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,

DRC

ReliefWeb

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…..”

DRC

WHO

Ebola virus disease – Democratic Republic of the Congo

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

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

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

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

For more information, see:

• Ebola situation reports: Democratic Republic of the Congo

ublic health response

The MoH rapidly initiated response mechanisms in North Kivu and Ituri provinces with support from WHO and partners. Priorities include the establishment and strengthening of surveillance, contact tracing, laboratory capacity, IPC, clinical management, vaccination, risk communication and community engagement, safe and dignified burials, response coordination, cross-border surveillance, and preparedness activities in neighbouring provinces and countries.

• During a two-day mission to the outbreak epi-centre, the WHO Director-General (DG), WHO Regional Director (RD) for Africa and WHO Deputy Director-General (DDG), Emergency Preparedness and Response, together with the Minister of Health, observed the launch of Ebola vaccination activities, visited the Emergency Operations Centre (EOC), met with partners and staff to discuss the challenges ahead, and assessed response measures and needs.
• The WHO DG and the RD then visited Uganda where they were briefed by the WHO Representative on the country’s EVD preparedness. The DG and RD later met the Uganda Prime Minister, the Minister of Foreign Affairs, the Minister of Health, and the Minister of State for Primary Health Care to discuss EVD preparedness and WHO support.
• The MoH has activated a multi-partner incident management system and an EOC to coordinate the response, with the main centre in Beni and the field coordination centre in Mangina. WHO has established an incident management team with personnel from the WHO Country Office, Regional Office for Africa and headquarters who are collaborating closely to ensure a comprehensive and effective response to the outbreak.
• On 8 August, the MoH, with support from WHO and partners, launched the Ebola ring vaccination activities for high-risk populations. In the first days, health care and other frontline workers were vaccinated. As of 15 August, a total of five rings have been defined around 13 recently confirmed cases. Within these initial rings, more than 500 contacts and their contacts consented and received rVSV-ZEBOV Ebola vaccine thus far. Teams are continuing to identify and vaccinate all eligible contacts to help interrupt transmission of the virus.
• The MoH and WHO continue to strengthen surveillance in the affected and surrounding areas. As of 15 August, nearly 1600 contacts, including more than 120 health workers, in North Kivu and Ituri provinces have been registered and are being followed up on daily basis.
• As of 15 August, WHO has deployed over 100 technical and logistics specialists to support response activities. Global Outbreak Alert and Response Network (GOARN) partner institutions continue to support the response as well as ongoing readiness and preparedness activities in non-affected provinces of the Democratic Republic of the Congo and in bordering countries. For more information about operational readiness and preparedness activities, please see the DON published on 14 August.
• In addition to the mobile laboratory established in Beni on 3 August, local testing with Xpert Ebola has since been established in hospital facilities in Beni, Goma, and Mangina to facilitate the timely diagnosis of suspected cases.
• The Alliance for International Medical Action (ALIMA) and Médecins Sans Frontières (MSF) have established 60-bed ETCs in Beni and Mangina, respectively. The partners are preparing the ETCs to provide therapeutics under the monitored emergency use of unregistered and experimental interventions (MEURI) protocol in collaboration with MoH and Institut National de Recherche Biomédicale (INRB). WHO is providing technical expertise support on site and assisting with the creation of a data safety management board.
• The MoH team, with support from UNICEF, are training 90 psychosocial agents to provide psychosocial care to patients and other affected people.
• Knowledge, Attitude and Practice (KAP) surveys were conducted in Beni and Mabalako health zones to assess the levels of EVD awareness in the communities. Findings from the survey will be used to improve the risk communication, social mobilization and community engagement strategy.
• Two planes with supplies of cold chain equipment, isolation units and vehicles arrived in Beni on 11 and 12 August.

WHO risk assessment

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

WHO advice

The Strategic Advisory Group of Experts (SAGE) working group on Ebola vaccines and the SAGE members have reviewed the epidemiological situation and the evidence available with regard to the different candidate Ebola vaccines and the impact of different interventions. While ring vaccination remains the preferred strategy (as stated in the April 2017 SAGE report, a geographic targeted approach was proposed as an exceptional alternative if the ring vaccination around a laboratory-confirmed case of Ebola proves unfeasible. The following interim recommendation was agreed upon: “Should an Ebola disease outbreak occur before the candidate vaccine is licensed, SAGE recommended that the rVSV-ZEBOV Ebola vaccine be promptly deployed under the Expanded Access framework, with informed consent and in compliance with Good Clinical Practice. If the outbreak is caused by an Ebola virus species other than Zaire, consideration should be given to the use of other candidate vaccines that target the putative viral species”.

For more information, see:

• WHO Interim recommendation Ebola vaccines

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

WHO advises against any restriction of travel and trade to the Democratic Republic of the Congo based on the currently available information. WHO continues to closely monitor and, if necessary, verify travel and trade measures in relation to this event.

For more information, see:

• WHO recommendations for international travellers
• – 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.

MSF

DRC

DRC 

One more Ebola case was confirmed.

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

WHO

Ebola virus disease – Democratic Republic of the Congo

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

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

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

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

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

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

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

Public health response

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

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

WHO risk assessment

This new outbreak of Ebola virus disease is affecting north eastern provinces of the Democratic Republic of the Congo, which border Uganda. Potential risk factors for transmission of EVD at national and regional levels include the transportation links between the affected areas, the rest of the country, and neighbouring countries; the internal displacement of populations; and displacement of Congolese refugees to neighbouring countries. The country is concurrently experiencing several epidemics and a long-term humanitarian crisis. Additionally, the security situation in North Kivu may hinder the implementation of response activities. Based on this context, the public health risk is considered high at the national and regional levels and low globally.

WHO advice

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

WHO advises against any restriction of travel and trade to the Democratic Republic of the Congo based on the currently available information. WHO continues to monitor travel and trade measures in relation to this event.