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Published Date: 2018-11-20 22:04:06
Subject: PRO/AH/EDR> Ebola update (137): Congo DR (NK, IT) cases, summary, response
Archive Number: 20181120.6156862
EBOLA UPDATE (137): DEMOCRATIC REPUBLIC OF CONGO (NORTH KIVU, ITURI) CASES, SUMMARY, 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, 19 Nov 2018, DRC Ministry of Health
- Epidemiological situation report, 18 Nov 2018, DRC Ministry of Health

[2] Summary
- WHO AFRO
- CIDRAP [Center for Infectious Disease Research and Policy]

[3] Response
- World Food Program
- Voices from the field
- IOM crisis communication system

******
[1] Case update
Tue 20 Nov 2018. Epidemiological situation report, DRC Ministry of Health [in French, machine trans., edited]
https://us13.campaign-archive.com/?u=89e5755d2cca4840b1af93176&id=97b8d385d1

The epidemiological situation of the Ebola Virus Disease dated 19 Nov 2018:

-Since the beginning of the epidemic, the cumulative number of cases is 373, of which 326 are confirmed and 47 are probable. In total, there were 217 deaths (170 confirmed and 47 probable) and 110 people healed.
-71 suspected cases under investigation.
-No new cases confirmed.
-1 new confirmed case death in Beni.
-2 new people healed in Beni.
-Continuing the joint work between surveillance, laboratory and management for the redistribution of cases and deaths by health zone as well as validation of confirmed and probable cases and deaths

News of the response
---------------------
Vaccination
Since the beginning of vaccination on 8 Aug 2018, 32 626 people have been vaccinated, including 16 210 in Beni.

--
Communicated by:
ProMED-mail Rapporteurs Mary Marshall and Kunihiko Iizuka

[The report includes a video in French describing the vaccination procedure followed in the villages.

The cases hold another day at 373, although more than 70 are under investigation. In addition, there is 1 new death reported. - Mod LK]

Mon 19 Nov 2018. Epidemiological situation report, DRC Ministry of Health [in French, machine trans., edited]
https://us13.campaign-archive.com/?u=89e5755d2cca4840b1af93176&id=133e4b89be

The epidemiological situation of the Ebola Virus Disease dated 18 Nov 2018:

-Since the beginning of the epidemic, the cumulative number of cases is 373, of which 326 are confirmed and 47 are probable. In total, there were 216 deaths (169 confirmed and 47 probable) and 108 people cured.
-72 suspected cases under investigation.
-7 new confirmed cases, including 3 in Beni, 3 in Katwa and 1 in Butembo.
-2 new confirmed cases, including 1 in Butembo and 1 in Katwa.
-1 new person healed in Beni.

News of the response
-------------------
Press point in Beni
-On Mon 19 Nov 2018, the Coordinator of the response, Dr. Ndjoloko Tambwe Bathe, held a press briefing in Beni to present the evolution of the epidemic and reassure the population of the ongoing commitment of the Ministry of Health and international partners to end the Ebola outbreak in North Kivu province. Despite the evacuation of 20 WHO staff over the weekend, the human resources deployed in Beni remain very important. The Ministry of Health has more than 900 experts in Beni, of which almost 85 percent are locals who have been trained to participate effectively in all pillars of the response. WHO has 191 national and international consultants who continue to work in Beni. Added to this are the hundreds of other people employed by the other organizations involved in the response. In addition, he recalled that according to the new community-based monitoring approach, it is the local actors who lead more field activities with the technical support of national and international experts.

-Dr. Bathe also discussed the epidemiological situation in the health zone of Kalunguta, which is a red zone. The spread of the epidemic in the village of Kanihunga was caused by the arrival of a confirmed case from Beni who fled several weeks ago to escape the monitoring teams. The Minister of Health, Dr Oly Ilunga Kalenga, instructed the coordination of the response to provide substantial technical and medical support to all health centers in this area so that they can provide quality care to the population. Thanks to the goodwill of the village leaders who granted access to the response teams, 895 people were vaccinated in the village.

-In order to contain the epidemic in and around Butembo Health Zone, the coordination decided to send additional intervention teams to the Katwa, Kalunguta and Lubero areas to support local health care providers.

News of the response
------------
Vaccination
-Resumption of vaccination in Beni since Sun 18 Nov 2018. Since the start of vaccination on 8 Aug 2018, 32 108 people have been vaccinated , including 15 962 in Beni.

--
Communicated by:
ProMED-mail Rapporteur Mary Marshall

[See Helen Branswell's tweets on this DRC MoH update:
Helen Branswell @Helen Branswell https://twitter.com/HelenBranswell. - Rapp.MJM
#Ebola update: For the 1st time in 49 days, there were no new cases reported today in DRC. The last time there were no new cases was 2 Oct 2018. There have been 203 cases reported since then. One death was reported, bringing the outbreak totals to 373 cases, 217 deaths.

She includes a very informative figure of North Kivu cases by date of report. - Mod.LK]

******
[2] summary

- Mon 19 Nov 2018. WHO AFRO: Ebola update - evolution of the response to the Ebola epidemic in North Kivu and Ituri
[WHO AFRO report, edited]
http://apps.who.int/iris/bitstream/handle/10665/275935/OEW46-1016112018.pdf

Week 46: 10-16 Nov; data reported as of 16 Nov 2018
Includes event description, public health actions, situation interpretation

--
Communicated by:
ProMED-mail Rapporteur Mary Marshall

[See full report at URL above. Also see Crofs blog https://crofsblogs.typepad.com/h5n1/2018/11/who-afro-ebola-update-november-19.html:
"Thanks to Helen Branswell for tweeting about the latest Weekly Bulletin from WHO AFRO. Here's an excerpt from the Bulletin...then a comment:

The Ebola virus disease (EVD) outbreak in North Kivu and Ituri provinces, Democratic Republic of the Congo continues to be closely monitored. Since our last report on 9 Nov 2018 (Weekly Bulletin 45), 37 new confirmed EVD cases have been reported, and 9 new deaths have occurred.

As of 17 Nov 2018, there have been a total of 366 EVD cases, including 319 confirmed and 47 probable cases. To date, confirmed cases have been reported from 14 health zones: Beni (163), Mabalako (67), Kalunguta (25), Katwa (20), Butembo (10), Masereka (6), Kyondo (2), Musienene (2), Oicha (2), Vuhovi (2), and Mutwanga (1) in North Kivu Province; and Mandima (16), Tchomia (2) and Komanda (1) in Ituri Province. A total of 214 deaths were recorded, including 167 among confirmed cases, resulting in a case fatality ratio among confirmed cases of 52% (167/319). A total of 39 health workers have been infected to date, including 11 deaths.

On 17 Nov 2018, 49 new suspected patients were hospitalized, bringing the total number of patients admitted to 124, including 35 confirmed cases. As of 17 Nov 2018, the number of patients cured and discharged back into the community is 107. Bed occupancy in Beni Ebola Treatment Centre (ETC) is 100 percent.

Beni, Kalunguta and Katwa remain the principal hotspots of the outbreak with, respectively, 46 percent (n equal to 45), 31 percent (n equal to 30) and 11 percent (n equal to 11) of the 97 confirmed and probable cases reported in the past 21 days (from 28 Oct-17 Nov 2018).

Contact tracing is still of concern due to insecurity and persistent community resistance. Of the 4430 contacts listed for follow up, 4182 (94 percent) were seen on 17 Nov 2018. The proportion of contacts seen in the previous 24 hours varies from 80 percent to 100 percent.

Branswell points out that the HCW cases last week numbered 30, with just 3 fatalities; she suspects the new cases are traditional healers, who are often the 1st consulted." - Rapp.MJM

[The World Health Organization (WHO) African regional office today [20 Nov 2018], in its weekly outbreak and health emergencies update, said that over the past 21 days, Beni, Kalunguta, and Katwa have been the main hotspots. It added that against a backdrop of escalating insecurity, the outbreak remains dangerous and unpredictable.

The agency said there's a critical need to strengthen infection prevention and control in Beni and other areas and to continue collaborating with Mai Mai rebel groups regarding security in the Kalunguta red zone to help with death investigations, follow-up, and vaccination.

The report notes that bed occupancy in Beni's Ebola treatment center is at full capacity. It said 39 healthcare workers have been sickened in the outbreak, 11 of them fatally, signifying an increase of 9 cases and 8 deaths. [Note this figure differs from that quoted in Helen Branswell's tweet above. - Mod.LK]

-19 Nov 2018. DRC reports 21 more cases of Ebola amid more violence in Beni
[CIDRAP, edited]
http://www.cidrap.umn.edu/news-perspective/2018/11/drc-reports-21-more-cases-ebola-amid-more-violence-beni
[Byline: Stephanie Soucheray]

Outbreak grows in Kalunguta: Bathe addressed the recent cases in Kalunguta, a health district in one of the DRC's security red zones. He explained that Ebola was spread to the area by a confirmed case-patient from Beni who escaped surveillance in that city. Bathe said the community has been accommodating to health workers, and more than 800 people have been vaccinated.

At least 2 of the 21 new cases recorded this weekend were in Kalunguta.

In updates over the weekend, the DRC's health ministry efforts to clean up the Ebola case database were continuing.

--
Communicated by:
ProMED-mail Rapporteur Mary Marshall

******
[3] Response
-Mon 19 Nov 2018. WFP's Response to the Ebola Outbreak in DRC
[Relief web; World Food Programme, edited]
https://reliefweb.int/report/democratic-republic-congo/wfp-s-response-ebola-outbreak-drc-19-november-2018

WFP continues to respond to the worst Ebola outbreak in DRC's history, providing food assistance to prevent a further spread of the virus, and serving the wider humanitarian community with critical logistical support.

The Ebola response is led by the Ministry of Health, in partnership with the World Health Organization (WHO). WFP supports the medical response with food assistance to affected people, logistical support to WHO and the provision of common services to the response community. Coordination mechanisms consist of numerous technical commissions led by the Ministry of Health, including ones dedicated to tracing and monitoring, vaccination, psychosocial support, prevention and patient care. The commissions meet daily to share information and make the required adjustments to response planning and execution.

WFP coordinates with all relevant commissions, including those responsible for surveillance, psychosocial support, vaccination and logistics. The surveillance commission is WFP's main source of information, facilitating prompt reaction to the latest contact tracing information.

WFP leverages 2 key comparative advantages in its response to Ebola. 1st, the capacity to quickly deliver food in remote and insecure locations. 2nd, its agility and speed in logistics, construction, infrastructure repair and supply chain management. 32 WFP staff have been deployed to Beni. Since August 2018, WFP and cooperating partner Caritas have delivered food and nutrition assistance to about 60 000 Ebola-affected people. Distributions are intended to:

Care: WFP provides food to confirmed/suspected cases receiving medical care in health facilities, to sustain their nutritional status.

Contain: WFP provides food to registered contacts. This helps mitigate the risk of Ebola spreading by limiting population movements. Food distribution also encourages Ebola contacts to present themselves for registration. Family food rations are provided weekly door-to-door for 4 weeks, thereby ensuring coverage of the 21-day observation period. Rations are also provided to health workers and other front-line personnel.

Protect: This targets discharged suspect cases and Ebola survivors and their families, supporting their reintegration to communities of origin. Survivors also receive special nutritious products to support recovery.

Drawing on its expertise and experience from responding to Ebola in West Africa, WFP plays an enabling role for the medical response. This includes engineering works, response hubs and accommodation for responders, movements and warehousing of medical supplies, as well as constructing safe rooms to accommodate response teams. WFP has put in place daily special UNHAS flights to Beni, the epicentre of the outbreak, and stationed a helicopter there.

WFP plans to provide food to some 20 000 people a month, and a range of common logistical services to the response community. Given that the response is highly dynamic and requires considerable agility, WFP will augment its deep field presence and deploy Rapid Response Teams (RRTs). It will also ramp up its logistical support to the medical response.

The risk of Ebola spreading geographically remains very high. WFP is preparing to react promptly to new outbreaks in other parts of DRC, especially in urban areas.

The crisis is occurring in a context of chronically poor health and nutrition indicators, and a large IDP population. It is likely to impact the food security of affected communities in the medium-term, and food assistance will have to evolve accordingly. WFP is working closely with Ebola Treatment Centres and the government response team to have a complete contact list of all Ebola survivors to which food and nutrition assistance can be provided for 12 months.

--
Communicated by:
ProMED-mail Rapporteur Kunihiko Iizuka

-19 Nov 2018. Ebola in DRC: Cutting the chains of transmission
[Medecins Sans Frontieres (MSF) International/Doctors without Borders, edited]
https://www.msf.org/drc-2018-ebola-outbreak-cutting-transmission-chains

Voices from the Field: an account by a water and sanitation engineer, a "Watsan," discussing his responsibilities in support of the medical teams in the treatment centers.

--
Communicated by:
ProMED-mail Rapporteur Kunihiko Iizuka

[Firsthand accounts from individuals working in the field are always inspiring to read. There are so many ways in which people help fight the Ebola outbreak. - Mod.LK]

-Tue 20 Nov 2018. Real-time IOM Crisis Communications System Deployed to Help Save Lives During Ebola Response in DR Congo [Relief Web, edited]
https://reliefweb.int/report/democratic-republic-congo/real-time-iom-crisis-communications-system-deployed-help-save-lives

The World Health Organization is now using IOM's innovative Security Communications and Analysis Network (SCAAN) in the Democratic Republic of the Congo (DRC) to support the security of its staff fighting the Ebola epidemic. The effectiveness of this innovative crisis communications system was demonstrated almost immediately.

IOM developed SCAAN, a security mobile app and digital platform to enhance the safety of its own and other UN staff who so often are exposed to danger during their work, in collaboration with CENTRIC, a research and innovation centre at Sheffield Hallam University. Over the past year, IOM has field-tested the security communications system that includes a dashboard for security professionals to monitor global risks to staff and a mobile app to enable staff to send alerts and receive push notifications on developing threats to ensure a rapid and well-directed response for those in danger.

On their mobile devices, staff are equipped with:
-Easily installed app to provide emergency alerts, receive warning information, and crowd-source reports about incidents in their vicinity.
-One-touch contact with security professionals to get help and respond to requests for accountability and status.
-Geo-location which can provide critical information in case of hostage taking or security incident.
-Live interface with the UN TRIP system so that travel notifications can be input and received on the go.

On the live dashboard, security professionals are equipped with:
-A map-based security dashboard for monitoring the status, safety and location of all enrolled staff.
-Graphical visualization of the number of staff members on the system, current location, and any indicating a "NOT OK" status.
-Ability to push warnings of specific or general nature to all staff or targeted groups based on location.
-Interactive analysis of security trends and threats by region, type and risk level.

Communicated by:
ProMED-mail Rapporteur Mary Marshall

[Terrific idea! - Mod.LK]

[Maps of DR Congo: http://goo.gl/DM2AT8 and http://healthmap.org/promed/p/194]

See Also

Ebola update (136): Congo DR (NK,IT) cases, response 20181119.6154485
Ebola update (135): Congo DR (NK,IT) cases, security 20181118.6152384
Ebola update (134): Congo DR (NK, IT) cases, challenges 20181117.6150791
Ebola update (133): Congo DR (NK,IT) cases, international 20181116.6149045
Ebola update (132): Congo DR (NK,IT) cases, vaccine, plans 20181115.6146562
Ebola update (131): Congo DR (NK,IT) cases, trial, prospects 20181114.6143952
Ebola update (130): Congo DR (NK, IT) cases, control 20181112.6141091
Ebola update (129): Congo DR (NK, IT) cases, summary, testing 20181110.6137491
Ebola update (128): Congo DR (NK, IT) cases, approach 20181109.6135658
Ebola update (127): Congo DR (NK, IT) cases, summary, Uganda vaccination 20181108.6133491
Ebola update (126): Congo DR (NK, IT) cases, fear, summary 20181107.6130618
Ebola update (125): Congo DR (NK, IT) cases, vaccine, WHO, CDC, response 20181106.6129471
Ebola update (124): Congo DR (NK, IT) cases, summary, response 20181104.6125320
Ebola update (123): Congo DR (NK, IT) cases, summary, maps and graphs 20181103.6124809
Ebola update (122): Congo DR (NK, IT) cases, WHO, vaccines, experimental tx 20181101.6123477
Ebola update (121): Congo DR (NK, IT) cases, children 20181029.6117351
Ebola update (120): Congo DR (NK, IT) cases, WHO, vaccination in pregnancy 20181027.6114985
Ebola update (119): Congo DR (NK, IT) case update, summary 20181025.6110665
Ebola update (118): Congo DR (NK, IT) case update, summaries, response 20181024.6108433
Ebola update (117): Congo DR (NK, IT) case update, summaries 20181023.6106210
Ebola update (116): Congo DR (NK, IT) case update, violence 20181021.6103880
Ebola update (115): Congo DR (NK, IT) case update, summaries, South Sudan 20181020.6102472
Ebola update (114): Congo DR (NK, IT) case update, summaries, WHO, Uganda, cell phones 20181019.6099431
Ebola update (113): Congo DR (NK, IT) case update, PHEIC not declared 20181017.6096315
Ebola update (112): Congo DR (NK, IT) update, community, response, WHO, S Sudan 20181016.6094337
Ebola update (111): Congo DR (NK, IT) case update, security concerns 20181015.6091128
Ebola update (110): Congo DR (NK, IT) case update, hearse 20181013.6089833
Ebola update (109): Congo DR (NK, IT) case update, DNA vaccine 20181013.6088789
Ebola update (108): Congo DR (NK, IT) cases, WHO, new vaccine warehouse 20181011.6084235
Ebola update (107): Congo DR (NK, IT) cases, int'l donations, novel PPE suit 20181009.6079086
Ebola update (106): Congo DR (NK, IT), case update, knowledge attitudes, practices 20181007.6076081
Ebola update (105): Congo DR (NK, IT) cases, WHO, airport 20181005.6072036
Ebola update (104): Congo DR (NK, IT) cases, strife, context 20181004.6069637
Ebola update (103): Congo DR (NK, IT) cases, risk, response, research 20181003.6067199
Ebola update (102): Congo DR (NK, IT) cases, orphans 20181002.6064981
Ebola update (101): Congo DR (NK, IT) cases 20181001.6062627
Ebola update (100): Congo DR (NK, IT) case update, survivors, suspect cases 20180930.6061276
Ebola update (99): Congo DR (NK, IT) case update, risk, preparedness, unrest 20180929.6059771
Ebola update (98): Congo DR (NK, IT) case update, protection, WHO 20180927.6057088
and other items in the archives
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