Milestones :: Perspectives
Ebola – Democratic Republic of the Congo
21: Situation report on the Ebola outbreak in North Kivu
27 December 2018 [Excerpts]
Situation Update
…As of 25 December 2018, a total of 585 EVD cases, including 537 confirmed and 48 probable cases (Table 1), were reported from 16 health zones in the two neighbouring provinces of North Kivu and Ituri (Figure 1), of which 13 reported at least one confirmed case in the last 21 days (5-25 December 2018). Over this period, 117 confirmed cases were reported from 13 health zones, the majority of which were concentrated in major urban centres and towns in Katwa (30), Komanda (20), Beni (15), Butembo (15), and Mabalako (15), which remain the main hotspots of this outbreak.
Trends in case incidence reflect the continuation of the outbreak across these geographically dispersed areas. The general decrease in the weekly incidence observed in Beni since late October is continuing; however, the outbreak is intensifying in Butembo and Katwa, and new clusters have emerged in other health zones.
Forty-one additional deaths among confirmed and probable cases occurred since our last report on 18 December 2018. Overall, 356 cases have died (case fatality 61%), including 308 among confirmed cases. As of 25 December 2018, 201 patients have recovered and been discharged from ETCs.
A healthcare worker from Mabalako has been reported among the new cases, bringing the number of healthcare workers affected to 54, with 18 deaths…
…Case management
On 24 November 2018, MoH announced the launch of a randomized control trial for Ebola therapeutics. This first-ever multi-drug randomized control trial within an outbreak setting, is an important step towards finding an effective evidence-based treatment for Ebola. The trial is coordinated by WHO and led and sponsored by the Democratic Republic of the Congo’s National Institute for Biomedical Research (INRB) which is the principal investigator. The trial has begun in the ALIMA Ebola treatment center (ETC) in Beni, where patients are enrolled in the study after obtaining voluntary informed consent.
Other ETCs continue to provide therapeutics under the MEURI (compassionate use) protocol, in collaboration with the MoH and the 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. UNICEF is providing nutritional treatment and psychological support for all hospitalized patients.
As of 25 December 2018, a total of 131 patients were hospitalised in transit centres and ETCs, of whom 29 were laboratory confirmed.
…Implementation of ring vaccination protocol
On 25 December 2018, 138 contacts were vaccinated, along with 201 contacts of contacts and 62 front line workers in 12 vaccination centres.
From 17 to 26 December 2018, 5,491 new people were vaccinated, The cumulative number of people vaccinated as of 26 December 2018 was 53 610.
Vaccination rings were opened around confirmed cases in Vutetse, Kanzulinzuli, Keyshero, Matanda, Muchanga, Vungi, Nyankunde, Wanamahika, and Aloya…
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DONs Ebola virus disease – Democratic Republic of the Congo
28 December 2018
[Excerpt]
…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.
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WHO Director-General concludes New Year visit to Ebola-affected areas in the Democratic Republic of the Congo
3 January 2019, News Release, Geneva
WHO Director-General Dr Tedros Adhanom Ghebreyesus traveled over the New Year to Ebola-affected areas in the Democratic Republic of the Congo (DRC) to review the response at this critical phase. Efforts to end the outbreak are continuing after recent disruptions, but further interruptions could have serious consequences, he warned.
Civil unrest resulted in vandalism to an Ebola transit centre in Beni and several other health facilities last week. The insecurity slowed down vaccinations and epidemiological surveillance and follow-up for several days.
“I’m concerned about the impact of the recent disruptions at this critical moment. This outbreak is occurring in the most difficult context imaginable. To end it the response needs to be supported and expanded, not further complicated. Ebola is unforgiving, and disruptions give the virus the advantage,” said Dr Tedros….
Director of the Wellcome Trust and Chair of WHO’s Research and Development Blueprint Dr Jeremy Farrar joined the mission to see the outbreak first-hand.
“I came away humbled by the dedication of the Ebola responders, but worried by the immense challenges they face in such a complex environment. This outbreak is in a critical phase. It is vital the international community recognizes this and ensures the DRC and WHO have the support needed to ensure this outbreak does not spiral out of control,” Dr Farrar said…
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Statement on disruptions to the Ebola response in the Democratic Republic of the Congo
by Dr Tedros Adhanom Ghebreyesus, WHO Director-General
28 December 2018 Statement Geneva
WHO and partners are continuing to respond to the Ebola outbreak in North Kivu and Ituri provinces in the Democratic Republic of the Congo, despite a deterioration of the security situation since yesterday morning.
Yesterday our teams in Beni were unable to carry out critical field work, including vaccinations, contact tracing, and following up on alerts of potential new cases. Protests at government buildings in Beni spilled over to an Ebola transit centre, frightening people waiting for Ebola test results and the staff who were caring for them. Staff at the centre temporarily withdrew and most suspected cases were transferred to a nearby treatment centre.
In Butembo, some alerts of potential cases were investigated and confirmed cases were referred to treatment centres but teams were unable to trace contacts or to conduct vaccinations.
Response activities have not been interrupted in other affected areas.
We have reached a critical point in the Ebola response. After an intensification of field activities, we were seeing hopeful signs in many areas, including a recent decrease in cases in Beni.
These gains could be lost if we suffer a period of prolonged insecurity, resulting in increased transmission. That would be a tragedy for the local population, who have already suffered too much.
Our teams in Beni and Butembo are doing everything possible to continue responding, despite the challenging security environment. For example, in Beni, contact tracing is being resumed with the support of local community relays, and WHO is supporting local health authorities to undertake other critical surveillance functions where possible.
In general, the communities in affected areas have been supportive of the response. We ask for everyone to protect health facilities and provide access for responders to the affected populations so that we can stop this outbreak. The population must also have safe access to transit and treatment centres that save lives and stop the spread of Ebola.
Working side by side with the Ministry of Health and our partners, our priority is to end the outbreak. We hope to return to full operations as soon as possible while remaining committed to ensuring the safety of all staff deployed. We cannot afford to take a step back at this critical point in the response
vaccines and global health :: ethics and policy 