Many in the Democratic Republic of Congo have been waiting for this moment: A new vaccine to battle the Ebola outbreak is about to be released. It could reach broader parts of the population than earlier attempts.
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The second-deadliest Ebola epidemic in the world has been raging in the Democratic Republic of Congo for over a year. More than 3,200 people have been infected with the virus and, up to this week, at least 2,144 people have died from the illness.
But now there are signs of progress in the battle to stop the outbreak. The World Health Organization (WHO) reports that the number of reported new infections is declining. Only 14 people were confirmed in the first week of October — making it the lowest number in a year. At the peak of the Ebola epidemic, in April, the number of new infections was 126 per week.
In addition, all recently reported cases are concentrated in a relatively limited area, close to the Ugandan border. It is a geographical triangle between the towns of Mambasa, Mandima and Komanda in Ituri province and Oicha in North Kivu province.
However, the region has been gripped by armed conflict for decades. The ongoing violence hinders medical efforts and also makes local communities wary of outsiders, further limiting the effectiveness of medical interventions.
The cities of Beni and Goma in North Kivu province have also received positive news. From November, physicians will use a new vaccine from Johnson & Johnson that is better suited for broad-based prophylaxis than Merck's existing VSV-EBOV vaccine.
"The vaccines are very different in strategy," says Dr. Marylyn Addo. "The vaccine that is currently being used, takes effect after only one shot — very quickly. The new vaccine, however, consists of two components that need to be administered at eight-week intervals."
Despite the highest safety standards, people in Europe and the US have been infected with the Ebola virus. Protective suits and airports checks are being used to prevent the further spread of the disease.
Image: picture-alliance/dpa/J. Woitas
Protective clothing
Proper protective clothing for doctors and nurses is critical. All exposed skin must be covered with a material that cannot be penetrated by the virus. But the suit alone isn't enough: Proper procedure is also important.
Suiting up
Health care workers must practice correctly putting on a protective suit, as seen here at the special isolation unit in Dusseldorf. New suits are used every time, so there is no risk of infection when getting dressed. Unprotected workers are therefore able to help.
Image: picture-alliance/dpa/Federico Gambarini
Completely separate
The patient rooms in the Dusseldorf isolation unit are completely shielded from the outside world. Air is filtered, and wastewater must go through a separate treatment process. The protective suits, used at all times in the ward, are kept at positive pressure. These measures go further than is necessary: While Ebola can be transmitted by contaminated objects, the virus is not airborne.
After the patient is treated, the entire suit is sprayed from the outside with a disinfectant to kill off any potential viruses. Only after this shower can the suit be removed - cautiously.
Image: picture-alliance/dpa/Sebastian Kahnert
Outside help
When removing the protective suit, health care workers must exercise extreme caution. Using permanently installed protective gloves, outside assistance can be provided without coming into direct contact with the suit. After use, the suit is immediately disposed of and burned.
Image: picture-alliance/dpa/Federico Gambarini
Infected nurses
Despite the high safety standards, a total of three nurses in Spain and the United States have contracted the disease. The circumstances surrounding the infection have not yet been clarified. The nurses' homes (as seen here in Texas) were sealed off and disinfected after the discovery of the transmission.
Image: Reuters/City of Dallas
Protection in Africa
Doctors and nurses in West Africa have now also been outfitted with protective suits. However, these do not always meet the standards deemed necessary for effective protection. Sometimes, small areas of skin are left unprotected, or the material used in the suit is permeable. In addition, putting the suit on and removing it can be risky.
Image: picture alliance/AP Photo
Isolating the dead
Extreme caution is also necessary at the funerals of people who have died of Ebola. A West African tradition, which sees the family of the deceased wash the body has led to many new infections. For mourning friends and family, these strict isolation measures are often hard to understand.
Image: Reuters/James Giahyue
Tent as isolation units
In a region where medical care is extremely underdeveloped, such an outbreak provides a daunting challenge. Infected people, like here in Liberia, are cared for in hastily constructed tents. But even a country like Germany would probably be overwhelmed by such an epidemic. At the moment, the country only has around 50 beds set up in isolation units.
Image: Zoom Dosso/AFP/Getty Images
Incineration instead of sunlight
In some of the affected West African regions, contaminated suits are hung out in the sun in an attempt to disinfect them for further use. But it's much safer to burn the clothing immediately after use, as seen here in Guinea. However, supply shortages and the high prices of suits make such advice difficult to follow. Protective clothing can cost between €30 and €200 ($40-$250).
Image: Cellou Binania/AFP/Getty Images
Airport controls
Air travelers represent the biggest threat when it comes to transmission of the virus over long distances. For this reason, travelers' temperatures are now being monitored at some airports. However, this method does not provide absolute security: Ebola's incubation period is up to 21 days.
Image: Pius Utomi Ekpei/AFP/Getty Images
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Addo, an infectious disease expert researching emerging infections for the Bernhard Nocht Institute for Tropical Medicine, says: "The new vaccine is not really suitable to immunize contact-persons in the case of acute suspected or confirmed Ebola cases. It is more likely to be used in areas that are at risk. There, the whole population could be vaccinated prophylactically."
Although the new vaccine does not work so quickly, it has other advantages. "It is easier to produce and does not need to be cooled as much," she says.
While Merck's current fast-acting vaccine has to be cooled to minus 60 to 70 degrees Celsius, the new vaccine only needs to be cooled to minus 20 degrees Celsius. "These are all advantages. In this respect, we hope that doctors can reach more people with the new vaccine," she says.
Because it is easier to produce, the new vaccine will probably help vaccinate many more people. So far, around 235,000 people have been immunized with the first vaccine. Approximately the same number of vaccine doses are currently available.
About 1.5 million doses of the new vaccine are already available even though the vaccine is still in Phase III of approval, a stage that requires the medicine to show its effectiveness. "This is, of course, one way to find out whether the vaccine is really effective in Phase III. It has shown very good tolerability and a very good immune response. Therefore, we assume that it will also protect against the virus, but that has not been proven yet," says Addo.
That is precisely why the people living in the four cities affected, as well as in Beni and Goma, should be vaccinated. Residents here would otherwise have no chance of accessing vaccination because they do not belong to the circle of those who have had — or still have — direct or indirect contact with Ebola patients. "If you want to prepare a city for an emergency or vaccinate health workers now, this new vaccination is a good choice," says Addo.
If and when the Ebola outbreak is overcome, the immediate question arises: how will authorities vaccinate against Ebola in the future in order to be prepared for new outbreaks.
The problem is that Ebola is transmitted by wild animals. Since 1967, cases have occurred in a vast area of sub-Saharan Africa, from Uganda in the east to Guinea and Sierra Leone in the very far west of the continent. Almost 5,000 kilometers lie between those countries and hundreds of millions of people live in these potential Ebola risk areas. It is therefore unrealistic to expect, that the health authorities will ever be able to vaccinate every single person prophylactically. They will only be able to react to acute outbreaks.
With the two vaccines, they now have a better arsenal of weapons to target the virus. In addition, there are better medicines for patients who are already infected with the illness. With two antibody therapies, doctors have succeeded in reducing the Ebola mortality rate from 67% to 35%.
"Considering that we have only known Ebola since 1967, we have made a major step forward. And we have to build on this," says Addo confidently.
With all the fear of Ebola, says Addo, it is important to not forget about the more common infectious diseases, which cost many more lives. "We have many challenges when it comes to vaccinating. Congo is currently experiencing the world's largest measles outbreak and also a very large cholera outbreak," she says.
Ticks - a plague for humans and animals alike
They're small, robust and dreaded by young and old: ticks put a dampener on summer fun, and not only for humans. Animals have developed creative ways to deal with the parasite. Don't try their methods at home.
Beware of ticks!
There are approximately 900 tick species across the world. The eight-legged crawlies are not insects, but rather belong to the Acari, which also include mites. They live in shrubs or grass and are just waiting for a bloody meal to walk past. The most common tick in Germany is the castor bean tick (Ixodes ricinus).
Image: zecken.de
Sting and suck
Ticks use their front legs and mouths to dig into their victim's skin. They pick spots where the skin is especially thin and the capillaries are right under the surface. The main part of their diet is not blood, however, but lymph, which leaks from the wound.
Image: picture-alliance/OKAPIA KG, Germany
Tick saliva with healing powers?
Many ticks transfer bacteria or viruses that can lead to serious illnesses. If you get bitten by a tick in Germany, you could contract Lyme disease or Encephalitis. But the small animals can also do good. Oxford researchers have recently found out that a protein from the tick's saliva can block infections, which makes it a potential cure for a certain type of heart disease.
Despite this discovery, ticks are still overwhelmingly negative. Elks, for example, suffer an increased number of ticks because of shorter and warmer winters in the eastern US. Last winter, 70 percent of elk calves there died - because they were sucked empty by ticks, according to researchers at the University of New Hampshire.
Image: picture-alliance/AP Photo/J. Cole
Anti-parasite symbiosis
In Africa, birds and mammals work together to get rid of ticks. This yellow-billed oxpecker (Buphagus africanus) is eating the ticks off a warthog. It's a win-win: the warthog gets rid of the bloodsuckers and the bird gets a delicious meal.
Image: picture-alliance/WILDLIFE
Tobacco to turn off ticks
Birds get ticks, too. The house finch has developed a strategy to fight ticks. A study in the Avian Biology journal has shown that breeding house finches use cigarette stubs to "proof" their nests. The nicotine wards off parasites, but sadly the neurotoxin can also have negative effects on the chicks.
Image: picture-alliance/All Canada Photos
Little hope of improvement
There's currently no plan for getting rid of the ticks for good, and it wouldn't be an easy task either. The little parasites are quite robust and can survive a cycle in the washing machine as well as time in the freezer. If you have a tick bite, make sure your encephalitis vaccination is up-to-date.