The Africa Centre for Disease Control & Prevention (CDC) says that the majority of people testing positive for Ebola in the Democratic Republic of Congo are not on health workers’ radars, suggesting that contact tracing is lagging dangerously behind, reports The New York Times.
“If we don’t stop this outbreak now, it will be the largest outbreak ever,” said Dr Jean Kaseya, director-general of the Africa CDC.
The first step to breaking the chain of transmission is identifying anyone who has been in contact with an infected patient, enabling health workers to monitor them, test them if they develop symptoms, and isolate those who test positive before they can spread the virus.
Last week, Kaseya said health workers needed to track and trace 80% of a confirmed Ebola patient’s contacts to end the outbreak, but the current figure stands at just 30%.
“There is huge, huge community transmission,” he warned.
Most of the those testing positive for Ebola in Ituri Province, the epicentre of the outbreak, are not on health workers’ radars, he said, adding that health agencies are recruiting 20 000 paid workers, many of them young people from affected communities, who will be trained in the coming weeks to do contact tracing and to educate residents on how to protect themselves. They will also be taught how to conduct safe burials.
More than 1 100 people have tested positive for Ebola since May. Congo's Health Ministry said more than 250 people have died, though the true number is probably far higher, as the virus appears to have spread for months before it was identified.
Epidemiologists expect a minimum of 20 contacts to be identified for each infected person, but Kaseya said that in urban areas, 40 contacts is a more realistic number.
Exacerbating the crisis, the virus causing the current outbreak, Bundibugyo, is now spreading in camps that are home to about a third of the 1m displaced people in the region where conflict has raged for years. In a camp setting, an infected person would more than likely have 120 contacts, Kaseya said.
Almost all beds in emergency Ebola treatment facilities in eastern Congo – a staggering 95% – are already occupied by patients, suggesting the local health system is close to its breaking point.
Clinical trials of medications to treat the virus, and of a drug that could stop infection in anyone exposed to it, are expected to begin shortly. One will test treatment for patients who are already sick: some will receive the antiviral remdesivir, which has shown efficacy in treating people with other species of Ebola viruses. Others will receive remdesivir plus a monoclonal antibody – a molecule that locks onto the surface of a virus and prevents it from getting into cells – called MBP-134.
MBP-134 has shown promise against Bundibugyo in animal studies and was expected to arrive in Bunia, the capital of Ituri province, last weekend, said Dr Mosoka Fallah, director for science and innovation at Africa CDC.
Another trial will test a 10-day course of an oral form of remdesivir called obeldesivir as post-exposure prophylaxis. If it works against Bundibugyo, it could provide a critically important weapon against the virus both by protecting those who have been exposed to it and by stopping them from passing it along to others.
This trial is expected to begin in mid-July and will enrol 1 200 people. Fallah said that if data analysis after 600 patients shows it is protecting people, the goal will be to extend access to the drug to all contacts for the duration of the outbreak.
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