H5N1

Branswell: A pivotal day in world's response to Ebola nears

Via STAT, Helen Branswell writes: A pivotal day in world's response to Ebola nears: the launch of a clinical trial. Excerpt:

Health officials are preparing to launch a clinical trial designed to test whether experimental Ebola therapies improve patients’ chances of survival in the outbreak in the Democratic Republic of the Congo — a landmark moment in the world’s efforts to respond to this and future crises. 

The randomized controlled trial will compare three different antibody treatments and an antiviral drug to each other, rather than involving a placebo. It is unlikely that the trial will produce clear results based on a single epidemic; it is expected to span several outbreaks and countries — a novel and challenging design.  

In the current outbreak, the trial will be made all the more complicated by a difficult security environment. 

“I don’t think the world quite appreciates the challenge of the environment in which this is happening,” said Dr. Jeremy Farrar, head of the Wellcome Trust and co-chair of a group that has been working under the auspices of the World Health Organization to draft the trial protocol.  

“People are being shot at, and it’s not just the occasional bit of gunfire,” Farrar said of the security environment in North Kivu. “There’s mortars, there’s kidnappings — it is an intensely fragile environment with a lot of conflict that’s been going on for years.” 

The four experimental therapies that will be tested have been used for weeks in Ebola treatment units being operated by nongovernmental organizations Doctors Without Borders (MSF) and Alima. Those therapeutics are the Gilead antiviral drug Remdesivir and three monoclonal antibody preparations: ZMapp, made by Mapp Biopharmaceuticals, Regeneron’s REGN 3470-3471-3479, and mAb 114, which is being developed by the National Institutes of Health and DRC’s National Institute of Biomedical Research. 

As of Friday, 139 patients had received one of the four. 

To date, there have been 329 confirmed and probable cases of Ebola and 205 deaths, making this Ebola outbreak, which began in July, the third largest on record.  

It is unusual for unlicensed drugs to be used in such quantities outside of the context of a clinical trial. In this case, the authorization came through a sort of compassionate use protocol established by the WHO.

EBOLA DRC - Evolution of the response to the Ebola outbreak in North Kivu and Ituri to Sunday 11 November 2018

The MOH has published EBOLA DRC - Evolution of the response to the Ebola outbreak in the provinces of North Kivu and Ituri to Sunday 11 November 2018. In addition, Dr. Tedros reports that Beni was violently attacked last night, apparently with fatalities though not among WHO personnel. Excerpt from the Google translation:

EPIDEMIOLOGICAL SITUATION IN THE PROVINCES OF NORTH KIVU AND ITURI 

Sunday, November 11, 2018   

The epidemiological situation of the Ebola Virus Disease  dated November 10, 2018: 

• Since the beginning of the epidemic, the cumulative number of cases is 329, of which 294 confirmed and 35 probable. In total, there were 205 deaths (170 confirmed and 35 probable). 

• 38 suspected cases under investigation. 

• 3 new confirmed cases, including 2 in Beni and 1 in Kyondo. 

• 4 new confirmed deaths, including 2 in Beni and 2 in Butembo.

  

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 

Ebola Survivors Tracking Program 

• At the ninth Ebola outbreak in Equateur Province, the Ministry of Health launched an Ebola survivors follow-up program to provide clinical, biological and psychosocial follow-up for people who have recovered from Ebola. The Minister of Health, Dr. Oly Ilunga Kalenga, also initiated the establishment of the National Association of Ebola Winners to bring together all survivors in the Democratic Republic of Congo. The national coordinator of the program and association is Dr. Richard Kitenge. Survivors' monitoring centers will be set up in Beni, Butembo and Mangina. The Ministry of Health gives priority to local health personnel in all areas of the program to build local capacity. The survivor monitoring program teams are reviewing the database of all survivors since the start of this tenth outbreak. The Ministry of Health will resume sharing survivor data as soon as this cleanup of the database is complete. 

Vaccination 

• Since the start of vaccination on August 8, 2018, 28,727  people have been vaccinated , including 14,966 in Beni, 4,544 in Mabalako, 2,152 in Katwa, 1,663 in Mandima, 1,435 in Butembo, 1,237 in Kalunguta, 732 in Masereka, 434 in Bunia, 355 in Tchomia, 293 in Vuhovi, 258 in Mutwanga, 240 in Komanda, 178 in Oicha, 160 in Musienene and 80 in Kyondo.

EBOLA DRC - Evolution of the response to the Ebola outbreak in North Kivu and Ituri at Friday 9 November 2018

The MOH has published EBOLA DRC - Evolution of the response to the Ebola outbreak in the provinces of North Kivu and Ituri at Friday 9 November 2018. Not good: seven new confirmed cases, one of them in a new health zone, and a reminder of the violence healthcare workers must risk. Excerpt from the Google translation:

EPIDEMIOLOGICAL SITUATION IN THE PROVINCES OF NORTH KIVU AND ITURI 

Friday, November 9, 2018   

The epidemiological situation of the Ebola Virus Disease  dated November 8, 2018: 

• A total of 319 cases of haemorrhagic fever were reported in the region, of which 284 confirmed and 35 probable. 

• Of the 284 confirmed, 163 died and 97 are cured . The others are hospitalized in the different Ebola Treatment Centers (ETCs) installed. 

• 52 suspected cases under investigation. 

• 7 new confirmed cases, including 3 in Beni, 2 in Butembo, 1 in Kyondo and 1 in Vuhovi. 

º A new confirmed case has been identified in a new Kyondo Health Zone, located next to Butembo Health Zone. The investigations are in progress. 

• 7 new confirmed deaths, including 3 in Beni, 2 in Butembo, 1 in Kyondo and 1 in Mutwanga.   

• 6 new people healed, including 5 in Beni and 1 in Butembo.

  

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   

Vaccination 

• Since the beginning of vaccination on August 8, 2018, 27,832  people have been vaccinated , including 14,653 in Beni, 4,515 in Mabalako, 2,152 in Katwa, 1,663 in Mandima, 1,385 in Butembo, 715 in Masereka, 947 in Kalunguta, 434 in Bunia, 355 at Tchomia, 250 at Vuhovi, 240 at Komanda, 185 at Mutwanga, 178 at Oicha, and 160 at Musienene. 

Message from His Excellency the Minister of Health   

On Friday, November 9, 2018, the Ebola Virus Disease epidemic in the provinces of North Kivu and Ituri just exceeded that of the first epidemic recorded in 1976 in Yambuku, the province of Equateur. To date, 319 cases and 233 deaths have been recorded.   

At the sight of these figures, my thoughts and prayers go to the hundreds of bereaved families, the hundreds of orphans, and the missing families.   

At the heart of this unprecedented response are hundreds of men and women who have been working tirelessly for more than three months in a difficult and volatile environment to prevent this epidemic from spreading to other provinces in the Democratic Republic of Congo. Congo and neighboring countries.   

No other epidemic in the world has been as complex as the one we are currently experiencing. Since their arrival in the region, the response teams have faced threats, physical assaults, repeated destruction of their equipment, and kidnapping. Two of our colleagues in the Rapid Response Medical Unit even lost their lives in an attack.   

Yet, despite the risks and with the support of a majority of the population, our agents continue to do their job with passion and dedication to protect the Nation and the world.   

Among their achievements, we particularly remember the vaccination, including in red areas, of more than 27,000 high-risk contacts, at least half of which could have developed the disease. Without the prompt and effective intervention of national and international experts, it is a drama of considerable magnitude that we would be experiencing at the moment. For this courage, they deserve all our gratitude.   

However, this epidemic remains dangerous and unpredictable, and we must not let our guard down. We must continue to pursue a very dynamic response that requires permanent readjustments and real ownership at the community level.   

We are writing a new page in history and public health. It is with the cooperation and the commitment of all, the Government, the international community, and especially the population, that we will overcome this epidemic.   

Thank you.

EBOLA DRC - Evolution of the response to the Ebola outbreak in North Kivu and Ituri on Thursday 8 November 2018

The MOH has published EBOLA DRC - Evolution of the response to the Ebola outbreak in the provinces of North Kivu and Ituri on Thursday 8 November 2018. Excerpt from the Google translation:

EPIDEMIOLOGICAL SITUATION IN THE PROVINCES OF NORTH KIVU AND ITURI 

Thursday 8 November 2018   

The epidemiological situation of the Ebola Virus Disease  dated November 7, 2018:

• A total of 312 cases of haemorrhagic fever were reported in the region, 277 confirmed and 35 probable. 

• Of the 277 confirmed, 156 have died and 91 are cured. The others are hospitalized in the different Ebola Treatment Centers (ETCs) installed. 

• 40 suspected cases under investigation. 

• 4 new confirmed cases, including 1 in Beni, 2 in Kalunguta and 1 in Mutwanga. 

º Mutwanga is a new health zone affected. It is a health zone close to that of Beni. The new case is a known contact followed by a confirmed case of Beni who refused the vaccination and fled to Mutwanga before the end of his follow-up. The central office of the Mutwanga Health Zone, which had been informed of the presence of a high-risk contact in their territory, found him ill. He finally agreed to be transferred to the CTE of Beni.   

• No confirmed case deaths.

    

* A confirmed case reported in the bulletin of November 7, 2018 was counted in Kalunguta while he came from Butembo. 

• 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   

Vaccination 

• Since the start of vaccination on August 8, 2018, 27,398 people have been vaccinated , including 14,479 in Beni, 4,480 in Mabalako, 2,152 in Katwa, 1,663 in Mandima, 1,385 in Butembo, 690 in Masereka, 807 in Kalunguta, 434 in Bunia, 355 in Tchomia, 240 in Komanda, 185 in Mutwanga, 178 in Oicha, 160 in Musienene and 190 in Vuhovi.

DRC: Several cases of Ebola reported in a village occupied by Mai-Mai militiamen

Via Actualite.cd: DRC: Several cases of Ebola reported in a village occupied by Mai-Mai militiamen in North Kivu. Excerpt from the Google translation:

Several cases of Ebola have been identified in a village occupied by Mai-Mai militia in the health zone of Kalunguta in Beni territory (North Kivu), reported Tuesday, November 7 the Ministry of Health without giving the name of the town. 

The epidemic spread in this village "following the escape of a confirmed case of Beni to this village in order to escape the teams of the response," says the health authority. 

Among the new confirmed cases, there is a 6-day newborn baby from a confirmed case who died on November 4 at Butembo's Ebola Treatment Center (ETC).  

The child's mother began to show symptoms of the disease 5 days before giving birth to her son.  

To reach the village, the health teams negotiated with the "leaders" of the village. Several deaths have been reported in the village during the previous weeks.  

An investigative mission has been organized to "identify deaths caused by Ebola and classify them as probable cases," according to the ministry, saying the villagers have been "cooperative" for the vaccination.

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. 

We're in constant fear of armed attack as we treat Ebola patients in Congo

In The Guardian, Dr. Eric Mukama writes: We're in constant fear of armed attack as we treat Ebola patients in Congo. Excerpt:

I have been responding to different disease outbreaks in the Democratic Republic of the Congo for 18 years, yet I have never seen anything as challenging as containing Ebola in an armed-conflict zone. 

DRC is facing its 10th Ebola outbreak, but this epidemic, which broke out in August, is the country’s first in an area where fighting is ongoing. Since 2014, about 2,000 people have been killed in clashes between armed groups. 

I’m a doctor stationed in Beni, in the north-eastern province of North Kivu. It’s the epicentre of the current Ebola outbreak. Here, any aid worker, especially us locals, can be in imminent danger. Active shooting is common. A few weeks ago, a vehicle of humanitarian staff moving an Ebola patient’s dead body to be buried was attacked and passengers were injured. 

I cannot access entire villages. Not because of the unequipped terrain and unpaved dirt roads but because these villages act as frontlines between the different armed groups.  

Ebola is a fatal disease. Because it is a viral infection, it does not have an effective cure. People here in Beni have never encountered Ebola and in many cases have never even heard of it. There is strong resistance from people to accept the existence of the disease and cooperate with people like me working to eliminate it. 

Recent reports have said the epidemic has been controlled. This is not true. We still have new confirmed cases, almost on a daily basis. To confirm an Ebola epidemic is under control we need to wait for at least six weeks after the last confirmed case, which involves inspecting all the direct contacts of every infected person, and ensuring that during that period we have not had a single new case. 

Despite communities’ resistance, people are becoming aware of the disease and its danger. But even the most basic ways to counter it are almost impossible to implement in some inaccessible villages. These include installing handwashing stations and refilling them, conducting awareness-raising sessions, or doing some basic distributions of much-needed items such as soap, buckets and hand sanitisers. In some areas we cannot confirm if the symptoms and even deaths occurring are due to Ebola. This is why we have some “probable” cases. 

One of the biggest challenges is providing direct help to infected people, while ensuring caregivers do not get infected. When you walk around the city and visit response sites and clinics, no one shakes hands. When we want to greet each other, we do it through touching elbows, to avoid any possibility of spreading the virus, which is only transmitted through direct contact of body fluids.

'End war on Yemen's children': conflict escalates around Hodeidah hospital

Via The Guardian: 'End war on Yemen's children': conflict escalates around Hodeidah hospital. Excerpt:

Fighting has intensified around the largest hospital operating in the port city of Hodeidah, preventing access to severely malnourished and vulnerable children, the UN’s children’s agency has warned. 

The escalation in conflict follows US calls for a ceasefire and suggestions that peace talks may be held in Sweden. On Thursday, the Saudi-led coalition said it had attacked Sana’a international airport and an adjoining airbase being used by Houthi insurgents. 

“It’s very clear that, despite the call for talks, and despite the call for an agreement on the cessation of hostilities in the next 30 days, the parties are intensifying the fighting – unfortunately, with an incredible impact on children,” said Geert Cappelaere, Unicef’s regional director for the Middle East and north Africa, speaking from Sana’a.

Cappelaere said the few shipments of crucial medical supplies and food arriving in the port of Hodeidah were regularly blocked, sometimes for months. “Even the humanitarian aid is taken hostage at times. It’s just unacceptable. All parties are carrying responsibility,” said Cappelaere. “The war on children needs to stop.”  

Active fighting is taking place within a few hundred metres of the largest of Hodeidah’s handful of hospitals, according to Cappelaere, who visited the city this week. Families were delaying seeking medical attention because of the hostilities, or because they could not afford the transport costs. 

Hodeidah, which has been hit particularly hard by cholera and acute diarrhoea, was already among the worst places for children in Yemen, Cappelaere said. 

The latest Unicef figures show there are an estimated 1.8 million malnourished children in Yemen. Almost 400,000 children are suffering from severe acute malnutrition, which is life-threatening, with four in 10 of such cases in Hodeidah and neighbouring governorates. 

On a visit to Al-Thawra hospital, Cappelaere said he saw the emaciated bodies of acutely malnourished children, as well as several children paralysed by diphtheria, which is preventable by vaccine. Among them was a 10-year-old girl, Sara, who is paralysed from the chest downwards because of the infection.  

“I was just thinking overnight when I heard the shelling happening … What does that mean for that poor girl who is already half-paralysed and who now has to hear all these bombs around her? For what reason? To get a better negotiating position around the table in Sweden?” said Cappelaere. 

It is feared that intensified fighting in Hodeidah would not only have a devastating impact on its population but also cut off food, fuel and medical imports to the rest of the country. Aid agencies have repeatedly warned the conflict is driving Yemen to the brink of the worst famine in living memory.

North Kivu’s Ebola outbreak at day 90: What is to be done?

Via the Center for Strategic and International Studies, an excellent overview: North Kivu’s Ebola Outbreak at Day 90: What Is to Be Done? Excerpt:

Thus far, money has not been a serious constraining factor. Funding pledges have arrived, including a $100 million grant to the DRC through the recently created World Bank Pandemic Emergency Funding facility (PEF). 

By contrast with the West Africa outbreak, a vaccine has been available, and thus far over 24,000 exposed or vulnerable individuals have been immunized. Patients are receiving five experimental therapies, made available under compassionate use authorities. The foundation is in place to carry out surveillance and integrate data, conduct case investigation and contact tracing, isolate and treat those sick with Ebola, and promote safe and dignified burials. 

The UN peacekeeping force—the United Nations Organization Mission in Democratic Republic of the Congo (MONUSCO)—has provided security escorts on the roads leading in and out of the urban center of Beni. To date, no international or civilian national health provider has been injured or killed. (Two DRC military medical personnel were among those killed October 21. Separately, two local staff of an International Federation of the Red Cross safe burial team were recently seriously injured by community members.) 

Insecurity, Demographics, Elections, Mistrust 

Yet to the increased dismay of those many committed individuals leading the Ebola response on-the-ground, that effort has run headlong into a plethora of complex barriers and vulnerabilities. 

Armed attacks persist, with impunity. The Allied Democratic Forces (ADF) is responsible for repeated attacks on DRC military forces in and around Beni. Each has had a concussive impact, intensifying the environment of fear and seriously disrupting the response effort. There have also been local attacks by eastern Congo’s armed, community-based Mai-Mai militias. As long as ADF and other attacks continue, the response effort will remain vulnerable to debilitating setbacks. 

These attacks emerge within what WHO has described as North Kivu and Ituri’s “perfect storm”—over 40 armed groups, potentially destabilizing elections, and a large, highly mobile population in close proximity to porous, international borders. Its population for years has lived through recurrent humanitarian emergencies. The DRC national government, located a thousand miles away in Kinshasa, has never truly gained effective control or legitimacy in the east. While criminal groups, Mai-Mai militias, and the rebel ADF are credited with the majority of the violence, the DRC’s security forces have an equally infamous reputation; since 2017 they have killed over 100 civilians in North Kivu.

EBOLA DRC - Evolution of the response to the Ebola epidemic in North Kivu and Ituri on Thursday 1 November 2018

The Ministry of Health has published  EBOLA DRC - Evolution of the response to the Ebola epidemic in North Kivu and Ituri on Thursday 1 November 2018. Excerpt from the Google translation:

EPIDEMIOLOGICAL SITUATION IN THE PROVINCES OF NORTH KIVU AND ITURI 

Thursday, November 1, 2018   

The Epidemiological Situation of Ebola Virus Disease as of October 31, 2018: 

• A total of 285 cases of haemorrhagic fever were reported in the region, of which 250 confirmed and 35 probable. 

• Of the 250 confirmed, 145 died and 81 are cured. The others are hospitalized in the different Ebola Treatment Centers (ETCs) installed. 

• 41 suspected cases under investigation. 

• 6 new confirmed cases, including 4 in Beni and 2 in Butembo. 

• 1 new confirmed case death in Beni. 

• 5.801 contacts to follow to date.   

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 

Electoral operations in areas affected by Ebola 

• Since the beginning of the epidemic, the Ministry of Health has been in regular contact with the Independent National Electoral Commission (CENI) to keep it informed of developments. The Ministry does not expect that the evolution of the current outbreak will impede the smooth conduct of electoral operations in the affected areas of the provinces of North Kivu and Ituri. Indeed, one of the Department's priorities was to ensure that response activities only minimally disrupted the normal functioning of society. As a result, markets, schools and places of worship remained open in accordance with Ministry recommendations. 

• A special consultation committee between the Coordination of the Ebola Virus Disease Response and the CENI will be set up to coordinate epidemiological surveillance activities around electoral operations. We plan to install health checkpoints with handwashing and temperature sensing devices at the entrance of all polling stations in the areas affected by the outbreak.    

Free care 

• From Thursday 1 November 2018, free health care is effective in all health areas of Butembo health zones, Katwa, Masereka and Kalunguta. Implemented through the Health System Development Project (HSDP), this measure aims to encourage the population in the areas affected by the epidemic to go as quickly as possible to public and private health facilities that meet the standards. from the Ministry of Health. Free healthcare was already effective in the health zones of Beni, Mabalako and Oicha since August 20, 2018. In Beni, free admission was effective in the priority health areas that have reported confirmed cases of Ebola but will soon be extended. to all health areas in the Beni area. 

Vaccination 

• Since the start of vaccination on August 8, 2018, 25,336  people have been vaccinated , including 13,326 in Beni, 4,391 in Mabalako, 2,062 in Katwa, 1,663 in Mandima, 1,355 in Butembo, 690 in Masereka, 434 in Bunia, 355 in Tchomia, 240 to Komanda, 307 to Kalunguta, 160 to Musienene, 143 to Oicha, 110 to Vuhovi and 100 to Mutwanga. 

Monthly summary of epidemiological data  

October 2018   

For the period from 1 to October 31, 2018, we recorded:  

• 121 new confirmed cases. 

• 75 deaths, including 72 confirmed cases and 3 probable cases. 

• 36 new people healed. 

The month of October was marked by a major outbreak of which Beni is the main focus. 

Confirmed cases 

• 121 of the 250 confirmed cases reported since the beginning of the epidemic were recorded during the month of October, or 48.4%. 

• Of these 121 new confirmed cases, 95 were in Beni, or 78.5% . 

Deaths (confirmed and probable) 

• 75 of the 180 deaths (confirmed and probable) reported since the beginning of the epidemic were recorded during the month of October, ie 41.6%. 

• Of these 75 deaths, 59 were in Beni, 78.6%.  

Recoveries 

• 36 of the 81 cures reported since the start of the epidemic were recorded during the month of October, or 44.4%. 

Of these 36 healed, 27 were in Beni, 75%.