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On August 1, 2018, the Democratic Republic of Congo (DRC) declared its tenth outbreak of Ebola in 40 years. The home is located in the town of Mangina, North-Kivu province, in the north-east of the country.
267
TOTAL CASES
232
CONFIRMED CASES
135
DEATHS CONFIRMED
Retrospective surveys suggest a possible start to the epidemic in May – at about the same time as the outbreak in Ecuador earlier this year. Although no link can be established between the two homes, it can not be excluded either.
The delay in the alert and the resulting reaction can be attributed to several factors, including a failure of the surveillance system due to the security context (movements are limited and access is difficult) and Health workers strike in the region started in May, due to non-payment of wages.
The initial alert took place after a Mangina woman was admitted to the local health center on July 19 for heart disease. She was discharged but died at home on July 25, after experiencing symptoms of haemorrhagic fever. Members of his family later developed the same symptoms and also died soon after. A joint survey by the Ministry of Health and the World Health Organization (WHO) revealed six other suspected cases, four of which were positive. This result led to the declaration of the home.
On August 7th, the National Laboratory (INRB) confirmed that the current outbreak is that of Zaire Ebola, the most deadly strain and the same one that affected West Africa during the 2014 outbreak. -2016. Zaire Ebola was also the virus discovered during the epidemic in the Equateur province, in western DRC, earlier in 2018, although it was noticeable. of a strain different from that affecting the current epidemic.
Current situation
More than ten weeks after the declaration of the epidemic, it seems that we are facing a second peak of the epidemic: the epicenter has now moved from the small village of Mangina to the city Beni, where the number of confirmed cases showed a clear increase in October. Ten health zones in the provinces of North Kivu and Ituri (Mandima, Mabalako, Beni, Oicha, Butembo, Kalunguta, Komanda, Masareka, Musienene and Tchomia) have so far reported confirmed or probable cases. d & # 39; Ebola. The epidemiological situation in North Kivu is more worrying than in September, when the number of cases appeared to be decreasing.
On September 20, a new case appeared in Tchomia, 60 km south of Bunia, in Ituri province. The infected patient died at Tchomia hospital, but was probably infected in Beni and traveled north. The epidemic is now very close to the Ugandan border, increasing the risk of overflowing into the country.
Epidemiological teams are still working to identify all active chains of transmission. This is not easy since local communities in the affected areas are highly mobile and move from village to village for work and family reasons, as well as for health care. Sick people went to more than one health center before being identified as suspicious and referred to an Ebola treatment center.
Since the beginning of the epidemic, more than 8,000 contacts have been identified and more than 2,732 people are currently being followed by the Congolese Ministry of Health. The search for contacts and follow-up are done by the Ministry of Health with a team of epidemiologists.
Area
Mangina, a town of 40,000 inhabitants, is located in Beni territory, North-Kivu province, in northeastern DR Congo. Beni, the administrative center of the territory, is about 30 kilometers away and has about 420,000 inhabitants. The region is bordering Uganda to the east; Goma, the capital of North Kivu, and the Rwandan border are further south. This area sees a lot of trade, but also traffic, including "illegal" crossings. Some communities live on both sides of the border, which means that it is very common for people to cross the border to visit relatives or merchandise at the market on the other side. The region is densely populated and the Ugandan border is a sensitive area and is crucial for the development of the epidemic that is spreading in the region.
The territory is characterized by great insecurity. It is considered a zone of conflict. It is estimated that more than 100 armed groups are active in North Kivu. Kidnappings and carjackings are very common. It is an area of intensive military operations underway – the city of Beni is subject to military regime and justice, and moving in certain areas of the region is quite difficult and sometimes impossible. Two attacks in Beni – the most recent one on October 20 – resulted in several deaths and forced the Ebola outbreak activities to temporarily halt for several days before resuming.
The epidemic has spread in the neighboring province of Ituri, but the majority of cases still occur in North Kivu.
EXISTING MSF PRESENCE IN THE AREA
MSF has projects in North Kivu since 2006. We regularly have projects along the Goma-Beni axis, as follows:
- Lubero Hospital: pediatric / nutritional care and treatment of sexual and gender-based violence.
- Bambu-Kiribizi: Two teams support emergency rooms and pediatric and malnutrition treatment services, as well as the care and treatment of sexual and gender-based violence.
- Rutshuru Hospital: MSF left the hospital at the end of 2017. However, in the face of the unstable situation prevailing in the region, we returned to support the emergency room, emergency surgery programs and pediatric nutrition.
- Goma: HIV program supporting four medical centers (including access to antiretroviral therapy).
The response to the current epidemic
The DRC Ministry of Health, with the support of WHO, is leading the response to the epidemic. The MoH team responsible for coordinating the response to Beni was sent from Kinshasa. This is the same team that coordinated the response in Equateur Province. The WHO emergency pool was mobilized in the region after the declaration of the outbreak.
Epidemiological surveillance is being implemented in the provinces of North Kivu and Ituri and a test laboratory is fully operational in Beni (each sample was previously sent to Kinshasa). Other partners are involved in activities related to water and sanitation, health promotion and community awareness.
MSF RESPONSE
At the request of the Ministry of Health, MSF is part of the working group to coordinate the intervention and focuses on the care of patients affected by the virus, the vaccination of front-line workers, as well as the protection of patients. local health structures (and their workers) by helping with: triage, decontamination and training. MSF also supports surveillance activities.
In total, more than 100 people are currently working on MSF Ebola projects in the provinces of North Kivu and Ituri.
The first task of MSF was to improve an isolation unit for suspected and confirmed cases in the Mangina health center, the epicenter of the epidemic, where patients were isolated and treated during the epidemic. construction of a treatment center. On August 14, a treatment center with 68 beds was opened. It has since been reduced to 24 beds due to the reduced volume of activities in Mangina and the displacement of the outbreak to other areas.
Butembo, a town estimated at one million inhabitants, has seen imported cases from Beni. On 20 September, MSF immediately set up an isolation center in a local hospital, followed by an Ebola treatment center, jointly run by MSF and the Ministry of Health.
As of 22 September, MSF had treated 74 Ebola-confirmed patients and admitted 195 patients in total for the virus to Mangina and Butembo. Of those confirmed Ebola positive patients in our Ebola treatment center, 33 recovered and returned to their families, while 5 confirmed patients and 8 suspected patients were still on treatment.
A third CTE was opened on 12 October following the appearance of confirmed cases in Tchomia, Ituri province, on Lake Albert (on the Ugandan border). MSF currently supports Ministry of Health staff working in the center by providing training and technical expertise.
Another isolation center was built by MSF in Beni and handed over to the Ministry of Health, which was entrusted to another NGO. It is now a treatment center.
Health centers in Mangina and Beni that have seen positive cases are also being decontaminated. MSF is also involved in these infection prevention and control activities. In addition, MSF teams are working in the regions of Beni and Mangina, as well as in Ituri, between Mambasa and Makeke (North Kivu border) and Bunia-Tchomia, visiting health centers and training. the appropriate triage staff for the Ebola virus. suspects, as well as the establishment of isolation zones when needed.
MSF teams also built a seven-bed transit center in Makeke (North-Kivu-Ituri border), where suspected patients could be isolated and tested for HIV, and then transferred to Ebola treatment centers at Mangina or Beni. The center has now been closed as the Ministry of Health and the International Medical Corps have opened an Ebola treatment center in Makeke.
Further south, MSF sent a rapid response team to Luotu, a village outside Lubero, on 9 September, in response to alerts about a positive case. The team consisted of a doctor, a nurse and a water and sanitation expert; she not only participated in the investigation, but also in the construction of a small isolation unit in an existing structure to receive suspected cases. The positive case had spent time at the health center before dying at home, many health center staff, as well as the family, were considered high-risk contacts. Fortunately, no confirmed cases were recorded and MSF withdrew our staff from this center on 27 September leaving the structure to the Ministry of Health.
Treatment with drugs for development
In our ETCs, MSF teams have progressively increased the level of supportive care (oral and intravenous hydration, treatment of malaria and other co-infections and treatment of Ebola symptoms) and have also been able to offer new potential therapeutic treatments to patients. with confirmed Ebola infection according to the MEURI protocol. A team of clinicians selects five potential drugs on a case-by-case basis (Favipiravir, Remdesivir (GS5734), REGN3470-3471-3479, ZMapp and mAb114). Treatments are given only with the informed consent of the patient (or a family member if they are too young or too sick to give their consent) and are provided in addition to the care of the patient. support.
These five drugs have not passed the clinical tests yet and we are not able to measure their effectiveness. However, their use has been approved by the ethics committees of the Ministry of Health and MSF, as it is thought that they can improve the patient's chances of survival. Although caution is required, these treatments are an additional resource for the response. Because of their untested status, their use is subject to a strict protocol that places special emphasis on the informed consent of the patient. Discussions about setting up an appropriate clinical trial are underway.
Vaccination activities
MSF is also vaccinating front-line workers (health workers, religious leaders, burial workers, etc.) from Makeke on the Ituri-North-Kivu border to Biakato. As the population of Mangina often moves in this direction, it is hoped that this vaccination will help prevent the spread of infection in Ituri. So far, 360 frontline workers have been vaccinated by MSF. On October 18, we also began vaccinating frontline workers in the city of Beni.
surveillance
Two MSF teams in Beni support the MSP and WHO teams, who decide on the strategy of this pillar. Our teams examine local health structures.
Health promotion
MSF health promotion teams in Beni work in support of IPC and immunization teams, as these activities require intensive communication with the community. HP teams are also in touch with local leaders from multiple health zones to share information about Ebola and the community.
Emergency Preparedness
MSF is also working with the Ministry of Health to contribute to the intervention launched in Tchomia (Ituri) in response to new confirmed cases.
Our teams in Uganda have also been mobilized to be ready in case the epidemic spreads across the border. They set up an isolation tent in Bwera, a small town just on the border between Beni and Butembo. The non-urgent MSF project in Hoima (Uganda) has also set up an isolation tent.
All MSF projects in the regions of North Kivu and Ituri have been equipped with Ebola equipment, including personal protective equipment (PPE), and have implemented protocols for the prevention of Ebola. Hygiene and infection control appropriate to protect staff and patients from the risk of contamination, if the outbreak spread further.
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