Underscoring concerns that health worker Ebola infections could amplify the current outbreak in the Democratic Republic of Congo (DRC), the country's health ministry today reported five more confirmed cases, including four involving health workers at a health center in Mangina. The other is a patient recently treated at that facility.
The batch of new cases puts the outbreak total at 57, which now exceeds the 54 illnesses reported in recent Equateur province outbreak, which was declared over just a week before officials announced the latest outbreak.
In other developments, World Health Organization (WHO) Director-General Tedros Adhanom Ghebreyesus, PhD, today filled reporters in on a visit he and his colleagues made to the new outbreak zone and warned that inaccessible "red zones" due to armed conflict might be hiding places for the Ebola virus and make it difficult for responders to enter and for infected residents to seek outside help.
"I was worried before I got there," he said of the area, which he said is home to more than 100 armed groups and has experienced about 120 violent attacks since January. "After the visit, I am even more worried."
Tedros said the night his delegation stayed in Beni, an incident took place about 9 miles away, which resulted in the killing of four civilians with a number of people kidnapped.
Infection patterns also show more illnesses in women and children
According to the DRC health ministry's daily update, the 57 Ebola cases includes 30 confirmed and 27 probable cases. Also, health officials are investigating 58 suspected cases, up from 45 reported on Aug 12. Two more deaths were reported, pushing the total number to 41.
Besides the four new confirmed cases among health workers from Mangina Reference Health Center, there is one new confirmed case in a man from neighboring Ituri province who had been treated for heart problems at Mangina Reference Health Center. He died after returning to his village in Ituri, which is a short distance from Mangina.
Yesterday, the WHO signaled that it was worried about early exposure in healthcare workers and warned that, given the amplifying effect sick healthcare workers have on spread of the disease, the outbreak could get worse before it gets better.
At today's briefing, Tedros said 7 health workers are among the confirmed Ebola cases and that as a precaution, all 74 of the facility's workers are considered contacts and are under home monitoring. He noted that replacement workers have already been provided to staff the treatment center.
He said there are several features of the North Kivu outbreak that are different than the recent event in Equateur province, including high population density and population movement, high numbers of displaced people, armed conflict in the area, and a different Ebola genotype. Another, Tedros said, is high numbers of infected women and children. He said the pattern could be due to women's responsibilities as caregivers and the dependence of children on women. However, he said other factors may be in play, such as cultural factors, which require further investigation.
Vaccination strategy could change
In a vaccination update, Tedros said 216 health workers have received the VSV-EBOV vaccine and that 20 people from the community have also been immunized.
Health officials are hoping to speed up deployment of the vaccine, he said, adding that experienced immunization teams from Guinea arrived in Kinshasa yesterday and are expected to be on the ground in Beni and Mangina today.
So far, responders are sticking with the ring vaccination strategy, which targets contacts of confirmed cases and the contacts of the contacts, he said. However, depending on how events unfold, officials may need to consider other strategies.
Given the high numbers of healthcare worker infected in Mangina, Tedros said health officials have proposed vaccinating the entire community of about 1,200 people to more quickly contain the virus.
There are about 3,000 doses of vaccine in the DRC, and up to 300,000 doses are available on short notice, he said. "We are OK, we are comfortable," he said of the vaccine supply situation.
First patients get experimental treatment
In another new development, the DRC's health ministry said health teams have started using the experimental monoclonal antibody treatment mAb114 in treatment centers in Beni and Mangina, making it the first experimental therapy to be used in an active Ebola outbreak in the DRC.
In the earlier outbreak this year, the ministry's scientific and ethics committees approved the use of five experimental therapies, which included mAb114. At the start of the North Kivu outbreak, the country's National Institute of Biomedical Research (INRB) asked the makers of all five therapies to reauthorize their use and amend treatment protocols for the ethics committee to review again.
Supplies of all treatments have arrived in Beni, except for ZMapp, which must be stored at -20°C (-4°F).
The ethics committee has already cleared mAb114 for use, and the other four have just been submitted to the group for reconsideration, according to the health ministry.
At today's briefing, Tedros said five patients have already received mAb114. He added that the INRB and the US National Institutes of Health (NIH) had launched a study of the treatment in May.
The monoclonal antibody is based on antibodies of a patient who survived Ebola in the DRC city of Kikwit in 1995. A WHO expert committee in May evaluated five experimental Ebola therapies, including mAb114. It said early data on the treatment looked promising, but more were needed before recommending it for compassionate use.
Aug 13 CIDRAP News story "Worries about security and healthcare exposures as DRC Ebola total grows to 52"