Ebola virus disease outbreak in Democratic Republic of Congo 2018

The Democratic Republic of Congo (DRC) is phasing through new EBOLA virus disease (EVD) outbreak. The life-threatening (CFR>75%) deadly hemorrhagic fever is caused by Ebola virus infection. As of now, the current outbreak is majorly prevailing in three health zones in Equateur Province of DRC. Multinational multi-agencies are dealing with the situation. Let's understand the situation well.

Go to the profile of RANJEET SINGH MAHLA
May 25, 2018
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2018 DRC EVD Declaration

May 3: Equateur Provincial Health division reports 21 cases of undiagnosed illness (17 died), from Ikoko-Impenge health centre. 

May 5: Team from DRC ministry of health visited Ikoko-Impinge health zone, found 5 case-patients (2 admitted to Bikoro General Hospital and 3 admitted to Ikoko-Impenge health centre), samples. 

May 6: Samples submitted to Institute National de Recherche Biomédicale (INRB), Kinshasa.

May 7: Two samples tested positive for ZEBOV (Zaire strain of EBOLA virus) qRT-PCR.  

May 8: Official declaration of national outbreak. 


Case Summary[Equator Province May 21]

Confirmed casesProbable casesSuspect casesTotal casesDeathCFR
28219582747%

Equator Province 

  • Area: 130 442 square Km 
  • Population:  2 543 936
  • Health Zones: 16 (Bikaro, Iboko, Wangata and 13 other)
  • Health centres: 284

Zone wise case report May 21

BikoroIbokoWangata
(N=29)
Confirmed =10
Probable=19
(N=22)
Confirmed =14
Probable=2
Suspected=6
(N=7)
Confirmed =4
Suspected=3
  • Around 600 contacts have been identified to determine index case.  

Bikaro 

  • Area: 1075 square Km 
  • Population:  163, 065
  • Health centres: 19
  • Hospitals: 3

The Ikoko-Impenge village (not accessible by road and telephone) is located 45 km away from Bikaro.  


THE BRIEF HISTORY OF MAJOR EVD OUTBREAKS IN DRC [1976-2017]

Outbreak CauseCases DeathCFRRegion
August 1976 to November 1976ZEBOV31828088%Équateur province
January 1995 to July 1995KEBOV31525079%Kwilu Province
June 2005 to July 2005ZEBOV121083%Cuvette-Ouest province
August 2007 to November 2007ZEBOV26418771%Kasai Occidental Province
December 2008 to February 2009ZEBOV321547%Kasai Occidental Province
June 2012 to November 2012BEBOV87(#36)36(#13)41%
(#36%)
Orientale Province
August 2014 to November 2014

ZEBOV694971%Équateur province
May 2017 to 
July 2017
ZEBOV8450%Bas-Uele
Province
All EightZEBOV
BEBOV
KEBOV
110583175%Multicentric

ZEBOV: Zaire EBOLA virus; BEBOV: Bundibugyo EBOLA virus; CFR: case fatality rate; #36/#13 & #36% represents laboratory-confirmed cases (refer to Table-1 in the linked manuscript). 

  •  Z-EBOV, K-EBOV and B-EBOV had caused 831 deaths in DRC from 1976-2017. 
  • The average CFR for DRC EVD is 75% (41% to 88%).

Case management in DRC

  • Multinational multi agencies (WHO, MSF, NICD and many others) are dealing with the situation.
  •  Symptomatic treatment of infection consequences is the possible treatment option available. 
  • Experimental ring vaccination with rVSVΔG-ZEBOV vaccine [7540 doses are already placed in the field, additional 8000 doses will arrive soon] has been approved for in field use in DRC for dealing with the ongoing situation of EVD. 
  • Ebola virus can spread from infected bodily fluids contacts. In order to deal with the situation trained medical staffs are been deployed on ground in the DRC.

Challenges  

  • Tracking contacts.
  • Making people understand with the situation is really difficult task [recently three patients escaped quarantine centre (2 died, and 1 has returned to quarantine centres), religious and emotional practices don't fall in line with medical interventions].
  • Dealing with the situation to restrict the outback with no further case fatalities. 
  • The confirmed case from Mabandaka (580 km from the capital Kinshasa), the city with population more than 1 million has mounted paramount chellenges to deal with the situation and such cases might boil the out the situation.
  • Minimization of bats to human (bats are the natural reservoir for EBOLA), bats to animals and human to human transmission. 

The national health emergency for DRC is not yet over. 




Go to the profile of RANJEET SINGH MAHLA

RANJEET SINGH MAHLA

Ph.D. , Indian Institute of Science Education and Research Bhopal

Ranjeet Singh Mahla, Research Scholar IISER Bhopal, (Research interest: Emerging Infectious Diseases & Antimicrobial Resistance).

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