DR Congo - Ebola outbreak confirmed May 2018 (May - July 25, 2018)

[Gert van der Hoek]

Ebola virus disease ? Democratic Republic of the Congo

Disease outbreak news

10 May 2018

On 8 May 2018, WHO was notified by the Ministry of Health of the Democratic Republic of the Congo of two confirmed cases of Ebola virus disease occurring in Bikoro health zone, Equateur province.

From 4 April through 9 May 2018, a total of 32 Ebola virus disease cases (among which two are confirmed, 18 probable and 12 suspected cases) were reported from Bikoro health zone, Equateur province, including 18 deaths. Three of the 32 cases were among healthcare workers. The patients presented with fever, diarrhoea, abdominal pain, myalgia and arthralgia, and some also showed haemorrhagic signs and symptoms. All cases were reported from the catchment area of the Ikoko-Impenge health facility, located 30 km from the central health zone office of Bikoro, which is 280 km by road from Mbandaka, the capital of Equateur province. Of the 21 initially reported cases on 8 May 2018, 17 had epidemiological links (potential contacts with another suspect case).

Five samples were collected from hospitalized patients, three from Ikoko-Impenge and two from Bikoro. These were sent to Institute National de Recherche Biom?dicale in Kinshasa on 7 May 2018, where the two samples from Ikoko-Impenge were found positive by reverse transcriptase polymerase chain reaction (RT-PCR) assay for Ebola virus on the same day.

Over the last four decades, the Democratic Republic of Congo has experienced eight Ebola outbreaks. The most recent epidemic took place in May 2017 in the health zone of Likati, province of Bas-Uele. The ongoing epidemic is located in the Bikoro health zone, located in Equateur province, in western Democratic Republic of the Congo and on the border with the Republic of Congo. This is the fourth time that an Ebola outbreak has been reported in the former province of Equateur, following those of 1976, 1977 and 2014. However, this is the first time that the Bikoro health zone is facing an Ebola outbreak.

The province of Equateur has an estimated population of 2.5 million people with 284 registered health facilities. Bikoro health zone has a population of around 163 000 people with three hospitals and 19 health centres covering the population, most with limited functionality. Medical supplies are provided by international bodies, but stock outs are frequent.

Public health response

• • The Ministry of Health in the Democratic Republic of the Congo deployed Rapid Response Teams to investigate cases and deaths reported in Bikoro health zone in the Equateur province.
  • One million US dollars from the WHO contingency fund for emergencies have been mobilized.
  • WHO has provided technical and operations support to the Ministry of Health and Partners in the activation of multi-partner multi-agency Emergency Operations Centre to coordinate the response at all levels.
  • M?decins Sans Fronti?res is setting up a treatment centre for the management of cases in Bikoro health zone.
  • WHO has shared risk communication materials in French and Lingala with the WHO country offices.
  • Active surveillance activities among the community, the Ikoko-Impenge health centre team and Bikoro General Reference Hospital are being undertaken.
  • Immediate logistical capabilities and needs are being established.
  • Wellcome Trust is providing two million pounds sterling for the critical research needed to support the operational response which is now underway in the country.

WHO risk assessment

To date, the outbreak is reported in a remote area and appears to be geographically limited. However, in view of the available data, the overall risk is considered high at the national level due to the nature of the disease and the lack of epidemiological and demographic information to estimate the magnitude of the epidemic.
The overall risk at the regional level is considered moderate because of the proximity to the Congo river, which links with both the capitals of the Republic of the Congo and the Central African Republic.
Information is currently limited and investigations are ongoing to assess the full extent of the outbreak. Based on the information currently available and the rapid response measures implemented by the Ministry of Health in collaboration with WHO and partners, the event does not meet the criteria of a public heath event of international concern as defined in the IHR (2005)1, and does not warrant the convening of an Emergency Committee under the IHR (2005).

WHO advice

WHO advises against any restriction of travel and trade to Democratic Republic of the Congo based on the currently available information. WHO continues to monitor travel and trade measures in relation to this event, and currently there are no restrictions of the international traffic in place.

For more information on Ebola virus disease, please see the link below:

• Ebola Virus Disease fact sheet

[Pathfinder]

Translation Google

EBOLA BIKORO RIPOSTE

MIN SANTE - PRESS RELEASE - MAY 10, 2018 Statement by the Minister of Health during the press briefing on the Ebola epidemic in Bikoro this Thursday, May 10, 2018 Dear compatriots, Since Tuesday, May 8, 2018, the Democratic Republic of Congo faces a new epidemic of the Ebola virus disease which constitutes a public health emergency of international scope. To date, 11 cases of haemorrhagic fever and one suspicious death have been recorded . Currently, seven people, including the two confirmed Ebola cases in the laboratory, are currently hospitalized at the Bikoro Health Zone General Hospital. And the Itipo Health Center, located in the nearby health zone of Iboko, reported 4 new cases and one death in the night of Wednesday, May 9, 2018. One of the peculiarities of the current epidemic is the fact that three health professionals have been affected. As health professionals are the main actors in the government's response to Ebola, this situation is worrying and requires a response that is all the more immediate and energetic. That is why the Government of the Democratic Republic of Congo deployed a first team of 12 experts who arrived in Mbandaka this Wednesday, May 9 to launch the first investigations and organize the response in the field. They forwarded rapid diagnostic tests for the Ebola virus, as well as the first protection and treatment kits. In addition, this advance team has the difficult task of collecting and examining new samples on site thanks to the mobile laboratories of the National Institute for Biomedical Research (INRB). It is important to remember that there are several types of haemorrhagic fever besides Ebola in the Democratic Republic of Congo. As the tests of the first samples have revealed, not all suspected cases are necessarily cases of Ebola. Only the analysis of the samples taken will make it possible to follow with precision the evolution of the current epidemic. Dear compatriots, This is the ninth epidemic that our country is facing. Our health professionals have, in the past, demonstrated their expertise and expertise in controlling past episodes, including in other African countries. To ensure the protection of the population, the Head of State asked the Ministry of Health to use all the diagnostic and therapeutic arsenal at its disposal, including vaccination. Communication and awareness kits will be sent out tomorrow to begin training community relays and the dissemination of prevention messages. The crisis communication unit of the Ministry of Health will keep you regularly informed of the evolution of the response. Thank you. Dr. Oly Ilunga Kalenga Minister of Health

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[tetano]

Why Does Ebola Keep Showing Up in the Democratic Republic of the Congo?

When news broke this week that the Democratic Republic of the Congo is facing yet another Ebola outbreak, many public health experts were not surprised. The vast central African country has dealt with more outbreaks of this often-fatal hemorrhagic disease than any other nation. Yet exactly why the DRC is hit so often remains an unanswered question.
The DRC Ministry of Health announced the latest outbreak this week after laboratory testing confirmed two cases had occurred in the northwestern part of the country, near the its border with the similarly named Republic of the Congo. This is DRC?s ninth Ebola outbreak since scientists first identified the disease.

...

https://www.scientificamerican.com/article/why-does-ebola-keep-showing-up-in-the-democratic-republic-of-the-congo/

[tetano]

WHO prepares for worst case Ebola scenario, hopes to deploy vaccine

The WHO is preparing for the worst case scenario in an Ebola outbreak in a remote area of Congo, including spread to a major town.
WHO Deputy Director-General of Emergency Preparedness and Response, Peter Salama, on Friday told a regular UN briefing in Geneva that he hoped the Democratic Republic of Congo would give the green light within days for the deployment of an experimental vaccine, but warned that the drug was complicated to use and was not a magic bullet.
He said the WHO had alerted the nine neighbouring countries but currently regarded the risk of regional spread as ?moderate?.
The vaccine is called ?rVSV-ZEBOV?.

..

https://www.premiumtimesng.com/news/top-news/268036-who-prepares-for-worst-case-ebola-scenario-hopes-to-deploy-vaccine.html

[sharon sanders]

DRC reports four more Ebola cases

Four more cases of Ebola have been detected in northwest Democratic Republic of Congo, doctors said Thursday, two days after DRC reported a fresh outbreak of the disease.
Of the four affected people, two are caregivers at the hospital in Bikoro where the Ebola outbreak has been concentrated, the hospital’s chief surgeon Serge Ngalebato told AFP.
The latest Ebola outbreak in the region northeast of Kinshasa near the border with the Republic of Congo has so far killed 17 people.

https://mg.co.za/article/2018-05-10-drc-reports-four-more-ebola-cases

Reportedly one of the sick health care workers has died:

"The nurse died overnight at a hospital in nearby Ikoko Impenge, where four new suspected cases of Ebola have been reported, Health Minister Oly Ilunga said at a news conference. Seven people with a hemorrhagic fever, including two confirmed cases of Ebola, lay in hospital late Thursday, he added."

http://www.dw.com/en/nurse-is-first-to-die-in-congos-latest-ebola-outbreak/a-43735309

[sharon sanders]

WHO prepares for worst case Ebola scenario, hopes to deploy vaccine

The WHO is preparing for the worst case scenario in an Ebola outbreak in a remote area of Congo, including spread to a major town.
WHO Deputy Director-General of Emergency Preparedness and Response, Peter Salama, on Friday told a regular UN briefing in Geneva that he hoped the Democratic Republic of Congo would give the green light within days for the deployment of an experimental vaccine, but warned that the drug was complicated to use and was not a magic bullet.
He said the WHO had alerted the nine neighbouring countries but currently regarded the risk of regional spread as ?moderate?.
The vaccine is called ?rVSV-ZEBOV?.

..


https://www.premiumtimesng.com/news/...y-vaccine.html

Tedros Adhanom GhebreyesusVerified account @DrTedros 6h6 hours ago More

Yesterday I spoke by phone with the Minister of Health of the Democratic Republic of the Congo @OlyIlunga to discuss the #Ebola response in #DRC. We agreed to ship vaccines as quickly as possible so they can be used to save lives.

[Pathfinder]

ENGLISH11-May-201800:02:09
The international response to an Ebola outbreak in Democratic Republic of the Congo (DRC) is well under way but it is going to be ?tough? and ?costly?, a World Health Organization (WHO) senior official said today. UNTV CH

Video:

https://www.unmultimedia.org/avlibrary/asset/2149/2149321/

[tetano]

Ebola outbreak: WHO puts 10 countries on 'high alert'

The World Health Organization (WHO) on Friday said 10 countries, including the Democratic Republic of Congo (DRC) and its neighbors, have been put on high alert after local authorities declared an Ebola outbreak earlier this week.
"We are very concerned, and we are planning for all scenarios, including the worst-case scenario," said WHO emergency response chief Peter Salama in Geneva. Up to 18 people are suspected of dying from infection so far.

Salama said that WHO officials are most worried about the spread of Ebola in Congo-Brazzaville and the Central African Republic, since they are both connected to the outbreak area through river systems.
'Highly complex'
He noted that the latest outbreak has occurred in a remote area near Bikoro. But if the virus spreads to Mbandaka, the capital of DRC's Equateur province home to more than one million inhabitants, it could have devastating consequences, he added.
"This is a highly complex, sophisticated operation in one of the most difficult terrains on earth," Salama said. "If we see a town of that size infected with Ebola, then we are going to have a major urban outbreak."

http://www.dw.com/en/ebola-outbreak-who-puts-10-countries-on-high-alert/a-43746378

[Gert van der Hoek]

WHO and partners working with national health authorities to contain new Ebola outbreak in the Democratic Republic of the Congo

11 May 2018 News Release

Geneva/Brazzaville/Kinshasa

The World Health Organization (WHO) and a broad range of partners are in the Democratic Republic of the Congo (DRC) working with the Government to contain an outbreak of Ebola virus disease (EVD) in Bikoro health zone, Equateur Province. The outbreak was declared three days ago. WHO Director-General Dr Tedros Adhanom Ghebreyesus will travel to the DRC over the week-end to take stock of the situation and direct the continuing response in support of the national health authorities.

As of 11 May, 34 Ebola cases have been reported in the area in the past five weeks, including 2 confirmed, 18 probable (deceased) and 14 suspected cases. Five samples were collected from 5 patients and two have been confirmed by the laboratory. Bikoro health zone is 250 km from Mbandaka, capital of Equateur Province in an area of the country that is that is very hard to reach.

?WHO staff were in the team that first identified the outbreak. I myself am on my way to the DRC to assess the needs first-hand,? said Dr Tedros. ?I?m in contact with the Minister of Health and have assured him that we?re ready to do all that?s needed to stop the spread of Ebola quickly. We are working with our partners to send more staff, equipment and supplies to the area.?

A multidisciplinary team including WHO experts, along with staff from the Provincial Division of Health and M?decins Sans Fronti?res (MSF), arrived in Bikoro on 10 May. This first group of responders is now gathering more data to understand the extent and drivers of the epidemic. The team will also set up an active case search and contact tracing, establish Ebola treatment units to care for patients, set up mobile labs, and engage the community on safe practices. WHO will also work with national authorities in planning further public health measures such as vaccination campaigns.

?WHO is supporting the Government of the Democratic Republic of the Congo in coordinating this response; this is the country?s ninth Ebola outbreak and there is considerable expertise in-country,? said Dr Matshidiso Moeti, WHO Regional Director for Africa. ?However, any country facing such a threat may require international assistance. WHO and its partners including MSF, World Food Programme (WFP), UNICEF, International Federation of Red Cross and Red Crescent Societies (IFRC) and the Congolese Red Cross, UNOCHA and MONUSCO , US Centers for Disease Control and Prevention (US-CDC), the International Organization for Migration (IOM), are all stepping up their support.?

The response plan to the outbreak includes surveillance, case investigation, and contact tracing; community engagement and social mobilization; case management and infection prevention and control; safe and dignified burials; research response including the use of ring vaccination and antivirals; and coordination and operations support.

?It is too early to judge the extent of this outbreak,? said Dr Peter Salama, WHO Deputy Director-General for Emergency Preparedness and Response. ?However, early signs including the infection of 3 health workers, the geographical extent of the outbreak, the proximity to transport routes and population centres, and the number of suspected cases indicate that stopping this outbreak will be a serious challenge. This will be tough and it will be costly. We need to be prepared for all scenarios.?

In its latest Disease Outbreak News, WHO lists the risks to surrounding countries as moderate. WHO has however, already alerted those countries and is working with them on border surveillance and preparedness for potential outbreaks. WHO does not at this time advise any restrictions on travel and trade to the Democratic Republic of the Congo.
ENDS

Note to editors:

Current operations:
The first multidisciplinary team comprised of experts from WHO, M?decins Sans Fronti?res and the Provincial Division of Health arrived in Bikoro on 9 May to strengthen coordination and investigations. More deployments of epidemiologists, logisticians, clinicians, infection prevention and control experts, risk communications experts and vaccination support teams should arrive in Bikoro on Saturday.

WHO is working with Government and key partners ? including M?decins Sans Fronti?res, World Food Programme, the International Federation of the Red Cross, UNICEF and US-CDC ? to strengthen coordination of the EVD response at the national level and in the affected Bikoro health zone and is calling on its development partners to ensure a strong, comprehensive and rapid response to support the DRC Government to prevent and control the spreading of the disease.

Two mobile labs are planned to be deployed on 12 May.

Current bed capacity includes 15 beds in Bikoro. MSF is currently establishing isolation on site and has also deployed four mobile isolation units (5 beds each).

WHO is coordinating a major flight plan with UNHAS/WFP to deploy experts, equipment and materials to the field and is working closely with other health partners to prevent further geographical spread, improve surveillance data and reduce deaths by improving treatment of Ebola patients in Bikoro and the epicentre of Ikoko-Impenge. The cost of the air bridge for 3 months is estimated at US$ 2.4 million.

A logistician is expected to arrive in Bikoro this afternoon/evening to arrange accommodation/staff logistics. Additional information on access, transportation, and logistics requirements will be communicated tomorrow.
WHO is in the process of sending (Saturday) medical supplies to Bikoro to support the Ebola response, including:

• Personal Protective Equipment kits (PPE)
• Interagency Emergency Health Kit (IEHK)
• boxes for transportation
• body bags

WHO is helping with surveillance of cases by setting up community-based data collection to complement information provided by health facilities.

WHO has alerted neighbouring countries and is supporting the Central African Republic and Republic of Congo to strengthen surveillance in case of cross-border spread of the outbreak.

Funding requirements
WHO released US$ 1 million from its Contingency Fund for Emergencies to kick start the rapid response. Based on current assessment and response needs the estimated budget for the international response is US$ 18 million for a 3-month operation. Wellcome Trust and UK Department for International Development (DFID) announced a commitment of up to ?3 million to support a rapid response to the outbreak.

[Pathfinder]

Translation Google

ECHOS EBOLA RDC 2018

EPIDEMIOLOGICAL SITUATION Friday, May 11, 2018 The epidemiological situation of the Ebola Virus Disease of this Friday, May 11, 2018: 2 new suspected cases of haemorrhagic fever : 1 in the Bikoro Health Zone and 1 in the Iboko Health Zone 3 alerts in Mbandaka ( negative tests ) : Experts from the Ministry of Health were alerted to the presence of 3 sick people. They went to the scene to investigate further. Rapid diagnostic tests for Ebola have been shown to be negative. As a reminder, the figures given above relate exclusively to the active cases since the declaration of the epidemic on May 8, 2018 and do not include the 21 historical suspected cases reported before the declaration that were not the subject of laboratory analysis. News from the Ebola response At the request of the Ministry of Health, WHO has confirmed the availability of doses of the Ebola vaccine corresponding to the serotype identified for this epidemic. This vaccine has proven its effectiveness. The vaccine will be administered exclusively to exposed health professionals and those who have been in contact with confirmed Ebola cases. As soon as the two Ebola cases were confirmed in the laboratory on the night of May 7, 2018, the Minister of Health, Dr. Oly Ilunga Kalenga, considered that vaccination should be part of the means of response to the new epidemic. because of the density of the population and its high mobility in the region. For this reason, he has been in direct contact with Dr Tedros Adhanom, Director General of WHO, to ask him to make vaccines available to the Democratic Republic of Congo. As a reminder, during the Ebola outbreak in Likati last year, the vaccine could not be deployed because the logistic and epidemiological conditions were not met. This Saturday, May 12, 2018, the Minister of Health will lead to the epicenter of the outbreak a delegation composed of members of the National Coordinating Committee (CNC). The mobile laboratories of the National Institute of Biomedical Research (INRB) will be deployed in Mbandaka and Bikoro this Saturday, May 12, 2018. HISTORY OF EBOLA EPIDEMICS IN THE DEMOCRATIC REPUBLIC OF CONGO

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[Ronan Kelly]

Democratic Republic of Congo: Ebola Virus Disease - External Situation Report 1, 11 May 2018

REPORT

from World Health Organization Published on 11 May 2018


Download PDF (2.35 MB)


1. Situation update
Grade 2
Cases 34
Deaths 18
CFR 52.9 %
On 8 May 2018, the Ministry of Health (MOH) of the Democratic Republic of the Congo declared an outbreak of Ebola virus disease in Bikoro Health Zone, Equateur Province. This is the ninth outbreak of Ebola virus disease over the last four decades in the Democratic Republic of Congo, with the most recent occurring in May 2017.
On 3 May 2018, the Provincial Health Division of Equateur reported 21 cases of fever with haemorrhagic signs including 17 community deaths in the Ikoko-Impenge Health Area in this region. A team from the Ministry of Health, supported by WHO and M?decins Sans Fronti?res (MSF) visited the Ikoko-Impenge Health Area on 5 May 2018 and detected five active cases, two of whom were admitted to Bikoro General Hospital and three who were admitted in the health centre in Ikoko-Impenge. Samples were taken from each of the five active cases and sent for analysis at the Institute National de Recherche Biom?dicale, Kinshasa on 6 May 2018. Of these, two tested positive for Ebola virus, Zaire ebolavirus species, by reverse transcription polymerase chain reaction (RT-PCR) on 7 May 2018 and the outbreak was officially declared on 8 May 2018.
As of 11 May 2018, there are a total of 34 cases, with 18 deaths (case fatality rate 52.9%), among which two cases are confirmed, 14 suspected and 18 probable. Three health workers have been affected, with two suspected cases and a probable case who died. So far, 75 contacts are being monitored by the field teams.
The province of Equateur covers an area of 130 442 km2 and has an estimated population of 2 543 936 people, it has 16 health zones and 284 health centers. However, the affected health area of Bikoro covers 1,075 km2 and has a population of 163, 065 inhabitants. It has three hospitals and 19 health centers, most of which have limited functionality. Medical supplies are provided by international agencies, but stockouts of medical supplies are common. The village of Ikoko-Impenge is located 45 km from the central office of the Bikoro area and is not accessible by road, and falls outside the telephone network. However, there is an airstrip 8 km from Bikoro.

https://reliefweb.int/report/democratic-republic-congo/democratic-republic-congo-ebola-virus-disease-external-situation

[tetano]

WHO reports new Ebola case in DR Congo, vaccine this week

The head of the World Health Organization said Sunday there has been another reported case of Ebola in the Democratic Republic of Congo and that an experimental vaccine to fight the disease is expected to become available in the country this week.


Doctor Tedros Adhanom Ghebreyesus, on a two-visit to DR Congo, said the suspected new case was in Bikoro, at the centre of the latest Ebola outbreak in the country's northwest, where so far 18 people have died.
It brings to 35 the number of reported cases, including two confirmed, according to the WHO tally.
The WHO is planning to begin a vaccination campaign in the area, near the border with the Republic of Congo, using an available stockpile of an experimental vaccine.
"The vaccines are going to arrive on Wednesday or Thursday. We have enough of them," said Tedros, without specifying the number of doses.
After meeting with DR Congo President Joseph Kabila in Kinshasa, the WHO chief praised "the government's very strong leadership" in responding to the health crisis and its "good coordination" with partners such as Unicef and Doctors without Borders (MSF).

https://medicalxpress.com/news/2018-05-ebola-case-dr-congo-vaccine.html

[Gert van der Hoek]

Ebola virus disease – Democratic Republic of the Congo

Disease outbreak news

14 May 2018

Since the publication of the first Disease Outbreak News on the Ebola outbreak in Equateur province, Democratic Republic of the Congo on 10 May 2018, an additional seven suspected cases have been notified by the country’s Ministry of Health. Importantly, since the last update, cases have been reviewed and reclassified, and some discarded.
From 4 April through 13 May 2018, a total of 39 Ebola virus disease cases have been reported, including 19 deaths (case fatality rate = 49%) and three health care workers. Cases were reported from the Bikoro health zone (n=29; two confirmed, 20 probable and 7 suspected cases), Iboko health zone (n=8; three probable and five suspected cases) and Wangata health zone (n=2; two probable cases). To date, 393 contacts have been identified and are being followed-up. Wangata health zone is adjacent to the provincial port city of Mbandaka (population 1.2 million). Response teams on the ground are in the process of verifying information on reported cases. Case numbers will be revised as further information becomes available.

Public health response

• The Ministry of Health in the Democratic Republic of the Congo is coordinating the response.
• WHO is working with the Ministry of Health and MSF to conduct ring vaccination using the investigational recombinant vesicular stomatitis virus–Zaire Ebola virus (rVSV-ZEBOV).
• In Bikoro, Iboko, and Mbandaka health zones, the Ministry of Health along with WHO and partners are engaged in strengthening surveillance for new cases, carrying out contact tracing, case management, and community engagement, ensuring safe and dignified burials, and coordinating the response.
• WHO is deploying 50 public health experts to support the Ministry of Health with response activities.
• An air bridge for supplies and personnel will be established by the United Nations Humanitarian Air Service (UNHAS) starting 13 May with daily flights scheduled from Kinshasa to Mbandaka and Mbandaka to Bikoro.
• WHO has released $1 million US dollars from the contingency fund for emergencies, the United Nations has released $2 million US dollars from the Central Emergency Response Funds, and the Welcome Trust has provided 2 million pounds sterling for critical research needs.
• The WHO Director General, Deputy Director General for Emergency Preparedness and Response together with the WHO Regional Director for Africa will be in Kinshasa on 13 May to review operations and discuss further support to the Ministry of Health.

WHO risk assessment

Information about the extent of the outbreak is still limited and investigations are ongoing. The cases are being reported from remote locations that are difficult to access. However, the proximity of the affected area to the Congo River, which links to the Republic of the Congo and the Central African Republic, increases the risk of cases occurring in neighboring countries. Currently, WHO considers the public health risk to be high at the national level, moderate at the regional level, and low at the international level. As further information becomes available, the risk assessment will be reviewed.
At present, this event does not meet the criteria of a public heath event of international concern as defined in the IHR (2005) 1, and does not warrant the convening of an Emergency Committee under the IHR (2005).

WHO advice

WHO advises against any restriction of travel and trade to Democratic Republic of the Congo based on the currently available information. WHO continues to monitor travel and trade measures in relation to this event, and currently there are no restrictions of the international traffic in place.
For more information on Ebola virus disease, please see the link below:

• Ebola Virus Disease fact sheet

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1 “Public health emergency of international concern” means an extraordinary event which is determined, as provided in these Regulations: (i) to constitute a public health risk to other States through the international spread of disease and (ii) to potentially require a coordinated international response”. International Health Regulations (2005).

[Pathfinder]

Outbreaks and Emergencies Bulletin, Week 19: 5 May - 11 May 2018


Ebola virus disease Democratic Republic of the Congo
39
Cases
19
Deaths
48.7%
CFR

EVENT DESCRIPTION

On 8 May 2018, the Ministry of Health of the Democratic Republic of
the Congo notified WHO of an outbreak of Ebola virus disease in Bikoro
Health Zone, in the north-western Equateur Province. The event was
initially reported by the provincial health authority on 3 May 2018 when
a cluster of 21 cases of an undiagnosed illness, involving 17 community
deaths, occurred in Ikoko-Impenge health area. The event reportedly
occurred between early-April and early-May 2018, with the initial casepatients
presenting with fever, vomiting, abdominal pain, conjunctivitis,
and diarrhoea, which were not responsive to antibiotics or antimalarial. A
few of the case-patients reportedly had bleeding diathesis.

On 5 May 2018, the national rapid response team (RRT) obtained five
blood specimens from the initial case-patients (admitted in two local
health facilities). The specimens were received at the Institute National
de Recherche Biom?dicale (INRB) in Kinshasa on 6 May 2018. Test
results released by the INRB on 7 May 2018 showed that two of the
five specimens were positive for Zaire Ebolavirus species by reverse
transcription polymerase chain reaction (RT-PCR). Accordingly, the
Ministry of Health formally declared an outbreak of Ebola virus disease
on 8 May 2018.

As of 13 May 2018, a total of 39 suspected cases of Ebola virus disease,
including 19 deaths (case fatality rate 48.7%), have been reported. Two
probable cases (positive on rapid diagnostic test) were reported on 13
May 2018. Of the 34 suspected cases, two were confirmed, 18 have been
classified as probable and 12 remains suspected cases. Three healthcare
workers have been affected, one of them died. The outbreak has been localised to three health areas, namely Bikoro (29 cases), Iboko (8 cases) and Wangata (2 cases).

As of 13 May 2018, a total of 362 contacts have been listed and are being followed up. Further investigations to describe and characterize the outbreak are ongoing.


PUBLIC HEALTH ACTIONS

On 8 May 2018, the Minister of Health of the Democratic Republic of the Congo held a press conference to formally declare the outbreak of Ebola virus disease,
done in collaboration with the WHO Representative.
On 8 May 2018, the three levels of WHO (Headquarter (HQ), Regional Office for Africa (AFRO) and Country Office in the Democratic Republic of the Congo) issued
a joint News Release to announce the outbreak of Ebola virus disease to the global community.
The WHO Director General, Deputy Director General for emergencies and the Regional Director for WHO African Region, accompanied by senior staff, visited
the Democratic Republic of Congo from 12-13 May 2018 to assess the situation and direct the continuing response, in support of the national health authorities.
The Ministry of Health has reactivated coordination structures at the national, provincial and local levels, with involvement of all partners. At the national level,
daily coordination meetings are ongoing, chaired by the Minister of Health and attended by all humanitarian partners. Additionally, a health cluster meeting took
place 10 May 2018 to mobilize partners to respond to the outbreak.
WHO is in full response mode in support of the national authorities, working with key partners, including MSF, World Food Programme (WFP), UNICEF,
International Federation of Red Cross and Red Crescent Societies (IFRC) and the Congolese Red Cross, UNOCHA and MONUSCO , US Centers for Disease Control
and Prevention (US-CDC), the International Organization for Migration (IOM), and others.
WHO has established its Incident Management System of fully dedicated staff and resources across the three levels of the organization to support response to
the outbreak. Arrangements for immediate deployment of technical experts, including epidemiologists, clinicians, infection prevention and control experts, risk
communications specialists, logisticians, and vaccination support teams have been finalised. An advance team, including the Incident Manager, has arrived incountry
on 9 May 2018.
WHO released US$ 1 million from its Contingency Fund for Emergencies to support response activities for the next three months, with the goal of containing the
outbreak promptly.
On 9 May 2018, the Ministry of Health, in conjunction with WHO and M?decins Sans Fronti?res (MSF), deployed additional teams of technical experts to the
affected health zone to support outbreak investigations and local response. More deployments will be effected in the coming days.
Surveillance, case management, risk communication, and psychosocial support have all been initiated and are being strengthened. Infection prevention and
control and water, sanitation and hygiene (WASH) activities are ongoing with the start of safe water supply installation at Bikoro General Hospital and supervision
of waste management activities at the local market.

SITUATION INTERPRETATION

The Democratic Republic of the Congo has confirmed a new outbreak of Ebola virus disease, coming just about a year since the last outbreak was declared on 11 May
2017. This is the ninth outbreak of Ebola virus disease in the country since the virus was discovered in 1976 (in the same country).
The Ministry of Health and other national authorities, WHO and partners have mounted a response to the outbreak. The objective of the response is to rapidly contain
the current outbreak in the localized affected area. To achieve this, rapid scaling up of the proven containment measures is paramount. It is critical to ensure adequate
presence of qualified and experienced staff on the ground, as well as the necessary logistics. Given the known logistical challenges on the ground (in terms of access,
communication and accommodation), adequate logistical preparation and support is crucial. Alongside, there is a need to mobilize adequate financial resources to
facilitate the response, thus the need to quickly finalize the national response plan, to be used as a tool for resource mobilization.

http://apps.who.int/iris/bitstream/h...-511042018.pdf

http://www.afro.who.int/publications...ay-11-may-2018

[Pathfinder]

Frequently asked questions on Ebola virus disease vaccine

14 May 2018

1. Is there a vaccine for Ebola virus disease

An experimental Ebola vaccine has shown to be highly protective against the Ebola virus. This product, called rVSV-ZEBOV. It was studied in several trials that involved more than 16,000 volunteers in Europe, Africa and the United States and has been judged safe for use in humans based on available results. In Guinea, the vaccine was tested in 7,500 adults in 2015 and found safe and protective against Ebola infection. This trial was conducted by WHO, with the Guinean Ministry of Health, Doctors Without Borders and the Norwegian Institute of Public Health, in collaboration with other international partners.

The Ebola vaccine, that has the technical name rVSVΔG-ZEBOV- GP, was developed by the Public Health Agency of Canada, licensed to NewLink Genetics, who in turn licensed it to Merck & Co. The vaccine works by replacing a gene from a harmless virus known as vesicular stomatitis virus (VSV) with a gene encoding an Ebola virus surface protein. The vaccine does not contain any live Ebola virus.

2. Is now the right time to use the candidate vaccine in DRC?

• The current outbreak is due to the Ebola Zaire. Strategic Advisory Group of Experts on Immunization (SAGE) recommended in 2017 that should an Ebola disease outbreak occur before the candidate vaccine is licensed, the rVSVΔG-ZEBOV- GP vaccine be promptly deployed under the Expanded Access framework, with informed consent and in compliance with Good Clinical Practice.
• Given the location and access challenges in the area, getting the vaccination teams to the affected area will be challenging but the Ministry of Health, MSF, WHO and partners are working together to address the logistics constraints.
• WHO has a small stockpile of rVSV-ZEBOV. Merck has provided this yet to be licensed vaccines and pledged to allow access to more.

3. Who authorized the use of this vaccine in DRC?

The protocol was reviewed and approved by the national regulatory authorities and the national ethics committee.

4. How will the candidate vaccine be administered and who will receive it?

Ring vaccination, is the recommended delivery strategy. This will be adapted to the social and geographic conditions of the outbreak areas and include people at risk including but not limited to: (i) contacts and contacts of contacts; (ii) local and international health-care and front-line workers in the affected areas and (iii) health-care and front-line workers in areas at risk of expansion of the outbreak. They constitute the “ring” for the vaccination. With their agreement and consent, the individuals in the ring will be considered for the vaccination. After receiving the candidate vaccine, they will be followed up for a set period of time.

5. Is participation in the ring vaccination voluntary?

Yes. Participation in this ‘expanded access’ or compassionate use of the Ebola vaccine is entirely free and voluntary. Each eligible person makes their own decision whether to participate or not and can withdraw at any time. Their rights will be respected. Disregard of whether the eligible person chooses to participate or not, it will not have an impact on their access to health services.

6. What will happen to people who will be included in the ring vaccination?

The team from the Ministry of Health, MSF and WHO will determine who is eligible to be vaccinated, depending on their level of risk and health condition. The following people will be considered for vaccination: (i) contacts and contacts of contacts, (ii) local and international health-care and front-line workers in the affected areas and (iii) health-care and front-line workers in areas at risk of expansion of the outbreak will receive an injection of the candidate vaccine in the arm. As a follow up, they will be visited in their homes to check their health six times – on days 3, 14, 21, 42, 63 and 84 after vaccination.

It is very important that the persons vaccinated continue to protect themselves from Ebola virus infection by not touching a patient's bodily fluids (blood, vomit, saliva, urine, feces), avoid being in direct physical contact with a patient's body (alive or dead), touching the sheets, clothes that may have been contaminated, practice hand hygiene and other preventive measures.

7. Can the vaccine cause side effects?

The vaccine can produce some side effects. People who are vaccinated may have a mild fever or cold like symptoms, malaise that can last 1-3 days. Among those vaccinated, one in five felt temporary swelling at the point of injection into the skin. Some people will have a mild and transient fever 1 to 2 weeks after the injection or some small blisters may appear. It is possible to have joint pain in the feet, hands or knees. Very rarely, vaccines can cause a serious allergic reaction immediately after the vaccine has been administered. This can cause breathing difficulties and weakness.

8. Can a person vaccinated be infected with Ebola by the vaccine?

The vaccine cannot cause the disease because there is no Ebola virus in the vaccine. The vaccine is manufactured according to international standards for vaccines. If a person receiving the vaccine has been infected with the Ebola virus before he/she is vaccinated, they could develop Ebola virus disease after they receive the vaccine. For those infected before the vaccination, the vaccine cannot provide protection. If they develop any symptom of illness, they should immediately contact the vaccination team.

http://www.who.int/ebola/drc-2018/faq-vaccine/en/