News on Friday about the reemergence of several Ebola cases in the Democratic Republic of Congo (DRC) highlights the need for both a robust global and national health security strategy, said Dr. Jeffrey Duchin, immediate past chairman of the public health committee for the Infectious Diseases Society of America (IDSA).
“This is another wake-up call. Diseases like Ebola, MERS and various global pandemics are always going to be out there. We need to maintain the highest level of preparedness,” Duchin told Homeland Preparedness News on Friday.
“It is imperative that the United States and other countries be able to catch and respond to outbreaks at any time and we must be sure we’re doing everything to prevent diseases from entering and spreading in the U.S.,” said Duchin, an allergy and infectious diseases professor in the Department of Epidemiology at the University of Washington’s School of Public Health in Seattle.
While the United States currently has no indication that there’s a stateside Ebola threat, Duchin, also a health officer for Public Health for Seattle and King County, said the nation should remain “very vigilant, closely monitor and ensure our national capacity developed during the last Ebola outbreak is able to be reactivated.”
“We really can’t sell short our public health system and expect to have national health security. It requires ongoing resources and attention and it must be strong at the national, state and local levels,” he said.
Zaire species reemerges
The World Health Organization (WHO) earlier Friday reported a cluster Ebola outbreak in the DRC’s remote Bas-Uele province located near the Central African Republic border.
The first case appeared April 22. As of Friday, there are nine suspected cases—three people have died and six others are hospitalized, according to WHO.
The Centers for Disease Control and Protection (CDC), which Duchin described as the U.S. “mothership” for handling such epidemics, defines Ebola as a rare and deadly disease spread by direct contact with blood or body fluids of a person infected with the Ebola virus, or by contact with a contaminated object or infected animal.
An investigation team supported by WHO and the organization’s partners has been deployed by the DRC’s Ministry of Health, according to Dr. Peter Salama, WHO executive director for emergencies.
The team is expected to reach the affected area “in the coming days,” Salama said in a statement Friday. WHO and its partners will “support the Ministry of Health in all aspects of the response,” Salama said, including epidemiological research to assess how many people are at risk, surveillance, logistics, communications, local engagement and bringing in supplies.
So far, testing at the country’s National Biomedical Research Institute in Kinshasa has proven that one of five samples is positive for the Zaire species of the Ebola virus, the same strain responsible for the 2014-15 Ebola epidemic in West Africa. The outbreak was the largest in history, affecting at least 28,600 people in 10 countries, with more than 11,300 people dying after they contracted the disease, according to the CDC.
Already, WHO has started working on its logistics plan to help deal with the emergency head on.
“The first teams of epidemiologists, biologists and experts in the areas of social mobilization, risk communication and community engagement, [as well as] personnel specializing in water, hygiene and sanitation, are scheduled to reach the affected area today or tomorrow,” Dr. Yokouidé Allarangar, WHO representative in the DRC, said in a separate statement.
Although the DRC health district is in a remote area, such fast action is necessary for contact tracing, an essential action to contain the outbreak, Allarangar said.
“We have to support our colleagues internationally through WHO and help them increase the capacity of other countries to detect and respond rapidly to threats that can spread quickly,” Duchin said.
In the United States, which currently isn’t experiencing an Ebola threat, rapid detection and response is likewise needed at ports-of-entry and other cities where people are arriving from countries where they may have contracted diseases like Ebola, he added.
“Federal funding is a critical part to maintain national public health security and to ensure lead organizations like the CDC remain strong,” Duchin said.
Experimental vaccine exists
For the first time, an experimental Ebola vaccine exists that may be used if it’s needed to help contain the outbreak in the DRC.
The vaccine was designed at Canada’s National Microbiology Laboratory and initially was tested during the West African Ebola outbreak. Pharmaceutical giant Merck is developing the vaccine and work is ongoing to get it licensed.
In the meantime, Gavi, a public-private partnership that makes vaccines available to lower-income countries, has an agreement with Merck to stockpile the vaccine.
“Gavi’s work with Merck means there are 300,000 doses of Ebola vaccine available if needed to stop this outbreak from becoming a pandemic,” Gavi CEO Dr. Seth Berkley said Friday.
A WHO spokesman said if needed, the vaccine would be used in a ring vaccination strategy in which anyone who has had contact with a confirmed Ebola case would be vaccinated—in essence, creating a ring of protected people to limit transmission of the virus.
The current suspected Ebola cases in the DRC have some wondering if perhaps the virus was lying latent and has now reemerged as a “flare,” a term WHO uses to describe small clusters of cases that ignite from Ebola survivors.
The Ebola virus can remain in certain body fluids—including semen, fluids in the eye and fluids found around the brain and spine—of people who have recovered from Ebola, the CDC says. And it’s also possible for Ebola to spread through sex or other contact with the semen of a man who has recovered from Ebola, according to the CDC.
While “it’s theoretically possible” that the DRC cases could be flares, Duchin said only time will tell if that’s actually true; it also depends on if the cases can be traced backwards. The longer the interval of time between outbreaks, he said, the less likely the cases could be flares or a smoldering transmission. “But that’s only speculation,” he added.