The World Health Organization is set to deploy over 100 experts to Guinea – to respond to a widening circle of Ebola virus cases in a country that was also at the epicenter of the historic 2013-2016 West African Ebola outbreak, officials said at twin press events in Brazzaville and Geneva on Thursday.     

As critical new vaccines are being rushed to the region, there is a growing concern about transmission abroad, said Health Emergencies Executive Director Mike Ryan at a WHO press conference in Geneva.  He noted that Guinea’s initial cluster of cases has occurred in proximity to Nzérékoré, the country’s second-largest city, at the crossroads of routes to Liberia, Côte d’Ivoire, and elsewhere. 

“Remember that these governments are currently responding to COVID-19 outbreaks in their own countries, while having to either respond to Ebola, or prepare for the potential arrival of Ebola,” said Ryan. 

WHO African Region Sounding Alarm 

Speaking at another press briefing in Brazzaville, WHO’s African Regional Director sounded an even greater note of alarm.  

“It’s a huge concern to see the resurgence of Ebola in Guinea, a country which has already suffered so much from the disease,” said Dr Matshidiso Moeti, WHO Regional Director for Africa at the briefing.

However, banking on the expertise and experience built during the previous outbreak, health teams in Guinea are on the move to quickly trace the path of the virus and curb further infections,” she added, saying that “WHO is supporting the authorities to set up testing, contact-tracing and treatment structures and to bring the overall response to full speed.”

WHO staff are already on the ground at Guinea, providing surveillance as well as ramping up infection, prevention, and control of health facilities. A humanitarian flight arrived on 15 February in N’Zerekore with 700 kg of medical equipment donated by WHO and partners. 

The country is also grappling with a surge of COVID-19 cases. On Feb 14 when the new Ebola outbreak in Guinea was announced, the country had also reported 72 new cases of COVID-19.  As of Thursdsay, the cumulative number of confirmed COVID-19 cases in Guinea had risen to 15,088 with a total of 85 deaths.

Using the glass half full or empty analogy, Moeti noted that Guinean response to COVID-19 and Ebola at the same time could be mutually reinforcing – building on already established guidelines and good practices, particularly around coordination, engaging with communities and leadership. 

“That also comes from preventive measures like physical distancing for COVID-19 and ‘don’t touch’ messages for Ebola, as well as the importance of hand hygiene for both,” she said. 

Rapid Ebola Vaccines Rollout – The Keys To Fast Containment 

But like with COVID-19, vaccination will provide an even more durable response. A consignment of more than 11,000 doses of Ebola vaccine was expected to arrive in Guinea this weekend. In addition, more than 8,500 doses are being shipped from the United States for a total of 20,000 doses. Vaccination is set to kick off soon after they arrive. 

Some 4,000 kilometers away, another Ebola accination drive was just launched in the city of Butembo, Democratic Republic of Congo, on 15 February – shortly after another Ebola virus outbreak was detected in there on 7 February involving four cases and two deaths so far, according to WHO’s African Regional Office. 

But unlike Guinea, DR Congo did not have to wait for Ebola vaccines from Geneva or the US as it had 8,000 doses remaining from an Ebola outbreak last year, and thus was immediately able to commence immunizations.  

“So far nearly 70 people have been vaccinated against Ebola.  The quick roll-out of vaccines is a testament to the enormous local capacity built in the previous outbreaks by the government, WHO and partners,” Moeti said.

As a new and powerful Ebola control tool in both the Guinea and DR Congo response, WHO is simultaneously trying to step up procurement and rollout of a recently-approved Ebola vaccine through a new global vaccine stockpile. The vaccine was instrumental in finally stamping out a much larger 2018-2019 Ebola outbreak in the eastern part of the Democratic Republic of Congo. 

The single-dose Ebola vaccine (rVSV∆G-ZEBOV-GP, live), manufactured by Merck, Sharp & Dohme (MSD), received emergency regulatory approval from the US Food and Drug Administration in 2019. In addition, Johnson & Johnson also received European Medicines Agency approval last year for its Ebola vaccine, a two-dose regimen of Zabdeno® (Ad26.ZEBOV) and Mvabea® (MVA-BN-Filo).

“The ultimate endpoint for this is a multi-valent vaccine capable of protecting against multiple Ebola strains,” said Ryan at the briefing.  The precise Ebola virus strain responsible for the Guinea outbreak has not yet been determined.   

The WHO, UNICEF, International Federation of Red Cross and Red Crescent Societies (IFRC) and Médecins Sans Frontières (MSF) announced in January the establishment of a global Ebola vaccine stockpile to ensure rapid response to future outbreaks. 

In his remarks in Geneva, Ryan lauded both Merck and Johnson & Johnson for pushing ahead with the R&D on the vaccines – as well as seeing to their production at cost. 

“These measures have been implemented to protect vulnerable populations,” said Ryan, adding that people at risk include “not just healthcare workers, but “occupational workers, charcoal workers, and people who work in the rainforest” – groups that might also have contact with animals carrying the Ebola virus.  

“This is really the holy grail of Ebola is to have those countermeasures in place, and not just be responding to outbreaks, but preventing the recurrence by the pre-emptive practical use of vaccination, which is always the best way to use vaccines.”

Rapid Response in Guinea – Result of Hard Experience in 2013-16 West African Outbreak

WHO has released some US$ 1.25 million to support the response in Guinea and to shore-up readiness in six neighbouring countries.

“Within the epicentre of the outbreak in a border area, the sub-region is on high alert and authorities are reinforcing public health measures, including surveillance, to quickly respond to possible cross-border infections,” Moeti said.

In other aspects of the response, Guinea’s Ministry of Health has activated national district and emergency management committees, and have advised the public to take measures to avert the spread of the disease, and to report any persons with symptoms to seek care. 

The ongoing, rapid response in Guinea and preparedness in neighboring countries is a result of the experience gained during the 2013-2016 outbreak in West Africa. 

The Ministry of Health of Guinea first reported to WHO about a cluster of Ebola Virus Disease (EVD) cases on 14 February, in the sub-prefecture of Gouécké, Nzérékoré Region, Guinea. 

Patient Zero was a nurse who originally presented at a health center in the region on 18 January 2021 with symptoms of headache, physical weakness, nausea, vomiting, loss of appetite, abdominal pain, and fever.

She was diagnosed with malaria.  On 24 January, she consulted with a traditional practitioner in Nzérékoré, and died four days later on 28 January. She was buried unsafely on 1 February in Gouécké, a town in the Nzérékoré Prefecture of Guinea. 

The other six known cases are her five family members and a traditional practitioner that she first visited for treatment. Of these seven reported cases, five people have already  died. The other two confirmed cases are currently in isolation in dedicated health facilities in the Conakry and Gouécké, Nzérékoré region.

As of 15 February, some 192 contacts of the nurse had been identified, including in N’Zérékoré Health District and 28 in Ratoma Health District, Conakry. To date, none of these contacts have reported traveling to neighboring countries. 

The Ebola virus strain responsible for the Guinea outbreak has not yet been determined. 

Image Credits: Trocaire/Flickr, Twitter: @WHO, WHO.