Friday, May 25, 2018

ECDC Rapid Risk Assessment On Ebola Outbreak In The DRC


















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Although their numbers are already surpassed by more recent updates (see WHO DRC Ebola Update - May 23rd) the ECDC has today published a 9 page RRA (Rapid Risk Assessment) of the ongoing Ebola outbreak in the DRC.
This RRA provides both an overview of the current outbreak and background information on the disease, along with a special emphasis on the potential of Ebola spreading to the EU (which is considered `Very Low').
First, the Executive Summary as provided by the ECDC, followed by a couple of excerpts from a much larger document.

Rapid risk assessment: Ebola virus disease outbreak in Equateur Province, Democratic Republic of the Congo, First update
risk assessment

25 May 2018

From 4 April until 20 May 2018, 49 cases and 26 deaths have been recorded: of which 22 are confirmed, 21 are probable and six are suspected cases.

Executive summary

This is the ninth Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo (DRC) since the discovery of the virus in 1976. 

From 4 April until 20 May 2018, 49 cases and 26 deaths have been recorded: of which 22 are confirmed, 21 are probable and six are suspected cases. Cases have been reported from the Bikoro health zone (n=29; 10 confirmed and 19 probable), the Iboko health zone (n=16; eight confirmed, two probable and six suspected) and the Wangata health zone (n=4; all confirmed) [1]. The current outbreak is taking place in health zones neighbouring the Congo River, which is an important pathway of trade and travel. In addition, four confirmed EVD cases have been reported in the health zone of Wangata within the port city of Mbandaka which has a population of 1.2 million people. These factors have raised concerns about an increased probability of the spread of the disease at the national level. The identification of EVD cases in the urban area of Mbandaka city and around Tumba Lake both connected to the Congo River increases the risk of regional spread to other provinces of DRC and neighbouring countries (namely Republic of the Congo and the Central African Republic). ECDC is closely monitoring this outbreak in liaison with the Ministry of Health in DRC, WHO and other partners, and will reevaluate the risk for EU/EEA citizens if necessary according to epidemiological findings.

Under the coordination of the Ministry of Health in the DRC, the timely EVD outbreak response is being implemented with the support of UN agencies and international partners. The strategic activities being implemented for the prevention and control of this outbreak include: coordination of the response activities, enhanced epidemiological surveillance for early detection of cases and contact tracing, increase of laboratory capacity, appropriate case management, reinforcement of infection prevention and control (IPC) measures, ensuring safe and dignified burials, social mobilisation and community engagement.

For the European Union/European Economic Area (EU/EEA) citizens living in, or travelling through areas of DRC not known to have EVD cases, the risk of exposure is very low, provided they adhere to the recommended precautions. The overall risk of introduction and further spread of Ebola virus within the EU/EEA is currently considered to be very low.



From the RRA itself:

Risk to EU/EEA citizens living or traveling in DRC
 
The probability of exposure of EU/EEA citizens living in or travelling through areas of DRC not known to have outbreak cases is very low in general as transmission of the Ebola virus occurs in the context of direct contact with sick or dead persons or animals infected with Ebola. Due to the current limited number of cases and affected areas, the risk of infection through daily interaction in the community in Equateur province remains low if visitors and long-term residents adhere to the recommended precautions (see Green Box).
Risk of introduction and further spread within the EU/EEA
 The most likely mode of introduction into the EU/EEA would be through an infected traveller coming from the affected area. The likelihood of EVD-infected individuals arriving in the EU is expected to be minimal due to the limited outbreak size (less than 50 EVD cases), and the fact that its epicentre is currently reported to be primarily in remote and rural areas of Equateur Province, according to available information. Therefore, the overall risk of introduction and further spread of Ebola virus within the EU/EEA is currently considered to be very low.
For comparison, during the substantially larger EVD outbreak in West Africa in 2014, which included a total of about 28 600 cases and 11 300 deaths, only one local transmission occurred in the EU/EEA (Spain) in a healthcare worker attending to an evacuated Ebola patient [38]. However, if there is a substantial increase in the number of cases or in the geographical spread of the EVD outbreak the probability of introduction in Europe may increase.
To date, WHO advises against the application of any travel or trade restrictions on the Democratic Republic of the Congo based on the currently available information and in accordance with the IHR 2005 [30]. Travel restrictions and active screening of passengers on arrival from affected area in DRC at sea ports, airports or ground crossings in non-affected countries are also not currently recommended by WHO.
Exit screening measures are increasingly implemented in DRC both at Kinshasa airport and Mbandaka airport. More information about the value of entry screening during the unprecedented EVD outbreak in Guinea, Sierra Leone and Liberia, is available in the Rapid Risk Assessment Eighth update, 18 November 2014 [4].
Exit screening at borders is part of a continuum of measures to contain the epidemic at the source, in conjunction with educating travellers on risk and self-reporting in case of symptoms. Containment measures also include increased vigilance for detection and management of suspect cases on board of conveyances and at point of exit.


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