Milestones :: Perspectives
Ebola – Democratic Republic of the Congo
Ebola virus disease – Democratic Republic of the Congo
Disease Outbreak News (DONs) 4 October 2018
The response to the Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo is at a critical juncture. WHO faces a precarious situation given recent increases in insecurity, incidents of community mistrust, and increased geographical spread.
The period of mourning and general strike (ville morte) in Beni, Butembo and Mabalako has officially ended; the ville morte was organized by civil society leaders following an attack in Beni on 22 September, in which 21 people were killed. Activities that had slowed during the ville morte period included health workers being unable to reach and monitor the health of Ebola patient contacts, social mobilization and community engagement efforts significantly slowed or suspended, risk communications seriously constrained or suspended in areas highly impacted by EVD, and severe limitations on field teams’ ability to investigate alerts of suspected cases and carry out safe and dignified burials. WHO operations are currently back to full scale; however, WHO remains vigilant given ongoing security constraints.
The Ministry of Health (MoH), WHO and partners continue to work closely with people in the affected areas. Most communities support the response efforts and are open to vaccination and treatment; collaboration between communities and local authorities is ongoing to overcome the reluctance and mistrust which has developed in some places. Faced with rumours and misinformation, some families have chosen to care for sick relatives at home, increasing the risk of transmission to caregivers, family and children. Some patients have also left health facilities to seek alternative care, or actively avoid follow-up from health workers. Despite concerted efforts by local community leaders to ensure safe and dignified burials, in some cases these are rejected in favour of traditional practices. Avoiding contact with health workers, home care and unsafe burials all increase the risk to patients themselves, caregivers, children and other family members, and to health/frontline workers, and have contributed to the spread of the outbreak.
The affected areas now cover hundreds of kilometres, including a confirmed case who has moved into a ‘red zone’ – a highly insecure and challenging environment where implementing response activities is extremely difficult. The geographic expansion further strains frontline resources, as an effective Ebola response requires hubs established in multiple locations, as close as possible to the affected population…
…Public health response
The MoH continues to strengthen response measures, with support from WHO and partners. Priorities include coordinating the response, surveillance, contact tracing, laboratory capacity, IPC measures, clinical management of patients, vaccination, risk communication and community engagement, psychosocial support, safe and dignified burials (SDB), cross-border surveillance and preparedness activities in neighbouring provinces and countries.
:: As of 2 October, over 200 experts have been deployed by WHO to support response activities including emergency coordinators, epidemiologists, laboratory experts, logisticians, clinical care specialists, communicators and community engagement specialists.
:: Over 5700 contacts have been registered, of which approximately 1900 remain under surveillance as of 2 October 2 . Following the conclusion of a ville morte imposed in Beni, Butembo and Mabalako Health Zones, there has been a marked improvement in the proportion of follow-up contacts on the day of reporting, with the proportion rising to 93% (1768/1900) from 78% (1401/1785) seven days prior. Beni Health Zone has the greatest challenges in contact tracing as a result of the deteriorating security situation.
:: As of 2 October, 69 vaccination rings have been defined in addition to 26 rings of health and frontline workers. To date, 13,758 people consented and were vaccinated, including 5678 health or frontline workers and 2915 children. Ebola Treatment Centres (ETCs) are operational in Beni and Mangina with support from the Alliance for International Medical Action (ALIMA) and Médecins Sans Frontières (MSF), respectively. MSF Switzerland and the MoH are supporting an ETC in Butembo. International Medical Corps (IMC) is supporting the recently opened Makeke ETC in Ituri Province. MSF and the MoH are setting up a 12-bed isolation facility in Kasenyi. An isolation unit is being developed from existing facilities in Tchomia.
:: WASH and IPC activities are ongoing in the Democratic Republic of the Congo and are supported by several partners in the field. Numerous activities have occurred in health facilities in the affected areas including facility assessments, decontamination of centres, establishment of triage areas and training on standard precautions as well as Ebola-specific IPC measures. A comprehensive plan to strengthen IPC in 200 health facilities, with WHO’s support, aims to: train medical staff; provide IPC kits; and replace incinerated materials in health facilities and households.
:: The MoH, WHO, UNICEF, Red Cross and partners are intensifying activities to engage with local communities in the affected areas. Due to conditions imposed by a community-declared ville morte from 24-28 September 2018, social mobilization teams were in lockdown for five days in Beni and unable to engage with communities; the situation in Beni has since improved. Engagement with local leaders in Ndindi in the past weeks has helped increase community ownership, with positive signs that leaders are actively reporting suspected cases through a telephone hotline. More collaboration has also been observed between local authorities and community focal points. Local frontline community outreach workers are collaborating with Ebola response teams to strengthen community engagement and psychosocial support in contact tracing, patient care, SDBs and vaccination of close contacts. In Butembo, community engagement was strengthened through collaboration with a popular singer, Mayaya Santa, producing a song with key messages about Ebola response. The activation of Tchomia’s communication commission has been a priority, and a meeting organized with two religious networks successfully reached 233 leaders from 141 churches in Tchomia Health Zone; youth leaders and motor taxi associations were also engaged as part of the meeting…
:: 09: Situation report on the Ebola outbreak in North Kivu 4 October 2018
:: Ebola Treatment Centres (ETCs) continue to provide therapeutics under the monitored emergency use of unregistered and experimental interventions (MEURI) protocol, in collaboration with the MoH and the Institut National de Recherche Biomédicale (INRB). WHO is providing technical clinical expertise onsite and is assisting with the creation of a data safety management board.
:: As of 1 October 2018, 47 patients have received investigational Ebola therapeutics, 26 treated with mAb 114, 10 with Remdesivir and 8 with Zmapp. A new molecule, Regeneron, has been used for the first time in three patients in Beni.