Monday, July 9, 2018

PRO/AH/EDR> Ebola update (51): Congo DR, cases, response

A ProMED-mail post
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International Society for Infectious Diseases

In this update:
[1] Cases
- Epidemiological situation 6 Jul 2018
- WHO: outbreak nearly over

[2] Response
- Batwa communities
- Oxfam

[1] Cases

- Epidemiological situation 6 Jul 2018
Date: Fri 6 Jul 2018
Source: DRC Ministry of Health [trans. edited]

Epidemiological Situation
The epidemiological situation of the Ebola Virus Disease dated 6 Jul
- A total of 53 cases of haemorrhagic fever were reported in the
region, of which 38 were confirmed and 15 were probable.
- 24 people have been cured of Ebola virus disease since the beginning
of the epidemic.
29 deaths were recorded, including 14 confirmed cases.

News from the Ebola response
Strategic Review of the Response

>From 3-5 Jul 2018, the Ministry of Health, together with the partners,
conducted a strategic review of the response to assess the current
epidemiological situation, assess the progress of the response, and
identify essential surveillance activities to be pursued in the
affected areas.

During the strategic review, the technical experts from the Ministry
of Health and the various agencies involved in the response presented
the Minister with the next steps, namely:
- A 21-day disengagement plan that aims to gradually reduce activities
and staffing in affected areas while maintaining an optimal level of
surveillance until the declaration of the end of the Ebola outbreak.
- A plan to stabilize and consolidate gains of 3 months from the end
of the Ebola epidemic, which aims to draw lessons from the response
and identify future prospects. This phase will be closed by the review
after action.
- A 3-month resilience plan aimed at strengthening the capacity of the
Congolese health system to monitor, detect and respond more
effectively to long-term epidemics.

The main factor contributing to the good results achieved in the
response is the alignment of all partners around a single response
plan under the leadership of the Ministry of Health. It is important
to maintain this alignment of all actors to ensure the success of the
next steps.

National Association of Ebola Winners (ANVE)
On Fri 6 and Sat 7 Jul 2018, the Ministry of Health and WHO are
organizing a workshop for the implementation of the Ebola Healing
Program in Mbandaka. During the 9th Ebola outbreak in the Democratic
Republic of Congo, 24 people were cured with adequate care. During
their recovery period, people who are cured of Ebola need medical,
psychological and social care to start their new life. It is in this
context that the National Association of Ebola Winners was created to
meet their specific needs.

The workshop aims to define a structured and integrated program of
clinical and psychological follow-up for people cured of Ebola. This
program includes 3 areas: medical follow-up, sperm testing and
counseling, and psychosocial support. Planned activities include
neurological monitoring, psychological assessment, counseling for the
prevention of sexual transmission of the virus, fertility and
pregnancy monitoring for women, as well as assessment of social status
and stigma.

In addition to the representatives of the Ministry of Health and WHO,
representatives of ANVE, INRB, ALIMA, MSF and UNICEF were also invited
to participate in the workshop.

Communicated by:
ProMED-mail Rapporteur Mary Marshall

- WHO: outbreak largely contained
Date: Fri 6 Jul 2018
Source: NBC News [edited]

Ebola outbreak in DR Congo likely over; no case for 21 days but 42
days must pass before it is officially over
Ebola virus outbreak likely over in Congo, WHO says.
No new cases have been reported in the Democratic Republic of the
Congo in 3 weeks.

The outbreak of Ebola in the Democratic Republic of the Congo is
probably over, with no new cases reported for 3 weeks, the World
Health Organization said Fri [6 Jul 2018].

WHO called the outbreak "largely contained." But it's too soon to
declare the outbreak fully ended because it's possible someone has
been infected and has not started showing symptoms yet, the WHO said.

WHO said 53 people had been infected with the virus, and 29 had died.
The last confirmed case was treated and released on 12 Jun 2018.

No one appears to have carried the virus out of the country, and WHO
is lowering the risk advisory to neighboring countries. The risk of
wider export out of the region was never considered high.

"In the absence of ongoing transmission, the probability of exported
cases is low and diminishing," WHO said.

WHO said more than 3300 people had been given an experimental Ebola
vaccine using a technique called ring vaccination, in which cases of
the disease are tracked down, and all the people they have been in
direct contact with are vaccinated. Then the contacts of those
vaccinated people are tracked down and vaccinated. This method
eradicated smallpox at the end of the 1970s.

This was the 9th outbreak of Ebola in the Democratic Republic of the
Congo. Until this one, the outbreaks had been in remote regions and
affected usually fewer than 100 people, although a 1995 outbreak
sickened 315 people and killed 250 of them, and the 1st outbreak, in
1976, affected 318 people and killed 280.

Winning hearts and minds in the newest Ebola zone
Health experts were worried about this outbreak because cases were
seen in a large city, Mbandaka, which sits on the busy Congo River.

Urban outbreaks of Ebola are especially frightening. In 2014-2016, an
epidemic of Ebola sickened more than 28 000 people and killed more
than 11 000 of them in Liberia, Guinea and Sierra Leone. It spread
explosively in both urban and rural regions.

Quick reaction probably helped contain this outbreak, experts said.

"However, there remains a risk of resurgence from potentially
undetected transmission chains and possible sexual transmission of the
virus by male survivors. It is, therefore, critical to maintain all
key response pillars until the end of the outbreak is declared," WHO

"Before the outbreak can be declared over, a period of 42 days (2
incubation periods) following the last possible exposure to a
confirmed case must elapse without any new confirmed cases being

Ebola can pop up unexpectedly because it can survive in male semen for
months after a man has recovered from an infection.

WHO also said it was helping the Congolese Ministry of Health to set
up a year of care for Ebola survivors, who can suffer long-term

[Byline: Maggie Fox]

Communicated by:

[2] Response

- Batwa communities
Date: Fri 6 Jul 2018
Source: WHO Africa [edited]

An inclusive response: reaching Batwa communities to combat Ebola
Dr Bijoux Sambu Fiti is part of the surveillance team working in
Itipo, a small community in the Democratic Republic of the Congo (DRC)
that has been battling Ebola since May 2018. Her job is to go deep
into the forest around Itipo to seek out sick people in Batwa villages
potentially suffering from undiagnosed cases of Ebola. The Batwa,
which is the plural term for Twa people, are hunter-gatherers living
primarily off the forest. Dr Sambu Fiti, who is from DRC herself, was
keenly aware of the challenges she would face in engaging with a
population so culturally different from the rest of the country.

In Itipo, 60% of the population is Batwa and 40% is Bantu.

"The Bantu have the same kind of culture, so it's very easy for
another Congolese person to communicate with them," says Dr Sambu
Fiti. "The Twa have a completely different culture. They shut off when
they meet someone they don't know. There's a good chance they will
just melt into the forest."

The Batwa people are often less inclined to visit state health
centres, saying the cost of care is too high and that they sometimes
do not feel welcome by the staff. This puts them at increased risk in
the midst of an Ebola outbreak, where accessing care is one of the
most important ways to prevent the spread and increase chances of
surviving the virus.

Dr Sambu Fiti was able to locate Batwa villages by asking nurses at
local health posts to identify the locations they knew traditional
healers to be present. Next, she teamed up with a Bantu acquaintance
whom the Batwa villagers had previously met. By going with someone
they trusted, she hoped this would encourage them to talk to her and
listen to her messages about protecting their health.

On entering each village, Dr Sambu Fiti introduced herself, explaining
that she was a doctor and part of the Ebola response. She discovered
that many people in the communities either did not know about Ebola or
had only the slightest understanding of the disease.

For Dr Sambu Fiti, a key issue was whether the Batwa community would
agree that any sick person she found could go to a clinic rather than
stay in the community to be treated by a traditional healer using
medicinal plants.

"They understood that Ebola is a disease that kills," she explains.
"For them, there are certain times it's acceptable go to a hospital,
and Ebola is one of those times." Healthcare was provided
free-of-charge by the government in Ebola-affected areas, which has
also helped people access care.

When Dr Sambu Fiti did come across a sick Batwa lady, she learned that
she had previously given birth in a clinic and was comfortable with
being admitted for tests. (She subsequently tested negative for

Jose Maria Masanga is an anthropologist and WHO consultant, who is
also from DRC. He works with the surveillance and risk communication
teams in Itipo. As an anthropologist, he has played an important role
in the response by analyzing the Batwa community's attitudes to the
Ebola outbreak.

Communicated by:
ProMED-mail Rapporteur Mary Marshall

[This report on a local doctor seeking out individuals in the Batwa
community with illness, highlights the difficulty of controlling Ebola
in a remote and culturally distinct habitat. It was found that "many
people in the communities either did not know about Ebola or had only
the slightest understanding of the disease." Therefore, it would take
an astute doctor to pick up a single Ebola case, or a cluster of
cases, to set off the alarm. One has to wonder whether Ebola virus may
circulate under the radar in such locations as Itipo, with no one
noticing. - Mod.LK]

- Oxfam
Date: Mon 9 Jul 2018
Source: Media Congo [edited]

In northwestern DRC, the end of the Ebola outbreak is emerging. The
authorities hope to declare it by 22 Jul 2018, the last suspected case
being released from quarantine on 27 Jun 2018. However, for the
healed, the situation is always difficult. They must face isolation
and ostracism. Along with the World Food Program (WFP) and UNICEF, the
NGO Oxfam distributes food for them until they return to normal life.

W is still affected by what she has experienced. Rescued from Ebola,
she contracted the virus as part of her work as a nurse. To pass on
the other side of the barrier was a test, with the pains, the fever,
the treatment and above all the banishment of the society.

"My friends isolated me when I was sick. We love each other only when
we are in shape, and if we are sick, friends abandon you, she
explains. So, there are children at home; that's what I was able to do
to try a little to get my daily life back."

W has not yet been allowed by her employer to return to work. In the
meantime, she receives food from Oxfam. The NGO provides food to the
sick as well as to those at risk in quarantine. But the purpose of
this action is also social.

"There is a commission called psycho-social, which follows all those
people affected for a certain reintegration into their ordinary
environment, explained Olivier Makita, coordinator in Mbandaka.
Through this food distribution activity, there is a household that
said, for example, that it was the 1st time they had been able to
receive family members and neighbors again. Because there was this
contribution, the mother could do the meals, and the rest of the
family came to eat."

Support is all the more important as the region is poor and rural. As
Olivier Makita pointed out, the response to the virus is teamwork and
is not limited to healing the sick.

Communicated by:
ProMED-mail Rapporteur Mary Marshall

[See ProMED-mail Ebola update (34): Congo DR, cases, response, WHO for discussion of Oxfam's
contribution to the Ebola response. Oxfam is distributing rice, beans
and flour to about 4525 people. This is in addition to providing clean
water and working with communities to ensure that they know how to
protect themselves against the virus and prevent its spread.

Oxfam is providing door-to-door information to the most vulnerable
people, working with communities, and carrying out mass awareness
activities including film screenings and working with local community
radio stations.

Oxfam is also installing chlorinated water points in hospitals, health
centres, schools, and ports, and helping to disinfect houses in which
Ebola cases have been detected. It also provides disinfection kits and
hygiene kits to communities.

Oxfam has made a tremendous contribution to control of the DRC Ebola
outbreak! - Mod.LK

HealthMap/ProMED map available at:
DR Congo: <>]

[See Also:
Ebola update (50): Congo DR, Japanese response, CIDRAP, WHO, survey
Ebola update (49): Congo DR, suspect deaths comment
Ebola update (48): Congo DR, MSF, susp. deaths, RFI
Ebola update (47): DR Congo, epidemiology, response, Libya RFI
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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