Sunday, 14 October 2018

MSF - New Medical Approaches as Ebola Continues to Spread


As the Ebola outbreak in the northeast of the Democratic Republic of Congo (DRC) continues to spread, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) has begun using novel medical approaches to prevent new infections and improve survival chances for those infected.

MSF launched its intervention, within the response plan of the Congolese Ministry of Health (MoH), soon after the outbreak was registered in Mangina, a small town to the northwest of Beni Province, in early August. In addition to the traditional “six pillars” of Ebola response—including caring for those who are sick, carrying out health promotion activities, and conducting infection prevention and control activities—MSF is using more innovative approaches and new tools to best meet the needs of patients. For example, MSF has started testing blood samples of suspect cases in laboratories within the Ebola Treatment Centers (ETCs) themselves rather than in an outside lab, which allows the teams to react faster to changing medical conditions of patients.

“While the number of confirmed Ebola cases is not skyrocketing, the situation remains worrying,” said Laurence Sailly, MSF emergency coordinator. “There are confirmed patients in big cities like Beni and Butembo, but also in places far away from the epicenter, 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.”

To date, 181 cases have been reported—of which 146 have been confirmed by laboratory tests—80 people have died, and 50 have recovered.

MSF is currently working with the MoH in ETCs in Mangina, Butembo, and Tchomia, close to the Ugandan border.

For the first time during an Ebola outbreak, five developmental drugs are being used to treat people. The presence of on-site testing capability means people who test positive for the virus are offered these new treatments within 24 hours of their confirmation. Mortality among those infected is very high, at roughly 50 percent, so administering the new drugs quickly may have the potential to increase the chance of survival.

“It’s very positive to have a treatment that seems promising, even if there is currently no scientific evidence that any of these drugs work for people with Ebola,” said MSF doctor and Ebola expert, Hilde De Clerk. “But it’s a good step forward. We can offer Ebola patients access to potentially lifesaving drugs while preparing for a clinical trial implementation that will hopefully determine efficacy and safety.”

The outbreak has occurred in a densely populated area of DRC, marked by conflict and regular population movements, making it difficult to identify and track active chains of transmission and trace contacts of those infected with Ebola.

“A potential key to successfully control the outbreak is to react fast,” said Sailly. “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 those areas.

Immunization activities with the Ebola vaccine (rVSVDG-ZEBOV) quickly followed the declaration of the epidemic as the WHO and MoH began providing the vaccine to people who had contact with someone with Ebola. Soon after, MSF began offering vaccinations to frontline health workers, people involved in burials, and religious figures, who run a higher risk of becoming infected. So far, 13,750 people have been vaccinated.

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Posted by Dr. Tim Sandle, Pharmaceutical Microbiology

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