Friday, November 09, 2018

WHO Ebola Disease Outbreak Update - DRC

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Three weeks ago the WHO IHR Committee Determined DRC Ebola Outbreak Is Not Currently A PHEIC (Public Health Emergency Of International Concern), but the situation remains both fluid and perilous.
While stating that `substantial progress has been achieved in all aspects of the response' -  the WHO reports today that 29 new cases have been confirmed over the past week, including 3 healthcare workers.
Due to concerns over cross-border movement of the virus into neighboring Uganda, on Wednesday Uganda Began Targeted Vaccination Of Front-Line HCWs Against Ebola.

Overnight the WHO has published a lengthy update (see below). I've only excerpted a portion, so you'll want to follow the link to read it in its entirety. 

Ebola virus disease – Democratic Republic of the Congo

Disease outbreak news: Update
8 November 2018

As the Ebola virus disease (EVD) outbreak enters the fourth month since declaration, and case numbers surpass 300, substantial progress has been achieved in all aspects of the response. Nevertheless, there remains a challenging road ahead to control intense transmission in the city of Beni and emerging hotspots in villages around Beni and Butembo. Security incidents and pockets of community resistance continue to impact civilians and frontline workers, requiring the response to continually adapt to the situation. The UN is committed to staying and supporting the Ministry of Health (MoH), and confident that the outbreak can be contained. This week, the WHO Director-General, UN Under-Secretary-General for peacekeeping, and WHO Deputy Director-General (DDG) Emergency Preparedness and Response travelled to the Democratic Republic of the Congo to review how further support can be offered to strengthen the response.

Over the past week (31 October – 6 November), 29 new confirmed EVD cases were reported: 15 from Beni, seven from Butembo, four from Kalunguta, two from Mabalako, and one from Vuhovi. The two cases reported in Mabalako were a mother and her new-born child, residing and infected in Beni, but sought treatment at the Mabalako Ebola treatment centre (ETC). Three health workers from health posts in Beni and Kalunguta were among the newly infected; 28 health workers have been infected to date. Ten additional survivors were discharged from the Beni ETC and reintegrated into their communities; 88 patients have recovered to date.

As of 6 November, 308 EVD cases (273 confirmed and 35 probable), including 189 deaths (154 confirmed and 35 probable)1, have been reported in eight health zones in North Kivu Province and three health zones in Ituri Province (Figure 1). While fewer cases were reported from Beni this week, new cases continue to be detected daily here and elsewhere, and delays in case detection persist; therefore, trends in weekly incidence must be interpreted cautiously (Figure 2).

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 South Sudan, Uganda and Yemen; EVD has been ruled out for all alerts to date. Uganda (geographically closest to outbreak affected areas), continues to intensify preparedness activities, and this week began to vaccinate health and frontline workers at priority health facilities.

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.

(Continue . . . )
The largest Ebola outbreak occurred in West Africa in 2014, but as the CDC map below illustrates, Central Africa has been the home of most of the known outbreaks since the virus was identified in 1976.

While it pales in comparison to the 2014 West African Outbreak (28,000+ cases), this current outbreak's case count is 312, making it the 5th largest on record, and will likely surpass 4th place Kitwik (1995) and 3rd place Yambuku (1976) in the next few days (list).

The CDC has also recently updated their Level 2 Travel Alerts for Ebola in the DRC.
Ebola in Democratic Republic of the Congo
Alert - Level 2, Practice Enhanced Precautions
Key Points
  • There is an outbreak of Ebola in the North Kivu (Kivu Nord) and Ituri provinces in the the northeastern part of the Democratic Republic of the Congo (DRC).
  • The outbreak is in a part of the country identified by the U.S. State Department as a do not travel zone because of armed group activity and major outbreaks of violence targeting civilians.
  • The armed conflict and violence in the outbreak area is hampering response activities including early identification of cases, and monitoring of "contacts" (people who may have been exposed to Ebola).
  • Travelers to this area could be infected with Ebola if they come into contact with an infected person’s blood or other body fluids.
  • Travelers should seek medical care immediately if they develop fever, headache, body aches, sore throat, diarrhea, weakness, vomiting, stomach pain, rash, or red eyes during or after travel.
        (Continue . . . . )

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