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Crisis Info #1

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Crisis Info #1

30 May 2018 

Since the Ebola epidemic in DRC was declared on 8 May 2018, 54 people who presented symptoms of haemorrhagic fever, including 35 confirmed Ebola cases and 25 deaths (of whom 12 were confirmed as Ebola), have been notified by the national health authorities in the Equateur region, where the outbreak started.

  Suspect cases Probable cases Laboratory-confirmed cases Deaths
Mbandaka 1 0 4 3
Bikoro 1 11 10  16 
Iboko 21 
Total  13  35  25 

Context

The outbreak is currently affecting the city of Mbandaka and the health zones of Bikoro (Bikoro and Ikoko villages), and Iboko (Itipo and Iboko villages). Bikoro, a small city where some Ebola cases have been detected, is approximately four hours’ drive from Mbandaka. Connections with Bikoro are also possible via Lake Tumba, which the local community uses to reach the Congo River.

This is the ninth Ebola outbreak in DRC in the last 40 years[1]. So far, most of the previous outbreaks have occurred in relatively remote and isolated areas, with little spread of the disease. The last Ebola outbreaks in DRC occurred in Likati district in May 2017, with eight people infected, of whom four died, and in Boende (Thsuapa region) in 2014, with 66 people, of whom 49 died.

Unlike in previous Ebola outbreaks in DRC, where cases have been concentrated in remote villages, patients have now been diagnosed in Mbandaka, a Congo River port city of more than one million inhabitants. While easy access to transport increases the risk of the virus spreading, surveillance is being reinforced, and as of 29 May 2018, only four lab confirmed patients have been identified in Mbandaka. For now, it’s important to emphasise that the epidemic has not spread widely within the city. With the correct intervention and careful monitoring of the situation, it is possible to limit the spread of the outbreak.

MSf, Doctors Without Borders, DRC, Ebola, Outbreak
Desinfection of staff dressed in full PPE in the ETC (Ebola Treatment Centre) in Bikoro. Photo: Louise Annaud/MSF

During the past few weeks, MSF has been working closely with the Congolese Ministry of Health (MoH) and with other organisations on the ground to coordinate the response. The response is based on the ‘six pillars’ of Ebola intervention (1. care of diagnosed patients and isolation; 2. outreach activities to find patients; 3. tracing and follow-up with patient contacts; 4. health promotion activities to inform people about the risks and how to avoid them; 5. support of regular healthcare; 6. safe burials to avoid infections). We are currently carrying out activities in Mbandaka, Bikoro, Iboko and Itipo.

MSF and its research unit, Epicentre, are working with the local health authorities and the World Health Organization (WHO) to participate in the implementation of the Ebola vaccine rVSVDG-ZEBOV-GP, which is being used as part of the overall strategy to control the Ebola outbreak.

MSF operational highlights

 To tackle the Ebola epidemic and limit the spread of the virus, Doctors Without Borders (MSF) is stepping up its response in the affected areas.

 MSF emergency teams are present in four locations where suspect and confirmed patients have been identified, and are working in collaboration with DRC’s Ministry of Health (MoH) and the   WHO.

 The organisation currently operates two Ebola Treatment Centres (ETC), with a total of 32 beds in isolation, and one transit centre in Itipo. As of 29 May, we are currently caring for 19       patients.

 Around 60 tonnes of supplies have been shipped to Kinshasa and dispatched to the affected areas since the beginning of the epidemic.  

MSF’s Ebola response in DRC started on 5 May, with an epidemiological alert in the Equateur region. A small team from MSF’s Congo Emergency Pool (PUC) assessed the situation, together with teams from the MoH and WHO. When the Ebola epidemic was officially declared on 8 May, experts from MSF’s emergency pools arrived in the field to deploy a rapid response in the Ebola hotspots. Among the MSF staff on the ground are some of the organisation’s most experienced Ebola field workers, including medical personnel, experts in infection control and logisticians.

MSF, Doctors Without Borders, DRC, Ebola, outbreak
Staff getting dressed in full PPE in the ETC (Ebola Treatment Centre) in Bikoro. Photo: Louise Annaud/MSF

Mbandaka

At the beginning of the outbreak, we set up an isolation zone with five beds in Mbandaka’s main hospital (Wangata hospital). An MSF ETC with 12 beds was also built, and has been operational since 28 May. The bed capacity in the ETC can be upgraded to 40 if needed. This will allow the main hospital to refocus on providing non-Ebola healthcare to the local population.

In addition to the treatment and isolation of suspected and confirmed Ebola cases, the focus of MSF’s response is on surveillance, investigation of new cases and contacts, infection control and prevention, health promotion and training activities.

Bikoro

The team is also intervening in Bikoro, where an MSF ETC with 20 beds has been built, and continues to reinforce outreach activities including investigation on contact cases, monitoring and surveillance. 

Itipo/Iboko

MSF teams are also present in the remote areas of Itipo and Iboko, where suspected and confirmed Ebola cases have been identified. In Itipo, a transit centre with isolation capacity is already functional. In this transit centre, suspected cases are isolated and cared for, and samples are taken to confirm diagnosis. If Ebola is confirmed, they are transferred to the Bikoro ETC.

In Iboko, an isolation area has been built in the main hospital and the team is constructing a further ETC.

Vaccination

MSF and its research unit (Epicentre) are working closely with the MoH and the WHO on the implementation of the Ebola vaccine      rVSVDG-ZEBOV-GP, as an additional measure to control the outbreak.

Overview of operations

Where  Patients 
Mbandaka (Wangata hospital –isolation zone) 0
Mbandaka (MSF ETC) 0
Bikoro (MSF ETC) 10 confirmed 
Itipo (Ebola Transit and Treatment Centre) 6 suspected 
Total 19 
  • Staff on the ground - date of info: 28/05/2018

TOTAL: 60 international and 106 national staff are currently working in Equateur province in response to the Ebola outbreak.

  • Supply material - date of info: 26/05/2018

Supply material includes: medical kits; protection and disinfection kits (isolation items such as gloves, boots and Personal Protective Equipment-PPE, etc.); logistic and hygiene kits (plastic sheets, jerry cans, water distribution kits, chlorine spray kits, water treatment kits, etc.); drugs; transport (cars and motorbikes); tents and construction material for building ETCs.

As part of MSF’s emergency preparedness in DRC, some supplies were already available in Kinshasa. These were sent to hotspot zones as soon as the outbreak started.

Sixty tonnes of supplies (sent from MSF supply centres in Europe) have been received in Kinshasa. A total 45 tonnes of supplies (medical and logistical supplies, including six vehicles and 10 motorbikes) have already been sent to Mbandaka and Bikoro, with more to be sent in the coming days.

Ebola facts

  • Transmission: The Ebola virus is introduced into the human population through close contact with the blood, secretions, organs or other bodily fluids of infected animals. Human-to-human transmission occurs through direct contact with blood or other bodily secretions of sick people with mucous membranes, such as the mouth or nostrils. This often happens when patients are tended to without proper protection measures; or during the burial (the body remains infectious even after the patients have died).
  • Signs and symptoms: Sudden onset of fever, fatigue, muscle pain, headache and sore throat is followed by vomiting, diarrhoea, rash, symptoms of impaired kidney and liver function, and in some cases both internal and external bleeding.
  • Diagnosis: On a clinical basis, Ebola is difficult to distinguish from a number of other infectious diseases such as malaria. Confirmation of infection with Ebola virus can only be obtained with a lab test on a sample of bodily fluid.
  • Vaccination:  beyond the six pillars of the Ebola response, Ebola vaccine rVSVDG-ZEBOV-GP is being administered by following a “ring approach”, and on a voluntary and free-of-charge basis. This vaccine has not yet been licensed and is being implemented through a study protocol.
  • Prevention and control: Outbreak control requires a package of interventions, including case management, surveillance and contact tracing, laboratory services, safe burials and social mobilisation

[1] Previous outbreaks in DRC: Yambuku (1976) 318 cases - 280 deaths; Tandala (1977) 1 case -1 death; Kikiwit (1995) 315 cases- 250 deaths; Mweca (2007)  264 cases - 187 deaths; 2008-2009-  32 cases - 15 deaths; Isiro (2012) 36 cases - 13 deaths; Djera-Boende (2014) 66 cases - 49 deaths; Likati (2017) 8 cases - 4 deaths (source: DRC Ministry of Health)


For more, consult WHO Ebola factsheet