Global & Disaster Medicine

Archive for the ‘Ebola’ Category

With 11 new Ebola cases confirmed yesterday and today, the Democratic Republic of Congo’s Ebola outbreak total climbed to 205 cases

WHO

Ebola virus disease – Democratic Republic of the Congo

Disease outbreak news
11 October 2018

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

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

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

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

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

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

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

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

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

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

Public health response

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

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

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

WHO risk assessment

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

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

WHO advice

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

For more information, see:


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

2The total number of contacts under surveillance is highly dynamic with new cases being registered daily, and those who complete 21 days of post-exposure follow up, without developing symptoms, are released from surveillance.


A significant increase in the number of new Ebola cases in DRC: “…. In just nine days, there have been 33 new cases and 15 deaths….”

Rescue

“…..a World Health Organization (WHO) official says the epidemic will likely carry well into 2019.….”

 


Ebola: The situation in DRC is precarious given recent increases in insecurity, incidents of community reluctance and geographical spread.

WHO

Ebola virus disease – Democratic Republic of the Congo

Disease outbreak news
27 September 2018

The response to the Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo is at a critical juncture. While substantial progress has been made, the situation is precarious given recent increases in insecurity, incidents of community reluctance and geographical spread.

There have been a number of incidents in recent days, notably in Beni, which have led to loss of life among the local communities. WHO response activities have been severely limited as Beni and other towns mark a period of mourning for those who were killed. Security in Beni and other areas remains challenging.

The Ministry of Health (MoH), WHO and partners continue to work closely with people in the affected areas to overcome reluctance and mistrust which has developed among some communities. Rumours, misinformation and traditional practices have led some families to opt to care for sick relatives at home; some patients have also left health facilities to seek alternative care. Together this results in health workers being unable to provide optimal treatment, and also increases the risk of infection for relatives and local community members. These factors have contributed to the geographical spread of the outbreak.

The movement of several cases across health zones in recent weeks is concerning; one infected individual who recently moved to Kalunguta Health Zone is the first to move into a ‘red’ zone – highly insecure and challenging environments where implementing response activities is extremely difficult, if not impossible. Responders are employing a range of new techniques in these red zones, including using armed escorts and training local health workers to trace contacts.

Where they have access, response teams continue to enhance activities to prevent new clusters and the potential spread to new areas. WHO continues to work in the affected areas, side-by-side with national and international partners, to support the response led by the MoH. There continues to be challenges with identifying all contacts, registered contacts being lost to follow up, delayed recognition of EVD in health centres, poor infection prevention and control (IPC) in health centres, and reluctance among some cases to be treated in Ebola treatment centres (ETCs). The priority remains strengthening all components of the public health response in all affected areas, as well as continuing to enhance operational readiness and preparedness in the non-affected provinces of the Democratic Republic of the Congo and in neighbouring countries.

Since the last Disease Outbreak News (data as of 18 September), nine new confirmed EVD cases were reported: five from Beni, one from Butembo and one from Mabalako health zones in North Kivu Province, as well as two from Tchomia Health Zone in Ituri Province. These are the first confirmed EVD cases to be reported from Tchomia Health Zone which is near the Ugandan border; both cases, a couple, were linked to the ongoing Beni transmission chain. Two of the remaining seven cases have been linked to ongoing transmission chains within the respective communities, while the last five cases are under investigation.

As of 25 September 2018, a total of 151 EVD cases (120 confirmed and 31 probable), including 101 deaths (70 confirmed and 31 probable)1, have been reported in seven health zones in North Kivu Province (Beni, Butembo, Kalunguta, Mabalako, Masereka, Musienene and Oicha), and two health zones in Ituri Province (Mandima and Tchomia) (Figure 1). An overall decreasing trend in weekly case incidence continues (Figure 2); however, these trends must be interpreted with caution given the expected delays in case reporting, the ongoing detection of sporadic cases and the security situation which is limiting contact tracing. Of the 149 confirmed and probable cases for whom age and sex information is known, 23%, 20% and 22% are aged 15-24, 25-34 and 35-44 years, respectively; females (56%) accounted for the greatest proportion of cases (Figure 3). Cumulatively, 19 (18 confirmed and one probable) health workers have been affected to date, three of whom have died.

The MoH, WHO and partners continue to closely monitor and investigate all alerts in affected areas, in other provinces in the Democratic Republic of the Congo and in neighbouring countries. As of 25 September, 17 suspected cases in the Democratic Republic of the Congo are awaiting laboratory testing. Since the last report was published, alerts were investigated in several provinces of the Democratic Republic of the Congo, as well as in neighbouring countries; and to date, EVD has been ruled out in all alerts from neighbouring provinces and countries.

Figure 1: Confirmed and probable Ebola virus disease cases by health zone in North Kivu and Ituri provinces, Democratic Republic of the Congo, data as of 25 September 2018 (n=151)

Public health response

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

  • As of 18 September, 201 experts have been deployed by WHO to support response activities including emergency coordinators, epidemiologists, laboratory experts, logisticians, clinical care specialists, communicators and community engagement specialists.
  • Over 5700 contacts have been registered, of which 1660 remain under surveillance as of 25 September2. From 19 to 25 September, a high proportion of contacts ranging between 95-98% were followed up daily; however, coverage fell to between 60-76% from 23 to 25 September due to the suspension of field activities in Beni and a new front of operations in Tchomia..
  • As of 25 September, 63 vaccination rings have been defined in addition to 26 rings of health workers and other frontline workers. These rings include the contacts (and their contacts) of all confirmed cases from the last four weeks. To date, 12 029 people consented and were vaccinated, including 5041 health or frontline workers and 2497 children. The ring vaccination teams are currently active in three health areas in North Kivu and two in Ituri.
  • ETCs are operational in Beni and Mangina with support from the Alliance for International Medical Action (ALIMA) and Médecins Sans Frontières (MSF), respectively. MSF Switzerland and the MoH are supporting an ETC in Butembo. International Medical Corps (IMC) is supporting the recently opened Makeke ETC in Ituri Province. MSF and the MoH are setting up a 12-bed isolation facility in Kasenyi.
  • WASH and IPC activities are ongoing in the Democratic Republic of the Congo and are supported by several partners in the field. Numerous activities have occurred in health facilities in the affected areas including facility assessments, decontamination of centres, establishment of triage areas and training on standard precautions as well as Ebola-specific IPC measures.
  • The MoH, WHO, UNICEF, Red Cross and partners are intensifying activities to engage with local communities in the affected areas. Community feedback is being systematically collected and concerns are being addressed. Local frontline community outreach workers are collaborating with Ebola response teams to strengthen community engagement and psychosocial support in contact tracing, patient care, SDBs and vaccination of close contacts. The focus continues to be on intensifying activities aimed at addressing community concerns through direct partnership with community members.
  • Red Cross SDB teams are trained and operational in Mabalako, Beni and Butembo health zones. Due to the new confirmed EVD cases in Ituri, the Red Cross is strengthening response capacity in Bunia where one SDB team was initially trained. In preparation, training of Red Cross SDB teams in Goma started on 24 September. Civil protection SDB teams from Beni, Butembo and Oicha have been trained as part of the ‘red zone strategy’. As of 24 September, Red Cross SDB teams have successfully responded to 144 of the 176 SDB alerts received; 37% of alerts were for community deaths, 36% were from ETCs and 27% were from non-ETC health facilities. In addition, four alerts were sent to the civil protection SDB teams.
  • Expert teams have deployed to six at-risk provinces (Bas Uele, Haut Uele, Ituri, Maniema, South Kivu and Tanganika) to facilitate implementation of priority readiness actions, including strengthening multisectoral coordination, surveillance for early detection, laboratory diagnostic capacity, points of entry (PoE) surveillance, rapid response teams, risk communication, social mobilization and community engagement, psychosocial support, case management and IPC capacities, operations support, and logistics.
  • As of 25 September, health screening has been established at 45 PoEs and close to six million travellers have been screened and over 17 000 means of travel have been decontaminated at these PoEs.
  • To support the MoH, WHO is working intensively with a wide range of multisectoral and multidisciplinary regional and global partners and stakeholders for EVD response, research and urgent preparedness, including in neighbouring countries. Among the partners are a number of UN agencies and international organizations including International Organization for Migration (IOM), the United Nations Children’s Fund (UNICEF), World Food Programme (WFP), United Nations Office for the Coordination of Humanitarian Affairs (OCHA), Inter-Agency Standing Committee (IASC), European Civil Protection and Humanitarian Aid Operation (ECHO), UK Public Health Rapid Support Team, multiple Clusters, and peacekeeping operations; World Bank and regional development banks; African Union, Africa Centers for Disease Control and Prevention (CDC), and regional agencies; Health Cluster partners and NGOs including ALIMA, ADECO, AFNAC, CARITAS, CEPROSSAN, CARE, COOPI, CORDAID, ICRC, IFRC, INTERSOS, MEDAIR, MSF, OXFAM, PNHF, Samaritan’s Purse, and SCI; Global Outbreak Alert and Response Network (GOARN), Steering Committee, technical networks and operational partners, and the Emergency Medical Team (EMT) Initiative. GOARN partners continue to support the response through deployment for response and readiness activities in non-affected provinces and in neighbouring countries and to different levels of WHO.

WHO risk assessment

This outbreak of EVD is affecting north-eastern provinces of the Democratic Republic of the Congo, which border Uganda, Rwanda and South Sudan. Potential risk factors for transmission of EVD at the national and regional levels include the transportation links between the affected areas, the rest of the country, and neighbouring countries; the internal displacement of populations; and the displacement of Congolese refugees to neighbouring countries. The country is concurrently experiencing other epidemics (e.g. cholera, vaccine-derived poliomyelitis), and a long-term humanitarian crisis. Additionally, the security situation in North Kivu and Ituri continues to hinder the implementation of response activities. Since the last Disease Outbreak News on 20 September 2018, WHO has assessed the risk to be very high at the national and regional levels, and low globally3.

As the risk of national and regional spread is very high, it is important for neighbouring provinces and countries to enhance surveillance and preparedness activities3. WHO will continue to work with neighbouring countries and partners to ensure health authorities are alerted and are operationally ready to respond.

WHO advice

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

For more information, see:


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

2The total number of contacts under surveillance is highly dynamic with new cases being registered daily, and those who complete 21 days of post-exposure follow up, without developing symptoms, are released from surveillance.

3Please note that these sentences under “WHO risk assessment” were updated on 28 September 2018.


DRC: 150 confirmed and suspected cases of Ebola, with 9 cases under investigation and the death toll stands at 100

CIDRAP

“…..According to the WHO, 39 patients during this outbreak have been treated with experimental Ebola therapies, including mAb 114, remdesivir, and Zmapp. Of these 39 patients, 12 have died.

The DRC said that since immunization campaigns began on Aug 8, 11,563 people have been vaccinated….”

Sep 25 WHO media briefing:

 

 


DRC: Ebola in three more people

WHO

Ebola virus disease – Democratic Republic of the Congo

Disease outbreak news
14 September 2018

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

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

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

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

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

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

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

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

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

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

Public health response

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

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

WHO risk assessment

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

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

WHO advice

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

For more information, see:


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

2The total number of contacts under surveillance is highly dynamic with new cases being registered daily, and those who complete 21 days of post-exposure follow-up, without developing symptoms, are released from surveillance.

 


DRC: 3 more confirmed cases of Ebola, including one in a patient who died in Butembo.

CIDRAP

  • The new cases raise outbreak totals to 127, of which 96 confirmed and 31 probable.
  • 87 deaths.
  • 6,343 people have now been vaccinated during this outbreak,

 


New worries: a patient with EBV has died in Butembo, a city of nearly 1 million people.

DRC

ReliefWeb


DRC-Ebola update: The outbreak totals 116, which includes 86 confirmed and 30 probable cases.

WHO

“……As of 29 August 2018, a total of 116 EVD cases (86 confirmed and 30 probable) including 77 deaths (47 confirmed and 30 probable)1 have been reported in five health zones in North Kivu (Beni, Butembo, Oicha, Mabalako, Musienene) and one health zone in Ituri (Mandima). Eight suspected cases from Mabalako (n=5) and Beni (n=3) are currently pending laboratory testing to confirm or exclude EVD. The majority of cases (65 confirmed and 21 probable) have been reported from Mabalako Health Zone (Figure 2). The median age of confirmed and probable cases is 35 years (interquartile range 19–45.5 years), and 56% were female (Figure 3).

Fifteen cases have been reported among health workers, of which 14 were laboratory confirmed; one has died…..”


Ebola in DRC: If responders can’t turn the outbreak around over the next 7 to 10 days, the risk of the disease spreading to more dangerous conflict-ridden areas becomes greater, posing more difficult challenges for health teams.

DRC

SITUATION ÉPIDÉMIOLOGIQUE DANS LA PROVINCE DU NORD-KIVU
Mardi 28 août 2018
La situation épidémiologique de la Maladie à Virus Ebola en date du 27 août 2018 :

  • Au total, 112 cas de fièvre hémorragique ont été signalés dans la région, dont 84 confirmés et 28 probables.
  • 18 cas suspects sont en cours d’investigation, dont 2 dans la ville de Goma.
  • 1 nouveau cas confirmé à Mandima (contact connu).
  • Aucun nouveau décès.
  • 3 nouvelles personnes guéries.

 


WHO: Prioritizing Emerging Infectious Diseases in Need of Research and Development

The World Health Organization R&D Blueprint aims to accelerate the availability of medical technologies during epidemics by focusing on a list of prioritized emerging diseases for which medical countermeasures are insufficient or nonexistent. The prioritization process has 3 components: a Delphi process to narrow down a list of potential priority diseases, a multicriteria decision analysis to rank the short list of diseases, and a final Delphi round to arrive at a final list of 10 diseases.

A group of international experts applied this process in January 2017, resulting in a list of 10 priority diseases. The robustness of the list was tested by performing a sensitivity analysis. The new process corrected major shortcomings in the pre–R&D Blueprint approach to disease prioritization and increased confidence in the results.

Multicriteria scores of diseases considered in the 2017 prioritization exercise for the development of the World Health Organization R&D Blueprint to prioritize emerging infectious diseases in need of research and development. A) Disease final ranking using the geometric average of the comparison matrices. B) Disease final ranking using the arithmetic average of the raw data. Error bars correspond to SD, indicating disagreement among experts. C) Disease final ranking using the SMART Vaccines

Multicriteria scores of diseases considered in the 2017 prioritization exercise for the development of the World Health Organization R&D Blueprint to prioritize emerging infectious diseases in need of research and development. A) Disease final ranking using the geometric average of the comparison matrices. B) Disease final ranking using the arithmetic average of the raw data. Error bars correspond to SD, indicating disagreement among experts. C) Disease final ranking using the SMART Vaccines prioritization tool (56). P1, Ebola virus infection; P2, Marburg virus infection; P3, Middle East Respiratory Syndrome coronavirus infection; P4, severe acute respiratory syndrome; P5, Lassa virus infection; P6, Nipah virus infection; P7, Rift Valley fever; P8, Zika virus infection; P9, Crimean-Congo hemorrhagic fever; P10, severe fever with thrombocytopenia syndrome; P11, South American hemorrhagic fever; P12, plague; P13, hantavirus infection.

Si Mehand M, Millett P, Al-Shorbaji F, Roth C, Kieny MP, Murgue B. World Health Organization methodology to prioritize emerging infectious diseases in need of research and development. Emerg Infect Dis. 2018 Sep [date cited]. https://doi.org/10.3201/eid2409.171427


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