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Fearing cross-border spread, Uganda to start vaccinating against Ebola

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Uganda will begin vaccinating heath care and other front-line workers against the Ebola virus next week amid concerns that a large outbreak in neighboring Democratic Republic of the Congo will spread across the border.

Ugandan health minister Jane Ruth Aceng, MBChB, MMed, MPH, said Merck’s investigational V920 vaccine would be given to workers in high-risk districts starting Monday. The country has 2,100 doses of the vaccine available, Aceng said.

As of Thursday, the DRC reported at least 250 cases and 145 deaths in the ongoing outbreak in the provinces of North Kivu and Ituri and said 41 other suspected cases were being investigated. North Kivu and Ituri abut Uganda’s western border.

So far, Uganda’s health ministry said there have not been any confirmed Ebola cases in the country, but there is an ongoing search for infections “in all communities, health facilities and on formal and informal border crossing in all districts especially in the high-risk ones.” In the meantime, the country appears to be preparing for the eventuality that it will see cases, conducting training sessions on Ebola infection prevention and control, case management and surveillance, the ministry said.

“An undiagnosed Ebola patient could present to a health facility in Uganda for medical attention. This context puts the health care workers and frontline workers in Uganda at risk of being in contact with an EVD case in the context of the current outbreak in DRC,” the ministry said.

The DRC used Merck’s investigational vaccine in two outbreaks this year — the first time a vaccine has been deployed to stop Ebola. More than 25,000 people have been vaccinated since the start of the recent outbreak, which began just days after the previous outbreak was brought under control. Like Uganda, the DRC also prioritized health care workers, who are at an increased risk for infection during Ebola outbreaks.

The vaccine will be deployed in Uganda under an “expanded access” — or “compassionate use” — framework used for unlicensed products. The DRC used the recommended ring vaccination strategy, in which contacts of confirmed cases and their contacts are vaccinated. This is how the vaccine was tested during the West African Ebola epidemic. Uganda also said it would use ring vaccination.

Escalating violence by armed government opposition groups has made responding to the current outbreak challenging. That, and considerable cross-border movement between the DRC and other neighboring countries has raised fears that the virus would spread. On Sept. 27, WHO announced the first cases in a health zone near the Ugandan border and said the risk for regional spread was “very high.” – by Gerard Gallagher