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DRC - Ebola outbreak in North Kivu and Ituri: July 30, 2018+
EPIDEMIOLOGICAL SITUATION IN THE PROVINCES OF NORTH KIVU AND ITURI
Friday, March 22, 2019
The epidemiological situation of the Ebola Virus Disease dated 21 March 2019 :
Since the beginning of the epidemic, the cumulative number of cases is 993, of which 928 are confirmed and 65 are probable. In total, there were 621 deaths (556 confirmed and 65 probable) and 318 people cured.
231 suspected cases under investigation;
2 new confirmed cases, including 1 in Mandima and 1 in Masereka;
7 new confirmed case deaths, including
2 community deaths: 1 in Mandima and 1 in Masereka;
5 deaths at Butembo CTE.
/! \ 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
Vaccination
Since the start of vaccination on 8 August 2018, 90,650 persons have been vaccinated , including 22,622 in Katwa, 21,036 in Beni, 11,027 in Butembo, 6,109 in Mabalako, 2,985 in Kalunguta, 2,833 in Mandima, 2,851 in Goma, 2,317 in Komanda, 2,147 to Oicha, 1,540 to Kayina, 1,429 to Masereka, 1,408 to Bunia, 1,389 to Kyondo, 1,357 to Karisimbi, 1,271 to Vuhovi, 1,025 to Biena, 1,021 to Lubero, 936 to Musienene, 772 to Mutwanga, 690 to Rutshuru, 557 in Rwampara (Ituri), 527 in Nyankunde, 496 in Mangurujipa, 355 in Tchomia, 333 in Lolwa, 307 in Kirotshe, 280 in Mambasa, 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.
"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
The Ebola virus disease (EVD) outbreak in North Kivu and Ituri provinces has recently shown an increase in the number of cases reported by week, after many weeks of overall decline (Figure 1). This rise is not unexpected and, in part, likely a result of the increased security challenges, including the recent direct attacks on treatment centers, and pockets of community mistrust, which slowed some response activities in affected areas for a few days.
Katwa, Butembo, Masereka and Mandima account for over 80% of all cases in the last 21 days. A total of 97 confirmed cases were reported during the last 21 days from 38 of the 130 health areas affected to date (Table 1, Figure 2). This week, EVD was confirmed in an infant who died in Bunia Health Zone, but whose parents are in good health. This is the first confirmed case from this health zone; a previous case was identified from neighbouring Rwampara Health Zone in early February. While investigations are ongoing to determine the source of the infection, teams in place have rapidly implemented response activities including contact tracing, vaccination and heightened surveillance. Given the geographical spread of the epidemic and the high mobility in this region, the risk of Ebola spreading to unaffected areas or being reintroduced to previously affected areas remains high.
Response teams are fully operational in all outbreak affected areas. There are encouraging improvements in community acceptance of the response, despite the ongoing challenges of insecurity caused by armed groups. Over 90% of people eligible for vaccination have accepted to do so, and over 90% of these individuals having participated in follow-up visits. To date, 89 855 people have been vaccinated. Vaccination teams are continuing to follow-up on the rings where some families have not yet accepted the intervention.
Field laboratories have sustained similar testing rates as previous weeks. On average, 1300 samples are tested weekly and more than 23 000 samples have been tested to date with a turnaround time of less than 48 hours. Ebola Treatment Centres (ETCs) and Transit Centres continue to operate, and the Katwa Transit Centre is being scaled up by ALIMA to increase capacity to respond to the outbreak in that area. To date, 335 patients have received one of the four investigational therapeutics under the MEURI protocol (compassionate use), and 80 patients under the RCT protocol.
In Butembo, Katwa, and Vuhovi health zones, response teams have continued to engage communities through various community dialogue platforms. Five community dialogue platforms have been organised in three health areas in Katwa, one health area in Butembo and one health area in Vuhovi. This initiative allows community members to participate and lead in decisions regarding Ebola response interventions in their localities. In other EVD-affected areas, ongoing activities include systematic collection of community feedback and responding to community concerns through adjustments of activities in consultation with community leaders and influencers. Community outreach activities are carried out in faith-based settings, market places, and schools with the collaboration of faith-based leaders and civil society groups (including women and youth). Civil society groups and community health volunteers also assist in the door-to-door community outreach activities on a regular basis.
Since the beginning of the outbreak to 19 March 2019, 980 EVD cases1 (915 confirmed and 65 probable) have been reported, of which 57% (554) were female and 30% (293) were children aged less than 18 years. Cumulatively, cases have been reported from 130 of 339 health areas across 21 health zones of the North Kivu and Ituri provinces (Table 1). Overall, 610 deaths (case fatality ratio: 62%) have been reported, and 317 patients have been discharged after treatment in ETCs. Figure 1: Confirmed and probable Ebola virus disease cases by week of illness onset, data as of 19 March 2019*
*Data in recent weeks are subject to delays in case confirmation and reporting, as well as ongoing data cleaning. 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 17 March 2019
Enlarge image Table 1: Confirmed and probable Ebola virus disease cases, and number of health areas affected, by health zone, North Kivu and Ituri provinces, Democratic Republic of the Congo, data as of 19 March 2019
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:
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. Attacks on ETCs in Katwa and Butembo represented the first large-scale and organized attacks targeted directly at the Ebola response, and were of a different order of magnitude to episodes of mistrust in communities or dangers of being caught in crossfire between fighting parties. In addition, the persistence of pockets of community resistance and 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. The high proportion of community deaths reported among confirmed cases, persistent delays in detection and isolation in ETCs, challenges in the timely reporting and response to probable cases, collectively increase the likelihood of further chains of transmission in affected communities and increased risk of geographical spread within the Democratic Republic of the Congo and to neighbouring countries. As do the risk of increased population movement anticipated during periods of heightened insecurity. 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:
DIRECTORATE GENERAL FOR DISEASE CONTROL
EPIDEMIOLOGICAL SITUATION IN THE PROVINCES OF NORTH KIVU AND ITURI
Saturday, March 23, 2019
The epidemiological situation of the Ebola Virus Disease dated March 22, 2019 :
Since the beginning of the epidemic, the cumulative number of cases is 999, of which 934 are confirmed and 65 are probable. In total, there were 625 deaths (560 confirmed and 65 probable) and 320 people cured.
220 suspected cases under investigation; 6 new confirmed cases, including 3 in Katwa, 1 in Butembo, 1 in Vuhovi and 1 in Oicha;
4 new confirmed case deaths, including
1 community death in Oicha;
3 deaths at CTE, including 2 in Butembo and Mangina (one patient from Mandima);
2 new cured patients, 1 of which was released from the Mangina CTE and 1 from the Butembo CTE.
...
DIRECTORATE GENERAL FOR DISEASE CONTROL
EPIDEMIOLOGICAL SITUATION IN THE PROVINCES OF NORTH KIVU AND ITURI
Sunday, March 24, 2019
The epidemiological situation of the Ebola Virus Disease dated March 23, 2019 :
Since the beginning of the epidemic, the cumulative number of cases is 1,009, of which 944 are confirmed and 65 are probable. In total, there were 629 deaths (564 confirmed and 65 probable) and 321 people cured.
240 suspected cases under investigation; 10 new confirmed cases, including 4 in Vuhovi, 2 in Katwa, 2 in Butembo, 1 in Beni and 1 in Lubero;
4 new confirmed case deaths, including
2 community deaths, including 1 in Butembo and 1 in Vuhovi;
2 deaths at Butembo CTE;
1 new patient healed from Butembo CTE.
...
"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
As Ebola cases reach 1000 a dramatic shift is needed to put communities first
As the number of Ebola cases in Democratic Republic of Congo reaches 1,000 people, Oxfam highlights some of the challenges facing the humantarian response that is working to stem the disease.
Oxfam?s Humanitarian Programme Manager in DRC, Tamba Emmanuel Danmbi-saa, said: ?It?s extremely worrying that nine months after it began, Ebola is still not under control. The recent attacks on health facilities in Butembo, one of the worst affected places, are having a massive impact. Humanitarian access has deteriorated, as has the ability of people to get the healthcare they need. Community trust in the response is almost non-existent.
?The growing presence of police and military is fanning the flames and making many people even more frightened. While there is an imperative to protect staff in the field, using security forces during the Ebola response should be done with extreme caution. If communities feel that they are being coerced into vaccination or decontamination they lose trust in the response. Building that trust is vital to stopping the spread of the disease.
?The current response is failing the people it is supposed to be helping as focusing purely on the medical side is not enough to contain the epidemic. Health workers and other responders must prioritize the people affected, not only the disease, and start putting them first. There needs to be a real change in the response to end the epidemic as soon as possible.?
...
"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
EPIDEMIOLOGICAL SITUATION IN THE PROVINCES OF NORTH KIVU AND ITURI
Monday, March 25, 2019
The epidemiological situation of the Ebola Virus Disease dated March 24, 2019 :
Since the beginning of the epidemic, the cumulative number of cases is 1,016, 951 confirmed and 65 probable. In total, there were 634 deaths (569 confirmed and 65 probable) and 321 people cured.
226 suspected cases under investigation;
7 new confirmed cases, including 4 in Katwa, 2 in Mandima, and 1 in Beni;
5 new deaths of confirmed cases, including
3 community deaths, 2 in Katwa and 1 in Mandima;
2 deaths at Butembo CTE.
/! \ 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 .
"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
EPIDEMIOLOGICAL SITUATION IN THE PROVINCES OF NORTH KIVU AND ITURI
Tuesday, March 26, 2019
The epidemiological situation of the Ebola Virus Disease dated March 25, 2019 :
Since the beginning of the epidemic, the cumulative number of cases is 1,022, 957 confirmed and 65 probable. In total, there were 639 deaths (574 confirmed and 65 probable) and 324 people cured.
161 suspected cases under investigation (Information unavailable for health zones covered by Butembo's sub-coordination due to an internet connection problem)
6 new confirmed cases, 2 in Katwa, 2 in Mandima, and 2 in Vuhovi;
5 new deaths of confirmed cases, including
4 community deaths, 2 in Katwa and 2 in Mandima;
1 death at the CTE of Butembo;
3 new patients recovered from Butembo CTE.
/! \ 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
New strategy for prevention and control of community infections
Following the attacks on the Ebola Treatment Centers in Katwa and Butembo, the coordination launched community dialogues in several health zones to invite the community to share their concerns and suggestions regarding the conduct of the response. Ebola outbreak. Many recommendations were made and two pillars of the response were then targeted by coordination, namely Infection Prevention and Control (ICP) and Risk Communication and Community Engagement (CREC).
PCI teams are responsible for putting in place measures and practices to stop the transmission of infectious diseases in health facilities and in the community. These measures include the disinfection of health facilities and households, the installation of handwashing points, and the provision of personal protective equipment (PPE).
The coordination organized a first workshop on ICP from 21 to 23 March 2019 in Goma to improve the quality of ICP interventions and the perception of ICP by communities. The main recommendations of the workshop are:
Adapting standard ICP community-based operating procedures targeted at community engagement and integrating families into the process;
Development of a specific communication strategy on new approaches to community-based PCI to improve community understanding;
The revitalization of the Villages et ?coles Assainis program and the Water, Hygiene & Sanitation projects, particularly in Butembo and Katwa.
A second workshop on risk communication and community engagement was held in Goma from 25 to 26 March 2019 and recommendations will be shared shortly.
Vaccination
Since the beginning of vaccination on 8 August 2018, 91,891 persons have been vaccinated , including 22,893 in Katwa, 21,105 in Beni, 11,163 in Butembo, 6,109 in Mabalako, 3,075 in Mandima, 3,005 in Kalunguta, 2,871 in Goma, 2,317 in Komanda, 2,234 at Oicha, 1,630 at Kayina, 1,597 at Masereka, 1,409 at Bunia, 1,389 at Kyondo, 1,357 at Karisimbi, 1,353 at Vuhovi, 1,041 at Lubero, 1,025 at Biena, 936 at Musienene, 772 at Mutwanga, 690 at Rutshuru, 557 in Rwampara (Ituri), 527 in Nyankunde, 496 in Mangurujipa, 355 in Tchomia, 333 in Lolwa, 342 in Kirotshe, 280 in Mambasa, 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.
"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
Institutional trust and misinformation in the response to the 2018?19 Ebola outbreak in North Kivu, DR Congo: a population-based survey
Patrick Vinck, PhD
Phuong N Pham, PhD
Kenedy K Bindu
Juliet Bedford, DPhil
Eric J Nilles, MD
Published:March 27, 2019
...
Findings
Among 961 respondents, 349 (31?9%, 95% CI 27?4?36?9) trusted that local authorities represent their interest. Belief in misinformation was widespread, with 230 (25?5%, 21?7?29?6) respondents believing that the Ebola outbreak was not real. Low institutional trust and belief in misinformation were associated with a decreased likelihood of adopting preventive behaviours, including acceptance of Ebola vaccines (odds ratio 0?22, 95% CI 0?21?0?22, and 1?40, 1?39?1?42) and seeking formal health care (0?06, 0?05?0?06, and 1?16, 1?15?1?17).
...
There have been great advances in the response to many outbreak-prone pathogens over the past decade, but our understanding of the social dynamics and community perceptions related to behaviour during outbreaks require more research. The EVD outbreak in this study occurred in a highly insecure, densely populated environment, with attacks against civilians and a tense political situation, including delayed presidential elections. Attacks against health professionals, condemned by the UN, jeopardise the response to the EVD outbreak.31 A lack of institutional trust and widespread misinformation are, our findings suggest, additional factors that undermine control efforts. Engaging locally trusted leaders and service providers could help to build trust with Ebola responders who are not from these communities. If those involved in the EVD response are transparent and consistent in responding to the local needs to stop this outbreak, the trust established during this response could translate into long-term general trust in institutions. Until trust building is effectively translated into response strategies and communication protocols, the basic principles of intensive risk communication by trusted sources in a transparent, sincere, and consistent manner should be the cornerstone of the social mobilisation and community engagement efforts. Mediation (eg, by local and international peacebuilding organisations) and interactive dialogue between communities, community leaders, and local and international Ebola responders might address misinformation about the reality and politicisation of outbreaks, reducing the tensions between EVD responders and the community at risk.
...
"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
EPIDEMIOLOGICAL SITUATION IN THE PROVINCES OF NORTH KIVU AND ITURI
Thursday, March 28, 2019
The epidemiological situation of the Ebola Virus Disease dated March 27, 2019 :
Since the beginning of the epidemic, the cumulative number of cases is 1,044, of which 978 are confirmed and 66 are probable. In total, there were 652 deaths (586 confirmed and 66 probable) and 325 people healed.
218 suspected cases under investigation;
14 new confirmed cases, including 6 in Katwa, 4 in Vuhovi, 1 in Beni, 1 in Lubero, 1 in Oicha and 1 in Mandima;
9 new confirmed cases, including
4 community deaths, including 3 in Vuhovi and 1 in Mandima;
5 deaths at CTE, including 4 in Butembo and 1 in Mabalako;
1 new probable cases validated in Vuhovi whose death occurred on March 1st 2019. This is the nurse of a confirmed patient who died February 14, 2019 in Vuhovi;
1 new cured patient taken out of Mabalako CTE;
2 health workers among the newly confirmed cases in Katwa, all working in the health facility in the Muchanga health area where several confirmed cases have passed since 10 March 2019. The cumulative confirmed / probable cases among health workers is 80 (7.7% of all confirmed / probable cases), including 27 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
Beni and Oicha: Reactivation of the epidemic following mobility of the population
Due to a relatively well developed road network, the population of North Kivu is very mobile and travels frequently from one health zone to another. This mobility is the main cause of reactivation of the epidemic in areas of health where the transmission of the virus had already been stopped.
This is notably the case of Beni, which had no new confirmed cases between 21 February and 20 March 2019. Since 20 March, the Beni outbreak has been reactivated after a person infected with Ebola from Biakato Mine (Mandima) has moved to Beni for treatment. Preliminary investigations revealed that of the seven new confirmed persons notified to Beni since March 20, six are linked to a Biakato Mine transmission line and one was contaminated after attending the funeral of a confirmed case in Butembo.
The same is true for the last two new confirmed cases in Oicha. These are the family members of a confirmed case child from Biakato Mine who died in Oicha on March 20th.
"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
EPIDEMIOLOGICAL SITUATION IN THE PROVINCES OF NORTH KIVU AND ITURI
Friday, March 29, 2019
The epidemiological situation of the Ebola Virus Disease dated March 28, 2019 :
Since the beginning of the epidemic, the cumulative number of cases is 1,059, 993 confirmed and 66 probable. In total, there were 660 deaths (594 confirmed and 66 probable) and 325 people healed.
225 suspected cases under investigation;
15 new confirmed cases, including 5 in Vuhovi, 4 in Katwa, 2 in Mandima, 2 in Oicha and 2 in Beni;
8 new confirmed case deaths, including
4 community deaths, including 3 in Katwa and 1 in Vuhovi;
4 deaths at CTE, 2 in Butembo and 2 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 .
"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
The ongoing Ebola virus disease (EVD) outbreak in the North Kivu and Ituri provinces saw a rise in the number of new cases this past week. At this time, response teams are facing daily challenges in ensuring timely and thorough identification and investigation of all cases amidst a backdrop of sporadic violence from armed groups and pockets of mistrust in some affected communities. Despite this, progress is being made in areas such as Mandima, Masereka and Vuhovi, where response teams are gradually able to access once again and acceptance by the community of proven interventions to break the chains of transmission is observed.
During the last 21 days (6 ? 26 March), a total of 125 new cases were reported from 51 health areas within 12 of the 21 health zones affected to date; 38% of the 133 health areas affected to date (Figure 2). The majority of these cases were from remaining hotspot areas of Katwa (36), Butembo (14), and three emerging clusters in Mandima (19), Masereka (18) and Vuhovi (17), in addition to a limited number of cases in other areas (Table 1). All cases link back to chains of transmission in hotspot areas, with onward local transmission observed in a limited number of towns and villages within family/social networks or health centers where cases have visited prior to their detection and isolation.
As of 26 March, a total of 1029 confirmed and probable EVD cases have been reported, of which 642 died (case fatality ratio 62%). Of 1029 cases with reported age and sex, 57% (584) were female, and 30% (307) were children aged less than 18 years. The number of healthcare workers affected has risen to 78 (8% of total cases), including 27 deaths.
Community engagement efforts to encourage greater local participation and ownership of the outbreak response is ongoing and has yielded some success in many areas. In Butembo and Katwa this past week, a total of 4171 households have been visited by community health volunteers and Red Cross volunteers. This past week also saw the establishment of nine community committees to enhance direct dialogue with healthcare workers and empower community members to partake in the decision-making process of the local response. Special dialogues are being held in the communities where there have been the most frequent incidents. Herein, an anthropologist first meets with the community to ascertain their concerns, then arranges for communal meetings where these concerns can be discussed, including amongst local youth leaders, women?s associations, traditional practitioners, and healthcare providers.
As of 26 March, 324 EVD patients have recovered and been discharged from Ebola Treatment Centres. In Beni, local NGOs and international teams are currently conducting eye care training for ten ophthalmologists and establishing dedicated eye care clinics to provide screening and eye care for EVD survivors. To date, 145 survivors have been screened in these clinics and a total of 293 survivors have enrolled in the survivor?s programme.
Notable strides have also been made in improving IPC capacities in healthcare facilities. Since January, IPC field teams have decontaminated over 250 healthcare facilities and households, provided over 100 supply kits, and trained over 3000 healthcare workers in IPC. A recent National IPC workshop has been completed to aid the implementation of new IPC strategies, while the establishment of an IPC task force has further improved partner communication and coordination at all levels. The work is, however, is ongoing and IPC teams continue to respond to new instances of nosocomial transmission with the emergence of clusters in previously unaffected communities and health facilities.
These local successes do not come without its challenges. When visiting communities in high risk areas, Ebola response teams sometimes face security challenges. Though no major security incidents have been reported over the last 10 days, the overall situation remains fragile. WHO and partners have recently established operational analysis and coordination centres to both gain a more holistic understanding of how we can engage communities more effectively, as well as further increase operational awareness of the day to day operations to ensure the safety of frontline healthcare workers and the communities they are aiding. WHO and partners have also strengthened physical security in the treatment centres and accommodations of healthcare workers.
Finding a balance between providing adequate operational protection to community members at risk of Ebola and healthcare workers while simultaneously winning the trust of communities remains an iterative learning process. WHO is constantly evolving the response efforts to address these operational challenges and will continue to step up collaboration with communities to increase acceptance on the ground. Figure 1: Confirmed and probable Ebola virus disease cases by week of illness onset, data as of 26 March 2019*
*Data in recent weeks are subject to delays in case confirmation and reporting, as well as ongoing data cleaning. 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 24 March 2019
Enlarge image Table 1: Confirmed and probable Ebola virus disease cases, and number of health areas affected, by health zone, North Kivu and Ituri provinces, Democratic Republic of the Congo, data as of 26 March 2019**
Enlarge image
**Total cases and areas affected based during the last 21 days are based on the initial date of case alert, and may differ from date of confirmation and daily reporting by the Ministry of Health. Public health response
For further 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:
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. Attacks on ETCs in Katwa and Butembo represented the first large-scale and organized attacks targeted directly at the Ebola response, and were of a different order of magnitude to episodes of mistrust in communities or dangers of being caught in crossfire between fighting parties. In addition, 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. The high proportion of community deaths reported among confirmed cases, persistent delays in detection and isolation in ETCs, challenges in the timely reporting and response to probable cases, collectively increase the likelihood of further chains of transmission in affected communities and increased risk of geographical spread within the Democratic Republic of the Congo and to neighbouring countries. As do the risk of increased population movement anticipated during periods of heightened insecurity. 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:
EPIDEMIOLOGICAL SITUATION IN THE PROVINCES OF NORTH KIVU AND ITURI
Saturday, March 30, 2019
The epidemiological situation of the Ebola Virus Disease dated March 29, 2019 :
Since the beginning of the epidemic, the cumulative number of cases is 1,069, of which 1,003 are confirmed and 66 are probable. In total, there were 665 deaths (599 confirmed and 66 probable) and 329 people cured.
293 suspected cases under investigation;
10 new confirmed cases, including 3 in Vuhovi, 2 in Mandima, 2 in Katwa, 1 in Oicha, 1 in Mambasa and 1 in Beni;
New health zone potentially affected : A girl living in Mandima (Biakato Mine) was detected as a confirmed case in Mambasa (Ituri). It seems that she went there after getting sick to be cared for where her parents live. Further investigations will determine whether the case should be reclassified to Mandima.
5 new deaths of confirmed cases, including
2 community deaths, 1 in Katwa and 1 in Vuhovi;
3 deaths at CTE, including 2 in Butembo and 1 in Beni;
4 new cured patients, 2 of whom were from Butembo CTE and 2 from CTE de 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
Reopening of the Katwa Ebola Treatment Center
The Ebola Treatment Center in Katwa has been officially reopened since Saturday, March 30, 2019. After the attacks of the two CTEs in Butembo town in late February, a general feeling of fear had invaded both the communities and the response teams. The coordination then initiated community dialogues to listen to the community and rebuild trust so that the communities would accept the interventions of the response (CTE referencing, household decontamination, vaccination, dignified and secure burials, etc.).
Following the new wave of positive cases from Masereka, Katwa and Vuhovi since mid-March 2019, the Butembo CTE was full and the reconstruction of the Katwa CTE was becoming a real priority. Thus, in consultation with the district leaders of Vighole, Rughenda and Katwa, the communication teams of the response and the socio-anthropologists worked on a plan to rebuild the CTE that would promote the ownership of the CTE by the community.
Neighborhood leaders were pleased with this initiative as community women were concerned about the future of Ebola-infected patients in the community in the absence of an appropriate care structure for their care.
Socio-anthropologists have played an important role in defining the practical modalities for rebuilding the CTE and ensuring community ownership. They recommended that neighborhood leaders organize community meetings to ensure transparency in the recruitment of local workers. Then they asked that the traditional chiefs carry out rituals of appeasement of spirits in the presence of the district chiefs and all the members of the community recruited before initiating the cleaning and reconstruction work of the CTE. It was also important to sensitize all workers and the community at large about the importance of seeing the CTE as a community property where all members of this community can entrust their patients so that the experts take care of them with respect.
Management of the Katwa CTE is now provided by the Ministry of Health in collaboration with WHO and UNICEF. Dr Richard Kitenge, national coordinator of CTE and country leader in the management of Ebola Virus Disease (EVD), welcomed the rapid reopening of the Katwa CTE to relieve the congestion of the Butembo CTE. He recalled that the CTE is fully operationalized by local health workers and native Butembo territory. He invited the population to refer to the CTE as soon as possible any patient suspected of having Ebola to increase their chances of survival. According to patient data, 80% of patients (8 out of 10 patients) who were treated less than 3 days after onset of symptoms survived.
Vaccination
Since the beginning of the vaccination on August 8, 2018, 93,206 persons have been vaccinated , including 23,047 in Katwa, 21,233 in Beni, 11,362 in Butembo, 6,109 in Mabalako, 3,425 in Mandima, 3,005 in Kalunguta, 2,961 in Goma, 2,333 in Oicha, 2,317 to Komanda, 1,630 to Kayina, 1,629 to Masereka, 1,456 to Bunia, 1,413 to Vuhovi, 1,399 to Kyondo, 1,357 to Karisimbi, 1,187 to Lubero, 1,025 to Biena, 936 to Musienene, 772 to Mutwanga, 690 to Rutshuru, 557 in Rwampara (Ituri), 527 in Nyankunde, 496 in Mangurujipa, 355 in Tchomia, 333 in Lolwa, 342 in Kirotshe, 280 in Mambasa, 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.
"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
EPIDEMIOLOGICAL SITUATION IN THE PROVINCES OF NORTH KIVU AND ITURI
Sunday, March 31, 2019
The epidemiological situation of the Ebola Virus Disease dated March 30, 2019 :
Since the beginning of the epidemic, the cumulative number of cases is 1,082, of which 1,016 confirmed and 66 probable. In total, there were 676 deaths (610 confirmed and 66 probable) and 331 people cured.
279 suspected cases under investigation;
13 new confirmed cases, including 5 in Katwa, 3 in Vuhovi, 2 in Mandima, 1 in Masereka, 1 in Musienene and 1 in Beni;
The case initially notified in the health zone of Mambasa in the bulletin of March 30, 2019 was reclassified in the health zone of Mandima where the symptoms of the patient began.
11 new confirmed case deaths, including
8 community deaths, including 4 in Katwa, 2 in Vuhovi, 1 in Mandima and 1 in Masereka;
3 deaths at CTE, including 2 in Butembo and 1 in Beni;
2 new patients recovered from Butembo CTE.
/! \ 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
The voice of the community
The community dialogue initiated by coordinating the response to Ebola treatment attacks in late February has given community members a voice in continuing the Ebola response at home.
In general, the three main objectives achieved in these community dialogues were to discuss social and development issues of importance to communities, the establishment of local response committees, and the signing of a trust agreement between communities and response teams. Some of the communities' concerns can be realized in the immediate future while others will require more in-depth consultations with the technical and financial partners for their implementation.
The communities demanded that the Government and international partners also invest in improving the overall living conditions of the population, especially by improving sanitation facilities, increasing access to drinking water, improving the road network, to create jobs for young people and to build modern public markets.
In addition, the establishment of local response committees has already begun in several neighborhoods. These committees allowed the community to own and feel responsible for the success of the response activities in their neighborhood.
Finally, trust contracts were established between the community and the actors of the response in neighborhoods where the greatest number of attacks had been recorded. By signing this contract of trust, the communities commit themselves to facilitate the work of the teams of the response and to guarantee their safety when they carry out actions in their district. In return, the response teams are committed to always listening to communities and ensuring that response interventions respect community desires and local customs. Following the signing of these contracts of confidence in several neighborhoods of Butembo, the coordination has agreed to reduce the use of law enforcement to secure the movement of agents of the response,
Vaccination
Since vaccination began on 8 August 2018, 93,613 people have been vaccinated, including 23,206 in Katwa, 21,270 in Beni, 11,372 in Butembo, 6,109 in Mabalako, 3,498 in Mandima, 3,005 in Kalunguta, 2,970 in Goma, 2,333 in Oicha, 2,317 at Komanda, 1,630 at Kayina, 1,629 at Masereka, 1,499 at Vuhovi, 1,466 at Bunia, 1,413 at Kyondo, 1,357 at Karisimbi, 1,193 at Lubero, 1,025 at Biena, 936 at Musienene, 772 at Mutwanga, 690 at Rutshuru, 557 in Rwampara (Ituri), 527 in Nyankunde, 496 in Mangurujipa, 355 in Tchomia, 333 in Lolwa, 342 in Kirotshe, 280 in Mambasa, 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.
Training new recruits to carry out dignified and safe burials in Butembo
"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
Congo Ebola outbreak spreading faster than ever: WHO
GENEVA (Reuters) - Democratic Republic of Congo?s Ebola outbreak is spreading at its fastest rate yet, eight months after it was first detected, the World Health Organization (WHO) said on Monday.
Each of the past two weeks has registered a record number of new cases, marking a sharp setback for efforts to respond to the second biggest outbreak ever, as militia violence and community resistance have impeded access to affected areas.
Less than three weeks ago, the WHO said the outbreak of the hemorrhagic fever was largely contained and could be stopped by September, noting that weekly case numbers had halved from earlier in the year to about 25.
...
"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
EPIDEMIOLOGICAL SITUATION IN THE PROVINCES OF NORTH KIVU AND ITURI
Monday, April 1, 2019
The epidemiological situation of the Ebola Virus Disease dated March 31, 2019 :
Since the beginning of the epidemic, the cumulative number of cases is 1,089, of which 1,023 are confirmed and 66 are probable. In total, there were 679 deaths (613 confirmed and 66 probable) and 331 people cured.
180 suspected cases under investigation;
7 new confirmed cases, including 2 in Katwa, 2 in Vuhovi, 1 in Mandima, 1 in Beni and 1 in Oicha;
3 new deaths of confirmed cases, including
2 community deaths, 1 in Katwa and 1 in Vuhovi;
1 death at the CTE of Butembo;
1 health worker among newly confirmed cases. The cumulative number of confirmed / probable cases among health workers remains at 81 (7.4% of all confirmed / probable cases), including 28 deaths.
Partial response activities on Sunday, March 31, 2019 to avoid disrupting the smooth running of elections in Beni and 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 .
"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
EPIDEMIOLOGICAL SITUATION IN THE PROVINCES OF NORTH KIVU AND ITURI
Wednesday, April 3, 2019
The epidemiological situation of the Ebola Virus Disease dated 2 April 2019 :
Since the beginning of the epidemic, the cumulative number of cases is 1,100, of which 1,034 confirmed and 66 probable. In total, there were 690 deaths (624 confirmed and 66 probable) and 338 people healed.
269 suspected cases under investigation;
8 new confirmed cases, including 3 in Katwa, 3 in Mandima, 1 in Butembo and 1 in Beni;
7 new confirmed case deaths, including
5 community deaths including 3 in Mandima, 1 in Katwa and 1 in Butembo;
2 deaths in CTE including 1 in Butembo and 1 in Mangina (Mandima patient);
5 new patients cured including 4 from the CTE of Butembo 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.
News of the response
Evolution of the epidemiological situation
The three main outbreaks of the epidemic during these 21 days are Katwa (44), Vuhovi (32) and Mandima (24) who together reported 62.5% (100/160) of all cases.
Katwa :
In Katwa, 23 of the 44 reported cases , more than half of the cases (52.3%), come from the health area of Muchanga . The other health areas in the Katwa area have all reported fewer than 6 new confirmed cases in the last 21 days.
The community death rate remains very high in Katwa with 22 community deaths out of the 44 reported cases, or 50% .
Of the reported cases, 3 are health workers , or 6.8%.
The main difficulties over the last 21 days were the absence of CTE in Katwa following the armed attack, the reluctance of part of the community and insecurity in some health areas following activities of armed groups.
The main interventions of the response in the Katwa area to address these challenges include recommendations made by the population during the community dialogues, including:
Training youth from the community to integrate dignified and secure burial and infection prevention and control (IPC) teams;
Highlighting local actors on the ground; and
The organization of interdisciplinary teams in households to avoid disturbing the families of the sick several times.
Vuhovi
In Vuhovi, 17 of the 32 reported cases , or 53.1%, come from the Mutendero health area . The second most affected health area is Isonga with 7 cases, or 21.9%. Other health areas recorded fewer than 2 cases in the last 21 days.
Of the 32 reported cases, 9 were community deaths , or 28% .
Of the reported cases, 2 are health workers , or 6.3%.
Mandima
In Mandima, 17 of the 24 reported cases , 70.8%, come from the Biakato Mine health area .
Of the 24 reported cases, 10 were community deaths , or 41.7%.
Of the reported cases, 1 is a health worker, 4.2%.
Vaccination
Since the start of vaccination on 8 August 2018, 94,388 people have been vaccinated , including 23,474 in Katwa, 21,414 in Beni, 11,399 in Butembo, 6,109 in Mabalako, 3,624 in Mandima, 3,030 in Goma, 3,005 in Kalunguta, 2,362 in Oicha, 2,317 to Komanda, 1,679 to Masereka, 1,630 to Kayina, 1,552 to Vuhovi, 1,487 to Bunia, 1,413 to Kyondo, 1,357 to Karisimbi, 1,193 to Lubero, 1,025 to Biena, 936 to Musienene, 772 to Mutwanga, 690 to Rutshuru, 557 in Rwampara (Ituri), 527 in Nyankunde, 496 in Mangurujipa, 355 in Tchomia, 333 in Lolwa, 342 in Kirotshe, 280 in Mambasa, 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.
"Safety and security don't just happen, they are the result of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of violence and fear." -Nelson Mandela
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