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WHO is “cautiously optimistic” about Ebola ring vaccination programme in DRC

BMJ 2018; 361 doi: https://doi.org/10.1136/bmj.k2388 (Published 30 May 2018) Cite this as: BMJ 2018;361:k2388
  1. Jacqui Wise
  1. London

Over 400 suspected contacts have been vaccinated against Ebola virus disease in the first stage of the ring vaccination programme in the Democratic Republic of the Congo (DRC). A senior World Health Organization official said that he was cautiously optimistic, as 90% of people at risk in the city of Mbandaka had now been vaccinated.

Latest WHO figures show that 54 cases of Ebola have occurred in DRC, including 25 deaths. Of these cases, 35 are confirmed, 13 are probable, and six are suspected.

The unlicensed rVSV-ZEBOV Ebola vaccine has so far been used only in Mbandaka, a provincial capital with a population of 1.2 million people that has had four confirmed cases.

Peter Salama, WHO deputy director general for emergency preparedness and response, told a press briefing in Geneva, Switzerland, that Mbandaka had been the first priority because it is a transport hub on the Congo river and so preventing an urban outbreak was vital. “We have reached more than 90% of contacts of the cases in Mbandaka, and there have been no reports of a refusal of the vaccine,” he said. “We haven’t seen an explosive increase in cases in Mbandaka, so we have reason to be cautiously optimistic.”

The next stage will be to vaccinate contacts in the two epicentres of the outbreak—Bikoro and Iboko. These are rural areas with very limited facilities and thus pose more logistical problems, Salama said.

A ring vaccination programme relies on tracing all of the contacts, and the contacts of contacts, of a recently confirmed case as soon as possible and offering them vaccination. Salama said that over 900 contacts of Ebola cases had been identified to date and were currently being followed up.

The drug company Merck has donated the vaccines, and Gavi, the vaccine alliance, has contributed $1m (£0.75m; €0.86m) towards operational costs. The vaccination programme is being implemented by Médecins Sans Frontières with support from the International Federation of Red Cross and Red Crescent Societies, Unicef, and WHO.

The vaccine was shown to be highly protective against Ebola in a major trial in 2015 in Guinea.1 Among the 5837 people who received the vaccine no Ebola cases were recorded nine days or more after vaccination. While the vaccine is awaiting review by relevant regulatory authorities, WHO’s Strategic Advisory Group of Experts on Immunization has recommended using the rVSV-ZEBOV Ebola vaccine under an expanded access/compassionate use protocol.

Salama said that he hoped to get government approval within days for five experimental drugs to treat patients with Ebola. Two of the drugs have previously been used in Western countries, he said, but data on the other three are mainly from animal models. The drugs would be used as part of a clinical trial, he said, so that more would be known for future outbreaks.

He added that WHO had met with ministers of health in nine neighbouring countries to check on their regional preparedness, and all of these governments were proactively carrying out contingency planning in case Ebola spread beyond DRC’s borders.

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