H5N1

WHO: Ebola virus disease – Democratic Republic of the Congo

WHO has published Ebola virus disease – Democratic Republic of the Congo. Excerpt:

As the Ebola virus disease (EVD) outbreak enters the fourth month since declaration, and case numbers surpass 300, substantial progress has been achieved in all aspects of the response. Nevertheless, there remains a challenging road ahead to control intense transmission in the city of Beni and emerging hotspots in villages around Beni and Butembo. 

Security incidents and pockets of community resistance continue to impact civilians and frontline workers, requiring the response to continually adapt to the situation. The UN is committed to staying and supporting the Ministry of Health (MoH), and confident that the outbreak can be contained. This week, the WHO Director-General, UN Under-Secretary-General for peacekeeping, and WHO Deputy Director-General (DDG) Emergency Preparedness and Response travelled to the Democratic Republic of the Congo to review how further support can be offered to strengthen the response.  

Over the past week (31 October – 6 November), 29 new confirmed EVD cases were reported: 15 from Beni, seven from Butembo, four from Kalunguta, two from Mabalako, and one from Vuhovi. The two cases reported in Mabalako were a mother and her new-born child, residing and infected in Beni, but sought treatment at the Mabalako Ebola treatment centre (ETC). Three health workers from health posts in Beni and Kalunguta were among the newly infected; 28 health workers have been infected to date. Ten additional survivors were discharged from the Beni ETC and reintegrated into their communities; 88 patients have recovered to date.  

As of 6 November, 308 EVD cases (273 confirmed and 35 probable), including 189 deaths (154 confirmed and 35 probable), have been reported in eight health zones in North Kivu Province and three health zones in Ituri Province (Figure 1). While fewer cases were reported from Beni this week, new cases continue to be detected daily here and elsewhere, and delays in case detection persist; therefore, trends in weekly incidence must be interpreted cautiously (Figure 2).  

The risk of the outbreak spreading to other provinces in the Democratic Republic of the Congo, as well as to neighbouring countries, remains very high. Over the course of the past week, alerts have been reported from the South Sudan, Uganda and Yemen; EVD has been ruled out for all alerts to date. Uganda (geographically closest to outbreak affected areas), continues to intensify preparedness activities, and this week began to vaccinate health and frontline workers at priority health facilities.

Democratic Republic of Congo: Ebola virus disease - External Situation Report 14

Via ReliefWeb, a WHO report: Democratic Republic of Congo: Ebola Virus Disease - External Situation Report 14. The situation update:

The Ebola virus disease (EVD) outbreak in North Kivu and Ituri provinces, Democratic Republic of the Congo continues to be closely monitored by the Ministry of Health (MoH), WHO and partners. Since WHO’s last situation report issued on 30 October 2018 (External Situation Report 13) reporting on data as of 28 October, an additional 26 new confirmed EVD cases and 12 new deaths have been reported. Cases were reported from Beni (n=16), Butembo (n=6), Mabalako (n=2), Kalunguta (n=1) and Vuhovi (n=1) – a health zone between Beni and Butembo. The two cases reported in Mabalako are a mother and her new-born, residing and identified in Beni, who were transferred to the Mabalako Ebola treatment centre (ETC). Among the new confirmed cases from Beni were two nurses, thus bringing the number of affected health workers to 27, including 26 confirmed and three deaths. Among the 12 deaths reported, six occurred in ETCs and six occurred outside of ETCs (4 in Beni, 1 in Butembo, 1 in Vuhovi).  

As of 4 November 2018, a total of 300 EVD cases, including 265 confirmed and 35 probable cases, have been reported (Table 1). The cases have been reported from eight health zones in North Kivu Province and three health zones in Ituri Province (Figure 3). Among the 300 cases, 186 deaths have been reported among confirmed cases (n=151) and probable cases (n=35) – a case fatality ratio (CFR) of 62% (186/300). 

Among the 295 cases with known age and sex, 59% (n=175) were female, and adults aged 15-44 accounted for 59% (n=174) of cases (Figure 2). Fifteen additional cases have recovered and been discharged this past week; 14 from Beni ETC and one from Butembo ETC. As of 4 November 2018, 88 cases have recovered. On 4 November 2018, 91 patients (61 suspected and 30 confirmed cases) remained hospitalized at the ETCs.  

The MoH, WHO and partners are monitoring and investigating 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 South Sudan, Uganda and Yemen. To date, EVD has been ruled out in all alerts from neighbouring provinces and countries.

WHO: Uganda vaccinates front-line health-workers against Ebola

WHO AFRO has published Uganda Vaccinates Front-line health-workers against Ebola. Excerpt:

Kampala, 7th November 2018:- The Ministry of Health (MoH) with support from the World Health Organization (WHO) has started vaccinating frontline health workers against the Ebola Virus Disease (EVD). The exercise has begun today in Ntoroko district and will initially be implemented in the five high-risk districts bordering the Democratic Republic of Congo (DRC).  

A total of 2100 doses of the ‘rVSV-Ebola’ vaccine will be administered to the health workers to protect them against the type of Ebola virus strain that is currently circulating in some parts of DRC. Indeed, this particular vaccine is currently being administered in DRC and is demonstrating positive protective results and potency against the Ebola virus-Zaire type. 

In vaccinating frontline health workers against EVD even before Uganda detects a single case, health authorities are being cautious having learnt bitter lessons from previous outbreaks. A number of health workers including the renowned Dr Mathew Lukwiya contracted the disease and died as they cared for EVD patients. These could have been saved had a vaccine been available then. 

Although the ‘rVSV-Ebola’ vaccine is not commercially licensed, it is being used under “expanded access” or what is also known as “compassionate use” in the ongoing Ebola outbreak DRC. This vaccine was also used in the Ebola outbreak in Equateur province in May-July 2018. In 2015, the vaccine was given to more than 16,000 volunteers involved in several studies in Africa, Europe and the United States where it was found to be safe and protective against the Ebola virus. 

Several studies have shown that the vaccine is safe and protective against the Ebola virus but more scientific research is needed before it can be licensed. The vaccine is, therefore, being used on a compassionate basis, to protect persons at highest risk of the Ebola outbreak, under a “ring vaccination” strategy, which is similar to the approach used to eradicate smallpox. In this strategy, informed and written consent is needed from people, for them to be vaccinated which in turn may limit mass media coverage of the exercise. 

It is highly likely that Uganda may import EVD from DRC given the closeness of the current epicenter, the high population movements due to trade, social-cultural connections and easy accessibility of health services in Uganda. 

Uganda begins Ebola vaccinations amid Congo transmission fears

Via Reuters: Uganda begins Ebola vaccinations amid Congo transmission fears. Excerpt:

Uganda says it will start to vaccinate some of its health workers against Ebola on Monday, amid fears that the viral haemorrhagic fever could spread from Democratic Republic of Congo which is battling an outbreak.

The East African country has suffered regular outbreaks of Ebola and Marburg over the years, both high-fatality viral haemorrhagic fevers. 

Parts of Uganda’s western border are about 100 km (62 miles)from sites of an Ebola outbreak taking place in Congo. 

Health Minister Jane Ruth Aceng said authorities would administer about 2,100 vaccinations covering so called frontline health personnel working in districts near the border. 

Tens of thousands cross the border in both directions weekly for trade and family visits and other purposes, Aceng said. 

Because of this the “risk of cross border transmission was assessed to be very high ... hence the need to protect our health workers with this vaccine,” she told a news conference.

WHO: Ebola virus disease – Democratic Republic of the Congo

WHO has published Ebola virus disease – Democratic Republic of the Congo. Click or tap through for the full extensive report. Excerpt:

The increase over the past four weeks in confirmed case incidence (Figure 1), most notably in the city of Beni and communities around Butembo, is concerning. Security incidents continue to severely impact both civilians and frontline workers. Moreover, pockets of community resistance or reluctance continue to hamper timely detection of new cases and the effectiveness of response operations. 

Nevertheless, the response to the Ebola virus disease (EVD) outbreak has seen significant improvements over the past weeks, including strong performances by field teams conducting case investigations, vaccinations, and community engagement and risk communication in priority areas. 

Since the last Disease Outbreak News (i.e. during 24–30 October), 32 new confirmed EVD cases were reported: 24 from Beni, and seven from Butembo and one from Vuhovi. The seven new cases reported from Butembo reside in suburbs and villages within and surrounding the city. Of the newly reported cases, 14 were known contacts of previously confirmed cases at the time of reporting, one was linked retrospectively to a transmission chain, and 17 remain under investigation. Four health workers, from various health posts and hospitals around Beni, were among the newly infected; 25 health workers have been infected to date, of whom three have died. 

As of 30 October 2018, 279 EVD cases (244 confirmed and 35 probable), including 179 deaths (144 confirmed and 35 probable)1, have been reported in eight health zones in North Kivu Province and three health zones in Ituri Province (Figure 2). Over the past week, 14 additional surivors were discharged from Ebola treatment centres (ETCs) and reintegrated into their communities; 81 patients have recovered to date. 

With ongoing transmission in communities in North Kivu, the risk of the outbreak spreading to other provinces in the Democratic Republic of the Congo, as well as to neighbouring countries, remains very high. Over the course of the past week, alerts have been reported from the Tanganyika Province, Republic of the Congo, South Sudan, Uganda and Yemen. To date, EVD has been ruled out for all alerts from neighbouring provinces and countries.

WHO EMRO: Rapid response team training for MERS

Via ReliefWeb, WHO EMRO has published Weekly Epidemiological Monitor: Volume 11, Issue 43 (28 October 2018). Excerpt:

Current major event 

Rapid Response Team training for MERS 

Since the emergence of Middle East respiratory syndrome coronavirus (MERSCov) in September 2013, Saudi Arabia has reported over 80% of the cases. Current scientific evidence suggests that dromedary camels are a major reservoir for MERS-Cov and an animal source of infection in humans has been implicated. 

Although there is no evidence of sustained human-to-human transmission, sporadic outbreaks and clusters of cases have been reported mainly in health care settings. This signifies the need for having a trained Rapid Response Team (RRT) on stand by for investigation of any suspected cluster in the community or in healthcare settings. Recently, the ministry of health of Saudi Arabia and WHO jointly organized two rounds of training for its RRTs specially focussing on investigation of cluster of Middle East respiratory syndrome (MERS). 

Editorial note 

Middle East respiratory syndrome (MERS) is a viral respiratory disease caused by a novel coronavirus (MERSCov) that emerged in September 2012. It causes severe human infections resulting in high mortality in about 40% of reported cases. By end of September 2018, more than 2,200 laboratory-confirmed MERS cases were reported globally including 800 deaths (Case fatality rate is 36%). More than 90% of these cases that have been reported, globally, are from 12 countries in the WHO Eastern Mediterranean Region.

MERS is an emerging zoonotic infection. The current scientific evidence suggests that dromedary camels are major reservoir for MERS-Cov. However, currently it remains unknown how the virus spills over to humans from camels. 

Although no efficient human-to-human transmission has been seen or documented to be associated with MERS-Cov, clusters of infection have repeatedly occurred in health care settings amongst the unprotected close contacts of a case who had documented animal exposure. So far, 877 confirmed cases of MERS were reported to be part of clusters, mainly in health care settings. 

EBOLA DRC - Evolution of the response to the Ebola outbreak in North Kivu and Ituri to Monday, October 22, 2018

The Ministry of Health, after several bad days, has a lot to report today: EBOLA DRC - Evolution of the response to the Ebola outbreak in the provinces of North Kivu and Ituri to Monday, October 22, 2018. Excerpt from the Google translation:

EPIDEMIOLOGICAL SITUATION IN THE PROVINCES OF NORTH KIVU AND ITURI 

Monday, October 22, 2018   

The epidemiological situation of the Ebola Virus Disease  dated 21 October 2018: 

• A total of 238 cases of haemorrhagic fever were reported in the region, 203 confirmed and 35 probable. 

• Of the 203 confirmed, 120 died and  63 are cured. 

• The others are hospitalized in the different Ebola Treatment Centers (ETCs) installed. 

• 14 suspected cases under investigation. 

• 1 new case confirmed in Beni. 

• 2 new deaths of confirmed cases in Beni. 

Disruption of the response activities this Sunday, October 21, 2018 following the demonstrations of the population   

Remarks: 

• To avoid that the total number of cases varies (up or down) daily, the suspect cases have been placed in a separate category. Thus, suspect cases with positive laboratory tests will be added to the confirmed category, while negative ones (non-cases) will be removed from the table. 

• The category of probable cases includes all reported deaths for which it was not possible to obtain biological samples for laboratory confirmation. The investigations will determine whether these deaths are related to the epidemic or not. 

• A community death is a death in the community, outside of a licensed health center. 

News of the response    

Press conference in Beni 

• The coordinator of the response, Dr. Ndjoloko Tambwe Bathé, held a press conference this Monday, October 22, 2018 in Beni. He reviewed several important developments in the epidemiological situation in Beni, community involvement, the impact of community resistance, dignified and safe burial (DHS), the security situation, and the meeting of the Committee of Experts. Emergency for the International Health Regulations (IHR). 

• He recalled the importance for the population to respect the hygiene and precautionary measures recommended by the health authorities. He regrets the fact that the public continues to put themselves in danger despite the many tips they receive daily to protect themselves against Ebola. He gave the example of young people from a neighborhood in Beni who stole the body of a lady who died of Ebola on her way to the cemetery in agreement with her family. After manipulating the body, one of the youths became infected, became ill and recently died. 

• The response coordinator also took the opportunity to ask the different health structures to strictly observe hygiene measures, especially the use of single-use equipment. This recommendation is of paramount importance because the sharp increase in cases confirmed, with a majority of children, in Beni was caused by non-compliance with the measures of prevention and infection control in tradimodern structures (between traditional medicine and medicine). modern). The majority of the last confirmed cases in the city were infected by Ebola during their passage in these health facilities which became the main factor of amplification of the epidemic. 

• In order to be able to respond more quickly to EDS alerts within the community, he said that the WHO had started the training of 8 additional teams within the civil protection of Beni. In addition, to address the concern of families complaining of the delay in waiting for results after a community death, the coordination decided to start using the rapid tests during the raids in the community to have the preliminary results instantly. 

• Dr. Bathé also mentioned the risks run by the agents of the response. He obviously mentioned the death of 2 health workers of the Medical Unit of Rapid Intervention (UMIR) in Butembo. But he said that the physical attacks of the teams are common. On average, the teams of the response are attacked, and sometimes injured, 3 to 4 times a week by the population. This is the first time that our health workers, both locally and nationally, are facing so much violence in an Ebola response. He also stressed that the response time of the response teams depends on the security situation because before deploying the teams in the field, a preliminary analysis of the security situation is necessary.  

Vaccination 

• No vaccination activity in Beni this Sunday, October 21, 2018. Since the start of vaccination on 8 August 2018, 20,849  people have been vaccinated , including 9,823 in Beni, 4,391 in Mabalako, 1,663 in Mandima, 1,672 in Katwa, 1,145 in Butembo, 690 in Masereka, 434 in Bunia, 355 in Tchomia, 240 in Komanda, 160 in Musienene, 121 in Oicha, 105 in Kalunguta and 50 in Mutwanga.

Epidemiological Data Summary

Week 42 (October 15-21, 2018)

For the week of October 15 to 21, 2018 , we recorded:
239 suspected cases investigated and tested in the laboratory
22 new confirmed cases, including 19 in Beni.
16 confirmed cases, including 15 in Beni.
6 new people healed, including 5 in Beni

Summary of data for dignified and secure burials

Since the beginning of the epidemic, 314 EDS alerts have been received in all affected areas, including:
262 successful EDSs (83.4%)
39 EDS unsuccessful due to refusal or resistance (12.4%)
7 unanswered alerts (2.2%)
6 incomplete DHSs, ie collected, secured but buried by the family (1.9%)
The source of the EDS alerts is distributed as follows:
134 of the community (43%)
94 ETC (30%)
86 health facilities (27%)

 

UN employee in DR Congo tests positive for Ebola

Via The Guardian: UN employee in Democratic Republic of the Congo tests positive for Ebola. This does not appear to be the plumber mentioned in today's MOH update. Excerpt:

A United Nations employee in eastern Democratic Republic of the Congo has tested positive for Ebola, the first such incident during the current outbreak, according to the head of the UN peacekeeping mission. 

“I am writing today to inform you that my leadership team and I have regretfully just received news that a UN colleague based in Beni has tested positive for Ebola and is now receiving the necessary medical treatment,” Leila Zerrougui wrote in the letter seen by Reuters. 

Zerrougui said the employee had not been to work for several weeks and that tracing the person’s contacts had begun. 

The news came after health officials warned that the rate of new Ebola cases had more than doubled since September after rebel violence in north-eastern DRC caused response efforts to be briefly suspended, health officials said on Thursday. 

The International Rescue Committee (IRC) said it was alarmed that there were 33 new cases between October 1 and 9, compared with 41 cases during all of September.  

Most of the new cases have been in Beni, where experts had to suspend Ebola containment efforts for days after a deadly rebel attack. With multiple armed groups active in the region, health officials have said they are effectively operating in a war zone. 

“This is a sign not only that the outbreak is not under control, but that without full engagement from the community things could get a lot worse,” said Dr Michelle Gayer, the IRC’s senior director of emergency health.  

Earlier this week, the World Health Organization said that 19 of the health workers who had caught Ebola in this epidemic had been infected outside of hospitals or clinics, meaning the virus is spreading in the community.

WHO: Ebola virus disease – Democratic Republic of the Congo

WHO has published Ebola virus disease – Democratic Republic of the Congo. Excerpt:

The response to the Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo is becoming increasingly undermined by security challenges in at-risk areas, particularly Beni. These incidents severely impact both civilians and frontline workers, forcing suspension of EVD response activities and increasing the risk that the virus will continue to spread. 

WHO continues to distinguish between the incidents of conflict between rebel and government forces, and pockets of community push-back on the response. A recent increase in the incidence of new cases (Figure 1) is the result of the multitude of challenges faced by response teams. This also reflects improved active surveillance and reporting from the community. 

Since the last Disease Outbreak News (data as of 9 October), 29 new confirmed EVD cases were reported: 23 from Beni, four from Butembo, one from Mabalako, and one from Masereka Health Zones in North Kivu Province. Fifteen of these confirmed cases have been linked to known cases or were linked retrospectively through case to transmission chains within the respective communities, while fourteen recently reported cases remain under investigation.  

As of 9 October 2018, a total of 194 EVD cases (159 confirmed and 35 probable), including 122 deaths (87 confirmed and 35 probable) 1, have been reported in seven health zones in North Kivu Province (Beni, Butembo, Kalunguta, Mabalako, Masereka, Musienene and Oicha), and three health zones in Ituri Province (Mandima, Komanda and Tchomia) (Figure 1). An overall increasing trend in weekly case incidence is seen (Figure 2); however, these rising trends are likely underestimated given expected delays in case reporting, the ongoing detection of sporadic cases, and security concerns which limit contact tracing and investigation of alerts. 

Of the 194 confirmed and probable cases for whom age and sex information is known, the majority (64%) are within 15-44 years age range. Females (55%) accounted for a greater proportion of cases (Figure 3). Since the last Disease Outbreak News update, one new health care worker infection was reported, bringing the cumulative case count to 20 (19 confirmed and one probable), of whom three have died.

DR Congo: Ebola virus disease - External Situation Report 10

Via ReliefWeb, a WHO AFRO report: Democratic Republic of Congo: Ebola Virus Disease - External Situation Report 10. The situation update:

The Ebola virus disease (EVD) outbreak in North Kivu and Ituri provinces, Democratic Republic of the Congo continues to be closely monitored, with the Ministry of Health (MoH), WHO and partners making progress in response to the outbreak. A recent increase in the incidence of new cases (Figure 1) reflects the multitude of challenges faced by response teams in recent weeks. The outbreak remains active predominantly in Beni Health Zone, although additional risks remain following the confirmation of EVD cases in Butembo and Mabalako.  

Since WHO’s last situation report on 2 October 2018 (External Situation Report 9), an additional 19 new confirmed EVD cases and nine new deaths have been reported. A total of 21 new suspected cases are under investigation in Beni (13), Mabalako (4), Masereka (2) and Tchomia (1).  

As of 7 October 2018, a total of 181 confirmed and probable EVD cases, including 115 deaths, have been reported – resulting in a global case fatality ratio (CFR) of 63.5%. Among the 181 cases, 146 are confirmed and 35 are probable. The CFR among confirmed cases only was 54.8% (80/146). As of 7 October 2018, 50 cases have recovered, been discharged from ETCs, and re-integrated into their communities. A total of 32 cases (14 confirmed and 18 suspected) remain hospitalized in the ETCs.  

Among the 159 cases with known age and sex, 55% (n=87) are female. Among both males and females, the most affected age group is 35-44 years old (Figure 2). Cumulatively, 19 health workers have been affected, of whom 18 are confirmed cases; three health workers have died. All health workers’ exposures occurred in health facilities outside the dedicated Ebola treatment centres (ETCs). 

The confirmed cases were reported from nine health zones: Mabalako (70), Beni (49), Oicha (2), Masereka (1), Butembo (11), Kalunguta (1), Mandima (9), Tchomia (2), and Komanda (1). The epicentres of the outbreak remain Mabalako and Beni Health Zones in North Kivu Province, reporting 50.3% (n=91) and 31.5% (n=57) of all confirmed and probable cases respectively. 

Beni, Butembo and Mabalako continue to report an increasing number of new cases, indicating the persistence of Ebola virus transmission in these areas. The Beni Health Zone has reported 66% of all cases reported since September 2018. Of the total deaths reported to date, 56.5% (n=65) were from Mabalako, while 30.4% (n=35) were from Beni.  

The Ministry of Health (MoH), WHO and partners are monitoring and investigating 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 from neighbouring provinces and countries.