Portal de Periódicos da CAPES

Ebola outbreak in the DR Congo

2017; Elsevier BV; Volume: 389; Issue: 10084 Linguagem: Inglês

10.1016/s0140-6736(17)31424-1

1474-547X

Andrew Green,

Global Public Health Policies and Epidemiology

International agencies are implementing response protocols after an Ebola virus disease outbreak was confirmed in the DR Congo. Andrew Green reports. On May 12, an outbreak of Ebola virus disease (EVD) was declared, affecting a remote area of the northern DR Congo. As we went to press, WHO reported 37 cases of infection, including one confirmed and three probable deaths from EVD. The outbreak triggered a response involving more than 13 international agencies. It could prompt the roll-out of an Ebola vaccine candidate, pending government approval of its use. Partners quickly set up the standard response protocols. This includes surveillance to identify both suspected EDV cases and people who have come into contact with suspected and confirmed patients with EVD, who will need to be monitored for symptoms for 21 days. WHO officials said they have already identified more than 400 contacts. “If we find active cases, patients that are sick now, they should be isolated and we will give them treatment”, said Hilde de Clerck, Mobile Implementation Officer Viral Hemorrhagic Fevers, who is helping direct the response of the emergency medical group Médecins Sans Frontières (MSF). An Ebola treatment centre had been established and is operational at the Likati General Hospital. de Clerck said the MSF team is currently discussing whether to establish an additional centralised treatment facility or—because of the remote nature of the community where the outbreak is happening—smaller centres closer to where the patients live. Responders to the EVD outbreak in west Africa—that began in 2014 and killed more than 11 300 people over 2 years—set up large treatment facilities, but de Clerck said, “small centres are usually better accepted and they are closer to where the cases are”. These could be important in a remote region where travel is extremely difficult. Peter Salama, the executive director of WHO's Health Emergencies Programme, said the epicentre of the outbreak—the Likati Health Zone—is 350 km from the nearest major town. The area only has 20 km of paved roads and “virtually no functioning telecommunications”, Salama said. Officials have had to use aircrafts in the early stages of the response, adding to an overall price tag they are now estimating will reach US$10 million in the first 6 months. Meanwhile, community sensitisation, one of the pillars outlined in the WHO global response plan alongside case management, surveillance, and safe burial, is also underway. A local radio station is transmitting information about EVD symptoms and how to prevent the spread of the virus. Matshidiso Moeti, WHO regional director for Africa, visited the DR Congo after the outbreak was declared and said there is fear among patients and the people who have come into contact with them. But experts are working with communities “to understand what people are thinking, what people are believing, what people are feeling”. Although the region's relative inaccessibility makes it difficult to launch a response, officials said they hope it might also help to contain the spread of EVD. Except for the situation in west Africa, where EVD reached major cities and spread quickly, de Clerck said outbreaks have historically been confined to remote areas, which has made them easier to contain. That includes seven previous outbreaks in the DR Congo, the deadliest of which resulted in 280 deaths in 1976. Salama recently stated WHO's risk assessment on the outbreak found the risk high at a national level, medium at African regional level, and low at global level. There is, however, some concern about ongoing violence in Bangassou, a Central African Republic town just across the border from the DR Congo region where the outbreak is happening. The UN Refugee Agency has reported thousands of Central African Republic residents streaming across the border in recent days. “This is a big issue that really gives a deep concern as the EVD outbreak is ongoing”, said Eugene Kabambi, a WHO emergency communications officer based in Kinshasa, DR Congo. Officials expect all of these issues to factor into the government's decision about whether to deploy an EVD vaccine candidate. The vaccine was first tested in 2015 in parts of Guinea during the west Africa outbreak and conferred high protection against the virus. WHO Strategic Advisory Group of Experts on Immunization recommended in April that if an outbreak occurred before a vaccine was licensed, the candidate should be “promptly deployed under the Expanded Access framework”, as long as officials got informed consent from people being immunised. Salama said that if the Congolese Government agreed to deploy the vaccine, it would take about a week to get the logistics in place, including a cold chain, and fly the vaccine out. At that point, they would set up a ring vaccination to immunise contacts of suspected and confirmed patients, the contacts of those contacts, and health workers. DR Congo officials have not provided a timeline on when they will reach a decision.