Ebola virus disease – Democratic Republic of the Congo

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Ebola virus disease – Democratic Republic of the Congo

The Ebola virus disease (EVD) outbreak in North Kivu and Ituri provinces in the Democratic Republic of the Congo continued this week with similar transmission intensity to recent weeks with an average of 86 cases per week (range 80 to 91 cases per week) in the past six weeks (Figure 1). There are currently no confirmed cases of EVD outside of the Democratic Republic of the Congo.

In the 21 days from 17 July through 6 August 2019, 65 health areas within 16 health zones reported new cases (Table 1, Figure 2). During this period, a total of 257 confirmed cases were reported, with the majority coming from the health zones of Beni (46%, n=119) and Mandima (23%, n=58). The majority of recent cases in Mandima Health Zone were reported from the northern health areas of Somé (n=39) and Mayuano (n=8). Of the eight cases reported in Mambasa Health Zone in the past 21 days, the majority have epidemiological links to Somé Health Area, with limited local transmission in Mambasa thus far.

Credit: CDC Cynthia Goldsmith

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By |2019-08-13T12:30:01+00:00August 13th, 2019|

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Ebola virus disease – Democratic Republic of the Congo

Disease outbreak news: Update
28 February 2019

The Ebola virus disease (EVD) outbreak is continuing with moderate intensity. Katwa and Butembo remain the major health zones of concern, while simultaneously, small clusters continue to occur in various geographically dispersed locations. During the last 21 days (6 – 26 February 2019), 77 new cases have been reported from 33 health areas within nine health zones (Figure 1), including: Katwa (45), Butembo (19), Vuhovi (4), Kyondo (3), Kalunguta (2), Oicha (1), Beni (1), Mandima (1), and Rwampara (1).

 

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By |2019-03-06T19:33:06+00:00March 6th, 2019|

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Ebola virus disease – Democratic Republic of the Congo

Disease outbreak news: Update
28 December 2018

The Ministry of Health (MoH), WHO and partners continue to respond to the Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo. While communities in affected areas are generally supportive of the Ebola response, operations in some areas have been temporarily disrupted due to insecurity. On 27 December 2018, protests at government buildings in Beni spilled over to an Ebola transit centre, frightening people waiting for Ebola test results and the staff who were caring for them. Staff at the centre temporarily withdrew and most suspected cases were transferred to a nearby treatment centre. WHO is concerned about the negative effects that the current insecurity is having on efforts to control the outbreak. After an intensification of field activities, marked improvements in controlling the outbreak were observed in many areas, including a recent decrease in cases in Beni. These gains could be lost if we suffer a period of prolonged insecurity that results in increased Ebola virus transmission. While maintaining focus on ending the outbreak and resuming normal operations as soon as possible, all response partners remain committed to ensuring the safety of staff. WHO continues to monitor the situation closely and will adapt their response as needed.

As of 26 December 2018, a total of 591 EVD cases, including 543 confirmed and 48 probable cases, have been reported from 16 health zones in the two neighbouring provinces of North Kivu and Ituri (Figure 1). Of these cases, 54 were healthcare workers, of which 18 died. Overall, 357 cases have died (case fatality ratio 60%). In the past week, ten additional patients were discharged from Ebola treatment centres; overall, 203 patients have recovered to date. The highest number of cases were from age group 15‒49 years with 60% (355/589) of the cases, and of those, 228 were female. Highest attack rates have been observed in children aged more than one year (especially male infants) and females aged 15 years and older.

Trends in case incidence (Figure 2) reflect the continuation of the outbreak across these geographically dispersed areas. The general decrease in the weekly incidence observed in Beni since late October continued; however, the outbreak is intensifying in Butembo and Katwa, and new clusters have emerged in other health zones. Thirteen health zones reported a total of 109 confirmed cases in the last 21 days (5‒26 December 2018). The majority of which were concentrated in major urban centres and towns in Katwa (26), Komanda (21), Mabalako (15), Beni (14) and Butembo (10) health zones. An isolated case was also recently detected in Nyankunde Health Zone – a newly affected area in Ituri Province – whom likely acquired the infection in Komanda. This case, highlights the continued high risk of continued spread of the outbreak and the need to strengthen all aspects of the response in Ituri, North Kivu and surrounding provinces and countries.

The MoH, WHO and partners continue to monitor and investigate all alerts in affected areas, in other provinces in the Democratic Republic of the Congo, and in neighbouring countries. Since the last report was published, alerts were investigated in several provinces of the Democratic Republic of the Congo as well as in Uganda. To date, EVD has been ruled out in all alerts outside of the abovementioned outbreak affected areas.

Figure 1: Confirmed and probable Ebola virus disease cases by health zone in North Kivu and Ituri provinces, Democratic Republic of the Congo, data as of 26 December 2018 (n=591)

Figure 2: Confirmed and probable Ebola virus disease cases by week of illness onset, data as of 26 December 2018 (n=591)*

*Data in recent weeks are subject to delays in case confirmation and reporting, as well as ongoing data cleaning – trends during this period should be interpreted cautiously.

Public health response

The MoH continues to strengthen response measures, with support from WHO and partners. Priorities include coordination, surveillance, contact tracing, laboratory capacity, infection prevention and control (IPC), clinical management of patients, vaccination, risk communication and community engagement, psychosocial support, safe and dignified burials (SDB), cross-border surveillance, and preparedness activities in neighbouring provinces and countries. Infection prevention and control practices in health care facilities, especially antenatal clinics, need to be further strengthened.

For detailed information about the public health response actions by WHO and partners, please refer to the latest situation reports published by the WHO Regional Office for Africa:

WHO risk assessment

This outbreak of EVD is affecting north-eastern provinces of the country bordering Uganda, Rwanda and South Sudan. Potential risk factors for transmission of EVD at the national and regional levels include: travel between the affected areas, the rest of the country, and neighbouring countries; the internal displacement of populations. The country is concurrently experiencing other epidemics (e.g. cholera, vaccine-derived poliomyelitis, malaria), and a long-term humanitarian crisis. Additionally, the security situation in North Kivu and Ituri at times limits the implementation of response activities. WHO’s risk assessment for the outbreak is currently very high at the national and regional levels; the global risk level remains low. WHO continues to advice against any restriction of travel to, and trade with, the Democratic Republic of the Congo based on currently available information.

Credit: CDC

As the risk of national and regional spread is very high, it is important for neighbouring provinces and countries to enhance surveillance and preparedness activities. The International Health Regulations (IHR 2005) Emergency Committee has advised that failing to intensify these preparedness and surveillance activities would lead to worsening conditions and further spread. WHO will continue to work with neighbouring countries and partners to ensure that health authorities are alerted and are operationally prepared to respond.

WHO advice

International traffic: WHO advises against any restriction of travel and trade to the Democratic Republic of the Congo based on the currently available information. There is currently no licensed vaccine to protect people from the Ebola virus. Therefore, any requirements for certificates of Ebola vaccination are not a reasonable basis for restricting movement across borders or the issuance of visas for passengers leaving the Democratic Republic of the Congo. WHO continues to closely monitor and, if necessary, verify travel and trade measures in relation to this event. Currently, no country has implemented travel measures that significantly interfere with international traffic to and from the Democratic Republic of the Congo. Travellers should seek medical advice before travel and should practice good hygiene.

For more information, see:

WHO report on Ebola outbreak in Congo 28 Dec 2018

 

By |2018-12-29T21:20:30+00:00December 29th, 2018|

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Ebola virus disease – Democratic Republic of the Congo

The response to the Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo is becoming increasingly undermined by security challenges in at-risk areas, particularly Beni. These incidents severely impact both civilians and frontline workers, forcing suspension of EVD response activities and increasing the risk that the virus will continue to spread. WHO continues to distinguish between the incidents of conflict between rebel and government forces, and pockets of community push-back on the response. A recent increase in the incidence of new cases (Figure 1) is the result of the multitude of challenges faced by response teams. This also reflects improved active surveillance and reporting from the community.

Since the last Disease Outbreak News (data as of 2 October), 29 new confirmed EVD cases were reported: 23 from Beni, four from Butembo, one from Mabalako, and one from Masereka Health Zones in North Kivu Province. Fifteen of these confirmed cases have been linked to known cases or were linked retrospectively through case to transmission chains within the respective communities, while fourteen recently reported cases remain under investigation.

As of 9 October 2018, a total of 194 EVD cases (159 confirmed and 35 probable), including 122 deaths (87 confirmed and 35 probable)1, have been reported in seven health zones in North Kivu Province (Beni, Butembo, Kalunguta, Mabalako, Masereka, Musienene and Oicha), and three health zones in Ituri Province (Mandima, Komanda and Tchomia) (Figure 1). An overall increasing trend in weekly case incidence is seen (Figure 2); however, these rising trends are likely underestimated given expected delays in case reporting, the ongoing detection of sporadic cases, and security concerns which limit contact tracing and investigation of alerts. Of the 194 confirmed and probable cases for whom age and sex information is known, the majority (64%) are within 15-44 years age range. Females (55%) accounted for a greater proportion of cases (Figure 3). Since the last Disease Outbreak News update, one new health care worker infection was reported, bringing the cumulative case count to 20 (19 confirmed and one probable), of whom three have died.

The MoH, WHO and partners continue to closely monitor and investigate all alerts in affected areas, in other provinces in the Democratic Republic of the Congo, and in neighbouring countries. As of 9 October, 25 suspected cases in the Democratic Republic of the Congo are awaiting laboratory testing. Since 4 October, alerts have been investigated in several provinces of the Democratic Republic of the Congo, as well as in neighbouring countries. To date, EVD has been ruled out in all alerts from neighbouring provinces and countries.

Figure 1: Confirmed and probable Ebola virus disease cases by health zone in North Kivu and Ituri provinces, Democratic Republic of the Congo, data as of 9 October 2018 (n=194)

Figure 2: Confirmed and probable Ebola virus disease cases by week of illness onset, data as of 9 October 2018 (n=190)*

*Data in recent weeks are subject to delays in case confirmation and reporting, as well as ongoing data cleaning. Date of illness onset unknown for n=7 cases. Edited on 12 October 2018.

Figure 3: Confirmed and probable Ebola virus disease cases by age and sex, data as 9 October 2018 (n=159)*

*Age and/or sex unknown for n=35 cases.

Public health response

The MoH continues to strengthen response measures, with support from WHO and partners. Priorities include coordinating the response, surveillance, contact tracing, laboratory capacity, infection prevention and control (IPC) measures, clinical management of patients, vaccination, risk communication and community engagement, psychosocial support, safe and dignified burials (SDB), cross-border surveillance and preparedness activities in neighbouring provinces and countries.

  • Surveillance: Over 8000 contacts have been registered, of which 2732 remain under surveillance as of 9 October2. Beni Health Zone has the greatest number of contacts (n=1834) and the greatest challenges in contact tracing due to a combination of factors, including: community reluctance and refusal for contact tracing; contacts lost to follow-up; and a deteriorating security situation.
  • Vaccination: As of 10 October, 90 vaccination rings have been defined, in addition to 31 rings of health and frontline workers. To date, 15 828 eligible and consented people have been vaccinated, including 6327 health and frontline workers and 3439 children. Vaccination preparedness progress is being made in neighbouring Uganda, South Sudan, Rwanda, and Burundi. The Ebola Treatment Centre (ETC) managed by the Alliance for International Medical Action (ALIMA) in Beni has increased its capacity to 25 beds.
  • IPC activities are ongoing and are supported by several partners in the field. In Butembo Health Zone, fine-tuning of IPC infrastructure at Matanda Hospital is ongoing alongside follow-up and supervision of pre-triage; IPC construction is estimated to be at least 80% complete at Sainte Famille Hospital. Training on triage and pre-triage took place at Sainte Famille Hospital on 5 October, and three additional structures have been identified for pre-triage support in Butembo.
  • Risk communication, community engagement, and social mobilization has been integrated with surveillance, contact tracing, and vaccination work as part of a revised strategy to address community concerns about the response. Under this approach, young persons under civil society leaders’ supervision are notified of community alerts, arrive first on-site to engage in dialogue with families, and remain with family members and the response teams to address any concerns or issues. This strategy has been implemented in 12 Beni neighbourhoods and is under consideration for scaling across health zones. Community engagement activities have also been extended to essential groups like women’s groups, taxi drivers, youth groups, and students. Refresher training with community relays and leaders to improve the quality of engagement and community-based surveillance is underway in Beni and Tchomia, with sessions planned in Oicha and Butembo next week.
  • Red Cross safe and dignified burial (SDB) teams are operational in Mangina, Beni, Oicha and Tchomia; trained teams are on stand-by in Mambasa and Goma. The recent escalation of violence, including an incident resulting in injury to three Red Cross volunteers on 2 October, has resulted in the cessation of Red Cross SDB activities in Butembo until further notice. Civil Protection teams are currently responding to SDB alerts in Butembo. As of 10 October, a total of 236 SDB alerts were received, of which 190 were responded to successfully. Thirty-two responses were unsuccessful due to community refusals or burials conducted prior to the arrival of SDB teams. Seven SDB alerts have not been responded to due to security concerns. Capacity for Beni SDB is being strengthened due to an anticipated increase in alerts, and the mayor of Beni has announced that all deaths must be accompanied by a death certificate. Rapid diagnostic tests are being considered as part of validating hospital and community deaths.
  • Point of Entry (PoE): A cross-border coordination meeting was held from 2-4 October in Uganda to discuss preparedness and response to the current Ebola outbreak, with representatives from Democratic Republic of the Congo, Uganda, South Sudan, Rwanda, Burundi, Tanzania and Kenya in attendance. As of 9 October, health screening has been established at 57 Points of Entry (PoEs) and over 7.7 million travellers have been screened. IOM and PNHF have set a community-based cross-border coordination meeting in Tchomia. Staff from the United States Centers for Disease Control and Prevention (CDC) have deployed to support health screening at 11 operational PoEs in South Sudan.

To support the MoH, WHO is working intensively with a wide range of multisectoral and multidisciplinary regional and global partners and stakeholders for EVD response, research and urgent preparedness, including in neighbouring countries. Among the partners are a number of UN agencies and international organizations including: European Civil Protection and Humanitarian Aid Operation (ECHO; International Organization for Migration (IOM); the United Nations Children’s Fund (UNICEF); UN High Commission for Refugees (UNHCR); World Food Programme (WFP); United Nations Office for the Coordination of Humanitarian Affairs (OCHA); Inter-Agency Standing Committee (IASC); UK Public Health Rapid Support Team; United States Agency for International Development (USAID); Centers for Disease Control and Prevention (CDC); multiple Clusters, peacekeeping operations and the UN mission; UN Department of Safety and Security (UNDSS); World Bank and regional development banks; African Union, Africa Centres for Disease Control and Prevention and regional agencies; Health Cluster partners and NGOs including ALIMA, ADECO, AFNAC, CARITAS DRC, CEPROSSAN, CARE International, COOPI, CORDAID/PAP-DRC, ICRC, IFRC, Red Cross of the Democratic Republic of the Congo, INTERSOS, IRC, MEDAIR, MSF, PNHF, Samaritan’s Purse, and SCI; Global Outbreak Alert and Response Network (GOARN), Steering Committee, EDPLN, ECCARN, technical networks and operational partners, and the Emergency Medical Team (EMT) Initiative. GOARN partners continue to support the response through deployment for response and readiness activities in non-affected provinces and in neighbouring countries and to different levels of WHO.

WHO risk assessment

This outbreak of EVD is affecting north-eastern provinces of the country, which borders Uganda, Rwanda and South Sudan. Potential risk factors for transmission of EVD at the national and regional levels include: transportation links between the affected areas, the rest of the country, and neighbouring countries; the internal displacement of populations; and the displacement of Congolese refugees to neighbouring countries. The country is concurrently experiencing other epidemics (e.g. cholera, vaccine-derived poliomyelitis), and a long-term humanitarian crisis. Additionally, the security situation in North Kivu and Ituri at times limits the implementation of response activities. On 28 September 2018, based on the worsening security situation, WHO revised its risk assessment for the outbreak, elevating the risk at national and regional levels from high to very high. The risk remains low globally. WHO continues to advise against any restriction of travel to, and trade with, the Democratic Republic of the Congo based on currently available information.

As the risk of national and regional spread is very high, it is important for neighbouring provinces and countries to enhance surveillance and preparedness activities. WHO will continue to work with neighbouring countries and partners to ensure that health authorities are alerted and are operationally prepared to respond.

WHO advice

WHO advises against any restriction of travel and trade to the Democratic Republic of the Congo based on the currently available information. WHO continues to closely monitor and, if necessary, verify travel and trade measures in relation to this event. Currently, no country has implemented travel measures that significantly interfere with international travel to and from the Democratic Republic of the Congo. Travellers should seek medical advice before travel and should practice good hygiene.

For more information, see:

WHO

 

By |2018-10-13T22:22:24+00:00October 13th, 2018|

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Ebola virus disease – Democratic Republic of the Congo

Six weeks into the Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo, the overall situation has improved since the height of the epidemic; however, significant risks remain surrounding the continued detections of sporadic cases within Mabalako, Beni and Butembo health zones in North Kivu Province. While the majority of communities have welcomed response measures, such as daily contact monitoring and vaccination where appropriate, in some, risks of transmission and poor disease outcomes have been amplified by unfavourable behaviours, with reluctance to adopt prevention and risk mitigation behaviours. There have been challenges with contact tracing activities due to the constant movement of people between health zones, individuals hiding when symptoms develop and reports of community resistance. Risks are heightened by continued transmission in local health facilities because of poor infection prevention and control (IPC) measures, sporadic reports of unsafe burials, and the detection of cases in hard-to-reach and insecure areas.

Since the last Disease Outbreak News (data as of 5 September), eight new EVD cases, all of which are confirmed, have been reported: three from Beni, three from Butembo and two from Mabalako health zones. All eight new cases have been directly linked to an, ongoing transmission chain stemming from a community in Beni.

Of the three new cases in Butembo, one was an adult male from Mangina who reported an earlier illness and then was laboratory confirmed post-recovery via testing of a semen sample when his spouse was diagnosed with EVD. Given that he was asymptomatic since travelling to Butembo, the risk of onward transmission from this individual is minimal. The other two cases were health workers who cared for a subsequently-confirmed case (reported in the last Disease Outbreak News) at a small health post and assisted in her transfer to a tertiary hospital. This brings the total to 19 reported cases among health workers: 18 were laboratory confirmed and three have died. All 19 exposures occurred in local health facilities outside of dedicated Ebola treatment centres (ETCs).

As of 12 September 2018, a total of 137 EVD cases (106 confirmed and 31 probable), including 92 deaths (61 confirmed and 31 probable)1 have been reported in seven health zones in North Kivu Province (Beni, Butembo, Kalunguta, Mabalako, Masereka, Musienene and Oicha), and Mandima Health Zone in Ituri Province (Figure 1). An overall decreasing trend in weekly case incidence continues (Figure 2); however, these trends must be interpreted with caution given the expected delays in case reporting and the ongoing detection of sporadic cases. Of the 130 probable and confirmed cases for whom age and sex information is known, adults aged 35–44 years (22%) and females (57%) accounted for the greatest proportion of cases (Figure 3).

Alerts for suspected viral haemorrhagic fever cases in the outbreak-affected areas, other provinces of the Democratic Republic of the Congo, and in neighbouring countries continue to be closely monitored and rapidly investigated. In the outbreak-affected areas, 15–31 new alerts were reported each day during the past week, of which 4–16 alerts were verified as new suspected cases requiring further investigation and testing. As of 12 September, 17 suspected cases are currently pending testing to confirm or exclude EVD. Moreover, EVD was ruled out for recent alerts from Kasaji, Tanganyika, Tshopo and Kinshasa provinces, as well as for all alerts from neighbouring countries.

Figure 1: Confirmed and probable Ebola virus disease cases by health zone in North Kivu and Ituri provinces, Democratic Republic of the Congo, data as of 12 September 2018 (n=137)

Figure 2: Confirmed and probable Ebola virus disease cases by week of illness onset, data as of 12 September 2018 (n=137)*

*Data in recent weeks are subject to delays in case confirmation and reporting, as well as ongoing data cleaning.

Figure 3: Confirmed and probable Ebola virus disease cases by age and sex, data as 12 September 2018 (n=130)*

*Age and/or sex unknown for n=7 cases.

Public health response

The MoH continues to strengthen response measures, with support from WHO and partners. Priorities include coordinating the response, surveillance, contact tracing, laboratory capacity, IPC, clinical management of patients, vaccination, risk communication and community engagement, safe and dignified burials, cross-border surveillance, and preparedness activities in neighbouring provinces. WHO and partners are also conducting preparedness activities in neighbouring countries.

  • As of 13 September, 190 experts are deployed by WHO to support response activities including emergency coordinators, epidemiologists, laboratory experts, logisticians, clinical care specialists, communicators, and community engagement specialists.
  • Over 5500 contacts have been registered to date, of which 1751 remain under surveillance as of 12 September 1. Of these, 75–92% were followed-up daily during the past week. A dip in contact tracing performance rates observed earlier in the week was partly attributed to delays and challenges in establishing contact tracing teams around recent cases in Butembo and Masereka health zones. Response teams are working to address these challenges and improvements in the proportion of contacts successfully reached have been observed in recent days. Strategies are being reviewed to ensure those at high risk of disease are prioritized, rapidly detected, isolated and admitted for treatment if symptoms develop.
  • As of 13 September, 52 vaccination rings have been defined, in addition to 17 rings of health workers and other frontline workers. These rings include the contacts (and their contacts) of 55 confirmed cases from the last three weeks. To date, 8902 people consented and were vaccinated, including 2951 health care or frontline workers, and 2054 children.
  • To support the MoH, WHO is working intensively with a wide range of, multisectoral and multidisciplinary regional and global partners and stakeholders for EVD response, research and urgent preparedness, including in neighbouring countries. The includes the UN secretariat, sister Agencies, including International Organization for Migration (IOM), the United Nations Children’s Fund (UNICEF), World Food Programme (WFP), United Nations Office for the Coordination of Humanitarian Affairs (OCHA), Inter-Agency Standing Committee (IASC), multiple Clusters, and peacekeeping operations; World Bank and regional development banks; African Union, and Africa Centres for Disease Control and Prevention (CDC) and regional agencies; Global Outbreak Alert and Response Network (GOARN), Steering Committee, technical networks and operational partners, and the Emergency Medical Team Initiative. GOARN partners continue to support the response through deployment for response, and readiness activities in non-affected provinces and in neighbouring countries.
  • ETCs are fully operational in Beni and Mangina with support from The Alliance for International Medical Action (ALIMA) and Médecins Sans Frontières (MSF), respectively. MSF Switzerland and the MoH are building a 10-bed ETC in Butembo, which is expected to be operational by 15 September and will replace the current transit centre. In Beni, ALIMA is planning to expand treatment capacity over the next two weeks. A 20-bed ETC is being constructed in Makeke in Ituri Province with the support of International Medical Corps (IMC), which is expected to be operational during the week of 17 September. A MSF transit centre is already operational in Makeke. Samaritan’s Purse continues to support the isolation unit in Bunia.
  • ETCs continue to provide therapeutics under the monitored emergency use of unregistered and experimental interventions (MEURI) protocol in collaboration with the MoH and the Institut National de Recherche Biomédicale (INRB). WHO is providing technical clinical expertise onsite and is assisting with the creation of a data safety management board.
  • The MoH, WHO, UNICEF, Red Cross and partners are intensifying activities to engage with local communities in Beni, Butembo and Mangina. Local leaders, religious leaders, opinion leaders, and community networks such as youth groups and motorbike taxi drivers are being engaged on a daily basis to support community outreach for Ebola prevention and early care seeking through active dialogues on radio and interpersonal communication. Community feedback is being systematically collected and their concerns are being addressed. Local frontline community outreach workers are working closely with Ebola response teams to strengthen community engagement and psychosocial support in contact tracing, patient care and safe and dignified burials (SDBs). The current focus is to intensify activities aimed at addressing community concerns through direct partnership with community members.
  • The Red Cross of the Democratic Republic of the Congo, with support from the International Federation of Red Cross (IFRC) and International Committee of the Red Cross (ICRC), are coordinating SDB. As of 12 September, Red Cross has established three operational bases in Beni, Mangina and Butembo; in total, 10 SDB teams are operational. To date, 124 SDBs are reported to have been successfully conducted. Red Cross has supported the training of civil protection SDB teams to ensure operational capacity in hard-to-reach areas.
  • Health screening has been established at 37 Points of Entry (PoE) and more than three million travellers have been screened at these PoE

WHO risk assessment

This outbreak of EVD is affecting north-eastern provinces of the Democratic Republic of the Congo, which border Uganda, Rwanda and South Sudan. Potential risk factors for transmission of EVD at the national and regional levels include the transportation links between the affected areas, the rest of the country, and neighbouring countries; the internal displacement of populations; and the displacement of Congolese refugees to neighbouring countries. The country is concurrently experiencing other epidemics (e.g. cholera, vaccine-derived poliomyelitis), and a long-term humanitarian crisis. Additionally, the security situation in North Kivu and Ituri continues to hinder the implementation of response activities. Based on this context, the public health risk was assessed to be high at the national and regional levels, and low globally.

As the risk of national and regional spread remains high, it is important for neighbouring provinces and countries to enhance

Medical workers lead a young girl with suspected Ebola into the unconfirmed Ebola patients ward run by The Alliance for International Medical Action (ALIMA), Aug. 12, 2018 in Beni, northeastern DRC.

surveillance and preparedness activities. WHO will continue to work with neighbouring countries and partners to ensure health authorities are alerted and are operationally ready to respond.

WHO advice

WHO advises against any restriction of travel and trade to the Democratic Republic of the Congo based on the currently available information. WHO continues to closely monitor and, if necessary, verify travel and trade measures in relation to this event. Currently, no countries have implemented any travel restriction to and from the Democratic Republic of the Congo. Travellers should seek medical advice before travel and should practice good hygiene.

For more information, see:

WHO

 

By |2018-09-15T18:37:19+00:00September 15th, 2018|

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Ebola virus disease – Democratic Republic of the Congo

Since the last Disease Outbreak News on 17 August 2018, 25 additional cases have been laboratory confirmed for Ebola virus disease (EVD) in the Democratic Republic of the Congo. These new confirmed cases have been reported in Beni, Oicha and Mabalako health zones (North Kivu province) and Mandima health zone (Ituri Province). However, all exposures and transmission events, to date, have been linked back to the outbreak epi-centre, Mabalako. Beyond the EVD outbreak, the Democratic Republic of the Congo is in a complex humanitarian crisis and is experiencing several other concurrent epidemics.

As of 22 August 2018, a total of 103 EVD cases (76 confirmed and 27 probable) including 63 deaths (36 confirmed and 27 probable) have been reported1 in five health zones in North Kivu (Beni, Butembo, Oicha, Mabalako, Musienene) and one health zone in Ituri (Mandima) (Figure 1). The majority of cases (62 confirmed and 21 probable) have been reported from Mabalako in Mabalako Health Zone (Figure 2). As of 22 August, six new suspected cases from Mabalako (n=3) and Beni (n=3) are pending laboratory testing to confirm or exclude EVD. A total of 88 confirmed and probable cases have age and sex reported. As of 19 August, the median age was 32 years (age range: 0-74), with the age group 30-39 accounting for 28% (25/88) of cases. Fifty eight percent (51/88) of all cases were female (Figure 3).

Fourteen cases have been reported among health workers, of which 13 were laboratory confirmed; one has died. Many of these health care workers were likely infected in clinics before the declaration of the outbreak, not in Ebola treatment centres (ETCs). WHO and partners are working with health workers and communities to increase awareness on infection, prevention and control (IPC) measures, as well as vaccinate those at risk of infection.

The MoH, WHO and partners continue to systematically monitor and rapidly investigate all alerts in all provinces of the Democratic Republic of Congo, and in neighbouring countries2. Alerts in several provinces of the Democratic Republic of Congo as well as in Uganda, Rwanda, and the Central African Republic have been investigated; EVD has been ruled out in all alert events to date.

For more information, see:

Figure 1: Confirmed and probable Ebola virus disease cases by week of illness onset, 22 August 2018 (n=103)

Figure 2. Confirmed and probable Ebola virus disease cases by health zone in North Kivu and Ituri provinces, Democratic Republic of the Congo, 15 August 2018

Figure 3: Confirmed and probable Ebola virus disease cases by age and sex, 19 August 2018 (n=88)

Public health response

The MoH has rapidly initiated response mechanisms in North Kivu and Ituri provinces, with support from WHO and partners. Priorities include the establishment and strengthening of surveillance, contact tracing, laboratory capacity, IPC, clinical management, vaccination, risk communication and community engagement, safe and dignified burials, response coordination, cross-border surveillance, and preparedness activities in neighbouring provinces and countries.

  • The Prime Minister and the MoH of the Democratic Republic of the Congo visited various points of entry (PoEs) in Goma where health measures to screen travellers are being implemented.
  • On 20 August, 7160 additional doses of vaccines arrived in Kinshasa and were promptly transported to Beni. An additional 2160 doses of vaccine will be shipped before the end of the week.
  • As of 20 August, contact tracing activities have resumed in Mandima health zone following the engagement of communities by the national and local authorities. A network of partners has been set up to develop geographic information and interactive visualization tools to allow real-time monitoring of the evolution of the situation and the response.
  • As of 19 August, WHO has deployed over 100 technical and logistics specialists to support response activities. Global Outbreak Alert and Response Network (GOARN) partner institutions continue to support the response as well as ongoing readiness and preparedness activities in non-affected provinces of the Democratic Republic of the Congo and in neighbouring countries.
  • The Alliance for International Medical Action (ALIMA) and Médecins Sans Frontières (MSF) have established Ebola treatment centres (ETCs) in Beni and Mangina. ETCs have been prepared to provide therapeutics under the monitored emergency use of unregistered and experimental interventions (MEURI) protocol in collaboration with the MoH and the Institut National de Recherche Biomédicale (INRB). WHO is providing technical expertise on site and is assisting with the creation of a data safety management board. To date, 13 patients have received investigational therapeutics.
  • A medical evacuation (medevac) support team from Norway arrived in Goma to provide specialized training on medevac procedures and handling of equipment using already existing facilities donated by Norway.
  • Efforts to improve communication and engagement between responders and community members are being prioritized, especially in relation to patient care and loss of lives as a result of EVD. Additionally, outreach and sensitization activities with community influencers and networks will continue in affected areas.
  • The WHO Regional Office for Africa (AFRO) has facilitated the deployment of nine experts and is in the process of deploying an additional 15 experts to 10 countries including the Democratic Republic of the Congo for EVD preparedness activities.
  • GOARN and AFRO regional partners are implementing preparedness and readiness missions in at-risk countries neighbouring the Democratic Republic of the Congo. Multi-disciplinary teams composed of staff from WHO and other operational partners have been deployed in Rwanda and Burundi.
  • The International Federation of Red Cross and Red Crescent Societies (IFRC) is supporting the Congolese Red Cross to conduct safe and dignified burial (SBD). As of 23 August 2018, six SDB teams are operational in Beni, Mangina and Butembo. Two additional teams will complete their training this week and will be operational. As of 21 August, 47 SDBs have been successful conducted.
  • The International Organization for Migration (IOM), WHO and the U.S. Centers for Disease Control and Prevention (CDC) are supporting the National Border Health Programme of the MoH to map and equip critical points of entry to help detect and prevent the spread of the disease to other provinces and internationally.
  • As of 20 August 2018, Points of Entry (POE) surveillance (health screening) activities, along with risk communication and hygiene promotion, are in place at 21 sites in Beni and in Goma.
  • The WHO preparedness team in the Democratic Republic of the Congo, in collaboration with the MoH and partners, have identified 14 provinces (priority 1: Sud Kivu, Ituri, Maniema, Tshopo; priority 2: Haut-Uele, Mongala, Nord-Ubangi, Sud-Ubangi; priority 3: Sankuru, Kasai, Kasai Central, Kasai Oriental, Bandundu, Lomani) to enhance their preparedness and readiness capacities.

WHO risk assessment

This latest outbreak of EVD is affecting north-eastern provinces of the Democratic Republic of the Congo which border Uganda, Rwanda and South Sudan. Potential risk factors for transmission of EVD at the national and regional levels include the transportation links between the affected areas, the rest of the country, and neighbouring countries; the internal displacement of populations; and displacement of Congolese refugees to neighbouring countries. The country is concurrently experiencing several epidemics and a long-term humanitarian crisis. Additionally, the security situation in North Kivu and Ituri may hinder the implementation of response activities. Based on this context, the public health risk was assessed to be high at the national and regional levels, and low globally.

WHO advice

The Strategic Advisory Group of Experts (SAGE) working group on Ebola vaccines has reviewed the epidemiological situation and the evidence available with regard to the different candidate Ebola vaccines and the impact of different interventions. While ring vaccination remains the preferred strategy (as stated in the April 2017 SAGE report), a geographic targeted approach was proposed as an exceptional alternative if the ring vaccination around a laboratory-confirmed case of Ebola proves unfeasible. The following interim recommendation was agreed upon: “Should an Ebola disease outbreak occur before the candidate vaccine is licensed, SAGE recommended that the rVSV-ZEBOV Ebola vaccine be promptly deployed under the Expanded Access framework, with informed consent and in compliance with Good Clinical Practice. If the outbreak is caused by an Ebola virus species other than Zaire, consideration should be given to the use of other candidate vaccines that target the putative viral species”3.

For more information, see:

 JUNIOR D. KANNAH/AFP/Getty Images)

As investigations continue to establish the full extent of this outbreak and the risk of national and regional spread remains high, it is important for neighbouring provinces and countries to enhance surveillance and preparedness activities. WHO will continue to work with neighbouring countries and partners to ensure health authorities are alerted and are operationally ready to respond.

WHO advises against any restriction of travel and trade to the Democratic Republic of the Congo based on the currently available information. WHO continues to closely monitor and, if necessary, verify travel and trade measures in relation to this event. Currently, no country has implemented any travel restriction to and from the Democratic Republic of the Congo. Travellers to DRC should seek medical advice before travel and should practice good hygiene.

For more information, see:

WHO

 

By |2018-08-25T13:18:53+00:00August 25th, 2018|

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