The Ebola situations in the three hardest-hit countries continue to reflect a mixed picture, with Guinea's pattern fluctuating and the virus extending its reach, Sierra Leone's incidence starting to level off, and Liberia's cases sinking to low levels, the World Health Organization (WHO) said today in its weekly snapshot of the outbreak and response.
In other developments, experts will meet at WHO headquarters in Geneva tomorrow for the second time to discuss Ebola vaccine trials and a funding structure for an immunization campaign in the region, once vaccine is available.
Updates on numbers, goals
The global number of Ebola cases has grown to 20,747, with the death toll rising to 8,235, the WHO said. The group also provided an update on two Jan 1 goals set by the United Nations Mission for Ebola Emergency Response (UNMEER).
Guinea, Liberia, and Sierra Leone all have the capacity to isolate and treat all Ebola patients, averaging more than two treatment beds for each confirmed or suspected case. However, treatment beds are unevenly distributed in some areas, meaning UNMEER's 100% goal still hasn't been met in some places.
Though the three countries have enough capacity to bury all people known to have died from Ebola, underreporting of deaths means that UNMEER's 100% safe burial target wasn't met, the WHO said.
Many of the outbreak's hot spots are still located in and around the capital cities of all three countries, which has been a unique feature of West Africa's epidemic.
Guinea over the past week reported 74 more Ebola cases, with no clear indication whether cases are going up or down, according to the WHO. The disease is continuing to spread geographically, with the western prefecture of Fria confirming its first Ebola cases. Roughly half of the new cases were reported from Conakry and nearby Dubreka district, with Lola district—an area in eastern Guinea that borders Ivory Coast—reporting 12 confirmed cases.
Sierra Leone is still the worst-affected country, but the WHO said there are signs that incidence may have leveled off. Over the past week the country reported 248 new confirmed cases. The western part of the country is still seeing intense activity, with Freetown and the neighboring Port Loko and Western Rural districts accounting for 184 of last week's cases.
In eastern Sierra Leone, Kono district, bordering Guinea, reported 32 cases last week, according to the WHO.
Liberia reported 8 new confirmed cases last week, along with 40 probable ones. For comparison, the WHO said at the country's peak in August and September it reported about 300 new cases each week. Montserrado County, which includes the capital, Monrovia, accounted for most of Liberia's latest cases.
The WHO upped the number of health worker infections to 838, which is 160 more than reported last week. However, it said the jump reflects infections reported from Sierra Leone earlier in the outbreak that have been added to the total, not a recent spike in cases.
Vaccine experts to meet
In a statement today the WHO said experts meeting in Geneva tomorrow will discuss safety and immunogenicity results so far from phase 1 clinical trials of Ebola vaccines. The experts will also review plans for phase 2 and phase 3 efficacy trials, it said. The meeting is a follow-up to a similar meeting held on Oct 23.
Human trials are under way for three vaccines: one developed by the National Institutes of Health (NIH) and GlaxoSmithKline (ChAD3) that uses a modified chimpanzee adenovirus, one developed by Canadian researchers and licensed by NewLink Genetics and Merck that uses a modified vesicular stomatitis virus (VSV-EBOV), and a prime-boost combination from Johnson & Johnson based on AdVac technology from Crucell Holland BV and MVA-BN technology from Bavarian Nordic.
The WHO also said experts will hear updates on the Global Alliance for Vaccines and Immunization (GAVI) announcement on Dec 11 that its board approved a plan to buy millions of Ebola vaccine doses to support large-scale vaccination in West Africa. The plan would commit $300 million to purchase the vaccine supply and an extra $90 million to help countries deploy it and shore up their health systems.
Helen Rees, MBBS, a professor at the University of Witwatersrand and cochair of the WHO's Ebola vaccine working group, will lead tomorrow's meeting. The WHO said it will host a telebriefing with journalists on Jan 9 to announce the group's conclusions and related developments.
African-region response developments
In the outbreak region, UNMEER's new leader, Ismail Ould Cheikh Ahmed, visited Liberia on Jan 5 and 6, meeting with the country's president and several high-level officials involved in the outbreak response. He warned that Liberia still faces a critical time, despite recent progress.
Liberian President Ellen Johnson-Sirleaf said cases could rise again if enough attention isn't paid to cross-border coordination, according to the latest UNMEER update today. UNMEER said it is coordinating cross-border meetings with government officials, with representatives from Liberia and Sierra Leone meeting today,
Response groups are still grappling with community resistance, and UNMEER said a community transit center that was under construction in Lola prefecture burned down yesterday. The arson is likely linked to continuing local resistance to response efforts, UNMEER said, adding that the center would have been one of the first functional community transit centers in Guinea.
Antiviral trial launches at Liberian MSF center
In other developments, a clinical trial of the oral antiviral drug brincidofovir has been launched at a Doctors without Borders (MSF) treatment center in Monrovia, with the first patient receiving a dose on Jan 2, according to a statement today from Oxford University, which is leading the study. The drug is produced by US-based Chimerix, and the study is funded by the Wellcome Trust.
Brincidofovir was developed to treat other viral diseases, and experts have some idea of its safety profile from clinical studies of its use in treating adenovirus and cytomegalovirus infections. In vitro studies have hinted that it may have activity against the Ebola virus.
A handful of people who were sickened in the outbreak and airlifted out of the region have been treated with brincidofovir, alongside supportive therapy and sometimes other experimental treatments.
Trudie Lang, PhD, one of the Oxford investigators, said experts learn little when drugs are given on a case-by-case basis. It's essential to conduct properly designed clinical trials to see if the drugs are safe and if they work, she added. "Typically it takes over 18 months to start a trial. Here we have done it in less than four months. Everyone has pulled together to make it happen—a Herculean effort by all those involved."
The single-arm, open-label trial won't have a control group and will include up to 140 adult volunteers who will be given a 2-week course of the drug. Researchers will compare the fatality rate in study subjects with the rate in those treated at the center before the trial's launch.
Jan 7 WHO Ebola situation update
Jan 7 UNMEER update
Jan 7 Oxford University press release
Jan 7 WHO meeting announcement