EBOLA VIRUS DISEASE Democratic Republic of the Congo External Situation Report 26
Date of information: 22 June 2017 1. Situation update WHO, UN Agencies, international organizations, non-governmental organizations (NGOs) and partners continue to support the Ministry of Health (MoH) in the Democratic Republic of the Congo to rapidly investigate and respond to the outbreak of Ebola virus disease (EVD) in Likati Health Zone, Bas Uele Province in the north-east of the country. On 22 June 2017, no new confirmed, probable or suspected cases have been reported since the last situation update on 19 June. Ten alerts have been reported in the previous three days from Muma, Ngayi and Azande Health Areas, on investigation none fulfilled the suspected case definition. Cumulatively, since the start of the outbreak, there have been five confirmed and three probable cases. Additionally there have been 99 suspected cases reported that following laboratory analysis tested negative for EVD and therefore were deemed not to be cases. The last confirmed case was isolated on 17 May 2017 and tested negative for EVD by PCR for the second time on 21 May 2017. Of the confirmed and probable cases, four survived and four died, resulting in a case fatality rate of 50%. The confirmed and probable cases were reported from Nambwa (four confirmed and two probable), Ngayi (one probable) and Mabongo (one confirmed). Data modelling suggests that the risk of further cases is currently very low. As of the reporting date, 98% of simulated scenarios predict no further cases in the next 30 days. All seven response committees are maintaining functionality at the national level, namely monitoring, case management, water sanitation and hygiene (WASH) and biosafety, laboratory and research, pyscho-social management, logistics, and communication. A response team will remain in the affected areas until the declaration of the end of the outbreak. This EVD outbreak in the Democratic Republic of the Congo was notified to WHO by the MoH on 11 May 2017. The cluster of cases and deaths of previously unidentified illness had been reported since late April 2017. Likati Health Zone shares borders with two provinces in the Democratic Republic of the Congo and with the Central African Republic (Figure 1). The affected area is remote and hard to reach, with limited communication and transport infrastructure.
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Figure 1. Geographical distribution of confirmed and probable cases of Ebola virus disease in the Democratic Republic of the Congo as of 22 June 2017
Legend Confirmed Probable
As this is a rapidly changing situation, the reported number of cases and deaths, contacts being monitored and the laboratory results are subject to change due to enhanced surveillance, contact tracing activities, ongoing laboratory investigations, reclassification, and case, contact and laboratory data consolidation.
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Current risk assessment The previous risk assessment undertaken on 16 May 2017 was re-evaluated on 6 June 2017 by WHO in light of the evolution of the outbreak and the available information. • • The overall risk at the national level has been revised to moderate due to the fact that a rapid response team was deployed, field investigation identified cases and contacts and all contacts completed their 21 day monitoring period. A response team remains in the field and treatment units are established. The risk at the regional and global level is low as no cases have been reported outside of Likati health zone and the area is remote with limited access and transport to/from the affected area.
WHO advises against the application of any travel or trade restrictions on the Democratic Republic of the Congo based on the currently available information. WHO continues to monitor reports of measures being implemented at points of entry. WHO’s strategic approach to the prevention, detection and control of EVD WHO recommends the implementation of proven strategies for the prevention and control of Ebola outbreaks. These strategies include (i) coordination of the response, (ii) enhanced surveillance, (iii) laboratory confirmation, (iv) contact identification and follow-up, (v) case management, (vi) infection prevention and control, (vii) safe and dignified burials, (viii) social mobilization and community engagement, (ix) logistics, (x) risk communication, (xi) vaccination, (xii) partner engagement, (xiii) research and (xiv) resource mobilization
2. Actions to date In support of the MoH and the other national authorities, an interagency rapid response team was deployed to Likati Health Zone to support the immediate investigation of the outbreak and rapidly establish key pillars of the response at the epicentre. The interagency response team is coordinated by the MoH, and supported by WHO, Institut National de Recherche Biomédicale (INRB), Médecins Sans Frontières (MSF), United Nations Children’s Fund (UNICEF), The Alliance For International Medical Action (ALIMA), International Federation of Red Cross and Red Crescent Societies (IFRC), World Food Programme (WFP), and United Nations Humanitarian Air Service (UNHAS) and other partners. WHO continues to provide direct technical and operational support to the country, and is collaborating closely with partners to maintain a rapid and effective response to this outbreak.
Coordination of the response • • Regular meetings of the Health Emergency Management Committee (COGUS) at all levels of the response operations continue in the Democratic Republic of the Congo at Health Zone, Provincial and National level, with MOH, and partners. Regular coordination meetings of WHO incident management teams in Kinshasa, Brazzaville, and Geneva continue across the 3-Levels of WHO.
Surveillance • • Identification and investigation of alert cases and community deaths continues to be carried out through active search methods in the communities affected. A report has been drafted on the enhanced surveillance measures required for the 90 days following the declaration of the end of the outbreak.
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Laboratory • Training has been undertaken for laboratory technicians in Likati, Nambwa and Mabango health areas on the use of Ebola rapid diagnostic tests.
Case management • • Support is being provided to the four survivors on prevention against potential sexual transmission of the virus. In order to increase access to and use of primary health care services, free health care is operational in Likati covering consultations and essential drug provisions. This has increased service utilisation and since 31st May 2017, 6816 patients have been seen for medical consultations in 11 health areas.
Infection prevention and control (IPC) and WASH • • • A briefing was held with the communication commission in three health areas (Azande, Mobenge and Tobongisa) on the benefits of aquatab distributions The Ebola Treatment Center in Nambwa has been disinfected Safe burials continue to be conducted for community deaths
Social mobilization, community engagement and risk communications • • Awareness raising on the signs and symptoms of EVD as well as prevention measures continues in the Likati health zone with house to house visits, briefing of community leaders and community workers and radio broadcasts. Awareness-raising sessions through local radio broadcasts have been held targeting local authorities, community leaders and the population on the process of the Ebola response team disengagement and the post-Ebola outbreak interventions.
Logistics • Since the beginning of the outbreak, WHO has set up and maintained an airlift between Kinshasa and the affected area, and provides logistic support to response activities. Three logistic bases in Kinshasa, Kisangani, and Likati are still operational and continue to assist with deployment of WHO staff and partner organizations (including UNICEF, MSF, ALIMA, and Red Cross), to and from the affected areas including transportation of over 10 metric tons of materials and equipment. WHO logistics team continue to support the distribution of donated drugs and hospital supplies to the health areas in Likati as part of the temporary free medical care programme. Planning for the repatriation of staff and return or distribution of equipment has commenced.
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Partnership • • • WHO and GOARN continue to mobilize partners to provide technical and logistical support to the country, and work closely together with UN Clusters, stakeholders and donors to ensure appropriate support for the response. GOARN Operational Support Team hosts weekly assessment and coordination teleconference for operational partners on current outbreaks of international concern, particularly the EVD outbreak in DRC. At the request of Dr Salama (Executive Director of the WHO Health Emergencies Programme) at WHO HQ convened a time-limited Ebola Inter-Agency Coordination Group with senior leadership from MSF, IFRC, UNICEF, US CDC and WFP, to provide agency updates about response actions and discuss any critical coordination issues.
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IHR travel measures • • WHO does not currently recommend any restrictions of travel and trade in relation to this outbreak. As of 22 June 2017, nine countries have instituted entry screening at airports and ports of entry (Kenya, Malawi, Nigeria, Rwanda, South Africa, Uganda, the United Republic of Tanzania, Zambia and Zimbabwe), and one country has issued travel advisories to avoid unnecessary travel to the Democratic Republic of the Congo (Rwanda). Two countries (Kenya and Rwanda) implemented information checking on arrival for passengers with travel history from and through the Democratic Republic of the Congo. These measures are within the prerogative of the States Parties and do not qualify as additional health measures that significantly interfere with international traffic under Article 43 of the IHR (2005). In addition, Rwanda instituted denial of entry for passengers with fever travelling from the affected areas in the Democratic Republic of the Congo, which significantly interferes with international traffic, in accordance with Article 43 of the IHR (2005). WHO is working with Rwandan authorities to receive the public health rationale and scientific evidence for this measure. It is expected that the measure will be rescinded once the outbreak in Democratic Republic of Congo is declared ended.
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3. Summary of public health risks, needs and gaps The most critical needs include active case search to ensure no suspected case is undetected, maintenance of laboratory capacity in the field to enable rapid confirmation of results, the need for differential diagnosis of those who remain sick but have tested negative for EVD, enhancement of IPC measures and planning for strengthening of the surveillance system post-response activities.
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Annex 1: Ebola virus disease outbreak epidemiological data
Health area Date of data collection Nambwa Cases Suspected Probable Confirmed Total cases 21/06/2017 21/06/2017 21/06/2017 21/06/2017 0 2 4 6 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1
Muma
Ngayi
Azande
Ngabatala
Mogenbe
Mabongo
Cumulative (since beginning of the outbreak)
Comments
0 3 5 8 There is a total of 99 noncases
Deaths Deaths among suspected cases Deaths among probable cases Deaths among confirmed cases Total deaths registered 21/06/2017 21/06/2017 21/06/2017 21/06/2017 0 2 1 3 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 1 4
Contacts Total contacts registered Contacts of non-cases no longer under follow-up Total contacts under follow-up Contacts seen 21/06/2017 21/06/2017 21/06/2017 21/06/2017 The lastest date of followup completion is 6/06/17 . As of 9/06/17 , 15 contacts from Nambwa and 18 from Azande completed follow-up. 197 70 0 116 28 0 180 72 0 11 33 0 10 10 0 6 1 0 63 12 0 583 226 0
Contacts who have completed 21 days follow-up Contacts lost to follow-up
21/06/2017
118
77
93
18
0
0
51
357
21/06/2017
Laboratory 2 cases had a positive PCR result and 3 cases were classified as positive following increasing IgG titres. The last confirmed patient tested PCR negative on 21/05/17 following recovery. Samples were collected after unusually high number of deaths in pigs. As of 12/06/17 , 12 pig and 6 goat samples initially tested Ebola PCR negative. Samples from ducks that hand presented with haemorrhagic signs were Ebola-PCR negative.
Cases with a positive result
21/06/2017
4
1
5
Animal samples
21/06/2017
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Annex 2: Timelines of key activities during the EVD outbreak in Likati, Democratic Republic of the Congo