The World Health Organization said in an emergency meeting Friday that the conditions for a Public Health Emergency of International Concern have not currently been met in the Democratic Republic of Congo, where an outbreak of Ebola virus disease was first identified 10 days ago.
Vaccinations with ZMapp, an experimental biopharmaceutical drug developed to combat Ebola, could begin as soon as Sunday.
Prior to the meeting, WHO raised the DRC’s Ebola health assessment risk to “very high.”
Dr. Robert Steffen, the chairman of WHO’s Emergency Committee, said that 25 deaths have occurred and 45 cases have been reported, including three in health care personnel. Among the 45 cases, 14 have been confirmed, mostly in the remote Bikoro health zone, although there’s one confirmed case in Mbandaka, a city of 1.2 million.
“The risk of international spread is particularly high since the city of Mbandaka is in proximity to the Congo river, which has significant regional traffic across porous borders,” a statement noted.
Dr. Peter Salama of WHO Emergency Preparedness and Response said, “Overall, we’re tracing more than 532 contacts.” He described the effectiveness of identifying and reaching contacts as “very high” in Bikoro, where most of the cases have occurred, though medical personnel are experiencing difficulty in smaller outlying villages.
While doses of the experimental vaccine, ZMapp, first began to arrive in country on Wednesday, Salama said that WHO is still seeking the necessary government approvals to use the vaccine. He added that the inoculation program will be complex since ZMapp is an infusion that takes several hours.
The first phase of the vaccination program, which includes confirmation of cases and then identification of primary contacts and secondary contacts, will include “in the range of (8,000) to 10,000 people,” said Salama, adding that inoculation will begin in populous Mbandaka. “And then we go from there”
Nine neighboring countries, including Republic of the Congo and Central African Republic, have been advised that they are at high risk of spread and have been supported with equipment and personnel.
On Saturday, the International Organization for Migration plans to help deploy teams of medical staff from the health ministry to 16 points of entry along the country’s borders, according to a statement from the UN agency.
Border health officials will set up infection control and prevention measures at priority border crossings, travel routes and congregation points to prevent the outbreak spreading beyond the DRC.
Dr. Tedros Adhanom Ghebreyesus, the WHO director-general, said he has asked international heads of state to commit to the necessary funding and “we’ll hear their responses soon.” The strategic response will require $26 million dollars over three months and $9 million dollars have already been pledged. He noted that the Ebola crisis occurring in 2014 in West Africa cost between $3 and $4 billion dollars.
“We are very encouraged despite the challenges we’ve seen because of the strong coordination between government and partners,” said the director-general, who said he visited the epicenter of the outbreak last weekend.
Outbreak enters ‘new phase’
The discovery of a case in Mbandaka indicates the outbreak has entered a “new phase,” the country’s health minister, Dr. Oly Ilunga Kalenga, said Wednesday.
The case was confirmed in Wangata, one of three health zones of Mbandaka, the capital of Equateur Province in northwestern Congo. Previously, infections and deaths had been limited to the rural Bikoro health zone, nearly 150 kilometers away.
The spread of the virus from rural areas into a city has raised fears it could quickly spread and become harder to control.
“This is a concerning development, but we now have better tools than ever before to combat Ebola,” said WHO’s director-general.
The organization is working with health NGO Medecins Sans Frontières (MSF), the Red Cross and other partners to boost the number of special isolation wards to treat patients. WHO’s own staffing will include 100 experts deployed in country by the weekend, said the director-general, while the US Centers for Disease Control and Prevention, a team from the UK and the European Union will also provide personnel.
“Tens of thousands will be ready,” said the director-general, if a big response becomes necessary.
WHO personnel and others will conduct surveillance in the city and inform local communities on treatment and prevention methods in collaboration with the country’s Ministry of Health.
Community workers have been deployed to Bikoro and Mbandaka to conduct information campaigns and engage with communities to help contain the disease, UNICEF said Friday.
“It is crucial that communities understand how to protect themselves at home and in public places, especially in health facilities and schools,” said Dr. Gianfranco Rotigliano, UNICEF representative in the Democratic Republic of Congo. “Experience in previous outbreaks has shown that when we engage communities in prevention efforts, we stand the best chance of containing the disease.”
Water and hygiene supplies have also been provided, as well as hand-washing points in 122 schools in both regions.
Hundreds in contact with infected
The DRC is the ninth the country that has faced an Ebola outbreak in the past four decades.
“This outbreak is very close to the Republic of Congo and Central African Republic. And we are taking it very seriously,” Dr. Ibrahima-Soce Fall, the WHO regional emergency director for Africa, said Monday.
The Ebola virus disease, which most commonly affects people and nonhuman primates such as monkeys, gorillas and chimpanzees, is caused by one of five Ebola viruses. On average, about 50% of people who become ill with Ebola die.
The first human outbreaks of Ebola occurred in 1976, one in the north of what is now Congo and in the region that is now South Sudan.
Humans can be infected by other humans if they come in contact with body fluids from an infected person or contaminated objects from infected persons. Humans can also be exposed to the virus, for example, by butchering infected animals.
West Africa experienced the largest recorded outbreak of Ebola over a two-year period beginning in March 2014; a total of 28,616 confirmed, probable and suspected cases were reported in Guinea, Liberia and Sierra Leone, with 11,310 deaths, according to the WHO.