Update on the Outbreak of Ebola Virus Disease in the Democratic Republic of the Congo

On May 8, 2018 The World Health Organisation (WHO) announced that the Democratic Republic of the Congo (DRC) had declared a new outbreak of Ebola virus disease (EVD). This is the ninth EVD outbreak in the DRC since the virus was first discovered in 1976.  Although the risk of international spread remains low, developments in this particular outbreak, including identification of a confirmed case in Mbandaka, a large urban centre of the DRC, has increased of risk for spread. Mbandaka’s location near major national and international rivers, roads and international air routes has increased the risk for spread both within the DRC and internationally, prompting the World Health Organisation (WHO) to assess the public health risk as very high at the national level in the DRC and high at the regional level (i.e. DRC and neighbouring countries).

The Government of Canada is closely monitoring the outbreak, and is continually assessing the risks, while providing advice on personal protective measures to Canadians travelling and working in the DRC. At the same time, the Canadian authorities are engaging with international partners to monitor the evolving situation and containment operations, which are being coordinated by the Ministry of Health in the DRC, supported by UN agencies and other international responders.

Learn more about Ebola, its causes, symptoms, risks, treatment, prevention and surveillance. Also find health professional guidance, and awareness resources.

Causes

Ebola Virus Disease (EVD), is a rare but severe viral disease (case fatality in humans ranges from 25-90%). Although the natural reservoir for the virus is in animals, humans can become infected through contact with the blood, organs, bodily fluids, or other secretions of infected animals.  Once introduced into human populations, EVD primarily spreads from person-to-person through close contact with the bodily fluids/secretions of infected human cases. Transmission is not known to occur through casual contact or the airborne route. 

Vaccination

Vaccination is one of several infection prevention and control mechanisms being used in this Ebola outbreak.  An EVD vaccine called rVSV-ZEBOV, which was developed by researchers at the Public Health Agency of Canada's National Microbiology Laboratory (NML), is being implemented as part of the public health response to this outbreak.

Based on rVSV-ZEBOV vaccination trials conducted in Guinea in 2015, the vaccine was shown to be well tolerated and highly protective against Ebola virus infection in humans.  When administered, it induces an immune response against the Ebola virus without the vaccine needing to contain any live Ebola virus components. Hence, there is no risk of contracting EVD from the vaccine.

Although the rVSV-ZEBOV vaccine has yet to be licensed by regulatory authorities, studies indicate that the vaccine is highly effective in preventing Ebola infection when used before and immediately after exposure to the Ebola virus.  In 2017, the WHO Strategic Expert Advisory Group on Immunization (SAGE) recommended that, in the case of an Ebola outbreak, the rVSV-ZEBOV vaccine should be rapidly deployed and offered with informed consent and in compliance with good clinical practice.

On May 21, 2018, the Government of the DRC, with the support of WHO, Médecins Sans Frontières (MSF) and other international partners initiated a ring vaccination campaign using the rVSV-ZEBOV vaccine to control spread of disease in high risk areas. A ring vaccination program offers vaccines to all contacts of confirmed cases as well as the contacts of those contacts, creating a broad ring of containment around each confirmed case.  To date, approximately 8,000 doses of rVSV-ZEBOV vaccine have been sent to the DRC to contain and help stop the current Ebola outbreak. WHO has indicated that further doses will be available for deployment.

Ring vaccination strategies help target the vaccine to those at highest risk of infection in the high-risk zones where laboratory confirmed cases and chains of transmission have been identified through enhanced surveillance activities.  Accordingly, the use of the vaccine has been initially focused on the three DRC locations where lab confirmed cases have been found to date.  Contacts are defined as individuals who, within the prior 21 days, have lived with, visited (or were visited by) a patient before or after he/she developed symptoms, and/or were in close physical contact with the patient's body, bodily fluids, linen or clothes.  The vaccination ring zone is not a geographic area; but rather the ring of social networking (home, work, school) contacts with that patient during or after their illness or death.

In addition to ring vaccination, vaccination is also being made available, on a voluntary basis, to certain health care and other responders who are at high risk of exposure to the virus. Persons considered for the vaccine include: 1) contact of a confirmed EVD patient (dead or alive); 2) frontline or healthcare workers in an affected region (health zone); and, 3) frontline or healthcare worker in areas at immediate risk of the spread of the outbreak. Currently, the vaccine is not recommended for children under age 6 or pregnant or lactating women. Likewise, due to limited vaccine availability and the low risk that can be managed with personal protective measures, the vaccine is not available or recommended for travellers or other Canadians living or working in the DRC.

Figure 1
Map - Text description

This is a map showing the number of Ebola Virus Disease cases in affected health zones in Equateur Province, Democratic Republic of Congo, "as reported by the World Health Organization on June 5, 2018." Overall, there are a total of 56 cases, with 25 cases including 5 deaths in the Iboko health zone; 26 cases including 17 deaths in the Bikoro health zone; and 5 cases including 3 deaths in the Wangata health zone

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