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    Ebola in the DRC: For Jean-Jacques Muyembe, "a second vaccine is not our priority"

    06 AUG 2019
    Updated 06.08.2019 at 20:24 by
    Jean-Luc Eyguesier

    In the DRC, Professor Jean-Jacques Muyembe Tamfun has headed since the end of July 2019 the committee of experts responsible for the "national response" against the Ebola epidemic in the north-east, which recently won Goma. The co-discoverer of the Ebola virus does not rule out the use of a second vaccine, but explains today that "it is not the priority". Interview.

    Uganda announced on Monday (August 5th) that it has begun testing an experimental Ebola vaccine that could be used in the neighboring Democratic Republic of Congo. In this country, the epidemic has killed more than 1,800 people in one year.

    The trial of the MVA-BN vaccine produced by the Belgian laboratory Janssen, a subsidiary of the American Johnson & Johnson is expected to last two years, said the Council of Medical Research (MRC) of Uganda in a statement.

    The subject is debated in the Democratic Republic of Congo, where the former Minister of Health was openly opposed to its use. He finally resigned on 22 July, feeling disavowed after appointing a committee of experts to oversee control of the Ebola response led by Professor Jean-Jacques Muyembe Tamfun, National Director of the Institute for Biomedical Research from Kinshasa.

    He says he is much more in favor of this experimental vaccine even if for him, "it is not the priority". Since July, the epidemic has gained Goma, already two deaths in this major city in the east of the country.


    TV5MONDE: There is much talk of using a second vaccine, developed by Johnson & Johnson Laboratories, to complement Merck's rVSV vaccine to fight the Ebola outbreak in eastern DRC. Has a decision been made?

    Dr. Muyembe: For now, this is not our priority, we want to first control this epidemic that has arrived in a big city of the DRC (Goma), a hub for travelers. We still use the Merck rVSV vaccine. This second vaccine is a recommendation of the group of experts advising WHO on immunization and at its meeting on May 5, he suggested using it as a preventive vaccine.

    In our research institute, we have studied several candidate vaccines and it turns out that the Johnson & Johnson vaccine is the one for which we have the most scientific data. In addition, it allows to provide the largest number of doses. So, at first glance, our choice fell on this vaccine, but it should be noted that it is a vaccine under study, not yet approved.

    It is said that you personally support the use of this Johnson & Johnson vaccine. Is it true ?

    Dr. Muyembe: I am the director of the National Institute of Biomedical Research and my team has studied it. It is not me who wants to impose a vaccine, but on the basis of scientific evidence, the team of researchers thought that this second vaccine could be used. Moreover, it is already used and tested in Guinea and now in Uganda.

    What does it bring more than the Merck vaccine?

    Dr. Muyembe: Its advantage is that it is preventive, like that of measles. The intention was to create a "curtain" of immunized people between the currently infected area in North Kivu and Goma. Geographically, there is a whole region between the two that is not affected by the epidemic and if we act there, we create a "belt" that stops the spread of the virus and thus we protect the city of Goma. It was the hypothesis.

    This vaccine requires two injections 56 days apart, is this realistic in North Kivu conditions?

    Dr. Muyembe: The problem is not the logistical effort. Moreover for the first vaccine, the "Merck", it was said that it would be impossible for cold chain issues among others, but we get there. At the Institute, we have the experience of vaccination against yellow fever ... All this is a question of methodology, communication with the population. If the population accepts, there is no problem.

    What is even more important is to do some research. During this epidemic, we must do some research to find solutions for future epidemics. Not just for today's epidemic.

    In your opinion, how do you convince the population that has often been hostile to caregivers?

    Dr. Muyembe: Everyone is asking for a vaccine, and we know that with the first, the rVSV, we can not vaccinate a large population (for reasons of availability). Moreover, it proved its effectiveness while it was still in experimental form. It was during the Guinea epidemic in 2014, and we have confirmed it here in 2018, but we must continue the research.

    As for the hostility of the populations, it is the weakness of our response whose communication is not anchored. We must strengthen it, get the commitment of the people. As long as we do not have this community commitment, it is unlikely that we will be able to successfully extinguish this epidemic.
    ...
    Another problem is insecurity in the region.

    Dr. Muyembe: Yes, that's even the main problem. That's why we say that the fight against Ebola is not just a public health problem. In our current strategy, we will include other responsible sectors. The problem of insecurity concerns the Ministry of the Interior, and then we have to integrate the Ministry of Defense to escort the teams, and still others...

    You will go to Rwanda. What is the purpose of this meeting with the Rwandan authorities?

    Dr. Muyembe: The disease is on our side and we must do everything to reassure the Rwandan authorities about the efforts we are making, how we control our borders. There will be meetings at the political and expert level. When the WHO Director General made this epidemic a public health emergency "of international concern", he added in his recommendations that there is no point in closing the borders to prevent displacement.

    He urged neighboring countries not to choose this strategy, but rather to cooperate and be transparent. We need Rwanda and Rwanda needs the DRC.

    Many countries in the region are worried. Are you worried about a regional extension of the epidemic?

    Dr. Muyembe: If there is a risk of extension, it is more important inside the DRC than in neighboring countries, but we have teams that monitor travel and contacts to minimize the risk of spread to neighboring countries.

    The President of the Republic entrusted you with the national coordination of the fight against the epidemic. What is your feeling about this load?

    Dr. Muyembe: Three months ago, we said that we could control this epidemic in three months, given our experience in this area. Unfortunately, this appointment has just been made and the situation on the ground has completely changed.

    Still, we remain confident and in three or four months we can stop this epidemic. The challenge is great and the responsibility is heavy, but we count a lot on the support of the population, the support of the civil society and our partners to carry out quality work.

    Jean-Luc Eyguesier
    Updated 06.08.2019 at 20:24

    https://information.tv5monde.com/afr...riorite-314840
    "Safety and security don't just happen, they are the result of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of violence and fear."
    -Nelson Mandela

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    • Translation Google

      DRC: Seven Ebola deaths in Mambasa

      Posted on Tue, 06/08/2019 - 19:40 | Modified on Tue, 06/08/2019 - 19:40

      Three people died of Ebola on Monday, August 5, in Mayuano and Lolwa in Mambasa territory, said Franklin Yakani, interim administrator of the Ituri territory. This news brings to seven the number of deaths recorded in the space of four days in this entity, he said, adding that the response team is working hard to contain the disease.

      Among the victims, two people died of Ebola in Mayuano 32 km from Mambasa center. This is a girl of 20 years and a child of three years, says the interim administrator. Another case of death was recorded on the same Monday in Lolwa 62 km from the capital of the territory.

      According to the same source, four more cases of death were reported on Friday, August 2 in Mambasa-Center and Some. "In Mambasa, the same day, there were two confirmed cases and two deaths as well. Thirty people were vaccinated, "said Yakani.

      The response team is vaccinating the people contacted to prevent the spread of the disease, he said.

      The coordinator of the Ituri response team, Christophe Shako, said that at Some - which is considered the epicenter of the disease - the vaccine is being given to the entire population to contain Ebola. According to him, it was difficult to identify high-risk contacts, some of which are hidden among the population.

      https://www.radiookapi.net/2019/08/0...debola-mambasa
      "Safety and security don't just happen, they are the result of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of violence and fear."
      -Nelson Mandela

      Comment


      • Source: https://www.who.int/csr/don/08-augus...-ebola-drc/en/
        Ebola virus disease – Democratic Republic of the Congo

        Disease outbreak news: Update
        8 August 2019

        The Ebola virus disease (EVD) outbreak in North Kivu and Ituri provinces in the Democratic Republic of the Congo continued this week with similar transmission intensity to recent weeks with an average of 86 cases per week (range 80 to 91 cases per week) in the past six weeks (Figure 1). There are currently no confirmed cases of EVD outside of the Democratic Republic of the Congo.
        In the 21 days from 17 July through 6 August 2019, 65 health areas within 16 health zones reported new cases (Table 1, Figure 2). During this period, a total of 257 confirmed cases were reported, with the majority coming from the health zones of Beni (46%, n=119) and Mandima (23%, n=58). The majority of recent cases in Mandima Health Zone were reported from the northern health areas of Somé (n=39) and Mayuano (n=8). Of the eight cases reported in Mambasa Health Zone in the past 21 days, the majority have epidemiological links to Somé Health Area, with limited local transmission in Mambasa thus far.
        No new confirmed cases have been reported in Goma city since our last report, with a total of four confirmed cases reported from Goma (n=1) and Nyiragongo (n=3) health zones to date. Of the four cases, two have died and two are in an Ebola Treatment Centre(ETC). On 3 August, all 256 contacts related to the first confirmed case in Goma Health Zone (reported 14 July), finished their 21-day follow up period. A total of 232 contacts (including 114 high risk contacts) of the Nyiragongo cases remain under surveillance. Ongoing vaccination activities have reached the majority (98%) of eligible contacts, and 1314 contacts, contacts of contacts and frontline workers vaccinated to date.
        New infections continue to be reported among personnel working in community health posts and other facilities. In the last 21 days, 14 new cases were reported among health workers from Mandima (n=5), Beni (n=4), and one each in Katwa, Mambasa, Masereka, Oicha, and Vuhovi. Cumulatively, 149 (5%) healthcare workers have been infected to date.
        As of 6 August, a total of 2781 EVD cases were reported, including 2687 confirmed and 94 probable cases, of which 1866 cases died (overall case fatality ratio 67%). Of the total confirmed and probable cases, 56% (1572) were female, and 28% (791) were children aged less than 18 years.
        Figure 1: Confirmed and probable Ebola virus disease cases by week of illness onset by health zone. Data as of 6 August 2019*




        Enlarge image
        *Data in recent weeks are subject to delays in case confirmation and reporting, as well as ongoing data cleaning. Other health zones include: Alimbongo, Ariwara, Biena, Bunia, Goma, Kalunguta, Kayna, Komanda, Kyondo, Lubero, Manguredjipa, Masereka, Mutwanga, Nyankunde, Oicha, Rwampara and Tchomia.
        Figure 2: Confirmed and probable Ebola virus disease cases by week of illness onset by health zone. Data as of 6 August 2019*




        Enlarge image
        Table 1: Confirmed and probable Ebola virus disease cases, and number of health areas affected, by health zone, North Kivu and Ituri provinces, Democratic Republic of the Congo, data as of 6 August 2019**




        Enlarge image
        **Total cases and areas affected based during the last 21 days are based on the initial date of case alert and may differ from date of confirmation and daily reporting by the Ministry of Health.
        Public health response

        For further information about public health response actions by the Ministry of Health, WHO, and partners, please refer to the latest situation reports published by the WHO Regional Office for Africa: WHO risk assessment

        WHO continuously monitors changes to the epidemiological situation and context of the outbreak to ensure that support to the response is adapted to the evolving circumstances. The last assessment, carried out on 5 August 2019, concluded that the national and regional risk levels remain very high, while global risk levels remain low.
        Substantial rates of transmission continue within outbreak affected areas of North Kivu and Ituri provinces, with demonstrated extension to new high risk areas and across borders in recent months, although without sustained local transmission in these areas. The high proportion of community deaths, relatively low proportion of new cases who were known contacts under surveillance, existence of transmission chains linked to nosocomial infection, persistent delays in detection and isolation of cases, and challenges in accessing some communities due to insecurity and pockets of community reticence are all factors increasing the likelihood of further chains of transmission in affected communities. The report of confirmed cases and local transmission in Goma, capital of North Kivu with a population of over two million inhabitants, highlights the potential of spread within the Democratic Republic of the Congo and to neighbouring countries. Bolstered by months of preparedness, a sizable response, including exhaustive contact tracing and ring vaccination, was rapidly implemented upon detection of these cases with the aim of preventing tertiary spread or sustained local transmission in Goma city.
        The security situation over the past week increased in volatility, with the continued presence of non-state armed groups observed throughout operational areas. In Beni Health Zone, a number of recent attacks by suspected ADF elements that resulted in numerous civilian casualties led to a demonstration on 7 August 2019 in Beni/Mavivi to protest against the continued insecurity in the area. This was followed by larger demonstrations on 8 August in Beni due to an attack by ADF in Mbau on the Beni/Oicha axis that led to six civilian deaths, including a prominent civil society leader. EVD operations in the area have been temporarily suspended until the situation calms. The continuity of response activities is facilitated by the close monitoring of the operational environment and the corresponding implementation of appropriate security measures.
        The factors mentioned above, coupled with high rates of population movement from outbreak-affected areas to other parts of the Democratic Republic of the Congo, and across porous borders to neighbouring countries, increase the risk of geographical spread – both within the Democratic Republic of the Congo and to neighbouring countries. Conversely, substantive operational readiness and preparedness activities in a number of neighbouring countries have increased capacity to rapidly detect cases and mitigate local spread. These efforts must continue to be scaled-up and sustained.
        WHO advice

        On 17 July 2019, the Director-General convened the Emergency Committee under the International Health Regulations (IHR) to review the situation on the Ebola outbreak in the Democratic Republic of the Congo. The Director-General accepted the Emergency Committee’s recommendation that the outbreak constitutes a Public Health Emergency of International Concern (PHEIC). Further information, including temporary recommendations advised by the Emergency Committee, is available in the statement, speech by WHO Director General, and news release.
        WHO advises against any restriction of travel to, and trade with, the Democratic Republic of the Congo based on the currently available information. There is currently no licensed vaccine to protect people from the Ebola virus. Therefore, any requirements for certificates of Ebola vaccination are not a reasonable basis for restricting movement across borders or the issuance of visas for travellers to/from the affected countries. WHO continues to closely monitor and, if necessary, verify travel and trade measures in relation to this event. Currently, no country has implemented travel measures that significantly interfere with international traffic to and from the Democratic Republic of the Congo. Travellers should seek medical advice before travel and should practice good hygiene. Further information is available in the WHO recommendations for international traffic related to the Ebola Virus Disease outbreak in the Democratic Republic of the Congo.
        For more information, please see:

        Comment



        • https://en.wikipedia.org/wiki/Tshopo

          Translation Google

          Ebola in the DRC: theft of prevention equipment in Kisangani

          By Le Figaro with AFP Posted on 09/08/2019 at 16:17

          Ebola prevention materials were stolen in Kisangani, a large city in the north-east of the Democratic Republic of Congo, seriously weakening the capacity of health teams, AFP told AFP on Friday.

          "We lost a thermoflash. It was stolen, there is no trace of a large amount of chlorine and vials of yellow fever vaccine. All our statistics on the prevention of Ebola are also lost, "told AFP Dr. Paulin Muteba, coordinator of the national hygiene program of the province of Tshopo (north-east) in Kisangani. The thermoflash makes it possible to take the temperature without contact, first step in the detection of a possible presence of the disease. This equipment disappeared Tuesday during a forced evacuation operation of this Congolese State service of a building he occupied, by a court decision.

          "We had only nine thermoflashes, one broken down and one stolen. With a thermoflash, we can not control more than 15,000 passengers who come from Ituri because more than 20,000 people checked, the results are biased, "said Dr. Paulin Muteba. "This situation will also disrupt the prevention activities at Kisangani airport," added the doctor: "without chlorine mixed with water, passengers will not wash their hands and we can no longer disinfect vehicles from Bunia in Ituri ".

          The Ituri region is marginally affected by the outbreak of Ebola reported last August in Beni, neighboring North Kivu province. Located 480 km west of Beni, Kisangani, capital of Tshopo province, is an important commercial hub of more than 1.6 million inhabitants. It has important exchanges with the neighboring province of Ituri and the territory of Beni, the epicenter of the Ebola epidemic in North Kivu (east). A possible spread of the haemorrhagic fever epidemic to large, densely populated urban centers and beyond the DRC's borders would give it a new dimension.

          http://www.lefigaro.fr/flash-actu/eb...ngani-20190809
          "Safety and security don't just happen, they are the result of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of violence and fear."
          -Nelson Mandela

          Comment


          • Translation Google

            DRC: Lolwa, a new health zone affected by Ebola in Ituri

            Saturday, August 10, 2019 - 01:48

            A first confirmed case of Ebola Virus Disease has been detected in the locality of Lolwa, in Mambasa territory in Ituri province.

            The first case is a 30-year-old woman "whose signs began to manifest in Some in the health zone of Mandima.", Indicated in his bulletin, published Friday, the technical secretariat of the multisectoral committee of the response against the Ebola outbreak.

            The woman "used self-medication from 03 to 04 August 2019 until she left Some for Lolwa and was hospitalized at the Lolwa General Hospital on 05 August 2019, where the alert was issued.

            She has been investigated, validated and placed in isolation, "reports the same source.

            She is still alive and investigations to identify her contacts "continue," according to the newsletter.

            Lolwa is located 60 km east of the city of Mambasa, in the Babila Bakwanza chiefdom on the national road number 4 which connects the city of Bunia, capital of Ituri to Kisangani, chief town of Tshopo. This health zone is the ninth affected by Ebola in Ituri, the twenty - seventh in the two provinces (North - Kivu and Ituri) devastated by the epidemic for a year.

            The record is heavy: 1873 deaths including 1779 among the 2,699 confirmed cases, according to the last official count.

            Ituri alone records 175 deaths among the 318 confirmed and probable cases. The worst-hit health area is Katwa with 451 deaths, followed by Beni with 394 deaths and Butembo with 312.

            Another health area heavily affected by Ebola is Mabalako near Beni.

            It has already notified 282 deaths. All these localities are located in the northern part of North Kivu province.

            https://actualite.cd/2019/08/10/rdc-...ebola-en-ituri
            "Safety and security don't just happen, they are the result of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of violence and fear."
            -Nelson Mandela

            Comment


            • Translation Google

              Ebola: Two Promising Treatments Lower Mortality Rate

              These two treatments are antibodies that neutralize the ability of the virus to affect other cells.

              franceinfo with AFP
              France Télévisions
              Updated 13/08/2019 | 10:36
              published on 13/08/2019 | 10:28

              The hope of a cure for the Ebola virus is emerging. Two drugs have significantly increased the survival rate of patients in a clinical trial conducted in the Democratic Republic of Congo , announced Monday, August 12, the US health authorities, who co-funded the study.

              These two treatments, titled REGN-EB3 and mAb114, are monoclonal antibodies that work by neutralizing the ability of the virus to affect other cells. "They are the first drugs that, in the context of a solid scientific study, have clearly shown a significant decrease in mortality in people with Ebola," said to AFP Anthony Fauci, director of the American Institute of Infectious Diseases and Allergies.

              A mortality rate below 30%

              Of the approximately 500 people whose data were analyzed (out of a total of 681 participants), mortality fell to 29% with REGN-EB3. This rate reaches 34% with mAb114. For comparison, the mortality rate is between 60 and 67% for people not taking any treatment.

              The current phase of this study, initiated in November in the African country, will be stopped so that all future patients receive these treatments. Patients may choose to take these two treatments instead of two other medications, Zmapp and Remdesivir. The mortality rates for the latter two products are 49% and 53% respectively. The US authorities added that the final analysis of the data collected would be carried out at the end of September or the beginning of October, and that the complete results would then be published.

              https://www.francetvinfo.fr/sante/ma...e_3575175.html
              ---------------------------------------------------------------

              DRC: "There is now an effective and curative treatment against Ebola", (Dr. Muyembe)

              Posted Mar 13/08/2019 - 11:18
              7SUR7.CD

              The Ebola virus disease, which has been raging in two eastern DRC provinces for a year now, now has "a cure and not an experimental treatment".

              Within Ebola treatment centers in North Kivu and Ituri, will now be incorporated two treatment molecules, tested in the laboratory of the National Institute of Biomedical Research "INRB" Jean-Jacques Muyembe, current coordinator response and secretary of the multi-sectoral committee.

              Dr. Jean-Jacques Muyembe gave this clarification on the treatment on Tuesday, August 13 in Goma, after the discharge ceremony of two patients cured, after about two weeks spent in CTE.

              "There is a cure now. We have two molecules that are very effective and can heal quickly. These are the two molecules that we will now use in ETCs, and these patients in Goma have received, "he reassured.

              Before going further: "This is mAb114 and REGN-EB3, these are the two molecules that will now be used because according to the studies and the results we obtained in the lab, these are the two molecules that are effective.

              Dr. Muyembe also assured that currently the city of Goma, capital of North Kivu with more than one million inhabitants is out of danger, since about 200 contacts and suspected cases have been identified and are waiting for results and monitoring at points of entry is reinforced.

              Glody Murhabazi from Goma


              https://www.7sur7.cd/2019/08/13/rdc-...ola-dr-muyembe
              "Safety and security don't just happen, they are the result of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of violence and fear."
              -Nelson Mandela

              Comment


              • Translation Google

                Ituri: police disperse protest against Ebola response team

                Posted on Tue, 13/08/2019 - 17:39 | Edited on Tue, 13/08/2019 - 17:39

                Police on Tuesday (August 13th) dispersed a demonstration by residents of the Mputu district in Mambassa Center (Ituri) against the Ebola response team. In fact, a resident of the neighborhood, suffering from Ebola, died Monday, August 12 at the treatment center of Makayanga.

                According to protesters who develop a conspiracy theory around this case, this death is orchestrated by the response team to obtain funding for its activities.

                Police officers were deployed at strategic points in the city of Mambasa center, as at the Mambasa Reference General Hospital where a temperature control and hand washing device is installed.

                The police commander in Mambassa reports that youths are threatening to attack this site to show their anger.

                According to Franklin Yakani, administrator of the interim territory of Mambassa, the protesters say they are not convinced that the victim, a resident of their neighborhood, died of Ebola.

                The coordinator of the Ebola response in Ituri, Christophe Shako says it is a high-risk contact that has been tested positive. The latter had lost his son on July 30, died of Ebola. The man and his wife had all been admitted to the Makayanga Treatment Center.

                According to statistics provided by the medical team, the health zone of Mambassa has registered to date sixteen confirmed cases of Ebola, with six deaths.

                https://www.radiookapi.net/2019/08/1...ipe-de-riposte
                "Safety and security don't just happen, they are the result of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of violence and fear."
                -Nelson Mandela

                Comment


                • Source: https://www.who.int/csr/don/15-augus...-ebola-drc/en/
                  Ebola virus disease – Democratic Republic of the Congo

                  Disease outbreak news: Update
                  15 August 2019

                  The Ebola virus disease (EVD) outbreak in North Kivu and Ituri provinces in the Democratic Republic of the Congo continued this week with similar transmission intensity to recent weeks, with an average of 81 cases per week (range 68 to 91 cases per week) in the past six weeks (Figure 1). There are currently no confirmed cases of EVD outside of the Democratic Republic of the Congo.
                  This week, initial data from a randomized clinical trial (RCT) of EVD therapeutics were announced. The data showed that two of the four treatments trialled were more effective in treating EVD. As a result, patients in the four Ebola treatment centres that participated in the RCT will now be randomized to receive the two better performing treatments. Patients in treatment centres not participating in the RCT will continue to be able to access those treatments under a compassionate use protocol. This change will help ensure that every treatment centre patient receives the best possible treatment with the greatest chance of survival, based on the most recent evidence.
                  The data indicates that when people are willing and able to access care soon after the onset of symptoms, they have an increased chance of survival. Providing each patient with optimal supportive care, closely monitoring their progress, and addressing any other health issues has saved lives and will continue to be a top priority. More information is available in the following update and press release.
                  No new confirmed cases have been reported in Goma city since our last report, with a total of four confirmed cases reported from Goma (n=1) and Nyiragongo (n=3) health zones to date. Two cases, who were infected via direct contact with the case reported on 30 July, received treatment at an Ebola Treatment Centre in Goma city and were discharged on 13 August. A total of 203 contacts of the Nyiragongo cases remain under surveillance.
                  In the 21 days from 24 July through 13 August 2019, 66 health areas within 17 health zones reported new cases (Table 1, Figure 2). During this period, a total of 228 confirmed cases were reported, with the majority coming from the health zones of Beni (42%, n=96) and Mandima (20%, n=46). A case was confirmed in Lolwa Health Zone, which is the first confirmed case in that health zone to date, bringing the total number of affected health zones over the course of the outbreak to 27. The case travelled from Mandima to Lolwa, where they became symptomatic. Currently, there is no evidence of local transmission of EVD in this health zone. Close identification and follow up of contacts is ongoing to minimize the chance of local transmission.
                  New infections continue to be reported among personnel working in community health posts and other facilities. In the last 21 days, 11 new cases were reported among health workers from Beni (n=3), Mandima (n=2), and one each in Katwa, Mabalako, Mambasa, Masereka, Mutwanga, and Vuhovi. Cumulatively, 151 (5%) health workers have been infected to date.
                  As of 13 August, a total of 2842 EVD cases were reported, including 2748 confirmed and 94 probable cases, of which 1905 cases died (overall case fatality ratio 67%). Of the total confirmed and probable cases, 57% (1608) were female, and 29% (815) were children aged less than 18 years.
                  Pillar 1 of the fourth Strategic Response Plan (SRP4) for the control of the EVD outbreak in the Democratic Republic of the Congo is now available on the WHO website. Other pillars of the plan and their funding needs are being finalized by response partners and will be progressively released.
                  Pillar 1 covers the core public health response to the outbreak; the funding requirement for all partners to sustain the health response as outlined in this plan is 287 million US dollars, including 120-140 million US dollars for WHO. So far, 15.3 million US dollars have been received, with further funds pledged but not yet received. Despite recent announcements of new contributions, WHO’s operations are impacted by a lack of cash flow. The funding shortfall is immediate and critical. A summary of funding received by WHO since the start of this outbreak can be found here.
                  Figure 1: Confirmed and probable Ebola virus disease cases by week of illness onset by health zone. Data as of 13 August 2019*




                  Enlarge image
                  *Data in recent weeks are subject to delays in case confirmation and reporting, as well as ongoing data cleaning. Other health zones include: Alimbongo, Ariwara, Biena, Bunia, Goma, Kalunguta, Kayna, Komanda, Kyondo, Lolwa, Lubero, Mambasa, Manguredjipa, Masereka, Musienene, Mutwanga, Nyankunde, Nyiragongo, Oicha, Rwampara, Tchomia, and Vuhovi.
                  Figure 2: Confirmed and probable Ebola virus disease cases by week of illness onset by health zone. Data as of 13 August 2019*




                  Enlarge image
                  Table 1: Confirmed and probable Ebola virus disease cases, and number of health areas affected, by health zone, North Kivu and Ituri provinces, Democratic Republic of the Congo, data as of 13 August 2019**




                  Enlarge image
                  **Total cases and areas affected based during the last 21 days are based on the initial date of case alert and may differ from date of confirmation and daily reporting by the Ministry of Health.
                  Public health response

                  For further information about public health response actions by the Ministry of Health, WHO, and partners, please refer to the latest situation reports published by the WHO Regional Office for Africa: WHO risk assessment

                  WHO continuously monitors changes to the epidemiological situation and context of the outbreak to ensure that support to the response is adapted to the evolving circumstances. The last assessment, carried out on 5 August 2019, concluded that the national and regional risk levels remain very high, while global risk levels remain low.
                  Substantial rates of transmission continue within outbreak affected areas of North Kivu and Ituri provinces, with demonstrated extension to new high risk areas and across borders in recent months, although without sustained local transmission in these areas. The high proportion of community deaths, relatively low proportion of new cases who were known contacts under surveillance, existence of transmission chains linked to nosocomial infection, persistent delays in detection and isolation of cases, and challenges in accessing some communities due to insecurity and pockets of community reticence are all factors increasing the likelihood of further chains of transmission in affected communities.
                  The factors mentioned above, coupled with high rates of population movement from outbreak-affected areas to other parts of the Democratic Republic of the Congo, and across porous borders to neighbouring countries, increase the risk of geographical spread – both within the Democratic Republic of the Congo and to neighbouring countries. Conversely, substantive operational readiness and preparedness activities in a number of neighbouring countries have increased capacity to rapidly detect cases and mitigate local spread. These efforts must continue to be scaled-up and sustained.
                  WHO advice

                  WHO advises against any restriction of travel to, and trade with, the Democratic Republic of the Congo based on the currently available information. There is currently no licensed vaccine to protect people from the Ebola virus. Therefore, any requirements for certificates of Ebola vaccination are not a reasonable basis for restricting movement across borders or the issuance of visas for travellers to/from the affected countries. WHO continues to closely monitor and, if necessary, verify travel and trade measures in relation to this event. Currently, no country has implemented travel measures that significantly interfere with international traffic to and from the Democratic Republic of the Congo. Travellers should seek medical advice before travel and should practice good hygiene. Further information is available in the WHO recommendations for international traffic related to the Ebola Virus Disease outbreak in the Democratic Republic of the Congo.
                  For more information, please see:

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