Orientale, Dem. Rep. Congo - Ebola Bundibugyo: 36 suspected deaths (25 confirmed/probable), 800+ contacts traced, 77 suspected cases (52 confirmed/probable) since March 2012

[sharon sanders]

hat tip Pathfinder

machine translation

Sunday, August 12, 2012
DRC: 5 suspected cases of Ebola virus detected in Eastern Province


(Xinhua) - Five suspected cases of Ebola haemorrhagic fever have been detected in Isiro, chief town of the district of Haut Uele, Orientale Province (north-eastern DRC), said Jean-Marc Madindi Sunday, provincial medical inspector of the Eastern Province.


more...

http://www.afriscoop.net/journal/spip.php?breve12773

[alert]

Re: Dem. Rep. Congo - 5 suspected cases of Ebola virus in Eastern province - tests pending

The same article also mentions one suspected fatal VHF case in Dungu, also in Orientale (Eastern) Province.

Dungu is notable for reporting one fatal suspect VHF case last year that was actually confirmed to be due to Lassa:

http://www.flutrackers.com/forum/showthread.php?t=171097

the only Lassa case ever confirmed in DRC. Dungu also reported 18 undiagnosed fatalities early last year that turned out to be due to multiple etiologies:

http://www.flutrackers.com/forum/showthread.php?t=162812

We will have to wait to see if these six current cases are due to Ebola, Lassa, or some other cause.

We are also awaiting the results of the investigation of 14 unexplained, possibly hemorrhagic, fatalities in Kasai Occidental Province as well:

http://www.flutrackers.com/forum/showthread.php?t=191001

[alert]

Re: Dem. Rep. Congo - 6 suspected cases (1 fatal) of hemorrhagic fever in Orientale province - tests pending

There is audio (in French) from Radio Okapi of the chief medical officer discussing the situation in Isiro:

http://radiookapi.net/files/100812-p-f-JournalFrancaisSoir-00.mp3

[alert]

Re: Dem. Rep. Congo - 6 suspected cases (1 fatal) of hemorrhagic fever in Orientale province - tests pending

This was released about an hour ago about Ebola prevention in Orientale Province. Note that it doesn't mention any actual suspected cases in Orientale.

http://radiookapi.net/regions/province-orientale/2012/08/13/province-orientale-mise-en-place-dun-programme-de-prevention-de-la-fievre-hemorragique-debola/

Eastern Province: development of a program of prevention of Ebola hemorrhagic fever
published 54 minutes ago, | Last Update August 13, 2012 at 1:56 |

The epidemic of Ebola hemorrhagic fever is rife in Uganda in the Kibale district where sixty cases including sixteen deaths have been recorded in recent weeks.
Because the district in which Kibari raging epidemic is near the district of Aru in the Eastern Province, the Congolese authorities to turn this disease do not cross borders.

[alert]

Re: Dem. Rep. Congo - 6 suspected cases (1 fatal) of hemorrhagic fever in Orientale province - tests pending

According to Google Maps, Isiro is about 50 miles SW of Dungu, which is itself about 50 miles SW of the South Sudanese border.

Kibaale is about 200 miles SE of Isiro.

[Pathfinder]

Re: Dem. Rep. Congo - 9 suspected cases (5 fatal) of hemorrhagic fever in Orientale province - test negative for ebola

From link provided by Sharon:

http://reliefweb.int/sites/reliefweb.int/files/resources/HAG%20-%20Briefing%20humanitaire%20de%20la%20RDC%20-%20100812%20-%20FINAL.pdf

Translation Google

Excerpt:

HUMANITARIAN SITUATION REPORT OF THE DEMOCRATIC REPUBLIC OF CONGO
August 10, 2012

ORIENTALE PROVINCE

health

Alert: Two health zones of the DRC in Orientale Province reported suspected cases of VHF. The health zone of Isiro reported from June 25, 2012 to date six suspected cases and four deaths, case fatality of 66.6%. Health workers are not affected so far and contact information and followed up are not available.

The health zone of Dungu reported three suspected cases and one death of suspected VHF during the month of August. The results of the investigation and charges are expected for better learning of the situation.

Alert: MEDAIR also reported cases of bloody diarrhea in the health area of Bokoyo (90 km north of Banda) where 69 cases with 12 deaths (17.4%) were reported between June and July 2012. These cases have not been handled for two reasons: difficult access to Bokoyo for security reasons and lack of medicines.

[alert]

Re: Dem. Rep. Congo - 9 suspected cases (5 fatal) of hemorrhagic fever in Orientale province - test negative for ebola

It might be safe to assume that Marburg is also being tested for and hopefully being excluded, as it would also spread like Ebola.

Now the hard work begins. What is causing these cases? The lone Lassa fever case in 2011 took over two weeks to confirm, mainly because no one would even think to test for that virus in this area, as Lassa is endemic in West Africa, not Central Africa. Lassa is contagious, however, and could easily spread to HCW, although it did not in 2011. Spread of Lassa to HCW has been reported in West Africa.

Crimean-Congo Hemorrrhagic Fever (CCHF) is also native to Central Africa, hence its name.

The above article indicates that "bloody diarrhea" (likely dysentery) is also being reported from Orientale. Could the most severe cases of this be mistaken for VHF? Or might these suspected VHF cases be caused by something non-infectious?

I don't see any evidence from locations reported of any clustering (things like reports of contacts of cases taking ill), and these cases do seem spread over a somewhat large area. The above article also indicates that the six cases in Isiro have been reported over a period of seven weeks, which is a bit long to be a single cluster.

[alert]

Re: Dem. Rep. Congo - 9 suspected cases (5 fatal) of hemorrhagic fever in Orientale province

http://www.promedmail.org/

Published Date: 2012-08-14 16:29:47
Subject: PRO/EDR> Ebola hemorrhagic fever - Congo DR: (OE) susp
Archive Number: 20120814.1244138

EBOLA HEMORRHAGIC FEVER - DEMOCRATIC REPUBLIC OF CONGO: (ORIENTALE) SUSPECTED
************************************************** ***************************
A ProMED-mail post

http://www.promedmail.org

ProMED-mail is a program of the
International Society for Infectious Diseases

http://www.isid.org

Date: Sun 12 Aug 2012
Source: AFRIScoop.com (Xinhua report) [In French, transl., edited]

http://www.afriscoop.net/journal/spip.php?breve12773

Suspected cases of Ebola virus detected in Orientale Province
-------------------------------------------------------------
A total of 5 suspected cases of Ebola haemorrhagic fever have been detected in Isiro, chief town of the district of Haut Uele, Orientale Province (north eastern Democratic Republic of Congo [DRC)], said Jean-Marc Madindi, provincial medical inspector of the Eastern Province, on Sun 12 Aug 2012. "Another case where death ensued, was notified in Dungu, one of 6 areas that make up the district of Haut Uele. We are waiting for test results to diagnose the virus," said Mr Madindi, adding that all cases are closely monitored in Dungu and Isiro, without giving further details.

An outbreak of Ebola haemorrhagic fever (VHF) has emerged since last July [2012], 200 km [124 miles] from Kampala in Uganda, killing 14 people on 20 confirmed cases. Given the proximity between the Eastern Province and the eastern part of Uganda, and the intense traffic between the 2 countries, humanitarian actors [doctors?] in DRC have taken preventive measures to deal with this epidemic.

Haemorrhagic fever, against which there is no treatment or vaccine, kills between 50 and 90 per cent of sufferers. It is also highly contagious by direct contact with blood, bodily fluids, or when handling contaminated corpses carelessly. In the DRC, Ebola haemorrhagic fever occurred previously in Equateur province in 1976-1977 (north west), in Bandundu province (south west) in 1995, in the Eastern Province in 1999 and 2000, and in Kasai Occidental (center) in 2007 and 2008.

--
communicated by:
ProMED-mail
<promed@promedmail.org>

[This Orientale province of the Democratic Republic of Congo is adjacent to the region of Uganda currently experiencing an outbreak of Ebola haemorrhagic fever. It is tempting to infer that the 2 outbreaks are related. The Ugandan outbreak has been caused by Sudan ebolavirus. Confirmation and identification of the virus responsible for the DRC outbreak are awaited.

A map of the provinces of the Democratic Republic of Congo is available at http://www.mapsofworld.com/democrati...tical-map.html. The HealthMap/ProMED-mail interactive map of the Democratic Republic of the Congo can be accessed at http://healthmap.org/r/008z. - Mod.CP]

[alert]

Re: Dem. Rep. Congo - 9 suspected cases (5 fatal) of hemorrhagic fever in Orientale province

This is a BAD article. Note the bold, underlined text. Ebola has NOT yet been confirmed. There are a lot of other things that may be responsible for these cases.

It is irresponsible reporting to call this outbreak "Ebola" until laboratory confirmation is obtained.

Note also a slight discrepancy in the reporting: This article misses the two reported surviving cases in Dungu (have they been discarded?) and reports 3 of the 6 in Isiro as alive, whereas the weekly ReliefWeb report lists only 2.

http://www.afriquinfos.com/articles/2012/8/15/virus-ebola-personnes-enregistres-province-orientale-208346.asp

DRC: Ebola virus kills 4 out of 7 cases recorded in Eastern Province
KINSHASA (Xinhua) - The Ebola haemorrhagic fever has killed four people on seven cases in the district of Haut Uele, Orientale Province (north-eastern DRC), said on Aug. 14 Jean-Marc Madindi , provincial medical inspector of the Eastern Province. Wednesday, August 15, 2012 | 13:48 UTC CommentairesImprimerEnvoyer


According to Dr. Madindi, there were 3 deaths in 6 cases registered in Isiro, capital of the district of Haut Uele and 1 death in Dungu territory. "Samples from patients were sent to appropriate laboratories in Uganda for analysis and we expect results, "he said, adding that the provincial department of health has the support of MSF / Belgium, including equipment.

Moreover, the chief medical officer of health district Butembo, Dr. Mundama Witende, called the urban population of Beni and Butembo, along the border with Uganda, in strict compliance with preventive measures to avoid the contamination. He also forbade the people to consume the meat of primates and move to the neighboring Uganda and the DRC, without good reason.

In addition, they were also asked to avoid touching blood, fluids or other secretions from patients suspected hit by Ebola, or touching or washing a patient who would be carrying the disease, or touch or to wash the bodies of those who have died of Ebola. The outbreak of Ebola haemorrhagic fever (VHF), has emerged since last July, 200 km from Kampala, Uganda, and about 50 kilometers from the border with the DRC and specifically with the provinces of Orientale and North Kivu.

Haemorrhagic fever is highly contagious through direct contact with blood, bodily fluids, or careless when handling contaminated corpses. Since the Ebola virus was identified in 1976, fifteen outbreaks have already hit central Africa, including the DRC, Gabon, Congo / Brazzaville, Sudan and Uganda.

In the DRC, Ebola haemorrhagic fever has already declared in 1976 in Ecuador (northwest) in 1995 in Bandundu (southwest), in 1999 and 2000 in the Eastern Province and in 2007 and 2008 Kasai Occidental (center).

[Catbird]

Re: Dem. Rep. Congo - 9 suspected cases (5 fatal) of hemorrhagic fever in Orientale province

A little article dated Aug. 15, from Radio Opaki also mentions suspected cases in the Ituri district, which is on the Sudan and Ugandan borders. That puts it between Isiro and Uganda. There's a big difference between suspected and confirmed but it's worth watching to see if anything more comes of this report.

Google translation of article:

"Suspected cases of Ebola haemorrhagic fever have been detected in Isiro, Head of the district's top Uele in Orientale Province.

In North Kivu, Provincial Minister of Health stated, during the Provincial Council of Ministers held last weekend, that this epidemic is at the door of the city of Goma.

Other suspected cases are also reported in some localities in the district of Ituri. "

[alert]

Re: Dem. Rep. Congo - 9 suspected cases (5 fatal) of hemorrhagic fever in Orientale province

Where is this coming from? How do they know this? No previous source has reported this:

http://www.promedmail.org/fr

Published Date: 2012-08-14 4:20:05 p.m.
Subject: PRO / EDR> Ebola hemorrhagic fever - Congo DR: (Northeast)
Archive Number: 20120814.268293

Ebola haemorrhagic fever - DEMOCRATIC REPUBLIC OF CONGO: (NORTHEAST)
************************************************** **********************

A ProMED-mail

http://www.promedmail.org

ProMED-mail is a program of
International Society for Infectious Diseases

http://www.isid.org

Date: Mon 13 August 2012Source: Afriquinfos.com


5 suspected cases of Ebola virus detected in Eastern Province
----------------------------------------------
5 suspected cases of Ebola haemorrhagic fever
Ebola, were detected in Isiro, capital of the
district of Haut Uele in Orientale province
(North-eastern DRC), said Sunday [12 August
2012] Jean-Marc Madindi, medical inspector
province of Orientale.
"Another case where death ensued, was
notified in Dungu, one of six areas that account
the district of Haut Uele. We expect the
test results to diagnose
virus, "said Mr. Madindi, adding that all
cases are under strict surveillance in Dungu and
Isiro, without giving further details.

The outbreak of Ebola haemorrhagic fever
(FHV) has emerged since last July, 200
km from Kampala in Uganda, killing 14 people
the 20 confirmed cases.
Given the proximity between the Eastern Province and
eastern part of Uganda, and the intense
traffic between the two countries, humanitarian actors
DRC has taken preventive measures
to deal with this epidemic.
Hemorrhagic fever, against which it
there is no cure or vaccine, kills between 50 and
90 percent of sufferers. It is
also highly contagious through direct contact
with blood, bodily fluids, or
without precautions when handling dead bodies
contaminated.

In the DRC, Ebola haemorrhagic fever
has already declared in the province in 1976-1977
of Ecuador (northwest), in 1995 in the
Bandundu province (southwest), in 1999 and 2000
in the Eastern Province and in 2007 and 2008
Kasai Occidental (center).

-
Communicated by:
ProMED-


[The occurrence of cases of Ebola haemorrhagic fever
DR Congo is not at all surprising.
When the epidemic broke out in Uganda, a body
died of the Ebola virus would have been transported
Uganda and buried in DR Congo during the
night without the authorities and villagers
attended the burial were unable to take
appropriate precautionary measures. Of
People have certainly been contaminated
during transport of the body and also in
funeral ceremonies. Authorities
health of the DRC would take
very stringent measures to limit
the epidemic at the border
Uganda.

The interactive map HealthMap / ProMED-mail
Democratic Republic of Congo
Available at: http://healthmap.org/r/1jPk.-
Mod.BM]

[sharon sanders]

Re: Dem. Rep. Congo - 9 suspected cases (5 fatal) of hemorrhagic fever in Orientale province

The article in post 8 quotes Dr. Madindi who is the provincial medical inspector of the Eastern Province of DRC. I think he probably knows an ebola case when he sees it.

As to the ProMED article above, I do not see any link or substantive information to support the origin of any ebola cases in RDC.

I do not personally believe the animal bite story as referenced for the index case in the ebola outbreak in Uganda.

[alert]

Re: Dem. Rep. Congo - 9 suspected cases (5 fatal) of hemorrhagic fever in Orientale province

This is from the August 14th report.

Might the reduction in case counts indicate some of the cases have been excldued due to alternative diagnoses? I don't like that only one sample (from a surviving case?) seems to have been taken, unless it is a pooled sample, as it runs the risk that single case might have an alernative diagnosis than some of the others.

http://rdc-humanitaire.net/images/documents/2398/Weekly&#37;20PO%2008%20du%207%20au%2013%20vf.pdf

[snip]

Bloody diarrhea ��
MEDAIR reported 69 cases including 12 deaths in the area of Health Bokoyo (90 km north of Banda, Lower Uele)
between June and July 2012. These cases are not yet supported because of the insecurity and Bokoyo lack of medicine.

Suspected cases of viral hemorrhagic fever (VHF) in ZS Isiro and Dungu ��
The health authorities have reported seven suspected cases and four deaths in the health zones of Isiro (6 cases
and 3 deaths) and Dungu (1 case and 1 death), between 1 and August 13, 2012.
Actions taken:
- A team of the Provincial Division of health and that of Medecins Sans Frontieres (MSF) arrived since
the end of the week in Isiro, have made available protection kits and sampling.
- MSF briefed all members of the nursing staff of Isiro on precautions.
- A site of isolation is primed to HGR Isiro, six nurses and two doctors will be charged in cases isolation.
- A sample was taken on August 13 in Isiro and sent to MSF in Dungu to be transferred to Kampala on 14 August.
- The daily organization of the meeting of the Crisis Committee in Isiro.

Gaps:
- Need a team best equipped mobile surveillance (monitoring must be done within 30 km radius) thus requiring dynamism and speed)
- Difficult to transport samples collection (one commercial flight a week and a
single weekly service with MONUSCO .

[alert]

Re: Dem. Rep. Congo - 9 suspected cases (5 fatal) of hemorrhagic fever in Orientale province

http://www.promedmail.org/

Published Date: 2012-08-16 15:27:18
Subject: PRO/EDR> Ebola hemorrhagic fever - Congo DR (02): (OR) susp
Archive Number: 20120816.1247447

EBOLA HEMORRHAGIC FEVER - DEMOCRATIC REPUBLIC OF CONGO (02): (ORIENTALE) SUSPECTED
************************************************** ********************************
A ProMED-mail post

http://www.promedmail.org

ProMED-mail is a program of the
International Society for Infectious Diseases

http://www.isid.org

Date: Wed 15 Aug 2012
Source: Afriquinfos.com, Xinhua News Agency [in French, machine trans., edited]

http://www.afriquinfos.com/articles/2012/8/15/virus-ebola-personnes-enregistres-province-orientale-208346.asp

DRC: Ebolavirus kills 4 out of 7 cases in Orientale province
------------------------------------------------------------
[Ebola virus disease] has killed 4 people among 7 cases in the Haut Uele District of Orientale Province of the Democratic Republic of Congo (DRC), according to a statement on 14 Aug 2012 by Jean-Marc Madindi, provincial medical inspector of Orientale Province. According to Dr Madindi, 3 deaths among 6 cases occurred in the district of Haut Uele, and a angle death in Dungu district. Samples from these cases have been sent to a diagnostic Laboratory in Uganda for confirmation by laboratory techniques, and the results are awaited. The provincial health authorities are being supported by the Belgian branch of Medecins Sans Frontieres.

The chief medical officer of health of the Butembo District Health District, Dr Mundama Witende, has advised the urban populations of Beni and Butembo, which are located along the border with Uganda, to adopt strict procedures to prevent cross-border movements without good reason. The population have also been instructed to avoid consumption of meat derived from primates. Likewise, the population has been advised to avoid contact with the blood or secretions of patients suspected to have contracted [Ebola virus disease]. The bodies of those thought to have died as a result of ebolavirus infection should not be touched or washed.

An outbreak of [Ebola virus disease] was reported at the beginning of July [2012] in Uganda at a place located 200 kilometres [124 mi] from the capital Kampala and about 50 kilometres [31 mi] from the border with the Orientale and Nord-Kivu provinces of the DRC.

Ebola fever is highly contagious through direct contact with blood, bodily fluids, or when carelessly handling contaminated corpses. Since ebolavirus virus was first identified in 1976, 15 epidemics have affected central Africa, including the DRC, Gabon, Congo/Brazzaville [Republic of the Congo], Sudan, and Uganda. In the DRC, [Ebola virus disease] has previously occurred in 1976 in Equateur (northwest), in 1995 in Bandundu (southwest), in 1999 and 2000 in Orientale Province, and in 2007 and 2008 in Kasai Occidental (central).

--
communicated by:
ProMED-mail from HealthMap alerts
<promed@promedmail.org>

[The Orientale province of the Democratic Republic of Congo is adjacent to the region of Uganda currently experiencing an outbreak of Ebola virus disease. It is tempting to infer that the 2 outbreaks are related. The Ugandan outbreak has been caused by Sudan virus. Confirmation and identification of the virus responsible for the DRC outbreak are awaited.

A map of the provinces of the Democratic Republic of Congo is available at http://www.mapsofworld.com/democrati...tical-map.html. The HealthMap/ProMED-mail interactive map of the Democratic Republic of the Congo can be accessed at http://healthmap.org/r/35-r. - Mod.CP]

[Shiloh]

Re: Dem. Rep. Congo - 9 suspected cases (5 fatal) of hemorrhagic fever in Orientale province

Source: http://www.trust.org/alertnet/news/e...ee-in-dr-congo

Ebola outbreak kills one, infects three in DR Congo
Fri, 17 Aug 2012 19:34 GMT

Source: reuters // Reuters

KINSHASA, Aug 17 (Reuters) - An outbreak of Ebola has killed one person and is believed to have infected three others over the last week in northeastern Congo, medical charity Medecins Sans Frontieres said on Friday.

The outbreak is in Isiro, a busy town in Democratic Republic of Congo's Oriental province, which shares a border with Uganda, but the strain of the deadly disease is different to the one that killed 16 there last month, MSF said...