DRC
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On June 25th, 2020 the Minister of Health of the Democratic Republic of the Congo (DRC) declared the end of the Ebola virus disease (EVD) outbreak in North Kivu, Ituri and South Kivu Provinces that had begun 23 months earlier.
According to the WHO's July 3rd, 2020 Weekly Epidemiological report:
From 1 August 2018 to 25 June 2020, a total of 3470 EVD cases were reported from 29 health zones including 3317 confirmed cases and 153 probable cases. Of the total confirmed and probable cases, 57% (n=1974) were female, 29% (n=1006) were children aged less than 18 years and 5% (n=171) were health care workers. There were 2287 deaths recorded (overall case fatality ratio 66%), 33% (1152/3470) of cases died outside of Ebola treatment centres, and 1171 cases recovered from EVD. Over the course of the outbreak, more than 250 000 contacts of cases were registered in North Kivu, Ituri and South Kivu Provinces (Figure 1).
Four days ago (Feb 7th) the Ministry of Health of the DRC announced that a new, fatal case of Ebola has been detected in Butembo, a city in North Kivu Province, where the aforementioned recent outbreak was declared over in June 2020.
The case involved a 42 year-old woman, who was the wife of an Ebola Survivor.
While there have been reports of Ebola transmission from survivors as long as a year after recovery from the virus (see EID Journal: Ebola Virus Infection Associated with Transmission from Survivors), exactly how and where this woman contracted the virus has yet to be established.
While only one case has been identified in this latest outbreak, the patient was treated at at least 3 medical facilities, and had contact with more than 115 people.
Overnight the WHO published a Disease Outlook News (DON) and risk assessment on this latest case, and the public health measures now underway in the region.
bola virus disease – Democratic Republic of the Congo
Disease outbreak news
10 February 2021
On 7 February 2021, the Minister of Health of the Democratic Republic of the Congo declared an outbreak of Ebola Virus Disease (EVD) after the laboratory confirmation of one case in Butembo, North Kivu Province. The case was a 42-year-old female living in Masoya Health Area, Biena Health Zone. She was a spouse of an EVD survivor, who has been followed up and whose biological samples have tested negative since 28 September 2020.
On 25 January 2021, the case presented with nasal bleeding. From 25 January to 1 February, she reportedly received outpatient care in Ngubi health center. From 1 to 3 February, she was admitted to Masoya health center with signs of physical weakness, dizziness, joint pain, epigastric pain, liquid stools, headache and difficulty breathing. On 3 February, a blood sample was collected for EVD testing due to her epidemiological link with an EVD survivor. On the same day, she was referred to Matanda Hospital, in Katwa Health Zone, Butembo territory following the deterioration of her condition. She was admitted to the intensive care unit the same day and died on 4 February. On 5 February, the body was buried in Musienene Health Zone, not under safe burial practices.
On 6 February, Butembo laboratory confirmed the case positive for EVD by GeneXpert. On 7 February, the sample was shipped to Goma laboratory, and tested positive for EVD by GeneXpert on 8 February.
As of 8 February 2021, a total of 117 contacts has been identified and are under follow up. Investigations and response activities are ongoing.
Public health response
An urgent meeting was convened on 8 February by the Minister of Health, and a team led by the Provincial Minister of Health of North Kivu was deployed to Butembo to organize immediate response activities;There are currently therapeutics (Regeneron and mAb114) available for up to 400 patients in the Democratic Republic of the Congo.
- Investigations are on-going in Katwa, Biena and Musienene Health Zones to identify the source(s) of transmission, identify contacts and conduct active case finding;
- Health facilities that were visited by the case have been disinfected;
- The decommissioned Ebola Treatment Center of Katwa is being assessed for reopening;
- WHO is providing ongoing support to the national authorities through staff present in Butembo territory, by preparing shipment of vaccine doses to Butembo and supporting shipment of cold chain equipment to Butembo territory;
- WHO and national authorities are strengthening laboratory capacities by ensuring availability of GeneXpert cartridges at Butembo laboratory; and
- WHO is supporting local authorities to implement immediate actions including case investigation, case finding, contact listing and follow-up.
WHO risk assessment
Preliminary information indicates that the patient visited at least three health facilities in two health zones and was unsafely buried in a third health zone (Musienene). There is therefore a risk of EVD spreading to other health zones. WHO is closely monitoring the situation and the risk assessment will be updated as more information becomes available.
The resurgence is not unexpected given that EVD is endemic in the Democratic Republic of the Congo and that Ebola virus is present in animal reservoirs in the region. The risk of re-emergence through exposure to animal hosts or bodily fluids of Ebola survivors cannot be excluded. In addition, it is not unusual for sporadic cases to occur following a major outbreak.
There are a number of ongoing challenges for surveillance, including access to affected areas and community mistrust toward authorities and outbreak responders. Other health emergencies such as coronavirus 2019 (COVID-19), cholera and measles outbreaks may jeopardize the country’s ability to rapidly detect and respond to re-emergence of EVD cases.
WHO advice
WHO advises the following risk reduction measures as an effective way to reduce EVD transmission in humans:To reduce the risk of wildlife-to-human transmission, such as through contact with fruit bats, monkeys and apes:
- Continue to train and retrain the health workforce for early detection, isolation and treatment of EVD cases;
- Prepare for vaccination of health workers;
- Engage with communities to reinforce safe and dignified burial practices; and
- Ensure availability of personal protective equipment and infection prevention and control supplies to manage ill patients and for decontamination.
To reduce the risk of human-to-human transmission from direct or close contact with people with EVD symptoms, particularly with their bodily fluids:
- Handle wildlife with gloves and other appropriate protective clothing; and
- Cook animal products (blood and meat) thoroughly before consumption and avoid consumption of raw meat from wild animals.
To reduce the risk of possible transmission from virus persistence in some body fluids of survivors, WHO recommends providing medical care, psychological support and biological testing (until two consecutive negative tests) through an EVD survivors care programme. WHO does not recommend isolation of male or female convalescent patients whose blood has been tested negative for Ebola virus.
- Wear gloves and appropriate personal protective equipment when taking care of ill patients at home; and
- Wash hands regularly after visiting patients in hospital, as well as after taking care of patients at home or touching or coming into contact with any body fluids.
