Disease Outbreak News: Ebola Virus Disease-Democratic Republic of the Congo (December 16, 2021) -Democratic Republic of the Congo

December 16, 2021, Ministry of Health (MoH) of the Democratic Republic of the Congo (DRC) Declared the end of the outbreak of Ebola virus disease (EVD) It affected the Beni Health Zone (HZ) in North Kivu, Democratic Republic of the Congo.The declaration was made according to WHO recommendations 42 days after the second negative test of the last confirmed case.

Between October 8 and December 16, BeniHZ reported a total of 11 cases (8 confirmed, 3 estimated), including 9 deaths and 2 survivors. .. Of the nine deaths, seven occurred in the community and two in the Ebola Treatment Center (ETC). The overall case fatality rate (CFR) is 82% (9/11) in all cases, compared to 75% (6/8) in confirmed cases.

This outbreak was declared on October 8, 2021, when the proband was the origin. A 3-year-old boy developed symptoms such as weakness, loss of appetite, abdominal pain, dyspnea, black stool and blood in vomiting, and then died on October 6 (for more information, see Disease outbreak news published on October 10, 2021).

On October 7, samples were tested using reverse transcription-polymerase chain reaction (RT-PCR) at the National Institute of Biomedical Sciences (INRB) laboratory in Beni. These were then sent to the Rodolph Mellieu INRB laboratory in Sesame on October 8, and EVD was confirmed by RT-PCR on the same day. This event followed a group of three dead (two children and their father) who were neighbors of the proband. These three patients died on September 14, 19, and 29 after developing symptoms consistent with Ebola, but none were tested for the virus. A whole-genome sequence from the first confirmed case performed by INCRA in Kinshasa shows that this outbreak is not the result of a new zoonotic disease from an animal reservoir, but is associated with persistent Ebola virus infection. Indicates that you are.

During the outbreak (October 8 to December 16, 2021), 3 (16%) of the 19 health areas of Beni HZ were identified: Butiri (6 cases), Bungi (1 case). And Ngiringa (1 case) were reported. Children under the age of 5 accounted for 50% (4/8) of all confirmed cases. To date, all contacts have completed a 21-day follow-up period and have been released from active follow-up.

In addition, from October 8th to December 13th, a total of 21916 alerts were reported from nine health zones, including 15 642 in Beni, of which 21 558 (98%) were investigated and 1709 was suspected of EVD. Verified as a case.

Public health measures

The Ministry of Health (MoH) has begun working with WHO and other partners to curb outbreaks and prevent further spread. MoH has activated national and district emergency management committees to coordinate responses. An interdisciplinary team was stationed on-site to actively search for cases and provide care. Identify contacts, get in touch, and follow up. Sensitive to the community about outbreak prevention and management interventions.

In addition, the following public health measures have been taken in response to the outbreak of EVD.

• Continuous use of alert monitoring for active case detection in medical facilities as well as during passive monitoring.
• The approved dose of ERVEBO vaccine (4,800) was first provided in response to the development of EVD through the International Coordinating Group for Vaccine Delivery Mechanisms (ICG). Vaccination with ERVEBO began on 25 November and as of 14 14 December, a total of 1193 frontline workers have been vaccinated against Ervebo.
• Vaccination with the investigational drug began on October 13. As of November 22, 656 people have been vaccinated with the investigational drug, including 98 high-risk contacts, 300 contacts, and 258 potential contacts. Of these 81, they are the frontline workers.
• As of December 14, a total of 1827 samples, including 834 cotton swabs, have been tested. Eight of them are EVD cases identified at the INRB Field Labs in Beni, Butembo, Mangina and Sesame.
• Establishment of ETC and other medical facilities with the ability to care for suspicious cases. Three confirmed live patients received BeniETC-approved monoclonal antibodies, two of whom recovered from EVD.
• Strengthen infection prevention and control (IPC) capabilities at 83 priority healthcare facilities through IPC kit donations, training, supportive supervision, assessments, and other activities. Additional support was provided to 221 other healthcare facilities through donations of kits and explanations to healthcare providers.
• From the declaration of occurrence from October 8th to December 12th, a total of 14 entry points were set, 4 745 892 people were screened, and 216 alerts were validated. Nothing has been confirmed.
• Healthcare workers training and retraining for early detection, isolation and treatment of EVD cases, as well as retraining on safe and dignified burial and IPC activities were conducted.
• Several community groups conducted risk communication and community sensitization activities using a wide range of communication channels (community dialogue, community radio, social media, etc.) to raise awareness of Ebola throughout this outbreak. The community was also engaged in response intervention. In addition, a joint feedback mechanism has been set up among eight partners to record rumors, questions and comments from the community. This enables targeted communication and timely dialogue with the community.
• Psychological and social support is provided to affected individuals and families and includes psychological support for identified and suspected patients, their close relatives, and, if necessary, children. The community regularly held psychosocial sessions on various aspects of the EVD response.
• The Integrated Outbreak Analysis (IOA) cell was set up in Beni under the leadership of MoH in collaboration with Global Outbreak Alert and Response Network (GOARN) partners. The IOA cell is designed to answer operational and strategic questions (lessons learned from Beni 2018-2020, children’s EVD risk, alert performance assessment, healthcare professional awareness and behavior, health-seeking behavior). Provided 5 extraordinary surveys and analyzes. -Development of evidence-based strategic and operational recommendations.
• The International Red Cross and the Red Crescent Federation supported the Congolese Red Cross by providing safe and dignified burials throughout the outbreak.
• WHO continued to support DRCMOH in implementing the EVD Survivor Care Program. The two who recover are entitled to 18 months of medical and psychological follow-up along with a biological test.

WHO risk assessment

The current EVD reappearance is the fifth outbreak in less than three years. The last EVD outbreak was reported in North Kivu in February this year and declared on May 3, 2021 (for more information, see Disease outbreak news published on May 4, 2021)

All possible and confirmed EVD cases were identified in three healthy areas of Beni HZ in the densely populated Beni city. WHO continues to monitor the situation and will update the risk assessment as more information becomes available.

WHO says the current resurgence is not desirable, but not unexpected given the fact that EVD is endemic in DRC and the Ebola virus is present in animal reservoirs in the region. This means that the risk of reappearance due to exposure to animal hosts cannot be ruled out. In addition, it is not uncommon for sporadic cases to occur after an outbreak. Ebola virus can persist in certain body fluids of EVD survivors. In a limited number of cases, secondary infections result from exposure of survivors to body fluids. Therefore, maintaining a partnership with the Survivor Association while monitoring survivors is a priority for mitigating potential risks.

The re-emergence of EVD is a major public health issue for the DRC, and there are gaps in the country’s ability to respond in the event of an outbreak. The confluence of environmental and socio-economic factors such as poverty, community distrust, weak health care systems and political instability is accelerating the emergence of EVD in the DRC.

WHO threatens the country’s ability to quickly detect and respond to re-emergence with ongoing challenges regarding access and security, epidemiological surveillance, the emergence of COVID-19, and ongoing outbreaks such as cholera and measles. I think it may be exposed to.

WHO advice

WHO advises on the following risk mitigation measures as effective ways to reduce EVD infections in humans.

• To reduce the risk of wildlife to human transmission through contact with infected bats and monkeys / apes and consumption of raw meat. Animals should be handled with gloves and other suitable protective clothing. Animal foods (blood and meat) need to be completely cooked before consumption.
• To reduce the risk of person-to-person transmission from people with symptoms of Ebola, especially through direct or close contact with body fluids. Appropriate personal protective equipment should be worn when caring for a sick patient. Regular hand washing is required after visiting the patient in the hospital and after touching or coming into contact with body fluids.
• To reduce the risk of infection from persistent virus in some body fluids of survivors, WHO has provided medical, psychological support, and biological testing (two consecutive tests) through the EVD Survivor Care Program. It is recommended to provide (up to a negative test). WHO does not recommend the isolation of male or female convalescent patients whose blood has been tested negative for the Ebola virus.
• Continue training and retraining healthcare professionals for early detection, isolation and treatment of EVD cases, and retraining on safe and dignified burial and IPC ring approaches.
• Ensure availability of PPE and IPC supplies for managing and decontaminating sick patients
• In preparation for managing Ebola patients, a medical facility assessment (“scorecard”) for compliance with IPC measures will be conducted, including WASH, waste management PPE supply, triage / screening capabilities, etc. ).
• Work with the community to strengthen safe and dignified burial practices

Based on current risk assessments and previous evidence of the occurrence of Ebola, WHO advises on travel and trade restrictions to the Democratic Republic of the Congo.