Milestones :: Perspectives
DRC – Ebola
29: Situation report on the Ebola outbreak in North Kivu 19 February 2019
The Ebola virus disease (EVD) outbreak in North Kivu and Ituri provinces, Democratic Republic of the Congo, continues to prove challenging to contain as ongoing security incidents and pockets of community mistrust hamper response efforts. Following our last report on 12 February 2019, 24 new EVD cases have been reported, including 20 confirmed and four probable cases. The four probable cases were all deaths that occurred in November and December 2018 in Komanda Health Zone, with a clinical history consistent with EVD but without the opportunity to be tested…
On 24 November 2018, MoH announced the launch of a randomized control trial (RCT) for Ebola therapeutics. The RCT is now enrolling and treating patients at ETC sites in Katwa, Beni and Butembo. This is ongoing, with all confirmed cases in ETCs receiving therapy under the compassionate use protocol, together with supportive care. To date, 66 patients have been enrolled in the RCT and 334 patients have received therapy under the compassion use protocol.
An Ebola transit (TC) centre was opened in Katwa in the last week.
…Implementation of ring vaccination protocol
As of 17 February 2019, a cumulative total of 80,989 people have been vaccinated since the start of the outbreak.
Vaccination of HCWs and FLsWS are underway in bordering areas of Uganda and South Sudan. Advanced preparations are ongoing in Rwanda.
February – July 2019
13 February 2019
[Excerpts’ full plan at title link qbove]]
The tenth epidemic of Ebola virus disease (EVD) in the Democratic Republic of the Congo, affecting the provinces of North Kivu and Ituri, was declared by the Ministry of Health on 1 August 2018. The initial strategic response plan (SRP-1) covering the period up to in October 2018 and then the second strategic response plan (SRP-2) for the period from October 2018 to January 2019 facilitated deployment of the important resources of the Congolese Government and its partners.
Despite the complexity of this epidemic (dense and mobile population, insecurity, community resistance and risk of spread at the national and regional levels), the implementation of the interventions made it possible to significantly reduce the spread of the outbreak in the initial epicentres of Mangina / Mandima and Beni and stopped transmission in some secondary focal points like Tchomia, Masereka and Mutwanga.
Nevertheless, since the beginning of December a significant increase in the incidence of new cases has been observed particularly along the corridor towards the large urban center of Butembo (health zones of Butembo and Katwa) and beyond in the zone of Kayna health center located about 150 km from Goma. In addition, active outbreaks have emerged to the north, particularly in the health zones of Komanda and Oicha.
The third strategic response plan (SRP-3), which covers February through end July 2019, considers the salient points and recommendations made during the operational review of the implementation of the SRP-2 and other guidance based on lessons learned and risk analysis.
…6.9 Vaccination of at-risk groups
Despite the context and challenges, as of January 27, 2019, in North Kivu and Ituri Provinces 695 rings (3 February) were defined in the community and 2 targeted geographical areas. A total of 73,298 contacts and contacts of contacts were listed. Of those vaccinated, 18,895 are contacts, 22,441 are health and front-line staff and 16,855 are children aged 1 to 18 years.
As the number of cases reported from unknown contacts remains high, efforts have been made to improve the identification of contacts and contact of contacts, particularly in all locations where the symptomatic case visited a high-risk health facility before being isolated or dying.
It is important to emphasize that the investigational vaccine will continue to be used according to WHO recommendations in compliance with Good Clinical Practice (GCP) and that sustained attention be paid to the quality of the processes, procedures and management of clinical trials data in accordance with international standards.
However, there is a shortage of national staff trained in GCP, low involvement of HZMTs and the community in the organization of vaccination and an increase in the number of ineligible people (pregnant women, breastfeeding women and infants).
Other measures to establish and continue to prevent the spread of transmission include:
:: Further improve the listing of the “satellites” of the rings (i.e. outside the place of residence of the case, these are all places that the symptomatic person visited before being isolated or dying) to identify and offer vaccination to all people at risk.
:: Organize vaccination teams performing “sweeping” operations to review how rings were defined for cases with onset of symptoms in the last 7 days and to verify if contacts at the place of residence and in the satellites have been fully enumerated and vaccinated.
:: Organize teams that primarily vaccinate all health personnel and front-line staff in priority-identified facilities because they have seen or treated a case of EVD within the previous 21 days.
:: Modify the protocol for the use of the rVSV vaccine to include vaccination of pregnant women after the 1st trimester of pregnancy and vaccination of infants including new-borns, as recommended by the National Ethics Committee. Arrangements will be made for the follow-up of pregnant women who were vaccinated through the end of their pregnancies.
:: The supply of infrared thermometers and handwashing facilities, drinking water, soap and capacity building on hygiene behaviour in schools.
:: The construction of isolation rooms for suspected cases at school.
:: Providing specific documentation and protocol for the prevention, guidance and management of suspected cases at school to provide key messages on family-based Ebola prevention.
:: Strengthen the technical capacity of national PCB teams to be able to deploy an experimental vaccine for this epidemic and in the future and consider appropriate study options for the evaluation of other vaccines against GCPs…