Ebola virus disease – Democratic Republic of the Congo
A recent report from the World Health Organization (WHO) states that although the security situation has subsided mildly into an unpredictable calm, the transmission of Ebola virus disease (EVD) continues to intensify in North Kivu and Ituri provinces with more than 100 confirmed cases reported during the week of May 13. The number of healthcare workers affected has risen to 102 (6 percent of total cases).
WHO says the main drivers behind the continued rise in cases stems from insecurity hampering access to critical hotspot areas, persistent pockets of poor community acceptance and hesitation to participate in response activities, and delayed detection and late presentation of EVD cases to Ebola Treatment Centers (ETCs)/Transit Centers (TCs).
Community deaths denote all EVD (confirmed and probable) cases who died outside of an ETC/TC. This includes cases who die at home, as well as those who die within public/private hospitals and other health centers. On average, the report says community deaths comprise approximately 40 percent of cases reported each week and that this proportion fluctuates on a weekly basis, ranging from 28 percent to 43 percent of cases since the beginning of April – after peaking as high as 71 percent in February. Of the total deaths 1,147 currently listed in surveillance systems, WHO says approximately two thirds (68 percent) occurred outside of ETCs. Many of the patients who arrive at ETCs, often do so in a severe condition with a poor prognosis, and subsequently die shortly after admission.
Community deaths also pose a major transmission risk as these cases have spent more time in the community while symptomatic and remain highly infectious at the time of their death and thereafter; propagating EVD to other members of the community such as family members and healthcare workers.
Transmission remains most intense in seven main hotspot areas: Katwa, Mabalako, Mandima, Butembo, Musienene, Kalunguta, and Beni. Collectively, these health zones account for the vast majority (93 percent) of the 350 cases reported in the last 21 days between April 24 and May 14, 2019. A new case was also reported in the health zone of Alimbongo with links to cases deriving from Katwa. Current transmission patterns also illustrate the challenges resulting from cases originating from hotspot health zones and re-introducing the virus to areas where transmissions have previously been successfully halted. During this period, new cases were reported from 91 health areas within 18 of the 22 health zones affected to date. Of the EVD patients who received care at ETCs, 459 have been successfully discharged.
Risk communication and community engagement teams continue to spread messages about the importance of seeking care early at healthcare facilities for an increased chance of survival. These messages have been particularly effective in Beni, where affected individuals have been reporting to the ETCs more frequently and more rapidly after onset of symptoms. The risk communication and community engagement actors have been instrumental in mediating instances of reluctance and resistance at the community level to ensure peaceful agreements are reached and that other pillars of the response such as vaccination, infection prevention and control, and safe and dignified burials are able to carry out their respective response activities.
It is anticipated that the rising case figures will continue within the hotspot areas in the coming weeks given the resumption of most major response activities, which will lead to the detection of more cases. The increased transmission rates witnessed recently continue to demonstrate a heightened risk of EVD spreading to other neighboring provinces in the Democratic Republic of the Congo, and to surrounding countries.
WHO advises against any restriction of travel to, and trade with, the Democratic Republic of the Congo based on the currently available information. There is currently no licensed vaccine to protect people from the Ebola virus. Therefore, any requirements for certificates of Ebola vaccination are not a reasonable basis for restricting movement across borders or the issuance of visas for passengers leaving the Democratic Republic of the Congo. WHO continues to closely monitor and, if necessary, verify travel and trade measures. Currently, no country has implemented travel measures that significantly interfere with international traffic to and from the Democratic Republic of the Congo. Travelers should seek medical advice before travel and should practice good hygiene.
