WHO cautious about declaring victory in DRC Ebola epidemic

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The head of the World Health Organisation (WHO) has cautioned against declaring victory too early in Democratic Republic of Congo’s Ebola epidemic, despite encouraging signs that it may be brought under control. “The outbreak is stabilising, but still the outbreak is not over,” WHO chief Tedros Adhanom Ghebreyesus is quoted in a Reuters Africa report as saying. “We are still at war, and we need to continue to strengthen our surveillance and … be very vigilant.”

WHO officials have expressed cautious optimism that the epidemic of the deadly virus was stabilising, partly owing to the swift deployment of vaccines. But a day earlier, DRC’s Health Ministry reported its first confirmed case of Ebola in over a week, in the rural community of Iboko.

Ghebreyesus said 2,200 people had been vaccinated, and that case management and tracing contacts of victims had gone well. But he said: “It’s not over until it is over. Even if one case crosses into Congo (Republic) and gets to an urban area, that could trigger another epidemic”.

The report says the haemorrhagic fever has killed 27 people since the outbreak began in April, and there have been 62 cases, 38 of which were confirmed in a laboratory. A further 14 are probable Ebola cases, and 10 more people are suspected of having Ebola.

In contrast to past Ebola outbreaks health workers have moved quickly to halt Congo’s latest epidemic. Ebola killed at least 11,300 people in 2013-16 in West Africa and during that outbreak WHO was criticised for not taking it seriously enough in its early stages.

 

The WHO says for the first time doctors have been given the go-ahead to deploy experimental drugs for all patients in an Ebola outbreak. SciDev.Net reports that the DRC has approved five experimental treatments, including two drugs used to treat the only baby to survive Ebola in the West Africa epidemic.

The drugs are experimental because they have not yet completed the large-scale trials normally required but officials believe approval is warranted in an emergency, as long as patients give consent and results are monitored.

The report says the approval by the Congolese government is being followed up by ongoing negotiations with the WHO and the medical charity Doctors without Borders (Medicines Sans Frontiers). The aim is to fine-tune the details on which of these drugs are to be used as a first-line of defence, according to Séverine Caluwaerts, a gynaecologist with the charity.

“MSF specifically wants to focus on Zmapp as first line, and (on a drug called) GS-5734,” she is quoted in the report as saying.

The two drugs were among three experimental therapies used successfully by MSF to save Nubia — the only baby known to have survived being born with Ebola — in Guinea towards the end of the West Africa epidemic in 2015.

Zmapp, a cocktail of monoclonal antibodies, initially improved Nubia’s condition. But it wasn’t enough to clear the virus until she was given GS-5734, also known as Remdesivir. “Because the Zmapp was not enough to clear her virus, we sort of believe in the GS compound but this is more belief, no science, since the sample size is too small,” explains Caluwaerts.

“There’s a solid argument in favour of Zmapp but not Remdesivir until further evidence is developed,” says Daniel Kelly, from the School of Medicine at the University of California – San Francisco, who has worked on the Ebola response in Sierra Leone over the years. Kelly believes the drugs can be useful for special cases, but WHO’s guidance for “aggressive supportive care” – such as IV fluids for severely dehydrated people – should still be what doctors turn to first.

Nubia was only the second person worldwide to be given Remdesivir. The report says the first was Scottish nurse Pauline Cafferkey who caught the deadly virus in Sierra Leone.

Mortality in MSF’s treatment centres in the DRC stands at 20%-30%, much lower than in previous epidemics, and there are signs the epidemic is waning. But the charity remains cautious. “We don’t know if the epidemic is over – one case can spark a new cluster,” Caluwaerts is quoted in the report as saying.

Reuters Africa report
WHO report
SciDev.Net report


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