PASSIVE VOICE

ARTICLE 1

Congo Says 3 New Ebola Cases Confirmed in Large City

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Health care workers wearing protective gear at a treatment center in Bikoro, Congo. The country’s latest Ebola outbreak has spread to a city of more than one million people.CreditJohn Bompengo/Associated Press

By The Associated Press

May 19, 2018

KINSHASA, Congo — Three new cases of the often lethal Ebola virus have been confirmed in a city of more than one million people, Congo’s health minister announced, as the spread of the hemorrhagic fever in an urban area raised alarm.

The statement late on Friday said the confirmed cases are in Mbandaka, a city where a single case was confirmed earlier in the week.

There are now 17 confirmed Ebola cases in this outbreak, including one death, plus 21 probable cases and five suspected ones.

The World Health Organization on Friday decided not to declare the outbreak a global health emergency, but it called the risk of spread within Congo “very high” and warned nine neighboring countries that the risk to them was high. The W.H.O. said there should be no international travel or trade restrictions.

The outbreak is a test of a new experimental Ebola vaccine that proved effective in the West Africa outbreak a few years ago. Vaccinations are expected to start early in the week, with more than 4,000 doses already in Congo and more on the way.

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

While Congo has contained several Ebola outbreaks in the past, all of them were based in remote rural areas. The virus has twice made it to Congo’s capital of 10 million people, Kinshasa, in the past but was rapidly stopped.

Health officials are trying to track down more than 500 people who have been in contact with those feared infected, a task that became more urgent with the spread to Mbandaka, which lies on the Congo River, a busy traffic corridor, and is an hour’s flight from the capital.

The outbreak was declared more than a week ago in Congo’s remote northwest. Its spread has some Congolese worried.

“Even if it’s not happening here yet, I have to reduce contact with people,” Grace Ekofo, 23, a student in Kinshasa, told The Associated Press.

A teacher in Mbandaka, Jean Mopono, 53, said they were trying to introduce preventive measures by teaching students not to greet each other by shaking hands or kissing.

“We pray that this epidemic does not take place here,” Mr. Mopono said.

The W.H.O., which was accused of bungling its response to the West Africa outbreak — the biggest Ebola outbreak in history with more than 11,000 deaths — appears to be moving swiftly to contain this latest epidemic, experts said.

There is “strong reason to believe this situation can be brought under control,” said Dr. Robert Steffen, who chaired the W.H.O. expert meeting on Friday. But without a vigorous response, “the situation is likely to deteriorate significantly.”

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 percent of cases, depending on the strain.

PASSIVE VOICE ARTICLE 1

ARTICLE 2

As Aid Workers Move to the Heart of Congo’s Ebola Outbreak, ‘Everything Gets More Complicated’

Medical investigators will need to overcome the rural region’s extreme logistical hurdles to reconstruct transmission chains, vaccinate contacts and halt the spread.

By Emily Baumgaertner

• June 1, 2018

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Health care workers preparing a makeshift center to administer an experimental vaccine in Mbandaka, Democratic Republic of Congo, where the outbreak began, in May.CreditKenny Katombe/Reuters

Aiming to squelch an Ebola outbreak that has infected 54 people, killing almost half of them, aid workers in the Democratic Republic of the Congo have begun giving an experimental vaccine to people in the rural region at the epicenter of the outbreak.

Epidemiologists working in the remote forests have not yet identified the first case, nor many of the villagers who may have been exposed. Investigators will need to overcome extreme logistical hurdles to reconstruct how the virus was transmitted, vaccinate contacts and halt the spread.

“For an epidemic to be under control, you need a clear epidemiological picture,” said Dr. Henry Gray, the emergency coordinator for Doctors Without Borders.

“If you don’t know the stories of the people involved — who their families were, what their jobs were, where they went to weddings and funerals — then you don’t know the epidemic.”

Almost 500 people received the experimental vaccine, VSV-EBOV, last week around Mbandaka, a riverfront city of more than 1.5 million people where four Ebola cases have been confirmed.

Mbandaka is a priority because it is a traffic hub. The Republic of the Congo lies just across the Congo River, and Kinshasa, Congo’s capital of 10 million, is less than 500 miles downstream.

Aid workers are using the ring method: The vaccine is given to groups of people in contact with each Ebola case, such as family caregivers, as well as the contacts of those contacts.

About 7,500 doses are available to vaccinate 50 rings of 150 people each, according to Dr. Peter Salama, the deputy director-general for emergency response at the World Health Organization. An additional 8,000 doses will follow.

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Administering the VSV-EBOV vaccine in Mbandaka. Epidemiologists have not yet identified the first case, nor do they know how many have been infected.CreditJunior Kannah/Agence France-Presse — Getty Images

The W.H.O. is monitoring more than 900 contacts throughout Équateur province. As the vaccination program expands to the Bikoro and Iboko communities, where most cases have been reported, teams are relying on contact tracing to identify the most urgent recipients.

“This is where everything gets more complicated,” said Chiran Livera, the operation leader in Congo for the International Federation of Red Cross and Red Crescent Societies.

The villages surrounding Bikoro and Iboko are among the most isolated and densely wooded pockets of Congo. Aid workers must use motorbikes to navigate cratered dirt roads that flood during the rainy season. Maps of some regions are incomplete, and vast gaps in cellular service thwart efforts to report data to central operations.

“Following the virus’s narrative may sounds easy to do on a suburban street outside Chicago,” said Dr. Salama. “But when you’re traveling hundreds of kilometers in a forest by motorbike to find each person, that’s very different epidemiological work.”

If the outbreak worsens, a second vaccination may be offered to health workers. That vaccine, developed by Johnson and Johnson, requires two doses and would take longer than VSV-EBOV’s seven to 10 days to become effective — but may protect health workers for several years.

The Congolese Ministry of Health is planning to deploy up to five experimental treatments, though the two most highly recommended by the W.H.O. may prove impractical in a remote setting.

ZMapp, a cocktail of three antibodies used in West Africa, must be given in multiple doses and must be refrigerated. Remdesivir, a drug developed by Gilead Sciences, requires intensive monitoring of liver and kidney function — nearly impossible for treatment centers without electricity, running water or standard equipment.

Another option, called MAb114, began safety trials earlier this month. Made from the antibodies of an Ebola survivor, it can be crystallized and reconstituted with saline-like fluids in the field.

“These are all investigative products,” Dr. Salama said. Vaccine makers have struggled to show efficacy without live Ebola cases in which to test their drugs. “Many consider this outbreak their chance to prove themselves,” he said. Drug companies are not alone in that mission.

The W.H.O.’s emergency committee gathered 10 days after the Congolese government notified the organization of an Ebola case, a stark contrast to the West African epidemic in 2014, when the group did not convene until almost 1,000 people had died.

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Health care workers arriving at Ngobila Beach in Kinshasa to screen others coming into Kinshasa. The capital of 10 million is less than 500 miles downriver from the outbreak.CreditJohn Bompengo/Associated Press

Since May 8, the W.H.O. has sent 156 technical experts to the region. A mobile laboratory has been set up to expedite case confirmations in Bikoro; another is planned for Mbandaka. A cellular tower has been erected in Mbandaka to help workers trace people who may have been infected throughout the region.

The W.H.O. has more than doubled its budget request to $56 million from $26 million to account for the possibility of the virus may reach an urban setting.

“The biggest problem of 2014 was that there had never been an Ebola epidemic before,” said Ron Klain, the White House’s Ebola response coordinator for West Africa. “This time, there is an intensity, a focus, a pace. No one is underestimating the risk, and that alone is a big advantage.”

Another advantage is context: Unlike West Africa, Congo has experienced eight previous Ebola outbreaks since the virus was identified in 1976. Aid workers who arrived in Kinshasa this month found pre-established surveillance protocols, according to Mr. Livera.

The W.H.O.’s strategy assumes the virus will ultimately infect 100 to 300 people. Each rural case may infect 10 contacts, and each urban case may infect 30. Response activities may continue into July, according to a revised plan released May 27.

Until investigators identify the index case, it is impossible to discern whether the first patient detected in April was truly the first human case or the hundredth, according to Dr. Gianfranco Rotigliano, the regional director of Unicef. Until then, it is impossible to quantify the crisis.

“These are the early days of the outbreak,” Dr. Salama said. “There can be lulls. We’ve seen that before. But there only needs to be one event — a super-spreader, like a funeral — to cause an explosion.”

PASSIVE VOICE ARTICLE 2

SUMBER

https://www.nytimes.com/2018/05/19/world/africa/congo-ebola.html

https://www.nytimes.com/2018/06/01/health/ebola-congo-outbreak.html?rref=collection%2Ftimestopic%2FEbola&action=click&contentCollection=timestopics&region=stream&module=stream_unit&version=latest&contentPlacement=1&pgtype=collection