Wednesday, August 22, 2018

PRO/AH/EDR> Ebola update (74): Congo DR (NK) cases, response, WHO, reflections

EBOLA UPDATE (74): DEMOCRATIC REPUBLIC OF CONGO (NORTH KIVU) CASES,
RESPONSE, WHO, REFLECTIONS
**********************************************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

In this update:
[1] Case update
- Epidemiological situation report, 20 Aug 2018, DRC Ministry of
Health
- Healthcare workers hit hard
- Healthcare workers case numbers
[2] Response
- Ring vaccination
- Local government response
- Safe burial training
- Mangina: WHO Africa, reference health centre. Non-Ebola health care
- Mapping
[3] Reflections

******
[1] Case update
- Tue 21 Aug 2018. Epidemiological situation report, 20 Aug 2018, DRC
Ministry of Health
[in French, machine trans., edited]
<https://us13.campaign-archive.com/?u=89e5755d2cca4840b1af93176&id=b6c7746a89>

- A total of 102 cases of haemorrhagic fever were reported in the
region, 75 confirmed and 27 probable.
- 9 suspected cases are under investigation.
- 6 new confirmed cases, including 4 in Mabalako, 1 in Beni, and 1 in
Oicha.
- 4 confirmed cases, including 3 in Mabalako and 1 in Beni.

News of the response
Support
-------
- The Ethics Committee approved the use of 4 additional experimental
therapeutic molecules, namely ZMapp, Remdesivir, Favipiravir, and
Regn3450 - 3471 - 3479. Ebola Treatment Centers (ETC) treatment and
care teams will be able to use these molecules for the treatment of
patients infected with Ebola virus disease. The protocols for
administering these molecules meet strict conditions related in
particular to the condition of the patient, the ease of use of the
treatment and the capacity of the medical team of the ETC. This Tue 21
Aug 2018, the Remdesivir, produced by Gilead Sciences, was
administered to a patient treated at ETC Beni, who is doing well. As a
reminder, the mAb114 has started to be used since Sat 11 Aug 2018.

Vaccination
-----------
- Immunization activities continue at the 3 sites of Mabalako, Beni,
and Mandima. Since vaccination began on 8 Aug 2018, 1693 people have
been vaccinated, including 903 in Mabalako, 471 in Beni and 319 in
Mandima.

- Fri 17 Aug 2018. Congo's new Ebola outbreak is hitting healthcare
workers hard
[Science magazine, excerpted, edited]
<http://www.sciencemag.org/news/2018/08/congo-s-new-ebola-outbreak-hitting-health-care-workers-hard>
[Byline: Jon Cohen]

Healthcare [HCWs] workers have been especially hard hit by the current
outbreak of Ebola in the northeastern part of the Democratic Republic
of the Congo (DRC). To date, 9 of the 51 confirmed cases of Ebola have
been in people caring for the ill, says Peter Salama, an
epidemiologist based in Geneva, Switzerland, who heads the response to
the outbreak for the World Health Organization (WHO).

"There's an extremely low level of knowledge and awareness about Ebola
in the area," Salama says. "Early on, the healthcare workers took no
precautions whatsoever, and unfortunately, we're expecting more
confirmed cases from that group."

- Tue 21 Aug 2018. WHO: 13 health workers infected in DRC Ebola
outbreak
[CIDRAP (Center for Infectious Disease Research and Policy),
excerpted, edited]
<http://www.cidrap.umn.edu/news-perspective/2018/08/who-13-health-workers-infected-drc-ebola-outbreak>
[Byline: Stephanie Soucheray]

Tarik Jasarevic, a spokesperson with the World Health Organization
(WHO), told CIDRAP News that 13 healthcare workers have tested
positive for Ebola, a troubling development, because infected health
workers [HCWs] were one of the main factors in the rapid spread of the
disease during the 2013-2016 outbreak in West Africa.

Jasarevic also commented on a recent UNICEF report that said children
were being infected at high rates during this outbreak.

"The case distribution is slightly younger than what we might expect
when compared to previous outbreaks, but still within the general
range; each outbreak is different," he said.

--
Communicated by:
ProMED-mail Rapporteur Mary Marshall

[Note the increase in number of healthcare workers reported here, as
indicated by Peter Salama, who noted above that more such cases are to
be expected because of the lack of precautions taken early in the
outbreak. Since the vaccine is now being administered to HCWs and
other front-line workers, it is hoped this increase will slow down
significantly very soon as protective antibody post-vaccination
becomes effective. - Mod.LK]

******
[2] Response
- Sun 19 Aug 2018. Ring vaccination. Ebola: 10 rings have been defined
around 28 recently confirmed cases
[WHO African Region Twitter message]
<https://twitter.com/WHOAFRO>

On [8 Aug 2018], @MinSanteRDC, WHO and partners launched the #Ebola
ring vaccination for high-risk populations in northeastern #DRC.

As of 19 Aug 2018, 10 rings have been defined around 28 recently
confirmed cases and approximately 1300 people have consented and been
vaccinated.

[Real progress in the vaccination campaign, tempered by other reports
that some contacts are inaccessible because of armed rebel activity. -
Mod.LXL]

- Tue 21 Aug 2018: Local government response. North Kivu: Provincial
Government informed of level of response to Ebola
[Digital Congo, in French, machine trans., excerpted, edited.]
<https://www.digitalcongo.net/article/5b7c1c2e33074a0004d8f85c/>

Unsecured funerals and burials of the dead, untimely hospitalization,
nosocomial contamination, non-observance of hygiene rules,
uncontrolled movement of populations from contaminated areas, and
ignorance of the disease by the population are the causes of the
spread of Ebola virus disease.

The provincial health minister of North Kivu, Dr Martial Kambumbu
Kayenga, explained [Fri 17 Aug 2018] to the government meeting in
ministerial council on the level of response against this disease in
the territory of Beni. According to the report read by Mrs Marie
Shematsi Baeni, spokesperson of the government, the participants were
edified on the factors of propagation of the disease.

According to the same source, thanks to the speed with which the
Central Government reacted, 6 pillars of response were set up namely
surveillance, care, communication, security, psychosocial care, and
vaccination.

The installation of the 3 specialized laboratories of the National
Institute for Biomedical Research in Goma, Beni, and Mangina and the
establishment in Goma of a sentinel treatment center at the North Kivu
Provincial Hospital constitute reassuring measures to deal with this
officially declared disease in the Mabalako area since the beginning
of this month of August [2018].

[The "Six pillars of Ebola control" promulgated by Medecins Sans
Frontieres/MSF during the 2014-2015 West African epidemic included
Care, Safe burials, Awareness raising, Surveillance, Contact tracing,
and Non-Ebola health care. It is interesting to see that the current
"6 pillars of response" in North Kivu include the new elements of
"Security" and "Vaccination." - Mod.LXL]

- Tue 21 Aug 2018: Safe burial training. Bunia: 24 Red Cross rescuers
trained on the burial of Ebola corpses
[Radio Okapi, in French, machine trans., excerpted, edited]
<https://www.radiookapi.net/2018/08/21/actualite/societe/bunia-24-secouristes-de-la-croix-rouge-formes-sur-linhumation-des>

On 20-21 Aug 2018, 24 Red Cross volunteers from Bunia and Mambasa
(Ituri) were trained on the burial of the bodies of those who died of
the Ebola virus disease.

This training was provided by the International Committee of the Red
Cross (ICRC). For 2 days, these rescuers learned how to add chlorine
to water before disinfecting places where sick people would have
stayed.

The 24 rescuers were also briefed on the importance of securing
individual equipment such as masks, boots, rubber overalls, or gloves.
They learned how to secure the body bags to avoid getting infected or
contaminating other members of the community.

A risky job, is how Hubert Dedegbeu, in charge of the program at ICRC,
characterizes it. "When there is a body [to be buried], the clothing
worn by the person who died of Ebola must be disinfected. There is a
huge risk of contamination. There is a step-by-step protocol to
explain to volunteers," [he] said.

[Safe burials are still a mainstay of Ebola outbreak control. Thus far
we seem to have heard less about local cultural and religious norms in
the eastern DRC -- and how they impact the implementation of safe
burial procedures -- compared to West Africa. - Mod.LXL]

- Fri. 17 Aug 2018. Mangina: WHO Africa, reference health centre.
Non-Ebola health care
[WHO Africa, excerpted, edited]
<https://www.afro.who.int/news/ebola-hope-end-tunnel-mangina-east-drc>

To ensure that everyone has access to care during this period of the
epidemic, the Ministry of Health decided to provide free care to all
patients attending health centres in the region.

These positive advances are welcomed by other health officials in the
region. "This will help us to provide not only the free patient care,
but also with rapid detection of cases in our health facilities,"
notes Musubao Tongo, a treating nurse who came from the nearby health
zone of Oicha with about 50 other colleagues to help out at the
Mangina health centre.

Built in 1976 and managed by the Diocese of Butembo, a neighbouring
town of Beni, Mangina's reference health centre is among the largest
in the area, with an installed capacity of 119 beds. According to the
figures of this health unit, each month, around 250-300 patients are
admitted and between 700 and 800 outpatients are taken care of.

[The mention here of the very sizeable regular patient load of the
Mangina hospital is a reminder that people continue to take ill and
die of causes other than Ebola during an outbreak, and in greater
numbers. As huge as the West African Ebola epidemic was, it is
generally acknowledged that more people died because of healthcare
system disruptions caused by the epidemic, than died of Ebola itself.
Amongst the common endemic infectious diseases, one would expect that
fatalities from malaria and typhoid fever in the setting of an ongoing
Ebola outbreak would not rise, because these 2 diseases are screened
for and/or empirically treated (artesunate compounds and ceftriaxone)
in febrile suspect cases. However, if an outbreak develops into a
prolonged epidemic that disrupts the entire healthcare system, as we
saw in West Africa, then mortality from tuberculosis and AIDS
increases, because those patients are dependent on long-term
multi-drug prophylactic and treatment regimens through supervised
outpatient programs. Thus, non-Ebola health care should remain a
pillar of Ebola outbreak control. - Mod.LXL]

- Sat 18 Aug 2018. Mapping. Ebola: researchers plot maps, collect data
to fight future infectious disease outbreaks
[VOA (Voice of America), excerpted, edited]
<https://www.voanews.com/a/ebola-prevention/4534422.html>
[Byline: Salem Solomon]

Researchers in the DRC are collecting data that will improve how we
respond to, and prevent, future outbreaks of Ebola and other
infectious diseases. Their work involves building a comprehensive
picture of how diseases like Ebola spread by tracking cases and
mapping where people live, work and seek health care. Over time, a
more sophisticated understanding of the environments through which
contagious diseases spread will lead to faster, more effective
treatment.

[...]

[Anne] Rimoin's [Associate professor of epidemiology at the UCLA
School of Public Health and director of the UCLA-DRC Health Research
and Training Program, an effort based in Kinshasa, Congo] group
partners with several organizations, including the DRC's Ministry of
Health, the World Health Organization, and the Centers for Disease
Control and Prevention, part of the US Department of Health and Human
Services.

Rimoin said the Health Research and Training Program in Kinshasa uses
a mix of high-tech solutions and local knowledge. The group analyzes
satellite imagery to understand the terrain and population centers in
the DRC. But they also rely on insights from residents to compile a
more accurate and complete data set.

These data-collection tools allow Rimoin's team to figure out not just
boundaries but human activities, including traffic flows and health
centers.

[...]

Working with local populations is critical to the project's success.
It's these experts who know the terrain and the population, and that
expertise often proves invaluable ...[more]

--
Communicated by:
ProMED-mail Rapporteur Mary Marshall

******
[3] Reflections
- Tue 21 Aug 2018. From 1976 to 2018: reflections on early
investigations into the Ebola virus
[Transactions of the Royal Society of Tropical Medicine & Hygiene,
edited]
<https://doi.org/10.1093/trstmh/try088>

ref: Piot P, Spencer J. From 1976 to 2018: reflections on early
investigations into the Ebola virus. Trans R Soc Trop Med Hyg. 2018;
try088
----------------------------------------------------------------------
Abstract
In the late 1970s, early investigations into the Ebola virus informed
the world's understanding of what was then an unknown disease. One
such study, published by Bowen and colleagues in 1978, laid the
foundations for future research into its prevention and treatment.
However, nearly 4 decades later, scientific progress had not
translated into action on the ground with no approved drugs, no
vaccines, and no diagnostic tests available when the 2014-15 outbreak
began in West Africa. Encouragingly, it appears that we have learned
important lessons from the 2014-2015 outbreak, with a swift and
rigorous response to the most recent outbreaks in Equateur province,
Democratic Republic of Congo, including the deployment of a vaccine.
Ebola will certainly remain a challenge in the years to come and we as
the global health community must ensure that innovative research
translates into policy and action on the ground, with the full
participation of affected communities.

--
Communicated by:
ProMED-mail Rapporteur Mary Marshall
from
Greg Folkers
NIAID, NIH
<gfolkers@nih.gov>

[Important reading to gain insight into the history of the response to
Ebola, written after the DRC Equateur outbreak began, but before the
current North Kivu outbreak emerged. - Mod.LK

Maps of DR Congo: <http://goo.gl/DM2AT8> and
<http://healthmap.org/promed/p/194>]

[See Also:
Ebola update (73): Congo DR (NK) cases, anti-viral, research
http://promedmail.org/post/20180821.5977639
Ebola update (72): Congo DR (NK) cases, response, research
http://promedmail.org/post/20180820.5975692
Ebola update (71): Congo DR (NK) cases, response, bats
http://promedmail.org/post/20180818.5974137
Ebola update (70): Congo DR (NK) cases, recommendations, war, comment
http://promedmail.org/post/20180817.5971731
Ebola update (69): Congo DR (NK,IT) cases, Uganda NOT, WHO response
http://promedmail.org/post/20180816.5968689
Ebola update (68): Congo DR (NK) WHO, Uganda cases, concerns,
challenges http://promedmail.org/post/20180815.5966397
Ebola update (67): Congo DR (NK) cases, response, issues, research
http://promedmail.org/post/20180814.5964660
Ebola update (66): Congo DR (NK) cases, response
http://promedmail.org/post/20180813.5962221
Ebola update (65): Congo DR (NK) cases, vaccines
http://promedmail.org/post/20180812.5960584
Ebola update (64): Congo DR (NK) cases, security, genome
http://promedmail.org/post/20180810.5959744
Ebola update (63): Congo DR (NK) cases, vaccine, security, burial,
genome http://promedmail.org/post/20180809.5957277
Ebola update (62): Congo DR (NK) WHO, response, genetics
http://promedmail.org/post/20180808.5953189
Ebola update (61): Congo DR (NK) WHO, cases, response
http://promedmail.org/post/20180806.5950109
Ebola update (60): DR Congo (NK) case update, response, risk
http://promedmail.org/post/20180805.5948198
Ebola update (59): Congo DR (NK) case update, risk, response,
treatment http://promedmail.org/post/20180804.5946851
Ebola update (58): Congo DR (NK) outbreak, Ebola Zaire confirmed
http://promedmail.org/post/20180802.5944088
Ebola update (57): Congo DR (NK):
http://promedmail.org/post/20180801.5941427
Ebola update (56): northeast Congo DR, Ebola-like cases, US negative,
RFI http://promedmail.org/post/20180730.5936610
Ebola update (55): Sierra Leone Ebola virus variant, Congo DR cases,
WHO http://promedmail.org/post/20180727.5931686
Ebola update (54): Congo DR, cases, therapeutics
http://promedmail.org/post/20180725.5926964
Ebola update (53): Congo DR, cases, surveillance, action
http://promedmail.org/post/20180720.5916987
Ebola update (52): Congo DR, cases, health workers, W Africa survivor
problems http://promedmail.org/post/20180713.5902694
Ebola update (51): Congo DR, cases, response
http://promedmail.org/post/20180709.5895475
Ebola update (50): Congo DR, Japanese response, CIDRAP, WHO, survey
http://promedmail.org/post/20180706.5891820
Ebola update (49): Congo DR, suspect deaths comment
http://promedmail.org/post/20180704.5888151
Ebola update (48): Congo DR, MSF, susp. deaths, RFI
http://promedmail.org/post/20180703.5886426
Ebola update (47): DR Congo, epidemiology, response, Libya RFI
http://promedmail.org/post/20180701.5884463
Ebola update (46): Congo DR, cases
http://promedmail.org/post/20180629.5882196
Ebola update (45): Congo DR, cases, outbreak, MSF
http://promedmail.org/post/20180628.5880392
Ebola update (44): Congo DR, cases, research, course
http://promedmail.org/post/20180626.5877543
Ebola update (43): Congo DR, cases, vaccine, persistence, lessons
http://promedmail.org/post/20180625.5873949
Ebola update (42): Congo DR, cases, vaccine
http://promedmail.org/post/20180625.5872757
Ebola update (41): Congo DR, cases, WHO, contacts
http://promedmail.org/post/20180623.5871358
Ebola update (40): Congo DR, cases, WHO, vaccine, treatment,
preparedness http://promedmail.org/post/20180622.5869267
Ebola update (39): Congo DR, cases, WHO, response, facilities,
treatment, research http://promedmail.org/post/20180620.5865023
Ebola update (38): DR Congo, cases, WHO, Oxfam
http://promedmail.org/post/20180618.5861962
Ebola update (37): Congo DR, cases, response
http://promedmail.org/post/20180617.5859839
Ebola update (36): Congo DR, cases, threat, assistance
http://promedmail.org/post/20180615.5858111
Ebola update (35): Congo DR, cases, response, WHO
http://promedmail.org/post/20180614.5855415
Ebola update (34): Congo DR, cases, response, WHO
http://promedmail.org/post/20180613.5853602
Ebola update (33): Congo DR, cases, response, WHO, diagnosis
http://promedmail.org/post/20180612.5850968
Ebola update (32): Congo DR, cases, preparation, research
http://promedmail.org/post/20180611.5849759
Ebola update (31): Congo DR, cases, response, WHO
http://promedmail.org/post/20180610.5848785
Ebola update (30): Congo DR, cases, WHO, action
http://promedmail.org/post/20180609.5847441
Ebola update (29): Congo DR, cases, MSF, antivirals
http://promedmail.org/post/20180608.5845483
Ebola update (28): Congo DR, cases, WHO, response, treatment, funding
http://promedmail.org/post/20180607.5843872
Ebola update (27): Congo DR, cases, travel screening, children
http://promedmail.org/post/20180606.5841051
Ebola update (26): Congo DR, border controls, bat reservoir
http://promedmail.org/post/20180604.5838529
Ebola update (25): Congo DR, case update, intl. travel screening
http://promedmail.org/post/20180603.5836552
Ebola update (24): Congo DR, case update, African aid response
http://promedmail.org/post/20180602.5835414
Ebola update (23): Congo DR, cases, vacc. campaign targets, vaccine
development http://promedmail.org/post/20180601.5834040
Ebola update (22): Congo DR, cases, cures, domestic and international
travel http://promedmail.org/post/20180531.5831747
Ebola update (21): Congo DR, update, WHO, vaccination, therapeutics
http://promedmail.org/post/20180530.5829192
Ebola update (20): Congo DR, case update, lessons, logistics,
financing, flights http://promedmail.org/post/20180529.5824985
Ebola update (19): Congo DR, case update
http://promedmail.org/post/20180528.5822466
Ebola update (18): cases, Uganda NOT, Congo DR vaccination campaign
http://promedmail.org/post/20180527.5821927
Ebola update (17): case update, public fears, government responses
http://promedmail.org/post/20180526.5820606
Ebola update (16): cases, Congo DR cultural factors, vaccine impl.,
case terminology http://promedmail.org/post/20180525.5817907
Ebola update (15): case update, quarantine breaches, border controls,
vaccine http://promedmail.org/post/20180524.5816349
Ebola update (14): case update, response, prediction, maps
http://promedmail.org/post/20180523.5812835
Ebola update (13): case update, prevention
http://promedmail.org/post/20180521.5809540
Ebola update (12): update, USA, response
http://promedmail.org/post/20180520.5806396
Ebola update (11): WHO, vaccination, response
http://promedmail.org/post/20180519.5805133
Ebola update (10): urban case Congo DR, response, support
http://promedmail.org/post/20180517.5801917
Ebola update (09): update, alerts, prevention
http://promedmail.org/post/20180516.5799567
Ebola update (08): summary, emergency plan, vaccine, roads
http://promedmail.org/post/20180515.5797415
Ebola update (07): Congo DR, nurse, Uganda susp, WHO, border, vaccine
http://promedmail.org/post/20180513.5795881
Ebola update (06): Congo DR, susp, RFI, vulnerability, response,
control http://promedmail.org/post/20180512.5794300
Ebola update (05): Congo DR, outbreak update, vaccine, preparedness,
research http://promedmail.org/post/20180511.5792856
Ebola update (04): Nigeria, Kenya, Congo DR (ET), WHO
http://promedmail.org/post/20180510.5791247
Ebola update (03): Congo DR (ET), WHO
http://promedmail.org/post/20180509.5790577
Ebola update (02): Congo DR (ET)
http://promedmail.org/post/20180508.5789723]
.................................................lk/lxl/mj
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