News from epidemic outbreaks: Ebola virus disease – Democratic Republic of the Congo (December 16, 2021) – Democratic Republic of the Congo

On December 16, 2021, the Ministry of Health (MoH) of the Democratic Republic of Congo (DRC) declared the end of the Ebola virus disease (EVD) epidemic which affected the health zone (ZS) of Beni in the province of North Kivu, DRC. The declaration was made in accordance with WHO recommendations , 42 days after the second negative test of the last confirmed case.

Between October 8 and December 16, a total of 11 cases (eight confirmed, three probable) including nine deaths and two survivors were reported in Beni HZ. Of the nine deaths, seven occurred in the community and two occurred at the Ebola Treatment Center (CTE). The overall case fatality rate (CFR) is 82% (9/11) among the total number of cases, while 75% (6/8) among confirmed cases.

This outbreak was declared on October 8, 2021 when the index case; a 3-year-old boy developed symptoms including physical weakness, loss of appetite, abdominal pain, difficulty breathing, dark stools and blood in vomit and died later on October 6 (for more details , please consult the Outbreak news published on October 10, 2021).

On October 7, samples were tested by reverse transcription polymerase chain reaction (RT-PCR) at the laboratory of the National Institute of Biomedical Research (INRB) in Beni. These were then sent to the Rodolphe Mérieux INRB Laboratory in Goma on October 8 and the EVD was confirmed by RT-PCR the same day. This event followed a group of three deaths (two children and their father) which were neighbors of the index case. All three patients died on September 14, 19 and 29 after developing symptoms consistent with Ebola, however, none were tested for the virus. The complete genome sequencing, carried out by the INRB in the city of Kinshasa, from the initial confirmed case indicates that this epidemic was not the result of a new zoonosis originating from an animal reservoir but was linked to an infection. persistent Ebola virus.

During the epidemic period (October 8 to December 16, 2021), three (16%) of the 19 health areas of the Beni ZS reported confirmed cases, namely Butsili (six cases), Bundji (one case) and Ngilinga (one case). Children under five accounted for 50% (4/8) of all confirmed cases. To date, all contacts have completed their 21-day follow-up period and have exited active follow-up.

In addition, from October 8 to December 13, a total of 21,916 alerts were reported in nine health zones including 15,642 in Beni, of which 21,558 (98%) were investigated and 1,709 were validated as suspected EVD cases.

Public health response

The Ministry of Health (MoH), in collaboration with the WHO and other partners, has taken steps to control the outbreak and prevent its spread. The Ministry of Health activated national and district emergency management committees to coordinate the response. Multidisciplinary teams have been deployed in the field to actively seek and treat cases; identify, reach and follow up on contacts; and sensitize communities on epidemic prevention and control interventions.

In addition, the following public health measures have been taken in response to the EVD epidemic;

• Continued use of alert tracking for active case finding in health facilities as well as during passive surveillance.
• For the first time ever, authorized doses of ERVEBO vaccine (4,800) were delivered in response to an EVD outbreak, through the International Coordinating Group (ICG) in the vaccine delivery mechanism. Vaccination with ERVEBO started on November 25 and as of December 14 a total of 1193 frontline workers have been vaccinated with Ervebo.
• Vaccination activities with experimental doses were launched on October 13. As of November 22, 656 people have been vaccinated with experimental doses, including 98 high-risk contacts, 300 contacts of contacts and 258 probable contacts; of these 81 are frontline workers.
• As of December 14, a total of 1,827 samples, including 834 swabs, had been tested; including eight confirmed cases of EVD in INRB field laboratories in Beni, Butembo, Mangina and Goma.
• Establishment of a CTE and other health establishments capable of handling suspected cases. Three patients confirmed alive received monoclonal antibodies approved at Beni ETC, two of them have since recovered from Ebola virus disease.
• Capacity building for infection prevention and control (IPC) in 83 priority health facilities through donation of IPC kits, training, supportive supervision, evaluation and other activities. Additional support was provided to 221 other health facilities through donation of kits and briefings from health providers.
• From the declaration of the outbreak on October 8 to December 12, a total of 14 entry points were set up which detected 4,745,892 people and validated 216 alerts. None have been confirmed.
• Training and retraining of health personnel for the early detection, isolation and treatment of EVD cases as well as retraining on safe and dignified burials and IPAC activities were carried out.
• Several community groups have carried out risk communication and community awareness activities, using a wide range of communication channels (community dialogues, community radio, social media, etc.) to raise awareness of Ebola throughout this period. epidemic. Communities have also been engaged in intervention interventions. In addition, a joint feedback mechanism has been put in place between eight partners to record rumors, questions and comments from communities. This allowed for targeted communication and timely dialogue with the communities.
• Psychosocial support was offered to affected individuals and families, including psychological support to confirmed and suspected patients, their immediate family and children, as needed. In the communities, psychosocial sessions were regularly organized on different aspects of the response to EVD.
• An integrated epidemic analysis unit (IOA) has been set up in Beni, under the direction of the Ministry of Health and in collaboration with partners of the Global Epidemic Alert and Response Network (GOARN). The IOA unit provided five surveys and ad hoc analyzes to answer operational and strategic questions (lessons learned from Beni 2018-2020; risks of EVD in children; assessment of alert performance; perception and behavior of health workers; health-seeking behaviors) and contributed to the co-development of evidence-based policy and operational recommendations.
• The International Federation of the Red Cross and Red Crescent has supported the national Congolese Red Cross by organizing safe and dignified burials throughout the epidemic.
• WHO continued to support the DRC Ministry of Health in the implementation of the EVD survivor care program. The two healed people are entitled to medical and psychological follow-up for 18 months as well as biological tests.

WHO risk assessment

The current re-emergence of EVD is the fifth epidemic in less than three years. The last EVD outbreak was reported in North Kivu province earlier this year in February and was declared over on May 3, 2021 (for details, please see the Disease Outbreak News published May 4, 2021)

All probable and confirmed cases of EVD have been identified in three health areas of the Beni ZS, within the densely populated town of Beni. WHO continues to monitor the situation and the risk assessment will be updated as more information becomes available.

WHO noted that although the current resurgence is undesirable, it is not unexpected given that EVD is enzootic in DRC and Ebola virus is present in animal reservoirs in the region; this means that the risk of re-emergence by exposure to a host animal cannot be excluded. In addition, it is not uncommon for sporadic cases to occur following a major outbreak. Ebola virus can persist in some bodily fluids of EVD survivors. In a limited number of cases, secondary transmissions resulting from exposure to bodily fluids of survivors have occurred. Therefore, maintaining collaborative relationships with survivor associations while monitoring survivors is a priority to mitigate any potential risk.

The re-emergence of EVD is a major public health problem in DRC and there are gaps in the country’s capacity to prepare for and respond to epidemics. A confluence of environmental and socio-economic factors, including poverty, community mistrust, weak health systems, and political instability are accelerating the rate of EVD emergence in DRC.

WHO considers that the current challenges in terms of access and security, epidemiological surveillance, coupled with the emergence of COVID-19, as well as ongoing epidemics such as cholera and measles could compromise the country’s capacity. to detect and respond quickly to re-emergence.

WHO advice

WHO recommends the following risk reduction measures as an effective way to reduce transmission of EVD in humans:

• Reduce the risk of transmission from wildlife to humans through contact with infected fruit bats or monkeys / monkeys and consumption of their raw meat. Animals should be handled with gloves and other suitable protective clothing. Animal products (blood and meat) must be well cooked before consumption.
• Reduce the risk of human-to-human transmission through direct or close contact with people showing symptoms of Ebola, especially with their bodily fluids. Appropriate personal protective equipment should be worn when managing sick patients. Regular hand washing is necessary after visiting patients in hospital, as well as after touching or coming into contact with bodily fluids.
• To reduce the risk of possible transmission due to the persistence of the virus in some bodily fluids of survivors, WHO recommends providing medical care, psychological support and laboratory tests (up to two consecutive negative tests) as part of the an EVD survivor care program. WHO does not recommend the isolation of convalescent male or female patients whose blood has tested negative for Ebola virus.
• Continue training and retraining of health personnel for early detection, isolation and treatment of EVD cases, as well as retraining on safe and dignified burials and the IPC ring approach.
• Ensure the availability of PPE and IPC supplies for the care of sick patients and for decontamination
• Carry out assessments of health facilities (“dashboard”) of compliance with IPC measures in preparation for the management of Ebola patients (this includes WASH, PPE supplies for waste management, triage / screening capacity , etc.)
• Work with communities to strengthen safe and dignified funeral practices

Based on the current risk assessment and past evidence of Ebola outbreaks, WHO advises against any restrictions on travel and trade to the Democratic Republic of the Congo.