The Democratic Republic of the Congo (DRC) is battling an outbreak of the Bundibugyo strain of Ebola, with 1,792 confirmed cases and 625 deaths as of July 9. No vaccine or approved treatment exists for this strain.
Just six weeks after the World Health Organization (WHO) declared the outbreak a public health emergency of international concern on May 17, the first patients have been enrolled in a treatment trial—a record pace, scientists say.
In Bunia, the capital of Ituri province where the virus is raging, residents are growing impatient. “I hope these drug trials proceed quickly,” said Neema Haba, a mother of three and banana seller. “Financially, we are being driven to the brink by this outbreak and nothing is going right.”
The outbreak is still in its “expansion phase,” according to the WHO. Response efforts rely on case identification, isolation, and contact tracing. About 75% of known contacts are being traced, but low trust in authorities and a highly mobile population are hampering progress. Some frontline workers stopped work this week to protest unpaid wages.
Ovide Maliabo, a driver for a burial team in Rwampara, a mining town in Ituri, said the work is dangerous due to community mistrust. “At one point, we narrowly escaped being lynched,” he said. Team leader Bahati John said he lost a tooth after being attacked by locals. DRC officials claim payments have been made, but it is unclear if activities have fully resumed. The closure of Bunia’s airport is hampering the response, including the supply of banknotes.
Hopes now rest on the Partners treatment trial, which has opened with two drugs: remdesivir (an antiviral by Gilead Sciences) and MBP134 (a monoclonal antibody by Mapp Biopharmaceutical). Patients will be randomly assigned to receive one drug, a combination, or standard supportive care. Both drugs have shown efficacy against the Bundibugyo virus in animal models.
“They showed great efficacy, but now we need to test it in humans,” said Prof. Laurens Liesenborghs of the Institute of Tropical Medicine, Antwerp. The Bundibugyo strain kills about one in three of those infected. The trial aims to enroll 700–1,000 patients, with results expected in months. The WHO said enough remdesivir and MBP134 have been donated for 1,200 patients.
Patients of any age, including pregnant and breastfeeding women, can enroll. “We always think of risk-benefit. Here the benefit is potentially very high,” Liesenborghs said. Prof. Amanda Rojek of the University of Oxford, international principal investigator for Partners, praised the rapid start: “If we look back at west Africa [2014-16 outbreak], where it took over a year to start clinical trials, we’re very proud.” The trial is sponsored by the WHO and funded by Wellcome Trust, FCDO, and UKRI.
Prof. Yap Boum, head of emergency response at Africa CDC, warned the danger is not over but said the trials “will enable us to access treatment.” Another trial is due to begin this week, testing whether obeldesivir can prevent disease in people exposed to the virus. Africa CDC said it needs about $18 million for that trial, with $6 million committed so far.
Source: www.theguardian.com