Ebola Outbreak in the Democratic Republic of the Congo Shines Light on Global Challenges
Last Week the WHO Declared the Epidemic a Public-Health Emergency of International Concern
Baltimore, MD, USA, July 24, 2019: Last week, the World Health Organization (WHO) declared the current Ebola outbreak in the Democratic Republic of the Congo (DRC) a public-health emergency of international concern (PHEIC), signaling a risk to multiple countries that requires a coordinated international response. Worse than the previous nine Ebola outbreaks in the DRC combined, more than 2,500 people are listed as confirmed or probable cases and at least 1,700 have died. This is only the fifth PHEIC declared following similar alarms for the H1N1 influenza pandemic (2009), a major outbreak of wild polio (2014), the West African Ebola epidemic (2013-16) and the Zika epidemic (2015-16). Each of these public health emergencies have highlighted weaknesses in our response systems, exposing the urgent need for improved infrastructure, scientific knowledge, and diagnostic technologies in areas most at risk.
“The Global Virus Network and all the scientists collaborating with the network will strongly support efforts of WHO following up on the PHEIC declaration for the current Kivu Ebola epidemic” said Prof. Christian Bréchot, MD, PhD, president of the Global Virus Network (GVN), professor at the University of South Florida and executive director of the Romark Company Institute for Medical Research.
The declaration of the PHEIC was triggered when a case of Ebola was diagnosed in Goma, the capital of North Kivu province in the eastern Democratic Republic of the Congo, with greater than 1 million people that directly borders Rwanda and has an international airport. Previously, two children and their grandmother carried the virus into Uganda, while all three died. Uganda, where no more Ebola cases have occurred, is the site of a GVN center and has a strong track record of controlling Ebola.
Prof. Pontiano Kaleebu, PhD, MB ChB, director of the Uganda Virus Research Institute (UVRI), director, Center of Excellence, GVN and director of the Medical Research Council/ Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit said, “Uganda has a strong surveillance network and fortunately has been able to limit this Ebola outbreak as well as outbreaks over the past decade to only a few cases.”
The current outbreak was declared in August 2018, but the Ebola virus was likely already spreading in eastern DRC for many months. Bringing the outbreak under control has proven to be challenging. While more than 70 million people are controlled and more than 160,000 vaccines have been administered, the outbreak continues The eastern provinces of North Kivu and Ituri border Rwanda and Uganda, and are active conflict zones where there have been over 70 attacks on Ebola clinics or health workers since January. There are many new confirmed cases that are unable to be traced to an existing Ebola contact. Therefore, it is likely that there are many deaths that have occurred that have gone unrecorded.
Despite the security challenges of the current epidemic, research on four therapies for Ebola is ongoing. This proves that research on cures and prevention of Ebola can, and should, occur under even the most dire outbreak conditions.
“The 2014-2015 Ebola outbreak drove an impressive advancement of knowledge,” said Prof. Giuseppe Ippolito, MD, MSc (HCMO), FRCPE, the scientific director of the National Institute for Infectious Diseases (INMI) “Lazzaro Spallanzani” in Rome, director, Center of Excellence, Global Virus Network and director of the World Health Organization (WHO) Collaborating Center for clinical care, diagnosis, response and training on Highly Infectious Diseases at INMI. “Preparedness and response must now be driven by scientific results and available evidence, involving more international and national public health institutions to alleviate the burden for humanitarian NGOs that so far stand alone. Investing in the training of a new generation of experts in virology and clinical epidemiology is critical to addressing emerging infections.”
The current Ebola outbreak in Congo has not yet achieved the magnitude of the West African epidemic. The West African Ebola epidemic, which infected at least 28,000 people and killed over 11,000, is again in the news this week with the release of a new book, Crisis in the Red Zone, a sequel to The Hot Zone by Richard Preston. The Hot Zone, published twenty-five years ago, documented events in which monkeys at a primate holding facility in Reston Virginia, only 20 miles from the center of Washington DC, developed a fatal illness. As the disease caused by Reston virus, a close relative of the Ebola virus, spread through the monkeys at the facility, the help of scientists at the nearby United States Army Medical Research Institute for Infectious Diseases (USAMRIID) at Fort Detrick Maryland was enlisted.
This time Preston puts much more focus on African healthcare workers and scientists. Crisis in the Red Zone describes the early events of the Ebola outbreak as the virus spread from Guinea to the Kenema Government Hospital where Dr. Sheik Humarr Khan and his team attempted to manage the influx of Ebola cases. Doctors and nurses such as Dr. Khan, head nurse and midwife Mbalu Fonnie, and nurses Alex Moigboi, Alice Kovoma and Nancy Yoko, who paid the ultimate price, are fittingly portrayed as heroes. Kenema Government Hospital has been closely affiliated with the Tulane University GVN Center of Excellence for nearly 15 years, working on Lassa fever, a disease that has many similarities to Ebola.
Prof. Robert F. Garry, Jr., PhD, professor of microbiology and immunology, Tulane University and director, Center of Excellence, GVN., commented that, “Crisis in the Red Zone provides a detailed accounting of the challenges my Sierra Leonean colleagues faced in the early days of the West African Ebola outbreak, while they awaited needed assistance from the international community. Unfortunately, some believed that the outbreak in Sierra Leone would burn out in a few weeks delaying a full scale intervention by the United States, WHO and others. New approaches to outbreak responses based on local preparedness, like those lead by GVN, are urgently needed.”
The current Ebola outbreak in the eastern DRC and the West African Ebola outbreak are but two examples of inadequate approaches to disease outbreaks that rely on an influx of foreign responders and have repeatedly been delayed and under-resourced. GVN is founded on the principle that preparedness for emerging viral diseases will necessitate deeply rooted collaborative research between local and global partners, and transformation of diagnostic tools and regional surveillance networks.
“The world is still vulnerable and under-prepared,” said Prof. Robert C. Gallo, MD, The Homer & Martha Gudelsky Distinguished Professor in Medicine, co-founder and director, Institute of Human Virology, University of Maryland School of Medicine and co-founder and international scientific advisor, Global Virus Network. “There is an urgent, unmet need for new proactive measures that are locally established, community-based and rooted in symmetrical partnerships to address the challenges that viruses, including those that are as yet unknown, pose to global health and security.”
GVN represents 48 Centers of Excellence and 7 affiliates in 29 countries and comprises foremost experts in every class of virus causing disease in humans. It is a global authority and resource for the identification and investigation, interpretation and explanation, control and suppression, of viral diseases posing threats to mankind. It enhances the international capacity for reactive, proactive and interactive activities that address mankind-threatening viruses and addresses a global need for coordinated virology training through scholarly exchange programs for recruiting and training young scientists in medical virology. The GVN also serves as a resource to governments and international organizations seeking advice about viral disease threats, prevention or response strategies, and GVN advocates for research and training on virus infections and their many disease manifestations.
About the Global Virus Network (GVN)
The Global Virus Network (GVN) is essential and critical in the preparedness, defense and first research response to emerging, exiting and unidentified viruses that pose a clear and present threat to public health, working in close coordination with established national and international institutions. It is a coalition comprised of eminent human and animal virologists from 48 Centers of Excellence and seven Affiliates in 29 countries worldwide, working collaboratively to train the next generation, advance knowledge about how to identify and diagnose pandemic viruses, mitigate and control how such viruses spread and make us sick, as well as develop drugs, vaccines and treatments to combat them. No single institution in the world has expertise in all viral areas other than the GVN, which brings together the finest medical virologists to leverage their individual expertise and coalesce global teams of specialists on the scientific challenges, issues and problems posed by pandemic viruses. The GVN is a non-profit 501(c)(3) organization. For more information, please visit www.gvn.org. Follow us on Twitter @GlobalVirusNews
Nora Samaranayake, GVN
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