H5N1

WHO: DRC Ebola External Sitrep 37

Via ReliefWeb, a WHO AFRO report: Democratic Republic of Congo: Ebola Virus Disease - External Situation Report 37. Excerpt:

This past week saw the continued rise in the number of Ebola virus disease (EVD) cases in the North Kivu and Ituri provinces of the Democratic Republic of the Congo, with a total of 110 new confirmed cases. Documented transmission, however, remains geographically confined, with the majority of recent cases reported from the health zones of Katwa, Mandima, Butembo, and Vuhovi. 

During the last 21 days (25 March to 14 April 2019), 55 health areas within 11 health zones reported new cases; 38% of the 144 health areas affected to date (Table 1 and Figure 2). During this period, a total of 238 confirmed and probable cases were reported from Katwa (119), Vuhovi (41), Mandima (27), Beni (20), Butembo (14), Oicha (7), Mabalako (5), Kalunguta (1), Masereka (1), Musienene (1), and Lubero (1). 

As of 14 April 2019, a total of 1264 EVD cases, including 1198 confirmed and 66 probable cases, were reported. A total of 814 deaths were reported (overall case fatality ratio 64%), including 748 deaths among confirmed cases. 

Of the 1264 confirmed and probable cases with reported age and sex, 56% (712) were female, and 28% (355) were children aged less than 18 years. The number of healthcare workers affected has risen to 89, including 32 deaths, with four new health workers confirmed in the last week; all from community health centres within hotspot areas.

DRC Ebola: 100,000 vaccinated, 13 new cases, 11 deaths today

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 Monday, April 15, 2019. The news continues bad, despite the landmark achievement of 100,000 vaccinations. The report of the dead unvaccinated nurse is especially discouraging. Excerpt from the Google translation:

EPIDEMIOLOGICAL SITUATION IN THE PROVINCES OF NORTH KIVU AND ITURI 

Monday, April 15, 2019   

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

• Since the beginning of the epidemic, the cumulative number of cases is 1,264, of which 1,198 confirmed and 66 probable. In total, there were 814 deaths (748 confirmed and 66 probable) and 374 people cured. 

• 231 suspected cases under investigation; 

• 13 new confirmed cases, including 7 in Katwa, 2 in Mabalako, 1 in Mandima, 1 in Musienene, 1 in Butembo and 1 in Oicha;  

• 11 new confirmed case deaths, including 

º 6 community deaths, including 4 in Katwa and 2 in Mabalako; 

º 5 deaths at CTE, including 3 in Katwa and 2 in Butembo; 

• 3 new cures, including 1 from the Butembo CTE, 1 from the Beni CTE and 1 from the Mabalako CTE; 

• One Katwa health worker is among the new confirmed cases (community deaths).  

º This is an unvaccinated nurse who was in contact with a confirmed patient. When she started the illness, she hid and was cared for at home by her colleagues from 4 to 13 April 2019. Following the deterioration of her clinical condition, she consulted a health center in Butembo where she died.   

º The cumulative number of confirmed / probable cases among health workers is 89 (7% of all confirmed / probable cases) including 32 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 of the response 

More than 100,000 vaccinated people 

• This Sunday, April 14, 2019, the cap of 100,000 people vaccinated against Ebola in the provinces of North Kivu and Ituri has been reached. Of these 100,000, 27,766 are front-line health workers, 26,328 are high-risk contacts for confirmed cases, and 46,376 are contacts.  

• So far, the only vaccine to be used in this outbreak is the rVSV-ZEBOV vaccine, manufactured by the pharmaceutical group Merck, after the approval of the Ethics Committee in its decision of 19 May 2018. The strategy used, called vaccination, aims to create a circle of people immunized against the Ebola virus around a confirmed patient in order to break the chain of transmission.  

• Preliminary results from a study by the National Institute for Biomedical Research (INRB) and the World Health Organization (WHO) confirmed the very high efficiency of the vaccine and vaccination belt to limit the spread of Ebola outbreak. Moreover, the significant increase in new cases confirmed in recent weeks, particularly in active households in Butembo and Katwa, is partly explained by the temporary cessation of vaccination activities in March following the rise in violence against the teams of the response. Because of the problems of violence and safety, 45 vaccination rings could not be opened around confirmed cases.  

Vaccination  

• Since vaccination began on August 8, 2018, 100,470 people have been vaccinated , including 25,917 in Katwa, 21,908 in Beni, 12,437 in Butembo, 6,451 in Mabalako, 4,220 in Mandima, 3,080 in Kalunguta, 3,070 in Goma, 2,540 in Oicha, 2,423 at Komanda, 1,845 at Vuhovi, 1,729 at Masereka, 1,630 at Kayina, 1,619 at Kyondo, 1,487 at Bunia, 1,357 at Karisimbi, 1,193 at Lubero, 1,027 at Musienene, 1,025 at Biena, 772 at Mutwanga, 690 at Rutshuru, 557 in Rwampara (Ituri), 527 in Nyankunde, 496 in Mangurujipa, 420 in Mambasa, 355 in Tchomia, 333 in Lolwa, 342 in Kirotshe, 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.

EBOLA DRC - Evolution of the response to the Ebola outbreak in North Kivu and Ituri to Friday April 12 2019

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, April 12, 2019. Excerpt from the Google translation:

EPIDEMIOLOGICAL SITUATION IN THE PROVINCES OF NORTH KIVU AND ITURI  

Friday, April 12, 2019   

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

• Since the beginning of the epidemic, the cumulative number of cases is 1,220, of which 1,154 are confirmed and 66 are probable. In total, there were 772 deaths (706 confirmed and 66 probable) and 364 people cured. 

• 287 suspected cases under investigation; 

• 14 new confirmed cases, including 8 in Katwa, 2 in Vuhovi, 1 in Mandima, 1 in Butembo, 1 in Komanda, and 1 in Beni;  

• 8 new confirmed case deaths, including 

º 4 community deaths in Katwa; 

º 4 deaths at CTE, 2 in Katwa, 1 in Butembo and 1 in Beni; 

• 6 new cures including 4 from the Butembo CTE, 1 from the Katwa CTE and 1 from the CTE de Beni; 

• One Beni health worker is among the new confirmed cases. The cumulative number of confirmed / probable cases among health workers is 88 (7.2% of all confirmed / probable cases), including 31 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 of the response     

Emergency Committee of the World Health Organization 

• The meeting of the Emergency Committee for International Health Regulations, convened by the Director-General of WHO, was held this Friday, April 12, 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. However, the Committee expressed its deep concern about the recent increase in transmission in some areas, and thus the potential risk of spread in neighboring countries.  

• The Committee also commended the efforts of the Government of the Democratic Republic of Congo's response teams, the World Health Organization and partners to contain the epidemic in a complex and difficult environment.  

• In addition, the Committee made the following public health recommendations:  

• No restrictions on travel or international trade should be imposed and exit screening at airports, ports and land borders remains an important activity; 

• Redouble efforts to detect cases as early as possible, identify and track contacts, and ensure maximum immunization coverage of all contacts and contacts;  

• Increase efforts to prevent nosocomial transmission and reduce the time between onset of illness and access to quality health care in Ebola treatment centers; 

• Pay particular attention to respond to the increasing number of cases in the remaining epicenters, including Butembo, Katwa, Vuhovi and Mandima; 

• Identify, target and expand community dialogue and participation, involvement of traditional healers and other techniques to strengthen and broaden community acceptance;  

• Implement the latest recommendations of the WHO Strategic Advisory Group of Experts (SAGE) on the immunization strategy, ie the inclusion of pregnant women and children under one year of age in the vaccination strategy in a belt;  

• The security of the actors of the response must be a priority, while avoiding the security of interventions; 

• Given the very high risk of regional spread, neighboring countries need to continue to accelerate their preparedness and surveillance efforts, including immunization of primary care providers; 

• Continue to strengthen cross-border collaboration, including data sharing and alerts, cross-border community engagement and awareness raising. In addition, it is also recommended to improve the mapping of population movements and the understanding of social networks that transcend national borders. 

• The members and advisers of the Emergency Committee met by teleconference. Representatives from the DRC Ministry of Health gave a presentation on the epidemiological situation, response strategies and recent adaptations, including the strategy to improve community engagement. MONUSCO representatives discussed their logistics and security activities to support the response. Finally, the WHO Secretariat presented in detail the situation on the evolution of the current epidemic as well as the preparedness activities in neighboring countries.

Vaccination

• Since the beginning of vaccination on August 8, 2018, 98,422 people have been vaccinated , including 24,903 in Katwa, 21,640 in Beni, 12,045 in Butembo, 6,331 in Mabalako, 4,172 in Mandima, 3,070 in Goma, 3,080 in Kalunguta, 2,540 in Oicha, 2.347 to Komanda, 1.795 to Vuhovi, 1.729 to Masereka, 1.630 to Kayina, 1.569 to Kyondo, 1.487 to Bunia, 1.357 to Karisimbi, 1.193 to Lubero, 1.025 to Biena, 997 to Musienene, 772 to Mutwanga, 690 to Rutshuru, 557 in Rwampara (Ituri), 527 in Nyankunde, 496 in Mangurujipa, 420 in Mambasa, 355 in Tchomia, 333 in Lolwa, 342 in Kirotshe, 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.
 

IHR Emergency Committee says Ebola is not a PHEIC

WHO has published Statement on the meeting of the International Health Regulations (2005) Emergency Committee for Ebola virus disease in the Democratic Republic of the Congo on 12th April 2019. The key findings:

It was the view of the Committee the ongoing Ebola outbreak in North Kivu and Ituri provinces of the Democratic Republic of the Congo does not constitute a Public Health Emergency of International Concern (PHEIC). However, the Committee wished to express their deep concern about the recent increase in transmission in specific areas, and therefore the potential risk of spread to neighbouring countries.  

The Committee also wishes to commend the efforts of responders from the government of the Democratic Republic of Congo, the World Health Organization and partners to contain the outbreak in a complex and difficult setting.  

Additionally, the Committee has provided the following public health advice:  

• The committee advises to redouble efforts to detect cases as early as possible, identify and follow up all contacts, ensure the highest level of coverage vaccination of all contacts and contacts of contacts. 

• Sustained efforts must be made to prevent nosocomial transmission and to shorten time between onset of disease and access to high standards of care and therapeutics at Ebola treatment units. 

• Special emphasis should be placed on addressing the rise in case numbers in the remaining epicentres, notably Butembo, Katwa, Vuhovi, and Mandima. 

• The Committee advises WHO and all partners to identify, target, and scale up community dialogue and participation, engagement of traditional healers, and other community engagement tactics to strengthen and broaden community acceptance.  

• The Committee also noted the need to follow the recommendations of SAGE with regards to the vaccination strategy provided at its latest meeting. 

• The safety of responders should be prioritized, while avoiding the securitization of the response. 

• Because there is a very high risk of regional spread, neighbouring countries should continue to accelerate current preparedness and surveillance efforts, including vaccination of health care workers and front-line workers in surrounding countries.    

• Cross-border collaboration should continue to be strengthened, including timely sharing of data and alerts, cross-border community engagement and awareness raising. In addition, work should be done to better map population movements and understand social networks bridging national boundaries. 

• The Committee maintains its previous advice that it is particularly important that no international travel or trade restrictions should be applied. Exit screening, including at airports, ports, and land crossings, is of great importance; however, entry screening, particularly in distant airports, is not considered to be of any public health or cost-benefit value. 

• The committee strongly emphasized the critical need to strengthen currents efforts in both preparedness and response. This will require substantial, immediate and sustained additional financial support. 

• While there is no added benefit to declaring a PHEIC at this stage, there was concern about current levels of transmission requiring close attention to the evolving situation. The committee advised the WHO Director General to continue to monitor the situation closely and reconvene the Emergency Committee as needed.

WHO: Ebola virus disease – Democratic Republic of the Congo

WHO has published its weekly update: Ebola virus disease – Democratic Republic of the Congo. We will likely hear much more from WHO tomorrow and over the weekend. Excerpt:

The rise in number of Ebola virus diseases cases observed in the North Kivu provinces of the Democratic Republic of the Congo continues this week. During the last 21 days (20 March to 9 April 2019), 57 health areas within 11 health zones reported new cases; 40% of the 141 health areas affected to date (Table 1 and Figure 2). During this period, a total of 207 probable and confirmed cases were reported from Katwa (83), Vuhovi (41), Mandima (29), Beni (21), Butembo (15), Oicha (8), Masereka (4), Lubero (2), Musienene (2), Kalunguta (1), and Mabalako (1).  

As of 9 April, a total of 1186 confirmed and probable EVD cases have been reported, of which 751 died (case fatality ratio 63%). Of the 1186 cases with reported age and sex, 57% (675) were female, and 29% (341) were children aged less than 18 years. The number of healthcare workers affected has risen to 87 (7% of total cases), including 31 deaths. To date, a total of 354 EVD patients who received care at Ebola Treatment Centres (ETCs) have been discharged.  

WHO Director-General Dr. Tedros Adhanom Ghebreyesus has convened the Emergency Committee for a meeting on 12 April, to consider whether the current EVD outbreak constitutes a public health emergency of international concern and to provide recommendations.  

Progress on the ground this week focused primarily on intensifying infection prevention and control (IPC) activities in and around outbreak hotspot areas. IPC teams are concentrating their efforts at addressing reluctance to decontamination activities amongst some local residents by actively engaging in regular direct dialogues with community leaders. 

Along with intensifying decontamination efforts, other IPC measures being undertaken include rapid evaluation of IPC practices in healthcare facilities and patients’ homes and identifying facilities at increased risk of contact with EVD cases. Results from these rapid evaluations demonstrated a range of IPC gaps depending on the type of facility, which were then promptly addressed through supplementary supervision. 

Reoccurring issues include limited knowledge of standard precautions, lack of triage and isolation capacity, insufficient supplies (e.g., of personal protective equipment), inappropriate waste management, and lack of capacity for decontaminating medical equipment. These findings highlight the importance of maintaining supportive supervision and mentorship at priority facilities throughout the response. WHO is confident that strengthening these IPC measures would be an integral means of slowing the spread of EVD in the outbreak areas. 

WHO and partners in Risk Communication and Community Engagement are continuing with activities to build and maintain a trusting relationship between communities and the Ebola response teams. 

Dialogues with community committees are ongoing in the hotspot areas of Butembo, Katwa, and Vuhovi, and form a key part of a larger increase ownership of the Ebola response by the communities. Information about community disquiet are systematically collected and monitored to ensure that any misunderstanding leading to reluctance, refusal, or resistance of the Ebola response is followed up with and resolved as quickly as possible. This has been made possible by feedback from the community members, received through ongoing dialogue and various research activities within both the Democratic Republic of the Congo, and neighbouring areas.  

In an effort to address the feedback received and specific concerns over the outbreak response, guided visits of the Ebola Treatment Centres (ETCs) in various affected areas have been organized. Students and community associations who attended these guided visits to the ETCs can see first-hand how EVD patients are treated and help stop the potential dissemination of misinformation surrounding EVD and the ongoing response efforts.  

The security situation has remained calm for the past week as well. Provisional results released on 9 April by the Commission Électorale Nationale Indépendante concerning the national and provincial legislative elections in Beni, Butembo city (North Kivu), and Yumbi territory (Mai-Ndombe) have caused no significant unrest or disruption to outbreak response activities.  

The continued increase in cases this past week reflects the complex reality of conducting an effective outbreak response in a geographically difficult area with a highly fluid population, intermittent attacks by armed groups, and limited healthcare infrastructure. Despite these challenges, WHO and partners remain committed to limiting the spread of EVD amongst these vulnerable populations through the continued strengthening of our multi-faceted response efforts.

DRC MoH: 18 new Ebola cases, 10 deaths today

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, April 10, 2019. The news is even worse than it looked on the Ebola dashboard earlier today. Excerpt from the Google translation:

EPIDEMIOLOGICAL SITUATION IN THE PROVINCES OF NORTH KIVU AND ITURI 

Wednesday, April 10, 2019   

The epidemiological situation of the Ebola Virus Disease  dated April 9, 2019: 

• Since the beginning of the epidemic, the cumulative number of cases is 1,186, of which 1,120 are confirmed and 66 are probable. In total, there were 751 deaths (685 confirmed and 66 probable) and 354 people cured. 

• 316 suspected cases under investigation; 

• 18 new confirmed cases, including 11 in Katwa, 3 in Vuhovi, 3 in Mandima, and 1 in Beni;  

º Of the new patients in Katwa, two volunteered for CTE at the onset of symptoms; 

• 10 new confirmed deaths, including 

º 8 community deaths, 5 in Katwa, 2 in Mandima and 1 in Vuhovi; 

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

• 4 new cures including 2 from the CTE of Beni and 2 from the CTE of Butembo; 

• 1 health worker in Mandima is one of the new confirmed cases. The cumulative number of confirmed / probable cases among health workers is 87 (7.3% of all confirmed / probable cases), including 31 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 of the response    

Vaccination  

• Since the start of vaccination on 8 August 2018, 97,376 people have been vaccinated , including 24,316 in Katwa, 21,582 in Beni, 11,953 in Butembo, 6,279 in Mabalako, 4,120 in Mandima, 3,070 in Goma, 3,055 in Kalunguta, 2,540 in Oicha, 2.347 to Komanda, 1.729 to Masereka, 1.675 to Vuhovi, 1.630 to Kayina, 1.509 to Kyondo, 1.487 to Bunia, 1.357 to Karisimbi, 1.193 to Lubero, 1.025 to Biena, 997 to Musienene, 772 to Mutwanga, 690 to Rutshuru, 557 in Rwampara (Ituri), 527 in Nyankunde, 496 in Mangurujipa, 420 in Mambasa, 355 in Tchomia, 333 in Lolwa, 342 in Kirotshe, 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.

EBOLA DRC - Evolution of the response to the Ebola outbreak in North Kivu and Ituri to Tuesday April 9 2019

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 Tuesday, April 9, 2019. Bad news continues: Not only 14 new cases and 10 deaths, but one of the seven community deaths was of a healthcare worker. Excerpt from the Google translation:

EPIDEMIOLOGICAL SITUATION IN THE PROVINCES OF NORTH KIVU AND ITURI 

Tuesday, April 9, 2019   

The epidemiological situation of the Ebola Virus Disease dated April 8, 2019:   

• Since the beginning of the epidemic, the cumulative number of cases is 1,168, of which 1,102 are confirmed and 66 are probable. In total, there were 741 deaths (675 confirmed and 66 probable) and 350 people healed. 

• 274 suspected cases under investigation; 

• 14 new confirmed cases, including 7 in Katwa, 3 in Vuhovi, 1 in Butembo, 1 in Mandima, 1 in Masereka and 1 in Beni;  

• 10 new confirmed deaths, including 

º 7 community deaths, 3 in Katwa, 1 in Butembo, 1 in Vuhovi, 1 in Masereka and 1 in Mandima; 

º 3 deaths at CTE, 2 in Katwa and 1 in Butembo; 

• One Vuhovi health worker (community death) is one of the new confirmed cases. The cumulative number of confirmed / probable cases among health workers is 86 (7.8% of all confirmed / probable cases), including 31 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 of the response    

Record number of cures unloaded in Butembo

• The week of 1 to 7 April 2019, 17 patients were discharged cured CTE Butembo, a record never before achieved. Dr. Richard Kitenge, National Coordinator of CTE and Country Leader for Ebola Virus Disease (EVD), hopes that this good news will help change people's perceptions of ETC. In the town of Butembo, many patients avoided or refused to be transferred to the ETC for fear of dying there. Thus, the patients arrived late at the CTE, at an advanced stage of the disease to be able to be saved. 

• Despite the persistence of a high rate of community deaths in Butembo town, it has been noted that an increasing number of sick people detected in the community or local health facilities agree to be transferred to the CTE soon after the start symptoms, increasing their chance of survival. As a reminder, 80% of patients (ie 8 out of 10 patients) who were taken care of less than 3 days after the onset of symptoms have come out of ETCs.  

• Since the reopening of the Katwa and Butembo CTEs, changes have been made in the medical management of patients. The capacity of the Butembo CTE is now 94 beds and that of the Katwa CTE is 76 beds.  

• At the Butembo CTE, the number of caregivers increased from 62 to 90 nurses and from 14 to 32 doctors, all recruited locally. The caregivers were divided into three teams: a team exclusively responsible for admissions to reduce the waiting time for patients arriving at the CTE, a team for monitoring patients in stable condition and a last larger team for patient follow-up. in critical condition. For patients in serious condition, psychologists are assigned to families to accompany them throughout the process. Psychologists serve as a link between CTE families and doctors to explain the evolution of the patient's medical situation in a simple and regular way to families. Families of patients are allowed to visit their sick relatives every day with the support of the health promotion teams. In addition, the therapeutic molecules are used again but in the context of the former therapeutic protocol for compassionate purposes and no longer in the context of the clinical trial.   

Vaccination  

• Since the beginning of the vaccination on August 8, 2018, 97,035 people have been vaccinated , including 24,245 in Katwa, 21,582 in Beni, 11,854 in Butembo, 6,279 in Mabalako, 4,073 in Mandima, 3,070 in Goma, 3,055 in Kalunguta, 2,489 in Oicha, 2.347 to Komanda, 1.729 to Masereka, 1.661 to Vuhovi, 1.630 to Kayina, 1.489 to Kyondo, 1.487 to Bunia, 1.357 to Karisimbi, 1.193 to Lubero, 1.025 to Biena, 958 to Musienene, 772 to Mutwanga, 690 to Rutshuru, 557 in Rwampara (Ituri), 527 in Nyankunde, 496 in Mangurujipa, 420 in Mambasa, 355 in Tchomia, 333 in Lolwa, 342 in Kirotshe, 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.

WEEKLY SUMMARY OF EPIDEMIOLOGICAL DATA

Week 14 (April 1-7, 2019)

For the week of April 1 to 7, 2019, we recorded:

• 1,979 suspected cases investigated and tested in the laboratory;

• 65 new confirmed cases:

º Katwa is the main household with 29 cases (44.6%);

º No new health zone affected.

• 52 deaths of confirmed cases:

º The main households are Katwa (15) and Butembo (15), which together account for 57.7% of new deaths during the week;

º Of the 52 deaths, 26 were community deaths and 26 occurred in an ETC.

• 19 new people healed:

º Significant increase compared to the previous week when 8 new cures were unloaded;

º Record for the Butembo CTE which unloaded 17 new cures this week.

WHO AFRO - Ebola outbreak in DRC - Sitrep 36

WHO AFRO has published Situation Report - Ebola Virus Disease Outbreak in DRC - Sitrep 36 (2019). Excerpt:

The recent escalation in the number of Ebola virus disease (EVD) cases continues in the North Kivu provinces of the Democratic Republic of the Congo. This past week saw 65 new confirmed cases reported in the last seven days, predominantly from the areas of Katwa, Mandima, Butembo, and Vuhovi. During the last 21 days (18 March to 7 April 2019), 58 health areas within 13 health zones reported new cases; 42% of the 137 health areas affected to date. During this period, a total of 199 confirmed cases were reported from Katwa (69), Vuhovi (36), Mandima (30), Beni (18), Butembo (16), Masereka (13), Oicha (8), Kayna (2), Lubero (2), Musienene (2), Kalunguta (1), Bunia (1) and Mabalako (1).   \

As of 7 April 2019, 1154 EVD cases, including 1088 confirmed and 66 probable cases, were reported. A total of 731 deaths were reported (overall case fatality ratio 63%), including 665 deaths among confirmed cases. Of the 1154 confirmed and probable cases with reported age and sex, 57% (662) were female, and 29% (331) were children aged less than 18 years. The number of healthcare workers affected has risen to 85, including 30 deaths, with three new health workers among the newly confirmed cases in Katwa and one in Musienene. 

This week also saw further strengthening of Infection, Prevention and Control (IPC) activities in the various outbreak hotspots. IPC teams on the ground are partaking in community dialogues with local leaders of different health zones to address persisting community reluctance related to decontamination efforts. 

Current IPC activities continue to be vigorously conducted as per protocol, with IPC rings open around every confirmed case. This includes decontamination of the healthcare facilities and homes, rapid evaluation of IPC practices at healthcare facilities, and identification of other healthcare facilities within a 500 m (urban) or 1 km (rural) radius due to being at high risk of receiving contacts of the case. 

Based on the results of the healthcare facility assessments, IPC teams follow up with supportive supervision to address any IPC gaps identified, which range from once a day to once a week depending on severity. WHO is confident that a robust implementation of effective IPC measures will aid in slowing the spread of EVD in hotspot areas in the coming weeks.

Culture of secrecy shields hospitals with outbreaks of drug-resistant infections

Via The New York Times: Culture of Secrecy Shields Hospitals With Outbreaks of Drug-Resistant Infections. Excerpt from a disturbing report:

In January, the Centers for Disease Control and Prevention sent out an urgent public alert about a deadly bacteria, resistant to virtually every known antibiotic, that sickened more than a dozen Americans who had elective surgery at Grand View Hospital in Tijuana, Mexico. 

But when similar outbreaks take place at hospitals on American soil, the C.D.C. makes no such public announcement. That is because under its agreement with states, the C.D.C. is barred from publicly identifying hospitals that are battling to contain the spread of dangerous pathogens.  

The rise of a deadly drug-resistant fungus called Candida auris, a focus of a New York Times report last weekend, has raised fresh questions about the secrecy enveloping infectious outbreaks at American medical institutions.

Patient advocates say hospitals and health authorities are often slow to alert the public about drug-resistant germs, potentially endangering patients. 

“They might not get up and go to another hospital, but patients and their families have the right to know when they are at a hospital where an outbreak is occurring,” said Lisa McGiffert of the Patient Safety Action Network. “That said, if you’re going to have hip replacement surgery, you may chose to go elsewhere.” 

Kevin Kavanagh, board chairman of the advocacy group Health Watch USA, contrasted the C.D.C.’s handling of the infections in Tijuana with a 2016 outbreak of a different drug-resistant pathogen, known as carbapenem-resistant Enterobacteriaceae, or CRE, at a rural hospital in Kentucky. It was not until early 2018 that the C.D.C. issued a report on that outbreak — and even then, the agency did not name the hospital where it occurred.  

CRE sometimes kills up to half of people infected. No deaths were reported in the Kentucky outbreak, but at least two dozen patients at the hospital were colonized with the bug, meaning they were not sick but could have spread it to others.

The report identified a cleaning cart as a possible source for the spread of the pathogen, which had traveled between the hospital’s emergency room and its surgical ward. 

The C.D.C. declined to comment, but in the past officials have said their approach to confidentiality is necessary to encourage the cooperation of hospitals and nursing homes, which might otherwise seek to conceal infectious outbreaks.  

Those pushing for increased transparency say they are up against powerful medical institutions eager to protect their reputations, as well as state health officials who also shield hospitals from public scrutiny.

EBOLA DRC - Evolution of the response to the Ebola outbreak in North Kivu and Ituri to Sunday April 7 2019

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 Sunday, April 7, 2019. More bad news: 16 new cases (11 of them in Katwa), three cases among healthcare workers, and seven deaths (including one HCW). Excerpt from the Google translation:

EPIDEMIOLOGICAL SITUATION IN THE PROVINCES OF NORTH KIVU AND ITURI 

Sunday, April 7, 2019   

The epidemiological situation of the Ebola Virus Disease  dated April 6, 2019:   

• Since the beginning of the epidemic, the cumulative number of cases is 1,146, of which 1,080 are confirmed and 66 are probable. In total, there were 721 deaths (655 confirmed and 66 probable) and 345 people cured. 

• 303 suspected cases under investigation;

• 16 new confirmed cases, including 11 in Katwa, 3 in Vuhovi, 1 in Beni, and 1 in Mandima;  

• 7 new confirmed case deaths, including 

º 5 community deaths including 4 in Katwa and 1 in Mandima; 

º 2 deaths at the CTE of Beni; 

• 3 new healed people, including 2 exits from Butembo CTE and 1 from CTE de Beni; 

• Three Katwa health workers (including one death) are among the new confirmed cases. The cumulative number of confirmed / probable cases among health workers is 85 (7.4% of all confirmed / probable cases) including 30 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 of the response 

Laboratories, the pillar at the heart of the response 

• Laboratories play a central role in the response to the Ebola outbreak. The positive result of a sample taken from a patient will trigger a series of interventions around the patient to minimize the risk of contamination of his relatives and the spread of the epidemic. These interventions include the transfer of the patient from the transit center to the Ebola treatment center, the vaccination of the patient's contacts, the disinfection of his household and the health centers through which he would have passed, as well as the psychological follow-up of the patient and from his family. It is therefore important to ensure rapid communication of laboratory test results to both the patient and other teams in the Ebola response.  

• Community feedback mechanisms revealed that residents of the affected areas, particularly Butembo and Katwa, complained of the slow availability of laboratory test results and the perception that local laboratories and labs are not involved.   

• The laboratories are managed by the National Institute for Biomedical Research (INRB) whose director, Professor Jean-Jacques Muyembe, is the chairman of the national laboratory commission in the context of the Ebola response. To date, seven mobile laboratories have been established in Beni, Bunia, Butembo, Goma, Katwa, Komanda and Mangina. This is the first time that the INRB has had the technical capacity to deploy as many mobile laboratories in the field as part of an active Ebola outbreak. While the majority of the sites have two GeneXpert machines, the sites of Beni, Butembo and Katwa have installed three to four per site to quickly test the hundreds of samples collected each day. Moreover, on all sites,     

Vaccination  

• Since the start of vaccination on 8 August 2018, 96,136 people have been vaccinated , including 23,947 in Katwa, 21,515 in Beni, 11,804 in Butembo, 6,199 in Mabalako, 3,934 in Mandima, 3,070 in Goma, 3,015 in Kalunguta, 2,429 in Oicha, 2.347 to Komanda, 1.729 to Masereka, 1.630 to Kayina, 1.552 to Vuhovi, 1.487 to Bunia, 1.433 to Kyondo, 1.357 to Karisimbi, 1.193 to Lubero, 1.025 to Biena, 958 to Musienene, 772 to Mutwanga, 690 to Rutshuru, 557 in Rwampara (Ituri), 527 in Nyankunde, 496 in Mangurujipa, 420 in Mambasa, 355 in Tchomia, 333 in Lolwa, 342 in Kirotshe, 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.