As Ebola cases hit 111, DRC responders address local concerns

The Democratic Republic of the Congo (DRC) health ministry reported eight more lab-confirmed Ebola cases over the past 4 days, along with another probable infection, all from areas that have already reported illnesses.

In other outbreak developments, outbreak coordinators held a public meeting in Beni to ease tensions following recent community protests against the response, and health teams closed and disinfected a clinic in Beni that recently reported three cases. Another health ministry report said two patients who were given the experimental treatment mAb114 have recovered from their infections.

Also, a group of experts wrote in a Stat commentary that pregnant and lactating women should be included in vaccination efforts.

Total includes 83 confirmed cases

The newly confirmed cases are from Mabalako, the health zone that includes the hot spot city of Mangina, as well as Beni and Oicha, where an illness was confirmed in a physician last week and where at least two more suspected cases were reported.

The new developments push the overall outbreak total to 111 cases, including 83 confirmed and 28 probable cases. Nine more deaths were reported, raising that total to 72. Health officials are investigating 10 suspected cases, according to the ministry's update today.

The World Health Organization (WHO) in an Aug 24 update provided some epidemiologic details about the patients sickened in the outbreak so far.

Of 88 confirmed and probable cases reported as of Aug 19, the median age is 32 years old, with an age range of 0 to 74 years. Adults ages 30 to 39 account for 28% (25) of the cases. Of all cases, 58% (51) are female. Earlier in the outbreak, WHO officials had said responders were seeing a higher-than-expected number of illnesses in women and children.

Illness onsets range from late April to Aug 13, according to the WHO.

Community meeting to ease tensions

The meeting in Beni included the mayor, community leaders, customary chiefs, cell leaders, youth movements, and civil society, the health ministry said today in its update. More than 350 people met with outbreak response coordinators for more than 4 hours asking questions and raising concerns.

"This exchange helped to ease tensions within the community," the ministry said, adding that at the end of the meeting authorities agreed to prepare an action plan to support the response, including signaling of alerts.

Last week, media outlets reported that angry youth burned a health center in the village of Manbangu where Ebola vaccine was given. A health ministry spokeswoman told Reuters that an incident took place at the clinic, but that it hadn't been burned.

Beni clinic shuttered after illnesses

The DRC's health ministry said health teams have closed and disinfected a clinic in Beni after it reported three Ebola cases, two confirmed and one probable, according to its Aug 25 update. It said the steps are geared toward curbing transmission to other people and health workers.

Several health workers have been infected in the outbreak in Mangina and Beni, many of whom were thought to have been exposed to sick patients before the outbreak was declared.

Health workers are known to amplify the spread of the disease, and outbreak response teams have removed staff from at least two facilities so that potentially exposed health workers can be quarantined and monitored for any symptoms.

Two recoveries after mAb114 treatment

Earlier this month, health teams started using an antibody treatment called mAb114 in treatment centers in Beni and Mangina, marking the first time an experimental therapy has been used in an active Ebola outbreak in the DRC.

Two of the first 10 patient to receive mAb114 have recovered from their Ebola infections, the health ministry said in its Aug 24 update.

"The short, medium and long-term observations of patients and survivors will make it possible to evaluate the extent to which the molecule has contributed to their recovery," it said.

mAb114 is based on antibodies of a patient who survived Ebola in the DRC city of Kikwit in 1995 and is one of five treatments approved for compassionate use in the DRC's current outbreak.

Regarding vaccination, the number of people immunized with VSV-EBOV has risen to 4,130, the health ministry said in its update yesterday. The total includes 1,822 in Mabalako, 761 in Beni, 887 in Mandima, and 121 in Oicha.

In its recent update, the WHO said 7,160 more vaccine doses arrived in Kinshasa on Aug 20 and were immediately sent to Beni. It added that it expected that an additional 2,160 doses would be shipped by the end of the week.

Push for vaccinating pregnant women

In a commentary in Stat today, three US health experts wrote that the decision by outbreak responders not to immunize pregnant and lactating women with the experimental Ebola vaccine unfairly deprives them of protection against the deadly disease.

The authors are Ruth Faden, PhD, MPH, founder of the Johns Hopkins Berman Institute of Bioethics, Ruth Karron, MD, director the Center for Immunization Research and the Johns Hopkins Vaccine Initiative, and Carleigh Krubiner, PhD, a policy fellow at the Center for Global Development. All are part of the Pregnancy Research Ethics for Vaccines, Epidemics, and New Technologies (PREVENT) international working group.

Though the scientists acknowledged that information about the safety of the experimental vaccine in pregnancy is limited, they wrote that the knowledge gap is dwarfed by what's known from previous outbreak about the impact of the disease on pregnant women. They said up to 90% of pregnant women infected with Ebola have died from the disease, and nearly 100% of pregnancies in Ebola-infected women resulted in miscarriage or neonatal death.

The trio also contended that pregnant and lactating women are more likely than others to care for sick relatives, putting them in harm's way.

Though the VSV-EBOV vaccine has shown benefits in efficacy trials, its use in pregnant women outside of an outbreak setting wouldn't be seen as appropriate, they said. "But during a high-incidence Ebola outbreak, the catastrophic maternal and fetal mortality rates change the calculus, with the potential benefits of offering the vaccine to pregnant contacts clearly outweighing the potential harms," they wrote.

The group also noted that at least 20 pregnant women were unintentionally vaccinated in a previous trial, with no evidence of harm. They urged health leaders to apply the recent WHO rationale for using yellow fever vaccine—which also contains live vaccine virus—for pregnant women.

See also:

Aug 24 DRC update

Aug 25 DRC update

Aug 26 DRC update

Aug 27 DRC update

Aug 24 WHO statement

Aug 24 Reuters story

Aug 27 Stat commentary

Related Aug 27 Stat story

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