Sunday, July 1, 2018

PRO/AH/EDR> Ebola update (47): DR Congo, epidemiology, response, Libya RFI

A ProMED-mail post
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International Society for Infectious Diseases

In this update:
[1] Epidemiologic study DRC
[2] European response
[3] Libya RFI

[1] Epidemiologic study DRC
Date: Fri 29 Jun 2018
Source: The Lancet [edited]

Citation: The Ebola Outbreak Epidemiology Team. Outbreak of Ebola
virus disease in the Democratic Republic of the Congo, April-May,
2018: an epidemiological study. Lancet.

... We provide early epidemiological information arising from the
ongoing investigation of this outbreak.

We classified cases as suspected, probable, or confirmed using
national case definitions of the Democratic Republic of the Congo
Ministère de la Santé Publique. We investigated all cases to obtain
demographic characteristics, determine possible exposures, describe
signs and symptoms, and identify contacts to be followed up for 21
days. We also estimated the reproduction number and projected number
of cases for the 4-week period from 25 May - 21 Jun 2018.
The ongoing Ebola virus outbreak in the Democratic Republic of the
Congo has similar epidemiological features to previous Ebola virus
disease outbreaks. Early detection, rapid patient isolation, contact
tracing, and the ongoing vaccination programme should sufficiently
control the outbreak. The forecast of the number of cases does not
exceed the current capacity to respond if the epidemiological
situation does not change. The information presented, although
preliminary, has been essential in guiding the ongoing investigation
and response to this outbreak. ...

At present, the source of the outbreak is unknown. Investigations are
ongoing, but one hypothesis is that this outbreak is linked to a
cluster of 15 cases of febrile illness in Ingende and Bikoro health
zones in February 2018. Of those 15 people, 11 had haemorrhagic signs,
of whom 8 died. According to the investigation report, the 1st person
died on 20 Dec 2017. The cause of that cluster has not been confirmed.
Although a link between the 2 clusters cannot be ruled out, the long
period of time between these 2 events without identified chains of
transmission calls into question whether they were causally linked.
However, there are epidemiological links between the ongoing clusters
in the different locations, which underscores the potential for
geographical spread, even in remote areas.

Forward projections suggest that if interventions remain as effective
as they were between 30 Apr and 24 May 2018, an estimated twice as
many cases would occur by 21 Jun 2018. Even in this pessimistic
scenario, the current isolation capacity available in the affected
communities would be sufficient. Nonetheless, considering that a
period of 42 days after the last potential exposure is required before
the outbreak can be considered to be over, the ongoing occurrence of
cases would mean that the response will need to continue for at least
the next 3 months or more. Furthermore, it is not possible to rule out
further expansion of the outbreak if there is exportation of cases to
new areas, or if there are ongoing but hitherto unrecognised chains of
transmission. It is also possible that a new chain of transmission
could occur after sexual transmission of the virus from a male
survivor, if appropriate services and counselling are not provided,
requiring an even longer response.

As for all outbreak investigations, some data are collected
retrospectively, and some data are incomplete. Data about signs and
symptoms for some patients were collected retrospectively from medical
records, which might have resulted in errors or missing data. Detailed
information about chains of transmission is being compiled by field
investigation teams and is not yet available. The dynamic nature of
outbreaks and response means that case numbers and the analysis
presented will be revised as additional information becomes

A major sustained response is, therefore, needed to ensure ongoing
case identification, isolation, contact tracing, and other control
measures. Implementation of WHO's Early Warning Alert and Response
System, a data collection system that uses handheld devices,
represents a major improvement for data collection since the 2014-16
West Africa epidemic. However, this information system is not
optimally designed for contact tracing. Collecting, managing, and
analysing epidemiological data in real time continues to be a
substantial challenge in the field. Nonetheless, our analysis
presented shows that real time data collection and epidemiological
analysis for the control of complex Ebola virus disease outbreaks is

The epidemiology of the current Ebola virus outbreak in the Democratic
Republic of the Congo has similar features to previous Ebola
outbreaks. This similarity suggests that early detection of the
outbreak, combined with tried-and-tested interventions such as early
isolation and treatment, contact tracing, safe burials, and community
engagement, which are currently being implemented, along with the
additional benefit of targeted vaccination, should be sufficient to
control this outbreak. However, the combination of remote communities
and spread to an urban centre that is connected to the capital city
and neighbouring countries makes this outbreak the most complex and
highest risk ever experienced by the Democratic Republic of the

Communicated by:
ProMED-mail Rapporteur Mary Marshall

[While this outbreak was, as stated above, the most complex and
highest risk ever experienced by the Democratic Republic of the Congo,
the response was well organized, comprehensive, rapid, and carefully
executed, even with the inherent difficulties of the situation. This
should serve as a model for what are likely to be future outbreaks in
the region not only of Ebola, but of other infectious diseases. -

A HealthMap/ProMED-mail map of DR Congo can be found at

[2] European response
Date: Sat 30 Jun 2018
Source: ERCC PORTAL, Emergency Response Coordination Centre (ERCC),
European Civil Protection and Humanitarian Aid Operations [edited]

Democratic Republic of the Congo - Ebola outbreak (DG ECHO, WHO, DRC
Ministry of Health, media) EUCPM activation

- The Ebola outbreak, which was declared on 8 May 2018, is not yet
over but has been "largely contained" according to the World Health
Organization (WHO). The organization views the situation with
"cautious optimism." The last confirmed case of Ebola virus disease
(EVD) was reported on 6 Jun 2018. The incubation period of the Ebola
virus is 21 days. The end of the outbreak will be declared once 42
days have passed without a new Ebola case.

- The epidemiological situation on 28 Jun 2018 was as follows: In
total, 56 reported cases with 38 confirmed EVD cases, 15 probable
cases and 3 suspected ones. 29 people died. All remaining contacts and
contacts-of-contacts of EVD patients have been followed up.

- This 9th outbreak of Ebola in the DRC since the virus was discovered
there in 1976 has been "the most challenging and complex outbreak the
country has ever had to face, mainly because it started in 2 rural
zones at the same time and quickly reached a city of more than one
million inhabitants directly connected to Kinshasa," said the
Congolese Minister of Health.

- Ring vaccination with an experimental vaccine was a new element in
the response and used for the very 1st time. It is seen as a paradigm
shift for Ebola control. "The use of vaccination in this Ebola
response has been a game-changer, as it allowed us to break the chain
of transmission and contain the virus more quickly," said Dr. Kalenga.
In total, 3330 persons -- health workers and contacts -- were

- That the outbreak has not turned into an enormous epidemic has only
been possible thanks to the rapid and robust response and the
collective intervention by national authorities, WHO and other
international organizations such as Médecins Sans Frontières (MSF).
WHO's response plan required USD 57 million and was quickly funded.

- The European Union has mobilised all EU emergency response
instruments, including humanitarian aid worth EUR 3.43 million [USD 4
million] (plus individual EU Member States' contributions), logistical
support through the Commission's humanitarian air service called "ECHO
Flight," and the activation of the Union Civil Protection Mechanism
(UCPM) at the request of WHO, which allowed for the deployment of
medical personnel and equipment. As EU Ebola Coordinator, the European
Commissioner for Humanitarian Aid and Crisis Management, Christos
Stylianides, continues to follow the situation closely until it is
safe to say the outbreak is over.

Communicated by:
ProMED-mail Rapporteur Mary Marshall

[This summary specifically addresses the European response to the DRC
Ebola outbreak and does not discuss the response by other regions such
as Asia. Both Japan and China also sent support to combat the
outbreak. - Mod.LK]

[3] Libya RFI
Date: 1 Jul 2018
Source: Libya Observer [edited]

The National Centre for Disease Control denied on Sat [30 Jun 2018]
the registration of any cases of Ebola disease at Sabha Medical
Center. On its Facebook page, the Centre explained that the management
of Sabha Medical Centre has an electronic system for early warning of
communicable diseases, denying the news about recording any Ebola
cases in Sabha.

The Centre for Disease Control also explained that it is issuing a
weekly epidemiological bulletin to inform specialists and analyse the
epidemiological situation of communicable diseases in the country and
confirm the diagnosis of all communicable diseases detected in the
World Health Organization's Reference Laboratory for Community

Several social networking sites have reported recently the
registration of cases of Ebola disease in the city of Sabha.

[Byline: Safa Alharathy]

Communicated by:
ProMED-mail Rapporteur Mary Marshall

[Sabha is on a migration route from sub-Saharan countries. Sabha is an
oasis city in southwestern Libya, approximately 640 km (400 miles)
south of Tripoli. It was historically the capital of the Fezzan region
and the Military Territory of Fezzan-Ghadames and is now capital of
the Sabha District. (<,_Libya>). -
Rapporteur Mary Marshall]

[Any information on these possible cases of Ebola is welcome. How many
cases have been reported? How is the situation being monitored? Who is
participating in the investigation, and what tests are being done to
confirm or rule out the diagnosis of the possible cases? - Mod.LK

A HealthMap/ProMED-mail map of Libya can be found at

[See Also:
Ebola update (46): Congo DR, cases
Ebola update (45): Congo DR, cases, outbreak, MSF
Ebola update (44): Congo DR, cases, research, course
Ebola update (43): Congo DR, cases, vaccine, persistence, lessons
Ebola update (42): Congo DR, cases, vaccine
Ebola update (41): Congo DR, cases, WHO, contacts
Ebola update (40): Congo DR, cases, WHO, vaccine, treatment,
Ebola update (39): Congo DR, cases, WHO, response, facilities,
treatment, research
Ebola update (38): DR Congo, cases, WHO, Oxfam
Ebola update (37): Congo DR, cases, response
Ebola update (36): Congo DR, cases, threat, assistance
Ebola update (35): Congo DR, cases, response, WHO
Ebola update (34): Congo DR, cases, response, WHO
Ebola update (33): Congo DR, cases, response, WHO, diagnosis
Ebola update (32): Congo DR, cases, preparation, research
Ebola update (31): Congo DR, cases, response, WHO
Ebola update (30): Congo DR, cases, WHO, action
Ebola update (29): Congo DR, cases, MSF, antivirals
Ebola update (28): Congo DR, cases, WHO, response, treatment, funding
Ebola update (27): Congo DR, cases, travel screening, children
Ebola update (26): Congo DR, border controls, bat reservoir
Ebola update (25): Congo DR, case update, intl. travel screening
Ebola update (24): Congo DR, case update, African aid response
Ebola update (23): Congo DR, cases, vacc. campaign targets, vaccine
Ebola update (22): Congo DR, cases, cures, domestic and international
Ebola update (21): Congo DR, update, WHO, vaccination, therapeutics
Ebola update (20): Congo DR, case update, lessons, logistics,
financing, flights
Ebola update (19): Congo DR, case update
Ebola update (18): cases, Uganda NOT, Congo DR vaccination campaign
Ebola update (17): case update, public fears, government responses
Ebola update (16): cases, Congo DR cultural factors, vaccine impl.,
case terminology
Ebola update (15): case update, quarantine breaches, border controls,
Ebola update (14): case update, response, prediction, maps
Ebola update (13): case update, prevention
Ebola update (12): update, USA, response
Ebola update (11): WHO, vaccination, response
Ebola update (10): urban case Congo DR, response, support
Ebola update (09): update, alerts, prevention
Ebola update (08): summary, emergency plan, vaccine, roads
Ebola update (07): Congo DR, nurse, Uganda susp, WHO, border, vaccine
Ebola update (06): Congo DR, susp, RFI, vulnerability, response,
Ebola update (05): Congo DR, outbreak update, vaccine, preparedness,
Ebola update (04): Nigeria, Kenya, Congo DR (ET), WHO
Ebola update (03): Congo DR (ET), WHO
Ebola update (02): Congo DR (ET)]
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