Global & Disaster Medicine

Archive for the ‘Ebola’ Category

WHO Director-General: Though the spread of Ebola to Uganda is a new development, it doesn’t signal a shift in outbreak dynamics.

WHO

14 June 2019

Thank you, Dr Aavitsland,

Good evening from DRC.

I would like to thank Dr Aavitsland for his leadership of the Emergency Committee, and all the members of the committee, as well as the advisors and those who made presentations.

As you have heard, the Emergency Committee has recommended for a third time, and I have agreed, that the current Ebola outbreak in DRC does not constitute a public health emergency of international concern.

Although the outbreak does not at this time pose a global health threat, I want to emphasise that for the affected families and communities, this outbreak is very much an emergency.

Today I have been in Kinshasa to discuss the current Ebola outbreak with the Prime Minister of DRC, the Minister of Health, opposition leaders, donors and others.

Tomorrow I will travel to Goma and Butembo, to meet with our incredible staff and partners who are on the frontline of this outbreak.

I will also be traveling to Uganda to assess the situation.

Since the outbreak started last August, there have been 2108 cases of Ebola, and 1411 deaths. This is tragic.

Although the spread of Ebola to Uganda is tragic, it is not a surprise. We have said since the beginning of the outbreak that the risk of cross-border spread was very high, and it remains very high.

The fact that it has taken this long is a testament to the incredible work of all partners on both sides of the border.

I particularly want to commend the Government of Uganda for the way it has responded. So far, the investments they have made and the plans they have put in place to prepare for Ebola are paying off.

The spread of Ebola to Uganda is a new development, but the fundamental dynamics of the outbreak haven’t changed.

We have the people, the tools, the knowledge, and the determination to end this outbreak.

We need the sustained political commitment of all parties, so we can safely access and work with communities.

We also need the international community to step up its financial commitment to ending the outbreak.

WHO’s current funding needs for the period from February to July are 98 million U.S. dollars, of which 43.6 million dollars has been received, leaving a gap of 54 million dollars. We call on all our partners to fill this gap as soon as possible.

I will not hesitate to convene it again if needed.

Thank you.

DRC:

Total cases: 2108
– Confirmed cases: 2014
– Probable cases: 94

Deaths: 1411
– Confirmed: 1317
– Probable: 94


Statement on the meeting of the International Health Regulations (2005) Emergency Committee for Ebola virus disease in the Democratic Republic of the Congo

WHO

14 June 2019

The meeting of the Emergency Committee convened by the WHO Director-General under the International Health Regulations (IHR) (2005) regarding Ebola virus disease in the Democratic Republic of the Congo (DRC) took place on Friday, 14 June 2019, from 12:00 to 17:00 Geneva time (CEST).

Context and Discussion

The Committee expressed its deep concern about the ongoing outbreak, which, despite some positive epidemiological trends, especially in the epicentres of Butembo and Katwa, shows that the extension and/or reinfection of disease in other areas like Mabalako, presents, once again, challenges around community acceptance and security. In addition, the response continues to be hampered by a lack of adequate funding and strained human resources.

The cluster of cases in Uganda is not unexpected; the rapid response and initial containment is a testament to the importance of preparedness in neighbouring countries. The Committee commends the communication and collaboration between DRC and Uganda.

At the same time, the exportation of cases into Uganda is a reminder that, as long as this outbreak continues in DRC, there is a risk of spread to neighbouring countries, although the risk of spread to countries outside the region remains low.

The Committee wishes to commend the heroic work of all responders, who continue to work under extremely challenging and stressful conditions.

The Committee extensively debated the impact of a PHEIC declaration on the response, possible unintended consequences, and how these might be managed. Differing views were expressed, as the Committee acknowledged that recent cases in Uganda constitute international spread of disease.

Conclusions and Advice

It was the view of the Committee that the outbreak is a health emergency in DRC and the region but does not meet all the three criteria for a PHEIC under the IHR. While the outbreak is an extraordinary event, with risk of international spread, the ongoing response would not be enhanced by formal Temporary Recommendations under the IHR (2005).

The Committee provided the following public health advice, which it strongly urges countries and responding partners to heed:

  • At-risk countries should improve their preparedness for detecting and managing exported cases, as Uganda has done.
  • Cross-border screening in DRC should continue and its quality improved and sustained.
  • Continue to map population movements and sociological patterns that can predict risk of disease spread.
  • All priority countries should put in place approvals for investigational medicines and vaccines as an immediate priority for preparedness.
  • Optimal vaccine strategies that have maximum impact on curtailing the outbreak, as recommended by WHO’s Strategic Advisory Group of Experts (SAGE), should be implemented rapidly.
    • The Committee is deeply disappointed that WHO and the affected countries have not received the funding and resources needed for this outbreak. The international community must step up funding and support strengthening of preparedness and response in DRC and neighbouring countries.
    • Continue to strengthen community awareness, engagement, and participation. There has been a great deal of progress in community engagement activities. However, in border communities, where mobility is especially likely, community engagement needs to be more sharply targeted to identify the populations most at risk.
    • The implementation by the UN and partners of more coordinated measures to reduce security threats, mitigate security risks, and create an enabling environment for public health operations is welcomed and encouraged by the Committee as an essential platform for accelerating disease-control efforts.
    • The Committee strongly emphasizes its previous advice against the application of any international travel or trade restrictions.
    • The Committee does not consider entry screening at airports or other ports of entry to be necessary.
  • The Committee advised the WHO Director-General to continue to monitor the situation closely and reconvene the Emergency Committee as needed.

    Proceedings of the meeting

    Members and advisors of the Emergency Committee were convened by teleconference.

    Because the Chair, Dr Robert Steffen, was unable to attend the meeting in person, Dr Preben Aavitsland chaired the proceedings.

    The Director-General welcomed the Committee by phone from the Democratic Republic of the Congo.

    Representatives of WHO’s legal department and the department of compliance, risk management, and ethics briefed the Committee members on their roles and responsibilities, as well as the requirements of the IHR and the criteria that define a PHEIC: an extraordinary event that poses a public health risk to other countries through international spread and that requires a coordinated international response. The Committee’s role is to give advice to the Director-General, who makes the final decision on the determination of a PHEIC. The Committee also provides advice or temporary recommendations as appropriate.

    Committee members were reminded of their duty of confidentiality and their responsibility to disclose personal, financial, or professional connections that might be seen to constitute a conflict of interest. Each member was surveyed and no conflicts of interest were identified.

    The Chair then reviewed the agenda for the meeting and introduced the presenters. Presentations were made by representatives of the Ministry of Health of the Democratic Republic of the Congo and of the National Communicable Disease Control Commission of Uganda.

    The situation in the Democratic Republic of the Congo was reviewed, including the current epidemiological situation and response strategies, including changes instituted to improve community engagement. Sustained, serious security incidents, which have resulted in injuries and deaths among responses have seriously impeded the response. There have been four waves of the outbreak since August 2018, but during the last month there has been a reduction in numbers of cases. Active case-finding for missing contacts is ongoing. Factors contributing to the ongoing outbreak include population movement, health-seeking behavior directed to traditional healers, poor infection prevention and control measures in health facilities, security challenges, and lack of involvement by political leaders.

    Representatives of the National Communicable Disease Control Commission in Uganda reviewed recent cases, contacts, and contact tracing. They updated the Committee on their response actions, including notification to WHO and political involvement, and preparedness activities that have been taking place since August 2018. A national coordination task force has been activated and a rapid response team deployed. Clinical management is available in an Ebola Treatment Unit in Bwera. Screening is taking place at official points of entry. Ring vaccination will begin on 15 June.

    A representative of the WHO Regional Office for Africa presented the status of regional preparedness activities, particularly in Burundi, Rwanda, South Sudan, and Uganda. Ongoing challenges were noted, especially at district/subnational levels, as well as inadequate crossborder collaboration and a lack of funding to sustain preparedness activities.

    A representative of the International Organization for Migration updated the Committee on prevention, detection, and control measures at points of entry, for cross-border preparedness.

    The UN Ebola Emergency Response Coordinator gave an update on the security situation and efforts to create a dynamic, nimble enabling environment to support outbreak response. There have been frequent disruptions to the response, which has had implications for increased numbers of cases. UN-wide support is needed to strengthen the public health response and coordinate international assistance. Access and community acceptance are increasing, with decreases in cases in some areas. Increases in attacks in some areas are being addressed.

    The WHO Secretariat gave an update on the current situation and provided details on the response to the current Ebola outbreak and preparedness activities in neighbouring countries. The risk assessment for DRC remains very high at national and regional levels but low at global level. Risk in Uganda remains moderate at the national level and low and regional and global levels. However, the high risks of the Uganda event have been mitigated by rapid communication and coordination among authorities across jurisdictions; detection at points of entry and subsequent response activities; and operational preparedness and readiness in Uganda. A high level of cooperation and transparency between DRC and Uganda was noted with appreciation.

    There has been an overall decline in case incidence in the last 5 weeks, but substantial rates of transmission continue, especially in a few hotspots. IPC measures, safe burials, and population mobility were reviewed, along with details of contact tracing. Operational scale-up was reviewed and a serious need for funding, both for the response and for preparedness, was underscored. Less than one-third of the resources needed are available; presently there is a funding shortfall of USD $54 million against $98 million needed for the response through July 2019.

    Based on the above advice, the reports made by the affected States Parties, and the currently available information, the Director-General accepted the Committee’s assessment that the Ebola outbreak in the Democratic Republic of the Congo does not constitute a Public Health Emergency of International Concern. In light of the advice of the Emergency Committee, WHO advises against the application of any travel or trade restrictions. The Director-General thanked the Committee Members and Advisors for their advice.


A flare-up of Ebola in Uganda: 2 dead

Ars Technica

“……Uganda announced its first case stemming from the outbreak on Tuesday, June 11. The case was in a 5-year-old Congolese boy who traveled across the border with family a few days earlier. The Ugandan Health Ministry reported shortly after that the boy succumbed to his infection the morning of June 12. Two of his family members also tested positive by that time: the boy’s 50-year-old grandmother and his 3-year-old brother.

Today, June 13, the Ministry announced that the grandmother had also passed….Also on Friday, the WHO will reconvene an Emergency Committee to assess whether the outbreak now constitutes a “public health emergency of international concern,” or PHEIC……..”

Uganda Map


First case of Ebola hits Uganda


WHO: The world is entering “a new phase” where large outbreaks of deadly diseases like Ebola are a “new normal”

BBC

“……There have been 2,025 cases of Ebola and 1,357 deaths from the virus during the outbreak in the Democratic Republic of Congo……”


DRC: The ministry of health confirmed 17 new Ebola case and 11 deaths

CDC

  • Situation update
    * Cases: 2008
  • *  Deaths: 1346

WHO

Psychological support for life after Ebola

It is a bittersweet day for Kennedy, 8 years old, who is about to be released from the Ebola Treatment Centre (ETC) in Butembo, in the Democratic Republic of the Congo.

On the one hand, he is cured.

On the other, he has lost two family members to the disease – and he does not know it yet.

Ebola has a fatality rate of about 50%, so explaining the loss of family members and helping patients through the grieving process is a daily task for psychologists who work alongside doctors, nurses and caregivers.

There are five psychologists and 11 psychosocial assistants, trained by the Danish Refugee Council and financed by UNICEF, working at the Butembo ETC.

Kennedy’s psychosocial assistant, Shabani Dezy, sits down with him for his session. First, he asks Kennedy some questions. Is he aware his sister and grandfather were also sick? When was the last time he saw them?

Then he explains how they too were admitted to the ETC as suspect cases and transferred to the confirmed cases ward. He talks about the time he and other health workers spent with them and the care they were given.

Finally, he asks about which religious background Kennedy belongs to and he explains they have gone to heaven for their second life.

“Kennedy, if today we call you a hero, it’s because God wanted you to stay alive because there is something you will accomplish in your life.”

Mental Health after Ebola

Outside the treatment centre, Kennedy’s family is waiting to receive him. His mother is still mourning the loss of her father and daughter. She too has been working with psychologist Dezy to move forward. He reminds her anytime she or Kennedy need help to come see him.

Dezy explains the people in the area are already traumatised by the ongoing conflict, and Ebola exacerbates the situation.

“Ebola is a new threat in this community. It has affected everyone’s mental health. It’s a disease that kills so many, and everyone is afraid of death. It also affects the economy because decontamination efforts require mattresses and other personal effects to be destroyed.”

Then there is the stigmatisation. Some households have had multiple deaths in the family. The surviving family members tend to be stigmatised by the community who stop doing business with them or coming to visit.

“They say, ‘there’s the family that brought us Ebola. We don’t want anything to do with them.’ My colleagues and I have worked hard to understand the environment surrounding families and to work to reintegrate them.”

Notes for editors

Providing Psychological Support to Ebola patients, survivors and affected communities

Ebola is a traumatic illness both in terms of symptom severity and mortality rates. Those affected are likely to experience psychological effects due to the traumatic course of the infection, fear of death and the experience of witnessing others dying. It can have a significant impact on the wellbeing of those affected, their family, community members and the health workers treating people with Ebola.

Survivors can experience psychosocial consequences due to feelings of shame or guilt (e.g. from transmitting infection to others) and stigmatization or blame from their communities. Some have been threatened, attacked, evicted, left behind by, or excluded from, their families and communities because they were seen as tainted and dangerous. Fear and stigma of Ebola are contributed to by cultural beliefs, widespread fears due to high infection risk, lack of information and misinformation.

WHO and partners provide financial resources, guidelines and training materials for responders to provide humane, supportive and practical help to communities affected by the Ebola outbreak in North Kivu, DRC.


The Ebola case count in the Democratic Republic of the Congo (DRC) will likely surpass 2,000 cases

DRC


MONUSCO Deputy UN Special Representative of the Secretary-General (DSRSG) David Gressly has been appointed UN Emergency Ebola Response Coordinator (EERC) in the Ebola affected areas of the DRC.

WHO

3 May 2019

Statement
Kinshasa/Butembo

Latest numbers as of 22 May 2019

Total cases: 1877
– Confirmed cases: 1789
– Probable cases: 88

Deaths: 1248
– Confirmed: 1160
– Probable: 88

With the Ebola epidemic in the Democratic Republic of the Congo now in its tenth month and the number of new cases increasing in recent weeks, the United Nations announced today measures to strengthen its response and end the outbreak.

The Ebola epidemic has claimed more than 1,200 lives and the risk of spread to other provinces in the eastern Congo as well as neighbouring countries remains very high. A third of those who have fallen ill are children, which is a higher proportion than in previous outbreaks.

Under the leadership of the Government and Congolese communities, with support from the UN and non-governmental organizations (NGOs), the response has contained Ebola in parts of Ituri and North Kivu provinces. But ongoing insecurity and community mistrust in the response continue to hamper access to communities. This is hindering efforts by WHO and the Ministry of Health to detect sick people and ensure access to treatment and vaccination, ultimately leading to more intense Ebola transmission.

In view of the increasingly complex environment, the UN in partnership with the Government and all partners is now strengthening its political engagement and operational support to negotiate access to communities; increasing support for humanitarian coordination; and bolstering preparedness and readiness planning for Goma and surrounding countries. WHO is adapting public health strategies to identify and treat people as quickly as possible; expanding vaccination to reach and protect more people; and redoubling work to end transmission in health facilities.

The UN Secretary-General has established a strengthened coordination and support mechanism in the epicenter of the outbreak, Butembo.

MONUSCO Deputy UN Special Representative of the Secretary-General (DSRSG) David Gressly has been appointed UN Emergency Ebola Response Coordinator (EERC) in the Ebola affected areas of the DRC. Mr. Gressly, who brings a wealth of humanitarian leadership and political and security experience to the role, will report to the SRSG, Leila Zerrougui. He will oversee the coordination of international support for the Ebola response and work to ensure that an enabling environment—particularly security and political—is in place to allow the Ebola response to be even more effective.

Mr. Gressly will work closely with WHO, which will continue to lead all health operations and technical support activities to the Government response to the epidemic. Dr. Ibrahima Socé Fall, Assistant Director-General, Emergency Response, who has been in Butembo since end-March, is leading the WHO response in DRC. WHO will also continue to coordinate public health interventions that are being implemented by other UN partners.

“The Ebola response is working in an operating environment of unprecedented complexity for a public health emergency—insecurity and political protests have led to periodic disruptions in our efforts to fight the disease. Therefore, an enhanced UN-wide response is required to overcome these operating constraints and this includes moving senior leadership and operational decision making to the epicenter of the epidemic in Butembo. We have no time to lose,” said DSRSG Gressly.

WHO’s Dr. Fall said: “This system-wide and international support is exactly what WHO has been calling for. We know that the outbreak response must be owned by the local population, and this new approach reflects what they have asked for: better security for patients and health workers, wider access to vaccination, and a more humane face to the response.” Dr. Fall has been working alongside Dr. Michel Yao, the WHO Ebola Incident Manager who has been in place since August 2018.  In Kinshasa, WHO has also appointed a special representative to the Ebola Response, Dr. Peter Graaff, to coordinate with partners there.

Additional UN measures will bolster the critical work of non-governmental organizations (NGOs) and agencies already on the ground, including UNICEF. Working with NGOs, UNICEF leads community engagement activities; provides psychosocial interventions; and helps prevent infection through water, sanitation and hygiene services.

Financial planning and reporting will also be strengthened and efforts will be accelerated to ensure sustainable and predictable funding required for the Ebola strategic response plan considering the ongoing needs.


DRC and Ebola

DRC

La situation épidémiologique de la Maladie à Virus Ebola en date du 18 mai 2019 :
  • Depuis le début de l’épidémie, le cumul des cas est de 1.816, dont 1.728 confirmés et 88 probables. Au total, il y a eu 1.209 décès (1.121 confirmés et 88 probables) et 482 personnes guéries.
  • 291 cas suspects en cours d’investigation ;
  • 15 nouveaux cas confirmés, dont 4 à Butembo, 4 à Mabalako, 2 à Katwa, 2 à Beni, 1 à Musienene, 1 à Kalunguta et 1 à Mandima ;
  • 11 nouveaux décès des cas onfirmés, dont
    • 6 décès communautaires, dont 2 à Butembo, 2 à Mabalako, 1 à Katwa et 1 à Beni ;
    • 5 décès au CTE, dont 4 à Butembo et 1 à Mabalako ;
  • 16 nouveaux guéris sortis du CTE, dont 12 à Butembo et 4 à Katwa.

UN strengthens Ebola response in Democratic Republic of the Congo

WHO

23 May 2019

Statement
Kinshasa/Butembo

With the Ebola epidemic in the Democratic Republic of the Congo now in its tenth month and the number of new cases increasing in recent weeks, the United Nations announced today measures to strengthen its response and end the outbreak.

The Ebola epidemic has claimed more than 1,200 lives and the risk of spread to other provinces in the eastern Congo as well as neighbouring countries remains very high. A third of those who have fallen ill are children, which is a higher proportion than in previous outbreaks.

Under the leadership of the Government and Congolese communities, with support from the UN and non-governmental organizations (NGOs), the response has contained Ebola in parts of Ituri and North Kivu provinces. But ongoing insecurity and community mistrust in the response continue to hamper access to communities. This is hindering efforts by WHO and the Ministry of Health to detect sick people and ensure access to treatment and vaccination, ultimately leading to more intense Ebola transmission.

In view of the increasingly complex environment, the UN in partnership with the Government and all partners is now strengthening its political engagement and operational support to negotiate access to communities; increasing support for humanitarian coordination; and bolstering preparedness and readiness planning for Goma and surrounding countries. WHO is adapting public health strategies to identify and treat people as quickly as possible; expanding vaccination to reach and protect more people; and redoubling work to end transmission in health facilities.

The UN Secretary-General has established a strengthened coordination and support mechanism in the epicenter of the outbreak, Butembo.

MONUSCO Deputy UN Special Representative of the Secretary-General (DSRSG) David Gressly has been appointed UN Emergency Ebola Response Coordinator (EERC) in the Ebola affected areas of the DRC. Mr. Gressly, who brings a wealth of humanitarian leadership and political and security experience to the role, will report to the SRSG, Leila Zerrougui. He will oversee the coordination of international support for the Ebola response and work to ensure that an enabling environment—particularly security and political—is in place to allow the Ebola response to be even more effective.

Mr. Gressly will work closely with WHO, which will continue to lead all health operations and technical support activities to the Government response to the epidemic. Dr. Ibrahima Socé Fall, Assistant Director-General, Emergency Response, who has been in Butembo since end-March, is leading the WHO response in DRC. WHO will also continue to coordinate public health interventions that are being implemented by other UN partners.

“The Ebola response is working in an operating environment of unprecedented complexity for a public health emergency—insecurity and political protests have led to periodic disruptions in our efforts to fight the disease. Therefore, an enhanced UN-wide response is required to overcome these operating constraints and this includes moving senior leadership and operational decision making to the epicenter of the epidemic in Butembo. We have no time to lose,” said DSRSG Gressly.

WHO’s Dr. Fall said: “This system-wide and international support is exactly what WHO has been calling for. We know that the outbreak response must be owned by the local population, and this new approach reflects what they have asked for: better security for patients and health workers, wider access to vaccination, and a more humane face to the response.” Dr. Fall has been working alongside Dr. Michel Yao, the WHO Ebola Incident Manager who has been in place since August 2018.  In Kinshasa, WHO has also appointed a special representative to the Ebola Response, Dr. Peter Graaff, to coordinate with partners there.

Additional UN measures will bolster the critical work of non-governmental organizations (NGOs) and agencies already on the ground, including UNICEF. Working with NGOs, UNICEF leads community engagement activities; provides psychosocial interventions; and helps prevent infection through water, sanitation and hygiene services.

Financial planning and reporting will also be strengthened and efforts will be accelerated to ensure sustainable and predictable funding required for the Ebola strategic response plan considering the ongoing needs.

 


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