H5N1

DRC Ebola: 14 cases, 6 deaths (4 in community)

The Ministry of Health has published EBOLA DRC - Evolution of the response to the Ebola outbreak in the provinces of North Kivu and Ituri on Saturday, June 15, 2019. Excerpt from the Google translation:

EVOLUTION OF THE EBOLA EPIDEMIC  IN THE PROVINCES OF NORTH KIVU AND ITURI 

Saturday, June 15, 2019 

The epidemiological situation of the Ebola Virus Disease dated June 14, 2019: 

• Since the beginning of the epidemic, the cumulative number of cases is 2,134, 2,040 confirmed and 94 probable. In total, there were 1,427 deaths (1,333 confirmed and 94 probable) and 588 people healed. 

• 363 suspected cases under investigation; 

• 14 new confirmed cases, including 

º 5 in Mabalako, 3 in Mandima, 2 in Butembo, 2 in Katwa, 1 in Kalunguta and 1 in Lubero; 

• 6 new confirmed case deaths:  

º 4 community deaths, 2 in Mandima, 1 in Mabalako and 1 in Lubero; 

º 2 deaths at CTE, including 1 in Beni and 1 in Butembo.  

• The 3-year-old brother of the index case tested in Uganda died on his arrival at the CTE de Beni on Thursday, June 13, 2019. 

/! \  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. 

FIGURES OF THE RESPONSE  

134,671 people vaccinated   

• Vaccination of pregnant and lactating women, as well as children under one year old. 

• 669 people vaccinated on 14/06/2019. 

• Of those vaccinated, 37,148 are high-risk contacts (CHRs), 67,286 are contacts of contacts (CC), and 30,237 are front-line providers (PPLs).  

• Persons vaccinated by health zone: 34,071 in Katwa, 26,245 in Beni, 18,397 in Butembo, 11,746 in Mabalako, 6,461 in Mandima, 4,666 in Kalunguta, 3,364 in Goma, 3,168 in Komanda, 3,008 in Musienene, 2,569 in Oicha, 2,401 in Masereka , 2,045 to Vuhovi, 1,998 to Lubero, 1,980 to Kayna, 1,905 to Kyondo, 1,506 to Bunia, 1,271 to Mutwanga, 1,040 to Biena, 782 to Mangurujipa, 776 to Rwampara (Ituri), 690 to Rutshuru, 527 to Nyankunde, 494 to Alimbongo, 420 to Mambasa, 355 to Tchomia, 342 to Kirotshe, 333 to Lolwa, 250 to Mweso, 245 to Kibirizi, 161 to Nyiragongo, 97 to Watsa (Haut-Uélé) and 13 to 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.

DRC Ebola: 13 new cases, 66 this week, 2,109 total

The MoH/WHO AFRO Ebola DRC KIVU 2018 Dashboard reports 13 cases on June 14, making a total of 66 so far this week and 2,109 since the outbreak began. Out of 15,600 contact, 1,800 are not being tracked.

DRC Ebola: 12 new cases, 9 deaths (2 in community)

The Ministry of Health has published EBOLA DRC - Evolution of the response to the Ebola outbreak in the provinces of North Kivu and Ituri to Friday, June 14, 2019. Excerpt from the Google translation:

EVOLUTION OF THE EBOLA EPIDEMIC  IN THE PROVINCES OF NORTH KIVU AND ITURI 

Friday, June 14, 2019 

The epidemiological situation of the Ebola Virus Disease  dated June 13, 2019: 

• Since the beginning of the epidemic, the cumulative number of cases is 2,120, 2,026 confirmed and 94 probable. In total, there were 1,420 deaths (1,326 confirmed and 94 probable) and 588 people cured. 

• 322 suspected cases under investigation; 12 new confirmed cases, including 5 in Mabalako, 3 in Biena, 2 in Kalunguta, 1 in Rwampara and 1 in Mandima; 

• 9 new confirmed case deaths:  

º 2 community deaths at Biena; 

º 7 deaths at CTE, including 4 in Beni and 3 in Mabalako; 

• 3 new cures out of ETCs, 2 in Mabalako and 1 in Butembo.

 

/! \  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   

Meeting of the Emergency Committee of the International Health Regulations 

• The meeting of the Emergency Committee for International Health Regulations , convened by the Director-General of WHO, was held on Friday, June 14, 2019. The Emergency Committee concluded that the Ebola outbreak in the provinces North Kivu and Ituri did not constitute a public health emergency of international concern, although it constitutes a health emergency for the Democratic Republic of Congo. 

• The Committee noted that epidemiological trends are evolving positively in the Butembo and Katwa epicentres. However, the response is beginning to face challenges related to community acceptance and security in areas such as Mabalako where the epidemic has resumed recently. On the other hand, the response continues to be limited by the lack of adequate funding and limited human resources. 

• The Committee commended the communication and collaboration between the DRC and Uganda that rapidly contained Ebola cases that crossed the border. Uganda's rapid response proves the importance of preparing border countries for DRC.  

• After lengthy discussions, the Committee considered that the criteria for declaring a public health emergency of international concern were not fulfilled. The Committee considered that all public health measures and recommendations needed to end the epidemic were already being implemented by WHO and the affected countries.

FIGURES OF THE RESPONSE  

134,002 vaccinated  persons   

• 674 people vaccinated on 13/06/2019. 

• Among the vaccinated persons, 36,999 are high-risk contacts (CHR), 66,814 are contacts of contacts (CC), and 30,189 are first-line providers (PPL). 

•  Persons vaccinated by health zone: 34,071 in Katwa, 26,177 in Beni, 18,349 in Butembo, 11,691 in Mabalako, 6,443 in Mandima, 4,636 in Kalunguta, 3,349 in Goma, 3,098 in Komanda, 2,973 in Musienene, 2,569 in Oicha, 2,381 in Masereka , 2.045 to Vuhovi, 1.986 to Lubero, 1.980 to Kayna, 1.905 to Kyondo, 1.506 to Bunia, 1.119 to Mutwanga, 1.040 to Biena, 754 to Mangurujipa, 706 to Rwampara (Ituri), 690 to Rutshuru, 527 to Nyankunde, 494 to Alimbongo, 420 to Mambasa, 355 to Tchomia, 342 to Kirotshe, 333 to Lolwa, 250 to Mweso, 245 to Kibirizi, 161 to Nyiragongo, 97 to Watsa (Haut-Uélé) and 13 to 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.

DRC Ebola: 12 new cases, 55 this week, 2,117 total

The MoH/WHO AFRO Ebola DRC KIVU 2018 Dashboard reports 12 new cases on June 13, making 55 so far this week, 222 in the past 3 weeks, and 2,117 since the outbreak began last August.

Uganda discloses greater Ebola threat than previously known

Via The New York Times: Uganda Discloses Greater Ebola Threat Than Previously Known. Excerpt and then a comment:

Uganda’s exposure to Ebola infection from the neighboring Democratic Republic of Congo appeared to have increased on Thursday, as the death toll rose to two and three suspected cases were reported in a Ugandan border hospital.  

The number of people in Uganda who may have been exposed to carriers of the Ebola virus expanded significantly, from eight to at least 27.

The disclosures, in a Ministry of Health update on its website, suggested an accelerating threat to Uganda from the Ebola virus, which has been ravaging eastern Congo for the past year and was reported to have spread to Uganda this week.  

A 5-year-old Congolese boy who entered a border town in western Uganda with his family on June 9 died of Ebola on Wednesday, the first case in Uganda since the Congo outbreak. His 50-year-old grandmother who was traveling with him became the second fatality, the Uganda Health Ministry said on Thursday.   

The spread of Ebola to Uganda has alarmed international health officials, who had expressed hope that the outbreak, centered in a recurrent conflict zone in eastern Congo, could be contained and defeated there. 

The World Health Organization is convening a meeting of its International Health Regulations Emergency Committee on Friday at its headquarters in Geneva, with expectations it will declare the Ebola outbreak to be what is known as a public health emergency of international concern.  

That declaration would trigger a far more aggressive response to combat the outbreak, which could lead to more stringent border controls and other travel restrictions. 

The Uganda Health Ministry said five others from Congo who had been with the first victim — his mother and father, a 3-year-old sibling, a 6-month-old sibling and a maid — had all been returned to the Congo side of the border. The 3-year-old was confirmed to be infected with Ebola and the others are all suspect cases, it said. 

“As of now, there is no confirmed case of Ebola in Uganda,” the ministry said. It sought to assure international travelers that the country was “safe and all our national parks and tourist sites remain open and accessible to the public.” 

 However, the ministry said, three suspected cases unrelated to the first two fatalities had been isolated for treatment at the hospital in Bwera, the border town where the spread of Ebola into Uganda was first reported.

The three suspected cases are presumably the three people who escaped before their blood could be tested. See the post below from the Daily Monitor.

Estimating undetected Ebola spillovers

As if the news weren't quite grim enough, PLOS Neglected Tropical Diseases has just published Estimating undetected Ebola spillovers. The abstract:

The preparedness of health systems to detect, treat, and prevent onward transmission of Ebola virus disease (EVD) is central to mitigating future outbreaks. Early detection of outbreaks is critical to timely response, but estimating detection rates is difficult because unreported spillover events and outbreaks do not generate data. 

Using three independent datasets available on the distributions of secondary infections during EVD outbreaks across West Africa, in a single district (Western Area) of Sierra Leone, and in the city of Conakry, Guinea, we simulated realistic outbreak size distributions and compared them to reported outbreak sizes. These three empirical distributions lead to estimates for the proportion of detected spillover events and small outbreaks of 26% (range 8–40%, based on the full outbreak data), 48% (range 39–62%, based on the Sierra Leone data), and 17% (range 11–24%, based on the Guinea data). 

We conclude that at least half of all spillover events have failed to be reported since EVD was first recognized. We also estimate the probability of detecting outbreaks of different sizes, which is likely less than 10% for single-case spillover events. 

Comparing models of the observation process also suggests the probability of detecting an outbreak is not simply the cumulative probability of independently detecting any one individual. Rather, we find that any individual’s probability of detection is highly dependent upon the size of the cluster of cases. 

These findings highlight the importance of primary health care and local case management to detect and contain undetected early stage outbreaks at source.

WHO: Ebola virus disease – Republic of Uganda

WHO has published Ebola virus disease – Republic of Uganda. Excerpt from the risk assessment section:

All three confirmed cases are imported from DRC and belong to the same family who travelled together from Mabalako Health Zone, an area currently affected by Ebola outbreak in North Kivu, DRC. To date, they remain as a single episode of EVD in Uganda, and the geographical spread in Uganda appears to be limited to one district near DRC border. Further investigations are ongoing both in Uganda and DRC to assess the full extent of the outbreak. 

Since the beginning of the Ebola outbreak in DRC in August 2018, WHO has advised neighbouring countries (Priority 1 countries: Uganda, Rwanda, South Sudan, and Burundi / Priority 2 countries: Angola, Zambia, Tanzania, Central African Republic and Republic of Congo) to reinforce their preparedness measures. 

Considering that to date i) the EVD cases confirmed in Uganda were epidemiologically linked to the DRC; ii) all three cases belong to single family cluster with a common high-risk exposure to a confirmed case, iii) the level of preparedness and the proven experience of Ugandan authorities to manage previous EVD outbreaks, and iv) the rapidity of the detection and a limited geographical area affected (Kasese district), the overall level of risk at national level is assessed as moderate. 

Moreover, given that there is no evidence of local transmission of EVD in Uganda and the location of the outbreak being close to the DRC border, the overall risk posed at regional level by the Ugandan outbreak is considered low. However, the overall regional risk posed by the outbreak in DRC remains very high. The overall risk at international level remains low.  

The Director-General will convene a third meeting of the Emergency Committee under the International Health Regulations (IHR 2005) following the most recent risk assessment which noted a cross-border spread of Ebola from DRC to Uganda. WHO has convened the emergency committee under International Health Regulations (IHR 2005) twice (October 2018 and April 2019) since the outbreak in DRC was announced in August. The committee will discuss whether the event constitute a public health emergency of international concern (PHEIC).

DRC Ebola: 24 new cases, 6 deaths (3 in community), 2,108 total

The Ministry of Health has published EBOLA DRC - Evolution of the response to the Ebola outbreak in the provinces of North Kivu and Ituri on Thursday, June 13, 2019. Another double-digit day for new cases, and another vaccinated healthcare worker infected nonetheless. Excerpt from the Google translation:

EVOLUTION OF THE EBOLA EPIDEMIC  IN THE PROVINCES OF NORTH KIVU AND ITURI 

Thursday 13 June 2019 

The epidemiological situation of the Ebola Virus Disease  dated June 12, 2019: 

• Since the beginning of the epidemic, the cumulative number of cases is 2,108, of which 2,014 are confirmed and 94 are probable. In total, there were 1,411 deaths (1,317 confirmed and 94 probable) and 585 people healed. 

• 335 suspected cases under investigation; 

• 24 new confirmed cases, including 13 in Mabalako, 4 in Beni, 3 in Mandima, 1 in Katwa, 1 in Butembo, 1 in Mangurujipa and 1 in Rwampara; 

º Uganda's index case and 7 other family members were classified in Mabalako, the health zone where they began to develop symptoms. Of these 8 confirmed cases from the same family, 5 remained in the DRC and 3 had crossed the border.  

• 6 new confirmed case deaths:  

º 3 community deaths, 2 in Mandima and 1 in Mangurujipa; 

º 3 CTE deaths, including 1 in Mabalako and 2 in Bwera (Uganda); 

º The 2 deaths of Bwera are the 5-year-old boy and the 50-year-old grandmother who were classified in Mabalako; 

• Six new cures emerged from CTEs, including four in Katwa, one in Beni and one in Butembo.

 

/! \  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

Response operations  

Case of Ebola Virus Disease in Uganda 

• This Thursday, June 13, 2019, five family members were repatriated to the DRC. Returnees are the mother of the index case, the 3-year-old brother (who is a confirmed Ebola case), a 6-month-old baby, the father of Ugandan children, and the nanny. Thus, to date, no more cases of Ebola are found in Uganda.

FIGURES OF THE RESPONSE  

133,328 vaccinated  persons   

• 649 people vaccinated on 12/06/2019. 

• Of those vaccinated, 36,803 are high-risk contacts (CHRs), 66,377 are contacts of contacts (CC), and 30,148 are front-line providers (PPLs).  

• Persons vaccinated by health zone: 34,052 in Katwa, 25,998 in Beni, 18,330 in Butembo, 11,540 in Mabalako, 6,443 in Mandima, 4,619 in Kalunguta, 3,329 in Goma, 3,048 in Komanda, 2,895 in Musienene, 2,569 in Oicha, 2,351 in Masereka , 2,045 to Vuhovi, 1,998 to Lubero, 1,980 to Kayna, 1,888 to Kyondo, 1,487 to Bunia, 1,040 to Biena, 1,062 to Mutwanga, 706 to Rwampara (Ituri), 690 to Rutshuru, 676 to Mangurujipa, 527 to Nyankunde, 494 to Alimbongo, 420 to Mambasa, 355 to Tchomia, 342 to Kirotshe, 333 to Lolwa, 250 to Mweso, 245 to Kibirizi, 161 to Nyiragongo, 97 to Watsa (Haut-Uélé) and 13 to 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. 

Health checkpoints

65,720,401 people under control 

• 80 entry points (PoE) and operational health checkpoints (PoC). 

Infected healthcare workers

116 contaminated health workers 

• One Mabalako health worker, vaccinated, is one of the new confirmed cases.  

• The cumulative number of confirmed / probable cases among health workers is 116 (5.5% of all confirmed / probable cases), including 38 deaths.

DRC Ebola: 21 new cases, 43 this week, 2,105 total

The MoH/WHO AFRO Ebola DRC KIVU 2018 Dashboard reports 21 new cases on June 12, bringing the total for this week so far to 43 and the outbreak total to 2,105. The ministry's daily update will provide more details in a few hours.

DRC Ebola: 13 new cases, 9 deaths (7 in community) and a destroyed family

The Ministry of Health has published EBOLA DRC - Evolution of the response to the Ebola outbreak in the provinces of North Kivu and Ituri on Wednesday, June 12, 2019. Apart from being a bad day, June 11 was aggravated by the cases in a Congolese-Ugandan family that managed to cross the border back into Uganda. Excerpt from the Google translation:

EVOLUTION OF THE EBOLA EPIDEMIC  IN THE PROVINCES OF NORTH KIVU AND ITURI 

Wednesday, June 12, 2019  

The epidemiological situation of the Ebola Virus Disease dated 11 June 2019: 

• Since the beginning of the epidemic, the cumulative number of cases is 2,084, including 1,990 confirmed and 94 probable. In total, there were 1,405 deaths (1,311 confirmed and 94 probable) and 579 people healed. 

• 339 suspected cases under investigation; 

• 13 new confirmed cases, including 7 in Mabalako, 4 in Beni, 1 in Kalunguta and 1 in Komanda; 

• 9 new confirmed case deaths:  

 º 7 community deaths, including 5 in Mabalako, 1 in Kalunguta and 1 in Komanda; 

º 2 deaths at CTE, including 1 in Katwa and 1 in Butembo; 

• 4 new cures out of ETCs, 2 in Beni and 2 in Butembo. 

INFO: All family members of the Ebola case in Uganda are not yet included in the caseload. The confirmed cases of the family, both on the Ugandan and Congolese side, will be officially added in the epidemiological situation that will be published this Thursday, June 13, 2019.

  

/! \  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   

Case of Ebola Virus Disease in Uganda 

• The first confirmed case of Ebola in Uganda, a five-year-old boy, passed away on the morning of Wednesday, June 12, 2019. His dignified and safe burial will be on Thursday, June 13, 2019 in Kasese, the district where he resided with his parents.  

• Laboratory tests have confirmed that of the six family members who have crossed the border, two others are also infected with Ebola. This is the 50 year old grandmother and the 3 year old brother of the deceased boy. Of the six family members left in Kasindi and transferred to the Beni Ebola Treatment Center, five were tested positive. Around this family, about 50 contacts were listed in Kasese on the Ugandan side and 80 contacts in Kasindi on the Congolese side. Kasindi's vaccination ring was opened on Wednesday. 

• On Wednesday, June 12, 2019, the Congolese and Ugandan health authorities also held a meeting in Kasese, about 140 kilometers from Beni, to discuss mechanisms for cross-border collaboration. The Ugandan Minister of Health, Dr Jane Ruth Aceng, led the Ugandan delegation while the Congolese side was led by Dr. Gaston Tshapenda, coordinator of Beni. 

• The main decisions taken are: 

º Strengthen surveillance at ports of entry, especially secondary roads; 

º Maintain continuous information sharing in real time between the two countries; 

º Start vaccinating the contacts as soon as possible. The DRC has already donated 400 doses of rVSV-ZEBOV vaccine to Uganda. The DRC is willing to send vaccination teams to Uganda to vaccinate all contacts more quickly if needed; 

º Repatriate all family members in the DRC after obtaining their informed consent. Since the father of the deceased child was Ugandan, the family was free to choose the place of hospitalization. Living family members have all agreed to return to the DRC for further medical treatment and 21-day follow-up. The advantage of continuing medical treatment in the DRC is the possibility of benefiting from new therapeutic molecules that are not yet available in Uganda; 

º Finalize the Memorandum of Understanding between Uganda and the DRC that will define the procedures for in-depth health collaboration between the two countries.

FIGURES OF THE RESPONSE

132,679 people vaccinated

• 415 people vaccinated on 11/06/2019.

• Of those vaccinated, 36,595 are high-risk contacts (CHRs), 65,944 are contacts of contacts (CC), and 30,140 are front-line providers (PPLs).

• Persons vaccinated by health zone: 33,990 in Katwa, 25,890 in Beni, 18,234 in Butembo, 11,387 in Mabalako, 6,443 in Mandima, 4,619 in Kalunguta, 3,329 in Goma, 3,048 in Komanda, 2,835 in Musienene, 2,569 in Oicha, 2,351 in Masereka , 2,045 to Vuhovi, 1,998 to Lubero, 1,980 to Kayna, 1,888 to Kyondo, 1,487 to Bunia, 1,040 to Biena, 1,012 to Mutwanga, 690 to Rutshuru, 666 to Rwampara (Ituri), 596 to Mangurujipa, 527 to Nyankunde, 494 to Alimbongo, 420 to Mambasa, 355 to Tchomia, 342 to Kirotshe, 333 to Lolwa, 250 to Mweso, 245 to Kibirizi, 161 to Nyiragongo, 97 to Watsa (Haut-Uélé) and 13 to 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.

Health checkpoints

65,448,742 people under control

• 80 entry points (PoE) and operational health checkpoints (PoC).

Infected healthcare workers

115 contaminated health workers

• Two Mabalako health workers, unvaccinated, are among the new confirmed cases. One of the health workers died in the health center where he was working (community death).

• The cumulative number of confirmed / probable cases among health workers is 115 (5.5% of all confirmed / probable cases), including 38 deaths.