Chief Medical Officer
Extracted from our World Health Report July 2019
On 17th July 2019, the International Health Regulations Emergency Committee for Ebola Virus Disease in the Democratic Republic of Congo reconvened for the fourth time since the outbreak began in August 2018 to discuss once again whether this outbreak now meets the criteria to be declared a Public Health Emergency of International Concern (PHEIC).
Since it was declared almost a year ago the outbreak has been classified as a level three emergency. Citing recent developments in the outbreak in making its recommendation, the World Health Organisation (WHO) Director-General Dr. Tedros Adhanom Ghebreyesus declared that the Ebola outbreak in the DRC is now a PHEIC.
There have been four declarations of public health emergencies since 2005, when the WHO’s new regulations were introduced: swine flu in 2009, polio in 2014 when there was a resurgence after near-eradication, Ebola in west Africa in 2014 and the Zika virus in Brazil in 2016. This designation can rally international support but can also isolate a country when other states impose travel bans, as occurred in the West African Ebola epidemic.
As was demonstrated in the 2013-16 West Africa outbreak, community involvement is crucial and even when it is thought that the outbreak is under control more cases appeared for months after. The latest official statistics (as of 15th July 2019) list a total of 2,395 confirmed cases, with 1,665 deaths. As the number of cases creeps up every week there seems little prospect of a quick conclusion to this outbreak.
First case of Ebola Virus Disease arrives in Goma
The first ever patient to be diagnosed with Ebola in Goma, the capital of North Kivu province in eastern Democratic Republic of Congo (DRC), has died in transit back to Butembo according to the DRC health ministry.
A 46 year old pastor who had recently preached in several churches in Butembo, which is a hot centre of EVD, travelled by bus to Goma in the eastern DRC. He passed through three medical checkpoints on the 18 hour journey without showing any signs of illness. On arrival in Goma, he presented to a medical facility and was transferred immediately to an Ebola treatment centre, where EVD was confirmed. The patient sadly died while in transit back to Butembo. All contacts on the bus have been traced and isolated, and have been vaccinated.
Rwanda remains on high alert in view of its close proximity to Goma, where people walk freely across the border between Goma and the Rwandan city of Gisenyi. There have been no cases confirmed to date in Rwanda.
The number of people moving around or through the zone worst hit by Ebola has been a big challenge for health services. Public Health authorities and NGOs attempting to control the outbreak have been severely hampered by attacks against health workers and treatment facilities. The Health Ministry have announced this week that two Ebola awareness workers had been killed in the affected zone, bringing the number to seven killed since January. There have been an additional 198 nonfatal attacks on health facilities and health workers in the past six months. Eastern DRC is home to a number of armed groups, and Mai Mai militia fighters are active near the hardest-hit towns. Health teams have been unable to access areas affected by violence to vaccinate people at risk of infection and to bring infected patients into isolation. At other times the violence against health teams has come from relatives who do not want their loved ones taken to treatment centres or buried in accordance with guidelines aimed at reducing Ebola transmission.
If the disease spreads within Goma then Rwanda will need to be prepared to manage and contain cases to prevent spread into Gisenyi and beyond.
Uganda holds its breath as no new cases of Ebola reported, while the DRC continues to struggle
Following the confirmation that a five year old boy and his grandmother died from EVD in Uganda last month, there have been no further reports of new cases.
The last of the contacts that were isolated have shown no symptoms and have completed their 21 day observation period.
The two deaths resulted from a trip over the border to the DRC to attend the funeral of a family member who had died following a brief illness with confirmed EVD. One other family member went back to the DRC and died there in an Ebola treatment centre.
The Ugandan health authorities quickly identified the potential for EVD in the patients and transferred them immediately to the nearest Ebola treatment centre. Here the diagnosis of EVD was confirmed but they both died within days of admission. There was a dedicated and focused response and all potential contacts were traced and isolated for observation. None of those has tested positive for EVD and there have been no further cases reported in Uganda since the 13th June 2019.
In the DRC there has been a decrease in number of cases in some key areas while other areas have seen significant increases. North Kivu and Itori provinces in the north east of the country continue to suffer from the long-standing humanitarian crisis caused by armed insurgents that continue to disrupt efforts to contain the spread of infection.
Until there is a political solution to the deep social and economic problems and an end to the security issues in this region of the DRC there will continue to be many, many avoidable deaths from Ebola, malaria and cholera. In the meantime, neighbouring countries need to maintain the highest level of vigilance and preparedness for the cases of EVD that will inevitably cross the border from the DRC, as they did into Uganda last month.
As insurgents continue to disrupt healthcare workers and cause mass people movements other vaccine preventable illnesses are proving to be even more deadly than Ebola in the DRC
A measles crisis has caused a reported 115,000 cases, and claimed almost 2,000 deaths in 2019 alone – two thirds of the victims being children under five years of age. This dwarfs the many reported outbreaks around the world and is almost double the total number of cases for the whole of 2018.
Health authorities, already heavily stretched by the difficulties of administering an Ebola vaccination campaign in the insecurity of northeast DRC, are now having to organise an urgent measles vaccination campaign.
Many thousands of families have been forcibly displaced by the ongoing conflict and also by fear of the Ebola virus, and are living in overcrowded and unsanitary displacement camps. Spread of disease is inevitable and often deadly, especially for children. An estimated 400,000 people are living in temporary camps.
Frontline health workers are having to take extra protective measures against infection and triage meticulously, ever alert for any symptoms that point to either measles or EVD, or even malaria or cholera – they all have very similar symptoms in the early stages. There will be no let-up until political and economic stability can be achieved in the region.
ADVICE TO TRAVELLERS TO EVD AFFECTED COUNTRIES…
Take the following enhanced precautions and your risk of becoming infected is low:
- Avoid contact with symptomatic patients and their body fluids
- Avoid contact with the corpses and body fluids from deceased Ebola virus disease victims
- Avoid contact with all wild animals and their corpses
- Avoid handling/eating bush or wild meat
- Wash and peel fruits and vegetables before consumption
- Wash hands regularly and carefully with soap and water/alcohol gel
- Practise safer sex using barrier contraception
- Seek immediate medical advice if you become ill within 21 days of leaving the EVD affected area.
Read our Ebola Virus Disease Medical Briefing for more information.