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"Rebel groups must be integrated into the Ebola surveillance network"
Emmanuel Nakoune Yandoko, scientific director of the Institut Pasteur in Bangui, draws lessons from the recent alert in the Central African Republic.
Interview by Ga?l Grilhot (contributor Le Monde Afrique, Bangui)
THE WORLD The 17.08.2018 at 14h54 ? Updated 17.08.2018 at 16h24
A serious warning shook the Pasteur Institute of Bangui Thursday, August 9. While a new Ebola epidemic is raging in the eastern Democratic Republic of Congo (DRC), seven people with fever and haemorrhage have been reported in Mboki hospital, a town near the Congolese border. .
The Ministry of Health and the Pasteur Institute, which serves as a reference center at the World Health Organization (WHO) for the diagnosis of viruses and haemorrhagic fevers, sent a rapid response team. Taking samples from patients quickly eliminated possible Ebola cases and the alert system put in place after the last major epidemic in West Africa in 2014 (Guinea, Sierra Leone and Liberia) was the first time was tested.
Emmanuel Nakoune Yandoko, scientific director of the Institut Pasteur in Bangui, draws lessons from the exercise and insists on the need to cooperate with rebel groups to prevent the spread of a possible epidemic.
Why is the city of Mboki strategic in the prevention system?
Emmanuel Nakoune Yandoko Mboki is a sub-prefecture located 900 km from Bangui, in the south-east of the Central African Republic, in a large region of almost uninhabited forests. The city is therefore in the middle of an ecosystem favorable to the emergence of diseases with high epidemic potential. It has the only health center in the region and attracts people around the world who are threatened by an epidemic. Local people, of course, but also those of DRC or South Sudan. But all the staff who were employed in Mboki went to Bangui and there remains only one rescuer, poorly trained. Because the area, due to the presence of rebel groups, has huge security problems.
How does the presence of armed groups increase the risk of spreading the virus?
Groups, such as the Lord's Resistance Army (LRA), circulate between the DRC, Uganda and even South Sudan. Other Central African rebel groups regularly cross this zone. Recently, we received samples from rebels arrested in the DRC and extradited to Bangui, and found that 80% of them had antibodies against the Ebola virus. This means that they have been in contact with a probable reservoir of the virus and that they are potentially vectors of transmission.
It is therefore essential to sensitize them. These groups respect the health structures and we can put them to use. For example, the Ebola outbreak in Gabon clearly showed that the episode was preceded by abnormal mortality of animals, such as great apes or antelopes. Rebels in the forest could alert us to such situations.
How to get their cooperation?
By setting up a surveillance system in which they will be integrated. During our mission, we met with representatives of these groups in Bria and Mboki. I do not doubt that they will collaborate, because they too are afraid of Ebola. They consume bushmeat, which is a source of contamination. It is therefore in their interest to be in a surveillance network.
If Ebola is confirmed, what would be the role of the Pasteur Institute in Bangui?
There is a quota plan developed by the Ministry of Health with the support of WHO. The Pasteur Institute of Bangui has been strengthened in technical platform, to allow the diagnosis and confirmation of cases. We also received personal protective equipment. If a case is confirmed, we have the opportunity to deploy the laboratory on the site to avoid the transport of samples to the capital, with all the difficulties that entails.
We have a P3 + safety laboratory in Bangui, with a depressurization system and a "glove box", which allows us to face all threats, including arboviruses such as Ebola or Marburg. If a case was confirmed in the Central African Republic, with WHO experts and humanitarian workers deployed in the country, like M?decins sans Fronti?res, we would have the resources to start taking care of infected patients while waiting for help from other partners International.
Is the country prepared for an epidemic risk?
The Mboki alert showed a good level of responsiveness. We managed to mobilize all partners, including Minusca [the UN Mission in Central Africa], in less than forty-eight hours. But we realized that within the team, all were not well prepared. As an anecdote, the clinician who was supposed to care for the patients could not put on his suit because he was too stressed. We had to ask him to stay outside the center. In real situations, the stress is great. It is important to train motivated and courageous people and to multiply the exercises to be ready for possible interventions if ever a case of Ebola should be confirmed.
https://www.lemonde.fr/afrique/arti...e-surveillance-contre-ebola_5343504_3212.html
"Rebel groups must be integrated into the Ebola surveillance network"
Emmanuel Nakoune Yandoko, scientific director of the Institut Pasteur in Bangui, draws lessons from the recent alert in the Central African Republic.
Interview by Ga?l Grilhot (contributor Le Monde Afrique, Bangui)
THE WORLD The 17.08.2018 at 14h54 ? Updated 17.08.2018 at 16h24
A serious warning shook the Pasteur Institute of Bangui Thursday, August 9. While a new Ebola epidemic is raging in the eastern Democratic Republic of Congo (DRC), seven people with fever and haemorrhage have been reported in Mboki hospital, a town near the Congolese border. .
The Ministry of Health and the Pasteur Institute, which serves as a reference center at the World Health Organization (WHO) for the diagnosis of viruses and haemorrhagic fevers, sent a rapid response team. Taking samples from patients quickly eliminated possible Ebola cases and the alert system put in place after the last major epidemic in West Africa in 2014 (Guinea, Sierra Leone and Liberia) was the first time was tested.
Emmanuel Nakoune Yandoko, scientific director of the Institut Pasteur in Bangui, draws lessons from the exercise and insists on the need to cooperate with rebel groups to prevent the spread of a possible epidemic.
Why is the city of Mboki strategic in the prevention system?
Emmanuel Nakoune Yandoko Mboki is a sub-prefecture located 900 km from Bangui, in the south-east of the Central African Republic, in a large region of almost uninhabited forests. The city is therefore in the middle of an ecosystem favorable to the emergence of diseases with high epidemic potential. It has the only health center in the region and attracts people around the world who are threatened by an epidemic. Local people, of course, but also those of DRC or South Sudan. But all the staff who were employed in Mboki went to Bangui and there remains only one rescuer, poorly trained. Because the area, due to the presence of rebel groups, has huge security problems.
How does the presence of armed groups increase the risk of spreading the virus?
Groups, such as the Lord's Resistance Army (LRA), circulate between the DRC, Uganda and even South Sudan. Other Central African rebel groups regularly cross this zone. Recently, we received samples from rebels arrested in the DRC and extradited to Bangui, and found that 80% of them had antibodies against the Ebola virus. This means that they have been in contact with a probable reservoir of the virus and that they are potentially vectors of transmission.
It is therefore essential to sensitize them. These groups respect the health structures and we can put them to use. For example, the Ebola outbreak in Gabon clearly showed that the episode was preceded by abnormal mortality of animals, such as great apes or antelopes. Rebels in the forest could alert us to such situations.
How to get their cooperation?
By setting up a surveillance system in which they will be integrated. During our mission, we met with representatives of these groups in Bria and Mboki. I do not doubt that they will collaborate, because they too are afraid of Ebola. They consume bushmeat, which is a source of contamination. It is therefore in their interest to be in a surveillance network.
If Ebola is confirmed, what would be the role of the Pasteur Institute in Bangui?
There is a quota plan developed by the Ministry of Health with the support of WHO. The Pasteur Institute of Bangui has been strengthened in technical platform, to allow the diagnosis and confirmation of cases. We also received personal protective equipment. If a case is confirmed, we have the opportunity to deploy the laboratory on the site to avoid the transport of samples to the capital, with all the difficulties that entails.
We have a P3 + safety laboratory in Bangui, with a depressurization system and a "glove box", which allows us to face all threats, including arboviruses such as Ebola or Marburg. If a case was confirmed in the Central African Republic, with WHO experts and humanitarian workers deployed in the country, like M?decins sans Fronti?res, we would have the resources to start taking care of infected patients while waiting for help from other partners International.
Is the country prepared for an epidemic risk?
The Mboki alert showed a good level of responsiveness. We managed to mobilize all partners, including Minusca [the UN Mission in Central Africa], in less than forty-eight hours. But we realized that within the team, all were not well prepared. As an anecdote, the clinician who was supposed to care for the patients could not put on his suit because he was too stressed. We had to ask him to stay outside the center. In real situations, the stress is great. It is important to train motivated and courageous people and to multiply the exercises to be ready for possible interventions if ever a case of Ebola should be confirmed.
https://www.lemonde.fr/afrique/arti...e-surveillance-contre-ebola_5343504_3212.html