Three months after the declaration of the eleventh Ebola virus disease (EVD) outbreak in Equateur Province, Democratic Republic of the Congo, the number of confirmed cases continues to increase, and the geographic spread of the outbreak continues to expand.
As of 1 September 2020, 110 cases (104 confirmed and six probable) including 47 deaths (case fatality ratio 43%) have been reported from 36 health areas in 11 health zones. In the past 21 days (12 August – 1 September 2020), 24 confirmed cases have been reported in 15 health areas across eight health zones. To date, three healthcare workers have been affected, making up 3% of all cases. In addition, 48 people have recovered from EVD to date.
Public health response
The Ministry of Health is leading the response in affected health zones with the support of WHO and partners. Response priorities include strengthening surveillance and contact tracing, enhancing laboratory capacity, implementing adequate clinical management of suspect and confirmed cases, continuing ring vaccination around confirmed cases, vaccinating frontline workers, providing safe and dignified burials, supporting infection prevention and control in health facilities, and engaging with affected communities.
Key response measures to date include:
- Contact follow-up and alert investigation activities are ongoing.
i. On 1 September 2020, six out of eight health zones which have reported cases in the past 21 days reported on contact tracing activities for 3227 contacts listed; 2614 (81%) of these contacts were followed up.
ii. On 1 September 2020, 611 alerts (including three deaths) were reported from nine of the eleven health zones which have been affected during this outbreak, of which 592 (97%) were investigated within 24 hours. Of the 592 alerts investigated, 123 (20%) were validated, requiring specialized care and laboratory testing to rule-out EVD.
- Laboratories have been established in Mbandaka, Bikoro, Itipo, and Bolomba. A fifth laboratory is planned to be established in Ingende. Work is ongoing to ensure that health areas with no laboratories are able to transport samples to the four established laboratories. Since the start of the outbreak, a total of 6265 samples have been tested.
- Vaccination activities are ongoing in all affected health zones. From 5 June 2020 to 1 September, a total of 27 492 people (including 2641 frontline workers) have been vaccinated, including 7244 high-risk contacts.
- Forty-six (46) points of entry and control are currently operational in Equateur province with 91% (829 709/907 137) travelers screened to date. A total of 107 alerts have been detected as a result of this screening, of which 65 were investigated. Of the 65 alerts investigated, 61 were validated and none were confirmed.
- Efforts are on-going to initiate an EVD survivors care programme in clinics in Bikoro, Bolomba, Iboko and Mbandaka.
- As of 1 September 2020, 239 death alerts from affected health zones were received by the safe and dignified burials (SDB) teams, resulting in 122 successful SDB (51%). Among death alerts received, 136 were successfully swabbed, including 16 confirmed. These activities need to be strengthened to support local communities to safely manage burials and prevent the potential spread of EVD.
- Current clinical management capacities include: Ebola Treatment Centers in Wangata, Bikoro and Bolomba and three General Referral Hospitals with enhanced capacities to manage confirmed cases (total of 183 beds); a transit center in Mbandaka (10 beds); health facilities with isolation capacities in Iboko, Itipo, Yuli, Bosomondomba, Kalamba, Lilanga, Ikoko Bondinga, Ndote and Monieka (total of 68 beds). Some people who are confirmed to have EVD are reportedly reluctant to access treatment and are staying in their communities. This highlights the need to strengthen clinical care capacities in all locations and to ensure that all patients have access to the appropriate level of care. As of 1 September, 23/66 (35%) patients were administered monoclonal antibodies.
WHO risk assessment
A lack of funding is constraining the ability of WHO and partners to respond, as is a lack of sufficient human resources. Scaling-up response activities has been further hampered by ongoing strikes among locally-based response teams. WHO is supporting the Ministry of Health and partners to address this challenge.
WHO has not received adequate EVD funding since the start of 2020, and is currently using its emergency funds to support epidemiological and public health interventions. Access to financial and human resources are further challenged by the ongoing COVID-19 outbreak which is putting an additional burden on the national health system. The risk of disruption to surveillance and routine public health activities due to COVID-19 might jeopardize the country’s ability to rapidly contain re-emergence of these EVD cases. As of 29 August 2020, the Democratic Republic of the Congo has reported 1044 COVID-19 cases and 258 deaths.
In addition, response teams are currently operating in a logistically challenging environment, with many of the affected areas only accessible by boat or helicopter and with limited telecommunications capacity. Further challenges include:
- Inadequate surveillance of deaths in communities, which limits the capability to accurately assess the scope of the outbreak and to control the chains of transmission;
- Sub-optimal clinical care in most of the affected health zones;
- Limited laboratory capacity slows EVD confirmation and patient management.
Investigations are ongoing in recently affected health zones to assess the full extent of the outbreak and therefore high vigilance should be maintained.
On 1 September 2020, WHO revised the risk assessment for this event from moderate to high at the regional level, while the risk level remained high at the national level and low at the global level. The level of risk will be continuously reassessed in the coming days based on available and shared information from partners.
WHO advises the following risk reduction measures as an effective way to reduce Ebola virus disease transmission in humans:
- Reducing the risk of wildlife-to-human transmission from contact with infected fruit bats or monkeys/apes and the consumption of their raw meat. Animals should be handled with gloves and other appropriate protective clothing. Animal products (blood and meat) should be thoroughly cooked before consumption.
- Reducing the risk of human-to-human transmission from direct or close contact with people with Ebola symptoms, particularly with their bodily fluids. Gloves and appropriate personal protective equipment should be worn when taking care of ill patients at home. Regular hand washing is required after visiting patients in hospital, as well as after taking care of patients at home.
- Reducing the risk of possible sexual transmission, based on further analysis of ongoing research and consideration by the WHO Advisory Group on the Ebola Virus Disease Response, WHO recommends that male survivors of EVD practice safe sex and hygiene for 12 months from onset of symptoms or until their semen tests negative twice consecutively for Ebola virus. Contact with body fluids should be avoided and washing with soap and water is recommended. WHO does not recommend isolation of male or female convalescent patients whose blood has tested negative for Ebola virus.
- Ongoing training and re-training of health work force for early detection, isolation and treatment of EVD cases.
WHO continues to advise against any restriction of travel and trade to the Democratic Republic of the Congo in relation to this event, based on the currently available information.