Tuesday, August 21, 2018

PRO/AH/EDR> Ebola update (73): Congo DR (NK) cases, anti-viral, research

EBOLA UPDATE (73): DEMOCRATIC REPUBLIC OF CONGO (NORTH KIVU) CASES,
ANTI-VIRAL, RESEARCH
****************************************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

In this update:
[1] Case update
- Epidemiological situation report, 19 Aug 2018, DRC Ministry of
Health
[2] Experimental anti-viral
- mAB114
[3] Research
- biorxiv


******
[1] Case update
- Mon 20 Aug 2018. Epidemiological situation report, 19 Aug 2018, DRC
Ministry of Health
[in French, machine trans., edited]
<https://us13.campaign-archive.com/?u=89e5755d2cca4840b1af93176&id=604fda8a2d>

- A total of 96 cases of haemorrhagic fever were reported in the
region, 69 confirmed and 27 probable.
- 5 suspected cases are under investigation .
- 5 new confirmed cases in Mabalako.
- 5 confirmed case deaths in Mabalako

News of the response
Free care
--------
The Ministry of Health has decreed free healthcare in the 3 health
zones most affected by the epidemic, namely Mabalako, Oicha, and Beni
[North Kivu]. Since Mon 20 Aug 2018, free care is effective in the 7
public health centers of Mabalako and will be effective in other
affected areas in the coming days.

Vaccination
-----------
Immunization activities continue at the three sites of Mabalako, Beni,
and Mandima. Since vaccination began on 8 Aug 2018, 1273 people have
been vaccinated , including 697 in Mabalako, 367 in Beni, and 209 in
Mandima.

Support
-------
A new Ebola Treatment Center (ETC) will be built in Makeke, Mandima
Health Zone, in Ituri province. During the last visit of the Minister
of Health to Mangina, the epicenter of the epidemic, it was found that
the 50-bed ETC installed by Médecins Sans Frontières (MSF) was
filling up rapidly and could no longer accommodate additional patients
given the rapid increase in confirmed and suspicious cases to be
supported. Thus, the coordination made the decision to install a 2nd
ETC in this area. Due to the lack of space in Mangina and the demands
of the population, this new ETC will be built in Makeke, a neighboring
area of Mangina, which also reported confirmed cases.

Response plan
-------------
The response plan submitted by the Ministry of Health has been
approved and all funds necessary for its implementation have been
lifted. The Ministry of Health thanks the partners for their
collaboration and contribution to the response.

--
Communicated by:
ProMED-mail Rapporteur Mary Marshall

[The number of cases is increasing steadily, especially in Mabalako,
as are the deaths, which is a disturbing trend. More ETCs are being
built in anticipation of the ever increasing number of patients
needing care. Offering free health care is an important step as
individuals will be more likely to come to the clinics when they are
sick. - Mod.LK

Important questions raised by Crofsblog
(<http://crofsblogs.typepad.com/h5n1/2018/08/ebola-drc-evolution-of-the-response-to-the-ebola-outbreak-in-north-kivu-province-on-monday-20-august-2018.html>):
"Out of today's 5 new deaths, how many were in the community and how
many in the local ETC? How many of the cases in this outbreak are
family clusters? Are "red zone" nurses still able to phone in to
report on their local cases? And if MSF's 50-bed hospital is filling
up, how big will the new ETC be, and how quickly can it be up and
running?" - Rapp.MM

HealthMap/ProMED-mail map:
North Kivu, Congo: <http://healthmap.org/promed/p/29837>]

******
[2] Experimental anti-viral
- Mon 20 Aug 2018. DRC: experimental Ebola treatment 'successful-
authorities'
[africanews, Reuters report [edited]
<http://www.africanews.com/2018/08/20/drc-experimental-ebola-treatment-successful-authorities/>

The Democratic Republic of Congo's National Institute for Biomedical
Research (INRB) has said a drug used for the 1st time on Ebola
patients, the mAb114, is working well in North Kivu. It said it
expects some patients to leave hospital on Tue 21 Aug 2018.

Professor Jean-Jacques Muyembe, the INRB's director-general said 10
Ebola patients had received mAb114 in Beni and that they are waiting
for its US manufacturers to deliver more doses this week.

"Until now 10 people have already received this treatment (mAb114) via
infusion, it's an hour of treatment, one injection and until now all
10 are getting better and I think Mon or Tue [20-21 Aug 2018] the 1st
case will leave the hospital," said Muyembe.

Muyembe said another 5 treatments that have been approved by the WHO
including Zmapp, Regeneron, Remdesvir, and Favipiravir should also be
available.

The patients receiving mAb114 have been closely monitored and no side
effects have yet been identified although he added it was too early to
tell.

The mAb114 treatment was developed in the United States from a blood
sample of an Ebola survivor in Kikwit, DRC, in 1995 and was 100
percent effective when tested on monkeys.

Muyembe said if the treatment was fully effective the fight to control
the spread of Ebola in North Kivu could move from containment to
cure...[more]

"This epidemic (in north Kivu) is not like the epidemic in Equateur
that we have known already. This epidemic will bring with it a lot of
surprises: the number of cases is going up and the number of infected
zones is increasing so it will take a long time to control this
epidemic and for the anti-virals which the companies will provide us,
they are ready to increase the doses," said Muyembe.

There have been renewed campaigns to raise awareness and inform the
public on how to protect themselves.

--
Communicated by:
ProMED-mail Rapporteur Mary Marshall

[The apparent success of mAb114 is very exciting, but it may be a
little early to label it a cure, even if all continues to go well. It
is a concern that conditions may often be too basic in many locations
to use mAb114 on a regular basis, since it has to be delivered in an
infusion, as do some of the other experimental therapies. Furthermore,
it will always take a multi-pronged approach to control Ebola
transmission including cessation of hunting bushmeat, adoption of
personal protective measures, safe burials, vaccination, and
anti-virals in concert to meet the challenges of this devastating
virus. - Mod.LK]

******
[3] Research
- bioRxiv
[ref: Wec AZ, Bornholdt ZA, He Shihua, et al. Human antibody cocktail
deploys multiple functions to confer pan-ebolavirus protection.
bioRxiv 395525;
<https://www.biorxiv.org/content/early/2018/08/20/395525>]
----------------------------------------------------------------------
Abstract. During the unprecedented 2013-2016 Ebola virus disease (EVD)
epidemic in Western Africa and in its aftermath, the passive
administration of monoclonal antibodies (mAbs) emerged as a promising
treatment approach. However, all antibody-based therapeutics currently
in advanced development are specific for a single member of the
_Ebolavirus_ genus, Ebola virus (EBOV), and ineffective against
divergent outbreak-causing ebolaviruses, including Bundibugyo virus
(BDBV) and Sudan virus (SUDV). Here we advance MBP134, a cocktail of 2
broadly neutralizing human mAbs targeting the filovirus surface
glycoprotein, GP, as a candidate pan-ebolavirus therapeutic. One
component of this cocktail is a pan-ebolavirus neutralizing mAb,
ADI-15878, isolated from a human EVD survivor. The second, ADI-23774,
was derived by affinity maturation of a human mAb via yeast display to
enhance its potency against SUDV. MBP134 afforded exceptionally potent
pan-ebolavirus neutralization in vitro and demonstrated greater
protective efficacy than ADI-15878 alone in the guinea pig model of
lethal EBOV challenge. A second-generation cocktail, MBP134-AF,
engineered to effectively harness natural killer (NK) cells afforded
additional, unprecedented improvements in protective efficacy against
EBOV and SUDV in guinea pigs relative to both its precursor and to any
mAbs or mAb cocktails tested previously. MBP134 AF is a best-in-class
mAb cocktail suitable for evaluation as a pan-ebolavirus therapeutic
in nonhuman primates.

--
Communicated by:
ProMED-mail Rapporteur Mary Marshall

[See Also:
Ebola update (72): Congo DR (NK) cases, response, research
http://promedmail.org/post/20180820.5975692
Ebola update (71): Congo DR (NK) cases, response, bats
http://promedmail.org/post/20180818.5974137
Ebola update (70): Congo DR (NK) cases, recommendations, war, comment
http://promedmail.org/post/20180817.5971731
Ebola update (69): Congo DR (NK,IT) cases, Uganda NOT, WHO response
http://promedmail.org/post/20180816.5968689
Ebola update (68): Congo DR (NK) WHO, Uganda cases, concerns,
challenges http://promedmail.org/post/20180815.5966397
Ebola update (67): Congo DR (NK) cases, response, issues, research
http://promedmail.org/post/20180814.5964660
Ebola update (66): Congo DR (NK) cases, response
http://promedmail.org/post/20180813.5962221
Ebola update (65): Congo DR (NK) cases, vaccines
http://promedmail.org/post/20180812.5960584
Ebola update (64): Congo DR (NK) cases, security, genome
http://promedmail.org/post/20180810.5959744
Ebola update (63): Congo DR (NK) cases, vaccine, security, burial,
genome http://promedmail.org/post/20180809.5957277
Ebola update (62): Congo DR (NK) WHO, response, genetics
http://promedmail.org/post/20180808.5953189
Ebola update (61): Congo DR (NK) WHO, cases, response
http://promedmail.org/post/20180806.5950109
Ebola update (60): DR Congo (NK) case update, response, risk
http://promedmail.org/post/20180805.5948198
Ebola update (59): Congo DR (NK) case update, risk, response,
treatment http://promedmail.org/post/20180804.5946851
Ebola update (58): Congo DR (NK) outbreak, Ebola Zaire confirmed
http://promedmail.org/post/20180802.5944088
Ebola update (57): Congo DR (NK):
http://promedmail.org/post/20180801.5941427
Ebola update (56): northeast Congo DR, Ebola-like cases, US negative,
RFI http://promedmail.org/post/20180730.5936610
Ebola update (55): Sierra Leone Ebola virus variant, Congo DR cases,
WHO http://promedmail.org/post/20180727.5931686
Ebola update (54): Congo DR, cases, therapeutics
http://promedmail.org/post/20180725.5926964
Ebola update (53): Congo DR, cases, surveillance, action
http://promedmail.org/post/20180720.5916987
Ebola update (52): Congo DR, cases, health workers, W Africa survivor
problems http://promedmail.org/post/20180713.5902694
Ebola update (51): Congo DR, cases, response
http://promedmail.org/post/20180709.5895475
Ebola update (50): Congo DR, Japanese response, CIDRAP, WHO, survey
http://promedmail.org/post/20180706.5891820
Ebola update (49): Congo DR, suspect deaths comment
http://promedmail.org/post/20180704.5888151
Ebola update (48): Congo DR, MSF, susp. deaths, RFI
http://promedmail.org/post/20180703.5886426
Ebola update (47): DR Congo, epidemiology, response, Libya RFI
http://promedmail.org/post/20180701.5884463
Ebola update (46): Congo DR, cases
http://promedmail.org/post/20180629.5882196
Ebola update (45): Congo DR, cases, outbreak, MSF
http://promedmail.org/post/20180628.5880392
Ebola update (44): Congo DR, cases, research, course
http://promedmail.org/post/20180626.5877543
Ebola update (43): Congo DR, cases, vaccine, persistence, lessons
http://promedmail.org/post/20180625.5873949
Ebola update (42): Congo DR, cases, vaccine
http://promedmail.org/post/20180625.5872757
Ebola update (41): Congo DR, cases, WHO, contacts
http://promedmail.org/post/20180623.5871358
Ebola update (40): Congo DR, cases, WHO, vaccine, treatment,
preparedness http://promedmail.org/post/20180622.5869267
Ebola update (39): Congo DR, cases, WHO, response, facilities,
treatment, research http://promedmail.org/post/20180620.5865023
Ebola update (38): DR Congo, cases, WHO, Oxfam
http://promedmail.org/post/20180618.5861962
Ebola update (37): Congo DR, cases, response
http://promedmail.org/post/20180617.5859839
Ebola update (36): Congo DR, cases, threat, assistance
http://promedmail.org/post/20180615.5858111
Ebola update (35): Congo DR, cases, response, WHO
http://promedmail.org/post/20180614.5855415
Ebola update (34): Congo DR, cases, response, WHO
http://promedmail.org/post/20180613.5853602
Ebola update (33): Congo DR, cases, response, WHO, diagnosis
http://promedmail.org/post/20180612.5850968
Ebola update (32): Congo DR, cases, preparation, research
http://promedmail.org/post/20180611.5849759
Ebola update (31): Congo DR, cases, response, WHO
http://promedmail.org/post/20180610.5848785
Ebola update (30): Congo DR, cases, WHO, action
http://promedmail.org/post/20180609.5847441
Ebola update (29): Congo DR, cases, MSF, antivirals
http://promedmail.org/post/20180608.5845483
Ebola update (28): Congo DR, cases, WHO, response, treatment, funding
http://promedmail.org/post/20180607.5843872
Ebola update (27): Congo DR, cases, travel screening, children
http://promedmail.org/post/20180606.5841051
Ebola update (26): Congo DR, border controls, bat reservoir
http://promedmail.org/post/20180604.5838529
Ebola update (25): Congo DR, case update, intl. travel screening
http://promedmail.org/post/20180603.5836552
Ebola update (24): Congo DR, case update, African aid response
http://promedmail.org/post/20180602.5835414
Ebola update (23): Congo DR, cases, vacc. campaign targets, vaccine
development http://promedmail.org/post/20180601.5834040
Ebola update (22): Congo DR, cases, cures, domestic and international
travel http://promedmail.org/post/20180531.5831747
Ebola update (21): Congo DR, update, WHO, vaccination, therapeutics
http://promedmail.org/post/20180530.5829192
Ebola update (20): Congo DR, case update, lessons, logistics,
financing, flights http://promedmail.org/post/20180529.5824985
Ebola update (19): Congo DR, case update
http://promedmail.org/post/20180528.5822466
Ebola update (18): cases, Uganda NOT, Congo DR vaccination campaign
http://promedmail.org/post/20180527.5821927
Ebola update (17): case update, public fears, government responses
http://promedmail.org/post/20180526.5820606
Ebola update (16): cases, Congo DR cultural factors, vaccine impl.,
case terminology http://promedmail.org/post/20180525.5817907
Ebola update (15): case update, quarantine breaches, border controls,
vaccine http://promedmail.org/post/20180524.5816349
Ebola update (14): case update, response, prediction, maps
http://promedmail.org/post/20180523.5812835
Ebola update (13): case update, prevention
http://promedmail.org/post/20180521.5809540
Ebola update (12): update, USA, response
http://promedmail.org/post/20180520.5806396
Ebola update (11): WHO, vaccination, response
http://promedmail.org/post/20180519.5805133
Ebola update (10): urban case Congo DR, response, support
http://promedmail.org/post/20180517.5801917
Ebola update (09): update, alerts, prevention
http://promedmail.org/post/20180516.5799567
Ebola update (08): summary, emergency plan, vaccine, roads
http://promedmail.org/post/20180515.5797415
Ebola update (07): Congo DR, nurse, Uganda susp, WHO, border, vaccine
http://promedmail.org/post/20180513.5795881
Ebola update (06): Congo DR, susp, RFI, vulnerability, response,
control http://promedmail.org/post/20180512.5794300
Ebola update (05): Congo DR, outbreak update, vaccine, preparedness,
research http://promedmail.org/post/20180511.5792856
Ebola update (04): Nigeria, Kenya, Congo DR (ET), WHO
http://promedmail.org/post/20180510.5791247
Ebola update (03): Congo DR (ET), WHO
http://promedmail.org/post/20180509.5790577
Ebola update (02): Congo DR (ET)
http://promedmail.org/post/20180508.5789723]
.................................................lk/mj/lxl
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