WHO releases next phase of Ebola response plan

The World Health Organization (WHO) today unveiled its game plan for helping West African countries battle Ebola though the end of 2015, as its African regional office said talks are under way about a possible trial of Johnson & Johnson's Ebola vaccine in Sierra Leone.

The WHO's new Ebola strategy follows its initial Ebola plan, which was released in August 2014 and was designed to cover only response steps that would take place through February.

The new plan seeks to drive down cases as low as possible before the rainy season ramps up this month and next. It also focuses on limiting cases to the coastal areas, aggressively identifying all new cases, enhancing contact tracing, and boosting surveillance.

Tracing, treatment challenges remain

Persistent Ebola transmission is still occurring in Guinea and Sierra Leone, the WHO said in its response plan, because of continued unidentified cases and deaths in community settings, cases arising in people who are not on known contact lists, and a limited number of unsafe burials.

Case management still has gaps, the WHO said, noting that it still takes 2 to 3 days to isolate a potentially infectious case. The agency also highlighted high fatality rates among hospitalized patients and noted that healthcare workers are still being infected.

Steps include intensified case finding

For the next steps, the WHO said it's crucial to build on progress and lessons already learned and that the priority is to identify all new cases by the end of May and to confirm that the people are from known transmission chains and contact lists.

More specifically, the WHO said more in-depth and integrated community and epidemiologic investigations will help identify more cases, and that the goal is to decrease case fatality rates in treatment centers from 70% to less than 40% while ensuring the safety of health workers.

Mainstreaming community engagement activities into service delivery, such as through frontline health staff, is a critical part of an effective response, as is targeting community strategies to different groups, such as chiefs, religious leaders, women, and youth, according to the plan.

The WHO's Ebola plan for the rest of the year also involves preventing outbreaks in other nations, with a special emphasis on the bordering countries of Ivory Coast, Guinea-Bissau, Mali, and Senegal; safely restarting health systems in the outbreak countries; and fast-tracking the development of Ebola drugs, vaccines, and diagnostic tests.

Phase 3 trial for third vaccine?

In a related development, the WHO's African regional office said yesterday that an expert meeting convened in Accra, Ghana, Apr 8 through Apr 10 to review a clinical trial application for Johnson & Johnson's Ebola vaccine in Sierra Leone produced a signed agreement between Sierra Leone and the study sponsor. The office added that more documentation and timelines are needed before a final regulatory decision is made.

Johnson & Johnson's prime-boost vaccine regimen became the third Ebola vaccine to enter human trials in January in the United Kingdom. It uses a combination of two components based on AdVac technology from Crucell Holland BV, a Janssen subsidiary, and MVA-BN technology from Bavarian Nordic.

Declining numbers of cases in the three main outbreak countries are making it difficult to conduct studies that show efficacy for both vaccines and treatments that have been developed as potential tools to fight the disease.

The WHO said that about 60 experts took part in the Accra meeting, which reviewed the scientific and ethical aspects of the proposed trial in Sierra Leone.

Case number update

In a separate update today, the WHO said the number of confirmed, probable, and suspected Ebola infections in the outbreak region has reached 26,277, including 10,884 deaths.

The totals reflect increases of 118 cases and 42 deaths since the WHO's update yesterday. Today's numbers include data from Guinea and Sierra Leone as of Apr 26 and Liberia as of Apr 23.

See also:

WHO 2015 Ebola strategic response plan

Apr 27 WHO African regional office statement

Jan 6 CIDRAP News story "UK researchers launch human trial of third Ebola vaccine"

Apr 28 WHO situation update

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