Ebola virus disease – Democratic Republic of the Congo (14.12.2018)

Non-engagement from communities and conflict continue to hamper response activities in some affected areas.

GENEVA, Switzerland, December 14, 2018 – The Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo is occurring in an unforgiving context. Non-engagement from communities and conflict continue to hamper response activities in some affected areas. Moreover, poor infection prevention and control (IPC) practices across numerous private and public health centers remain a major source of amplification of the outbreak and risk to health and other frontline workers.

Despite these challenges, substantial progress has been made on multiple fronts to address the situation, and daily successes are being observed in the implementation of proven public health measures alongside newer tools, such as vaccination and novel therapeutics. Together with the Ministry of Health (MoH) and our partners, WHO is further scaling up our response to the developing situation. WHO especially emphasizes the need to continuously improve quality, judiciously deploy new tools at our disposal, and sustain international commitment to response efforts well into 2019. Nonetheless, we remain confident the outbreak can be brought to a conclusion.

During the reporting period (5 through 11 December 2018), 37 new cases were reported from 10 health zones in North Kivu and Ituri provinces: Katwa and Butembo (18), Beni (seven), Mabalako (four), Oicha (three), as well as one case each in Komanda, Kyondo, Mandima, Musienene and Vuhovi. Four new infections of health workers have been reported in Musienene, Katwa and Butembo health zones. In total, 51 (49 confirmed and two probable) health workers have been infected to date, of whom 17 have died. Twenty-three additional survivors were discharged from Ebola treatment centres (ETCs) and reintegrated into their communities. A total of 177 patients have recovered to date.

As of 11 December, 505 EVD cases (457 confirmed and 48 probable), including 296 deaths, have been reported in 12 health zones in North Kivu Province and three health zones in Ituri Province (Figure 1). These zones represent a mix of densely populated urban areas and remote villages, each bringing a variety of factors driving transmission and posing different challenges. Trends in case incidence (Figure 2) reflect the continuation of the outbreak across these geographically dispersed areas, with an average of 33 new cases reported each week since mid-October. Although there has been a general decrease in the intensity of transmission in Beni in recent weeks, the outbreak is intensifying in Butembo and Katwa, and new clusters are emerging elsewhere. At present, the situation remains concerning.

The very high risk of further geographical spread of the outbreak was highlighted this week by the movement of several contacts of confirmed cases from Beni to Kisangani and Goma. All of these contacts were rapidly traced, and have since returned to Beni where they will complete their 21 day follow-up. Several alerts of potential cases were also received from Goma, and towns between Goma and Butembo. These individuals were promptly isolated, reported and tested negative for EVD. Preparedness and operational readiness activities in other areas of North Kivu and Ituri provinces, other provinces of the Democratic Republic of the Congo, and neighbouring counties, must continue to be upscaled to rapidly detect and respond to any potential cases.

WHO risk assessment

This outbreak of EVD is affecting north-eastern provinces of the country bordering Uganda, Rwanda and South Sudan. Potential risk factors for transmission of EVD at the national and regional levels include: travel between the affected areas, the rest of the country, and neighbouring countries; the internal displacement of populations. The country is concurrently experiencing other epidemics (e.g. cholera, vaccine-derived poliomyelitis, malaria), and a long-term humanitarian crisis. Additionally, the security situation in North Kivu and Ituri at times limits the implementation of response activities. WHO’s risk assessment for the outbreak is currently very high at the national and regional levels; the global risk level remains low. WHO continues to advice against any restriction of travel to, and trade with, the Democratic Republic of the Congo based on currently available information.

As the risk of national and regional spread is very high, it is important for neighbouring provinces and countries to enhance surveillance and preparedness activities. The International Health Regulations (IHR 2005) Emergency Committee has advised that failing to intensify these preparedness and surveillance activities would lead to worsening conditions and further spread. WHO will continue to work with neighbouring countries and partners to ensure that health authorities are alerted and are operationally prepared to respond.

WHO advice

International traffic: WHO advises against any restriction of travel and trade to the Democratic Republic of the Congo based on the currently available information. There is currently no licensed vaccine to protect people from the Ebola virus. Therefore, any requirements for certificates of Ebola vaccination are not a reasonable basis for restricting movement across borders or the issuance of visas for passengers leaving the Democratic Republic of the Congo. WHO continues to closely monitor and, if necessary, verify travel and trade measures in relation to this event. Currently, no country has implemented travel measures that significantly interfere with international traffic to and from the Democratic Republic of the Congo. Travellers should seek medical advice before travel and should practice good hygiene.

RDC: Union Democratique Africaine Orginelle (05.12.2018)

RDC: Ceni – “Concerne demande d’une ultimate concentration avec les Candidate President de la Republique” (04.12.2018)

Nord Kivu, Democratic Republic of Congo: Ebola epidemic spreads further into urban communities and isolated areas (04.12.2018)

The newest areas to be affected include the city of Butembo and a number of isolated areas that are hard to reach. So far, 440 people have been infected with the virus, 255 of whom have died.

GENEVA, Switzerland, December 4, 2018 – The Ebola epidemic continues to spread through the Democratic Republic of Congo (DRC)’s North Kivu province. The newest areas to be affected include the city of Butembo and a number of isolated areas that are hard to reach. So far, 440 people have been infected with the virus, 255 of whom have died. Teams from international medical organization Médecins Sans Frontières/Doctors Without Borders (MSF) continue to strengthen their efforts to help bring the epidemic under control.

This is DRC’s tenth and most serious epidemic of Ebola since the virus was discovered in 1976 near the Ebola River in what was then called Zaire. Forty years later, despite a massive and coordinated mobilization by the World Health Organization (WHO), the Congolese Ministry of Health and organizations such as MSF, the deadly virus is still spreading.The newest urban locations to be affected are the city of Butembo, as well as Kalenguta, 25km to its north, and Katwa, 30km to its east. These places have all seen an increase in confirmed cases of Ebola as well as some resistance from the community. For now, the number of cases in Butembo’s city centre is low, but cases are rising quickly in its eastern suburbs and outlying isolated districts.

“We are very concerned by the epidemiological situation in the Butembo area” says John Johnson, MSF project coordinator in Butembo. “We now know that this outbreak will last and that 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.”

MSF’s 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 Butembo, where MSF manages an Ebola treatment centre in collaboration with the Ministry of Health. The number of beds in the Butembo centre has recently been increased to 64.

Meanwhile, MSF has reinforced its activities to decontaminate health centres and vaccinate frontline health workers to help contain the epidemic. So far, 2,000 frontline workers have received the Ebola vaccine.

In Mangina, where the epidemic started, no new cases have been reported for several weeks. “We should be able to end our activities in the treatment centre shortly,” says Axelle Ronsse, coordinator of MSF’s Ebola response.

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 centre that remains is still busy” says Ronsse. “We also, for example, perform decontaminations in health centres where a confirmed patient has been. But our actions aren’t limited to reactive responses: we have increased our training of health professionals and 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.”

Antoine is in charge of health promotion activities at Butembo Ebola treatment centre. “My daily work is essential in addressing the epidemic” says Antoine. “We want to encourage people to come and get treated as quickly as possible. We also spread the message that recovering from Ebola is possible. We ask every survivor who leaves our centre to become an ambassador and raise awareness by telling their story. Some people who are now immune to the virus can, in turn, provide valuable help, particularly looking after children isolated from their families. It is by working together that we will beat this epidemic. It concerns us all.”

RDC: Declaration Politique d’Adhesion du Regroupement ARC-EN-CIEL Du Congo, “ACC” Ala Plateforme “Lamuka” (03.12.2018)

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