NYT

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

DRC

WHO

Ebola virus disease – Democratic Republic of the Congo

The Ministry of Health (MoH), WHO and partners continue to respond to the Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo. While communities in affected areas are generally supportive of the Ebola response, operations in some areas have been temporarily disrupted due to insecurity. On 27 December 2018, protests at government buildings in Beni spilled over to an Ebola transit centre, frightening people waiting for Ebola test results and the staff who were caring for them. Staff at the centre temporarily withdrew and most suspected cases were transferred to a nearby treatment centre. WHO is concerned about the negative effects that the current insecurity is having on efforts to control the outbreak. After an intensification of field activities, marked improvements in controlling the outbreak were observed in many areas, including a recent decrease in cases in Beni. These gains could be lost if we suffer a period of prolonged insecurity that results in increased Ebola virus transmission. While maintaining focus on ending the outbreak and resuming normal operations as soon as possible, all response partners remain committed to ensuring the safety of staff. WHO continues to monitor the situation closely and will adapt their response as needed.

As of 26 December 2018, a total of 591 EVD cases, including 543 confirmed and 48 probable cases, have been reported from 16 health zones in the two neighbouring provinces of North Kivu and Ituri (Figure 1). Of these cases, 54 were healthcare workers, of which 18 died. Overall, 357 cases have died (case fatality ratio 60%). In the past week, ten additional patients were discharged from Ebola treatment centres; overall, 203 patients have recovered to date. The highest number of cases were from age group 15‒49 years with 60% (355/589) of the cases, and of those, 228 were female. Highest attack rates have been observed in children aged more than one year (especially male infants) and females aged 15 years and older.

Trends in case incidence (Figure 2) reflect the continuation of the outbreak across these geographically dispersed areas. The general decrease in the weekly incidence observed in Beni since late October continued; however, the outbreak is intensifying in Butembo and Katwa, and new clusters have emerged in other health zones. Thirteen health zones reported a total of 109 confirmed cases in the last 21 days (5‒26 December 2018). The majority of which were concentrated in major urban centres and towns in Katwa (26), Komanda (21), Mabalako (15), Beni (14) and Butembo (10) health zones. An isolated case was also recently detected in Nyankunde Health Zone – a newly affected area in Ituri Province – whom likely acquired the infection in Komanda. This case, highlights the continued high risk of continued spread of the outbreak and the need to strengthen all aspects of the response in Ituri, North Kivu and surrounding provinces and countries.

The MoH, WHO and partners continue to monitor and investigate all alerts in affected areas, in other provinces in the Democratic Republic of the Congo, and in neighbouring countries. Since the last report was published, alerts were investigated in several provinces of the Democratic Republic of the Congo as well as in Uganda. To date, EVD has been ruled out in all alerts outside of the abovementioned outbreak affected areas.

Figure 1: Confirmed and probable Ebola virus disease cases by health zone in North Kivu and Ituri provinces, Democratic Republic of the Congo, data as of 26 December 2018 (n=591)

Figure 1: Confirmed and probable Ebola virus disease cases by health zone in North Kivu and Ituri provinces, Democratic Republic of the Congo, data as of 26 December 2018 (n=591)

Figure 2: Confirmed and probable Ebola virus disease cases by week of illness onset, data as of 26 December 2018 (n=591)*

*Data in recent weeks are subject to delays in case confirmation and reporting, as well as ongoing data cleaning – trends during this period should be interpreted cautiously.

Public health response

The MoH continues to strengthen response measures, with support from WHO and partners. Priorities include coordination, surveillance, contact tracing, laboratory capacity, infection prevention and control (IPC), clinical management of patients, vaccination, risk communication and community engagement, psychosocial support, safe and dignified burials (SDB), cross-border surveillance, and preparedness activities in neighbouring provinces and countries. Infection prevention and control practices in health care facilities, especially antenatal clinics, need to be further strengthened.

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

• Ebola situation reports: Democratic Republic of the Congo

WHO risk assessment

This outbreak of EVD is affecting north-eastern provinces of the country bordering Uganda, Rwanda and South Sudan. Potential risk factors for transmission of EVD at the national and regional levels include: travel between the affected areas, the rest of the country, and neighbouring countries; the internal displacement of populations. The country is concurrently experiencing other epidemics (e.g. cholera, vaccine-derived poliomyelitis, malaria), and a long-term humanitarian crisis. Additionally, the security situation in North Kivu and Ituri at times limits the implementation of response activities. WHO’s risk assessment for the outbreak is currently very high at the national and regional levels; the global risk level remains low. WHO continues to advice against any restriction of travel to, and trade with, the Democratic Republic of the Congo based on currently available information.

As the risk of national and regional spread is very high, it is important for neighbouring provinces and countries to enhance surveillance and preparedness activities. The International Health Regulations (IHR 2005) Emergency Committee has advised that failing to intensify these preparedness and surveillance activities would lead to worsening conditions and further spread. WHO will continue to work with neighbouring countries and partners to ensure that health authorities are alerted and are operationally prepared to respond.

WHO advice

International traffic: WHO advises against any restriction of travel and trade to the Democratic Republic of the Congo based on the currently available information. There is currently no licensed vaccine to protect people from the Ebola virus. Therefore, any requirements for certificates of Ebola vaccination are not a reasonable basis for restricting movement across borders or the issuance of visas for passengers leaving the Democratic Republic of the Congo. WHO continues to closely monitor and, if necessary, verify travel and trade measures in relation to this event. Currently, no country has implemented travel measures that significantly interfere with international traffic to and from the Democratic Republic of the Congo. Travellers should seek medical advice before travel and should practice good hygiene.

For more information, see:

• Democratic Republic of the Congo begins first-ever multi-drug Ebola trial
• South Sudan set to vaccinate targeted healthcare and frontline workers operating in high risk states against Ebola
• Summary report for the SAGE meeting of October 2018
• Statement on the October 2018 meeting of the IHR Emergency Committee on the Ebola virus disease outbreak in the Democratic Republic of the Congo
• WHO Interim recommendation Ebola vaccines
• WHO recommendations for international travellers related to the Ebola Virus Disease outbreak in the Democratic Republic of the Congo
• Ebola virus disease in the Democratic Republic of the Congo – Operational readiness and preparedness in neighbouring countries
• Ebola virus disease fact sheet

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

WHO

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

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

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

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

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

Data in recent weeks are subject to delays in case confirmation and reporting, as well as ongoing data cleaning – trends during this period should be interpreted cautiously.

Public health response

The MoH continues to strengthen response measures, with support from WHO and partners. Priorities include coordination, surveillance, contact tracing, laboratory capacity, IPC, clinical management of patients, vaccination, risk communication and community engagement, psychosocial support, safe and dignified burials (SDB), cross-border surveillance, and preparedness activities in neighbouring provinces and countries. Infection prevention and control practices in health care facilities, especially antenatal clinics, need to be further strengthened.

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

• Ebola situation reports: Democratic Republic of the Congo

WHO risk assessment

This outbreak of EVD is affecting north-eastern provinces of the country bordering Uganda, Rwanda and South Sudan. Potential risk factors for transmission of EVD at the national and regional levels include: travel between the affected areas, the rest of the country, and neighbouring countries; the internal displacement of populations. The country is concurrently experiencing other epidemics (e.g. cholera, vaccine-derived poliomyelitis, malaria), and a long-term humanitarian crisis. Additionally, the security situation in North Kivu and Ituri at times limits the implementation of response activities. WHO’s risk assessment for the outbreak is currently very high at the national and regional levels; the global risk level remains low. WHO continues to advice against any restriction of travel to, and trade with, the Democratic Republic of the Congo based on currently available information.

As the risk of national and regional spread is very high, it is important for neighbouring provinces and countries to enhance surveillance and preparedness activities. The International Health Regulations (IHR 2005) Emergency Committee has advised that failing to intensify these preparedness and surveillance activities would lead to worsening conditions and further spread. WHO will continue to work with neighbouring countries and partners to ensure that health authorities are alerted and are operationally prepared to respond.

WHO advice

International traffic: WHO advises against any restriction of travel and trade to the Democratic Republic of the Congo based on the currently available information. There is currently no licensed vaccine to protect people from the Ebola virus. Therefore, any requirements for certificates of Ebola vaccination are not a reasonable basis for restricting movement across borders or the issuance of visas for passengers leaving the Democratic Republic of the Congo. WHO continues to closely monitor and, if necessary, verify travel and trade measures in relation to this event. Currently, no country has implemented travel measures that significantly interfere with international traffic to and from the Democratic Republic of the Congo. Travellers should seek medical advice before travel and should practice good hygiene.

UNICEF

“…..Since the start of the response to the latest Ebola outbreak in the DRC, UNICEF and its partners have:

•  Provided psycho-social and material assistance to 520 affected families with children;
•  Provided psychosocial support to 421 children in the Ebola Treatment Centers;
•  Sensitized more than 91,000 children with Ebola prevention messages in schools;
•  Briefed 4,310 teachers in schools on Ebola;
•  Equipped 444 schools in high risk areas with hand-washing facilities;
•  Reached more than 6,753,000 people with Ebola-prevention messages;
•  Provided access to water to 889,440 people in the affected areas…..”

DRC

WHO

“The Ministry of Health (MoH), WHO and partners continue to respond to the Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo, and remain confident that the outbreak can be contained, despite ongoing challenges. During the reporting period (27 November – 3 December 2018), 31 new confirmed cases and one new probable case were detected. The cases were reported from eight health zones in North Kivu Province: Beni (n=8), Katwa (n=8), Vuhovi (n=3), Kalunguta (n=2), Butembo (n=1), Masereka (n=1), Mutwanga (n=1) and Mabalako (n=1), as well as Komanda Health Zone (n=7) in Ituri Province. A total of 27 deaths occurred during the reporting period.
As of 3 December 2018, a total of 453 EVD cases, including 405 confirmed and 48 probable cases (Table 1), have been reported from 14 health zones in the two neighbouring provinces of North Kivu and Ituri (Figure 2). The health zones of Komanda, Masereka and Mabalako have reported one new confirmed case each, respectively 61 days, 48 days and 56 days after confirmation of previously confirmed cases, and investigations are ongoing regarding links and travel history from other areas to these cases. Over the last 21 days (13 November to 3 December 2018), 110 confirmed and probable cases were reported from 11 health zones. The majority were reported from Beni (n=35), Katwa (n=34), Kalunguta (n=15) and Butembo (n=10). The other affected health zones were Komanda, Kyondo, Mabalako, Masereka, Mutwanga, Oicha and Vuhovi. Of the 453 cases, 268 died (case fatality rate 59%), including 220 among confirmed cases. Females account for 59% of all confirmed and probable cases. Two health workers were among the new confirmed cases, bringing the total number of health workers infected to 44, including 12 deaths.
As of 3 December 2018, 144 confirmed cases have recovered and been discharged from Ebola Treatment Centres (ETCs). On this day, 114 patients were hospitalised in transit centres and ETCs, of which 35 were laboratory confirmed and are receiving compassionate therapy under the monitored emergency use of unregistered and experimental interventions (MEURI) guidelines…..”

FDA

The Emergency Use Authorization (EUA) authority allows FDA to help strengthen the nation’s public health protections against CBRN threats by facilitating the availability and use of MCMs needed during public health emergencies.

Under section 564 of the Federal Food, Drug, and Cosmetic Act (FD&C Act), the FDA Commissioner may allow unapproved medical products or unapproved uses of approved medical products to be used in an emergency to diagnose, treat, or prevent serious or life-threatening diseases or conditions caused by CBRN threat agents when there are no adequate, approved, and available alternatives.

Section 564 of the FD&C Act was amended by the Project Bioshield Act of 2004 and the Pandemic and All-Hazards Preparedness Reauthorization Act of 2013 (PAHPRA), which was enacted in March 2013

Current EUAs

The tables below provide information on current EUAs:

• Anthrax: Doxycycline Mass Dispensing EUA Information and National Postal Model Anthrax EUA Information
• Ebola Virus EUA Information
• Enterovirus D68 (EV-D68) EUA Information
• French Freeze Dried Plasma Information
• H7N9 Influenza EUA Information
• Middle East Respiratory Syndrome Coronavirus (MERS-CoV) EUA Information
• Nerve Agent EUA Information
• Zika Virus EUA Information

DRC