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Old 09-16-2019, 05:35 AM
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Or there isn't enough of the vaccine for everyone that needs it?
Or it's gotten to places where people aren't in a financial/political position to obtain it (i.e., TPTB instead of medical is determining access, or shipments are being hijacked/diverted/held for ransom)?
Or that it's spread to places the outside can readily observe/monitor?
Or there are finally enough cases that it's beginning to spread too rapidly/widely for tracking in time? How many new cases would it take to start that exponential curve up?


For those inclined, more prayer...
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Old 09-16-2019, 07:29 AM
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They still have a lot of the original vaccine, but they are thinking ahead that it could run short given the large population involved.

They also made the point that the ONLY way to test a new vaccine for effectiveness is to deploy it during an Ebola outbreeak.

I have no idea how good their numbers reporting is. It seems like they are suceeding in control, but with all the violence, who knows how good their numbers reporting is?
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Old 09-16-2019, 10:46 AM
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Quote:
Originally Posted by Justme11 View Post
They still have a lot of the original vaccine, but they are thinking ahead that it could run short given the large population involved.

They also made the point that the ONLY way to test a new vaccine for effectiveness is to deploy it during an Ebola outbreeak.

I have no idea how good their numbers reporting is. It seems like they are suceeding in control, but with all the violence, who knows how good their numbers reporting is?
The only way to test the vaccine is to take a person you know doesn't have ebola, give them the vaccine, and then try to give them ebola.

For some reason we frown on that kind of testing. So really the vaccine can't be fully tested and relies on crossed fingers for success.
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Old 09-16-2019, 08:41 PM
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Quote:
Originally Posted by Paravani View Post
Or maybe they don't want him talking about the hokey numbers that are coming out now that he's no longer in charge.

I find it curious indeed that over the past few weeks the infection rate has dropped by at least 30%, but the mortality rate has risen to 80%!


Could it be that the most of the Ebola cases they are reporting are the ones they must report, because they're dead?

Or has the disease suddenly become overwhelmingly virulent, in spite of advances in treatment?

Keep watch and stay safe.
Aside from the obvious potential of a biased government and reporting system...

I suspect the real reason is there's a breakdown between the at risk population and the government. The people who were possibly infected do not trust the health system and are not self reporting early on, and are instead waiting for later symptoms or death.

The infections are a leading indicator to deaths. Assume no change to the ratio, if those who survive the illness never reported it, then, today's deaths are / by exposure 3 weeks the total infected at that time - those who declined to self reported.

Deaths will always be reported; illness won't.
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Old 10-12-2019, 02:39 PM
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Looks like Ebola is under control.


EVOLUTION OF THE EPIDEMIC IN THE PROVINCES OF NORTH AND Kivu Ituri AT October 10, 2019
Friday, October 11, 2019
Since the beginning of the epidemic, the accumulated cases is 3,210, including 3,096 confirmed and 114 probable. In total, there were 2,146 deaths (confirmed in 2032 and 114 probable) and 1028 people healed.
422 suspected cases under investigation;
2 new confirmed case CTE in Ituri Mandima;
2 new confirmed deaths, including one in North Kivu Mabalako and 1 in Ituri Mandima;
1 person healed output of CTE in Ituri in Mambasa;
No health worker among the new confirmed cases. The accumulation of confirmed / probable among health workers is 161 (5% of all confirmed / probable cases), including 41 deaths.
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Old 10-12-2019, 04:59 PM
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Good news for the health care workers.

Because of that vaccine????

Because of better protection protacals????

Because fewer of them had actual contact????

How many health care workers total were exposed and thus how many percentagewise got sick/died?

41 deaths out of 161 healthcare workers means a death rate of 25% which is better than the roughly 30% death rate [assuming my mental math skills are still working].
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Old 10-12-2019, 05:09 PM
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Quote:
Originally Posted by Florida Jean View Post
Good news for the health care workers.

Because of that vaccine????

Because of better protection protacals????

Because fewer of them had actual contact????

How many health care workers total were exposed and thus how many percentagewise got sick/died?

41 deaths out of 161 healthcare workers means a death rate of 25% which is better than the roughly 30% death rate [assuming my mental math skills are still working].

Well, I signed up for regular email updates from their health ministry several months ago.
They send me an email in French about once a week.
I hit the translate button and provided the info here.
You might want to try and subscribe to the same email.
I believe if you send an email to the gmail account shown below, they would probably still add you.

The rest of the email :

"VACCINATION
- Vaccination symbolic of the local chief Butama vaccination resistant in Mambasa health zone in Ituri. Still in Ituri, continuation of vaccination around two confirmed cases from 07 and August 8, 2019 at Biakato mine Mandima with a low turnout because of the reluctance Community;
- Vaccination of frontline personnel continues in Kyondo reference Hospitals and Kayna in North Kivu;
- Continuation of local immunization days against polio integrated vitamin A supplementation and worming Mebendazole 17 in the antenna of health areas Butembo in North Kivu;
- Since the beginning of the vaccination August 8, 2018, 236,772 people were vaccinated;
MONITORING TO ENTRY POINTS
- Since the beginning of the epidemic, the cumulative controlled travelers (temperature measurement) health control points is 104 765 252;
- To date, a total of 111 points of entry (PoE) and sanitary control points (PoC) was set up in the provinces of North Kivu and Ituri to protect major cities and prevent the spread of the epidemic in neighboring countries.
Remember, the recommendations of the COMMITTEE OF MULTI-SECTOR RESPONSE TO THE DISEASE VIRUS Ebola are:

1. Follow the basic hygiene, including regular hand washing with soap and water or ash;
2. If knowledge from an epidemic area coming to visit and she is sick, do not touch it and call directly the toll of civil protection in North Kivu;
3. If you are identified as contacts of a patient with Ebola #, agree to be vaccinated and monitored for 21 days;
4. If a person dies because of Ebola, follow the instructions for funerals worthy and secure. It is simply a burial fashion that respects the funerary customs and traditions while protecting families and communities from contamination by the Ebola virus.
5. For all the health professionals follow the hygiene in health centers and declare anyone who is sick with symptoms of Ebola # (fever, diarrhea, vomiting, fatigue, anorexia, bleeding.
If all citizens meet these health measures recommended by the Secretariat, it is possible to quickly end this epidemic 10th."



Contact MWHC
MIPHY BUATA Eleke
+243 815 183 977
[email protected]
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Old 10-12-2019, 05:14 PM
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Quote:
Originally Posted by Florida Jean View Post
Good news for the health care workers.

Because of that vaccine????

Because of better protection protacals????

Because fewer of them had actual contact????

How many health care workers total were exposed and thus how many percentagewise got sick/died?

41 deaths out of 161 healthcare workers means a death rate of 25% which is better than the roughly 30% death rate [assuming my mental math skills are still working].
I think the big game changer is that they now have a treatment drug that is providing a fair number of cured patients.
So this reduces the fear of their people seeking help in the medical facilities when they get symptoms. Before it was massive mistrust and they would resist going to the medical centers. (and even attack them, burn them down etc).
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Old 10-12-2019, 07:05 PM
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i've been getting my info from promed.

Hadn't had time to read the email that came from them Wed.

It is sort of a major email dump of information [and I often skim parts of it].

**********

PRO/AH/EDR> Ebola update (97): Congo DR (NK,IT,SK) cases, WHO, summaries, response, research

Wed, Oct 9, 2019 10:47 am


EBOLA UPDATE (97): CONGO DR (NK,IT,SK) CASES, WHO, SUMMARIES.
RESPONSE, RESEARCH


A ProMED-mail post


<http://www.promedmail.org>


ProMED-mail is a program of the International Society for Infectious Diseases

<http://www.isid.org>

In this update:


[1] Case updates


- WHO/AFRO Ebola dashboard 7 Oct 2019


- CMRE (Comite Multisectoriel de la Riposte a la maladie a virus Ebola) update 7 Oct 2019

[2] Outbreak summaries

- WHO/AFRO external situation report 62

- CIDRAP (Center for Infectious Disease Research and Policy) 8 Oct 2019

- CIDRAP (Center for Infectious Disease Research and Policy) 7 Oct 2019

- WHO/AFRO, Weekly bulletin on outbreaks and other emergencies

[3] Response - WHO, International Health Regulations Emergency Committee on the Ebola outbreak in Congo DR


- MSF: vaccination

- Beni: community meeting

[4] Research - Antibody response to vaccination

******
[1] Case updates


- Mon 7 Oct 2019. WHO/AFRO Ebola dashboard [WHO/AFRO, abridged, edited]


<https://who.maps.arcgis.com/apps/opsdashboard/index.html#e70c3804f6044652bc37cce7d8fcef6c>

- 3206 cases (including 1 new confirmed case), of which 3092 confirmed

- 114 probable cases, 441 suspected cases

- 73 cases in the last 21 days

- 1016 survivors

- 2143 deaths

- 6.1K contacts being followed out of 7K identified

--


Communicated by: Mary Marshall <[email protected]>

[See Helen Branswell figure showing steady decline in cases over the last 21 days (the incubation period of Ebola).
<https://twitter.com/HelenBranswell>]

******

- Sun 6 Oct 2019. CMRE (Comite Multisectoriel de la Riposte a la maladie a virus Ebola) [in French, machine trans., abridged, edited]


<https://crofsblogs.typepad.com/h5n1/2019/10/drc-ebola-cmre-update-october-6.html>

The epidemiological situation of the Ebola virus disease in the provinces of North Kivu and Ituri dated 5 Oct 2019:

[In addition to zero new cases on 5 Oct 2019, we also learn that the response shutdown in Lwemba seems to have been resolved.]

- Since the beginning of the epidemic, the cumulative number of cases is 3204, of which 3090 are confirmed and 114 are probable. In total, there were 2142 deaths (2028 confirmed and 114 probable) and 1004 people cured;

- 414 suspected cases under investigation;

- no new cases confirmed;

- 1 new deaths of confirmed cases at the ETC in Komanda [Ituri];

- no recoveries released from ETCs;

- no health workers are among the newly confirmed cases. The
cumulative number of confirmed/probable cases among health workers is
161 (5% of all confirmed/probable cases), including 41 deaths.

- 19th day without response activities in Lwemba to Mandima health area in Ituri, where dialogue is ongoing in the community.

News Reconciliation between displaced people from Lwemba to Biakato and
communities left in Lwemba in Mandima [Ituri].
--------------------------------------------------------------------------------

The Lwemba communities who moved to Biakato in Mandima in Ituri
reconciled on Sun 6 Oct 2019 with the communities that remained in
Lwemba, in the presence of the response team led by the Deputy General
Coordinator, Dr Justus Nsio Mbeta, the Chief of the chiefdom and MCZ
[and area chief physician] of Mandima, the Coordinator of the Mangina
Response Sub-coordination, as well as some partners of the Ministry of
Health, including WHO, MSF, UNICEF, and the United Nations.

- From this meeting, the following recommendations emerged: setting up
a community committee to support the response, local recruitment of
sensitizers in the monitoring of community-based surveillance,
decontamination and labour in the construction of burnt houses. The
Ministry of Health has promised a supply of drugs to Lwemba soon.

- The Deputy General Coordinator for the Ebola Response to the Epidemic, representing the Ministry of Health and the Technical Secretariat of the CMRE, Dr Justus Nsio Mbeta, took this opportunity to recall the regulatory role of the Ministry Health and the role of each partner involved in the response.

- For the community affected by the fire, it calls for assurances of their safety, emergency humanitarian aid, compensation for their destroyed property and the reconstruction of their burned homes, the
involvement or employment of all victims in the various services at all levels, the immediate arrest of all alleged perpetrators of these acts and the care of the affected children.

- These fires occurred following the death of a nurse from Lwemba,
confirmed with Ebola virus disease. His death sparked the uprising of the population to burn down the houses and other property of all the unknown persons of Lwemba. This remains the cause, even of the cessation of the response activities in this health area for more than15 days.


- The leaders of the Lwemba community also called for the construction
of houses for the displaced, the organization of an inter-community
dialogue session by the Territorial Administrator or his delegate and the rehabilitation of the road leading to Lwemba.

- In the response, WHO is responsible for epidemiological surveillance, communication and prevention of infection (PCI) and vaccination. UNICEF for communication, psychosocial care. PCI, MSF, and ALIMA are responsible for the treatment of patients in the Ebola and PCI treatment centre and psychosocial support within ETC. WFP provides food products to contacts, IOM is responsible for the entry and control points (water supply, soap, and chlorine).

- As for the National Institute of Biomedical Research (INRB), Dr Nsio said that it takes care of the diagnosis and gives MSF and ALIMA the drugs to treat patients at ETCs.

- The World Health Organization promised to rebuild burned homes, ensure community monitoring (community watch) and investigations of all suspected cases, as well as build a transit centre in Lwemba, while UNICEF promised to improve communication and awareness using the premises, support PCI, decontamination, and psychosocial support, develop water sources, and build latrines in 5 priority schools.

- On the other hand, Medecins Sans Frontieres intends to help the community of Lwemba to resume Primary Health Care, organize triage in
the Health Areas present in the village, secure PCI, as well as train sensitizers.

- At the end of this Lwemba meeting, all partners, including WHO, UNICEF and MSF, met around the Deputy General Coordinator at the Biakato Reference Health Center to review the joint and shared planning of activities in Lwemba.


Vaccination
-----------

- Since the start of vaccination on 8 Aug 2018, 234 108 people have been vaccinated;

- the only vaccine to be used in this outbreak is the rVSV-ZEBOV vaccine, manufactured by the pharmaceutical group Merck, following approval by the Ethics Committee in its decision of 20 May 2018.


Monitoring at entry points
--------------------------

- 3 high-risk contacts were intercepted on Sat 5 Oct 2019 at Maboya
Checkpoint (PoC) in Butembo [North Kivu]. They are all from the same
family and came from the Kabasha health area to Kalunguta for Bunyuka
in Vuhovi [North Kivu];

- they are all contacts of a confirmed case, died of the Ebola virus disease (EVD) of 30 Sep 2019 in Kabasha;

- the 1st contact is an 8-year-old unvaccinated girl who presented fever of 38 deg C [100.4 deg F]. She was taken to the ETC of Butembo for care after validation of the alert;

- the 2nd contact is a 24-year-old man vaccinated and asymptomatic, the biological father of the 1st contact;

- the 3rd contact, grandmother of the 1st contact, 54, unvaccinated and asymptomatic;

- since the beginning of the epidemic, the cumulative number of travelers checked (temperature measurement ) at the sanitary control points is 102 840 774 ;


- to date, a total of 111 entry points (PoE) and sanitary control points (PoCs) have been set up in the provinces of North Kivu and Ituri to protect the country's major cities and prevent the spread of the epidemic in neighboring countries.

Communicated by: Mary Marshall

******


[2] Outbreak summaries

- Tue 8 Oct 2019. Democratic Republic of Congo: Ebola virus disease -
external situation report 62 [WHO/AFRO Health Emergency Information and Risk Assessment, edited]
<http://newsletters.afro.who.int/outbreak-dashboards/18ei4m71px7>

Situation update; data as reported by Sun 6 Oct 2018
----------------------------------------------------


In the past week, from 30 Sep to 6 Oct 2019, 14 new confirmed Ebola virus disease (EVD) cases, with an additional 9 deaths, have been reported from 7 health zones in 2 affected provinces in the Democratic Republic of the Congo. Although the decline in the number of new cases is encouraging, the recent fluctuations in case numbers per week must be interpreted with caution, as case reporting is contingent upon the level of access and security.

During mid-September [2019], serious security incidents in Lwemba health area, Mandima health zone [Ituri], stalled outbreak response activities for more than 2 weeks. Response activities have since resumed but remain limited. Last week [week of 30 Sep 2019], an open forum for discussion and reconciliation was held in Lwemba with partners and civil society to dispel mistrust and enhance engagement in future response activities. Improved access may result in enhanced case finding and an increase in the number of reported cases from the area.


In the 21 days from 16 Sep to 6 Oct 2019, 28 health areas in 11 health
zones reported new cases. During this period, a total of 73 confirmed cases were reported, with the majority coming from the health zones of Mambasa (30%; n=22 cases), and Mandima (23%; n=17 cases) [Ituri]. In the past 21 days, 10 cases were reported from Komanda [Ituri] and Oicha [North Kivu] health zones with links to cases from Beni [North Kivu] and Mambasa health zones. Issues with under reporting are possible in the Oicha health zone, as poor access and security constraints limit response activities. The occurrence of transmission along a major road in from Komanda and Mambasa also poses greater risk of spread westward to other major cities in the Democratic Republic of the Congo (such as Kisangani [Tshopo]).


As of 6 Oct 2019, a total of 3205 EVD cases were reported, including 3091 confirmed and 114 probable cases, of which 2142 cases died (overall case fatality ratio 67%). Of the total confirmed and probable cases, 59% (1796) were female, 30% (909) were children aged less than 18 years, and 5% (162) were healthcare workers.

As of 4 Oct 2019, 1000 people have survived EVD in this outbreak. Of the approximately 1555 confirmed cases admitted to Ebola treatment centers, 1000 of them, or nearly 2/3, have survived. The reintegration of survivors into community can create opportunities to discuss their experiences and strengthen the participation of local communities in the response. Many survivors are working within the response, and are an important part of caring for the sick and reaching out to communities. A programme is in place to monitor survivor health and support them in the year after they leave care.


Under Pillar 1 of the Strategic Response Plan

[<https://www.who.int/docs/default-source/documents/drc-srp4-9august2019.pdf>,


the estimated funding requirement for all partners for the period July to December 2019 is USD 287 million, including USD 120-140 million for
WHO. As of 8 Oct 2019, USD 60.4 million has been received by WHO, with
additional funds committed or pledged. Further resources are needed to
fund the response through to December 2019 and into Q1 2020.


Under Pillar 5 Regional Preparedness

[<http://newsletters.afro.who.int/outbreak-dashboards/1haas63fkz9>,


the funding requirement for all partners is USD 66 million, of which WHO requires USD 21 million. As of 8 Oct 2019, WHO has received USD
1.6 million. While some additional pledges are in the pipeline, increased funding for preparedness in neighbouring countries is urgently needed. WHO is appealing to donors to provide generous support. A summary of funding received by WHO since the start of this outbreak can be found at <https://tinyurl.com/yxdhgzw5>


The complete situation report is available at
<https://apps.who.int/iris/bitstream/handle/10665/328853/SITREP_EVD_DRC_20191008-eng.pdf>

Communicated by: Mary Marshall



[Helen Branswell (<https://twitter.com/> ) Update on the case fatality rate among patients cared for in ETCs -- #Ebola treatment centers.


Roughly 2/3 of them survive. That's the mirror image of the fatality rate of the outbreak as a whole, which has a 67% case fatality rate.]

- Tue 8 Oct 2019. New Ebola case

[CIDRAP (Center for Infectious Disease Research and Policy), edited]
<http://www.cidrap.umn.edu/news-perspective/2019/10/news-scan-oct-08-2019>
For 2nd day in a row, only 1 new Ebola case recorded in DRC
-----------------------------------------------------------


Today [8 Oct 2019] the World Health Organization's (WHO's) online Ebola dashboard shows one new case in the Democratic Republic of the Congo (DRC), which raises the outbreak total to 3206 cases, including 2143 deaths. A total of 441 suspected cases are still under investigation.

The past few weeks have witnessed a significant drop in cases, with only 5 in the past 4 days. The latest update yesterday from the WHO's African regional office noted 16 confirmed cases recorded from 29 Sep-5 Oct 2019.


"The number of new confirmed cases does seem to be declining, but
previous experience shows that this trend needs to be interpreted with
caution. Notwithstanding this, in areas where robust public health measures have succeeded, no new confirmed cases have been reported, showing that these approaches need to continue," the WHO said.


According to daily reports from the DRC's Ebola technical committee (CMRE), the single case recorded yesterday was in Oicha. In the past 3 weeks, Mambasa, Mandima, and Kalunguta have been the main outbreak hot spots.


Communicated by:Mary Marshall


- Mon 7 Oct 2019. 4 more Ebola cases reported in DRC
[CIDRAP (Center for Infectious Disuse Research and Policy)

<http://www.cidrap.umn.edu/news-perspective/2019/10/news-scan-oct-07-2019>


With 4 more cases recorded over the weekend and through today [7 Oct
2019], the Ebola outbreak in the Democratic Republic of the Congo (DRC) now stands at 3205 cases, including 2142 deaths. Officials are still investigating 411 suspected cases.

In recent weeks, reports of new cases have slowed significantly, and
transmission has shifted to rural villages in North Kivu and Ituri provinces.


According to daily reports from the DRC's Ebola technical committee
(CMRE), the 3 new cases first reported late last week [week of 30 Sep
2019] were from Beni, Mambasa, and Mandima. Over the weekend, the CMRE confirmed 3 additional cases from Oicha, Lolwa, and Mandima.

Communicated by: Mary Marshall


- Tue 8 Oct 2019. WHO/AFRO Weekly bulletin on outbreaks and other
emergencies

[WHO/AFRO, Health Emergency Information and Risk Assessment abridged,
edited]

<https://apps.who.int/iris/bitstream/handle/10665/328778/OEW40-300906102019.pdf>


Week 40: 30 Sep-6 Oct 2019 Data reported as of 6 Oct

Event description. The Ebola virus disease (EVD) outbreak in North Kivu, South Kivu and Ituri provinces in Democratic Republic of the Congo continues, with 11 health zones and 28 health areas reporting confirmed cases in the past 21 days (15 Sep-5 Oct 2019). Since our last report on 29 Sep 2019 (Weekly bulletin 39), there have been 16 new confirmed cases and 13 new deaths. The principal hot spots of the outbreak in the past 21 days are Mambasa (30%; n=23 cases), Mandima (24%; n=18 cases), and Kalunguta (12%; n=7 cases). 7 health zones have reported new confirmed cases in the past 7 days, (Mandima, Katwa, Oicha, Kalunguta, Mambasa, Beni, and Lolwa) while 13 health zones have not reported any new cases for at least 42 days.

Communicated by: Mary Marshall
******


[3] Response - Mon 7 Oct 2019. WHO, International Health Regulations Emergency Committee on the Ebola outbreak in Congo DR

[Africanews, APO group, WHO report, abridged, edited]

<https://www.africa-newsroom.com/>


WHO Director-General, Dr Tedros Adhanom Ghebreyesus, has reconvened an
Emergency Committee under the International Health Regulations (IHR)
2005 on Ebola virus disease in the Democratic Republic of the Congo.

The Ebola outbreak in the Democratic Republic of the Congo was declared a Public Health Emergency of International Concern on 17 Jul 2019 following the 4th meeting of the Emergency Committee. The 1st meeting took place on 17 Oct 2018.

The Committee will meet for a 5th time on 10 Oct 2019, in Geneva from
12-5 pm CEST, to ascertain whether the ongoing outbreak still constitutes a public health emergency of international concern and to review the temporary recommendations that are in place to manage the outbreak.

The Committee's advice will be made public on WHO's website and via a
press conference (details below).

Background on the Ebola virus disease outbreak in Eastern DRC
-------------------------------------------------------------

The Democratic Republic of the Congo is grappling with the world's 2nd
largest Ebola epidemic on record, with more than 2000 lives lost and
1000 survivors among the 3000 confirmed infections. The outbreak was
declared on 1 Aug 2018, and has affected North Kivu, South Kivu, and
Ituri provinces. WHO and partners have been supporting national officials responding to the outbreak since it was first declared.

WHO has more than 650 staff on the ground.

Neighbouring countries are taking steps to mitigate the risk of spread.

Sources of information
----------------------


- Ebola outbreak:
<https://www.who.int/emergencies/diseases/ebola/drc-2019>


- Media resources:
<https://www.who.int/emergencies/diseases/ebola/drc-2019/media-resources>


- Emergency Committee:
<https://www.who.int/ihr/procedures/ihr_committees/en/>

Communicated by: Mary Marshall

- Wed 2 Oct 2019. Vaccination
[MSF (Medecins sans Frontieres), abridged, edited]


<https://www.doctorswithoutborders.org/what-we-do/news-stories/story/vaccinating-people-against-ebola-challenges-containing-outbreak>

Vaccinating people against Ebola: The challenges of containing the outbreak in Democratic Republic of Congo
--------------------------------------------------------------------------------
The vaccine feels painful in their arms, but side effects are mostly mild and early results show the vaccine provides effective protection for a promising 95 percent of participants after 10 days.

Setting up the vaccination sites is a well-coordinated routine for MSF's teams. A series of plastic tables are lined up next to a waiting area, registration and consent forms put into place, and the vaccination team dresses up in protective gowns. Then, an MSF vehicle delivers the 1st vials of the vaccine in a cooling container that keeps the vaccines cold and effective, and a member of the surveillance team starts identifying eligible participants.

Due to the restricted use and the investigational status of the vaccine, the vaccination strategy in North Kivu is currently limited to a "ring approach," which means only contacts of people who likely or have been confirmed to have Ebola and their contacts -- plus frontline workers like doctors and humanitarian staff who are most likely to interact with people who have Ebola -- are eligible to be vaccinated in the current campaign.

While the number of people infected with Ebola has been on the decline in Beni since late August 2019, there are still new people admitted to isolation zones in local health care facilities or the MSF-operated Ebola Treatment Center (ETC) every day. Twice already -- in December 2018 and June 2019 -- the outbreak seemed contained only to soar again with even higher numbers.

Across all of North Kivu, the average time from suspecting someone has
Ebola to diagnosing them is 5 days, during which patients often travel and visit several health centers and could spread the disease to others.

Identifying and vaccinating contacts is crucial to protecting people at risk, and poses one of the major challenges of containing the outbreak. The 3 MSF teams supported 700 vaccinations in the 1st 2 weeks of vaccinating in Beni alone, and more than 51 000 people have been vaccinated in the city by the national Ebola response and its partners so far.

Throughout the outbreak, national surveillance teams have only managed
to trace 1/4 of known and probable Ebola contacts, while a majority remains unidentified or is never followed up with. MSF has called for an international, independent committee to evaluate and broaden the strategy and manage vaccine supplies more transparently.

"We would like to broaden our vaccination strategy and be more flexible in responding faster to health zones with confirmed Ebola cases, but are currently limited to a fixed number of daily doses and working in pre-allocated vaccination sites," said MSF Activity Manager Joseph Musakane.

Making treatment more accessible and building trust with the local
population proved equally important for patients presenting with Ebola
symptoms earlier in the outbreak. At first, MSF was working at a large
central transit center for people who may have Ebola, but soon realized isolation capacities were much better positioned closer to communities. "We started integrating small isolation structures into 6 of the 18 health centers of Beni's health zones, where patients and suspect cases felt more comfortable to present at the time," said Tristan Le Lonquer, emergency coordinator with MSF in Goma.

The health centers now also make for possible vaccination sites, offering a secure and sheltered space close to communities. At the same time, MSF strengthens the centers' existing primary health care services. "We support ambulatory patient consultations, maternities, or laboratory capacities, which are much needed services at risk of being neglected during the complex Ebola response," added Le Lonquer.


A 2nd experimental vaccine requiring 2 doses given 56 days apart has just ben greenlighted in DRC as part of an extended clinical trial, and MSF and its research arm Epicenter are part of the global consortium leading the rollout.

In Beni, ending the deadly Ebola epidemic remains a complex task, and
MSF has only recently taken over the large ETC with 13 isolation cubes for emergency care, 3 large isolation wards for up to 40 patients, and more than 160 staff.

"Breaking the chain of transmission requires us to extend our vaccination approach, provide integrated isolation and treatment options, have a central ETC available, but also sustain other health care needs and build a relation of trust with the local community," Le Lonquer said. "We need to be present on all fronts to win the complex fight against Ebola."

Communicated by: ProMED-mail from HealthMap Alerts

<[email protected]>


- Mon 7 Oct 2019. Beni: community meeting [USAID/Internews, in French, machine trans., edited]

<http://koma-ebola.info/les-habitants-de-ndoli-simpliquent-dans-la-lutte-contre-ebola>

[Byline: Jeremie Soupou]


Information saves lives
-----------------------


"What is the mechanism to be put in place by the community of Beni to
stop Ebola that has lasted too long in the region"? It is around this question that the inhabitants of [Ndoli1], a Beni cell, held a debate this weekend [5-6 Oct 2019].

The participants in this debate initiated by Internews were for the most part active members of a Ndoli1 association called "Vuuma Wisdom". For 2 hours, they discussed the challenges of Ebola virus disease in the city of Beni before deciding to "appropriate the response".

For them, Ebola has not been defeated for more than a year in Beni because of a part of the population that has not yet become aware of this disease, but also by the fact of some agents of the riposte that are not quick in the answer.

"It is the lack of awareness of the population about the existence of this disease and community resistance. On the part of the teams in the response, it is notably the delay in getting the patients to the hospital," said Philete Kavulo, coordinator of the "Vuuma la sagesse" association of Ndoli1.

Then, participants in this public debate expressed their commitment to fight Ebola. They will now be sensitizers in their homes, families, and neighborhoods.

"We are committed to transmitting messages received today to our loved
ones. We will be among the sensitizers. We will indicate where the
suspected cases would be," promised a participant. "With the grassroots leaders, we will announce the visitors so that Ebola is eradicated in Beni," said another.

Note that in this cell, some residents did not believe yet the existence of this disease. This is how they were wary of anti-Ebola activities. During the debate, several people expressed the wish to receive the vaccine against Ebola.
Communicated by: Mary Marshall


[4] Research Date: Mon 7 Oct 2019

Source: Nature Medicine journal [edited]
<https://www.nature.com/articles/s41591-019-0602-4>

ref: Ehrhardt SA, Zehner M, Kraehling V, et al. Polyclonal and
convergent antibody response to Ebola virus vaccine rVSV-ZEBOV. Nature
Medicine. 2019; 25: 1589-1600
--------------------------------------------------------------------------------

Abstract. Recombinant vesicular stomatitis virus-Zaire Ebola virus
(rVSV-ZEBOV) is the most advanced Ebola virus vaccine candidate and is
currently being used to combat the outbreak of Ebola virus disease (EVD) in the Democratic Republic of the Congo (DRC). Here we examine the humoral immune response in a subset of human volunteers enrolled in a phase 1 rVSV-ZEBOV vaccination trial by performing comprehensive single B cell and electron microscopy structure analyses. 4 studied vaccinees show polyclonal, yet reproducible and convergent B cell responses with shared sequence characteristics. EBOV-targeting antibodies cross-react with other Ebolavirus species, and detailed epitope mapping revealed overlapping target epitopes with antibodies isolated from EVD survivors. Moreover, in all vaccinees, we detected highly potent EBOV-neutralizing antibodies with activities comparable or superior to the monoclonal antibodies currently used in clinical
trials. These include antibodies combining the IGHV3-15/IGLV1-40
immunoglobulin gene segments that were identified in all investigated
individuals. Our findings will help to evaluate and direct current and future vaccination strategies and offer opportunities for novel EVD therapies.

The results of 2 ring vaccination trials estimate vaccine efficiency to be 97%, and no fatal EVD cases occurred 10 days post vaccination (27,32). As a vaccine candidate with available efficacy data, rVSV-ZEBOV has been designated as the lead candidate for administration in current and future EVD outbreaks (33,34). However, despite its broad application, a detailed understanding of the rVSV-ZEBOV immune response is still limited and no single-cell analysis has been performed to elucidate the molecular composition of the induced antibody response. Therefore, we set out to investigate the humoral immune response to rVSV-ZEBOV immunization on a molecular level.

Communicated by: Mary Marshall


[See full publication at the source URL above for details and references. - Mod.LK

Maps of Congo DR: <http://goo.gl/DM2AT8> and <http://healthmap.org/promed/p/194>]


[See Also: Ebola update (96): Congo DR (NK,IT,SK) cases, WHO, summaries


http://promedmail.org/post/20191005.6710406 Ebola update (95): Congo DR (NK,IT,SK) cases, WHO, survivors, vaccine http://promedmail.org/post/20191003.6706383 Ebola update (94): Congo DR (NK,IT,SK) TZ response, corr. http://promedmail.org/post/20191003.6706745

Ebola update (94): Congo DR (NK, IT, SK) cases, summary, TZ response,
JP vaccine http://promedmail.org/post/20191001.6703940 Ebola update (93): Congo DR (NK, IT, SK) cases, summaries, response
http://promedmail.org/post/20190927.6698322


Ebola update (92): Congo DR (NK,IT,SK) cases, summaries, response
http://promedmail.org/post/20190925.6692867


Ebola update (91): Congo DR (NK,IT,SK) cases, summaries, response,
Uganda http://promedmail.org/post/20190920.6684164


Ebola update (90): Congo DR (NK,IT,SK) cases, summaries, response,
Tanzania, story http://promedmail.org/post/20190918.6680252


Ebola update (89): Congo (NK,IT) Tanzania case update, NOT Ebola
http://promedmail.org/post/20190914.6674377


Ebola update (88): Congo DR (NK,IT) cases, summaries, front line,
response http://promedmail.org/post/20190914.6673644


Ebola update (87): Congo DR (NK,IT,SK) Uganda, summaries, response,
therapeutics http://promedmail.org/post/20190908.6662930


Ebola update (86): Congo DR (NK,IT,SK) Uganda, summaries, response,
reading http://promedmail.org/post/20190905.6659380


Ebola update (85): Congo DR (NK, IT) Uganda, cases, summaries,
response http://promedmail.org/post/20190901.6652681


Ebola update (84): Congo DR (NK,IT,SK) cases, Uganda, summaries,
response http://promedmail.org/post/20190830.6649635


Ebola update (83): Congo DR (NK,IT,SK) cases, summaries, response
http://promedmail.org/post/20190827.6644258


Ebola update (82): Congo DR (NK,IT,SK) cases, response
http://promedmail.org/post/20190823.6636225


Ebola update (81): Congo DR (NK,IT,SK) cases, summaries, response
http://promedmail.org/post/20190820.6630575


Ebola update (80): Congo DR (NK,IT,SK) cases, summaries, therapeutics
response http://promedmail.org/post/20190816.6624873


Ebola update (79): Congo DR (NK, IT) therapeutics, response, research
http://promedmail.org/post/20190813.6620807


Ebola update (78): Congo DR (NK, IT) cases, summary, WHO, response,
research http://promedmail.org/post/20190811.6616470


Ebola update (77): Congo DR (NK,IT) cases, WHO, response, vaccine,
research http://promedmail.org/post/20190807.660957

[and more but Icut a lot to ge the character size down]
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