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DRC: Ebola cases climb to 835

WHO

Ebola virus disease – Democratic Republic of the Congo

Disease outbreak news: Update
14 February 2019

Despite slightly fewer cases reported during the past week (Figure 1), current epidemiological indicators highlight that 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 regions. During the last 21 days (23 January – 12 February 2019), 97 new cases have been reported from 13 health zones (Figure 2), including: Katwa (59), Butembo (12), Beni (7), Kyondo (4), Oicha (4), Vuhovi (3), Biena (2), Kalunguta (2), Komanda (1), Manguredjipa (1), Mabalako (1), Masereka (1), and Mutwanga (1).1 The recent case reported in the Komanda health zone was a resident of Katwa who was exposed to the virus, and subsequently travelled to both Bunia and Komanda. This case comes one month after the last reported case in Ituri Province; underscoring the high risks of reintroduction to previously affected areas, as well as the potential for spread to new ones.

As of 12 February, 823 EVD cases2 (762 confirmed and 61 probable) have been reported, including 517 deaths (overall case fatality ratio: 63%). Cumulatively, cases have been reported from 118 of 287 health areas across 18 health zones, of which 37 health areas have reported a case in the last 21 days. Thus far, 283 people have been discharged from Ebola Treatment Centers (ETCs) and enrolled in a dedicated monitoring and support programme. One new health worker infection was reported in Katwa. To date, a total of 68 health workers have been infected.

Main challenges this past week primarily pertain to community mistrust, particularly in Katwa, and the difficulty in encouraging community members to be more proactive in reporting suspected cases, presenting early to ETCs for treatment, and participating in community-based prevention and response efforts. However, in the face of these protracted challenges, response strategies have demonstrated to be effective in curtailing the spread of EVD. Fostering greater community trust by strengthening engagement with its members remains a top priority for response teams.

On 13 February, the Ministry of Health (MoH) launched the Strategic Response Plan 3 (SRP 3). The plan lays out the response strategy, objectives and budget requirements for the MoH, WHO, and all implementing partners for the next six months (February through July 2019). SRP 3 takes into account recommendations from operational reviews, and builds on a series of new strategic directions that capitalize on lessons learned under the scope of SRP 2. Activities laid out aim to stop the transmission of EVD in North Kivu and Ituri provinces, and prevent its spread to other provinces and neighbouring countries.

WHO remains confident that this outbreak can be successfully brought to an end through strategies outlined in SRP 3. To achieve the goals set out by the plan, MoH, WHO, and partners are appealing for US$ 148 million. WHO and partners count on the continued support of the international community to provide the required funding in order to stop this outbreak.

Figure 1: Confirmed and probable Ebola virus disease cases by week of illness onset, data as of 12 February 2019 (n=822)

Figure 2: Confirmed and probable Ebola virus disease cases reported between 22 January and 11 February by place of residence, North Kivu and Ituri provinces, Democratic Republic of the Congo (n=101)*

*Map based on the latest available detailed line lists (data as of 11 February 2019), and excludes cases reported after this date, as well as cases with delayed/missing village or health area details. Categorization of cases by health zone may differ from the reported place of residence.

Public health response

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

WHO risk assessment

WHO continuously monitors changes to the epidemiological situation and context of the outbreak to ensure that support to the response is adapted to the evolving circumstances. The last review conducted on 7 February 2019, outlines the high risk the EVD outbreak poses at the national and regional levels, though global risk levels remain low. This EVD outbreak is affecting primarily the north-eastern provinces of the Democratic Republic of the Congo bordering Uganda, Rwanda, and South Sudan. There is a potential risk for transmission of EVD at the national and regional levels due to extensive travel between the affected areas, the rest of the country, and neighbouring countries for economic and personal reasons, as well as due to insecurity. The country is concurrently experiencing other epidemics (e.g. cholera, vaccine-derived poliomyelitis, malaria), and a long-term humanitarian crisis. Additionally, the fragile security situation in North Kivu and Ituri, further limits the implementation of response activities.

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 to, and trade with, 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:


1 Excludes newly probable cases from Katwa (7) and Komanda (5), who died in November and December 2018 and were reported during the period of 21 January to 10 February following a retrospective re-classification of cases.

2 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.


DRC and EBV: Outbreak totals now stand at 800 cases, including 502 deaths, and 178 suspected cases are still under investigation.

SITUATION ÉPIDÉMIOLOGIQUE DANS LES PROVINCES DU NORD-KIVU ET DE L’ITURI

Vendredi 8 février 2019

La situation épidémiologique de la Maladie à Virus Ebola en date du 7 février 2019 :
  • Depuis le début de l’épidémie, le cumul des cas est de 800, dont 739 confirmés et 61 probables. Au total, il y a eu 502 décès (441 confirmés et 61 probables) et 271 personnes guéries.
  • 178 cas suspects en cours d’investigation.
  • 2 nouveaux cas confirmés, dont 1 à Oicha et 1 à Kyondo
  • 3 nouveaux décès de cas confirmés :
    • 1 décès communautaire à Kyondo
    • 2 décès au CTE, dont 1 à Butembo et 1 à Katwa
  • 7 nouveaux cas probables (décès historiques) validés à Katwa.
    • Plus d’informations à ce sujet seront fournis dans le bulletin du samedi 9 février 2019.
  • 4 nouvelles personnes guéries sorties du CTE de Butembo.

Ebola cases in DRC jump to 785

DRC

Lancet

“…..Faced with an evolving complex humanitarian crisis, and recent elections complete, WHO Director-General Tedros Adhanom Ghebreyesus should reconvene the Emergency Committee (EC) and consider declaring a Public Health Emergency of International Concern (PHEIC)……..”


The Ministry of Health of South Sudan, with support from the World Health Organization (WHO), Gavi, the Vaccine Alliance, UNICEF and the US Centers for Disease Control and Prevention (CDC) and other partners, today started vaccinating health workers and other front-line responders against Ebola as part of preparedness measures to fight the spread of the disease.

WHO

Yambio, 28 January 2019 – The Ministry of Health of South Sudan, with support from the World Health Organization (WHO), Gavi, the Vaccine Alliance, UNICEF and the US Centers for Disease Control and Prevention (CDC) and other partners, today started vaccinating health workers and other front-line responders against Ebola as part of preparedness measures to fight the spread of the disease.

Vaccination began in Yambio, Gbudue State, but health workers in Tombura, Yei and Nimule as well as the capital city, Juba, will also be offered the vaccine. These are high-risk areas bordering the Democratic Republic of the Congo (DRC), now experiencing its tenth outbreak of Ebola. The outbreak began 1 August 2018. Neighbouring countries have not reported any cases of Ebola, but preparedness is crucial.

As part of these preparedness activities, South Sudan received 2 160 doses of the Ebola vaccine (rVSV-ZEBOV) from Merck, the vaccine developer. The vaccine offers protection against the Zaire strain of the virus, which is the one affecting DRC at present.

“It is absolutely vital that we are prepared for any potential case of Ebola spreading beyond the Democratic Republic of the Congo,” said Dr Matshidiso Moeti, WHO Regional Director for Africa. “WHO is investing a huge amount of resources into preventing Ebola from spreading outside DRC and helping governments ramp up their readiness to respond should any country have a positive case of Ebola.”

Vaccination is one of a raft of preparedness measures South Sudan is putting into place. WHO has deployed more than 30 staff members to support these activities.

In particular, WHO has helped train 60 health workers in good clinical practice principles and protocol procedures to administer the yet-to-be-licensed Ebola vaccine. To detect any travellers entering the country who may be infected with the virus, the Ministry of Health, with the support of its partners, has established 17 screening points. Nearly 1 million people have been screened to date.

WHO is also supporting engagement with communities, active surveillance for the disease at the community and health facility levels, strengthening capacity for infection prevention and control and case management, and supporting dissemination of Ebola information through the media. Local laboratory capacity to test samples taken from people suspected of having Ebola is also being strengthened. Protective gear for responders has been stockpiled in a dedicated warehouse.

Gavi, the Vaccine Alliance, in addition to its work making the Ebola vaccine stockpile available, is providing US$2 million to support the WHO’s vaccination efforts in countries neighbouring the DRC, including South Sudan.

“Although research is ongoing, the evidence so far suggests the Ebola vaccine is a highly effective tool to help stop epidemics and can be used to prevent this national outbreak from becoming a regional one,” said Dr Seth Berkley, CEO of Gavi. “Vaccinating front-line workers and health workers in South Sudan border regions will be crucial: an outbreak in South Sudan would be deeply concerning.”

Uganda began vaccinating its front-line workers in November 2018. So far, more than 2 600 health workers in eight high-risk districts have been immunized. In DRC, more than 66 000 people have been vaccinated – more than 21,000 of them are health and other front-line workers. Rwanda also plans to vaccinate its front-line responders.

The yet-to-be-licensed rVSV-ZEBOV vaccine has been shown to be highly protective against the Zaire strain of the Ebola virus in a major trial. Though not yet commercially licensed, the vaccine is being provided under what is known as “compassionate use” in the ongoing Ebola outbreak in North Kivu province of DRC as part of recommendations from the Strategic Advisory Group of Experts on Immunization. This vaccine was also used in the Ebola outbreak in Equateur province of DRC in May–July 2018.

 


The Democratic Republic of the Congo (DRC) reported 15 more Ebola cases

DRC

SITUATION ÉPIDÉMIOLOGIQUE DANS LES PROVINCES DU NORD-KIVU ET DE L’ITURI

Lundi 28 janvier 2019

La situation épidémiologique de la Maladie à Virus Ebola en date du 27 janvier 2019 :
  • Depuis le début de l’épidémie, le cumul des cas est de 736, dont 682 confirmés et 54 probables. Au total, il y a eu 459 décès (405 confirmés et 54 probables) et 257 personnes guéries.
  • 161 cas suspects en cours d’investigation.
  • 3 nouveaux cas confirmés, dont 2 à Katwa et 1 à Beni.
  • Aucun décès de cas confirmé rapporté ce jour.
  • 1 nouvelle personne guérie sortie du CTE de Beni.

For the first time, the type of deadly Ebola virus responsible for recent epidemics has been found in a bat in West Africa

NYT

“……Knowing which types of bat carry Ebola may help health officials prevent outbreaks by educating the public about how to prevent contact with the creatures…….”

See the source image


The number of confirmed cases in the Democratic Republic of the Congo (DRC) Ebola outbreak has jumped by 19

DRC

SITUATION ÉPIDÉMIOLOGIQUE DANS LES PROVINCES DU NORD-KIVU ET DE L’ITURI

Mardi 22 janvier 2019

La situation épidémiologique de la Maladie à Virus Ebola en date du 21 janvier 2019 :
  • Depuis le début de l’épidémie, le cumul des cas est de 699, dont 650 confirmés et 49 probables. Au total, il y a eu 433 décès (384 confirmés et 49 probables) et 246 personnes guéries.
  • 252 cas suspects en cours d’investigation.

Ebola in DRC: case total climbs to 593

WHO

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 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.

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:


1The number of cases is subject to change due to ongoing reclassification, retrospective investigation, and the availability of laboratory results.


The Democratic Republic of the Congo (DRC) ministry of health confirmed 18 new Ebola cases, including 9 deaths

EPIDEMIOLOGICAL SITUATION IN THE PROVINCES OF NORTH KIVU AND ITURI

Monday, December 17, 2018

The epidemiological situation of the Ebola Virus Disease dated December 16, 2018 :
  • Since the beginning of the epidemic, the cumulative number of cases is 539, of which 491 are confirmed and 48 are probable. In total, there were 315 deaths (267 confirmed and 48 probable) and 186 people cured.
  • 75 suspected cases under investigation.
  • 8 new confirmed cases, 3 in Katwa, 2 in Butembo, 2 in Komanda and 1 in Oicha.
  • 2 new deaths from confirmed cases in Katwa.
  • 2 new people healed out of Butembo CTE.


Ebola virus disease – Democratic Republic of the Congo Update

WHO

Disease outbreak news: Update
13 December 2018

The Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo is occurring in an unforgiving context. Non-engagement from communities and conflict continue to hamper response activities in some affected areas. Moreover, poor infection prevention and control (IPC) practices across numerous private and public health centers remain a major source of amplification of the outbreak and risk to health and other frontline workers.

Despite these challenges, substantial progress has been made on multiple fronts to address the situation, and daily successes are being observed in the implementation of proven public health measures alongside newer tools, such as vaccination and novel therapeutics. Together with the Ministry of Health (MoH) and our partners, WHO is further scaling up our response to the developing situation. WHO especially emphasizes the need to continuously improve quality, judiciously deploy new tools at our disposal, and sustain international commitment to response efforts well into 2019. Nonetheless, we remain confident the outbreak can be brought to a conclusion.

During the reporting period (5 through 11 December 2018), 37 new cases were reported from 10 health zones in North Kivu and Ituri provinces: Katwa and Butembo (18), Beni (seven), Mabalako (four), Oicha (three), as well as one case each in Komanda, Kyondo, Mandima, Musienene and Vuhovi. Four new infections of health workers have been reported in Musienene, Katwa and Butembo health zones. In total, 51 (49 confirmed and two probable) health workers have been infected to date, of whom 17 have died. Twenty-three additional survivors were discharged from Ebola treatment centres (ETCs) and reintegrated into their communities. A total of 177 patients have recovered to date.

As of 11 December, 505 EVD cases (457 confirmed and 48 probable), including 296 deaths, have been reported in 12 health zones in North Kivu Province and three health zones in Ituri Province (Figure 1). These zones represent a mix of densely populated urban areas and remote villages, each bringing a variety of factors driving transmission and posing different challenges. Trends in case incidence (Figure 2) reflect the continuation of the outbreak across these geographically dispersed areas, with an average of 33 new cases reported each week since mid-October. Although there has been a general decrease in the intensity of transmission in Beni in recent weeks, the outbreak is intensifying in Butembo and Katwa, and new clusters are emerging elsewhere. At present, the situation remains concerning.

The very high risk of further geographical spread of the outbreak was highlighted this week by the movement of several contacts of confirmed cases from Beni to Kisangani and Goma. All of these contacts were rapidly traced, and have since returned to Beni where they will complete their 21 day follow-up. Several alerts of potential cases were also received from Goma, and towns between Goma and Butembo. These individuals were promptly isolated, reported and tested negative for EVD. Preparedness and operational readiness activities in other areas of North Kivu and Ituri provinces, other provinces of the Democratic Republic of the Congo, and neighbouring counties, must continue to be upscaled to rapidly detect and respond to any potential cases.

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, 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.

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.


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