Lab tests have confirmed Ebola infections in four more people from four different locations in the Democratic Republic of the Congo (DRC), the country's health ministry said today.

In other developments, a new survey conducted among residents of the DRC's Ebola-hit region found that the vaccine was well tolerated and had high acceptability .

Four new cases, 4 more deaths

The four new cases are in Mandima, Katwa, Butembo, and Kayina. Also, 240 suspected illnesses are under investigation. The new cases push the outbreak total to 936 cases, which includes 871 confirmed and 65 probable infections.

Four more people died from their infections, including two in community settings in Mandima and Butembo, an occurrence known to raise the transmission risk. Two of the deaths occurred in Ebola treatment centers, one in Mabalako and one in Beni.

Since the outbreak began, 591 people have died from Ebola.

Some vaccine resistance noted

In the vaccine survey, researchers from the DRC and Canada administered a 34-item questionnaire to a convenience sample of 96 people in Mangina, where the outbreak began, and Butembo. They reported their findings Mar 13 in Vaccine.

The study included 90 people who received the VSV-EBOV vaccine and 96 controls who weren't eligible to be vaccinated.

The survey took place from Sep 7 to Sep 10 of 2018. The questions, modeled after earlier studies in Ebola outbreak countries, asked people about their perceptions of the disease and their impressions of response efforts, such as vaccination and safe burials. Regarding the vaccine component, respondents were asked about side effects and if they would recommend immunization to a friend or family member.

Side effects were reported by 83% of vaccine recipients, but only five (7%) reported joint pain and four (5%) reported rash. The researchers noted that although side effects were commonly reported, the rate they saw in the survey was lower than that of an earlier clinical study involving healthy volunteers.

Of the people vaccinated, 84% were classified as "promoters," meaning they would recommend it to others. And of the unvaccinated controls, 72% said they'd want to be vaccinated if supply was available. Of both groups combined, 82% said the vaccine was acceptable for family members.

When they looked at people who had negative attitudes about the vaccine, researchers found an association between lower Ebola knowledge, resistance toward Ebola control measures, and negative vaccine attitudes among some people who hadn't received the vaccine.

"This finding may signal the presence of a significant sub-group of people in Eastern DRC demonstrating social resistance to EVD control efforts that require special attention, consistent with numerous media reports," the investigators wrote.

Community mistrust has been a feature of past Ebola outbreaks and, along with insecurity, has been a steep challenge in the current outbreak. In a related development, the Paul G. Allen Family Foundation recently announced an Ebola response accelerator challenge to identify innovative solutions to address both insecurity and community mistrust.

The challenge closes Mar 25, and the group expects to review proposals and make decisions in early April.

See also:

Mar 15 DRC update

Mar 13 Vaccine abstract

Paul G. Allen Foundation Ebola challenge information