EBOLA VIRUS DISEASE

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 EBOLA VIRUS DISEASE
Date of issue: 14 August 2018
Data as reported by: 12 August 2018

Cases Deaths
1. Situation update
57 41

The Ministry of Health in the Democratic Republic of the Congo, WHO and partners are responding to a new
Ebola virus disease (EVD) outbreak in the eastern North Kivu Province. On 6 August 2018, the INRB confirmed
that the current outbreak is caused by a distinct Ebolavirus (EBOV) strain, different from the one that caused
the outbreak in Equateur Province in May-July 2018. This means that, although both events are caused by
Zaire Ebolavirus species, the two outbreaks are not connected.

Since our last situation report on 7 August 2018 (External Situation Report 1), 14 additional confirmed EVD
cases and seven deaths have been reported. As of 12 August 2018, a total of 57 EVD cases, including 41 deaths
have been reported. Of the 57 cases, 30 have been laboratory confirmed and 27 remain probable. Of the 41
deaths, 14 occurred in confirmed cases. Eight healthcare workers (7 confirmed, 1 probable) have been
affected, of which one has died. Six health zones in two provinces have reported confirmed and probable EVD
cases, including Beni, Butembo, Oicha, Mabalako, and Musienene in North-Kivu Province, and Mandima in Ituri
Province (Figure 1). An additional 58 suspected cases are currently pending laboratory testing to confirm or
exclude EVD.

As of 11 August, a total of 990 contacts are under surveillance in Mabalako (790), Beni (141) and Mandima (59)
health zones. Of these, 129 are healthcare workers in Mabalako (72) and Beni (57) health zones. On 11 August
2018, 940 (95%) contacts were successfully followed up.

Context
On 1 August 2018, the Ministry of Health of the Democratic Republic of the Congo notified WHO of a new
outbreak of Ebola virus disease (EVD) in North Kivu Province, in the eastern part of the country. The event was
initially reported by the North Kivu Provincial Health authority on 28 July 2018 when a cluster of 26 cases of
acute haemorrhagic fever, including 20 deaths (mostly in the community), occurred in Mabalako Health Zone
during mid-late July 2018. Local health officials additionally identified sporadic, antecedent deaths in the
community since May 2018 (tentatively classified as probable cases), which are subject to ongoing
investigations to determine if they are related to the current outbreak.

Blood specimens collected from six hospitalized case-patients on 31 August 2018 were shipped to the Institut
National de Recherche Biomédicale (INRB) in Kinshasa. On 1 August 2018, four of the six blood specimens
tested positive for Ebolavirus by GeneXpert automated-polymerase chain reaction (PCR) and conventional
PCR. The Ministry of Health Officially declared the outbreak on 1 August 2018.

The province of North Kivu is among the most populated provinces, with eight million inhabitants. It shares
borders with four other provinces (Ituri, South Kivu, Maniema and Tshopo) as well as with Uganda and
Rwanda. The subregion has been experiencing intense insecurity and worsening humanitarian crisis, with over
one million internally displaced people and a continuous efflux of refugees to the neighbouring countries,
including Uganda, Burundi and Tanzania.

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 Table 1: Confirmed and probable Ebola virus disease cases by health zones in North Kivu
and Ituri provinces, Democratic Republic of the Congo, as of 12 August 2018

Description North Kivu Ituri Total

Cumulative cases Beni Butembo Oicha Mabalako Masereka Musienene Mandima

Total probable 0 2 1 21 0 1 2 27

Total confirmed 5 0 0 24 0 0 1 30
Total number of
5 2 1 45 0 1 3 57
cases
Cases under investigation
New suspected
2 2 0 8 0 0 0 12
cases
Previous
5 0 0 37 4 0 0 46
suspected cases
Total suspected
cases under 7 2 0 45 4 0 0 58
investigation
Deaths

New deaths 0 0 0 1 0 0 1 2

Total deaths 2 2 1 32 0 1 3 41
Total deaths
among confirmed 2 0 0 11 0 0 1 14
cases

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 Figure 1: Geographical distribution of confirmed and probable Ebola virus disease cases in
North Kivu and Ituri provinces, Democratic Republic of the Congo, 12 August 2018

Current risk assessment

This new EVD outbreak is affecting north eastern provinces of the Democratic Republic of the Congo, which
border Uganda and Rwanda. Potential risk factors for transmission of EVD at national and regional levels
include the transport links between the affected areas, the rest of the country, and neighbouring countries;
the internal displacement of populations; and displacement of Congolese refugees to neighbouring countries.
The country is concurrently experiencing several epidemics and a long-term humanitarian crisis. Additionally,
the security situation in North Kivu may hinder the implementation of response activities. Based on this
context, the public health risk is considered high at the national and regional levels and low globally.

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 Strategic approach to the prevention, detection and control of EVD

WHO recommends the implementation of proven strategies for the prevention and control EVD outbreaks.
These include (i) strengthening the multi-sectoral coordination of the response, (ii) enhanced surveillance,
including active case finding, case investigation, contact tracing and surveillance at Points of Entry (PoE), (iii)
strengthening diagnostic capabilities, (iv) case management, (v) infection prevention and control in health
facilities and communities, including safe and dignified burials, (vi) risk communication, social mobilization and
community engagement, (vii) psychosocial care (viii) immunization of risk groups and research response, and
(ix) operational support and logistics.

2. Actions to date

Coordination of the response

The Ministry of Health, with technical and operations support of WHO and partners, has activated a
multi-partner, multi-agency Incident Management System and Emergency Operations Centre to
coordinate the response. The main coordination centre is based in Beni while field technical
coordination is at Mangina.

The Ministry of Health, WHO and partners have deployed Rapid Response Teams to the affected
health zones to implement response activities. As of 14 August 2018, WHO has deployed a total of 95
experts in the various response pillars. WHO has activated country, regional and global coordination
mechanisms to assess risk and respond to the outbreak accordingly.

An incident management team has been established in the Democratic Republic of the Congo and
support teams have been reactivated at the WHO Regional Office for Africa and at Headquarters.

Surveillance

The Ministry of Health and WHO continue to strengthening surveillance capacity and activities.

A total of 40 health workers have been oriented on EVD surveillance and response activities, including
proper application case definitions, contact registration and contact tracking.

On 10 August 2018, 22 new alerts were notified and investigation in Mabalako (10), Beni (7),
Masekeraka (2), Semuliki (1), Kipriani (1), and Butembo (1). Of these, eight alerts have been validated.
In addition, numerous alerts have been registered in other provinces of the Democratic Republic of the
Congo, as well as neighbouring countries, and were rapidly investigated this past week. Ebola virus
disease was ruled out in all, with further laboratory testing ongoing to identify the cause of illness in
these individuals.

A contact follow-up programme started on 4 August 2018, following training of Community Action
Committees and Community Relay teams. As of 10 August 2018, 990 contacts have been registered.

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 The Ministry of Health continues to strengthening surveillance capacities at points of entry (PoE),
including hand hygiene, travellers screening and management of alerts, and risk communication. This
includes 18 international POEs in North Kivu, over 30 points of internal connection for travellers,
migrants and displaced people, refugee transit centres and other congregation sites, and additional
POEs in other vulnerable provinces, most notably international airports.

A network of partners has been set up to coordinate the management of geographic information and
interactive visualization tools are being developed to allow real-time monitoring of the evolution of
the situation and the response.

Laboratory

On 3 August 2018, a mobile laboratory was established in Beni to facilitate timely diagnosis of
suspected cases. The process to establish a mobile laboratory in Mangina and in Goma is ongoing.
Plans to establish additional laboratory facilities elsewhere are being explored.

As of 10 August 2018, 15 samples from North Kivu Province have been analysed at the Beni field-based
laboratory, of which one was positive. As of 10 August 2018, a total of 136 samples were tested in
different sites, identifying 22 positive cases.

Case management

As of 10 August 2018, 64 patients are under admission at the various Ebola treatment centres.

Health personnel identified as high-risk contacts in the Beni General Hospital and the Mangina
Reference Health Centre have been replaced.

Ebola treatment centres are being established in Mangina and Beni, with the support of international
partners. The deployment of experienced clinicians to support partners in caring for patients is in
process.

Infection prevention and control and water, sanitation and hygiene (IPC and WASH)

A complementary team to train service providers in affected health zones has been deployed,

A total of 24 volunteers from Beni Health Zone were trained in disinfection and safe and dignified
burials.

Three chlorination points were installed in Bingo, with the support of Oxfam and UNICEF.

Chlorination points have been installed in Mangina and Makeke, and 20 hand-washing points were
placed in Beni, with the support of WHO and UNICEF, along with distribution of 15 kg chlorinating
material, and 100 leaflets on the prevention of EVD were distributed.

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 Implementation of ring vaccination protocol

The Ministry of Health Expanded Program for Immunization and WHO held a meeting the potential
vaccination strategies in the affected provinces.

A total of 3 220 doses of the rVSV-ZEBOV Ebola vaccine are currently available in the country, while
supplementary doses have been requested. While the vaccine goes through the licensing process, an
agreement between Gavi, the Vaccine Alliance and Merck, the developer of the vaccine, ensures that
additional investigational doses of the vaccine are available.

Vaccination of frontline health care workers began on 8 August 2018, with the Ministry of Health
teams delivering the vaccines. About 40 health workers from Mangina hospital were the first to be
vaccinated. By end of this week, once all the necessary steps are in place, vaccination of community
contacts and their contacts will start. A clinical team with therapeutics arrived on 7 August 2018. A
team of Guinean vaccination experts will also be deployed.

WHO has submitted a revised protocol for approval by the Strategic Advisory Group of Experts (SAGE)
Ebola vaccine working group. It is likely that the ring vaccination strategy will be expanded to include
strategies that will address security concerns in the affected areas.

Psychosocial care

A total of 90 Psychosocial Agents are being trained by the MSP team, with the support of UNICEF.

A total of 15 patients and 14 ill guards at the Mangina Reference Health Centre are being offered
psychosocial care.

Risk communication, social mobilization and community engagement

A working meeting between the communication and community mobilization commission, including
UNICEF, INCEF, UNFPA, and the Red Cross was held on the EVD response in North Kivu and Ituri.

Activities to sensitize communities to the outbreak, and hygiene and sanitation measures, through
media and churches have begun in affected communities, and in neighbouring Uganda and Rwanda.

Door-to-door awareness campaigns around EVD were carried out by the community committees,
reaching 8 660 people in the affected areas.

Sensitization meetings were held with the leaders of nine motorcycle taxi associations, five car parks
and women’s trade associations in Beni.

WHO and Red Cross had meetings with community and neighbourhood leaders, teachers, religious
leaders, journalists and community groups to raise awareness about Ebola, the current outbreak and
preventive measures.

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 Knowledge, Attitude and Practice (KAP) surveys were conducted in 12 health areas in Beni Health Zone
and six health areas in Mabalako Health Zone. Findings from the survey will be used to improve the
pillar strategy.

Logistics

A logistics team has been established to support the different response committees in the two
affected provinces.

The Logistics Commission of the Beni Health Zone has received a second batch of materials and
equipment for PoEs.

Four ambulances, donated by the World Bank, have arrived in Goma to facilitate transportation and
referral of patients.

The first 10 security-complaint vehicles for MONUSCO arrived in Beni on 5 August 2018, and will be
used to support the response.

Two plane loads of supplies consisting of cold chain equipment, isolation units and vehicles arrived in
Beni on 11 - 12 August 2018.

Resource mobilization

A joint strategic response plan and budget totalling US$ 43 million has been developed and approved
by the Minister of Health of the Democratic Republic of the Congo.

WHO has released US$ 2 million from its Contingency Fund for Emergencies to initiate response
interventions, the United Nations Central Emergency Response Fund has approved US$ 3 million for
rapid response and USAID provided US$ 1.1 million to support WHO response.

Preparedness

The WHO Director General (DG) and the Regional Director (RD) for WHO in Africa visited Uganda on 11
August 2018, on their way from the Democratic Republic of the Congo, where they had assessed the
ongoing response to the EVD outbreak and provided support. The WHO Representative to Uganda
briefed the mission on Uganda’s EVD preparedness. The DG and RD later met the Uganda Prime
Minister, the Minister of Foreign Affairs, the Minister of Health, and the Minister of State for Primary
Health Care to discuss Uganda’s EVD preparedness and WHO support.

WHO has provided additional funding (with the funds received from DFID) to eight countries for EVD
preparedness activities.

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 WHO has started deploying different experts to support country preparedness activities. Three experts
(an EVD team lead to support coordination, an EOC expert and a risk communication expert from
UNICEF (deployed through WHO partnership network)) have arrived in Rwanda. An additional two
expert (epidemiologist/surveillance and case management expert) will arrive on 15 August 2018. The
remaining countries will receive experts in the coming days. These experts will support the countries
to enhanced risk communication and community mobilization, strengthened surveillance in PoEs, at
health facilities and in communities at high risk, form or update rapid response teams for the swift
investigation of EVD alerts and suspected cases, ensure laboratory capacities for the rapid laboratory
confirmation, ensure treatment of suspected and confirmed cases, and establish appropriate infection
prevention and control measures.

Operations partnership

On 1 August 2018, the Global Outbreak Alert and Response Network (GOARN) Operational Support
Team issued an alert to its network partners, providing an overview of the current situation and
ongoing response activities. The GOARN preliminary call for support sent to all GOARN partners on 3
August 2018. As of 14 August 2018, 39 offers of support have been received, and two are deploying for
the immediate response. GOARN and other partners continue to contribute to field response
activities.

US CDC has sent eight staff to WHO Headquarters in Geneva to work with the Incident Management
System Team (IMST). UNICEF and IFRC are also deploying senior coordinators to ensure close liaison
with the IMST

WHO is engaging GOARN and regional partners in Africa to deploy multidisciplinary teams to support
preparedness and readiness actions in the countries neighbouring the Democratic Republic of the
Congo.

WHO is working with AFENET and Africa CDC to deploy more epidemiologist to the hotspots

The GOARN Steering Committee and WHO Regional Office for Africa conduct twice-weekly joint
coordination calls for operational partners in Africa. Updates shared by operational partners during
the call are as follow:
 Alima
Setting up an Ebola Treatment Centre (ETC) in Mangina using ‘Cubes’, with eight cubes already
at site. Each cube can accomodate six suspect beds, but can be expanded. The ETC should be
opening in the upcoming days. Additional field experts are set to arrive by 15 August 2018.

 Médecins Sans Frontières Operational Centre Brussels (MSF OCB)

 US CDC
Deployed a senior Ebola expert to support the response in the Democratic Republic of the
Congo. Two vaccines subject matter experts are joining the response effort in the country.
Four staff have been deployed to Uganda: two border health and two IPC/case management
experts. Five staff: two IPC, two laboratory experts and one vaccine expert have been
deployed to Rwanda

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  IFRC
Support alert system in the affected and non-affected health areas, with 12 alerts responded
to. The body is conducting risk communications training on the ground.

 UNICEF
Deployed 17 staff in North Kivu supporting risk communications and community engagement,
IPC, WASH, child protection, and psychosocial support. Also supporting preparedness efforts in
Rwanda, Uganda and South Sudan, focusing on communications and community engagement,
as well as pre-positioning of supplies.

 IOM
Worked with partners to train and supervise activities of PNHF staff on EVD, including health
screening, risk communication, prevention methods such as hand washing and health seeking
behaviour, as well as setting up screening points at key Points of Entry (PoE).
Identified 20 PoEs and flow monitoring has been set up at four PoE, namely, Goma Airport,
Petite Barriere, Port Goma SCNN, and Grande Barriere.

 IRC
IRC and IMC are working with the Ministry of Health in Beni to provide routine healthcare
services.

Samaritan’s Purse
• Supporting provision of routine healthcare services in Nyankune hospital and will set up an
isolation area.

NECSI (New England Complex System Institute)

IHR travel measures and cross border health

WHO advises against any restriction of travel and trade to the Democratic Republic of the Congo based on the
currently available information. WHO continues to monitor and verify, if necessary, travel and trade measures in
relation to this event.

As investigations continue to establish the full extent of this outbreak, it is important for neighbouring provinces
and countries to enhance surveillance and preparedness activities.

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 3. Conclusion

The Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo is evolving, with new
confirmed cases and deaths occurring. Efforts to establish effective response structures on the ground are
ongoing and good progress has been made. Most components of the response, including active
surveillance, contact tracing system, infection prevention and control measures, care for patients,
compassionate use of vaccines, safe and dignified burials of victims, and community engagement and social
mobilization are already functional. However, there is a need to continue scaling up and improve
effectiveness and efficiency of all aspects of the response. The prevailing insecurity in the affected
provinces, invariably, could influence several aspects of the response, including the model, strategy,
timeliness, etc.

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