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Online Discussion: Tracking new emerging diseases and the next pandemic

Ebola Again

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Post Options Post Options   Thanks (0) Thanks(0)   Quote Technophobe Quote  Post ReplyReply Direct Link To This Post Posted: May 17 2018 at 2:45am

Ethiopia Declares Maximum Alert for New Outbreak of Ebola in DRC

Addis Ababa, May 13 (Prensa Latina) The Ethiopian government declared a maximum alert to counteract the Ebola virus disease after an outbreak in the Democratic Republic of Congo (DRC) this week.

According to the Ethiopian Health Ministry, inspections are carried out at the main international airports and in the border areas to prevent the entry of the deadly disease.

The organization specified that clinics and hospitals throughout the country received the necessary equipment to treat suspected cases of Ebola, and training is being given to strengthen response capabilities.

A new outbreak was declared on Tuesday by the government of the DRC, after two samples tested positive in Bikoro, province of Equateur.

The African Union (AU) announced that the Center for Disease Control and Prevention (CDC of Africa) activated an emergency operation to support the fight against the epidemic.

Thus, the CDC mobilized combat resources for an imminent deployment; The team includes experts with experience in the treatment of the condition, who in turn participated in the 2014 pandemic that affected West Africa.

At that time, Ethiopia also previously sent a medical team, made up of about 200 health workers.

Source:   http://www.plenglish.com/index.php?o=rn&id=28155&SEO=ethiopia-declares-maximum-alert-for-new-outbreak-of-ebola-in-drc

[Technophobe:  The  CDC may be relying on the vaccine, but at least someone is taking care in case it does not work.]

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Post Options Post Options   Thanks (0) Thanks(0)   Quote Technophobe Quote  Post ReplyReply Direct Link To This Post Posted: May 17 2018 at 2:52am
[Technophobe: Reports seem to be quite varied on the scope of the spread to Mbandaka.  I have come across reports that three people there had the disease, which I find unlikely this early.  This is the most up-to-the-minute report I can find and that says one person in the city has the diseae.]

The Democratic Republic of Congo’s efforts to head off an Ebola epidemic is running into obstacles, with the announcement of the first registered urban case.

Health officials have confirmed a case in the northwest city of Mbandaka, a busy river port located at the intersection of the Congo and Ruki rivers and with trade routes to the capital Kinshasa. The spread of the deadly virus from the countryside and into a city that is home to about a million people pushes the current outbreak into a “new phase,” essentially making the efforts to contain the outbreak far harder.

Authorities said they were tracing all air, river, and road routes in and out of the city to find the source of the virus. Two brothers in Mbandaka who recently visited the outbreak’s starting point in Bikoro town are probable cases, with samples awaiting laboratory confirmation. So far, 23 people are known to have died while 42 others have been infected since the outbreak started earlier this month.

The announcement came just as thousands of doses of the experimental Ebola vaccine arrived in the country, with vaccinations expected to commence this coming weekend. Sent by the World Health Organization, the vaccine is still not licensed but proved effective in the 2014 Ebola outbreak in West Africa. WHO says it will use the “ring vaccination” method by administering the treatment to voluntary contacts, and contacts of those contacts, besides health workers. The health body also sent 300 body bags for safe burials in affected communities.

The swift response to quickly tackle the outbreak is in contrast to the response to the 2014 outbreak, when international agencies and governments were criticized for their slow response. More than 11,300 people were confirmed dead between March 2014 and Jan. 2016 in Liberia, Guinea, Sierra Leone, Nigeria, the US, and Mali.

In the DR Congo, a quick response is also crucial given the recurring nature of the virus in the nation: since 1976, there have been nine major outbreaks of the deadly virus in the central African nation.

Source:   https://qz.com/1280450/dr-congo-ebola-outbreak-spreads-to-mbandaka-city/


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Post Options Post Options   Thanks (0) Thanks(0)   Quote Technophobe Quote  Post ReplyReply Direct Link To This Post Posted: May 17 2018 at 3:10am
..... 'And here is the ECDC report PDF on the risks posed to Europe/Europeans:

https://ecdc.europa.eu/sites/portal/files/documents/15-05-2018-RRA-Ebola-Dem-Rep-Congo.pdf
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Technophobe Quote  Post ReplyReply Direct Link To This Post Posted: May 17 2018 at 5:34am

WHO calls emergency meeting on Congo's Ebola outbreak

The U.N. World Health Organization will convene an Emergency Committee on Friday to consider the international risks of an Ebola outbreak in the Democratic Republic of Congo, WHO spokesman Christian Lindmeier said on Thursday.


GENEVA: The U.N. World Health Organization will convene an Emergency Committee on Friday to consider the international risks of an Ebola outbreak in the Democratic Republic of Congo, WHO spokesman Christian Lindmeier said on Thursday.

The expert committee will decide whether to declare a "public health emergency of international concern", which would trigger more international involvement, mobilising research and resources, Lindmeier said

Source:   https://www.channelnewsasia.com/news/world/who-calls-emergency-meeting-on-congo-s-ebola-outbreak-10243926

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Post Options Post Options   Thanks (0) Thanks(0)   Quote Technophobe Quote  Post ReplyReply Direct Link To This Post Posted: May 18 2018 at 1:29am
[Technophobe: There is not much information available this morning, but this up-to-the-minute report is both detailed and from a well respected source.  It also gives rather clearer figures than most of the others who do not divide up the figures so precicely.]

DR Congo Ebola outbreak: WHO in emergency talks as cases spread

7 hours ago

The World Health Organization (WHO) is to hold an emergency meeting to discuss the risk of Ebola spreading from the Democratic Republic of Congo.

A panel will decide on Friday whether to declare a "public health emergency of international concern", which would trigger a larger response.

At least 44 people are believed to have been infected in the current outbreak and 23 deaths are being investigated.

Cases emerged in a rural area with one now confirmed in the city of Mbandaka.

The city of about one million people is a transport hub on the Congo River, prompting fears that the virus could now spread further, threatening the capital Kinshasa and surrounding countries.

Ebola is an infectious illness that causes internal bleeding and often proves fatal. It can spread rapidly through contact with small amounts of bodily fluid, and its early flu-like symptoms are not always obvious.

WHO has previously admitted that it was too slow to respond to a deadly Ebola outbreak in West Africa from 2014-2016 that killed more than 11,000 people.

Why is the case in Mbandaka a concern?

Senior WHO official Peter Salama said the spread to Mbandaka meant there was the potential for an "explosive increase" in cases.

"This is a major development in the outbreak," he told the BBC. "We have urban Ebola, which is a very different animal from rural Ebola. The potential for an explosive increase in cases is now there."

-------------------------------------------------------------------------------------------------------------------------------

44 people believed infected

3 confirmed cases

20 probable cases

21 suspected cases

-------------------------------------------------------------------------------------------------------------------------------

Mr Salama, the WHO's deputy director-general for emergency response, said Mbandaka's location on the Congo river raised the prospect of Ebola spreading to Congo-Brazzaville and the Central African Republic, as well as downstream to Kinshasa, which has a population of 10 million.

"This puts a whole different lens on this outbreak and gives us increased urgency to move very quickly into Mbandaka to stop this new first sign of transmission," he said.

The 2014-16 West Africa outbreak became particularly deadly when it spread to the capitals of Guinea, Sierra Leone and Liberia.

What is being done to contain the outbreak?

WHO says that of the 44 Ebola cases reported, three are confirmed, 20 are probable, and 21 are suspected.

They were recorded in Congo's Equateur province. Mbandaka is the provincial capital.

Mr Salama said that isolation and rudimentary management facilities had been set up in Mbandaka.

He said the disease could have been taken there by people who attended the funeral of an Ebola victim in Bikoro, the south of Mbandaka, before travelling to the city.

On Wednesday more than 4,000 doses of an experimental vaccine sent by the WHO arrived in Kinshasa with another batch expected soon.

These would be given as a priority to people in Mbandaka who had been in contact with those suspected of carrying the Ebola virus before people in any other affected area, Mr Salama said.

The vaccine, from pharmaceutical firm Merck, is unlicensed but was effective in limited trials during the West Africa outbreak. It needs to be stored at a temperature of between -60 and -80 C. Electricity supplies in Congo are unreliable.

WHO said health workers had identified 430 people who may have had contact with the disease and were working to trace more than 4,000 contacts of Ebola patients who had spread across north-west DR Congo.

Many of these people were in remote areas, Mr Salama said.

Why does Ebola keep returning?

There have been three outbreaks in DR Congo since the 2014-16 epidemic. Ebola is thought to be spread over long distances by fruit bats and is often transmitted to humans via contaminated bushmeat.

It can also be introduced into the human population through contact with the blood, organs or other bodily fluids of infected animals. These can include chimpanzees, gorillas, monkeys, antelope and porcupines.

It is not possible to eradicate all the animals who might be a host for Ebola. As long as humans come in contact with them, there is always a possibility that Ebola could return.

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Post Options Post Options   Thanks (0) Thanks(0)   Quote Technophobe Quote  Post ReplyReply Direct Link To This Post Posted: May 18 2018 at 4:29am
[Technophobe:  Now the WHO says the risk has risen to 'very high'.  Well, no sh:it, Sherlock‽  Here are their conclusions:]

WHO says Congo faces 'very high' risk from Ebola outbreak

Tom Miles
GENEVA (Reuters) - Democratic Republic of Congo faces a “very high” public health risk from Ebola because the disease has been confirmed in a patient in a big city, the World Health Organization (WHO) said on Friday, raising its assessment from “high” previously.

The risk to countries in the region was now “high”, raised from “moderate”, but the global risk remained “low”, the WHO said.

The reassessment came after the first confirmed case in Mbandaka, a city of around 1.5 million in the northwest. Previous reports of the disease had all been in remote areas where Ebola might spread be more easily contained.

“The confirmed case in Mbandaka, a large urban center located on major national and international river, road and domestic air routes, increases the risk of spread within the Democratic Republic of the Congo and to neighboring countries,” the WHO said.

WHO Deputy Director-General for Emergency Preparedness and Response Peter Salama had told reporters on Thursday that the risk assessment was being reviewed.

“We’re certainly not trying to cause any panic in the national or international community,” he said.

“What we’re saying though is that urban Ebola is very different phenomenon to rural Ebola because we know that people in urban areas can have far more contacts so that means that urban Ebola can result in an exponential increase in cases in a way that rural Ebola struggles to do."

Later on Friday, the WHO will convene an Emergency Committee of experts to advise on the international response to the outbreak, and decide whether it constitutes a “public health emergency of international concern”.

The nightmare scenario is an outbreak in Kinshasa, a crowded city where millions live in unsanitary slums not connected to a sewer system.

Jeremy Farrar, an infectious disease expert and director of the Wellcome Trust global health charity, said the outbreak had “all the features of something that could turn really nasty”.

“As more evidence comes in of the separation of cases in space and time, and healthcare workers getting infected, and people attending funerals and then traveling quite big distances - it’s got everything we would worry about,” he told Reuters.

The WHO statement said there had been 21 suspected, 20 probable and 3 confirmed cases of Ebola between April 4 and May 15, a total of 44 cases, including 15 deaths. Mbandaka had three suspected cases in addition to the confirmed case.

The WHO is sending 7,540 doses of an experimental vaccine to try to stop the outbreak in its tracks, and 4,300 doses have already arrived in Kinshasa. It will be used to protect healthworkers and “rings” of contacts around each case.

The vaccine supplies will be enough to vaccinate 50 rings of 150 people, the WHO said. As of 15 May, 527 contacts had been identified and were being followed up and monitored.

Source:   https://www.reuters.com/article/us-health-ebola/who-says-congo-faces-very-high-risk-from-ebola-outbreak-idUSKCN1IJ0CM
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Post Options Post Options   Thanks (0) Thanks(0)   Quote FluMom Quote  Post ReplyReply Direct Link To This Post Posted: May 18 2018 at 5:17am
Hey just learned that there is a vaccine for Ebola and it works. Is Ebola something we can put down now that there is a vaccine?
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Technophobe Quote  Post ReplyReply Direct Link To This Post Posted: May 18 2018 at 7:40am
I don't think it was ever much of a risk, as it kills too fast, so its spread is self-limiting.  The vaccine  reduces the risk even further, FluMom, but does not erase it completely. 

The vaccine appears to work very well, but requires some very specific and difficult storage conditions.  That causes big distribution problems.  Also, we do not yet know how easy it is to make (production line of millions of doses, or handmade hundreds?).  On top of that, how good is ebola at mutating; will the vaccine continue to work or does it need changing like the flu?

Personally, I expect this is the end of all things ebola, but we will have to wait to find out if I am right.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Technophobe Quote  Post ReplyReply Direct Link To This Post Posted: May 18 2018 at 11:05am

Ebola: two more cases confirmed in Mbandaka in DRC

Total of three cases confirmed in city of 1 million people, raising fears of wider outbreak

Two more cases of Ebola have been confirmed in the north-western city of Mbandaka in the Democratic Republic of the Congo, health officials have said.

The report brings to three the number of confirmed cases in the city of 1 million people, raising the prospect of a wider outbreak than feared.

The DRC is one of Africa’s most fragile states, with millions threatened by hunger, disease and low-level conflict. Political instability has intensified since the refusal of Joseph Kabila to step down as president when his second term ended in 2016.

International aid is pouring in to reinforce health services, with a campaign of vaccinations due to begin on Sunday. The health ministry declared it had activated an action plan in Mbandaka.

After visiting the city, which is 360 miles (580km) from the capital, Kinshasa, the health minister, Oly Ilunga, announced on television that all healthcare would be free. “Financial hurdles should not in any way be a brake to having access to healthcare, especially at a time of epidemic,” he said.

Prof Jean-Jacques Muyembe, the director general of the DRC’s National Institute for Biomedical Research, told the Guardian on Friday that “the situation had evolved overnight with the confirmation of two new cases” in the Wangata neighbourhood of Mbandaka.

“It is very concerning. It’s a big city. We are all doing everything we can, but nonetheless with Ebola there are always surprises,” said Muyembe.

The discovery of the first case in Mbandaka this week was described as a “major gamechanger” by the World Health Organization. An emergency meeting of experts was held on Friday to consider the danger of the disease spreading to other countries. “At the global level, the risk is currently low,” the WHO said.

Late on Thursday, the DRC health ministry confirmed 11 previously suspected cases of Ebola and two more deaths, taking the total number of cases, including 25 deaths, to 45.

All the deaths so far have occurred in Bikoro, a rural area about 75 miles from Mbandaka. The presence of the disease in more isolated areas has given authorities a better chance of preventing its spread.

Muyembe said laboratory results released late on Thursday had confirmed the two new cases. He was unable to give any further details about whether the individuals knew each other. The aid agency Médecins san Frontières, however, said it was aware of only one new laboratory-based confirmation from Mbandaka.

Mbandaka is located on the banks of the Congo river, a key trade and transport route into Kinshasa, though experts said water transport between the cities could take weeks, slowing any potential spread of the disease. Air transport is limited and expensive.

Ebola has twice made it to DRC’s capital in the past and was rapidly stopped.

Ilunga said epidemiologists were working to identify people who had been in contact with suspected cases, and authorities would intensify population tracing on routes out of Mbandaka.

This is a big task even for medical services in developed countries, but the DRC is one of the world’s poorest.

Four times the size of France, the DRC has been chronically unstable and episodically racked by violence since it gained independence from Belgium in 1960. Hospitals, roads and electricity have problems, especially in remote areas.

In Mbandaka, medical staff have been issued with infrared pistol thermometers to check travellers for high temperatures, as well as soap and basins of water, and logbooks for writing down visitors’ names and addresses.

In the privately run port of Menge, health ministry workers were systematically checking people’s temperatures with thermometers. But Joseph Dangbele, a port official, said: “We don’t have enough of the thermometers, so people are crowding up and getting annoyed.”

On Thursday, a doctor at Mbandaka general hospital, who requested anonymity, said more than 300 people in the city had either direct or indirect contact with Ebola.

Despite police being deployed in key areas, residents showed little confidence in authorities’ response.

Gaston Bongonga said: “Delegations come here and then go, but on the ground, you don’t see any change. They were all unable to hold back Ebola in Bikoro because they don’t do anything effective.”

Residents of Bikoro said there were only two checkpoints on a 60-mile stretch of road. One said: “This isn’t effective because many people travelling by motorbike or on foot evade inspection.”

Ebola has been recorded nine times in the DRC since the disease first appeared near the northern Ebola river in the 1970s. It can cause internal and external bleeding.

More than 4,000 shots of a newly developed vaccine were sent by the WHO to Kinshasa on Wednesday.

Source and map:   https://www.theguardian.com/world/2018/may/18/more-ebola-cases-confirmed-in-congolese-city-of-mbandaka


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Post Options Post Options   Thanks (0) Thanks(0)   Quote pcusick Quote  Post ReplyReply Direct Link To This Post Posted: May 18 2018 at 1:59pm
WHO Update link for Ebola, recent case confirmed in metropolitan center.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Technophobe Quote  Post ReplyReply Direct Link To This Post Posted: May 18 2018 at 2:30pm
The Guardian says two more confirmed in the city raising the number to three there, pcusick. 

Admitedly, no one else has claimed this yet, but the Guardian is not some rag.  It is a serious (albeit rather left-wing) newspaper with a great reputation for accuracy.  I know, the WHO is the bottom line, but they do not have a reputation for being forthcoming with information.  They prefer to avoid panic, sometimes even at the expense of the truth. 

Most of us AFTers learned not to trust them during the last ebola outbreak.  Thankfully, Margaret Chan is now gone, so perhaps they will have improved.  Who knows?
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Technophobe Quote  Post ReplyReply Direct Link To This Post Posted: May 19 2018 at 12:38am

Statement on the 1st meeting of the IHR Emergency Committee regarding the Ebola outbreak in 2018

18 May 2018
Statement

The 1st meeting of the Emergency Committee convened by the WHO Director-General under the International Health Regulations (IHR) (2005) regarding the Ebola Virus Disease (EVD) outbreak in the Democratic Republic of the Congo took place on Friday 18 May 2018, from 11:00 to 14:00 Geneva time (CET).

Emergency Committee conclusion

It was the view of the Committee that the conditions for a Public Health Emergency of International Concern (PHEIC) have not currently been met.

Meeting

Members and advisors of the Emergency Committee met by teleconference. Presentations were made by representatives of the Democratic Republic of the Congo on recent developments, including measures taken to implement rapid control strategies, and existing gaps and challenges in the outbreak response. During the informational session, the WHO Secretariat provided an update on and assessment of the Ebola outbreak.

The Committee’s role was to provide to the Director-General their views and perspectives on:

  • Whether the event constitutes a Public Health Emergency of International Concern (PHEIC)
  • If the event constitutes a PHEIC, what Temporary Recommendations should be made

Current situation

On 8 May, WHO was notified by the Ministry of Health of the Democratic Republic of the Congo of two lab-confirmed cases of Ebola Virus Disease occurring in Bikoro health zone, Equateur province. Cases have now also been found in nearby Iboko and Mbandaka. From 4 April to 17 May 2018, 45 EVD cases have been reported, including in three health care workers, and 25 deaths have been reported. Of these 45 cases, 14 have been confirmed. Most of these cases have been in the remote Bikoro health zone, although one confirmed case is in Mbandaka, a city of 1.2 million, which has implications for its spread.

Nine neighbouring countries, including Congo-Brazzaville and Central African Republic, have been advised that they are at high risk of spread and have been supported with equipment and personnel.

Key Challenges

After discussion and deliberation on the information provided, the Committee concluded these key challenges:

  • The Ebola outbreak in the Democratic Republic of the Congo has several characteristics that are of particular concern: the risk of more rapid spread given that Ebola has now spread to an urban area; that there are several outbreaks in remote and hard to reach areas; that health care staff have been infected, which may be a risk for further amplification.
  • 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.
  • There are huge logistical challenges given the poor infrastructure and remote location of most cases currently reported; these factors affect surveillance, case detection and confirmation, contact tracing, and access to vaccines and therapeutics.

However, the Committee also noted the following:

  • The response by the government of the Democratic Republic of the Congo, WHO and partners has been rapid and comprehensive.
  • Interventions underway provide strong reason to believe that the outbreak can be brought under control, including: enhanced surveillance, establishment of case management facilities, deployment of mobile laboratories, expanded engagement of community leaders, establishment of an airbridge, and other planned interventions.
  • In addition, the advanced preparations for use of the investigational vaccine provide further cause for optimism for control

In conclusion, the Emergency Committee, while noting that the conditions for a PHEIC are not currently met, issued Public Health Advice as follows:

  • Government of the Democratic Republic of the Congo, WHO, and partners remain engaged in a vigorous response – without this, the situation is likely to deteriorate significantly. This response should be supported by the entire international community.
  • Global solidarity among the scientific community is critical and international data should be shared freely and regularly.
  • It is particularly important there should be no international travel or trade restrictions.
  • Neighbouring countries should strengthen preparedness and surveillance.
  • During the response, safety and security of staff should be ensured, and protection of responders and national and international staff should prioritised.
  • Exit screening, including at airports and ports on the Congo river, is considered to be of great importance; however entry screening, particularly in distant airports, is not considered to be of any public health or cost-benefit value.
  • Robust risk communication (with real-time data), social mobilisation, and community engagement are needed for a well-coordinated response and so that those affected understand what protection measures are being recommended;  
  • If the outbreak expands significantly, or if there is international spread,  the Emergency Committee will be reconvened.  

The Committee emphasized the importance of continued support by WHO and other national and international partners towards the effective implementation and monitoring of this advice.

Based on this advice, the reports made by the affected States Parties, and the currently available information, the Director-General accepted the Committee’s assessment and on 18 May 2018 did not declare the Ebola outbreak in the Democratic Republic of the Congo a Public Health Emergency of International Concern (PHEIC). In light of the advice of the Emergency Committee, WHO advises against the application of any travel or trade restrictions. The Director-General thanked the Committee Members and Advisors for their advice.

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Post Options Post Options   Thanks (0) Thanks(0)   Quote Technophobe Quote  Post ReplyReply Direct Link To This Post Posted: May 19 2018 at 12:39am
NEWS

Experimental drugs poised for use in Ebola outbreak

International health organizations are in discussions with the Democratic Republic of Congo about how and whether to deploy treatments in addition to a vaccine.

Aid workers responding to the Ebola virus outbreak in the Democratic Republic of Congo (DRC) are seeking approval to treat patients with experimental drugs. These include three potential treatments — ZMapp, favipiravir and GS-5734 — that were given to patients during the 2014–16 Ebola outbreak in West Africa.

The three drugs are being considered in addition to an existing plan to deploy an experimental vaccine; none of the treatments has been definitively proved to lower the risk of death from Ebola.

The move to test experimental drugs and vaccines early in the outbreak, which was confirmed on 8 May, is part of a push to start research as soon as possible after Ebola cases are detected in order to save lives. That’s a change from the past, when doing research during an outbreak was seen as a distraction.

“In the past our major objective was containment," said Peter Salama, the World Health Organization (WHO) director-general for emergencies, at an 18 May press conference. "One of the paradigm shifts we’re seeing in this response is to offer communities a lot more."

The switch has been driven by the availability of new vaccines and drugs — and by memories of the 2014–16 epidemic. Officials were so slow to deploy potential vaccines and drugs that the epidemic had waned before clinical trials could start. “What’s changed is that there’s an acceptance that research during an outbreak is something we need to do. It’s an opportunity and an obligation, not a luxury item,” says Daniel Bausch, director of the UK Public Health Rapid Support Team in London.

Although it took weeks or months to greenlight the use of experimental treatments in previous Ebola outbreaks, public-health officials say that it could happen more quickly now. The DRC allowed the use of an experimental Ebola vaccine during its last outbreak, in May 2017, although the outbreak ended before the vaccine was shipped. Earlier this month the government approved the shipment of 4,000 doses of the vaccine. They arrived in the DRC on 16 May and could be administered next week to outbreak responders, patients and their contacts, says Jean-Jacques Muyembe-Tamfum, director-general of the National Institute for Biomedical Research in Kinshasa. “The Congolese went through this a year ago and they recognize vaccines and therapeutics as a potential solution to the problem,” says Bausch.

Emergency measures

Public-health experts hope that the experimental vaccine, called rVSV-ZEBOV, will help to control the outbreak. Forty-five people have been infected and 25 have died, the WHO said on 18 May. The virus has spread over a wide geographical area and infected at least one person in a major city, Mbandaka, which has a population of 1.2 million.

The rVSV-ZEBOV vaccine, manufactured by Merck, was shown to be highly protective against Ebola in a trial run during the West African outbreak. None of the 5,837 volunteers who took the vaccine in that trial became infected with the virus.

Officials in the DRC have quashed eight previous outbreaks through conventional public-health measures, such as tracking down people with Ebola and their contacts to understand the disease’s path. But they are concerned about how far the virus has already travelled in the current outbreak — including its entry into a major city — and by the possibility that it could spread even farther, as did the West African epidemic, which took root in three countries and claimed more than 11,000 lives.

“We think the outbreak could become complicated, as it did in West Africa, so we must do everything to stop it as soon as possible,” says Muyembe-Tamfum.

Practical and ethical questions

Whether that will include deploying experimental drugs in addition to the vaccine is now under discussion. The WHO is consulting experts to consider the evidence for such treatments, and the medical humanitarian organization Médecins Sans Frontières (MSF) is talking to DRC officials about the possibility of using experimental Ebola medicines, says Annick Antierens, who coordinates Ebola clinical trials for MSF.

Although the rVSV-ZEBOV vaccine could help to prevent people from becoming infected, Antierens says, experimental treatments might still be needed because officials lack a thorough understanding of where Ebola first emerged during this outbreak or how it is spreading. So there are likely to be very many people who have already been infected.

“It we’re lucky and the disease doesn’t spread, the outbreak will be quickly resolved and we will have to use few experimental products,” Antierens says. “But if we’re unlucky we’ll need to use them.”

Administering experimental vaccines and drugs in an outbreak raises ethical and logistical complexities, such as delivering them to remote settings by aeroplane or motorbike and designing humane and rigorous clinical trials. The 2014–16 Ebola outbreak saw intense controversy over whether potential drugs and vaccines should be tested in randomized controlled trials, in which patients are assigned by chance to receive either the experimental treatment or standard care. MSF and officials at the WHO argued that withholding experimental medicines from patients who had few other options would be unethical.

The treatments MSF is now considering include the antibody treatment ZMapp, and two antiviral drugs, favipiravir and GS-5734, which were given to varying numbers of patients in the 2014–16 epidemic.

Zmapp, made by Mapp Biopharmaceutical in San Diego, California, was tested in a trial involving 72 patients; 22% of the 36 people who received the drug died, compared with 37% of the 35 who did not receive ZMapp. But the Ebola outbreak ended before the study was able to enrol the 200 people needed to obtain a statistically significant result.

ZMapp is also impractical for use in remote settings, such as parts of Bikoro and Iboko, the two health zones in Équateur province that have seen the most Ebola cases in this outbreak so far. There is an extremely limited supply of the drug, several doses must be administered by intravenous infusion under constant supervision, each infusion takes many hours, and the drug must be refrigerated.

Sparse data

Favipiravir, an antiviral drug made by the Japanese company Toyama Chemical, was given to 126 patients in the West African outbreak, and a few dozen patients in other trials. GS-5734 was given to three people, including an infant and a Scottish nurse who developed meningitis months after apparently recovering from an acute Ebola infection. Both the nurse and the infant survived; the infant was the first documented case of a baby surviving Ebola.

Favipiravir and GS-5734 would be easier than ZMapp to administer to patients during the outbreak, as neither needs to be refrigerated. But the drugs have not been proved to improve the chance that people will survive an Ebola infection, because the favipiravir trial was not designed to test efficacy, and GS-5734 has been tested in so few patients.

The Congolese Ministry of Health and a national ethics review board would need to greenlight trials of these treatments. Observers say that the trials, if approved, must proceed more equitably than they did in the 2014–16 outbreak, when experimental treatments were given first to international doctors and aid workers.

“We were pretty tone deaf. The interventions were used first and primarily on Westerners, including medevacing them out of the country and treating them,” says Lawrence Gostin, director of the WHO Collaborating Center on Public Health Law and Human Rights at Georgetown University in Washington DC. “We need to do that completely differently this time.”

Source:   https://www.nature.com/articles/d41586-018-05205-x

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WHO calls for extra funds to contain ebola outbreak.

The World Health Organisation has urged the international community to provide $26m to contain a growing outbreak of the Ebola virus in the Democratic Republic of Congo or risk a much larger bill if the epidemic spreads.

Medical authorities have identified 45 Ebola cases since the DRC government informed the WHO of the outbreak on May 8, of which 25 have been fatal. The vast majority of these are in the remote Bikoro area, 400km north-east of the capital Kinshasa.

But on Thursday the first case was identified in a city, Mbandaka, 150km from the other cases. Late on Friday, two more were found. This prompted the WHO to raise the risk awareness to “very high” for the country and “high” for the region.

Peter Selama, WHO deputy director-general, said the amount requested, which is expected to cover the next three months, was “relatively small”.

“If we can stamp out this outbreak now [it will be] a major gain in terms of lives saved, most importantly, but also in terms of dollars saved,” he told a press conference in Geneva. “That may sound like a considerable sum of money, but let us remember that the Ebola west Africa outbreak two years [ago] cost the international community between three and four billion dollars.”

The 2014-2016 outbreak in Liberia, Sierra Leone and Guinea infected 28,000 people, of whom 11,600 died.

Dr Selama said the WHO had already received pledges for almost $9m of the funds requested.

Robert Steffen, chairman of a WHO emergency committee that met on Friday to assess the threat, said the “poor infrastructure and remote location” presented huge challenges in containing the outbreak. “These factors affect surveillance, case detection and confirmation, and also contact tracing and access to therapeutics.”

He also warned that the “risk of international spread is particularly great”. Mbandaka is a major transport hub on the Congo River with routes into the DRC capital. “You can travel on it to Kinshasa and Brazzaville [the capital of the Republic of Congo],” he said. There is significant regional traffic across porous borders.”

However the committee said it was premature to declare a public health emergency of international concern. “The immediate response of the government of the Democratic Republic of Congo, the WHO and other partners…. provides strong reason to believe this situation can be brought under control,” Mr Steffen said.

More than 8,000 trial vaccine doses, developed by Merck, have arrived in DRC and the WHO said these would be distributed in the next few days.

Jeremy Farrar, director of Wellcome, a biomedical research charity, said that this outbreak of Ebola was “really serious” compared to the last one in DRC, which killed four people last year, because it has been going on for several months and so is geographically dispersed over an area that is close to cities. The strain of the virus is also similar to the one in west Africa in 2014-16.

“The next two or three weeks will be crucial,” he said. “If the numbers stabilise and we don’t have multiple transmission then it should be containable. But if the numbers are going up, there are multiple transmissions in cities, cross-border infections and health workers getting infected then all bets are off.”

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Congo announces six new confirmed cases of Ebola virus


Congo's health ministry announced six new confirmed Ebola cases and two new suspected cases on Tuesday as vaccinations entered a second day in an effort to contain the deadly virus in a city of more than 1 million.

Dozens of health workers in the northwestern provincial capital, Mbandaka, have received vaccinations amid expectations that some will be deployed to the rural epicenter of the epidemic.

Front-line workers are especially at risk of contracting the virus, which spreads in contact with the bodily fluids of infected people, including the dead.

"In the next five days 100 people must be vaccinated, including 70 health professionals," Health Minister Oly Ilunga said. "The priority of the government is to ensure that all these brave health professionals can do their job safely."

READ MORE:
* Experimental vaccine main hope against Ebola
Congo confirms Ebola outbreak
Five new suspected Ebola cases reported in Congo's northwest

Congo's health ministry said there are now 28 confirmed Ebola cases, 21 probable ones and two suspected. The six new confirmed cases were in the rural Iboko health zone, it said. Of the confirmed Ebola cases, 14 are in Iboko, 10 are in Bikoro where the outbreak began and four are in the Wangata area of Mbandaka.

The death toll from hemorrhagic fever stands at 27, with three of them confirmed as Ebola. Two of the Ebola victims were nurses, one in Iboko and the other in Bikoro.

Allowing Congolese to watch health officials receive vaccinations is crucial, health worker Ezela Elange told The Associated Press.

"Our hope is that ... the sick will heal, the whole province will be healed," Elange said.

Two dozen vaccinators, including Congolese and Guineans who administered the vaccine in their country during the ...
JOHN MOORE/GETTY IMAGES

Two dozen vaccinators, including Congolese and Guineans who administered the vaccine in their country during the 2014-2016 outbreak, are in Mbandaka to start injecting the 540 doses that have arrived. (File photo)

The World Health Organization said 33 people received the first vaccinations on Monday, including a few people in two communities of Mbandaka. More than 7500 doses are available in Congo, WHO said on Monday, and another 8000 doses will be available in the coming days.

The vaccination campaign eventually will move to cover the two other health zones where confirmed cases have been reported.

The vaccine, provided by US company Merck, is still in the test stages but it was effective toward the end of the Ebola epidemic that killed more than 11,300 people in Guinea, Sierra Leone and Liberia from 2014 to 2016.

A major challenge will be keeping the vaccines cold in this vast, impoverished, tropical country where infrastructure is poor.

Those who are vaccinated in outbreak areas still will have to strictly follow infection-control measures, especially since the vaccine doesn't protect immediately. It takes a week to 10 days, said Dr Pierre Rollin, an epidemiologist with the US Centers for Disease Control and Prevention and a veteran of more than a dozen Ebola outbreaks.

Rollin warned that the large geographic area between Mbandaka and the remote towns where the outbreak's first cases were reported must be scoured for the infected and the people who have come into contact with them.

"Travel from Mbandaka to Bikoro can take four hours to four days" depending on transportation and if it's raining, he said. "Before making any assumption we're going to have to look along this road and all the villages."

Members of a Red Cross team don protective clothing before heading out to look for suspected victims of Ebola, in ...
KARSTEN VOIGT/AP

Members of a Red Cross team don protective clothing before heading out to look for suspected victims of Ebola, in Mbandaka, Congo.

The US Agency for International Development on Tuesday said it was contributing another up to US$7 million (NZ$10.1 million) to combat the outbreak on top of the US$1 million (NZ$1.4 million) it committed last week.

The International Federation of Red Cross and Red Crescent Societies in Congo warned that the outbreak is far from over. It said it will expand operations for community-based surveillance and safe burials.

"The risk of spreading within the country and to neighbouring nations remains real," said Dr Fatoumata Nafo-Traore, IFRC's regional director for Africa.

This is Congo's ninth Ebola outbreak since 1976, when the disease was first identified. While all of the outbreaks were based in remote rural areas the virus has twice made it to Kinshasa, the capital of 10 million people, but was effectively contained.

Mbandaka is an hour's flight from Kinshasa and several days' travel by barge.

There is no specific treatment for Ebola. Symptoms include fever, vomiting, diarrhea, muscle pain and at times internal and external bleeding. The virus can be fatal in up to 90 per cent of cases, depending on the strain.

There is no specific treatment for Ebola. Symptoms include fever, vomiting, diarrhoea, muscle pain and at times internal ...
NIAID/NIH

There is no specific treatment for Ebola. Symptoms include fever, vomiting, diarrhoea, muscle pain and at times internal and external bleeding. The virus can be fatal in up to 90 per cent of cases, depending on the strain.


Source:  https://www.stuff.co.nz/world/africa/104097920/congo-announces-six-new-confirmed-cases-of-ebola-virus

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May 23, 2018 / 11:16 AM / Updated 2 hours ago

Ebola patients slip out of Congo hospital as medics try to control outbreak


BANDAKA, Democratic Republic of Congo (Reuters) - Three patients infected with the Ebola virus slipped out of an isolation ward at a hospital in the Congolese city of Mbandaka, health officials said, as medics raced to stop the deadly disease from spreading in the busy river port.

The cases represent a setback to costly efforts to contain the virus, including the use of an experimental vaccine, and show efforts to stem its spread can be hampered by age-old customs or scepticism about the threat it poses.

Two patients left the hospital on Monday night with the help of family members, then headed to a church, the World Health Organization’s spokesman in Congo, Eugene Kabambi, told Reuters.

One died at home the next day and was buried with the help of medical charity Medecins Sans Frontieres (MSF). The other was sent back to hospital and died that night, Kabambi said.

Health Ministry sources, who asked not to be named, said two police officers had been deployed to help track them down.

Another patient who was close to being discharged left on Sunday evening but was later found, Kabambi said.

The WHO and MSF said they could not force patients to stay in hospital but hoped that growing awareness of the disease and its risks would convince people to follow medical advice.

“This is a hospital. It’s not a prison. We can’t lock everything,” Henry Gray, the head of the MSF mission in Mbandaka, told Reuters.

WHO spokesman Tarik Jasarevic said health workers had redoubled efforts to trace contacts with the patients. Health workers have drawn up a list of 628 people who have had contact with known cases who will need to be vaccinated.

“It is unfortunate but not unexpected,” he said. “It is normal for people to want the loved ones to be at home during what could be the last moments of life.”

The report came as another WHO official warned that the fight to stop Democratic Republic of Congo’s ninth confirmed outbreak of Ebola had reached a critical point.

“The next few weeks will really tell if this outbreak is going to expand to urban areas or if we’re going to be able to keep it under control,” WHO’s emergency response chief, Peter Salama, said at the U.N. body’s annual assembly. “We’re on the epidemiological knife edge of this response.”

KINSHASA FEARS

Health officials are particularly concerned by the disease’s presence in Mbandaka, a crowded trading hub upstream from Kinshasa, a city of 10 million people. The river runs along the border with the Republic of Congo.

The WHO said health officials received an alert on Wednesday from Kinshasa’s main hospital, but the health ministry said later that it was a false alarm.

The outbreak, first spotted near the town of Bikoro, about 100 km (60 miles) south of the city, is believed to have killed at least 27 people so far.

The WHO said health workers were following up on three separate transmission chains for cases in Mbandaka’s Wangata neighborhood - one linked to a funeral, one to a church and another to a rural health facility.

“It’s really the detective work of epidemiology that will make or break the response to this outbreak,” Salama said.

The disease was first discovered in Congo in the 1970s. It is spread through direct contact with body fluids from an infected person, who suffers severe bouts of vomiting and diarrhea.

More than 11,300 people died in an Ebola outbreak in the West African countries of Guinea, Liberia and Sierra Leone between 2013 and 2016.

Source:    https://www.reuters.com/article/us-health-ebola-congo/ebola-patients-slip-out-of-congo-hospital-as-medics-try-to-control-outbreak-idUSKCN1IO1AW


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Post Options Post Options   Thanks (0) Thanks(0)   Quote Technophobe Quote  Post ReplyReply Direct Link To This Post Posted: May 23 2018 at 12:55pm
[Technophobe:  with the death toll rising and quarrantine patients escaping, here is a plea not to cut funding]

US and global community has to keep the Ebola outbreak from spreading — don't cut funds

By Peter Yeo, opinion contributor — 05/22/18 01:00 PM EDT 28
The views expressed by contributors are their own and not the view of The Hill

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WHO: DRC Ebola outbreak on a 'knife's edge' as urban cases rise

Efforts under way in Democratic Republic of Congo in bid to prevent Ebola outbreak spreading across borders.

An outbreak of the deadly Ebola virus in Democratic Republic of Congo has the clear "potential to expand" as the number of confirmed cases continues to rise, the World Health Organization warned.

Health workers' response is on an "epidemiological knife's edge" after the number of people stricken with Ebola in the DRC rose to 28 since an outbreak was detected earlier this month, said WHO Deputy Director Peter Salama, in comments made on Wednesday at a conference in Geneva, Switzerland.

Seven of the confirmed cases were in urban settings.

"The next few weeks will really tell if this outbreak is going to expand to urban areas or if we're going to be able to keep it under control," Salama said.

Following the meeting, Salama told AFP news agency the outbreak "could go either way" in coming weeks.

"We are working around the clock to make sure it [goes] in the right direction," he said.

The average fatality rate among those infected with Ebola, which has no proven cure, is about 50 percent, according to WHO.

DRC's most recent Ebola outbreak - its ninth since the disease was first identified in 1976 - initially appeared to be confined in a rural setting near the town of Bikoro, in the central African nation's northwestern Equateur Province.

But a confirmed instance of the virus last week in the city of Mbandaka, home to 1.2 million people and about 150km away from Bikoro, plunged the ongoing crisis into a "new phase", the DRC's Health Minister Oly Ilunga said last week.

Twenty-seven people have died and at least 58 others in DRC's northwest have shown Ebola symptoms since it was identified on May 8, according to the health ministry.

Health ministry spokeswoman Jessica Ilunga said the figures amounted to "the normal evolution of an outbreak".

"As soon as you have a few confirmed cases, the persons who have been in contact with them are at risk. We knew there was a risk of more cases coming in," Ilunga told Al Jazeera.

"What we are trying to do first is contain the outbreak so that it doesn't spread towards other urban centres in the DRC."

Regional response

On Wednesday, WHO said it would work with nine countries neighbouring DRC in a bid to prevent the virus spreading across borders.

Matshidiso Moeti, WHO director for Africa, told the conference Central African Republic and Republic of Congo were the organisation's top priority countries because of their proximity.

Efforts to detect and stem a possible cross-border spread would also be rolled out in Angola, Burundi, Rwanda, South Sudan, Tanzania, Zambia and Uganda, Moeti said.

The WHO has sent 7,540 experimental vaccines to DRC so farIt will send another 8,000 doses, made by pharmaceutical firm Merck, over the next few days.

Though unlicensed, the experimental vaccine proved effective when used in trials in West Africa between 2013-2016 during an Ebola outbreak, which killed about 11,300 people as it surged through Guinea, Sierra Leone, and Liberia.

'Break the transmission chain'

Ilunga said the vaccinations were a vital part of the DRC's strategy to combat the latest emergence of the disease.

"Ebola has a 21-day incubation period, so as soon as you have confirmed cases you know that in the following three weeks more cases might appear," she told Al Jazeera.

"That's why vaccination is really important in this Ebola response, simply because it will allow us to vaccinate and protect the circles of people who were in contact with those who were, or are, infected and break the disease's transmission chain."

Ebola, which can cause multiple organ failure, is passed from human to human by contact through the mouth, nose, or broken skin with blood or other bodily fluids of those infected.


Source, statistics, photos and more:   https://www.aljazeera.com/news/2018/05/drc-ebola-outbreak-knife-edge-urban-cases-rise-180523134122470.html

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[Less than 48 hours ago I was commenting that faith can sustain you in survival situations.  Apparently it can make you dangerously stupid too...........]

Ebola outbreak in DR Congo: Patients 'taken to church'

Three Ebola patients left a treatment centre in the Democratic Republic of Congo after their families demanded to take them to church, according to the World Health Organization (WHO).

Two of the patients later died, while the third returned to the centre in the city of Mbandaka.

This presents a new challenge for health workers battling to stop the spread of the contagious disease, says the BBC's Anne Soy in DR Congo.

Ebola has no known cure.

Health officials fear it could spread rapidly in Mbandaka, a densely populated city of one million.

Isolation is the main way to keep the disease under control.

The WHO says 58 cases of Ebola have been recorded since the outbreak was declared on 8 May. There have been 27 deaths so far, with three deaths confirmed as Ebola.

How did the patients leave?

The patients' relatives came to the centre, which is run by medical aid agency Medecins Sans Frontieres (MSF), and demanded to take them for prayers, WHO officer Eugéne Kabambi told the BBC.

They were reportedly taken away on motorbikes and a search was ordered by the police.

One patient was found dead at home and his body was returned to the hospital for a safe burial. The other was sent back to hospital on 22 May and died that evening, according to MSF.

Efforts were made by staff to convince the patients not to leave and continue treatment, MSF says.

"However, forced hospitalisation is not the solution to this epidemic. Patient adherence is paramount," it said in a statement.

The families of the three patients are now being monitored and some of them have been vaccinated against the disease.

Is the situation under control?

The disease's spread from rural areas to Mbandaka, located on the Congo River, has sparked fears of it spreading downstream to the capital, Kinshasa, and to neighbouring countries.

The WHO says the outbreak has the potential to expand.

"We are on the epidemiological knife-edge," Peter Salama, head of emergency responses at the WHO, said at a special meeting to discuss the crisis in Geneva.

"The next few weeks will really tell if this outbreak is going to expand to urban areas or if we are going to be able to keep it under control," he added.

Health workers began an immunisation campaign to halt the spread of the Ebola virus on 21 May.

Limited trials of the experimental vaccine was rolled out during the epidemic in West Africa in 2014-16, which killed more than 11,300 people.

This is the ninth outbreak of Ebola in DR Congo.


Source:   http://www.bbc.co.uk/news/world-africa-44229346

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Congo Faces Obstacles to Fighting Ebola Outbreak

By


Nine new suspected cases of Ebola were reported in the northwestern Democratic Republic of Congo as authorities tackling the outbreak face challenges including resistance by local communities and multiple chains of transmission.

Fifty-eight cases, including 30 confirmed and 14 probable, have been registered since the outbreak was declared on May 8, Congo’s Health Ministry said in a statement Thursday. Of the nine new suspected cases, three are in Mbandaka, a provincial capital of 1.2 million habitants where four cases have so far been confirmed. Twenty-seven people have died, according to the World Health Organization.

A motocycle drives past the entrance of the Wangata Reference Hospital in Mbandaka May 20, 2018.

Photographer: JUNIOR KANNAH/AFP

Congo’s latest Ebola outbreak was first identified around the remote town of Bikoro, 150 kilometers (93 miles) from Mbandaka. The detection of the virus in an urban center connected by busy river routes to Congo’s capital, Kinshasa, home to about 12 million people, as well as cities in the Republic of Congo and Central African Republic, has fueled concerns the disease could spread more widely.

On Monday, the Health Ministry and WHO launched a “ring vaccination” campaign in Mbandaka and Bikoro with the still-unlicensed rVSV-ZEBOV treatment, whose manufacturer, Merck & Co., has donated 7,540 doses that arrived in Congo last week. Another 8,000 doses will be made available, the WHO said.

Vaccination Plans

Health professionals who’ve been exposed to confirmed cases, as well the patients’ direct and indirect contacts, will be offered the vaccination. Over 600 people have been traced, the WHO said Wednesday.

This week, three people confirmed to be carrying Ebola were removed by their families from an isolation ward in Mbandaka, the Health Ministry said. Two have died while one has returned to hospital and is under observation.

“All efforts were made by staff to convince the patients, as well as their families, to not leave the center,” but “Ebola treatment centers are not prisons,” the ministry said. “Even in an epidemic period, health professionals have the duty to respect the will and dignity of patients.”

Medical teams have to tread carefully, Henry Gray, Doctors Without Borders’ emergency coordinator in Mbandaka, said by phone on Thursday

“We don’t want to criminalize patients because if we criminalize people, they hide,” he said. At the same time, medical organizations are working to ensure that “the families and the patients understand what’s going on, that they understand the best chance of a full recovery is in a center where they can be looked after.”

Community Resistance

Health workers were unable to take samples from a dead person in Bikoro “because of the resistance of the community,” the Health Ministry said. The fatality was accordingly classified as a probable case of Ebola.

There was a “lot of fear and confusion” about Ebola in the affected communities, the ministry said.

Medical teams in Mbandaka are investigating three separate transmission chains -- one associated with a funeral in Bikoro, another linked to a health center near Bikoro and the third related to a church service.

“Each one has the potential to expand if not controlled,” WHO Deputy Director-General for Emergency Preparedness and Response Peter Salama said Wednesday at a briefing in Geneva. “It’s the detective work of epidemiology which will make or break the response to this outbreak.”

Source:   https://www.bloomberg.com/news/articles/2018-05-24/ebola-fight-in-congo-faces-obstacles-amid-more-suspected-cases

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