Ebola Returns, and Central Africa’s Virus Hunters Are Ready

ON APRIL 22, a man with a fever, nosebleed, and bloody stool and vomit came to a clinic in Likati, in the northern province of Bas-Uele in the Democratic Republic of Congo. He died on the way to a bigger hospital.

Within days, other people were getting sick, and the pattern was familiar. First it was the chauffeur who drove the initial victim, with the same symptoms. Then the people who’d transported the chauffeur via motorcycle came to a clinic with the classic signs. Now six people are in the hospital, three people have died, and the DRC’s national lab in Kinshasa says at least five of them tested positive for Ebola.

Now Médecins Sans Frontières—Doctors Without Borders—is sending 14 people to meet a 10-person team from the DRC’s Health Ministry on Saturday. A cargo plane carrying 16 tons of medical and logistical supplies is en route from Kinshasa to meet them. The disease outbreak fighters are on the way.

A catastrophic Ebola epidemic killed more than 11,300 people in West Africa between 2013 and 2016; so far this new outbreak looks small and containable. It’s also a chance for the world’s disease response infrastructure to get its act together; report after report criticized the World Health Organization and the US Department of Health and Human Services for the way they handled that outbreak. They were slow, didn’t follow set procedures, and didn’t deploy enough personnel until too late. It was terrible for West Africa, and it didn’t bode well for future outbreak responses.

Don’t panic. The DRC has experienced eight small Ebola outbreaks since 1976; the disease is named after a river there. The country has people with experience. “There is precedent. We’ve seen this before, and it’s been possible to contain it,” says Peter Hotez, head of the National School for Tropical Medicine at Baylor College of Medicine. “On the other hand, we’ve seen the consequences of not being aggressive to put public health control measures in place.”

Straight-ahead public health measures like sanitation and protective gear tend to control Ebola despite its florid, grand-guignol symptoms—lots of highly infectious blood and fluids. Only people who come into very close contact with the sick tend to get sick themselves. That puts two particular groups at the highest risk of infection: healthcare workers and people taking care of their own family members or burying the recently deceased.

So on the ground, the MSF team will start administering care, potentially building a clinic. They might also work with locals to do triage and surveillance. So far, representatives from the World Health Organization are doing much the same. Bas-Uele is rural and poorly mapped, so MSF is also trying to crowdsource a mapping project, asking locals to add detail and tags to satellite images. Epidemiologist Anne Rimoin’s UCLA-DRC Research Program was already working on mapping parts of the country to help with disease surveillance, so her team has been contributing and helping coordinate in Kinshasa. “Having high quality, detailed maps and geospatial data is crucial for being able to respond and contain outbreaks,” she says. “If you don’t have this information, you might miss lots of villages people just don’t know about.”

When you have disease outbreaks in these remote, rural areas that are difficult to get to, they’re also difficult to get out of, and populations don’t move as easily. The problem in West Africa was that this happened in areas that are highly populated with a lot of movement, and that makes outbreaks hard to contain.ANNE RIMOIN, UCLA-DRC RESEARCH PROGRAM

The 2014 epidemic got as bad as it did in part because West Africa had no real experience with Ebola, and in part because the disease spread from rural areas to cities in Guinea, Liberia, and Sierra Leone. But Bas-Uele is really far, populated mostly by subsistence farmers and hunters. “When you have disease outbreaks in these remote, rural areas that are difficult to get to, they’re also difficult to get out of, and populations don’t move as easily,” Rimoin says. “The problem in West Africa was that this happened in areas that are highly populated with a lot of movement, and that makes outbreaks hard to contain.”

The other issue back then was the lack of a vaccine. That’s no longer the case; a dozen are in trials, and in 2016 a crowd of international researchers published results from Guinea showing that a vaccine called rVSV-Zebov effectively prevented infection of Ebola Zaire, the strain at fault in 2014 and the one at work in the Democratic Republic of Congo. Merck now makes the vaccine, and a 2016 deal between Merck and Gavi, the Vaccine Alliance, means it has 300,000 doses ready to use. But so far no one has officially licensed the vaccine.

That’s not necessarily dispositive. “Preparations are being accelerated to ensure that vaccine and equipment be available on site,” emails Tarik Jašarević, a WHO spokesperson. “Appropriate ethical and regulatory authorization has been sought as the vaccine can only be used under ‘extended access’ US-FDA provisions as it is not yet registered.” If the new outbreak is bigger than it looks, or starts getting bigger, WHO can start “ring vaccinations,” administering the drug to everyone who has had contact with someone infected, and then to their contacts, too. (Hey, it’s worked pretty well in the past.)

With luck, they won’t need to use the vaccines. The outbreak will be contained, and the international response efficient and speedy. Because every one of these is an emergency for the people affected, and no matter its scale, it teaches something important for the next one—whether it’s Ebola in Bas-Uele or Zika in Miami.

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