If the recent figures are an accurate assessment of the Ebola virus outbreak in the eastern DRC, then it may be that an end to the second deadliest outbreak of EVD is within sight. Data released by the DRC health authorities through the WHO indicate that in the week ending 13th of October only 15 cases were recorded. This is in stark contrast to the week ending 28th of April, where 126 new cases were reported.

However, the WHO reports that in spite of this case number decline, new cases are being seen in extremely rural areas, as opposed to the urban areas in and around the city of Beni. When EVD occurs in harder to reach areas, the outbreak response teams have more of a challenge in attending patients and communities in need. The ongoing civil unrest in the area, which is more pronounced in the rural areas, further complicates the response. This is coupled with an awareness that citizens in affected areas still retain a deep distrust of many aspects of the response to EVD, including preventative vaccination (as published in The Lancet in May of this year and reviewed here on the RAN News section: Ebola Virus in the Democratic Republic of the Congo, July 15).

This EVD outbreak has seen the large-scale use of the first effective vaccine against Ebola virus. By the end of September, over 223,000 people had received the rVSV-ZEBOV-GP immunisation (manufactured by Merck). Preliminary results collated by the WHO in early April showed that the vaccine was 97.5% effective, and of over 68,000 ring-vaccinated individuals at the time of that study, only two of their contacts went on to report EVD. In the few vaccinated individuals who developed EVD (71), there was a 100% recovery rate (15/15) if disease occurred more than ten days post-vaccination. 

Protection against disease was lower when infection occurred less than nine days after vaccination, where nine individuals out of 56 cases died. Recently, it has been announced that another vaccine, the Adenovirus 26 vectored glycoprotein / MVA-BN (Ad26.ZEBOV/MVA-BN) manufactured by Johnson & Johnson will be given to individuals initially in the city of Goma. 

These citizens will be in ‘at-risk’ groups, but not populations where there is currently circulating virus. This regimen involves two inoculations, compared to Merck’s one, which are given 56 days apart. Half a million doses are set to arrive in the country within the next week with hopes that these will complement the ongoing use of the ring vaccination strategy using Merck’s vaccine, though the logistics of ensuring individuals receive a second vaccine dose 2 months later will be a significant challenge.

With these preventative vaccines and the efforts of many international, domestic and local aid organisations and health care workers, the rate of new infections in this outbreak appears to be declining. However, despite highly effective vaccines and several community engagement programs, community mistrust is still prevalent, especially in the remote areas where current cases are being seen. To ensure full containment of this, and future EVD outbreaks, continued attention needs to be paid to respectful community engagement, for a vaccine is only useful if it is accepted by the community in need.