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

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Congo' military said Sunday, Oct. 21, that rebels attacked an Ebola treatment centre in Beni, leaving over a dozen civilians dead and abducted about a dozen children, which could force crucial virus containment efforts to be suspended in the area.

https://www.npr.org/2018/10/21/65929...-efforts-again


My thoughts: The 'rebels' seem to have figured that they can promote the spread of ebola in their enemy's population by attacking ebola treatment centres which will drive patients into the communities. I wonder what their plans are for the kidnapped pediatric ebola patients (I am hoping that they didn't actually kidnap ebola patients thereby denying them treatment which could save their lives but that seems to be what happened from what I read.)

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EPIDEMIOLOGICAL SITUATION IN THE PROVINCES OF NORTH KIVU AND ITURI

Sunday 21 October 2018

The epidemiological situation of the Ebola Virus Disease dated October 20, 2018 :

• A total of 237 cases of haemorrhagic fever were reported in the region, 202 confirmed and 35 probable.
• Of the 202 confirmed, 118 died and 63 are cured . The others are hospitalized in the different Ebola Treatment Centers (ETCs) installed.
• 33 suspected cases under investigation.
• 2 new cases confirmed in Beni.
• 1 new death of confirmed cases in Beni.
• 2 new people healed in Beni.
• 5.518 contacts to follow to date.

Security incident in Beni

• On the evening of Saturday, October 20 , 2018, 12 people were killed and a dozen kidnapped in the Rwenzori commune by suspected ADF fighters. The FARDC supported by MONUSCO forces intervened to repel the rebels during clashes that lasted about 3 hours. This Sunday, October 21 , 2018, residents took to the streets to express their anger at the violence, preventing any traffic in the streets of Beni. The demonstrators destroyed several administrative buildings including the office of the town hall, the post office and the office of the Order of Doctors. However, the Beni General Reference Hospital where the CTE is located has not been targeted.
• The majority of the agents of the riposte had to spend their day in their respective hotels. The first teams that had gone out before 8am have taken refuge at Beni's General Reference Hospital while waiting for the end of the demonstrations. They were able to return to the hotel from 13h. All immunization and awareness activities were suspended this Sunday. Community monitoring activities have been slow and have been done by telephone with the focal points within the neighborhoods. The care teams worked at the ETC and 5 dignified and safe funerals were carried out during the afternoon.

Ministry of Health of the Democratic Republic of Congo

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My thoughts: This report differs from the NPR's report which had stated that the ETC was attacked. There are also reports that most of the cases are now occurring in undocumented transmission chains and that there are a higher than normal number of child cases, which could indicate that the children are the tip of the iceberg.

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Translation Google

DIRECTORATE GENERAL FOR DISEASE CONTROL

EPIDEMIOLOGICAL SITUATION IN THE PROVINCES OF NORTH KIVU AND ITURI Monday, October 22, 2018 The epidemiological situation of the Ebola Virus Disease dated 21 October 2018 : A total of 238 cases of haemorrhagic fever were reported in the region, 203 confirmed and 35 probable. Of the 203 confirmed, 120 died and 63 are cured . The others are hospitalized in the different Ebola Treatment Centers (ETCs) installed. 14 suspected cases under investigation. 1 new case confirmed in Beni. 2 new deaths of confirmed cases in Beni. Disruption of the response activities this Sunday, October 21, 2018 following the demonstrations of the population Remarks: To avoid that the total number of cases varies (up or down) daily, the suspect cases have been placed in a separate category. Thus, suspect cases with positive laboratory tests will be added to the confirmed category, while negative ones (non-cases) will be removed from the table. The category of probable cases includes all reported deaths for which it was not possible to obtain biological samples for laboratory confirmation. The investigations will determine whether these deaths are related to the epidemic or not. A community death is a death in the community, outside of a licensed health center. News of the response Press conference in Beni The coordinator of the response, Dr. Ndjoloko Tambwe Bath?, held a press conference this Monday, October 22, 2018 in Beni. He reviewed several important developments in the epidemiological situation in Beni, community involvement, the impact of community resistance, safe and dignified burial (DHS), the security situation, and the Committee Meeting. Emergency for the International Health Regulations (IHR). He recalled the importance for the population to respect the hygiene and precautionary measures recommended by the health authorities. He regrets the fact that the public continues to put themselves in danger despite the many tips they receive daily to protect themselves against Ebola. He gave the example of young people from a neighborhood in Beni who stole the body of a lady who died of Ebola on her way to the cemetery in agreement with her family. After manipulating the body, one of the youths became infected, became ill and recently died. The response coordinator also took the opportunity to ask the different health structures to strictly observe hygiene measures, especially the use of single-use equipment. This recommendation is of paramount importance because the sharp increase in cases confirmed, with a majority of children, in Beni was caused by non-compliance with the measures of prevention and infection control in tradimodern structures (between traditional medicine and medicine). modern). The majority of the last confirmed cases in the city were infected by Ebola during their passage in these health facilities which became the main factor of amplification of the epidemic. In order to be able to respond more quickly to EDS alerts within the community, he said that the WHO had started the training of 8 additional teams within the civil protection of Beni. In addition, to address the concern of families complaining about the delay in waiting for results after a community death, the coordination decided to start using rapid tests during raids in the community to have preliminary results instantly. Dr. Bath? also mentioned the risks run by the agents of the response. He obviously mentioned the death of 2 health workers of the Medical Unit of Rapid Intervention (UMIR) in Butembo. But he said that the physical attacks of the teams are common. On average, the teams of the response are attacked, and sometimes injured, 3 to 4 times a week by the population. This is the first time that our health workers, both locally and nationally, are facing so much violence in an Ebola response. He also stressed that the response time of the response teams depends on the security situation because before deploying the teams in the field, a preliminary analysis of the security situation is necessary. Vaccination No vaccination activity in Beni this Sunday, October 21, 2018. Since the start of vaccination on 8 August 2018, 20,849 people have been vaccinated , including 9,823 in Beni, 4,391 in Mabalako, 1,663 in Mandima, 1,672 in Katwa, 1,145 in Butembo, 690 in Masereka, 434 in Bunia, 355 in Tchomia, 240 in Komanda, 160 in Musienene, 121 in Oicha, 105 in Kalunguta and 50 in Mutwanga. Epidemiological Data Summary Week 42 (October 15-21, 2018) For the week of October 15 to 21, 2018 , we recorded: 239 suspected cases investigated and tested in the laboratory 22 new confirmed cases, including 19 in Beni. 16 confirmed cases, including 15 in Beni. 6 new people healed, including 5 in Beni Summary of data for dignified and secure burials Since the beginning of the epidemic, 314 EDS alerts have been received in all affected areas, including: 262 successful EDSs (83.4%) 39 EDS unsuccessful due to refusal or resistance (12.4%) 7 unanswered alerts (2.2%) 6 incomplete DHSs, ie collected, secured but buried by the family (1.9%) The source of the EDS alerts is distributed as follows: 134 of the community (43%) 94 ETC (30%) 86 health facilities (27%)

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Ebola control in North Kivu: response teams face aggression

Posted on Tue, 23/10/2018 - 09:23 | Edited on Tue, 23/10/2018 - 09:23

Ebola response teams have been facing attacks in several areas since the government declared the presence of the disease in North Kivu. It was the Director-General for Disease Control at the Ministry of Health and coordinator of the response who lamented it during a press conference held on Monday (October 22nd) in Beni.

According to Dr. Bathe Ndjoloko, four days ago two nurses from the FARDC Rapid Medical Intervention Unit (UMIR) were killed in Butembo during an armed attack while other officers were killed. acts of violence.

"All the sites included, that is to say, Beni, Butembo, Mangina and others we have around three and four incidents a week, it's huge. If we take Beni alone, it does not happen a week if we did not notice an incident on our teams. It's still extremely deplorable, the people who come to save you, to treat you so that you can attack them to that point, "regrets Dr. Bathe Ndjoloko.

He denounces and rebels against the deaths of those who will save the lives of the people of this region.

"We just hinted at the colleagues who died, two nurses died and that's the extreme. We have about ten of our colleagues who are wounded, that is to say, the blood has flowed, we have colleagues who have been sequestrated, they took off their clothes, they burned their clothes in front of them, all these forms. of violence our teams face this. In which area in particular, we do not want to stigmatize areas. But besides Oicha, Komanda, Tchomia everywhere else there was aggression of our teams, "said Dr. Bathe Ndjoloko.

https://www.radiookapi.net/2018/10/23/actualite/sante/lutte-contre-ebola-au-nord-kivu-les-equipes-de-riposte-font-face-aux

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Translation Google

DIRECTORATE GENERAL FOR DISEASE CONTROL

EPIDEMIOLOGICAL SITUATION IN THE PROVINCES OF NORTH KIVU AND ITURI Tuesday 23 October 2018 The Epidemiological Situation of Ebola Virus Disease, October 22, 2018 : A total of 244 cases of haemorrhagic fever were reported in the region, 209 confirmed and 35 probable. Of the 209 confirmed, 122 died and 63 are cured . The others are hospitalized in the different Ebola Treatment Centers (ETCs) installed. 37 suspected cases under investigation. 6 new confirmed cases in Beni. 2 new deaths of confirmed cases in Beni (community deaths). Beni Health Zone has surpassed 100 confirmed cases of Ebola. Remarks: To avoid that the total number of cases varies (up or down) daily, the suspect cases have been placed in a separate category. Thus, suspect cases with positive laboratory tests will be added to the confirmed category, while negative ones (non-cases) will be removed from the table. The category of probable cases includes all reported deaths for which it was not possible to obtain biological samples for laboratory confirmation. The investigations will determine whether these deaths are related to the epidemic or not. A community death is a death in the community, outside of a licensed health center. News of the response Vaccination Immunization activities in Beni are slowing down due to insecurity in some areas of the city. Since the beginning of vaccination on 8 August 2018, 20,939 people have been vaccinated , including 9,853 in Beni, 4,391 in Mabalako, 1,732 in Katwa, 1,663 in Mandima, 1,145 in Butembo, 690 in Masereka, 434 in Bunia, 355 in Tchomia, 240 in Komanda, 160 in Musienene, 121 in Oicha, 105 in Kalunguta and 50 in Mutwanga.

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EPIDEMIOLOGICAL SITUATION IN THE PROVINCES OF NORTH KIVU AND ITURI

Thursday, October 25, 2018 The epidemiological situation of the Ebola Virus Disease dated October 24, 2018 :

• A total of 251 cases of haemorrhagic fever were reported in the region, including 216 confirmed and 35 probable.
• Of the 216 confirmed, 127 died and 67 are cured . The others are hospitalized in the different Ebola Treatment Centers (ETCs) installed.
• 46 suspected cases under investigation.
• 4 new confirmed cases, including 3 in Beni and 1 in Butembo.
• 3 new deaths of confirmed cases, including 2 in Beni (including 1 community death) and 1 in Butembo.
• 2 new cures, including 1 in Beni and 1 in Butembo.
• 5,813 contacts to follow so far

https://mailchi.mp/sante.gouv.cd/ebola_kivu_25oct

[Shiloh]

Source: http://www.who.int/csr/don/25-octobe...-ebola-drc/en/
Ebola virus disease ? Democratic Republic of the Congo

Disease outbreak news: Update
25 October 2018

Security incidents over the past week, ranging from clashes between rebel and government forces resulting in civilian deaths to response vehicles being pelted with stones, continued to cause community distress and severely impede response activities for the Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo. These incidents are occurring amidst intense EVD transmission in communities in the city of Beni. In spite of these challenges, the Ministry of Health (MoH), WHO and partners are reinforcing efforts to contain the outbreak; WHO does not currently plan to reduce the response team comprised of over 250 WHO staff.
Since the last Disease Outbreak News (i.e. during 16?23 October), 27 new confirmed cases were reported: 24 from Beni (including one resident of Mandima who was hospitalized in Beni), and three from Butembo. Of the newly reported cases, eight were known contacts of previously confirmed cases at the time of reporting, two were linked retrospectively to transmission chains, and 17 remain under investigation. A health worker from a community health post in Beni was among the newly infected; 21 health workers have been infected to date, of whom three have died.
As of 23 October 2018, 247 EVD cases (212 confirmed and 35 probable), including 159 deaths (124 confirmed and 35 probable)¹, have been reported in seven health zones in North Kivu Province and three health zones in Ituri Province (Figure 1). Sixty-five cases have recovered, been discharged from Ebola treatment centres (ETCs) and reintegrated into their communities. Trends in weekly case incidence and the secondary peak observed earlier this month reflect the intensity of transmission in and around Beni (Figure 2). These trends must be interpreted cautiously given the persistently long delays between illness onset and reporting of cases, and the ongoing challenges in investigating this outbreak.
Risk of the outbreak spreading to other provinces in the Democratic Republic of the Congo, as well as to neighbouring countries, remains very high with ongoing transmission in communities in North Kivu. Enhanced efforts are needed to ensure areas beyond the main affected health zones are prepared and operationally ready to rapidly detect, investigate and respond to any such exportations of the virus. Over the course of the past week, alerts have been reported from Mauritania, South Sudan, Sudan, Uganda, and the United Republic of Tanzania. To date, EVD has been ruled out in all these alerts from neighbouring provinces and countries.
Figure 1: Confirmed and probable Ebola virus disease cases by health zone in North Kivu and Ituri provinces, Democratic Republic of the Congo, data as of 23 October 2018 (n=247)




Figure 2: Confirmed and probable Ebola virus disease cases by week of illness onset, data as of 23 October 2018 (n=246)*




*Data in recent weeks are subject to delays in case confirmation and reporting, as well as ongoing data cleaning.
Public health response

The MoH continues to strengthen response measures, with support from WHO and partners. Priorities include coordinating the response, surveillance, contact tracing, laboratory capacity, infection prevention and control (IPC) measures, clinical management of patients, vaccination, risk communication and community engagement, psychosocial support, safe and dignified burials (SDB), cross-border surveillance and preparedness activities in neighbouring provinces and countries.

• Surveillance: As of 23 October, over 11 000 contacts have been registered, of which 5723 remain under surveillance². Follow-up rates over the past week ranged from 85-97% across all health areas. At present, Beni Health Zone presents the greatest challenges in contact tracing due to a combination of factors, including the unstable security situation. As surveillance activities have been enhanced, responders have seen a significant rise in the number of reported alerts and suspected cases tested each day. During 16-23 October, an average of 116 alerts (range 75-159) were reported, of which 35 alerts (range 7-48) were validated as suspected cases for testing each day. Investigations are ongoing for all recently reported cases to elucidate the chains of transmission to interrupt the spread of the virus.
• Vaccination: As of 24 October, 122 vaccination rings have been defined, in addition to 37 rings of health and frontline workers. To date, 22 288 eligible and consented people have been vaccinated, including 8471 health and frontline workers and 5488 children. Overall, vaccination teams have reached an additional 3345 eligible and consenting people in the past week.
• Clinical management and IPC: Activities are ongoing in the Democratic Republic of the Congo and are supported by several partners in the field. The ETC managed by the Alliance for International Medical Action (ALIMA) in Beni has increased its capacity from 41 to 60 beds in the past week.
• Risk communication, community engagement, and social mobilization activities continue to focus on community ownership of the response through engagement with local leaders and influencers, such as community chiefs, religious leaders and civil society groups, in order to build community confidence in the response. Community feedback through door-to-door house visits, community dialogue sessions, focus group interviews and knowledge, attitudes and practices (KAP) surveys is being systematically collected and analyzed to adjust response strategies.
• Safe and dignified burial (SDB) capacity is provided both by Red Cross (RC) and Civil Protection (CP) teams. RC teams are operational in Mangina, Beni, Butembo (stand-by), Tchomia and Bunia. CP teams are operational in Beni and Oicha. In addition, RC has trained teams in Goma and Mambasa that can be activated as needed. Security remains a challenge in Beni and Butembo which is negatively SDB interventions. Discussions are ongoing in Beni focused on finding workable solutions to respond in areas where neither RC nor CP teams have access. Six additional teams have been trained in Beni and are now operational. As of 23 October, a total of 346 SDB alerts were received; of these, 293 (85%) were responded to successfully either by the RRC or CP teams. Response to 40 alerts were unsuccessful due to community refusals or burials conducted prior to the arrival of SDB teams. Among all SDB alerts, 42% were from communities, 30% from ETCs, and 28% from other health facilities (non-ETCs). From 1- 24 October 86 alerts were received from Beni and only 11 alerts from Butembo.
• Point of Entry (PoE): As of 23 October 2018, health screening has been established at 64 Points of Entry (PoEs) and over 10.4 million travellers have been screened, 17 430 means of transport have been decontaminated. The International Organization for Migration (IOM), US Centers for Disease Control and Prevention (CDC) and WHO continue to support the Border Health programme of the MoH in the Democratic Republic of the Congo. As of 23 October, 44 of the 64 PoEs were functional due to security incidents, in particular in Beni, and a strike by health personnel at PoEs in Ituri Province. With support from IOM, 16 National Program of Hygiene at Borders (PNHF) supervisors will be deployed as of 23 October to North Kivu and Ituri, with the aim of supporting coordination and capacity building at PoEs. IOM-supported population mobility mapping was finalized in in Tchomia and Kasenyi, and five additional PoEs will be established. IOM also supports four PoEs in bordering areas of South Sudan; as of 21 October, 9955 individuals have passed through these POEs. US CDC also supports PoE activities in the Democratic Republic of the Congo and South Sudan.
• Laboratory capacity: Diagnostic testing capability has continued to expand as cases spread to new geographic areas. Five field Ebola laboratories providing near-patient testing have been established in Beni, Mutembo, Goma, Mangina and Tschomia; these are in addition to the national laboratory in Kinshasa. Testing volumes have increased in the past week; 337 samples tested in the week ending 21 October which is 30% more than the previous week. Notably, testing of oral swabs from community deaths has increased by 44% and was responsible for detection of a third of all new confirmed cases in the past week. Testing of deceased persons will be scaled up. Rapid diagnostic testing that can be performed at gravesites is slated for implementation in the testing of corpses in order to simplify the procedure and decrease tension with families and the community.
• Operational readiness and preparedness: Starting in mid-September, the MoH, with support from WHO and partners, implemented a 30-day plan in six high-risk provinces neighbouring North Kivu. Implementation of that plan made substantial progress in establishing and strengthening multisectoral coordination, rapid response teams, surveillance and IPC, contact tracing, PoEs, risk communications and stockpiling of personal protective equipment (PPE). Building on this success and with a focus on sustained capacity development, the readiness plan has been extended for the next three months through the end of January 2019 within the Strategic Response Plan. Tshopo Province and Goma, North Kivu were added to this extension plan. All three levels of WHO are working closely with the governments of the nine neighbouring countries and partners to address major challenges of outbreak management, particularly at the PoE, and with focus on priority 1 countries (Uganda, South Sudan, Burundi and Rwanda). A substantial funding gap remains for the Regional Strategic Plan for EVD preparedness, posing challenges for full-scale implementing.

Partners

To support the MoH, WHO is working intensively with a wide range of multisectoral and multidisciplinary regional and global partners and stakeholders for EVD response, research and urgent preparedness, including in neighbouring countries. Among the partners are a number of UN agencies and international organizations including: European Civil Protection and Humanitarian Aid Operation (ECHO); IOM; UK Public Health Rapid Support Team; United Nations Children?s Fund (UNICEF); UN High Commission on Refugees (UNHCR); World Bank and regional development banks; World Food Programme (WFP) and UN Humanitarian Air Service (UNHAS); UN mission and UN Department of Safety and Security (UNDSS); Inter-Agency Standing Commission; United Nations Office for the Coordination of Humanitarian Affairs (OCHA); and the United Nations Population Fund (UNFPA); Africa Centres for Disease Control; US CDC; UK Department for International Development (DFID); United States Agency for International Development (USAID); Adeco Federaci?n (ADECO); Association des femmes pour la nutrition ? assisse communautaire (AFNAC); Alliance for International Medical Action (ALIMA); CARITAS DRC; CARE International; Centre de promotion socio-sanitaire (CEPROSSAN); Cooperazione Internationale (COOPE); Catholic Organization for Relief and Development Aid (CORDAID/PAP-DRC); International Medical Corps; International Rescue Committee (IRC); Intersos ? Organizzatione Umanitaria par l?Emergenza (INTERSOS); MEDAIR; M?decins Sans Fronti?res (MSF); Oxfam International; Red Cross of the Democratic Republic of Congo, with the support of the International Federation of Red Cross and Red Crescent Societies (IFRC) and International Committee of the Red Cross (ICRC); Samaritan?s Purse; Save the Children (SCI); Global Outbreak Alert and Response Network (GOARN), Emerging and Dangerous Pathogens Laboratory Network (EDPLN), Emerging Disease Clinical Assessment and Response Network (EDCARN), technical networks and operational partners, and the Emergency Medical Team Initiative (EMT). GOARN partners continue to support the response through deployment for response and readiness activities in non-affected provinces and in neighbouring countries and to different levels of WHO.
WHO risk assessment

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

WHO advises against any restriction of travel and trade to the Democratic Republic of the Congo based on the currently available information. 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 travel 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:

• Statement on the October 2018 meeting of the IHR Emergency Committee on the Ebola virus disease outbreak in the Democratic Republic of the Congo
• WHO Interim recommendation Ebola vaccines
• WHO recommendations for international travellers
• Ebola virus disease in the Democratic Republic of the Congo ? Operational readiness and preparedness in neighbouring countries
• Ebola virus disease fact sheet

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¹The number of cases is subject to change due to ongoing reclassification, retrospective investigation, and the availability of laboratory results.
²The total number of contacts under surveillance is highly dynamic with new cases being registered daily, and those who complete 21 days of post-exposure follow up, without developing symptoms, are released from surveillance.

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Translation Google

DIRECTORATE GENERAL FOR DISEASE CONTROL

EPIDEMIOLOGICAL SITUATION IN THE PROVINCES OF NORTH KIVU AND ITURI Friday, October 26, 2018 The epidemiological situation of the Ebola Virus Disease dated October 25, 2018 : A total of 257 cases of haemorrhagic fever were reported in the region, 222 confirmed and 35 probable. Of the 222 confirmed, 129 died and 67 are cured . The others are hospitalized in the different Ebola Treatment Centers (ETCs) installed. 47 suspected cases under investigation. 6 new confirmed cases in Beni. 2 new confirmed cases, including 1 in Beni and 1 in Butembo. 5,918 contacts to follow to date Remarks: To avoid that the total number of cases varies (up or down) daily, the suspect cases have been placed in a separate category. Thus, suspect cases with positive laboratory tests will be added to the confirmed category, while negative ones (non-cases) will be removed from the table. The category of probable cases includes all reported deaths for which it was not possible to obtain biological samples for laboratory confirmation. The investigations will determine whether these deaths are related to the epidemic or not. A community death is a death in the community, outside of a licensed health center. News of the response Medical care The capacity of the Mangina CTE has been reduced to 16 beds, while that of the CTE of Beni has been increased to 60 beds in order to offer the best quality of care to the numerous suspected cases and confirmed cases detected every day in the city. Vaccination Since the start of vaccination on August 8, 2018, 22,811 people have been vaccinated , including 11,328 in Beni, 4,391 in Mabalako, 1,907 in Katwa, 1,663 in Mandima, 1,195 in Butembo, 690 in Masereka, 434 in Bunia, 355 in Tchomia, 240 to Komanda, 227 to Kalunguta, 160 to Musienene, 121 to Oicha, and 100 to Mutwanga.

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EPIDEMIOLOGICAL SITUATION IN THE PROVINCES OF NORTH KIVU AND ITURI

Saturday, October 27, 2018

Epidemiological Status of Ebola Virus Disease, 26 October 2018 :

• A total of 266 cases of haemorrhagic fever were reported in the region, of which 231 confirmed and 35 probable.
• Of the 231 confirmed, 133 died and 70 are cured . The others are hospitalized in the different Ebola Treatment Centers (ETCs) installed.
• 42 suspected cases under investigation.
• 9 new confirmed cases, including 7 in Beni and 2 in Butembo.
• 4 new deaths of confirmed cases, including 3 in Beni and 1 in Butembo (community death).
• 3 new cures in Beni.
• 6.126 contacts to follow.

https://mailchi.mp/sante.gouv.cd/ebola_kivu_27oct

my thoughts: I believe that 9 new cases is the most there have been in this outbreak. I'd have to research if we've seen that many cases in one day since West Africa.

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EPIDEMIOLOGICAL SITUATION IN THE PROVINCES OF NORTH KIVU AND ITURI

Sunday, October 28, 2018

Epidemiological Status of Ebola Virus Disease, 27 October 2018 :

• A total of 267 cases of haemorrhagic fever were reported in the region, 232 confirmed and 35 probable.
• Of the 232 confirmed, 135 died and 70 are cured . The others are hospitalized in the different Ebola Treatment Centers (ETCs) installed.
• 43 suspected cases under investigation.
• 1 new confirmed case in Butembo.
• 2 new deaths of confirmed cases, including 1 in Beni and 1 in Butembo.
• 6,026 contacts to follow.

https://mailchi.mp/sante.gouv.cd/ebola_kivu_28oct

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Translation Google DIRECTORATE GENERAL FOR DISEASE CONTROL

EPIDEMIOLOGICAL SITUATION IN THE PROVINCES OF NORTH KIVU AND ITURI Monday, October 29, 2018 The Epidemiological Situation of Ebola Virus Disease, October 28, 2018 : A total of 274 cases of haemorrhagic fever were reported in the region, including 239 confirmed and 35 probable. Of the 239 confirmed, 139 died and 73 are cured . The others are hospitalized in the different Ebola Treatment Centers (ETCs) installed. 32 suspected cases under investigation. 7 new confirmed cases, including 4 in Beni and 3 in Butembo. 4 new confirmed cases, including 3 in Beni and 1 in Butembo. 3 new cures, 2 in Butembo and 1 in Beni. 5,991 contacts to follow to date. Remarks: To avoid that the total number of cases varies (up or down) daily, the suspect cases have been placed in a separate category. Thus, suspect cases with positive laboratory tests will be added to the confirmed category, while negative ones (non-cases) will be removed from the table. The category of probable cases includes all reported deaths for which it was not possible to obtain biological samples for laboratory confirmation. The investigations will determine whether these deaths are related to the epidemic or not. A community death is a death in the community, outside of a licensed health center. News of the response Vaccination Since the start of vaccination on August 8, 2018, 24,142 people have been vaccinated , including 12,464 in Beni, 4,391 in Mabalako, 1,962 in Katwa, 1,663 in Mandima, 1,295 in Butembo, 690 in Masereka, 434 in Bunia, 355 in Tchomia, 240 to Komanda, 227 to Kalunguta, 160 to Musienene, 121 to Oicha, 100 to Mutwanga and 40 to Vuhovi. Epidemiological Data Summary Week 43 (October 22-28, 2018) For the week of October 22-28, 2018 , we recorded: 263 suspected cases investigated and tested in the laboratory. 36 new confirmed cases, including 28 in Beni and 8 in Butembo. 19 confirmed cases, including 14 in Beni and 5 in Butembo. 10 new people healed, including 5 in Beni and 5 in Butembo.

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Security Council urges responder-safety focus, as DR Congo Ebola outbreak worsens



UN Photo/Manuel Elias
The Security Council unanimously adopts resolution 2439 concerning the Ebola outbreak in the Democratic Republic of the Congo (DRC).

30 October 2018

Peace and Security


The United Nations Security Council has voiced “serious concern” over the impact of deteriorating security situation in the Democratic Republic of the Congo (DRC) on the response to the deadly Ebola outbreak and fears that the virus could spread further into the country and the wider region.

A large country in central Africa, DRC has been plagued by violence and insecurity for decades. Across the country, local populations and humanitarian workers assisting them have come under attacks by armed groups, necessitating the deployment of a large UN peacekeeping mission.
Unanimously adopting resolution 2439 (2018), the 15-member Council “demanded” that all armed groups in the region respect international law and ensure full, safe, immediate and unhindered access for humanitarian and medical personnel, and their equipment, transport and supplies to the affected areas.

Humanitarian response teams and hospitals providing life-saving assistance and relief to those in need “must be respected and protected, and that they must not be a target,” said the Security Council in the resolution.

The UN body also stressed the need for gender-sensitive response to the Ebola outbreak that addresses the specific needs of both men and women, given that men and women are affected differently by the socio-economic impacts of the outbreak.

The Council also stressed the importance of the “full, active and meaningful engagement” of women in the development of such responses.
According to the UN World Health Organization (WHO), as of 22 October, over 200 cases have been confirmed and at least 150 people have lost their lives since the outbreak was declared in DRC’s North Kivu and Ituri provinces in August. This is the tenth outbreak in the country in the past 40 years.
In its latest assessment, the UN health agency also warned of the potential for the virus to spread into Uganda, Rwanda, South Sudan and Burundi, and called on these countries to step up readiness efforts.

Primary Responsibility

In the resolution, the Council also noted that the Government of the DRC “bears the primary responsibility” to protect civilians subject to its jurisdiction and stressed the need for the international community to “remain engaged” in supporting national health systems, as well as maintaining financial, technical and in-kind support for efforts to control the outbreak.

It also encouraged the Government and countries in the region to “continue efforts to address and resolve the wider political, security, socioeconomic and humanitarian consequences of the Ebola outbreak, as well as to provide sustainable and responsive public health mechanisms.”

The Security Council also expressed its appreciation towards the work of humanitarian and health staff on the ground and as well as the “positive role” of the UN peacekeeping mission in the country (MONUSCO) in support of the response and in protecting civilians.

It also requested all relevant parts of the UN System to step up their response to the outbreak, within the overall coordination of WHO, including by supporting the development and implementation of preparedness and operational plans, in collaboration with governments of the region and those providing assistance.

https://news.un.org/en/story/2018/10/1024442

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DIRECTORATE GENERAL FOR DISEASE CONTROL

EPIDEMIOLOGICAL SITUATION IN THE PROVINCES OF NORTH KIVU AND ITURI Wednesday, October 31, 2018 The epidemiological situation of the Ebola Virus Disease dated October 30, 2018 : A total of 279 cases of haemorrhagic fever were reported in the region, of which 244 confirmed and 35 probable. Of the 244 confirmed, 144 died and 81 are cured . The others are hospitalized in the different Ebola Treatment Centers (ETCs) installed. 51 suspected cases under investigation. 3 new confirmed cases, 2 in Beni and 1 in Vuhovi. Vuhovi is a new health zone located between Beni and Butembo. He is the husband of a confirmed case who died at Butembo CTE on October 26, 2018. He refused to follow up and transfer to CTE. He died at the Vuhovi health center where the sample was taken. 4 new confirmed cases, 2 in Beni, 1 in Butembo and 1 in Vuhovi. 7 new cures, including 6 in Beni and 1 in Butembo. 5,679 contacts to follow. Remarks: To avoid that the total number of cases varies (up or down) daily, the suspect cases have been placed in a separate category. Thus, suspect cases with positive laboratory tests will be added to the confirmed category, while negative ones (non-cases) will be removed from the table. The category of probable cases includes all reported deaths for which it was not possible to obtain biological samples for laboratory confirmation. The investigations will determine whether these deaths are related to the epidemic or not. A community death is a death in the community, outside of a licensed health center. News of the response Active search of cases in health facilities Investigations in recent weeks in Beni have revealed that many centers of traditional medicine are late referring suspected cases to the CTE. In order to overcome this problem, the surveillance has set up a new active case search strategy in the city's 254 public and private health facilities. Thus, every day, surveillance officers visit the various health facilities in Beni to examine hospitalized patients and determine whether the clinical picture corresponds to the Ebola virus disease. During their visit to the health facilities, they also review the patient's register being passed out to identify potential suspected cases. This active search strategy of cases explains the significant increase of the isolated suspect cases and taken in recent days in Beni. On average, surveillance teams visit 140 health facilities a day. Vaccination Since the beginning of vaccination on August 8, 2018, 24,863 people have been vaccinated , including 13,015 in Beni, 4,391 in Mabalako, 2,002 in Katwa, 1,663 in Mandima, 1,355 in Butembo, 690 in Masereka, 434 in Bunia, 355 in Tchomia, 240 to Komanda, 227 to Kalunguta, 160 to Musienene, 121 to Oicha, 110 to Vuhovi and 100 to Mutwanga.

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DIRECTORATE GENERAL FOR DISEASE CONTROL

EPIDEMIOLOGICAL SITUATION IN THE PROVINCES OF NORTH KIVU AND ITURI Thursday, November 1, 2018 The Epidemiological Situation of Ebola Virus Disease as of October 31, 2018 : A total of 285 cases of haemorrhagic fever were reported in the region, of which 250 confirmed and 35 probable. Of the 250 confirmed, 145 died and 81 are cured . The others are hospitalized in the different Ebola Treatment Centers (ETCs) installed. 41 suspected cases under investigation. 6 new confirmed cases, including 4 in Beni and 2 in Butembo. 1 new confirmed case death in Beni. 5.801 contacts to follow to date. Remarks: To avoid that the total number of cases varies (up or down) daily, the suspect cases have been placed in a separate category. Thus, suspect cases with positive laboratory tests will be added to the confirmed category, while negative ones (non-cases) will be removed from the table. The category of probable cases includes all reported deaths for which it was not possible to obtain biological samples for laboratory confirmation. The investigations will determine whether these deaths are related to the epidemic or not. A community death is a death in the community, outside of a licensed health center. News of the response Electoral operations in areas affected by Ebola Since the beginning of the epidemic, the Ministry of Health has been in regular contact with the Independent National Electoral Commission (CENI) to keep it informed of developments. The Ministry does not expect that the evolution of the current outbreak will impede the smooth conduct of electoral operations in the affected areas of the provinces of North Kivu and Ituri. Indeed, one of the Department's priorities was to ensure that response activities only minimally disrupted the normal functioning of society. As a result, markets, schools and places of worship remained open in accordance with Ministry recommendations. A special consultation committee between the Coordination of the Ebola Virus Disease Response and the CENI will be set up to coordinate epidemiological surveillance activities around electoral operations. We plan to install health checkpoints with handwashing and temperature sensing devices at the entrance of all polling stations in the areas affected by the outbreak. Free care From Thursday 1 th November 2018, free health care is effective in all health areas of Butembo health zones, Katwa, Masereka and Kalunguta. Implemented through the Health System Development Project (HSDP), this measure aims to encourage the population in the areas affected by the epidemic to go as quickly as possible to public and private health facilities that meet the standards. from the Ministry of Health. Free healthcare was already effective in the health zones of Beni, Mabalako and Oicha since August 20, 2018. In Beni, free admission was effective in the priority health areas that have reported confirmed cases of Ebola but will soon be extended. to all health areas in the Beni area. Vaccination Since the start of vaccination on August 8, 2018, 25,336 people have been vaccinated , including 13,326 in Beni, 4,391 in Mabalako, 2,062 in Katwa, 1,663 in Mandima, 1,355 in Butembo, 690 in Masereka, 434 in Bunia, 355 in Tchomia, 240 to Komanda, 307 to Kalunguta, 160 to Musienene, 143 to Oicha, 110 to Vuhovi and 100 to Mutwanga. . Monthly summary of epidemiological data October 2018 For the period from 1 th to October 31, 2018 , we recorded: 121 new confirmed cases. 75 deaths, including 72 confirmed cases and 3 probable cases. 36 new people healed. The month of October was marked by a major outbreak of which Beni is the main focus. Confirmed cases 121 of the 250 confirmed cases reported since the beginning of the epidemic were recorded during the month of October, or 48.4% . Of these 121 new confirmed cases, 95 were in Beni, or 78.5% . Deaths (confirmed and probable) 75 of the 180 deaths (confirmed and probable) reported since the beginning of the epidemic were recorded during the month of October, ie 41.6% . Of these 75 deaths, 59 were in Beni, 78.6% . heal 36 of the 81 cures reported since the start of the epidemic were recorded during the month of October, or 44.4% . Of these 36 healed, 27 were in Beni, 75% .

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Source: http://www.who.int/csr/don/01-novemb...-ebola-drc/en/
Ebola virus disease ? Democratic Republic of the Congo

Disease outbreak news: Update
1 November 2018

The increase over the past four weeks in confirmed case incidence (Figure 1), most notably in the city of Beni and communities around Butembo, is concerning. Security incidents continue to severely impact both civilians and frontline workers. Moreover, pockets of community resistance or reluctance continue to hamper timely detection of new cases and the effectiveness of response operations. Nevertheless, the response to the Ebola virus disease (EVD) outbreak has seen significant improvements over the past weeks, including strong performances by field teams conducting case investigations, vaccinations, and community engagement and risk communication in priority areas.
Since the last Disease Outbreak News (i.e. during 24?30 October), 32 new confirmed EVD cases were reported: 24 from Beni, and seven from Butembo and one from Vuhovi. The seven new cases reported from Butembo reside in suburbs and villages within and surrounding the city. Of the newly reported cases, 14 were known contacts of previously confirmed cases at the time of reporting, one was linked retrospectively to a transmission chain, and 17 remain under investigation. Four health workers, from various health posts and hospitals around Beni, were among the newly infected; 25 health workers have been infected to date, of whom three have died.
As of 30 October 2018, 279 EVD cases (244 confirmed and 35 probable), including 179 deaths (144 confirmed and 35 probable)¹, have been reported in eight health zones in North Kivu Province and three health zones in Ituri Province (Figure 2). Over the past week, 14 additional surivors were discharged from Ebola treatment centres (ETCs) and reintegrated into their communities; 81 patients have recovered to date.
With ongoing transmission in communities in North Kivu, the risk of the outbreak spreading to other provinces in the Democratic Republic of the Congo, as well as to neighbouring countries, remains very high. Over the course of the past week, alerts have been reported from the Tanganyika Province, Republic of the Congo, South Sudan, Uganda and Yemen. To date, EVD has been ruled out for all alerts from neighbouring provinces and countries.
Figure 1: Confirmed and probable Ebola virus disease cases by week of illness onset, data as of 30 October 2018 (n=274)*




Figure 2: Confirmed and probable Ebola virus disease cases by health zone in North Kivu and Ituri provinces, Democratic Republic of the Congo, data as of 30 October 2018 (n=279)




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

The Ministry of Health (MoH) continues to strengthen response measures, with support from WHO and partners. Priorities include coordinating the response, surveillance, contact tracing, laboratory capacity, infection prevention and control (IPC), clinical management of patients, vaccination, risk communication and community engagement, psychosocial support, safe and dignified burials (SDB), cross-border surveillance and preparedness activities in neighbouring provinces and countries.

• Surveillance: A review of surveillance activities highlighted a number of challenges in case and contact detection and investigation, as well as in data management. WHO is working closely with the MoH at the field level, with remote analytical support provided by Regional and headquarters teams to address these. At the field level, strategies and standard operation procedures (SOPs) are being revised and staff retrained, to optimise systems and processes, better integrate activities of contact tracing and vaccination teams, enhance active case searching, and improve data management. Investigations continue around the latest confirmed cases not originating from known transmission chains. As of 30 October, over 15 000 contacts have been registered, of which 5813 remain under surveillance². Follow-up rates over the past week ranged from 85-92% across all health areas.
• Vaccination: As of 31 October, 154 vaccination rings have been defined, in addition to 37 rings of health and frontline worker. To date, 25 298 eligible and consented people have been vaccinated, including 8916 health and frontline workers and 6578 children. Overall, vaccination teams have reached an additional 3345 eligible and consenting people in the past week.
• Clinical management and IPC: Activities are ongoing in both clinical management and IPC and are supported by several partners in the field. Almost all newly confirmed patients admitted to ETCs receive therapeutics. There remains ongoing challenges with delayed recognition of cases and referral to ETCs, which are often occurring only after a patient has visited a number of health facilities. Some patients die before reaching ETCs or shortly after arrival due to late presentation in illness course. In rare instances, therapeutics may need to be withheld due to a very poor prognosis. Breaches in various aspects of IPC practices remain an important reason for continuing transmission. Several activities are ongoing in the field to address these concerns.
• Risk communication, community engagement, and social mobilization activities continue to focus on community ownership of the response and are integrated closely with other response pillars. The risk communication and community engagement (RCCE) teams are supporting community-based surveillance activities by reinforcing the reporting of alerts by community focal points and traditional healers. Safe and dignified burial and vaccination teams are also supported by RCCE in engaging families in dialogue to improve the acceptance of response interventions. Door-to-door house visits, community dialogue sessions, community sensitization activities and mass communication via local radio stations continue.
• Safe and dignified burial (SDB) Capacity is provided both by Red Cross (RC) and Civil Protection (CP) teams. RC teams are operational in Mangina, Beni, Butembo, Tchomia and Bunia. CP teams are operational in Beni and Oicha. In addition, RC has trained teams in Goma and Mambasa that can be activated as needed. As of 30 October, a total of 384 SDB alerts were received, of which 328 (85%) were responded to successfully. Due to access restrictions to certain areas, briefing sessions are planned to sensitize all RC volunteers in North Kivu and Ituri about EVD. Similar sessions will be hled by the International Committee of the Red Cross for the Police services and Armed Forces. In addition, a harm reduction approach to community burials in hard-to-reach communities (whether because of security or geographical constraints) is planned so that access to information and materials to perform burials in a safer manner is available if SDB teams cannot access the burial location.
• Point of Entry (PoE): As of 30 October 2018, health screening has been established at 65 PoEs. Over 11.9 million travellers have been screened, 17 467 means of transport have been decontaminated and 92 alerts have been notified (14 were validated and one was confirmed for EVD). The International Organization for Migration (IOM), US Centers for Disease Control and Prevention (US CDC) and WHO continue to support the Border Health programme of the MoH in the Democratic Republic of the Congo. With the support from IOM, a revised PoE Supervision Checklist has been validated in the field and will be rolled out starting 1 November. IOM will conduct operational research on the effectiveness of PoEs in the Democratic Republic of the Congo during EVD outbreaks.
• Laboratory capacity: Diagnostic testing capability has continued to expand as cases spread to new geographic areas. Five field Ebola laboratories providing near-patient testing have been established in Beni, Mutembo, Goma, Mangina and Tchomia; these are in addition to the national laboratory in Kinshasa. Testing volumes have increased in the past week; 438 samples tested in the week ending 28 October which is 30% more than the previous week.

Partners

To support the MoH, WHO is working intensively with a wide range of multisectoral and multidisciplinary regional and global partners and stakeholders for EVD response, research and urgent preparedness, including in neighbouring countries. Among the partners are a number of UN agencies and international organizations including: European Civil Protection and Humanitarian Aid Operation (ECHO); International Organization for Migration (IOM); UK Public Health Rapid Support Team; United Nations Children?s Fund (UNICEF); UN High Commission on Refugees (UNHCR); World Bank and regional development banks; World Food Programme (WFP) and UN Humanitarian Air Service (UNHAS); UN mission and UN Department of Safety and Security (UNDSS); Inter-Agency Standing Commission; United Nations Office for the Coordination of Humanitarian Affairs (OCHA); and the United Nations Population Fund (UNFPA); Africa Centres for Disease Control; US CDC; UK Department for International Development (DFID); United States Agency for International Development (USAID); Adeco Federaci?n (ADECO); Association des femmes pour la nutrition ? assisse communautaire (AFNAC); Alliance for International Medical Action (ALIMA); CARITAS DRC; CARE International; Centre de promotion socio-sanitaire (CEPROSSAN); Cooperazione Internationale (COOPE); Catholic Organization for Relief and Development Aid (CORDAID/PAP-DRC); International Medical Corps; International Rescue Committee (IRC); Intersos ? Organizzatione Umanitaria par l?Emergenza (INTERSOS); MEDAIR; M?decins Sans Fronti?res (MSF); Oxfam International; Red Cross of the Democratic Republic of Congo, with the support of the International Federation of Red Cross and Red Crescent Societies (IFRC) and International Committee of the Red Cross (ICRC); Samaritan?s Purse; Save the Children (SCI); Global Outbreak Alert and Response Network (GOARN), Emerging and Dangerous Pathogens Laboratory Network (EDPLN), Emerging Disease Clinical Assessment and Response Network (EDCARN), technical networks and operational partners, and the Emergency Medical Team Initiative (EMT). GOARN partners continue to support the response through deployment for response and readiness activities in non-affected provinces and in neighbouring countries and to different levels of WHO.
WHO risk assessment

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

International traffic: WHO advises against any restriction of travel and trade to the Democratic Republic of the Congo based on the currently available information. There is currently no licensed vaccine to protect people from the Ebola virus. Therefore, any requirements for certificates of Ebola vaccination are not a reasonable basis for restricting movement across borders or the issuance of visas for passengers leaving the Democratic Republic of the Congo. WHO continues to closely monitor and, if necessary, verify travel and trade measures in relation to this event. Currently, no country has implemented travel measures that significantly interfere with international traffic to and from the Democratic Republic of the Congo. Travellers should seek medical advice before travel and should practice good hygiene.
Vaccination: WHO convened a meeting of the Strategic Advisory Group of Experts (SAGE) on Immunization from 23-25 October. The group noted that the risk of adverse effects from administering the live virus vaccine, rVSVΔG-ZEBOV-GP, to pregnant women remains largely unknown given the limited amount of data. SAGE recognized that the decision on whether to offer the vacicine to pregnant women is a complex matter and that inclusion of pregnant women in a research protocol depends on the local National Regulatory Authority and local Ethics Review Committee and, more importantly, on informed consent of the pregnant woman. SAGE therefore encourages researchers to seek opportunities to gather more data on the benefits and risks of administering this vaccine to pregnant women, particularly under conditions permitting close and sufficiently long follow-up of vaccinees to completely document outcomes. Such evidence may be available in the near future. The experts also encouraged research efforts to assess whether the vaccination of other contacts provides an effective ring of protection around pregnant women who do not receive the vaccine.
For more information, see:

• Summary report for the SAGE meeting of October 2018
• Statement on the October 2018 meeting of the IHR Emergency Committee on the Ebola virus disease outbreak in the Democratic Republic of the Congo
• WHO Interim recommendation Ebola vaccines
• WHO recommendations for international travellers
• Ebola virus disease in the Democratic Republic of the Congo ? Operational readiness and preparedness in neighbouring countries
• Ebola virus disease fact sheet

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¹The number of cases is subject to change due to ongoing reclassification, retrospective investigation, and the availability of laboratory results.
²The total number of contacts under surveillance is highly dynamic with new cases being registered daily, and those who complete 21 days of post-exposure follow-up, without developing symptoms, are released from surveillance.