Ebola response resumes in Beni, but protests spread to Butembo

Ebola temperature check
Ebola temperature check

GPE, Tabassy Baro / Flickr cc

Ebola response activities in the Democratic Republic of the Congo's (DRC's) hot spot in Beni started again slowly today, following talks yesterday among health, city, and community officials, but field activities slowed in the city of Butembo after a pressure group called for a community mourning period to protest deadly violence that flared last weekend in Beni.

In other developments, one new Ebola infection was confirmed in Beni, and researchers reported on adverse events following vaccination with VSV-EBOV—which were mild to moderate and of short duration—based on a ring vaccination trial in frontline workers in Guinea's outbreak.

Response pause spreads to Butembo

In an update yesterday, the DRC's health ministry said the civil society had called on Beni residents to observe a 5-day protest over a violent clash on Sep 22 between rebels and armed forces, which killed 21 people and suspended response activities. Several recent cases have resulted from a transmission chain Beni, where health officials have struggled to trace and vaccinate contacts amid pockets of community resistance.

The protest threatened to stall response activities, but yesterday after meeting with the country's response coordinator Beni's mayor met with the civil society president to explain the dangers of stopping the response for a whole week, the health ministry said in its update yesterday. Following the meetings, the civil society president announced that all response teams from both the government and partner organizations could work during the protest days.

Today the ministry said field activities in Beni began cautiously and that teams were able to conduct their work in the community safety.

The agency added, however, that in Butembo, a pressure group called La Veranda Mutsanga declared a multi-day protest to sympathize with the people in Beni, which slowed down field activities in the urban area, where 8 cases have been reported, 6 of them confirmed.

One new case in Beni

The DRC's update yesterday reported one new case, a patient from Beni, raising the outbreak total to 151 cases, 120 of them confirmed. One more death was reported, also involving a resident of Beni.

No new cases were reported today, but the ministry said 17 suspected cases are under investigation.

Vaccination teams continued to make more progress, and 11,921 people have received Merck's experimental VSV-EBOV vaccine, including 108 in Tchomia, where a pair of cases were recently detected near the border with Uganda.

The World Health Organization (WHO) said yesterday in a weekly situation update that overall, the proportion of contacts followed up daily has improved over the past week, rising to between 93% and 98%, compared with 85% to 94% the previous week.

The WHO added, however, that the improvement should be interpreted with caution, given that five of the confirmed cases reported over the past week involved unregistered contacts, which pose a greater risk of spreading the disease. The agency said that in Beni, the proportion of contacts traced fell to 35% on the day field activities were suspended following the Sep 22 violence.

"This highlights the need to reinforce contact listing and tracing of missing contacts who could eventually generate new transmission chains," the WHO said.

Vaccine trial raises pregnancy concerns

The vaccine study details a sub-study of a ring vaccination trial of VSV-EBOV that took place during Guinea's outbreak that was designed to look at humoral and cellular immune response and assess the frequency, incidence, and nature of adverse events, including serious ones. Researchers from Doctors Without Borders, Paris-based Epicentre, and Guinea published their findings yesterday in Vaccine.

Frontline workers were invited to participate, which included health workers, burial team members, and community outreach workers. The trial took place in Conakry from March 2015 to July 2016 and included 2,016 people who were vaccinated and 99 controls who had declined vaccination.

The researchers followed most participants for 3 months and followed a subset for 6 months, monitoring solicited and unsolicited adverse events at each visit. Women who became pregnant during follow-up were monitored for the duration of their pregnancies.

In the 3 days following vaccination, adverse events were very common, with 70% of participants reporting at least one. The most common symptoms were headache, fatigue, joint pain, subjective fever, and myalgia. Of those who kept fever diaries, 15.2% reported post-vaccination fever. The adverse events typically disappeared within 3 to 4 days.

Compared with the control group, local reaction, fatigue, headache, arthralgia, myalgia, and subjective fever within the first 3 days was statistically significant. Eight serious adverse events were reported, two of them related to pregnancy.

The authors wrote that the proportions of patients reporting fever after vaccination was similar to phase 1 and phase 2 trials of the vaccine and that vaccine-related fever has also been reported for two other Ebola vaccine platforms—the chimpanzee- and human adenovirus–vectored versions.

They noted that fever is a concern during an Ebola outbreak, given that fever could point to an active infection. They added that managing fever in future uses of the vaccine in outbreak settings would need protocols to distinguish adverse events after vaccination and suspected Ebola.

The negative outcomes in pregnant women is also a concern, they said, but Ebola infection during pregnancy has also been linked to high rates of complications. In addition, Ebola infections in pregnant women pose added risk to health workers, they note, adding that it's critical to collect more information on the safety of the vaccine in pregnant women to guide future recommendations.

See also:

Sep 25 DRC update

Sep 26 DRC update

Sep 25 WHO situation report

Sep 25 Vaccine abstract

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