Global & Disaster Medicine

Archive for the ‘Ebola’ Category

Three more health workers infected in Ebola outbreak in DRC

WHO

Disease outbreak news: Update
11 July 2019

The outbreak of Ebola virus disease (EVD) in North Kivu and Ituri provinces, Democratic Republic of the Congo continues this past week with a similar transmission intensity to the previous week. While the number of new cases continues to ease in former hotspots, such as Butembo, Katwa and Mandima health zones, there has been an increase in cases in Beni, and a high incidence of cases continues in parts of Mabalako Health Zone. In addition to these re-emerging hotspots, there are a large number of people with confirmed and probable infections moving to other health zones, with the greatest number coming from Beni Health Zone. The movement of cases causes the outbreak to spread to new health zones and re-emerge in health zones with previously controlled infections. Overall, this underscores the importance of robust mechanisms for listing and following up contacts and understanding the motivations for peoples’ decisions to move.

After the first reported case in the Ariwara Health Zone on 30 June, no new cases have been observed in that health zone. A response team deployed to that zone continues to identify contacts, engage the community, and vaccinate individuals at risk. Response personnel from the bordering countries of Uganda and South Sudan continue to support operational readiness activities. Resources are being dedicated to monitoring the Uganda-Democratic Republic of the Congo border in that area.

In the 21 days from 19 June through 9 July 2019, 72 health areas within 22 health zones reported new cases, representing 11% of the 664 health areas within North Kivu and Ituri provinces (Figure 2). During this period, a total of 247 confirmed cases were reported, the majority of which were from the health zones of Beni (41%, n=101), Mabalako (19%, n=48), Lubero (6%, n=16), and Mandima (5%, n=13). As of 09 July 2019, a total of 2437 EVD cases, including 2343 confirmed and 94 probable cases, were reported (Table 1). A total of 1646 deaths were reported (overall case fatality ratio 68%), including 1552 deaths among confirmed cases. Of the 2437 confirmed and probable cases with known age and sex, 57% (1384) were female, and 29% (704) were children aged less than 18 years.


DRC: Ebola outbreak total up to 2,277

WHO

Kampala, 26 June 2019 – After assessing one of the high-risk districts for Ebola virus disease in western Uganda today, Dr Matshidiso Moeti, World Health Organization (WHO) Regional Director for Africa, commended the corps of health workers and Health Ministry officials for their sharpened preparedness to respond to an outbreak.

Dr Moeti toured the Kasese border area with the Minister of Health of Uganda, Dr Jane Ruth Aceng, who thanked WHO for the support the organization has provided both in preparing the country for Ebola and in responding to the recent confirmed cases.

“WHO has provided crucial support to Uganda in fighting Ebola,” said Dr Aceng. “I am glad to see how my teams on the ground have responded quickly and effectively.”

Prime Minister, Right Honourable Ruhakana Rugunda also expressed his commitment to the Ebola response during a meeting with Dr Moeti and senior governmental officials in Kampala.

Since 11 June, when Uganda declared the Ebola virus disease outbreak, there have been three confirmed cases, all of whom had travelled to the neighbouring Democratic Republic of the Congo (DRC). Uganda shares a nearly 900-kilometre long, often porous border with the DRC, where the disease has claimed more than 1 400 lives since August 2018.

More than 100 people who had contacts with the confirmed cases are being monitored. Since the outbreak was declared, 1063 high risk individuals have been vaccinated. This vaccination of contacts and contacts of contacts, known as ring vaccination, has showed good results in the DRC and other countries in West Africa. There are currently no new, confirmed cases of Ebola in Uganda.

“I commend Uganda for its quick response to the Ebola outbreak,” Dr Moeti said. “During my visit to the Kasese area, I spoke with health authorities who told me how the training they had received in detecting the disease meant they were on high alert for patients with any signs of infection. They were able to move swiftly when the first Ebola cases arrived in their health facility and to restrict possible exposure to relatively few health workers.”

During her two-day visit, Dr Moeti travelled to Bwera Hospital, near the border with the DRC where two of the three people who had the infection had died. A further three suspected cases are being treated at the hospital. Due to its investment into preparedness, the hospital can now obtain presumptive results to tests for the Ebola Zaire strain within two hours.

With support from WHO and partners, Uganda has trained more than 16 000 community leaders and volunteers in remote border areas to spot the symptoms, provide medical attention to potential patients and to alert the authorities. The local teams serve as the eyes and ears of the district and national emergency systems that cover surveillance, infection prevention and control, patient care, cross-border activities and coordination with communities.

“People are aware of the problem, how to protect themselves and where to report for action and support,” Dr Moeti pointed out.

Cross-border surveillance and collaboration between Uganda and DRC health authorities facilitated the early detection and response in Kasese where the cases were confirmed. Rapid reporting by DRC counterparts led to the easy tracing of the cases by Ugandan health authorities.

Since the first outbreak in the DRC in 2018, Uganda has trained more than 9 000 of its health workers to spot the signs of Ebola and vaccinated nearly 5 000 of them against the disease.

“The cost of preparedness is cheaper than response,” Dr Moeti added at the conclusion of her visit, adding donors and partners in her praise of the extensive preparedness activities. “It is the contribution of donors that has enabled us to help countries prepare and, as we have seen in Uganda, prevent the tragedy of an outbreak escalating to unimaginable numbers.”


Ebola Map of Uganda- 6/21/19

20190621_DailyMap_DRC_NordKivu_Ebola.png

ERCC


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


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