DRC - Ebola outbreak in North Kivu and Ituri: July 30, 2018+

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DIRECTORATE GENERAL FOR DISEASE CONTROL

EPIDEMIOLOGICAL SITUATION IN THE PROVINCES OF NORTH KIVU AND ITURI Sunday, May 5, 2019 The epidemiological situation of the Ebola Virus Disease dated May 4, 2019 : Since the beginning of the epidemic, the cumulative number of cases is 1,554, of which 1,488 have been confirmed and 66 are probable. In total, there were 1,029 deaths (963 confirmed and 66 probable) and 438 people healed. 213 suspected cases under investigation; 9 new confirmed cases, including 3 in Katwa, 2 in Musienene, 2 in Mandima, 1 in Kalunguta and 1 in Mabalako; 10 new deaths of confirmed cases, including 6 community / hospital deaths, 2 in Katwa, 2 in Mandima and 2 in Musienene; 4 CTE / CT deaths, including 3 in Butembo and 1 in Mabalako; 4 new cures out of the CTE of Beni. /! \ The data presented in this table are subject to change later, after extensive investigations 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. Deaths occurring at the level of the CTEs are provisionally recorded in the health zones of CTE implantation pending reclassification in the health zone of case notification. The probable case category includes all deaths for which it was not possible to obtain biological samples for laboratory confirmation but where the investigations revealed an epidemiological link with a confirmed or probable case. A community death is any death occurring outside of an Ebola Treatment Center. News of the response Temporary paralysis of Butembo's response activities Response activities were temporarily paralyzed in Butembo and nearby health areas this Saturday, May 4, 2019 following a demonstration by motorcycle taxi drivers who had placed wooden barricades on the main road arteries of Butembo town. Protesters also attacked handwashing devices throughout the city. The day before, Friday, May 3, 2019, the teams of safe and dignified burials (EDS) of the civil protection of North Kivu were called to carry out the DHS of a woman living in Katwa recently deceased of Ebola. At the end of the DHS, an altercation would have occurred after bikers tried to attack the EDS teams and their security escort. Two bikers were shot and died. An investigation is underway. To ease tensions, the ATAMOV President, the Motorcycle Taxi Drivers Association, and the customary chiefs exchanged with the bikers and asked them not to hinder the work of the response teams. The response activities had partially resumed this Sunday, May 5, 2019. An increase in the number of cases and deaths is expected in the coming days following this temporary cessation of response activities to limit the spread of the virus in the community.

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DIRECTORATE GENERAL FOR DISEASE CONTROL

EPIDEMIOLOGICAL SITUATION IN THE PROVINCES OF NORTH KIVU AND ITURI Monday, May 6, 2019 The epidemiological situation of the Ebola Virus Disease dated May 5, 2019 : Since the beginning of the epidemic, the cumulative number of cases is 1,572, of which 1,506 are confirmed and 66 are probable. In total, there were 1,045 deaths (979 confirmed and 66 probable) and 439 people healed. 193 suspected cases under investigation; 18 new confirmed cases, including 7 in Mandima, 4 in Katwa, 2 in Beni, 1 in Mabalako, 1 in Kalunguta, 1 in Oicha, 1 in Butembo and 1 in Masereka; 16 new deaths of confirmed cases, including 8 community / hospital deaths including 3 in Mandima, 2 in Katwa, 1 in Mabalako, 1 in Kalunguta and 1 in Masereka; 8 deaths at CTE / CT, including 3 in Katwa, 2 in Butembo, 2 in Beni and 1 in Mandima; 1 new healed from the Butembo CTE; 1 health worker in Mandima is one of the new confirmed cases (community deaths). This is a hygienist from a health post in Katanga health area who was unvaccinated and not followed because she refused. She died at home. The cumulative number of confirmed / probable cases among health workers is 95 (6% of all confirmed / probable cases), including 34 deaths. /! \ The data presented in this table are subject to change later, after extensive investigations 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. Deaths occurring at the level of the CTEs are provisionally recorded in the health zones of CTE implantation pending reclassification in the health zone of case notification. The probable case category includes all deaths for which it was not possible to obtain biological samples for laboratory confirmation but where the investigations revealed an epidemiological link with a confirmed or probable case. A community death is any death occurring outside of an Ebola Treatment Center. News of the response Temporary paralysis of Butembo's response activities Response activities slowed down in Butembo town and nearby health areas on Sunday, May 5 and Monday, May 6, 2019. Local response committees located in different parts of the city provided minimal service. An increase in the number of cases and deaths is expected in the coming days following this slowdown in response activities to limit the spread of the virus in the community.

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WHO Adapts Ebola Vaccination Strategy in the Democratic Republic of the Congo to Account for Insecurity and Community Feedback

7 May 2019 News release Geneva

WHO?s Strategic Advisory Group of Experts (SAGE) today issued new recommendations to address vaccination challenges in the ongoing Ebola outbreak in the Democratic Republic of the Congo (DRC).

The recommendations include endorsing operational adjustments that make the vaccination process faster and adjusting the dosage based on available efficacy data. The SAGE also suggested expanding the population eligible for vaccination with rVSV-ZEBOV-GP (developed by Merck & Co., Inc), introducing an additional experimental vaccine (developed by Johnson & Johnson), and redoubling ongoing efforts to train nurses, doctors and medical students from Ebola-affected communities to work on vaccination teams.
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https://www.who.int/news-room/detail/07-05-2019-who-adapts-ebola-vaccination-strategy-in-the-democratic-republic-of-the-congo-to-account-for-insecurity-and-community-feedback

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?On a knife edge?: Ebola outbreak threatens to escalate as violence rises

By HELEN BRANSWELL MAY 7, 2019
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Michael Osterholm, director of the University of Minnesota?s Center for Infectious Diseases Research and Policy, called the situation unprecedented.

?We are truly in uncharted Ebola-control territory,? Osterholm said. ?Even in the 2014-15 [Ebola] epidemic in West Africa, once public health programs and vaccination efforts were put into place, it brought about a rather rapid reduction of cases. We?ve never encountered a situation where a geographic region becomes almost completely impossible to work in because of insecurity.?

If a way isn?t found quickly to bend the outbreak trajectory, an explosion of cases will follow, Farrar, from the Wellcome Trust, predicted.

?I think at the moment it?s in a phase where it could expand out of control very easily.
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https://www.statnews.com/2019/05/07/ebola-outbreak-escalate-violence/

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Ebola in DRC: a fatal accident again disrupts the response to Butembo

First published: 07/05/2019 - 19:46

Butembo (DR Congo) (AFP)

The death of a motorcycle taxi driver, after a collision with a vehicle of an Ebola team, paralyzed on Tuesday the commercial activities and those of the response to the disease in Butembo in eastern Democratic Republic of Congo.

"A jeep in the Ebola response accidentally rammed a motorcyclist who was killed on the spot and his comrades threw stones at the hospital when they brought the body back to the morgue," the doctor told AFP. Chrisostome Shako from the Matanda General Hospital in Butembo (North Kivu, East).

The doctor said that "these incidents will negatively impact response activities", fearing that Ebola teams will be attacked by motorcycle taxi drivers.

The Ebola epidemic reported in the provinces of North Kivu and Ituri on August 1 totaled 1,045 deaths, according to the latest assessment by the Ministry of Health on Monday.

"All activities in Butembo City have been paralyzed because of a motorcycle accident and Ebola response vehicle," confirmed Butembo police chief Colonel Paul Polo Ngoma.

"Joint patrols of the police and army are deployed to secure the population and their property," said the officer.

It has been three days in a row that Ebola efforts are slowing down due to insecurity in Butembo (a trade hub) that is particularly targeted at the response teams.

Congolese Minister of Health Dr Oly Ilunga warned that every time there is a disruption in response activities, the number of new cases and the number of deaths should be expected to rise.

The current Ebola outbreak is the tenth highest recorded on Congolese soil since 1976. It is the second worst after the one that hit West Africa in 2014 (with more than 11,000 deaths in Guinea, Sierra Leone and in Liberia mainly).

2019 AFP

https://www.france24.com/fr/20190507-ebola-rdc-accident-mortel-perturbe-nouveau-riposte-a-butembo

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BUTEMBO: anger of taxi-motorcycle drivers at the base of the paralysis of socio-economic activities

Posted on: 07/05/2019 at 18h35min01s
By Radio Moto Butembo-Beni

Paralysis of activities this Tuesday, May 07 in Butembo town. For good reason, angry motorcycle taxi drivers have destroyed a van of the agents of the response on the Boulevard Julien PALUKU KAHONGYA not far from the gallery GTB and the shop PALOS.

On site, elements of the order came to calm the situation. But, the two sides did not get along. As a result, police and FARDC soldiers fired live ammunition to disperse the protesters. Under the helpless eyes of the RMBB reporter, private motorcycles and taximen, money and phones were looted by the elements supposed to secure the population. A witness who also lived the scene tells.

"We had just opened our doors in the morning. We saw the taximen follow the van to the taximen parking at the PALOS building. The destruction of the truck then took place. They then explained that the truck had just caused an accident in the ITAV dealership. This is how the police came to crack the bullets in the air. People started to flee and the disorder was started by taximen and police officers. At that moment, the soldiers took people's motorcycles and the situation deteriorated, "said the civilian.

As if that were not enough, the military also burst into the Cathedral Roundabout where MISISA Jackson was trying to gather taximen to find a favorable outcome in relation to the security situation around mid-day. In the field, FARDC elements whipped some taximen again under the powerless eyes of ATAMOV President MISISA Jackson. One of the taximen cried after being hit by boxing and FARDC whips.

"We said we were going to claim because they started to do inconceivable acts against us. When we went very calmly to the Town Hall, they crackled balls and the motorcycles were left alone on the ground. They fled with them, "said the taxi driver, moaning.

It should be noted that taximen were protesting against a driver of the damaged car for stamping a motorcycle taxi driver named LUC de VUTSUNDO.


Posted on: 07/05/2019 at 18h35min01s
By Radio Moto Butembo-Beni

https://radiomotofm.info/lirearticle.php?billet=5823

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EPIDEMIOLOGICAL SITUATION IN THE PROVINCES OF NORTH KIVU AND ITURI Tuesday, May 7, 2019 The epidemiological situation of the Ebola Virus Disease dated May 6, 2019 : Since the beginning of the epidemic, the cumulative number of cases is 1,585, 1,519 confirmed and 66 probable. In total, there were 1,055 deaths (989 confirmed and 66 probable) and 441 people healed. 251 suspected cases under investigation; 13 new confirmed cases, including 4 in Mandima, 2 in Beni, 2 in Lubero, 2 in Kalunguta, 1 in Mabalako, 1 in Katwa and 1 in Masereka; 10 new deaths of confirmed cases, including 4 community / hospital deaths including 1 in Kalunguta, 1 in Katwa, 1 in Mandima and 1 in Masereka; 6 deaths at CTE / CT, including 3 in Mabalako, 2 in Beni and 1 in Butembo; 2 new healed from the CTE of Butembo. /! \ The data presented in this table are subject to change later, after extensive investigations 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. Deaths occurring at the level of the CTEs are provisionally recorded in the health zones of CTE implantation pending reclassification in the health zone of case notification. The probable case category includes all deaths for which it was not possible to obtain biological samples for laboratory confirmation but where the investigations revealed an epidemiological link with a confirmed or probable case. A community death is any death occurring outside of an Ebola Treatment Center. News of the response Security situation The response activities were not able to completely resume this Tuesday, May 7, 2019 in Butembo because of a rumor shared on social networks that the vehicle of a team of the riposte would have overthrown a biker who died on the spot . This rumor having caused a risk of uprising of the population, the teams of the riposte had to limit their displacements in the city this Tuesday. However, at the end of the day, the president of ATAMOV, the bikers' association, denied this rumor. An accident did occur but the motorcycle taxi driver did not die and he continued to work during the day. Since the beginning of May, this is the fourth consecutive day in which the teams have not been able to carry out all the necessary response activities to Butembo. A meeting was held on Tuesday between the city's urban safety committee and motorcycle taxi drivers. The bikers confessed before the members of the urban security committee that they are infiltrated by enemies who commit incidents on their behalf and that some of their members are used by malicious people to destabilize the city. Among the decisions taken, there is notably the census of all true taximen today. The Urban Safety Committee warned motorcyclists who have been warned that if they are still at the base of security incidents impeding the response to Ebola, the committee will be forced to take tougher action against them. The bikers confessed before the members of the urban security committee that they are infiltrated by enemies who commit incidents on their behalf and that some of their members are used by malicious people to destabilize the city. Among the decisions taken, there is notably the census of all true taximen today. The Urban Safety Committee warned motorcyclists who have been warned that if they are still at the base of security incidents impeding the response to Ebola, the committee will be forced to take tougher action against them. The bikers confessed before the members of the urban security committee that they are infiltrated by enemies who commit incidents on their behalf and that some of their members are used by malicious people to destabilize the city. Among the decisions taken, there is notably the census of all true taximen today. The Urban Safety Committee warned motorcyclists who have been warned that if they are still at the base of security incidents impeding the response to Ebola, the committee will be forced to take tougher action against them. there is the census of all true taximen today. The Urban Safety Committee warned motorcyclists who have been warned that if they are still at the base of security incidents impeding the response to Ebola, the committee will be forced to take tougher action against them. there is the census of all true taximen today. The Urban Safety Committee warned motorcyclists who have been warned that if they are still at the base of security incidents impeding the response to Ebola, the committee will be forced to take tougher action against them. The triage service of the Sainte Famille Mukuna hospital center in the health zone of Katwa was burned by incivists. As part of the Ebola outbreak, razors were constructed at the entrance of the city's main hospitals and health centers. The yards are structures through which patients wanting to go to the hospital must pass to disinfect their hands and shoes as well as take their temperature. In order to reduce the risk of hospitalization of confirmed patients and thus nosocomial infections in the health facilities of the city, it was important to sort the patients before they entered the hospital.

Vaccination Since the start of vaccination on August 8, 2018, 112,225 people have been vaccinated , of which, 30,432 in Katwa, 23,681 in Beni, 13,803 in Butembo, 7,202 in Mabalako, 5,218 in Mandima, 3,608 in Kalunguta, 3,070 in Goma, 2,879 in Komanda, 2,569 at Oicha, 1,980 at Kayna, 1,930 at Masereka, 1,915 at Vuhovi, 1,748 at Kyondo, 1,487 at Bunia, 1,372 at Lubero, 1,357 at Karisimbi, 1,197 at Musienene, 1,025 at Biena, 1,012 at Mutwanga, 690 at Rutshuru, 557 in Rwampara (Ituri), 527 in Nyankunde, 496 in Mangurujipa, 420 in Mambasa, 355 in Tchomia, 342 in Kirotshe, 333 in Lolwa, 254 in Alimbongo, 250 in Mweso, 245 in Kibirizi, 161 in Nyiragongo, 97 in Watsa (Haut-U?l?) and 13 in Kisangani. On Tuesday, May 7, 2019, the World Health Organization (WHO) Strategic Advisory Group of Experts (SAGE) released several recommendations to adapt the Ebola vaccination strategy to address insecurity and community feedback. . These recommendations include expanding the targeted population by adding an additional experimental vaccine manufactured by Johnson & Johnson, as well as the greater use of pop-up vaccination and targeted geographic vaccination. In addition, it was recommended that vaccine doses be adjusted to increase the number of people who can be vaccinated. The targeted geographic immunization strategy is the strategy already used by Ministry of Health vaccinators in unsecured areas such as villages controlled by community militias (Mayi-Mayi). Targeted geographic vaccination, which is wider than vaccination in the belt, consists of vaccinating several houses around a confirmed case, or even an entire village or neighborhood, when the security conditions do not allow the necessary investigations to be made to establish the list of contacts. . To date, the authorized Congolese authorities, namely the Scientific Committee, the Ethics Committee, the Expanded Program on Immunization and the Directorate of Pharmacy and Medicine (DPM), have not approved the use of another vaccine that the vaccine rVSV-ZEBOV, manufactured by the pharmaceutical group Merck. Congolese authorities have already received applications for the use of three other vaccines as part of the ongoing Ebola outbreak. The different requests are being analyzed. A comparative scientific analysis of these different vaccines is needed to determine which one will be most effective in limiting the number of Ebola victims in the provinces of North Kivu and Ituri.

WEEKLY SUMMARY OF EPIDEMIOLOGICAL DATA Week 18 (April 29 to May 5, 2019) For the week of April 29 to May 5, 2019, we recorded: 1,840 suspected cases investigated and tested in the laboratory 106 new confirmed cases : The main focus of the epidemic remains Katwa with 41 of the 106 new confirmed cases of the week, or 38.7%. 88 deaths of confirmed cases: The town of Butembo is also the main focus of confirmed case fatalities reported last week. The health zones of Butembo and Katwa together reported 49 of the 88 new confirmed cases, or 55.7%; Other important foci are Mabalako and Mandima; Of the 88 deaths, 47 were community deaths, or 53.4%, and 41 occurred in an ETC. 28 new healed people came out of CTEs. /! \ Due to the paralysis of the response activities in Butembo and neighboring areas since this Saturday, May 4, 2019, the figures presented above are undervalued compared to the reality on the ground.

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DRC: Butembo, in the East, target of new attack

By RFI Published on 08-05-2019 Last modified on 08-05-2019 at 15:37

In the eastern DRC, in Butembo town, at least 8 militiamen were killed and another wounded during the army's counter-offensive, according to his spokesman. A policeman is also dead. As a result, the work of the Ebola Epidemic Teams, which continue to spread rapidly and of which Butembo is currently one of the main outbreaks, has again been disrupted.

It was around 5.30 am that the attack was launched according to Butembo Mayor Sylvain Kanyamanda. The attackers were dressed in "civilians" and equipped with white weapons, firearms, but also with grigris. The assailants, suspected Mai-Mai, have targeted, he says, a military position in the northern part of the city. The local civil society evokes clashes in several strategic points. The clashes reportedly stopped around 10am in the city center according to witnesses. But sporadic gunfire was still heard on the outskirts of Butembo in the middle of the morning.

Did the attackers plan to attack the Ebola response teams? Impossible to say at this point. The hearing of at least one captured attacker, according to the authorities, should make it possible to know more about said the mayor of the city. In any case, the activities of the medical teams in charge of fighting the epidemic were once again paralyzed this morning.

Already on Tuesday, they were severely slowed following the death of a motorcycle taxi driver who collided with a vehicle from the response team, which resulted in stone-throwing against the general hospital and fueled the fire. crisis of trust between medical teams and the population. Last Friday, two bikers had already lost their lives during a clash that took place on the site of a safe burial of a patient who died of Ebola, resulting in two days of demonstrations, reports the civil society of Butembo.

It has been five days now since Ebola response activities are slowing down. This raises the fear of outbreaks of contaminations and deaths linked to the disease.

http://www.rfi.fr/afrique/20190508-rdc-butembo-est-cible-nouvelle-attaque

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EPIDEMIOLOGICAL SITUATION IN THE PROVINCES OF NORTH KIVU AND ITURI Wednesday, May 8, 2019 The epidemiological situation of the Ebola Virus Disease dated May 7, 2019 : Since the beginning of the epidemic, the cumulative number of cases is 1,600, of which 1,534 are confirmed and 66 are probable. In total, there were 1,069 deaths (1,003 confirmed and 66 probable) and 442 people healed. 267 suspected cases under investigation; 15 new confirmed cases, including 5 in Katwa, 4 in Kalunguta, 4 in Mabalako, 1 in Mandima and 1 in Musienene; 14 new confirmed case deaths, including 10 community / hospital deaths including 4 in Kalunguta, 4 in Mabalako, 1 in Katwa and 1 in Musienene; 4 CTE / CT deaths, 2 in Mabalako, 1 in Katwa and 1 in Butembo; 1 new healed patient from Mabalako CTE; Two Katwa health workers, including one vaccinated, are among the new confirmed cases. The cumulative number of confirmed / probable cases among health workers is 97 (6% of all confirmed / probable cases), including 34 deaths. /! \ The data presented in this table are subject to change later, after extensive investigations 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. Deaths occurring at the level of the CTEs are provisionally recorded in the health zones of CTE implantation pending reclassification in the health zone of case notification. The probable case category includes all deaths for which it was not possible to obtain biological samples for laboratory confirmation but where the investigations revealed an epidemiological link with a confirmed or probable case. A community death is any death occurring outside of an Ebola Treatment Center. News of the response Security situation Armed men launched several attacks in the town of Butembo on Wednesday, May 8, 2019 around 5:30 am. The attackers were repulsed by the Armed Forces of the Democratic Republic of Congo (FARDC). A dozen attackers were killed and six were captured. A policeman from the city also died in the attack. Because of this new security incident, the response teams have limited their movements in the city. Only a minimum service was performed. Since the beginning of May, this is the fifth consecutive day in which the response teams have not been able to carry out all the necessary response activities in Butembo, such as active case finding in the community, vaccination and dignified and secure burials. The triage of the Masiki Health Center in Katwa Health Zone was set on fire on Tuesday, May 7, 2019. A dignified and secure burial team officer was murdered in Vuhovi on the night of May 7 to 8, 2019. It was in this health zone that the nurse in charge of the Isonga health area had been kidnapped and killed in February 2019. Vaccination Since vaccination began on 8 August 2018, 112,485 people have been vaccinated , including 30,432 in Katwa, 23,752 in Beni, 13,803 in Butembo, 7,202 in Mabalako, 5,407 in Mandima, 3,608 in Kalunguta, 3,070 in Goma, 2,879 in Komanda, 2,569 at Oicha, 1,980 at Kayna, 1,930 at Masereka, 1,915 at Vuhovi, 1,748 at Kyondo, 1,487 at Bunia, 1,372 at Lubero, 1,357 at Karisimbi, 1,197 at Musienene, 1,025 at Biena, 1,012 at Mutwanga, 690 at Rutshuru, 557 in Rwampara (Ituri), 527 in Nyankunde, 496 in Mangurujipa, 420 in Mambasa, 355 in Tchomia, 342 in Kirotshe, 333 in Lolwa, 254 in Alimbongo, 250 in Mweso, 245 in Kibirizi, 161 in Nyiragongo, 97 in Watsa (Haut-U?l?) and 13 in 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.

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EPIDEMIOLOGICAL SITUATION

EVOLUTION OF THE EBOLA EPIDEMIC IN THE PROVINCES OF NORTH KIVU AND ITURI Thursday 9 May 2019 The epidemiological situation of the Ebola Virus Disease dated 8 May 2019 : Since the beginning of the epidemic, the cumulative number of cases is 1,604, of which 1,538 are confirmed and 66 are probable. In total, there were 1,074 deaths (1,008 confirmed and 66 probable) and 442 people healed. 264 suspected cases under investigation; 4 new confirmed cases, including 3 in Mabalako and 1 in Beni; 5 new deaths of confirmed cases, including 3 community deaths, 2 in Mabalako and 1 in Beni; 2 deaths at CTE Mabalako. /! \ Paralysis of the activities of the Butembo sub-coordination on Wednesday, May 8, 2019.

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Ebola virus disease ? Democratic Republic of the Congo

Disease outbreak news: Update
9 May 2019

The Ebola virus disease (EVD) outbreak response this past week continues to be hampered by insecurity. On 3 May in Katwa, a Safe and Dignified Burial (SDB) team was violently attacked following the completion of a burial for a deceased EVD case. In Butembo and surrounding health zones, response activities were repeatedly halted due to a number of serious security incidents taking place from 4-6 May. On 8 May, a group of over 50 armed militia infiltrated the city centre. Security forces repelled the attack following intense gunfire in close proximity to staff accommodations. Although activities resumed on 9 May, after almost five consecutive days of suspension, threats of further attacks against EVD response teams and facilities remain prevalent.
These security incidents, and especially the resultant lack of access to EVD affected communities, remain a major impediment to the response, with teams unable to perform robust surveillance nor deliver much needed treatment and immunisations. The ongoing violent attacks sow fear, perpetuate mistrust, and further compound the multitude of challenges already faced by frontline healthcare workers. Without commitment from all groups to cease these attacks, it is unlikely that this EVD outbreak can remain successfully contained in North Kivu and Ituri provinces.
EVD transmission remains most intense in Katwa, Butembo, Mandima, Mabalako, Musienene, Beni and Kalunguta hotspot health zones, which collectively account for the vast majority (93%) of the 303 cases reported in the last 21 days between 17 April ? 7 May 2019 (Figure 1 and Table 1). During this period, new cases were reported from 78 health areas within 15 of the 21 health zones affected to date (Figure 2). It is expected that the resumption of response activities will bring a substantial increase in the number of cases reported in the coming weeks due to the backlog from the disruptions.
As of 7 May, a total of 1600 confirmed and probable EVD cases have been reported, of which 1069 died (case fatality of 67%). Of the total cases with recorded sex and age, 57% (907) were female and 30% (475) were children aged less than 18 years. The number of healthcare workers affected has risen to 97 (6% of total cases). 442 EVD patients who received care at Ebola Treatment Centres (ETCs) have been successfully discharged.
Adapted vaccination strategies

On 7 May 2019, the Strategic Advisory Group of Experts (SAGE) issued new vaccination recommendations in light of the increasing number of EVD cases and continued insecurity in this outbreak in the Democratic Republic of the Congo (click here for the full recommendations). The panel made recommendations pertaining to adjusting vaccine dosages, expanding vaccine eligibility, ring vaccination operational improvements, and strengthening training of local healthcare workers to aid in the EVD response.
The rVSV ZEBOV GP vaccine dosage and eligibility criteria have been revised. For high-risk individuals such as contacts and contacts of contacts, the new SAGE recommendations advise the use of 0.5mL of vaccine instead of 1mL. This revised dose has been previously used during the 2015 Ebola ?a Suffit! trial in Guinea, and is expected to provide similar efficacy in this current EVD outbreak. Those at lower risks are now to receive 0.2mL instead. SAGE also recommends expanding the accessibility of the vaccine to more individuals in affected health areas. In addition to high-risk individuals, it is now recommended that individuals who are potential contacts due to their residence in the villages or neighbourhoods with incident cases (i.e. where EVD cases have been reported in the last 21 days) be offered the rVSV ZEBOV GP vaccine. SAGE believes that by expanding vaccine eligibility, this would address some of the requests from communities in affected health areas for the vaccine to be more widely available, foster greater trust, and improve willingness of communities to engage with other EVD response activities.
SAGE advised the implementation of an adaptive operational approach to ring vaccinations, implemented in two main methods: pop-up vaccinations and targeted geographic vaccinations. Pop-up vaccination would be conducted by inviting contacts and contacts of contacts to a previously agreed upon temporary location some distance away from the residence of contacts. In areas where accurate identification of contacts and contacts of contacts is not possible due to insecurity, targeted geographic vaccination of whole villages or quartiers would be administered at a fixed location with security present. Both of these vaccination operational methods have been utilised successfully before, and are expected to make the vaccination process more efficient and secure for both healthcare providers and the patients they are caring for.
SAGE additionally recommends offering an alternative vaccine (other than rVSV-ZEBOV-GP) to those at lower risk within affected health areas or neighbouring areas. WHO has reviewed evidence provided by two vaccine manufacturers, and the adenovirus 26 vectored glycoprotein / MVA-BN (Ad26.ZEBOV/MVA-BN) investigational Ebola vaccine is being considered and evaluated by a coalition led by the Coalition for Epidemic Preparedness (CEPI) and the London School of Hygiene & Tropical Medicine. At this time, this vaccine is in the late stages of formal trials and is expected to be deployed to the field in the near future. These efforts are in line with previous SAGE recommendations regarding the need for more studies to assess the efficacy of additional, alternative Ebola vaccines.
SAGE also supported the proposal to introduce alternative individual informed consent forms and follow up procedures which can potentially simplify and expedite both the vaccination and safety follow up processes. Aside from pregnant women who will be actively followed up until delivery or end of pregnancy, and infants 6-12 months of age who will receive a single visit at day 21, all other case follow up will be completed through passive reporting of adverse events via telephone.
In addition to technical recommendations, WHO and partners are working closely with residents of Ebola-affected communities to empower them to take on greater ownership of the EVD response. Through intensifying training and engagement with local community members, WHO aims to have the majority of vaccination teams comprised of local healthcare providers by the end of the month. Other key elements to transferring ownership of the response to the communities includes fulfilling community requests made in relation to development projects, and ensuring all persons residing in at-risk areas are well-informed about the status of the outbreak, transmission prevention, and availability of care through further mass communication initiatives.
Confirmed and probable Ebola virus disease cases by week of illness onset by health zone. Data as of 7 May 2019*




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*Data in recent weeks are subject to delays in case confirmation and reporting, as well as ongoing data cleaning. Other health zones include: Biena, Bunia, Kalunguta, Kayna, Komanda, Kyondo, Lubero, Mangurujipa, Masereka, Musienene, Mutwanga, Nyankunde, Oicha, Rwampara and Tchomia.
Figure 2: Confirmed and probable Ebola virus disease cases by health area, North Kivu and Ituri provinces, Democratic Republic of the Congo, data as of 7 May 2019




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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 7 May 2019**




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**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 detailed information about the public health response actions by the MoH, WHO, and partners, please refer to the latest situation reports published by the WHO Regional Office for Africa:

• Ebola situation reports: Democratic Republic of the Congo

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 concluded that the national and regional risk levels remain very high, while global risk levels remain low. Weekly increases in the number of new cases has been ongoing since late February 2019. A general deterioration of the security situation, and the persistence of pockets of community mistrust exacerbated by political tensions and insecurity, have resulted in recurrent temporary suspension and delays of case investigation and response activities in affected areas, reducing the overall effectiveness of interventions. However, recent community dialogue, outreach initiatives, and restoration of access to certain hotspot areas have resulted in some improvements in community acceptance of response activities and case investigation efforts. The high proportion of community deaths reported among confirmed cases, 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 in ETCs, and challenges in the timely reporting and response to probable cases, are all factors increasing the likelihood of further chains of transmission in affected communities and increasing the risk of geographical spread both within the Democratic Republic of the Congo and to neighbouring countries. The high rates of population movement occurring from outbreak affected areas to other areas of the Democratic Republic of the Congo and across porous borders to neighbouring countries during periods of heightened insecurity further compounds these risks. Additional risks are posed by the long duration of the current outbreak, fatigue amongst response staff, and ongoing strain on limited resources. Conversely, substantive operational readiness and preparedness activities in a number of neighbouring countries have likely increased capacity to rapidly detect cases and mitigated local spread. However, these efforts must continue to be scaled-up at this time.
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 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, please see:

• Press briefing on Ebola, WHO Director-General Dr Tedros
• WHO Director-General reiterates commitment to Ebola response despite another attack
• WHO expresses concern over damage to Ebola treatment facilities in DRC
• Highlights from the April 2019 meeting of the IHR Emergency Committee on the EVD outbreak in the Democratic Republic of the Congo
• SAGE interim recommendations on vaccination against EVD, 20 February 2019
• WHO Interim recommendation Ebola vaccines
• Ebola response in Democratic Republic of the Congo risks slowdown
• WHO recommendations for international travellers related to the Ebola Virus Disease outbreak in the Democratic Republic of the Congo
• Ebola virus disease in the Democratic Republic of the Congo ? Operational readiness and preparedness in neighbouring countries
• Ebola virus disease fact sheet

https://www.who.int/csr/don/09-may-2019-ebola-drc/en/

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MSF: no one knows where the situation is with Ebola

THIS CONTENT WAS PUBLISHED ON MAY 10, 2019 16: 5510. MAY 2019 - 16:55
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KEYSTONE / EPA / HUGH KINSELLA CUNNINGHAM

(SDA-ats)

"We do not know how bad the situation is" on Ebola in the DRC, according to M?decins Sans Fronti?res (MSF). The NGO welcomes recent announcements from WHO and does not know when it will be able to restart activities in Butembo and Katwa after the attacks against it.

"We do not see a positive evolution" to the epidemic, said in an interview Friday with Keystone-ATS MSF emergency coordinator for the response to Ebola in the Democratic Republic of Congo (DRC), Trish Newport. The number of cases is accelerating and now exceeds 1600 confirmed and suspects, while that of the victims has passed the 1000 last week.

In recent weeks, more than 80% of people added to this total had not been identified as suspected in their health center. Insecurity increases and recent cases extension is not linked to "poor response" but "lack of access," said Ms Newport, on the margins of the General Assembly of MSF Switzerland in Geneva.

On Wednesday, a health worker was killed, a few days after a doctor of the World Health Organization (WHO). Like this institution, Mrs Newport raises the threat of extension to other parts of the country but also to neighboring states.

A few months ago, MSF International President Joanne Liu called on all actors in Geneva to change their approach and felt that the answer had "failed". For his part, WHO Director-General Tedros Adhanom Ghebreyesus still believed that the epidemic could be controlled in a few months.

Extension of the expected vaccination

But his institution announced last week "smaller" transit centers run by communities. An announcement greeted by Ms. Newport who can not assess when the epidemic can be eliminated. A dialogue with the communities "will not solve all the problems" but "it is a first step" crucial to fight against the virus, she adds.

Another announcement from the WHO that she welcomes if it is in line with the will of the communities, vaccination is now planned outside the difficult areas and will extend to a wider population. The NGO will be involved in these efforts.

Some people blame international actors for not having worked during the massacres in the region in recent years, nor for fighting against malaria. They say these organizations "are not worried" about their situation, says Ms Newport. According to her, it is necessary to answer all the problems of these populations to succeed to control Ebola.

MSF admits its own "mistakes" and has recently changed its approach to make it more relevant to local needs. She provided assistance for water sanitation and care for all diseases and not just Ebola. While maintaining a separation of people affected by the virus to avoid infections of other patients, responsible for many new recent cases.

Dozens of employees

According to Ms Newport, only confirmed cases should be treated in treatment centers, and suspected cases should be identified upstream directly with key people in the communities that patients first visit.

MSF has not been spared from attacks by armed groups. She had to suspend her two treatment centers in Butembo and Katwa. "Before coming back, we have to make sure that the communities want it" and that the security "currently uncertain" allows it, says the head of MSF Switzerland. Civil society needs to convince this area that Ebola is a problem.

Dozens of MSF employees are still in the DRC and the NGO is supporting a treatment center and piloting two transit centers, one of which is still functioning.

https://www.swissinfo.ch/fre/msf--personne-ne-sait-o%C3%B9-en-est-la-situation-avec-ebola/44955442

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EPIDEMIOLOGICAL SITUATION

EVOLUTION OF THE EBOLA EPIDEMIC IN THE PROVINCES OF NORTH KIVU AND ITURI Friday, May 10, 2019 The epidemiological situation of the Ebola Virus Disease dated 9 May 2019 : Since the beginning of the epidemic, the cumulative number of cases is 1,649, of which 1,561 are confirmed and 88 are probable. In total, there were 1,105 deaths (1,017 confirmed and 88 probable) and 444 people healed. 310 suspected cases under investigation; 23 new confirmed cases, including 5 in Katwa, 5 in Butembo, 2 in Kalunguta, 2 in Mandima, 2 in Mangurudjipa, 2 in Musienene, 2 in Mabalako, 2 in Lubero and 1 in Beni; 9 new deaths of confirmed cases, including 8 community deaths, 2 in Mandima, 2 in Kalunguta, 1 in Mabalako, 1 in Musienene, 1 in Beni and 1 in Lubero; 1 death at Katwa CTE; 22 new validated probable cases, including 12 in Vuhovi, 3 in Katwa, 2 in Kalunguta, 2 in Lubero, 2 in Masereka and 1 in Biena; These are community deaths that occurred between January 30 and May 8, 2019 for which it was not possible to obtain biological samples for confirmation in the laboratory but where the investigations revealed an epidemiological link with a confirmed or confirmed case. probable; 2 new cures, including 1 in Komanda and 1 in Beni. /! \ The data presented in this table are subject to change later, after extensive investigations 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. Deaths occurring at the level of the CTEs are provisionally recorded in the health zones of CTE implantation pending reclassification in the health zone of case notification. The probable case category includes all deaths for which it was not possible to obtain biological samples for laboratory confirmation but where the investigations revealed an epidemiological link with a confirmed or probable case. A community death is any death occurring outside of an Ebola Treatment Center. Distribution of Ebola Virus Disease (EVD) Cases by Health Zone in the Provinces of Ituri and North Kivu as of 9 May 2019 Epidemiological curve since January 2019 NEWS Visit of the Special Representative of the UN Secretary-General in Butembo Ms. Le?la Zerrougui, the UN Secretary-General's Special Representative in the DRC and Head of MONUSCO, visited the Butembo response teams on Friday, May 10, 2019. She met with members of the sub-coordination of Butembo. Highlights of the visit focused on the degrading security situation and the spread of the Ebola outbreak in Butembo and surrounding areas. This senior UN official in the DRC reiterated United Nations support for the response team to prevent the epidemic from being declared a public health emergency of international concern. She added that the Secretary-General of the United Nations and the President of the Democratic Republic of the Congo accord particular priority to the fight against this disease. She also urged coordination and partners in the response to better align intelligence to respond to challenges to build trust with communities.

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EPIDEMIOLOGICAL SITUATION

EVOLUTION OF THE EBOLA EPIDEMIC IN THE PROVINCES OF NORTH KIVU AND ITURI Saturday, May 11, 2019 The epidemiological situation of the Ebola Virus Disease dated May 10, 2019 : Since the beginning of the epidemic, the cumulative number of cases is 1,662, of which 1,574 confirmed and 88 probable. In total, there were 1,112 deaths (1,024 confirmed and 88 probable) and 446 people healed. 325 suspected cases under investigation; 13 new confirmed cases, including 5 in Butembo, 2 in Kalunguta, 2 in Mandima, 1 in Musienene, 1 in Mabalako, 1 in Katwa and 1 in Masereka; 7 new confirmed case deaths, including 6 community deaths, including 3 in Butembo, 2 in Kalunguta and 1 in Katwa; 1 death at the CTE of Mabalako; 2 new cures out of ETCs, including 1 in Butembo and 1 in Beni; 1 non-vaccinated Butembo health worker is one of the new confirmed cases. The cumulative number of confirmed / probable cases among health workers is 98 (5.9% of all confirmed / probable cases), including 34 deaths.

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EPIDEMIOLOGICAL SITUATION

EVOLUTION OF THE EBOLA EPIDEMIC IN THE PROVINCES OF NORTH KIVU AND ITURI Sunday, May 12, 2019 The epidemiological situation of the Ebola Virus Disease dated May 11, 2019 : Since the beginning of the epidemic, the cumulative number of cases is 1,680, of which 1,592 are confirmed and 88 are probable. In total, there were 1,117 deaths (1,029 confirmed and 88 probable) and 450 people healed. 268 suspected cases under investigation; 18 new confirmed cases, including 5 in Mabalako, 4 in Beni, 2 in Mangurudjipa, 2 in Kalunguta, 1 in Butembo, 1 in Mandima, 1 in Musienene, 1 in Katwa and 1 in Kyondo; 5 new deaths of confirmed cases, including 4 community deaths, including 1 in Butembo, 1 in Kalunguta, 1 in Kyondo and 1 in Beni; 1 death at Katwa CTE; 4 new healed CTE survivors, including 3 in Katwa and 1 in Butembo; One of Manugurujipa's unvaccinated health workers is one of the new confirmed cases. The cumulative number of confirmed / probable cases among health workers is 99 (5.9% of all confirmed / probable cases), including 34 deaths. /! \ The data presented in this table are subject to change later, after extensive investigations 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. Deaths occurring at the level of the CTEs are provisionally recorded in the health zones of CTE implantation pending reclassification in the health zone of case notification. The probable case category includes all deaths for which it was not possible to obtain biological samples for laboratory confirmation but where the investigations revealed an epidemiological link with a confirmed or probable case. A community death is any death occurring outside of an Ebola Treatment Center. Distribution of Ebola Virus Disease (EVD) Cases by Health Zone in the Provinces of Ituri and North Kivu as of May 11, 2019 Epidemiological curve since January 2019 NEWS Release of a new miraculous baby from Katwa CTE A 42-day-old baby was discharged from the Katwa CTE on Saturday, May 11, 2019. Daniella was admitted to the CTE with her mother on April 11, 2019 when she was only 12 days old. Her mother, who arrived in a state of advanced coma, died at CTE the next day. Daniella was collected on April 12 and was positive. After 30 days of treatment with mAb 114, Daniella was cured. She survived thanks to the work of the health staff and the nannies who took turns at her bedside 24 hours a day but also because she was taken care of as soon as she became ill. Nannies are men and women cured of Ebola, and therefore immune to the virus, who care for sick children and babies during their hospitalization. Medical management in Butembo and Katwa Since the departure of M?decins Sans Fronti?res (MSF) from the health zones of Butembo and Katwa following the deterioration of the security situation last February, the management of the two Ebola Treatment Centers (ETCs) in the city of Butembo has been taken over by the Ministry of Health in partnership with the World Health Organization (WHO) and UNICEF since March 2019. Since this transfer of management, many changes have been made to the medical care of patients suffering from Ebola. These changes include: Increased number of health providers in CTEs. The new managers continued to work with MSF-trained caregivers, but they also recruited more care providers to ensure better individual follow-up for each patient. Moreover, from now on, the whole of the medical staff is Congolese and has been recruited locally. Improvement of the nutritional care of the patients which increases their chance of survival. Creation of a team dedicated exclusively to admissions to reduce the waiting time for admission. Involvement of the family from the beginning of the treatment of patients with the support of psychologists. Two months after this transfer of management, it was important to conduct an analysis to assess the quality of medical care for Ebola patients. The main conclusions of this analysis are: The average duration of hospitalization in CTEs has been reduced, allowing more patients to be treated for the same duration. At Butembo CTE, the average duration of hospitalization increased from 9 to 4 days. And at the Katwa CTE, the average length of stay was 7 to 5 days. There was a reduction in the intra-CTE lethality rate and an increase in the survival rate. Without taking into account those who died less than 48 hours after admission to the CTE, the case-fatality rate for confirmed patients increased from 43.4% to 31.1% in the Butembo CTE and from 43.2% to 33.8%. % at Katwa CTE. As a corollary, Butembo's CTE survival rate increased from 56.6% to 68.9%. At the Katwa CTE, the survival rate increased from 56.8% to 66.2%. These data come from the patient database compiled by the Ministry of Health and partners involved in medical care. These data are encouraging as they prove that local health workers are now able to properly care for Ebola patients. It is a great success to congratulate and encourage. Decentralized operational approach The Ministry of Health invited MSF to present their "decentralized operational approach" project at a strategic meeting in Kinshasa this Thursday, May 9, 2019. In summary, the MSF project is structured around three axes: OPTION 1 : If the patients accept it, they will be treated in the CTE which remain the reference places for the management of confirmed Ebola patients and who guarantee the best survival rate. OPTION 2 : If patients do not wish to visit an ETC, they may go to a local health center or hospital that is prepared to accommodate them. OPTION 3 : If patients do not wish to visit a CTE or a health center, they could be cared for at home with the support of the patient and the family with training in transmission reduction with equipment individual protection 'light' and in symptomatic treatment with supervision (if possible). Many questions, suggestions and concerns were shared by the Ministry of Health and the technical and financial partners present at this meeting. These questions include: How to ensure team safety in such a decentralized approach? How to ensure strict compliance with prevention measures at the community health centers and at home? What to answer to patients who would like to be cared for in traditional healer centers that are very popular? How will families manage contaminated biological fluids for home treatment? Can daily support for health centers or families be done remotely when response teams are unable to move about the city due to a security incident? MSF was also asked to draw lessons learned from Beni and Mangina where the decentralized approach in the hospitals was used early in the response, prior to the construction of the CTEs. In both areas, this decentralized approach has led to a high rate of nosocomial infections and a high level of contamination among health care workers. A workshop will be organized in the coming weeks with the actors in the field to evaluate the relevance, the feasibility and the acceptability of this approach. Community dialogues will also be organized to involve communities in the choice of response strategies to use.

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Ebola in the DRC: an attacked treatment center

By Le Figaro with AFP Posted on 13/05/2019 at 12:47

An assailant was killed in the night of Sunday to Monday by security forces who repelled a new attack on an Ebola treatment center (ETC) in eastern Democratic Republic of Congo, AFP learned. administrative source.

"An attack on an Ebola treatment center in Katwa has been repelled by the army and the police. A Mayi-Mayi (rebel) was killed in the counteroffensive of the security forces, "told AFP Sylvain Kanyamanda, mayor of Butembo (North Kivu). "The security forces prevented these attackers from crossing a 40-meter perimeter around the ETC, thus sparing the sick and CTE facilities," added Sylvain Kanyamanda.

In this area of North Kivu, the Ebola response is complicated by the presence of armed groups and the "resistance" of a part of the population (denial of the disease, refusal of prevention, care, funerals "Dignified and secure" led by the Red Cross). In eastern Congo, the Mai-Mai are militia members of armed community self-defense groups.
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http://www.lefigaro.fr/flash-actu/ebola-en-rdc-un-centre-de-traitement-attaque-20190513

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Ebola: a Belgian vaccine ready to immunize 1.5 million patients in the DRC

This is an experimental vaccine.

Posted on 13/05/2019 at 08:58 by Belga

An experimental Ebola vaccine developed by Janssen Pharmaceutica is ready for delivery to the Democratic Republic of Congo. The Belgian company estimates that half a million patients could be vaccinated in the short term, and "if necessary" even 1.5 million people, report titles Mediahuis Monday.

The World Health Organization (WHO) has already given the green light to the vaccine, but Janssen Pharmaceutica is now waiting for authorization from the Congolese authorities. Negotiations would be in the home stretch.

More than 111,000 Congolese have already received an experimental vaccine against the Ebola virus. But as the number of patients continues to climb, especially in the provinces of North Kivu and Ituri in the west, WHO wants to accelerate vaccinations.

Previously an effective experimental vaccine developed by the American company Merck was used. But to keep the stocks, the vaccine Janssen Pharmaceutica is also taken into account. The Belgian company developed the product with the Danish company Bavarian Nordic.

"We know that our vaccine needs a little more time to properly protect people," said Johan Van Hoof, head of the Janssen Vaccines department. "This is why it is appropriate for people at lower risk of contracting the Ebola virus than for those who have had some contact with patients. "

https://www.lesoir.be/223921/article/2019-05-13/ebola-un-vaccin-belge-pret-immuniser-15-million-de-patients-en-rdc