Milestones :: Perspectives
Ebola – Democratic Republic of the Congo
18: Situation report on the Ebola outbreak in North Kivu 5 December 2018
:: Since the beginning of the response, 5 649 samples have been tested (including repeat samples).
:: The ETCs continue to provide therapeutics under the MEURI protocol, in collaboration with the MoH and the Institut National de Recherche Biomédicale (INRB), together with supportive care measures. WHO is providing technical clinical expertise on-site and is assisting with the creation of a data safety management board.
:: New patients continue to be treated in ETCs. As of 3 December 2018, 144 confirmed cases have recovered and been discharged. Bed occupancy was 63% in Beni ETC, 75% in Beni transit centre and 56% in Butembo ETC. All confirmed cases are being treated with a therapeutic under the MEURI framework after evaluation by clinical expert committee. All hospitalized patients receive food and psychological support.
…Implementation of ring vaccination protocol
:: Vaccination continued on 3 December 2018 in Beni, Katwa, Butembo, Komanda, Vuhovi and Lubero, with 568 persons vaccinated, including 114 contacts, 175 contacts of contacts and 279 first line workers.
:: As of 3 December 2018, the cumulative number of people vaccinated,is 39 845.
DONs Ebola virus disease – Democratic Republic of the Congo 6 December 2018
…Ebola virus disease in women and children
Concerns have been raised regarding the disproportionate number of women and children infected during this outbreak (Figure 3). To date, females accounted for 62% (280/450) of overall cases where sex was reported. Of all female cases, 83% (230/277) were aged ≥15 years. Of these women, at least 18 were pregnant, and an additional seven were breastfeeding or recently delivered at the time of infection. There have been 27 cases among infants less than one year of age, with 70% (19) of these being boys, and 21 fatalities (age-specific case fatality of 78%). There were also nine cases in infants aged less than one month. Children less than 15 years of age accounted for 24% (106/447) of cases.
There are likely a multitude of factors contributing towards this disproportionate disease burden observed in women and children. These include: exposure within formal and informal health facilities, involvement in traditional burial practices, transmission within family groups (including transmission between mothers caring for children), differences in health seeking behaviour, as well as the impact of ongoing conflict on the underlying population structure in affected areas. Among those with available information, commonly identified risk factors reported by cases include: having contact to a known case (224/320, 70%), having attended funerals (121/299, 40%) and having visited/admitted to a health facility before onset of EVD (46/139, 33%). Of note, 46% of female cases (84/181) reported having attended funerals, in contrast to 31% of male cases (37/118).
A concurrent increase in cases of malaria and the inadequate accompanying IPC in health settings are also likely to be contributory to the high rates of EVD among children. The recent conclusion of a four-day malaria control campaign in Beni on 2 December aimed at preventing further malaria deaths, as well as lessen the burden on health centres in order to address this potential source of transmission.
The MoH, WHO, are actively working with UNICEF and other partners to address the increased risks observed in women (including pregnant or breastfeeding women) and young children, and further strengthen measures to prevent and manage infections in these groups…