WHO concerned as one Ebola case confirmed in urban area of Democratic Republic of the Congo :: Statement on the 1st meeting of the IHR Emergency Committee regarding the Ebola outbreak in 2018 :: FAQ on Ebola virus disease vaccine

Milestones :: Perspectives

EBOLA/EVD  [to 19 May 2018]
http://www.who.int/ebola/en/

WHO concerned as one Ebola case confirmed in urban area of Democratic Republic of the Congo
17 May 2018   News Release
One new case of Ebola virus disease (EVD) has been confirmed in Wangata, one of the three health zones of Mbandaka, a city of nearly 1.2 million people in Equateur Province in northwestern Democratic Republic of the Congo.

The Ministry of Health of the Democratic Republic of the Congo announced the finding, after laboratory tests conducted by the Institut National de Recherche Biomédicale (INRB) confirmed one specimen as positive for EVD.

Until now, all the confirmed Ebola cases were reported from Bikoro health zone, which is also in Equateur Province but at a distance of nearly 150 km from Mbandaka. The health facilities in Bikoro have very limited functionality and the affected areas are difficult to reach, particularly during the current rainy season, as the roads are often impassable.

“This is a concerning development, but we now have better tools than ever before to combat Ebola,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “WHO and our partners are taking decisive action to stop further spread of the virus.”

WHO is deploying around 30 experts to conduct surveillance in the city and is working with the Ministry of Health and partners to engage with communities on prevention and treatment and the reporting of new cases.

“The arrival of Ebola in an urban area is very concerning and WHO and partners are working together to rapidly scale up the search for all contacts of the confirmed case in the Mbandaka area,” said Dr Matshidiso Moeti, WHO Regional Director for Africa.
WHO is also working with Médecins Sans Frontières (MSF) and other partners to strengthen the capacity of health facilities to treat Ebola patients in special isolation wards.

As of 15 May, a total of 44 Ebola virus disease cases have been reported: 3 confirmed, 20 probable, and 21 suspected.

WHO partners in the DRC Ebola response include:
The International Federation of Red Cross and Red Crescent Societies (IFRC), the Congolese Red Cross (Congo ICRC), the  Red Cross of the Democratic Republic of the Congo (DRC ICRC), Médecins Sans Frontières (MSF), the Disaster Relief Emergency Fund (DREF), the Africa Centers for Disease Control and Prevention (Africa-CDC), the US Centers for Disease Control and Prevention (US-CDC), the World Food Programme (WFP), UNICEF, UNOCHA, MONUSCO, International Organization for Migration (IOM), the FAO Emergency Management Centre – Animal Health (EMC-AH), the International Humanitarian Partnership (IHP), Gavi – the Vaccine Alliance, the African Field Epidemiology Network (AFENET), the UK Public Health Rapid Support team, the EPIET Alumni Network (EAN), and the International Organisation for Animal Health (OIE) and and the Emerging Diseases Clinical Assessment and Response Network (EDCARN). Additional coordination and technical support is forthcoming through the Global Outbreak Alert and Response Network (GOARN) and Emergency Medical Teams (EMT).

 
Statement on the 1st meeting of the IHR Emergency Committee regarding the Ebola outbreak in 2018
The 1st meeting of the Emergency Committee convened by the WHO Director-General under the International Health Regulations (IHR) (2005) regarding the Ebola Virus Disease (EVD) outbreak in the Democratic Republic of the Congo took place on Friday 18 May 2018, from 11:00 to 14:00 Geneva time (CET).

Emergency Committee conclusion
It was the view of the Committee that the conditions for a Public Health Emergency of International Concern (PHEIC) have not currently been met.

Meeting
Members and advisors of the Emergency Committee met by teleconference. Presentations were made by representatives of the Democratic Republic of the Congo on recent developments, including measures taken to implement rapid control strategies, and existing gaps and challenges in the outbreak response. During the informational session, the WHO Secretariat provided an update on and assessment of the Ebola outbreak.

The Committee’s role was to provide to the Director-General their views and perspectives on:
Whether the event constitutes a Public Health Emergency of International Concern (PHEIC)
If the event constitutes a PHEIC, what Temporary Recommendations should be made.

Current situation
On 8 May, WHO was notified by the Ministry of Health of the Democratic Republic of the Congo of two lab-confirmed cases of Ebola Virus Disease occurring in Bikoro health zone, Equateur province. Cases have now also been found in nearby Iboko and Mbandaka. From 4 April to 17 May 2018, 45 EVD cases have been reported, including in three health care workers, and 25 deaths have been reported. Of these 45 cases, 14 have been confirmed. Most of these cases have been in the remote Bikoro health zone, although one confirmed case is in Mbandaka, a city of 1.2 million, which has implications for its spread.

Nine neighbouring countries, including Congo-Brazzaville and Central African Republic, have been advised that they are at high risk of spread and have been supported with equipment and personnel.

Key Challenges
After discussion and deliberation on the information provided, the Committee concluded these key challenges:
:: The Ebola outbreak in the Democratic Republic of the Congo has several characteristics that are of particular concern: the risk of more rapid spread given that Ebola has now spread to an urban area; that there are several outbreaks in remote and hard to reach areas; that health care staff have been infected, which may be a risk for further amplification.
:: The risk of international spread is particularly high since the city of Mbandaka is in proximity to the Congo river, which has significant regional traffic across porous borders.
:: There are huge logistical challenges given the poor infrastructure and remote location of most cases currently reported; these factors affect surveillance, case detection and confirmation, contact tracing, and access to vaccines and therapeutics.

However, the Committee also noted the following:
:: The response by the government of the Democratic Republic of the Congo, WHO and partners has been rapid and comprehensive.
:: Interventions underway provide strong reason to believe that the outbreak can be brought under control, including: enhanced surveillance, establishment of case management facilities, deployment of mobile laboratories, expanded engagement of community leaders, establishment of an airbridge, and other planned interventions.
:: In addition, the advanced preparations for use of the investigational vaccine provide further cause for optimism for control

In conclusion, the Emergency Committee, while noting that the conditions for a PHEIC are not currently met, issued Public Health Advice as follows:
:: Government of the Democratic Republic of the Congo, WHO, and partners remain engaged in a vigorous response – without this, the situation is likely to deteriorate significantly. This response should be supported by the entire international community.
:: Global solidarity among the scientific community is critical and international data should be shared freely and regularly.
:: It is particularly important there should be no international travel or trade restrictions.
:: Neighbouring countries should strengthen preparedness and surveillance.
:: During the response, safety and security of staff should be ensured, and protection of responders and national and international staff should prioritised.
:: Exit screening, including at airports and ports on the Congo river, is considered to be of great importance; however entry screening, particularly in distant airports, is not considered to be of any public health or cost-benefit value.
:: Robust risk communication (with real-time data), social mobilisation, and community engagement are needed for a well-coordinated response and so that those affected understand what protection measures are being recommended;
:: If the outbreak expands significantly, or if there is international spread,  the Emergency Committee will be reconvened.

The Committee emphasized the importance of continued support by WHO and other national and international partners towards the effective implementation and monitoring of this advice.

Based on this advice, the reports made by the affected States Parties, and the currently available information, the Director-General accepted the Committee’s assessment and on 18 May 2018 did not declare the Ebola outbreak in the Democratic Republic of the Congo a Public Health Emergency of International Concern (PHEIC). In light of the advice of the Emergency Committee, WHO advises against the application of any travel or trade restrictions. The Director-General thanked the Committee Members and Advisors for their advice.

FAQ on Ebola virus disease vaccine
14 May 2018