Democratic Republic of Congo: Ebola update June 2018
Since the Ebola epidemic in Democratic Republic of Congo (DRC) was declared on 8 May 2018, 60 people who presented symptoms of haemorrhagic fever, including 37 confirmed Ebola cases and 27 deaths (of whom 13 were confirmed as Ebola)*, have been notified by the national health authorities in the Equateur region, in the west of the country, where the outbreak started. 23 patients (confirmed Ebola cases) have recovered from the disease and been discharged from treatment centres.
*Latest figures (source: DRC Ministry of Health) – date of info: 28 May 2018
So far, the outbreak has affected the health zones of Bikoro (Bikoro and Ikoko villages) and Iboko (Itipo and Iboko villages), with four laboratory-confirmed cases of Ebola also detected in the city of Mbandaka, the main city of the region. As of 6 June, there is one patient confirmed to be suffering from Ebola, as well as four suspected to be suffering from Ebola under treatment in all of DRC, but this could of course change quickly.
This is the ninth Ebola outbreak in DRC in the last 40 years. So far, most of the previous outbreaks have occurred in relatively remote and isolated areas, with little spread of the disease. The last Ebola outbreaks in DRC occurred in Likati district in May 2017, with eight people infected, of whom four died, and in Boende (Thsuapa region) in 2014, with 66 people infected, of whom 49 died.
Unlike in previous Ebola outbreaks in DRC, where most of the cases have been concentrated in remote villages, this time patients have also been diagnosed in Mbandaka, a Congo River port city of more than one million inhabitants. While easy access to transport increases the risk of the virus spreading, surveillance is being reinforced. Despite the media hype, it is important to emphasise that the epidemic has not spread widely within the city.
During the past few weeks, MSF has been working closely with the Congolese Ministry of Health (MoH) and with other organisations on the ground to coordinate the response. The response is based on the ‘six pillars’ of Ebola intervention:
1. Care of diagnosed patients and isolation;
2. Outreach activities to find patients;
3. Tracing and follow-up with patient contacts;
4. Health promotion activities to inform people about the risks and how to avoid them;
5. Support of regular primary healthcare;
6. Safe burials to avoid infections.
If this intervention is followed well, an Ebola epidemic can often be contained in a relatively short period of time.
For all these activities, building a good understanding with local communities is vital. Medical and health promotion teams are working hard to explain to the population what the symptoms of Ebola are, how to avoid contamination, the importance of coming to health structures as quickly as possible if they suffer from symptoms, and the importance of isolation measures to contain the disease. The sooner patients are admitted and receive medical care, the sooner their families are protected and the greater the chance of limiting the spread of the epidemic.
After almost a month since the outbreak was officially declared, the epidemiological picture is beginning to clear but areas of uncertainty remain. Now is certainly not the time for complacency, the six pillars of the Ebola response must be meticulously implemented and maintained, with a particular focus on outreach and surveillance activities, in order to end this outbreak.
Confirmed patients currently under treatment – date of info: 6 June 2018 (source: MSF)
Staff on the ground - date of info: 6 June 2018
Supply material - date of info: 5 June 2018
TOTAL: 75 international and more than 360 national staff are currently working in Equateur province in response to the Ebola outbreak.
Supply material includes: medical kits; protection and disinfection kits (isolation items such as gloves, boots and Personal Protective Equipment-PPE, etc.); logistic and hygiene kits (plastic sheets, jerry cans, water distribution kits, chlorine spray kits, water treatment kits, etc.); drugs; transport (cars and motorbikes); tents and construction material for building ETCs.
As part of MSF’s emergency preparedness in DRC, some supplies were already available in Kinshasa. These were sent to hotspot zones as soon as the outbreak started.
Almost 100 tonnes of supplies (sent from MSF supply centres in Europe) have been received in Kinshasa, and an additional 15 are expected by the end of the week. A total 63 tonnes of supplies (medical and logistical supplies, including six vehicles and 10 motorbikes) have already been sent to Mbandaka and Bikoro, with more to be sent in the coming days.
MSF’s Ebola response in DRC started on 5 May, with an epidemiological alert in the Equateur region. A small team from MSF’s Congo Emergency Pool (PUC) assessed the situation, together with teams from the MoH and WHO. When the Ebola epidemic was officially declared on 8 May, experts from MSF’s emergency pools arrived in the field to deploy a rapid response in the Ebola hotspots. Among the MSF staff on the ground are some our most experienced Ebola field workers, including medical personnel, experts in infection control and logisticians.
At the beginning of the outbreak, we set up an isolation zone with five beds in Mbandaka’s main hospital (Wangata hospital). An MSF ETC with 12 beds was also built, and has been operational since 28 May. The bed capacity in the ETC can be upgraded to 40 if needed. At the moment there are no patients in the ETC.
In addition to the treatment and isolation of suspected and confirmed Ebola cases, the focus of MSF’s response is on surveillance, investigation of new cases and contacts, infection control and prevention, health promotion and training activities.
In Bikoro, we have set up an ETC with 20 beds, and we continue to reinforce outreach activities including case investigation, monitoring and surveillance. We also have two teams responding to alerts about suspected and probable cases in the surrounding villages.
MSF teams are present in the remote areas of Itipo and Iboko, where suspected and confirmed Ebola cases have been identified. In Itipo, a 14-bed transit centre with isolation capacity is already functional. In this transit centre, suspected patients are isolated and tested for Ebola. If Ebola is confirmed and the patient is well enough to be transported, they are taken to Bikoro for treatment. In Iboko, teams have nearly finished setting up an ETC in the main hospital and are involved in other aspects of the Ebola response, such as ambulance services, contact tracing, active case finding, health structure support, communication, safe burial and disinfection of health centres and houses.
MSF and our epidemiological research unit, Epicentre, are working with the local health authorities and the World Health Organization (WHO) in the use of the Ebola vaccine rVSVDG-ZEBOV-GP, which is being used as part of the overall strategy to control the Ebola outbreak. Rather than launch a mass vaccination campaign, vaccines have been targeted at the contacts of confirmed Ebola patients (as well as the contacts of these contacts), and Ebola health workers in Bikoro. Frontline workers who are deemed to be most at risk of Ebola infection including health workers and hygienists working in Ebola treatment Centres, religious leaders and traditional healers have also been offered the vaccine.
MSF’s vaccination activities started on 28 May in Bikoro, Itipo, Bokongo, Butela, Ikoko Impenge and Bolendo. So far, 670 people have been vaccinated by MSF, and 1,737 overall (source: DRC Ministry of Health).
The vaccinations are voluntary and free-of-charge. This vaccine has not yet been licensed and is therefore being implemented through a study protocol, which has been accepted by the national authorities and the ethical review board in Kinshasa, as well as MSF’s ethical review board.
 Deaths that are probably due to Ebola but were not tested before burial. Cumulative since the beginning of the outbreak.
 Cumulative since the beginning of the outbreak.
Among confirmed patients.
 Previous outbreaks in DRC: Yambuku (1976) 318 cases - 280 deaths; Tandala (1977) 1 case -1 death; Kikiwit (1995) 315 cases- 250 deaths; Mweca (2007) 264 cases - 187 deaths; 2008-2009- 32 cases - 15 deaths; Isiro (2012) 36 cases - 13 deaths; Djera-Boende (2014) 66 cases - 49 deaths; Likati (2017) 8 cases - 4 deaths (source: DRC Ministry of Health)