DRC Ebola outbreak puts neighbours on high alert

[YAOUNDÉ, SciDev.Net] Health authorities battling to contain an outbreak of Ebola in the Democratic Republic of Congo (DRC) are urging neighbouring countries to be vigilant and strengthen response plans to stop the disease spreading across borders.

Since the start of the outbreak in late August, 48 confirmed and probable cases have been reported and 31 people have died in the Bulape health zone, in DRC’s southwestern Kasai province, according to the World Health Organization (WHO).

Although the disease is currently limited to this remote area, the WHO says it is working with nearby countries to ensure they are ready to rapidly detect the virus and implement control measures.

Angola, which shares a land border with Kasai province, is the top priority, due to the high risk of cross-border spread. Burundi, the Central African Republic, Congo, Rwanda, South Sudan, Uganda, Tanzania and Zambia are considered at moderate risk.

Charles Njuguna, regional advisor for strengthening country readiness at WHO Africa, said the WHO had provided ministries of health with the tools to carry out “readiness assessments” to help develop response plans and identify priorities.

“Seven of them have already completed the entire process. We are following up with other countries,” he told an online press conference Thursday (18 September), adding that the level of preparedness in these countries was currently “moderate”.

A key priority will be surveillance at ports of entry, particularly at the Angola-DRC border.

“We all know that diseases do not need permission to cross borders, they do not need visas,” Njuguna added.

“So we are working with Angola to build capacity at the ports of entry.”

WHO is also working with the International Organization for Migration on the ground in Angola to monitor the movement of people between affected areas and country borders.

Vaccination campaign

Central to efforts to contain the outbreak is a vaccination campaign underway in Bulape health zone where at least 600 people have received the Ervebo vaccine since 14 September.

Groups most at risk of infection, such as frontline health workers and people who have been in contact with those infected, are the priority targets for the operation, planned by Congolese health authorities, the WHO and the United Nations Children’s Fund (UNICEF).

About 50 WHO experts in disease surveillance, clinical care, infection prevention and control, logistics and community engagement are working alongside Congolese response teams in the affected area, where a treatment centre has been set up.

The Africa Centres for Disease Control and Prevention (Africa CDC) has also mobilised a field team to support the DRC’s health ministry in setting up community-based surveillance.

Justus Nsio Mbeta, epidemiologist and deputy DRC country director for Africa CDC, told SciDev.Net: “This team, alongside the government, will recruit community relays, train them to search for and detect suspected cases in households during their home visits, and to be able to list contacts and follow them.”

‘Don’t panic’

Health authorities say building public trust and communicating with local communities is essential to assuage fears.

One of the challenges, says Mbeta, is that people are fearful of being found to have been in contact with an infected person.

“There is strong resistance and reluctance from the community to be denounced as a contact,” said Mbeta.

“The sick are still hiding in the community,” he added.

He says community relay teams will go “from household to household” to reassure people and advise on what to do when a person is infected or develops clinical signs of Ebola.

According to the WHO, the follow-up of contacts of confirmed cases has improved from 19 per cent a fortnight ago to more than 90 per cent. Nearly 950 contacts are currently being followed in the health zone.

“At the beginning, when the investigation was still ongoing, panic among the population was reported, but after we had confirmation [that it was Ebola] and put in place the necessary measures, and thanks to our continued engagement with the population, we did not record any new incidents of panic and displacement,” said Otim Patrick Ramadan, WHO programme manager for emergency response.

He reassured local populations: “There is no need to be afraid, no need to panic and the epidemic can be quickly contained if all the measures recommended on the ground are followed.”

These measures include putting contacts of infected people under observation for 21 days and vaccination for those deemed at risk, he said.

“Sick people should be reported quickly and taken to a health facility so that they do not expose those living under the same roof,” he added.

“They are being taken care of and any death must be reported. People should not participate in dangerous burials.”

Zaire strain

The first confirmed case in the outbreak was a 34-year-old pregnant woman, admitted on 20 August to the Bulape General Hospital with symptoms including fever, vomiting and bleeding.

Samples analysed at the National Institute of Biomedical Research in the capital Kinshasa confirmed a diagnosis of Ebola virus disease, which was identified as the Zaire strain, which can be effectively prevented with the Ervebo vaccine.

Experts say sequencing of the virus and rapid identification of the strain was crucial in facilitating a quick response to the outbreak.

Anticipating possible shortages of vaccine stocks, WHO says the International Coordinating Group on Vaccine Provision has approved the shipment of about 45,000 additional doses to the DRC.

Yap Boum, deputy head of the incident management support team at Africa CDC, said continued vigilance was critical.

“The Ebola outbreak in Kasai continues to pose a major threat to health systems, even as treatment and vaccination capacities have improved,” he told the press conference Thursday.

This article was produced by SciDev.Net’s Sub-Saharan Africa French edition.