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

Interview

Q&A: Congo Ebola outbreak at critical juncture, says top WHO official

Peter Salama points to a ?paradigm shift? in response, but warns the virus could still spread to blind spots or across national borders

31 August 2018
Anthony Morland
Africa Editor
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IRIN: Do you have a full picture of the extent of this outbreak?

Peter Salama: I?d characterise our picture as fairly comprehensive, one month in. The major additional variable and complicating factor is the fact that it's taking place in an area that is highly volatile, from a security perspective. There are one million displaced people, out of the population of eight million of northern Kivu. Many of the areas to the east of the epicentre of major areas of operation are classified in the UN as security level four [red zones], and many of those areas are real blind spots because of the conflict in northern Kivu. There are no health workers, no health facilities. And so there's no real reliable source of information to give us the alerts of any potential suspected cases. But? I don't think we're missing any large cluster of cases in the area of northern Kivu because we have a large number of people and such a lot of outreach, such a lot of contacts with people at all levels from the community. It is entirely possible in the areas of highest insecurity however, we are missing a small number of cases somewhere.
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IRIN: Looking ahead, what are the best- and worst-case scenarios?

PS: The best-case scenario is that over the coming seven to 10 days, we'll see that epi-curve really begin to tail off, and there's some promising data to suggest that in the last few days... So we limit the outbreak to its current geographical confines.

The worst-case scenario is that we see either cases across borders of Uganda, Rwanda, most concerningly South Sudan, which has very little infrastructure to deal with it, or Burundi, and we see cases in those very difficult to access security areas, [including] that far eastern hinterland close to the DRC-Ugandan border, on the DRC side.

...

http://www.irinnews.org/interview/2...break-critical-juncture-says-top-who-official
 
[h=1]Ebola virus disease ? Democratic Republic of the Congo[/h] Disease outbreak news
31 August 2018

The outbreak of Ebola virus disease (EVD) in the Democratic Republic of the Congo is at a key juncture. Recent trends (Figure 1) suggest that control measures are working. Over the past week, contact follow-up rates have substantially improved, most patients recently admitted to Ebola treatment centres (ETC) received therapeutics within hours of being confirmed, and ring vaccination activities have scaled to reach contacts (and their contacts) of most confirmed cases reported in the last three weeks. However, the outbreak trend must be interpreted with caution. Since the last Disease Outbreak News on 24 August 2018, 13 additional confirmed and probable cases have been reported, the majority (n=8) were from the city of Beni. Moreover, substantial risks remain, posed by potential undocumented chains of transmission; four of the 13 new cases were not known contacts. Likewise, sporadic instances of high-risk behaviours in some communities (such as unsafe burials, reluctance towards contact tracing, vaccination and admission to ETCs if symptoms developed), poor infection prevention and control (IPC) practices in some community health centres, and delays in patients reaching ETCs when symptoms develop, all have the potential to further propagate the outbreak.
As of 29 August 2018, a total of 116 EVD cases (86 confirmed and 30 probable) including 77 deaths (47 confirmed and 30 probable)1 have been reported in five health zones in North Kivu (Beni, Butembo, Oicha, Mabalako, Musienene) and one health zone in Ituri (Mandima). Eight suspected cases from Mabalako (n=5) and Beni (n=3) are currently pending laboratory testing to confirm or exclude EVD. The majority of cases (65 confirmed and 21 probable) have been reported from Mabalako Health Zone (Figure 2). The median age of confirmed and probable cases is 35 years (interquartile range 19?45.5 years), and 56% were female (Figure 3).
Fifteen cases have been reported among health workers, of which 14 were laboratory confirmed; one has died. All health worker exposures likely occurred in health facilities outside of the dedicated ETCs. WHO and partners continue to work with health workers and communities to increase awareness on IPC measures, as well as vaccinate those at risk of infection.
In addition to the ongoing response activities within outbreak affected areas, the MoH, WHO and partners will be implementing a 30-day strategic plan to ensure operational readiness measures against EVD are strengthened in all provinces of the Democratic Republic of the Congo. The first phase of implementation will prioritise six provinces at highest risk of case importations: South Kivu, Maniema, Ituri, Tanganika, Haut Uele and Bas Uele. The main objective is to ensure that these provinces implement essential operational readiness measures, including enhancing surveillance, IPC and social mobilization to mitigate, rapidly detect, investigate and effectively respond to a possible outbreak of EVD.
For more information, see:
[h=4]Figure 1: Confirmed and probable Ebola virus disease cases by week of illness onset, 29 August 2018 (n=115)[/h]
figure1_20180831.PNG



*Data is incomplete for the week starting 27 August 2018.
[h=4]Figure 2: Confirmed and probable Ebola virus disease cases by health zone in North Kivu and Ituri provinces, Democratic Republic of the Congo, 29 August 2018[/h]
figure2_20180831.PNG



[h=4]Figure 3: Confirmed and probable Ebola virus disease cases by age and sex, as of 29 August 2018 (n=111)[/h]
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[h=3]Public health response[/h] The MoH continues to strengthen response measures, with support from WHO and partners. Priorities include response coordination, surveillance, contact tracing, laboratory capacity, IPC, clinical management, vaccination, risk communication and community engagement, safe and dignified burials, cross-border surveillance, and preparedness activities in neighbouring provinces and countries.
  • As of 29 August, 2444 contacts remain under surveillance, of which 79?97% were followed-up daily during the past seven days. During this period, contact tracing teams have faced and are working to overcome many challenges, including community refusal in some areas, insecurity and the movement of contacts making them hard to follow.
  • The Ministry of Health (MoH), WHO and partners continue to systematically monitor and rapidly investigate all alerts in all provinces of the Democratic Republic of the Congo, and in neighbouring countries.
  • As of 29 August, 26 vaccination rings have been defined and four additional rings are being defined. Vaccination teams have been vaccinating these rings which include the contacts and the contacts of contacts of 44 recently confirmed cases from the last 21 days.
  • As of 30 August, over 5130 contacts and contacts of contacts have been vaccinated, of which over 1040 health care or front line workers and over 1340 are children. More than 7000 additional doses of vaccine have been transported to Beni to supplement doses currently in place and additional doses (2160) arrived on 29 August from the United States.
  • As of 30 August, WHO has deployed over 180 multidisciplinary specialists to support response activities including logisticians, epidemiologists, laboratory experts, communicators, clinical care specialists, community engagement specialists, and emergency coordinators. Global Outbreak Alert and Response Network (GOARN) partner institutions continue to support the response as well as ongoing readiness and preparedness activities in non-affected provinces of the Democratic Republic of the Congo and in neighbouring countries.
  • ETCs are fully operational in Beni and Mangina with support from The Alliance for International Medical Action (ALIMA) and M?decins Sans Fronti?res (MSF) respectively. MSF opened a seven bed transit center in Makeke on 9 August. International Medical Corps (IMC) is planning on establishing an ETC in Makeke which will then replace the transit center. ETCs are providing therapeutics under the monitored emergency use of unregistered and experimental interventions (MEURI) protocol in collaboration with the MoH and the Institut National de Recherche Biom?dicale (INRB). WHO is providing technical clinical expertise onsite and is assisting with the creation of a data safety management board.
  • For the first time, there is regulatory and ethical approval to provide access to five investigational Ebola therapeutics under the MEURI framework for people infected with Ebola virus disease. Three are already in use (mAb114, Remdesivir (GS5734) and ZMapp) and more may follow (REGN3470-3471-3479 and Faviripir). To date, 20 patients have received investigational therapeutics: 13 mAb 114, 5 remdisivir, and 2 zMAPP.
  • A team of IPC specialists are holding daily training with healthcare and frontline workers, assessing and decontaminating facilities, and providing essential hand hygiene solutions and personal protective equipment. A team of experts deployed by WHO are supplementing local capacity, working with dozens of health care centres identifying areas requiring strengthening, and providing training and supplies as needed. They are assisting the health centres to set up triage to ensure that patients with suspected Ebola can be separated and treated away from other patients, to reduce the risk of the disease spreading.
  • The MOH, WHO, UNICEF, the Red Cross and partners are intensifying activities to engage with local communities in Beni and Mutembo. Local leaders, religious leaders, opinion leaders, and community networks such as youth groups, motorbike taxi drivers are engaged with to support community outreach for Ebola prevention and early care seeking through active dialogues on radio and interpersonal communication. Local frontline community outreach workers are working closely across Ebola response teams to strengthen community engagement and psychosocial support in contact tracing, patient care and safe and dignified burials.
  • From 6 through 8 August, Knowledge, Attitudes and Practices (KAP) surveys were conducted on 335 individuals in Mabalako and Beni and found that there was a high level of awareness on EVD (76%). However, it was also found that there was a low level of knowledge on EVD transmission and prevention (22%) and low level of knowledge of the EVD vaccine (23%). The second KAP survey is planned for the week of 8 September. A community feedback mechanism for collecting feedback, questions, complaints and rumours to inform localized community engagement strategies is established to adapt risk communication and community engagement strategies to community needs.
  • The Red Cross of the Democratic Republic of the Congo with the support of the International Federation of Red Cross (IFRC) and International Committee of the Red Cross (ICRC) is responding to the current EVD outbreak in North Kivu with Safe and Dignified Burials (SDB). As of 29 August 2018, 10 SDB teams are operational in Beni, Mangina, Butembo, Bunia and Mambasa. As of 29 August, 80 SDBs have been successful conducted.
  • As of 27 August 2018, 34 Points of Entry (PoE) in North Kivu are functional with health screening activities and the total number of alerts from these PoEs to this date is 36.
[h=3]WHO risk assessment[/h] This latest outbreak of EVD is affecting north-eastern provinces of the Democratic Republic of the Congo which border Uganda, Rwanda and South Sudan. Potential risk factors for transmission of EVD at the national and regional levels include the transportation links between the affected areas, the rest of the country, and neighbouring countries; the internal displacement of populations; and displacement of Congolese refugees to neighbouring countries. The country is concurrently experiencing several epidemics and a long-term humanitarian crisis. Additionally, the security situation in North Kivu and Ituri may hinder the implementation of response activities. Based on this context, the public health risk was assessed to be high at the national and regional levels, and low globally.
As the risk of national and regional spread remains high, it is important for neighbouring provinces and countries to enhance surveillance and preparedness activities. WHO will continue to work with neighbouring countries and partners to ensure health authorities are alerted and are operationally ready to respond.
[h=3]WHO advice[/h] 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 any travel restriction to and from the Democratic Republic of the Congo. Travellers should seek medical advice before travel and should practice good hygiene.
For more information, see:


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

http://www.who.int/csr/don/31-august-2018-ebola-drc/en/
 
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[TD="class: mcnTextContent"] EPIDEMIOLOGICAL SITUATION IN THE PROVINCE OF NORTH KIVU
Friday 31 August 2018

The epidemiological situation of the Ebola Virus Disease dated 30 August 2018 :
  • A total of 118 cases of haemorrhagic fever were reported in the region, 88 confirmed and 30 probable.
  • 13 suspected cases are under investigation.
  • 2 new confirmed cases in Beni.
  • No new deaths.

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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.
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News of the response​


Day of Traditional Medicine
  • This Friday, August 31, 2018, African countries celebrated the Day of Traditional Medicine. Traditional medicine practiced by traditional healers remains particularly popular with the Congolese population, especially in rural areas. In many areas, traditional healers are the primary providers of primary care because people first go to their homes before seeing a conventional doctor at a health center. This is an important factor to consider in the context of an Ebola outbreak. Therefore, sensitization and involvement of traditional healers in the response is essential. It is for this reason that the Social Mobilization Commission organized today a briefing with the traditional healers of Beni. During this briefing,
Vaccination
  • Since the start of vaccination on 8 August 2018, 5,150 people have been vaccinated , including 2,707 in Mabalako, 1,286 in Beni, 1,017 in Mandima, 121 in Oicha and 19 in Kinshasa.
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Traditional healers in Beni learn good hand washing skills​
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https://us13.campaign-archive.com/?u=89e5755d2cca4840b1af93176&id=916e9fac6b
 
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Monday, September 3, 2018

The epidemiological situation of the Ebola Virus Disease dated 2 September 2018 :
  • A total of 121 cases of haemorrhagic fever were reported in the region, of which 91 confirmed and 30 probable.
  • 14 suspected cases are under investigation.
  • 1 new case confirmed in Beni.
  • 2 new people healed.
  • 1 confirmed case death in Beni.

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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.
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News of the response​


Back to School
  • Back to school was timid in Beni and Mangina this Monday, September 3, 2018 but this shyness was not entirely related to the Ebola Virus Disease epidemic. The Mayor of Beni City and Beni Response Coordinator Dr. Ndjoloko Tambwe Bath? organized a new exchange session with Beni teachers' unions to address their concerns. They emphasized the steps to be taken in schools in the context of the Ebola outbreak and the roles and responsibilities of all stakeholders.
surveillance
  • 4,296 contacts have been registered since 17 August 2018.
  • To date, 1,926,873 travelers have been checked at the 37 entry points activated.

Vaccination
  • Since vaccination began on August 8, 2018, 5,946 people have been vaccinated , including 3,076 in Mabalako, 1,633 in Beni, 1,067 in Mandima, 121 in Oicha, 30 in Katwa and 19 in Kinshasa.
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https://us13.campaign-archive.com/?u=89e5755d2cca4840b1af93176&id=9d307afe8f
 
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Butembo: Fifteen suspected contacts of a confirmed case of Ebola have already been vaccinated

Posted on: 03/09/2018 at 18h08min42s
By Radio Moto Butembo-Beni

The information was given during the parade held at Butembo town hall this Monday, September 3rd. This popular address has seen the presence of two distinguished visitors. It is Jean Christophe CHAKO of the general direction of fight against the Ebola Virus disease and the mechanical fitter Natalis BUETO of the adapted technology study center. Their presence is to be part of the awareness campaign against Ebola.

Stakeholders expressed their fear of having confirmed cases in Butembo. This, to the extent that some listed contact contacts miss the vaccination campaign. But, it can be said that fifteen people were vaccinated among the 37 people suspected of having taken part in a ceremony of dote in which participated a confirmed case currently being in Beni.

The call was made to all those who resist to hurry. Jean Christophe CHAKO announced the installation of the sub-coordination of the fight against Ebola virus disease in Butembo. Natalis BUETO has raised the need for pedestal sinks to prevent contamination.


Posted on: 03/09/2018 at 18h08min42s
By Radio Moto Butembo-Beni


https://radiomotofm.info/lirearticl...un cas confirmé d’Ebola ont déjà été vaccinés
 
WORLD NEWSSEPTEMBER 4, 2018 / 8:00 AM / UPDATED 3 HOURS AGO

Rebels ambush South African peacekeepers in Congo Ebola zone

GOMA, Democratic Republic of Congo (Reuters) - Two South African peacekeepers were wounded in a rebel ambush near the epicenter of an Ebola outbreak in eastern Democratic Republic of Congo, their U.N. mission said on Tuesday.

The attack on Monday on the outskirts of the city of Beni underscored the challenges authorities face in tackling a flare-up of the deadly disease in an active conflict zone stalked by dozens of armed groups.

Health officials say they have made progress slowing the hemorrhagic fever?s spread with experimental vaccines and treatments. But they cannot be sure the situation is under control due to difficulties accessing some areas.
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MONUSCO peacekeepers are providing near-daily escorts to the town of Oicha, where one case has been confirmed, World Health Organization spokesman Tarik Jasarevic told reporters in Geneva.

Parts of the 30 km (18 mile) stretch of road between Beni and Oicha are considered a ?red zone? because of recurrent rebel attacks.

https://www.reuters.com/article/us-...eacekeepers-in-congo-ebola-zone-idUSKCN1LK1HY
 
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[TD="class: mcnTextContent"] EPIDEMIOLOGICAL SITUATION IN NORTH KIVU PROVINCE
Tuesday, September 4, 2018

The epidemiological situation of the Ebola Virus Disease dated September 3, 2018 :
  • A total of 124 cases of haemorrhagic fever were reported in the region, of which 93 were confirmed and 31 were probable.
  • 16 suspected cases are under investigation.
  • 2 new cases confirmed in Beni.
  • 1 probable case in Beni: Burial not secured by the family before samples could be taken.
  • 3 confirmed cases, including 2 in Beni and 1 in Mabalako.

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  • 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.
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News of the response​


Community resistance
  • The district of Ndindi in Beni City has become the main focus of the epidemic at present concentrating 70% of the last 20 confirmed cases reported. This situation is linked to the resistance of the community in this district to collaborate with the health authorities. Some families have long been hiding sick people, denied that health care providers take patients to the Ebola Treatment Center (ETC), and refused to be vaccinated. Several violent incidents against medical staff and care facilities had also been reported. To ease tensions, a community dialogue was launched between coordinating the response and Ndindi community leaders. Otherwise,
Supported
  • To date, 22 patients have been treated with mAb 114, Remdesivir, or Zmapp. Of these 22 patients, 11 are cured, 4 have died and 7 are still hospitalized but have seen their condition improve.
surveillance
  • To date, 2,068,733 travelers have been checked at the 37 entry points activated.

Vaccination
  • Since the beginning of vaccination on August 8, 2018, 6,134 people have been vaccinated , including 3,120 in Mabalako, 1,747 in Beni, 1,067 in Mandima, 121 in Oicha, 60 in Katwa (Butembo) and 19 in Kinshasa.
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Healthcare providers arrive at a Mangina health center to take a confirmed case and bring it to the Ebola Treatment Center​
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WORLD NEWSSEPTEMBER 5, 2018 / 6:32 AM / UPDATED 40 MINUTES AGO

Congo records first Ebola death in major eastern trade hub

Fiston Mahamba

GOMA, Congo (Reuters) - Democratic Republic of Congo has recorded its first death from Ebola in the eastern trading hub of Butembo, a city of almost a million with links to Uganda that could complicate efforts to control the outbreak, health officials said on Wednesday.
...
Butembo, about 55 km (35 miles) away, is two or three times the size of Beni. It straddles a major trading route for consumer goods entering Congo from East Africa and for Congolese exports of artisanal gold, coltan, timber and other materials to East African ports via Uganda.
...
Butembo?s mayor Sylvain Kanyamanda said the victim was a woman who was likely infected as a result of participating in an unsafe burial. She died in a university clinic.
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https://www.reuters.com/article/us-...n-major-eastern-city-of-butembo-idUSKCN1LL1FG
 
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[TD="class: mcnTextContent"] EPIDEMIOLOGICAL SITUATION IN THE PROVINCE OF NORTH KIVU
Wednesday 5 September 2018

The epidemiological situation of the Ebola Virus Disease dated September 4, 2018 :
  • A total of 127 cases of haemorrhagic fever were reported in the region, of which 96 confirmed and 31 probable.
  • 4 suspected cases are under investigation.
  • 3 new confirmed cases, including 1 in Mabalako, 1 in Mandima and 1 in Butembo.
  • Investigations revealed that a confirmed case in Beni came from Kalunguta, a rural health area between Beni and Butembo. The case is already cured and has been discharged from the Ebola Treatment Center (ETC).
  • 2 deaths of confirmed cases, including 1 in Beni and 1 in Butembo

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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.
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News of the response​

Coordination in Butembo
  • This Tuesday, September 4, 2018, a sample taken from a person who died in Butombo was positive for Ebola. This is the first confirmed case of Ebola in Butembo. This is a contact from Beni who refused to cooperate with the health authorities and fled to Butembo after falling ill. He died at Butembo University Hospital. The hospital's health staff, having already been trained on how to deal with suspected cases, complied with individual protection measures. The burial has been secured.
  • For several days, a coordination monitoring team had already settled in Butembo after receiving information that several contacts living in Beni had moved to Butembo.
  • On Wednesday, 5 September 2018, Response Coordinator Dr Ndjoloko Tambwe Bathe traveled to Butembo with other coordinators to set up a full response team. They also identified the location sites of the mobile laboratory and a new CTE (the fifth to date). Vaccination of identified first contacts was also able to begin.
Port of entry monitoring
  • The National Border Health Program (PNHF) has established a mapping of population mobility in the areas affected by the epidemic in collaboration with the World Organization for Migration (IOM). This mapping has identified 5 priority areas for strengthening surveillance at ports of entry. These 5 priorities are:
    • Mangina - Kyanzaba - Mabalako
    • Mangina - Beni
    • Beni - Maboya - Butembo
    • Beni - Bunia / Beni - Kisangani
    • Beni - Kasindi
Vaccination
  • Since vaccination began on August 8, 2018, 6,343 people have been vaccinated , including 3,210 in Mabalako, 1,856 in Beni, 1,067 in Mandima, 121 in Oicha, 70 in Katwa (Butembo) and 19 in Kinshasa.
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[TD="class: mcnTextContent"] EPIDEMIOLOGICAL SITUATION IN THE PROVINCE OF NORTH KIVU
Thursday 6 September 2018

The epidemiological situation of the Ebola Virus Disease dated September 5, 2018 :
  • A total of 129 cases of haemorrhagic fever were reported in the region, including 98 confirmed and 31 probable.
  • 7 suspected cases are under investigation.
  • 2 new confirmed cases, including 1 in Beni and 1 in Masereka.
    • The confirmed case of Masereka is a health worker who is a known contact of Beni but who refused follow-up and vaccination.
  • 2 confirmed cases, including 1 in Beni and 1 in Masereka.

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  • 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.
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DRC: Two new confirmed Ebola cases in Butembo

By RFI Published on 06-09-2018 Last modified on 06-09-2018 at 22:54

Two people died of Ebola haemorrhagic fever in the town of Butembo, opening another outbreak of infection in eastern DRC. A total of 195 people were identified as having been in contact with these two patients. Patients who must now be vaccinated urgently, but in the area, the fight against the epidemic is complicated because of the numerous population displacements and security problems.

The first Ebola victim in Butembo town was known to the Congolese health services. This is a woman identified as carrying the disease in Beni, but who refused to be vaccinated and moved to Butembo opening another source of contamination.

As proof, the nurse who treated her is the second confirmed Ebola case in Butembo, who died too. 195 people were identified by the health services as having been in contact with these two people. People who must be vaccinated urgently according to Dr. Ndjoloklo Tambwe Bath?, sent by the Ministry to organize the response.

Another emergency for the doctor: to ensure the safety of these teams in the area. "In keeping with the international health regulations, we can not prevent people from moving around. This is a first factor. The second is the security issue. Our teams do not move as we want. Here, security supplants the whole response. Today, for example, my teams did not go to Butembo because safety was not guaranteed on the road. "

Located 55 kilometers from Beni, Butembo is an agglomeration of nearly a million inhabitants. And it has important trade links with neighboring Uganda.

For Jerome Kouachi, who leads the fight against the epidemic for Unicef ​​in the area, this extension of the disease reveals how strong resistance is and how information to fight against Ebola circulate poorly. "The number one problem is fear and ignorance of this disease," he recalls. The environment may be quite small, as long as we have not really faced the disease, we remain quite dubitative. It is from the moment they are confronted with the disease that people begin to understand the messages. "

http://www.rfi.fr/afrique/20180906-rdc-deux-nouveaux-cas-ebola-confirmes-butembo
 
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Posted on: 08/09/2018 at 17h47min45s

By Radio Moto Butembo-Beni

Lubero: Numerous religious leaders and Luotu residents vaccinated after the death of the first confirmed case

It is after the confirmation of a case of Ebola in rural commune of Luotu that the response team against this epidemic was deployed, this Friday, September 7, 2018 on the ground in order to prevent the spread of the disease. The day of this Friday was dedicated to the vaccination of the medical staff of the MUHATIKANI medical and surgical center. It is in the health zone of Masereka.

It is here that a confirmed case died Wednesday, September 05, 2018. Many religious leaders and inhabitants of this administrative entity were also vaccinated. The director of the Diocesan Office of Medical Works, BDOM, traveled with the delegation to Luotu. Sister Fran?oise MASIKA SYAGHUSWA encouraged health workers to deal with Ebola. The Luotu delegate also spoke after he was vaccinated. NDOVYA MAURU Evariste sensitizes its citizens to be vaccinated.

At the same time, health experts provided advice on preventive measures to learners in Luotu schools. Some schools in this municipality lack means of protection. Hence the advocacy of the teachers of the place to get some equipment from the response team, including sinks, said the teacher.

The health experts ask the population to respect the hygienic rules and especially to denounce the health workers for their care because this disease is a reality.


Posted on: 08/09/2018 at 17h47min45s
By Radio Moto Butembo-Beni

https://radiomotofm.info/lirearticl...x et des habitants de Luotu vaccinés après le % 20d% C3% A9c% C3% A8s% 20of% 20premier% 20cas% 20confirm% C3% A9
 
Ebola virus disease – Democratic Republic of the Congo

Disease outbreak news

7 September 2018


1 September 2018 marked one month since the declaration of this Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo. Good progress has been made in detecting and responding rapidly to new cases, and providing protection and therapeutics where appropriate. However, significant risks remain that could lead to further spread of this outbreak: reluctance by some communities to adopt Ebola prevention measures, transmission in health care facilities because of weak infection prevention and control (IPC) measures, delays in patients reaching Ebola treatment centres (ETCs) once they develop symptoms, and potential for the virus to spread to insecure areas that will be more difficult to access.

ght increase in case incidence (Figure 1). The focus of transmission has shifted from in and around Mangina in Mabalako Health Zone to the city of Beni; 15 of the 22 confirmed and probable cases in Beni, and at least 3 confirmed cases in other health zones, have been linked to a single transmission chain. Since the last Disease Outbreak News on 31 August (data as of 29 August), 13 new EVD cases (12 confirmed and one probable) were reported, including eight confirmed and one probable from Beni, two from Mabalako, and one each from Mandima,
Butembo and Masereka health zones. While the situation has significantly improved in Mangina and Mandima health zones, sporadic cases are still being observed. The risk of spread was heightened by the movement of two, subsequently confirmed, cases from Beni to the city of Butembo and a nearby village in Masereka Health Zone (Figure 2). Given the mobility of populations in the affected areas, these two cases were expected, rapidly detected and additional response measures swiftly activated to interrupt further spread of the virus.

As of 5 September 2018, a total of 129 EVD cases (98 confirmed and 31 probable), including 86 deaths (55 confirmed and 31 probable) have been reported in seven health zones in North Kivu Province (Beni, Butembo, Kalunguta, Mabalako, Masereka, Musienene and Oicha), as well as Mandima health zone in Ituri Province (Figure 2). While cases have been recorded in other areas, recent confirmed transmission events were localized to Beni, Mabalako and Mandima health zones. Of 123 probable and confirmed cases with known age and sex, adults aged 35–44 years (24%) and females (58%) accounted for the greatest proportion of confirmed and probable cases (Figure 3). Seventeen cases have been reported among health workers, of which 16 were laboratory-confirmed: Mabalako (14), Beni (1) and Masereka (1). All health worker exposures occurred in health facilities in Mandima and Beni outside of dedicated ETCs. Two health workers died. In addition to confirmed and probable cases, seven suspected cases from Mabalako (5), Beni (1), and Mandima (1) are currently pending laboratory testing to confirm or exclude EVD.

The presence of response teams and the implementation of Ebola control measures have by and large been accepted and supported by local communities in the affected areas. In some areas challenges remain. Teams are continuing to address sporadic instances of reluctance towards response activities.

Instances of insecurity and conflict in the immediate vicinity of response activities are also being monitored closely. WHO and UN security teams ensure that internal safety policies and procedures are strictly observed and complied with. The UN policy for the use of armed escorts (as applied in past outbreaks), continues to be observed with the use of military escorts in separate vehicles only when required, but with no direct involvement of security personnel in the response operations.

Figure 1: Confirmed and probable Ebola virus disease cases by week of illness onset, data as of 5 September 2018 (n=127)*

figure1-7-sept-2018.PNG



*Date of illness onset unknown for n=2 cases. 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 zone in North Kivu and Ituri provinces, Democratic Republic of the Congo, data as of 5 September 2018 (n=129)

figure2-7-sept-2018.PNG



Figure 3: Confirmed and probable Ebola virus disease cases by age and sex, data as 5 September 2018 (n=123)*

figure3-7-sept-2018.PNG



*Age and/or sex unknown for n=6 cases.

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, IPC, clinical management, vaccination, risk communication and community engagement, safe and dignified burials, cross-border surveillance, and preparedness activities in neighbouring provinces. WHO and partners are also conducting preparedness activities in neighbouring countries.
  • Over 4500 contacts have been registered to date, of which over 2100 have completed 21 days of follow-up. As of 5 September, 2265 contacts remain under surveillance, of which 93–97% were followed-up daily during the past seven days. In some areas, contact tracing teams have faced various degrees of community refusal, but also insecurity and challenges posed by the continuous movement of contacts.
  • As of 6 September, 44 vaccination rings have been defined, in addition to ten rings of health workers and other frontline workers. These rings include the contacts (and their contacts) of the 52 most recently confirmed cases. To date, 6830 people consented and were vaccinated, including 1746 health care or front line workers, and 1762 children.
  • As of 5 September, WHO has deployed 194 experts to support response activities including logisticians, epidemiologists, laboratory experts, communicators, clinical care specialists, community engagement specialists, and emergency coordinators. Global Outbreak Alert and Response Network (GOARN) partner institutions continue to support the response as well as readiness and preparedness activities in non-affected provinces and in neighbouring countries.
  • The sub-national Health Cluster Coordinator who was deployed in Kananga through the Standby Partner (SBP) NORCAP, has been reassigned to North Kivu to support the EVD response. Efforts are ongoing to backfill positions through additional SBP deployments. SBPs are also prepared to support and deploy health professionals for EVD preparedness and response activates.
  • ETCs are fully operational in Beni and Mangina with support from The Alliance for International Medical Action (ALIMA) and M?decins Sans Fronti?res (MSF). In Beni, ALIMA are planning to expand treatment cube capacity over the next 2 weeks. A 20 bed ETC is being constructed in Makeke (Ituri Province) with the support of International Medical Corps (IMC), which is expected to be operational during the week of 9 September. A seven bed MSF transit centre is already operational in Makeke. Samaritan's Purse continue to support the isolation unit in Bunia with infection, IPC and isolation training.
  • ETCs continue to provide therapeutics under the monitored emergency use of unregistered and experimental interventions (MEURI) protocol in collaboration with the MoH and the Institut National de Recherche Biom?dicale (INRB). WHO is providing technical clinical expertise onsite and is assisting with the creation of a data safety management board. As of 6 September, 27 patients have received investigational Ebola therapeutics, including: mAb114 (13 patients), Remdesivir (9 patients) and ZMapp (5 patients).
  • A team of IPC specialists is holding daily training with health care and frontline workers, assessing and decontaminating facilities, and providing essential hand hygiene solutions and personal protective equipment. A team of experts deployed by WHO are supplementing local capacity, working with dozens of health care centres to see where there are gaps, and providing training and supplies as needed. They are assisting the health centres to set up triage to ensure that patients with suspected EBV can be separated and treated away from other patients, to decrease transmission risks.
  • The MoH, WHO, the United Nations Children's Fund (UNICEF), the Red Cross and partners are intensifying activities to engage with local communities in Beni, Butembo and Mangina. Local leaders, religious leaders, opinion leaders, and community networks such as youth groups and motorbike taxi drivers are being engaged to support community outreach for Ebola prevention and early care seeking through active dialogues on radio and interpersonal communication. Local frontline community outreach workers are working closely with Ebola response teams to strengthen community engagement and psychosocial support in contact tracing, patient care and safe and dignified burials (SDBs).
  • As of 6 September, over 642 religion leaders, traditional healers, magistrates/judges and teachers were oriented to support the encouragement of community members to practice Ebola prevention measures, seek early treatment and assist with surveillance, SDB and other response measures. and International Committee of the Red Cross (ICRC), are coordinating SDB. As of 6 September, Red Cross has established 3 operational bases in Beni, Mangina and Butembo; in total nine SDB teams are operational, and initial training has been conducted for teams in Bunia and Mambasa. To date, 112 SDBs are reported to have been successfully conducted.
  • Health screening has been established at 45 Points of Entry (PoE). More than two million travellers have been screened at these PoE.
WHO risk assessment

This outbreak of EVD is affecting north-eastern provinces of the Democratic Republic of the Congo, which border Uganda, Rwanda and South Sudan. Potential risk factors for transmission of EVD at the national and regional levels include the 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 may hinder the implementation of response activities. Based on this context, the public health risk was assessed to be high at the national and regional levels, and low globally.
As the risk of national and regional spread remains high, it is important for neighbouring provinces and countries to enhance surveillance and preparedness activities. WHO will continue to work with neighbouring countries and partners to ensure health authorities are alerted and are operationally ready 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 countries have implemented any travel restriction to and from the Democratic Republic of the Congo. Travellers should seek medical advice before travel and should practice good hygiene.
 
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[TD="class: mcnTextContent"] EPIDEMIOLOGICAL SITUATION IN THE PROVINCE OF NORTH KIVU
Saturday, September 8, 2018

The epidemiological situation of the Ebola Virus Disease dated September 7, 2018 :
  • A total of 131 cases of haemorrhagic fever were reported in the region, 100 confirmed and 31 probable.
  • Of the 100 confirmed, 58 died, 35 are cured and 7 are hospitalized.
  • 14 suspected cases are under investigation.
  • 2 new cases confirmed in Beni.
  • 1 confirmed case death in Beni.
  • 2 new people healed in Mabalako.

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  • 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.
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News of the response​

Press conference
  • The Minister of Health, Dr. Oly Ilunga Kalenga, held a press conference in Kinshasa this Saturday, September 8, 2018 to take stock of the first month of the response to the Ebola Virus Disease outbreak in the Northern Province -Kivu.
  • Here are the key points of the press conference:
    • The process of genetic sequencing of the virus by the National Institute of Biomedical Research (INRB) confirmed that the strains of the virus responsible for the two epidemics declared this year in the Democratic Republic of Congo are different although both belong to the species Ebola Zaire.
    • The spread of the virus has been brought under control in Mangina, which is the epicenter of the current epidemic. However, the response efforts were slowed down by the community resistance center in the Ndindi district of Beni, which recorded 71% (17/24) of the last confirmed cases. The last confirmed cases in the neighboring areas of Butembo and Masereka are related to these cases of resistance in Beni who refused follow-up contacts and vaccination.
    • Community resistance forced the coordination of the response to review its strategy in the city of Beni by directly involving community leaders, meeting in local coordination. This strategy paid off and community leaders convinced the family to cooperate with the health authorities. Members of this family, who are considered contacts, finally agreed to be vaccinated.
    • The security situation in North Kivu province remains worrying, but so far it has not prevented the response teams from doing their job and reaching the areas affected by the epidemic.
    • Regarding medical management, 26 patients were treated with mAb 114, Zmapp or Remdesivir. Of these 26 patients, 15 are cured and have been discharged from the Ebola Treatment Center (ETC), 6 have died and 5 are hospitalized.
Follow-up of contacts
  • The surveillance teams continue to trace the contacts of the last confirmed cases in the health zones of Butembo, Masereka and Kalunguta. A total of 5,156 contactshave been recorded in the 7 health zones affected since August 17, 2018.
Vaccination
  • Since the start of vaccination August 8, 2018, 7 .069 people were vaccinated , including 3,435 in Mabalako, 2130 in Beni, in 1117 Mandima Oicha 121 to 107 in Butembo, Katwa 70, 70 and 19 to Masereka Kinshasa (medical staff to deploy).

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https://us13.campaign-archive.com/?u=89e5755d2cca4840b1af93176&id=aa8ea0730e
 
250px-Democratic_Republic_of_the_Congo_%2826_provinces%29_-_Tshopo.svg.png

https://en.wikipedia.org/wiki/Tshopo

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Translation Google

Tshopo: A girl with signs of Ebola died in Kisangani

Posted on Mon, 10/09/2018 - 13:50 | Edited Mon, 10/09/2018 - 13:50

A 15-year-old girl with symptoms of Ebola died on Sunday (September 9th) at the Makiso Reference General Hospital in Kisangani (Tshopo). She died an hour after being rushed to hospital by her family members.

This is an alert given the outbreak reported in North Kivu province, says the head of the provincial health division / Tshopo, Dr. Francis Baelongandi.

The victim returned to Kisangani last week after spending her summer holidays in Mambassa territory in Ituri, reports Dr. Francis Baelongandi.

The same source says that the family saw fit to send her daughter to the hospital after a few days of high fever and headaches.

For the moment says Dr. Francis Baelongandi, about thirty contacts have been identified and are followed. Among them, 13 health providers and 26 other people in the family of the deceased and the immediate surroundings.

Samples were taken from the victim as well as contact persons to be sent to the National Institute for Biomedical Research (INRB), says Dr. Baelongandi.

After the death of the patient, urgent measures were taken, including the disinfection of the hospital, the nursing staff, the family home of the deceased and the secure burial of the body.

Pending the results of analysis, measures of hygiene and sensitization on a large scale are recommended at this time, underlines the head doctor of provincial division of the Health.

https://www.radiookapi.net/2018/09/...ntant-des-signes-debola-est-decedee-kisangani
 
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[TD="class: mcnTextContent"] EPIDEMIOLOGICAL SITUATION IN THE PROVINCE OF NORTH KIVU
Monday, September 10, 2018

The epidemiological situation of the Ebola Virus Disease dated September 9, 2018 :
  • A total of 132 cases of haemorrhagic fever were reported in the region, 101 confirmed and 31 probable.
  • Of the 101 confirmed, 60 died and 36 are cured .
  • 9 suspected cases are under investigation.
  • 1 new confirmed case in Butembo.
    • This is a man whose wife was one of confirmed cases of Mandima. The tests on his blood samples were negative, but the Ebola virus was identified in his sperm. He became ill during August and was admitted to the Makeke Health Center in the Mandima Health Zone (Ituri). He refused to transfer to Mangina's Ebola Treatment Center (ETC) but fled to Butembo and his illness had progressed well. During his recovery period, his wife visited him. Later, she became ill and was confirmed as suffering from Ebola.
  • 1 confirmed case death in Beni
  • 1 new person healed in Beni.

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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.
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News of the response​


Epidemiological surveillance
  • The Ministry of Health has received a haemorrhagic fever alert in Kisangani, the provincial capital of Tshopo. These are three girls from the same family returning from a vacation in Mambasa, a neighboring town in Mandima Health Zone where 9 confirmed cases of Ebola were recorded. All three samples were collected and sent to the Beni laboratory for analysis. The results are negative.
Vaccination
  • Since the start of vaccination August 8, 2018, 7 .780 people were vaccinated , including 3,503 in Mabalako, 2284 in Beni, in 1257 Mandima 287 in Butembo, 220 Masereka, 121 Oicha, 70 and 38 to Katwa Kinshasa (medical staff to deploy).

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https://us13.campaign-archive.com/?u=89e5755d2cca4840b1af93176&id=b346aee4fe
 
Translation Google


DRC: There is no Ebola outbreak in Goma, health authorities deny

Health authorities have denied on Tuesday, September 11, 2018 rumors of the presence of a case of the Ebola outbreak in the city of Goma (North Kivu).

The newly constructed Ebola Treatment Center (ETC) at Goma General Hospital has never hosted a case of the disease, said Dr Richard Kitenge, in charge of the response to the outbreak.

"We have always had suspected Ebola cases. The one from yesterday (Monday) was taken and tested negative. In Goma, there is no Ebola case. We have put in a contingency plan that allows us to delve into all the cases that go through the care structures and meet the case definition. So, let the people calm down. This contingency plan ensures that only one case can not escape and that it can expose the population. The treatment center is already in place. There is a medical ambulance with trained staff. There are investigative teams that shoot in the city every day. We have prevention and protection teams that are also put in place. And those of awareness and communication, "he told ACTUALITE.CD.

While the response has been against the disease since its outbreak in early August in the locality of Mangina, a second person was affected by the Ebola virus in the town of Butembo, about 300 km north of Goma, said Monday the Ministry of the health.

"This is a man whose wife was one of the confirmed cases of Mandima (Ituri)." The tests performed on his blood samples were negative but the Ebola virus was identified in his sperm ", said the statement from the Ministry of Health.

Any suspected cases detected in Goma are taken care of at the Ebola Treatment Center. "Once the sample is taken and the case is negative, the patient is discharged from the ETC," added Dr. Kitenge.

The epidemic has already killed 91 people, including 60 of the 101 confirmed cases, according to a report drawn up on September 9, 2018 by the Ministry of Health. 36 patients were cured while 9 suspected cases are under investigation, according to the ministry.

Patrick Maki

https://actualite.cd/2018/09/11/rdc...ebola-goma-dementent-les-autorites-sanitaires
 
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[TD="class: mcnTextContent"] EPIDEMIOLOGICAL SITUATION IN NORTH KIVU PROVINCE
Thursday 13 September 2018


The epidemiological situation of the Ebola Virus Disease dated 12 September 2018 :
  • A total of 137 cases of haemorrhagic fever were reported in the region, of which 106 confirmed and 31 probable.
  • Of the 106 confirmed, 61 died and 37 are cured .
  • 17 suspected cases are under investigation.
  • 4 new confirmed cases, including 2 in Mabalako, 1 in Beni and 1 in Butembo.
  • No new deaths.

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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.
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News of the response​


Videoconference between the Ministry of Health and the CDC Atlanta
  • This Thursday, September 13, 2018, the Minister of Health, Dr Oly Ilunga Kalenga, chaired a videoconference between Kinshasa Emergency Operations Center (EOC), Beni NUC and the Centers for Disease Control and Prevention.(CDC) Atlanta. This videoconference is an extension of the collaboration between the Ministry of Health and the CDC and the visit of CDC Director Dr. Robert Redfield to the Democratic Republic of Congo last August. After a short word of welcome by the Minister of Health, the Beni-based response coordinator Dr Ndjoloko Tambwe Bathe presented the current dynamics of the epidemic. Secondly, exchanges focused on identifying and monitoring contacts in affected areas, and progress in vaccination. The various stakeholders decided to make these videoconferences each week in order to share the respective analyzes on the situation and the latest developments of the epidemic.
Vaccination
  • Since the beginning of the vaccination on August 8, 2018, 8,738 people have been vaccinated , including 3,654 in Mabalako, 2,656 in Beni, 1,328 in Mandima, 544 in Butembo, 220 in Masereka, 150 in Katwa, 121 in Oicha and 65 in Kinshasa ( medical staff to deploy).

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https://us13.campaign-archive.com/?u=89e5755d2cca4840b1af93176&id=14b280ec31
 
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[TD="class: mcnTextContent"] EPIDEMIOLOGICAL SITUATION IN THE PROVINCE OF NORTH KIVU
Friday 14 September 2018


The epidemiological situation of the Ebola Virus Disease dated 13 September 2018 :
  • A total of 140 cases of haemorrhagic fever were reported in the region, 109 confirmed and 31 probable.
  • Of the 109 confirmed, 63 died and 37 are cured .
  • 13 suspected cases are under investigation.
  • 3 new confirmed cases in Beni.
  • 2 confirmed cases, including 1 in Mabalako and 1 in Beni.

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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.
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News of the response​


Press conference of coordination of the response to Beni
  • The coordination of the response to Beni held a press conference on Friday, September 14, 2018 to present the results of the first six weeks of the response. Response Coordinator Dr. Ndjoloko Tambwe Bathe chaired the press conference with the head of the North Kivu Provincial Health Division, Dr Janvier Kubuya, and the WHO Emergency Operations Officer in Africa. , Dr. Michel Yao. This press conference was also an opportunity to remind journalists of their role during an epidemic, namely to inform the population on the evolution of the epidemic, to raise awareness of the good behavior to adopt and to calm it by denying rumors. .
  • Some highlights of the press conference:
    • The laboratory is one of the essential elements of the response. The coordinator explained that the average time to obtain the results of the sample tests is 3 hours with Gene Xpert. A scientific breakthrough is the ability to differentiate Ebola from other acute viral infections (Marburg virus, Rift Valley fever, Crimean-Congo fever) and arboviruses (yellow fever, West Nile virus, Zika, Dengue, Chikungunya) in 24 hours thanks to the differential diagnosis.
    • The coordination identified 400 priority schools to benefit from hygiene kits offered by the government or partners. Of these 400 schools, 369 have already been supplied. It was recalled that having a handwashing kit for students and teachers is a civic duty for all schools, even outside a period of epidemic.
    • The coordinator responded to criticisms that the sensitizers were not from the region by recalling that 90% of social mobilisers were hired locally and are Nande, the majority ethnic group in the Beni and Butembo regions. Moreover, the coordination collaborates with about twenty local NGOs in the sensitization of the population.
    • At the psycho-social level, all patients admitted to different Ebola treatment centers and their families receive psychological support. All children orphaned by Ebola are 100% nutritionally assisted.
    • With regard to staffing, the coordinator explained how the system of standardized premium scales applies to the entire Ministry of Health. The difference in rates between local staff who reside locally and staff from other provinces is justified by the fact that non-local providers have to pay for their housing and other livelihoods for the duration of their mission.
Vaccination
  • Since the start of vaccination on 8 August 2018, 8,963 people have been vaccinated , including 3,667 in Mabalako, 2,781 in Beni, 1,365 in Mandima, 594 in Butembo, 220 in Masereka, 150 in Katwa, 121 in Oicha and 65 in Kinshasa ( medical staff to deploy).

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https://us13.campaign-archive.com/?u=89e5755d2cca4840b1af93176&id=bc94f386dc
 
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