Global & Disaster Medicine

Archive for the ‘Ebola’ Category

DRC: As of 15 August 2018, 78 EVD cases (51 confirmed and 27 probable), including 44 deaths, have been reported.

WHO

Ebola virus disease – Democratic Republic of the Congo

Disease outbreak news
17 August 2018

On 1 August 2018, the Ministry of Health (MoH) of the Democratic Republic of the Congo declared a new outbreak of Ebola virus disease (EVD) in the town of Mangina, Mabalako Health Zone, North Kivu Province. Confirmed cases have since between reported from Beni and Mandima health zones, Ituri Province; however, all confirmed exposures and transmission events to date have been linked back to the outbreak epi-centre, Mangina. North Kivu and Ituri are among the most populated provinces in the country, share borders with Uganda and Rwanda, and experience conflict and insecurity, with over one million internally displaced people and migration of refugees to neighbouring countries.

As of 15 August 2018, 78 EVD cases (51 confirmed and 27 probable), including 44 deaths, have been reported.1 Since the DON published on 9 August, 34 new confirmed cases have been reported: seven from Ituri Province (Mandima Health Zone) and 27 from North Kivu Province (one in Beni and 26 in Mabalako health zones). The 78 confirmed or probable cases reside in five health zones in North Kivu and one health zone in Ituri. The majority of cases (39 confirmed and 21 probable) have been reported from Mangina in Mabalako Health Zone (Figure 1). As of 15 August, 24 suspected cases are currently pending laboratory testing to confirm or exclude EVD.

Eight new confirmed cases among health care workers have been reported, bringing the total number of infected health care workers to 10 (nine confirmed and one probable deceased case). These health care workers were likely exposed in clinics, not Ebola treatment centres (ETCs), many of which may have been infected before the declaration of the outbreak. WHO and partners are working to increase awareness of Ebola among health care and other frontline workers, and to strengthen infection prevention and control (IPC) measures.

The MoH, WHO and partners continue to systematically monitor and rapidly investigate all alerts in other provinces and in neighbouring countries. Since the last DON was published, alerts in several provinces of the Democratic Republic of Congo as well as in Uganda, Rwanda, and the Central African Republic were investigated; EVD was ruled out for all.

For more information, see:

 

ublic health response

The MoH 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.

  • During a two-day mission to the outbreak epi-centre, the WHO Director-General (DG), WHO Regional Director (RD) for Africa and WHO Deputy Director-General (DDG), Emergency Preparedness and Response, together with the Minister of Health, observed the launch of Ebola vaccination activities, visited the Emergency Operations Centre (EOC), met with partners and staff to discuss the challenges ahead, and assessed response measures and needs.
  • The WHO DG and the RD then visited Uganda where they were briefed by the WHO Representative on the country’s EVD preparedness. The DG and RD later met the Uganda Prime Minister, the Minister of Foreign Affairs, the Minister of Health, and the Minister of State for Primary Health Care to discuss EVD preparedness and WHO support.
  • The MoH has activated a multi-partner incident management system and an EOC to coordinate the response, with the main centre in Beni and the field coordination centre in Mangina. WHO has established an incident management team with personnel from the WHO Country Office, Regional Office for Africa and headquarters who are collaborating closely to ensure a comprehensive and effective response to the outbreak.
  • On 8 August, the MoH, with support from WHO and partners, launched the Ebola ring vaccination activities for high-risk populations. In the first days, health care and other frontline workers were vaccinated. As of 15 August, a total of five rings have been defined around 13 recently confirmed cases. Within these initial rings, more than 500 contacts and their contacts consented and received rVSV-ZEBOV Ebola vaccine thus far. Teams are continuing to identify and vaccinate all eligible contacts to help interrupt transmission of the virus.
  • The MoH and WHO continue to strengthen surveillance in the affected and surrounding areas. As of 15 August, nearly 1600 contacts, including more than 120 health workers, in North Kivu and Ituri provinces have been registered and are being followed up on daily basis.
  • As of 15 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 bordering countries. For more information about operational readiness and preparedness activities, please see the DON published on 14 August.
  • In addition to the mobile laboratory established in Beni on 3 August, local testing with Xpert Ebola has since been established in hospital facilities in Beni, Goma, and Mangina to facilitate the timely diagnosis of suspected cases.
  • The Alliance for International Medical Action (ALIMA) and Médecins Sans Frontières (MSF) have established 60-bed ETCs in Beni and Mangina, respectively. The partners are preparing the ETCs to provide therapeutics under the monitored emergency use of unregistered and experimental interventions (MEURI) protocol in collaboration with MoH and Institut National de Recherche Biomédicale (INRB). WHO is providing technical expertise support on site and assisting with the creation of a data safety management board.
  • The MoH team, with support from UNICEF, are training 90 psychosocial agents to provide psychosocial care to patients and other affected people.
  • Knowledge, Attitude and Practice (KAP) surveys were conducted in Beni and Mabalako health zones to assess the levels of EVD awareness in the communities. Findings from the survey will be used to improve the risk communication, social mobilization and community engagement strategy.
  • Two planes with supplies of cold chain equipment, isolation units and vehicles arrived in Beni on 11 and 12 August.

WHO risk assessment

This latest outbreak of EVD is affecting north-eastern provinces of the Democratic Republic of the Congo which border Uganda. 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 and the SAGE members have 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”.

For more information, see:

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.

For more information, see:


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


“…..Doctors Without Borders/Médecins Sans Frontières (MSF) opened an Ebola treatment center on Tuesday, August 14 in Mangina, a small town considered to be the epicenter of the outbreak in North Kivu, Democratic Republic of Congo. A total of 37 patients are currently hospitalized in this facility, with 31 of those cases confirmed and six suspected cases….”

MSF

 


DRC: The EBV outbreak total has risen to 52 cases, reflecting 25 confirmed and 27 probable cases.

DRC

SITUATION ÉPIDÉMIOLOGIQUE DANS LA PROVINCE DU NORD-KIVU
Dimanche 12 août 2018
La situation épidémiologique de la Maladie à Virus Ebola en date du 12 août 2018 :

  • Au total, 52 cas de fièvre hémorragique ont été signalés dans la région, dont 25 confirmés et 27 probables.
  • 48 cas suspects sont en cours d’investigation.
  • 3 nouveaux cas confirmés, dont 1 à Béni et 2 à Mangina (y compris un personnel de santé du Centre de Santé de Référence de Mangina)
  • 1 décès d’un cas confirmé à Mabalako
  • Des alertes avaient été notifiées dans la zone de santé d’Idjwi, dans la Province du Sud-Kivu. Les échantillons prélevés ont été analysés au laboratoire mobile de Goma et les tests se sont révélés négatifs.

WHO Director-General Dr Tedros Adhanom and WHO Regional Director Dr Matshidiso Moeti visiting Ebola treatment centre in Mangina


DRC & the EBV Outbreak: SITUATION ÉPIDÉMIOLOGIQUE DANS LA PROVINCE DU NORD-KIVU

DRC 

One more Ebola case was confirmed.

  • The overall total is now 44, which included 17 confirmed and 27 probable cases.
  • Health officials are investigating an additional 47 cases.
  • So far 36 deaths have been reported.


Mercredi 8 août 2018
La situation épidémiologique de la Maladie à Virus Ebola en date du 7 août 2018 :

  • Au total, 44 cas de fièvre hémorragique ont été signalés dans la région, dont 17 confirmés et 27 probables.
  • 47 cas suspects sont en cours d’investigation.
  • 1 nouveau cas confirmé à Béni.

 


Ebola and DRC: The number of confirmed and probable cases hit 43, across six health zones, and include 33 deaths.

WHO

Ebola virus disease – Democratic Republic of the Congo

Disease outbreak news
4 August 2018

On 28 July 2018, the North Kivu Provincial Health Division notified the Ministry of Health of the Democratic Republic of the Congo of a cluster of suspected acute haemorrhagic fever cases. On 1 August 2018, the Institut National de Recherche Biomédicale (INRB) in Kinshasa reported that four of six samples collected from hospitalised patients tested positive by GeneXpert automated PCR. These presumptive positive tests prompted an immediate escalation of response activities by the Ministry of Health, WHO and partners, and the declaration of the outbreak by the Minister of Health.

The prompt alert by the Ministry of Health to WHO, under the International Health Regulations, followed the detection and rapid investigation of a cluster of suspected viral haemorrhagic fever in a family in North Kivu Province during mid to late July 2018. Local health officials have since identified sporadic, antecedent deaths in the community since May 2018 (tentatively classified as probable cases), which are subject to ongoing investigations to determine if they are related to the current outbreak.

The Ministry of Health, WHO, and partners are working to establish the full extent of this outbreak. As of 3 August 2018, a total of 43 Ebola virus disease cases (13 confirmed and 30 probable), including 33 deaths, have been reported. An additional 33 suspected cases are currently pending laboratory testing to confirm or exclude Ebola virus disease. Three healthcare workers have been affected, of whom one has died.

Geographically, confirmed and probable cases are currently localised to five health zones in North Kivu Province (38 cases, including 13 confirmed and 25 probable), and one health zones in Ituri Province (5 probable cases) (Figure). Suspected cases are currently under investigation in one additional health zone of Ituri Province. The affected areas host over one million displaced people and shares borders with Rwanda and Uganda, with frequent cross border movement due to trade activities. The prolonged humanitarian crisis and deterioration of the security situation is expected to hinder response to this outbreak.

Further laboratory testing by INRB has detected Ebolavirus using conventional PCR in three of the initial batch of six samples from Mabalako Health Zone. These results are highly suggestive that Ebola Zaire species is the cause of this outbreak; however, genetic sequencing is necessary to definitively confirm the virus species.

Characterization of viral sequences will help to inform the potential use of vaccines and therapeutics, and any link to the recent outbreak in Équateur Province – located in the far west of the country, some 2 500 km from the current outbreak. Currently there is no evidence to suggest that these events are related.

Figure 1: Ebola virus disease by health zone, North Kivu and Ituri Provinces, Democratic Republic of the Congo, 3 August 2018

Public health response

The Ministry of Health has initiated response mechanisms in North Kivu and Ituri provinces with support from WHO and partners. Priorities include the establishment and strengthening of surveillance, contract tracing, laboratory capacity, infection prevention and control (IPC), clinical management, community engagement, safe and dignified burials, response coordination, cross-border surveillance and preparedness activities in neighbouring provinces and countries. In addition, the potential for use of Ebola vaccines, as well as therapeutics for treatment of Ebola virus disease, are being reviewed.

  • The Ministry of Health and WHO have deployed Rapid Response Teams to the affected health zones to initiate response activities.
  • WHO has activated country, regional and global coordination mechanisms to assess risks and respond accordingly to the event. An incident management team has been established in the Democratic Republic of the Congo, and support teams have been reactivated at the WHO Regional Office for Africa and at headquarters. Coordination meetings with Ministry of Health and partners were held on 1 August 2018 for deployment of human resources and material. Immediate logistical capabilities and needs are being established, and a full response plan is being developed.
  • WHO has provided technical and operations support to the Ministry of Health and partners in the activation of a multi-partner multi-agency Emergency Operations Centre to coordinate the response.
  • With support of international partners, Ebola treatment centres are being established in Mangina, Beni and Goma.
  • A mobile laboratory has been established in Beni to facilitate timely diagnoses of suspected cases. The establishment of additional laboratory capacities elsewhere is being explored.
  • Contact tracing activities have been initiated. Thus far, 879 contacts have been registered for follow-up.
  • The Regional Emergency Director for Africa has informed neighbouring countries (Rwanda and Uganda) of the outbreak and emphasized the importance of surveillance and preparedness actions, especially along the border.
  • Activities to sensitize communities to the outbreak, and hygiene and sanitation measures, through media and churches have begun in affected communities, and in neighbouring Uganda and Rwanda.
  • On 1 August, the Global Outbreak Alert and Response Network (GOARN) Operational Support Team has issued an alert to its network partners, providing an overview of the current situation and ongoing response activities. On 2 August, the GOARN Steering Committee and WHO Regional Office for Africa conducted a joint coordination call for operational partners in Africa. GOARN partners continue to contribute to response activities.

WHO risk assessment

This new outbreak of Ebola virus disease is affecting north eastern provinces of the Democratic Republic of the Congo, which border Uganda. Potential risk factors for transmission of EVD at 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 may hinder the implementation of response activities. Based on this context, the public health risk is considered high at the national and regional levels and low globally.

WHO advice

As investigations continue to establish the full extent of this outbreak, it is important for neighbouring provinces and countries to enhance surveillance and preparedness activities. WHO will continue to work with neighbouring countries to ensure health authorities are alerted and prepared 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 monitor travel and trade measures in relation to this event.


The Democratic Republic of Congo (DRC) health ministry announced that it has received reports of 25 fever cases with symptoms similar to Ebola in the eastern part of the country.

DRC Ministry of Health

MIN SANTE – PRESS RELEASE – JULY 30, 2018
Reported fever cases in Mabalako Health Zone, North Kivu Province
Kinshasa, July 30, 2018 – This Saturday, July 28, 2018, the Provincial Health Division of North Kivu has notified 25 cases of fever in the health area of ​​Mangina, located about 30 km southwest of the city of Blessed. Samples have been collected and are being sent to Kinshasa for analysis by the National Institute for Biomedical Research (INRB).

An investigative team from the General Directorate for the Fight Against Disease (DGLM) composed of three experts, including two epidemiologists and a biologist, will arrive in Beni as early as Tuesday, July 31, 2018 to support the provincial team.

The Ministry of Health instructed health professionals in the province to respect individual protection measures. In addition, the Ministry invites the population in the areas concerned to remain calm, vigilant and to respect the hygiene measures, in particular the regular washing of the hands.

END

Ebola outbreak in DRC ends

WHO

Ebola outbreak in DRC ends: WHO calls for international efforts to stop other deadly outbreaks in the country

24 July 2018

News Release
KINSHASA/GENEVA

Today marks the end of the ninth outbreak of Ebola in the Democratic Republic of the Congo (DRC). The World Health Organization (WHO) congratulates the country and all those involved in ending the outbreak, while urging them to extend this success to combatting other diseases in DRC.

WHO Director-General, Dr Tedros Adhanom Ghebreyesus, and Regional Director for Africa, Dr Matshidiso Moeti, joined Minister of Health Dr Oly Ilunga for the announcement in Kinshasa.

“The outbreak was contained due to the tireless efforts of local teams, the support of partners, the generosity of donors, and the effective leadership of the Ministry of Health. That kind of leadership, allied with strong collaboration between partners, saves lives,” said Dr Tedros.

Unlike previous Ebola outbreaks in the country, this one involved four separate locations, including an urban centre with river connections to the capital and to neighbouring countries, as well as remote rainforest villages. There were initial concerns that the disease could spread to other parts of DRC, and to neighbouring countries.

Within hours of the outbreak being declared on 8 May, WHO released US$2 million from its Contingency Fund for Emergencies, deployed a team to augment capacity in the field, and activated an emergency incident management system.

“WHO moved quickly and efficiently,” said Dr Moeti, “We also demonstrated the tremendous capacity of the African region. More than three-quarters of the 360 people deployed to respond came from within the region. Dozens of experts from Guinea spent weeks leading Ebola vaccination efforts here, transferring expertise which will enable the DRC to mount an effective response both within its borders and beyond.”

Dr Tedros urged the DRC Government and the international community to build on the positive momentum generated by the quick containment of the Ebola outbreak.

“This effective response to Ebola should make the Government and partners confident that other major outbreaks affecting the country such as cholera and polio can also be tackled,” said Dr Tedros. “We must continue to work together, investing in strengthened preparedness and access to healthcare for the most vulnerable.”

  • WHO’s rapid response and scale up of operations in the DRC was funded by a total of US$4 million disbursement from the WHO Contingency Fund for Emergencies (CFE).
  • WHO and partners appealed for US$57 million to stop the spread of Ebola. The total funds received by all partners, as tracked by OCHA, amount to US$63 million.

A case of Ebola disease in a Liberian woman in 2015 who had recovered from the disease

The Lancet

Persistence of Ebola virus after the end of widespread transmission in Liberia: an outbreak report

Dokubo, Emily Kainne et al.
The Lancet Infectious Diseases

“…..Based on serology and epidemiological and genomic data, the most plausible scenario is that a female case in the November, 2015, cluster survived Ebola virus disease in 2014, had viral persistence or recurrent disease, and transmitted the virus to three family members a year later...…”


Ebola & severe neurologic sequelae among survivors

CDC-EID

Howlett PJ, Walder A, Lisk DR, Fitzgerald F, Sevalie S, Lado M, et al. Case series of severe neurologic sequelae of Ebola virus disease during epidemic, Freetown, Sierra Leone. Emerg Infect Dis. 2018 Aug [date cited]. https://doi.org/10.3201/eid2408.171367

“….We describe a case series of 35 Ebola virus disease (EVD) survivors during the epidemic in West Africa who had neurologic and accompanying psychiatric sequelae. Survivors meeting neurologic criteria were invited from a cohort of 361 EVD survivors to attend a preliminary clinic. Those whose severe neurologic features were documented in the preliminary clinic were referred for neurology specialist evaluation, ophthalmology examination, and psychiatric assessment. Of 35 survivors with neurologic sequelae, 13 had migraine headache, 2 stroke, 2 peripheral sensory neuropathy, and 2 peripheral nerve lesions. Of brain computed tomography scans of 17 patients, 3 showed cerebral and/or cerebellar atrophy and 2 confirmed strokes. Sixteen patients required mental health followup; psychiatric disorders were diagnosed in 5. The 10 patients who experienced greatest disability had co-existing physical and mental health conditions. EVD survivors may have ongoing central and peripheral nervous system disorders, including previously unrecognized migraine headaches and stroke.….”

 


An Ebola outbreak in the Democratic Republic of Congo has been declared “largely contained” by the WHO.

NY Times

  • More than 3,200 people were vaccinated in Congo
  • None of those vaccinated became ill

    53 cases that were laboratory-confirmed or considered “probable” had been detected, and 29 patients had died

    More than 1,500 contacts of the confirmed or probable cases had been followed for 21 days and had not displayed Ebola symptoms, the W.H.O. said. Three weeks is considered the maximum incubation period for the infection.

    The outbreak will not officially be declared over until at least one more 21-day incubation period has passed

    Vue partielle de l’Unité de virologie et de l'immunologie Moléculaires de l'Institut national de recherche biomédicale (INRB) de Kinshasa. OMS/Eugene Kabambi


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