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→‎Increasing cases: You meant the DRC, not Uganda. The article doesn't mention Uganda, and if the epidemic does spread to Uganda it would start in the nearby southwest, not eastern Uganda. Also a comma splice and other proofreading.
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believes a combination of factors could establish conditions for an epidemic.<ref>{{cite web |last1=Schlein |first1=Lisa |title=WHO Warns Ebola Spreading in Eastern DR Congo |url=https://www.voanews.com/a/who-warns-ebola-is-spreading-in-eastern-dr-congo/4586363.html |website=VOA |accessdate=25 September 2018 |language=en|quote="A perfect storm of active conflict limiting our ability to access civilians, distress by segments of the community already traumatized by decades of conflict and of murder, driven by a fear of a terrifying disease"}}</ref> On 18 October, the [[Centers for Disease Control and Prevention]] raised its travelers' alert to the Democratic Republic of the Congo from a level 1 to level 2 for all U.S. travelers.<ref>{{cite web |title=Ebola in Democratic Republic of the Congo - Alert - Level 2, Practice Enhanced Precautions - Travel Health Notices {{!}} Travelers' Health {{!}} CDC |url=https://wwwnc.cdc.gov/travel/notices/alert/ebola-democratic-republic-of-the-congo |website=wwwnc.cdc.gov |accessdate=19 October 2018 |language=en-us}}</ref> On 26 October, the World Health Organization indicated that half of confirmed cases were not showing any fever symptom, thus making diagnosis more difficult.<ref name=nofever/>
believes a combination of factors could establish conditions for an epidemic.<ref>{{cite web |last1=Schlein |first1=Lisa |title=WHO Warns Ebola Spreading in Eastern DR Congo |url=https://www.voanews.com/a/who-warns-ebola-is-spreading-in-eastern-dr-congo/4586363.html |website=VOA |accessdate=25 September 2018 |language=en|quote="A perfect storm of active conflict limiting our ability to access civilians, distress by segments of the community already traumatized by decades of conflict and of murder, driven by a fear of a terrifying disease"}}</ref> On 18 October, the [[Centers for Disease Control and Prevention]] raised its travelers' alert to the Democratic Republic of the Congo from a level 1 to level 2 for all U.S. travelers.<ref>{{cite web |title=Ebola in Democratic Republic of the Congo - Alert - Level 2, Practice Enhanced Precautions - Travel Health Notices {{!}} Travelers' Health {{!}} CDC |url=https://wwwnc.cdc.gov/travel/notices/alert/ebola-democratic-republic-of-the-congo |website=wwwnc.cdc.gov |accessdate=19 October 2018 |language=en-us}}</ref> On 26 October, the World Health Organization indicated that half of confirmed cases were not showing any fever symptom, thus making diagnosis more difficult.<ref name=nofever/>


On 6 November, the [[Centers for Disease Control and Prevention]] indicated that the current outbreak in the east region of Uganda may not be containable due to several factors, this would be the first time since 1976 that on outbreak has not been able to be curbed.<ref>{{cite web |title=CDC director warns that Congo’s Ebola outbreak may not be containable |url=https://www.washingtonpost.com/health/2018/11/05/cdc-director-warns-that-congos-ebola-outbreak-may-not-be-containable/?noredirect=on&utm_term=.74d501d70f66 |website=Washington Post |accessdate=6 November 2018 |language=en}}</ref>
On 6 November, the [[Centers for Disease Control and Prevention]] indicated that the current outbreak in the east region of the DRC may not be containable due to several factors. This would be the first time since 1976 that an outbreak has not been able to be curbed.<ref>{{cite web |title=CDC director warns that Congo’s Ebola outbreak may not be containable |url=https://www.washingtonpost.com/health/2018/11/05/cdc-director-warns-that-congos-ebola-outbreak-may-not-be-containable/?noredirect=on&utm_term=.74d501d70f66 |website=Washington Post |accessdate=6 November 2018 |language=en}}</ref>


===Military conflict===
===Military conflict===

Revision as of 14:50, 6 November 2018

This article is about the 2018 Kivu Democratic Republic of the Congo virus outbreak. For the prior Ebola outbreak in DRC, see 2018 Équateur province Democratic Republic of the Congo Ebola virus outbreak.
2018 Kivu Democratic Republic of the Congo Ebola outbreak
Initial case: 1 August 2018
North Kivu (province)
Location of North Kivu province in the Democratic Republic of the Congo
Map showing the location the Democratic Republic of the Congo in Africa
Location of the Democratic Republic of the Congo in Africa (update as of 11/05/18)
Confirmed cases265[1]
Probable cases35[1]
Suspected cases41[1]
Total cases341[1]
Deaths186[1]

The 2018 Kivu Democratic Republic of the Congo Ebola virus outbreak[note 1] began on August 1, 2018, when it was confirmed that four cases had tested positive for Ebola virus in the eastern region of Kivu in the Democratic Republic of the Congo (DRC).[3][4][5] The viral infection outbreak also includes Ituri Province, after the first case was confirmed on 13 August.[2]

The affected province and general area are currently undergoing a military conflict, which is hindering treatment and prevention efforts. The World Health Organization's Deputy Director-General for Emergency Preparedness and Response has described the combination of military conflict and civilian distress as a potential "perfect storm" that could lead to a rapid worsening of the outbreak.[6][7] Due to the deteriorating situation in DRC (North Kivu and surrounding areas) the World Health Organization, on September 27, has raised the risk assessment at the national and regional level from 'high' to 'very high'.[8]

On 3 October, the United Nations Security Council stressed that all armed hostility should come to a stop in the Democratic Republic of the Congo, to better fight the ongoing Ebola virus outbreak.[9] For the week ending October 14, DRC indicated 33 cases of EVD were identified, of which 24 died, in one week.[10]

Epidemiology

First cases and transmission

The Democratic Republic of Congo declared an Ebola outbreak on 1 August, when four cases had tested positive for the Ebola virus in the province of North Kivu. Additionally, on 1 August, 26 individuals with haemorrhagic signs, and 20 deaths were reported in the area of North Kivu.[11][12] On 2 August, Oxfam indicated it would be taking part in the response to this latest outbreak in the DRC.[13]

By 3 August, the virus had developed in multiple locations; cases were reported in five health zones – Beni, Butembo, Oicha, Musienene and Mabalako – in North Kivu province and additionally, Mandima and Mambasa in Ituri Province.[14] However, one month later there had been confirmed cases only in the Mabalako, Mandima, Beni and Oicha health zones. The five suspected cases in the Mambasa Health Zone proved not to be EVD; it was not possible to confirm the one probable case in the Musienene Health Zone and the two probable cases in the Butembo health zone. No new cases had been recorded in any of those health zones. The first confirmed case in Butembo was announced on 4 September, the same day that it was announced that one of the cases registered at Beni had actually come from the Kalunguta Health Zone.[15]

The DRC Ministry of Public Health confirmed that the new Ebola outbreak is caused by the Zaire ebolavirus species. This is the same strain that was involved in the early 2018 outbreak in western DRC.[16] Health authorities in the DRC confirmed they will use the ZEBOV vaccine once again.[16]

On 4 August, the World Health Organization (WHO) indicated that the current situation in the DRC, due to several factors, warranted a "high risk assessment" at the national and regional level for public health.[17]

2018 Kivu Democratic Republic of the Congo Ebola virus outbreak (total cases-death as of Nov. 2[18])


Timeline of reported cases and deaths[19]
Date Cases #  Deaths CFR Contacts Sources
Confirmed Probable Suspected Total
 2018-08-01† 4 22 0 26 20 - - [20]
2018-08-03 13 30 33 76 33 76.7%‡ 879 [21][22]
2018-08-05 16 27 31 74 34 79%‡    966 [23][24]
2018-08-10 25 27 48 100 39 75%‡    953 [25]
2018-08-12 30 27 58 115 41 - 997 [26]
2018-08-17 64 27 12 103 50 55.6%‡ 1,609 [27]
2018-08-20 75 27 9 111 59 - 2,408 [28]
2018-08-24 83 28 6 117 72 65%‡    3,421 [29]
2018-08-26 83 28 10 121 75 67.6%‡ 2,445 [30]
2018-08-31 90 30 8 128 78 65%‡    2,462 [31]
2018-09-02 91 31 9 131 82 - 2,512 [32]
2018-09-07 100 31 14 145 89 68%‡    2,426 [33]
2018-09-09 101 31 9 141 91 - 2,265 [34][35]
2018-09-14 106 31 17 154 92 67.2%‡ 1,751 [36]
2018-09-16 111 31 7 149 97 - 2,173 [37][38]
2018-09-21 116 31 n/a 147 99 67.3%‡ 1,641 [39]
2018-09-23 119 31 9 159 100 67%‡    1,836 [40]
2018-09-28 126 31 23 180 102 65%‡    1,410 [41]
2018-10-02 130 32 17 179 106 65.4%‡ 1,463 [42]
2018-10-05 142 35 11 188 113 63.8%‡ 2,045 [43]
2018-10-07 146 35 21 202 115 63.5%‡ 2,115 [44]
2018-10-12 176 35 32 243 135 64%‡    2,663 [45]
2018-10-15 181 35 32 248 139 64%‡    4,707 [46]
2018-10-19 202 35 33 270 153 65%‡    5,518 [47]
2018-10-21 203 35 14 252 155 65%‡    5,341 [48]
2018-10-26 232 35 43 310 170 64%‡    6,026 [49]
2018-10-28 239 35 32 306 174 63.5%‡ 5,991 [50]
2018-11-02 263 35 70 368 186 62.4%‡ 5036 [18]

# numbers are subject to revision both up, when new cases are discovered, and down consequently, when tests show cases were not Ebola-related.
† DRC Ministry of Public Health
‡ indicates suspected cases were not counted towards CFR

Increasing cases

The Uganda Ministry of Health has issued an alert for extra surveillance as the neighboring outbreak in the DRC is just 100 kilometres (62 mi) away from its border.[51] On 7 August, the DRC Ministry of Public Health indicated that the total count had climbed to almost 90 cases;[52] two days later, on 9 August, it was nearly 100 cases.[53] On 16 August, the United Kingdom indicated it would help with EVD diagnosis and monitoring in the Democratic Republic of the Congo.[54] On 17 August, the WHO reported that "contacts" numbered about 1500 individuals, however there could be more in certain conflict zones in the DRC that can not be reached.[55] Some 954 contacts were successfully followed up on 18 August, however, Mandima Health Zone indicated resistance; as a consequence, contacts were not followed up there per the World Health Organization.[27] On 3 September, WHO stated that 16 health workers had contracted the lethal virus.[32] Health workers must don PPE for protection during treatment of those affected by the virus, as well as various other tasks.[56]

On 4 September, Butembo, a city with almost one million people, logged its first fatality in the Ebola outbreak. The city of Butembo, in the Democratic Republic of the Congo has trade links to Uganda, which it borders.[57][15]

On 24 September, it was reported that all contact tracing and vaccinations would stop for the foreseeable future in Beni, due to an attack the day before by rebel groups that left several individuals dead.[58] On 25 September, Peter Salama of the World Health Organization indicated that insecurity is obstructing efforts to stop the virus and believes a combination of factors could establish conditions for an epidemic.[59] On 18 October, the Centers for Disease Control and Prevention raised its travelers' alert to the Democratic Republic of the Congo from a level 1 to level 2 for all U.S. travelers.[60] On 26 October, the World Health Organization indicated that half of confirmed cases were not showing any fever symptom, thus making diagnosis more difficult.[49]

On 6 November, the Centers for Disease Control and Prevention indicated that the current outbreak in the east region of the DRC may not be containable due to several factors. This would be the first time since 1976 that an outbreak has not been able to be curbed.[61]

Military conflict

Further information: Kivu conflict
North Kivu

The area in question, North Kivu, is also currently in the middle of the Kivu Conflict, a military conflict with thousands of displaced refugees.[62][63] The affected area has about one million uprooted people and shares borders with Rwanda and Uganda, with cross border movement because of trade activities. The humanitarian crisis and deterioration of the security situation is expected to affect any response to the outbreak.[64][65] The DRC is expected to hold presidential elections at the end of this year.[66]

There are about 70 armed military groups, among them the Alliance of Patriots for a Free and Sovereign Congo and the Mai-Mayi Nduma défense du Congo-Rénové, in North Kivu. The armed fighting has apparently displaced thousands of individuals.[67] According to WHO, health care workers will be accompanied by military personnel for protection; additionally, ring vaccination may not be possible.[68] On 11 August, it was reported that seven individuals were killed in Mayi-Moya due to a military group, about 24 miles from Beni where there are several EVD cases.[69][70] The WHO is asking for safe passage to those areas that are within conflict zones, so that possible EVD cases may be found.[71]

On 24 August, it was reported that an Ebola-stricken physician had been in contact with some 97 individuals in an inaccessible military area, hence those 97 contacts cannot be diagnosed.[72][73]

On 4 September, it was reported that on the outskirts of the city of Beni (one of the areas affected by the EVD outbreak) 2 peacekeepers were attacked and wounded by rebel groups in the area which is part of a larger military conflict.[74] On 23 September, it was reported that 14 individuals were killed in a military attack in the city of Beni, which is an area affected by the current EVD outbreak.[75] In September 2018, the World Health Organization's Deputy Director-General for Emergency Preparedness and Response described the combination of military conflict and civilian distress as a potential "perfect storm" that could lead to a rapid worsening of the outbreak.[6][7] On 5 October, the Nobel Peace Prize was awarded to Dr. Denis Mukwege, who tends to the female victims of the ongoing internal armed conflict in the Democratic Republic of the Congo.[76]

On 20 October, an armed rebel group in DRC killed some 13 civilians and took 12 children as hostages. This attack occurred in Beni which is the current epicenter of the Ebola virus outbreak.[77][78]

Uganda and border points

Further information: Refugees of Uganda
Uganda

On 11 August, a U.N. agency indicated that steps were being taken to assure that those leaving the DRC into Uganda are not infected with Ebola; this is being done via active screening.[2][79] On 13 August, the DRC reported a total of 115 cases of the virus within its borders so far.[2][79] Three individuals in Uganda that were suspected of contracting the virus were tested, with negative results.[80]

On 22 August, it was reported that the government of Uganda had opened two Ebola treatment centers at the border with the Democratic Republic of the Congo, though there are as yet no confirmed cases in the country of Uganda.[81][82]

According to the International Red Cross, a 'most likely scenario' entails an asymptomatic case will at some point enter the country of Uganda undetected among the numerous refugees coming from the DRC.[83]On 20 September Uganda indicated it was ready for immediate vaccination, should the Ebola virus be detected in any individual[84][85]

On 21 September, officials of the Democratic Republic of the Congo indicated a confirmed case of EVD at Lake Albert, an entry point into Uganda, though no case has been confirmed within Ugandan territory.[86][87]

On 2 November, it was reported that the Ugandan government would start vaccination of health workers along the border with the Democratic Republic of the Congo as a proactive measure against the virus.[88]

Virology

Further information: Ebola virus
Fruit bats

Zaire ebolavirus strain is the most lethal of the six known strains (including the newly discovered Bombali strain);[89] it is fatal in up to 90% of cases.[90] Both Ebola and Marburg virus are part of the Filoviridae family.[91]

The filovirus genome contains seven genes, including VP40.[92] The natural reservoir of the virus is thought to be the African fruit bat,[93] which is used in many parts of Africa as bushmeat.[94]

Treatment

Further information: Ebola virus disease treatment research

Vaccination

On 27 August, the World Health Organization evaluated the benefits and risks of drug treatment for EVD: Remdesivir, ZMapp, REGN3470-3471-3479, mAb114 and favipiravir.[95]mAb114 (which is a monoclonal antibody) is being used for the first time to treat infected individuals during this EVD outbreak.[96] An alternative treatment of ZMapp has not been used because it requires storage at −20 °C (−4 °F).[2]

On 8 August, the process of vaccination began with rVSV-ZEBOV Ebola vaccine.[97] Although the Ebola vaccine has had efficacy, a review by Medaglini et al. indicated that "long-term protection is undefined" via the vaccine mechanism.[98] The DRC Ministry of Public Health reported on 16 August that 316 individuals had been vaccinated.[99]

On 24 August, the Democratic Republic of the Congo Ministry of Public Health indicated it had vaccinated 2,957 individuals, including 1,422 in Mabalako against the Ebola virus.[100] On 29 August it was reported that women who are pregnant are not being given the vaccine,[101] even though more than 20,000 individuals have been and many more continue to be vaccinated.[102]

Treatment Centres

On 14 August, it was reported that the Mangina Ebola Treatment Center was now operational.[103][104] A fourth Ebola Treatment Center (after those in Mangina, Beni and Butembo) was inaugurated on 18 September in Makeke in the Mandima Health Zone of Ituri Province.[105] Makeke is less than five kilometers from Mangina along a well-traveled local road; the site had been proposed in August when it appeared that a second ETC would be needed in the area, and space was insufficient in Mangina itself to accommodate one.[106] By mid-September, however, there had been only two additional cases in the Mandima Health Zone, and only sporadic cases were being reported in the Mabalako Health Zone.[107]

Prognosis

Main article: Post-Ebola virus syndrome

In terms of prognosis, aside from the possible effects of post-Ebola syndrome,[108] there is also the reality of survivors returning to communities where they might be shunned due to the fear many have in the respective areas of the virus (EVD),[109][110] hence psychosocial assistance is needed.[111]

History

Further information: List of Ebola outbreaks
Ebola virus

The Ebola virus disease outbreak in Zaire (Yambuku) started in late 1976, and was the second outbreak ever after the earlier one in Sudan the same year.[112][113] On 1 August 2018 the 10th Ebola outbreak was declared in the Democratic Republic of Congo, only a few days after the prior outbreak in the same country had been declared over on 24 July.[114][115] World Health Organization chief Tedros Adhanom Ghebreyesus indicated on 15 August that the current outbreak in DRC may be worse than the West Africa outbreak of 2013-2016,[116] due to several factors.[117]

The table below indicates the 10 outbreaks that have occurred in the Democratic Republic of the Congo since 1976:

Timeline of Ebola outbreaks in the Democratic Republic of the Congo (formerly Zaire) since 1976
V・T
Date		 Country Major location Outbreak information Source
Strain Cases Deaths CFR
Aug 1976 Zaire Yambuku EBOV 318 280 88% [118]
Jun 1977 Zaire Tandala EBOV 1 1 100% [119][120]
May–Jul 1995 Zaire Kikwit EBOV 315 254 81% [121]
Aug–Nov 2007 Democratic Republic of the Congo Kasai-Occidental EBOV 264 187 71% [122]
Dec 2008–Feb 2009 Democratic Republic of the Congo Kasai-Occidental EBOV 32 14 45% [123]
Jun–Nov 2012 Democratic Republic of the Congo Orientale BDBV 77 36 47% [119]
Aug–Nov 2014 Democratic Republic of the Congo Tshuapa EBOV 66 49 74% [124]
May–Jul 2017 Democratic Republic of the Congo Likati EBOV 8 4 50% [125]
Apr–Jul 2018 Democratic Republic of the Congo Équateur Province EBOV 54 33 61% [126]
Aug 2018–June 2020 Democratic Republic of the Congo Kivu EBOV 3,470 2,280 66% [127]
June–Nov 2020 Democratic Republic of the Congo Équateur Province EBOV 130 55 42% [128]
Feb 2021–May 2021 Democratic Republic of the Congo North Kivu EBOV 12 6 50% [129]
April 2022 Democratic Republic of the Congo Équateur Province EBOV 5 5 100% [130][131]
August 2022 Democratic Republic of the Congo North Kivu EBOV 1 1 100% [132]

This map and graph also show previous EVD outbreaks in the area of central Africa, which includes the Democratic Republic of the Congo (the graph is updated as total cases and deaths number may increase as the outbreak expands):

Ebola (and Marburg virus) outbreaks on the African continent[133][134]
Ebola (and Marburg virus) outbreaks on the African continent[133][134]
Democratic Republic of the Congo EVD outbreaks 1976-Nov. 2, 2018[18][19]
(Uganda has second most EVD cases '00-'01/425[135]
West African Ebola virus epidemic '13-'16/ >28,000[136])

See also

Notes

  1. ^ Ituri province was added to N. Kivu province, in terms of viral infection, when the first case of EVD was confirmed on 13 August.[2]

References

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