H5N1

WHO denies reporting Ebola case in Tanzania

Health Organization country representative Dr Tigest Ketsela Mengestu (Left) During the talks with deputy minister for home affairs and international cooperation Dr Damian Ndumbalo. Credit: The Citizen.

The Citizen, an English-language daily in Tanzania, has now published WHO denies reporting Ebola case in Tanzania. The story can't be excerpted, but it's worth reading. 

In the report, WHO representative Dr. Tigest Ketsela Mengestu "insisted that WHO has never reported that there was an Ebola outbreak in Tanzania." But that isn't the issue: WHO's complaint was about the lack of information that Tanzania should have provided under the IHR.

 

The only context for the report is in the last line: "Recently there were unconfirmed reports of the disease, following the death of a woman with Ebola-like symptoms." And that's it: nothing about the woman's previous history or where she fell ill, and absolutely nothing about what the medical tests revealed or failed to reveal.

 

So the Tanzanians twisted Dr. Mengestu's arm to say something vaguely true but definitely spinnable, without really answering WHO's original complaint. If nothing else, it's a reminder that for public health to be done, like justice it must be seen to be done.

WHO: Tanzania not sharing information on Ebola

I'm finding very little in the Tanzanian media about Ebola, and not much more in the media of neighbouring countries. That may change as those media begin posting their Monday reports tonight. But for the time being, this Reuters report offers a reasonable summary of what we know so far: World Health Organization: Tanzania not sharing information on Ebola.

DAR ES SALAAM (Reuters) - Tanzania is refusing to provide detailed information on suspected Ebola cases, the World Health Organization (WHO) said in a rare public rebuke as the region struggles with an outbreak already declared a global health emergency.  

Transparency and speed are key to combating the deadly hemorrhagic fever because it can spread rapidly. Anyone deemed to have been in contact with potentially infected people must be quarantined and the public warned to step up precautions such as handwashing.  

WHO said in a statement late on Saturday that it was made aware on Sept. 10 of the death of a patient in Dar es Salaam, and unofficially told the next day that the person tested positive for Ebola. The woman had died on Sept. 8.  

“Identified contacts of the deceased were unofficially reported to be quarantined in various sites in the country,” the statement said.  

WHO said it was unofficially told that Tanzania had two other possible Ebola cases. One had tested negative and there was no information on the other.  

Officially, the Tanzanian government said last weekend it had no confirmed or suspected cases of Ebola. The government did not address the death of the woman directly and did not provide further information.  

Despite several requests, “clinical data, results of the investigations, possible contacts and potential laboratory tests performed ... have not been communicated to WHO”, the U.N. agency said. 

“The limited available official information from Tanzanian authorities represents a challenge.” 

Officials in Tanzania’s health ministry could not be reached for comment.

Authorities in east and central Africa have been on high alert for possible spillovers of Ebola from the Democratic Republic of Congo, where a year-long outbreak has killed more than 2,000 people. 

The WHO was heavily criticized by experts during West Africa’s 2014-2016 Ebola epidemic, which claimed more than 11,300 lives in Guinea, Liberia and Sierra Leone, for not moving more quickly to contain the outbreak, which remains the world’s worst.  

FEARS SPREAD 

Last week the U.S. health secretary, Alex Azar, criticized Tanzania for failing to share information on the possible outbreak. The next day he sent a senior health official to Tanzania. 

Uganda has already recorded several cases after sick patients crossed the border from Congo. A quick government response there prevented the disease spreading.  

The 34-year-old woman who died in Dar es Salaam had traveled to Uganda, according to a leaked WHO document circulated earlier this month. She showed signs of Ebola including headache, fever, rash and bloody diarrhea on Aug. 10 and died on Sept. 8. 

Tanzania relies heavily on tourism and an outbreak of Ebola would likely discourage visitors. 

WHO spokesman Tarik Jasarevic said the organization stood ready to help Tanzania should an outbreak be confirmed and that its country office in Tanzania had been reinforced with experts in patient care, infection prevention and other specialities. 

“WHO is standing by to facilitate the delivery of various supplies, including vaccines and therapeutics. This will occur upon request by the government,” Jasarevic said, adding there were enough supplies of vaccine to provide if needed.  

The Geneva-based agency had also shipped 1,000 sets of protective equipment to Tanzania 10 days ago. 

 WHO’s statement is not the first time international organizations have queried information from the government of President John Magufuli, nicknamed The Bulldozer.  

Earlier this year, the World Bank and the International Monetary Fund contradicted the government’s economic growth figure for 2018.

Tanzania appeals for help to stop Ebola spread

Via The East African: Tanzania appeals for help to stop Ebola spread. The complete report and then a comment:

As the region increases vigilance and preparedness to deal with a likely spread of Ebola in eastern DRC, Tanzania has already sought international support. 

Permanent Secretary of Health Zainabu Chaula has written to the World Health Organisation, the Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ), the UK Department for International Development (DfID) and the World Food Programme, requesting $9.5 million to support the country’s preparedness and operational readiness.  

In the letter dated September 18 and seen by The East African, Tanzania says; “It is our expectation that you will help us to accomplish these tasks at the shortest possible time frame.” 

The government cites the free movement of people across the border to and from the country, “making Tanzania at a very high risk, since the affected health zones in DRC are all located to eastern and southern areas near the long borders of western Tanzania that has over 300 unofficial border crossings.”  

Last week, Dar es Salaam was thrown into a panic after unconfirmed reports of the death of one person from an unknown disease suspected to be Ebola.  

The WHO and the government confirmed that there was no reported Ebola case or death in the country.

This report was published today, September 21, and the last paragraph is very carefully worded: "there was no reported Ebola case..." 

The Tanzanians certainly know of WHO's extraordinary criticism of their failure to provide information, but they're trying to spin it as positively as possible.

 

I don't know much about Tanzania's current government, but no doubt we'll all soon learn more than we'd like to. Governments that don't want to talk about disease outbreaks usually have a lot more on their consciences than their neglect of public health.

Tanzania Ebola? Cases of undiagnosed febrile illness – United Republic of Tanzania

Thanks to Helen Branswell for alerting us to this unusual DON from WHO: Cases of Undiagnosed Febrile Illness – United Republic of Tanzania. This is a big deal and an alarming development. It's extremely rare for WHO to be so critical of a member state. Excerpt, with my bolding, and then a comment:

The following is a description of the current situation in the United Republic of Tanzania regarding unofficial reports of a number of cases of illness and a summary of WHO efforts to obtain information about this situation.  

As specified in Article 9 of the International Health Regulations (IHR), WHO may take into account reports from sources other than notifications from Member States and shall assess these reports according to established epidemiological principles under the IHR. 

On 10 September 2019, through its regular event-based surveillance process, WHO was made aware of unofficial reports regarding the death of a person with suspected Ebola Virus disease (EVD) case in Dar es Salaam, United Republic of Tanzania. The identified contacts of the deceased were unofficially reported to be quarantined in various sites in the country. Under the IHR Articles 9 and 10, WHO immediately sent a verification request to the National IHR Focal Point (NFP) of the country.  

On 11 September, through its regular event-based surveillance process, WHO was made aware of unofficial reports that a RT-PCR test performed at the Tanzanian National Health Laboratory was positive for EVD for this patient. On the same day, WHO received unofficial reports regarding another suspected EVD case in Mwanza, located in the northern region of the United Republic of Tanzania, who later tested negative for EVD. WHO continued to reach out under the IHR to the health authorities of the United Republic of Tanzania to verify these signals.  

On 12 September 2019, WHO was informed by unofficial sources of a 27-year-old patient suspected of EVD admitted in a hospital of Dar es Salaam without further information regarding laboratory tests and results  

Despite several requests, WHO did not receive further details of any of these cases from Tanzanian authorities.  

Considering: (i) the absence of any detailed information received by WHO from the United Republic of Tanzania at that stage, (ii) that EVD/suspected EVD is a notifiable disease under the IHR, and (iii) the potential public health significance of a presumptive EVD case, WHO took the following steps:  

• Continued to reach out to the Tanzanian IHR National Focal Point (NFP) to obtain verification of the rumours under the IHR. 

• Conducted an internal Rapid Risk Assessment. Due to uncertainties around the event, the absence of any official information, and considering that if confirmed this would have been the first EVD outbreak reported in this country, and that the presumptive case travelled extensively within the United Republic of Tanzania, the risk was assessed as very high at national level. The risk at regional level was considered as high due to potential cross-border travels and significant population movements as well as potential unknown transmission chains. The risk at the global level was considered low. 

• Informed all Member States’ IHR National Focal Points (NFP) of the available information, including questions, concerns, and recommendations, through the WHO Event Information Site (EIS) for IHR NFP. This is a password restricted, secure, web-based platform dedicated to information sharing between WHO and its Member States under the IHR. 

• Issued a press release on the website of the WHO Regional Office for Africa 

• Deployed a multidisciplinary rapid response team to the United Republic of Tanzania to expand response capacity in the WHO country office. The team is also available to provide further technical assistance to the national officials in their investigation, should this be requested. 

On 14 September, the United Republic of Tanzania officially reported to WHO that no case of EVD was confirmed in the country. According to the information provided by the Ministry of Health in a press release, two suspected cases were identified and both tested negative for EVD at a national laboratory via RT-PCR. The information did not include a potential differential diagnosis regarding the cause of illness.

On 16 September, WHO was officially informed that Tanzanian health authorities were not considering secondary confirmation testing for EVD at a WHO Collaborating Centre for Viral Haemorrhagic Fever (VHF). WHO reiterated its recommendation for secondary confirmation testing to be performed and renewed its offer to assist in liaising with a WHO Collaborating Centre for VHF. WHO collaborating centres are institutions such as research institutes, parts of universities or academies, which are designated by the Director-General to carry out activities in support of the Organization's programmes.

On 18 September, WHO informed all Members States’ IHR NFPs through the EIS platform that the United Republic of Tanzania had officially reported that no case of EVD was confirmed in the country, based on the tests performed at a national laboratory. The same day, this was also communicated to the general public on the website of the WHO regional office for Africa. The statement indicated that no further information had been provided.

On 19 September 2019, through its regular event-based surveillance process, WHO was made aware of unofficial reports regarding a contact of the initially presumptive case of EVD who was reported to be sick and hospitalized. In accordance with Article 10 of IHR, WHO immediately sent a formal verification request through the IHR National Focal Point (NFP) of the United Republic of Tanzania. The response of the IHR NFP of the United Republic of Tanzania was received on the same day and stated that as of 19 September 2019, “the United Republic of Tanzania does not have any EVD case” and does not “have any suspected case admitted anywhere.”

However, to date, clinical data, results of the investigations, possible contacts and potential laboratory tests performed for differential diagnosis of those patients have not been communicated to WHO. This information is required for WHO to be able to fully assess of the potential risk posed by this event.

On 20 September, WHO informed all Member States’ IHR NFPs through the EIS platform.

Public health response

• The United Republic of Tanzania has initiated the implementation of EVD preparedness since May 2018, with an assessment of EVD preparedness status that led to the development of a national EVD contingency plan. As part of the recommended EVD preparedness activities, an Ebola treatment centre (ETC) has been established in Dar es Salaam, a public health emergency operation centre (PHEOC) has been operationalized, training of three rapid response teams has been conducted, a hotline for alerts has been activated, and key EVD messages have been developed and translated to major local languages with ongoing EVD sensitization in both radio and print media. However, an EVD simulation exercise conducted in the United Republic of Tanzania in August 2019 identified areas for improvement

• WHO continues to work with the United Republic of Tanzania to support preparedness activities undertaken by the national health authorities in order to improve the capacities for prevention, detection, confirmation of any suspicion of EVD.

• In preparation for vaccination of frontline health workers in case of an EVD outbreak, a vaccination protocol (for rVSV-ZEBOV-GP) has received provisional approval from the national authorities. On 13 September, WHO shipped 1000 personal protective equipment (PPE) sets and additional logistics equipment. WHO has also shipped supplies to support vaccination.

• WHO and partners continue to engage with national authorities.

WHO risk assessment

The limited available official information from Tanzanian authorities represents a challenge for assessing the risk posed by this event.

To date, the clinical details and the results of the investigation, including laboratory tests performed for differential diagnosis of these patients, have not been shared with WHO. The insufficient information received by WHO does not allow for a formulation of a hypotheses regarding the possible cause of the illness. At this stage, WHO is not aware of signs of a widespread transmission of any illness related to these cases, however investigations, including with the support of WHO Collaborating Centres, should continue to reach a diagnosis and further inform the risk assessment.

WHO advice

On 17 July 2019, the EVD outbreak in the Democratic Republic of the Congo was declared a Public Health Emergency of International Concern, and the overall EVD risk at the regional level was assessed to be very high. In that context, WHO urges Member States of the region to strengthen operational readiness and preparedness activities, including timely detection, verification, reporting, and laboratory confirmation of any suspicion of EVD.

In line with the WHO Interim Guidelines on the laboratory diagnosis of EVD, WHO strongly recommends Member States liaise with a WHO Collaborating Centre for Viral Haemorrhagic Fever (VHF) for secondary confirmation testing, in particular Member States where EVD tests are not performed routinely. When a negative laboratory diagnosis for EVD is reached in accordance with the principles of these guidelines, WHO recommends further investigations and laboratory tests be performed in order to reach a final diagnosis regarding the cause of disease.

WHO continues to monitor the EVD situation at global level to detect and verify, under the IHR, any signals regarding suspicions of EVD.

I find nothing on the website of Tanzania's health ministry about this. In the country's English-language media I find one story, an interview with US Health Alex Azar, who calls on Tanzania to come clean on the medical test results.

Ugandan government to deploy medical drones to ease delivery of Ebola vaccines and blood samples

Via KMA Updates, a New Vision report: Ugandan government to deploy medical drones to ease delivery of Ebola vaccines and blood samples.

Dr. Susan Nabadda, the executive director of National Health Laboratory and Diagnostic Services said drones are faster than any other means of transport in delivering vaccines. 

“Medical drones are the fastest means of transport. In outbreaks, we want responses as faster as possible. For an Ebola outbreak, we need to confirm it in time and transport vaccines in the next minute,” Nabadda explained. 

She, however, wondered if the drones can fly across the country, giving an example of Kasese district where the recent outbreak of Ebola took place, adding that it would be important if at all drones can cover the distance where the samples are being taken. 

“The technology is good like for outbreaks such as Ebola. We take about six hours to get samples from Kasese to Kampala. But for drones, it would take a few minutes to get back the samples,” she added.  

Speaking during the stakeholder’s workshop in Kampala, Tinah Mutabazi from Uganda flying Labs said medical drones minimise contact with samples and are vehicles for quick response and accuracy. 

Early this year Ghana inaugurated medical delivery drones in Omenako. The drones designed by Zipline, a California-based robotics company, benefited 12 million people across the country.  

At least up to 600 daily drone flights are made to deliver vaccines, blood supplies and life-saving medicines to 2,000 health centres in remote areas around the country.  

Recently, Dr. Charles Olaro, the commissioner for clinical services at the Ministry of Health said that they are engaged in discussions with a number of partners in the process of introducing medical drones. 

According to Alaro, the approach is good and that the discussions were among others exploring the modalities of financing. He added that the partner is finalising on how it is going to be financed and be able to see how to pull other partners who can support the technology. 

Globally, access to vital health products is hampered by the difficulty of supplying medicines from central storage to remotely located patients at the time of need.

Ebola came quietly to the village of Chowe but WHO's response was rapid

WHO has published Ebola came quietly to the village of Chowe but WHO's response was rapid.

Chowe village is a string of houses, nestling along a road cutting into the sides of seemingly vertical hills. This is spectacular country. Conical peaks brushing the clouds, coated with green, red soil tracks seaming the green.  

What is not so spectacular is the arrival of Ebola virus disease in Chowe. Ebola came quietly to Chowe, in a local woman, who had travelled to the North Kivu hotspot, Beni, to spend time with family there, and came into contact with several people infected with Ebola. After a time, she travelled home with her two young children to join her husband in Chowe. 

That quiet homecoming has now extended the massive geography of the Ebola outbreak in North Kivu and parts of Ituri, in the eastern side of the Democratic Republic of the Congo (DRC), to another province, South Kivu. 

By the time this young mother had returned home -- it is a 700-kilometre journey by bus, boat and taxi -- she was weak and ill. She went to the local health care post, where, on August 14, soon after seeking care, she died. Aware that a death like this should be reported, the local health care worker alerted the authorities and a test was done on August 15.

Even before the results were known, WHO and the Ministry of Public Health sent responders to the site to identify people who had become infected with or who could have come into contact with the Ebola virus, to organise vaccination, to conduct awareness raising, and to provide medical care. 

“This rapid response is only possible because we have trained people who are ready and able to move as soon as we know a new area has become infected,” says Dr Socé Fall, WHO Assistant Director-General for Emergencies who is overseeing the Ebola response in the DRC. 

“It is hard work, difficult and expensive but it is what we have to do, and will continue to do, until we have found every last case and shut down every chain of transmission in the DRC.”  

The rapid response team arrived on the evening of August 15 ready to begin work immediately, and Ebola was confirmed as the cause of death that same day. The woman's son, just six months old, was showing signs of infection. With nowhere safe to isolate and care for him, one room of the family home was set aside. Equipment flown down by helicopter was used to provide treatment and also protect the medical staff caring for the child. 

"We used bamboo sticks to set up a fence around the hut to isolate the space," said Dr Janet Diaz, lead for Clinical Case Management in the WHO Health Emergencies programme, and a member of the team sent to provide medical care for people in Chowe. “It was a struggle finding everything we needed, but we were still able to treat the baby for Ebola.” 

Since those early days, the baby and his father -- who also developed symptoms and has been confirmed positive for Ebola virus disease --have been moved to the local health post which has been turned into a temporary treatment centre.      

Dr Patrice Kabongo from the Ministry of Public Health, trained alongside Ebola veterans in Goma and Mangina, is now leading the fight to save their lives. “It’s very difficult. We don’t have much water, no light, we sleep on the floor but, we are here to do all that we can do to stop the virus.” 

At the same time, a kilometre or so down the road, a vaccination team have set up their tables and are vaccinating not only those who came into contact with people confirmed to have Ebola, but also the entire village. 

“It’s an adaptation of the strategy,” says Alhassane Toure, WHO lead for vaccination. “We have vaccinated all the contacts and contacts of contacts but because it’s a small village, we are able to widen it to the whole village.”  

Overall, 35 WHO staff are now working in Chowe alongside many partners, including Medecins Sans Frontieres, UNICEF, the World Food Programme and the US Centres for Disease Control, to ensure that every person at risk is identified, followed up, that everyone is being vaccinated, that the people in the area understand the disease and why stopping transmission is essential to protect their lives and their communities, and that the best possible medical care is available to those who do develop Ebola virus disease.

Ebola preparations falter in war‑weary South Sudan

Via The New Humanitarian: Ebola preparations falter in war‑weary South Sudan. Excerpt:

After vomiting blood and exhibiting fever – two of the virus’s telltale symptoms – the teenager had come to the Ebola isolation ward here in Yambio, a South Sudanese town near the border with the Democratic Republic of Congo.  

But it wasn’t until he noticed Ebola posters hanging on the walls and medical staff in unusual scrubs that the shy boy – whose name has been withheld to protect his identity – realised why he had actually been confined. Nobody had thought to confirm it to him.

Lingering insecurity, a lack of funding, and issues with managing cases like the boy in Yambio are hampering efforts to prevent a possible outbreak of Ebola in South Sudan, according to health workers, government officials, and community leaders interviewed by The New Humanitarian. 

With over 2,000 deaths in neighbouring Congo and at least four imported cases in recent weeks in Uganda, health experts say it is only a matter of time before the first cases emerge in South Sudan, where five years of conflict have left nearly 400,000 people dead, millions displaced, and brought an already weak healthcare system to its knees.  

“Given the geographic proximity to – as well as population movements across – the border with Congo, it’s most probably not ‘if’ but ‘when’ South Sudan will see an imported case,” said Sudhir Bunga, South Sudan country director for the Centers for Disease Control and Prevention, the US health protection agency known by the initials CDC.  

Funding gaps 

South Sudan’s health ministry officials, together with international and local partners, have been preparing for a potential outbreak since Congo declared its epidemic last August – 32 screening points have been established in border towns and almost 3,000 frontline health workers have been vaccinated.  

The country ramped up surveillance at some of its busiest crossings after a 41-year-old woman was discovered with Ebola in June in Ariwara, a Congolese town just 43 miles (70 kilometres) from the border. 

Dr. Ali Ahmed Yahaya, a programme manager at the World Health Organisation, said there has been “significant progress”, such as establishing a new health emergency centre and a laboratory to test suspected cases. 

Yet, despite more than a year of planning and preparation, the country’s war-weakened healthcare system is still struggling to keep up.  

“No amount of preparedness is adequate for the country, given the nascent public health infrastructure,” said the CDC’s Bunga. 

A lack of funding is also hampering efforts, according to Richard Lako from the South Sudanese government’s Ebola task force – $12 million was requested for the current round of Ebola preparations, but just 38 percent of that has been received so far. 

Leaning his elbow on the wooden barrier that separates the green zone from the high-risk red area, the 15-year-old South Sudanese boy timidly asked the question that had been troubling him for days: “Do I have Ebola?” 

Members of a rapid response team – whose job is to identify and monitor cases – have left their roles because they are not being paid, Lako said.  

The challenge of preparing for Ebola can be seen most clearly in places like Yambio – a rural, conflict-hit border town where nine suspected cases of the virus have been isolated since February, including the 15-year-old mentioned above.  

Insecurity from years of fighting has cut off direct access to neighbouring Uganda, forcing traders in Yambio to reroute through Congo’s Ituri province, which has seen more than 350 confirmed Ebola cases since the outbreak began in August last year. The majority of Congo’s more than 3,000 cases have been further south, in North Kivu province. 

Poor case management 

On a visit to Yambio last month, TNH witnessed a community struggling to prepare for the virus and health workers struggling to manage cases safely and effectively.  

At Yambio’s Ebola isolation ward, four patients – two suspected cases and two contacts (people known to have had contact with suspected cases) – said it took around 24 hours for doctors to explain why they were being held in isolation.  

A health worker involved in Ebola preparations, who wasn’t authorised to speak on the record, described the delay as “outrightly shocking”.  

“Patients have a right to know why they are admitted, and they and their caregivers or family members must be made aware in real-time,” said the health worker. While doctors don’t want to panic people, there are ways to properly communicate the situation without hiding it from them, he added.  

Patients suspected of having Ebola are also not being isolated properly. 

After vomiting blood and showing signs of fever, 50-year-old John Henry said he spent a night at the state hospital in Yambio instead of being isolated, because there was no doctor on duty to tell them where to go. Henry tested negative for the disease, but if the results had been different more people would have been exposed to Ebola risk.

Questions about the new Ebola case in Uganda

Google Maps

Via VOA: Uganda's Ministry of Health Confirms Ebola Case from DR Congo. Excerpt and then a comment:

KAMPALA, UGANDA - Uganda's Ministry of Health has confirmed a case of the Ebola virus in the western district of Kasese.  

In a statement released Thursday evening, Dr. Joyce Moriku Kaducu, Uganda's minister of state in charge of primary health care, said, "The confirmed case is a 9-year-old female of Congolese origin who traveled with her mother on Wednesday."  

The child and her mother entered Uganda through the Mpondwe main border post to seek medical care.  

The child reportedly has symptoms including high fever, body weakness, rash and unexplained mouth bleeding. 

A blood sample was drawn and sent for testing at the Uganda Virus Research Institute and was confirmed positive for Ebola on Thursday. 

"She was subsequently isolated and transferred to Bwera Hospital Ebola treatment unit, where she is currently being managed," Moriku said.

I've spent much of the day trying to learn more than this about the new case. Neither the Ugandan nor the DRC media have anything new to add yet, so questions remain:

For example, where were the mother and daughter when the girl started showing symptoms? Was it in a health zone with continuing cases, or a new zone, or one that hasn't seen a new case in weeks or months?

 

Why did the mother decide that local care wasn't enough? Did she have more confidence in the Ugandan healthcare system? Or family in Uganda? 

 

How did mother and daughter get from wherever they'd been to the border? By bus? Moto taxi? We're told no Ugandans came in contact with them (apart, presumably, from the border officials who screened them), but what about their contacts in the DRC? Any family or neighbours there?

 

Why didn't the Ugandans return mother and daughter to the DRC? Was it because Beni is much farther from the border checkpoint than Bwera? If so, it was the decision, given Bwera's Ebola treatment centre and Ugandan experience with Ebola.

 

It's impressive that the Ugandans spotted the girl right at the border, isolated her, got a sample, and tested it so quickly. Kampala is 7 hours by road from Bwera; however the sample got there, by road or air, transportation and testing were both exemplary.

 

I hope we soon get a statement from Uganda or the DRC (preferably a joint statement) with answers to these questions. 

Study: Community-based wildlife carcass surveillance is key for early detection of Ebola virus in Central Africa

Thanks to Stephen Sautner for sending the link to this news release from the Wildlife Conservation Society: Study: Community-based wildlife carcass surveillance is key for early detection of Ebola virus in Central Africa. Excerpt:

Human Ebola epidemics, like the current outbreak in the Democratic Republic of Congo, are known to start from a contact with wildlife infected with Ebola virus. In the early 2000s a series of such outbreaks in Central Africa began from different infected animal sources. In response, WCS (Wildlife Conservation Society) and NIH (National Institutes of Health) scientists partnered with the Republic of Congo Ministry of Health to develop a low-cost educational outreach program and surveillance system for wildlife mortality that has continued now for over a decade. While the region is a high-risk zone, Republic of Congo has not had a human case or detection of Ebola virus since 2005. The study authors provide the first description of the early warning system for Ebola in the journal Philosophical Transactions of the Royal Society B.  

Comprised of a mix of public health and conservation experts, the authors recognized the utility of monitoring great ape health early on. During Ebola outbreaks from 2001-2005, surveys of closely monitored gorilla populations in Central Africa found mortality from Ebola reached over 90 percent. In fact the western lowland gorilla is classified as critically endangered and the chimpanzee as endangered in part because of Ebola. 

If an Ebola outbreak among wildlife, or an epizootic, could be detected early on, measures could be put in place to prevent the virus from spilling over and causing a human outbreak.  

According to Eeva Kuisma, Health Program Coordinator, WCS Congo Program, “The multitude of challenges facing the current DRC outbreak highlight the value of early detection and proactive prevention and education. These are at the core of our community-based wildlife mortality surveillance program and the only way to succeed is to work together with multi-sectorial partners and in mutual cooperation with the communities.” 

A long-term wildlife mortality surveillance system coupled with community education was built over the ensuing years. To date the program has reached over 6,600 people living in rural northern Republic of Congo, and in total the surveillance effort covers an area of approximately 50,000 km2. The surveillance network is comprised of hunter-gathers, park rangers, and WCS-affiliated project personnel who report great ape and mammal carcasses they encounter to a trained response team. 

To establish and maintain the hunter-gatherer surveillance network the response team visits villages, with permission of the village chief, and delivers a verbal presentation on the basics of Ebola virus transmission to all interested community members. The emphasis is, ‘do not touch, move or bury the carcass and contact the surveillance network immediately’. 

Said Dr. Alain Ondzie, Program Veterinarian, WCS Congo Program: “If we want to detect animal mortalities in the forest, both in search of animal diseases and in order to proactively protect communities from animal diseases that can transmit to people, it is crucial to involve hunters, field biologists, rangers, and forest personnel.”  

When a report is called in, the team first checks in with the village chief. Then using biosafety methods and lessons learned from past outbreaks, the carcass is sampled and the sample sent for molecular testing at the National Public Health Laboratory in Brazzaville. Test results are available within 3-4 days and communicated back to the village. All 58 carcasses tested to date have been negative for Ebola virus.

DRC Ebola: Suspected case in Maniema

Via Digitalcongo.net: Ebola: Suspected case in Maniema. The Google translation:

An alert has just been given by the New Maniema Civil Society about a suspected case of Ebola virus disease detected in Punia, one of Maniema's territories. According to Mukubua Katiayi, coordinator of local civil society, the suspect case came from North Kivu. 

"The suspect case was in the territory of Punia. It was suspected that the person had come to Lubutu, probably from North Kivu province. The provincial government has brought people together to organize the response as soon as possible ... ", he said on Top Congo FM's phone. 

As for the profile of the alleged Ebola patient, the same source describes: "It was a child who was accompanied by his mother ... we took precautions to isolate in time all the people who accompanied them." For this coordinator, the samples are in the laboratory to confirm or refute this suspect case. "We sent the samples to Kinshasa to see if this is the case of the Ebola virus," he said. 

These samples were sent to Kinshasa at the National Institute for Biomedical Research (INRB) for further analysis. On the spot in Maniema, the provincial division of health is organized to face this health situation in case the disease is confirmed. 

By signing on Monday, August 26, 2019, the note of 60 tons of material to fight against this epidemic, Jean-Jacques Muyembe, technical secretary of the multisectoral committee for the response to the Ebola virus disease called the populations to collaborate with the response teams to stem this outbreak.