Ebola has surfaced in a remote part of the Democratic Republic of the Congo (DRC), the first outbreak of the disease since the West African epidemic that killed more than 11,000 people before it came to an end 2 years ago. A vaccine proved its worth in the West African epidemic—which hit major cities—but it still is awaiting approval from regulatory agencies, and the DRC government has yet to request its use for this outbreak.
According to a statement issued by the World Health Organization (WHO) today, nine suspected cases have been reported so far, and only one has been confirmed as Ebola. Three of the people have died. The outbreak began 22 April in the Likati Health Zone of the Bas Uele Province, which is in the northern region of the DRC that borders the Central African Republic. WHO notes that it “was informed” about the cluster of cases 9 May and the confirmation of the one case occurred 2 days later. The Washington Post reports that the confirmed case, the first victim, had to travel by motorbike across the large province to reach a hospital in Likati and that it took 10 days for his blood sample to reach Kinshasa. DRC has no roads that span the country and long-distance travel largely is restricted to river boats and private airplanes.
Marie-Paule Kieney, an assistant director general at WHO who played a central role during the West African epidemic, says Merck, the maker of the vaccine that appeared to work in a trial held in Guinea in 2015, is ready to provide the product if necessary. “Discussions are ongoing with the government on whether vaccination should be undertaken or not,” Kieney says. “The outbreak is very small, so it may be stopped through containment only.” Traditional “containment” efforts include isolating and confirming cases, providing protective gear for health care workers, using safe burial procedures, and educating the public about how to reduce their risks.
One person helping with the response who asked not to be identified said there are now 52 suspected cases—and deep frustration that a decision has yet to be made about whether to use the vaccine. “If it were up to me I’d already be using it,” the person says. “It’s hard to dream up a rationale for not using the vaccine as quickly as possible.”
Doctors Without Borders (MSF)— which led the initial health care response in West Africa—tomorrow plans to send 14 people to Likati, including doctors, nurses, logisticians, water and sanitation experts, health promoters, and an epidemiologist. An MSF statement explains that they will be joined by 10 people from the DRC’s Ministry of Health as well 15 tons of medical and logistical supplies sent by cargo plane from Kinshasa. A spokesperson did not know whether MSF had requested the vaccine for its team.
Plenty of the Merck vaccine exists, though its experimental status would require what’s known as an “Expanded Access” study protocol to be approved by regulatory bodies before it could be shipped to the DRC. WHO has some 10,000 doses in Geneva, Switzerland, leftover from the West Africa outbreak, sources tell ScienceInsider, and Merck has some 700,000 doses on ice in the United States.
At a meeting 25–27 April by WHO’s Strategic Advisory Group of Experts on Immunization (SAGE), the experts recommended that the Merck vaccine “be promptly deployed” if the strain known as Ebola Zaire—which is the virus in the DRC—surfaces. SAGE further suggested that Expanded Access study “be implemented promptly after the confirmation of a case” and that the vaccine be used in the same “ring vaccination” strategy that worked in Guinea, which gave shots to people (including health care workers) who were in close contact with each confirmed case.
The first documented Ebola outbreak, which occurred in 1976, hit Yambuku in the DRC. The country since has had six other outbreaks, and the worst one was contained with only 315 cases of the highly lethal disease.