Picture: Dr Azadeh
KINSHASA, Congo) — Congo’s health ministry has confirmed two cases of Ebola in this central African country, a resurgence nearly 10 months after the end of an earlier outbreak. The Health Ministry said Tuesday that five samples were taken from suspected cases in Bikoro in the northwest. It said of the five samples sent to the National Institute of Biological Research in Kinshasa, two came back positive for Ebola. It said since the notification of the cases on May 3, no deaths have been reported among those hospitalized or among health personnel. The ministry said a team of experts will go to Bikoro on Wednesday to supervise and help monitor the situation to avoid further spread of the disease. This is the ninth outbreak of the hemorrhagic fever in Congo since 1976.
Ebola is back
For more than four decades, the rare but deadly virus has terrorized the world, with news of a new outbreak cropping up seemingly every few years. The largest of these outbreaks took place in West Africa from 2014 through 2016 when Ebola killed more people than in all previous outbreaks combined: 11,310. Now, the world is once again on the brink of another Ebola outbreak, this time in the Democratic Republic of the Congo (DRC). As of Monday, the World Health Organization (WHO) estimates there have been 41 cases and 20 deaths in this latest Ebola outbreak. They’ve traced the first case back to early April, and the DRC’s Ministry of Health (MoH) officially declared the situation an “outbreak” on May 8.
Here’s what you need to know about this latest Ebola threat.
What makes this outbreak different from the one in 2014
Traditionally, health officials have largely relied on something called contact tracing to contain Ebola outbreaks. They work backwards from each infected person, figuring out everyone they might have come in contact with and monitoring those individuals for any sign at all of infection. Unfortunately, people can fall through the cracks. Someone sick with Ebola might not be able to provide a comprehensive list of everyone they’ve come in contact with. As the CDC notes, just one missed person can delay the end of an outbreak.
This time though, health officials have another, far more proactive weapon in the fight against Ebola: an experimental vaccine known as Merck’s r VSV-ZEBOV, or V920.
How “experimental” is this Ebola vaccine
It’s experimental in the sense that officials have never attempted to use it to prevent an outbreak. As far as clinical trials go, though, it looks like a pretty sure thing.
In December 2016, WHO officials announced the results of a V920 test involving 12,000 individuals in Guinea, which was just in the end stages of the West Africa outbreak at the time of the trial.
Of the nearly 6,000 individuals vaccinated during the course of the study, none contracted Ebola. Meanwhile, 23 people in the control group (who didn’t receive the vaccine) contracted the virus. This Ebola vaccine isn’t officially licensed by the U.S. Food and Drug Administration (FDA) yet, seemingly as a matter of the nation’s slow and complicated approval process. However, the DRC can use it under the FDA’s “compassionate use” protocol – essentially a way to grant patients access to drugs that are still in development.
So, what’s the plan now
On May 16, the first batch of 4,000 Ebola vaccine doses arrived in the DRC capital of Kinshasa. More doses should follow, according to the WHO. In addition to healthcare workers, the first people to receive the vaccine will be those who’ve already been in contact with people infected with the virus, WHO Director-General Tedros Adhanom Ghebreyesus told STAT News. Using the tried-and-true contact tracing method, officials have identified 382 such people so far. Getting the Ebola vaccine to those who need it won’t be easy, though.
Physically moving the vaccine from one region to another in the difficult terrain of the DRC is just one challenge. Keeping it stored at a temperature where it’s most effective — between -60 and -80 degrees Celsius (-76 and -112 degrees Fahrenheit) — is another. Still, while using V920 might not be simple, it has the potential to play a major role in preventing this Ebola outbreak from turning out like the one in West Africa just a couple of years back. And if the WHO and other organizations are able to overcome the logistical hurdles and prove that V920 is effective at preventing an outbreak from escalating, Ebola’s reign of terror over the world might finally come to an end.
Where Did the Ebola Virus Get Its Name
The Ebola virus was named after the Ebola River in central Africa. The Ebola virus was first discovered in 1976 during two outbreaks, one in Sudan and one in the Democratic Republic of Congo, according to the World Health Organization, or WHO
The Ebola virus is thought to have originated in fruit bats, and it can spread to people and other animals through close contact, as stated by WHO. As of 2015, the 2014 Ebola outbreak was the largest outbreak of Ebola since the virus was discovered, and it is believed to have started in Guinea and spread to other countries by land and air travel.
What Are the Details of the 2014 Ebola Outbreak in West Africa?
The Ebola outbreak in West Africa is the largest in history. It effects multiple countries in West Africa, and the outbreak has produced over 23,900 total cases, as of February 2015, reports the Centers for Disease Control.
Ebola virus is a highly contagious hemorrhagic fever. Ebola spreads through contact with bodily fluids from an infected person. The incubation period for the virus can last from two days to three weeks, and people remain contagious as long as their bodily secretions contain the virus, states to the CDC. Symptoms of the virus include joint and muscle pain, fever, and internal and external bleeding, reports The Washington Post.
The 2014 outbreak is concentrated in Sierra Leone, Liberia and Guinea, three small, West African states. The hysteria surrounding the outbreak has caused various conspiracy theories, leading some of the local population to fight government aid workers, says The Washington Post.
Ebola had not previously been seen in these regions of West Africa, so the first cases were not immediately identified. Inadequate local health facilities did not have the materials to contain the virus. Additionally, the population is increasingly mobile, allowing the virus to spread quickly, states CBS news.
The 2014 outbreak involves the Ebola-Zaire strain of the virus, which has a fatality rate of up to 60 percent. CBS news reports that, while Ebola has a very high death rate, it effects far fewer people than other dangerous, infectious diseases.
What are the common Symptoms of the disease
Common symptoms of the disease include:
· Severe headache
· Muscle pain
· Stomach pain
· Unexplained bleeding or bruising
After exhibiting symptoms of a transient ischemic attack, such as numbness, confusion, difficulty speaking or walking, individuals may require hospitalization and treatment with medications or surgery, according to WebMD. If blockage is found in the carotid arteries, an endarterectomy may be performed to reopen them
If a high risk of stroke is present, blood-thinning, anti-coagulant medications, such as aspirin or warfarin, may be given during inpatient observation and testing, notes WebMD.
Transient ischemic attacks, or TIAs, are warnings that a stroke may follow. The symptoms are identical to those of a stroke except that they are temporary and usually cease within 20 minutes. Depending upon which region of the brain is affected, signs of a TIA in progress can include vision loss, tingling in the face or weakness in the limbs that is often confined to one side of the body. The individual may be unable to comprehend language and have sudden balance issues.
After a TIA, dietary changes and medications may be used to lower blood pressure and help control diabetes in order to prevent another TIA occurrence or a full-blown stroke, explains WebMD. An aspirin regimen may be implemented, an increase in activity levels is often suggested, and individuals who smoke are advised to stop.
When living in or traveling to a region where Ebola virus is widespread, there are a number of ways to protect yourself and prevent the spread of EVD. Practicing good hand hygiene is an effective method in preventing the spread of dangerous germs, like the Ebola virus. Proper hand hygiene means washing hands often with soap and water or an alcohol-based hand sanitizer.
While in an area affected by Ebola, it is important to avoid the following:
· Contact with blood and body fluids (such as urine, feces, saliva, sweat, vomit, breast milk, semen, and vaginal fluids).
· Items that may have come in contact with an infected person’s blood or body fluids (such as clothes, bedding, needles, and medical equipment).
· Funeral or burial rituals that require handling the body of someone who died from EVD.
· Contact with bats and nonhuman primates or blood, fluids and raw meat prepared from these animals (bush meat) or meat from an unknown source.
· Contact with semen from a man who had EVD until you know the virus is gone from the semen.
These same prevention methods apply when living in or traveling to an area affected by an Ebola outbreak. After returning from an area affected by Ebola, monitor your health for 21 days and seek medical care immediately if you develop.
There is currently no vaccine licensed by the U.S. Food and Drug Administration (FDA) to protect people from Ebola virus.
An experimental vaccine called r VSV-ZEBOV was found to be highly protective against the virus in a trial conducted by the World Health Organization (WHO) and other international partners in Guinea in 2015. FDA licensure for the vaccine is expected in 2018. In the meantime, 300,000 doses have been committed for an emergency use stockpile under the appropriate regulatory mechanism (Investigational New Drug application [IND] or Emergency Use Authorization [EUA]) in the event an outbreak occurs before FDA approval is received. Scientists continue to study the safety of this vaccine in populations such as children and people with HIV.
Another Ebola vaccine candidate, the recombinant adenovirus type-5 Ebola vaccine, was evaluated in a phase 2 trial in Sierra Leone in 2015. An immune response was stimulated by this vaccine within 28 days of vaccination, the response decreased over six months after injection. Research on this vaccine is ongoing.
Ebola: Information for the general public
To protect yourself, your family, and your community from Ebola virus disease transmission, immediately report to the nearest health facility, if you develop symptoms: high fever, body aches, joint pain, vomiting, diarrhea, or hemorrhaging. Isolation and professional clinical treatment increase a person’s chance of survival
Further Information about the outbreak of Ebola at the WHO Gambia Office, WHO and UN websites to be found on internet, Email to firstname.lastname@example.org
Text only to DR AZADEH on 002207774469/3774469 working days from 3pm to 6pm.
Author DR AZADEH Senior Lecturer at the University of the Gambia, Senior Consultant in Obstetrics & Gynaecology, Clinical Director at Medicare Health Services.