快猫短视频

THE Ebola outbreak in the Democratic Republic of the Congo (DRC) has reached a critical juncture. It seems to be subsiding, after striking 121 people and killing 81 as of 2 September. But the coming days may be crucial, says Tedros Ghebreyesus, head of the World Health Organization (WHO).

That is partly because the outbreak is in North Kivu province in the war-torn east of the DRC, where fighting by more than 50 armed groups puts many areas off limits.

To stop the virus spreading, medical teams must isolate and vaccinate anyone who has had contact with an infected person, and all the people they in turn came into contact with. But the teams can鈥檛 work much more than 30 kilometres from the epidemic鈥檚 centre in the city of Beni.

Worse, the UN鈥檚 International Organisation for Migration (IOM) has found that people in the region are highly mobile, with traders and miners transiting to Uganda and Rwanda, and a million people have been displaced by violence.

Such high population mobility, plus a slow medical response, caused an Ebola outbreak in West Africa to mushroom into an unprecedented epidemic that killed more than 11,000 in 2014.

This time, the response has not been slow. The outbreak was recognised on 1 August, only a week after an Ebola epidemic on the other side of the DRC had been halted. A week later, teams in North Kivu were vaccinating.

This selective 鈥渞ing vaccination鈥� of the contacts of known cases, then their contacts, makes best use of limited vaccine stocks by containing virus spreading from known cases. It seems to be working: on 1 September, with 5462 contacts vaccinated, the WHO reported 13 new cases the previous week, down from 25 and 35 in the weeks before that.

If that continues, the 300,000 doses of vaccine available worldwide should be more than enough to contain this epidemic. But epidemics can hit tipping points and soar exponentially. Stopping that requires stopping all the chains of transmission, says Mike Ryan, head of emergency response at the WHO.

鈥淓bola comes in waves: the next surge could still be incubating, or invisible in violent no-go areas鈥�

Moreover, Ebola epidemics come in waves: the next surge could be incubating, or invisible in violent no-go areas. Worryingly, four of the new cases reported last week were not from known chains of transmission, so there are unknown chains out there.

They may be hard to find. The IOM has used its data to choose the 34 most important transport hubs where people leave the region, and Congolese authorities have so far checked 840,000 travellers there for symptoms.

It has also mapped highly vulnerable spots, such as popular markets and churches with strong connections to the outbreak zone, for closer monitoring.

But the IOM is only able to monitor relatively safe zones. 鈥淭he news of two confirmed cases in Oicha is extremely distressing, because the area is almost entirely surrounded by armed militants,鈥� says Michelle Gayer of the US-based International Rescue Committee.

Last week, a medical team with a heavy UN military escort vaccinated 97 contacts of the two infected people in Oicha, discovered only because one travelled to Beni. Anyone in the area around Oicha cannot be reached.

The WHO also last week decided to test three antiviral drugs in randomly chosen patients. No one will get a placebo, so the trials can鈥檛 establish formally how much better the drugs are than getting no drug. But they can compare the three.

Two people have received ZMapp, a cocktail of antibodies, the immune proteins that attack the Ebola virus. It showed promise in 2014, but is hard to administer and must be stored at -80掳C, which is difficult in the DRC. Five have had remdesivir, a molecule that blocks the infection process.

The big surprise is that 13 have been given mAb114, an antibody from a survivor of the 1995 Ebola epidemic in Kikwit, DRC, which can be kept in a refrigerator and needs only one simple injection.

Last year, a WHO panel judged it too untested to use in epidemics, but the US National Institutes of Health has since rushed through safety trials in humans. Two people on it have recovered, says the WHO, but it is not yet known if the drug helped.

This article appeared in print under the headline 鈥淐runch time for Ebola in the DRC鈥�