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Medical Alerts
Created: Wednesday, May 09, 2018 03:27 GMT
Updated: Friday, Jul 13, 2018 23:58 GMT
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Congo, Democratic Republic
Ebola in Equateur Province

Level: Notice
Location: Bikoro/ Ikoko Impenge, Ingende, Iboko, Mbandaka/ Wangata - Congo (DRC)
Category: Ebola

Latest update: World Health Organization downgrades risk for spread within the DRC and regionally. The Ebola outbreak in Equateur Province appears to be contained. Ebola is spread by contact with the blood or other bodily fluids (especially vomit and diarrhoea) of infected or dead people. Healthcare workers, household members and people participating in traditional funeral practices (touching the body) are at high risk. International SOS is monitoring the situation closely.

Advice

  • Travel to affected areas can resume. Your organisation's travel policy takes precedence over our advice; in the event of a difference, seek confirmation from your management.
  • Monitor the situation.
  • Pay strict attention to hygiene.
  • Do not participate in high risk activities such as funerals in outbreak areas. (Do not touch / wash dead bodies.)
  • Avoid hospitals that are treating suspected Ebola cases.
  • Avoid direct contact with sick people and their bodily fluids. This includes items that may have been contaminated with fluids like bedding and clothing.
  • Avoid direct contact with animals, including bats. Both dead and live animals pose a risk.
  • Do not eat bats or "bush meat" from gorillas, monkeys and other primates.
  • If you should require medical attention, call International SOS and we will direct you to a suitable facility.
  • Do not travel if you are sick. Some locations may implement screening, and travellers may face quarantine and testing.

More detail

The situation
The last confirmed case occurred in early June. Though a few suspected cases have been reported since, none have tested positive for Ebola. All contacts of Ebola cases completed their 21-day monitoring period at the end of June. An additional 21-day period of ongoing surveillance is underway. During this time, anyone with Ebola symptoms will be tested and classified as 'suspected cases'. If no new cases are confirmed in this time, the outbreak will be declared over in late July.

In total, 53 cases have been reported in this outbreak: 38 confirmed cases and 15 cases classified as "probable." Three health zones in Equateur province reported infections - Bikoro, Iboko, and Wangata (an area in the city of Mbandaka). Twenty-nine of the cases were fatal.

No exported cases have been reported to date. Still, exit screening will remain in place in locations of the DRC as a precautionary measure until the outbreak is officially over. There is a risk of resurgence of Ebola within the DRC if there are transmission chains that have not yet been detected, and from possible sexual transmission from male Ebola survivors to their partners.

In light of these risks, tempered by the country's current level of preparedness, WHO revised their assessment of public health risk from this outbreak on 6 July. The public health risk is now considered to be to be moderate at the national level. That is significantly decreased from the "very high" risk assessment that had been in place since April. Regionally, the risk has dropped from "high" to "low." Globally, the risk has been assessed as "low" since April. The likelihood of exported cases, per the WHO, is "low and diminishing."

Background
This outbreak was first reported in April. Initially, most of the cases occurred in remote areas around the Ikoko-Impenge (also known as Ikoko-Iponge) health facility, about 30 km from Bikoro. However, the outbreak's first urban cases were reported in mid-May, in the provincial capital city Mbandaka. More than a million people live in this densely-populated port, and these infections raised concerns that the disease could spread both in the city and along the Congo River to other areas. However, no new confirmed cases have been reported in that area since 17 May. No international spread has been reported.

The strain identified in the confirmed cases is Ebola Zaire virus, the same strain that caused previous outbreaks in DRC. Ebola is persistently present in the DRC. This is the ninth outbreak recorded since the discovery of the virus in 1976. In 2017, an outbreak in the northern part of the country was quickly contained as a result of a rapid and collaborative effort by local and national authorities and their international partners.

The response
A multidisciplinary response team from the World Health Organization (WHO), Medecins Sans Frontieres (MSF) and the Ministry of Health are in the area. Isolation zones have been established in Mbandaka's main hospital and Bikoro hospital. Ebola treatment centres (ETCs) have been set up in Bikoro, Wangata and Iboko.

A ring vaccination strategy was implemented from late May until the end of June. Ebola vaccine rVSV-ZEBOV was offered to healthcare workers with direct exposure to confirmed cases of Ebola. Other at-risk individuals, including contacts of confirmed Ebola cases and contacts of these contacts, were also offered the vaccine. Over 3,300 people were vaccinated. There are additional supplies of vaccine available in country.

Screening measures
The WHO and its partners have developed a strategic response plan for points of entry and locations where travellers congregate and interact with the local population.

Exit screening from DRC
Travellers at airports in Mbandaka and Kinshasa, and departing at the port in Kinsha, must complete a Traveller Public Health Declaration and have their temperature assessed before they are cleared to board.

Neighbouring countries have been alerted. Some have implemented screening measures.

  • Angola has closed its border with DRC in Malanje province and has increased surveillance of travellers crossing into Luanda Sul province.
  • Central African Republic is temperature screening people at ports where people arrive from the DRC.
  • Ethiopia enhanced screening across all points of entry into the country, including temperature screening and interviews at the international airport in Addis Ababa. All travellers from DRC will be monitored for 21 days by health authorities.
  • Gabon has stepped up measures to increase surveillance across all borders.
  • Kenya is screening all travellers at Jomo Kenyatta International Airport, Busia and Malaba border points for fever.
  • Nigerian authorities have stepped up screening measures at all airports and land border points. All incoming travellers will be screened, particularly those from DRC and its neighbouring countries.
  • Rwanda is screening all travellers from DRC at the Kigali International airport and at border crossing points at Rubavu and Rusizi districts.
  • South Africa is screening passengers coming in from DRC and Congo at the OR Tambo airport in Johannesburg.
  • South Sudan enhanced border screening in Western and Central Equatoria regions.
  • Tanzania is using thermal scanners at airports, border posts and other ports of entry.
  • Uganda introduced screening measures at airports and border posts.

The World Health Organization has said that entry screening, especially at airports distant from Ebola activity, is not an efficient public health measure. Conversely, exit screening for people leaving Ebola risk areas (including airports and ports on the Congo River) is very important.

What is Ebola virus disease?

Ebola is a potentially severe illness, which kills about 50% of those infected. Wild animals initially spread the virus to humans. Once humans are infected, they can spread the disease to others and large outbreaks can occur. Ebola is present in the blood and/ body fluids of the infected person. It spreads when someone has contact with these fluids, which may happen when caring for a sick person or through certain funeral practices such as communal washing of the body. This is how household members, friends and healthcare workers are exposed to the virus.

Symptoms develop between 2 and 21 days after someone is exposed to infected bodily fluids. Initial symptoms are sudden fever, weakness, muscle pain, headache and sore throat. Vomiting, diarrhoea, rash and abdominal pain follow in most cases. Some people progress to organ failure and bleeding, both internally and externally, which leads to death.

Supportive treatment (such as intravenous fluids and managing secondary infections) increase a person's chance of survival, especially if medical care is given early in the illness.

Ebola outbreaks are controlled through public health measures, such as isolating and treating infected people promptly, monitoring contacts for symptoms and isolating them immediately if they develop, strict handling of infectious materials, and safe burials. Vaccination campaigns have been conducted as part of control measures in recent outbreaks.

Ebola can also be transmitted by survivors of the disease through unprotected sexual contact.

For more information:

  • About Ebola: see the Ebola disease and prevention article on International SOS country guides.
  • See the International SOS country guide for the Democratic Republic of the Congo
  • Contact any International SOS assistance centre.

Assessment

The outbreak is expected to be declared over by 19 July. As Ebola remains present in the environment in the country, new outbreaks may occur. As experience in responding to outbreaks grows, and vaccination is available, any future outbreaks may be smaller and shorter in duration.

Advice for managers

Ensure your travellers (and other employees if relevant) are aware of:

  • Regional health threats including Ebola.
  • What to do if they get sick during and after travel.
  • The potential consequences if they attempt to travel while sick, including mandatory quarantine.



View Congo, Democratic Republic Country Report




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