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DRC – Ebola/Cholera/Polio/Measles
Disease Outbreak News (DONs}
Ebola virus disease – Democratic Republic of the Congo
11 July 2019
The outbreak of Ebola virus disease (EVD) in North Kivu and Ituri provinces, Democratic Republic of the Congo continues this past week with a similar transmission intensity to the previous week. While the number of new cases continues to ease in former hotspots, such as Butembo, Katwa and Mandima health zones, there has been an increase in cases in Beni, and a high incidence of cases continues in parts of Mabalako Health Zone. In addition to these re-emerging hotspots, there are a large number of people with confirmed and probable infections moving to other health zones, with the greatest number coming from Beni Health Zone. The movement of cases causes the outbreak to spread to new health zones and re-emerge in health zones with previously controlled infections. Overall, this underscores the importance of robust mechanisms for listing and following up contacts and understanding the motivations for peoples’ decisions to move…
CDC Lab Research Shows Two Treatments Effective Against DRC Ebola Strain
Tuesday, July 9, 2019
New research by the Centers for Disease Control and Prevention (CDC) shows two investigational Ebola treatments being used in the ongoing outbreak in eastern Democratic Republic of the Congo (DRC) are effective in laboratory studies.
The treatments – the antiviral remdesivir and antibodies in the ZMapp treatment – blocked growth of the virus strain causing the outbreak in human cells in the laboratory. The research suggests these treatments hold promise for allowing patients to recover from the deadly illness. The research will be published Tuesday, July 9, in Lancet Infectious Diseases.
Importantly, the study also shows that the lab test most often used in DRC and neighboring countries to diagnose Ebola – which was developed during the 2014-2016 West Africa outbreak for use against a different strain of Ebola virus – appears to be accurate for the outbreak strain now circulating in DRC, which researchers are calling the Ituri strain. The Ituri strain and the strain that caused the West Africa outbreak are both strains of Ebola virus (formerly called Ebola Zaire).
“All of the treatments being tested in the current DRC outbreak were developed to fight Ebola viruses from previous outbreaks,” said Laura McMullan, Ph.D., CDC microbiologist and the paper’s lead author. “RNA viruses are always mutating – and because Ebola is an RNA virus it’s vitally important to make sure existing treatments work against the virus that’s making people sick now.”
How and Why This Research Was Done
Lacking samples from patients infected with the Ebola virus strain causing the current outbreak, CDC laboratory scientists reconstructed the Ituri strain of Ebola virus using reverse genetics in the CDC Biosafety Level 4 laboratory, under the highest level of biosecurity and safety. They based this work on virus sequence data generated from recent patient samples by the DRC National Institute of Biomedical Research (INRB) and the U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID) and published in GenBank, an open-access database for pathogen sequences.
By having access to the virus strain, CDC laboratory experts can learn more about the Ituri strain and how it fits into the Ebola virus family tree, which may provide clues to finding additional promising treatments. The scientists will also be able to test new therapies as they are developed to see if they can effectively fight against the actual virus making people sick. They will also be able to compare it to future Ebola strains to explore how the virus changes over time.
“This work has benefits beyond the current study. Having access to this virus will allow us to explore whether other compounds or potential therapies affect the virus in the lab,” said Inger Damon, M.D., PhD, chief strategy officer for the CDC’s 2018 Ebola response and director of CDC’s Division of High-Consequence Pathogens and Pathology. “We hope the knowledge gained from this work can be translated into safe and effective therapies to help cure Ebola patients.”
Laboratory experts within CDC’s Viral Special Pathogens Branch have been testing compounds and antivirals since 2007 to look for potential treatments for viral hemorrhagic fevers – some of the world’s deadliest diseases, including Ebola and Marburg. In addition to assessing the effectiveness of remdesivir and the antibodies in the ZMapp cocktail against the Ituri strain, CDC researchers also encourage the future testing of the investigational vaccine being used in DRC and of other investigational therapies – such as mAb114 and Regeneron’s REGN-3EB against the current Ebola Ituri virus.
The current DRC outbreak is the second-largest ever recorded and DRC’s tenth Ebola outbreak since 1976. To date, more than 2,400 people have become infected and more than 1,600 have died. Uganda also has reported three travel-associated deaths tied to a DRC Ebola patient. Armed conflicts and public mistrust in the area have complicated public health response efforts. Despite efforts from the DRC Ministry of Health and international health partners, including CDC, the current outbreak has continued for 10 months.
The research will be available on the Lancet Infectious Diseases websiteexternal icon at 6:30 p.m. EST Tuesday, July 9. For more information on Ebola and the current DRC outbreak, please visit www.cdc.gov/ebola.
Vaccination to contain severe measles outbreak underway in the Democratic Republic of the Congo amidst Ebola and mass displacement
Campaign led by the Ministry of Health with support from UNICEF and MSF
ITURI, Democratic Republic of the Congo/DAKAR/GENEVA/NEW YORK, 11 July 2019 – Health workers are urgently rolling out a complex measles vaccination campaign targeting 67,000 children in Ituri, northeast Democratic Republic of the Congo (DRC), a region ravaged by armed conflict that is now also the hub of the second-deadliest Ebola outbreak on record.
At least 1,981 deaths due to measles have been reported across the DRC this year, over two-thirds of them among children below 5 years old. As of 23 June, nearly 115,000 cases of suspected measles had been reported, far more than the 65,000 recorded in all of 2018.
Ituri, one of the two provinces (the other is North Kivu) struck by Ebola since the outbreak began nearly a year ago, has recorded over 5,400 cases and 50 deaths.
“The combined threat of Ebola and measles for the thousands of families living in overcrowded and unsanitary displacement camps is unprecedented,” said UNICEF DRC Representative Edouard Beigbeder. “We have a small window to prevent a potentially massive loss of life.”
The first sites targeted for measles vaccinations are four displacement camps in Bunia, Ituri, that have seen a huge influx of families forcibly uprooted by fighting in recent weeks. The boundary of one camp, located alongside Bunia’s General Hospital, is less than 100 metres away from an Ebola treatment center. It is also less than 3 kilometres away from parts of Bunia that have seen 5 Ebola cases since the start of the outbreak, 2 of them in the past three weeks.
The Ebola outbreak means the measles vaccination campaign must incorporate extra measures to protect against infection and meticulous triage. Health workers will need to wear gowns to prevent contact with blood or other body fluids. Teams will include an additional health worker who will evaluate and refer suspected Ebola cases, check temperatures and oversee handwashing and other safety measures.
An additional layer of complexity is that some of the early symptoms of Ebola – fever, redness around the eyes, diarrhoea – are virtually indistinguishable from those of measles, malaria or cholera – all of which are prevalent, especially in severely congested displacement sites.
Up to 400,000 people are thought to be internally displaced across Ituri, the vast majority of them women and children. Many live in about 35 camps scattered throughout the province, in territory that is virtually inaccessible due to insecurity. Fighting among various armed groups has damaged or destroyed up to half the health facilities and schools in the province.
“The northeastern part of DRC is home to one of the worst humanitarian crises today. Whether it is from measles, Ebola, or the reality of living in a displacement camp, children are at grave risk. We must do everything we can to protect them,” Beigbeder said.
Measles campaigns are also being planned for Tchomia and Nyankunde health zones.
As of 8 July, there were 2,428 cases of Ebola, with 1,641 deaths. Almost 30 per cent of cases are among children.