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Published Date: 2018-09-29 10:00:08
Subject: PRO/AH/EDR> Ebola update (99): Congo DR (NK, IT) case update, risk, preparedness, unrest
Archive Number: 20180929.6059771
EBOLA UPDATE (99): DEMOCRATIC REPUBLIC OF CONGO (NORTH KIVU, ITURI) CASE UPDATE, RISK, PREPAREDNESS, UNREST
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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, 27 Sep 2018, DRC Ministry of Health
[2] Risk assessment
[3] Preparedness
[4] Unrest

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[1] Case update
- Fri 28 Sep 2018. Epidemiological situation report, DRC Ministry of Health [in French, machine trans., edited]
https://us13.campaign-archive.com/?u=89e5755d2cca4840b1af93176&id=2466e64d46

The epidemiological situation of the Ebola virus disease dated 27 Sep 2018:
A total of 155 cases of haemorrhagic fever were reported in the region, of which 124 were confirmed and 31 were probable.
- Of the 124 confirmed, 71 died and 45 are cured.
- 15 suspected cases are under investigation.
- 1 new case confirmed in Beni.
- 1 new confirmed case death in Beni.
- 2 new people healed in Butembo.

News of the response

Epidemiological surveillance
- All contacts in the Masereka Health Zone have come out of their 21-day follow-up period.
- Caregivers at the Mangina Reference Health Center, who had been discharged early in the epidemic as contacts, have also completed their follow-up period and will be able to return to work in the next few days.

Vaccination
- Since the beginning of vaccination on 8 Aug 2018, 12 250 people have been vaccinated, including 4122 in Mabalako, 3712 in Beni, 1632 in Mandima, 884 in Butembo, 993 in Katwa, 270 in Masereka, 164 in Komanda, 177 in Tchomia, 121 in Oicha, 110 in Bunia, and 65 in Kinshasa (medical staff to deploy).

--
Communicated by:
ProMED-mail Rapporteur Mary Marshall

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[2] Risk assessment
- Fri 28 Sep 2018. More DRC Ebola cases as risk raised to "very high"
[Center for Infectious Disease Response and Policy (CIDRAP) News, extracted, edited]
http://www.cidrap.umn.edu/news-perspective/2018/09/more-drc-ebola-cases-risk-raised-very-high

As new Ebola cases continue in the Democratic Republic of Congo (DRC), the World Health Organization (WHO) yesterday [Thu 27 Sep 2018] raised the risk assessment for spread of the disease within the country and regionally from "high" to "very high" while keeping the risk of international transmission of Ebola virus disease (EVD) low.

"This outbreak of EVD is affecting northeastern provinces of the DRC, which border Uganda, Rwanda, and South Sudan," the WHO said in a statement. "Potential risk factors for transmission of EVD at the national and regional levels include the transportation links between the affected areas, the rest of the country, and neighbouring countries; the internal displacement of populations; and the displacement of Congolese refugees to neighbouring countries."

Recent violence by armed rebels in Beni, the site of the WHO's response efforts in eastern DRC, has led the agency to call this week a "critical juncture" in the outbreak.

"WHO response activities have been severely limited as Beni and nearby towns mark a period of mourning for those who were killed. Security in Beni and other areas remains challenging," the WHO said. The agency added that rumors and traditional practices have led relatives to care for sick family members at home, which increased the risk for infection.

The past week has also seen Ebola patients move in to "red zones," insecure communities that health workers cannot reach.

Yesterday and today [27-28 Sep 2018] the DRC's health ministry reported 4 more Ebola patients, all in Beni, 2 of whom are known contacts who declined vaccination but voluntarily went to an Ebola treatment center after their symptoms began.

The health ministry today also noted one new death in Beni. There are now a total of 155 cases (124 confirmed, 31 probable), including 102 deaths, in this outbreak. Eleven suspected cases are currently under investigation.

As of 26 Sep 2018, response efforts in Beni resumed after a period of mourning following the 22 Sep 2018 attacks in the city was lifted. DRC officials said there was more enthusiasm and cooperation among community members in the Ndindi district, which has been referred to as Beni's "cradle of resistance." The DRC said residents of Ndindi voluntarily registered to get vaccinated with Merck's unlicensed Ebola vaccine.

According to the WHO, of the 149 confirmed and probable cases for whom age and sex are known, 23%, 20%, and 22% are aged 15-24, 25-34, and 35-44 years, respectively; females accounted for 56% cases. A total of 19 healthcare workers, 3 of whom have died, have been infected.

[Byline: Stephanie Soucheray]

--
Communicated by:
ProMED-mail Rapporteur Mary Marshall

[WHO has appropriately raised the risk level in the DRC to very high. It seems a little surprising, however, that WHO continues to consider international risk low, since at least one neighboring country, Uganda, has ramped up preparedness in parallel with increasing concern that Ebola virus might spill over from the DRC. See [3] below. - Mod.LK]

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[3] Preparedness
- Thu 27 Sep 2018. Uganda steps up Ebola preparedness response in 22 high-risk districts
[AllAfrica, extracted, edited]
https://allafrica.com/stories/201809280145.html

The epicentre of the current outbreak is close to Uganda's border to the west, with a lot of cross-border movements. Natives from both countries cross to engage in business, attend school, and access healthcare and social services.

In that regard, with 22 at-risk districts identified, Ministry of Health (MoH) and partners have implemented Ebola preparedness and readiness activities to prevent the disease from crossing into Uganda and to ensure early detection of the disease should it be imported.

The activities include coordinating the preparedness activities, strengthening surveillance, capacity building in contact tracing, laboratory diagnostics, infection prevention and control, and clinical management of patients, including psycho-social care. Safe and dignified burials, enhanced risk communication and community engagement, and cross-border surveillance are also part of the activities.

Border-entry screening at all major border points in all the very high-risk districts has been implemented. Using volunteers trained by the WHO and Red Cross, and infrared thermometers, everyone crossing into Uganda from DRC is screened for body temperature. The people found with high temperatures are further screened for Ebola-like symptoms.

On average, the busy border-screening points receive 5000 people; however, during market days, the number grows tremendously. For instance, Mpondwe border point registers over 20 000 people during the market days, every Tuesday and Friday. Surveillance and active case search have also been heightened to detect any alert or suspected case.

In preparation for any suspected case, Ebola Treatment Units (ETUs) have been set up at Bundibugyo General Hospital, Bwera Hospital in Kasese, and Rwebisengo Health Center in Ntoroko district, and another is under construction at Naguru Friendship Hospital in Kampala.

Risk communication and community engagement are also ongoing. Teams are engaged in door-to-door visits and distribution of Information Education Communication (IEC) material. In addition, messages are also running on TV and radio to reach the wider public within and outside the high-risk districts.

To ensure proper handling of Ebola samples, WHO supported MoH to build the capacity of 40 laboratory technicians in the 5 very high-risk districts in sample collection, packaging, handling, and transportation. Additionally, 19 technicians from the national reference labs were trained in the diagnosis of Ebola virus disease using GeneXpert and Rapid Diagnostic Tests.

--
Communicated by:
ProMED-mail Rapporteur Mary Marshall

[One should read the full report for this proactive, very comprehensive response to the threat of Ebola virus entering the country. Should the virus spread to Uganda, the country will be well prepared on many fronts to combat it. - Mod.LK]

******
[4] Unrest
- Fri 28 Sep 2018. Violence and displacement in Ebola-hit DR Congo threatens humanitarian response.
UN News [extracted, edited]
https://news.un.org/en/story/2018/09/1021322

Speaking in Geneva, Mr. Baloch [UN Refugee Agency, UNHCR spokesperson] explained that there has been a sharp rise in attacks and displacement in recent months in the Beni area of North Kivu province and further north, in Ituri province.

"It is estimated that more than a million people are displaced in North Kivu," he said. "An estimated half a million have been forced from their homes this year alone."

Some 13 000 people fled their homes in August around Beni, the UNHCR spokesperson added, before underlining the significance of the attack on the city, where residents have been effectively under siege for 2 months by armed militia.

"While these groups have previously been active around Beni, it is the 1st time that fighting has reached the city itself," he said. "Security is what they want. And security from all risks as well."

UNICEF, the UN Children's Fund, has more than 50 staff in the Ebola-affected areas including Beni, Mangina, and Butembo. It has deployed specialists in community communications, education, and psycho-social assistance, in addition to water, sanitation, and hygiene experts to help contain the disease and avoid any further spread.

--
Communicated by:
ProMED-mail Rapporteur Mary Marshall

[This civil unrest is a major obstacle to control efforts. It's not clear what it will take to suspend hostilities. - Mod.LK

HealthMap/ProMED-mail map:
DR Congo: http://healthmap.org/promed/p/194]

See Also

Ebola update (98): Congo DR (NK, IT) case update, protection, WHO 20180927.6057088
Ebola update (97): Congo DR (NK, IT) case update, unrest 20180926.6051893
Ebola update (96): Congo DR (NK,IT) case update, unrest 20180924.6048330
Ebola update (95): Congo DR (NK, IT) case update, Uganda 20180923.6046043
Ebola update (94): Congo DR (NK, IT) case update, WHO, Ugandan border 20180921.6044107
Ebola update (93): Congo DR (NK,IT) case update 20180920.6040094
Ebola update (92): Congo DR (NK,IT) case update, hostility, CDC 20180919.6033537
Ebola update (91): Congo DR (NK) case update, suspect cases 20180917.6033538
Ebola update (90): Congo DR (NK) case update, response, CDC 20180915.6032119
Ebola update (89): Congo DR (NK) case update, WHO 20180914.6030543
Ebola update (88): Congo DR (NK) case update, preparedness, publications 20180913.6027398
Ebola update (87): DR Congo (NK) case update, challenges 20180911.6023285
Ebola update (86): Congo DR (NK) case update, outbreak status 20180911.6020957
Ebola update (85): DR Congo (NK) case update, Butembo 20180909.6017592
Ebola update (84): Congo DR (NK) case update, risk health workers 20180908.6016025
Ebola update (83): Congo DR (NK) case update, Butembo fatalities 20180906.6012775
Ebola update (82): Congo DR (NK) case update, treatment 20180905.6008197
Ebola update (81): Congo DR (NK) case update, response, clinical trials 20180901.6002182
Ebola update (80): Congo DR (NK) case update 20180830.5996306
Ebola update (79): Congo DR (NK) case update, response, vacc., support, research 20180828.5991478
Ebola update (78): Congo DR (NK) case update, health protection of medical teams 20180826.5988617
Ebola update (77): Congo DR (NK) case update, risk, control, research 20180825.5986666
Ebola update (76): Congo DR (NK) case update, response 20180824.5984263
Ebola update (75): Congo DR (NK) cases, WHO, response, perspectives 20180823.5981519
Ebola update (74): Congo DR (NK) cases, response, WHO, reflections 20180822.5979052
Ebola update (73): Congo DR (NK) cases, anti-viral, research 20180821.5977639
Ebola update (72): Congo DR (NK) cases, response, research 20180820.5975692
Ebola update (71): Congo DR (NK) cases, response, bats 20180818.5974137
Ebola update (70): Congo DR (NK) cases, recommendations, war, comment 20180817.5971731
Ebola update (69): Congo DR (NK, IT) cases, Uganda NOT, WHO response 20180816.5968689
Ebola update (68): Congo DR (NK) WHO, Uganda cases, concerns, challenges 20180815.5966397
Ebola update (67): Congo DR (NK) cases, response, issues, research 20180814.5964660
Ebola update (66): Congo DR (NK) cases, response 20180813.5962221
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
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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
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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
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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
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Ebola update (49): Congo DR, suspect deaths comment 20180704.5888151
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Ebola update (36): Congo DR, cases, threat, assistance 20180615.5858111
Ebola update (35): Congo DR, cases, response, WHO 20180614.5855415
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Ebola update (33): Congo DR, cases, response, WHO, diagnosis 20180612.5850968
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Ebola update (02): Congo DR (ET) 20180508.578972
.................................................lk/tw/dk

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