The Ministry of Health has published EBOLA RDC - Evolution de la riposte contre l'épidémie d'Ebola dans les provinces du Nord Kivu et de l'Ituri au Dimanche 12 mai 2019. This is a long report. Excerpt from the Google translation:
EVOLUTION OF THE EBOLA EPIDEMIC IN THE PROVINCES OF NORTH KIVU AND ITURI
Sunday, May 12, 2019
The epidemiological situation of the Ebola Virus Disease dated May 11, 2019:
• Since the beginning of the epidemic, the cumulative number of cases is 1,680, of which 1,592 are confirmed and 88 are probable. In total, there were 1,117 deaths (1,029 confirmed and 88 probable) and 450 people healed.
• 268 suspected cases under investigation;
• 18 new confirmed cases, including 5 in Mabalako, 4 in Beni, 2 in Mangurudjipa, 2 in Kalunguta, 1 in Butembo, 1 in Mandima, 1 in Musienene, 1 in Katwa and 1 in Kyondo;
• 5 new deaths of confirmed cases, including
º 4 community deaths, including 1 in Butembo, 1 in Kalunguta, 1 in Kyondo and 1 in Beni;
• 1 death at Katwa CTE;
• 4 new healed CTE survivors, including 3 in Katwa and 1 in Butembo;
• One of Manugurujipa's unvaccinated health workers is one of the new confirmed cases.
º The cumulative number of confirmed / probable cases among health workers is 99 (5.9% of all confirmed / probable cases), including 34 deaths.
/! \ The data presented in this table are subject to change later, after extensive investigations and after redistribution of cases and deaths in their health areas.
NEWS
Release of a new miraculous baby from Katwa CTE
• A 42-day-old baby was discharged from the Katwa CTE on Saturday, May 11, 2019. Daniella was admitted to the CTE with her mother on April 11, 2019 when she was only 12 days old. Her mother, who arrived in a state of advanced coma, died at CTE the next day. Daniella was collected on April 12 and was positive. After 30 days of treatment with mAb 114, Daniella was cured. She survived thanks to the work of the health staff and the nannies who took turns at her bedside 24 hours a day but also because she was taken care of as soon as she became ill. Nannies are men and women cured of Ebola, and therefore immune to the virus, who care for sick children and babies during their hospitalization.
Medical management in Butembo and Katwa
• Since the departure of Médecins Sans Frontières (MSF) from the health zones of Butembo and Katwa following the deterioration of the security situation last February, the management of the two Ebola Treatment Centers (ETCs) in the city of Butembo has been taken over by the Ministry of Health in partnership with the World Health Organization (WHO) and UNICEF since March 2019.
• Since this transfer of management, many changes have been made to the medical care of patients suffering from Ebola. These changes include:
1. Increased number of health providers in CTEs. The new managers continued to work with MSF-trained caregivers, but they also recruited more care providers to ensure better individual follow-up for each patient. Moreover, from now on, the whole of the medical staff is Congolese and has been recruited locally.
2. Improvement of the nutritional care of the patients which increases their chance of survival.
3. Creation of a team exclusively responsible for admissions to reduce the waiting time for admission.
4. Involvement of the family from the beginning of the treatment of patients with the support of psychologists.
• Two months after this transfer of management, it was important to conduct an analysis to assess the quality of medical care for Ebola patients. The main conclusions of this analysis are:
1. The average duration of hospitalization in CTEs has been reduced, allowing more patients to be treated for the same duration. At Butembo CTE, the average duration of hospitalization increased from 9 to 4 days. And at the Katwa CTE, the average length of stay was 7 to 5 days.
2. There was a reduction in the intra-CTE lethality rate and an increase in the survival rate. Without taking into account those who died less than 48 hours after admission to the CTE, the case-fatality rate for confirmed patients fell from 43.4% to 31.1% in the Butembo CTE and from 43.2% to 33.8%. % at Katwa CTE. As a corollary, Butembo's CTE survival rate increased from 56.6% to 68.9%. At the Katwa CTE, the survival rate increased from 56.8% to 66.2%.
• These data come from the patient database compiled by the Ministry of Health and partners involved in medical care. These data are encouraging as they prove that local health workers are now able to properly care for Ebola patients. It is a great success to congratulate and encourage.Decentralized operational approach
• The Ministry of Health invited MSF to present their "decentralized operational approach" project at a strategic meeting in Kinshasa this Thursday, May 9, 2019. In summary, the MSF project is structured around three axes:
º OPTION 1 : If the patients accept it, they will be treated in the CTE which remain the reference places for the management of confirmed Ebola patients and who guarantee the best survival rate.
º OPTION 2 : If patients do not wish to visit an ETC, they may go to a local health center or hospital that is prepared to accommodate them.
º OPTION 3 : If patients do not wish to visit a CTE or a health center, they could be cared for at home with the support of the patient and the family with training in transmission reduction with equipment individual protection 'light' and in symptomatic treatment with supervision (if possible).
• Many questions, suggestions and concerns were shared by the Ministry of Health and the technical and financial partners present at this meeting. These questions include:
º How to ensure team safety in such a decentralized approach?
º How to ensure strict compliance with prevention measures at the community health centers and at home?
º What to answer to patients who would like to be cared for in traditional healer centers that are very popular?
º How will families manage contaminated biological fluids for home treatment?
º Can daily support for health centers or families be done remotely when response teams are unable to move about the city due to a security incident?
• MSF was also asked to draw lessons learned from Beni and Mangina where the decentralized approach in the hospitals was used early in the response, prior to the construction of the CTEs. In both areas, this decentralized approach has led to a high rate of nosocomial infections and a high level of contamination among health care workers. A workshop will be organized in the coming weeks with the actors in the field to evaluate the relevance, the feasibility and the acceptability of this approach. Community dialogues will also be organized to involve communities in the choice of response strategies to use.
Security situation
Nothing to report.
FIGURES OF THE RESPONSE
114,067 People vaccinated
• 400 people vaccinated on 11/05/2019.• Of those vaccinated, 30,648 are high-risk contacts (CHR), 54,994 are contact contacts (CC), and 28,425 are front-line providers (PPL).
• Persons vaccinated by health zone: 30,701 in Katwa, 23,918 in Beni, 13,896 in Butembo, 7,730 in Mabalako, 5,784 in Mandima, 3,608 in Kalunguta, 3,070 in Goma, 2,928 in Komanda, 2,569 in Oicha, 1,980 in Kayna, 1,930 in Masereka , 1,915 to Vuhovi, 1,748 to Kyondo, 1,472 to Lubero, 1,487 to Bunia, 1,357 to Karisimbi, 1,197 to Musienene, 1,025 to Biena, 1,012 to Mutwanga, 690 to Rutshuru, 557 to Rwampara (Ituri), 527 to Nyankunde, 496 to Mangurujipa, 420 in Mambasa, 355 in Tchomia, 342 in Kirotshe, 333 in Lolwa, 254 in Alimbongo, 250 in Mweso, 245 in Kibirizi, 161 in Nyiragongo, 97 in Watsa (Haut-Uélé) and 13 in Kisangani.
• The only vaccine to be used in this outbreak is the rVSV-ZEBOV vaccine, manufactured by the pharmaceutical group Merck, following approval by the Ethics Committee in its decision of 19 May 2018.
