With more than 4 000 Ebola Bundibugyo cases and 1 800 deaths so far in the Democratic Republic of Congo (DRC), the Africa CDC said a study is now being launched to see whether the virus is mutating to become more infectious, reports Health Policy Watch.
Dr Jean Kaseya, DG of the Africa Centres for Disease Control and Prevention, said that over the past three months, the outbreak had swelled at eight times the pace of the world’s biggest Ebola outbreak – in West Africa between 2018 and 2020.
Every day for the past week, 75 new cases and 35 deaths had been recorded, and Kaseya said he and WHO Director-General Dr Tedros Adhanom Ghebreyesus had agreed “to conduct a study to check for any additional issue, or maybe if the virus is mutating, because the level of severity … is unprecedented”.
After a joint high-level meeting last week to the DRC and Uganda, including with DRC President Felix Tshisekedi, Tedros, Kaseya and Dr Mohamed Janabi, WHO’s Africa regional director, called for “an urgent scale-up of the community-led Ebola response … with stronger early detection, contact follow-up, access to care, support for frontline health workers and faster delivery of resources to affected communities”.
Tedros also said: “Building trust and respecting local traditions, including around safe and dignified burials, are essential to reaching affected communities and stopping transmission.”
Community engagement
Kaseya said one of the main purposes of the delegation’s visit to Bunia, one of the Ebola hotspots in the DRC, was to listen to communities.
“All of them were sharing a critical message: we are not involved, and we want to be involved.”
Kaseya said internet connectivity via Starlink would now be extended to all villages in Ituri to enable timely data and information about the outbreak.
After Bunia, the delegation met with Tshisekedi and other top government officials in Kinshasa, the capital, and resolved to take the outbreak response to the village level in Ituri’s 6 542 villages to reach people more effectively.
The outbreak has not yet reached Kinshasa, which has a population of around 17m
Striking health workers
Tedros said that in the meeting with Tshisekedi, they discussed the need to continue to protect and support frontline health and community workers, including by ensuring they have adequate personal protective equipment, and are compensated for their work.
Around 140 health workers have been already been infected, and there have been several protests and strikes over unpaid wages. However, Kaseya said it was the responsibility of the DRC Government, not their outbreak partners, to pay their health workers.
More dying in communities than facilities
Most deaths are being recorded in communities than health facilities. Last week, 67% of all Ebola deaths were in communities, usually identified via tests administered after death.
“The contact lists don’t mean anything because it’s not accurate,” Kaseya said, again highlighting weaknesses around tracing people who have been in close contact with confirmed cases.
On average, around 10 contacts per patient in the DRC have been recorded, in comparison to 40+ in Uganda, which contained its Bundibugyo outbreak at 20 cases.
Uganda’s case fatality was 10% in comparison to the DRC’s 44%, and Kaseya suggested this could be because every patient was given the antiviral medicine Remdesivir (Gilead Sciences).
A trial to test Remdesivir’s efficacy against Bundibugyo is currently under way in the DRC, along with another antiviral known as MPP134. However, only 68 people have been recruited so far for this WHO trial.
The WHO said that the testing of experimental treatments was progressing, but that only clinical trials would determine whether these are effective, reports Reuters.
Vasee Moorthy, acting head of the WHO’s R&D Blueprint programme, said that research protocols developed before the epidemic’s onset have helped speed up the testing.
“If you compare this outbreak to previous Ebola outbreaks, we have been able to start trials more quickly,” he said, “and the preclinical data we’re seeing are promising.”
The WHO-sponsored treatment trial of MPP134 is now operating at three clinical management facilities in Ituri province in partnership with medical charities ALIMA and Doctors Without Borders (MSF), with confirmed patients having been enrolled and randomly assigned to experimental treatment options.
A separate prophylaxis study led by the Congo’s National Institute for Biomedical Research and international partners has enrolled more than 25 high-risk contacts in Ituri. Researchers are testing whether a 10-day course of the oral antiviral drug Obeldesivir can prevent disease after exposure.
Vaccine research is also accelerating. A Bundibugyo-specific vaccine developed by Oxford University and the Serum Institute of India entered a phase 1 trial in Britain on 24 July, while a second candidate developed by Moderna was expected to begin a Phase 1 trial in Canada last week.
WHO is also reviewing new animal data on whether Merck’s licensed Ebola vaccine, used against the Zaire strain, could provide cross-protection against Bundibugyo, Moorthy said.
A WHO advisory group met last week to assess the findings and is expected to publish recommendations shortly.
US pledges more funds
Meanwhile, the US State Department has said it would provide an additional $242m in funding for “immediate Ebola response and … humanitarian assistance related to the outbreak”.
It has now given more than $512m in direct assistance, as well as making $350m available for “critical humanitarian assistance in the DRC, South Sudan, and Uganda”.
Kaseya said that, taking into account the latest US contribution, $472m had been released and almost $700m was expected.
Health Policy Watch article – Alarming Ebola Spread Raises Question of Viral Mutation (Open access)
See more from MedicalBrief archives:
Uganda declares its Ebola-free status, as Congo cases keep rising
Mammoth struggle to contain rapidly-spreading Ebola cases in DRC
Clinical trials for Ebola Bundibugyo drug to start soon, say scientists
World experts call for urgent response, saying Ebola was preventable