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Earlier this week the World Health Organization's IHR Emergency Committee met to discuss whether the ongoing outbreak of Ebola in the DRC constituted a PHEIC (Public Health Emergency of International Concern).
While the threat level remains very high regionally, the WHO IHR Emergency Committee decided the outbreak did not rise to the level of a global threat (see WHO IHR Committee Determines DRC Ebola Outbreak Is Not Currently A PHEIC).Overnight the WHO posted a new update and risk assessment, citing some recent improvements seen on the ground while cautioning that many challenges remain ahead.
I've only posted some excerpts from a much longer report. Follow the link below to read it in its entirety.
Ebola virus disease – Democratic Republic of the Congo
Disease outbreak news: Update
18 October 2018
The response to the Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo has seen significant improvements over the past weeks, including strong performances by field teams conducting vaccinations, and improved community engagement and risk communication in priority areas.
However, as new cases continue to emerge from Beni and appear closer to security ‘red zones’, it is clear that risks remain and that strong response measures need to be prioritized. The virus’ spread is partly due to security conditions that severely impact frontline and health workers, at times forcing the suspension of response activities and increasing the risk that the virus may spread to neighbouring provinces and countries. The MoH, WHO and partners continue to rapidly adapt to these challenging circumstances, scaling up all pillars of the response: surveillance, contact tracing, community engagement, laboratory testing, infection prevention and control, safe and dignified burials, vaccination, and therapeutics.
Due to the challenges faced in Democratic Republic of the Congo, the 1st Meeting of the 2018 International Health Regulations (IHR) Emergency Committee for Ebola Viral Disease in the Democratic Republic of the Congo took place on 17 October. Due primarily to the strength and tempo of current response operations, it was the view of the Committee that the conditions for a Public Health Emergency of International Concern (PHEIC) have not been met. The Committee further concluded that the current outbreak has several characteristics of particular concern: the risk of more rapid spread given EVD presence in urban environments; that there are several outbreaks in remote and hard to reach areas; and that health care staff have been infected. Risk of international spread also remains very high due to the outbreak’s proximity to significant regional traffic. Logistical challenges due to poor infrastructure continue to affect surveillance, case detection and confirmation, contact tracing, and access to vaccines and therapeutics.
Despite these challenges, the Committee also noted that the response of the government of the Democratic Republic of the Congo, WHO, and partners has been rapid and comprehensive. The Committee concluded that interventions already underway provide strong reason to believe that the outbreak can be brought under control, and that this vigorous response should be supported by the entire international community. A decline in the current level of response would cause the situation to deteriorate significantly. It is particularly important that there should be no international travel or trade restrictions, and that neighbouring countries should strengthen both preparedness and surveillance.
Since the last Disease Outbreak News (data as of 16 October), 26 new confirmed EVD cases were reported: 19 from Beni, three from Butembo, one from Mabalako, one from Kalungata, and two from Masereka Health Zones in North Kivu. Five of these confirmed cases have been linked to known cases or transmission chains within the respective communities, while 21 cases remain under investigation.
As of 16 October 2018, a total of 220 EVD cases (185 confirmed and 35 probable), including 142 deaths (107 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). An increasing trend in weekly case incidence has been observed (Figure 2). The rising trends are likely underestimated given expected delays in case reporting, the ongoing detection of sporadic cases, and security concerns which limit contact tracing and investigation of alerts. Of the 211 confirmed and probable cases for whom age and sex information is known, the majority (60%) are within the 15-44 years age range. Females (54%) accounted for a greater proportion of cases (Figure 3). A total of 20 healthcare workers have been affected (19 confirmed and one probable), of whom three have died.
The MoH, WHO and partners continue to closely monitor and investigate all alerts in affected areas, in other provinces in the Democratic Republic of the Congo, and in neighbouring countries. As of 16 October, 34 suspected cases in the Democratic Republic of the Congo are awaiting laboratory testing. Since 11 October, alerts have been investigated in several provinces of the Democratic Republic of the Congo, as well as in neighbouring countries. To date, EVD has been ruled out in all alerts from neighbouring provinces and countries.
(Continue. . . . )
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 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.
