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Ebola outbreak 2018: What's different this time?



Although it is still too early to determine what the outcome of this outburst could be and how far it could spread, there is one aspect many experts agree with: the world seems to be more prepared than ever, this outbreak

The outbreak, which began in Guinea and spread to Sierra Leone and Liberia, saw more deaths and cases than any other Ebola epidemic, according to the World Health Organization.
During this outbreak, a total of 28,616 cases of Ebola virus disease and 11,310 deaths were reported in Guinea, Liberia and Sierra Leone – as well as another 36 cases and 15 deaths that occurred when the outbreak broke out outside these three developing countries, according to the CDC.
Then "there were many criticisms of the WHO response," Schuchat said. But now WHO Director-General dr. Tedros Adhanom Ghebreyesus has already visited the affected areas.

"The political level at the national, regional and global levels is determined to support this," Schuchat said WHO's response this year.

  Fear and Failure: How Ebola Has Triggered a Global Health Revolution

[19659005] In addition, "Democratic Republic of Congo has had Ebola epidemics before." This is the ninth. This is serious, since it is not only in a rural area, but has reached an urban area, but there is more familiarity with the disease and syndrome than there was in West Africa, "Schuchat said. Even at the outbreak in 2014-2016, research was just beginning to test Ebola vaccines and drug candidates in humans.

"We now have very good experience with one of the vaccines tested in the ring vaccine trial in Guinea and have also been tested in large studies in Sierra Leone and Liberia and appear to be very effective and very safe," she said. "We do not have any approved vaccines or medicines yet, but we have promising vaccine and drug candidates."

"We now have tools"

Authorities are distributing the experimental Ebola vaccine rVSV-ZEBOV in Mbandaka, a city of nearly 1.2 million people in the northwestern Congo province of Equateur.

In the outbreak of 2014/16, researchers were at a very early stage in the development of potential vaccines, and testing started only in the last days of the outbreak.

Between 2015 and 2016, the rVSV-ZEBOV vaccine was administered to people in Guinea who had contact with patients who had recently confirmed cases of Ebola virus disease, according to a study in the journal The Lancet
  A Health Worker prepares an Ebola vaccine to be administered to medical staff during treatment Vaccination campaign in Mbandaka, Congo

"The rVSV Vaccine […] was used in the ring vaccine program used in Guinea, "said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases in the US, who oversees a comprehensive research portfolio of studies on the Ebola virus.

"Ri In a vaccine you identify someone who has Ebola and you identify the contacts of that person and the contacts of the contacts, and you vaccinate them with the rVSV vaccine." This is the main difference between the beginning of the outbreak in West Africa and what we see now, "said Fauci.

"We did not have any tools back then, and when we got the vaccine ready for testing, most of them were burned out," he said. "We now have tools."

There are five known Ebola Viruses, named for the regions from which they originate, and three are responsible for major outbreaks in Africa: Zaire ebolavirus, Bundibugyo Ebola virus and Sudan ebolavirus The rVSV-ZEBOV vaccine from the pharmaceutical company Merck covers the strains of the Zaire group

The doses sent by Merck to WHO to help the current outbreak, said spokeswoman Pam Eisele Tuesday, that the company plans plans for approval of the vaccine next year.

  Experimental Ebola Vaccine Could

"We can now give this vaccine to people living on the Most people are at risk of getting Ebola, such as health care workers who treat Ebola patients, and contacts from Ebola cases, the hope is that this would involve the spread of the virus, the crucial difference in this recent outbreak is that the vaccine will be used in the early stages of the epidemic, "said Connor Bamford, Postdoc Assistant at the Medical Research Council of the University of Glasgow's Center for Viral Research in Scotland. [19659005] On the other hand, "vaccines are not as effective in curing a disease if you are already infected," he said. "There are no such licensed antiviral drugs for Ebola, but there are experimental drugs."

The experimental drugs that give hope

Experimental Ebola drugs – including ZMapp, favipiravir and GS-5734 – are available to the Ministry of Health of the Congo to gain access, if necessary, to treat patients in the current outbreak.

In 2014, ZMapp was used to treat two American mission workers. Kent Brantly and Nancy Writebol, who got Ebola in Liberia. Previously, the experimental drug had been tested only in monkeys.
That year, Teresa Romero Ramos, a nurse who contracted the virus while treating Ebola patients in Spain, was treated with an infusion of antibodies from an Ebola survivor and favipiravir
Reported in a case in which a newborn from his mother got an Ebola virus infection, the baby was treated with both ZMapp and GS-5734 and survived surviving a congenital infection with Ebola virus ,
GS-5734 "is a drug with which we have experience because we have a protocol that we implemented in West Africa, where we tried to suppress or eliminate the remaining Ebola virus in the semen of the survivors, said Fauci Protocol is still used in West Africa.
He added that another drug was being developed at the Vaccine Research Center of the National Institutes of Health: mAb114, which is in a Phase 1 study.

"The Minister of Health The Democratic Republic of the Congo has requested access to this antibody, "Fauci said." We are ready to provide mAb114 for them, and we are working with the health authorities in the Democratic Republic of the Congo and in coordination with the WHO to determine whether this is feasible. "

Bamford pointed out that these experimental drugs are giving hope not only to control the current outbreak, but to future outbreaks.

"We should strive to get antiviral drugs for Ebola, not just to save lives, but also to help communities who consider Ebola incurable to help their infection to authorities," he said. "Antiviral drugs give hope to the infected, and maybe ZMapp, favipiravir and GS-5734 are these drugs, but we do not know yet."

Although many of these drugs were used at the 2014-2016 outbreak and were promising, there are still questions about their clear effectiveness in reducing symptoms or likelihood of death Bruce Ribner, a professor at the Emory School of Medicine, who led the university's team in treating Ebola patients in 2014. He was named Time Person of the Year among the five listed Ebola doctors.

"The only clear difference I see between this outbreak and the 2014-2016 outbreak is the more robust response to this outbreak, which lacked the early introduction of vaccines, therapeutics, and external health advisors in early 2014," said Ribner. "We are also a little luckier, because the Congo has lived with Ebola."

"Every new outbreak teaches us a new lesson"

Ebola is endemic to Congo, and this is the ninth outbreak of Ebola virus disease since the discovery of the virus near the country's Ebola River ,

"So they are experienced in dealing with an Ebola outbreak," said Fauci.

Compared to the 2014/16 outbreak, "that's a huge difference, because in West Africa – in Sierra Leone, Liberia and Guinea – it was the first time they had experienced Ebola.

Many experts – including Dr. Susan Kline, an Associate Professor of Medicine at the University of Minnesota Medical School – I hope the lessons from the Ebola outbreak in 2014-16 will not be forgotten.

"In the last outburst you probably felt in retrospect The local, national, international response to The outbreak was not as fast and as widespread as needed. We have been working to prevent the outbreak from becoming so big, "said Kline, a member of the Society of Infectious Diseases at the US Department of Health [19659010] "I think people have learned from this experience that in order to control an outbreak, you have to work really fast, not just about Ebola Identify and isolate treatment centers, but also to do publicity work to identify contacts, "she said.

  An ambulance carries the mortal remains of an Ebola victim to a burial ground in Mbandaka, DRC.

In response to the Congo outbreak, the US has deployed a number of Ebola experts from the CDC to help with control efforts such as screening and tracing Ebola cases, Schuchat said , [19659014] She added that the CDC has an office in Congo where workers have postponed their tasks to support the outbreak. Other organizations are also leaders in clinical care and outbreak control, including Medecins Sans Frontières (MSF), UNICEF and USAID.

All in all, "We know that we have the tools to fight outbreaks now and in the future, we know we can not be complacent," Bamford said.

"We still do not know everything there is to know about the Ebola virus and every new outbreak teaches us a new lesson, such as the virus's ability to slumber in some rare patients, where it flares up years later could. "he said. "With Ebola we have to expect the unexpected."

CNN's Natalie Gallon, Euan McKirdy, Al Goodman and Susan Scutti contributed to this report.


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