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Published Date: 2019-07-21 12:23:05
Subject: PRO/AH/EDR> Ebola update (69): Congo DR (NK,IT): cases, WHO
Archive Number: 20190721.6579520
EBOLA UPDATE (69): DEMOCRATIC REPUBLIC OF CONGO (NORTH KIVU, ITURI) CASES, WHO
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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, 20 Jul 2019, DRC Ministry of Health
- Epidemiological situation report, 19 Jul 2019, DRC Ministry of Health
- Epidemiological situation report, 18 Jul 2019, DRC Ministry of Health
[2] WHO update
[3] Response
- American Society for Tropical Medicine and Hygiene: statement on PHEIC
- Survivors assist

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[1] Case updates
- Fri 20 Jul 2019. Epidemiological situation report, DRC Ministry of Health
[in French, machine trans., abridged, edited]
https://mailchi.mp/sante.gouv.cd/ebola_kivu_20juil19?e=77c16511ad

The epidemiological situation of the Ebola virus disease in the provinces of North Kivu and Ituri dated 19 Jul 2019:
- Since the beginning of the epidemic, the cumulative number of cases is 2564, 2470 confirmed and 94 probable. In total, there have been 1728 deaths (1634 in confirmed and 94 in probable cases) and 726 people have recovered;
- 392 suspected cases under investigation;
- 18 new confirmed cases, including 7 in Beni [North Kivu], 3 in Mandima [Ituri], 3 in Mabalako [North Kivu], 1 in Vuhovi [North Kivu], 1 in Butembo [North Kivu], 1 in Mambasa [Ituri], 1 in Lubero [North Kivu], and 1 in Masereka [North Kivu];
- 13 new deaths of confirmed cases, including 8 community deaths -- 4 in Beni, 2 in Mandima, 1 in Mabalako, and 1 in Masereka; 5 ETC/TC deaths -- 2 in Mabalako, 2 in Beni and 1 in Katwa [North Kivu];
- 5 new recoveries released from ETCs [Ebola treatment centres] -- 3 in Beni and 2 in Katwa.

News
Minister of Health visits Beni
------------------------------
- The minister of health, Dr Oly Ilunga Kalenga spent the day of Fri 19 Jul 2019 in Beni where he visited the various field teams and the transit center whose capacity will be increased in the coming days.
- Following the resurgence of patients in Beni, Dr Oly Ilunga said that one of the key lessons learned in this 10th epidemic is to rely on the health system. "If we really want to solve this epidemic and have a lasting impact, we need to strengthen the health system by working with the actors in this system and with the community," he said adding that this is how we can quickly stop this new outbreak in the city of Beni.
- He recalled that the declaration of this epidemic as an international public health emergency requires other countries to strengthen border surveillance, while for the response, the declaration recognizes the work that is being done as well as the performance of the response. managed to contain the epidemic in an extremely complex context.
- This declaration also stresses the need for a response with greater coordination and consultation. Another point that minister Oly Ilunga always insists on is the accountability of all actors on the ground, the sharing of information, the measurement of performance, and the use of data to guide and improve actions.

Figures of the response
-----------------------
- 168 746 vaccinated persons;
- the only vaccine to be used in this outbreak is the rVSV-ZEBOV vaccine, manufactured by the pharmaceutical group Merck, following approval by the Ethics Committee in its decision of 19 May 2018;
- 76 632 731 people under control;
- 80 entry points (PoE) and operational health checkpoints (PoC);
- 138 contaminated health workers;
- 1 health worker, vaccinated, is one of the new confirmed cases of Mandima [from 18 Jul 2019];
- the cumulative number of confirmed/probable cases among health workers is 138 (5% of all confirmed/probable cases) including 41 deaths.

--
communicated by:
and
ProMED-mail rapporteur Kunihiko Iizuka
and
Mary Marshall <mjm2020@googlemail.com>
from: Greg Folkers (NIH/NIAID) <gfolkers@niaid.nih.gov>


- Thu 19 Jul 2019. Epidemiological situation report, DRC Ministry of Health
[in French, machine trans., abridged, edited]
https://us13.campaign-archive.com/?u=89e5755d2cca4840b1af93176&id=fad9d7af01

The epidemiological situation of the Ebola virus disease in the provinces of North Kivu and Ituri dated 18 Jul 2019:
- Since the beginning of the epidemic, the cumulative number of cases is 2546, of which 2452 are confirmed and 94 are probable. In total, there have been 1715 deaths (1621 in confirmed and 94 in probable cases) and 721 people have recovered;
- 478 suspected cases under investigation;
- 14 new confirmed cases, including 6 in Beni, 5 in Mandima, 1 in Katwa, 1 in Mabalako and 1 in Mambasa;
- 10 new deaths of confirmed cases, including 6 community deaths -- 2 in Beni, 2 in Mandima, 1 in Mabalako, and 1 in Mambasa; 4 ETC deaths -- 2 in Butembo, 1 in Katwa, and 1 in Mabalako;
- 3 recoveries released from the Beni ETC.

--
communicated by:
ProMED-mail rapporteur Kunihiko Iizuka

- Thu 18 Jul 2019. Epidemiological situation report, DRC Ministry of Health
[in French, machine trans., abridged, edited]
https://us13.campaign-archive.com/?u=89e5755d2cca4840b1af93176&id=c0fbfca105

The epidemiological situation of the Ebola virus disease in the provinces of North Kivu and Ituri dated 17 Jul 2019:

News
Cross-border collaboration
--------------------------
- Uganda's health authorities have launched investigations to find the contacts of a patient who died at the ETC in Beni on 15 Jul 2019, and who had spent a day in Kasese district in Uganda a few days earlier. The patient is a Beni shopkeeper who went to the Mpondwe market in Kasese on Thu 11 Jul 2019 before returning to Beni on Fri 12 Jul 2019. She was a regular at the Kasese market where she bought her goods, including fish.
- To enter Uganda, she did not go through a formal entry point where there is a health check point, so health teams were not able to detect it. However, after her admission to the Beni ETC, she informed the medical teams of her trip to Kasese and the teams then alerted Ugandan authorities. During her visit to the market, she vomited 4 times, increasing the risk of contamination of people who had been in direct contact with her. The Ugandan Ministry of Health and WHO have launched an investigation in Kasese to identify all contacts and vaccinate them.

Port of entry monitoring
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- From now on, the port of entry monitoring team will operate 24 hours a day at Goma International Airport. This surveillance began on Thu 18 Jul 2019.
- Port of entry monitoring teams work night and day to track contacts of confirmed cases traveling in the area. It was the teams at the OPRP Health Checkpoint in the Nyragongo health zone who intercepted 2 bikers who had transported the deceased pastor and his mother. The 2 bikers were then directed to the vaccination teams to protect themselves against the disease. In general, when contacts from affected areas attempt to travel to Goma or Bunia and are intercepted at a checkpoint, they are usually returned to their original health zone to complete their 21-day follow-up period.

Minister of health on mission to Eastern DRC
--------------------------------------------
- Minister of Health Dr Oly Ilunga Kalenga arrived in Goma on Thu 18 Jul 2019. He spent the day on the ground to meet the different teams responsible to protect the city against the virus. He began his visit through the Great Northern Control Point, called the OPRP, located in the Nyragongo health zone where the pastor from Butembo died. In the same health zone, he also visited the new Ebola treatment center (ETC) still under construction. This ETC, built by Medecins Sans Frontieres (MSF), will have a capacity of 60 beds.
- His mission will continue throughout North Kivu and Ituri to ensure the proper conduct of the response.

Press conference in Goma: health minister reassured people
----------------------------------------------------------
- Coordination of the response held a press conference in Goma on [Thu 18 Jul 2019] following the WHO declaration of the international public health emergency.
- The minister of health reassured the population that the response teams and health staff in the city of Goma had prepared for the eventuality of the arrival of sick people from areas affected by the disease epidemic. Thus, the person was very quickly identified and isolated, he said, adding that all the people who were in contact with this case were found and vaccinated. He took the opportunity to congratulate the nurse at the Afia Himbi Health Center who had quickly recognized this case and promised to meet him during his stay in Goma.
- He called on caregivers to remain vigilant and attentive. To the population, he recommended the respect of the measures of hygiene, the calling of the green number if a relative is sick, the agreement to be vaccinated and followed during 21 days when one is identified as a contact, and the respect for safe and dignified burials.
- During this press conference, Dr Oly Ilunga also spoke about the statement of the international expert committee concerning the public health emergency. For the minister, the DRC welcomed this statement, noting that for the country the epidemic is a public health emergency with a risk of regional spread since its declaration in August 2018. "It is in this spirit that the coordination of the response has worked, in collaboration with international partners, such as WHO, UNICEF, and other actors," he said.
- He also pointed out that this declaration is more important for the DRC neighboring countries. He reassured his foreign counterparts of the intensification of surveillance in the DRC. He recalled that WHO has advised against closing borders and restricting international movements of the population. He hopes that this declaration will not have too much impact on the lives of the people.

--
communicated by:
ProMED-mail rapporteur Kunihiko Iizuka

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[2] WHO update
Date: Thu 18 Jul 2019
Source: WHO Emergencies preparedness, response, Disease Outbreak News (DONs) [abridged, edited]
https://www.who.int/csr/don/18-july-2019-ebola-drc/en/


On 17 Jul 2019, the director-general accepted the Emergency Committee's recommendation that the outbreak constitutes a Public Health Emergency of International Concern (PHEIC). The decision was based on the recent developments in the outbreak, including the geographical expansion of the virus.

The declaration of the PHEIC is not a reflection on the performance of the response team but rather a measure that recognizes the possible increased national and regional risks and the need for intensified and coordinated action to manage them. The Committee and WHO do not recommend any restrictions on travel or trade, which could hamper the fight against Ebola by affecting the movement of people and supplies. Further information, including temporary recommendations advised by the Emergency Committee, is available in the statement [https://www.who.int/ihr/procedures/statement-emergency-committee-ebola-drc-july-2019.pdf, speech by WHO director-general [https://www.who.int/dg/speeches/detail/ihr-emergency-committee-on-evd-drc-north-kivu], and news release [https://www.who.int/news-room/detail/17-07-2019-ebola-outbreak-in-the-democratic-republic-of-the-congo-declared-a-public-health-emergency-of-international-concern].

The outbreak of Ebola virus disease (EVD) in North Kivu and Ituri provinces continued this past week with similar transmission intensity to recent weeks. While the stability of the transmission intensity of the outbreak is an indication of the strong response efforts to limit local transmission in affected health zones, the spread of EVD into new geographical areas and continued insecurity in the affected regions continue to complicate the control of the outbreak.

A salient example of this is the confirmed case of EVD that was reported in Goma, a city of about 2 million inhabitants close to the Rwandan border, on 14 Jul 2019 [see ProMED-mail Ebola update (67): Congo DR (NK,IT) cases, WHO, Goma 20190717.6571650].

Preparation activities, including the vaccination of health workers, intensive training in infection prevention and control, and heightened surveillance have been ongoing for more than 6 months. Neighbouring Rwanda is also conducting preparedness activities. Rumours of his contacts travelling to Bukavu, South Kivu, have been investigated and ruled out by response teams.

In an unrelated event, 2 situation reports concerning Ebola virus disease in Uganda prepared and published by the Ugandan Ministry of Health, and posted on 16 and 17 Jul 2019 on the WHO African Regional Office website, erroneously included unverified information. This information concerned the movements of a female fishmonger from Beni, who contracted EVD and travelled to a town in Uganda for 1 day, after which she returned to Beni, where she was admitted to the ETC. Ongoing investigations have suggested that the individual travelled to Uganda prior to onset of EVD. As it is not possible to conclusively rule out that she was infectious with EVD during her travels, both Ugandan and Democratic Republic of the Congo authorities are closely following potentially exposed contacts. There are currently no confirmed cases of EVD outside of the Democratic Republic of the Congo [See ProMED-mail Ebola update (68): Congo DR (NK,IT) cases, WHO, Uganda 20190718.6574479].

In the last week, 2 Democratic Republic of the Congo nationals involved in the response, a community leader and local volunteer, were killed in separate locations in Beni; the underlying motive and possible relationship between these 2 killings in separate locations remain unknown at this time. Security forces are currently conducting an investigation into these 2 fatalities.

In the 21 days from 26 Jun through 16 Jul 2019, 67 health areas within 20 health zones reported new cases, representing 10% of the 664 health areas within North Kivu and Ituri provinces (figure 2: see URL above for figures and tables). During this period, a total of 245 confirmed cases were reported, the majority of which were from the health zones of Beni (50%, n=123), Mabalako (15%, n=37), Katwa (7%, n=18), Mandima (4%, n=10) and Butembo (4%, n=9). As of 16 July 2019, a total of 2522 EVD cases, including 2428 confirmed and 94 probable cases, were reported (Table 1). Bunia, Kyondo and Musienene health zones all recently cleared 21 days since their last reported case. However, high risks remain for the virus to be reintroduced to these areas, requiring teams to remain fully resourced and vigilant.

A total of 1698 deaths were reported (overall case fatality ratio 67%), including 1604 deaths among confirmed cases. Of the 2522 confirmed and probable cases with known age and sex, 56% (1423) were female, and 29% (720) were children aged less than 18 years. Cases continue to increase among health workers, with the cumulative number infected rising to 135 (5% of total cases).

[Available at the source URL above:]
- Figure 1: Confirmed and probable Ebola virus disease cases by week of illness onset by health zone. Data as of 16 Jul 2019
- Figure 2: Confirmed and probable Ebola virus disease cases by week of illness onset by health zone. Data as of 16 Jul 2019
- Table 1: Confirmed and probable Ebola virus disease cases, and number of health areas affected, by health zone, North Kivu and Ituri provinces, Democratic Republic of the Congo, data as of 16 Jul 2019
- Public health response
- WHO risk assessment
- WHO advice
[and additional information]

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

******
[3] Response
- Thu 18 Jul 2019. Statement on PHEIC
[AllAfrica, American Society for Tropical Medicine and Hygiene (ASTMH) report, edited]
https://allafrica.com/stories/201907180721.html


Congo-Kinshasa: Response to WHO's declaration of Ebola outbreak as global health emergency
------------------------------------------------------------------
ASTMH welcomes the WHO's declaration of the Ebola outbreak in the Democratic Republic of the Congo as a global public health emergency. The declaration will help to mobilize the additional support necessary for the men, women and children who are suffering from this disastrous and devastating disease, and for the brave health workers and researchers striving tirelessly to stop it.

This new case in Goma is one more of the many warnings of the powder-keg nature of this Ebola outbreak. The West African Ebola outbreak in 2014 was a demonstration of how interconnected we all are. Every country must pay attention to this fragile situation and do more to find solutions to this public health crisis. With new vaccines and the scientific tools available, the WHO's declaration is a significant step in the right direction.

"While the progress we've seen in developing new drugs and vaccines against Ebola is remarkable, we need to make further biological breakthroughs and match them with a political breakthrough," said ASTMH president, Chandy C John, MD, MS, FASTMH. "ASTMH is eager to work with decision-makers and government leaders in a worldwide collaborative effort to end this outbreak and prevent future outbreaks. As tropical infectious disease experts, we know what is at stake here. We believe it is past time to work together to bring this terrible outbreak to an end."

--
communicated by:
ProMED-mail
<promed@promedmail.org>

[Mission statement of ASTMH: The American Society of Tropical Medicine and Hygiene, founded in 1903, is the largest international scientific organization of experts dedicated to reducing the worldwide burden of tropical infectious diseases and improving global health. We accomplish this through generating and sharing scientific evidence, informing health policies, and practices, fostering career development, recognizing excellence, and advocating for investment in tropical medicine/global health research. For more information, visit http://astmh.org. - Mod.LK]

- Sat 20 Jul 2019. Survivors assist
[The Telegraph, abridged, edited]
https://www.telegraph.co.uk/global-health/science-and-disease/inside-ebola-treatment-centres-congo-survivors-bring-hope-edge/
[byline: Adrian Blomfield]

Inside the Ebola treatment centres of Congo, where survivors bring hope to those on the edge of death
--------------------------------------------------------------------------------
The deployment of Ebola survivors charged with going from village to village and tell their stories in the same tribal tongue as their inhabitants is at last having an impact, aid workers say. "There is a shift towards giving full responsibility for communication to the community," said Franck Abeille, UNICEF's senior Ebola project coordinator in Congo. "It has a massive effect on people when someone goes to the community and says, 'this is what I went through and this is how I survived'. It is one of the most valuable assets we have."

--
communicated by:
Mary Marshall

[One has to have tremendous respect for these individuals who have gone through so much themselves and are now reaching out to help others. - Mod.LK

Maps:
Congo DR: http://goo.gl/DM2AT8 and http://healthmap.org/promed/p/194
Uganda: http://en.wikipedia.org/wiki/Districts_of_Uganda and http://healthmap.org/promed/p/97]

See Also

Ebola update (68): Congo DR (NK,IT) cases, WHO, Uganda 20190718.6574479
Ebola update (67): Congo DR (NK,IT) cases, WHO, Goma 20190717.6571650
Ebola update (66): Congo DR (NK,IT) case update, Goma, media advisory 20190715.6568141
Ebola update (65): Congo DR (NK, IT) case update, summaries, opinion 20190713.6566907
Ebola update (64): Congo DR (NK,IT) update, WHO, summaries, challenges, vaccines 20190712.6565357
Ebola update (63): Congo DR (NK, IT) case update, summaries 20190706.6555278
Ebola update (62): Congo DR (NK, IT) case update, summaries, education 20190703.6550730
Ebola update (61): Congo DR (NK,IT) case update, summaries, leadership, response 20190629.6543844
Ebola update (60): Congo DR (NK, IT) case update, WHO, summaries, response 20190627.6540134
Ebola update (59): Congo DR (NK,IT) case update, summaries, WHO, vaccine 20190625.6536477
Ebola update (58): Congo DR (NK, IT) case update, summaries, spread, treatment 20190620.6530882
Ebola update (57): Congo DR (NK,IT) case updates, summary, borders, research 20190618.6525334
Ebola update (56): Congo DR (NK,IT) updates, no PHEIC, Merck vaccine, Africa CDC 20190615.6521868
Ebola update (55): Congo DR (NK,IT) Uganda (KS) ex DRC, case updates, summaries 20190614.6519943
Ebola update (54): Congo DR (NK,IT) Uganda (KS) ex DRC, case updates, summaries 20190613.6517597
Ebola update (53): Uganda (KS) ex Congo DR (NK) 1st cross-border cases, MOH, WHO 20190612.6516605
Ebola update (52): Congo DR (NK, IT), new UN emergency Ebola coordinator 20190609.6511167
Ebola update (51): Congo DR (NK, IT) cases, summary, support, response 20190606.6507016
Ebola update (50): Congo DR (NK, IT) cases, preparedness, response, vaccine 20190603.6501486
Ebola update (49): Congo DR (NK,IT) cases, WHO, response 20190531.6494013
Ebola update (48): Congo DR (NK, IT) cases, summary, WHO, response 20190525.6486623
Ebola update (47): Congo DR (NK, IT) cases, summary, situation, research 20190520.6476709
Ebola update (46): Congo DR (NK, IT) cases, summary, response 20190515.6470579
Ebola update (45): Congo DR (NK, IT) cases, summaries, WHO, risk, response 20190512.6465801
Ebola update (44): Congo DR (NK, IT) cases, WHO, response, vaccine, research 20190509.6461476
Ebola update (43): Congo DR (NK, IT) cases, summary, WHO, preparedness, response 20190506.6457148
Ebola update (42): Congo DR (NK, IT) cases, summary, WHO, Uganda, vaccine 20190503.6453732
Ebola update (41): Congo DR (NK, IT) cases, summary, WHO 20190428.6445655
Ebola update (40): Congo DR (NK, IT) cases, summary, response, vaccine, crisis 20190425.6438898
Ebola update (39): Congo DR (NK, IT) cases, summary, response 20190420.6432252
Ebola update (38): Congo DR (NK, IT) cases, summary, WHO, response, research 20190417.6426205
Ebola update (37): Congo DR (NK, IT) cases, WHO, vaccine 20190414.6421230
Ebola update (36): Congo DR (NK, IT) cases, summaries, WHO, response 20190411.6417629
Ebola update (35): Congo DR (NK,IT) cases, setbacks, preparedness, personal acct 20190408.6409642
Ebola update (34): Congo DR (NK, IT) cases, summaries, spread, research 20190405.6406092
Ebola update (33): Congo DR (NK, IT) cases, summaries, response 20190402.6400473
Ebola update (32): Congo DR (NK,IT) cases, summary, WHO, public trust, economics 20190329.6393553
Ebola update (31): Congo DR (NK, IT) cases, summaries, opinions, research 20190324.6384785
Ebola update (30): Congo DR (NK, IT) cases, summaries, WHO, preparedness 20190321.6378400
Ebola update (20): Congo DR (NK, IT) cases, summary, vaccine, response 20190221.6328121
Ebola update (10): Zaire ebolavirus detected, greater long-fingered bat, Liberia 20190124.6275982
Ebola update (01): Congo DR (NK, IT) cases, summaries, Uganda 20190103.6241326
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