Monday, August 20, 2018

PRO/AH/EDR> Ebola update (72): Congo DR (NK) cases, response, research

A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases

In this update:
[1] Case update
- Epidemiological situation report, 18 Aug 2018, DRC Ministry of
- Healthcare workers
[2] Response
- ALIMA (Alliance for International Medical Action)
[3] Research papers

[1] Case update
- Sun 19 Aug 2018. Epidemiological situation report, 18 Aug 2018, DRC
Ministry of Health
[in French, machine trans., edited]

- A total of 91 cases of haemorrhagic fever were reported in the
region, 64 confirmed and 27 probable.
- 12 suspected cases are under investigation.
- 1 new confirmed case in Mabalako, which is a known and followed
probable case contact.
- 1 confirmed case death in Mabalako.

News of the response
Monitoring and follow-up of contacts
- Investigations by field epidemiologists have already invalidated
several probable cases (or historical deaths) in the Mabalako area.
This means that these historic deaths were not caused by the Ebola
outbreak. Thus, several hundred contacts registered for these probable
cases have been cleaned from the list of registered contacts. To date,
surveillance teams have registered 1609 contacts to follow. The
invalidated probable cases will be officially removed from the summary
table later when the investigations are completed.

- Of these contacts to be followed, there are 41 who are in a red zone
to which the surveillance teams do not have access because of the
security situation. Of these 41 contacts, 15 were able to travel to
Beni to facilitate their follow-up and the organization of their
vaccination. For the other contacts who remained in the red zone, the
nursing staff of the on-site health center work with the community
relays to ensure their follow-up and transmit the data daily to the
coordination by phone.

Immunization activities continue at the 3 sites of Mabalako, Beni and
Mandima. Since vaccination began on 8 Aug 2018, 873 people have been
vaccinated , including 467 in Mabalako, 256 in Beni, and 150 in

Communicated by:
ProMED-mail Rapporteur Mary Marshall

[This report raises a number of questions. It states that "several
probable cases (or historical deaths) in the Mabalako area" are not
due to Ebola. The determination of these cases not being Ebola was
through investigations by field epidemiologists, and they won't be
removed from the summary table "until the investigation is completed".
Are their sera being tested against a complete panel of agents in the
laboratory to identify an etiologic agent? There are many pathogens
active in the region plus environmental issues that could cause
similar symptoms. If not Ebola, it would be good to know what else is
causing disease and even death.

Of the 873 people vaccinated, how many are healthcare workers, and how
many are contacts? - Mod.LK]

- Sun 19 Aug 2018. Ebola crisis worsens in Congo, health workers
[The Hill, edited]

At least 10 healthcare workers have been infected with the deadly
Ebola virus as they battle an outbreak in an eastern province of the
Democratic Republic of the Congo, officials said over the weekend
[18-19 Aug 2018], as concerns mount that the number of cases is
growing faster than public health officials can respond.

The Congolese Health Ministry said [Fri 17 Aug 2018] that at least 90
people had been infected in several regions of North Kivu province and
neighboring Ituri province. 49 people have died, including 1 of the 10
healthcare workers who had been infected.

The Health Ministry and the World Health Organization expect more
cases to emerge in the coming weeks. The Ebola virus disease carries
an incubation period of up to 21 days, meaning it can take as long as
3 weeks for an infected person to show symptoms.

Tarik Jasarevic, a spokesman for the World Health Organization in
Geneva, told The Hill that health officials had identified more than
1500 people who had come into contact with a possible or confirmed
Ebola patient.

Health officials will monitor those contacts for 3 weeks to make sure
they are quickly cared for -- or quarantined -- if they show symptoms.
But, Jasarevic said, the full number of potential contacts are not yet
known. "We're at a critical moment where we are not yet sure we have
all the chains of transmission identified," he said.

Those tasked with contact tracing, including employees of the Ministry
of Health, the WHO and other non-governmental organizations like
Doctors Without Borders [MSF], face a challenge in North Kivu province
unlike any they have faced during previous Ebola outbreaks. The
province is home to about 8 million people, including as many as a
million internally displaced people who live in refugee camps, after
fleeing their homes in the face of clashes between rival ethnic

North Kivu province sits on the border with Uganda, and the region's
largest city, Beni, has been hit by bombings carried out by Islamic
militants from across the border.

Jasarevic acknowledged the uncertain security situation has meant that
contact tracers cannot reach every corner of the province. Those
"blind spots," he warned, could give the virus a chance to spread.

WHO has sent virus-hunters to Beni and Mangina. Doctors Without
Borders last week opened an Ebola treatment center in Mangina. On [Thu
16 Aug 2018], the group said it was treating 37 patients at the center
-- including some of those healthcare workers.

"Among our patients, we have several colleagues from the Congolese
health system," said Gwenola Seroux, the Doctors Without Borders [MSF]
official coordinating the response to the outbreak. "They were the
first to respond, and some were exposed to the virus."

Anne Rimoin, an epidemiologist at UCLA, said the fact that healthcare
workers had been infected is a significant and troubling development.
In Guinea, Liberia, and Sierra Leone, where an outbreak that began in
2014 killed at least 11 300 people, already-vulnerable public health
systems were decimated as doctors, nurses, midwives, and other health
professionals came down with the virus.

"Healthcare workers are at the front line and extremely vulnerable to
infection. They work in poor conditions, often without personal
protective equipment [PPE], and thus [are] often exposed before an
outbreak is detected," Rimoin said. "The reason this is so important
is because healthcare workers can easily propagate disease given that
they have contact with many sick people and their own families."

The Ministry of Health and other responders have begun administering a
vaccine meant to protect against the Ebola virus, and healthcare
workers are the first to receive those vaccines. None of the more than
3000 people who received the vaccine in another outbreak earlier this
year [2018], in Congo's Equateur province, came down with the virus, a
promising sign.

A team of researchers, based in Kinshasa and overseen by Rimoin, is in
North Kivu province keeping tabs on the vaccine's efficacy.

The outbreak in North Kivu is already significantly worse than the one
that hit Equateur province earlier this year [2018]. By the time the
Ministry of Health declared that outbreak contained in July, 53 people
had contracted the Ebola virus, and 29 had died.

Only days after the end of the outbreak in Equateur province,
Congolese health officials alerted the WHO that at least 20 people had
already died from the new outbreak in North Kivu. The virus likely
started to spread after the funeral of one of the 1st victims, a woman
in Mangina. Several relatives who attended the funeral, and who
probably washed and dressed the body for the afterlife, began showing
symptoms just days later. ...[more]

[Byline: Reid Wilson]

Communicated by:
ProMED-mail Rapporteur Mary Marshall

[And now bombing is taking place on the border with Uganda, in the
largest city in the region, Beni. This will exacerbate border control
making it even more difficult to limit where individuals cross the
border so they can be checked for fever and other signs of illness.

The number of deaths among the healthcare workers (HCWs) is
concerning, as these individuals are vital to the community. While
many of these HCWs may have become infected prior to knowing Ebola was
active in the region, it is critical all HCW are vaccinated and
supplied with appropriate PPE to protect them and the patients they
serve. - Mod.LK]

- Sun 19 Aug 2018. ALIMA [Alliance for International Medical Action]
treating confirmed Ebola patients in their Biosecure Emergency Care
Units for Outbreaks (CUBE) in Beni, DRC
[Greg Folkers retweeted ALIMA‏ @ALIMA_ORG 17 Aug 2018; edited]

For the 1st time, ALIMA is treating confirmed Ebola patients within
our innovative Biosecure Emergency Care Units for Outbreaks (CUBE) at
our treatment center in Beni ...[more]

Communicated by:
ProMED-mail Rapporteur Mary Marshall

[Dakar/Paris, 18 Jun 2018. It was announced that "the medical
humanitarian organization ALIMA (The Alliance for International
Medical Action) will open an Ebola treatment center equipped, for the
1st time, with biosecure emergency care units, in Itipo in the
Equateur province of the Democratic Republic of Congo (DRC)."

And from the tweet above, it appears they are now working in Beni. A
good sign.

Biosecure Emergency Care Units for Outbreaks (CUBE), are certified P4
isolation units designed for the treatment of patients suffering from
highly infectious diseases with serious potential for outbreaks. ...
The CUBE offers the added advantage of needing fewer medical
personnel. It reduces the risk of exposure and contamination, and
requires fewer medical materials. Medical personnel benefit from being
able to work comfortably, protected from contamination without needing
to wear personal protective equipment.

In the event that the outbreak spreads, the CUBE has been designed to
be easily transportable, and can be decontaminated, disassembled, and
reinstalled in other areas if needed (excerpted from
<>). - Mod.LK

HealthMap/ProMED-mail map:
DR Congo:]

[3] New papers
- bioRxiv

[ref: West BR, Wec AZ, Moyer CL, et al. Structural basis of broad
ebolavirus neutralization by a human survivor antibody. bioRxiv
394502; <>]
Abstract. The structural features that govern broad-spectrum activity
of broadly neutralizing, anti-ebolavirus antibodies (Abs) are
currently unknown. Here we describe the 1st structure of a broadly
neutralizing human Ab, ADI-15946, in complex with cleaved Ebola virus
glycoprotein (EBOV GPCL). We find that ADI-15946 employs structural
mimicry of a conserved interaction between the GP core and the glycan
cap B17-B18 loop to inhibit infection. Both endosomal proteolysis of
EBOV GP and binding of monoclonal Ab (mAb) FVM09 displace this loop,
increase exposure of its conserved epitope and potentiate
neutralization. Our work also illuminated the determinants of the
reduced activity of ADI-15946 against Sudan virus (SUDV), and enabled
rational, structure-guided engineering to enhance binding and
neutralization against SUDV while retaining the parental breadth of

- bioRxiv
[ref: Bornholdt ZA, Herbert AS, Mire CE, et al. Two-antibody
pan-ebolavirus cocktail confers broad therapeutic protection in
ferrets and nonhuman primates. bioRxiv 395533;
Abstract. All available experimental vaccines and immunotherapeutics
against Ebola virus (EBOV), including rVSV-ZEBOV and ZMapp, lack
activity against other ebolaviruses associated with human disease
outbreaks. This year [2018], 2 separate outbreaks of EBOV in the
Democratic Republic of Congo underscored the unpredictable nature of
ebolavirus reemergence in a region that has historically experienced
outbreaks of the divergent ebolaviruses Sudan virus (SUDV) and
Bundibugyo virus (BDBV). Here we show that MBP134 AF, a pan-ebolavirus
therapeutic comprising 2 broadly neutralizing human antibodies (bNAbs)
(see companion manuscript, Wec et al) could protect against lethal
EBOV, SUDV, and BDBV infection in ferrets and nonhuman primates
(NHPs). MBP134-AF not only establishes a viable therapeutic
countermeasure to outbreaks caused by antigenically diverse
ebolaviruses but also affords unprecedented effectiveness and potency:
a single 25-mg/kg dose was fully protective in NHPs. This
best-in-class antibody cocktail is the culmination of an intensive
collaboration spanning academia, industry and government in response
to the 2013-2016 EBOV epidemic and provides a translational research
model for the rapid development of immunotherapeutics targeting
emerging infectious diseases

Communicated by:
ProMED-mail Rapporteur Mary Marshall

[HealthMap/ProMED-mail map of DR Congo:

[See Also:
Ebola update (71): Congo DR (NK) cases, response, bats
Ebola update (70): Congo DR (NK) cases, recommendations, war, comment
Ebola update (69): Congo DR (NK, IT) cases, Uganda NOT, WHO response
Ebola update (68): Congo DR (NK) WHO, Uganda cases, concerns,
Ebola update (67): Congo DR (NK) cases, response, issues, research
Ebola update (66): Congo DR (NK) cases, response
Ebola update (65): Congo DR (NK) cases, vaccines
Ebola update (64): Congo DR (NK) cases, security, genome
Ebola update (63): Congo DR (NK) cases, vaccine, security, burial,
Ebola update (62): Congo DR (NK) WHO, response, genetics
Ebola update (61): Congo DR (NK) WHO, cases, response
Ebola update (60): DR Congo (NK) case update, response, risk
Ebola update (59): Congo DR (NK) case update, risk, response,
Ebola update (58): Congo DR (NK) outbreak, Ebola Zaire confirmed
Ebola update (57): Congo DR (NK):
Ebola update (56): northeast Congo DR, Ebola-like cases, US negative,
Ebola update (55): Sierra Leone Ebola virus variant, Congo DR cases,
Ebola update (54): Congo DR, cases, therapeutics
Ebola update (53): Congo DR, cases, surveillance, action
Ebola update (52): Congo DR, cases, health workers, W Africa survivor
Ebola update (51): Congo DR, cases, response
Ebola update (50): Congo DR, Japanese response, CIDRAP, WHO, survey
Ebola update (49): Congo DR, suspect deaths comment
Ebola update (48): Congo DR, MSF, susp. deaths, RFI
Ebola update (47): DR Congo, epidemiology, response, Libya RFI
Ebola update (46): Congo DR, cases
Ebola update (45): Congo DR, cases, outbreak, MSF
Ebola update (44): Congo DR, cases, research, course
Ebola update (43): Congo DR, cases, vaccine, persistence, lessons
Ebola update (42): Congo DR, cases, vaccine
Ebola update (41): Congo DR, cases, WHO, contacts
Ebola update (40): Congo DR, cases, WHO, vaccine, treatment,
Ebola update (39): Congo DR, cases, WHO, response, facilities,
treatment, research
Ebola update (38): DR Congo, cases, WHO, Oxfam
Ebola update (37): Congo DR, cases, response
Ebola update (36): Congo DR, cases, threat, assistance
Ebola update (35): Congo DR, cases, response, WHO
Ebola update (34): Congo DR, cases, response, WHO
Ebola update (33): Congo DR, cases, response, WHO, diagnosis
Ebola update (32): Congo DR, cases, preparation, research
Ebola update (31): Congo DR, cases, response, WHO
Ebola update (30): Congo DR, cases, WHO, action
Ebola update (29): Congo DR, cases, MSF, antivirals
Ebola update (28): Congo DR, cases, WHO, response, treatment, funding
Ebola update (27): Congo DR, cases, travel screening, children
Ebola update (26): Congo DR, border controls, bat reservoir
Ebola update (25): Congo DR, case update, intl. travel screening
Ebola update (24): Congo DR, case update, African aid response
Ebola update (23): Congo DR, cases, vacc. campaign targets, vaccine
Ebola update (22): Congo DR, cases, cures, domestic and international
Ebola update (21): Congo DR, update, WHO, vaccination, therapeutics
Ebola update (20): Congo DR, case update, lessons, logistics,
financing, flights
Ebola update (19): Congo DR, case update
Ebola update (18): cases, Uganda NOT, Congo DR vaccination campaign
Ebola update (17): case update, public fears, government responses
Ebola update (16): cases, Congo DR cultural factors, vaccine impl.,
case terminology
Ebola update (15): case update, quarantine breaches, border controls,
Ebola update (14): case update, response, prediction, maps
Ebola update (13): case update, prevention
Ebola update (12): update, USA, response
Ebola update (11): WHO, vaccination, response
Ebola update (10): urban case Congo DR, response, support
Ebola update (09): update, alerts, prevention
Ebola update (08): summary, emergency plan, vaccine, roads
Ebola update (07): Congo DR, nurse, Uganda susp., WHO, border, vaccine
Ebola update (06): Congo DR, susp., RFI, vulnerability, response,
Ebola update (05): Congo DR, outbreak update, vaccine, preparedness,
Ebola update (04): Nigeria, Kenya, Congo DR (ET), WHO
Ebola update (03): Congo DR (ET), WHO
Ebola update (02): Congo DR (ET)]
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