Pakistan continues to be dealing with a polio outbreak as four fresh cases have emerged, pushing the national tally to 37 this year, according to health officials on October 19, 2024. Health officials said that the regional reference laboratory for polio eradication at the National Institute of Health in Islamabad confirmed wild poliovirus type-1 (WPV1) in two children-one from each Balochistan and Khyber-Pakhtunkhwa.

In recent cases, a girl has been affected from Pishin, and two boys from Chaman and Noshki of Balochistan, and a girl from Lakki Marwat in KP. These are the first detections of the virus within Noshki and Lakki Marwat this year; isolated cases of poliovirus were previously reported within Chaman and Pishin. The province of Balochistan was the worst hit with 20 cases, Sindh had 10, Khyber Pakhtunkhwa had five, and Punjab and Islamabad had one case each.

A gigantic fight against polio has been on going in Pakistan- especially in Balochistan and southern KP-over the last two years. Immunisation campaigns have often been suspended or delayed because of local protests, insecurity, and community boycotts. Consequently, quite a number of children did not get the necessary vaccinations, making existing patches of vulnerability for the virus to flow within those pockets.

Noshki, located near Afghanistan's border, and Lakki Marwat have also recently reported some positive environmental samples that confirm the virus is present here, said a local reference laboratory official. Samples of latest cases are currently under genetic sequencing for checking spread of virus and origin.

As the threat of polio continues to grow, Pakistan has vowed to mount a nationwide campaign against it beginning from October 28. With the zeal to tackle the menace in the most effective manner, over 45 million children under the age of five will be vaccinated across the country.

Today, Afghanistan and Pakistan remain one of the few countries where polio has not yet been eradicated. The WHO said the virus remains a potential serious public health threat in areas with low vaccination coverage and weak surveillance.

India On Alert Against Polio

The country declared itself polio-free since 2014 and has kept the disease on bay almost a decade with very robust vaccination programs; however, two cases of vaccine-derived poliovirus cases reported in recent days from Meghalaya create some amount of doubts over a possible resurgence. Experts observe that in India, despite these detections taking place, strong coverage of vaccination at 90-95% and mandatory surveillance measures keep the risk of this widespread outbreak at bay.

The experts point out, however, that such stable situation in India requires continued surveillance. "Countries like Pakistan and parts of Africa remain at a high risk because vaccination rates in those areas are much lower," Dr. Siddharth, public health expert, said. Vaccination is an indispensable act in order to avoid the spread of this incapacitating disease that manifests most importantly as a nervous system affliction leading to the paralysis of a long period.

With concerted efforts from health authorities, there is hope someday that the scourge of polio will be completely eradicated from the face of the earth and future generations will never suffer from its effects.

The ongoing Ebola virus outbreak in the Democratic Republic of Congo, which has also spread to Uganda, has been identified as caused by the rare Bundibugyo strain.

As per the US CDC, as of May 17, there are reports of 10 confirmed cases and 336 suspected cases, including 88 deaths, in DRC.

Uganda has reported 2 confirmed cases, including 1 death, among people who travelled from DRC. No further spread has been reported. These numbers are subject to change as the outbreak evolves.

Speaking exclusively to HealthandMe, Professor Emma Thomson, Director of the Centre for Virus Research (Virology) in the School of Infection and Immunity at the University of Glasgow, shared why the virus outbreak, which has been declared a Public Health Emergency of International Concern (PHEIC) by the World Health Organization (WHO), is of concern.

While the Bundibugyo virus, a member of the species Orthoebolavirus bundibugyoense, is closely related to the Ebola virus (species Orthoebolavirus zairense), it is still different and currently has no treatment or vaccine.

Professor Emma told HealthandMe that “there are several reasons for concern".

Ebola Outbreak: Likely Went Undetected For Some Time

The expert noted that "the reports that initial GeneXpert Ebola testing was negative suggest that the outbreak may have gone undetected for some time, with early diagnostic blind spots delaying recognition".

There have also been reports of infections in healthcare workers, which is "a serious warning sign in any filovirus outbreak, because they indicate unrecognized transmission in healthcare settings and gaps in infection prevention and control", the Professor said.

Notably, Ebola cases have been identified in Kinshasa and Kampala. These are "hundreds of kilometres from Ituri province, and it shows that the virus has already moved through human mobility networks before full containment was in place," Professor Emma said.

The Bundibugyo virus: Previous Outbreaks

The Bundibugyo virus has previously caused two recognized outbreaks. The first was in Bundibugyo District, Uganda, in 2007–2008, with 131 reported cases and 42 deaths, and a case fatality proportion of 34–40 per cent.

The second was in Isiro, Democratic Republic of the Congo, in 2012, with 38 laboratory-confirmed cases and 13 deaths, although wider outbreak reports, including probable and suspected cases, gave higher totals.

These figures are lower than the case fatality rates seen in many outbreaks caused by the Ebola virus, but they are still extremely serious. "Bundibugyo virus disease is not a mild infection," the expert said.

Ebola virus: Vaccine And Therapeutics

Currently, there is a licensed vaccine that targets the Ebola virus from the species Orthoebolavirus zairense (rVSV-ZEBOV).

"Experimental non-human primate work suggests that rVSV-ZEBOV may provide partial heterologous protection against Bundibugyo virus, but this cannot be assumed to translate into reliable protection in people during an outbreak," Professor Emma noted.

"Adenovirus- and MVA-vectored vaccine platforms may offer broader possibilities, particularly where multivalent constructs are used, but recent immunological data suggest that some licensed or advanced platforms still induce responses that are predominantly directed against the Ebola virus rather than broadly cross-reactive across all ebolaviruses," she added.

In other words, "we do not currently have a proven, licensed, Bundibugyo-virus-specific vaccine available for outbreak control," the Professor said, stressing the need for "urgent research" on vaccines.

Similarly, she stressed the need to boost "therapeutics" against the Ebola virus.

"Approved monoclonal antibody treatments such as Inmazeb and Ebanga were developed for the disease caused by the Ebola virus, not Bundibugyo virus, and their efficacy against other ebolaviruses has not been established," Professor Emma told HealthandMe.

"There are promising experimental broad-spectrum antibodies, but these are not yet a substitute for rapid detection, high-quality supportive care, infection prevention and control, and contact tracing," she added.

Bundibugyo-virus OutbreaK: What Should Be Prioritized?

Professor Emma further called for ramping up practical and scientifical priorities. These include:

• the Bundibugyo-virus-capable diagnostics,
• rapid genomic sequencing,
• strong infection prevention in healthcare settings,
• safe clinical pathways,
• contact tracing,
• community engagement,
• treatment centres able to deliver high-quality supportive care.

The expert also stressed the importance of genomic sequencing as it can:

• confirm the virus species,
• Identify whether cases are linked,
• reconstruct transmission chains,
• Detect whether the outbreak reflects sustained human-to-human transmission or multiple introductions.

“This outbreak also highlights a persistent weakness in epidemic preparedness. We tend to build tools around the best-known outbreak pathogens, but rarer viruses such as Bundibugyo virus can still cause severe disease and international spread," Professor Emma said.

The expert also highlighted the essential need for

• sustained investment in high-containment laboratories,
• diagnostic development,
• genomic surveillance,
• vaccine platforms,
• therapeutics and international research partnerships.

There is no case of Ebola reported in India, said the government today, while stepping up surveillance in the country at key places such as airports and seaports.

The government has also "initiated precautionary public health measures", following the declaration of a Public Health Emergency of International Concern (PHEIC) by the World Health Organization (WHO).

A senior official in the Ministry of Health clarified that "there is no reported case of Ebola in India and the current risk to the country remains minimal".

However, India is closely monitoring the outbreak that has so far 336 suspected cases, including 88 deaths, in DR Congo; and

2 confirmed cases, and 1 death in Uganda.

"Senior officials of the Ministry, including officials from the National Centre for Disease Control (NCDC), Integrated Disease Surveillance Programme (IDSP), ICMR, and other concerned divisions, have reviewed the evolving situation and initiated precautionary public health measures," said the Ministry.

Key preparedness measures include:

• Review of SOPs for screening, surveillance, quarantine , and case management;
• Strengthening laboratory preparedness, with NIV Pune designated for testing and additional laboratories being onboarded in phases;
• Enhanced coordination with relevant Ministries and agencies for monitoring international travel from affected regions;
• Identification and readiness of isolation and quarantine facilities at major airports and ports.

"India’s public health system remains vigilant and fully prepared to respond to any emerging situation,” it said, adding that “citizens are advised to follow official updates issued by the Ministry of Health & Family Welfare and WHO”.

The official asserted that India continues to maintain close coordination with international health authorities and will take all necessary measures to safeguard public health.

The Ebola Outbreak

On May 17, the WHO declared the Ebola outbreak in Central Africa a "public health emergency of international concern."

According to the Africa CDC, the outbreak is caused by a rare strain of the Bundibugyo virus, for which there is no vaccine available currently.

Bundibugyo virus disease is a rare and deadly illness that has caused outbreaks in several African countries in the past. It is different from other known ebolaviruses such as the Zaire ebolavirus and the Sudan ebolavirus.

How Does Ebola Bundibugyo Spread?

The Bundibugyo virus spreads through contact with the blood or bodily fluids of a person infected with or who has died from the rare Ebola strain.

It can also spread through contact with contaminated objects such as clothing, bedding, needles, and medical equipment, or through contact with infected animals such as bats and nonhuman primates.

Historically, Bundibugyo virus outbreaks have recorded fatality rates ranging from 25 per cent to 50 per cent.

Symptoms To Watch For

Symptoms of Bundibugyo virus disease are similar to other forms of Ebola and include:

• Fever
• Headache
• Muscle pain
• Weakness
• Diarrhea
• Vomiting
• Stomach pain
• Unexplained bleeding or bruising, usually in later stages of illness

Prof Trudie Lang from the University of Oxford also described dealing with Bundibugyo as “one of the most significant concerns” in the current outbreak, the BBC reported.

Symptoms are believed to appear between two and 21 days after infection.

With no approved drugs specifically targeting the Bundibugyo virus, treatment currently depends on supportive care, including managing pain, treating secondary infections, maintaining fluids, and ensuring adequate nutrition. Early medical care improves survival chances.

The Democratic Republic of Congo is currently facing its 17th outbreak of the Ebola virus. While scientists have identified the outbreak as being caused by the rare Bundibugyo strain, a major concern is that there is currently no approved treatment or vaccine specifically targeting it.

Although highly effective vaccines such as ERVEBO exist, they are designed specifically for the Zaire strain of Ebola and do not protect against other strains like Sudan or Bundibugyo.

Now, a team of scientists at the Université de Montréal (UdeM) in Canada has identified a new family of natural molecules with strong antiviral activity, particularly against the Ebola virus.

Previously, in 2016 and again in 2020, researchers at the university’s Montreal Clinical Research Institute (IRCM) demonstrated that a plant extract rich in isoquercitrin — a flavonoid found in many plants — showed strong antiviral activity in laboratory studies.

However, the exact source of the effect remained unclear.

What Were The Plant Molecules?

Researchers, including scientists from the University of Chicago, used advanced analytical methods and a rigorous bioassay-guided approach to determine that the antiviral activity did not originate from isoquercitrin itself, but rather from two previously unknown triterpenoid compounds.

Though present at only 0.4 per cent of the analyzed extract, these newly identified molecules — named dicitriosides — proved to be up to 25 times more active than the original extract against the Ebola virus under experimental conditions.

The compounds were also found to be effective against SARS-CoV-2, the virus responsible for the COVID-19 pandemic. Researchers noted that the molecules demonstrated antiviral efficacy at pharmacologically achievable concentrations.

“This discovery illustrates how compounds present in vanishingly small amounts in nature can have major therapeutic potential,” said Majambu Mbikay from the IRCM. “It also underscores the importance of carefully examining the true composition of natural products used in biomedical research.”

The scientists noted in the study that even though the findings are "still at the preclinical stage, it opens promising avenues for the discovery of new broad-spectrum antivirals derived from natural products”.

“No one knows when the next pandemic will occur, but one thing is certain: we must be prepared,” said Michel Chrétien, medical professor at UdeM. “These results demonstrate the importance of long-term fundamental research and international collaboration in anticipating the public-health challenges of the future.”

The Ebola Outbreak

On May 17, the World Health Organization declared it a "public health emergency of international concern." The outbreak has also spread to Uganda.

According to the Africa CDC, the outbreak is caused by a rare strain of the Bundibugyo virus, for which there is no vaccine available currently.

Bundibugyo virus disease is a rare and deadly illness that has caused outbreaks in several African countries in the past. It is different from other known ebolaviruses such as the Zaire ebolavirus and the Sudan ebolavirus.

As per the US CDC, as of May 17, there are reports of 10 confirmed cases and 336 suspected cases, including 88 deaths, in DRC.

Uganda has reported 2 confirmed cases, including 1 death, among people who travelled from DRC. No further spread has been reported. These numbers are likely to increase as the outbreak evolves.