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No new cases have been reported for two weeks in the Democratic Republic of Congo
When the Ebola virus erupted In the Democratic Republic of Congo In Congo last month, a wave of international public health workers had just left the country, where they had been deployed to fight cholera. But less than two weeks after their departure, some rushed to help the new crisis
Alhbadane Toure was among them. As a physician who quickly became the coordinator of the World Health Organization's efforts to deploy experimental Ebola inoculation in the DRC, it was necessary in the field. In his home country in Guinea, he had successfully led a vaccination campaign against the Ebola virus three years earlier, helping to deploy an experimental shot after the West African crisis had already struck the region. But this time, his team had access not only to the experimental vaccine, but also to financial support that would allow them to offer inoculation at the start of an Ebola outbreak – and try to contain it relatively early.
Toure also has other advantages. "Here people are already informed about how [the vaccine] was used in West Africa," he says. In addition, 37 of his colleagues are also from Guinea and helped organize and administer vaccines during the previous epidemic. And during another small outbreak of Ebola in the DRC a year ago, DRC government officials had already begun discussing with WHO and others about the procedures to be followed to offer the Ebola vaccine, if necessary.
As a result, about a month after the first shots were fired at people in the DRC, Toure was cautiously optimistic about their success in the three places that reported cases: two rural areas in
called Iboko and Bikoro, and Mbandaka, a city of 1.2 million. The last confirmed case of Ebola occurred on June 6, according to WHO figures on June 21. W with the help of community health workers from the DRC who promoted the acceptance of the vaccine developed by the pharmaceutical giant Merck-Toure. The team vaccinated 1,611 people, including 574 front-line health workers. Médecins Sans Frontières also offered the vaccine, and more than 3,000 vaccines were administered in the country.
"Now, in Mbandaka there was no vaccine, there have been cases for several weeks, so I'm not sure. team [WHO] is now right in Iboko and Bikoro, and maybe we'll be there for a week or more until we get more information. "" S & # 39; there are no new laboratory-confirmed cases in these places, we will start having the rest of the front-line workers and the team will come to Mbandaka to wait for all the reports to be finished. " Five Experimental Drugs Against the Ebola Virus Sick patients were not even used during this outbreak because an international working group and the DRC authorities had approved them for use in the DRC and sent the drugs, there were no new cases, notes Daniel Bausch, a veteran of the Ebola virus and director of the UK Public Health Rapid Support Team.
Public health officials say that they are far from declaring the outbreak over; this statement usually comes one day after two 21-day incubation periods without any new cases. Such counting begins after the confirmed recovery of the last sick patient or after the last burial related to the Ebola virus. The most recent burial was held on June 10, according to the WHO, but the official count has not started yet because the organization is not sure that this is the case. Was the last case. Ebola responders know that only one missed case could revive the chain of transmission, so they should remain alert for anyone with possible symptoms and check contacts of known Ebola patients. For the moment, the numbers of cases remain relatively stable. There were more than 60 probable or confirmed cases and 28 deaths.
Touré's team focuses on careful monitoring of vaccinated individuals for the three-week period. as a result of their shots – a key requirement for the team's real-time study on the experimental Merck vaccine. On three separate occasions – days 3, 14 and 21 after vaccination, health workers should meet the inoculated person, ask questions about the person's health status and check for fever. But people are not always reachable in person or by phone. The coverage of electricity and mobile telephony was greater than when the team was working in Guinea, says Toure. This made communication and coordination incredibly difficult. There are also other obstacles: the difficulty of reaching people in remote areas on difficult roads that are sometimes muddy and the need to stifle the rumors and mistrust that often hang over people. responses to major outbreaks.
That means health care workers have to return to remote sites again and again, crossing bad roads on motorbikes or cars for face-to-face recording. If they do not find the person vaccinated, the team members continue to try for 30 days before giving up and note in their official records that the person was lost sight of, explains Toure.
The selection of people to be vaccinated depends primarily on the reports of community health workers, the DRC Ministry of Public Health and other interested parties. WHO and Médecins Sans Frontières vaccinate people who are either direct contacts of Ebola patients or "contact contacts" – an approximate categorization typically determined by geographical proximity. For example, it includes neighbors, extended family members, and people living with high-risk contacts.
Finding all these people can be difficult in communities in the DRC. Many do not have mobile phones, and records of health workers may not include good addresses or even exact spellings of names. According to Jonathan Polonsky, WHO epidemiologist and one of the coordinators of surveillance activities and research contacts at Mbandaka people can also move or travel, which makes them difficult to locate. One day, says Polonsky, his team received a list of 25 direct contact names of probable or confirmed Ebola cases that community health workers had been unable to locate – so the list had been pbaded on to specialists like him. "We went very little, we had no address in some cases, or sometimes we did not even know the area in general," he says .
He s'. however, it turned out that, out of pure persistence, some of these people were relatively easy to find: "In one case, the person lived right in front of the address we had down," he says. having spent about an hour and a half street in search of an individual on the list based on his name and the fact that he was a doctor, says Polonsky, the team does not have a doctor. was able to find it only after finally realizing that his name spelled incorrectly.Some of the 25 – less than 10 – missing have not been found, out of about 300 people that the Polonsky team has in charge of locating in Mbandaka he says, even though the number of Ebola cases has remained stable in recent weeks, this are the people he continues to worry about
Last weekend, after five weeks in the DRC, Polonsky was sent home to rest. Yet even now, he says that he still thinks about those missing people and wonders if they could be sick or maybe make others sick. "It's frustrating," he says. "It's always a throbbing thought."
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