Wednesday, September 5, 2018

PRO/AH/EDR> Ebola update (82): Congo DR (NK) case update, treatment

EBOLA UPDATE (82): DEMOCRATIC REPUBLIC OF CONGO (NORTH KIVU) CASE
UPDATE, TREATMENT
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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, 4 Sep 2018, DRC Ministry of
Health
[2] Treatment
- ALIMA individual plastic Ebola patient treatment cubes

******
[1] Case update
- Tue 4 Sep 2018. Epidemiological situation report, DRC Ministry of
Health
[in French, machine trans., edited]
<https://us13.campaign-archive.com/?u=89e5755d2cca4840b1af93176&id=3415c0e963>

The epidemiological situation of the Ebola virus disease dated 3 Sep
2018:
- A total of 124 cases of haemorrhagic fever were reported in the
region, of which 93 were confirmed and 31 were probable.
- 16 suspected cases are under investigation.
- 2 new cases confirmed in Beni.
- 1 probable case in Beni: Burial not secured by the family before
samples could be taken.
- 3 confirmed cases, including 2 in Beni and 1 in Mabalako.

News of the response
Community resistance
--------------------
- The district of Ndindi in Beni city has become the main focus of the
epidemic at present concentrating 70 percent of the last 20 confirmed
cases reported. This situation is linked to the resistance of the
community in this district to collaborate with the health authorities.
Some families have long hidden sick people, refused to allow health
care providers to take patients to the Ebola treatment center (ETC),
and refused to be vaccinated. Several violent incidents against
medical staff and care facilities had also been reported. To ease
tensions, a community dialogue was launched between coordinating the
response and Ndindi community leaders. In addition, a local
coordination committee composed of neighborhood leaders was set up and
a community action plan was developed.

Support
-------
- To date, 22 patients have been treated with mAb 114, remdesivir, or
Zmapp. Of these 22 patients, 11 are cured, 4 have died and 7 are still
hospitalized but have seen their condition improve.

Surveillance
------------
- To date, 2 068 733 travelers have been checked at the 37 entry
points activated.

Vaccination
-----------
- Since the beginning of vaccination on 8 Aug 2018, 6134 people have
been vaccinated, including 3120 in Mabalako, 1747 in Beni, 1067 in
Mandima, 121 in Oicha, 60 in Katwa (Butembo), and 19 in Kinshasa.

--
Communicated by:
ProMED-mail Rapporteur Mary Marshall

[Since our last update 4 days ago (1 Sep 2018, Ebola update (81)
http://promedmail.org/post/20180901.6002182), case numbers have budged
only slightly, from a total of 120 to 124, an encouraging trend.
However, the DRC MOH reports several disturbing forms of community
resistance in Beni:
- Some families are concealing potential or probable Ebola cases among
them. This may relate to the aforementioned "unsecured burial" of a
probable case before patient samples could be taken.
- Even after some probable cases have been identified at home, their
families are refusing to allow the affected family member to be
quarantined and cared for in the Beni ETC.
- Others (presumably family or other case contacts) are refusing
vaccination.

All of these forms of community resistance jeopardize the
effectiveness of case finding, prevention, and treatment. The number
of new cases derived from known contacts has not been provided, but
this would provide a good indicator of unknown disease transmission
chains that could result from such dangerous behavior.

As if community resistance weren't enough of a problem in Beni, lethal
attacks by armed rebels continue in Beni territory, including 6
Congolese killed on 10-11 Aug 2018, following a clash between the
Congolese army and the Ugandan Islamist rebels of the Allied
Democratic Forces (ADF), and 2 Sudanese UN peacekeepers on 3 Sep 2018
in an attack attributed also to ADF. See
<https://taarifa.rw/2018/08/12/adf-rebels-clash-with-congolese-army-6-killed/>
and
<https://uk.reuters.com/article/uk-health-ebola-congo/rebels-ambush-south-african-peacekeepers-in-congo-ebola-zone-idUKKCN1LK1IH?rpc=401&>

It is unfortunate that some likely infected individuals in Beni have
refused to be cared for in the Beni ETC. By extrapolation from other
reports, this ETC is co-managed with ALIMA (Alliance for International
Medical Action), which has introduced the 1st individual patient
"treatment cubes" made of see-through plastic that should enhance not
only the medical care but also patient visibility and interactions
with family members while under care. (For more, see item [2] below).

Hopefully, community leaders and peer-to-peer dialogue and education
will help to overcome ignorance and fear in order to enhance Ebola
prevention, control, and treatment efforts in this already traumatized
population in North Kivu.

On a separate note, the DRC MOH reports that only 4 of the 22 patients
who have been treated with the experimental drugs mAb 114, remdesivir,
or Zmapp have died (so far), which is well below the typical ETC
mortality rate of about 50 percent. But of course it is far too early,
with too few treated patients, to begin to draw any conclusions about
the effectiveness of one or more of these therapeutic candidates. -
Mod.LXL]

******
[2] Treatment cubes
- Sun 2 Sep 2018
[The New York Times, excerpted, edited]
<https://www.nytimes.com/2018/09/02/health/ebola-virus-congo-outbreak-2018.html>
[Byline: Donald G McNeil Jr]

[...]

Alima, the Alliance for International Medical Action, deployed its new
biosecure emergency care units, which it calls "cubes," in its
treatment center in Beni.

The rooms, made of clear, flexible plastic with sleeves, gloves, and
bodysuits built into the walls, allow nurses to safely perform about
80 percent of the care an Ebola patient needs without having to put on
hot, cumbersome gowns, hoods, rubber aprons, boots, and goggles.

Wearing full gear, caregivers can look terrifying, especially to
children. "Now they can see us as human beings," said Claude
Mahoudeau, Alima's emergency response coordinator.

Nurses can check vital signs, feed patients, and change intravenous
drip rates, said Augustin Augier, Alima's secretary general, and may
eventually start inserting intravenous needles from outside. Workers
must still enter the cube to clean up diarrhea and vomit, unless
patients are strong enough to do it themselves and then seal the
soiled linens in bags and pass them out through a portal.

The chambers are air-conditioned for comfort. Also, patients'
relatives can safely sit outside and talk to them...[more]

[Byline: Donald G. McNeil Jr]

--
Communicated by:
ProMED-mail Rapporteur Mary Marshall

[HealthMap/ProMED-mail map of DR Congo:
<http://healthmap.org/promed/p/29837>]

[See Also:
Ebola update (81): Congo DR (NK) case update, response, clinical
trials http://promedmail.org/post/20180901.6002182
Ebola update (80): Congo DR (NK) case update
http://promedmail.org/post/20180830.5996306
Ebola update (79): Congo DR (NK) case update, response, vacc, support,
research http://promedmail.org/post/20180828.5991478
Ebola update (78): Congo DR (NK) case update, health protection of
medical teams http://promedmail.org/post/20180826.5988617
Ebola update (77): Congo DR (NK) case update, risk, control, research
http://promedmail.org/post/20180825.5986666
Ebola update (76): Congo DR (NK) case update, response
http://promedmail.org/post/20180824.5984263
Ebola update (75): Congo DR (NK) cases, WHO, response, perspectives
http://promedmail.org/post/20180823.5981519
Ebola update (74): Congo DR (NK) cases, response, WHO, reflections
http://promedmail.org/post/20180822.5979052
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]
.................................................lxl/mj/mpp
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