The Democratic Republic of Congo's (DRC) Ebola Bundibugyo outbreak, announced just two months ago, has already infected more than 2 120 people and caused about 900 deaths – and continues to outpace response, reports Health Policy Watch.
At a media briefing last week, World Health Organisation (WHO) Director-General Dr Tedros Adhanon Ghebreyesus said that intense transmission in Ituri province was the biggest worry.
“More than 80% of new cases are being detected outside known contact lists, showing that transmission chains are still being missed,” he said. “About two-thirds of deaths are in communities among people who never receive care in a health facility.”
In the 2018-2918 outbreak in the DRC, it took 10 months to reach 2 000 confirmed cases, said Tedros, adding that “active armed conflict is hampering access to the affected areas and hindering the response”. Last week, another treatment centre in Bunia had been attacked, he reported, and again appealed for international support to make up the $400m-plus shortfall needed to mount a sufficient response.
“This is not charity. It’s an investment in national security,” he pleaded.
Dr Chikwe Ihekweazu, Executive Director of WHO’s Health Emergencies Programme, said that the main focus “is getting cases into care”.
More than 60% of deaths are happening in communities, meaning people were likely to have been sick and infectious for weeks before their deaths – and were only diagnosed with Bundibugyo because health officials were taking swabs from dead people shortly before burials, Ihekweazu said.
“Your chances of survival are three to four times higher when you come into care. Currently, we have a case fatality ratio of about 30% to 40%. If you look at those who come into care, it’s about 10% to 15%. If you look at those dying in the community, it’s about 60% to 70%.”
“We are facing a very difficult situation… It is not out of control, but we need to work very hard and consistently to get ahead of this. This will be a marathon.”
Vaccine trials
The world’s first Phase I Bundibugyo ebolavirus vaccine trial was recently launched by the Oxford Vaccine Group (OVG) in Oxford in the United Kingdom, to assess the safety and immune response of the ChAdOx1 BDBV vaccine.
The vaccine uses the same viral vector platform as the Oxford/AstraZeneca Covid-19 vaccine. Meanwhile, the Serum Institute of India (SII) has manufactured and stockpiled 620 000 doses to support the rapid launch of the study and progression of the vaccine candidate into clinical evaluation.
The trial is funded by the Coalition for Epidemic Preparedness Innovations (CEPI) as part of its $8.6m programme to advance the development of Bundibugyo vaccines.
At the beginning of July, a trial of two antivirals started patient enrolment in the DRC. The PARTNERS trial will assess whether the antivirals, a monoclonal antibody called MBP134 and remdesivir, can improve the outcome and survival rate of people with Bundibugyo.
It will also evaluate whether combining the two antivirals provides additional benefits.
The WHO-sponsored trial is being co-ordinated by the DRC’s Institut National pour la Recherche Biomédicale (INRB), the Institute of Tropical Medicine in Belgium, and the University of Oxford.
It is a randomised, controlled trial that is enrolling patients of any age with confirmed Bundibugyo. Aside from the medicine, patients will receive “early supportive care, including oral or intravenous fluids, electrolyte replacement, oxygen support, blood pressure management, and pain control in line with WHO treatment guidelines”, said the WHO.
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