Ebola – Democratic Republic of the Congo

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…


DONs Ebola virus disease – Democratic Republic of the Congo   
28 December 2018
…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.