HPR volume 12 issue 30: news (17 August)
Updated 21 December 2018
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New Ebola virus outbreak in eastern DRC
On 1 August 2018, the Democratic Republic of the Congo (DRC) reported its tenth Ebola virus disease (EVD) outbreak, this time in eastern DRC. This came just one week after the declaration of the end of the EVD outbreak in the Equateur Province, approximately 2,500km away. Although Zaire Ebolavirus is responsible for both outbreaks, the viruses are distinct – indicating the 2 outbreaks are not connected.
As of 15 August, the DRC Ministry of Health has reported a total of 51 laboratory confirmed and 27 probable cases. To date, 44 fatalities have been reported, of whom 17 were in confirmed EVD cases [1].
Confirmed and probable cases have been reported from 6 health zones in 2 provinces (North Kivu and Ituri) (table 1), with the majority (39 confirmed and 21 probable) in Mabalako, the perceived epicentre of this outbreak [2].
It should be noted that the response to this latest EVD outbreak is still in the early stages and the extent (both total case numbers and geographical range) has yet to be fully understood. It is believed the index case died in early May. The delay in reporting of further sporadic deaths in the community since then may be associated with a strike among healthcare workers in the affected area.
Table 1. Case table for EVD outbreak in North Kivu and Ituri provinces, as of 15 August 2018. Data provided by DRC MoH
| Health zone | Confirmed | Probable | Fatalities |
|---|---|---|---|
| Béni – North Kivu | 5 | 0 | 4 |
| Butembo – North Kivu | 0 | 2 | 2 |
| Oicha – North Kivu | 0 | 1 | 1 |
| Mabalako – North Kivu | 39 | 21 | 33 |
| Musienene – North Kivu | 0 | 1 | 1 |
| Mandima – Ituri | 7 | 2 | 3 |
| TOTAL | 51 | 27 | 44 |
The provinces of North Kivu and Ituri are among the most populated provinces in DRC. North Kivu shares borders with 4 other provinces as well as with Uganda and Rwanda. In addition to Uganda, Ituri province also shares a border with South Sudan.
The World Health Organization (WHO) has stated that effective EVD outbreak control measures may be compromised by the unstable security situation in eastern DRC [3]. The long-term presence of armed groups, military operations against them, intercommunal violence and an influx of refugees from and to neighbouring countries all contribute to a deterioration in the political, security and humanitarian situation.
The country is concurrently experiencing several outbreaks of other infectious diseases (including cholera, malaria, monkeypox and vaccine-derived polio) and a long-term worsening humanitarian crisis. Given the political and humanitarian instability in the area, there is considerable movement within provinces and between neighbouring countries. Surveillance systems have been established in these neighbouring countries to rapidly identify (through border screening as well as through healthcare facility surveillance) and investigate suspected cases of EVD. To date, multiple alerts of suspected cases have been quickly investigated and negated.
The World Health Organization (WHO) considers the public health risk as high at the national and regional level, and low globally.[3]
The risk to the UK public is currently very low to negligible. The situation is being monitored closely and the risk assessment is reviewed regularly.
Table 2. Previous EVD outbreaks in the DRC (1976 to 2018)
| Year | Province | Cases | Deaths | Virus species |
|---|---|---|---|---|
| 2018 | Equateur | 54 | 33 | Zaire |
| 2017 | Bas Uele | 8 | 4 | Zaire |
| 2014 | Equateur | 66 | 49 | Zaire |
| 2012 | Haut-Uele [Orientale~] | 36 | 13 | Bundibugyo |
| 2008/09 | Kasai [Kasaï-Occidental~] | 32 | 15 | Zaire |
| 2007 | Kasai [Kasaï-Occidental~] | 264 | 187 | Zaire |
| 1995 | Kwilu | 315 | 250 | Zaire |
| 1977 | Mongola | 1 | n/a | Zaire |
| 1976 | Mongola | 318 | 280 | Zaire |
~ Previous name for province or area of outbreak.
Travel advice
The risk of being infected with EVD during a visit to DRC will depend on the areas of the country visited and the activities undertaken while there, but overall is negligible to very low. The Foreign and Commonwealth Office advises against all travel to North Kivu and Ituri provinces, and all but essential travel to Goma, the capital of North Kivu. There is no UK-licensed vaccine for use in travellers to prevent infection.
Individuals travelling to outbreak areas for humanitarian activities should seek additional advice from their sending organisation on infection control and health and safety guidance. A proportionate Returning Workers Scheme, operated by PHE, has been established to manage the expected small number of response workers who will return to the UK from DRC [5].
Further information sources
- PHE Ebola collection: Ebola virus disease: clinical management and guidance
- NaTHNaC: Travel Health Pro website
- WHO website EVD home page: Ebola virus disease
- FCO website: DRC advice
References
- DRC Ministry of Health (16 August 2018).
- WHO AFRO Situation Report No. 2 (14 August 2018).
- WHO press statement (12 August 2018).
- WHO Disease Outbreak News (14 August 2018).
- PHE website. Ebola: returning workers scheme (RWS).
Infection reports in this issue of HPR
This issue includes reports on: