2018 Kivu Democratic Republic of the Congo Ebola virus outbreak

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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
Confirmed cases 111[1]
Probable cases 31[1]
Suspected cases 7[1]
Total cases 149[1]
Deaths 97[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 seen as possibly hindering treatment and vaccination attempts against the Ebola virus disease (EVD), once they begin.[6] Vaccination is possible, however on 24 August an Ebola-stricken physician had been in contact with many individuals in an inaccessible military area which would make it difficult to diagnose those individuals.[7]

Epidemiology[edit]

First cases and transmission[edit]

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.[8][9] On 2 August, Oxfam indicated it would be taking part in the response to this latest outbreak in the DRC.[10]

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.[11] 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.[12]

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.[13] Health authorities in the DRC confirmed they will use the ZEBOV vaccine once again.[13]

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.[14]

Timeline of reported cases and deaths[15]
Date Cases #  Deaths CFR Contacts Sources
Confirmed Probable Suspected Total
2018-08-01 4 22 0 26 20 - - [16]
2018-08-03 13 30 33 76 33 76.7% 879 [17][18]
2018-08-05 16 27 31 74 34 79%    966 [19][20]
2018-08-10 25 27 48 100 39 75%    953 [21]
2018-08-12 30 27 58 115 41 - 997 [22]
2018-08-17 64 27 12 103 50 55.6% 1,609 [23]
2018-08-20 75 27 9 111 59 - 2,408 [24]
2018-08-24 83 28 6 117 72 65%    3,421 [25]
2018-08-26 83 28 10 121 75 67.6% 2,445 [26]
2018-08-31 90 30 8 128 78 65%    2,462 [27]
2018-09-02 91 31 9 131 82 - 2,512 [28]
2018-09-07 100 31 14 145 89 68%    2,426 [29]
2018-09-09 101 31 9 141 91 - 2,265 [30][31]
2018-09-14 106 31 17 154 92 67.2% 1,751 [32]

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

Increasing cases[edit]

Evolution of cases and deaths (data from WHO)

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.[33] On 7 August, the DRC Ministry of Public Health indicated that the total count had climbed to almost 90 cases;[34] two days later, on 9 August, it was nearly 100 cases.[35] On 16 August, the United Kingdom indicated it would help with EVD diagnosis and monitoring in the DRC.[36]

Democratic Republic of the Congo graph[17][19][37]

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.[38] 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.[23] On 3 September WHO stated that 16 health workers had contracted the lethal virus.[28] Health workers must don PPE for protection during treatment of those affected by the virus, as well as various other tasks.[39]

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.[40][12]

Military conflict[edit]

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.[41][42] 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.[43][44]

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.[45] According to WHO, health care workers will be accompanied by military personnel for protection; additionally, ring vaccination may not be possible.[6] 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.[46][47] The WHO is asking for safe passage to those areas that are within conflict zones, so that possible EVD cases may be found.[48]

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.[49][50]

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.[51]

Uganda border[edit]

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][52] On 13 August the DRC reported a total of 115 cases of the virus within its borders so far.[2][52] Three individuals in Uganda that were suspected of contracting the virus were tested, with negative results.[53]

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.[54][55]

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.[56]

Virology[edit]

Fruit bats

Zaire ebolavirus strain is the most lethal of the six known strains (including the newly discovered Bombali strain);[57] it is fatal in up to 90% of cases.[58] Both Ebola and Marburg virus are part of the Filoviridae family.[59]

The filovirus genome contains seven genes, including VP40.[60] The natural reservoir of the virus is thought to be the African fruit bat,[61] which is used in many parts of Africa as bushmeat.[62]

Treatment[edit]

For the first time Mab 114 (which is a monoclonal antibody) was used to treat infected individuals during this EVD outbreak; ZMapp, however, has not been used because it requires a −20 °C (−4 °F) storage.[2] On 14 August it was reported that the Mangina Ebola Treatment Center was now operational.[63][64] 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.[65] 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.[66] 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.[67]

On 27 August the World Health Organization evaluated the benefits and risks of drug treatment for EVD: Remdesivir (GS-5734), ZMapp, REGN3470-3471-3479, mAb 114 and favipiravir.[68]

Vaccine[edit]

On 8 August, the process of vaccination began with rVSV-ZEBOV Ebola vaccine.[69] Although the Ebola vaccine has had efficacy, a review by Medaglini et al. indicates "long-term protection is undefined" via the vaccine mechanism.[70] The DRC Ministry of Public Health reported on 16 August that 316 individuals had been vaccinated.[71]

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.[72] On 29 August it was reported that women who are pregnant are not being given the vaccine,[73] even though more than 6,000 individuals have been vaccinated.[74]

Prognosis[edit]

In terms of prognosis, aside from the possible effects of post-Ebola syndrome,[75] 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),[76][77] hence psychosocial assistance is needed.[78]

History[edit]

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.[79][80] 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.[81][82]

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,[83] due to several factors.[84]

The table below indicates the 10 outbreaks that have occurred since 1976:

Timeline of Ebola outbreaks in the Democratic Republic of the Congo (formerly Zaire)
VT
Date
Country Major location Outbreak information Source
Strain Cases Deaths CFR
Aug 1976  Zaire Yambuku EBOV 318 280 88% [85]
Jun 1977  Zaire Tandala EBOV 1 1 100% [86][87]
May–Jul 1995  Zaire Kikwit EBOV 315 254 81% [88]
Aug–Nov 2007  Democratic Republic of the Congo Kasai-Occidental EBOV 264 187 71% [89]
Dec 2008–Feb 2009  Democratic Republic of the Congo Kasai-Occidental EBOV 32 14 45% [90]
Jun–Nov 2012  Democratic Republic of the Congo Orientale BDBV 77 36 47% [86]
Aug–Nov 2014  Democratic Republic of the Congo Tshuapa EBOV 66 49 74% [91]
May–Jul 2017  Democratic Republic of the Congo Likati EBOV 8 4 50% [92]
Apr–Jul 2018  Democratic Republic of the Congo Bikoro EBOV 54 33 61% [93]
Aug 2018  Democratic Republic of the Congo Kivu ongoing ongoing ongoing

See also[edit]

Notes[edit]

  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 per[2]

References[edit]

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Further reading[edit]

External links[edit]

Video[edit]

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