Correspondence

Antibody Use during an Outbreak of Ebola Virus Disease in the Autonomous Republic of Congo, 2020

To the Editor:

An outbreak of Ebola virus affliction (EVD) occurred in Équateur Province, northwestern Democratic Republic of Congo (DRC), from June i to November 18, 2020. This was the 11th EVD outbreak in the DRC and overlapped with the conclusion of the 10th outbreak, which was centered in northeastern DRC.1 The 10th outbreak was the second largest in the world, later the 2014−2016 West Africa epidemic, and was the deadliest in DRC history. It lasted nearly ii years and resulted in 3296 confirmed cases, with a case fatality rate of 67%.2 Scientific breakthroughs, including the evaluation of four investigational treatments for EVD in a randomized, controlled trial, occurred during this time. The clinical trial led to the identification of two constructive drugs for EVD: the single monoclonal antibody ansuvimab and the triple monoclonal antibody cocktail REGN-EB3 (Tabular array S1 in the Supplementary Appendix, available with the full text of this letter at NEJM.org).3

Baseline Demographic and Clinical Characteristics of the Patients with EVD, 11th Outbreak, Équateur Province, DRC, June–November 2020.

The 11th outbreak made information technology possible to evaluate ansuvimab and REGN-EB3 in an epidemic resulting from strains of Ebola virus that differed from the one that had been circulating in the tenth outbreak.iv The EVD cases occurred in 13 widely dispersed wellness zones in Équateur Province (Fig. S1). The outbreak response, including the deployment of EVD-specific handling, was hampered past logistic constraints, including limitations in ground transportation that necessitated aeriform or riverine transport of treatments. From June through Nov 2020, the surveillance teams recorded 119 confirmed and xi likely EVD cases in Équateur Province; 72 of the patients (55%) were male and 30 (23%) were 18 years of historic period or younger (Table 1). The mean (±SD) baseline nucleoprotein cycle-threshold value on polymerase-chain-reaction testing among the 117 patients with confirmed EVD was 27.0±3.5. A total of xx patients (15%) reported previous receipt of the rVSVΔG-ZEBOV-GP vaccine.

Deaths among Patients Who Received or Did Not Receive EVD-Specific Treatment.

Afterward written informed consent had been obtained, EVD-specific treatment was given to 32 patients with confirmed EVD under an expanded-access protocol canonical past the ethics commission of the Academy of Kinshasa (17 patients received ansuvimab and 15 received REGN-EB3); 98 patients did non receive any EVD-specific treatment. In total, 55 deaths were recorded (42% of the patients). The percent of patients who died was lower in the grouping that received EVD-specific treatment than in the group that did not receive such treatment (half dozen% [95% confidence interval {CI}, 1 to 21] vs. 54% [95% CI, 44 to 64]) (Table two).

An expanded-access protocol was successfully implemented during the 11th EVD outbreak in the DRC. Although logistic challenges prevented the bulk of eligible patients from having access to treatment and there were differences between the patients who received the EVD-specific therapy and those who did not, outcomes among the treated patients were consistent with those in a previous randomized, controlled trial and in expanded-access-protocol studies of treatment for EVD and bear witness the potential utility of these 2 treatments against Ebola virus strains that differed from the one that had caused the 10th outbreak in northeastern DRC.

Sabue Mulangu, K.D.
Ridgeback Biotherapeutics, Miami, FL
[email protected]

Placide Mbala-Kingebeni, M.D.
Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of Congo

Olivier T. Mbaya, M.D.
Leidos Biomedical Inquiry, Frederick, MD

Supported by Ridgeback Biotherapeutics. Some financial and logistic support was provided by the National Constitute of Allergy and Infectious Diseases, the National Institutes of Health, and the World Health Organization.

Disclosure forms provided by the authors are available with the full text of this letter at NEJM.org.

  1. 1. World Health Arrangement. Ebola virus disease — Democratic republic of the congo: affliction outbreak news: update. November xviii, 2020 (https://reliefweb.int/report/autonomous-democracy-congo/ebola-virus-disease-democratic-republic-congo-disease-outbreak-111).

  2. 2. Aruna A, Mbala P, Minikulu 50, et al. Ebola virus disease outbreak — Democratic Republic of the Congo, August 2018–Nov 2019. MMWR Morb Mortal Wkly Rep 2019;68:1162-1165.

  3. three. Mulangu S, Dodd LE, Davey RT Jr, et al. A randomized, controlled trial of Ebola virus illness therapeutics. N Engl J Med 2019;381:2293-2303.

  4. 4. World Health Organization. No link between two ongoing Ebola outbreaks in the Autonomous Congo-brazzaville. June ix, 2020 (https://www.afro.who.int/news/no-link-between-two-ongoing-ebola-outbreaks-autonomous-republic-congo).

Supplementary Material

    • Facebook
    • Twitter
    • LinkedIn
    • Email
    • Copy URL
    • Download Citation
    • Permissions
    • Article Alert
    • Reprints