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Ebola cases could reach 300; health authorities consider five pipeline drugs

The World Health Organization expects that the current outbreak of Ebola virus will probably result in 100 to 300 cases, and the UN agency is preparing five experimental drugs for use, officials said at a press conference in Geneva on May 29.

Twenty-five people have died during the latest Ebola outbreak in the Democratic Republic of the Congo, or DRC. Of the 54 cases reported across three areas, 35 have been confirmed through testing. While most cases of the viral hemorrhagic fever have occurred in the rural Bikoro and Iboko regions, four infections in the northern city of Mbandaka raised international concern about two weeks earlier.

WHO and DRC authorities are working together to bring five experimental drugs to the country: Mapp Biopharmaceutical Inc.'s ZMapp, Gilead Sciences Inc.'s remdesivir or GS 5734, Regeneron Pharmaceuticals Inc.'s REGN3470-3471-3479, FUJIFILM Holdings Corp.'s favipiravir or Avigan and mAb114, developed by the U.S. National Institutes of Health and manufactured for the trials by AstraZeneca PLC.

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While all of the treatments are still in clinical trials, WHO Deputy Director-General for Emergency Preparedness and Response Peter Salama noted that people were treated with ZMapp and remdesivir during the 2014 West Africa epidemic, in which 11,300 people across several countries died out of more than 28,000 reported cases.

The other three have mostly been limited to animal testing but are still important in this outbreak, Salama said, adding, "If we don't use the opportunity to learn in this situation, we'll never be able to know which is better in terms of the drugs."

In the meantime, authorities have vaccinated more than 400 people who potentially came in contact with the infected population, using Merck & Co. Inc.'s experimental vaccine V920. Though V920 has shown some durability around the one-year mark, it is not clear how long its protections last. That is a "critical outstanding question" that could be answered in this outbreak, Salama said.

WHO and DRC are exploring whether to call in another pipeline vaccine from Johnson & Johnson which in trials suggested it may protect patients even longer than a year, Salama said.

Preparing porous borders

Leaders are "cautiously optimistic" about controlling the virus' spread in Mbandaka, Salama said. Yet the city of at least 1.2 million people sits against the Congo river, a long trade highway sharing a border with the Republic of the Congo to the north.

Authorities will not restrict movement on the river, said Michael Ryan, WHO assistant director general of emergency preparedness and response, adding that the country is "absolutely dependent" on the movement of people and goods for its economy.

"Blocking people from moving is ultimately counterproductive because it creates distrust and drives fear," he said.

However, WHO is looking into 80 screening points for the DRC alone, Salama noted.

One chief concern is the amount of infrastructure needed for many of these experimental treatments. Some of the drugs require six- to 12-hour intravenous infusions, Salama noted, while others require daily tracking of liver and kidney function.

Bikoro, one of the epicenters of the current outbreak, has no power or functioning laboratories, he said.

WHO is working with nine neighboring countries to prepare for the virus' possible spread, with the Republic of the Congo and Central African Republic at the top of that priority list, Salama said.