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Medical Alerts
Created: Wednesday, May 09, 2018 03:27 GMT
Updated: Thursday, May 24, 2018 14:08 GMT
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Congo, Democratic Republic
Ebola in Equateur Province

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

Latest update: increase in total confirmed cases. An Ebola outbreak has been declared in Bikoro, Equateur Province, as well as the provincial capital city of Mbandaka. 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. Defer non-essential travel to the Bikoro/Ikoko-Impenge, Ingende, Iboko and Mbandaka until outbreak control measures have been definitively established. In addition, avoid direct contact with sick people. Do not participate in traditional funerals.


Defer non-essential travel to Bikoro / Ikoko-Impenge, Ingende, Iboko and Mbandaka until outbreak control measures have been definitively established.

  • 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.
  • Avoid direct contact with animals, including bats. 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
Since the beginning of April, more than 55 suspected, probable or confirmed cases have been identified in Bikoro, Iboko and Wangata (an area in the city of Mbandaka) health zones in Equateur province. Of the total, at least 30 cases have been confirmed. Three of them are healthcare workers. More than 20 people have died in this outbreak. Over 500 contacts in Bikoro and Mbandaka are under surveillance.

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, raising concerns that the disease could spread both in the city and along the Congo River to other areas.

The origins
The strain identified in the confirmed cases is Ebola Zaire virus, the same strain that caused previous outbreaks in DRC. The origins of the current outbreak are still being investigated. It is possible that the first case in Bikoro may have been a policeman who travelled from Ingende, and died in Ikoko-Impenge. Ingende is a separate location from Bikoro. The situation is unclear, though there may have been over 130 cases of Ebola in Ingende since January - well before the current outbreak was identified in April. The possible cases in Ingende are currently unclassified. None have yet met the criteria to be called suspected, probable or confirmed cases. (Each of those terms has a set definition.)

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) are being set up in Mbandaka and Bikoro. Twenty beds are planned for each ETC.

A ring vaccination strategy is being implemented from 21 May, using the Ebola vaccine rVSV-ZEBOV. All healthcare workers who are directly exposed to confirmed cases of Ebola will be prioritised for vaccination followed by other at-risk individuals including contacts of confirmed Ebola cases and contacts of these contacts. All individuals who have been vaccinated will be monitored for three months to ensure no serious adverse effects develop.

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

  • Angolan authorities will increase surveillance of persons crossing into Luanda Sul province.
  • Ethiopia will enhance screening at international airports.
  • 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.
  • South Sudan will enhance border screening in Western and Central Equatoria regions.
  • Tanzania has also implemented thermal scanners at airports, border posts and other ports of entry.
  • Uganda has 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.


The outbreak may have started months prior to confirmation of Ebola. More cases can be expected. There is a possibility it may spread to other areas as people travel. Further border control measures may be introduced, and additional countries increase screening of arriving travellers for symptoms, including fever.

A strong response is underway. Similar efforts were successful in controlling the 2017 outbreak. However, as the affected area is remote and access is difficult, it may be some time before chains of transmission are interrupted. The detection of an urban case in mid-May further complicated the situation, as Ebola can spread more rapidly among densely-populated areas. Contacts must be monitored for 21 days from their last potential exposure, therefore it will be weeks before the outbreak can be considered over.

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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