in Russia). A third vaccine candidate (Ad26.ZEBOV & MVA-BN-Filo, based on a prime/boost strategy using a multivalent, Zaire Mayinga, Sudan, Tai Forest and Marburg,) will be submitted for approval under the United States Food and Drug Administration (US FDA) Animal Rule.

Conclusions and recommendations
Based on the empirical data available from DRC North Kivu province, and the preliminary results of modeling, SAGE concluded that the currently recommended strategies for rVSV-ZEBOV-GP vaccine delivery, ring vaccination and geographic targeted vaccination, are effective. The Ring + strategy will likely have a less marked impact on the number of new cases than that of the current recommended strategies, and it requires the vaccination of a larger number of additional people, several of them probably at low or no risk of EVD. The Ring + approach would be unlikely to provide added benefit over existing strategies and is therefore not recommended.

As SAGE noted previously1, it is important to advance the clinical evaluation of other vaccines against EVD and to accrue additional information on their immunogenicity, safety and efficacy if possible. Noting the available data, SAGE recommends that consideration is given to the use of any of these three above mentioned new vaccines to vaccinate HCWs and FLWs in the neighboring areas where there is a possibility of spread. Such vaccination should be implemented as part of a randomised clinical trial and in compliance with GCP and informed consent. Since these three new candidate vaccines are non-replicating or replication deficient, pregnant and lactating women should be included into the clinical trial protocols. The protocols must include provisions for safety monitoring and for documentation of EVD cases among vaccinees, including follow-up of pregnant women and their offspring. Choice of vaccine should be undertaken by national authorities based on a transparent and evidence-based process. The WHO R&D Blueprint expert group on vaccine trials is asked to provide guidance on the design of such trials.

If a confirmed case of Ebola (Zaire strain) is observed among the HCWs or FLWs vaccinated with one of these three candidate vaccine regimens, SAGE reiterated that the control of such an outbreak must include the use of rVSV-ZEBOV-GP using the ring vaccination, or the geographic targeted approach if necessary, as previously recommended by SAGE, in preference to these new candidate vaccines.

SAGE stressed that in outbreak affected areas, HCWs and FLWs should continue to be offered the rVSV-ZEBOV-GP vaccine. Similarly, peacekeeping forces deployed to such areas should be offered the vaccine.

In view of the severity of the outbreak and aligned with SAGE’s recommendation from October 2018 [1], SAGE welcomes and supports the recent recommendation of the ethics committee of DRC to also authorize the vaccination of pregnant women in outbreak affected areas, using the currently recommended vaccination strategies, with the live-replicating rVSV-ZEBOV-GP vaccine with informed consent and in compliance with GCP. As recommended by the ethics committee, every effort must be made to collect data on the safety of the vaccine in these populations, including a documentation of the pregnancy outcomes. SAGE advises that the use of rVSV-ZEBOV-GP vaccine in pregnant women currently remains limited to the EVD outbreak affected areas in DRC and should be continuously evaluated based on the emerging data on the safety and efficacy of the vaccine in this target population. This careful review of the emerging safety data is needed to inform vaccine recommendations for future outbreaks.

SAGE acknowledges the decision of the ethics committee of DRC to also proceed with vaccination of lactating women and children under 1 year of age given the ongoing outbreak and population risk. SAGE is now reviewing the data, including modelling, in relation to the use of the vaccine in these populations and will provide an updated assessment as soon as is feasible.

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