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Published Date: 2018-08-13 09:45:52
Subject: PRO/AH/EDR> Ebola update (66): Congo DR (NK) cases, response
Archive Number: 20180813.5962221
EBOLA UPDATE (66): DEMOCRATIC REPUBLIC OF CONGO (NORTH KIVU) CASES, RESPONSE
****************************************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

In this update:
[1] Case update
- Epidemiological situation report, 12 Aug 2018, DRC Ministry of Health
- 4 new cases
[2] Response
- Beni healthcare workers on leave
- WHO calls for free and secure access
- interview with Peter Salama

******
[1] Case update
- Sun 12 Aug 2018. Epidemiological situation. DRC Ministry of Health [in French, machine trans., edited]
https://us13.campaign-archive.com/?u=89e5755d2cca4840b1af93176&id=144926c9c0

The epidemiological situation of the Ebola virus disease dated 12 Aug 2018:
- A total of 52 cases of haemorrhagic fever were reported in the region, 25 confirmed and 27 probable;
- 48 suspected cases are under investigation;
- 3 new confirmed cases, including 1 in Beni and 2 in Mangina (including a health staff from the Mangina Reference Health Center);
- 1 death of a confirmed case in Mabalako

Alerts had been reported in the Idjwi health zone in South Kivu province. The samples taken were analyzed at the Goma mobile laboratory and the tests were negative.

Remarks
- To avoid [confusion with the total number of cases varying] (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.

--
Communicated by:
ProMED-mail Rapporteur Mary Marshall

[Note that 3 new confirmed cases are stated above, but 4 new cases in the next report from Reuters.]

- Sat 11 Aug 2018. Four new Congo Ebola cases as medics prepare experimental treatment
[Reuters, edited]
https://www.reuters.com/article/us-health-ebola-congo/four-new-congo-ebola-cases-as-medics-prepare-experimental-treatment-idUSKBN1KW071

The health ministry said 4 new cases of Ebola virus have been confirmed in eastern Democratic Republic of Congo, as authorities prepare to deploy an experimental treatment.

The latest confirmed cases near the town of Mangina in Congo's North Kivu province bring the total for the current outbreak to 21, the ministry said in a statement late on [Fri 10 Aug 2018].

Another 2 people -- one near Mangina and another in the city of Beni -- died of Ebola, the ministry said. In all, the haemorrhagic fever [see note in ProMED mail Ebola update (65): Congo DR (NK) cases, vaccines 20180812.5960584 regarding misnomer "hemorrhagic fever" for the recent outbreaks] is believed to have killed 38 people, although several of these cases have not been confirmed.

Authorities this week [week of 6 Aug 2018] began vaccinating health workers and people who had contact with confirmed cases. The experimental vaccine, manufactured by Merck, proved effective against an outbreak in western Congo that ended late last month [July 2018].

Officials are also ready to use an experimental treatment called mAB114 on Ebola patients for the 1st time, Steve Ahuka, a virologist at the National Institute for Biomedical Research (INRB) in the capital Kinshasa, told Reuters.

The treatment was developed in the United States using the antibodies of the survivor of an Ebola outbreak in the western Congolese city of Kikwit in 1995 and was 100 percent effective when tested on monkeys.

"It's experimental. So we are following the protocol. It has been submitted to the ethical committee and the ethical committee gave its okay," Ahuka said, adding it could be used within days.

He said other experimental treatments, including ZMapp, a similar antibody drug made by Mapp Biopharmaceuticals in San Diego, could also be used.

Ebola, which causes fever, vomiting, and diarrhea, is spread through direct contact with body fluids.

It killed more than 11 000 people during the largest-ever outbreak in West Africa from 2013-16. Authorities in Congo, which has experienced 10 outbreaks since 1976, have been more successful in containing it.

But the current flare-up poses fresh challenges as it is in a part of Congo stalked by myriad militia groups that regularly battle one another and kill and kidnap civilians.

So far, however, the disease has not touched so-called "red zones" where security risks would severely limit access for health workers.

[Reporting: Fiston Mahamba; writing: Aaron Ross; editing: Mark Potter

--
Communicated by:
ProMED-mail from HealthMap Alerts
<promed@promedmail.org>

[Jennifer Garland, PhD epidemiologist and special pathogens nursing manager in Los Angeles has highlighted 2 issues: the precise number of infected healthcare workers (HCWs), and how laboratory confirmation is made. A direct accounting of the number of HCWs with confirmed illness has not been provided. Healthcare workers are currently being vaccinated and those who had contact with infected individuals are being quarantined, but numbers have not been provided. In addition, it is not clear exactly what tests are required in the laboratory to consider a case confirmed. Is one positive PCR assay considered confirmatory? Or are 2 distinct targets required?

It is good news that a new promising anti-viral is available in addition to ZMapp. MAb114 is a single monoclonal antibody (as opposed to ZMapp, comprised of 3 chimeric monoclonal antibodies) isolated from a human survivor of the 1995 Ebola outbreak in Kikwit, DRC. Nancy Sullivan, PhD, chief of the Biodefense Research Section in NIAID's Vaccine Research Center (VRC), and her team, in collaboration with researchers from the National Institute of Biomedical Research (INRB) in the DRC and the Institute for Biomedical Research in Switzerland, discovered that the survivor retained antibodies against Ebola 11 years after infection. They isolated the antibodies and tested the most favorable ones in the laboratory and non-human primate studies, and selected mAb114 as the most promising. ...[more] (Excerpted from https://www.nih.gov/news-events/news-releases/nih-begins-testing-ebola-treatment-early-stage-trial). - Mod.LK]

******
[2] Response
- Sun 12 Aug 2018. Beni healthcare workers on leave
[Radio Okapi, in French, machine trans., edited]
https://www.radiookapi.net/2018/08/12/actualite/sante/ebola-beni-74-membres-du-personnel-du-centre-de-sante-de-mangina

"The temporary release process for the 74 staff members of the Mangina Reference Health Center (CSR) who are considered contacts is also complete. All those who have been in contact with confirmed cases will be followed up for 21 days and can not return to CSR until one month later. During this period, they were asked to avoid any movement outside the area. They will be temporarily replaced by temporary health workers from other health centers in Oicha, Mabalako, and Musienene," the health ministry said in a statement on Sat 11 Aug 2018.

The Ministry of Health also indicates in the same communiqué that, through its World Bank-funded health system development project (PDSS), it has finalized the practical arrangements to start free healthcare in 3 health zones. health around the epicenter, namely Mabalako, Beni, and Oicha.

"In an epidemic, it is important that the financial barrier is not a barrier to access to health care. This measure to introduce free healthcare in the affected areas aims to encourage the population to go to an approved health center as soon as the 1st symptoms appear, increasing their chance of survival," argues the Ministry of Health.

Two mobile laboratories of the National Institute of Biomedical Research (INRB) have arrived in Goma and Mangina to accelerate the testing of samples taken across the province of North Kivu.

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. ...[more]

--
Communicated by:
ProMED mail Rapporteur Mary Marshall

[The establishment of free healthcare in the affected areas and mobile laboratories to conduct testing are 2 important steps in controlling the spread of Ebola virus. Education on how to proceed when a family member appears sick, and the conduct of safe burials are also important to convey to the population. - Mod.LK]

- Sun 12 Aug 2018. WHO calls for free and secure access in responding to Ebola outbreak in the DRC
[WHO/AFRO, Democratic Republic of Congo, News, edited]
https://www.afro.who.int/news/who-calls-free-and-secure-access-responding-ebola-outbreak-democratic-republic-congo

WHO's global and African regional leadership saw 1st-hand the complexities of implementing the Ebola response in North Kivu in the Democratic Republic of the Congo, in visits with the Ministry of Health officials to affected areas over the last 2 days. While this is the country's 10th Ebola outbreak, it is the 1st time that the disease has struck a densely populated active conflict zone.

"WHO is calling for free and secure access by all responders to the affected populations," said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. "All of those participating in the response must be able to move freely and safely in conflict areas to do the work that is needed to bring the outbreak under control. The population must also have access to treatment centers that save lives and stop the spread of disease."

As was done in the recent outbreak in the west of the country, WHO is supporting the Ministry of Health in key aspects of the response.
A little more than a week since the government declared the new Ebola outbreak, Dr Tedros, Dr Matshidiso Moeti, WHO Regional Director for Africa, and Dr Peter Salama, WHO Deputy Director-General, Emergency Preparedness and Response went on a 2-day mission to the city of Beni and to the Mangina health area in North Kivu. Mangina, which is 30 km [about 19 mi] from Beni, lies at the epicenter of the epidemic and accounts for most of the confirmed cases so far.

A range of armed groups are active in the area and this insecurity creates a challenge for health teams needing to go deep into communities to actively find cases and then monitor them twice a day for 3 weeks. It can also discourage members of the community from coming forward for treatment.

"WHO has vast experience with delivering health services in conflict zones in Africa," said Dr Moeti. "We will build on this experience to ensure that our staff and partners can do their work and save the lives of the people we are here to help."

Together with the Minister of Health, Dr Oly Ilunga, the WHO delegation observed the launch of the Ebola vaccination for health workers in the Beni reference hospital. They also visited the Emergency Operations Centre in Beni, which was built and provided to partners by the UN mission in the Democratic Republic of the Congo, known as MONUSCO. They met with partners and staff to discuss the challenges ahead, and to take stock of what has already been put in place, including treatment centers run by partners, outreach to communities, a review of infection prevention and control in health centres, and reinforcement to the surveillance system.

--
Communicated by:
ProMED-mail Rapporteur Mary Marshall

[Free and secure access by all official responders to the affected populations should be standing operating protocol in all major outbreaks in order to bring infectious diseases under control. - Mod.LK]

- Wed 8 Aug 2018. The latest on the new Ebola outbreak in Central Africa; [BBC interview with Peter Salama, edited]
https://www.bbc.co.uk/programmes/w3cswjkt

The latest on the new Ebola outbreak in Central Africa by Dr Peter Salama, WHO Deputy Director-General, Emergency Preparedness and Response Director of Health Emergencies Programme at WHO since 2016.

Just weeks after the outbreak of Ebola was declared over in the west of the Democratic Republic of Congo, a new outbreak has emerged in the east of the country. The World Health Organization has responded rapidly to the emergency -- having learned lessons from the west Africa outbreak which killed more than 11 000 people. The WHO's Deputy Director of Emergency Preparedness Peter Salama says the current outbreak will be much trickier to contain because of conflict in North Kivu province.

--
Communicated by:
ProMED-mail Rapporteur Mary Marshall

[HealthMap/ProMED-mail map of North Kivu, Congo DR: http://healthmap.org/promed/p/29837]

See Also

Ebola update (65): Congo DR (NK) cases, vaccines 20180812.5960584
Ebola update (64): Congo DR (NK) cases, security, genome 20180810.5959744
Ebola update (63): Congo DR (NK) cases, vaccine, security, burial, genome 20180809.5957277
Ebola update (62): Congo DR (NK) WHO, response, genetics 20180808.5953189
Ebola update (61): Congo DR (NK) WHO, cases, response 20180806.5950109
Ebola update (60): DR Congo (NK) case update, response, risk 20180805.5948198
Ebola update (59): Congo DR (NK) case update, risk, response, treatment 20180804.5946851
Ebola update (58): Congo DR (NK) outbreak, Ebola Zaire confirmed 20180802.5944088
Ebola update (57): Congo DR (NK): 20180801.5941427
Ebola update (56): northeast Congo DR, Ebola-like cases, US negative, RFI 20180730.5936610
Ebola update (55): Sierra Leone Ebola virus variant, Congo DR cases, WHO 20180727.5931686
Ebola update (54): Congo DR, cases, therapeutics 20180725.5926964
Ebola update (53): Congo DR, cases, surveillance, action 20180720.5916987
Ebola update (52): Congo DR, cases, health workers, W Africa survivor problems 20180713.5902694
Ebola update (51): Congo DR, cases, response 20180709.5895475
Ebola update (50): Congo DR, Japanese response, CIDRAP, WHO, survey 20180706.5891820
Ebola update (49): Congo DR, suspect deaths comment 20180704.5888151
Ebola update (48): Congo DR, MSF, susp. deaths, RFI 20180703.5886426
Ebola update (47): DR Congo, epidemiology, response, Libya RFI 20180701.5884463
Ebola update (46): Congo DR, cases 20180629.5882196
Ebola update (45): Congo DR, cases, outbreak, MSF 20180628.5880392
Ebola update (44): Congo DR, cases, research, course 20180626.5877543
Ebola update (43): Congo DR, cases, vaccine, persistence, lessons 20180625.5873949
Ebola update (42): Congo DR, cases, vaccine 20180625.5872757
Ebola update (41): Congo DR, cases, WHO, contacts 20180623.5871358
Ebola update (40): Congo DR, cases, WHO, vaccine, treatment, preparedness 20180622.5869267
Ebola update (39): Congo DR, cases, WHO, response, facilities, treatment, research 20180620.5865023
Ebola update (38): DR Congo, cases, WHO, Oxfam 20180618.5861962
Ebola update (37): Congo DR, cases, response 20180617.5859839
Ebola update (36): Congo DR, cases, threat, assistance 20180615.5858111
Ebola update (35): Congo DR, cases, response, WHO 20180614.5855415
Ebola update (34): Congo DR, cases, response, WHO 20180613.5853602
Ebola update (33): Congo DR, cases, response, WHO, diagnosis 20180612.5850968
Ebola update (32): Congo DR, cases, preparation, research 20180611.5849759
Ebola update (31): Congo DR, cases, response, WHO 20180610.5848785
Ebola update (30): Congo DR, cases, WHO, action 20180609.5847441
Ebola update (29): Congo DR, cases, MSF, antivirals 20180608.5845483
Ebola update (28): Congo DR, cases, WHO, response, treatment, funding 20180607.5843872
Ebola update (27): Congo DR, cases, travel screening, children 20180606.5841051
Ebola update (26): Congo DR, border controls, bat reservoir 20180604.5838529
Ebola update (25): Congo DR, case update, intl. travel screening 20180603.5836552
Ebola update (24): Congo DR, case update, African aid response 20180602.5835414
Ebola update (23): Congo DR, cases, vacc. campaign targets, vaccine development 20180601.5834040
Ebola update (22): Congo DR, cases, cures, domestic and international travel 20180531.5831747
Ebola update (21): Congo DR, update, WHO, vaccination, therapeutics 20180530.5829192
Ebola update (20): Congo DR, case update, lessons, logistics, financing, flights 20180529.5824985
Ebola update (19): Congo DR, case update 20180528.5822466
Ebola update (18): cases, Uganda NOT, Congo DR vaccination campaign 20180527.5821927
Ebola update (17): case update, public fears, government responses 20180526.5820606
Ebola update (16): cases, Congo DR cultural factors, vaccine impl., case terminology 20180525.5817907
Ebola update (15): case update, quarantine breaches, border controls, vaccine 20180524.5816349
Ebola update (14): case update, response, prediction, maps 20180523.5812835
Ebola update (13): case update, prevention 20180521.5809540
Ebola update (12): update, USA, response 20180520.5806396
Ebola update (11): WHO, vaccination, response 20180519.5805133
Ebola update (10): urban case Congo DR, response, support 20180517.5801917
Ebola update (09): update, alerts, prevention 20180516.5799567
Ebola update (08): summary, emergency plan, vaccine, roads 20180515.5797415
Ebola update (07): Congo DR, nurse, Uganda susp, WHO, border, vaccine 20180513.5795881
Ebola update (06): Congo DR, susp, RFI, vulnerability, response, control 20180512.5794300
Ebola update (05): Congo DR, outbreak update, vaccine, preparedness, research 20180511.5792856
Ebola update (04): Nigeria, Kenya, Congo DR (ET), WHO 20180510.5791247
Ebola update (03): Congo DR (ET), WHO 20180509.5790577
Ebola update (02): Congo DR (ET) 20180508.5789723
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