Ebola:Developmental treatments complementing the traditional pillars of the response

On 1 August 2018, an Ebola epidemic was declared in North Kivu, in the north-east of the Democratic Republic of Congo: it is the 10th Ebola outbreak in the country and the second one this year. MSF quickly launched its intervention, within the response plan of the Congolese ministry of Health. The epidemic is not under control yet and new cases appeared more than hundred kilometres away from the epicentre. While the ongoing conflict in the region can represent an added challenge to the intervention, the response to the outbreak was immediate and some novelties in the medical approach may help to make the intervention more effective.
The first case of the outbreak was registered in Mangina, a little town to the North-West of Beni. The virus then spread to other parts of North-Kivu and crossed the border with Ituri province, north of North-Kivu. To date, 181 cases have been reported, of which 146 confirmed by laboratory tests. 80 people died because of the disease 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”, says Laurence Sailly, MSF Emergency Coordinator. 
MSF collaborates with the ministry of Health in the Ebola treatment centres of Mangina and Butembo (North-Kivu) and in Tchomia (Ituri, close to the Uganda border); the latter was quickly set up after a new confirmed case was reported there and an MSF team conducted an investigation on site. MSF also carries out health promotion activities and infection prevention and control to protect health structures between affected towns and cities. Some novelties in the 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 a laboratory installed within the Ebola treatment centers themselves. This allows the teams to react faster to the changing medical condition of patients.
This is also the first time that five developmental drugs are being used to treat Ebola patients in DRC and the presence of on-site testing capability means that new confirmed cases are offered these new treatments within 24 hours of their confirmation as positive to the virus. In Tchomia, where an ETC did not exist when the first case was reported, the first patient was under treatment within 72 hours. Mortality among Ebola patients is very high, at roughly 50%: these drugs have the potential to increase the odds of survival. “It’s very positive to have five molecules that seem promising, even if there is currently no scientific evidence that any of these drugs work for people with Ebola. But 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.” declares MSF medical doctor and Ebola expert, Hilde De Clerck .
Because this part of DRC is densely populated and there are a lot of population movements and trade, it’s difficult to identify and track all the active chains of transmission. “A potential key to successfully control the outbreak is to react fast” says Laurence Sailly, MSF Emergency Coordinator. “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.
Immunization activities with the 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.
While new approaches are being developed in the intervention, the traditional pillars of the Ebola response remain critical. While movement in this unstable area can sometimes be difficult, 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.