When Miriam Alia, head of vaccines and outbreak response at Doctors Without Borders, went to the community of an Ebola patient, she only had a notebook to write down the names of the people who had been in contact with him and very little hope.
“I knew that many were going to die.
Sometimes, up to 90% of those who become infected.”
That was until 2015, when in the middle of the epidemic in Guinea, Sierra Leone and Liberia – the worst in history, with 11,300 dead and 28,000 infected – an effective vaccine was developed against several of the six species of the virus.
“Now you arrive at the place where an outbreak has occurred and you have something to protect them, which prevents transmission.
You give hope to families.”
A study carried out by Epicentre, the NGO's medical research and epidemiology center, whose results are published in
The Lancet
,
shows that the rVSVΔG-ZEBOV-GP injection, the one recommended by the WHO in the event of an epidemic, requires a single dose, not only reduces the risk of infection, but also reduces mortality among patients by half.
The researchers analyzed the cases of 2,279 confirmed Ebola patients between July 2018 and April 2020 in the Democratic Republic of the Congo (DRC).
According to their findings, 56% of the unvaccinated died, compared to 25% of those who had received the Ervebo injection, the commercial name of the vaccine studied.
“It is important because we now know that if a person is already incubating the virus when they receive the vaccine, they are still more likely to survive,” underlines Etienne Gignoux, director of the Department of Epidemiology and Training at Epicenter, by phone.
“These are lives saved.
Ebola leaves many children orphaned, families destroyed, and health systems destroyed,” adds Alia, who has intervened in most of the outbreaks declared in that country, “before there was a vaccine and after,” she points out.
Jean-Pierre Kaposo, a doctor at the hospital in Goma, capital of the province of North Kivu (east of the DRC), one of the epicenters of this infection and the same one where that great epidemic of 2018 occurred, knows this well. -2020 in which the investigation was carried out.
“We faced insurmountable challenges, fear was omnipresent.
At first, the residents of Beni did not want to accept that Ebola was real,” he remembers those dark days.
“They believed it was a farce by the Government, in need of international financing.”
Despite these difficulties, the doctor and his team worked tirelessly to save lives and contain the spread of the virus.
“Every day was a struggle, but we found strength in our commitment to our patients and our community,” he adds.
Now you arrive at the place where an outbreak has occurred and you have something to protect them, which prevents transmission;
you give hope to families
Miriam Alia, MSF
According to data from the Center for Disease Prevention and Control, until June 25, 2020, when the WHO declared the end of the worst Ebola epidemic that this country has ever suffered, 3,470 cases had been reported, of which 2,287 were deaths. , 66%.
Marie, a mother from Goma who does not want her full name published, was one of the survivors.
“When I realized I had Ebola, I feared for my life and the lives of my children.
But thanks to the care of the doctors and my own determination, I defeated the disease,” she says.
The Ebola virus is named after the river in the Democratic Republic of the Congo next to which an outbreak occurred in which Belgian microbiologist Pier Pior discovered the infectious agent that had killed 400 people.
It was 1976. Since that year, 15 outbreaks have been recorded in that country;
the last, at the end of August 2022, when a case was detected in Beni, in the troubled province of North Kivu.
That only patient died, but no further infections occurred and the Congolese Government declared the end of the crisis just a month later.
Today it is known that the incubation period of that unknown worm-shaped virus that snaked under Pior's microscope is between two and 21 days, which is of animal origin, but it also spreads between human beings through direct contact through the blood or body fluids of infected people;
and that it is very deadly, killing, on average, half of the sick, although sometimes it wipes out up to 90% of those infected.
The most common thing is that the first symptoms - tiredness and headaches, muscles and joints - usually appear a week after being infected, although they are extremely similar to those of malaria and other common ailments, which makes early diagnosis difficult when A first case occurs in a community, almost always in a rural area.
This causes front-line health personnel and those close to them to also become infected.
“Retro-orbital pain and hiccups are very characteristic symptoms of Ebola and, in addition, they predict that it will be especially aggressive,” says Alia.
But the alerts that it may be this disease do not usually go off until a few days later the fever rises, vomiting, diarrhea, and internal and external bleeding appear.
With antiretroviral treatment, rehydration therapy and blood transfusions, among other interventions, patient survival has been increased.
It is now known that if they are also vaccinated, even if they are already exposed to the virus, it will further contribute to reducing the probability of dying.
The Ebola virus is very lethal: it kills, on average, half of the people infected
Research also shows that the sooner those who have been exposed to the virus are vaccinated, the more mortality is reduced.
Of the patients who were immunized at least 10 days before the appearance of the first symptoms, 17% died.
Of those who were vaccinated between three and nine days before developing the disease, 20.1% died.
Finally, 27.3% of deaths were recorded among those who received the injection just two days before presenting fever and pain.
“When an outbreak is declared, we recommend the vaccination of front-line health professionals and ring contacts of positive cases.
Now we add that it must be done as soon as possible,” notes Gignoux.
“As there is very little production of the vaccine and it is expensive – each dose costs about 100 euros – the vaccine is only used when there is an outbreak.
Although in 2023 it was used for the first time preventively for health professionals.
Now we also know that it has therapeutic value,” explains Alia.
“This means that we are certain that we can vaccinate contacts and that, although they are already incubating the virus, the injection will not make them worse.
In fact, it will contribute to reducing mortality.”
The researchers have also verified that the administration of Ervebo is compatible with the medication prescribed to Ebola patients.
“This opens the door to post-exposure vaccination of people with symptoms, which until now was not done,” celebrates the MSF specialist.
“Now, an unvaccinated person admitted with Ebola can be administered the vaccine at the same time as the treatment,” she clarifies.
Stop transmission, avoid stigma
A single confirmed case of Ebola is an outbreak.
Normally, it is usually a deceased.
Sometimes a nurse sees unexplained deaths in his community or entire families fall ill after a funeral.
Others, it is the professional himself who becomes infected after caring for patients with compatible symptoms.
In these cases, the health worker communicates as best he can, by telephone message or by sending a note by bicycle, his suspicions, which activates an investigation team that travels to the affected area.
“In one of the outbreaks in Congo, in 2014, the nurse began to treat the sick with garbage bags in his hands as the only protection while he sent someone to ask for help.
"And he didn't get infected!" Alia recalls with surprise, as if it were a miracle, since the Ebola virus is extremely contagious.
When an Ebola outbreak is declared, contacts of positive cases, and contacts of contacts, are offered the opportunity to be vaccinated to avoid contracting the disease.
Today it is known that, even if they are already incubating the virus, the injection is effective in reducing the probability of death.
This was done in North Kivu between 2018 and 2020. Samuel Sieber (MSF)
When the diagnosis of patient zero is confirmed, a single treatment center is established to which all suspected and confirmed cases are referred.
First it is usually the local dispensary, which paralyzes any other activity and, only when a specific health complex has been built, the previous one is disinfected and regains its function.
Positive cases are isolated and treated.
Within this clinic, specialists care for patients in teams of two: one works and another helps them put on and take off the protective suit (PPE), and ensures that they do not make mistakes that put their own safety at risk.
Outside, the investigation team draws up a list of contacts (including front-line healthcare workers), quickly isolates suspects, tests with rapid tests - the results of which are obtained in two hours - and now also vaccinates those who wish to do so.
The containment and treatment of hemorrhagic fevers is a scheduled process that the affected countries and the professionals from the organizations that support them know very well.
Almost always, Ebola manifests itself in small outbreaks in rural areas with a widely dispersed population that end up being quickly extinguished with this early isolation strategy, favored by the lack of contact between neighbors, and now also vaccination to stop transmission.
People were afraid of me, even after I was cured.
But I refuse to let my illness define me
Pierre, Ebola survivor in DRC
What happened then in the 2014 epidemic, which lasted two years and affected thousands in three countries?
“The outbreak began in March 2014 in a rural area that was a border intersection point where there is a lot of population movement,” explains Alia.
Once the virus reached the capitals and large hospitals, it spread like wildfire.
“The WHO response was delayed a lot, until August.
They called us exaggerated when we said we couldn't cope,” she recalls.
By then there were already 500 new infections per week between Guinea, Sierra Leone and Liberia.
“And there was a lack of coordination between the countries that made contact tracing difficult,” says the MSF specialist.
The stigma associated with Ebola is very strong, which is why it is so important to stop transmission and prevent the spread of infections thanks to the vaccine.
For Pierre, a young man from Beni, the social stigma that followed his recovery from Ebola posed an additional challenge.
“People were afraid of me, even after I was cured,” he says in a telephone conversation.
“But I refuse to let my illness define me.
“I am a survivor and I am proud of it.”
Alia remembers Salomé, a Liberian nurse who survived the 2014 epidemic and who starred on the cover of
Time
magazine .
At only 29 years old, she died in 2017, after suffering a complication after giving birth to her fourth child, as she was not treated in the hospital when it was learned that she had been sick with Ebola.
“Any scientific advance in disease prevention not only prevents people from dying, but also prevents them from getting sick in the first place,” concludes the expert.
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