September 2018 World Health Report

Published on 29th September 2018

Democratic Republic of Congo (DRC)

The 10th outbreak of the Ebola virus to occur in the Democratic Republic of Congo continues to cause concern as vaccination efforts are halted for 48 hours. This is following the resurgence of militia attacks in Beni – a city at the heart of the epidemic.

The Allied Democratic Forces (ADF), an Islamist militia group, has been reported to have killed 21 individuals in Beni, Eastern DRC. Whilst over 11,000 individuals at risk of Ebola have been immunised with the newly established vaccine VSV-ZEBOV so far, the continuation of the vaccination programme will be critical to the eventual control of the outbreak that has infected around 150 people to date, killing over 70. What is also crucial is the regular follow-up of contacts of Ebola patients to allow for early diagnosis and quarantine should symptoms present themselves – the militia activity has also hindered this important work. To complicate matters further, there are rumours circulating locally that are said to be reducing the willingness of the population to receive vaccination. Some have felt that the Ebola crisis was established in an effort to kill opposition to the government, others that it was started to make foreigners rich, and even that it is a result of a curse.

In a climate of fear and suspicion where rumours, however unlikely, are rife, the need for the WHO to use local experts well-versed in community engagement is clear. Local practices that have facilitated transmission of Ebola in past outbreaks have recently been reported to have occurred in the DRC again. One such practice is the ceremonial washing that is an integral part of local burial rites. As close contact can result between the deceased and the mourners during this stage of the burial, many have become infected with Ebola in this way in previous outbreaks.

Although the weekly number of newly infected patients has decreased, the WHO are urging caution as there is a delay in reporting new infections, and Ebola cases outside of known contact rings are still occurring. In this context, the new activities of the ADF present a concerning development that is likely to worsen and prolong the epidemic in the DRC. Although the Congolese army has launched new attacks against the ADF in an attempt to facilitate the WHO’s work, many fear that the internal displacement of individuals within the DRC may inexorably lead to the further spread of the disease to neighbouring countries.

Zimbabwe and Algeria

Cholera is a disease most often associated with poor sanitation, where drinking water becomes contaminated with the cholera bacteria, resulting in a profuse diarrhoea that can be life threatening in some circumstances.

Contaminated bore holes and wells in Harare, Zimbabwe have been attributed to instigating an epidemic of over 3,500 suspected cases, proving fatal in 32 patients. The WHO and partners have responded to the outbreak by increasing surveillance of the disease and improving the local capabilities for its diagnosis. Furthermore, the Zimbabwean Government is assessing the utility of initiating a widespread oral vaccination programme. In order to treat those affected, oral rehydration kits, IV fluids, and antibiotics are being issued by the WHO. In addition, a dedicated cholera treatment centre has recently been set up by MSF.

Algeria also has a cholera outbreak at present, centred in the northern parts of the country. Although smaller in scale than the Zimbabwean epidemic as yet, over 200 cases have so far been identified. Of the 21 water sources that have been tested for being the source of cholera, 10 have been condemned for human usage, including one water source that has tested positive for supporting the cholera bacteria.

South Korea

South Korea had a recent case of the Middle Eastern Respiratory Syndrome (MERS) diagnosed in a returning businessman from Kuwait. This infection can cause a severe chest infection that can often lead to complications and death in those with a significant past-medical history.

Although a solitary infection of MERS may not sound significant, in 2015 South Korea was faced with a similar situation that resulted in dire consequences for the country. In this earlier case, the patient had initially gone to several over-crowded hospitals in efforts to get treated. This led to many individuals becoming exposed to the MERS virus. In fact, by the end of the 2015 epidemic, almost 40 people succumbed to the illness, and many thousands of individuals who were at risk of developing the illness were quarantined. As tourism decreased and people were scared to go out in public, even the South Korean economy was said to have taken a temporary nose-dive.

Unlike the cases seen in the previous epidemic, however, this recent infection has been treated extremely promptly: all 400 contacts of the patient were put under immediate quarantine and have now been asymptomatic for two weeks. There will be none of the severe ramifications as were seen in 2015.

 

Written by Dr. Simon Worrell, Head of Medical Communications.