WEEKLY BULLETIN ON OUTBREAKS
AND OTHER EMERGENCIES
Week 32: 3 - 9 August 2020
Data as reported by: 17:00; 9 August 2020
...
Measles
Democratic Republic
of the Congo
380 143 Cases
6 999 Deaths
1.8% CFR
EVENT DESCRIPTION
The long-standing measles outbreak in Democratic Republic of the
Congo continues to show a declining trend, which started towards the
end of 2019, when there was a decrease in the number of cases from
week 49 of 2019 (week ending 7 December 2019) to week 6 of 2020
(week ending 8 February 2020). There was an increase between weeks
7 to 11 (weeks ending 15 February 2020 to 14 March 2020), and a
peak in week 13 (week ending 28 March 2020). This was followed by
a decrease to week 30 (week ending 25 July 2020). In week 30, a total
of 413 suspected cases were reported, with five deaths (case fatality
ratio 1.2%). These cases were reported from the 95 most affected health
zones.
As of 26 July 2020, a total of 380 143 cases have been reported, with
6 999 deaths (case fatality ratio 1.8%). All 26 provinces of the country
have been affected by the outbreak. The provinces that reported the most
cases in week 30 were Sankuru (110 cases), Kasai (36 cases), South
Ubangi (34 cases), Kasai Oriental (33 cases) and Tanganikya (21 cases).
However, no new health zones in these provinces have reported cases
since week 29 of 2020 (week ending 18 July 2020). From weeks 1 to 30
of 2020, a total of 68 626 suspected cases have been reported, with 968
deaths (case fatality ratio 1.4%).
Between weeks 1 to 30 of 2020, a total of 3 306 laboratory samples have
been received, of which 1 317 (40%) were IgM positive for measles, and
702 (21%) were IgM positive for rubella. Among children positive for
rubella, 16% were aged more than 14 years.
The under five-year age group remains the most affected across the
country, with the proportion of cases in this age group varying from
27.6% to 34.9% since the start of 2020. Where vaccination status is
known, 32% of cases had been vaccinated, 6% were not vaccinated and
status was unknown in 62%.
Reactive measles vaccination campaigns in 2019 and 2020 have reached
more than 6.4 million children aged between 6-59 months. Partial
results from 121 health zones targeted during 2020 show that more than
1.2 million children have been vaccinated.
PUBLIC HEALTH ACTIONS
The measles action plan has been validated and shared with all
stakeholders, along with evaluation of the implementation of the
operational plan for 121 health zones.
Surveillance information is regularly shared with the Department
of Health, WHO and other partners, and consultants have been
deployed in hotspots.
Laboratory samples continue to be collected and transported, with
results shared with stakeholders.
There is continued support for strengthening the quality of paediatric
care and intensification of awareness around the availability
of free healthcare in those health zones that have received case
management kits and where particular partners are involved.
Risk communication and social mobilization activities with
key messages and updates on the measles situation are being
implemented in selected urban and rural health areas, with the
support of the WHO sub-coordination team in Maindombe, along
with reinforcement of community relays in health zones that are
not reporting.
The reactive vaccination campaign has been implemented and
evaluated in 121 health zones, reaching 111.8% of children between
6-59 months and 99% of children aged 1-9 years; leaving a total of
72 640 children requiring vaccination (64 432 aged 6-11 months
and 8 208 over 12 months).
UNICEF is distributing case management kits, as is WHO, with
two boats provided to Maindombe sub-coordination in order to
complete immunization activities.
A number of partners are involved in the response, with funding
originating from GAVI, DFID, WHO, ODHA, UNICEF and USAID
among others; surveillance supported by WHO, MSF, Africa CDC,
ALIMA, and CAFID among others; case management is supported
by ALIMA, MSF, WHO, and UNICEF among others, most of whom
also support the immunization response.
Routine vaccine activities are being supported by WHO and UNICEF.
SITUATION INTERPRETATION
The decline in the number of cases of measles in Democratic Republic
of the Congo is welcomed and points to the efficacy of the reactive
vaccination campaigns that have been ongoing through the past two
years. However, there are still many challenges that must be addressed
if cases are to remain low. The COVID-19 outbreak is preventing
routine response teams from being deployed to affected areas, which
are relying on teleworking teams. Coordination requires repurposing
to a multisectoral approach and shortcomings in communication for
community involvement have been identified. Certain hospitals still
struggle with case management in complicated measles cases and poor
accessibility hampers case management in hard-to-reach areas, shown
by persistent high case fatality ratios in certain health zones. The effects
of the COVID-19 outbreak are potentially hampering routine vaccination
activities, complicated by persistent rumours around a vaccination
campaign against COVID-19 in some provinces, which require
community engagement and management. National and local authorities
and partners need to urgently address these challenges in order to
maintain the momentum of the reactive vaccination campaigns, while
at the same time ensuring that routine vaccination programmes remain
in operation, perhaps utilizing the COVID-19 response infrastructure in
order to achieve this.
https://apps.who.int/iris/bitstream/handle/10665/333769/OEW32-0309082020.pdf
