Update: Ebola in North Kivu, DRC

The Ebola epidemic in the north-east of the Democratic Republic of Congo (DRC) is not under control yet, says medical humanitarian organisation Medecins Sans Frontieres/Doctors Without Borders (MSF), though some new aspects to the medical approach may help to strengthen the response. To date, 181 cases have been reported, of which 146 confirmed by laboratory tests. 80 people have died and 50 have recovered. 

 

"The number of confirmed Ebola cases is not skyrocketing, but the situation remains worrying. There are confirmed patients in big cities like Beni and Butembo, but also in places far away from the epicentre, close to the Ugandan border. That makes it difficult to contain the epidemic. Like all Ebola outbreaks, it’s difficult to predict how it may evolve, but we are ready to react and support the Ministry of Health whenever new cases appear”, said Laurence Sailly, MSF Emergency Coordinator.

 

MSF Ebola response

MSF collaborates with the Ministry of Health in Ebola treatment centres in North-Kivu and in Ituri, close to the Uganda border. MSF also carries out health promotion activities and infection prevention and control activities to protect health facilities between affected towns and cities.

This part of DRC is densely populated and there are a lot of population movements and trade which makes it difficult to identify and track all the active chains of transmission. “It’s important to understand these movements because that is how the virus moves too. Understanding the people is the key to understanding Ebola. And as the Ebola outbreak moves, we have to move too. We have to be flexible,” said MSF medical doctor and Ebola expert, Hilde De Clerk.

While new approaches are being developed in the intervention, the traditional ‘six pillars’ of an Ebola response remain critical. Investigating alerts and tracing contacts continue to play a major role, particularly while the scattered geographical pattern of new cases leaves little doubt as to the complexity of the challenge.

“A potential key to successfully control the outbreak is to react fast” said Laurence Sailly. “Whenever a confirmed Ebola case is found, a small, multidisciplinary rapid response team (nurse, epidemiologist, logistician, health promoter, medical doctor) is sent as fast as possible to work on this new hotspot and prepare for a potential bigger intervention.” MSF sent such teams to Luotu and Tchomia immediately after a confirmed Ebola patient was detected in these areas.

 

Innovations in the response

Some new aspects of treatment may play a significant role in a faster, more effective response to the outbreak. For instance, the blood samples of suspect Ebola patients are now examined in laboratories installed within the Ebola treatment centers themselves. This allows the teams to respond more quickly to the changing medical condition of patients.

In addition, this is the first time that five developmental drugs are being used to treat Ebola patients in DRC. Mortality among Ebola patients is very high, at roughly 50%, but these drugs have the potential to increase the odds of survival. The possibility of on-site testing means that new confirmed cases are offered these new treatments within 24 hours of their confirmation as positive to the virus.

“It’s very nice to have five molecules that seem promising, but we also have to be realistic. There is no scientific evidence that any of these drugs work for people with Ebola. Still, it’s a good step forward. We can offer Ebola patients access to potentially life-saving drugs while preparing for a clinical trial implementation that will hopefully determine efficacy and safety,” said Hilde De Clerk.

Finally, immunization activities using sthe Ebola vaccine (rVSVDG-ZEBOV) quickly followed the declaration of the epidemic. The WHO and Ministry of Health are providing vaccination for people who had contacts with Ebola patients. In addition to that, MSF is also running vaccination activities, offered in particular to frontline workers (health workers, personnel involved in burials and religious figures), who run a higher risk of becoming infected. A total of 13,750 people have been vaccinated so far.