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  • Source: https://www.who.int/csr/don/28-decem...-ebola-drc/en/
    Ebola virus disease – Democratic Republic of the Congo

    Disease outbreak news: Update
    28 December 2018

    The Ministry of Health (MoH), WHO and partners continue to respond to the Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo. While communities in affected areas are generally supportive of the Ebola response, operations in some areas have been temporarily disrupted due to insecurity. On 27 December 2018, protests at government buildings in Beni spilled over to an Ebola transit centre, frightening people waiting for Ebola test results and the staff who were caring for them. Staff at the centre temporarily withdrew and most suspected cases were transferred to a nearby treatment centre. WHO is concerned about the negative effects that the current insecurity is having on efforts to control the outbreak. After an intensification of field activities, marked improvements in controlling the outbreak were observed in many areas, including a recent decrease in cases in Beni. These gains could be lost if we suffer a period of prolonged insecurity that results in increased Ebola virus transmission. While maintaining focus on ending the outbreak and resuming normal operations as soon as possible, all response partners remain committed to ensuring the safety of staff. WHO continues to monitor the situation closely and will adapt their response as needed.
    As of 26 December 2018, a total of 591 EVD cases, including 543 confirmed and 48 probable cases, have been reported from 16 health zones in the two neighbouring provinces of North Kivu and Ituri (Figure 1). Of these cases, 54 were healthcare workers, of which 18 died. Overall, 357 cases have died (case fatality ratio 60%). In the past week, ten additional patients were discharged from Ebola treatment centres; overall, 203 patients have recovered to date. The highest number of cases were from age group 15‒49 years with 60% (355/589) of the cases, and of those, 228 were female. Highest attack rates have been observed in children aged more than one year (especially male infants) and females aged 15 years and older.
    Trends in case incidence (Figure 2) reflect the continuation of the outbreak across these geographically dispersed areas. The general decrease in the weekly incidence observed in Beni since late October continued; however, the outbreak is intensifying in Butembo and Katwa, and new clusters have emerged in other health zones. Thirteen health zones reported a total of 109 confirmed cases in the last 21 days (5‒26 December 2018). The majority of which were concentrated in major urban centres and towns in Katwa (26), Komanda (21), Mabalako (15), Beni (14) and Butembo (10) health zones. An isolated case was also recently detected in Nyankunde Health Zone – a newly affected area in Ituri Province – whom likely acquired the infection in Komanda. This case, highlights the continued high risk of continued spread of the outbreak and the need to strengthen all aspects of the response in Ituri, North Kivu and surrounding provinces and countries.
    The MoH, WHO and partners continue to monitor and investigate all alerts in affected areas, in other provinces in the Democratic Republic of the Congo, and in neighbouring countries. Since the last report was published, alerts were investigated in several provinces of the Democratic Republic of the Congo as well as in Uganda. To date, EVD has been ruled out in all alerts outside of the abovementioned outbreak affected areas.
    Figure 1: Confirmed and probable Ebola virus disease cases by health zone in North Kivu and Ituri provinces, Democratic Republic of the Congo, data as of 26 December 2018 (n=591)




    Figure 2: Confirmed and probable Ebola virus disease cases by week of illness onset, data as of 26 December 2018 (n=591)*




    *Data in recent weeks are subject to delays in case confirmation and reporting, as well as ongoing data cleaning – trends during this period should be interpreted cautiously.
    Public health response

    The MoH continues to strengthen response measures, with support from WHO and partners. Priorities include coordination, surveillance, contact tracing, laboratory capacity, infection prevention and control (IPC), clinical management of patients, vaccination, risk communication and community engagement, psychosocial support, safe and dignified burials (SDB), cross-border surveillance, and preparedness activities in neighbouring provinces and countries. Infection prevention and control practices in health care facilities, especially antenatal clinics, need to be further strengthened.
    For detailed information about the public health response actions by WHO and partners, please refer to the latest situation reports published by the WHO Regional Office for Africa: WHO risk assessment

    This outbreak of EVD is affecting north-eastern provinces of the country bordering Uganda, Rwanda and South Sudan. Potential risk factors for transmission of EVD at the national and regional levels include: travel between the affected areas, the rest of the country, and neighbouring countries; the internal displacement of populations. The country is concurrently experiencing other epidemics (e.g. cholera, vaccine-derived poliomyelitis, malaria), and a long-term humanitarian crisis. Additionally, the security situation in North Kivu and Ituri at times limits the implementation of response activities. WHO’s risk assessment for the outbreak is currently very high at the national and regional levels; the global risk level remains low. WHO continues to advice against any restriction of travel to, and trade with, the Democratic Republic of the Congo based on currently available information.
    As the risk of national and regional spread is very high, it is important for neighbouring provinces and countries to enhance surveillance and preparedness activities. The International Health Regulations (IHR 2005) Emergency Committee has advised that failing to intensify these preparedness and surveillance activities would lead to worsening conditions and further spread. WHO will continue to work with neighbouring countries and partners to ensure that health authorities are alerted and are operationally prepared to respond.
    WHO advice

    International traffic: WHO advises against any restriction of travel and trade to 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 passengers leaving the Democratic Republic of the Congo. 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.
    For more information, see:


    1The number of cases is subject to change due to ongoing reclassification, retrospective investigation, and the availability of laboratory results.

    Comment


    • Translation Google
      DIRECTORATE GENERAL FOR DISEASE CONTROL
      EPIDEMIOLOGICAL SITUATION IN THE PROVINCES OF NORTH KIVU AND ITURI

      Friday, December 28, 2018


      The epidemiological situation of the Ebola Virus Disease dated 27 December 2018 :
      • Since the beginning of the epidemic, the cumulative number of cases is 593, of which 545 are confirmed and 48 are probable. In total, there were 359 deaths (311 confirmed and 48 probable) and 203 people healed.
      • 66 suspected cases under investigation.
        • Monitoring activities by the teams of Beni and Butembo were severely limited this Friday, December 28, 2018 following the demonstrations of the population. Thus, very few alerts could be investigated.
      • 2 new confirmed cases in Katwa.
      • 2 new confirmed cases, including 1 in Mabalako and 1 in Butembo.




      /! \ The data presented in this table is subject to further changes after thorough investigation and after redistribution of cases and deaths in their health areas.

      Remarks:
      • To avoid that the total number of cases varies (up or down) daily, the suspect cases have been placed in a separate category. Thus, suspect cases with positive laboratory tests will be added to the confirmed category, while negative ones (non-cases) will be removed from the table.
      • The probable case category includes all reported deaths for which it was not possible to obtain biological samples for laboratory confirmation. The investigations will determine whether these deaths are related to the epidemic or not.
      • A community death is a death in the community, outside of a licensed health center.
      News of the response


      Activities of the response to Beni and Butembo
      • The activities of the response to Beni and Butembo were still severely disrupted for the second day in a row following the protests of the population. The teams were not able to deploy in both cities, but they were able to work remotely with local health workers who maintained minimal field activity.
      • No vaccination activities took place in the health zones of Beni, Butembo, Katwa and Mabalako.
      • The community-based surveillance system and local health workers identified 18 alerts in Beni, of which 10 were investigated. Following these investigations, 4 new suspected cases were admitted to the CTE of Beni. As for the Butembo teams, they identified 11 alerts in Katwa and 8 in Kyondo, and 1 suspected case was transferred to Butembo CTE.
      • In terms of care, the Beni Transit Center is not operational. The CTEs of Beni and Butembo were operational but with a small number of caregivers.
      • No dignified and secure burial (EDS) has been performed in the health zones covered by the EDS teams in Beni and Butembo.
      • The Beni laboratory was not functional today but the Butembo laboratory was able to test the few samples received during the day.

      Vandalism in Beni
      • The Ministry of Health regrets that criminals took advantage of the elections-related protests in Beni to loot, vandalize and destroy several public and private health centers in the city. Although the Ministry respects the right to protest by the population, this right can not be used as an excuse to attack health facilities and health workers. In addition to being a crime, these serious acts unnecessarily expose the entire community to a greater spread of the Ebola outbreak.


      ...
      https://us13.campaign-archive.com/?u...&id=a405d11562
      "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


      • From: WorldHealthOrganizationNews@who.int
        To: undisclosed-recipients:;
        Subject: Statement on disruptions to the Ebola response in the Democratic Republic of the Congo by Dr Tedros Adhanom Ghebreyesus, WHO Director-General
        Date: Dec 28, 2018 12:44 PM

        Statement on disruptions to the Ebola response in the Democratic Republic of the Congo by Dr Tedros Adhanom Ghebreyesus, WHO Director-General


        28 December 2018 - WHO and partners are continuing to respond to the Ebola outbreak in North Kivu and Ituri provinces in the Democratic Republic of the Congo, despite a deterioration of the security situation since yesterday morning.

        Yesterday our teams in Beni were unable to carry out critical field work, including vaccinations, contact tracing, and following up on alerts of potential new cases. Protests at government buildings in Beni spilled over to an Ebola transit centre, frightening people waiting for Ebola test results and the staff who were caring for them. Staff at the centre temporarily withdrew and most suspected cases were transferred to a nearby treatment centre.

        In Butembo, some alerts of potential cases were investigated and confirmed cases were referred to treatment centres but teams were unable to trace contacts or to conduct vaccinations.

        Response activities have not been interrupted in other affected areas.

        We have reached a critical point in the Ebola response. After an intensification of field activities, we were seeing hopeful signs in many areas, including a recent decrease in cases in Beni.

        These gains could be lost if we suffer a period of prolonged insecurity, resulting in increased transmission. That would be a tragedy for the local population, who have already suffered too much.

        Our teams in Beni and Butembo are doing everything possible to continue responding, despite the challenging security environment. For example, in Beni, contact tracing is being resumed with the support of local community relays, and WHO is supporting local health authorities to undertake other critical surveillance functions where possible.

        In general, the communities in affected areas have been supportive of the response. We ask for everyone to protect health facilities and provide access for responders to the affected populations so that we can stop this outbreak. The population must also have safe access to transit and treatment centres that save lives and stop the spread of Ebola.

        Working side by side with the Ministry of Health and our partners, our priority is to end the outbreak. We hope to return to full operations as soon as possible while remaining committed to ensuring the safety of all staff deployed. We cannot afford to take a step back at this critical point in the response.

        Media contact:

        Tarik Jašarević
        "May the long time sun
        Shine upon you,
        All love surround you,
        And the pure light within you
        Guide your way on."

        "Where your talents and the needs of the world cross, lies your calling."
        Aristotle

        “In a gentle way, you can shake the world.”
        Mohandas Gandhi

        Be the light that is within.

        Comment


        • Translation Google
          DIRECTORATE GENERAL FOR DISEASE CONTROL
          EPIDEMIOLOGICAL SITUATION IN THE PROVINCES OF NORTH KIVU AND ITURI

          Wednesday, January 2, 2019


          The epidemiological situation of the Ebola Virus Disease dated January 1, 2019 :
          • Since the beginning of the epidemic, the cumulative number of cases is 608, of which 560 are confirmed and 48 are probable. In total, there were 368 deaths (320 confirmed and 48 probable) and 207 people cured.
          • 29 suspected cases under investigation.
          • 6 new confirmed cases, 2 in Butembo, 2 in Katwa and 2 in Beni.
          • 2 new deaths of confirmed cases in Beni.
          • 2 new people healed out of Butembo CTE.


          ...
          https://us13.campaign-archive.com/?u...&id=e297e9c9be
          "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


          • Flood of refugees fleeing Congo raises fears of spreading Ebola

            UPDATED ON: JANUARY 2, 2019 / 4:37 PM / CBS/AP

            Hundreds of refugees have crossed into Uganda from Congo in the days since that country's troubled presidential election, a Red Cross official said Wednesday, heightening concerns about the possible cross-border spread of Ebola. Separately, the head of the World Health Organization said he has asked the supplier of an experimental vaccine to produce more of it.
            ...
            The internet has been cut off in Congo this week in an apparent effort by the government to prevent social media speculation about the results, while the opposition and observers have reported multiple problems with the election. The internet outage also has affected Ebola response efforts, with Congo's health ministry on Wednesday citing "technical problems" for the delay in sending its daily update on the outbreak.
            ...
            The outbreak has been difficult to control amid armed violence and community protests, and the violence has increased "in intensity and frequency," the head of the World Health Organization said Wednesday.
            ...
            https://www.cbsnews.com/news/ebola-i...reading-ebola/
            "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


            • WHO Director-General concludes New Year visit to Ebola-affected areas in the Democratic Republic of the Congo

              3 January 2019 News Release

              Geneva


              WHO Director-General Dr Tedros Adhanom Ghebreyesus traveled over the New Year to Ebola-affected areas in the Democratic Republic of the Congo (DRC) to review the response at this critical phase. Efforts to end the outbreak are continuing after recent disruptions, but further interruptions could have serious consequences, he warned.

              Civil unrest resulted in vandalism to an Ebola transit centre in Beni and several other health facilities last week. The insecurity slowed down vaccinations and epidemiological surveillance and follow-up for several days.

              “I’m concerned about the impact of the recent disruptions at this critical moment. This outbreak is occurring in the most difficult context imaginable. To end it the response needs to be supported and expanded, not further complicated. Ebola is unforgiving, and disruptions give the virus the advantage,” said Dr Tedros.

              On the three-day mission (31 December 2018 - 2 January 2019) to Beni, Butembo and Komanda, Dr Tedros took stock of the outbreak, spent time with affected communities, and personally thanked responders for their dedication. WHO has 380 response staff in North Kivu and Ituri working together with hundreds more from the Ministry of Health and partners.

              “The Ebola responders are sacrificing a lot,” said Dr Tedros. “They’ve worked flat-out for months, away from their families, to combat one of the world’s deadliest viruses in a risky environment. I’m proud of them, and I wanted to tell them that personally over the New Year holiday.”

              Director of the Wellcome Trust and Chair of WHO’s Research and Development Blueprint Dr Jeremy Farrar joined the mission to see the outbreak first-hand.

              “I came away humbled by the dedication of the Ebola responders, but worried by the immense challenges they face in such a complex environment. This outbreak is in a critical phase. It is vital the international community recognizes this and ensures the DRC and WHO have the support needed to ensure this outbreak does not spiral out of control,” Dr Farrar said.

              Since the outbreak began in August 2018, there have been 608 cases and 368 deaths in North Kivu and Ituri provinces. To date, more than 54,000 high-risk contacts and frontline responders have been vaccinated, and almost every new patient receives one of four investigational treatments, something which was never previously possible during an Ebola outbreak.

              The main challenges are the security environment, pockets of mistrust among affected populations, and poor infection prevention and control in many public and private health facilities. Under the government’s leadership and working collaboratively with UN and NGO partners, WHO is committed to addressing these challenges and ending the outbreak.

              https://www.who.int/news-room/detail...c-of-the-congo



              "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/04-janua...-ebola-drc/en/
                Ebola virus disease – Democratic Republic of the Congo

                Disease outbreak news: Update
                4 January 2019

                The response by WHO and partners to the ongoing Ebola virus disease (EVD) outbreak continues despite disruptions to key services due to security incidents taking place in Beni and Butembo during the recent election on 30 December 2018. In order to ensure the safety of all staff deployed, as a precautionary measure, operations were scaled back for a few hours on election day. All normal operations have been fully restored as of 1 January 2019. After an intensification of field activities in early December, notable improvements can be observed in many areas, notably a decrease in cases in Beni. However, hard-earned progress could still be lost to rebound levels of transmission resulting from prolonged periods of insecurity hampering containment efforts.
                During the reporting period (27 December 2018 – 2 January 2019), 16 newly confirmed cases were reported from Beni (two), Butembo (five), Katwa (three), Komanda (one), Mabalako (one), and Oicha (four) health zones (Figure 1). As of 2 January 2019, there have been a total of 609 EVD cases1 (561 confirmed and 48 probable, Figure 2), including 370 deaths and 208 people having recovered. Overall, cases are occurring in localised hotspots within 16 health zones found in North Kivu and Ituri. Amongst confirmed and probable cases, the case load has been highest in females aged 15-49 who are eligible for vaccination (i.e. non-pregnant), and also females aged 50 years and older (Figure 3). Amongst confirmed and probable cases, 61% (374/609) were female (median age = 28) and were predominantly older than male cases (median age = 25.5). Of note, 16% (96/607) of cases were among children less than five years old, and 7% (41/607) were infants less than one year old. Most of the cases among children aged five years old or more were from Beni, 48% (46/96). There were 29 cases among pregnant women, of which 14 were from Beni. Fifteen of the 29 cases were reportedly breastfeeding women.
                As of 2 January, a total of 86 cases of nosocomial infection were reported in patients from the general public, primarily from Beni (34), Butembo (13), Katwa (11) and Mabalako (eight). There have been no new cases in healthcare workers during this reporting period. To date, there have been a total of 55 EVD cases involving healthcare workers, of which 18 have died and eight were hospitalised as patients. Of the healthcare workers with available clinical information, 36% (18/50) died. Eleven healthcare workers were reportedly infected in a general hospital while the other 30 health facilities reported between one to three cases each during the entire outbreak period. It should be noted that 22% (133/609) of all cases had history of exposure to a hospital 1-21 days prior to the onset of their illness.
                Thorough contact tracing during initial case investigations remains difficult in light of continued community resistance and the deteriorating security situation in the field during the recent elections. This resulted in a number of new confirmed cases not being identified as potential contacts. Of all cases, 66% (327/495) had known contact with a case, and 37% (177/478) had attended a funeral. A sizeable proportion of cases, 34% (155/451), had both these exposures.
                The Ministry of Health (MoH), WHO and partners continue to monitor and investigate all alerts in affected areas, in other provinces in the Democratic Republic of the Congo, and in neighbouring countries. Since the last report was published, alerts were investigated in several provinces of the Democratic Republic of the Congo as well as in Uganda. To date, EVD has been ruled out in all alerts outside of the above mentioned outbreak affected areas.
                Figure 1: Confirmed and probable Ebola virus disease cases by health zone in North Kivu and Ituri provinces, Democratic Republic of the Congo, data as of 2 January 2019 (n=609)




                Figure 2: Confirmed and probable Ebola virus disease cases by week of illness onset, data as of 2 January 2019 (n=609)




                Figure 3: Ebola virus disease cases by age groups in Northern Kivu and Ituri, Democratic Republic of the Congo, data as of 2 January 2019




                Public health response

                The MoH continues to strengthen response measures, with support from WHO and partners. Priorities include coordination, surveillance, contact tracing, laboratory capacity, infection prevention and control (IPC), clinical management of patients, vaccination, risk communication and community engagement, psychosocial support, safe and dignified burials (SDB), cross-border surveillance, and preparedness activities in neighbouring provinces and countries. Infection prevention and control practices in health care facilities, especially antenatal clinics, need to be further strengthened.
                For detailed information about the public health response actions by WHO and partners, please refer to the latest situation reports published by the WHO Regional Office for Africa: WHO risk assessment

                This outbreak of EVD is affecting north-eastern provinces of the country bordering Uganda, Rwanda and South Sudan. Potential risk factors for transmission of EVD at the national and regional levels include: travel between the affected areas, the rest of the country, and neighbouring countries; the internal displacement of populations. The country is concurrently experiencing other epidemics (e.g. cholera, vaccine-derived poliomyelitis, malaria), and a long-term humanitarian crisis. Additionally, the security situation in North Kivu and Ituri at times limits the implementation of response activities. WHO’s risk assessment for the outbreak is currently very high at the national and regional levels; the global risk level remains low. WHO continues to advice against any restriction of travel to, and trade with, the Democratic Republic of the Congo based on currently available information.
                As the risk of national and regional spread is very high, it is important for neighbouring provinces and countries to enhance surveillance and preparedness activities. The International Health Regulations (IHR 2005) Emergency Committee has advised that failing to intensify these preparedness and surveillance activities would lead to worsening conditions and further spread. WHO will continue to work with neighbouring countries and partners to ensure that health authorities are alerted and are operationally prepared to respond.
                WHO advice

                International traffic: WHO advises against any restriction of travel and trade to 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 passengers leaving the Democratic Republic of the Congo. 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.
                For more information, see:


                1Data in recent weeks are subject to delays in case confirmation and reporting, as well as ongoing data cleaning – trends during this period should be interpreted cautiously.

                Comment


                • Translation Google
                  DIRECTORATE GENERAL FOR DISEASE CONTROL
                  EPIDEMIOLOGICAL SITUATION IN THE PROVINCES OF NORTH KIVU AND ITURI

                  Sunday, January 6, 2019


                  The epidemiological situation of the Ebola Virus Disease dated January 5, 2019 :
                  • Since the beginning of the epidemic, the cumulative number of cases is 623, of which 575 are confirmed and 48 are probable. In total, there were 374 deaths (326 confirmed and 48 probable) and 216 people healed * .
                  • 122 suspect cases under investigation.
                  • 9 new confirmed cases, including 4 in Butembo, 2 in Oicha, 1 in Katwa, 1 in Kyondo and 1 in Kalunguta.
                  • No deaths of confirmed cases reported this day.
                  • 2 new people healed out of Butembo CTE.




                  /! \ The data presented in this table is subject to further changes after thorough investigation and after redistribution of cases and deaths in their health areas.

                  Remarks:
                  • To avoid that the total number of cases varies (up or down) daily, the suspect cases have been placed in a separate category. Thus, suspect cases with positive laboratory tests will be added to the confirmed category, while negative ones (non-cases) will be removed from the table.
                  • The probable case category includes all reported deaths for which it was not possible to obtain biological samples for laboratory confirmation. The investigations will determine whether these deaths are related to the epidemic or not.
                  • A community death is a death in the community, outside of a licensed health center.
                  News of the response

                  Vaccination
                  • Immunization launched for front-line providers in Nyiragongo Health Zone, Goma City.
                  • Since the beginning of vaccination on 8 August 2018, 56,211 people have been vaccinated , including 19,601 in Beni, 11,323 in Katwa, 6,369 in Butembo, 5,513 in Mabalako, 2,273 in Kalunguta, 1,663 in Mandima, 1,594 in Komanda, 1,172 in Oicha, 1,056 in Goma, 791 in Vuhovi, 750 in Masereka, 700 in Lubero, 659 in Kyondo, 599 in Mutwanga, 558 in Karisimbi, 434 in Bunia, 394 in Musienene, 355 in Tchomia, 167 in Nyankunde, 70 in Biena, 63 in Alimbongo, 34 to Nyiragongo and 13 to Kisangani.
                  • The only vaccine to be used in this outbreak is the rVSV-ZEBOV vaccine, manufactured by the pharmaceutical group Merck, following approval by the Ethics Committee in its decision of 19 May 2018.



                  ...
                  https://us13.campaign-archive.com/?u...&id=fd4d70a646
                  "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/10-janua...-ebola-drc/en/
                    Ebola virus disease – Democratic Republic of the Congo

                    Disease outbreak news: Update
                    10 January 2019

                    WHO and partners continue to respond to the ongoing Ebola virus disease (EVD) outbreak in one of the most complex settings possible. A decline in case incidence has been seen in Beni, the former epicentre. This is a strong positive indication of how effective the response can be despite multiple challenges. However, in Beni and elsewhere, trends must be interpreted cautiously, as delayed detection of cases is expected following recent temporary disruption in response activities due to insecurity. Nevertheless, WHO and partners remain committed, under the government’s leadership and through collaboration across agencies, to addressing challenges and ending the outbreak.
                    As of 8 January 2019, there have been a total of 628 EVD cases1 (580 confirmed and 48 probable), including 383 deaths (overall case fatality ratio: 61%). Thus far, 222 people have recovered, been discharged from an Ebola Treatment Centre (ETC) and enrolled in a dedicated program for monitoring and supporting survivors.
                    During the last 21 days (19 December 2018 to 8 January 2019), cases have been reported from ten health zones where the outbreak remains active, including: Katwa (18), Butembo (16), Oicha (13), Beni (13), Kalungata (6), Mabalako (5), Komanda (3), Musienene (2), Kyondo (1) and Nyankunde (1). Overall, cases have occurred in localised hotspots within 16 health zones found in North Kivu and Ituri provinces (Figure 1). Surveillance activities are being maintained to rapidly detect resurgences or reintroduction events in all areas.
                    Trends in numbers of new cases occurring (Figure 2) reflect the continuation of the outbreak across these geographically dispersed areas, with encouraging declines in case incidence in areas such as Beni. Hard-earned progress could still be lost from prolonged periods of insecurity hampering containment efforts.
                    Amongst confirmed and probable EVD cases, 61% (385/628) were female and 30% (189/628) were children aged less than 18 years. This includes a high number of cases in infants aged less than 1 year (38) and 1-4 years (58). While investigations to understand the risk factors for this disproportionate burden are ongoing, response teams continue to prioritise these population groups to mitigate, wherever possible, the risk of transmission.
                    All alerts in affected areas, in other provinces in the Democratic Republic of the Congo, and in neighbouring countries continue to be monitored and investigated. Since the last report was published, alerts were investigated in several provinces of the Democratic Republic of the Congo, Uganda, South Sudan, Rwanda and in a traveller returning from Burundi to Sweden. To date, EVD has been ruled out in all alerts outside the outbreak affected areas. International travellers who may have come into contact with the virus, including a doctor who returned to the United States of America after providing medical assistance in the Democratic Republic of the Congo, are also being followed closely; all remain asymptomatic.
                    Figure 1: Confirmed and probable Ebola virus disease cases by health zone in North Kivu and Ituri provinces, Democratic Republic of the Congo, data as of 8 January 2019 (n=628)




                    Figure 2: Confirmed and probable Ebola virus disease cases by week of illness onset, data as of 8 January 2019 (n=628)*


                    *Data in recent weeks are subject to delays in case confirmation and reporting, as well as ongoing data cleaning – trends during this period should be interpreted cautiously.


                    Public health response

                    The MoH continues to strengthen response measures, with support from WHO and partners. Priorities include coordination, surveillance, contact tracing, laboratory capacity, infection prevention and control, clinical management of patients, vaccination, risk communication and community engagement, psychosocial support, safe and dignified burials, cross-border surveillance, and preparedness activities in neighbouring provinces and countries.
                    For detailed information about the public health response actions by WHO and partners, please refer to the latest situation reports published by the WHO Regional Office for Africa: WHO risk assessment

                    WHO reviewed its risk assessment for the outbreak and the risk remains very high at the national and regional levels; the global risk level remains low. This outbreak of EVD is affecting north-eastern provinces of the Democratic Republic of the Congo bordering Uganda, Rwanda and South Sudan. There is a potential risk for transmission of EVD at the national and regional levels due to extensive travel between the affected areas, the rest of the country, and neighbouring countries for economic and personal reasons as well as due to insecurity. The country is concurrently experiencing other epidemics (e.g. cholera, vaccine-derived poliomyelitis, malaria), and a long-term humanitarian crisis. Additionally, the security situation in North Kivu and Ituri at times limits the implementation of response activities.
                    As the risk of national and regional spread is very high, it is important for neighbouring provinces and countries to enhance surveillance and preparedness activities. The International Health Regulations (IHR 2005) Emergency Committee has advised that failing to intensify these preparedness and surveillance activities would lead to worsening conditions and further spread. WHO will continue to work with neighbouring countries and partners to ensure that health authorities are alerted and are operationally prepared to respond.
                    WHO advice

                    International traffic: 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 passengers leaving the Democratic Republic of the Congo. 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.
                    For more information, see:


                    1Data in recent weeks are subject to delays in case confirmation and reporting, as well as ongoing data cleaning – trends during this period should be interpreted cautiously.

                    Comment


                    • Translation Google

                      DRC: Ebola staff attacked by residents of Marabo

                      Posted on Sat, 12/01/2019 - 10:41 | Modified on Sat, 12/01/2019 - 10:41


                      A group of angry residents assaulted a team of humanitarian workers responding to Ebola in Marabo on Friday (January 11th), 40 kilometers southwest of Bunia (Ituri). According to medical sources, protesters opposed the construction of an isolation center for suspected cases of Ebola in their entity.

                      Students at Nyakunde High School also emptied the classrooms following rumors of another team of aid workers arriving to vaccinate children against the disease.

                      Some residents of Marabo, mainly taximen, threw stones at a team of humanitarian workers who came to start the construction of an isolation center in a health facility of this entity.

                      They believe that implanting this center is a way to bring Ebola virus disease into their bodies to decimate them.

                      Local health officials say the police have been deployed as a matter of urgency to disperse protesters.

                      They deplore strong resistance from the population against Ebola response measures in the Nyakunde Health Zone.

                      On Friday morning, parents removed their children to Nyakunde High School to avoid being vaccinated against the Ebola outbreak.

                      This follows rumors that aid workers were in the area for vaccination.

                      A caregiver at Nyakunde Hospital reports that two students, who were found to be Ebola positive, escaped from the facility three days ago.

                      This situation worries this staff, who fear the exponential spread of this epidemic in the region.

                      A total of twenty-five doctors and nurses, who have been in contact with an Ebola patient, are under observation in Nyakunde for the prevention of this disease.

                      https://www.radiookapi.net/2019/01/1...-des-habitants
                      "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
                        DIRECTORATE GENERAL FOR DISEASE CONTROL
                        EPIDEMIOLOGICAL SITUATION IN THE PROVINCES OF NORTH KIVU AND ITURI

                        Wednesday, January 16, 2019


                        The epidemiological situation of the Ebola Virus Disease dated January 15, 2019 :
                        • Since the beginning of the epidemic, the cumulative number of cases is 663, of which 614 confirmed and 49 probable. In total, there were 407 deaths (358 confirmed and 49 probable) and 237 people cured.
                        • 123 suspected cases under investigation.
                        • 5 new confirmed cases, 2 in Katwa, 1 in Butembo, 1 in Kyondo and 1 in Oicha.
                        • 5 new confirmed cases, including:
                          • 3 community deaths, including 1 in Katwa, 1 in Butembo, and 1 in Kyondo.
                          • 2 at the Butembo CTE.


                        ...
                        https://us13.campaign-archive.com/?u...&id=1b813bd576
                        "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


                        • Translated Google
                          DIRECTORATE GENERAL FOR DISEASE CONTROL
                          EPIDEMIOLOGICAL SITUATION IN THE PROVINCES OF NORTH KIVU AND ITURI

                          Thursday, January 17, 2019


                          The epidemiological situation of the Ebola Virus Disease dated January 16, 2019 :
                          • Since the beginning of the epidemic, the cumulative number of cases is 668, of which 619 are confirmed and 49 are probable. In total, there were 410 deaths (361 confirmed and 49 probable) and 242 people cured.
                          • 136 suspected cases under investigation.
                          • 5 new confirmed cases, including 3 in Kayina, 1 in Katwa and 1 in Mangurujipa.
                          • 3 new deaths of confirmed cases (all community deaths), 2 in Kayina and 1 in Katwa.
                          • 5 new people healed, including 2 exits from Butembo CTE, 2 from Katwa CTE and 1 from CTE de Beni.




                          /! \ The data presented in this table is subject to further changes after thorough investigation and after redistribution of cases and deaths in their health areas.

                          Remarks:
                          • In order to prevent the total number of cases from going up or down daily, the suspect cases have been placed in a separate category. For example, suspect cases with positive laboratory tests will be added to the confirmed category, while negative ones (non-cases) will be removed from the table.
                          • The category of probable cases includes all reported deaths for which it has not been possible to obtain biological samples for laboratory confirmation. The investigations will determine whether these deaths are related to the epidemic or not.
                          • A community death is a death in the community, outside of a licensed health center.
                          News of the response

                          New health zone affected: Kayina
                          • Three new confirmed cases, including two community deaths, were detected in the same family in the Kayina Health Zone. This is the 18 th health area affected by the Ebola epidemic. The central office of the Kayina Health Zone was alerted to the presence of people with Ebola-compatible symptoms in their territory. A registered nurse visited the home concerned on 13 January 2019 and made three samples sent to Butembo. The three samples returned positive and two of the three patients died meanwhile on January 14, 2019.
                          • Investigations are underway to determine the health zone in which the three people were infected and to identify the chain of transmission.
                          • A joint team of epidemiologists, communicators, vaccinators and WASH experts (prevention and control of infections) arrived in Kayina to launch priority actions to contain the epidemic in this area. A reinforcement of the teams at the health zone of Lubero is also planned.


                          Vaccination
                          • Since the beginning of vaccination on 8 August 2018, 61,201 people have been vaccinated , including 19,990 in Beni, 12,815 in Katwa, 6,796 in Butembo, 5,741 in Mabalako, 2,433 in Kalunguta, 2,080 in Komanda, 1,751 in Goma, 1,663 in Mandima, 1,406 in Oicha, 1,157 in Karisimbi, 877 in Vuhovi, 750 in Masereka, 735 in Kyondo, 700 in Lubero, 599 in Mutwanga, 442 in Musienene, 434 in Bunia, 355 in Tchomia, 167 in Nyankunde, 120 in Biena, 63 in Alimbongo, 54 to Nyiragongo and 13 to Kisangani.
                          • The only vaccine to be used in this outbreak is the rVSV-ZEBOV vaccine, manufactured by the pharmaceutical group Merck, following approval by the Ethics Committee in its decision of 19 May 2018.



                          ...
                          https://us13.campaign-archive.com/?u...&id=938227cc36
                          "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


                          • This is the second expansion into a new health zone in the past few days and this health zone isn't connected geographically to other health zones. Also, no new cases have been detected in Beni after the violence there. It is a very challenging situation and seems to be getting more challenging with time.

                            Comment


                            • Translation Google

                              Ebola: MSF increases its activities in the DRC in a context of growing tensions

                              JANUARY 18, 2019
                              ...
                              While the number of confirmed Ebola cases continues to grow, the tense situation linked to the presidential elections has further restricted access of the population to care in and around the city of Beni, where several health centers have been damaged during the demonstrations. This makes it more difficult to quickly identify new cases of Ebola as the remaining health centers become overcrowded.

                              "In this case, patients may have no choice but to seek medical help in health facilities that do not have the means to triage or prevent and control the appropriate infections, which further increases the risk of contamination, explains Laurence Sailly, emergency coordinator for MSF in Beni.
                              ...
                              Raising awareness among communities about measures to stem the spread of Ebola remains one of the key challenges in responding to the epidemic and is now largely up to the actors involved in the response. Reaching communities became even more difficult as tensions following the postponement of elections in Beni and Butembo increased the distance between the population and Ebola response activities. Now residents are even more reluctant to accept infection prevention and control measures, such as dignified safe burials or decontamination of health centers and homes.

                              "In the face of Ebola, the treatment centers are insufficient. It is essential to create a link with communities and build mutual trust to control the epidemic, "says MSF anthropologist Roberto Wright in Katwa.
                              ...

                              https://www.msf.fr/actualites/ebola-...ns-croissantes
                              "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
                                DIRECTORATE GENERAL FOR DISEASE CONTROL
                                EPIDEMIOLOGICAL SITUATION IN THE PROVINCES OF NORTH KIVU AND ITURI

                                Friday 18 January 2019


                                The epidemiological situation of the Ebola Virus Disease dated January 17, 2019 :
                                • Since the beginning of the epidemic, the cumulative number of cases is 680, of which 631 are confirmed and 49 are probable. In total, there were 414 deaths (365 confirmed and 49 probable) and 243 people cured.
                                • 209 suspected cases under investigation.
                                • 12 new confirmed cases, including 6 in Katwa, 2 in Butembo, 1 in Musienene, 1 in Kayina, 1 in Kyondo and 1 in Beni.
                                • 4 new deaths of confirmed cases including
                                  • 3 community deaths in Katwa and
                                  • 1 hospital death in Beni.
                                • 1 new person healed out of Butembo CTE.




                                /! \ The data presented in this table is subject to further changes after thorough investigation and after redistribution of cases and deaths in their health areas.

                                Remarks:
                                • In order to prevent the total number of cases from going up or down daily, the suspect cases have been placed in a separate category. For example, suspect cases with positive laboratory tests will be added to the confirmed category, while negative ones (non-cases) will be removed from the table.
                                • The category of probable cases includes all reported deaths for which it has not been possible to obtain biological samples for laboratory confirmation. The investigations will determine whether these deaths are related to the epidemic or not.
                                • A community death is a death in the community, outside of a licensed health center.
                                News of the response

                                Medical care
                                • On Thursday, January 17, 2019, the Governor of Ituri Province, Pacific Keta, inaugurated a new Ebola Treatment Center (ETC) and a laboratory in Makayanga (Komanda). This is the ninth CTE built during this tenth Ebola epidemic after those of Beni, Bunia, Butembo, Goma, Katwa, Mandima, Mangina and Tchomia. This new 28-bed CTE, the third in the province of Ituri, is designed to treat and isolate confirmed and suspected cases of Ebola from the Komanda Health Zone and surrounding areas.


                                ...
                                https://us13.campaign-archive.com/?u...&id=45b7929f20
                                "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

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