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Published Date: 2018-12-04 21:16:01
Subject: PRO/AH/EDR> Ebola update (144): Congo DR (NK, IT) cases, summary, concerns
Archive Number: 20181204.6179592
EBOLA UPDATE (144): DEMOCRATIC REPUBLIC OF CONGO (NORTH KIVU, ITURI) CASES, SUMMARY, CONCERNS
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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 updates
- Epidemiological situation report, 3 Dec 2018, DRC Ministry of Health
- Epidemiological situation report, 2 Dec 2018, DRC Ministry of Health
[2] Summary
- CIDRAP (Center for Infectious Disease Research and Policy):case count climbs
[3] Major concerns
- Spread of infection
- Vaccine supply
- CDC expert assistance

******
[1] Case updates
- Mon 3 Dec 2018. Epidemiological situation report, DRC Ministry of Health
[in French, machine trans., edited]
https://us13.campaign-archive.com/?u=89e5755d2cca4840b1af93176&id=af4f77c907

The epidemiological situation of the Ebola virus disease in the provinces of North Kivu and Ituri dated 2 Dec 2018 :
- Since the beginning of the epidemic, the cumulative number of cases is 444, of which 396 are confirmed and 48 are probable. In total, there were 260 deaths (212 confirmed and 48 probable) and 140 people healed.
- 72 suspected cases under investigation.
- 4 new confirmed cases, including 2 in Beni, 1 in Katwa, and 1 in Kalunguta [North Kivu].
- 5 new deaths, including 3 in Beni, 1 in Butembo and 1 in Kalunguta.
- 1 new person healed and released from Butembo ETC.

News of the response
Vaccination
-----------
- Launch of immunization of front-line providers in Lubero [North Kivu] in a preventive manner as part of the preparation of the health zone.
- Since the start of vaccination on 8 Aug 2018, 39 277 people have been vaccinated, including 17 956 in Beni [total numbers of people vaccinated in North Kivu and Ituri provinces can be seen at the source URL above].

Video in French: The response against Ebola in images -- Vaccination of contacts of Ebola patients

--
Communicated by:
ProMED-mail Rapporteur Mary Marshall

[Frontline workers who will be immunized include healthcare providers, ambulance drivers, people who conduct safe burials of the Ebola dead, among others. - Mod.LK]

[Helen Branswell‏ @HelenBranswell (https://twitter.com/HelenBranswell)
Be prepared: Vaccination of frontline workers has started in Lubero, south of Butembo, per @MinSanteRDC. As I reported today, the virus seems to be moving south. The Ebola response wants the people who may have to face it to be protected.]

- Sun 2 Dec 2018. Epidemiological situation report, DRC Ministry of Health
[in French, machine trans., edited]
https://us13.campaign-archive.com/?u=89e5755d2cca4840b1af93176&id=5ffd88f6ad

The epidemiological situation of the Ebola virus disease in the provinces of North Kivu and Ituri dated 1 Dec 2018:
- Since the beginning of the epidemic, the cumulative number of cases is 440, of which 392 are confirmed and 48 are probable. In total, there were 255 deaths (207 confirmed and 48 probable) and 139 people cured.
- 97 suspected cases under investigation.
- 6 new confirmed cases, including 1 in Beni [North Kivu], 1 in Komanda [Ituri], 1 in Katwa [North Kivu], 1 in Butembo [North Kivu], 1 in Masereka [North Kivu], and 1 in Vuhovi [North Kivu].
- 3 new deaths, 2 in Butembo and 1 in Komanda.
- 1 new person healed and released from Butembo ETC.

News of the response
Vaccination
-----------
Since the start of vaccination on 08 Aug 2018, 38 821 people have been vaccinated , including 17 871 in Beni, 5608 in Katwa, 4544 in Mabalako, 3360 in Butembo, 1930 in Kalunguta, ...

--
Communicated by:
ProMED-mail Rapporteur Mary Marshall

******
[2] CIDRAP: DRC Ebola total climbs to 444 with cases in several areas
Date: Mon 3 Dec 2018.
Source: CIDRAP [Center for Infectious Disease research and Policy, abridged, edited]
http://www.cidrap.umn.edu/news-perspective/2018/12/drc-ebola-total-climbs-444-cases-several-areas


Over the weekend and through today [1-3 Dec 2018] the Democratic Republic of the Congo (DRC) reported 16 new Ebola cases in several locations in and around the main hot spots.

In other developments, health officials are starting to worry about the Ebola vaccine supply, especially if it's needed to curb widespread disease in one of the DRC's urban locations.

Latest cases in 8 cities
------------------------
The 16 cases reflected in the health ministry's daily updates for 1-3 Dec 2018 and were from 8 different locations: Beni (5 cases), Katwa (3), Vuhovi (2), Kalunguta (2), Mutwanga (1), Komanda (1), Butembo (1), and Masereka (1).

Komanda is north of Beni and is in Ituri province, while the other locations are located south of the city. Katwa is located just east of Butembo, the largest urban setting for cases reported so far.

Another 12 deaths were reported, which involved 6 patients in Beni, 4 in Butembo, 1 in Butembo, and 1 in Komanda.
...

Recruiting women for response
------------------------
The health ministry said in its Dec 2 report that health officials have decided to take more steps to involve women in the outbreak response to strengthen community engagement, given that they are pillars of their household and play an important role in commercial activities.

The agency said workshops for women's groups recently took place in Beni and Butembo, and for the next month, the new communicators will be paired with response teams in the field to help ease some of the community resistance that is still present in some neighborhoods.

In the DRC's latest outbreak, females have made up a large number of cases--61% of confirmed and probable cases, according to totals at the end of November.

Concerns about vaccine supply
------------------------
In other developments, as Ebola continues to spread in the DRC with no end of the outbreak in sight, health officials are starting to worry if the Ebola vaccine supply would run short if the virus spreads more widely in urban locations like Butembo, where several cases have already been reported, or in Goma, North Kivu province's capital, Stat reported today.
...

[Byline: Lisa Schnirring]

--
Communicated by:
ProMED-mail rapporteur Mary Marshall

[About recruiting women for the Ebola response, see ProMED-mail Ebola update (143): Congo DR (NK, IT) cases, response 20181202.6176037. Regarding concerns about vaccine supply, see report below. - Mod.LK]

******
[3] Major concerns: spread, vaccine, expert assistance
- Mon 3 Dec 2018. DRC: Country's worst Ebola epidemic continues to spread
[Médecins Sans Frontières (MSF), abridged, edited]
https://doctorswithoutborders.org/what-we-do/news-stories/news/drc-countrys-worst-ebola-epidemic-continues-spread

Ebola has reached the city of Butembo and a number of more isolated areas that are difficult to access as the epidemic continues to spread through the Democratic Republic of Congo (DRC)'s North Kivu province. Teams from the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) are expanding work in the affected region to help bring the Ebola epidemic under control.

The newest locations to be affected by this Ebola epidemic are the city of Butembo, as well as Kalunguta, approximately 15 miles [24 km] to the north, and Katwa, more than 18 miles [29 km] to the east. These places have all seen an increase in confirmed cases of Ebola, as well as some resistance from the community that complicates the response. It is difficult for teams working in these areas to help curb the spread of the virus by carrying out health promotion activities and gaining trust among the community so that people bring those suspected of having Ebola to hospitals for proper testing and treatment.

"We are very concerned by the epidemiological situation in the Butembo area," said John Johnson, MSF project coordinator in Butembo, a city of a million people. So far, the number of cases in Butembo city center is low, however the number of cases is rising quickly in the eastern suburbs and outlying, isolated districts. "We're expecting this outbreak will last for a while, and we must increase our efforts to get it under control. With the agreement of the authorities, we have made a strategic decision to roll out our activities close to the affected populations and to organize training of key people in the community so that we can reach patients and their relatives."

Efforts to reach Ebola suspects living in isolated areas have had initial success. New cases are being reported from these areas and patients are being brought to the Ebola Treatment Center in Butembo, where demand has led MSF to more than double the number of beds in the facility, from fewer than 30 when it was first opened to 64.

Meanwhile, MSF has also reinforced its activities to decontaminate health centers and vaccinate frontline health workers to help contain the epidemic. So far, 2000 frontline workers have received the Ebola vaccine.

In Mangina, where the epidemic started, no new cases have been reported for several weeks.

In Beni, the number of cases per week remains stable, however new cases are still being confirmed on a daily basis. "To fight this, we have stepped up our medical and health operations by opening a 48-bed transit center [in Beni] that remains busy," said Axelle Ronsse, coordinator of MSF's Ebola response. "We also, for example, perform decontaminations in health centers where a confirmed patient has been. But our actions aren't limited to reactive responses: we have increased our training of health professionals and are raising awareness amongst communities of hygiene practices. Four months after the start of the epidemic, we remain mobilized and vigilant in the face of new developments."

Working closely with WHO and the Congolese Ministry of Health, MSF teams have been responding to the Ebola epidemic in North Kivu and neighboring Ituri province since it was declared on 1 Aug 2018. MSF is currently running Ebola Treatment Centers in the towns of Mangina, Butembo [North Kivu], and Tchomia [Ituri]; an isolation center in Bunia [Ituri]; and a transit center in Beni [North Kivu]. MSF also carries out control, prevention, and awareness activities in health care centers and among affected communities.

--
Communicated by:
ProMED-mail Rapporteur Mary Marshall

- Mon 3 Dec 2018. As Ebola outbreak spreads in Congo, concern grows over supplies of experimental vaccine
[STAT News, abridged, edited]
https://www.statnews.com/2018/12/03/ebola-congo-vaccine-supplies/
[Byline: Helen Branswell]

The Ebola outbreak in the Democratic Republic of the Congo appears to be spreading southward from its current epicenter at Beni, raising concerns it will take root in some larger population centers, including a major regional hub, warned a senior World Health Organization official.

Should the outbreak spread more widely in cities like Butembo -- where there have already been a number of cases -- or Goma, a major center further south, the scale of the outbreak could tax the available supplies of an experimental vaccine being used to help contain spread, said Dr Peter Salama, who heads the WHO's emergencies program.

As of [Sun 2 Dec 2018] more than 42 000 doses of the vaccine had been used in this outbreak and one earlier in the year in the western part of the DRC. Merck, which is developing the vaccine, has committed itself to maintaining a stockpile of 300 000 doses.

"We are extremely concerned about the size of the vaccine stockpile," Salama told STAT in an interview. "And we're regularly in touch with Merck to discuss what can be done about that."

There have been calls from some outside observers to [immunize everyone] to try to extinguish this outbreak, which likely began in late April and is expected to continue well into next year. Salama has resisted these calls.

"When you consider that the global ... stockpile is 300 000 doses and Beni itself has a population of 400 000 and Butembo a million, you can imagine that when people are proposing large scale geographical vaccination that becomes extremely impractical," he said.

Merck has told STAT it takes about a year, start to finish, to produce a batch of the vaccine, which it has provisionally called V920. Some of the vaccine in the stockpile is already in vials, but much of it is stored in bulk. Converting the bulk product into vaccine in vials can take between 4 and 5 months, a Merck spokeswoman explained.

Salama suggested the size of the Ebola vaccine stockpile will need to be reconsidered in future, saying he doesn't think 300 000 doses is sufficient. "I don't believe that's adequate for urban outbreaks. And ... I think urban outbreaks are increasingly going to be the norm, including urban outbreaks in conflict-affected areas," he said.

"None of us would ever like to see a scenario where we have an outbreak in Goma," said Salama. "It's a very big city and it's also a crossroads in Eastern Africa in terms of transportation. Air. Road. Truck. Everything."

--
Communicated by:
ProMED-mail Rapporteur Mary Marshall

[Depletion of the vaccine supply would be devastating, particularly if the virus reaches a major city. One question is whether other vaccines in development that have shown promise could be used in addition to the Merck vaccine? - Mod.LK]

- Mon 3 Dec 2018
[My Mother Lode, Associated Press (AP) report, edited]
https://www.mymotherlode.com/news/health-news/511516/who-us-experts-not-needed-to-fight-ebola-outbreak-in-congo.html

The head of the World Health Organization says it doesn't need experts from the Centers for Disease Control and Prevention or any other US government agency to fight the deadly Ebola outbreak in Congo, insisting: "We can cover it."

WHO Director-General Tedros Adhanom Ghebreyesus says the UN health agency mostly needs the United States to continue the financial and other support it has provided.

He noted the US and many other developed countries have security guidelines that prevent deployments of experts in conflict zones like the Ebola-hit area of eastern Congo. Rebel groups there have complicated efforts to battle what is now the world's second-deadliest Ebola outbreak.

Tedros told reporters [Mon 3 Dec 2018] in Geneva: "We can mobilize from other parts, from those institutions who don't have very strict security provisions like that. We can cover it."

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

[There has been a lot of discussion about the CDC experts being removed from the areas of active transmission to Kinshasa. Most comments have expressed grave concern that the CDC is unavailable to facilitate control efforts to stop virus transmission. Certainly, more healthcare workers with as much experience as the CDC has would be helpful. But here WHO Director-General Tedros Adhanom Ghebreyesus feels financial support is even more important. It is true more money would facilitate combating this ever-expanding outbreak, but experienced personnel are equally important. - Mod.LK]

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

See Also

Ebola update (143): Congo DR (NK, IT) cases, response 20181202.6176037
Ebola update (142): Congo DR (NK, IT) cases, summary, WHO, suspect, response 20181130.6172738
Ebola update (141): Congo DR (NK, IT) cases, summary, WHO, challenges, response 
20181128.6169448
Ebola update (140): DRC (North Kivu, Ituri) cases, summary, preparedness 20181127.6167727
Ebola update (139): Congo DR (NK, IT) cases, WHO, news, control 20181124.6163036
Ebola update (138): Congo DR (NK, IT) cases, response, vaccine RFI 20181123.6160726
Ebola update (137): Congo DR (NK, IT) cases, summary, response 20181120.6156862
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
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