Ebola Virus Developments

 Developments in Ebola Virus Disease Control 

Controlling Ebola virus disease in the Democratic Republic of Congo (DRC) is extraordinarily difficult, but a recent development in terms of antiviral treatment could be useful.

The outbreak of the Ebola virus disease was first identified last August in the provinces of North Kivu and Ituri. It then spread to Goma, a city of more than one million inhabitants, and recently to the province of South Kivu. Since the beginning of the epidemic and as of September 8, 2019, the cumulative number of cases is 3,081, of which 2,970 are confirmed, 111 are likely and 403 are suspected. A total of 2,064 people died and 922 people recovered. The fatality rate is 69% (1). With more than one million displaced people living in the region and bordering Uganda, South Sudan, and Rwanda, there are fears of local and international spread of the disease among this socially unstable population.

Treatment centers have been established and surveillance has been organized, including case finding through contact identification, follow-up, and ring vaccination (i.e. contact and contact). The rVSV-ZEBOV-GP vaccine, which is effective on a limited scale in the context of the Ebola virus disease outbreak in West Africa, is used in the current outbreak in the DRC (2,3). Despite the implementation of these measures, and for many reasons, the epidemic has so far not been brought under control. The main obstacle is the mistrust of the local population regarding the effectiveness of the efforts made by the DRC and foreign health care workers, as well as the effectiveness of the health centers where they work, and the doubt that Ebola virus disease exists. This environment is complicated by the presence of numerous armed rebel groups that have attacked Ebola treatment centers and field personnel.

The very recent development of effective treatment could help foster desperately needed confidence. On November 20, 2018, a randomized controlled trial began in the DRC, involving four experimental agents for the treatment of patients with Ebola virus disease. The study included two previously used drugs, Zmapp and remdesivir, and two newer agents, monoclonal antibodies mAb114 and REGN-EB3. As of August 9, 2019, the trial had included 681 of the 725 patients needed to reach their target inclusion numbers in four Ebola Virus Disease (ETC) treatment centers located in areas of high disease burden. The study was supervised by a staff of the National Institute for Biomedical Research (INRB), the DRC Ministry of Health, and three medical humanitarian associations: Alliance for International Medical Action (ALIMA), International Medical Corps (IMC), and Medicines Sans Frontiers (MSF).

Preliminary results from 499 study participants indicated that individuals receiving REGN-EB3 or mAb114 had an overall mortality of 29% and 34%, respectively, and that early treatment in the early stages of the disease offered about a 90% chance of survival. In comparison, the mortality rate was 49% and 53% for participants in the other two arms. The independent monitoring committee overseeing the trial recommended its premature discontinuation due to the superior efficacy of newer drugs (4,5).

It is hoped that these cocktails of monoclonal antibodies will demonstrate that treatment centers can save lives and build confidence in the centers and their staff so that infected individuals can get there early. This will not solve all the problems impeding the control of the epidemic, but it will have a beneficial effect. Treatment with these monoclonal drugs will also prove effective if infected people travel to major urban centers such as Kinshasa or internationally.